What to expect on your first PT appointment.
We start by taking a detailed history of your current and past symptoms and medical history.
This allows us to
-rule out red flags
-hone in on what we need to evaluate
-make sure we know how painful/irritable your symptoms might be so we can make you feel comfortable throughout the process
Next we do our baseline assessment of
-how you move
-range of motion
-strength
-mobility
-functional activities.
Using this information we start to form a hypothesis of what might be causing your symptoms and what we need to address.
We will often follow this up by testing your symptom response to different types of movement to help us confirm or deny what we think is going on.
Once we have a better idea of what is contributing to your symptoms,
-we explain what is going on
- start treatment
- give you things to work on until our follow up appointment.
We decide when is appropriate to follow up to re-assess and progress.
Usually this is within 2-7 days of the initial appointment .
How to Set Yourself Up for A Successful Summer Season
Shoulder Season: How to Set Yourself Up for a Successful Summer
Spring - my favorite season! More sunshine, more warmth, days get longer. March Madness! Dusting off the bikes. Lacing up the running shoes. Getting back to the pickleball court.
As ski season nears its end and you start to transition to your warm weather sport of choice, it is important to be intentional in your preparation and training.
Why does it matter so much?
The demands of cold weather sports can vary significantly from warm weather sports. Frequently this means more repetitive stress on your joints and soft tissues. Or it may mean using muscles or muscle groups that haven’t been utilized as often or in the same way. Depending on the sport, it can also mean a higher aerobic demand. This may sound simple but it is vital to understand because of…
The SAID Principle
SAID stands for “Specific Adaptations to Imposed Demands.” Over time, our bodies adapt to the stressors we subject them to. If you’ve been spending all winter using certain muscle groups for one activity, your body needs some time to adapt to any new activity. A good general guideline is that we can see meaningful improvements in neuromuscular coordination - our brain’s ability to effectively recruit muscles for a specific purpose - in as little as two or three weeks. However, true tissue adaptation - building muscle and creating resilience to stress/load within our tendons, ligaments, and joints - takes a bit longer, more like 4-6 weeks.
The Risks of Doing Too Much Too Fast
If you don’t give your body time to go through this adjustment period, you can increase your risk of developing acute soft tissue damage and overuse injury. This can negatively impact your summer season and can turn into chronic problems if unaddressed.
How to Prepare for a Summer of Sends
The best way to prevent these injuries from occurring is to gradually build your volume, regardless of your sport. For example, if you are a runner and have kept up some mileage during the winter but plan to ramp up through the spring and summer, start by increasing your current mileage by about 10% each week. If you took the winter off completely, you will want to start with a low volume and intensity - something easily within your current capability - and then once again add 10% each week. 10% is a well proven method for adding volume without overdoing it, and can be adapted for other activities such as hiking and biking.
Another great way to reduce injury risk regardless of the season is strength training. When performed properly, strength training can improve your performance and tissue capacity by promoting many beneficial adaptations. Train the major movement patterns (push, pull, squat, hinge, lunge, carry), with a mix of bilateral and unilateral work while moving in different planes (sagittal, frontal, and transverse). Even just 1-2 short sessions a week is enough to capture some of these benefits!
If you follow these guidelines you’ll be well on your way toward crushing your summer endeavors. And if you’re coming into spring with nagging injuries, don’t assume they’ll disappear when you hang up the skis. Reach out to see how Pinyon can help you get back on the right track!
Why we don’t take insurance
Why don’t you take insurance? There are a handful of reasons. I get asked this all the time. My main reason is that I am ultimately able to provide you with better care. Cash pay practice allows me to see you at the rate and the frequency that I believe your problem dictates rather than what insurance will cover. I am able to incorporate treatments that I feel like you will benefit from rather than what is dictated by insurance. I am able to work on prevention care, maintenance care and rehab. I am able to spend more time with you and less time doing paperwork. My quality of life is better, my rate of burnout is less and thus my ability to deliver care to you is better.
It might actually be cheaper for you. A lot of people are on high deductible plans these days, which means you are responsible for all your costs up front up to a certain point. This means that if you go to a clinic that takes insurance, you will likely be paying the amount that they bill to insurance -- which is much higher than my cash rate. You might end up paying this for the entire treatment cycle depending on what your deductible is.
If you don’t have a deductible- you might have a copay which you are responsible for.
By the numbers
People who don’t have insurance.
This is an easy choice for you. A cash pay clinic will always be cheaper than a clinic who typically bills insurance.
People who have a high deductible
The cash pay rate will likely be cheaper-- or at least similar and you will get substantially more one-on-one care
People who have traditional insurance with a copay
Copays range between 20-50 dollars depending on the type of insurance
Typically get seen 2-3x a week for 4-6 weeks (that can really add up)
With one-on-one skilled care- usually get people back to normal with fewer visits over a shorter period of time for roughly the same amount of money
People who have good out of network coverage
If your insurance plan has good out-of-network coverage, cash pay might be a great option for you.
This type of coverage will allow you to submit Superbills (which Pinyon PT can easily generate) to your insurance in order to get reimbursed for some or all of your PT costs in the cash pay setting.
Headaches: Causes and Treatments
What causes headaches? How do we treat headaches?
Have you ever gotten a headache? Chances are pretty good--the prevalence of headaches is around 50% globally according to the WHO.
If you had one, you know how debilitating they can be. The tricky thing about headaches is that they can be caused by lots of different things. Sometimes understanding the cause is your best pathway to treatment.
Headache Types
There are many types but these are the most common
Tension Headaches: Tension headaches are often mechanical in nature (see below). Symptoms often originate at the base of the neck and travel upwards into head and face.
Migraines: These headaches are often pounding or throbbing in nature and can be accompanied by other symptoms like sensitivity to light, noise, and smell. Nausea and vomiting can sometimes occur as well. Symptoms can last for a few hours up to a few days.
Sinus Headaches: Typically present in the front of the face, above and below the eyes. These are a result of inflammation in the sinus cavities which can occur with infections, viruses and allergies. They are commonly accompanied by congestion, sore throat or runny nose.
Hormonal Headaches: These headaches vary in presentation but will occur in conjunction with hormonal changes.
Causes
There are many different causes of headaches. Knowing the cause and type of headache can often help you find an appropriate solution.
Illness: This can include infections, colds, a virus, and allergies. Inflammation of the sinuses can cause pressure headaches.
Mechanical: Meaning movement or lack there of influences your symptoms. Tightness in your upper traps, SCMs, and suboccipital muscles can refer pain to your face and head causing headache symptoms. Mobility deficits and restrictions in the upper cervical spine can also cause headache symptoms.
Environmental factors: smoke, pollutants, chemicals or certain smells can also cause headaches.
Physiological factors: hormones, lack of sleep, changes in blood glucose levels and food sensitivities, alcohol and dehydration.
Can physical therapy help?
Oftentimes, yes! Physical therapists are trained to help determine the cause. Through a skilled evaluation, physical therapists can help determine if there is a mechanical component to your headache. Meaning, is there some kind of range of motion limitation or mobility deficit that is contributing to your symptoms. This is done by taking a thorough history and performing a mechanically based physical exam. Through a movement assessment in screen, we are able to help rule out other causes of headaches. Once the type of headache and cause of the headache has been determined, we can provide skilled manual therapy and prescriptive exercises to help address those deficits. The main goal of headache treatment is to understand it so that we can provide you with the proper education and tools for self treatment and prevention.
Physical therapy treatments that can help headaches
Depending on the type of headache, there are multiple options that can be used to help treat headaches.
Self mobility exercises like a cervical retraction can be incredibly helpful in treatment of headaches, especially those that are mechanically related. Education on posture, sleeping position, hydration and other lifestyle factors can also help. Stretching and self trigger point releases, mindfulness/meditation, strengthening of the deep cervical muscles, posterior shoulder and paraspinal muscles, mobility of the cervical and thoracic spine, joint mobilizations, soft tissue mobilization and trigger point dry needling can also be used.
Do you get headaches more than once a month? Book online for a free consultation or schedule an appointment so we can help you figure out what the cause and appropriate treatments are.
References:
(https://www.who.int/news-room/fact-sheets/detail/headache-disorders)
https://www.webmd.com/migraines-headaches/migraines-headaches-basics
https://www.webmd.com/migraines-headaches/migraines-headaches-basics
Why Meditate?
Photo by Daniel Mingook Kim
The reasons to meditate are endless. Meditation and mindfulness have become sort of “en vogue” but honestly, for good reason.
Mindfulness meditation can reduce the severity of perceived pain and disability in a chronic pain population
Mindfulness meditation and reduce anxiety
Improve sports performance
Improve cardiovascular outcomes
Difference between meditation and mindfulness
Mindfulness: an awareness or specific way of thinking and living
Meditation : “Meditation is a practice where an individual uses a technique – such as mindfulness or focusing the mind on a particular object, thought, or activity – to train attention and awareness, and achieve a mentally clear and emotionally calm and stable state” (Positive Psychology)
You can utilize meditation to work towards living more mindfully.
Generally I will be speaking about the practice of meditation and its many forms. For people who have tried meditation and suggested that it wasn’t for them, I would recommend a few things: Try it more consistently for a longer period of time; and consider a different type of meditation practice to see if that resonates more with you.
Resources
The Effects of “Mindfulness Meditation for Pain Management” on the Severity of Perceived Pain and Disability in Patients With Chronic Pain
The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review
How Different Types of Meditation Can Enhance Athletic Performance Depending on the Specific Sport Skills
https://www.ahajournals.org/doi/full/10.1161/JAHA.117.002218
https://positivepsychology.com/differences-between-mindfulness-meditation/
My Meditation Journey
It all begins with an idea.
My own meditation journey has gone through some ups and downs and that’s ok. My first exposure to meditation was in college with my first exposure to yoga. I remember the yoga instructor walking us through a meditation during savasana. It was always easier for me to settle into that relaxed state when she guided us. I found it very difficult if left to my own devices to unwind and relax. Regardless, I always felt good after. After that initial introduction, I would dabble with a meditation here or there. I got a little more exposure when I was a student in PT school during my clinical rotations working with a chronic pain clinic. Looking back, it is shocking how little exposure I had, especially considering that all of my formal education was in the health and wellness realm.
Photo by Mathilde Langevin
After graduate school, I tried a few different apps but honestly was too cheap at the time to purchase the full version so would usually end my journey when the free trial was up. I restarted my journey with meditation again when I joined a 30-day meditation challenge hosted by another practitioner. It was nice to have a weekly accountability and go through some guided practices but even then I couldn’t “make it stick”. It wasn’t until part way through quarantine last year that I really had some consistency with my practice. I am by no means “a pro” if you can even be that (hint: you can’t). But hopefully through my ups and downs and personal struggles I can help you figure out what your meditation practice can look like and feel like.
From a professional standpoint, I often recommend meditation for my clients. Mediation can be useful to help modulate your nervous system, which can directly impact your pain symptoms. Mediation can also be useful for sleep regulation, improved performance, decreased depression and anxiety and overall improved happiness. Recognizing how difficult it can be to implement a new habit, I realized that just recommending meditation isn’t often enough. So thus began the concept of a 30-day challenge!
Things to consider: Like any behavior change adding meditation into your life can be challenging. In general, utilizing some sort of accountability can be super helpful in this (whether that is external or internal). Pair it with something that you are already doing. For me, I was able to make this habit stick only after I put it into something I do daily regardless of a workweek or weekend. We take our dogs for a walk every day (rain or shine) so putting my daily meditation practice in my schedule right after our dog walk has been very successful for me.
Types Of Meditation
It all begins with an idea.
TYPES OF MEDITATION
There are many different types of meditation, each with their own emphasis. I recommend trying a few different types out to see what works best for you.
Different types of meditation
Transcendental meditation: “TM is a passive and relaxing process. While practicing, one uses a mantra (in this case, a monosyllabic sound) to help the mind transcend the process of thought.” (Need a specific trained practitioner for this)
Mindfulness meditation: involves being aware of the mind and its thoughts as you gently redirect and refocus to the present moment. Not controlling thoughts, recognizing them and redirecting them to a specific focus of the present moment (like your breath).
Mantra meditation: Involves picking a mantra of your choice and repeating it. Mala beads can be a useful tool for this.
Zen meditation: Working on thinking about nothing (goal is to reach nirvana-like state)
Guided vs unguided: Guided meditation is led by someone else walking you through one of the types of meditation. This can be a useful tool for beginners. Unguided meditations (also called silent meditation) can be useful for someone who has already developed a practice. It involves the person sitting in silence and observing/redirecting their own thoughts and feelings and sensations. A meditation timer can be useful for this.
Focused attention: Focusing on your breath as an anchor. This is a simple and straightforward way to redirect your wandering mind.
Body scan: Focusing your attention on the sensations of your body -- starting at the top or bottom of your body and noting any of the sensations that arise. You can practice some non-judgment by noting them and not giving them any particular meaning. You can also go through a progressive relaxation of your body through your body scan.
Noting: This can be a useful practice to create space between thoughts and the present moment. This practice involves you observing what thoughts/emotions arise, naming them “thought” or “emotion” and then letting them go as you redirect to the present moment. Sometimes this can shed some light on frequent patterns we fall into.
Visualization: This involves visualizing a person or thing and drawing your attention to that. This technique is similar to focusing your attention on your breath. I will often visualize something that brings me joy, like a special spot in nature or my dogs or a friend or family member
Loving kindness (metta) : The practice of sending positive energy and good vibes to ourselves and others (including those we love dearly but also those we don’t know or don’t necessarily like). This can be helpful to get me out of a bad mood or help me get out of a cycle where I am ruminating about an interaction or situation.
Reflection mediation: This is often where a gratitude meditation would fall. You ask yourself questions and note the answers.
Yoga meditation: Kundalini or the practice of savasana are two examples.
Chakra meditation: Chakra meditation focuses on the energy pathways or chakras in our body. It works on clearing and opening them through breathwork and visualization
Soundbath meditation: This is the use of sound bowls and other vibrational musical instruments to create relaxation and focused energy in the body
Concentration vs mindfulness: You can’t be mindful without having concentration but concentration doesn’t necessarily mean that you are practicing mindfulness.
“To begin practicing concentration in meditation, you can set a timer on your phone and practice counting your breath. Start at 1, count to 10, and then go back to 1 again. Do this in a loop for 10–15 minutes, twice a day, and see how your concentration improves. Mindfulness begins with not judging yourself for where your mind wanders. Remember, be gentle.” - Joshua Schultz, Psy.D.
These are very general breakdowns. Meditation and mindfulness have a deeply rich history intertwined in many different cultures, religious beliefs, and spiritual practices. This is intended to be the tip of the iceberg in your understanding.
I recommend checking out some of these apps/resources to try out some different types of guided meditations:
Headspace
Insight Timer
Calm
Most common workout apps now have some basic meditations (Peloton App, Fitton App etc. )
YouTube
https://positivepsychology.com/differences-between-mindfulness-meditation/
How To Meditate for Beginners
It all begins with an idea.
Photo by Max van den Oetelaar
Find a comfortable place to be. It helps to find a place that you won’t be interrupted.
You can sit or lie down. You can be on a chair, ground, couch-- whatever you chose. You should be comfortable but alert.
If you are using an app-- start up a guided meditation. (Consider Insight time, Calm, or Headspace)
If you aren’t-- don’t worry. The simplest mediation to begin with is focusing on your breath. Take three deep breaths-- filling up your belly and lungs and then slowly releasing the breath.
Next, allow yourself to breathe normally. Focus on the breath without trying to control it, perhaps noting the sensation of the breath on your nose or how it feels in your chest or throat or belly. Don’t make any judgments about these sensations, just let them be. It is normal for thoughts to pop into your head or for your mind to wander. When you realize this is what is happening-- gentle redirect your attention back to your breathing.
There you have it-- you meditated-- CONGRATS!
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