 Welcome to Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. Movement Matters is designed to bring you not only the most effective physical therapy tips, but also holistic information to help you achieve total body wellness. In these pandemic times, medicine is becoming more virtual in order to safely bring the care you need right to you in your own home. Today, I have a special show where you'll get the top tips from your virtual physical therapist who is here to answer all your questions remotely on how to solve the ailments you've been suffering as a result of the recent changes in your daily routine. More people are working from home at less than desirable workstations. They're doing home remodeling, sorting, organizing, childcare, taking more walks or running outside since the gyms were all closed. We're doing gardening more time than we used to spend when we had to go to the office. And your body is moving more and moving differently during these activities. So let's think about it. Do your feet hurt more lately? Are you walking barefoot in your home more than you're accustomed to when wearing shoes at work? What about neck pain? Do you have neck or shoulder pain or maybe some tingling down your arm? Maybe you've injured your back while hunching, making masks or while gardening. How about your jaw? Are you clenching from the stress that these uncertain times have brought upon us all? Or your knees? Do they hurt from all the outside walking you're doing or all the squatting while you're attending to your kids, your home, your garden? In this show, I, your virtual physical therapist will provide simple tips and corrective exercises to you in your own home and pose solutions to the many injuries and ailments you're suffering as a result of the pandemic. So first, let's talk about back pain and back injury. I was inspired to do this show resulting from my patients coming in with severe pain from making masks. So one of them came in last week, a gentleman, and he said he was working for three hours making masks and he's sewing them all using a pattern. And so hunching over and he said all of a sudden he noticed he had pain running down the front of his thigh and then later his back started to hurt. So the next day, he has terrible back pain. He hasn't slept a wink at night because he's had pain all the way down the front of his thigh to his knee. And he was wondering why. So he comes in to see me four weeks later, three weeks later and the back pain is gone. But now he has this eight or nine out of 10 pain in the outside of his knee that wakes him up at night and is severe and he didn't hurt his knee. So I did my assessment and I asked him to stand on one leg. So now all day long, he's fine. And then at night, he has this terrible knife in his knee and he just can't sleep. He can't sleep but so painful. So I went through my exam. I had him stand on one leg in balance and on that leg, he was very wobbly but I had him to do a single leg squat on that one leg and he fell to the ground very softly but he fell to the ground and you could see that his leg was atrophied. So what happened with him is he was hunching. He's in his sixties, he's already retired. So he's already doing his normal activity. Nothing's changed in activity level because he's always at home. He's not going to the office but now he's sitting, making mass in a less than optimal position for the spine which cause strain on his joints, strain on the nerves, leading him to have some compression and pain down his leg and even weakness. So interestingly enough, I worked on his knee a little bit just to palliate the pain and taught him some core stabilization which we'll learn in a minute, gave him some stretches. He came back, he felt okay but he still didn't sleep at night. So I helped him decompress his nerve and I showed him how to lay on his side to open up the spaces around the joints where the nerve was, the hole was made a little smaller and irritated and he came back two days ago and he has no more pain at night since last Thursday. So some of the stretches that I gave to him that are pretty much safe for everyone to do because you're lying down and your back is anti-gravity is video number one. So first we're gonna lay down to keep our back safe and in the neutral position. We're gonna clasp our hands behind our knee so that the arms are relaxed and you're gonna gently kick your knee straight. It's a great way to stretch your hamstrings without straining your back and you can even pull your toes up at the end if you want a little bit of extra stretch. Then we're gonna take our knee and hug it tightly into our chest and breathe. Three to five breath cycles is great where you can count to 20 seconds and now we're gonna take and do the knee to opposite chest so you line your knee up with your opposite chest or your shoulder, take your outer hand, grab the shin and just gently hug it. You'll feel a nice stretch in here and also it's really good to take both knees, hug them into your chest and breathe. It helps to release the tension in the lower back while you're keeping it safe and anti-gravity. Enjoy having a healthy low back. Okay, those are great. So that's a safe way to just do some gentle stretching to your hamstrings, your glutes and decompress your low back if you've had an injury from doing gardening, bending over, leaning over your kids doing some homeschooling. So the second case was a woman. Again, she was retired and she was making masks. She was making 400 masks and she lives with her family and she lives down a large flight of stairs in a small area. So she was picking up her sewing machine from her kitchen table, which she said was small to the floor back and forth so that when she had to eat, she would have a clear space. So she was bending forward to pick up the sewing machine and then moving it up two to three times a day so she can continue to make these 400 masks for all of us in the community to keep us all safe. And she had pain going into both of her buttocks down the back of her leg into the outside of both of her shins. She went to the doctor, I think it was virtual actually and then she came to see me and I taught her how to stabilize her spine. She actually had scoliosis, which we found. So we did some anti-curve strategies and I taught her how to stabilize her spine, which we'll see in a minute by using your deepest abdominal muscle, the transverse abdominis, which when you activate your TA as I call it, it activates your deepest low back muscles and gives you this anatomical girdle right around your spine. And why I was having her do that is she was having terrible pain and weakness with one of her legs now when she walked up and down the stairs to her daughter's area so she could enjoy time with her family. And she felt like one of those legs was weak and she was trying to carry what she had to carry, go up and down the stairs holding onto the rail and having the leg weakness. So I asked her to do something that I learned from Mary Massery in her class a few years ago and on the shows she had, which is to use voicing or humming. I asked her, she sang and she said, no. So I said, let's hum up the stairs, try to pull your belly button in but I want you to focus on safety. So why don't you hum going up and down the stairs while you're activating your deep core. So let's look at video number two where I'll instruct you how to engage your deepest abdominal muscle correctly. And of course, for your low back pain, you wanna learn how to engage your transverse abdominis in neutral spine. So you wanna find a place where you can lay and not pin your back flat right here. You wanna keep the small space right here I think you could see and then you pull your belly button in from here. You pull it in, pull it in. You don't flex down like this or flatten your back or tuck your buttocks under from below. You just simply need to pull your belly button in. Let me see if you can see it. Pull it in right here. Belly button in, belly button in. Move it closer to your spine but with no back movement. And then your back's gonna feel better. And also you need to pull your belly button in before you move. So I'm gonna get up. I'm gonna pull my belly button in, engage my deep core, my anatomical girdle, roll to my side and then get up. So those two videos, the series of stretches that we showed in the first one and then activating your anatomical girdle before you move while you're moving, while you're breathing are gonna help you to get your back out of pain right now at home if you don't have the opportunity to go in to see anyone at this time. There's another point I wanted to talk about and that's the term sciatica. A lot of people say I have sciatica and sciatica is a generalized term for someone that has pain running pretty much from their buttock down their leg. But sciatica doesn't tell you what the cause of that pain is. Sciatica just tells you, oh, I have pain down my leg, my nerve is getting compressed somewhere and it hurts. So most of the time sciatica is occurring from compression in your back and compression in your back can happen from something as simple as walking with one foot turned out instead of straight like the other one that can happen if you have a sore foot, if you've had a bunion, an ankle sprain, hip arthritis or a knee injury. So it's important if you notice you have sciatica or pain down your leg, look down first to make sure both your feet are pointing symmetrically forward. Why that happens if your foot is towed out is when your foot is towed out, it doesn't set off the proper chain reaction of the kinetic chain, which is our lower body chain that happens when your foot hits the ground and it pronates some arch rolls in, your brain gets signals to turn on your glute muscles and all these muscles to stabilize your leg while you're walking. If your foot is out, your glutes don't fire as much and they don't stabilize your pelvis on your leg. I kind of glanced over at the spine there for a second because I could see it in the picture. So it's important to keep your foot straight because if you're walking with your foot turned out, it could cause your trunk to lean, which makes your spine shift like that. So you can be irritating a nerve again and again and again every step you take while you go on your outdoor walks, while you're trying to be more active and do something good for your body, while you're in the yard on uneven surfaces gardening. So turn your foot straight, that's one tip. The other thing is do those stretches where you hug your knee to your chest, hug your knee to your opposite shoulder, hug both knees up to your chest so that you can stretch out the glute muscle which often gets tight when the nerve is aggravated. The other thing that's important with sciatica is activating your anatomical muscle. So make sure you pull your belly button in if you're gardening, pull your belly button in and then bend forward to grab the shovel. Pull your belly button in and then bend to lift the plant. If you're gonna be on your hands and knees weeding, it's not an optimal position, but pull your belly button in and stabilize your side. So we're getting a question. Thank you so much for ascending it. Can you use a yoga strap to stretch your hamstrings? Is that better? Can't someone just take pain meds instead of doing these stretches? That's a great question. So question number one, can you use a yoga strap to stretch your hamstrings? Yes, you can use a yoga strap to stretch your hamstrings. A lot of people like to do that. Better or not, I like to say no because when you hold on to your yoga strap you're flexing your trunk to pull and when you gently clasp your hands behind your knee, I know you can't see what I'm doing. When you clasp your hands behind your knee with your arms straight, your back can be fully relaxed on the table and then you just kick your leg up. So not better but work still to stretch your hamstrings. I think you should try the one where you clasp it behind your hands, behind your knee first, with your whole body relaxed back on the table, your elbows locked and see if that works just as well or if you like it more and do the stretch that you like more. Do the stretch that helps you the most. Okay, can't someone just take pen meds instead of doing these extra stretches? Well, you can take pain medication, but pain medication is like putting, I hate to say it, it's like putting a bandaid on the problem so it doesn't bleed. So when you're cut yourself, you put a bandaid to stop the bleeding, but it doesn't mean you've healed. When you take pain pills, it stops the pain from happening so you can still function. So you can still get out of bed in the morning without severe pain so you can still get some sleep which is needed for the rest of our body, our organs, but it doesn't solve the problem which is that you're having compression in your spine because of how you're either repetitively moving or from an injury that you did because you didn't engage your anatomical girdle or your anatomical girdle wasn't working as well because of a previous injury. I hope that answered your question. So let's get on to posture. Let's look at video number three. Pull up your posture, save your neck and your shoulder and your low back while you're working from home, on your sofa, on your futon, at your kitchen chair in a different place than you're used to. You wanna use a vertical roll when you sit down. Use your lumbar roll as well, scoot your rear end all the way back towards the chair and place this in the upper part of your back to open up your thoracic spine. So now you're sitting here instead of sitting here, it helps to roll your shoulder blades around the roll. You can use a small pillow too, but then you can work on your laptop, you can do whatever you're doing and not be risking your neck and your shoulder. Okay, great. So that's one of my favorite things to do because when I was off for one month sitting at home, I was editing my book, which sadly I still haven't completed yet. So I'm still sitting on that futon, I've got my vertical pillow, I've got one across my low back and I'm happy there. My back is happy, my neck is happy. I had a back injury in the past helping a patient and so I don't have any symptoms when I support myself like that and I also feel very supported. I feel very wrapped into the futon but my spine is in good positions. So now to also help your posture, now we know how to position yourself at home on your sofa on your futon in your hard kitchen chair while your kids are doing homework, you're doing some work, you're paying the bills. But let's look at a few exercises, some of my favorites that you can do to help get you into better posture if you are hunched forward because you didn't know to be upright, you didn't know that you were having these problems and maybe now you're starting to have some neck pain. So let's look at video number four. The secret to a healthy shoulder is a well placed and healthy shoulder blade. So get to squeezing those blades. Excellent, so those are some of my favorites. When I work on patients in the office, if I'm not doing manual therapy on them, helping them stretch, correcting their joint biomechanics then I'm reaching to grab equipment to bring for them or help them with. So everything that I do is forward. So that is one thing that if you've seen the show before you've heard me say is undo the sport and it's okay to be bending forward. I engage my anatomical girdle of course and I bend at my hips, not my back when I can. But it's important to undo the sport. So everything I do is in front of me. My chest gets tight, my neck gets tight. So I do those as a regular diet of stretching between patients sometimes, I may lunch break or after work to open up my chest and that just undoes all of the forward use of my muscles that I've done throughout the day and fires up all my posture muscles so that I no longer have tension in my neck that can lead me to an injury in my neck or in my shoulder. And why I mentioned shoulder in the previous video is because you need to have proper posture to have a happy shoulder. I'm gonna get up and show you this one. So I'm just gonna stand right here. So if you're leaning forward like this, this shoulder has moved forward of the center point of your body as has your neck. Your ear has moved forward of the center point of your body. When you are upright and you squeeze your shoulder blades back, your shoulder is in the center point of your ear. So you have optimal spinal curve alignment. Now look at the spine in the background. That spine has been through the ringer but you wanna have proper shoulder alignment and proper neck alignment. So if you bend forward or even if you are stuck forward doing those exercises help you to bring your shoulder back and bring your neck back to get rid of your shoulder pain, to get rid of your neck pain. And also I saw someone recently who had very bad pain and tingling down their arm. And the first thing I noticed when we were having a conversation at their house is that their head was very forward of their shoulder like this. And so I pointed it out right away because when your head is forward of your shoulder these canals where the nerves pass out of your spine become more narrow and you can get pinched. And now let's say your home which they were and you're tending to your kids and you're cleaning up the house and you're trying to do projects and you're sitting on the sofa and they're relaxing these get compressed. So one of the first thing I did was get that shoulder blade squeeze. A happy shoulder means shoulder blades are in the right position and a happy neck means you have good posture. And we began doing these exercises, the exercises that I showed you in the video. So let's look at video number five right now. Here's what you do to stretch out your neck after sitting at your desk but looking down at your phone all day. You clasp your hands behind your head turn and face the beautiful view press your elbows back and squeeze. Fantastic, try them. Try them now if you're sitting watching this if you're not driving that is listening to me. Try clasping your hands at the base of your skull and lifting up and then lift one elbow up to the sky. Don't bend over, lift the elbow up keeping your neck nice and alignment. You can tuck your chin down if you want more of a stretch come back in the middle, lift the other elbow up and breathe and really elongate your spine. You may even feel that stretch between your shoulder blades and then you can push your elbows back and squeeze those shoulder blades. Undo the sport, undo tending to your kids, leaning forward, making a meal, doing all that sorting and organizing in your garage. It's excellent. Okay, like let's move on to the jaw. I had a patient ask me because I was asking for questions last week because I knew I was gonna be doing this show. What question would you wanna know that maybe you wouldn't think is important to ask your physical therapist? And she said, oh yeah, like what can I do for my jaw? And we're all stressed right now whether we feel it or not. And maybe we're feeling a little better about the situation because we're now living it. And we know that at some point this will all be over sooner, hopefully then later. But I showed her these exercises in video number six. If you are having tension or pain in your TMJ, which is your temporal mandibular joint, you wanna massage these muscles here and you can do it while you open and close your mouth, go down in circles, down and open, up and open, and really loosen up those jaw muscles. A favorite exercise of mine to restore the alignment in the temporal mandibular joint is to place your tongue up in the roof of your mouth and keep it touching the roof of your mouth while you open and close your mouth like this. You can do 50, 100 of those while you're driving in the car to restore the natural mechanics of your temporal mandibular joint and free yourself from pain, enjoy. Those are great exercises. I have been on the phone with family members before there was video chats to describe that exercise when somebody was having jaw pain and I remember my dad happening a couple of times and I said, dad, just put your tongue up in the roof of your mouth and keep it there while you open up your jaw. And why that works so well? If you have jaw pain when you bite into something, why that works so well is because the temporal mandibular joint, the ball spins before it slides forward. And so when you open your mouth and one of them slides forward, that's when you have the pain when you're taking a bite of something. When you put your tongue in the mouth and you open and close 50, 100 times, whatever multiple repetitions you are restoring the normal joint mechanic of that spin so it doesn't slide forward fast. Okay, we have another question. Will you be manufacturing and selling a pillow we can use instead of a towel to put between the shoulder blades? That's a very excellent question. So yes, I will be manufacturing a pillow that you can take anywhere that you wanna be on a plane in your car, fit it to your desk chair, put it on your chair at home, your hardback chair at home. I can't even begin to tell you when that's gonna happen, but yes, it's in the work. So that's a fantastic question. Thanks for asking it. Okay, so let's talk a little bit about the lower extremity, your foot, your knee. I haven't really had anybody with hip injury since the pandemic started, but I have had many with knee ankle and foot injury. And I wanted to talk about the foot first because the one thing I was most worried about when we were getting shut down at end of March was that people weren't gonna be doing what they normally did, which is go to work, come home, cook dinner for their families, eat with their families. They were gonna be at home, walking with their families, exercising with their families, and it's something that they never did that much. So I had a little foresight on potential foot and ankle injuries like runner's injuries, Achilles tendonitis, plantar fasciitis, knee pain, those sort of things from people now getting a little more active because they're not stuck in their office eight hours a day or commuting to and from work additionally. So one of the things I wanted to call your attention is the importance of flexible ankles and flexible calves. Caves are kind of one of those things that I've always stretched, but I also had foot pain when I was younger. So that's probably why. So I just assumed that everybody thought about stretching their calves after they walked, after they ran, after doing grocery shopping, after doing gardening, but people were not doing that and people were getting Achilles tendonitis, plantar fasciitis, and let's check out video number seven that shows you how to stretch your calves. Okay, to stretch your calves, it's really important to put one foot directly in front of the other, pointing straight and not turned out. So you'll go one foot in front of the other and then you bend the front knee, keeping the back knee straight. You wanna make sure that you don't fan your foot out. You wanna look down to make sure it's in a straight line. That stretches the one big calf muscle that crosses your knee joint. Then you wanna make sure that you bend the back knee to stretch the other big calf muscle that doesn't cross your knee joint. You shouldn't feel any pain during this stretch, just a pulling back here on the first stretch and a little bit lower. Enjoy your walk. So tight calves and lack of ankle range of motion as a result of that can cause things like plantar fasciitis and Achilles tendonitis because when your calf is too short, as you take a step forward, your foot has to pronate, which means in layman's terms, like the arch rolls inward or your arch collapse. And that puts an extreme amount of stress on the plantar fascia, which is the tissue on the arch of your foot as well as kind of twisting at your Achilles tendon. So if you're taking a hour walk now and you have tight calves and you're over pronating, but you don't know it, you may be experiencing some pain on the bottom of your foot that they call plantar fasciitis or some Achilles tendonitis or some knee pain because it goes up the kinetic chain to your knee. If your foot rolls in, the shin bone rolls in and you get a twisting at your knee. So one thing that is ace for rolling out your arches is rolling your foot over a tennis ball, a lacrosse ball. I use a golf ball, but that can be painful if you're very inflamed. So let's look at video eight. Please try it. I was at work the other day teaching someone how to do that over a lacrosse ball or like one of those exercise balls. There's so many now. It was a hard ball about the size of that ball that I showed in the video. And my back felt better. I had felt some tension in my back. It was the end of a long day. And I was demonstrating how to do it. And all of a sudden my back felt better. And so when we're a cell and then we're starting to unfold into this human things work close together. A lot of reflexology does with that and how your foot is related to this organ and that sort of thing. So rolling out your arches can actually relieve tension in your back. So please try it. You can stand and do it. I usually sit and roll my arch over the ball, golf ball. I've had plant officials before. So when I'm rolling the golf ball out I'm trying to smooth out all the abnormal tissue that's formed when I had an aggravation. And here's the other thing. If you're walking around barefoot in your home more because you're not wearing shoes in the office get house slippers that have arch support. So let's look at the last image, which is image nine. So you can see what that looks like. You can see how there's an arch support on the inside of that shoe. Those are ortho heels but Vionics are great. I see a lot of them around here on the island and they really support your arch. So invest in a pair of house slippers. So I hope that was helpful for everyone. I love the questions. Thank you so much for sending them in. And thank you so much for thank Tecawai for allowing us to bring this to you today. We'll see you in two weeks. Aloha everyone. And remember, life is better when you listen to your physical therapist.