Wearing Depends is Not a Rite of Passage!

Shhhhhh don’t tell anyone. Just hide it. It’s normal. I REALLY hope I don’t have to do Double unders today”

I work with women who have babies, teens, and grandchildren. Women who cross-fit, Ironman athletes, soccer moms and grandparents who just want to play with their grandchildren.

We talk about almost everything but no one talks about leaking. Leaking when they laugh or cough, leaking when they jump, run, or pick up a toddler.

IT IS NOT NORMAL, although sadly it is common.

I would love to open the door and discuss a topic that is so important but shied away from in conversation. So let’s understand the problem first in Part I and then later learn some basic tips in Part II

Part I – The Problem

I have friends and patients who go to the bathroom twice before they lift, jump or run. Some who wear the biggest pads they can buy when they have a cold, and others who are super dehydrated because they do not want to fill their bladder just in case.

I quote, “I thought that [Leaking] is just what happens after you have kids”, or, “It’s fine. It’s only when I exercise, or have a bad cough”.

Having children, old back injuries, sitting all day, lifting incorrectly, training incorrectly, can all put strain on the body. While our bodies are amazing in how they get us from point A to Point B pretty much no matter what, it may not be very efficient. People will compensate, then that compensation

creates bad movement habits. Over a period of time can result in injury, or dysfunction. A mirad of dysfunctions can occur but the one I want to address today is leaking when you lift, run, jump, cough, or laugh. This dysfunction is very common, but in no way normal.

My patient said to me the other day,” I didn’t know there was anything you could do about it”. YES! There are ways to address the problem and change it but first let’s understand this dysfunction.

Leaking urine is a muscular dysfunction. Imagine this; A beautiful ballet at the theatre where the prima-ballerina leaps gracefully in to the air and her partner (probably a very handsome prince ?), bounds over to catch her, but he is a millisecond too late… He doesn’t stick the landing without a bobble and a step back to catch her. So, while she doesn’t fall to the ground, it is not the graceful catch you’d expect. If the muscles in the body are coordinated in timing and sequence, he sticks the landing and the catch is flawless. If the timing is not there, it’s a stumble and regaining your balance to perform. That is essentially dysfunction and compensation.


From ballet to the muscular dysfunction in our body. Our body likes stability. Our stability system allows us to move our bodies into the position to be able to control our muscular balance. I am not just talking about balance that keeps your butt off the floor, but the balance of all the muscles moving supporting our skeletal structure, and keeping our bodily functions in control.

We have all heard about “the core”, but what really is “the core”? Most people think of it as the abdominals, a six pack. What I am referring to today is the deep core, a TEAM of muscles that must work together, the starting line-up. This line-up is composed of the diaphragm, pelvic floor, transverse abdominals, and lumbar multifidus. These muscles work synchronously, meaning they are team that are meant to fire in a specific sequence so the body can do what it is supposed to, like run, jump, lift your kids and hold in your pee all at the same time.

Julie Weibe ( www.julieweibe.com) explains this system by the visualization of gears. The gears must all move in a sequence to create force and stability. In the past few decades fitness and healthcare professionals have been teaching people to “hold the core” (navel to spine), or isometrically contract pelvic floor, called a Kegel, to strengthen the pelvic floor to help with incontinence. The problem with this is we are asking the muscles to just to “hold”, when really the goal is to move, (like in a kickboxing class or to chase a toddler). One example Julie Weibe gives is that would be like asking someone to hold the quad tight (lock out the knee) and still run.

This technique is in the same vein as “tighten” the abdominals and brace for a lift. New research has shown that static isolated bracing puts increased pressure on the pelvic floor, decreasing its ability to keep the urine in. The other big new discovery is that while for years people have been told to bring the navel to the spine, this “hollow” or “flat back” position puts the pelvic floor muscles in a poor mechanical position to fire. When these muscles are inefficient, dysfunction happens, and as I said before – this can result in many various symptoms that include not only incontinence, but also back, hip, shoulder, rib, and cervical pain, as well as decreased athletic performance.

So now what? The biggest point I want you to get from this article is don’t hide, talk about it. I will include links to find a pelvic floor Physical therapist or sports medicine PT who is educated in this area (not all are) to help you get awareness to re-coordinate your patterns, this is crucial. It will not get better with denial.

The anatomy: The “gears” that work in a sequence,

a. the anticipatory musculature is the pelvic floor (PF), the sling of muscles from front to back of pelvis. This is what is engaged in a Kegal exercise. It should be contracted dynamically not a static hold.

b. On to the diaphragm. Seriously, who thinks about strengthening the diaphragm, no matter how much I work that one it never gets ripped ?, but breath holding is one of the biggest contributors to leaking, and lowering athletic performance with regard to decreased speed and strength. As thediaphragm engages it dips down into the abdominal cavity to pull the air into the lungs. When the breath is held in, breathing with the chest vs the ribcage more pressure is pushing in to the poor pelvic floor. It’s just like stepping on a water balloon, just pushing the urine out. If we hold our breath the gears stop, it’s not dynamic movement.






c. The Transverse Abdominis: very low, low abdominals. Often when trying to contract this muscle people will bring the belly button to spine or flatten the back, that’s not quite right, instead it’s the muscle that engages with a cough or laugh. As I said before we (the fitness industry) have taught a generation to isometrically hold that muscle in the wrong position for effective stability.








d. Multifidus: Deep spinal musculature in between each vertebral segment this is the deep muscle that is so important for stabilization and correct positioning of the spinal segments.






2. The actions:

  • The beautiful coordinated ballet goes like this: the Pelvic Floor is the anchor, it sets itself up for all movements before they happen. You go to reach for a door your PF is ready, you go to kick a soccer ball your PF is engaged.
  • The Diaphragm: In the right alignment, you take a proper breath, the diaphragm should move down and out. A deep breath should feel like you are opening an umbrella upside-down in the bottom of your ribcage. As this happens the PF should descend into the pelvis and the TA (the belly) should be pushed out a bit. This action sets those muscles up for a recoil response. For example, think of a broad jump or a box jump. Squat down first (loading the muscles of the legs) to get a great burst of strength to jump. Same thing with the pelvic floor and TA we must first load them with breath then they recoil to hold the spine, pelvis and leg in a safe stable position to move.

3. Where the most common problems occur with poor posture or alignment:

Tucked in: Posture is slouchy, tush tucked under









Extended military: Chest is out and forward in front of hips









Lordosis: A huge curve in the low back tush pushed out.







When the alignment is off then the muscles are not in a good position to work effectively or efficiently. The muscles that control the stability system aren’t loaded or engaged correctly, leading to the compensation we spoke of at the very beginning of the article.

The Fix

First find your neutral spine.

1. Ribs stacked on/over your pelvis

2. pelvis in neutral. Tailbone not tucked under nor tailbone reaching for the stars. A good thing to check is boobs should point forward not down or up.

In neutral spine, take a deep breath feel your lungs expand, belly pop out and then chest rise. IF your ribs are forward over the pelvis your chest will rise before your belly. Play with the breathing in various postures: feel the diaphragm push down then as you exhale the recoil of the abdomen and the pelvic floor.

IF you can’t feel your pelvic floor, the ski jump position is a great trick Julie Weibe uses to put the body in a place to automatically engage lower abdominals and pelvic floor. Stand in facing a wall or a desk, lean forward from your ankles keeping the trunk stable as you begin to lean forward from your ankles this will make your brain engage the pelvic floor and TA to stop you from falling over (stand in front of a wall so you don’t feel as if you are going to fall) just feel the muscles in the front of you pelvis turn on then lean back to center. See if you can find that muscle again.

Here’s a video to help

If leaking is an issue for you then this is just the beginning… I want to shine a light on this topic, but to make changes there is a lot of work to do. I would like to direct you to a few great videos to help find the issues. Now you can train to be stronger than yesterday!


Resources for further understanding and investigation




Use this link to find a women health or pelvic floor specialist near you.


Youth Sports Injuries, Just Growing Pains?

When is it More than Just Growing Pains?

As a physical therapist specializing in sports medicine for 20 years, I have discovered a plethora of misinformation pertaining to the pain our youth are experiencing as a result of their athletic endeavors. In my practice, I have witnessed an increase in the numbers of kids, ages 5-18, who play one sport 4-6 days per week, year-round. Many of these kids have struggled with the same injury on and off for years before they come in for treatment. I frequently encounter upset parents because they were instructed to have their child “rest, it will just go away.” Rest can help to diminish the injury temporarily, but if it isn’t healed properly, that same injury will return to haunt and hinder every sports season.

Another myth I often hear is, “it’s just growing pains; they’re kids, they will just heal.” The problem is it doesn’t always just heal. Remember, pain is a signal to our bodies that something is wrong. Also, when someone has pain, compensatory patterns can develop. Think of a limp, it becomes a habit and even when the pain is gone, the limp may still be there. We have the opportunity to correct these problems BEFORE they become an issue. The beauty of the youth athlete is they are still growing and changing. This is the prime window of opportunity to guide their movement and strength progressions while they are developing, before it becomes a chronic injury.
Next, I want to highlight overuse injuries in the youth athlete. Over 70% of youth injuries are from overuse. Kids have common patterns of overuse that are very different from the adult athlete. Children are not small adults. There are variations we must consider in their athletic training.

1. Growth spurts, the pattern in which they grow, will change how they move. During a growth spurt, the brain does not know yet where the body is in space, therefore the child may be clumsy (think of the puppy with big paws that falls every time it runs). That in and of itself, will predispose the young athlete to injury.
2. Energy expenditure associated with growth may cause fatigue, and thereby increase risk of injury.
3. Year-round training in one sport has been shown to increase overuse injuries significantly in our youth athletes.

The common overuse injuries we’ll address today are fractures, growth plate injuries, soft tissue strains and chronic sprains.
A stress fracture is an overuse injury in a young athlete due to the increased porosity of the immature bone. When the muscles are tired, there is inevitably more impact and stress on the bones. With the increased volume of training sessions, the cells of the bones are unable to repair fast enough to keep up with demand. This often occurs more frequently in the lower legs. Stress on the shins (shin splints) is very common for runners and sports that involve high levels of running like: track, soccer, basketball, volleyball. Vertebral (low back) injuries are high among gymnasts, divers and skiers. It is very common to see the onset of pain early to mid-season, in concert with the increased volume of training because the body is not yet trained to keep up.

Growth Plate injuries are very common in children. The growth plates are the space on the ends of the long bones that have not hardened yet. Because the plate is sandwiched between the hard bone, it is more vulnerable to shear and compressive forces.

“Approximately 15% to 30% of all childhood fractures are growth plate fractures. Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention. If not treated properly, it could result in a limb that is crooked or unequal in length when compared to its opposite limb. Fortunately, serious problems are rare. With proper treatment, most growth plate fractures heal without complications.”

Common injuries that happen with trauma and overuse are Severs (heel pain), Osgood Schlatter disease (tibia: large painful bump just below the knee cap), little league elbow and gymnast wrist. These injuries can be overlooked and regarded as “just a sprain.” When these injuries are not identified, significant problems can arise that may affect the child well into their adult years.

Soft tissue injuries are something I see very frequently in my athletes. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC2213798/ These are commonly known as Tendonitis and chronic muscle strains. Shoulder pain is frequent throughout the season in our pitchers and swimmers. The ache just below the knee cap for our soccer players and volleyball players. The chronic hip flexor strain for all my track athletes, and don’t forget the “pulled hammy” that just won’t stop hurting with all my sprinting and cutting sports.

The soft-tissue injuries occur when the muscles around a joint are not balanced. The muscles are pulley systems. Image a huge round stone with a bunch of guidewires, we have 10 people pulling these wires to roll the stone in a straight path. If everyone pulls evenly in the right sequence the stone will roll straight. If one side pulls harder or at the wrong time, the stone moves in that direction. If the hamstrings pulls before the gluteus muscle, that muscle gets the brunt of the force. The outcome is an overtaxed and painful hamstring. The same goes for the quadriceps and hip-flexors. These are prime examples of the common compensation patterns I referred to at the beginning of the article.

Rest and ice are imperative to stop the symptoms of the injury. The way to address the root cause is to evaluate the movement patterns. A skilled physical therapist will evaluate the poor patterns and re-train for appropriate balanced muscle. This is needed to abolish the poor pattern that caused the stress. A good physical therapy program will include a strong focus on the neuromuscular education, teaching the nerves and muscles to move in a pain free efficient manner. The gains in strength and speed will be exponential!

The common ages that children experience growing pains are 3-5 and 8-12. To help ease that pain, I recommend a massage or gentle rubbing, Epsom salt baths, and gentle movement.
What can we do to help our kids?

1. Listen to them. If they hurt let them rest. They may still desire to play in the pool or goof-off in the backyard. This can be active recovery from a tough week of drills at practice.
2. There is a growing body of evidence that shows sports specialization before high school can lead to greater risks of overuse injury and burnout. They may do better with an entire season off. Let them play a recreational sport, one that is different from what they are doing competitively. The majority of professional athletes played more than one sport allowing the body to actively recover between seasons.
3. Find a physical therapist or trainer who will work with your child to teach effective patterned movements. Regardless of the injury or the cause, there will be imbalances in the injured region, in addition to, the joint above and below. The time of healing is the perfect time for a professional movement specialist to retrain the muscles and joints to move with the best efficient pattern. You will see huge gains when your child can move effectively without pain!

The list of potential injuries and treatments could fill a text book. Should you desire more information on specific injuries, I provided links to a few helpful articles. Remember, pain is a message to our bodies that something is wrong. Finding a trained practitioner to help your athlete move through their childhood with less pain will reap the rewards twenty fold.








Julie Granger Young Female Athlete, Prism Wellness 2016.

Battle Born Health

Freedom from Muscle Pain: It’s Not a Christmas Miracle, It’s Mechanics

Patients often come into the clinic because they are in pain, let’s say their shoulder hurts. When we ask what happened, we often hear answers like “I don’t know, I just woke up with this.” Left untreated, the muscle pain won’t go away and may worsen over time.    

First, the physical therapist will perform an evaluation to determine the issue. We ask a lot of questions, ask you to move in various directions, and build a 3D picture of what is happening inside your body.    

The Mechanics of Muscle Pain in the Body

To understand what we’re looking for, picture the construction of a skyscraper. Cranes move huge beams at all different heights and angles to construct the structure, or skeletal system of the building. This is accomplished by strong cables and pulleys manipulating the beams and structure, similar to the way muscles and tendons act on bones and joints. 

Now, picture one of the beams getting snagged or hung up on something as it’s being moved – the cables will continue to lift and pull, but the stuck area will prevent movement, placing extra strain on the pulleys and cables. In the body, when the tendons or muscles are strained, an inflammatory process begins. This process rushes cell-rich blood to the area resulting in a warm, red and sore joint. Rest is beneficial so that the biological response can perform its functions, but it can’t fix the root cause of the irritation – the mechanical hang-up within the body’s bone and joint structure.    

Physical Therapy Can Restore Joint Mobility

A physical therapist is able to perform manual techniques to get the joints moving, which may feel like an aggressive massage. These techniques allow the physical therapist to unstick the metaphorical beam and restore normal mobility of the joint. After treatment, or a series of treatments, the patient discovers that they’re finally able to move their shoulder without muscle pain, they’ll patient exclaim “it’s a miracle!”  NOPE it’s mechanics! Now the beams and cables are moving freely, no strain and no pain.   

That’s just part one of the solution.   

Part two involves re-educating muscles to move in the correct patterns so the joints don’t get stuck again.  When the joint has improper mobility for an extended period of time, the muscles will find a way to compensate, producing bad habits. Without correcting those bad habits, the hang-ups are likely to just recur, which is why your PT will work with you to help train your muscles to activate and move in the correct sequence to keep the joints healthy and moving properly. 

Neuromuscular Reeducation Creates Lasting Improvements

Physical therapists are specifically trained in neuromuscular re-education. Neuromuscular reeducation is the process of identifying bad movement habits, then training and the appropriate, coordinated patterns of movement.  Exercise with good form will promote strength, speed and pain free range of movement. This is not a quick fix, and requires dedicated work on the part of both the physical therapist and from the patient, but it is the best and only way to create real and lasting improvement toward the goal of becoming pain free. 

If you have a recurring injury, or aches and pains that refuse to go away despite plenty of resting and careful exercise, your body mechanics are likely off.  The physical therapists at Battle Born Health are ready and excited to offer you the one-on-one time and attention that’s needed to properly identify the problem and its root causes, create a personalized plan for recovery and prevention, and get you through your injury with a full and lasting recovery.  Every session puts you in their capable hands, one-on-one, with the goal of reducing your overall muscle pain. 

With Battle Born Health, there’s no techs, no time in another room with another patient while you do exercise. It’s just you and a Doctor of Physical Therapy.   

Call today to schedule a complimentary consultation, and let us show you how we can help you meet your goals.

Headache Part Two: Desk, Driving and Sleeping Posture

Headache Part Two: Desk, Driving and Sleeping Posture

There’s a lot of talk about how good posture is crucial for a healthy body, but it’s tough to know what exactly is good posture. In this article, we will discuss the best posture for sitting at a desk, driving and sleeping. These tips are especially important if you suffer from headaches because the position of your head and spine have a huge impact on how you feel. If you’re new to this blog, I recommend looking back to the previous article Headaches Part One: A Pain in the Neck for some background on how headaches can be caused by posture.

headache cure Battle Born Health therapy

A “normal” spine has 4 curves – the inward (lordotic) curve of the cervical spine or neck, the outward (kyphotic) curve of the thoracic spine, the inward (lordotic) curve of the lumbar spine or low back and the slight outward curve of the sacrum.

Between time, gravity, our jobs and hobbies, we tend to develop a forward head and shoulders posture which changes the forces through the spine. Our chin pushes forward, followed by our upper back resulting in increased strain on the joints and muscles as well as weakening of the deep stabilizing muscles of the neck. This can result in headaches at the base of the head, the temples, radiating up the back of the head and aching in the neck and shoulder blades. Keeping your spine in a neutral position helps minimize the extra forces on the neck and prevent aches and pains as you work and play.

Battle Born Health therapy posture Reno

To maintain good posture, imagine a vertical line being drawn down through your body from head to toe. That line should pass through the center of your ear, your shoulder, your hips and your ankles. This puts your spine into a strong, stacked column which distributes the pull of gravity evenly and reduces strain in the joints and muscles.

Sitting at your desk

Tips Physical therapy Battle Born Health

  • Position your monitor so your eyes are looking 2 to 3 inches below the top edge, keeping your chin parallel with the floor.
  • Squeeze your shoulder blades together gently to support the upper back, then pull your chin directly backwards into your spine like you’re giving yourself a double chin. The goal is to keep your chin level (not letting it drop toward the floor as you pull it backward) and reverse the curvature that was caused by the forward-head posture that was mentioned earlier.
  • Sit with your hips against the back of the chair with a small towel roll supporting the natural curve of the low back.
  • Finally position your chair so your hips are slightly higher than your knees and your feet can rest solidly on the floor.


This posture is similar to sitting at your desk and the goal is to maintain a tall, neutral spine.

  • Adjust the height of your seat so you can keep your eyes looking straight ahead with the chin level with the horizon. Pull your chin back toward your neck to prevent the forward head posture. Use the headrest as a cue – the back of your head should gently rest on it, while keeping your chin level
  • Relax shoulders and let them drop toward the ground
  • Recline the seat to no more than 30 or 40 degrees
  • Support the low back with a small towel roll
  • Adjust the steering wheel so that your arms are supported on the wheel with roughly 90 degrees of bend in the elbow and shoulders relaxed


People often ask what’s the best position for sleeping and my answer is whatever position you can sleep in.

Left-sided or right-sided – the key is support

Imagine lying on your favorite side…start with the pillow under your head only (not under your shoulders). Next, tuck one end under your chin, pulling the middle section into the crook of your neck and the end around to the back of your head. Picture a horseshoe shaped pillow wrapping around from your chin to your upper back. A great way to achieve the support of an expensive feather or memory foam pillow is to take a hand towel and roll it into a log, then slide that into the pillowcase at the base of the pillow. This creates support for the neck while also being adjustable to your comfort.

headache relief
headache relief
headache relief

Next, support your top arm. Grab a standard pillow and tuck it all the way up under your armpit and so the length of your arm is comfortably resting on the pillow. Make sure all of it is supported by the pillow – upper arm, elbow, forearm and hand.

headache relief

If you’re a back sleeper:

The goal is to support your head and neck while also keeping your neck in line with the rest of the spine. In the picture below, you see how too many pillows can raise the head so it’s no longer in line with the rest of the spine. Another important point about this picture is that the pillows are there to support your head and neck, and need not be under your shoulders. Pull the pillow under your head so that it fills the curve under your neck.

headache relief
headache relief

Finally, if you have any shoulder issues, you can put a pillow under your arm from your armpit to your belly button to support the weight of the arm. This support will allow the muscles in the neck to turn off at night and rest because they no longer have to hold the weight of the arm.

headache relief

If this sounds like a lot of information all thrown at you at once, try it out one tip at a time – spend a few days at work focusing on getting your desk chair set up just right and see how you feel at the end of the week. Do the same with adjusting your car seat and being aware of where your shoulders are while driving. If you notice an ache in your head or shoulder blades, take a deep breath and let your shoulders drop toward the ground. The more often you check your posture, the more awareness you will develop and will be able to avoid headaches from the start. Also, experiment with pillows and sleeping position because a good night’s rest is crucial for health.
If you’ve tried all of these tips and still aren’t feeling the relief you hoped for, consult a physical therapist. It’s so easy to ignore headaches and hope they just go away, but resist the urge and be proactive about your health – be stronger than yesterday!

Headache Part One: A Pain in the Neck

Headaches are one of my favorite issues to treat as a physical therapist because they are an everyday nuisance that are often completely fixable. The typical description I hear from patients is an ache at the base of head where it meets the neck that seems to get worse as the day goes on, especially while sitting at a desk.

As much as I’d like to tell everyone to just retire and the headaches will go away, that’s not sustainable for my patients. Their reports of aching and tightness at the base of the head often also includes a dull ache in the upper shoulders and shoulder blade region which improves briefly with massaging the area.

We all know that you can’t recruit someone to rub your neck and shoulders all day at work, so over the next few articles, I will offer tips for decreasing the pain and give techniques to manage it without medication or days off.

When dealing with headaches, it’s important to identify the cause or causes, so they can be treated effectively. Many times, there are a combination of issues which may include seasonal allergies, posture while sitting at your desk, driving or sleeping, stress, neurological problems and trauma. While not all of these causes are suited for physical therapy, there are many that can be improved and solved with physical therapy.

Headaches that are located behind the eyes, at the temples or radiate up the back of the head to the top are often caused by dysfunction in the neck and are called “cervicogenic headaches”. These types of headaches often respond very well to physical therapy. While the pain appears in these areas, it’s not actually caused by dysfunction there specifically.

Limited joint motion, tight muscles or instability at the joint can all cause these symptoms. A skilled physical therapist will utilize a variety of manual hands-on techniques focused on restoring normal joint motion, calming muscles that are overly tight or in a spasm, and re-educating the stabilizing muscles of the neck so that your body can maintain good posture.

Here are some basic ideas to get you started. In the next few blog posts, I will give advice on ergonomics at your desk, while driving and while sleeping as well as exercises to create a strong, stable posture, so stay tuned!

3 Tips

  1. Correcting the forward head posture

The problem: head or neck pain at the computer, while driving or reading.

headache relief

The reasoning: Posture is an important starting point because without restoring the neutral position of the spine, the joints and muscles will be perpetually strained and irritated which creates a pain cycle and forces your body to compensate with unhealthy patterns of movement.

When we sit at a desk or when driving, we all have the tendency to lean toward whatever we’re looking at, typically leading with the chin. This essentially shortens the muscles of at the base of the skull and overstretches the muscles on the front side of the neck. These muscles are deep; they bear the responsibility of stabilizing our spine. If you hold your head in the forward position long enough, those stabilizing muscles in the neck are unable to support the posture and you will begin to feel that ache at the base of your head.

The solution: Postural awarenessstart by sitting tall in a chair with back support, look straight ahead keeping your chin level with the horizon. Squeeze your shoulder blades together gently to support the upper back, then pull your chin directly backwards into your spine (think double chin). The goal is to keep your chin level (not letting it drop toward the floor as you pull it backward) and reverse the curvature that was caused by the forward-head posture that was mentioned earlier. Hold for 10 seconds, while breathing and relaxing. Keep this posture in mind as you drive, work at your computer or read.

headache relief
  1. Pain while sitting at the computer

The problem: working at the computer for hours at a time and ending up with a headache

The solution:

  1. Take frequent mini-breaks – stand up and walk around for a few minutes at least once every hour, or sooner if you begin to notice a headache or neck pain

  2. Good ergonomics – we will go in depth on this topic in the next blog post, but here are a few key points to keep in mind:

    • Sit in a chair with low back support that fills the natural curve of your spine. Using a rolled up sweatshirt or a few thin towels rolled together can accomplish this without needing to buy an expensive new chair.

    • The seat of your chair should be high enough that your hips are higher than your knees, but your feet are still fully on the ground. Try placing a few folded towels under your buttocks to achieve this position.

    • Your screen should be high enough so that you can see the most of the screen by looking straight ahead with your chin parallel with the floor, and without needing to tilt your head up or down.

    • Keep your chin tucked into your neck and avoid that forward-head posture we discussed before.

  3. Balancing flexion and extension – in our society we spend a lot of time bent forward at a computer, driving a car or just staring at our phones. Your body needs to spend time out of that forward bent position (called flexion) with backward bent positions (called extension).

Here is a simple exercise you can do at work to loosen the muscles on the front of your body and give the ones on the back a break:

Doorway Stretch

– Use a narrow doorway, place one forearm flat against each side of the doorframe with your elbows around shoulder height.

– Tighten your abdominal muscles and step into the doorway until you feel a stretch across your chest

– Hold this position for 30 seconds. You should feel the stretch in your chest and upper back. If you feel it in your low back, don’t step into the doorway so far.

– Repeat this stretch one to two times an hour as you go through your day

  1. Pain while sleeping

The problem: Restless sleep because of neck pain

The solution:

Left-sided or right-sided – the key is support

Imagine lying on your favorite side…start with the pillow under your head only (not under your shoulders). Next, tuck one end under your chin, pulling the middle section into the crook of your neck and the end around to the back of your head. Picture a horseshoe shaped pillow wrapping around from your chin to your upper back. A great way to achieve the support of an expensive feather or memory foam pillow is to take a hand towel and roll it into a log, then slide that into the pillowcase at the base of the pillow. This creates support for the neck while also being adjustable to your comfort.

headache relief
headache relief
headache relief

Next, support your top arm. Grab a standard pillow and tuck it all the way up under your armpit and so the length of your arm is comfortably resting on the pillow. Make sure all of it is supported by the pillow – upper arm, elbow, forearm and hand.

headache relief

If you’re a back sleeper:

The goal is to support your head and neck while also keeping your neck in line with the rest of the spine. In the picture below, you see how too many pillows can raise the head so it’s no longer in line with the rest of the spine. Another important point about this picture is that the pillows are there to support your head and neck, and need not be under your shoulders. Pull the pillow under your head so that it fills the curve under your neck.

headache relief
headache relief

Finally, if you have any shoulder issues, you can put a pillow under your arm from your armpit to your belly button to support the weight of the arm. This support will allow the muscles in the neck to turn off at night and rest because they no longer have to hold the weight of the arm.

headache relief
physical therapy

How Physical Therapy Can Cure the "Dreaded Plantar Fasciitis"

Do You Have Plantar Fasciitis Symptoms?

  • You get out bed and feel searing pain with that first step.
  • You dread the first 10 minutes in the morning of standing and almost pee your pajama pants trying to get to the bathroom because your foot hurts so bad and you have to hobble there.
  • You’ve stretched your foot, arch, and calves endlessly with no lasting improvement.
  • You rolled a golf ball under your arch to the point of tears.
  • You bought 16 pairs of ugly shoes only to wear your tennis shoes to work every day.

If you’re familiar with any of these situations, it’s likely that your plantar fascia is in trouble, and with the arrival of summer your symptoms only get worse. For many, summer means flip flops, cute sandals, and walking barefoot on the beach.

For others it means ramping up training to prepare for a race this fall. All of these can put strain on the bottom of your feet resulting in your poor plantar fascia becoming inflamed and irritated.

Here’s a secret…the problem isn’t your plantar fascia. It’s actually your core, your hips, and your butt.

The foot is structured in the shape of an arch with the plantar fascia, a long, flat, wide ligamentous structure like a hammock, across the bottom supporting the arch. If you have weakness of your core, hips and butt or these muscle groups aren’t working properly, they can’t maintain the correct joint position in the leg, thus placing all of the stress through the bottom of the foot.

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Look at your foot when you’re standing – do you have an arch or are your feet flat like a duck? Are your ankle bones pointing inward?

When your weight is evenly distributed through the foot, the body can utilize all the muscles, joints and ligaments to support that weight. The hips and legs can then exert forces upward to hold your body upright.

When weight is unevenly distributed, the feet will rest in pronation (weight on the inside edge) or supination (weight on the outside edge).  Pronation is the most common fault and can occur for a variety of reasons; one is genetic predisposition to flat feet.  Another cause is weakness in the external rotators of the hip, which leads to abnormal rotation of the femur (thigh bone) and creates valgus (knees together) posture. If you follow this down the chain from the hips to the foot, the knees come together the ankles squint in too, resulting in strain on the plantar fascia.

By strengthening the core, hips and thighs and being aware of proper posture, the strain can be reduced and the plantar fascia can begin to heal.

Physical Therapist Approved Activities for Healing 

Finding neutral foot

Sit on a chair with feet flat on the floor, knees bent at a 90⁰ angle with toes forward, and ankles directly under your knees. Try to create an arch by lifting the ankle bones but also keeping the big toe on the floor. The goal is to make the pointy bones inside the ankle to be level with each other (not the inner one lower than the outer one).

Make it tougher

Once you can hold that position, try it while standing. Put your hands on a table or a countertop to decrease the amount of weight on the feet and help balance. Once you can hold that for 30 seconds and repeat it 5-10 times, try on one foot. Do this in front of a mirror so you can be sure your hips stay level when you lift the foot off the ground.

Now practice it – all the time

Pay attention to your arch while you’re standing. For example, while waiting in line at the grocery store, or while brushing your teeth. The more you practice holding that arch, the easier it becomes.

Strengthen with a purpose

Squatting is a great way to strengthen the lower body, if special attention is paid to maintaining proper alignment.  Imagine screwing your feet into the ground, using an outward rotation motion but not actually moving the feet. This motion lifts your arches and direct the knees ever-so-slightly outward.  As you can see in the image, this helps maintain safe alignment of the knees and feet and prevents excessive strain on the joints and ligaments of the leg.

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Orthotics, or shoe inserts, are often used to help maintain the arch temporarily. Ultimately though, correcting the mechanics of the leg and building strength will reduce the inflammation at the plantar fascia. So will maintaining a neutral foot position during daily activities thus preventing irritation in the first place.

Try the activities above for a few days to gain awareness of your foot position and note any changes in your symptoms. As with any exercise program, if you feel increased pain stop!  The activities are designed to decrease irritation so if there is pain, it’s a signal that your body doesn’t like what you are doing to it.

If you aren’t finding relief or just can’t get the hang of it, call a physical therapist (check out our blog post How to Find the Right Physical Therapist). A thorough PT will examine the lower back, core, hips, knees, ankles and feet, not just focus on the symptoms at the bottom of the foot. The therapist will work with you to develop specific physical therapy goals and a program to reach them.

Remember the process of healing and retraining takes time and it won’t happen overnight. With work and dedication, you should be able to return to what you love doing without pain.

Battle Born Health, where you can be STRONGER THAN YESTERDAY.

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How to Find the Right Physical Therapist

Ok, you really are injured. Your doctor told you to go see a physical therapist, or maybe you’re realizing this injury won’t heal on its own. Now what? You don’t want to trust your most precious resource, your body, to just anyone, but most people’s first move would be to google physical therapy clinics in the Reno, Nevada area. Is that really how you want to find the person that will be restoring you to your previous glory?

You need to know all physical therapists and physical therapy clinics are not created equally.

If you were to have a surgery, you would most likely have a second opinion. We get multiple estimates before getting our car repaired. Doesn’t it make sense to research your physical therapist? Consider not just price, but quality, convenience, experience, and specialty. There’s no doubt that cost is an important consideration, but remember you only have one body and you want it to feel good. You want to rehabilitate and restore – not just get a rub down with no lasting effect.

So I offer you some tips for determining if a therapist is the right match for you:

  1. If you have no guidance from your doctor or friends, check out apta.org/findapt. Look at the specialties, extra certifications, and education. The letters don’t guarantee a great physical therapist, but it does show an effort on the therapist’s part to go above and beyond the status quo after graduation.
  1. Call the clinic or look on the website to learn more about that specific therapist. You should be able to see each therapist’s specialties, educational backgrounds, and years of experience.
  1. Ask about the size and treatment style of the clinic. Are you comfortable in a big open gym or would you prefer to be treated in a private room? Does that physical therapist have 4 patients in an hour or just one?
  1. Ask how long each visit is with the physical therapist. Many clinics have patients see both the therapist and an unlicensed therapy aide or technician. You want to make sure the bulk of your therapy is with the physical therapist (for example 45 min with the physical therapist and 15 with an aide). Aides can guide exercises if you have already been trained well by the physical therapist. The aide should not be teaching the exercises or performing any hands-on techniques to patients.
  1. Will you see the same physical therapist each visit? Consistency is important. As a therapist, having the patient’s full back story helps us put together the puzzle pieces. Without consistency of care, important details are often lost, which can have a significant impact on the extent and speed of recovery.
  1. Will a therapist take the time to talk to you on the phone prior to your appointment or answer questions and concerns between appointments? Now, realistically the physical therapist may not be able to jump on the phone whenever you call, but it is reasonable to expect a call back within 48 hours.

Once you have spoken to or met your therapist, consider a few other factors that will aid in the success of your care:

  1. Do you like the person? Be honest, this person will be in your face and touching your body, if you don’t feel comfortable with them, it could affect your outcome. Do they listen to your concerns? Were you involved in establishing goals for therapy?
  1. You should feel a difference in one to two visits. Notice I did not say you should be better in one to two visits, but there should be some change. That change may be good or bad. If it’s not good, the therapist should be able to answer why your symptoms are not improving.
  1. Often the symptoms that brought you to physical therapy are not the actual cause of the problem (which is a topic for another post, stay tuned). But frequently a knee hurts but it is because the hip is weak. Did your therapist look at your whole body, not just the injured region?

At Battle Born Health, our therapists have over 25 years of combined experience in Orthopedic and Athletic populations. Our therapists have completed post-doctoral certifications and board certifications. We do not employ technicians or aides. We strive for 100% consistency with patient scheduling.

We provide a free 30-minute discovery session for all potential patients. We would love to talk you, answer your questions about what is hurting or limiting your ability to do what you want to do.  We are different from the rest and would love the opportunity to prove it. If we are not the right fit for you, we are happy to direct you to the appropriate practitioner.

Give us a call!

A Good Physical Therapist Is Pro-Active

Many people think of physical therapy as the follow-up activity their GP or orthopedic surgeon often prescribes after an injury, or an inquiry into mystery aches and pains. Certainly that’s one function of PT, but perhaps our most critical function is to be a holistic, preventative health partner for people who want to remain active and healthy throughout their lives.

We loved Dr. Chris Telesmanic’s perspective in his column for The Sentinel.

“The vision for physical therapy moving into the 21st century, as stated by the American Physical Therapy Association, is to ‘transform society by optimizing movement to improve the human experience.’”

Promoting the role of physical therapy as a proactive one focused not only on recovery but on prevention and vitality makes good sense. By nature, human beings are built imperfectly, and even the most fit and athletic among us either suffer from—or very likely will one day—deficiencies in movement based on our unique bone and muscle structure, use (and over-use) patterns, and regular age-related wear and tear. A good physical therapist will take a holistic approach to patient health and mobility, and look closely at the bigger picture to identify these potential problems before they develop.

Including physical therapy in the suite of preventative care services allows us to contribute to a healthier, more functional society—and saves time, money, and unnecessary pain for patients who might otherwise find themselves scrambling to fix and recover from acute problems down the road.

Give our Reno team of physical therapists a call at 775-747-2278 to find out how physical therapy can be an important tool in your arsenal to keep that body active forever!

Personal Stories: Why I Love Being a Physical Therapist in Reno

Becoming a physical therapist was the best decision I’ve ever made. I love working with people who want to improve themselves and their lives, and physical therapy affords a rewarding way to do that. 

I’m also a die-hard muscle geek! Muscles are truly fascinating. They have personality, and can develop bad habits, like being over-achievers, which gets them in to trouble when other muscles slack off and don’t do their jobs. The over-achievers step in and work hard to do both jobs, which—you guessed it—can result in overuse injuries. 

Muscles are also great cooperators. They work well in groups, each doing their part to achieve a coordinated movement (like reaching for a glass in an overhead cabinet). The coordinated effort of a movement pattern from a group of muscles is like a beautiful ballet dance—the choreography and timing must be perfect to pull off the desired effect. One small slip-up can result in disaster. The same is true for the body. Things can go wrong quickly when even one muscle isn’t working properly or firing on time. Even issues that seem small, like a sleeping pattern that slowly tweaks a shoulder muscle over time, can result in behavioral changes that may be subtle at first, even subconscious, like holding the steering wheel differently to avoid discomfort in a certain position. But even these small changes in posture and movement can result in overcompensation habits that compound muscle problems, increase pain, and end in injury. 

Sometimes we ignore these issues for so long that we layer compensation over compensation until the original problem is obscured. I never get tired of playing detective to sleuth out an underlying problem, and developing custom, client-focused mobility techniques and therapies to retrain those muscles and return their bodies to that natural, beautiful, strong, well-orchestrated function. Who couldn’t love a job like that?

Battle Born Health’s team of certified physical therapists in Reno are ready to help you get back into life—pain free. Give us a call today at 775-747-2278 to schedule your appointment.

Pro Tip: Don’t Sacrifice True Health for a Fast Fix

Microwaves, remote controls, TiVo, cell phones, email and instantaneous Internet —the Millennial generation and even the generation before it have never had to think much about waiting. We have so many tools at our disposal to rush just about any process along, that we forget there can be a value to giving things time.  We’re so anxious about saving time, we’ll readily develop technology to help us do it.

Thankfully there’s not an app (yet) for fast-forwarding a sunset, a relaxing glass of wine, or a perfect fall day!

But even those of us who grew up without cell phones and Internet have our hurry-up crutches. Medications like pain-relievers and antibiotics are among them. These treatments can be helpful and sometimes even critical, but as a culture, we’ve gotten ourselves into a habit of popping a pill at the first sign of even minor issues. This can come at a price to our overall health. Antibiotics make us feel better quickly, and we all want to feel better quickly when we’re sick. But antibiotics can also change our gut ecosystems, compromising our immune systems and making us less able to fight off viruses and infection next time. These things can also mask pain and dysfunction, making it difficult to pinpoint the true problem and its behavior.

Our bodies have built-in tools that, paired with help from us, are finely-tuned to help us succeed. When we interrupt those natural processes with medicated shortcuts, we undermine our bodies’ ability to be self-sufficient in healing, and to build up our natural defenses.

At Battle Born Health’s physical therapy center in Reno, our role in healing is working with the body’s natural tools to identify the true source of an injury, learn how it’s affecting the body, and to re-train muscles to perform the way they’re supposed to. In other words, taking time to do things the right way. At Battle Born, you always work directly with a certified physical therapist—no technicians here—on your self-designated goals for getting back on track with sports, work, and other activities you’ve been missing out on. 

Give us a call at775-747-2278 to find out more information about how physical therapy can help you.