Hey guys. What's up? It's Stephen Dunn with CORE Therapy and Pilates. We're in Westlake Hills, Texas and today I want to go over something that's very important. 

The 4 Stages of Physical Therapy Rehabilitation

It's called the four stages of recovery and we're going to talk about the recovery from a physical therapy standpoint here. This graph is showing us two different things. Recovery from zero percent to 100 percent and the number of visits in physical therapy from zero to 14.

So with that said at the national average of 11 and this showing 14, the 14 is just getting into phase four and so that's where I want to now break down each phase.

The 4 Stages of Recovery

1 - Minimize Pain & Inflammation

Phase one is basically to minimize pain and inflammation and that's in this first six visits or so, usually twice a week in the first couple weeks. That allows your pain to lower and then we get into phase two as the pain is less.

2 - Restore Mobility, Flexibility, & Strength

Phase two is to restore mobility, flexibility and strength. From an again average standpoint across the whole nation, phase two is visit seven to eleven. All right, now again at the end of visit 11, we're sitting at 70% improved.

3 - Return to Normal Function & Activity

Phase three is the return to normal function and normal activity. People start feeling better here. A lot of people fall off the plan of care as soon as they feel better and then a lot of people fall off here because they're feeling better and they're moving better, their mobility is better but they're really not maybe ready to go back to tennis and ready to golf at full speed.

4 - Maintenance & Prevention of Injury

Stage four is the program that we're we're so proud of here at CORE, as it's the maintenance and the prevention of injury. For us, stage three and four is our pilates program.

Stage one and two is our physical therapy program and in phase three our physical therapists start progressing people into stage four on our pilates equipment with some clinical physical therapy or some clinical pilates or some pilates based physical therapy, whatever you want to call it.

Then stage four is really our pilates program where we have the ability for people to come in privately or in group sessions.

So... I wanted to go over that today because again most people get to this point here and they're 70% better. A lot of people will get to here and all of a sudden they're starting to make that 100 better and then they're not coming back into PT six months later. 

The reality is we teach people to do a lot of things at home and how to maintain it but people don't do it. 

Life takes over, their jobs, kids... reality takes over and it's hard to keep up with the program. Whereas, we’ve been designing programs that make it easy for you to stay committed and stay moving, progressing forward to meet those goals, to reach those goals and make those transformations. 

So, guys, thanks for watching those are the four stages of rehab broken down into each stage and y'all take care and we'll see you all soon.

Call 512-215-4227 if you would like to learn more about our programs to help you get out of pain.

Have You Been in a Car Accident?

If you're experiencing pain or stiffness following a car accident, understanding the recovery process is crucial. Our latest blog post, Stage 1 of Treating Auto Accident Injuries: Your Path to Pain-Free Recovery, delves into the vital initial steps of rehabilitation, focusing on minimizing pain and inflammation. Learn more about our expert approach to early injury care and how we can help you begin your journey towards healing

Hi everyone, hope you guys are having a great day. So today, I would like to hop on and then talk a little bit about carpal tunnel syndrome. The three great exercises or stretching exercises that can help to relieve carpal tunnel syndrome. The symptom of the numbness tingling going on.

What is Carpal Tunnel?

So first of all, we can talk about the mechanics of it. So Carpal Tunnel is pretty much like this. I’m using some pens and markers and a rubber band to make an analogy of this. Carpal Tunnel is a ligament on top of several bones in the wrist that’s forming a channel of tunnels.

And then we have several tendons going into our fingers that pass through the tunnel.  Also the median nerve that pass through the middle of the tunnel.

So, whenever there are tingling inflammation going on happening at the ligament on top of the carpal tunnel or some tingling swelling happening of all the tendons. Then the pressure within the tunnel will be increase.

And so, the nerve would be compressed, having pressured. And then the nerve starts to be angry. And then that’s why we are feeling some numbness tingling for carpal tunnel syndrome.  Also for some folks, there might be some weakness happening in their hand.

So the stretches are basically trying to restore the space within the tunnel so that the circulation to the nerve can be better. And then that’s how the stretches, the exercise I’m gonna show you guys can be effective in managing the condition.

3 Best Exercises to Manage Carpal Tunnel Syndrome

1. Rainbow Stretch

The first one, I call that a rainbow stretch. So a rainbow stretch is you start by crossing your arm to the other shoulder. And then you draw a rainbow all the way to the side. And then it’s very important to the side. 

Everything. The forearm, the inside of your arm is facing to the sealing, and then you are straightening your wrist, pointing your fingers towards the floor to fully elongate all the soft tissue there and then come back in. You straighten everything out, and then come back in.

And then remember that to manage carpal tunnel syndrome, nothing is a sustained hold because nerve cannot be stretched. Nerve, it’s not muscles, it’s not elastic. It can only be glide and mobilized but it can never be stretched.

That’s anatomically different for nerves compared to muscles. And then make sure the entire process of the rainbow is a stretch so you need to fully elongate your arm. All the way out, and then all the way in.

And then, the focus of this exercise is gliding the median nerve to move it long and then to move it short. So it’s kind of like creating a gliding type of motion of the median nerve happening within the tunnel. And so the circulation would be better this way.

And then also when during the process, we are fully elongating the arm all the way. It’s kind of creating the effect… 

Creating some tension along the fascia, which are the soft tissue that will eventually connect it to the ligament on top. It can create a very minimal effect of pulling it out and then coming back in. A very mild pull and then, coming back in.

Very, very minimal amount of enlarging the space during the process. So that’s why it’s being very important to reach all the way out, and then all the way in. That’s the first exercise, I call that a rainbow stretch.

2. Prayer's Stretch

The second one, is a prayer’s stretch. The prayer’s stretch will be more targeting the transverse carpal ligament which is the ligament I talked about on top of the carpal tunnel. To create a same effect of stretching, opening and then loosening the ligament on top.

And then the way to do that is you simply put your palms together to form a prayer’s position and then you go as low as you feel. A little pull, a little stretch there, and then you come back. And then you switch to your fist, and then you go down fist by fist. You go up again, prayer’s stretch and then fist against fist.

This is the same thing that create a little bit of opening mild stretching and then release of the ligament. The top of the carpal tunnel, very, very mild. And then it also creates some very mild gliding of the median nerve happening within the tunnel. That’s the second exercise, I call that a prayer’s stretch.

3. Air Guitar

The third exercise, I call that the air guitar. But that basically is you just flex your fingers along the second joint from your palm. So, it’s like this. It’s not the full fist, this is wrong. You only flex the second joint. Second joint of each of your hand.

And then if you want to have a better control, you can totally stabilize with the opposite hand. The air guitar. And then, the reason why this one is effective… It’s because, we not only have the tendon in the carpal tunnel.

Again, like what I said earlier. Other than the median nerve, we also have other tendons within the carpal tunnel. 

So, by just doing the air guitar exercise we are able to isolate each tendon. And then create gliding happening at each of the tendon which hence kind of provides a plumbing effect that can also increase the spacing, improve the circulation within the carpal tunnel. 

That’s how to relieve the pressure within the carpal tunnel that’s causing the carpal tunnel syndrome. And then causing the numbness, tingling and even weakness in our hands.

So these are the three good exercises to do to help you manage carpal tunnel syndrome.

And then last but not the least. I also want to talk a little bit about why people would develop carpal tunnel syndrome.

It’s hugely because now a days, we are using our computers a lot. And then most of the times, our tables are too high or our seats are too low. Or some sort of setting about our seats that’s having some problem.

And then eventually, we are putting a lot of pressure on to our wrist. Especially when we are tiny, we put too much pressure on our wrist. And then, that’s causing some extra pressure at the carpal tunnel syndrome.

So a very easy fix is to make sure the height of your chair/your stool and then the height of your table is proper. If it’s appropriately set-up, you should be able to put your forearm on the surface of the table. 

My elbow is at 90 degrees. And the forearm is fully supported so that my shoulders are relax, my arms up support it.

And then if you have better chairs, it would be great if they have some sort of arm support. And then, that can help your muscles to relax better.  So you won’t build up too much tension in the carpal tunnel in your wrist.

So these are the exercises and the tips and then some knowledge about carpal tunnel syndrome.
And I hope you guys learned something. 

If you have any questions, feel free to let us know. I’m Andy Tseng physical therapist and occupational therapist at CORE Therapy and Pilates.

If you ever have any question, feel free to give us a call at 512-215-4227.
We look forward to working with you. Have a great day everyone.

With the COVID-19 pandemic going on, a lot of the kids are restricted from going to school and are doing virtual school from home. A lot of families noticed that their kids are having a hard time to participate in their online school. People are not used to doing things that way.

Even though a lot of schools are starting to open back again and starting to have students back to school now. However, this issue of learning and how to keep the kids concentrated, is still a very hot topic. 

But what is learning have anything to do with Pilates?

Attention is a very big component of learning. If we are not able to pay attention to what's being delivered by a teacher, we will not absorb any new information. And guess what, because of the new technology and the information overload we are receiving nowadays. Everybody is having a much-shortened attention span. 

There are studies conducted stating that the average attention span of an adult is 8 seconds, which is shorter than a goldfish. And with kids who are also still in the face of developing their attention span, it's even worse for them to concentrate on what's delivered at school.

Nowadays, especially in a digital format, they get way more distraction. 

As an occupational therapist, when we are working with a lot of kids, and some adults who deals with attention issues like ADHD. Many other conditions leading to attention deficits, we use an approach called Sensory Integration.

What is sensory integration therapy?

We pretty much incorporate a lot of the sensory input for proper receptive, vestibular and for many different types of sensory input. Specially the appropriate receptive sensory input. It is found to be calm everything down, and help you to improve your attention span. 

Basically, it's like any sensory input related to changing your body position.  How you move your joints, body parts, etc. These are some of the inputs of proper reception. 

Also, with Pilates we are offering here at core, we constantly move our clients into different positions. From lying down your back on your stomach, sitting on the box, standing on the reformer, and different types of equipment. 

A very specific component we try to incorporate with every one of our class is a session of jam. It is a very good way to incorporate the sensory input, and facilitate some of the learning performance. Some of the attention the kids are going to need when they are dealing with schoolwork. 

School-Life Balance

If you are sitting in front of a computer doing work for several hours consecutively. Then during breaks, you change to a different tab or windows doing different tasks but still on the computer, then pretty much not a very good balance. The environment and the scene are pretty much the same. 

You lack the different types of sensory input and the variability of your environment. The lack of variation can also decrease somebody's compliance and attention span.  Enough to further limit one's learning ability. It is another thing that’s valuable for us who provide sessions like Pilates classes.  To make the kids move out of the computer and do something different. 

Something that's going to be beneficial to help them and change the scenery to give them a different input and experience. And help them to get back to their learning with better performance. 

This is actually applicable for everyone. As adults, when we are sitting in front of the computer all day to do our work, it's hard for us to concentrate on our tasks for a long period of time. It's very hard for us as well, we often need to take a break, like a five-minute break every two hours. 

For the athletes, they're not going to do the training for several hours a day consecutively. They're not going to just practice on the sports. But they are doing it professionally while doing different types of training to maintain the balance. 

They will also need to take a break to not doing any physical activities at all. Because sometimes, it's all about the balance. Balance is also a very important component to address learning. 

Probably one of the most complicated situations that we see in a rehab setting is a condition called the Complex Regional Pain Syndrome or the CRPS. It has many different names, but it's thought of as something related to a traumatic event which aggravates the sympathetic nervous system. And that can cause extreme pain to the patient. The pain is actually way more intense than the actual injury itself.

From my past experience, as an occupational therapist, some patients told me that there are doctors who told them that they made their pain up and that they didn't have any pain. There are also people saying that it was just their imagination. And I would like to just to say that you cannot just make up what you are experiencing, it's true. We acknowledge that. And we are to assure you that there are available solutions for your pain.

 
This is also a very challenging situation. CRPS does not follow a specific pattern, it doesn't follow a nerve root pattern, a dermatome myotome or any neurological examination that can categorize which makes it harder to be diagnosed.

It has different types of symptoms because the sympathetic nervous systems are involved. Some of the symptoms may include the hotness or coldness of a patient's hands or in some cases, the color changes into red or blue. That’s because some blood circulation is affected. It may also include extreme swelling, hair loss, hair growth, or nail losses, nail growth, but it’s very different in presentation.

Oftentimes, they have a lot of joint stiffness that they cannot move or it has a lot of range in motion which is mainly stopped by pain. But they can’t link it to any traumatic event that's specific or relevant to that situation.

The mechanism of injury can be very erratic and irrelevant to look like which is why it's hard for them to be diagnosed and be treated early. That is the reason why a lot of the treatment doesn't show as much of a research findings or effective treatment to treat this condition. Because they probably already failed. And when all of these patients are finally being categorized or diagnosed into CRPS, it’s already a little too late, which is sadly, one of the limitations the medical field is currently experiencing.

There are two lady patients I've been seeing lately. The first one, she just randomly had a thumb pain. She woke up one day, and the only thing she can remember was she had a long car ride during a road trip, which is not a traumatic event. But then, her thumb flared up very bad.

She described it as a 10 out of 10 in pain. And also, she described it as if she couldn't move her thumb or wrist at all. And when she came in, I felt that her hand was extremely hot and it looks red, it looks very swollen and the range of motion was very limited, which is the most typical presentation of the syndrome.

 
We did one session, talking a lot about stress and which one is the most common treatment approach. To handle this condition and adjust within one session, we are able to help her and drop her pain from 10 to 3 out of 10.

Then the next time she comes in, her range of motion was back to almost normal like 80% or 90%. To her other side of the hand, which has an extremely better result in just one session. Because of early recognition, she came in the next day or two days later, we were able to start a treatment quickly. We were able to take care of her condition immediately. 

A lot of the reason why CRPS is a very challenging situation is because most of the patients who finally receive the proper treatment, it's already after four or five months or years later, which already made the condition very chronic and hard to deal with. So, early recognition and early treatment is the key to effectively manage CRPS. 

If you just do regular desensitization program that many clinics offers, it's probably not that effective. The nerves are using different tracks. Normal desensitization program would actually make the condition worse. By making it worse, you are already making an angry nervous system to be even angrier by doing inappropriate treatment.

The proper treatment is actually putting a lot of stress to the joint and giving it enough of a stress sensation. We call that the deep pressure sensation, which uses a totally different nerve pathway into the brain, and helps you to inhibit the pain more effectively. This is the method I used with the Second Lady.

Then, she said that things would be way different if she had just found the right provider on the first time. This condition may be challenging, but there are clinicians who are capable of dealing with this. That can provide you a treatment so you can do better versus wasting months or years of your time suffering from a range of 10 in pain every single day.