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No Stink Eye with Stretching!

Posted on September 26, 2017 by

Are you feeling tight? Do feel like you have limited motion?

If so, are you stretching?? Are you making a stink eye while you stretch??








Before Imagine PT! (that’s quite the stink eye!)







In order for the human body to move in the most optimal way our joints must have the ability to move through their full range. Limited motion in our joints may be due to the joints themselves or even more common the muscles which surround it. Muscle tightness is one of the most common reasons for limited motion and as it’s so aptly named the reason for the tightness or “pull” that you feel when you move a certain way. So what do we do about this muscle tightness? We stretch!



But what makes a good stretch? What should you feel? What’s good and what’s bad? How long do I hold the stretch? These are all very common questions!

A good stretch is one in which you feel a slight pull or tensioning of the muscle without any pain with the goal being for the “pull” to lessen as you stretch. If pain or discomfort is present, you should back off of the stretch. We are blessed with a body that has pain receptors and so when they “speak” we should definitely listen! We want the “pull” or “stretchy” feeling but we don’t want the pain! The length at which you should hold the stretch depends on your age. In research performed by Bandy, it was determined that 30 seconds is the optimal stretch time for improving flexibility and range of motion. Any stretch held for less than 30 seconds was not enough to get a long lasting effect. In a separate study by Feland it was determined that individuals over the age of 65 should hold stretches for 60 seconds. As we get older, our bodies (especially our muscles) change and so we have to give them a little more TLC!



The simple answer to tightness and limited motion is this: stretch, holding it for 30 or 60 seconds depending upon your age. Most importantly, if you’re making a stink eye when you’re stretching, you’re doing too much! So come on in to see us and let’s get stretching! Just remember to leave your stink eye at home! You won’t need it because we’re all smiles here at Imagine PT!









After visiting Imagine PT! (All smiles here!)







Bandy WD, Irion JM.  The effect of time on static stretch on the flexibility of the hamstring muscle. Physical Therapy. 1994;74:845-852.

Feland JB, et al. The Effect of Duration of Stretching of the Hamstring Muscle Group for Increasing ROM in People aged 65 years and Older. Phys Ther.2001: 81:1110 – 1117.


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Does Size Matter?

Posted on September 25, 2017 by

Does size really matter? Now, of course, we are talking about dry needling here! Does the size of the needle used in dry needling really make a difference on its effectiveness? Here at Imagine Physical Therapy, we incorporate dry needling (the use of needles to release muscle trigger points or “knots”) into many of our patients’ plan of care. Let’s be honest – most of us aren’t extremely comfortable being pricked with large, menacing needles. But what about the thin, unassuming needles that we use here at Imagine – are they just as beneficial? According to the research, yes!


Research journals are full of articles that indicate that smaller diameter needles (.2, .25, and .3 mm needles), like the ones we use in our clinic, are very effective in their treatment of various diagnoses. They can be used to treat plantar fasciitis, low back pain, carpal tunnel, neck and shoulder pain, and knee osteoarthritis, just to name a few. While there is limited evidence that bigger needles may tend to provide somewhat better results, the evidence is clear – small needles can give big results. So why not stop by for a little prick? The therapists here at Imagine Physical Therapy offer a multifaceted approach (exercise, stretching, ultrasound, and, of course, dry needling) to help you reach your full physical potential.


Trust me, as a former needle-phobe, I had my reservations about dry needling. But when, after some convincing, I decided to take the plunge, I realized that my shoulder pain was gone – along with my fear of needles! The therapists here are very knowledgeable and professional and will do their best to ensure your safety, comfort, and rehabilitation.


So, does size matter? Well I guess it depends on who you ask. As for me, give me a #leetleneedle and some physical therapy, and I’ll be just fine!



Zhang, SP., Yip, T-P., and Li, Q-S. (2011). Acupuncture Treatment for Plantar Fasciitis: A Randomized Controlled Trial with Six Months Follow-Up. Evidence-Based Complementary and Alternative Medicine, Vol. 2011, Article ID 154108, 10 pages.

Cherkin, D., Sherman, K., Avins, A. (2009). A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain. Arch Intern Med, 169(9):858-866.

Khoswari, S., Moghtaderi, A., Haghighat, S. (2012). Acupuncture in Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial Study. Journal of Research in Medical Sciences, 17(1):1-7.

He, D., Veiersted, K., Hostmark, A., Medbo, J. (2004). Effect of Acupuncture Treatment on Chronic Neck and Shoulder Pain in Sedentary Female Workers: a 6-month and 3-year follow-up study. Pain Journal, 109(3):299-307.

Berman, B., Lao, L., Langenberg, P., Lee, W., Gilpin, A., Hochberg, M. (2004). Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial. Ann Intern Med, 141:901-210.

Wang, G., Gao, Z., Li, J., Tian, Y., Hou, J. (2016). Impact of Needle Diameter on Long-Term Dry Needling Treatment of Chronic Lumbar Myofascial Pain Syndrome. American Journal of Physical Medicine & Rehabilitation, 95 (7), 483–494.

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Irma Workout

Posted on September 11, 2017 by

No sandbaggin’ during the storm!

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Better Balance

Posted on June 27, 2017 by

Want to know more about balance and how to improve it? Check out this balance inservice article and learn ways to assess your balance and reduce the risk of falls through various exercises.



Evaluation and

Treatment of Balance Inservice

What is Balance?

  • A state of equilibrium
  • Always changing, dynamic
  • Coordination and stability of the body in space
  • Normal balance depends on information from the vestibular system in the inner ear, sight, touch, proprioception, muscles, and from the integration of sensory data by the cerebellum


Causes of Falls/Loss of Balance

There are many different reasons why a person could lose their balance and fall down.  Here are a few reasons:

  • Weakness
  • Decreased vision/hearing
  • Impaired reaction time
  • Temperature changes
  • Neuropathy
  • Medications
  • Environment
  • Low blood pressure
  • Parkinson’s disease, Ménière’s disease
  • Poorly controlled diabetes, epilepsy
  • Brain disorders, stroke
  • Osteoporosis, arthritis, decreased conditioning


Prevalence of Falls

  • One out of three elderly people fall (AAOS, Aging in the Know)
  • More than a third of adults aged 65 years or older fall each year (CDC)
  • 21-61% of elderly people report ‘fear of falling’ (Fear of Falling in the Elderly)
  • Fear of falling affects confidence in performing daily activities, causing self-limitation and a less active lifestyle (Hawk).
  • Direct and indirect costs associated with falls total $75–100 billion in the U.S. annually (Hawk).


Assessing Balance (see attached)


The Berg Balance Scale is mainly used in an in-patient setting, such as hospitals and in-patient rehabilitation clinics.  It assesses balance through 14 items in sitting and standing.  Each item is scored on an ordinal scale (0-4): 0 indicating inability to perform the skill and 4 indicating the ability to perform the skill at the highest level described.  The maximum score is 56.   The items range in difficulty from sitting unsupported for 2 minutes to standing on 1 foot for more than 10 seconds.  It does not include a gait component.



  • 41-56 = low fall risk
  • 21-40 = medium fall risk
  • 0-20 = high fall risk


Tinetti’s Balance and Mobility Assessment is used for higher-level patients and is the most widely used measure of balance and gait.  It includes 8 components of balance and 8 components of gait.  The 8 components of balance are sitting balance, arising from a chair, immediate and prolong standing balance, withstanding a nudge at the sternum, turning 360˚, balance with eyes closed, and sitting down.  The 8 components of gait are initiation, step length, height, and continuity, symmetry, path deviation, trunk sway, and walking stance.



  • ≥ 24 low risk for falls
  • 19-23 moderate risk for falls
  • ≤ 18 high risk for falls    


Timed Up and Go Test (TUG): is a timed walking test (including sit to stand transfer) that is used to assess balance with transitional movements, speed of walking and risk for falls. 



  • <12 seconds = normal
  • >16 seconds = increased fall risk in community dwelling elderly


Timed single leg stance (SLS) has been correlated with amplitude and speed of sway in people without disease.  Single leg stance has been shown to improve over the course of 6 months of rehabilitation.  Rossiter and Wolf found that older adults in the community could maintain SLS for 10 sec about 89% of the time and nursing home residents for 45% of the time.  


Interpretation (Berg Balance Scale)

  • 4= able to lift leg independently and hold › 10 seconds
  • 3 = able to lift leg independently and hold 5-10 seconds
  • 2= able to lift leg independently and hold ≥3 seconds
  • 1 = tries to lift leg unable to hold 3 seconds but remains standing I
  • 0= unable to try and needs assistance to prevent falls


Other Things to Assess

  • Functional Reach
    • Using a yardstick attached to a wall at approximately shoulder height, measure how far a person can reach forward without losing their balance
  • ROM necessary for normal gait (Perry):
    • Dorsiflexion= 10˚
    • Knee Flexion = 60-70˚
    • Hip Flexion= 30-40˚
  • Patient’s home environment (rugs, doorways, etc.)
  • Strength, especially trunk stabilizers and LE muscles (quadriceps, gluteals, hamstrings, gastrocs, tibialis anterior, peroneals)


What’s the Best Way?

There isn’t one!  The Timed Single Leg Stance and The Timed Up and Go are quick and easy to set up and are also repeatable and measurable.  Tinetti’s Balance and Mobility Assessment is a measure that’s widely used for higher-level patients and doesn’t require much set-up.  The Berg Balance Scale is slightly more complicated and requires more set-up but is easy to score.

Perhaps a combination of the assessments or their components would be best, depending on what your patient presents with.


Treatment of Balance Problems/ Fall Prevention

Most of the time, balance problems and falls aren’t due to just one thing, they happen because of a variety of things.

  1. Ask about medications and past/current medical history (Koski)
    • Sedatives: Ambien, Valium
    • Diuretics: Lasix, Lozol, Diuril
    • Psychotropic drugs: Haldol, Lithium, Prozac, Xanax
    • Calcium channel blockers: Diltazium, Cardizem, Dilacor, Tiazac
    • Anti-inflammatory drugs: Advil, Motrin, Aleve, Celebrex

*According to Koski, calcium channel blockers and anti-inflammatory drugs are both associated with slow walking speeds and muscles weakness, in particularly iliopsoas weakness with anti-inflammatory drugs.

  1. Test ROM and strength of lower extremity and trunk
  2. Evaluate (or have a family member, friend or co-worker evaluate) the person’s home/work environment


Strength Training vs. Balance Training:  Study # 1

Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults

  • 8-week, 3-day/week intense strength training program
  • 24 Subjects aged 61-87
  • Strength Training group: 12 subjects performed 2 sets of 10 , 6 lower body exercises
  • Control Group: 12 subjects had no intervention
  • Tested pre, mid and post- intervention using SLS and 5-rep sit-to- stand (as per Berg Balance Scale)


  • Post intervention strength was significantly better for all 12 strength training subjects  
  • No difference between groups for the SLS or 5-rep sit-to-stand tests
  • Schlicht J, et al.  found that strength training alone does not improve standing balance


Strength Training Combined with Balance Training:  Study #2

A Randomized Control Trial of a General Practice Program of home based exercise to prevent falls in elderly women

  • Control Group: 117 subjects received usual care, no physical therapy  
  • Exercise group: 116 subjects received a physical therapy program
    • Strength training component: ankle cuff weights for
      • Hip extensor and abductor muscles
      • Knee flexor and extensor muscles
      • Quadriceps
      • Ankle plantar and dorsiflexor muscles
    • Balance Training component:
      • Standing with one foot directly in front of the other
      • Walking placing one foot directly in front of the other
      • Walking on the toes and walking on the heels
      • Walking backwards, sideways, and turning around
      • Stepping over an object
      • Bending and picking up an object
      • Stair climbing
      • Rising from a sitting position to a standing one
      • Knee squat
  • Main Outcome Measures:
    • Number of falls and injuries related to falls
    • Time between falls during one year of follow up
    • Changes in muscle strength
    • Balance measures after six months
  • Assessment tests used: Functional Reach, Berg Balance, knee extensor strength, “Chair stand” test (time taken to rise from a chair and return to the seated position five times), time to walk 8 feet, stair climbing (4 steps), distance walked in 6-minutes using AD



  • After 1 year there were 152 falls in the control group and 88 in the exercise group
  • After 6 months balance had improved in the exercise group
  • Campbell J, et al. found that a home exercise program of strength training and balance training improved physical function as well as reduced falls and injuries.




“A Tool Kit to Prevent Senior Falls: The Costs of Fall Injuries Among Older Adults.” National Center for Injury Prevention and Control. 2006. 24 Sept.2006.


Abbruzzese, LD.  The tinetti performance-oriented mobility assessment tool. Am J Nur.  1998:98(12):16J-16L


Campbell  J, Robertson MC, Gardner MM, et al.  A randomized control trial of a general practice programme of home based exercise to prevent falls in elderly women.  BMJ. 1997;315:1065-1069


     Colby, Lynn Allen S, PT and Carolyn Kisner, MS, PT.  Therapeutic Exercise Foundations         

     and Techniques  4th Edition.  Philadelphia: F.A. Davis Company, 2002


“Don’t Let a Fall Be Your Last Trip: Who’s At Risk?” American Academy of Orthopaedic    Surgeons. 2000. 24 Sept. 2006. Thread_ID=74&topcategory=Prevent%20Fall.htm


“Falls.” Aging in the Know. 2005. 24 Sept. 2006. know/chapters_ch_trial.asp?ch=21


Farrell, MK. Using functional assessment and screening tools with frail older adults. T Ger Rehab 2004:20(1):14-20


Gagnon, Nadine, MD, FRCP(C) and Alastair Flint, MB, ChB, CRCP (C), FRANZCP.  Fear of falling in the elderly. Geri & Aging.  July/August2003:6(7)


Hawk C, Hyland JK, Rupert R, Colonvega M. Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older.  Chiropr Osteopat.2006; 14: 3


Koski K, Luukinen H, Laippala P, Kivela S.  Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study.  Age and Ageing 1996;25:29-38


Lusardi, M.M. Berg balance scale.  Jou Geriatric PT, 26(3), 14-22


Perrry, J.  Gait Anaylsis: Normal and Pathological Function.  Accessed at:,M1.  Accessed on December 3, 2007


Schilcht J, et al.  Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults .  Ger Soc Am. 2001;56:281-286


    “Strength and balance exercises.” Geriatrics. 2006.24 Sept. 2006.


Tinetti ME, Williams TF, Mayewski R, Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986:80:429-434


“What You Need To Know About Balance And Falls.” Balance and Falls. 2006. 24 Sept. 2006.



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“My BACK is costing me an arm and a leg!”

Posted on May 17, 2017 by

Your back will get BETTER FASTER and stay BETTER LONGER if you start Physical Therapy early after the onset of back pain.

Are you having low back? Weighing your options and wondering what you should try first?

TRY PHYSICAL THERAPY! An award-winning study published by BioMedCentral Health Services Research, “Implications of early and guideline adherent physical therapy for low back pain on utilization and costs,” Child et al. reviewed 122, 723 military health system patient records and found that by not trying physical therapy first, a patient’s costs are likely to go up, along with the potential use of opioid medications, spinal injections, surgery, and other treatments.


In this study, researchers split the patients into 4 different groups:


  1. Patients who received physical therapy within 14 daysof a physician visit
  2. Patients who received physical therapy after a wait of a LEAST 14 days
  3. Patients who received “adherent” physical therapy (meaning interventions followed    evidenced based guidelines)      
  4. Patients who received non-adherent physical therapy.


This study adds to the growing evidence that continues to demonstrate the importance of early physical therapy for low back pain to lower overall cost of care, and that starting low back pain treatment with imaging ultimately increases cost.


So…if you’re having low back pain and wondering what can be done about it, come see us at Imagine Physical Therapy. You will get BETTER FASTER and STAY BETTER LONGER and it will cost you less!



Resources: Childs, J. D., Fritz, J. M., Wu, S. S., Flynn, T. W., Wainner, R. S., Robertson, E. K., … & George, S. Z. (2015). Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC health services research15(1), 150.

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I know “they” say exercise is good for you, but I can’t seem to “remember” what exactly it’s good for….

Posted on May 12, 2017 by

Having trouble remember things? Chalking it up to old age? Well, did you know that exercise can help counter cognitive decline? More and more research continues to come out on the specific benefits of exercise in all aspects of health. According to a recent study in the journal of Medicine Science in Sports & Exercise, “Exercise keeps the Brain Young: Study,” moderate-to-vigorous exercise can help reduce the risk of cognitive decline by up to 36%.
This is great news! With the ever advancing medical field, individuals are living longer and healthier lives. However, despite these medical advances, there are continued projected increases for age-related cognitive impairments such as Alzheimer’s disease and other forms of dementia. It is these types of findings that bring hope to the aging population that exercise brings more benefits that just for the cardiovascular system or losing weight. Exercise helps your brain as well!

In this study, there were 6,400 individuals who were aged 65 years or older. Each individual was given an activity trackers of seven days, and their cognitive abilities were assessed during various tasks. After a period of three years, the study showed that people who performed moderate-to-vigorous levels of physical activity were deemed significantly less likely to experience cognitive problems than individuals who were sedentary or only performed light physical activity.
So how does physical therapy play a role in all of this? As physical therapist, we can design an exercise program for individuals that is safe, tailored to address each individual and what is best fit for them, as well as provide education of the specifics of intensity and what moderate-to-vigorous activities looks like on a daily basis.

So…here is something that is easy to remember! Come see us at Imagine Physical Therapy and you will get BETTER FASTER and STAY BETTER LONGER.

Study: Zhu, W., Wadley, V. G., Howard, V. J., Hutto, B., Blair, S. N., & Hooker, S. P. (2017). Objectively Measured Physical Activity and Cognitive Function in Older Adults. Medicine and science in sports and exercise, 49(1), 47-53.

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Our Furry Friends at Imagine PT

Posted on March 8, 2017 by

Daisy is a 8 year old boston terrier who loves to cuddle and sleep under a big pile of blankets.

Roxy is a 3 year old boston terrier who is crazy about her tennis balls and loves to run around and play for hours.
Both dogs are certified therapy dogs and love coming to Imagine on Tuesdays and Thursdays with their dad John to love on and greet patients.

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Best of Mount Pleasant 2017

Posted on January 5, 2017 by

We are excited to announce that Imagine Physical Therapy has been voted “Best Physical Therapist” again by the readers of Mount Pleasant Magazine! We appreciate every vote received from our wonderful patients. Thank you for allowing us to provide immeasurably more than you could ask or imagine, and we will continue to do so in 2017! Check out the article HERE


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Did you know?

Many insurance companies now cover Physical Therapy WITHOUT a doctor's referal.

Direct Access

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Did you know?

Many insurance companies now cover Physical Therapy WITHOUT a doctor's referal.

Direct Access

Learn More