Connect Physical Therapy: It's time to Own Your Body
  • Home
  • About
    • Michelle Dela Rosa, PT, DPT, PRPC
    • Karen A. Bruno, PT, DPT, PCES
    • Bryn Zolty, PT, DPT, PRPC, BCB-PMD, PCES
    • Katelyn (Kate) R. Sheehan, PT, DPT, ATC
    • Jennifer Watt, PT, DPT
    • Shraddha Wagh PT, DPT
    • Rosalind Cox-Larrieux, PT, MPT, PRPC
    • Giselle Oriendo, PT, CLT
    • Becca Ironside, PT, MSPT
    • Marzena Bard, PTA, CYT, PCES
    • Donna Zamost, PTA, PCES
  • Services
  • New Patients
  • Existing patients
    • Patient Cheat Sheet
    • Pelvic Floor Relaxation
    • Core Strengthening
    • Hip Strengthening
    • Pelvic Correctives
  • Videos
    • Female pelvic pain
    • Male pelvic health
    • Meditation
    • Back pain
    • Pregnancy & postpartum
    • Yoga
  • Ask us
  • Blog
  • Location

BLOG

Read about insights and research updates in
​orthopedic and pelvic physical therapy.

Can you spread your toes?

10/3/2022

 
​By Donna Zamost, PTA
Massage foot
As the weather turns cooler, it’s time to put away the flip flops and break out the fall boots. However, before you put on your favorite pair of fall shoes, ask yourself this important question; can you spread your toes in your shoes? If not, you may be wearing shoes that are too narrow. 

​Often, buying shoes labeled as “wide” will not solve the problem. 
Even wide shoes tend to be too narrow in the toe box. Shoes need to be wide across the balls of the feet for a proper fit, but they also need to be wide across the toes. Shoes that have a narrow toe box will squish the toes together.​​ Take your shoes off and notice that your toes are the same width as your metatarsal bones. (Or should be!) Therefore, doesn’t it make sense the toe box should also be as wide as the ball of your foot?
​The natural spread of your toes is known as toe splay.

​It is an important part of how a foot functions. Toe splay is necessary for ankle stability and arch support, as well as activation of the intrinsic foot muscles (muscles within the feet). ​Allowing the toes to maintain their natural spread promotes a good base of support. This not only helps with balance, but it helps to reduce stress at the front of the foot when pushing off during walking and running. In shoes with a tapered or narrow toe box, the big toe angles in and all the toes are squished together, reducing the base of support. Over time, this can cause painful issues, such as bunions, hammer toes and ingrown toenails.​​​
Toe tracing
Shoe tracing
Dance toes
It is not surprising that narrow or pointy toe boxes are common in high heels and dress shoes; but, ironically, they are also found in sneakers and running shoes. During exercise and other physical activities, we need our feet to be functional and comfortable. Wearing shoes that force our toes into an uncomfortable position does not allow our feet to properly do their job. As a professional dancer, I was often required to dance in uncomfortable shoes. Broadway dancers frequently wear character shoes when performing. These shoes have a 3-inch heel and a round narrow toe box. While these shoes may help to elongate a dancer’s legs, they are tough on the feet!
After years of dancing in this type of shoe, when I would take my shoes off, my toes would stay squished together. Over time, this unnatural position of my toes led to bunions and arthritis. I even required surgery in one of my big toes to restore a normal range of motion and allow me to walk without pain. Understandably, I am now very careful with my choice of shoes.
Tight shoes
Toe spread
Squished toes
If your toes feel a bit squished together, there are things you can do to help restore your natural toe splay: While sitting, cross your ankle onto your opposite thigh and interlace your fingers between your toes to help spread them out. You can use your fingers to help stretch the toes and then when comfortable, use your fingers to move your toes up and down and in circles.
Another great tool that is becoming popular is something called toe spacers. These are made of soft silicone and help to spread the toes apart, allowing them to go back into their proper alignment. Toe spacers are available on the internet. I have a pair from a company called Correct Toes and I often wear them around my house while bare foot. I’ll even wear them in my athletic shoes during my power walks. I can definitely feel the difference in my body when my toes and feet are in the correct alignment. 

​So, if you are guilty of wearing shoes that have reduced your proper toe splay, switch your shoes to a pair with a wider toe box and try the above suggestions. Or come see us at Connect PT. We’ll have you back on your toes in no time!​​

Making peace with your nervous system

9/26/2022

 
​by Karen Bruno, PT
Sometimes we're looking for something easy and quick to help us regain balance during our busy day. Here is a quick vagus nerve-regulating exercise that can be done daily. It will help to:
  • Lower stress, heart rate and blood pressure
  • Decrease anxiety
  • Calm your nervous system
  • Support sleep issues
  • Reduce body pain.
  • It can be useful for fainting, POTS, seizures, and epilepsy. 
This exercise provides general access to the vagus nerve where it comes around the ear. Please refer to the pictures.
Instructions
  1. Tuck your middle fingers into the little hollow behind your earlobes.
  2. No pressure is used; just make gentle, light contact. 
  3. Bring your palms together so  they come together in front of your throat.
  4. This connects into the vagus nerve in a variety of different ways. 
Hand position
Hand position
Peacemaker
Peacemaker
Crossover peacemaker
Crossover peacemaker
Half peacemaker
Half peacemaker
Crossover half peacemaker
Crossover half peacemaker
You can add some other techniques, such as humming, singing,  toning, rocking or ujjayi breathing/dragon breath while you hold this position (see video).
For more information on the vagus nerve, please refer to these Connect PT blog articles:
  • Get out of fight or flight with the vagus nerve
  • Balancing the nervous system during times of big change

How to help your abdominal muscles immediately after delivery

5/12/2022

 
by Bryn Zolty, PT

As a pelvic physical therapist there are many things I would have liked to have done differently immediately after giving birth to my daughter. If I had to pick one exercise to have started immediately after delivery, it would be this one. 
Picture
During pregnancy, your abdominal wall lengthens. The muscles have been working because even though they were stretched, the baby kept them on tension. Remember feeling like your abdominal wall was so tight? How could it stretch any more?! Picture a long string from the bottom of your sternum to your pelvis over your pregnant belly. Now the baby is delivered and suddenly the tension on the long rope is gone. The abdominal muscles are now hanging down, feeling loose, almost like they aren’t even yours. So many women are told to start working on their abdominal muscles lying flat. But, when you lie flat, picture the string again as your muscles. It is loose, and we cannot contract our muscles in their full length. We need to flip over, so the muscles can be all the way long. We also need to get the ribs moving. Rib motion will help the abdominal muscles, the diaphragm, and other core muscles working sooner!

You can try it in a few positions - pick the one most comfortable for you. Remember that you should be facing down, since we want the belly to be able to fall down:
  1. Stand at the kitchen counter with your elbows resting on the counter. Position your back in a comfortable position.
  2. Sit in a chair with wide legs and rest your elbows in front on a high table.
  3. Flip onto hands and knees, a mini version of cat/cow.  

Start with your belly relaxed, hanging down, no tension in the muscles. Inhale and feel your ribs expand wide, but gently. Then start your exhale with a gentle “shhhh” sound, like you are calming your baby to sleep. The “shhhhh” sound should start to create some tightening in your abdominal muscles. The loudness of the “shhh” may affect the amount of tightening you feel. 

​Once you feel the abdominal muscles tightening, gently help them draw in. Can you feel the tension start lower, above the pubic bone, and then the middle and upper abdomen tightens? As you start to reach the end of your exhale, can you feel the ribs tightening in as well?
​

Now inhale. Feel the ribs move wide and back, opening like an umbrella. Now, we use the muscles in reverse by slowly lowering the abdominal muscles back down. Slow down. We need to use our muscles to control this without dropping them. They are still strengthening even though they are getting longer.  

Repeat these steps. This is a gentle exercise, so you can do it throughout the day. Be mindful of how you feel to judge how much you should do this. I would recommend at least 3 times a day for 10 reps minimum. This can be done if you had a vaginal delivery or a c-section. It is just breathing and gentle tension as you are just following your breath. Pick the position that best suits how you feel.

Postpartum rib flare

6/17/2021

 
by Bryn Zolty, PT

Rib Flare

Rib flare refers to an altered ribcage position. This means the rib cage is tipped up/forward, flattened and wide, or both. Rib flare has many potential causes.  For this article, we will focus on the postpartum individuals.

Ribs Tipped Up Flare
First, let's look at the rib cage position from the side to identify the ribs tipped up flare. Ideally, the rib cage would line up over the pelvis and the curve in your lower back is greatest in your lower back. You can feel the top of your hips and walk your hands around to your back, this is where your lower back curve should be located. See the arrow from her hips to her lower back.

The first picture (left) demonstrates fairly neutral (good) posture. Notice the horizontal arrow from the top of the hip bone to the low back showing the curve. Also, note the vertical line running through the middle of the shoulder, trunk, and hip. The line is fairly centered in these locations. The ribs below her bra line are tucked in the abdomen.
​
The second picture demonstrates the tipped up rib flare.  Notice the curve in the spine compared to the first. The curve in the back is higher. It continues throughout the middle back and her shoulder blades sit further back. The ribs are tipped upwards and stick out further than her abdomen. Also, note the vertical line running through the shoulders, trunk, and hip. The trunk is more forward and not centered as in the first picture.
Trunk
This rib tipped up position, the second picture, in a postpartum population is common. Later in pregnancy as the baby grows, the ribs tip up to make room.  Women may lean back to maintain balance as their weight has increased forward.  Next, women carry around a growing baby and continue to lean back.   After standing in this position for months, your body begins to recognize this posture as straight. 
​

Postpartum, the front abdominal muscles are stretched and weakened. The muscles in the lower back have been in a shortened position and can become painful and overworked as their counter parts in the front need time to regain strength.  However, to do that, we need to restore posture. It is difficult to strengthen abs that are lengthened if the ribs stay tipped up! When this position is maintained for a long period of time, the back muscles can become tight and even maintain the tipped ribs when laying down. 
Picture
Note in the picture the space between the floor and the back. The left rib cage here is sticking up. This individual will require some release work and stretching in addition to posture modifications. 

Infrasternal Rib Flare
​

Another type of rib flare is seen in a front view. This is the infrasternal angle, the angle formed by the ribs coming together under the breastbone. A normal angle is 90 degrees. Place your thumbs together in this space and see if they form a 90 degree angle. When this angle is greater than 90 degrees, there is a rib flare. 
Picture
Picture
Commonly with a rib flare, the internal oblique muscles tend to be dominant, creating muscle imbalance. The internal oblique muscles flare the ribs wide. 

Here is the same individual lying flat looking at the front view to check for infrasternal rib flare.  Now you can see the left rib is more pronounced and wider than the right. This angle is greater than 90, and is asymmetrical.
​

In the picture below, she was asked to start to curl up her shoulders off the ground. Note the ribs pulling wide and as her internal oblique muscles contract strongly demonstrating her muscle imbalance.
Picture
Rib flare does not get better on its own and needs individualized care to improve posture and muscle recruitment. So many functions in the body rely on the diaphragm and rib position.   Dysfunction can alter digestion, create back pain, increase your sympathetic nervous system, and decrease pelvic floor muscle flexibility. Muscle imbalance can create compensatory patterns and resulting pain and/or weakness. Many women tell us they want their core back and their stomach to look pre-baby. Rib flare can prevent abdominal muscles from contracting well and even push(pooch) out the lower abdomen if muscle imbalances exist. 

The key to treating rib flare is improving alignment and muscle balance. And not just muscle imbalance in your back and abdomen, but also shoulders, legs, feet, and pelvis. How you stand, sit, carry your kids, and exercise at the gym can all be part of improving rib flare.

At Connect PT we are happy to help evaluate and treat your posture, muscle coordination, and improve your strength!

Reduce pelvic, hip, or low back pain during intercourse

2/23/2021

 
Penetrative sex positions for people with pelvic, hip, or low back pain
Many people with low back, pelvic floor or hip disorders experience pain with penetrative sex. Becca Ironside, PT, goes over how they can position themselves in four different sexual positions to decrease pain and improve satisfaction with their partners.

​Watch the video on YouTube.

Planks for prolapse

9/30/2020

 
By Bryn Zolty, PT

​Planks are one of the most well-known core exercises. Doing a plank incorporates many muscles to make us strong and support our joints. 
Typically an individual starting off with planks would try a modified plank and build up to a full plank. A modified plank means less difficulty when you are starting out so you can maintain a nice neutral spine, avoid holding your breath, and build strength. Two common modifications would be starting on your knees or placing your elbows on a higher surface than your feet as seen below in the Common Progression. After this position becomes easier, you can hold longer or perform more repetitions. Next you could try a full plank. Planks can continue to be progressed to have your feet above your elbows, your elbows on exercise balls, use exercise bands and more.  
​
Now let's add prolapse to the situation. Pelvic organ prolapse can feel like heaviness in the vagina and even progress to the organs (bladder, uterus, vagina, rectum) coming out of the body. These symptoms increase with gravity. The more upright you are, the more symptoms you may have. So with a prolapse, we may consider reversing the progression. We may start with your body inverted - check out the picture with the feet on a chair and elbows on the ground in step 1 of the Prolapse Progression. We also encourage you to monitor your breathing. Holding your breath can increase symptoms. Consider what happens when you breathe in and fill your system with air, and then hold your breath and strain in a position. This can push these organs down. In addition, you could consider adding a kegel, or pelvic floor squeeze, to help support the organs. Your progression might look like the reverse of the Common Progression! As you gain better control of the pelvic muscles and breathing, you may be able to progress to being more upright with less symptoms. Good Luck! Contact us if you need help modifying your exercises, breathing, or help with pelvic muscle strengthening so you can exercise with confidence.
Planks for prolapse

Case Study: Hip and abdominal Pain

10/30/2011

 
  • Patient: 54-year-old female
  • Chief Complaint: 4/10 right-sided abdominal pain that radiates to the right hip, for many years
  • Past Medical History: Uterine fibroid removal X 2, ectopic pregnancy and removal of fallopian tubes, surgical removal of abdominal adhesions
  • Pelvic Ultrasound: Negative
  
  • Treatment: Scar mobilization; trunk and hip stretches; manual therapy (including visceral mobilization) to abdomen, middle and lower back; moist heat and ultrasound treatment to abdomen; postural education and exercise; and home exercise program
  • Results: 0 radiating pain to R hip after 5 physical therapy visits, and 0 abdominal pain after 12 visits
Hip and abdominal pain, case study
    Pelvic blog

    Categories

    All
    Case Study
    Coccydynia
    Constipation
    Diabetes
    Did You Know
    Equipment
    Events
    Hip And Abdominal Pain
    Incontinence
    Interstitial Cystitis
    Interviews
    Low Back Pain
    Meditation
    Men's Health
    Neck And Shoulder Pain
    Pelvic Pain
    Pregnancy
    Prolapse
    Prostate
    Pubic Pain
    Q&A
    Research
    Resources
    Smoking
    Urinary Frequency
    Vagus
    Visceral Manipulation
    Vitamin D
    Vulvodynia
    What's New
    Yoga

    Archives

    January 2023
    December 2022
    October 2022
    September 2022
    August 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    January 2022
    December 2021
    November 2021
    October 2021
    September 2021
    August 2021
    July 2021
    June 2021
    May 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    March 2020
    February 2020
    January 2020
    December 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    February 2017
    December 2016
    October 2016
    September 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    January 2016
    December 2015
    November 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    March 2015
    January 2015
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    November 2013
    August 2013
    June 2013
    December 2012
    November 2012
    October 2012
    September 2012
    August 2012
    February 2012
    December 2011
    November 2011
    October 2011
    September 2011
    August 2011
    July 2011

©2009-2022 Connect Physical Therapy and Connect Physical Therapy East | It's Time to Own Your Body
facebook.com/connectphysicaltherapy | admin@connectpt.org
Whitehorse Professional Building | 1675 Whitehorse-Mercerville Rd, Ste 101 | Hamilton, NJ 08619 | P: 609-584-4770 | F: 609-584-4880
Candlewood Commons Office Park | 201 Candlewood Commons | Howell, NJ 07731 | P: 732-994-7755 | F: 732-994-7757
  • Home
  • About
    • Michelle Dela Rosa, PT, DPT, PRPC
    • Karen A. Bruno, PT, DPT, PCES
    • Bryn Zolty, PT, DPT, PRPC, BCB-PMD, PCES
    • Katelyn (Kate) R. Sheehan, PT, DPT, ATC
    • Jennifer Watt, PT, DPT
    • Shraddha Wagh PT, DPT
    • Rosalind Cox-Larrieux, PT, MPT, PRPC
    • Giselle Oriendo, PT, CLT
    • Becca Ironside, PT, MSPT
    • Marzena Bard, PTA, CYT, PCES
    • Donna Zamost, PTA, PCES
  • Services
  • New Patients
  • Existing patients
    • Patient Cheat Sheet
    • Pelvic Floor Relaxation
    • Core Strengthening
    • Hip Strengthening
    • Pelvic Correctives
  • Videos
    • Female pelvic pain
    • Male pelvic health
    • Meditation
    • Back pain
    • Pregnancy & postpartum
    • Yoga
  • Ask us
  • Blog
  • Location