Baltimore - Reduce Lower Back Pain Today
Hi, this is James with Pioneer PT. Day in and day out I get asked about lower back pain. It is the most common thing that people get. About 80% of people get debilitating lower back pain at least once in their lives. So, I wanted to come out with a video to show a few of the easiest exercises that people can start with. These are universal and most anyone with lower back pain can benefit from these. One of the hardest ones to teach is called a pelvic tilt. I want to go into more detail on that first.
While lying on your back, I want you to pull your pelvis up. I want you to think about pulling your belly button up and in and flattening your back to the bed. Think about your tailbone, your tailbone should be dropping towards your feet while your belly button pulls up. If you want feedback, with your hands wrapped around your hips; when you tighten up pulling your belly button up and in you should feel the abdominal muscles right underneath your fingers become tense. Hold this one for a good 10 second count and get at least 10 of those to help strengthen your core.
Next one, a nice easy stretch you can do is called a lower trunk rotation. Stretch from side to side, nice and easy, helping to gap the lower back. Get a good hold as you go side to side (10-30 seconds)
Lastly, I would recommend a piriformis stretch, to stretch out those tight glutes. With your ankle resting on your opposite knee, grab your knee (closest to the joint), and pull up and across getting a good stretch through your glutes. If you prefer more of an intense stretch, you can grab under your opposite leg and pull up. This will also target down on the glute. in the piriformis. Try to hold a good 30 seconds to a minute, and relax.
To review, the 3 universal exercises you can do for lower back pain include, pelvic tilts, lower trunk rotations, and piriformis stretching. If you have any severe aches or pains, especially burning, tingling, or numbness increasing, please contact your physical therapist. Take care, and best of luck!
Video Into and Tour of Pioneer PT
"Hi my name is James Dulkerian, doctor of physical therapy, and owner of Pioneer PT. I have been a physical therapist for about the past 10 years, and I always wanted better for the patients. So I came up with a mobile clinic. A mobile clinic has a lot of advantages. A couple main things, it is much more convenient, and it is also patient-centered. I can see each client one-on-one for a full hour, all with a doctor of physical therapy. You will not be passed off to another person. You will not be seen at the same time as another person. That's a huge advantage, that way I can focus on getting to the true source of the discomfort. Also being mobile, I can see you at the local park, I can see you at your home, and I can see you at your office, or anywhere we deem fit. That way it takes the stress out of commuting to physical therapy when you are not feeling well, because I show up to you.
I would also like to give you a look inside today to see what the mobile clinic is like. Inside I have a private treatment room, with a bed that I can take inside your home or office if you feel more comfortable. In the back, we've got all the equipment you need for strengthening purposes, and extra equipment in the cabinets. The van also has plenty height. I am over 6'2" and can still reach overhead. That way, if the weather is bad, we can keep the work inside, but we also have the advantage of going outside when the weather is great.
If you have any questions or concerns please feel free to reach out. I can be reached at (410) 929-3532 and I can help answer any questions you may have. I want to see you pursue your passions to the fullest! Take care."
Marathon Season Recovery
Congratulations and special shout out to everyone who participated in the Baltimore Running Festival! It is marathon season and you have just completed 26.2 miles! It is a lifetime achievement to be proud of and something that not many people can dream of accomplishing. The amount of preparation, hard work, and determination it takes to complete a marathon has paid off.
But now what? More than likely you never trained for the whole 26.2 miles, but rather only about 20 miles for your longest run and then relied on adrenaline and determination to get you to the finish line. By that 20 mile marker you could start to feel it deep in your muscles and joints. Asymmetries are bound to form as one calf tightens, you start to cramp in a hamstring, or your IT band becomes irritated as you push your body to its limits to reach the finish line. The soreness is from over-stressed muscles, which have caused micro tears within the muscle. Don't worry, this is a normal occurrence and your body will work to rebuild and become stronger. It does not change the fact that you may be sore.
Initially a hot/cold alternating shower to improve circulation, then refueling your body with proper fluids and protein should be taken into consideration. Starting the second day, a combination of rest with non-stressful movements to promote blood flow to sore muscles will be important to decrease tension. Try an easy walk, swim, stretching routine, or easy yin style yoga. You hope these areas of tension go away on their own with rest, but they often hang around feeling restrictions even with daily activities. After the initial rest period when you begin back training these muscle imbalances can hinder your body from performing at its peak ability and can lead to more serious injury.
It is advised that you follow up with a knowledgable physical therapist who can work these imbalances out through deep tissue work or even myofascial decompression. They will also teach you strengthening exercises to improve your running form by targeting the specific areas of weakness that lack the necessary endurance for such a long distance. If treated early you will often only need 2-3 sessions to get back to your baseline, plus you will have greater knowledge to maintain your body in the future. This is all at a relatively low cost considering registration fees, running shoes, hotel room, and your desire to continue your lifestyle in a worry free manner.
Pioneer PT has the ability to come directly to you via a mobile clinic and provide one-on-one care with a doctor of physical therapy for a full hour. Service is direct care meaning you will not need to waste crucial time going to your doctor or a specialist for a prescription. Pioneer PT is your musculoskeletal expert and direct point of access for heath related needs.
Fall Mountain Biking Tips:
Fall is my favorite time of the year in the Mid Atlantic. The colors, the smells, the weather, the food, and family are all amazing. It is the perfect time to get outside to take it all in and enjoy a nice trail ride.
The leaves are now falling and they sure look nice, but this is the time of year to be careful on the trail. Freshly fallen leaves are slick and act just like ice. They also hold moisture longer, which adds to a slippery ride. These tips will not only benefit you now, but can help you to become a better rider when conditions are ideal. Here are some tips to enjoy the fall mountain biking season.
First thing is first, know the trail if you are planning to get after it. Knowing the trail does not make it boring, it makes it more fun. Riding new trails are exciting, but it is not as enjoyable not knowing where you are going or the typical conditions. Your "home trail" is more fun, because you learn where you need to carry momentum to make it up a hill more easily, or hit off a log or rock to catch some air. You also learn where to slow down so you do not take a spill in sections of the trail that are technical or wet. Lessons are often learned the hard way and you remember them.
Second, always keep your eyes down the trail picking a line of attack. This will help you to avoid obstacles that slow you down and decrease the chance of pedal strikes. Sometimes with the added leaves and sticks that have fallen it will actually smooth out the trail in certain sections. Maintaining speed and keeping your eyes up allows you to hop obstacles that may be obstructive and help you to maintain a more direct line of attack on the trail. Always stay on the attack with the most direct route.
Third, stay light on your bike. This includes your hands and feet. There is no need to give your handle bars the death grip, it will just increase fatigue. Staying light on your bike allows you to roll over obstacles easier. For example helping to pull your bike or hop over an obstacle by first pulling up on your handle bars and then lifting your bike with your feet will decrease hard hits that slow you down. Use your legs to absorb the hits rather than holding your body stiff, and you will last longer on the trail.
Fourth, you must understand center of gravity and not be afraid to move around on your bike! Riding in a straight line it is definitely more efficient to keep your body still, but how often is your trail straight?
Keep your weight over your rear wheel the majority of the time. This will assist descending and even more so ascending. Keeping your weight over your rear wheel and maintaining a seated position will ensure that all the power you put out goes directly into forward momentum. If your weight shifts too far forward to your front wheel, then those difficult ascents will turn into hike a bike because your back wheel will lose traction and spin out especially on the leaves. On descents keeping your center of gravity low by either hanging off the back of your seat or hitting the dropper post will allow you to have greater control. The front wheel will float over obstacles and have less chance of hanging up causing you to go over the bars.
Watch the camber of the trail. For example, if the trail is on an angle from left to right with the left being the high side, DO NOT lay your bike on edge to left in attempt to turn left. These extremes cause decrease tire to ground contact area and with the slick conditions make you prone to slipping out. Instead shift your weight on the bike by moving your body to the LEFT with gentle handle bar turn to the left. Try to keep the bike more upright, which increases tire to ground contact area and helps to maintain traction.
Fifth, we just touched on: maintain maximum tire to ground contact area. This can also be achieved by running lower air pressure in your tires, which increases surface area of tire to ground contact. This can be achieved best tubeless, or with plus sized tires. 29 inch wheels have more contact area than 27.5, but fat bikes rule when conditions are not at the best.
Enjoy, stay safe out there, and see you on the trails!
Ice or heat? R.I.C.E or M.E.A.T?
One of the most common questions asked by clients is what to use for their injury, ice or heat? Both have their place, both are beneficial for pain relief, but one may be better than the other. Ice constricts your vessels helping to limit swelling, and heat increases circulation helping the healing process by bringing beneficial nutrients and flushing out the waste. Both heat and ice also assist in reducing pain because they give our bodies another sensation to contend with. When ice or heat are applied, our larger sensory pathways kick in and help to overshadow the smaller pain pathways; therefore dulling the effects of pain.
Traditionally ice is used 20 minutes on, 20 minutes off for the first 2-3 days after an injury. This is where RICE comes into play. RICE stands for Rest, Ice, Compression, and Elevation. RICE along with NSAIDs or non-steroidal anti-inflammatory drugs such as Advil are often utilized. However, please consult with your doctor before taking over-the-counter medication, because NSAIDs have been shown to limit long-term bone and tendon healing. Swelling is at its peak at this point and it should be reduced, or should it? Reducing swelling will reduce pain short-term, but our bodies produce this for a reason. Swelling acts as a natural "splint" causing us to protect the painful area and promote healing when it is most crucial.
Now, the next step depends on the extent of injury and you should consult with your doctor or physical therapist before beginning. Here, MEAT, another method of dealing with injury comes into play. Timing can range from the day of with a minor muscle injury to 1-2 months for severe ligament or bone damage. MEAT stands for Movement, Exercise, Analgesics, and Treatment. I am a huge fan of early mobilization as long as there is no fracture or surgery requiring a lengthened rest period. Nothing crazy, but movement targeting gentle range of motion should be initiated early on after injury. Heat applied for 10 minutes prior to motion can promote circulation and allow greater ease of motion. Exercise should begin next, starting to strengthen the muscles surrounding the injury site. The easiest type of exercise is an isometric where you tighten a muscle without moving, like when power lifters pose by tightening their muscles or some of you may know Charles Atlas. Concentric exercises, followed by eccentric, and finally progressing to full body functional movements with the goal to return to activity. A is for Analgesic, which means dulling the pain like Tylenol or Acetaminophen. Tylenol helps to dull the pain without limiting circulation like NSAIDS. Pain relief promotes improved movement, but Tylenol too can have side effects. Those with liver problems may want to stick to ice and heat if pain is tolerable. Again with medication please consult with your physician or pharmacist if you are unsure. Finally, Treatment that involves mobilization and releases by a skilled practitioner such as a physical therapist, who is an expert in movement will help you return to full function and the activities you desire.
Unfortunately there is no straightforward answer, but I will try to clarify. I prefer a combination, as pieces of both RICE and MEAT have their benefits. Swelling acts like a natural "splint" for a reason during the initial healing process. At a micro level our bodies need this crucial rest period to heal. However, do not wait too long because humans are the best at compensating and will often find other ways to function, which is not always the best. Ice can and should be used early on for the first 2-3 days after injury then a combination of heat and ice can be used to promote circulation during the rehab process.
5 Benefits of Physical Therapy
1.) Improved mobility : You will have greater flexibility and freedom to move as you like through targeted mobilizations and stretches that are catered specifically to you and your problem.
2.). Strength gains: You will have improved strength and control during simple and complex functional tasks by addressing the correct muscle groups.
3.) Decreased Pain and discomfort: With an increase in range of motion and strength, you will have less inflammation of tissues and decreased pain. This decreases the need for long term pain medication use and it's potential side effects.
4.) Have tools to manage symptoms: Physical therapy is unlike chiropractic work or massage therapy, because we encourage active participation in wellness through education. Education of posture, a specific home exercise program catered to you, and information on how to best deal with your condition.
5.) Do what you love to do without restriction: Improving flexibility and strength, as well as decreasing pain and providing intentional education allows for you to return to activities that you love with decreased discomfort and fear.
The vision statement for the American Physical therapy Association is "Transforming society by optimizing movement to improve the human experience." That is my role and my wish to share with society. We are only here for so long, so why not enjoy the treasures that life can offer?
What does a physical therapist (PT) do? I wanted to address this, because I am not sure enough people know exactly what PTs can do to help. Our job is to reduce a client's pain and improve or restore full mobility through hands-on techniques, individualized exercise programs, and education to prevent or manage their condition. We work on everything from head to toe that is musculoskeletal in origin. Some of the most common problems include rotator cuff issues, and neck or back pain. Both acute, or chronic issues can both benefit from a proper treatment plan. Treatment often allows clients to avoid costly surgery or the need for prolonged use and side effects from pain medication. We promote life-long health benefits by promoting fitness or wellness oriented programs that allow you to be more active.
How do we do all of this? First off, we are highly-educated and licensed health care professionals. I went to Ithaca College for both undergraduate and graduate degrees, graduating with a Doctorate of physical therapy. Graduating from an accredited university is a prerequisite prior to sitting for an intensive state licensure exam that you must pass in order to practice. Then, one of the most important parts, we evaluate each client as an individual, gathering a history of their health and current symptoms. Evaluations typically start out similar to an interview delving into what is going on, how long it has been going on, what makes symptoms better or worse, etc.. We will then proceed to a systems review, palpate tissues and joints, screen strength, range of motion, and functional mobility. If problems are apparent, special tests can be performed, which allow a physical therapist to be able to confirm a diagnosis. For example tenderness to lateral or outer joint line of the knee alone has been shown to be very accurate in diagnosing meniscal injuries. Between the history and evaluation we are able to have a really good idea of the diagnosis without the need for MRI. After the area of dysfunction is determined then our education on tissues and their healing processes as well as medical conditions sets us apart in prescribing a specific and appropriate plan of care for each individual. Goals are set for each client's needs and desires so we can get them back to doing what they want. To stay on top of our game, it is required that physical therapists take continuing education classes every year, not only to maintain our license but to stay most current with new techniques and research.
Until now, physical therapists typically work in the hospital, nursing home, rehabilitation settings, in schools with children, outpatient clinics and with home health agencies. Pioneer PT introduces a new delivery of treatment via a mobile "outpatient" clinic that makes treatment easier and more private for the client, all while giving the best one-on-one care possible. No longer will you have to have the extra hassle to find a ride when you are unable to drive or take the extra time out of your day to travel to an outpatient setting. Pioneer PT travels to you whether your home, office, or wherever we deem fit. You also won't be crammed into an outpatient setting where you spend very little time with the actual physical therapist before being passed off to a technician who solely trained on the job. Clients will receive a full hour of one-on-one care with a doctor of physical therapy. Pioneer PT will fill the gaps where traditional delivery of care is lacking.
Hope to see some of you soon, so we can restore your movement and fuel your passions!
How Pioneer PT Began
I know some of you may be wondering, "What the heck is that picture, and how does it relate to physical therapy?" In short, this is a picture from my once in a lifetime trip that got the wheels spinning. However, after contemplating the question a bit longer, everything in my life has brought me to this point of launching the first of it's kind on-demand physical therapy clinic with a doctor of physical therapy that travels directly to the client.
Years before I knew I wanted to be a physical therapist, I had a sense of small business instilled into me ever since I was a kid. Both my mother's and father's parents owned small businesses. My grandmom on my mom's side owned both a flower shop in OCMD, and a clothing store in Towson, while my grandfather owned a successful door manufacturing business. However, my father's family business, Dulkerian's Persian Rug Co., dulkerianspersianrugco.com, made the largest impact on my life as I helped my dad every summer growing up while school was out. My grandmother repaired rugs for years, while my dad took over for my grandfather. Getting up and commuting an hour into Baltimore every day to wash dirty rugs for a living will definitely make you humble. However, it was something I was proud of. Dad worked so hard to support his family and to help people out. He has always made it more convenient for customers with pick ups, deliveries, and sales directly to his customers out of his blue work van.
I found physical therapy in my junior year of high school, and I knew it was what I wanted to do for my career. I also knew that this career would allow me a chance to one day own my own business. I worked hard and ended up going to Ithaca College to study physical therapy. This was when I met the most influential person in my young career: my professor Ernie Nalette. He always talked about the profession of physical therapy and how it truly was in the real world. He became a mentor influencing me to question the status quo, and to want better for my patients. Physical therapy should not be an assembly line, packing as many people as possible into a day. I took his advice to heart, but worked on honing my skills for just about the past 10 years, becoming very proficient in hands-on techniques.
I have continually seen decreases in reimbursement from insurance companies forcing physical therapists to see more people, and increasing deductibles or co-pays for clients. I wanted something better. This was about the time I took a once in a lifetime trip along the California coastline camping, surfing, and hiking along the way via a 1984 Volkswagen Vanagon named Lone Star from Vintage Surfari Wagons, www.vwsurfari.com. Thank goodness we were not there during the mudslide this past year, because that was the same stretch of road in the Big Sur that we boondocked for the night to watch the sunset over the cliffs. I would highly recommend this drive at least once in your lifetime. Anyway, this was the time I began to realize that it may be possible to create a mobile clinic that I could take directly to clients, with everything I need inside to provide the best quality physical therapy. I made it my mission, putting in a lot of hard work preparing the business, even traveling all the way to the Lone Star State to purchase my big blue van. From scratch, I built out my van into a physical therapy office on wheels thanks to a lot of help from my family. Pioneer PT was born, and now I hope to help as many folks as I can by providing the best possible care directly to you!
James Dulkerian, DPT
Active outdoorsman with an honest soul and a passion for health.