August 2021 COVID Update – COR continues to follow COVID safety protocols

Healing Pubic Symphysis Pain During and After Pregnancy

Pubic Symphysis Pain

During pregnancy, many musculoskeletal changes happen in a woman’s body. For example, widening of the pubic symphysis and sacroiliac joints occurs before childbirth. However, the process can cause pubic symphysis pain for some women and impair their activities of daily living.

How Does the Pubic Symphysis Change During Pregnancy?

The pubic symphysis is a unique joint at the midline union of the pubic bone. It resists tensile and frictional forces and can move minimally —2 mm shifts and 1-degree rotation. However, this joint is capable of remarkable changes during pregnancy. Relaxin and other hormones cause structural changes that increase the joint’s width and mobility. Separation between 4 to 9 mm is normal during pregnancy. We expect the pelvic girdle to return to normal before five months postpartum.

What Causes Pubic Symphysis Pain?

The hormone relaxin softens the ligaments and joints to ease labor and delivery. Movement of the loose joint can be painful for the mother. In addition, excessive widening beyond 10 mm leads to a rare condition called pubic symphysis diastasis. Risk factors include:

  • Obesity 
  • Hypermobility
  • Large fetus 
  • Rapid second stage labor
  • Intense uterine contractions
  • History of pelvic trauma
  • Forceps used during delivery 

What Does Pubic Symphysis Pain Feel Like?

The pain is different for each person. Some women may feel a pinch or ache. For others, severe symphyseal pain causes difficulties with activities of daily living such as walking, climbing stairs, or turning over in bed. In some cases, the patient feels sore in the creases of the groin rather than over the pubic bone. Pubic symphysis pain can be debilitating to mothers, especially if it doesn’t resolve postpartum. It can get so bad that some women require crutches or bed rest. 

How Do You Treat Symphysis Pubis Dysfunction? 

Several treatment options are available to relieve symphysis pubis pain and provide for postpartum recovery. Many patients benefit from supportive devices such as a pelvic support belt, a pregnancy pillow for sleep, or using a wheelchair or walker for reduced mobility. Other treatments include strengthening the back and core, soft tissue therapy, applying ice or heat, and simulation with a TENS unit. A physical therapist can design a safe and effective treatment program to meet patients’ needs.

Referring Patients for Pubic Symphysis Pain

Physical Therapy is a first-line treatment for Symphysis Pubis Dysfunction. The PT can develop non-invasive therapies to relieve pain and help restore mobility and function. Call our office for referrals at 201-833-1333.

3 Benefits of Trigger Point Therapy for Runners

Trigger Point Therapy for Runners

Painful and tender trigger points, which can feel like knots,  may develop in runners from repetitive stress on the muscle fibers. While benign, these trigger points cause discomfort and range of motion issues. Trigger point therapy helps runners manage their pain and learn about the body mechanics behind muscle knots. Trigger point therapy is a minimally invasive way to reduce pain and improve range of motion, which can in turn improve running mechanics and efficiency. 

What is Trigger Point Therapy?

Everybody is different, so physical therapists have a variety of techniques to target trigger points, such as soft tissue mobilization, which is similar to massage, and stretching. Your PT may also use manual treatments or instruct you in techniques you can do at home to treat the trigger points, such as stretching. One of the most effective treatments is dry needling, which involves a trained therapist inserting sterile microfilaments to simulate areas between the muscle fibers. Dry needling is gaining traction as a treatment throughout the US, and there is legislation in progress to allow physical therapists in New Jersey to use dry needling.

Benefits of Trigger Point Therapy for Runners

1. Reduced Pain

The main benefit of trigger point therapy is pain reduction. Muscle knots restrict blood flow and block oxygen from your muscles, leading to inflammation and pain. In addition, trigger points can refer pain to other parts of the body, making them difficult to locate. However, the physical therapist can pinpoint your pain and work to release the trigger point. 

2. Improved Range of Motion

Trigger points are essentially contracted muscles that won’t release. They limit your range of motion because specific muscles cannot stretch to their full length. This, in turn, affects the surrounding muscles. Physical therapy releases the fibers and improves mobility, which is crucial for runners. With a full range of motion, you can get back to training.

3. Minimally Invasive

Physical therapy offers a natural and holistic approach to pain management. First off, many trigger point release techniques are non-invasive such as soft tissue mobilization, stretching, and heat. Even dry needling is minimally invasive, requiring no medication or surgery. Your PT will work with you to develop a treatment plan you are comfortable with.

Get Started Today

Your PT will tailor a treatment plan that is right for your specific situation. During your first appointment, ask your therapist what you can do between sessions to maximize the benefit of therapy. Finally, you can manage your pain and get back your full range of motion. Contact our physical therapists to get started with trigger point therapy for runners. Schedule a consultation online today.

What to Expect from Your First Pelvic Floor Physical Therapy Appointment

First Pelvic Physical Therapy Appointment

It’s normal to feel a little apprehensive before your first pelvic floor physical therapy appointment. You may be wondering what exactly is going to happen. However, physical therapists always want their patients to feel comfortable and at ease. So, if you’re not sure about something, ask! “We want to take the mystery out of it for you and let you know what to expect,” said Dr. Rachel Feldman, a Physical Therapist at COR who specializes in women’s health.

How do I prepare for pelvic floor physical therapy?

Dress in comfortable clothing that allows for a full range of motion. Bring your ID, insurance card, and any pertinent records. Arrive 15 minutes early, so you have time to fill out any intake forms, or you may fill out your forms at home before you arrive.

Arriving at your First Pelvic Floor Physical Therapy Appointment

When you first arrive for pelvic physical therapy, check in to let the staff know you are there. They will ask for your driver’s license, insurance, and form of payment. They will usually ask you to fill out forms beforehand, so bring a list of any prescriptions or test records. The information will give your PT insight into your current condition and medical history.

Meeting the Physical Therapist 

After your PT has looked over your forms, she will meet with you to discuss your case. The therapist will ask questions about the frequency and severity of your symptoms. Your answers give the therapist a fuller understanding of your specific needs. Likewise, the PT will provide education about anatomy so you can better understand your condition. “At our clinic, this will take approximately 20-30 minutes…depending on the complexity of your case,” said Dr. Feldman.

Initial Evaluation

After the discussion, your therapist will perform a series of simple assessments. These tests involve observation and palpation of the core, back, hips, and ribs. The therapist will examine your range of motion and look for the cause of your pain. This initial evaluation will help your PT determine your strength, flexibility, posture, and mobility.

Internal Exam

Based on each individual’s comfort level as well as specific complaints, your PT may want to perform a quick internal pelvic exam in order to best assess the muscles. You have the right to refuse, or this can be postponed to a future session. If you agree to the internal exam, you’ll be given the privacy to change into a patient gown. When she returns, your therapist will evaluate the pelvic floor muscles using a single gloved finger. There will be no specula or other instruments involved. An internal evaluation helps your PT get a fuller picture of the health of your pelvic floor muscles. As Dr. Feldman explains, “This exam gives the best insight into the strength, control, and any painful areas in your pelvic floor.”

Scheduling an Appointment 

Pelvic floor physical therapy can help women with urinary incontinence, organ prolapse, pelvic pain, and more. Our experienced physical therapists are here to help you regain your quality of life. Are you ready for your first pelvic physical therapy appointment? Schedule a consultation today. 

3 Common Running-related Injuries: Risk Factors, Prevention, and Treatment

Running-related Injuries

Runners are prone to acute and chronic injuries due to trauma or repeated strain. Common running-related injuries include issues with the shin, knee cap, and tendons. Novice runners have a significantly higher risk of injuries—about 18 per 1,000 hours of running. In comparison, recreational runners average around eight injuries per 1,000 hours of training.

What’s the Best Way to Treat Running Injuries?

For effective treatment, every runner needs individualized plans based on their own running patterns and risk factors. First, a physical therapist can use a biomechanical analysis and functional movement assessments to identify contributing factors. Then, the PT can develop personalized programs based on the patient’s results.

Risk Factors for Running-Related Injuries  

The single most common risk factor is prior injury. Likewise, weekly distance and training frequency also increase the risk of injury. Therefore, reducing the running volume and adding cross-training could lower the chance of harm.

Common Running-related Injuries 

Medial Tibial Stress Syndrome (Shin Splints)

Commonly referred to as shin splints, MTSS is common in runners. It is characterized by generalized  pain on the inner side of the shin, also called the tibia. Risk factors include inexperience, a low arch, use of orthotics, higher BMI, and increased hip rotation. MTSS can be addressed with stretching, ankle strengthening, and activity modification/rest.


Achilles and patellar tendinopathy are two of the most common injuries among runners. Males and older adults are at a higher risk for developing tendon issues due to overuse. Other risk factors include poor running form, sudden changes in load, strength imbalances between muscle groups, and unequal leg length.

Plantar Fasciitis

Plantar fasciitis refers to pain in the bottom of the foot, which is typically experienced during the first few steps in the morning. The pain of plantar fasciitis comes from inflammation or degeneration of the fascia (connective tissue) in the foot. Risk factors include a high foot arch, tight Achilles tendon, and excessive pronation (flat foot). Treatments can involve stretching the plantar fascia and Achilles tendons, calf strengthening exercises, and working on mechanics of walking and functional activities like squatting.

How to Prevent Running-Related Injuries

Prevention of running-related injuries is not straightforward. There is no one-size-fits-all methodology. A research study published in 2017 indicated limited evidence for generalized prevention strategies. The authors concluded, “Individual treatment should be used in clinical practice.” 

At Churchill Orthopedic Rehabilitation, we offer a state-of-the-art running analysis program with a biomechanical analysis and functional movement assessments. In addition, Carley Schleien, PT, DPT, our running specialist, can develop individualized prevention and treatment plans based on each patient’s history and risk factors. To refer a patient, call our office at 201-833-1333.

Physical Therapy After a C-section Improves Patient Outcomes

Physical Therapy After a C-section

Cesarean section is one of the most common surgeries performed in the U.S. Women who undergo  c-section often experience low back and pelvic pain. Patients who go to physical therapy after a c-section see significant improvements in recovery. Still, postoperative PT is not standard following abdominal surgery like it is with joint surgery.

Should Patients Receive Physical Therapy After a C-section?

Postoperative rehabilitation isn’t limited to knee surgery. Abdominal surgery requires recovery as well. PT is especially important for postpartum women who are also caring for a newborn. A physical therapist can assess patients’ strength, alignment, and functional movement. Early intervention leads to shorter recovery times and improved outcomes. Patients may need movement modifications, and a PT can guide them in ….?

Research on PT following a C-section 

A recent article published in the Journal of Women’s Health Physical Therapy found that physical therapy improves patient satisfaction and outcomes following C-section surgery. The study followed 72 postpartum women who gave birth by c-section. The control group received the hospital’s standard of care, which included consultation, suggested abdominal exercises, and scar management information. The rest went through six weeks of physical therapy, including scar mobilization, stretching and activities for the back, core, and hips, plus home exercise training. 

Improved Outcomes and Satisfaction 

Researchers measured outcomes using a visual pain rating scale, disability index, and patient questionnaires. Participants who received PT reported significantly lower pain scores than the control group. Plus, they also had higher rates of patient satisfaction. 

Postpartum Care at COR

Physical therapy after a c-section is a critical element of postpartum care. Women’s bodies need time to recover following major abdominal surgery. So, our specialty-trained Women’s Health therapist creates individualized programs for cesarean scar restrictions and other postpartum treatments. To refer a patient, contact our office at 201-833-1333.

Race Training: A Physical Therapist’s Guide for Runners

Race Training

When you start race training, pay attention to what your body is telling you. Your muscles need time to adapt to the stresses of running. Overly strenuous movement can lead to injury. Proper running form is also essential to injury prevention. If you train well, you’ll race well. 

FAQ: How do you train for a running race?

Easing into race training allows your body to adapt to the new routine. Physical therapists recommend slowly increasing running distance over time. Once you’ve established a base level of fitness, you can gradually increase your speed and pace. 

Three Essentials for Race Training

1. Form

Paying attention to how you run helps you make subtle corrections to your technique. Listen to how each heel strikes the ground. A balanced gait will sound the same on both sides. Where do your feet fall? Listen to how your body feels. Fatigue can compromise form, leading to injury.

2. Recovery 

Recuperation is an essential part of training. Incorporate recovery days into your training plan. However, recovery doesn’t mean taking a break. Cross-training, such as swimming or cycling, keeps you active while giving your muscles a chance to recoup. 

3. Care

Take care of your body. You can’t race if you’re injured. Always perform a dynamic warmup before running and stretch after running. Hydrate before, during, and after each session. Wear sunscreen and avoid the hottest part of the day. Pay attention to pain. There is a difference between soreness and injury. Seek medical advice if you have persistent, sharp pain that continues long after running. A physical therapist can evaluate your pain and develop a plan to treat the symptoms.  

COR Running Program

We can provide a personalized analysis to improve your running techniques and eliminate pain. Whether you’re an elite runner or you’re just starting, the COR Running Program can help you reach your race training goals safely and efficiently. Schedule an initial evaluation today. 

Best Practices for Medically-based Running Analysis in a Physical Therapy Clinic

Medically-based running analysis

Running and jogging are excellent forms of exercise that help patients stay healthy—so long as they follow proper techniques. Unfortunately, poor mechanics and an improper balance of strength and flexibility  can contribute to pain and injury. By using a medically-based running analysis, physical therapists can identify factors that can contribute to pain with running. Once we identify the underlying causes, we can integrate evidence-based safe running practices to optimize musculoskeletal care.

What is a biomechanical analysis?

Modern biomechanical analysis software uses motion capture to analyze athletic performance and technique. An experienced physical therapist can use this information to develop personalized interventions.

Medically-Based Running Analysis 

When a patient presents with running-related pain or an injury, often more information is needed to determine the cause. While they might be using poor running techniques, there could also be an underlying medical condition. Physicians can then refer the patient to a physical therapy clinic for further examination. A running-specific assessment consists of:

  • A comprehensive medical review
  • A complete history of training
  • A physician’s examination of injuries
  • A biomechanical analysis
  • A physical therapy consultation

Medical and Training History

Both recreational and elite runners can develop musculoskeletal pain. However, seasoned runners may seek treatment for different reasons than novice runners. Thus, a comprehensive training history provides crucial insight into the patient’s assessment. Part of intake includes a Physical Activity Readiness Questionnaire to address any significant risk factors for participating in exercise. In addition, the cumulative effects of exercise can play a role in the injury. So, when working with a new patient, the physical therapist finds out about the frequency and duration of training sessions as well as experience, pace, cross-training, running surface, and running shoes. 

Functional Movement Assessment

Functional movement screenings help the physical therapist determine the strengths and weaknesses of motion. For example, a series of squats, lunges, and hurdles can demonstrate the runner’s motor control. The therapist’s carefully trained eye can assess lower body  and core strength based on these motions. The functional assessment can also reveal symmetry imbalances that may contribute to joint pain. 

Motion Capture Analysis

Motion capture involves digitally reconstructing a three-dimensional model of the runner. For example, while the patient jogs on a treadmill, multiple cameras capture markers on specific anatomical landmarks—knees, hips, etc. The software then converts the footage into a computer model for further analysis. Full-view video capture from all angles provides the best information. 

Referring Patients for Assessment 

When referring patients for a medically-based running analysis, find a physical therapy clinic that operates best practices to identify underlying causes of pain and injury. At Churchill Orthopedic Rehabilitation, we combine functional movement assessment with the use of our unique biomechanical analysis software to determine contributing factors to runners’ pain. To refer a patient for evaluation, call our office at 201-833-1333.

Baby Belly: Diastasis Recti Abdominis During and After Pregnancy

diastasis recti abdominis

Women’s bodies are designed to grow and change during pregnancy. The abdominal muscles soften and stretch to accommodate the growing baby. When the connective tissue between the left and right abdomen gets stretched out, we call it diastasis recti abdominis (DRA). Abdominal widening is a natural part of pregnancy, and the muscles slowly come back together after the baby is born.

How do you fix diastasis recti abdominis?

The key to healing postpartum DRA is core strength. Start by strengthening the transverse abdominal and pelvic floor muscles to create stability from within. Also, physical therapy during and after pregnancy promotes optimal functioning and reduces the risk of impairment.

Exercises for Diastasis Recti Abdominis

Strengthening your core muscles during and after pregnancy can help support your organs and connective tissues as your body changes. Superficial exercises such as sit-ups won’t do much for DRA, and may in fact make diastasis rectus worse. Instead, what you want to do is reinforce the deep core stabilizers below the “six-pack.” Some exercises that you may do with your physical therapist include:

  • Deep Breathing  
  • Postural Training
  • Kegel Exercises  
  • Isometric Abdominal Contraction 

Individualized Treatment Plans for DRA

A trained physical therapist can work one-on-one to develop a personalized exercise program to help elevate the symptoms of diastasis recti abdominis during and after pregnancy. Talk to one of our Women’s Health experts to learn how we can help your baby belly bounce back. Schedule an appointment today!