Messy Play is Okay!

Messy Play is Okay!

By Jessica Holyoke, OTR/L

Kids Place Pediatric Occupational Therapist

In early development, a child begins to piece together information about their world using their seven senses: vision, hearing, smell, taste, touch, proprioception (position sense), and vestibular (movement sense). Children use their sensory experiences to make sense of their environment.  As a child grows, the information they gain from their environment through their sensory systems shape their development. Cognitive skills are developed through curiosity and exploration.  Physical skills are developed through a desire to move to objects or areas of interest.  Finally, social skills are developed through interaction with objects and people in their environment.  So, how can you facilitate this growth through sensory experience? The answer is simple - MESSY PLAY!!!

Messy play is an excellent way for your child to use all of their sensory systems.  It encourages curiosity, exploration, and creativity.  Because there is no wrong way to messy play, the child gains confidence as they are successful in their activities.  Messy play can be used to learn letters and numbers, to interact with peers, and to develop fine motor skills. Here are some messy ideas to get you started:

Spaghetti

Image courtesy of The Imagination Tree

• Cook some spaghetti noodles, strain and place in a large bowl (or on a high chair tray or play table). You can add food coloring if you choose. You can hide small toys in the noodles for your child to find or use the noodles to form shapes, letters or numbers.

Corn starch and water

• Mix corn starch and water in a large container (flatter surfaces work better, i.e. casserole dish). This should appear to be a fairly solid mixture.  Pick up a handful and watch it melt in your hands! 

Puffy paint

Image courtesy of Learning4Kids.net

• Mix equal parts Elmer’s glue and shaving cream. Add your desired color (food coloring or paint work well).  Paint onto paper of your choice with your fingers (or paint brush if you must) and let it dry into a puffy masterpiece. 

Gak

• Gak is a gooey, slimy, glob of fun.  Making it with your child can teach sequencing skills, following a recipe, measuring, and attention.  The finished product can be stored in a plastic bag to play with again and again. 
• For a simple Gak recipe, click here!

Play-dough

• Similar to Gak, following any recipe is a great way to teach kids valuable skills such as counting, sequencing, following directions, attention and social skills. 
• For a simple, uncooked Play-dough recipe, click here

Finger Paint/Shaving cream

• Great way to get messy while practicing writing letters, or just drawing using a pointer finger. 

Rice/Beans

• A dry alternative to other messy play options, but still a great way to gain the desired sensory experiences.  Fill a small bucket or large bowl with rice or beans (uncooked).  You can hide small toys inside for a treasure hunt.  Make two or more bowls to make it a race or work together to find all the treasures.

I would like to hear from you.  What other forms of messy play have you experienced with your child?  Did your child and you enjoy any of these ideas?  Please leave me a comment in the section below.

Keeping Your Child Safe in their Car Seat

Keeping Your Child Safe in their Car Seat

By Josh MacDonald, OTR/L

Kids Place Clinic Director

Pediatric Occupational Therapist

At Kids Place, our therapists see a lot of children coming into the clinic in their infant carriers.  Unfortunately, too many of them are fastened into the car seat incorrectly.  While every car seat is different, there are a few standard rules about how to fasten them into infant carriers and forward facing seats.

First, the plastic retainer clip (the plastic clip across the chest) should be slid up to the level of the armpits.  This may seem high and appear to put pressure between the straps and the child's neck.  But, if the clip is not high enough, it will not hold the belt in place, and the child will slide between the straps and out of the seat in an accident.

Second, the seat belt should be tight enough that you cannot pinch any excess at their shoulder.  This is relatively snug.  When applied taught against the body, the seat belt assists in riding out the deceleration slowly.  If the strap is too loose, then the child will 'collide' with the seat belt in an accident, resulting in further injury.

Lastly, no additional pieces of aftermarket items should be added to the car seat.  These pieces are often not fire retardant, and could catch fire quickly.  Any padding on the seat belt strap to protect the neck will only create space between the child and the strap.  Remember, this needs to be a tight fit.  Space is bad.  Items hanging from the handle or on the seat of the vehicle will come loose in the accident and potentially strike the child.  These items are marketed well to convince us of their necessity or cuteness, but they are not crash tested and will be dangerous in an accident.

These are only a few of the rules and guidelines about car seats.  Your local fire department is able to assist you installing your car seat, and will teach you how to properly use the car seat.  This may seem like a hassle, but 90% of car seats are installed incorrectly and will not protect a child during an accident.  Make your child's safety a priority.

Celebrating Family Health and Fitness Day

Celebrating Family Health and Fitness Day

with advice from Josh McDonald, OTR/L, MS
and Mark Salandra, CSCS

Americans young and old have been gaining weight and slowing down. A report on physical activity and health from the U.S. Surgeon General’s office in the late 1990s found that “nearly half of young people aged 12-21 are not vigorously active on a regular basis” and that more than 60% of adults aren’t as active as they should be.

(A more recent study in 2010 didn’t show any improvement, finding that only 15% of high school students achieve the recommendations set by the CDC for physical activity.)

These findings led to the creation of Family Health and Fitness Day on September 28, a celebration marking its 17th year in 2013 that celebrates activity for the whole family.

Why is this something Americans should commemorate? “Staying healthy as a family provides motivation to all members, and it increases support for the members of the family that are not as motivated for physical activity,” says Mark Salandra, CSCS, the founder of StrengthCondition.com (one of Physiquality’s partner programs). He adds that daily physical activity should be as routine as brushing your teeth or any other healthy activity you do for your body every day.

Activity expert Josh McDonald reminds parents that every action is a lesson for children. “If we want our children to value healthy and active lifestyles, then we need to model those choices for them,” says Josh, an occupational therapist at Kid’s Place, a clinic for children run by Arizona Orthopedic Physical Therapy (a Physiquality network member with two locations in Arizona).

He encourages parents to make good choices for the entire family. By turning off the television and taking them out to play catch, by enrolling them in sports and camps, or by gathering everyone for a bike ride, parents are showing their children the value of health and wellness. As a parent, he notes, “When I initiate healthy decisions for myself, and I include my kids in those decisions, I establish lifelong patterns that they will carry with them into adulthood.”

The easiest way to be active with the family is to take a walk. The CDC recommends walking at least 10,000 steps a day, Mark notes. Why not strive for that goal with a daily walk after dinner? It’s a way to burn off some of the calories in your meal while continuing discussions started around the dinner table.

There are lots of ways to make healthy choices with your family, but Josh reminds parents that the responsibility for such healthy choices starts with them. “These decisions aren’t always easy,” he notes, “but the benefits are immense for both the parents and the children.”

IT Band Syndrome

IT Band Syndrome 

By: Brooke Smith, DPT

Do you have knee pain or hip pain that occurs with walking or increased activity?  It could be caused by a tight Iliotibial (IT) Band.  The IT band is a thick band of fibrous tissue that begins at your hip and runs down the outer part of the leg, crossing the knee, and attaching to the top portion of your shin bone (tibia, figure 1).

http://www.aidyourhamstring.com/
_img/iliotibial-band-syndrome.jpg

The IT band and the associated musculature act to stabilize and coordinate muscle function of the knee with running and walking.  It is a common overuse issue that occurs in “4.3-7.5% of long distance runners”.3   However, IT band syndrome can also occur in military recruits, cyclists, tennis players, adolescents undergoing rapid growth, weightlifting, people who perform a lot of squats, short distance or sprint-distance runners, rowing, and cross training.   IT band syndrome has been reported to occur equally in men and women and most frequently occurs between the ages of 15-50 years old.

Some common mechanisms of injury, creating pain, could be decreased strength, decreased flexibility, abnormal hip alignment (pelvic tilt), “bowlegs”, improper alignment or mechanics of the feet with walking/running, improper posture/mechanics with running or exercises, running on angled or uneven ground, leg length discrepancy, poor footwear, sudden increase in activity, returning from injury too soon, overuse, or over-training.   

Someone who has IT band syndrome will usually experience pain on the outside of the knee.  However, some people can present with pain over the hip joint (greater trochanter), or pain starting at the knee traveling up to the hip. Sometimes the pain can be described as stinging or needle-like pricks that can occur every time your heel strikes the ground with activities.  Pain will usually increase with activities such as running or cycling, especially when running hills, and with walking up/down stairs.  This is due to inflammation of the IT band causing it to snap over the hip bones (greater trochanter), leading to pain.  Other common symptoms may include repetitive popping sounds in the knee when performing activities, as well as tenderness with pressure over the outside of the leg just above the knee. Some tenderness might also be present at the hip joint (greater trochanter).  

However, there could be multiple reasons for pain at your hip or knee and these include: hamstring strains, MCL and LCL injuries, meniscus injuries, myofascial pain, osteoarthritis, overuse injuries, patellofemoral syndrome, and trochanteric bursitis.  Therefore, it is critical to have a professional MD or physical therapist assess your individual problems to determine if it is truly IT band syndrome.

Physical therapists will help diagnose IT band syndrome by taking into account the patient’s history of the present condition, performing special tests specific to IT band syndrome, alternative tests to rule out any other pathology, and assess strength and joint motion/mobility.  Some common treatments provided by physical therapists include strengthening of weak musculature, stretching of tight muscles that are contributing to the pain, manual therapy, soft tissue mobilization, assisting in custom orthotics, modalities such as ultrasound, TENS, and ice, and providing home exercise program to maintain results.   All treatments are specific to each individual patient and their specific biomechanical faults are taken into consideration to fix the cause of IT band syndrome.

If you think you might have IT band syndrome here are some simple tips, exercises, and stretches you can try: rest, ice, appropriate use of ibuprofen/NSAIDs, IT band stretching, and use of a foam roller to release the IT band, use proper footwear, stretch prior to and after running, get adequate rest between workouts, and gradually increase your training or exercises.  If you continue to experience pain, you should seek the advice of a licensed physical therapist to assist in diagnosis and treatment.  If you have any questions, concerns, or would like to schedule an appointment contact AZOPT at (623)-242-6908.

References:

http://www.medicinenet.com/iliotibial_band_syndrome/article.htm

http://sportsmedicine.about.com/od/kneepainandinjuries/a/IT_Band_Pain.htm

http://emedicine.medscape.com/article/307850-overview

http://www.emedicinehealth.com/iliotibial_band_syndrome/article_em.htm

http://www.runnersworld.com/injury-prevention-recovery/treating-and-preventing-iliotibial-band-syndrome?page=1

http://orthopedics.about.com/cs/sportsmedicine/a/itbs.htm

http://www.webmd.com/pain-management/knee-pain/tc/iliotibial-band-syndrome-topic-overview

Who Wants Their Children to Sleep Better at Night?

Who Wants Their Children to Sleep Better at Night?

By Kelsie Noel, DPT

Kids Place Pediatric Physical Therapist

Try spending a night at the pool!

While at Lebanon Valley College in Annville, PA, I participated in a research project that studied the effects of aquatic exercise on sleep patterns in children with autism.  We hypothesized that children who actively participated in aquatic exercise would fall asleep faster, sleep for a longer duration, and wake up less frequently throughout the night.  The results of our study were remarkable!  In fact, the benefits of aquatic exercise can apply not only to children with autism, but all children!

In our research, it was found that when kids spend just an hour swimming, on average they fell asleep 17 minutes faster and slept an hour and a half longer. In a separate study, it was also found that when an individual exercises within four hours of bedtime, there is an increase in total time slept and decrease in wake time after sleep onset [1].  Other researchers conducted a study comparing high school athletes to a control group of students who were not physically active and found that athletes had higher scores for sleep quality, smaller number of awakenings, and quicker sleep onset [2].

Most kids enjoy any water-based activity rather than land, but the aquatic environment offers many additional benefits:

• Aquatic exercise is low impact - decreased risk of muscle soreness, stress fractures, and other injuries.

• Water provides resistance to movement in all directions - more muscles are being strengthened within each workout.  Additionally, the resistance is adjustable depending upon the speed of movement. 

• Hydrostatic pressure helps the heart circulate blood throughout the body - decreasing blood pressure and heart rate.  One can exercise longer in the water without an increase in effort.

• For children with autism, aquatic exercise provides constant somatosensory input - supplies even pressure to the entire body [3].

There are many aquatic activities for your kids to increase their heart rate, such as: walking, jumping jacks, high knees, butt kicks, arm circuits including bicep curls and arm circles, leg circuits including wall kicks and marching in place, kick board relays, and games like “Keep away.”  Your child does not have to be able to swim to perform most of these!  In the study, the average increase in heart rate was found to be 64 percent of the maximum heart rate, which is equivalent to a moderate-intensity workout. Remember the goal is to increase your child’s heart rate, thus tiring them out so they will sleep better at night!

Carryover effects were not found for consecutive nights.  If your child swam on Monday night and slept better that night, it does not mean your child will also sleep better on Tuesday night without going back to the pool.  While most parents do not have an hour in their schedule every night of the week to swim, improving a child’s sleep at least 2 night of the week could result in an improved sleep schedule and bedtime routine - beneficial to enhancing sleep.

Future research is looking into the benefits as a whole for children receiving more sleep at night, beyond having an easier time in the morning waking up your child.  Some suggested benefits include improved behavior during the day and increased attention span during school hours.

If you do not have a pool at home or in your community, you can try signing your child up for swim lessons, giving you some more time to complete your to-do list!  Some suggested locations for swim lessons include:

http://www.aquatots-phoenix.com/swim-schools/northwest-phoenix/#swimclasses

http://valleyymca.org/branchClasses.cfm?place=15&core=04

https://www.lifetimefitness.com/en/clubs/palm-valley-az/your-lt.html

[1] Youngstedt, S.D. (2005).  Effects of exercise on sleep. Clinics in Sports Medicine, 24, 355-365.

[2] Brand, S., Gerber, M., Beck, J., Hatzinger, M., Pühse, U., & Holsboer-Trachsler, E. (2010).  High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: A comparison of athletes and controls. Journal of Adolescent Health, 46(2), 133-141.

[3] Centers for Disease Control and Prevention. (2012, March 03). Autism Spectrum Disorders (ASDs).  Retrieved from http://www.cdc.gov/ncbddd/autism/index.html

Jump-Start Your Baby’s Language Learning with Baby Sign Language

Jump-Start Your Baby’s Language Learning with Baby Sign Language

By Lanni Reisinger, SLP-CFY

Kids Place Pediatric Speech Therapist

Teaching your baby a few basic signs can help jump-start their language learning at an early age.  By 6-months of age, a baby’s ability to understand language is more developed than their ability to speak.  They are great imitators of motor movements by this age, and typically will enjoy making signs and being able to make their intentions clear.  When exposed to signs at home, many babies are able to produce signs before they are able to verbalize true words.  

You can model simple signs for your baby as early as 3-months-old.  Begin by modeling the sign in familiar routines throughout the day until they are able to produce the signs on their own by 9-12 months old.  Choose signs that make sense for your family and will motivate your baby to learn.  

"MORE"

A good place to start is with the sign for MORE.  You make this sign by flattening your hands then bringing your thumbs underneath to make an “O” shape.  Bring your fingertips of both hands together and apart in front of you repeatedly.  Try modeling this sign during highly motivating activities such as mealtimes.

"EAT"

Another early sign you can try is the sign for EAT.  To make this sign, use the same flattened “O” hand shape as in the sign for MORE, but bring the sign close to your mouth (as if you are taking a bite!).  This is another sign to begin modeling during mealtimes.  

"ALL DONE"

A third, simple sign to try is the sign for ALL DONE.  Make this sign by beginning with both hands flattened and facing forward, palms facing up.  Rotate your palms inward while moving your hands apart until both hands are facing down.  You can begin modeling this sign at mealtimes or at the end of an activity (“We are ALL DONE bubbles/milk”).

If your baby appears to be motivated to use signs and is catching on, some other early signs to try include: HELP, PLEASE, MOMMY or DADDY.  Often, when babies do begin talking, the words they sign will be the first they verbalize.

The “Baby Sign Language” website is a great resource and online signing dictionary to explore more signs (http://www.babysignlanguage.com). 

Ugh, It Is Too Hot Outside and My Children Are Going Stir Crazy

Ugh, It Is Too Hot Outside and My Children Are Going Stir Crazy

By: Teri Roberts, DPT

Kids Place Owner and Pediatric Physical Therapist

An Arizona summer can pose a difficult challenge trying to keep children active, yet safe.  Without a pool, I often find myself telling my two children, 7 and 8 years old, it is too hot to play outside.  At the same time, I become aggravated with their non-stop energy.  This has to be the hardest time of the year for kids and parents.  With school beginning, our children are expected to behave properly and sit an entire day in school before returning home.  After completing homework, our children must entertain themselves with indoor activities until bedtime.  So when do they have the chance to release their energy?  How can we find a happy medium between being active, yet maintaining an inside pace?

As a physical therapist and parent, I have always been more lenient with outside activities coming indoors.  My kids have always been allowed to throw balls in the house (of course, using a softer ball as they begin to throw harder), jump rope in the kitchen, jump on couch cushions placed on the floor, and do handstands and cartwheels in an open room.  However, these rules are probably not the norm in most households and cannot apply to every household.  So, what gross motor activities are appropriate indoors?

Here are some great ideas for indoor activities that will keep your children safe and active during those long, hot summers and early fall evenings:

Play hide and seek

This is actually a very quiet game, yet children find very interesting places in which to stretch or squeeze their bodies.  They often have to hold various positions for a long time, while their seeker is searching.  You can also make a rule that in order to look for the hiders, the seeker needs to walk like a certain animal or jump on one foot.  Children can play hide and seek for a very long time, releasing some energy in a quiet way.

Play the animal game

You can play this game a thousand different ways.  Sometimes, we will play animal charades, or we complete an animal puzzle while walking like the animal with each piece of the puzzle. We may reach an animal book while acting like the animal, instead of just looking at pictures.

Obstacle courses

You can make your entire house an obstacle course, without breaking anything.  Use couch cushions, pillows, blankets, tape on the floor, tiles of your floor, and/or stairs.  Give your child a sequence of activities to complete and time them to see who can complete the obstacle course with the fastest time.  An example of an obstacle course we use at our house starts in the kitchen with a bear walk to the stairs.  The kids then carry a laundry basket (small with about 5 lbs of clothes) upstairs, walk back down stairs,  hop to the living room, and jump over pillows placed on the floor.  They will then gallop to the family room and perform 10 jumping jacks before skipping back to the starting line.  After teaching my kids how to create an obstacle course, it was amazing to see how many variations they could create on their own.

Kids Yoga

This can be both energy releasing and calming at the same time.  There are many companies that have Children Yoga cards, or you can go to different websites and make your own card (www.playtimeyoga.com).  Have your child look at the card, mimic the position and hold for 30 seconds.  They will have more fun if you do the positions with them.

Although the temperature may be hot outside, it is most important to remember to keep your children active.  As a mother, I know it is easier to turn on the television, or allow my children to play video games, but this creates a horrible habit that will be hard to break once the weather becomes enjoyable outdoors.  According to the American Academy of Pediatrics, children should receive more than 60 minutes of moderate to intense activity daily.   In Arizona without a pool, this can prove to be challenging.  

Hopefully, these ideas are a great start.  I would enjoy hearing your ideas.  Which indoor activities work for your family?  Please leave your comments in the section below, and contact me directly if you would like additional indoor activities for your children. 

Protecting Your Child’s Back from Their Own Backpacks

Protecting Your Child’s Back from Their Own Backpacks

By Tyler Guymon, DPT

It is the time of year again when we trade our kid’s swimming suits and flip flops for uniforms and backpacks.  The beginning of the school year brings with it an increase in back pain by school-aged children.  Unfortunately, many of our children suffer from this back pain by improperly wearing their backpacks as they return to the rigorous grind of school.

Here are a few beneficial safety tips for wearing a backpack as the wear and tear of the school year presses forward:

Wear both straps

Use of one strap causes one side of the body to bear the weight of the backpack. By wearing two shoulder straps, the weight of the backpack is better distributed.

Wear the backpack over the strongest mid-back muscles

Pay close attention to the way the backpack is positioned on the back.  It should rest evenly in the middle of the back.  Shoulder straps should be adjusted to allow your child to put on and take off the backpack without difficulty and allow free movement of the arms.  Straps should not be too loose, and the backpack should not extend below the lower back.

Lighten the load

Keep the load at 10-15% or less of your child's bodyweight.  Carry only those items that are required for the day.  Organize the contents of the backpack by placing the heaviest items closest to the back.  Some students even have two sets of books, which allow them to not carry heavy books to and from school.

Children come in all shapes and sizes, and some have physical limitations that require special adaptations.  A physical therapist can help you choose a proper backpack and fit it specifically to your child. 

Additionally, a physical therapist can help improve posture problems, correct muscle imbalances, and treat pain that can result from improper backpack use.  Physical therapists can also design individualized fitness programs to help children get strong and stay strong—and carry their own loads!

Call us at 623.242.6908 if you would like to schedule an appointment with a licensed physical therapy.  Please feel free to leave me your questions or comments in the section below.

Check out this video, provided by MoveForwardPT.com:

Strategies for a Successfully Potty-Trained Toddler

Strategies for a Successfully Potty-Trained Toddler

By Liezel Fernandez, OTR/L

Kids Place Pediatric Occupational Therapist

Potty training is around the corner.  Your child is finally ready to say goodbye to diapers!  But… will you be prepared?

Independent toileting is an important milestone and a complex task in a child’s life.  A child must be ready both physically and psychologically to begin the learning process of toileting.  Parents need to be prepared to devote significant time and effort in toilet training their child.  When starting to potty train, it is important to keep in mind your child’s developmental level, not their chronological age.  Children are likely ready for toileting if they have a regular pattern of urine and feces elimination.

The first sign of readiness is when a child indicates discomfort when wet or soiled.  Consider whether your child is able to follow simple directions and able to tell you through verbal or non-verbal communication (sign language/gestures) they need to go potty. 

Here are some helpful strategies to successfully potty train your child:

• Schedule toileting and use habit training.  For example, go at the same times of the day every day.
• If possible, dedicate a bathroom to toilet training.
• If you child is unable to communicate verbally, provide ways to indicate a need to go by using picture cues.
• Hang visual cues on walls, like step by step picture instructions.  We have all seen the hand washing examples in various bathrooms.  This is a perfect example of these visual cues.
• Demonstrate and explain the process.
• Use a story telling when trying to teach your child the socially acceptable behaviors in public restrooms.  These pretend stories can provide a model to teach your child what is appropriate.
• Teach physical, gestural cues, or sign language so your child can communicate the need easily.
• If your child does not stay long enough on the potty, use a timer and instruct your child to stay seated until timer rings.
• Use positive reinforcement, like a sticker chart to improve motivation.

Remember to teach all aspects of the task.  Independence in toileting or being fully potty trained includes:

1. Getting on and off the toilet. 
2. Managing fasteners and clothing.
3. Cleansing after toileting.
4. Washing and drying efficiently without supervision.

Potty training requires a lot of time and patience.  If you continue to have problems, you may want to consider getting professional assistance from an Occupational Therapist.  Good luck, and happy potty training!

What’s better For Pain - Heat or Cold?

What’s better For Pain - Heat or Cold?

By Doug Lehman, PT

Often times, patients will ask me if they should use heating pads or ice to treat pain.  My answer varies depending on the type of pain.  There are two basic types of pain that we treat: acute and chronic.  Acute pain is pain that occurred recently, usually within the past 24 or 48 hours.  Chronic pain is pain that extends beyond the expected period of healing.

Acute injuries are usually treated with cold therapy.  The general rule with cold therapy is if an area is red, swollen, or inflamed, or the injury just happened, we want to cool the area down and prevent further or reduce any inflammation.  Cold therapy will reduce swelling and pain by constricting blood vessels.  It will also limit any bleeding that may occur.  Cold therapy is generally used after exercise, again to cool the inflamed areas.  Cold should not be used to treat chronic injuries before exercise. 

Some choices for treatment can range from a bag of ice (or snow for cold weather climates), a gel cold pack purchased from a store, or a large bag of frozen peas (yes, this does work, just don't eat the peas!).  Cold treatment can be applied for 20 to 30 minutes before allowing your skin temperature to return to normal before reapplying the cold therapy.

Heat will generally be used for chronic injuries.  It can help sore, stiff, nagging muscles and joint pain.  Heat should not be used with acute injuries or any injury exhibiting signs of swelling or inflammation.  Heat can help relax tight muscles or muscle spasms. Heat used before exercise will increase the elasticity of joint connective tissues and stimulate blood flow. 

Choices for heat treatment include an electric heating pad, a microwavable hot pack, or uncooked rice in a tube sock heated in the microwave (yes, this works too!).  Heat should be used for 15 to 20 minutes at a time with enough layers between the heat source and skin to prevent burning. 

Heat or cold therapy works by stimulating your body's own healing force.  Many arthritis doctors recommend both heat and cold treatments to help reduce inflammation and ease the pain and stiffness that comes with arthritis. It may take a little "trial and error" to learn which therapy works best for your pain, but you can use this blog as a starting point.  For chronic pain, feel comfortable utilizing the method that works best for you.

Your Child is Going to be a Baseball Player!

Your Child is Going to be a Baseball Player!

By Teri Roberts, DPT

Owner and Pediatric Physical Therapist, AZOPT Kids Place

As a parent of a newborn, inevitably you have heard someone tell you “wow, your baby’s grip is so strong; I bet he will be a baseball player.”  While true, in all likelihood your baby’s grip is strong, it does not necessarily mean your child will grow up to be a baseball player.  The reason your baby has a strong grip when you place your finger in their hands is due to the Palmar Grasp Reflex. 

The Palmar Grasp Reflex occurs at birth until approximately 6 months of age.  You can elicit this response by placing your finger into a newborn’s hand from the pinky finger side.  Your child should immediately grasp their hand around your finger.  Even with a slight tug, your baby will most likely not release.  This reflex is important to teach children how to grab objects and use their hands in a functional purpose. 

At approximately 6 months of age, the grasping is no longer reflexive, but an automatic process of grasping objects and subsequently choosing to release these objects.  When this happens, the Palmar Grasp has been integrated.  Many babies develop the ability to grasp and release prior to six months.  These babies still require the use of the Palmar Grasp Reflex with activities like pulling to sit, standing, and bouncing on a parent’s legs with the support of a finger. 

Parents should watch for their baby’s ability to demonstrate open hand postures during awake or sleep times during the first few months.  Additionally, parents should look for their baby to release objects when grabbed after six months.  The inability to complete the above tasks can point to signs of neurological issues.  Please contact your physician or contact me at Kids Place if you are concerned with the overall development of your child.

So yes, your baby may grow up to be a Major League Baseball star, but it has nothing to do with newborn grip. 

Fight Obesity with AZOPT

Fight Obesity with AZOPT

Obesity is an epidemic in the United States.  Adults and children who are obese tend to have an increase in doctors’ visits with complaints of:

• Joint pain
• Headaches
• Foot pain
• Low back pain
• Greater risk for sleep apnea
• Constant fatigue
• Depression
• Unwillingness to perform physical activity

At AZOPT, obese and overweight patients will receive:

• Musculoskeletal evaluation of pain associated with joints, back, feet, and headaches
• Posture assessment
• Strength and endurance testing in a Pain-FREE zone
• Activities through manual therapy, stretching, and strengthening
• Exercise modifications that help meet fitness goals
• Individualized home exercise program
• Introduction to other community activities

Why AZOPT?

People who are obese do not become this way overnight.  It takes months or years of sedentary activity and poor eating habits to cause the obesity problems.  The transition to a healthy lifestyle is VERY difficult.  People who are overweight have honest issues with joint pain, fatigue, headaches, and consistent tiredness.  They are in constant pain when they move, so they simply don't move, creating an even more sedentary lifestyle and increase weight.  AZOPT can help break this cycle.  

AZOPT therapists will:

• Address the pain through manual therapy and therapeutic exercise
• Allow for safe and effective exercises to help the patient feel good when they move
• Adapt and progress the exercise program as these various pains are addressed
• Provide professional guidance while monitoring the exercise program

Through physical therapy, patients will develop the proper foundation for movement in a positive environment through safe and effective leadership.  

For more information or to schedule an appointment, call AZOPT at (623) 242-6908.

Using Physical Therapy to Help Relieve Pain and Ailments Following a Pregnancy

Using Physical Therapy to Help Relieve Pain and Ailments Following a Pregnancy:

How my Own Personal Experiences Guide my Perspective

By Pamela G.Guevarra, PT, DPT

My husband and I waited patiently for years to have a baby.  When our doctor told us we were pregnant with twins, like most families of multiples, we were surprised, yet felt extremely blessed.  However, I had a difficult pregnancy.  A herniated disc in my cervical (neck) spine, which existed prior to my pregnancy, worsened.  The pain I felt in my ribs from the extreme amount of pressure is something I cannot soon forget.  I had carpal tunnel syndrome that started on one wrist and eventually both.  Not to mention the pain in my lower back, which actually increased after my pregnancy, creating a radiating numbness on my right thigh, lower leg, and foot.

While physical therapy treats a wide range of physical ailments and conditions for men and women of all ages, many women are not aware of the benefits of physical therapy following their pregnancy.  During a pregnancy, women and physicians often utilize physical therapy to help relieve ailments and symptoms.  However, most women experience residual, or even new, ailments or symptoms after their pregnancy, yet many never even seek professional assistance.

Following the delivery of my twins, I became very ill.  My primary care physician explained I had an infection, my entire body was inflamed, and I was not recovering fast enough following my C-section.  Yet I still had to care for my newborn, premature twins.  I was so ill that I was not allowed to exercise.  I was so weak that standing up took time.  Sleepless nights led to constant fatigue.  I felt and looked like a frail, old lady stooped over from severe weakness.  After two months, I started to feel better, but was still experience neck pain, a stiff thoracic spine (upper back), pain and stiffness in my lower back, and numbness in my right leg and foot.  It is not normal to have symptoms like lower back pain and leg numbness.

Common symptoms that women experience after giving birth include pain in their back, pelvis, neck, legs, and/or arms along with weakness, stiffness, and headaches.  These symptoms, as well as other musculoskeletal conditions, can be intensified during or after birth, and may last for months to a year after delivery.  During pregnancy, the body's ligaments (tissues that connect bones together) become lax from a hormone called relaxin, which is released to allow the body to adapt with the growth of the baby.  This hormone predisposes pregnant women to injuries or can aggravate already existing conditions.  In addition, other reasons why women have musculoskeletal problems after pregnancy include postural changes, symptoms before and/or during pregnancy, a complicated vaginal delivery, C-section, a complication or illness after delivery, and giving birth to multiples.

Throughout a pregnancy, women experience an altered posture to compensate for the baby bump.  Nine months of pregnancy is more than enough time to stress joints and cause women to continue this altered posture after pregnancy.  An altered posture places unnecessary force on the body’s joints causing increased pain and decreased comfort while caring for the child and performing daily activities.  Another cause of symptoms arises from a complicated vaginal delivery.  A lengthy labor adds stress on top of stress to the pelvic floor muscles, leading to pain in the pelvis and incontinence issues. 

Women who choose to have a C-section, or require one following a lengthy labor, may experience weakness in the abdominal and pelvic muscles causing trunk weakness and low back pain.  A C-Section is now the recommended delivery option for women pregnant with twins (triplets, etc.) because it is safer for the babies and the mother.  However, not all women/couples are aware that a C-section is a major abdominal surgery; risks that are not adequately discussed in a birthing class.  The negative result of a C-section can cause emotional changes to some mothers who feel their body has failed in addition to the weakness and pain.

Physical therapy can treat these musculoskeletal conditions and reduce any residual symptoms.  Unfortunately, very few women seek the assistance of a licensed physical therapist because they assume nothing will help or they ignore their symptoms.  Most moms place themselves second, third, or even last after the demands of their family, their job, and other responsibilities despite the pain that they experience.  However, for a woman to give 100% to the demands of her role as a homemaker, mother, and/or a full-time employee, a woman must take care of her body and remove any and all obstacles or ailments preventing her from physically functioning at 100%.

A licensed physical therapist will be able to evaluate and treat the symptoms by addressing the specific problems individually and setting future health goals.  Treatments may include pain relief with manual therapy and modalities like cold pack, hot pack, and electrical stimulation.  Physical therapy will work to strengthen specific muscle groups, improve stability in specific muscle groups, increase endurance levels to avoid fatigue, improve posture through manual therapy and exercises, and relieve joint stiffness with manual therapy and stretching. 

I am a physical therapist, but I definitely needed another physical therapist to help me get back in shape for my husband, my twins, and to be able to return to work.  I was treated for my neck, my lower back, and thoracic spine.  Manual therapy loosened my spine to correct my posture and relieve pain and stiffness.  A home-exercise program was designed to improve my strength (especially in my core) flexibility, and endurance level.  Despite my daily demands, I had to create the time to complete these exercises at home, not only for my family, but for myself.

While every woman’s symptoms and speed of recovery are different, a licensed physical therapist will be able to frequently modify the treatment plan based on goals and improvement.  Some women, especially those who have an infection or other complication(s) during and after delivery, may need to see their physician prior to seeing a physical therapist.  New mothers must take special care of their bodies after giving birth to help regain energy and strength.  The better a woman takes care of herself, the more she will be able to provide the best care for her child.

Questions or comments?  Leave Pamela a comment below or contact AZOPT at (623) 242-6908 to find out how you can benefit from physical therapy.  Pamela will respond directly to your questions/comments within 24 hours.

Play-Doh®: Fun and Functional

Play-Doh®:  Fun and Functional

By Josh MacDonald, OTR/L

Occupational Therapist and Kids Place Clinic Director

Play-Doh® is a great tool for helping your child develop hand skills.  The texture and resistance are great for building up the muscles in the hands.  However, when it is time to pull out the tub of Play-Doh®, hold off on using all of the cool tools and gadgets. 

Hasbro has made some awesome and exciting accessories to go with the rainbow of colors for Play-Doh®.  Most of these tools do not promote the development of hand skills.  These tools and Play-Doh® factories rely on pushing or pulling levers and holding basic tool handles.  While playing with these items is not terrible for development, to make the most of this awesome Doh put the tools away and let the child’s hands work.

 

Learning how to keep a hand flat and active while rolling out a snake works different muscle groups than giving it a big squeeze to leave grip marks.  Rolling a ball between your palms requires more control than rolling it on the table, but both encourage exposure to different textures.  Pinching the Doh to squish small balls between the thumb and first finger builds up grip strength and thumb skill.  Small items can be hid forcing small finger movements to hunt for objects, and making flat pancakes takes more hand strength than banging with a hammer. 

The tools made for Play-Doh® are fun, but the creative, tactile and fine motor coordination benefits are so much greater when the child simply uses their own hands.  If your child insists on using the toys, try playing without them for 10 minutes, then allow the toys.  Even 10 minutes of direct hand play with Play-Doh® will improve overall hand strength and coordination.

Keeping Your Fluid Levels Up

Keeping Your Fluid Levels Up

By Ryann Roberts, DPT, CrossFit Level 1 Trainer

There’s nothing better than a cold glass of water after a workout, but don’t forget to fuel up on liquids before you hit the gym.  Athletes can lose a significant amount of fluid during physical activity; the more rigorous the routine, the more water they’ll need to replace – and who does not participate in rigorous exercise routines?

Approximately two-thirds of an average adult’s weight is made up of water.  Fluids are essential to proper body functioning, including temperature regulation, joint movement, and the transportation of oxygen throughout the body.  Dehydration, therefore, can elevate body temperatures, strain the cardiovascular system, and lead to heat injury.  Maintaining fluid levels is critical to any exercise routine.

The American College of Sports Medicine not only recommends adequate fluid replenishment, but also advises athletes to increase sodium intake after a strenuous workout.  While current medical advice calls for a reduced sodium diet, the temporary uptick in sodium is necessary to counteract the loss of electrolytes during physical exercise.

The next time you gear up for athletic activity, keep the following in mind:

Load up.  Drink 1 or 2 cups of water 30 minutes before starting exercise.

Maintain your levels.  Drink between ½ and 1 cup of water for every 15 minutes of exercise to replenish your fluids.

Weigh yourself.  Check your weight before and after exercise, and drink 2.5 cups of water for every pound lost during your workout.

Don’t rely on thirst. Water may be known as a “thirst quencher,” but if you’re thirsty, your body is already dehydrated.  Drink plenty of water after a workout, even if you’re not thirsty.  When your thirst is quenched, drink some more; you may not feel you need water, but your body does.

Use your body's natural indicators.  Urine can signal whether you’re adequately hydrated; look for a pale color, as opposed to a dark yellow, to know when your body has enough fluids.

Beware over-consumption.  While dehydration is a danger, drinking too much water can also pose a risk.  Athletes who consume excessive amounts of fluid can suffer from water intoxication, which occurs when sodium levels are depleted.  Be on the lookout for these symptoms: dizziness, nausea, apathy, confusion.

Eat your fluids.  Consider other forms of liquid refreshment to keep hydrated throughout the day.  Fruit, vegetables, and tea provide fluids and nutritional benefits.  But immediately after exercise, stick to water or electrolyte-enhanced fluids – they pack the best replenishing punch.

ACL Reconstruction: Allograft vs. Autograft

ACL Reconstruction:  Allograft vs. Autograft

By Erik Bassett, DPT

Recently, we posted a blog titled “Everyday People Rehabbing Major Knee Injuries with AZOPT.”  In this two part series, we focused on the rehab following a major tear in the ligaments of the knee.  In this scenario, AZOPT patient Josh had a surgical procedure known as an auto graft to repair the tears.  Many people wrote us wondering what exactly an autograft procedure is. 

First, just to refresh the memory, the ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) are inside the knee joint connecting the femur (thigh bone) to the tibia (large bone of the lower leg). The ACL and PCL form an “X” inside the knee that stabilizes the knee against front-to-back and back-to-front forces.  ACL tears occur approximately 200,000 times each year in America, of which nearly half require reconstruction.

There are two types of reconstructive surgeries to repair an ACL - allograft and autograft.  An allograft is a tendon used from something other than the individual patient, usually a cadaver.  An autograft is tendon used from the individual, usually the hamstring or patellar tendon.   What is the difference between the two types of reconstructive options, and is one better or worse than the other?  There are positives and negatives to each type of reconstructive surgery.

This year, The American Journal of Sports Medicine performed a meta-analysis, the best form of research, reviewing many articles on the subject written between 1999 and 2012[1].  According to the study, patients who received an autograft scored higher on a scale that rates common complaints of the knee.  Further, they report positive outcomes on a subjective report and positive results with a single leg hop test.  Comparatively, patients receiving an allograft report a positive return to pre-injury activity level along with a positive subjective report.  They also report positive results with a pivot shift and decreased anterior knee pain.  However, patients with an allograft procedure had a 3-fold increase in re-rupture rates compared to autografts.    

In March of 2011 I experienced a major ACL tear that required reconstruction.  I chose to have an allograft performed mainly due to the shortened length of recovery time.  With an allograft, there is a decreased recovery time due to smaller amounts of cutting other structures like the patellar and hamstring tendons.  While the recovery time is less with an allograft, after 12 months of rehabilitation both types of grafts result in equal knee range of motion, strength, and activity level if proper rehabilitation occurs.  To this day I am able to perform each and every activity the same as before my ACL reconstruction.  Occasionally, I experience only minimal pain after activity and mild aches during cooler weather. 

Rehabilitation is key to any ACL reconstruction.  Physical therapy is performed after an ACL reconstruction to enable the knee to recover in a timely manner.  Initial treatment following ACL reconstruction includes increasing range of motion both in flexion and extension, mild strengthening of knee and hip musculature, pain and swelling reduction using modalities, and soft tissue mobilization to increase tissue extensibility.   Crutches and a locked knee brace are typically used for the first 3 or 4 weeks.  As rehabilitation progresses, an increased amount of strengthening occurs.  It is important to strengthen the surrounding muscles to help support the ACL graft.

If you have ruptured your ACL and require a reconstruction, speak with your physician.  Generally, they will refer you to a surgeon for a consultation.  The surgeon will speak to you regarding the option for an allograft or an autograft.  Now that you know the difference between the two you can impress the surgeon with your knowledge.  Choose which type would be most beneficial for you in the long run.  When the operation is complete, call AZOPT to begin the rehabilitation process.  Good luck and happy recovery!

[1] American Journal of Sports Medicine. 2013 Apr 12. Bone-Patellar Tendon-Bone Autograft Versus Allograft in Outcomes of Anterior Cruciate Ligament Reconstruction: A Meta-analysis of 5182 Patients. Kraeutler MJ, Bravman JT, McCarty EC.