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What is Cervical Radiculopathy? Cervical radiculopathy is a condition where the nerve traveling down the arm is compressed at the neck. Sometimes the pain will travel down the arm and in other cases the pain may be in one area of the arm, such as the outside of the elbow. Where Does The Nerve Compression Happen? The picture below shows the anatomy of the neck (cervical spine), including the vertebrae, intervertebral discs, and cervical spinal nerves. Your cervical vertebrae are named from top to bottom, with C1 just below the skull. The picture below shows the C7 spinal nerve being compressed by a bulging disc, but increased bone growth around the joints (facet joints) connecting each vertebra can also contribute to nerve compression. It's important to consider other sources of nerve compression, as many people have bulging discs and extra bone growth without symptomatic nerve compression. This is why your physical therapist will also assess your posture, facet joint mobility, and mechanics with activities such as walking, as dysfunction in any of these areas can decrease the space where the nerve exits the neck. How Do We Treat Cervical Radiculopathy? We always look at why the nerve compression is happening to best decide how to treat it. The facet joints surrounding the nerve may be stiff so that you can't go through normal motions that would decompress the spinal nerve. If the upper back is tilted to the right from reaching the left hand on top of your steering wheel this causes a compensatory tilting to the left at your neck to keep your eyes level, which compresses the nerves on the left. If you're working at your desk and always looking to the left this rotation can also compress the nerves on the left. Working alongside your therapist, you'll identify specific movements or positions that may be increasing spinal nerve compression and work on modifying how you do these movements. What Movements Compress and Decompress the Spinal Nerve? In this example, we'll use the left cervical spine nerves which would cause pain down the left arm. Watch this video that shows how side bending the neck to the left as well as rotating the neck to the left decreases the amount of space between the facet joints, where the nerve exits the neck. The opposite motions will create more space and decompress the nerve. What About Double Crush? When there is compression of the nerve in a second location downstream from the neck this is called a double crush. For example, the nerve may be compressed at the neck and the elbow. Your therapist may have you work on loosening up muscles or joints at the shoulder, elbow, or wrist to address this downstream compression. Any deviations in your posture can lead to increased tension on the nerve and increased stress on muscles that contribute to nerve compression. How Can Arm Posture Perpetuate Symptoms? If there are deviations in your posture this can place muscles in an abnormal length (either shortened or lengthened). In either case, if a muscle is not in an optimal position that muscle has to work harder to create the same amount of force which can lead to muscle overuse and tightness. If the poor posture is not corrected then these muscular restrictions can keep recurring. Interested in Physical Therapy? Here at Rehab United, we care about our patients; we want to see you thrive and get back to the things you love. From the front desk to the physical therapists, our staff is full of wonderful and empathetic people dedicated to giving you the best care possible. We will support you throughout your entire recovery journey, don't wait, schedule today! Did You Enjoy This Blog? Subscribe to our mailing list to get more blogs sent straight to your inbox! Connie Hutchins, PT, DPT, OCS, BFR-1, CCI is a physical therapist at Rehab United. She completed her doctorate degree in physical therapy at USC as well as USC's residency program to specialize in orthopedics. Before moving back to San Diego, Dr. Hutchins was on faculty at USC, teaching doctoral students hands-on and clinical reasoning skills. Dr. Hutchins has a multifaceted approach to improving patients' results in physical therapy. She is always looking to create deeper understanding for patients and physical therapy students regarding why symptoms are happening and how to effectively treat the underlying causes.

Do you sit in front of a computer all day, either at home or in the office? If so, one must consider environmental factors and desk ergonomics and how they affect one’s posture. If you are suddenly experiencing tension headaches, neck pain, or back pain, assess your sitting posture when working on your laptop or desk computer. Desk Ergonomics Here are some general guidelines: Keyboard & Mouse Height: In alignment with your elbows, elbows are bent at < 90-degree angle. Computer Height: The top of your monitor should be in alignment with your eyes. Chair Height: Your hips and knees are nearly leveled, and your knees are bent at a nearly 90-degree angle. The feet should be flat on the ground or resting on a footrest. Stretches to Prevent Neck & Back Pain After improving your desk ergonomics, skilled physical therapy is aimed at restoring your muscle imbalances, as the forward head position we assume when using electronics (cell phones, laptops, desk computers, etc.) will ultimately lead to a combination of overactive muscles and underactive muscles. This postural imbalance is known as Upper Crossed Syndrome (UCS) and can lead to stiffness of the neck, tension headaches, and even shoulder pain and shoulder impingement. According to a recent study in 2016 (by Won-Sik Bae et. al) a combination of strengthening and stretching exercises has proven to be an effective treatment for Upper Crossed Syndrome. We can utilize a simple 3-step strategy: 1. Trapezius Stretches 2. Prone T's & Y's 3. Rows Improve postural awareness via postural re-setting by setting a timer for every 30-60 minutes to stretch and/or re-set your posture to make this a habit. When to Consider Physical Therapy If you continue to experience worsening headaches, neck pain, or back pain after improving your ergonomics and trying this 3-step strategy, schedule an evaluation to determine if physical therapy is required to discover the root cause of your pain. Shannon Garcia, PT, DPT received her Doctorate in Physical Therapy in 2017 from the University of St. Augustine for Health Sciences. She has taken numerous continuing education courses to expand her knowledge and manual techniques for the treatment of numerous disorders involving the musculoskeletal system, nervous system, and vestibular pathologies. She is most interested in the continuation of her professional education with an emphasis on the treatment of various vestibular disorders.

In our last blog post, Sarah Shaw, PT, DPT, touched on the prevalence of pelvic floor dysfunction in relation to bowel and bladder function, but can pelvic floor dysfunction be painful as well? In a word, YES. But how and why will depend on a multitude of variables. Pelvic pain is defined as pain between the pelvis and lower abdomen and affects approximately 15% of women[1],[2], and men.[3] Pelvic pain is generally a broad term used to include pain from many possible sources, including the genitourinary system, gastrointestinal system, and neuromusculoskeletal systems, and can cause functional deficits in bowel and bladder control and negatively impact sexual function, including pain with intercourse, inability to orgasm, or pain after orgasm. Pelvic pain can be divided into acute and chronic varieties as well, with acute pain having a recent onset and chronic pain being present for more than 3-6 months. Examples of acute pelvic pain include appendicitis, hernia, ectopic pregnancy, endometriosis, urinary tract infections, ovarian cysts, prostate dysfunction, and cancers related to the pelvic organs, such as uterine, ovarian, bladder, prostate, or rectal cancer. These are medical conditions that warrant screening by a physician to address the cause of pain and may require treatment, such as medications or surgery that are out of the scope of physical therapy. However, the pain and neuromusculoskeletal dysfunction associated with them may persist longer than the original pathology and become chronic pain. Chronic pain develops once the acute cause has been managed, but the pain signals continue to be sent from the body to the brain, despite the absence of a clear medical cause. Pelvic pain that begins acutely but becomes chronic over time is a form of “centralized pain,” or pain signals that are not processed correctly by the brain. In an optimal setting, the body is stimulated by something, such as a kiss on the cheek from a lover or dropping a book on your toe, and the signal is transferred through the peripheral nervous system (like nerve endings in skin and muscles) to the brain, where it is then interpreted for meaning. The kiss from the lover feels wet and squishy and we interpret that in the brain as GOOD and lean in to return the favor. The book being dropped on our foot is very hard and a lot of pressure in a short amount of time and the brain interprets it as BAD, so we jerk back and rub our foot to provide an alternative sensation to override the PAIN signals. This system tends to work well for us…until it doesn’t. After continually sending pain signals from the body to the brain, the nervous system becomes more reactive to input causing the body to change its threshold for pain, meaning that it interprets previously mild-moderate painful stimuli as severely painful (hyperalgesia) or it interprets previously non-painful stimuli as painful (allodynia). It is important to understand that pain is a sensation, not an indicator of tissue damage. Pain is an unpleasant sensation that gets our attention and causes us to change our behavior to fend off further intensifying that sensation, but the intensity of the pain sensation is not proportional to the amount of tissue damage that may be occurring. The pain signals are sent from the body to the brain for interpretation, and this tends to be where things can go off-track. When we don’t receive reliable information from the body or the information is reliable but interpreted incorrectly, things go awry for us. We may start to interpret the kind tickle from a friend as being painful or the loving embrace from our partner as crushing and suffocating. This is especially detrimental with respect to nerves and muscles in the pelvis, where that change in sensation can cause urination, bowel movements, vaginal/rectal penetration, intercourse, ejaculation, and/or orgasm to become painful. Physical therapy can help with desensitization and repetitive exposure to non-painful stimulation that helps to improve the reliability of the signals from the body to the brain and how the brain process and interprets the signals that it is receiving to reduce pain levels and improve bodily functions. Chronic pelvic pain can also develop gradually over time, related to poor function of the pelvic floor muscle group, causing a myofascial pain syndrome known as levator myalgia or levator ani syndrome. Typically, levator myalgia develops as the pelvic floor muscles are subconsciously activated and tension develops within the muscle group. This gradual muscle activation cycle can also develop in response to biomechanical changes, such as “sucking in” the stomach, a fall that jars the coccyx or pelvis, pregnancy, and delivery (both vaginal and c-section delivery) or musculoskeletal changes in the spine, pelvis and lower extremities that alter the available range of motion or strength, or psychological factors, such as generalized anxiety disorder, post-traumatic stress disorder, or sexual assault.[4] Physical therapists are neuromusculoskeletal experts and are equipped to help identify and address range of motion deficits, weakness, and poor movement patterns that may be contributing to poor pelvic floor muscle function. By addressing biomechanical dysfunctions and helping with desensitization of the nervous system, physical therapy can improve the symptoms related to pelvic pain. As physical therapists, we are equipped to help patients navigate the neuromusculoskeletal dysfunction and improve habits related to bowel and bladder function. In the absence of an acute medical cause for pelvic pain, physical therapists can help with understanding the dysfunctions present, rather than just the main symptom we recognize (PAIN). Whitney Landis, PT, DPT, FAFS, is a Physical Therapist, Director of Pelvic Health, and Fellow of Applied Functional Science.  Whitney graduated with her Doctorate in Physical Therapy from Chapman University in 2010 and has taken numerous continuing education courses pertaining to Women’s/Pelvic Health through Herman and Wallace Pelvic Rehabilitation Institute and Pelvic Guru. She has also completed the Gray Institute of Functional Transformation (GIFT) Fellowship in 2015. Sources: [1] https://www.nichd.nih.gov/health/topics/pelvicpain/conditioninfo/howmany [2] https://www.ncbi.nlm.nih.gov/books/NBK554585/?report=printable [3] https://pubmed.ncbi.nlm.nih.gov/18331265/ [4] https://tallirosenbaum.com/2018/12/14/the-pelvic-floor-keeps-the-score/

You read that right! Did you know that you can receive physical therapy for your pelvic floor? The pelvic floor is a muscle group that lies within a ring of bones at the base of the torso. The pelvis! It sits like a hammock and acts literally as the floor of your torso. This muscle group is responsible for some pretty crucial functions that we often take for granted: bowel, bladder, and sexual functions as well as stability to the pelvic ring and support for the pelvic organs. As probably the most neglected muscle group, it is easily forgotten when training, exercising, and even in rehab until one of its functions fail. Have you ever peed a little when you sneezed, laughed, or exercised? Ever have to urgently run to the bathroom and feel you have little control? Ever have pelvic pain? You don’t have to live with that! These are only a few of the commonly addressed symptoms our pelvic health team treats. Interestingly, pelvic floor dysfunction is much more common than you might think. One in every four women will have experienced some sort of pelvic floor dysfunction in their lifetimes. While the statistics are less for men, it still is very common for them too! Yet, oftentimes, we see patients who have suffered from painful or embarrassing symptoms for years before hearing about pelvic floor physical therapy. We often see that patients are apprehensive about what to expect or have hesitations about asking questions or sharing their struggles or are skeptical about the nature of the care they will need. As you might imagine, rehab for your pelvic floor may seem a little different than rehab for your knee or shoulder. It is! But not a lot. Here’s what to expect: Just like any other body part, pelvic floor PT begins with the initial evaluation. This is done in a private treatment room with your therapist (and some choose to bring a significant other, trusted family member, or friend). We start by chatting about your symptoms, answering and asking lots of pelvic floor-related questions (and trust me, there are no weird questions when you spend your days discussing poop, pee, and sex). That is followed by a full-body movement assessment because, guess what, the pelvic floor never works in isolation! So expect us to check out your walk, your squat, and your posture, and take some strength and range of motion measurements of your lower extremities. When necessary, we also do a pelvic floor assessment which is always optional and consensual, of course. This will involve a visual inspection of the affected area and an internal assessment of the pelvic floor muscles. Once the evaluation is all done, we make an individualized plan of care which usually involves a combination of education, exercise, and hands-on therapy. One patient shared, "To all the women out there, I was in PT for pelvic floor damage after the birth of my son and my PT was a Godsend after 18 months of pelvic pain and dysfunction. Her expert knowledge and care was the turning point for me in getting relief and healing. She was tuned in, intuitive, and always on top of my treatment plan and I'm happy to say that I have functionality that I had previously believed I would never regain. Also, during my 8 months of treatment, I had to bring my toddler to most appointments with me and I never felt awkward about it...the staff was so friendly to him, giving him space to play and engaging with him, greeting him by name every time we came in.” – Hannah B. We like to keep things light, fun, and interesting and patients always leave knowing so much more about their bodies. If you have questions about your pelvic floor or if you think you could use therapy, give us a call and we'll be happy to answer any questions. Or, you can always take advantage of our Free Telehealth Discovery Visits. When you're ready, you can easily get scheduled by clicking the Request Appointment button below. 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.

Last week, we posted Part 1 of this two-part Osteoarthritis blog series and discussed non-surgical management for knee osteoarthritis. Check out the blog post here. Knee Osteoarthritis: Physical Therapy Postsurgical Management There are various types of surgical interventions available for individuals suffering from knee osteoarthritis (OA) to help alleviate pain, restore lower extremity function and overall functional independence. When patients continue to experience clinically significant knee OA symptoms despite conservative treatment, the patient might elect to undergo surgical intervention. More than 670,000 total knee replacements (TKR) are performed annually in the United States due to knee OA. If a TKR is elected, we at Rehab United recommend preoperative physical therapy (“Pre-hab”) focused on general strength, ROM, and muscular endurance, which leads to better postoperative outcomes. After a TKR, skilled physical therapy is aimed at restoring lower extremity strength, knee ROM, balance, and improving gait. Research has shown that a postoperative Physical Therapy protocol including a warm-up, specific strengthening and endurance exercises, functional task-oriented activities, and a cool-down period led to improved functional lower extremity stability and walking endurance one year following a TKR. This type of functional rehabilitation is precisely the type of programming and plans of care that Rehab United prides itself in creating for each and every patient, in order to gain optimal results. 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.

Your vestibular system is a very small structure deep inside your ear (inner ear) that actually plays a HUGE role in your ability to maintain balance, stability, and spatial awareness. This system detects linear and rotational acceleration of your head and helps activate reflexes to keep your eyes on a target while your head moves. If this system wasn’t working properly, you wouldn’t be able to check your blind spot when driving, move your head to scan aisles at a grocery store or tilt your head back to wash your hair in the shower without a sense of dizziness or disequilibrium. The vestibular system is responsible for allowing you to perform a majority of your daily tasks with balance, and we typically take it for granted. MAJOR PLAYERS of the Vestibular system Semi-circular Canals: these 3- little loops are filled with fluid that shifts when your head nods up and down, shakes side to side, or tilts on a diagonal to the left or right. The movement of fluid activates sensory receptors ultimately stimulating a nerve, called the Vestibulocochlear Nerve, and sends signals to your brain to coordinate head, eye, and bodily movements to keep you upright and balanced. Otolitic Organs: the Utricle and Saccule also play a role in detecting gravitational forces and movement in the horizontal and vertical plane, like jumping up and down on a trampoline or rocking your baby to sleep. Vestibulo-ocular reflex: this mechanism connects the vestibular system to the muscles of your eyes to allow for stabilization of your gaze when your head moves. In other words, it allows you to have direct contact with your child’s eyes while quickly shaking your head “No!” With all of these players working together, we can go about our daily activities without dizziness, disequilibrium or vertigo. Problems arise when there is a disruption of one or all of these systems which can result in vertigo. Vertigo is a common symptom that people experience if they have a vestibular disorder. Vertigo makes you feel as if you are spinning or that your environment is spinning. Unless you’re on the Tea Cups ride at Disneyland, this sensation is not normal. The good news is that there are ways Physical Therapists can treat these symptoms to restore equilibrium within your vestibular system. Vestibular Rehabilitation is a service that we offer here at Rehab United, which includes a thorough examination to determine if you show signs and symptoms of a vestibular disorder, from which we can formulate a plan of care and exercises to help you recover and restore balance in your life. Brittany Hollenbeck, PT, DPT, FAFS, ATC, BFRC, is a physical therapist, certified vestibular physical therapist, and Clinic Director of Rehab United in La Mesa. She received her Doctorate in Physical Therapy in 2015 from San Diego State University and has stayed at the forefront of evidence-based treatment techniques through various continuing education courses. She has treated numerous injuries and disorders involving musculoskeletal, nervous system, and vestibular pathologies with great success.