What Really Happens at Physical Therapy?!

I’m the Marketing Director at Performance Rehabilitation. I’m also a patient.

I hurt my back, probably in Zumba class, using heavy weights for too long in the wrong way. Luckily, scans confirmed no serious fracture, but I did strain muscles, and further stressed a portion of my thoracic spine causing pain to radiate up into my neck.

I visited my doctor due to the pain. She ordered an x-ray, then MRI. Afterward she determined that physical therapy was in order. She wrote a PT prescription for 2 times/week for 6 weeks.

For me, the choice of physical therapy provider was a no-brainer. I picked Performance Rehabilitation not just because I work here, but because I have observed the professionalism, meticulous attention to detail, friendliness and expertise provided when caring for patients. If I was going to do this, I was happy it would be here.

I asked for a woman therapist. I’m not sure how many women ask for women and how many men ask for men. It shouldn’t matter because they are all professionals. But I suppose sometimes it does.

My First Visit – the Initial Evaluation (IE)

On my first visit I completed several pages of paperwork including history, symptoms and degree of pain. The information served to give the therapist a thorough understanding of my condition.

Next, I was brought into a private room with a table, desk, and some equipment that would be used for assessment. My physical therapist, Shruti, reviewed the reports I provided from my doctor. She also had me turn in various directions, squeeze her fingers for strength and perform a few other tasks to assess and observe my condition, including range of motion and pain level in performing tasks.

The Massage

Next, in the same room I was asked to put my head face-down in a hole at the top of the table – it was massage time. According to Shruti, it was “soft tissue release” time. Simply thinking about what was about to happen, my body became limp in relaxation. Shruti applied a massage lotion infused with arnica, ivy and cucumber extract. She then carefully massaged my neck and back muscles, priming me for the rest of the session. This part of the therapy was VERY enjoyable. Ahhhhh. I wanted it to last. It went on for about ten minutes and then it was time to get moving.

The Exercises

I was brought out into the main gym area where many other patients were going about their exercise routines. There are several tables lining the room and many types of exercise equipment, large and small, which are placed throughout the area. This includes a small wooden staircase strewn with colored bands (each color has a different level of resistance), stationary bicycles, treadmills, stability balls, and so much more.

I heard laughter on one side of the room, where a therapist was talking with a patient who was lying on a table. In contrast, across the room a finely built young man was wincing while bending his foot seemingly in rhythm to the music playing overhead. The atmosphere was warm and welcoming. It felt good to be among the patients instead of in the back office where I usually sit at my computer for much of the day. There I often write about the benefits of PT. Now I was living it. I was one of the “troopers,” sweating it out and working to get rid of the pain in my body, with the help of my therapist and her assistant.

Before each exercise Shruti described the steps and exact body position required to do them. Once she was sure that I was safely and independently performing each one, the assistant Margarita helped me maintain proper positioning, along with the equipment.

Every exercise plan is different. Mine consisted of:

  • Shoulder Resistive Rows with T-band. I held an elastic band with both hands, drawing my arms back while keeping my elbows close to my side. I had to do 3 sets of 10.
  • Thoracic Rotation – Seated. I sat in a chair with good, tall posture. I folded my arms and rotated to the right and then the left. I repeated 3 sets of 10. I held each stretch for 5-10 seconds.
  • Shoulder – Resistive – Horizontal Abduction. While holding an elastic band with my elbows straight and in front of my body, I pulled my arms apart and towards the side. I did 3 sets of 10.
  • Shoulder – Shoulder Rolls. I moved my shoulders in a circular pattern also in an up, back and down direction. I performed small circles for comfort. I did 3 sets of 10.
  • Doorway Stretch. I stood in a doorway with my hands flat against the sides of the door. Slowly I walked through the doorway until I felt a gentle stretch across the front of my chest and/or shoulders. I did this 3 times, each 30 seconds.
  • Chin Tuck. Lying down or sitting I tucked my chin in and out. 3 sets of 10.
  • Thoracic Stretch-Open Book. Lying on my side, arms out straight and hands together, I slowly lifted my top arm and rotated my body. I held this position 10 seconds, then repeated. 2 sets of 10.

It didn’t take long to get the hang of each exercise. Some were harder than others. While doing each one, I occasionally lost track of the number of reps I completed. I had never worked with resistance bands before and found those routines a little harder. In writing, and in pictures, the exercises do not seem strenuous. For me, with back and neck pain, the session was a true work-out. My body felt tired afterward. Throughout the exercises, Margarita was there to help and check to make sure I was performing the moves correctly.

Heating Pad

After the exercises were complete, it was time to go back to the private room. Shruti asked me how I felt. She assessed my pain and range of motion, to see my progress, by having me slowly twist and turn. I laid back on the table face-down and Shruti came in and applied a damp heating pad to my neck and back. It felt warm and comforting. I felt calm. I felt accomplished.

Proper Habits

I am a firm believer that injuries don’t happen to us in a vacuum and it is often poor habits that predispose us to getting hurt or even having accidents. My physical therapist believes this too. She also knows that proper habits such as using good posture when sitting or standing, sleeping with my pillow in proper position, and more, will help my recovery and enable me to stay healthier. She suggested that I be mindful at my desk at work – sit up straight and not cross my legs. I was so grateful for this advice which really served to make my treatment complete and gave me something I could take away and use my whole life – it was a gift. It reminded me that Performance Rehabilitation’s tagline “…with you every step of the way” is true and meaningful.

Homework

I was given a printout with the description of each exercise including a picture of someone doing them. I was advised to do the exercises at home.

The Next Sessions

As I went through the sessions, Shruti assessed and re-assessed my condition each time. At the beginning of every session she asked me how I felt and my level of pain. She also asked me to perform movements similar to those that I did the first session. Then, based on how I felt, I was given much or part of my routine to do, adding or taking away an exercise here or there. This has been repeated over the weeks that followed.

Is it Working?

Yes, it is! I am feeling better, even though I am not done yet with my sessions. Importantly, I am seeing the light at the end of the tunnel and looking forward to signing up for a dance class in the near future. This time though it won’t be Zumba – maybe I will try jazz instead!

How Exercise Affects Our Memory

Even a single workout may make our brain’s memory centers, like our muscles, more fit.

A single, moderate workout may immediately change how our brains function and how well we recognize common names and similar information, according to a promising new study of exercise, memory and aging. The study adds to growing evidence that exercise can have rapid effects on brain function and also that these effects could accumulate and lead to long-term improvements in how our brains operate and we remember.

Until recently, scientists thought that by adulthood, human brains were relatively fixed in their structure and function, especially compared to malleable tissues, like muscle, that continually grow and shrivel in direct response to how we live our lives. But multiple, newer experiments have shown that adult brains, in fact, can be quite plastic, rewiring and reshaping themselves in various ways, depending on our lifestyles.

Exercise, for instance, is known to affect our brains. In animal experiments, exercise increases the production of neurochemicals and the numbers of newborn neurons in mature brains and improves the animals' thinking abilities. Similarly, in people, studies show that regular exercise over time increases the volume of the hippocampus, a key part of the brain's memory networks. It also improves many aspects of people's thinking.

But substantial questions remain about exercise and the brain, including the time course of any changes and whether they are short-term or, with continued training, become lasting.

That particular issue intrigued scientists at the University of Maryland. They already had published a study in 201with older adults looking at the long-term effects of exercise on portions of the brain involved in semantic-memory processing.

Semantic memory is, in essence, our knowledge of the world and culture of which we are a part. It represents the context of our lives — a buildup of common names and concepts, such as "what is the color blue?" or "who is Ringo Starr?"

It also can be ephemeral. As people age, semantic memory often is one of the first forms of memory to fade.

So, they recruited 26 healthy men and women aged between 55 and 85, who had no serious memory problems and asked them to visit the exercise lab twice. There, they rested quietly or rode an exercise bike for 30 minutes, a workout the scientists hoped would stimulate but not exhaust them.

Afterward, the volunteers lay inside an M.R.I. brain scanner and watched names flash across a computer screen overhead. Some of the names were famous, such as, say, Ringo Starr, while others were lifted from the local phone book.

Famous names are an important element of semantic memory, and the volunteers were asked to press one key onscreen when they recognized celebrities' names, and a different key when the name was unfamiliar. Meanwhile, the researchers tracked their brain activity over all, as well as in the portions involved in semantic-memory processing.

The scientists had expected that the areas needed for semantic memory work would be quieter after the exercise, just as they were after weeks of working out, says J. Carson Smith, an associate professor of kinesiology and director of the Exercise for Brain Health Laboratory at the University of Maryland School of Public Health, who oversaw the new study.

But that is not what happened. Instead, those parts of the brains most involved in semantic memory fizzed with far more activity after people had exercised than when they had rested.

At first, the researchers were surprised and puzzled by the results, Dr. Smith says. But then they began to surmise that they were watching the start of a training response.

"There is an analogy to what happens with muscles," Dr. Smith says.

When people first begin exercising, he points out, their muscles strain and burn through energy. But as they become fitter, those same muscles respond more efficiently, using less energy for the same work.

But the Maryland scientists had found in their earlier study that a 12-week program of treadmill walking changed the working of portions of the brain involved in semantic memory. After four months of exercise, those parts of the brain became less active during semantic-memory tests, which is a desirable outcome. Less activity suggests that the brain had become more efficient at semantic-memory processing as a result of the exercise, requiring fewer resources to access the memories.

Now, for the new study, which was published in April in The Journal of the International Neuropsychological Society, the scientists decided to backtrack and parse the steps involved in getting to that state. Specifically, they wanted to see how a single workout might change the way the brain processed semantic memories.

The scientists suspect that, in the same way, the spike in brain activity after a first session of biking is the prelude to tissue remodeling that, with continued exercise, improves the function of those areas.

Our brain's memory centers become, in other words, more fit.

This study is short-term, though, and does not show the intervening steps involved in changing the brain with regular exercise. It also does not explain how activity alters the brain, although Dr. Smith believes that a surge in certain neurotransmitters and other biochemicals after workouts must play a role.

He and his colleagues are hoping to examine those issues in future studies and also zero in on the best types and amounts of exercise to help us maintain our memories of that genial Beatles drummer and all the other touchstones of our pasts.

A version of this article appears in print on May 6, 2019, on Page D4 of the New York Times edition with the headline: Exercise May Also Help Memory.

Profile of a PT Patient From Prima Ballerina to Pilates Precisionist

Becoming a ballet dancer is no easy feat. The hours and hours of training, discipline and rigor is beyond most people’s capacity.  Trained classically by the Boston Ballet, while also studying under such greats as Edward Villella, Annette Jackson was hand-picked by Robert Joffrey himself to perform in his company, the world renown Joffrey Ballet.

While dancing Annette found herself drawn to a Pilates studio down the street to engage in strengthening exercises. Ballet requires continuous physical and athletic choreography which can sometimes be asymmetrical. The demands and grind of workouts, the stress of stretching, kicking and jumping can take its toll on a dancer’s body. Annette found a remedy and comfort in Pilates class.

In 2009 Annette took a position as Pilates Director at the JCC in Scarsdale, where she is today.  She teaches private and group classes to adults of different ages, but mainly within the 50 – 90 year range. Annette says, Pilates “keeps the body feeling almost like it did when dancing.” She continues, “it teaches body awareness and challenges the mind.” Annette says there are a lot of people, with stressful jobs or retirees who have various ailments, who are relieved by her exercises.

A few years ago, due to years of wear and tear, grinding of bones and strenuous workout routines, Annette had to have hip replacement surgery.  She was strong through the whole ordeal and after a few months she was back to her “young” self, with full range of motion.

Then, it happened again, this time to her other hip! But like a pro, she completed her surgery and is currently undergoing physical therapy at Performance Rehabilitation in Yonkers. She is bouncing back again, and within a few months total we predict she will feel great again. “Working with Annette has been great. While we care for people of all ages and physical levels, it is wonderful to work with someone with such good body awareness. Her drive and motivation have been a tremendous asset to her recovery,” says her physical therapist David Burke, PT, MS, cert. MDT.

While at Performance Rehabilitation, she has taught some lessons literally and figuratively. She has shared her knowledge of Pilates exercise to staff.  Watching her do her therapy is inspirational because of attention to form and posture. She is giving everyone an extra dose of motivation to work through ailments – this applies to both other patients and staff.

We remain in awe of a lovely prima ballerina from the Joffrey Ballet and now Pilates Director at the JCC. She has moved through life with grace, as a great ballerina would.