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.

Premature Introduction of Solids to a Baby

Premature Introduction of Solids to a Baby
By Colleen Riordan, CCC-SLP
Speech and Feeding Therapist, Kids Place

First milestones for babies can be very exciting for a new parent.  First smiles, first words, and first steps are moments to be cherished.  But is there such a thing as pushing for these milestones to happen too early?  In the case of introducing solids to an infant, the answer is yes.  Although common advice is to begin introducing solids at 6 months of age, some health professionals are now giving the green light for solids at 4 months of age.  Recent polls have also revealed that some infants are receiving their first tastes of infant cereals and purees as young as 2 months.  Although it may be tempting to give your baby solids before 6 months of age, it is important to take into account your baby’s nutritional needs, gastrointestinal maturity, oral-motor development and a number of readiness cues.

Nutrition

Through the age of 6 months, breast milk or formula provides all of your baby’s nutritional needs.  In fact, many infants can thrive on breast milk or formula alone through 9 months of age.  Infant cereals and purees cannot provide the necessary calories, fat and nutrients for an infant’s developing body and mind.  Between the ages of 6 and 9 months, introduction of solids is for practice only; breast milk or formula is essential.  Some erroneously believe that infant cereal is necessary for iron supplementation. This is untrue.  Typically developing infants are born with iron stores to last them at least through the seventh month of life.  Another myth is that adding cereal to a bottle before 6 months of age will help a baby sleep through the night.  There are no studies to support this idea.  Adding cereal will change the nutrient content of the formula, and is linked to higher risk of obesity later in life.

Gastrointestinal Maturity

Before 6 months of age, infants have what is referred to as an “open gut”.  They are unable to filer out harmful substances and allergens.  Similarly, the intestinal tract is also unable to facilitate adequate absorption of nutrients in anything other than breast milk or formula, which contains enzymes to digest fats, proteins and starch.   By feeding a baby solids before his GI tract is mature, there is a higher risk of diabetes and food allergies.

Oral-motor Skills

Babies will exhibit a tongue thrust reflex which disappears between the ages of 4 and 6 months.  This reflex exists to protect an infant’s airway.  Before 6 months, infants will exhibit a sucking motion, a movement that is effective for anterior/posterior transit of liquids.  In order to deal with solids effectively, infants need to develop some tongue lateralization and rudimentary munching skills.  These skills are typically developed by 6 months.  Add to this the fact that most infants do not get their first teeth until after 6 months; this may be an evolutionary cue to us that infants are just not fully equipped to begin eating solids until after 6 months.

Reading the Cues

Many books will tell you that once a baby has doubled her birth weight, he is ready to begin solids.  Remember, that it is the combination of maturity of intestinal tract, nutritional needs, and oral motor skills that should be taken into account, instead of age or weight.   Conversely, if your baby is underweight at 4 or 6 months, the best nutrition is provided by breast milk or formula, and not solids.  Another cue parents should look for is the infant’s interest in the food that others are eating around her.  While this may be one readiness cue, it is also important to remember that infants are becoming great imitators at this age, mimicking your movements while eating.  This may be more of a social interaction than a cue that she really wants what’s on your plate!

Introduction of solids is one milestone that does not need to be forced. You will be eating with your baby in no time.  For now, enjoy the special moments breast or bottle feeding your infant, as they will go by quickly!                                                          

When a Home Exercise Program is Not Enough

When a Home Exercise Program is Not Enough
By Ryann Roberts, DPT
Owner and Physical Therapist, AZOPT

Ever had an injury or nagging pain that just won’t go away?  During the course of exercise, sports, and sometimes normal daily activities, these injuries occur frequently.  Some people will turn to word of mouth, YouTube, or a medical professional for assistance.  They will receive an abundance of information, exercise, and movements that may help alleviate or reduce the pain.  Many of these stretches and activities loosen tight muscles, strengthen weak muscles, alleviate the pain, and help you achieve full return to activity.  But what do you do when the home exercise program (HEP) does not resolve your injuries fully?

I see many people in the gym or who come into my office at AZOPT and tell me despite finding a good HEP and performing the exercises correctly and frequently, the pain still will not go away.  My response is always the same – you need the skilled hands of a physical therapist to manually release the restricted tissue.  A skilled physical therapist uses techniques and stretches you will not receive any other way.  A physical therapist will push your limits safely and effectively in a way you cannot on your own.

You can only foam roll or lacrosse ball out a tissue so much and so deep compared to what manual therapy from a physical therapist can perform with their hands.  Physical therapists can ‘feel’ the restriction and use several deep tissue methods to release the restriction deeper than a foam roll or a lacrosse ball.  A physical therapist’s hands can get pin point to the exact restriction and effect positive change. 

I talk with athletes daily about aches and pains they are having and how they should best attack the pain or restriction.  I am happy to give general stretches and advice to best resolve their problem, but nothing compares to the time spent on the table manually working through the pain.  On the table, I am able to feel the restriction and range of motion loss, and trace it to a certain area that is causing the limitation, thus the pain.  Through repeated sessions, I am able to address every factor contributing to the problem. 

HEPs are very good; I give them to my patients all the time, but as a part of a larger program.  I give instruction and advice all the time.  Without actually spending time with the person on the table, my advice is limited.  If your routine is working for you and you are able to function or compete on a daily basis with this program, then keep going!  If you find you are constantly searching for that next great stretch on the Internet to fix your problem, have a physical therapist perform an evaluation.

I treat the CrossFit Fury Games athletes consistently.  I know what their tissues feel like.  I know each individual’s range of motion.  Therefore, I also know their medical ailments and when their bodies are tight.  I can prepare them for competition in a couple sessions because they see me regularly.  I know their bodies.  They know that self-stretching and foam rolling will only take them so far.  At AZOPT, we understand all athletes because we are athletes.  We understand the physical demand of exercise from the everyday person trying to get fit to the competitive athlete we all admire. 

I decided to write this blog because I see too many people looking for the easy answer to their pain.  I do not mind giving advice to anyone who asks, but if you truly want the answer, you need to come see us.  Treating pain without the use of medication takes time and effort.  The easy answer is “take 2 of these and call me in the morning”.  The hard answer is “make an appointment and let’s get to work”.  You spend so much time, money, and energy to get healthy; do not fail yourself at the point of pain.  Put in that extra rep and call to make an appointment; we can only help you if you allow us to.  It was not easy getting to the point where you need help, and it will be work getting beyond the pain.  Physical therapy is the natural cure for the ailing athlete. 

If you are having nagging pain or an injury that just will not go away, give us a call at (623) 242-6908 and make an appointment.  We are here to help you get Stronger, Faster, Safer.  

Bouncers, Walkers and ExerSaucers, Oh My!

Bouncers, Walkers and ExerSaucers, Oh My!

By Bobbi Michels, PT

Kids Place Pediatric Physical Therapist

For a first time parent, standing in a Babies R Us equipment aisle is an overwhelming experience.  With all of the advertisements and Consumer Reports, it’s hard to tell which piece of equipment to use with your child.  There are bouncers, swings, Bumbo seats, ExerSaucers, and more.  So, what do you really need? 

The answer – nothing!  Truthfully, most infants are happy simply being held and listening to familiar voices.  When awake and not being held, infants are best on their stomachs on the floor, where they can explore their bodies and develop motor skills.  But this is an unrealistic proposition.  Parents still must have time for daily household activities like laundry, cooking, and dishes.  You also deserve a shower, maybe even a relaxing bath.

So what do you do with your baby when holding them or placing them on the floor is not an option?  This may be a very appropriate time to place your baby in their crib or playpen.  You may think this would also be a good time to place your baby in special equipment, like walkers or Exersaucers?  We say NO!

Studies indicate the two leading causes of head injuries in babies are from the use of walkers and falling from baby furniture.  Other studies indicate 40 percent of babies are injured during the use of a walker - falling down stairs, climbing out of the device, or tipping over in the device.  In most instances parents were present and supervising their baby prior to the injury, but were unable to react fast enough to prevent the injury. 

What about using an ExerSaucer or jumpy to work on leg strength, balance, and gait skills improvement?  Several studies have examined and concluded that motor development is decreased in infants and toddlers who spend the most time in play-assisted equipment.  On the same lines, in a study by A.L. Abbott and D.J. Bartlett, infants with lower equipment use scored higher on motor development tasks when tested using the standardized test - Alberta Infant Motor Scale. 

When placed in a walker or equipment that allows a baby to stand, the baby uses mostly the muscles in the back of the leg.  This is especially true in the beginning as they will often push forward leaning their chest on the support surface and rise up on tip-toes to move the device using both feet together.  This position does not allow the same use of the muscles at the front of the legs or the use of tummy muscles.  Walking requires equal use and strength of both the front and back leg muscles.  In these types of equipment, the baby’s balance point or center of gravity is lower and behind the normal balance point when leaning forward in equipment.  Further, normal balance reactions and arms are not used in the same manner as normal walking.

You are now asking, what are the possible long-term health risks of what we just described?  Without the proper development of leg muscles and balance there is an increased risk of muscle weakness and tightness which can lead to future surgeries and expensive medical bills.  We treat children who develop into “toe-walkers” which causes the foot and calf to shorten and tighten, eventually requiring surgery to release the muscles and realign the foot.  We also treat children with muscle weakness at the front of their leg, or at their hips and knees, causing many challenges with basic movements like dressing or walking up stairs.  Not all children will develop these issues with the use of these types of equipment, but the possibility exists.

If you find you have acquired a myriad of equipment, our recommendation is to limit the time your baby spends in equipment.  We understand you cannot hold your baby all day.  The floor may not always be the best option with older kids or pets around.  In Arizona, parents often are afraid their tile floors will cause injuries.  Our suggestion: use a pack and go or a playpen.  Using these will allow your baby to explore their environment and bodies to gain strength and awareness the way we did as children.  If you want to use walkers or ExerSaucers, the maximum amount of time per day in any piece of equipment should be 15 minutes.  Please note:  you should always supervise your baby closely in equipment to decrease the incidence of an injury.  As always, encourage your baby to spend most of their "play" time on the floor sitting, crawling, cruising and perfecting other motor skill milestones.

Read more: http://www.livestrong.com/article/495767-is-a-bouncer-harmful-for-a-babys-development/#ixzz2TEbM4D8x

References/Sources:

• Kauffman IB, Ridenour M (1977) Influence of an infant walker on onset and quality of walking pattern of locomotion: an electromyographic investigation. Percept Mot Skills 45:1323–1329. MedlineWeb of Science
• Kavanagh CA, Banco L (1982) The infant walker: a previously unrecognized health hazard. Am J Dis Child 136:205–206. CrossRefMedline
• Fazen LE III., Felizberto PI (1982) Baby walker injuries. Pediatrics 70:106–109. Abstract/FREE Full Text
• Stoffman JM, Bass MJ, Fox AM (1984) Head injuries related to the use of baby walkers. Can Med Assoc J 131:573–575. Abstract
• Infant walkers: developmental tool or weapon? Jacquelyn Chamberlin, OTR/L The Children’s Medical Center.
• Chelsea and Westminster Hospital; Promoting Your Baby's Physical Development; January 2011
• Consumer Reports; Bouncer-Seat Safety; April 2007
• "Child: Care, Health and Development"; Infant Motor Development; A.L. Abbott, D.J. Bartlett; May 2001
• National Institute of Child Health and Human Development; Safe Sleep; August 2009
• Healthy Children; Movement: 8 to 12 Months; May 12, 2011

The Long Term Dangers of W-sitting

The Long Term Dangers of W-sitting

By Teri Roberts, DPT

Kids Place Owner and Pediatric Physical Therapist

One of the greatest milestones achieved during a baby’s first year of life is sitting.  This is an enormous progression towards independence for the child and the parent.  Sitting is typically learned around 5 months of age through “prop sitting,” where the child is placed in a seated position with their hands down in front to assist with balance.  At 5 months, babies do not have the postural control (balance) to sit without some assistance.  Between 6 and 8 months of age, babies can sustain a seated position independently.

There are many varieties of seated positions:

• Long sitting with feet directly out in front
• Ring sitting with legs in a ring position and feet either touching or slightly apart
• Tailor sitting or Indian style sitting
• V-sitting with legs straight like a V
• Side sitting when knees are bent and both feet are pointed to the same direction
• W-sitting when both feet are behind and legs look like a W

Throughout a baby’s normal development, each of these sitting postures is normal.  You will frequently see your child transition in and out of these sitting postures frequently as they lead up to independent walking. 

A Baby W-Sitting

Although I just stated that all of these sitting postures are normal, I want to stress the importance of children not excessively W-sitting.  W-sitting does not pose a long term concern if your child transitions in and out of the position smoothly and efficiently, and does not maintain the position during periods of seated play.  W-sitting regularly can cause secondary hip and knee problems during walking, seen through excessive inward feet because of the position of their legs and hips.  

Not every child who W-sits will acquire a skeletal or muscular problem; however, it is extremely difficult to change these impairments once they begin.  W-sitting limits the amount of rotation that is typical during play, creating a pattern that does not utilize good core strength.  To prevent any negative hip or knee changes and the likelihood of core strength concerns, encourage your child to sit with “feet in front”.

By the time your child is 15 months old, you should rarely see your child in the W-sitting position.  Children are very intelligent and the W-sitting position (if hip flexibility allows for it) is the easiest way to sit without using any core strength.  It allows children to “lock out” at the pelvis and play in a seated position with the least amount of effort.  Children that have lower tone and need to work harder to maintain a seated position choose to W-sit frequently. 

If you notice your child W-sitting too frequently, encourage a feet forward seated position.  You could also bring toys up to a taller surface so your child either has to sit and play on a chair or in standing to discourage the W-sitting position. 

If you spend over a week with cueing and changing environment of play and you still notice constant W-sitting, an appropriate recommendation is to have your child evaluated by a pediatric physical therapist.  The physical therapist will check the range of motion of the hips to make sure that your child has functional external hip rotation to allow for a comfortable tailor sitting.  The physical therapist will also check to make sure that the core strength is appropriate to maintain a seated position with feet in front for functional play.

AZOPT Follow Up: Rehabbing Major Knee Injuries

AZOPT Follow Up: Rehabbing Major Knee Injuries

ACL injuries are a scary thing to see when they happen to athletes on television.  We see them writhing in pain, clutching their leg with tears rolling down their face.  An ACL injury to an athlete is season ending, potentially even career ending.  The rehabilitation is gruesome, tedious, and long.  But professional athletes have teams of doctors, physical therapists, trainers, and coaches to help them get back to 100 percent.  Not to mention their rehabilitation becomes a full time job.  That’s why, over time, most athletes bounce back from major ACL injuries. 

What about the common, middle-aged, weekend athlete?  In February, we posted an article Everyday People: Rehabbing Major Knee Injuries with AZOPT.  In that blog we met Josh, who suffered a grade 3 tear of his ACL and MCL, along with torn meniscus and bone bruising while practicing Judo with another adult in his son’s class.  A 35 year old father of three, Josh was an active person who participated in CrossFit, Judo, bike riding, and golf.  Josh had successful surgery on January 14, 2013 to repair his torn ACL, and he began physical therapy at AZOPT on January 23, 2013 with Ryann Roberts, DPT and Owner.

We interviewed Josh upon completion of his physical therapy March 8, 2013:

Your first appointment following surgery was January 23, your last March 8.  What was the focus of your rehabilitation during that time?

I attended physical therapy three times per week during that time.  We focused on strengthening, stretching, and balancing.  Strengthening exercises included squats, first with both legs, and then one leg at a time.  I also did various lunges and calf raises.  Stretching exercises were aimed at regaining range of motion with physical manipulations, static holds, and soft tissue massages.  The balancing exercises helped improve coordination by standing on one leg and throwing objects, or rocking on a tilted surface.  With going to physical therapy three times each week, I was pretty sore.  At home I tried to get good rest and kept up with stretching exercises Ryann had given me.

How helpful was physical therapy?

Physical therapy was very helpful as the first part of my recovery process.  Physical therapy took me from barely being able to walk to now (May 1) re-entering CrossFit and engaging in fairly rigorous physical activity.

On March 8, at your last physical therapy appointment, how far along were you in your complete rehab?

My rehab was progressing along nicely.  I had just been cleared to return to jogging and strengthening exercises, but not athletic type movements.  At the time, I felt I was ready to go off on my own and continue to rehab.  Ryann had given me a thorough home exercise program that included strengthening, stretching, and balance exercises. 

As of today, how far along are you in your rehab process?

My doctor has just cleared me to gradually return to sport-like activities.  I am participating in a form of modified CrossFit.  My doctor has just cautioned me to proceed slowly as my strength and coordination return.

What do you feel, if any, is the difference in rehabbing your knee with Ryann as oppose to anywhere else?

Ryann was an excellent fit for me.  His own athletic background gave him a unique perspective to appreciate my goals.  His more than capable oversight helped me achieve my best recovery possible.  My doctor has told me my knee represents their hope in all patients and is a best-case scenario. 

In our first article, we talked about your mental state and how faith has played an important role in accepting this injury and moving forward.  Having gone through the rehab now, what can you tell others about your experience?

The last seven months have been an unexpected sequence of events beginning with my injury then dealing with the consequences of the injury including doctor's appointments, rest, rehab, surgery, more rehab, etc.  Each of these has been accompanied with frustration, inconvenience, monetary expenditure, and physical pain and discomfort.   That is the honest reality of getting your leg snapped in two.  However, with that said, the thing that stands out most clearly is how fortunate I am.  God has been good to me.  I have received constant love, care, and encouragement from my family.  I was blessed to receive exceptional medical care from my doctor and the team over at AZOPT, and I have been blessed by the time and place I live so that I now have a reconstructed knee.  Think about how incredible this is.  Doctors used a portion of my hamstring muscle to recreate ligaments in my knee and because there were only minor incisions paired with modern medical techniques I will have a knee capable of returning to play in the NFL--pretty good for a middle-aged guy who is just trying to keep in shape and have an active life with my kids!  I have a lot of which to be thankful.

May is National Arthritis Awareness Month

May is National Arthritis Awareness Month

By: Brooke Smith, DPT

Do you or someone you know have pain in their joints, but do not know the cause?  You may have symptoms of arthritis.  Today, nearly 50 million Americans suffer from arthritis.  Arthritis is often misunderstood as minor aches and pain associated with getting old.  However, there are many different forms of arthritis that can occur at any age.  Two-thirds of the population with arthritis occurs in people under the age of 65, including children.  The three main types of arthritis are Osteoarthritis, Rheumatoid Arthritis, and Juvenile Arthritis.

Osteoarthritis (OA) is the most common form of arthritis and is characterized by progressive degeneration of the joint’s cartilage, causing bone to rub against bone.  It most commonly occurs in weight bearing joints such as the hips, knees, and lower back.  OA has also been known to affect the neck, small finger joints, the base of the thumb, and the big toe.  Some of the symptoms include gradual development of stiffness within the joint, pain or joint soreness after overuse or inactivity, morning stiffness, and loss of motion/movement within the joint.  Several risk factors can lead to the development of OA including obesity/overweight, history of joint injury, overuse, genetics, muscle weakness, and age.   OA usually occurs later in life as a person ages.  It is described as the “wear and tear” of your joints, and the older you are the more you have used your joints, putting them at greater risk for OA.   However, older age does not mean OA is inevitable.

Rheumatoid Arthritis (RA) is a systemic disease characterized as inflammation of the joint lining causing pain, stiffness, warmth, and swelling that can occur throughout the body.  RA is symmetrical, affecting the same joints on both sides of the body.  RA affects nearly three times the amount of women than men and most commonly begins between the ages of 30 and 60 years old.  RA has no cure and progression leads to development of rheumatoid nodules and joint deformities.   Although there is no cure for RA, highly effective treatments exist including medications, physical therapy, physical activity, weight control, and maintaining good overall health.

Juvenile arthritis (JA) can have many different forms but is generally described as an autoimmune and inflammatory condition that can develop in children ages 16 years and younger.  JA affects the joints like RA and OA; however, it can also affect the eyes, skin, and gastrointestinal tract.  There is no known cause for JA, but it has been suggested that toxins, foods, allergies, or genetics can cause a child to develop the disease.  Symptoms are similar to RA and OA and include inflammation of the joints, pain, and joint stiffness.  It is important with JA that the entire family maintains a sense of calm and normalcy, as well as sticking to daily routines and comforting habits.  It is also important to address emotions of sadness, anxiety, and anger the child may have to help maintain the attitude that “arthritis is something I have to live with but not what defines me”.

               

There are options, other than surgery, to help improve your symptoms like stretching, walking, strengthening, Tia Chi, and physical therapy.  As a physical therapist, my goals in treating arthritis are to decrease the amount of pain, improve strength of muscles to increase stability around the joint, stretch muscles that are tight and might be hindering proper body mechanics, and improve joint protection.  It has been shown in recent research that exercising is a valuable tool in decreasing the symptoms of arthritis.  Some specific interventions that physical therapy might provide include modalities, braces and splints to protect joints, and hot or cold packs.  A physical therapist will work with you to modify your daily activities and your environment to provide pain relief and improve function.  Physical therapy will improve flexibility in your hamstrings, quads, calves, and hip flexors while strengthening the muscles around your knee, hip, and ankle.  Your appointments may also include coordination and balance activities.

               

If you or someone you know is experiencing any of the signs and symptoms discussed above, or has been diagnosed with a form of arthritis, you might think about scheduling an evaluation with a physical therapist to address your symptoms.  You can contact AZOPT at (623) 242-6908 if you have any questions or concerns.

For more information, please visit www.arthritis.org.

Child Development of Self-Care Skills

Child Development of Self-Care Skills
By Jessica Holyoke, OTR-L

Activities of daily living (ADLs) are a necessary part of our day and include various tasks such as getting dressed, bathing, brushing our teeth or hair, and feeding ourselves.  Most of us place very little thought or effort when carrying out these tasks, but how did we learn to perform them?  Throughout the first year of our life, we will begin to develop the skills necessary to take care of ourselves.  It is important that children have many opportunities to practice these skills.  This blog will look at the typical development of these self-care skills and give examples of how to encourage your child’s development.

Dressing

A 1 year old child has already begun to explore how to take off clothes by removing their socks and raising their arms to help get a shirt off.  Between 1 and 2 years old, your child will continue this exploration and learn to take off his or her shoes and socks.  They will also begin to help put their arms through holes and hold out their legs for pants.  Between the ages of 2 and 3 years, a child can remove simple clothing on their own.  They are learning to put on front closing tops (jackets, button-up shirts) and to unzip and unbutton large buttons.  By 4 years old, a child can dress and undress themselves with assistance for fasteners and ties.  By 5 or 6 years old, a child is nearly independent with dressing skills needing help only with difficult fasteners such as belts and selecting appropriate clothing to match the weather.

Bathing & Grooming

A 1 year old child is starting to become aware of cleaning themselves.  They can wipe their face with a napkin or towel (not completely).  They can grasp tools such as a toothbrush or spoon, and mimic movements that will develop into controlled use.  Between 1 and 2 years, a child begins to enjoy bathing and takes an interest in helping.  By 3 years, they are actively participating in washing and helping with brushing teeth.  At 3 or 4 years, a child can wash themselves with supervision and some help with hair.  A 5 to 6 years child should be able to complete bathing and grooming tasks on their own with occasional reminders to do a thorough job.

Toileting

When to potty train can often be confusing for parents.  Typically, the first indication that a child is ready to start potty training is their ability to indicate when they are wet or soiled, which typically occurs by age 2.  The next step is their ability to indicate needing to go to the bathroom.  A 3 year old child should be using the bathroom with daytime control, still needing help for wiping and managing clothing.  By 4 years old, a child develops nighttime control and needs less help with wiping and managing fasteners on clothing.  At 5 or 6 years, a child is independent with toileting tasks.

Feeding

Around 6 months, a child develops the upper body and hand strength to hold their own bottle.  By 7-8 months, they can grasp small pieces of cereal or baby cookies and bring it to their mouth. They may start using a spoon for feeding by about 12 months.  Between 1-2 years, a child is using a spoon (with spilling) and can hold and drink from a Sippy Cup.  Between 2 and 5 years, a child develops the ability to use a spoon and fork, and can drink from a cup with no lid (with some spilling).

The most important thing to remember about any skill development in childhood is that is takes time and lots of practice.  Spend time on these skills, especially in the evenings and weekends when there is a bit more time to spare.  Give as little help as possible.  As the child gets older, allow them to work through problems and give more verbal feedback than hands on help.  Children learn through play so turn it into a game.  You can play dress-up or dress a stuffed animal for dressing skills, play peek-a-boo games where the child pulls a napkin or washcloth off their face or head for grooming skills, and use spoons and other utensils while playing in pudding or applesauce for feeding and utensil use.  Give your child as many opportunities as possible to practice their skills, let them make mistakes, and have fun learning new skills.

It is important to remember that these skills develop at a different pace for each child and the ages presented are considered average.  If your child develops these skills slightly faster or slower, there is no need for alarm.  If there is a significant delay in the development of these skills, your child may benefit from an occupational therapy evaluation.  Please feel free to leave your comments in the section below if you have specific questions regarding your child.  

Stretching for the Active Adult Woman

Stretching for the Active Adult Woman

By Ryann Roberts, DPT and Brooke Smith, DPT

It is hard enough to squeeze a daily exercise routine into your busy schedule.  You may think adding extra time with a before or after workout stretch is something you should just fit in when time permits.  The focus is on the exercise, not the stretch, right?  Wrong.

Stretching is just as important in your workout routine as the actual exercise.  Stretching increases flexibility, which in turn will help to increase your athletic performance and decrease your risk of injury.  For the active adult woman, the emphasis is on decreasing the risk of injury.  Understanding why stretching helps, and what stretches the active adult woman should perform, can help reduce and/or eliminate these injuries.

Stretching can help improve flexibility.  Flexibility may decrease your risk of injury by allowing your joints to move through their full range of motion.  For example, let’s say you are a 60 year old woman with tightness in her hips and ankles.  This tightness prevents your body from going through its full range of motion, which eventually can develop into tendonitis in your knee or lower back pain.  Properly stretching can increase the range of motion in your hips thereby reducing the risk of these micro traumas to your tendon that may lead to overload or injury.

Stretching also increases blood flow to the muscles, sending oxygen to the tendons and ligaments, essentially waking them up and preparing them for your workout.  

There are two types of stretching routines to perform – dynamic and static.  Dynamic stretching is stretching with movement, designed to propel the muscle into an extended range of motion.  This form of stretching prepares the body for physical exertion and performance.  Static stretching is used to stretch muscles while the body is at rest.  It is composed of various techniques that gradually lengthen a muscle to an elongated position (to the point of discomfort) and hold that position for 30 seconds to two minutes, two or three times per stretch. 30 seconds is the minimum duration to get the benefits of stretching, whereas two minutes is the maximum.

Always take the time to make sure you are stretching safely and effectively using proper technique.  Stretching incorrectly can actually do more harm than good.  Stretching cold muscles may cause injury, so we recommend warming up with some low intensity cardio for five minutes before beginning any stretching.  When stretching, do not bounce.  Bouncing can cause small tears in a muscle.  These tears cause scar tissue in the muscle that as it heals tightens the muscle even more, making you less flexible and more prone to increasing pain and causing injury.

To help, we have prepared a stretching routine to perform before and after you exercise.  

The following dynamic stretches are performed prior to exercise:

• Walking Lunge with Overhead Rotation
• Lateral Lunge
• Squats
• Walking Russian Kicks
• Arm Circles
• Posterior Deltoids Stretch
• Triceps Stretch

For a detailed description of these stretches, click here.

The following static stretches are performed after exercise:

• Standing Calf Stretch
• Hamstring Stretch
• Ilio-Tibial Band Stretching
• Standing Abductor Stretch
• Posterior Hip Stretch
• Low Lunge with Twist and Hip Flexor Stretch
• Standing Extensions
• Corner Stretch

For a detailed description of these stretches, click here.

It’s very easy to bypass stretching due to time constraints, but keep up with it.  The benefits of stretching are best when stretching is regular.  In some cases, you may need to approach stretching with caution. If you have a chronic condition or an injury, you may need to adjust your stretching techniques. For example, if you already have a strained muscle, stretching it may cause further harm.  

Lastly, stretching does not mean you cannot get injured.   Overuse injuries may still occur.  If you are feeling pain or are injured, please contact AZOPT for your FREE injury and/or performance screen with a licensed physical therapist.