Articles by

Denise Plastiras

08/12/11 3:52pm

One of the tests that physical therapists routinely use to evaluate patients with neck pain is a postural analysis. It’s performed by using a visual “plumb line,” a straight line from the ears to the ankles, looking at the position of certain bony landmarks to determine deviations from this neutral path. Our advantage is that we see your body from the side; a view you most likely don’t see.

You tend to look at yourself in the mirror often — for grooming, dressing, or possibly while working out in the gym, but the view is usually from the front. The head looks OK on the shoulders from the front view, but looking at the head from the side it most often is leading the way. Instead of being relaxed on a strong balanced lower body, it’s forging forward with little support or crunched because the deep muscles that stabilize the trunk of the body aren’t active. Watching people work out on the elliptical machine or an elevated treadmill has brought me to a new awareness. Both are great exercises for cardiovascular fitness and boosters for metabolism, but poor posture on these machines might be stressing your neck.

Neutral posture, or “good” posture, positions the ears directly over the shoulders, the shoulders directly over the outside of the hips and the hips to the outside of the ankles, all in a lovely straight line. In most cases, especially for those experiencing neck and back pain, the line deviates forward and back, and the most common faulty neck position is a forward head posture.

It’s difficult to change posture. The body has muscle memory, meaning that muscles are lengthened or shortened in positions they remember.

If your neck is chronically held forward, it will easily settle there in all activities, whether you’re on the computer or walking on the treadmill. To prevent neck pain and stiffness a new muscle memory must be integrated.

The goal is to give the superficial muscles in your neck a break and prevent them from working so hard by engaging stronger deeper core muscles. Physical therapists call the core muscles spinal stabilizers. We have two girdles in our bodies — the shoulder girdle and the pelvic girdle. Core muscles attach to these bony girdles and to the spine and dictate the path posture will take. The postural muscles around the shoulder girdle are the muscles that draw shoulders down and back. The muscles around the pelvic girdle bring neutrality in the lower back and provide a solid base for the upper body.

Let me share some simple changes you can make to draw in the core and reduce stress on the neck.

• The neck should never be forward in any prolonged activity. Muscles have memory; if you keep them in the same position for prolonged periods of time that’s their new habit. Shortened superficial muscles in the neck become over stressed and stay that way and the core muscles or stabilizers become inactive, resulting in neck, lower back and shoulder pain.

• While driving or sitting, position your knees and hips at a 90-degree angle. Positioning the knees above the hips, which decreases the 90-degree angle, can promote a forward head posture along with a humped mid back and sluggish abdominals. The 90-degree position is ordered for patients after hip replacements but not often for patients suffering with neck pain.

• Lighten your touch on the steering wheel; it’s amazing how a tight, non-necessary grip can activate superficial neck muscles. Lighten your grip on the treadmill, especially when it’s elevated. I see many people hanging on to the treadmill as they exercise, bringing tension up through the arms to the neck.

• If you use your arms on the elliptical machine, don’t push. There’s no tension on the upper body from the machine, so you’re causing your upper body tension. Stand tall and enjoy the rotation in your lower body that you get from decreasing the arm tension. Also feel your core muscles as the muscles between your shoulder blades become active and the abdominals become engaged. The core muscles can be strengthened in any activity but only if you keep them engaged.

• Walk into a room with your whole body leading. The neck doesn’t have the endurance or strength to carry the body forward, Take a deep breath, lengthen your neck, leading from your back. Keep shoulder blades down and your back deep trunk muscles activated. You’ll discover you have a back body and the more you use it, the stronger it will get. The forward posture will soon begin to feel uncomfortable.

With these simple changes, your “plumb line” will be in better shape. The added bonus is you’ll look taller and years younger.

Denise Plastiras is a physical therapist at Maximum Performance in Greenport.

06/17/11 5:19pm

Recent experiences have started me thinking about the importance of communal activities in enhancing the quality of our lives. Whether this activity takes place in a physical therapy setting or talking to the cashier at the local supermarket, it’s the sharing of one’s life with others through storytelling that creates healthy connections.

After more than 25 years of practicing in a healing profession, I’ve learned that enthusiasm and shared laughter enhance the rehab experience and everyone goes home feeling better.

I love the communal activity I see going on around me on the North Fork, and I have recently witnessed similar communications while walking on a boardwalk in New Jersey and on visits to Nassau County and to Brooklyn, where I’ve overheard groups of older people sitting together in the morning sharing stories while sipping coffee, their chairs in a circle. They’re always dressed for the weather, with light clothes when the sun is shining or sweaters and jackets in cooler weather. They’re laughing and at times moving closer to one another to capture an important moment in a story. They all live, at the most, a few blocks from their chosen gathering spots and can get there easily, either independently or with the help of family or friends, to share a morning ritual.

After one of these experiences, I called my mother-in-law, thinking she is isolated living in her apartment building in Albany and assuming she was without such a gathering place to go to after church. It has been years since her husband and her son, my husband, passed away. She tells me of her day and, yes, there are immediate concerns — her teeth, her hearing aides — and, of course, the sweetest stories about her new grandchild, Isabella, who is now 6 years old. But most of our conversation is about the new people she is meeting on the bus to the shopping center, or in the bingo room in her living facility. She lives in an apartment building in Albany city, with a diverse group of tenants. There is a city-funded bus that takes the tenants to various shopping centers.

She hasn’t cooked in years. She had moved from a moderate house in suburbia, where she entertained as many as 30 people almost every weekend for Sunday dinner, to a small apartment in Albany to be close to my brother-in-law. She has the Greek recipes that have been handed down for years, and the other ladies on the bus have their recipes to share. That’s what they talk about and share. They are women of diverse cultures sharing recipes, sharing spices, gabbing and seeing each other for the first time. Will they purchase the new spices, will they cook outside their norm? Maybe not, but they have shared what has been their life, and nurturing with food has often been the center of those lives. Going home, writing down the recipe and handing it over the next shopping day is a mission and the ultimate sharing. It makes me realize that such sharing goes on in all environments if people give themselves over to the experience.

I am so blessed to work in an environment where stories are shared. We share stories with patients and they share stories with each other. The stories most of the time start out with the obvious “Why are you here?” We then go on to discuss specific body parts or joint replacements and the shared symptoms in a discussion that often culminates in agreement that “it’s tough to get old.” Then almost ultimately the talk goes to food, whether it be new restaurants or farm stands or recipes; soon everyone in the room is chiming in. The one thing that all humans do is eat, and the desire to make that experience better for others is the most common form of caring.

The psychologist Eric Erikson named eight stages to define life and its conflicts. He felt that life stages one through six gear up to stage seven’s conflict, which he named “generativity versus stagnation.” Generativity is defined as care and concern for people besides family and self and develops during middle age. It is the positive side of the conflict, and I believe it can be experienced every day by getting out and sharing stories — listening compassionately and laughing about how alike we all are.

Denise Plastiras is a physical therapist at Maximum Performance in Greenport.

04/12/11 3:59pm

It’s hard to reproduce the joy that one feels when running. As the late Dr. George Sheehan, a well-renowned cardiologist and contributor to Runner’s World, said many years ago, “Put a pair of good shoes on and you are out the door.” Running is easy to do and requires no apparatus. Put on clothes to fit the weather and, of course, good running shoes. There’s no need for a car, no sign-up at the gym, no waiting for the elliptical. The big advantage — our bodies run naturally and the training effects are easy to calculate. If I ran this week more than I did last week at the same pace, I am in the process of training.

Dedicated runners run everywhere — while on vacation, on lunch breaks, at 5 in the morning before work, after a long day of work to clear the day’s endless chatter; on boardwalks and walkways and through beautiful scenic trails. When the runner’s body is in tune and nature is abounding no matter what season, senses are acute and the runner is one with his world. The more miles, the more the “runner’s high” escalates.

Is running an addiction? It absolutely is, and a good one at that. For me, the more I ran, the better I felt. I ate ridiculous numbers of pasta meals, never gaining a pound. In my long-distance years, my husband and I frequently split a pound of a pasta meal after a good run. We were in our 30s and early 40s, neither of us experiencing an injury that would curtail running for more than a few days.

I had my first severe injury several years ago. I heard a snap in my shin and couldn’t run another step. A tibial stress fracture was diagnosed and I was in a cast boot for four months and ordered not to run. I learned a lot from that experience. I had been fatigued that day. My shoes were worn. I ran on a road that was beveled. During those four months, I saw a personal trainer and learned the importance of aerobic cross training and strength training. My fracture healed and I returned to running, but not with the confidence and zest that I usually felt. I now harbored a fear in my body that I might get hurt again.

So when is it time to stop running and replace it with a different form of aerobic exercise? I asked several people who were forced to stop running in their late 40s and early 50s, and all said they stopped due to knee problems. The impact of running worsened the symptoms and they turned to biking or swimming. My patients who are now in their 50s and still running are more apt to complain of low back or unilateral hip pain. Upon evaluation, these patients usually present with limited motion in one hip and a significant leg length discrepancy. Due to weight bearing mostly on one side, tone in the muscles of the lower extremities becomes unbalanced and a symmetrical activity such as jogging or running becomes subtly asymmetrical. Degenerative changes in the challenged hip worsen and muscles and ligaments in the low back take up the slack and become overworked, leading to instability, or chronic sprain or strain.

In treating older runners post injury in physical therapy, the question inevitably arises whether to start running again. This is a tough question. When our joints are young we get away with misalignment problems in our hips, knees and feet. Degeneration, in our younger years, especially in the hip joints, is minimal and injuries heal faster. As we age into our 50s and above, old injuries, misalignment and joint degeneration seep into the picture, and a decision should be made whether running is speeding up the degenerative process and hindering our activities of daily living due to pain.

We all hear that the 60s are the new 40s. I am not sure our joints know that. Today there are so many modes of exercise to satisfy our craving for aerobic exercise. If you fear running, it might be time to lessen it or stop altogether. Power walking, aerobic dance and water running are great alternatives and score high as cardiovascular exercises.

If you want to give running a try when your injury has been resolved, start on a track with new supportive shoes and do interval training by running and walking. Possibly run the long sides and walk the short sides. Most of all, listen to your body and add strength training into your exercise routine. Increased strength around your joints will add symmetry and support the joints that are being stressed during your aerobic activity. Feel joyful and smile during any exercise you choose. There is no gain with pain as we age.

Dr. Denise Plastiras is a physical therapist with Maximum Performance in Greenport.

01/17/11 9:38am

After knee injury or knee surgery many of us have been instructed to go up with the good leg and down with the bad leg when negotiating stairs with an assistive device such as a cane or crutch. The sequence is right; however, physical therapy students are no longer taught to refer to a body part as bad or good.

Students are now taught to refer to the body part being rehabilitated as “involved” rather than “bad,” when training a patient to resume walking or resume stair climbing after an injury or surgery, Recently, I have discovered why this simple reference is so important to the success of physical therapy rehabilitation, especially with the knee.

Many of my patients suffer with chronic knee pain rather than acute knee pain. Acute trauma to the knee results in immediate pain and swelling. The knee does not tolerate forced rotation well. Twisting the knee or being struck violently at the side of the knee, which is a common football injury, can result in a ligament sprain or a meniscal strain and has to be managed by rest, ice, compression and elevation. This RICE recipe is surely the most successful in managing the swelling and pain after an acute trauma. Chronic knee pain, lasting more than three months, has to be cared for differently.

The most common chronic problem is degenerative meniscus, the wearing away of the cartilage between the bones of the knee. The meniscus acts as a shock absorber as we bear weight through the lower extremities. The most common site of degeneration is the inside or medial aspect of the knee. Pain can begin with a mild ache while descending stairs and may exacerbate with an increase in walking or running duration. It becomes the “bad” knee — uncooperative — and takes the blame for discontinuing exercise. We all know that putting exercise on hold affects psychological and physical well being.

I say “address” the knee with kindness; it might not be its fault. Maybe a flat foot has worsened and now is putting more stress on the meniscus, or footwear is old and no longer supports the arch. Another cause might be a small curvature in the spine, which may lead to weight bearing asymmetrically. Isolating the body part from the rest of the body, which often results in a gait disturbance, prolongs the chronic nature of the symptoms and can lead to disuse and atrophy as the muscles and supportive structures weaken.

So, think of your symptomatic knee as “involved” rather than “bad.” It’s involved because of undue stress that has been placed on it or an old injury that now has decided to flare up. Nurture the involved knee; try to manage it by reducing those stressors and rehabilitate by strengthening the structures around it. Even if arthroscopic surgery is indicated to repair the meniscus or partially remove it, strengthening exercise is indicated. It might remain involved but no longer bad.

Dr. Denise Plastiras is a physical therapist with Maximum Performance in Greenport. She teaches postural balance after injuries.

07/29/10 12:00am

Recently I witnessed a confrontation between a group of cyclists and a motorist. The motorist was waiting patiently at a light on Route 25 with her blinker on, signaling a left turn. The group of about 30 cyclists facing her on the opposite side of the road proceeded to go through the red light and when it turned green, the motorist was prevented from making a left turn. The motorist began screaming out her window to the cyclists that they should abide by the laws. Some of the cyclists answered her with lewd gestures. The question for you is, who will hold on to stress longer after the incident, the cyclists or the motorist?

If you answered the motorist, you’re probably right. In the past few weeks I have heard many people complain about traffic and cyclists and limos and vineyards and rock festivals. It’s summer, and we’re surely experiencing stimuli unlike at any other time of the year. Just trying to make a left turn can raise our physiology a few notches.

It doesn’t take much for anybody to recall an incident that stressed them out, and the need to commiserate is greatly understood. However, when you continue for days or weeks to relive stressful situations verbally or just in your mind, you prevent stress from dissipating. The more stress, the more the response. That can often cause issues in your tissues because it’s similar to trauma. While the injured tissue heals, adjacent structures around the site remain tight and splinted, still reacting to the initial response.

The immediate response to stress is to go into fight-or-flight mode. Dictated by the sympathetic nervous system, your heart rate increases, blood pressure soars, and muscles contract and tighten as you shout and gesture. These responses are all good, and the fight-or-flight response is healthy and protective so long as the response doesn’t linger far after the incident.

We have a built-in feedback system that can prevent these responses from lingering and return our physiological systems to a dynamic constancy or equilibrium. The feedback system is called our parasympathetic nervous system.

All through the day, we experience fluctuations. When the fluctuations are extreme, the body must fight harder to come back to a neutral state. With an untrained parasympathetic nervous system, the body may stay in the fight-or-flight mode, supplied by the sympathetic nervous system, which can lead to chronic stress syndromes, such as persistent neck pain, headache, stomach disorders and high blood pressure.

Yoga trains the parasympathetic nervous system. By the body’s being stressed in yoga postures and then moving into deep relaxation or meditation, the parasympathetic nervous system is challenged and strengthened.

Another thing you can do to boost this nervous system after a stressful incident is to take a deep, cleansing breath and relax your shoulders. Then smile; it’s by far the best face-lift.

Denise Plastiras is a physical therapist at Maximum Performance in Greenport. She also teaches yoga workshops.

04/29/10 12:00am

By Denise Plastiras

When your feet hurt your whole body hurts. My mom said this many times when I was in my 30s and she was in her 50s. It didn’t mean much then but I get it now. Recently I have seen a surge of patients coming to my practice for treatment of foot pain associated with various diagnoses. By far, plantar fasciitis is the most common.

There are two reasons. More people are exercising — walking and running way into their 70s and 80s and many baby boomers are now suffering with stiffness and pain in their knees and hips from degenerative arthritis. Since these symptoms are usually unilateral, stress can be put on the opposite foot.

Taking the first step in the morning can be agony for those who suffer from tightness in the foot associated with plantar fasciitis or heel spurs. As the foot hits the ground, a burning pain may be experienced in the arch of the foot, at the heel, or in both areas. The pain may last for several moments, several hours, or throughout the day depending upon the amount of tightness and inflammation.

Plantar fasciitis is a repetitive-stress injury to the fascial sheath which surrounds the muscles on the bottom of the feet. Fascia can best be described as a protective envelope of connective tissue. Fibrous in nature, fascia runs in line with our muscles, therefore, it shortens and lengthens as muscles contract and relax. When injured, the fascia may shorten and pull at its insertion at the heel, causing inflammation and pain.

Specific activities which call for repetitive motions such as walking and running can put undue stress on a posturally normal foot. Increasing mileage or speed or exercising with poorly constructed athletic footwear can elicit an acute plantar fasciitis. Ice and rest from prolonged weight-bearing activities and new supportive footwear should enable a quick return to activity. On the other hand a person with a high arched foot or a flat foot who has an onset of symptoms may not return to activity as fast and may be forced to seek out podiatric care and physical therapy.

Probably 90 percent of my patients who present with a diagnosis of plantar fasciitis have high arched feet, known medically as pes cavus. Patients with pes cavus have a shortened plantar fascia predisposing them to strains at the heel and along the fascia due to excessive loading. If symptoms are not treated early and become chronic, tissue will continue to lose extensibility. Physical therapy treatment usually involves moist heat, ultrasound, massage, and fascial release techniques. Instruction is then given to the patient on self-stretching techniques to the arch of the foot and to the heel cords.

Chronic plantar fasciitis may take months of treatment. Close monitoring of the patient by the podiatrist and the physical therapist is a must to ensure a return to pain-free weight-bearing and function. A steroid injection may be indicated and shoe inserts prescribed during the course of treatment.

Denise Plastiras is a physical therapist at Maximum Performance in Greenport.