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Is COVID 19 Stressing You Out?

Is COVID 19 Stressing You Out?

Mindfulness Definition: What Is Mindfulness?
By Kari Osborne DPT

As a physical therapist I am used to treating pain. Pain is often viewed as a physical response to injury, but it is very emotional as well. We can feel emotional pain from harm, change, and loss just to name a few. Many of us are experiencing emotional pain due to these and other reasons right now, and just like physical pain, unless it is managed, can turn into a cycle which is difficult to break. 

We have all been impacted by COVID19 in one way or another. Whether it is those working on the frontlines in essential industry, those managing working and schooling kids from home, or those who have lost their jobs. Not only have we experienced change in our work lives, but we have experienced substantial change in our social lives as well. We are social beings not meant to live in solitary which many of us have been asked to do. Before COVID even ramped up here in America feelings of loneliness were on the rise. A report released by Cigna in early 2020 showed greater than 60% of Americans feel lonely, a 13% increase from 2018. Loneliness can have significant effects on our health and has been linked to depression, heart disease, and has even been shown to impact our immune system. It is important that we carefully assess our mental health, and those around us, to help recognize changes that may need addressing. 

Below is a picture depicting the pain cycle. Now I don’t know about you, but I can recognize a few of those descriptors in my current life, fear of the unknown and anxiety just to name a few, so how do we break the cycle and move forward? 

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The first step is recognizing what is going on. Below is a list of symptoms associated with depression (see Table 1). Now there are many different types of depression some more severe than others but what I want to focus on is situational depression. Situational depression is typically short-term and brought on by traumatic or life changing events (ring any bells for you?). Oftentimes, as is our current state, there is not much you can do to change the traumatic event or life change. There are however things you can do to help combat the symptoms and break the cycle. 

Table 1

Symptoms of Situational Depression
Lack of enjoyment in activitiesRegular crying
Constant worrying/anxiousnessDifficulty sleeping
Difficulty focusingTrouble carrying out daily activities
Avoiding social interactionThoughts or attempts at suicide

One of the best things you can do to break the cycle is to increase your activity level. Research has shown that exercise reduces the risk of cardiovascular disease, stroke, and boosts our self-esteem. Research also shows a strong link between exercise and the reduction of stress and depression symptoms. Physical activity increases natural endorphins that make us feel good and boosts our mood. It also increases blood flow which has been shown to increase nerve cell connections in our brain and help us think more clearly. Although it may feel challenging at times it is important that we get up and move. It is recommended that we exercise for 30 minutes a day, but this can be broken up into smaller 10-minute intervals if needed. When combined with Vitamin D (aka sunshine) another natural depression fighter, the results can be exponential. I have found that on days I exercise I feel more motivated, accomplished, and sleep substantially better than days I do not, especially when done outside. If you are worried about managing your kids while trying to exercise get them involved by having them hunt for items while on walks or participate in an online workout with you. If there is an injury or physical ailment holding you back don’t hesitate to contact us as we are happy to help you get back up and moving.

Another way to combat feelings of depression and anxiety is to connect with others. Social connectedness has been shown to improve self-esteem, increase empathy, and even improve our immune system. In a society built on independence and self-reliance it is easy to fall into the idea that we are weak if we ask or help or rely on others, but this is necessary to our genetic make-up. We thrive on social interaction, whether you are introverted like myself and enjoy one-on-one conversations, or whether you are extroverted and love large gatherings. Make it a priority to find someone to connect with and be open with them. If social connectedness is not something you struggle with, make an effort to reach out to those who may have more difficulty than you. You will likely feel an emotional boost through your ability to help someone else.

Here are some other ways to help break the cycle of depression

  • Prayer/Meditation
  • Gardening
  • Serving others
  • Watch or listen to comedy
  • Listen to uplifting music
  • Healthy diet

If you have tried many of these suggestions and still find that you are struggling please reach out to your doctor or care giver. I am no stranger to depression as it has a long history in my family and unfortunately has led to losing loved ones. I myself have fought with anxiety disorder and have required treatment at times to help manage those symptoms. There is nothing to be ashamed about and I strongly encourage you to seek medical help if you are unable to manage your symptoms independently.

We at Flex are thinking of you and wish you all the mental health and physical wellness as we continue through this challenging season.

The Truth About Posture

The Truth About Posture

We’ve all been told at some point to “stand up straight!”, but what does good posture really entail? Correct standing posture involves alignment of our spine and shoulders over our pelvis with knees and ankles stacked under our hips. It can feel overwhelming to try and maintain this all at once so try this: sit at the edge of a chair with your feet on the floor, imagine a string pulling the top of your head towards the ceiling, lightly tuck your chin down, bring your shoulders back, and drop your rib cage downward (all without arching your back); now hold for 10 seconds. Performing this simple activity 5-10x daily can begin to train your body how to maintain correct alignment. Once your body learns the mechanics, the task becomes simpler and you’ll find yourself sitting with better posture in no time.

Although we often associate poor posture with causing low back pain, it can also lead to pain in our neck, shoulders, and knees and lead to conditions such as rotator cuff and meniscus tears. This happens because without proper alignment, it becomes difficult for our muscles to work effectively and puts strain on areas that aren’t meant to take on additional loads or forces. So as you are going about your day, whether standing or sitting, imagine that string pulling your head up and stand aligned–your body will thank you for it!

Pelvic Floor PT from a Mom’s Perspective

Pelvic Floor PT from a Mom’s Perspective

By Stacey Ellingson, PT, DPT

When I was in physical therapy school, my program very briefly touched on the pelvic floor; we were instructed to learn the anatomy,  offered a lecture, and then guided as “this is something you can pursue with additional education f you have interest.”  At the time, I had no interest.  I wanted to do orthopedics (work with backs/hips/knees/ankles) and I was content with that.  Fast forward to 5 years later when I gave birth to my first child.  I had a whole new prospective on the role of the pelvic floor, how critical it is, and how debilitating a dysfunction it is.  A vaginal delivery, while a very common experience for many women, is essentially a train wreck to your pelvic floor.  If any of us expelled a 5-10 pound mass from any other muscle group in our body, we most certainly would be referred to physical therapy; but in the post-partum world, this is often not the case.  If you are experiencing dysfunction, do not hesitate to seek out pelvic floor physical therapy, as it can so greatly improve your quality of life.

What is the Pelvic Floor?

The pelvic floor is essentially the bowl of muscles that lines our pelvis from the pubic bone to the tailbone.  There are three layers of these muscles and they play three important roles:  1.  Sphincteric– they help maintain continence.  They help keep things closed when they should be closed, and open when they should open. 2) Supportive– They help to support and hold our pelvic organs all day/every day for our entire life (talk about a BIG job!  And in the case of pregnancy; this includes a growing fetus!), 3) They play a role in sexual function.  Just like any other muscle group in the body they can go through dysfunction , they can get tight, spasm, or stretched and weak; or a combination of the two.

What happens during a pelvic floor physical therapy session?

First off, we chat!  We want to know everything that has been going on as it pertains to your pelvic dysfunction, clarify what your concerns are, and take a thorough history so we get a clear picture of why you came to see us.  Next we will perform a physical exam which most often includes both an internal and external component so we can objectively pinpoint what type of dysfunction may be present.  We will provide you with lots of education to help keep you as proactive and involved in your treatment plan as necessary.  You may learn more about your bladder than you ever wanted to know!  PT treatment can look very different from person to person, based on what your issues are.  It may involve hands on therapy, exercises, behavior modification strategies, or a combination of things!

What are some signs that I could benefit from pelvic floor PT?

Leaking urine or stool

Difficulty emptying bladder or bowels

Excessive urinary urgency and/or frequency


Painful intercourse

Vulvodynia (pain in vulvar area)

Pelvic pain

Painful bladder

Diastasis recti (muscle separation at abdominal wall)

Sacroiliac pain

Pelvic organ prolapse; heaviness/pressure in vaginal canal


While ANYONE can experience pelvic floor dysfunction at any time of their life, due to the demands on the body of pregnancy, labor, and delivery; mom’s often fall victim.  We also tend to put our own needs out the window, or blow off our symptoms because we think its “normal”.  But please know you are not alone, and there are people who can help if you are experiencing pelvic dysfunction.   The pelvic floor team at Flex Physical Therapy can’t wait to meet you!

Yes I’m a PT, but I’m a mom too. And I get it.

Body After Baby

Childbirth is an incredible experience and the care of a new child frequently takes priority over the mother’s recovery. Many fail to see the all-encompassing impact of pregnancy and childbirth on a woman’s body. During pregnancy, hormones prepare the body for birth by loosening many of the important ligaments in the back and pelvis, therefore decreasing stability. These changes matched with abdominal wall expansion often have an impact on symptoms. Sciatica and low back pain experienced during pregnancy can even continue post birth.
Thankfully there is action that can be taken, both during pregnancy and after, to help keep the body happy. Gentle strengthening and stretching exercises during pregnancy can improve stability and prevent the likelihood of pain or injury. Following birth, these exercises can be progressed to reduce separation of the abdominal wall and promote a tight core preparing the body to return to previously enjoyed activities such as weight lifting or Pilates.

Text Neck

A recent study conducted by IDC1 found that 4 out of 5 individuals reach for their phones within 5 minutes of waking and then keep it with them for all but 2 hours a day. In this tech savvy world we find ourselves looking down at our mobile devices more and more frequently and now our bodies are starting to pay for it.
When we look down at our mobile devices our head moves forward, shoulders round, and muscles tense; and for every inch that your head moves forward it feels like an extra 10lbs to your neck muscles! This can eventually take its toll on our bodies and cause symptoms such as headaches, neck aches, and even on occasion, numbness/tingling in our hands.
How do we prevent text neck, you ask? Simple changes such as holding your mobile device at eye level, moving your shoulders back, and keeping your ears over your shoulders can all help to decrease strain on your neck. If you’re experiencing any of these symptoms you may want to consult with your physical therapist.

1. http://www.nu.nl/files/IDC-Facebook%20Always%20Connected%20%281%29.pdf

What is the Graston Technique®?

The Graston Technique® effectively breaks down scar tissue and reduces inflammation that causes pain and restricted mobility. Used by therapists, the stainless steel instruments comb over and “catch” on fibrotic tissue, which immediately identifies areas of restriction. The instruments enable clinicians to treat soft tissue lesions with the depth, pressure and specificity necessary to affect the condition at the site of the pain, as well as following the kinetic chain to find and treat the cause. Once the tissue dysfunction has been identified, the instruments break up the scar tissue so it can be absorbed by the body. For more information, see the Graston Technique® website: http://www.grastontechnique.com/AboutUs.html

The Benefits of Taping for Sports Injuries

Wednesday, January 08, 2014  – by Stop Sports Injuries

Kinesiotaping has been around for more than 25 years assisting the sports medicine practitioner in the areas of pain management, sports performance, physical therapy and athletic training.  This taping method was designed to facilitate the body’s natural healing process while allowing support and stability to the muscles and joints without restricting the body’s range of motion.  The tape was designed with a texture and elasticity, close to the tissue of the human body.  There are 3 main taping techniques recognized in North America.  These techniques are:
White Athletic Taping
This is the most common technique. The white tape is extremely rigid and usually requires pre-wrap prior to application.

It is used for both acute and preventative measures and if left on for an extended period of time, may cause skin irritation, due to moisture entrapment and muscular compression.  There is little to no rehabilitative benefit gained from this tape.
McConnell Taping
This technique is a bracing or supportative measure using a super-rigid, cotton mesh highly adhesive tape.  It is most commonly used in knee conditions, shoulder dislocations, and back, foot, and hip impingement syndromes.

It may be left on for an extended period of time without causing skin irritation (<18 hours).  This technique may affect the biomechanics of the patient.
Kinesio Taping
This technique is  therapeutic in nature, offering the patient or athlete both the support  and rehabilitative properties of the affected area. This technique uses a  specifically designed tape that will allow the body’s full range of  motion.  Because there is no compression to the skin and its light to  the touch, this tape can be worn over a three to five day period.  The  tape works with the body’s lymphatic system to increase both blood and  lymph circulation in order to rehabilitate and relieve pain to the  affected area.  This technique is used for virtually all clinical  conditions.
Be sure to speak with your athletic trainer or  sports medicine professional to determine the best taping technique for a  given issue/condition.

For more information visit www.sportsmed.org.

A New Breed of Knee Injury in Young Athletes

Here is an interesting article I came across that talks about this trend we are seeing in our young athletes. Worth a read.
Sometimes physicians will notice a medical trend well before science confirms its existence. That has been the case with injuries to the anterior cruciate ligament, the main ligament that stabilizes the knee joint, in young athletes. “Doctors who treat kids have all been saying over and over that the numbers of A.C.L. tears are going up dramatically,” says Dr. J. Todd Lawrence, an orthopedic surgeon and pediatric sports medicine specialist at the Children’s Hospital of Philadelphia. But surprisingly little firm data has confirmed that hunch.
So, for a study presented this month at the annual conference of the American Academy of Pediatrics in Boston, Dr. Lawrence and his colleagues parsed emergency room records of pre-adolescent youngsters treated at Children’s Hospital, looking for A.C.L. tears, as well as tears of the meniscus, the small pillows of cartilage that help to cushion the knee bones.
They also checked for fractures of the tibial spine, a fingerling spit of bone that extends from the tibia, or shinbone, to which the A.C.L. attaches. In prepubescent children whose skeletons are still growing, the slender tibial spine can be weaker than the tissues of the A.C.L. and break under the pressures of hard twisting or planting of the knee, even as the A.C.L. remains intact. “There was a time when the tibial spine fracture was the knee injury of childhood,” Dr. Lawrence says. “Twenty years ago, medical textbooks usually included a statement saying that kids did not tear their A.C.L., that they fractured the tibial spine instead.”
But when the researchers examined the pediatric hospital records, from 1999 through early this year, they found only 155 tibial spine fractures, while there were 914 confirmed A.C.L. tears and 996 meniscus tears. More important, while the incidence of tibial spine fractures increased at a rate of about 1 percent per year during that period, the incidence of A.C.L. tears increased by more than 11 percent per year. The difference almost certainly was not a result of better equipment leading to better diagnoses of A.C.L. tears, Dr. Lawrence says. “Even in 1999, M.R.I. technology was quite good,” so it was possible for physicians to differentiate between the injuries.
Which means that increasingly large numbers of young athletes, both boys and girls, are now suffering an injury to which doctors once thought they were almost immune.
Why? Scientists still aren’t sure, and that question was outside the scope of the current analysis. But Dr. Lawrence, a pediatric orthopedic surgeon who treats many of the afflicted young athletes, is willing to speculate. “I think it’s primarily because kids are out there trying to emulate professional athletes,” he says. “You see these very young athletes playing sports at an extremely intense, competitive level. Kids didn’t play at that level 20 years ago. They didn’t play one sport year-round.” As a consequence, their knees never had to withstand the kinds of repeated twists, sprints, loads and hard hits that young players now regularly absorb, he says.
Most of the A.C.L. tears that were treated at Children’s Hospital and picked up by this study, Dr. Lawrence points out, also involved a simultaneous meniscus tear, an indication of just how much wrenching and grinding the knee had undergone. Injury patterns have changed, he continues, because childhood sports have changed. “There’s a developmental soccer team here” in Philadelphia, he says, “for U-6 players,” meaning a competitive, select team for 4- and 5-year-olds. “When I heard that, I said, are you kidding me?”
The long-term effects of sports-related A.C.L. and meniscus tears in youngsters remain largely unknown, in part because such injuries were so rare decades ago. But there are indications that the consequences could be calamitous.
Recent studies of adult Swedish soccer players who tore an A.C.L. found that, within 12 to 14 years after the injury, 51 percent of the female players and 41 percent of the men had developed severe arthritis in the injured knee. The same time frame could have an injured 10-year-old dealing with a severely arthritic knee before he or she is 25. Meanwhile, many athletes who return to sports after an A.C.L. tear report that they don’t play as well, according to a new study of 500 Australian athletes, and a third of the athletes in that study did not return to any activity afterward.
“It’s definitely not a minor injury,” Dr. Lawrence says, “and it’s not something you want to see in a child.”
Whether anything can be done to lessen the toll on young knees, though, is uncertain, he and other researchers say. Knee injury prevention programs, including those that teach balance and proper landing techniques, have shown some utility in reducing the incidence of A.C.L. tears, especially in girls. But the programs are relatively new and have not been universally successful, in part, perhaps, because they can make some young athletes overly self-conscious, as an interesting review article published earlier this year suggests. In teaching children to think overtly about how to plant a leg or bend a knee while maintaining balance, some youngsters may become less fluid in their movement, more ungainly — and potentially ripe for injury, the review’s authors speculate.
A better solution would probably be to stop assuming that children can train like miniature Ronaldos or Kobe Bryants. “A lot of what we see in our injury data is almost certainly due to a statistical measure called exposure hours,” Dr. Lawrence says. “The more you do a risky activity at a high level, the more likely you are to get hurt.” His advice? “Encourage kids to play multiple sports and not to do any one sport year-round, and especially not when they’re 5 or 6, or even 9 or 10. They’re kids. Let them play and have fun, like kids.”

Thinking about trying acupuncture?

If you’ve been thinking about trying acupuncture, Flex has just made it easier for you.
We are pleased to announce that Lori Field, M.S. LAc, OTR, of Abundant Life Acupuncture, and originally from Australia, will be working in our office on Mondays and Fridays from 9 am – 7pm.
You can learn more at her web site:
Or contact her directly at (425) 443-0831