What is Fibromyalgia and How Can PT Help?

treatment room EMH Physical TherapyFibromyalgia is a chronic syndrome that is composed of a group of symptoms.

The symptoms associated with fibromyalgia are varied and may include:

  • Musculoskeletal pain that is widespread
  • Fatigue
  • Sleep deprivation and sleep disorders
  • Loss of memory and cognitive difficulties
  • Mood disorders such as anxiety and depression
  • Tingling in hands or feet
  • Tension headaches
  • IBS
  • Joint pain and morning stiffness
  • Dysmenorrhea and urinary problems
  • Restless leg syndrome
  • Jaw pain
  • Nausea

The cause of fibromyalgia is still largely unknown; however it has been linked to injuries, illnesses, repetitive injuries, infection, surgery, trauma or stressful events, and possibly genetic factors.

If you suffer from fibromyalgia, there are some things you can do to help control fibromyalgia symptoms, which include:

  • Gradual and regular exercise performed in moderation
  • Relaxation techniques to reduce stress levels
  • Get adequate amounts of sleep
  • Limit caffeine intake
  • Eat healthfully

Chronic pain found in fibromyalgia may be initiated by trigger points, and after this pain is generated, the central nervous system amplifies the pain and results in hypersensitivity. This means that pain symptoms from specific causes are increased exponentially and even some sensations that should not be painful are interpreted as painful. So in order to decrease symptoms of pain, it is important to treat the causes to allow the nervous system to unwind from tension. Trigger points, tender areas in the body, and musculoskeletal imbalances are treated by physical therapists to help manage fibromyalgia pain and improve quality of life.

For further information on fibromyalgia:

National Fibromyalgia Association: http://www.fmaware.org/

American Chronic Pain Association: https://theacpa.org/

P-A-I-N is a 4 letter word, but so is T-E-A-M

IMG_4839Why a team approach of seeing MD and Physical Therapy under one roof is ideal for treating chronic pain.

If you have chronic pelvic, urologic,  sexual pain/dysfunction and can answer “Yes” to this statement:

“I’ve been to a number of medical practitioners about my pelvic condition and still don’t have a definitive treatment plan”, you’re not alone!

Just like the saying  “No man is an island”, no single practitioner can provide the breadth of treatment to help patients heal from chronic pelvic pain/dysfunction without working together in a TEAM of health care providers.

” Pelvic Help for Pelvic Pain”  is a 2 week intensive, non surgical program in NYC designed and provided by EMH Physical Therapy and Dr. Robert Echenberg MD.

The program is based on a Bio-psycho-social model of care which is evidence-based on neuroscience and pain processing disorders that are triggered by both functional and structural pain generators.

During the 2 weeks, you’ll receive a thorough education about pain and how pain can be retrained, receive a variety of treatments that includes medicines, trigger point injections, manual therapies, biofeedback and instruction in a tailored home exercise/management program.

It makes sense to address pain from all angles at the same time and this team approach with such open communication between MD, PT’s and other disciplines such as acupuncture and talk therapy is unprecedented and unmatched today. If you think you’ve tried everything else, try one more thing because it works!

Patients who attended our 2 week “Pelvic Help for Pelvic Pain”  program report a sense of well being, get pain relief, learn many self help tools and feel empowered that they can continue to heal.

The following is an interview of an international 32 year old female patient with 20 years of pelvic pain who traveled to NYC to attend our program:

Q: What was the best part of the intensive 2 week “Pelvic Help for Pelvic Pain” program?

A: The best part was the global approach to my health condition by MD and DPT. Working together,  which is rare in my country, gave me a broader view of my pain and of my power to overcome it.

The compassionate way Dr. Echenberg and the EMH PTs treated me was very supportive. As chronic pain is very stressful, the caring treatments and the kindness of these health professionals were very important and one of the best parts.

Q: How did you feel at the end of the 2 weeks?

A: I felt very well educated about my pain and about my role in my treatment. I was trained by PT to be able to continue my exercise program in South America and I felt I wasn´t alone with my pain, because they told me that they´ll continue support me even with the distance. The symptoms didn´t disappear, of course, because it´s a chronic pain but I felt better and well prepared to deal with it.

We have openings in our program!

Call (212) 288-2242 to schedule your appointment.

For more information about Dr. Echenberg go to his website, http://www.instituteforwomeninpain.com/For more information about EMH physical therapy, go to their website, http://www.emhphysicaltherapy.com.

Onward and Upward: Pilates Guillotine Tower

As many of you know, we recently moved up to the 9th floor to offer our patients larger treatment rooms and a tranquil, glass enclosed exercise space. In this blog, we’d like to introduce you to the latest and greatest addition to our gym, the newly acquired Pilates Tower, known by Pilates gurus as “The Guillotine”.  While the name “Guillotine Tower” may send shudders down the spine, evoking images of the historic reign of terror, the Pilates version is actually an easy-to-use, patient friendly, device designed to develop mobility, stability and strength of the hips, pelvis and spine. At EMH, we have taken “The Guillotine” to the next level, adapting basic exercises and stretches to treat the pelvic floor muscles.


Pilates Tower


Guillotine Tower Benefits:


  • Provides incredible feedback: which makes it a great assessment tool for stability, flexibility and articulation. Patients  can easily see when they are out of alignment or overusing a dominant side because the sliding bar will move in a jerky, uneven pattern.  When the bar glides smoothly and silently,  you know you have perfected the movement.
  • Offers  accessibility: The vertical slider allows patients with limited hamstring and lower-back flexibility (you know who you are!) to experience the full benefits of stretching and strengthening exercises.
  • Supplies versatility: Spring attachments of varying tensions can be used to create assistance or increase resistance modifying exercises for all levels in both upper and lower body exercises.
  • Targets the pelvic floor: A combination of common Pilates exercises and general pelvic floor exercises have been adapted by our expert physical therapists to address overactive or weak pelvic floor muscles that may be contributing to your specific diagnosis.


Pilates Tower Bar Lift Pilates Tower leg and core workout

Our Therapists Working with Pilates Tower Pilates Tower Leg Lifts

Pilates Tower Bar LIft One Leg Pilates Tower Bar Lift Two Legs

Pilates Tower Flying Back Bend Pilates Tower Core Workout


6 Exercises to Enhance Female Orgasm

Health conscious women of all ages know the many benefits of doing weekly exercises to keep their body strong and functioning well. Can exercises enhance or recharge a paltry orgasm? Definitely!

Let’s first review the details of “The Big O”


The Female Orgasm 


Orgasm is defined as the rhythmic contraction of the pelvic floor muscles following clitoral stimulation. These muscles quickly contract 10-15 times during orgasm.  Women can feel these contractions in both the vaginal and anal areas because the pelvic floor muscles surround these openings as they lie inside the base of the pelvis (that’s why they are called pelvic “floor” muscles).


A healthy orgasm requires the pelvic floor muscles to be both flexible & strong, not constantly tense and weak. The nerves that travel from the spine thru the pelvis to innervate the sexual organs must have an open pathway, not squeezed by scar tissue, tight muscles and/or restricted fascia. Same for the blood vessels that they have no barriers for good blood flow to the pelvic region.


Women of any age can experience more intense orgasms by stretching and strengthening the pelvic floor, core and hip muscles.  Practice-makes-perfect applies here too, so masturbating or having sex on a regular basis (once a week or once every 2 weeks, as long as there is consistency, this can further enhance your orgasmic response and experience.


Exercises to Enhance your Pleasure:

Here are some general exercises to do 2/3 times a week for 6-8 weeks before noting changes – remember it takes muscles a full 8 weeks for strength gains to show functional changes!

Consult a pelvic physical therapist for a full evaluation of your pelvic floor and core and to receive a tailored exercise program

Pelvic floor stretch: Happy Baby (see video)

Breathe deeply expanding your stomach and pelvic floor as you inhale, relax as you exhale. Do 10 breaths

Hip Openers (2 videos)

1.) Piriformis in chair – for beginners hold stretch for 30 seconds, repeat on both sides.

2.) Pigeon stretch – hold stretch while breathing for 30 seconds repeat on both sides


Bridges combined with Pelvic Floor muscle contractions (2 videos)

1.) Basic level both feet on the floor: Breathe out as you squeeze your pelvic floor and gluteals together while lifting hips off floor. Inhale as you lower to just hovering off the floor Repeat 20 reps

2.)Advanced single leg Bridges: Breathe out as you squeeze your pelvic floor and gluteals while lifting hips off the floor. Inhale as you lower to just hovering off the floor. Repeat 20 reps Both sides


Lower Abdominal Strengthening (1 video)

Do 2 sets of 20 reps

Pelvic floor Quick Flicks:

To strengthen the fast twitch pelvic muscle fibers which fires during orgasm, Contract your pelvic floor muscles fully for 1 second, then relax, Repeat 20 repetitions. Do 2x a day.


Six Ways to Help Manage Constipation

Constipation[Photo credit: PracticalCures.com]

Constipation is a common condition that affects up to 42 million Americans which is usually caused by:

  • Dysfunction with the nerves, muscles, or hormones in the body
  • Pelvic floor dysfunction leading to an outlet dysfunction
  • Delayed transit through the colon
  • Lifestyle and dietary habits

Specific factors such as medications, lack of physical activity, dehydration, lack of fiber in the diet, pregnancy, aging, travel, laxative overuse, diseases, and IBS form the majority of reasons a person develops constipation.


Constipation is currently diagnosed through a cluster of symptoms, which include hard stools that are difficult to pass, straining for 25% of defecation, a sensation of incomplete evacuation for at least 25% of bowel movements, and fewer than 3 bowel movements per week.  If your constipation results from a dysfunction of the nerves, muscles, or hormones in the body, you will need to consult your doctor and may need to seek out a physical therapist specializing in pelvic floor dysfunction; they can also assist you in making the necessary changes if your constipation results from lifestyle and dietary habits.


However, here are some simple lifestyle changes to help manage constipation:

 1.) Diet modifications

Certain types of foods can increase constipation (processed foods, cheese, white rice, red meat, bananas, dairy products).

Increasing fiber intake is important for the health of the digestive system and can help alleviate constipation. There are two types of fiber: soluble and insoluble. Soluble fiber helps to soften and bulk stool, while insoluble helps to promote movement through the colon.

  • Soluble fiber examples: fruits, vegetables, legumes, nuts, seeds, oats.
  • Insoluble fiber examples: whole grains, brown rice, oat and corn bran, some vegetables and root vegetable skins.

 2.) Anxiety and stress management

Stress is a common cause of constipation. Increased anxiety and stress triggers the sympathetic nervous system (our “fight or flight” response) and deactivates the parasympathetic nervous system (the “rest and digest” system).  This not only decreases the activity of the digestive system, slowing transit through the colon, but also decreases the body’s ability to relax the muscles of the pelvic floor to allow for defecation.

3.) Daily aerobic exercise

Moderate levels of aerobic exercise increases blood flow to the digestive system and improves function. Any form of exercise is beneficial, and can be as little as a 10-20 minute walk.

 4.) Toilet posture/positioning

Proper toilet posture can help assist in relaxation of pelvic floor muscles to allow for improved ease of bowel movement and decreased straining. Modern toilets typically create a sitting posture that does not allow the anorectal angle to straighten, which may increase difficulty with voiding.

For improved ease of bowel movement, the best toileting position is one that mimics a squatting posture. Placing the feet on a stool to increase the amount of hip flexion while sitting is a simple solution to create a better toilet posture.

 5.) Drink water, plenty of it

Dehydration is a common cause of chronic constipation. Decreased fluid intake can lead to firmer, harder stools that are more difficult to pass. Current recommendations for fluid intake vary depending on activity level, health status, and the environment. Generally, a good rule is to aim for around 2 liters of water intake per day.

 6.) Sleep!

Sleep deprivation can slow the intestinal slowdown and decrease bowel regularity. Sleep recommendations vary based on individual needs, however most resources continue to suggest aiming for 7-9 hours per night.

Sitting is Detrimental To Your Health

“In the interest of keeping our  current and prior patients healthy (and happy) I am pleased to introduce “EMH Physical Therapy Better Health & Movement Blog”

Today ‘s article is about posture. The key to a healthy spine, pain free neck and lower back is to maintain a neutral spine throughout the day, work or play.

EMH Physical Therapy offers manual therapy to release restrictions,  low level laser therapy to stimulate healing and tailored exercise programs. Yes, we still offer individual 45 minute treatment sessions by one licensed Doctor of Physical Therapist.

The-health-hazards-of-sittingWritten By: Lauren Calado, DPT, PT 

Our bodies have 650 muscles and their function is to contract, stretch, fire up… MOVE.

Did you know that more than 80% of us sit for over 10 hours a day? As technology in the work-place and at home increases, physical activity is rapidly declining.

A New York Times article reported, “Jobs requiring moderate physical activity, which accounted for 50 percent of the labor market in 1960, have plummeted to just 20 percent” (2011). Add on more time dining, watching television and more than 75% of your day could be spent sitting. This is a functional contradiction to human anatomy and physiology and has a negative impact on your health.

The health risks of prolonged sitting include low back pain, muscle weakness, impaired posture, neck/shoulder pain, nerve impingements, decreased flexibility and pelvic floor dysfunction. Other disorders that may develop as a result of long periods of sitting are decreased cardiovascular endurance, obesity, poor circulation and decreased life span. Yikes!

Tips to decrease the health risks of sitting:

• Take one flight of stairs up/down instead of taking an elevator to your floor destination
• Walk to a co-worker to talk instead of calling/texting/emailing
• Stand up during TV commercials
• Perform a few different core/strength exercises such as standing squat, push up, or an abdominal exercise 10 reps twice a day.
• Wear one of the new fit bracelets to track your walking or cardio results
• Park your car further away from the office or your house
• Enter/Leave the subway station that is one stop away versus the closest station to home/work

Research shows that your brain needs a movement break after 50 minutes of working, thinking, sitting. Get up for the last 10 minutes of each hour to take a walk, pet the dog, do a quick errand. Your brain will be refreshed and creative thinking will be enhanced.

If you are experiencing sitting related problems, consult a physical therapist. Physical therapists have 7 years of education in advanced anatomy and physiology, movement science and interventional healing therapies. The Direct Access law allows you to consult a PT first, so you don’t have to see a doctor, get a prescription and be referred to physical therapy. We can help you heal from sitting related dysfunction.


Pelvic PT highly rated in new IC Guidelines

The American Urological Association (AUA) released a new update to their 2011 Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). The original guidelines included research studies up through 2009. This new revision includes research studies through 2013. Read the amended guidelines here!

“Although the science relevant to IC/BPS is continually improving and evolving, it is still a challenging and complicated condition to diagnose and treat,” said Philip Hanno, MD, who chaired the multi-disciplinary Panel that developed and updated the Guideline. “…this Guideline is fully aligned to the latest science and provides physicians with a relevant blueprint to treating patients.”

Developed as a treatment guide and planning tool, the 2011 guidelines introduced a six step treatment plan. Newly diagnosed patients generally begin with strategies outlined in Step One and then, if those strategies do not bring symptom relief, are advised to try Step Two treatments and so forth. The treatments are classified within the steps based upon their risk of adverse events and/or if the treatment is reversible. Surgery, for example, would never be used as a first line intervention because it is irreversible and could cause very serious complications. Rather, surgery is listed as a Step Six treatment and would only be considered after the patient has tried and failed the therapies listed in Step One Through Step Five.

Two Key Changes

Comprehensive Physical Therapy Encouraged

In Step Two, Pelvic Physical Therapy was suggested for patients who present with pelvic floor tenderness with the highest review possible, Grade A. It states:

Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions), if appropriately-trained clinicians are available, should be offered to patients who present with pelvic floor tenderness. Pelvic floor strengthening exercises (e.g., Kegel exercises) should be avoided. Standard (Evidence Strength Grade A).

Botox Therapy Rating Improved!

Botox A was reclassified from Step Five to Step Four. New research emerged which showed that using BotoxA at a lower dosage, (from 200u to 100u) substantially reduced the risk of a troublesome complication, the need for self-catheterization. If a Botox treatment silences the nerves which control urination, a patient may be forced to self- catheterize until the effect wears off, often for months. One criteria for the use of Botox is the ability of a patient to self-catheterize if necessary. If a patient is unable to do so, this therapy is not recommended. The guidelines state:

Intradetrusor botulinum toxin A (BTX-A) may be administered if other treatments have not provided adequate symptom control and quality of life or if the clinician and patient agree that symptoms require this approach. Patients must be willing to accept the possibility that post-treatment intermittent self- catheterization may be necessary. Option (Evidence Strength- C)

Learn more about IC Treatments, including all treatment options in the AUA Guidelines here!

Good Posture is Key to Healthy Body

Good posture is a key factor in preventing many pelvic, hip, lower back, mid back and neck pain.  If we spend most of our day sitting in a slumped position, our knees crossed, our shoulders  rounded forward and our head  jutting in front of our body, and do nothing to counterbalance via exercise or change of pattern, overtime, muscles  become tight, joints lose their flexibility, nerves get pinched, our breathing is compromised, our abdominals become flabby, and off to the doctor we go.  These common problems related to poor posture are treatable with the appropriate lifestyle changes, daily postural exercises taught by a physical therapist and by making ergonomic changes.


Let’s tackle some basic lifestyle/ ergonomic issues.   The first step in knowing good posture is to become aware of your postures during work and home.  An easy way is to find out is to have your coworker take some random photos of you throughout the work day (no poses!) The best shots are the side and back views where you can see your spine curves. At home, have a family member take photos of you preparing meals, reading on the couch, etc.  Later you can look at the photos and marvel how upright, centered and how you maintain your natural spine curves throughout the day (probably not!)

Just by looking at your photos, you can figure out some of the changes you need to make.  Good posture is based upon keeping the natural curves of the spine during most activities.  This is called maintaining a “neutral spine” and requires flexible muscles, joints and having strong muscles.   Our body should not be placed in extreme positions for hours at a time. For example a hyperextended position, ie standing with both knees locked can cause lower back tension, conversely, a hyperflexed position , ie sitting in a slumped, rounded posture  can cause back and pelvic pain.


Sitting is what we do most of our day – to work, eat, learn, watch TV, read and  mostly sit during transportation.  Over time, poor sitting positions causes muscle tension, joint restrictions, strength deficits and pain that physiatrists diagnose and physical therapists treat every day.

Set up your computer/reading/art /work space to fit your body, to help support and maintain your natural spine curves instead of having your body adjust to the space.  The chair seat should be at a comfortable height, so that both feet (heels and toes) can touch the floor. Feet that are unsupported create tension in hips/legs/lumbar spine.  If your body is more of a petite size, so your feet do not touch the floor, use a footrest.

When sitting, the two bones at the bottom of the pelvis where your hamstrings attach, called Ischial Tuberosities  (IT’s), and the center of your pelvis inbetween the IT’s should be in contact with the chair seat.  Your lower back should rest against a lumbar cushion, either already built into your chair back, or purchased separately and strapped around the chair back. The lumbar cushion gently pushes your lower back forward to maintain its natural inward curve.  You should not slump backward to sit on your tail bone (coccyx) nor should you lean too far forward to bear weight on your pubic bone. Don’t sit on one side/hip as this creates imbalances at your sacroiliac joint, hip and lumbar spine.  (See photo 250)

With your lower back resting against the back of your chair against a lumbar cushion, this frees the thoracic spine , shoulders and neck to stack one on top of another, versus careening forward.  If you find yourself hunching forward to see the computer screen or to reach the keyboard, adjust the placement of this equipment so it is brought closer to you so you do not strain forward.

Lastly, during every hour of sitting, work/read/draw for 50 minutes, then get up for the last 10 minutes to take a brief walk, do a stretch, pet your dog, do something else.  Research shows that 50 min work/ 10 min of change recharges your brain/thinking powers. This timing is a great way to re-evaluate your posture and prevent build up of faulty postural patterns.


A  Upper body lift:  done either in sitting or standing position and has 3 distinct parts

If doing this exercise in sitting, keep your pelvis centered on the seat as described above, your lower back resting against the lumbar cushion. If doing this exercise in standing, keep both knees slightly bent.

1) Think of an invisible string gently lifting your sternum (the bone in front of your chest) upwards    You should feel your upper body move from a rounded upper back to a more elevated posture Hold this as you:

2) Roll your shoulders up towards your ears, then backward, then down.  This opens your front of your shoulders Maintain this position as you finally:

3) Gently tuck your chin towards your neck (think of creating a double chin position)

Hold all three positions together for a count of 20 seconds up to one minute.  Make sure to breathe slowly while holding the position   Repeat.  Do three times a day.

B  Thoracic twist combined with deep hip rotator stretch

While working at a computer we tend to get into a rounded upper back and forward head position. Our midspine, called the thoracic spine can become restricted as well as our hip muscles. Here is a simple stretch to open both areas\

R Spine twist:

Sit in a sturdy chair your buttocks slightly away from the chair back, feet comfortably touching the floor or on raised step stool

Cross the R ankle over the L knee

Place L hand on outside of R knee.

Place R hand on the chair seat behind you

Turn your upper body as far as possible to the right while gently pulling the R knee towards your L shoulder. Keep your neck centered over your chest, not to twist your neck too far

You should feel a stretch along your spine and in R buttock/hip region Hold for 10 up to 30 seconds while breathing slowly.

Return to center and repeat once more.  Repeat to the opposite side two times  Do twice a day


C Wall Angels

Do you remember making snow angels as a kid?  “Wall angels” are the grown up version of snow angels This exercise increases strength of  your upper back, posterior shoulder to counteract the effects of a forward head, rounded shoulders posture.

1)      Stand knees bent, your buttocks, lower back, upper back and back of your head are against a wall. Tighten your stomach to keep your core stable.  Bend your elbows comfortably by your sides with the back of your hands touching the wall.

2)      Keeping this body position, slowly slide both hands along the wall raising both arms until your hands meet overhead.    Slowly lower. Repeat 10 reps.  If it is difficult to go full range, try ½ or ¼ range.


There are more excellent postural exercises, for example keeping your abdominals, pelvic floor and lower back muscles flexible and strong is key.   Consult your local physical therapist to learn a tailored exercise home program  that is right for you.



Who Are Licensed Physical Therapists (PT)?

Physical Therapists (PT’s) are healthcare providers with a minimum of 7 years of medical education/training, passing their State Education licensing exam, to practice in the profession of physical therapy.  PT’s examine and treat a wide range of diagnoses that includes: neck/back pain; sports injuries; arthritis; burns; heart disease; post op surgery of shoulders/hips/knees; sciatica;  stroke; trauma; gait and balance difficulties; TMJ, headaches, pre/post pregnancy musculoskeletal injury; breathing problems; pelvic floor dysfunction and more.

Educational requirements for the three year (very competitive) PT education programs includes a bachelor’s degree (above 3.3GPA) from an accredited four year university with a degree in biology, psychology, kinesiology, or other fields related to human science.  Most PT programs offer a clinical doctorate in physical therapy (DPT).

What is the difference between a Licensed PT and Personal Trainer?

Personal trainers do not have the 7 years of educational requirements, scope of medical knowledge, and months of “hands on” clinical internships in hospitals, rehab centers, private practices, nor do personal trainers receive a license from the State Education Department.  Most personal trainers receive a certificate after passing a written test given by the company/organization offering such programs. One organization offered 75 hours of study and direct contact education (which is great, but very rare). Many certificate programs are self-study online courses with no direct contact training. One online program offered a self-study personal training certification for $69.95. Some fitness centers require their personal trainers to attend their in-house training programs to better their skills.  Personal trainers help healthy clients attain improved fitness and should refer any injured client to a PT for guidance and treatment.

PT’s refer their discharged patients to gyms/personal trainers once their patients are fully rehabilitated.

What is the Education of a PT?

The student PT studies human anatomy and movement sciences, which includes dissecting a human cadaver to appreciate alignment and position of nerves, muscles and bones.

Anatomical knowledge is the framework upon which PT’s understand physiological processes, evaluate pathology and trauma, and design the best intervention strategies for optimum recovery and function.

Studies also include basic medical sciences, biomechanics, neuroanatomy, pathology, mechanics of injury, and theory / practice of physical therapy.  Objective tests and measurements for multiple diagnoses are instructed and practiced. Tests are used as benchmarks to report improvement during physical therapy and to help motivate patients to continue with therapy, if needed and perform their home exercises.  Rehabilitative procedures such as manual therapies, therapeutic exercises, use of modalities, sports training, balance and coordination are taught.  Along with didactic study, the PT student receives hands-on experience through a number of 8 week clinical internships.

What Does a  Licensed PTs Do?

Physical therapists examine, evaluate and treat pain syndromes, movement dysfunctions, muscle/joint restrictions, scar tissue adhesions, strength deficits and balance and coordination issues. Therapeutic techniques such as myofascial release, trigger point therapy, joint mobilization, nerve mobilization, visceral mobilization, core stabilization, strengthening exercise, posture and body mechanics, instruction in a tailored home exercise program are utilized to return patients to optimum function.  PT’s are trained to restore, maintain and promote overall health, wellness and fitness.  Many fitness centers utilize equipment/training techniques, for example, physioball classes, therabands;  body blade and agility skills that were originally designed by physical therapists. PT work in hospitals, rehab centers, schools, in patient homes, have outpatient private practices.  They also work with all levels of high school, collegiate and professional sports teams and are the “go to” rehab specialists of the Olympics.

What Can I Expect During a PT Evaluation?                                                                                                                                                              

The PT will take a detailed history and then examine the patient’s symptoms or diagnosis For example, if a patient has neck pain, the PT may ask the patient to rate the pain on scale of 0 to 10; when does the pain occur and where is the pain is located; does pain travels towards the head or down the arm; what movements/positions makes neck pain worse/ better; is sleep is affected; what postures do the patient assume at work/home?

Following a history, the PT observes and measures the patient’s ability to actively move their cervical/shoulder and scapula joints followed by the PT passively moving these joints (with patient resting comfortably) to see if the same pain or restrictions are reproduced.

Palpation is next – the PT gently lifts the skin/connective tissue to note pain and mobility followed by palpation of muscles of the neck, shoulder/scapula to assess for restrictions, adhesions, trigger points. Neural mobilization techniques are performed to test if a nerve is compressed and/or symptomatic. Strength testing is done to note whether weakness of stabilizing muscles are causing overwork of neck muscles.  The overall movement patterns of the neck/shoulder and scapula are observed for imbalances, poor muscle firing and faulty patterning.

Depending on time scheduled for an Evaluation, the patient with neck pain may be instructed to modify their office desk arrangement, be taught a gentle neck stretching exercise and a general posture awareness technique.  The patient leave the PT practice with a good understanding of their condition, what kinds of therapy will be provided and feel hopeful that their neck pain will abolish with physical therapy.

Does the PT communicate with my Doctor?                                                                                                                                                        

Following an Evaluation, the PT sends a detailed report to the referring MD.  As treatment continues, physical therapists document progress, conduct periodic examinations, identify areas requiring more or less attention, and modify treatments.  Documentation is required by Medicare and health insurance companies. As part of the profession, PT’s are required to justify the reason for each physical therapy treatment session. Documentation is used to track the patient’s progress and helps motivate the patient as they see the changes.

Do I Need a Doctor’s Referral for PT?                                                                                                                                                                      

Under New York State Law, and in many other states, patients may directly seek and receive evaluation and treatment from a licensed PT without a physician’s referral for up to 10 visits or 30 days, whichever occurs first.  If permitted by their insurance company, patients can be evaluated and treated without having to first obtain a referral.

PT’s are well trained to refer to a MD if improvements are not being made in a timely manner or if any red flags are raised regarding a patient’s medical condition.. We are on the doctor’s team.

 What are “Red Flags” when physical therapy cannot help me?

1)  Fevers chills or night sweats –  this may be a systemic disorder such as an infection

2)  Recent unexplained weight changes – weight gain could be due to congestive heart failure, hypothyroidism or cancer; weight loss could be due to a GI disorder, hyperthyroidism, cancer or diabetes,

3)  Malaise – may be a systemic disorder

4)  Quadrilateral paresthesias (nerve symptom in both arms/legs) – CNS involvement

5) Shortness of breath – can indicate a myriad of conditions ranging from anxiety and asthma to serious cardiac or pulmonary dysfunction.

Can I find a Good Quality PT in an “In-Network” vs “Out of Network” practice?                                                                                       

The term “Good Quality PT” can be hard to define, as many PT’s with their seven years of education, may have to treat 4 to 5 patients/ hour due to the set up of the organization they are employed.

Most PT practices that accept “in-network” insurances receive very low reimbursement payment per patient (sometimes as low as $25.00 a visit).  In order to keep in business, these PT practices have a large open gym-like settings, no private rooms, where a licensed PT oversees a number of patients simultaneously being treated by either aides(non trained) or by trained personnel (Physical Therapy Assistants, Certified Athletic Trainers).  This fast paced environment combined with minimal direct patient contact by licensed PT’s does not result in consistent effective outcomes in patient care.  Many patients and PT’s are very frustrated with this practice model.

The PT practice setting that has licensed PT’s directly treating one patient at a time, for eg, every 30 or 40 minutes, is a much better choice. These practices are typically “out of network” that may accept “out of network” insurance payments, accept private pay fees and may be certified Medicare providers (accepting the Medicare fee payments).

Sometimes paying extra for this value added service can result in an overall lower cost with better outcome of care vs spending time and money in a busy “in-network” practice where multiple patients are co treated with potentially poor outcomes, resulting in more MD visits, more procedures, new medications and frustration.

How do I find a PT practice?                                                                                                                                                                                              

Go to the American Physical Therapy Association  (APTA) website, www.apta.org and look up your region for a list of members.  The organization also has a subsection, SOWH Section of Women’s Health to find providers who specialize in pelvic floor physical therapy for men, women and children.

You will need to do some sleuthing, by calling the individual practices and asking some questions:

  • How much individual time does your licensed PT directly spend with each patient at each treatment session?
  • Does your licensed PT co treat other patients during my treatment session and if so, how many are co treated simultaneously?
  • Will I receive treatment by a “PT aide” ( person with no formal PT education, usually trained on site by employer) or PT Assistant (person with education & licensed as a PT Assistant)  during my session?

Go online. Many PT practices have websites that outline the services they offer, their hours and location, and what to expect during your therapy session. These websites often have links to copies of the required paperwork to be completed prior to your visit so you can have them ready on the day of your evaluation.  Contact the practices you are interested in to ask the above questions as practice models may change without being updated on their websites

Who Needs a PT?                                                                                                                                                                                                                    

PT’s are becoming the first line of defense when an sports/orthopedic/work injury, sprain, strain, fall and pain occurs. Everyone should have a “good PT practice” on their mobile device, or speed dial on their home phone for immediate consultation and treatment.  In NYC, contact EMH Physical Therapy (212) 288-2242.   If needed, a PT will refer to a MD for further consultation.


What is your greatest success story?

As a licensed PT for over 25 years, I have thousands of success stories.

From the thirteen year old soccer star who dislocated her knee cap and thought she could not be a top player again; after 10 sessions of physical therapy, she was back in full playing mode with her teammates.

The postnatal woman with a 3 month old child who couldn’t lift her baby and couldn’t sit comfortably to feed her baby because of excruciating back pain, sacroiliac  joint malalignment and sciatica; after 2 months of physical therapy she is fully painfree and fully able to care for her baby (plus take care of husband, older child, work colleagues, you know how that goes!).

The male college student with history of sexual abuse experiencing constant “knife-like” pain in his pelvic floor region, could not sit for long periods for his classes, did not engage in sport due to pain and experienced constipation even after taking fiber rich foods and laxatives; after 4 months of PT, his symptoms have decreased markedly. He still needs to do his daily stretches and pelvic floor exercises, is able to sit and study without pain, is not constipated and is considering playing a sport.

The world traveling, bridge playing NYC senior who had a bad fall resulting in a hip fracture and is now fearful of walking down a city street thinking she will lose her balance and fall again.  She withdrew from social events and stayed home, getting more depressed.  After 3 months of physical therapy, she regained her strength and balance, resumed weekly bridge games and traveled to Paris.

Anyone, at any age who has experienced relief, return to pain free function, improved their strength and endurance, and returned to an active social life is a PT’s greatest success story.


What is Osteoarthritis / Why does it occur?

Osteoarthritis (OA) is the most common form of arthritis and affects nearly 20 million people in the United States.   Pain associated with OA stems from degeneration within joints, the site where two bones meet.  Cushioned surfaces, called cartilage, cover and protect the ends of bones, allowing for friction free motion within a joint.   With OA, the cartilage becomes thin and frayed, has decreased ability for friction-free movement, resulting in significant pain and joint dysfunction.

Osteoarthritis is considered a “chronic” disease meaning that it is long lasting & recurrent.  Although OA can affect any joint, the joints most commonly affected are those that bear the most weight, such as the knees & hips, followed by the spine.

At this time, there are limited effective treatments to reduce pain from OA.

Treatment Options


Injections such as Synvisc, Euflexxa, & Supartz are different synthetic forms of a substance known as hyaluronic acid which is naturally found in the joints of the body. The injections work to help re-lubricate the joint after it has lost some of its natural lubrication due to OA.  Injections are not able to “cure” osteoarthritis; however, pain relief from injections can last anywhere from days to months.


A doctor may prescribe an anti-inflammatory medication to reduce OA pain. Currently, there are no medications available to reverse the effects of OA; however, there is much research exploring the potential for such medication.

Physical Therapy:


Physical therapists spend 7 years of didactic and clinical medical education before obtaining their DPT (Doctor of Physical Therapy) degree.  They have the expertise to design and teach an individually tailored strengthening and proprioception training program to re-educate the muscles surrounding the osteoarthritic joint without stressing the joint.  Patients report a reduction in pain, decreased joint pressure and improved ability to move well within 8 weeks of starting their exercise program.


Current research supports manual techniques performed by physical therapists to reduce OA pain and improve function.  Manual therapy includes Joint and Soft Tissue Mobilization.  Joint mobilization helps to lubricate the joint, reduce friction between the two bones and increase joint range of motion. During joint mobilization the patient relaxes the muscles surrounding the joint while the physical therapist passively moves the joint in its full available ranges, providing a stretch to the joint capsule.

Soft tissue Mobilization reduces the tension /restrictions in soft tissues such as muscles, tendons, & ligaments.  When soft tissues become chronically tight, they have the potential to disrupt the normal movement of a joint. If the hamstring/gluteus muscles are restricted, they can alter hip position and low back posture.  Over time, the abnormal movement patterns of the hip and lumbar spine leads to  hip/low back pain.  During soft tissue mobilization, the patient is instructed to re lax their muscles as much as possible, while the therapist performs a variety of techniques  including: deep tissue massage, trigger point release, positional and  myofascial release to allow the muscle to reset & functional optimally.

Physical Therapy is an important part of regaining joint health and function and should be a part of every patient diagnosed with OA.