Category: Back to Life

Our awesome team of guiding physical therapists and volunteers are all smiles at our dance injury screening!

March 23rd marked SPEAR’s collaboration with Columbia Dance Medicine on a complimentary dance injury prevention screening for the NYC community! The second of its kind, our team of physical therapists volunteered to help the dancers evaluate their strength, flexibility, endurance, and balance. Many of the advising physical therapists on site were dancers themselves, pulling from their own personal range of dance backgrounds in ballet, Horton, musical theatre, salsa, and Irish step to guide participants through a series of assessment exercises. The team also recommended effective warm-up and conditioning practices, while asking questions to better understand not only dancers’ individual habits, physicalities, and experiences, but also the unique demands of their styles and training regimens.

Ninia Agustin, PT, DPT & Clinical Director of our Plaza Hotel clinic

“Dancers are an extreme outside of the normal patient population,” says Clinical Director Ninia Augustin. Oftentimes they come in with entirely different needs and skill sets from the average patient, such as hypermobility and pointework. Their goals when pushing their bodies to new extremes, or their desires not to miss out on training opportunities, can often be unnecessarily pitted against their doctors’ and therapists’ interests in helping them take the time to recover from injuries. “Sometimes I’ll put my hat on, and I’ll say, as a dancer yes, as a PT maybe not, but maybe [we can] figure out a way to mesh the two worlds together; I think that’s what’s lacking in the healthcare industry.”  

When beginning to train at such a young age, dancers may also develop a higher pain tolerance and have trouble distinguishing soreness that comes with building strength, from potentially concerning signs like sharp pain that may indicate something is wrong. “They’re so hyper-aware of every minutiae in their body, and they…don’t necessarily have the verbiage to explain how they’re feeling,”says Dr. Julia Iafrate of Columbia Sports Medicine. This can make it all the more difficult to address potential issues before they become major injuries requiring extensive rehabilitation, or to even know what questions are most useful to consider.

A common question that arose during the screening, for example, is the minimum age at which young dancers should begin dancing en pointe (or on their toes). But as Dr. Iafrate points out, the answer often depends on many factors, including arch strength and ankle stability, that are more difficult to assess and do not consistently correlate with age categories. And while for many years, most forms of dance have incorporated static stretching into students’ warm-ups to improve flexibility, it is now common knowledge among most PTs and sports medicine doctors that static stretching, if not preceded by proper warm-up, can actually lead to more injuries.

Gwen Giffard, PT, DPT, leads a dancer through an airplane test

Upon reflecting on what she learned from the screening, SPEAR physical therapist Gwen Giffard laughed and remarked, “I learned it’s really hard to do an airplane test.”  As our PTs rose to try the exercises they had just guided the dancers through moments before, one element became clear: finding opportunities to improve communication between dancers and PTs will undoubtedly improve a dancer’s overall health, and thus the longevity of their abilities to continue on with their passion.

Our injury prevention screenings aim not only to help participants become more familiar with their own bodies, but to educate dancers, parents, and teachers. With the knowledge they acquire, they may better articulate and analyze their biomechanical inefficiencies, and thus make the most of their physical therapy sessions. SPEAR’s budding dance medicine team hopes to encourage dancers to invest in more long-term relationships with their physical therapists so that we can work together not just for recovery, but for improved prevention of major injuries as well.

Dr. Jaclyn H. Bonder, Assistant Professor of the Department of Rehabilitation Medicine and the Medical Director of Women’s Health Rehabilitation at Weill Cornell Medical College – New York Presbyterian Hospital, has written a fantastic piece on the subject of Pelvic Girdle Pain, or PGP, a very true reality for many pregnant women:

Pelvic Girdle Pain (PGP) in Pregnancy

by Dr. Jaclyn H. Bonder

What is Pelvic Girdle Pain (PGP) in Pregnancy?

The pelvic girdle is the ring formed by the bones of your pelvis. The ring has three joints (a connection between two bones), the two sacroiliac joints in the buttock area and the pubic symphysis joint in the front of the body. These joints are connected by ligaments that can loosen during pregnancy as a result of the hormonal changes that occur. When the ligaments are looser, they cannot hold the joints together as well and are more unstable. In addition, there is increased strain on the joints because of the growing baby and changes that occur in a women’s body to accommodate the enlarging uterus.  For instance, the loosening of the ligaments allows for the necessary expansion of the pelvic girdle which allows enough room for the baby to pass through the birth canal during delivery.
Pelvic girdle pain (PGP) is pain from the sacroiliac joints and/or the pubic symphysis joint that occurs because of the instability in and strain on these joints. It occurs in about 1 in 5 women and is more common in women with a history of previous back problems or an injury in the area. Pain in the sacroiliac joint is usually the cause of “sciatica” during pregnancy.

What are the symptoms of PGP in pregnancy?

Symptoms of PGP include pain in the buttocks and pubic bone that can radiate into the thigh, hips, or groin areas. Unlike true sciatica, PGP will not radiate past the knee. It is often increased with movement, especially when you move from one position to another such as turning in bed and going from sitting to standing.  Women will also describe pain with activities such as with walking prolonged distances, climbing stairs, and standing on one leg to put on pants.  Women may also experience clicking and grinding with any of these movements.  Often, women will also have muscle aches in the buttocks in the inner thigh area because of strain and overuse of the muscles that need to do overtime to compensate for the loosened ligaments.

How is PGP diagnosed?

PGP can be diagnosed by a practitioner who is trained to assess musculoskeletal conditions in pregnant women. Practitioners can base your diagnosis on the symptoms you are having combined with doing a physical examination.  You do not need to have imaging or laboratory tests done to make a diagnosis of PGP. However, if some cases if pain is severe enough and symptoms are not improving with traditional treatments (see below), your doctor may order an MRI. MRIs do not have any radiation and are safe in pregnant women past the first trimester.

What are the treatments for PGP?

Treatment of PGP is usually quite helpful and most women will feel relief when incorporating these therapies. The most common and effective treatment is physical therapy with a therapist trained in pregnancy-related musculoskeletal conditions. At these sessions a physical therapist will often provide:

• Education on ways in which you can and should move to avoid strain on the region. They will often go through everyday activities with you to help you determine which ones may be aggravating your symptoms and show you how you can do them differently to avoid pain.
• Exercises to strengthen and stabilize your core muscles.  Your core muscles include the abdominal, back and pelvic floor muscles. These exercises will improve your spine, pelvic girdle and pelvic floor strength so that you have more support for the joints and ligaments that are being strained. It is safe to do certain core exercises but some can put a lot of strain on a women’s back or abdomen, which is why it is important learn how to do them correctly with a trained professional.  These will not hurt the baby but may hurt the mother, if done incorrectly!
• Manual therapy (hands-on treatment) to muscles and joints. This treatment can release muscles that may be tight from overworking to stabilize joints and contributing to the pain.  In addition, mobilizing joints in the pelvic girdle can shift bones into better position or help them move more normally.

Other treatment options include:

• Support belts – there are many types of belts out there.  You should work with your doctor or physical therapist to fine the one that is right for your particular issue. PGP usually gets better when you use a sacroiliac joint belt around the pelvic ring, rather than a supportive band for the belly.
• Warm baths – you should talk to your obstetrician and make sure you have no restrictions in taking a warm bath.  These can be helpful to relieve muscle spasm and ease pain.
• Heating pads – should only be applied for short periods of time (15 minutes or less) and should never be placed over the abdomen directly.
• Ice packs – can be used a few times per day for symptomatic relief.  Ice is the world’s most natural anti-inflammatory!  If you use it over your pubic joint, you may even feel the baby kicking.
• Ambulatory assistive devices – this includes walkers, crutches, and canes. Using these may be temporary until your pain decreases with some of the other modalities, but can also be quite useful when walking longer distances is necessary. A stroller is kind of like using a walker so you may find your pain is better when using one.
• Acetaminophen – an effective over-the-counter pain reliever is considered safe during pregnancy and usually recommended by most obstetricians.  You should always talk to your doctor though first before taking any medications.

What type of delivery is indicated for PGP?

A vaginal birth is considered safe and is the recommended mode of delivery in most women with PGP.  There is no evidence that a Caesarian section is necessary and in some studies, there has been evidence that it slows recovery and prolongs healing of PGP.

Will PGP go away after delivery?

In most cases, PGP will diminish after delivery and resolve within a few weeks of the baby being born. If symptoms persist, women should be referred to a physician (often a physiatrist) who can help decide if an additional workup and/or treatment is needed. Typically, physicians will recommend x-rays and non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, if pain persists after delivery. NSAIDs will help decrease inflammation in the area as well as control pain. ∎

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Thank you to Dr. Bonder for sharing her insight and knowledge!

Did you know SPEAR has a dedicated pelvic floor physical therapy program? Learn about SPEAR’s pelvicore classes,  view our expert specialists, or request an appointment today. You can also contac the pelvic floor team at pelvicfloor@spearcenter.com.

2019 marks 20 years of SPEAR, The Nation’s Top Physical Therapy Practice, and we are only continuing to expand: we are excited to announce our first-time venture into Queens, with the opening of a new clinic at Long Island City!

Modern and expansive fitness area

SPEAR has partnered with CityView Racquet Club, a premier luxury facility featuring incredible amenities and outstanding panoramic views of the city. Patients can expect to receive the same caliber of care and high quality experience we always aim to provide.

LIC’s New Clinical Director, John Mackarey, PT, DPT

John Mackarey, PT, DPT steps into the head role as Clinical Director of the clinic. A seasoned SPEAR team member, John was previously practicing out of our West 57^th Street location and has extensive experience with several specialties, including cupping, kinesiotaping, return to play testing, and personal training and transitional care, among many others.

Our newly designed space is equipped with various treatment tables, plyoballs, workout equipment, and everything else you need to get back to your active life. Patients will have access to the locker room space, complete with showers and a sauna. Saunter up to the café or the juice bar area for a quick refreshment. Access to the various racquet and tennis courts and massage services are also available at an additional fee.

SPEAR and the entire team at Long Island City – CityView are elated to be able to branch out and reach more New Yorkers with convenience and ease. We are right off the 7 train and can treat a plethora of concerns—just take a look at our full list of services available! We’ll work together to get you on the best path to achieve your goals.

Schedule an appointment at this brand new, gorgeous facility by calling 646-973-5439 or requesting an appointment here.

One of several tennis and squash courts on site

Sauna room with great views of Manhattan

Cozy bar/lounge area with stunning panoramic views

Before tearing her ACL on a ski trip in Lake Placid, Caitlyn was an active 28 year old in New York City. Pilates, skiing, running and kettlebell workouts were common parts of her everyday life. After her diagnosis, Caitlin reached out to us at SPEAR to begin treatment to strengthen her body; coming to SPEAR allowed Caitlin to feel better prepared for her approaching ACL surgery, scheduled for late April.

At the beginning of May, Caitlyn returned to SPEAR to continue physical therapy sessions. She recalls her most memorable moment as the day she was able to complete a full pedal stroke on the stationary bike. Just a few weeks later, she was cleared to walk without her brace!

By the summer of 2018, Caitlyn had resumed her active lifestyle and even traveled to Utah to tackle a big hiking trip. When asked to describe her experience, Caitlin stated: “My body feels fully recovered—it’s like night and day. I can do high-level Pilates, hike, and I am back to doing my normal workouts. All in all it was a slow process, but the progress was so rewarding and each day felt like an improvement.” Though an ACL injury can prove to be cumbersome, Caitlin is a prime example of what perseverance looks like. She’s turned her injury into a positive, and now has a better appreciation for apartment building elevators and ice packs! Caitlyn has just returned to the slopes again this winter and she’s excited to scale more mountains, both figuratively and literally, in her future.

Thank you, Caitlyn, for allowing the SPEAR team to be a part of your incredible journey getting Back to Life. We are so happy to see you doing what you love. We know that Life Can’t Wait—you’ve got to go out and tackle those obstacles!

Marie sums up why physical therapy matters.

Meet our patient, Marie Cajou. At 86 years old, Marie suffered a stroke that left her with visual impairments in her left eye and reduced spatial awareness along her entire left side. She came to us because she had been spending a lot of time in her wheelchair and developed lower back pain as well as right shoulder pain. She spent two months in physical therapy, treated by Marc Jacobchick, PT, DPT, and came to each visit with a new, brightly colored hat.

According to Marie, her favorite part of the day is when she gets to go to SPEAR and dance to some salsa or merengue music. We’re so grateful to be part of Marie’s healing process because we know that any age, #lifecantwait!