Strength Over Age 50

A recent article published in Reader’s Digest is grabbing the attention of medical and fitness professionals. The article, entitled ‘14 Exercises You Should Modify if You’re Over 50,’ has good intention but shells out some advice that may create fear or apprehension among readers interested in exercise. Reader’s Digest has since asked two physical therapists to rewrite the article due to the overwhelming response among healthcare professionals.

Exercises do not necessarily need to be modified simply based on age. The human body is incredibly complex and unique. We see many patients and clients in the Palisades well over the age of 50 doing what they love. Let’s go over some specific exercises and routines discussed in the article that, when performed appropriately for your body, can have immense health benefits.

High Intensity Interval Training (HIIT)

HIIT involves short bursts of low volume exercise with rest periods of decreased intensity.(1) HIIT is a well studied exercise practice known for improving cardiovascular and metabolic functioning.(1) HIIT will provide improvements in physical function at a more rapid rate than traditional endurance training, especially for non-athletic and sedentary populations.(1) Not to mention, typical HIIT sessions only last 20-30 minutes which makes it more convenient to integrate into your day. HIIT can be performed in many different ways. Work with a healthcare professional to design a graded, appropriate HIIT program to reap the benefits!

Pull ups

Lifting the entirety of your body weight is easily one of the most challenging physical tasks for a human being. But mastering this feat can hugely improve upper body strength and grip strength. Not to mention that it’s pretty cool to be able to accomplish this. Now, before you go hanging from door frames or your local park monkey bars, let’s go over some appropriate progressions to mastering the pull up. Start with pulling exercises that use a manageable amount of resistance that is moderately challenging for your body. Examples of this include rows and lat pull downs. Perform rows with a resistance band, on a machine, or bent over with a free weight. Lat pull downs can be performed on a machine at the gym or even sitting on the floor so that you can move through your full available range of motion and bonus, you get to work on getting up and down from the floor (something highly undervalued in our Western society).

Another method of working on your pull up is through Pilates. Chest expansion and bicep curls on the reformer are great initial exercises to build up the strength needed to do a pull up. Hanging back on the cadillac is an advanced exercise that combines pulling your body weight against gravity with back extensor strengthening.

As you get stronger with these pulling exercises, then you can practice static holds in a hanging position with a step underneath you so that your feet are only an inch off of the ground. Finally, progress to the full pull up.


Deadlifts are an excellent exercise for the posterior muscles of your body. This includes the back muscles, gluteal muscles, and hamstrings. But, again, proper progression to this exercise is necessary. Performing pelvic tilts, bridging, and/or spinal motor control exercises with a physical therapist or fitness professional who can give you feedback about body positioning is a good starting point. Then, you can progress to standing and practicing the hip hinge motion involved in a deadlift with a dowel against your tailbone and mid back for spinal positioning. Finally, perform the deadlift without the dowel and gradually add resistance.

Leg Press

This is suggested to be avoided in the article due to assumed back positioning during the exercise. The back is not necessarily rounded during this exercise unless you make it that way. The leg press is still a great exercise and most physical therapy rehabilitation facilities carry this piece of equipment because of its value. The leg press will improve not only the strength of the legs but also the strength of the muscles in your trunk. It also allows you to grade the amount of resistance you can tolerate. A Pilates reformer is a great piece of equipment to perform a leg press on.

The bottom line is - exercise is one of the most beneficial and necessary things you can do to enhance your body and life. The human body is incredibly robust, especially when provided appropriate challenges over time. Don’t get caught up in the plethora of information we have circulating around the internet. Be skeptical. If you ever have pain during an exercise, consult your physical therapist for an assessment of your movement. Furthermore, if you want guidance on how to effectively improve your strength and mobility, contact a trusted healthcare professional.


  1. Weston M, Taylor KL, Batterham AM, Hopkins WG. Effects of Low-Volume High-Intensity Interval Training (HIT) on Fitness in Adults: A Meta-Analysis of Controlled and Non-Controlled Trials. J. of Sports Medicine. Published April 18, 2014.

Finding Your Balance

Over 15% of America will be age 65 or older by 2020. That’s over 50 million Americans! As a society, we’re improving life expectancy in great strides. As we continue to add years onto our lives, we must take into account the quality of those years. We must realize that our daily choices impact our body and overall wellness. As we age, it takes more careful deliberation to curate the most optimal food choices and exercise routines. Ensuring that you work daily movement into your routine is vital. However, some daily movement practices along with the natural aging process can lead to an increased chance of fall or injury. As we age, our cognitive processing, sensory systems, and reaction times all experience some overall decline. Lack of proper stimulation to these systems have detrimental effects on our balance and ability to perform daily tasks. These are serious concerns, as a fall can lead to hospitalization, immobilization, and injuries which can be detrimental to overall health.


So, what is the best way to prevent falls? Let’s be clear - not all falls can be avoided. We live in a world full of obstacles and challenges. What we can focus on is improving balance, reaction time, and strength to best protect against falls. There are various factors that influence our balance. The systems that govern our balance include our somatosensory system (think tactile feedback), visual system, and vestibular system (inner ear). All of these systems must be functioning well for good balance.



Exercises to challenge your somatosensory system include those than narrow your base of support (distance between your feet) or those that create an unstable surface below your feet (soft cushion or wobble board). A beginning exercise to challenge your balance is to stand in a corner with a chair in front of you. Then, bring your feet all the way together. Challenge yourself by taking one hand off the chair, then the other. If this is easy, you can bring one foot in front of the other (heel to toe).

Visual System

Many of us heavily rely on our visual system for balance. Nevertheless, this can become an issue if we’re getting up in the middle of the night to use the restroom or walking on a dark lit street. It can even become an issue if our vision starts to decline. Besides getting your vision checked regularly, you should consider challenging your visual system. Ways to challenge your visual system are simple...just stand with your eyes closed! As this gets easier, you can work with your physical therapist to perform moving activities with eyes closed.


Vestibular System

The vestibular system consists of the structures of the inner ear on either side of the head. These structures send signals to the brain telling it where we are in space. To challenge this system, we typically add head movements to our balance challenges. An example of this would include standing with feet together or one in front of the other and looking side to side. You can also look up and down. This can be performed statically or dynamically (walking).

If performing these exercises on your own, be sure to perform in a corner with a chair in front of you to ensure optimal safety. If you do not feel that you can safely perform these exercises, please perform with a licensed physical therapist.



In a recent study in the Journal of American Medical Directors, 221 participants in care facilities performed an exercise program consisting of the balance exercises mentioned above along with a few arm strengthening exercises, standing up from a chair, and stepping exercises. The participants performed these exercises for two hours a week over 25 weeks as well as ‘maintenance’ sessions for the following 6 months. The participants experienced a 55% reduction in falls! That’s huge. The program is similar to the one curated for the balance class offered at The Cypress Center. Our class is taught by a licensed physical therapist and vestibular specialist every Monday, Wednesday, and Friday.


Concluding Thoughts

Balance is an area of our health where we can see improvements with consistent practice. Take control of your health and aging. Besides maintaining good balance, reaction time, and strength, it’s also important to live a healthy lifestyle. This means making sure all your basics are covered. Get good, quality sleep with minimal disturbances. Eat clean, whole foods that don’t come from a box. Making sure that your body is functioning as optimally as possible is going to make you better able to deal with all that life throws at you. Your body is the only sacred vessel that you have to get you through this life - treat it well!



  1. Hewitt et al. Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. JAMDA. 2018.

Unlocking the Mysteries of Manual Therapy

Manual Therapy.JPG

What actually happens in the body when your back cracks? How about when you stretch a muscle? Are you making a muscle longer? Are you putting a joint back in place? Let’s explore the current research on manual therapy and its effects in the body.

Manual therapy is defined as skilled, hands-on techniques used to target soft tissues and joints of the body (3). Examples include joint mobilization, massage, stretching, and sensory re-education. Manual therapy is an effective tool for many reasons. It has the potential to alleviate pain, affect muscle contraction, and improve body awareness (1-3). When applied correctly, manual therapy affects not only the local tissues, but the central nervous system (also known as your brain and spinal cord!) (3).

Pain Reduction

Manual therapy and its impact on pain reduction in the body is well documented in the literature (1). Even more recently, research is showing that manual therapy affects much more than simply the tissues of the body. It has an effect on the central and peripheral nervous system by improving the brain’s perception of pain/sensation (3). This improved perception allows the brain to better adapt and deal with stressors.

Range of Motion

Manual therapy can also influence the range of motion of a joint. Specific types of stretching, such as contract-relax, and high velocity spinal manipulation result in immediate changes in range of motion. These techniques stimulate the nervous system and can result in decreased sensitivity in larger ranges of motion. This means that you can lift your arm or leg higher with less pain!

Muscle Activation/Inhibition

Research shows that certain manual therapy techniques have the potential to cause muscle activation or inhibition (2). More specifically, high velocity joint manipulation can result in muscle activation whereas lower amplitude joint manipulation can lead to muscle inhibition (2). 


Although manual therapy is an effective tool for the reasons mentioned above, it is the most effective when combined with exercise. Many studies show improved outcomes for patients who receive hands-on techniques combined with exercise when compared with just exercise or just manual therapy. This is likely because manual therapy also has the ability to improve symptoms immediately which, in turn, allows one to strengthen without symptoms limiting them from moving. Although manual therapy may not make a permanent change in the tissues of the body as was previously believed, it gives you a window to move and exercise. One is then able to create more robustness in the body. Being strong allows the body to have more tolerance to insult and puts one at less risk for future injury. Strengthening also releases the body’s natural pain-killers...endorphins! That is why many physical therapists use manual therapy in the beginning of a session to reduce symptoms and improve joint range of motion necessary for strengthening.

In summary, manual therapy is an effective treatment to assist in pain reduction and improve function. When applied correctly, it can have an important impact on recovery time. The Cypress Center is home to physical therapists and massage therapists who utilize manual therapy to improve patient function. Examples of techniques that our therapists use include myofascial release techniques, joint manipulation, and instrument assisted soft tissue mobilization. Cypress therapists also have extensive sessions that allow us to  apply appropriate manual therapy and exercise techniques with precision. Make an appointment and take charge of your health today!


1. Cook et al. Does Early Change Predict Long-Term (6 months) Improvements in Subjects who Receive Manual Therapy for Low Back pain? J. of Physiotherapy. July 2017.

2. Fisher B. et al. The Effect of Velocity of Joint Mobilization on Corticospinal Excitability in Individuals With a History of Ankle Sprain. Journal Of Orthopaedic & Sports Physical Therapy [serial online]. July 2016;46(7):562-570.

3. Hildalgo et al. The Efficacy of Manual Therapy and Exercise for Treating Non-Specific Neck Pain: A Systematic Review. J Back Musculoskelet Rehabil. Nov. 2017.


Is Knee Surgery Right for You?

Knee pain.jpg

Arthroscopic surgery of the knee is a minimally invasive surgery that allows surgeons to obtain an image of the inner joint and soft tissue structure. Surgeons may also perform small procedures during this surgery including meniscal repair, ACL repair, and trimming of cartilage. Complications with this surgery are rare and recovery times depend on overall health, the amount of procedures performed, and patient lifestyle.

Although this seems like an easy, minimally invasive endeavor, why not make this the last option on your list? A recently published systematic review, which remains the highest tier of research, presents a well-rounded perspective on knee arthroscopy. In the study published in the British Medical Journal in 2017, researchers concluded that patients that chose to undergo knee arthroscopy had no differences in long-term pain or function when compared with patients who chose conservative treatment. With the long-term benefits being seemingly minimal and the risk for future knee replacement higher following this surgery, one should consider alternative options prior to jumping into surgery (figuratively, of course). Let’s summarize the pros and cons associated with this surgery:


It can be helpful in reducing pain and improving range of motion. The surgery is not aggressive and has minimal risk factors. Fortunately, we are surrounded by excellent surgeons that will provide informed advice on the best course of action for your ailment/injury according to the recent research and their experience. Over the course of the last 18 years The Cypress Center has worked with dozens of physician groups and are happy to give our recommendations for medical professionals as well as for your course of care.


With quick recovery times, patients may go in and out of PT quickly without actually addressing the underlying movement dysfunction that led to the surgery in the first place. Are there muscle imbalances that led to abnormal stress on the joint? Are you doing activities with poor posture everyday that cause increased pressure on the joint and soft tissue? Likely, the answer is yes. None of us are perfect and we’re naturally asymmetrical beings. Pain and functional limitations can return if these issues are not addressed.

This is not to say that arthroscopic surgery is never the answer. Every case is highly individual and some may find great benefit from this surgery. Surgery can be an absolutely effective choice when warranted. But as a consumer, it is important to stay educated on the most current evidence. Discuss the pros and cons with your healthcare team to ensure the best outcomes. You only get one body in this life, treat it well!


  1. Brignardello-Petersen R, Guyatt GH, Buchbinder R, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 2017;7:e016114. doi: 10.1136/bmjopen-2017-016114
  2. Wilkerson, R. “Knee Arthroscopy.” OrthoInfo. American Academy of Orthopedic Surgeons, September 2016.


Improving Your Relationship with Pain  

Pain is a simple sensation, right? You bump your knee and it hurts. It will probably hurt until it’s
healed. Is that all that’s going on? Not quite. Pain can persist (chronic pain), move to other parts of the body (radiating/referred pain), or even manifest in parts of the body that no longer exist (phantom limb pain). In the physical therapy world, we go even further as to classify pain as nociceptive, neurogenic, or central in origin. The study of pain and its various manifestations within the body is termed ‘pain science’.

The Science of Pain and Recent Discoveries
‘Pain science’ is a popular topic in the health realm. As is the association between pain, fear,
and disability. We’ve made big discoveries in the relationship between the brain and pain. The
introduction of brain scans opened our eyes to the hormonal contribution to pain,
neuroplasticity, and central/peripheral sensitization. Even more recently, brain scans of those
dealing with prolonged pain revealed changes in gray matter in the brain, especially in the
prefrontal cortex. These structural alterations are linked in research to increased rumination
over pain and decreased ability to cope with pain. Researchers believe that these structural
changes decrease the brain’s ability to activate pain inhibition pathways within the nervous
Pain, especially chronic pain (lasting more than 3 months), affects many people. It can lead to
missed work and antisocial behaviors. Not only is it stressful on our pockets, but it’s stressful
mentally. Many people are quick to ‘catatrophize’ pain and all of the events surrounding their
pain, particularly when pain becomes chronic. This can lead to depression and
avoidance of physical activities that they associate with their pain. Later down the line, this can
cause muscle deconditioning and a cycle of pain recurrence because the tissues aren’t getting
appropriate, graded stress necessary for the healing process.

How to Approach Pain
As you can now tell, pain is much more complex that we once assumed. Reframing pain to be
less threatening can better serve our bodies and minds. It is important to first understand that
pain does not equate to tissue damage. Increases in pain do not necessarily mean you’re
tissues are being damaged more. Movement is necessary and your physical therapist is a
movement expert who can help you move more efficiently. Don’t forget that movement produces
endorphins - our body’s natural pain-killers! Understanding the negative repercussions of
movement avoidance and interrupting the cycle of unhealthy emotional responses to pain can
have a profound effect on your overall wellbeing. It is empowering to know that you have control of your pain. This will ultimately assist in putting an end to the pain cycle.
Consult with your physical therapist to gain more insight into your pain and create an action plan to address it. You will learn ways to move without increasing pain, thus combating movement avoidance. In physical therapy, your therapist will help you set specific goals in relation to physical health. Goal setting is an important step in creating your own success.
Other methods to combat pain include mindfulness and breathing techniques. These techniques help promote relaxation and easy pain-related anxiety. Yoga and Pilates are excellent movement practices that promote mind-body connection through controlled poses and specific breathing techniques. If you’re into Chinese medicine, acupuncture is another great option for pain reduction. These strategies will help you take control of your pain and allow you to return to meaningful life activities.

1. BUNZLI S, SMITH A, SCHÜTZE R, LIN I, O'SULLIVAN P. Making Sense of Low Back
Pain and Pain-Related Fear. Journal Of Orthopaedic & Sports Physical Therapy [serial
online]. September 2017;47(9):628-636. Available from: CINAHL Complete, Ipswich,
Perspective on Pain Neuroscience Education in Physical Therapy. Journal Of
Orthopaedic & Sports Physical Therapy [serial online]. March 2016;46(3):131-134.
Available from: SPORTDiscus with Full Text, Ipswich, MA.
3. Moseley G. Reconceptualising pain according to modern pain science. Physical Therapy
Reviews [serial online]. September 2007;12(3):169-178. Available from: CINAHL
Complete, Ipswich, MA.
4. Moore J, Flynn T, Ceko M. [podcast] Exciting and Hopeful Research in Neuroplasticity.
December, 2017.

Finding Your Way Through Fall

By Tara Winters, P.T., DPT

Physical Therapist, BASI Pilates teacher

Fall is here - the days are getting shorter and holiday decorations are making their way onto our
front lawns. The only thing missing is the cooler weather...but I digress. Holiday parties, family
get togethers, and outings with friends tend to become paramount on our to-do list this time of
year. Unfortunately, amidst all of this fun and celebration lies somewhat less than optimal food
choices and a lack of self-care that we all need as we get busier. There are many ways to get in
the spirit of the holidays without letting the body get worn down. Let’s explore some ways to
have a happier and healthier November.

Eat What's In Season
Eating with the season is good for the body and good for the environment. Squash are a
versatile, classic Autumn food. Pumpkin, in particular, packs a ton of fiber (great for your gut
bacteria!) and benefits your vision with a healthy dose of Vitamin A. Don’t throw away the
seeds! The healthy fats found in pumpkin seeds shown to have anti-inflammatory effects in the
body. 4 They’re also high in zinc - an element that plays a role in digestion, hormone balance,
and fighting of free radicals commonly associated with accelerated aging and disease.7

Cranberries are another Fall powerhouse food. Cranberries are linked in research to aid in
everything from gut health to cardiovascular health.5,6,8. Avoid the traditional sugary cranberry
sauce (as this has the opposite effect on gut health) and opt for a healthier option. Look for a
recipe that incorporates a sweetener such as citrus or applesauce over white sugar.

Sip Up!
Tea has been around for centuries and is consumed in just about every culture. There must be
a reason for this, right? Served cold or hot, it can provide a ton of benefits in the health
department. Tea is high in polyphenols which are shown in research to aid in the prevention of
cancer and heart disease.1 Until recently, it was unknown as to how these compounds became
bioavailable in our bodies. Researchers found that specific gut bacteria digest these compounds
and allow our systems to use them in the prevention of disease.9 This is just another reason to
nourish your gut bacteria! Gut health is linked to just about everything going on in our
bodies...brain function, immunity, hormone expression, you name it! 9 Another study from the
European Journal of Nutrition analyzed the effect of both green and black tea on the gut.10  The
study suggests that both types of tea alter bacteria within the gut to promote weight loss.
10 So, ensure that your gut bacteria are happy and healthy to make a significant impact on your overall
wellbeing. Herbal tea can be another great option around the holidays. Naturally caffeine-free,
herbal tea is a relaxing option to choose before bedtime. Not to mention all of the comforting
flavors of herbal tea that will put you in the holiday spirit. Cinnamon, cloves, pumpkin...yum.

And If You Really Need An Extra Boost...
When our bodies are not performing at their highest ability or we’re unable to get certain
nutrients from the food we’re eating, supplements are a nice option to fall (pun intended) back
on. With the weather changing and our busy schedules keeping us from getting enough rest, sickness is lurking around many corners. Vitamin C supplements are shown to boost immunity when you start to feel that sniffle coming on. 11 Echinacea has also been used for years in the prevention of the common cold and is another great natural option to boost immunity. 3 A final supplement to consider is Vitamin D. Low vitamin D levels are connected with autoimmune
diseases. Be sure to get your levels tested before you try this vitamin, though. It is possible to
take too much. You can always ask your physical therapist for nutritional advice if you have more questions.
Our acupuncturists here at The Cypress Center also incorporate diet and nutrition into their
treatments depending upon the patient.

I hope this inspired you to embrace Autumn and all of the wonderful things it has to offer!


1. Mukhtar H, Ahmad N. Tea polyphenols: prevention of cancer and optimizing health.
American Journal of Clinical Nutrition [serial online]. 2000:Available from: Academic OneFile,
Ipswich, MA.
2. Zhang S, Ohland C, Jobin C, Sang S. The Role of Gut Microbiota on the Metabolism of Black
Tea Theaflavins. The FASEB Journal. 2017.
3. M. J, R. S, A. S, P. K, R. E. Safety and Efficacy Profile of Echinacea purpurea to Prevent
Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial.
Evidence-Based Complementary And Alternative Medicine, Vol 2012 (2012) [serial online].
4. Morrison M, Mulder P, Kleemann R, et al. Replacement of Dietary Saturated Fat by
PUFA-Rich Pumpkin Seed Oil Attenuates Non-Alcoholic Fatty Liver Disease and
Atherosclerosis Development, with Additional Health Effects of Virgin over Refined Oil. Plos
ONE[serial online]. 2015
5. Neto C, Amoroso J, Liberty A. Anticancer Activities of Cranberry Phytochemicals: an update.
Mold Nutr Food Res. 2008.
6. Bodet C, Grenier D, Chandad F, Ofek I, Steinberg D, Weiss E. Potential Oral Health Benefits
of Cranberry. Critical Reviews In Food Science & Nutrition [serial online]. August
7. Roohani N, Hurrell R, Kelishadi R, Schulin R. Zinc and its importance for human health: An
integrative review. Journal of Research in Medical Sciences : The Official Journal of Isfahan
University of Medical Sciences. 2013;18(2):144-157.
8. Blumberg J, Basu A, Toner C, et al. Impact of Cranberries on Gut Microbiota and
Cardiometabolic Health: Proceedings of the Cranberry Health Research Conference 2015.
Advances In Nutrition [serial online]. July 2016;7(4):759S-770S.
9. Dueñas M, Muñoz-González I, Bartolomé B, et al. A Survey of Modulation of Gut Microbiota
by Dietary Polyphenols. Biomed Research International [serial online]. February 22,
10. Henning, S.M., Yang, J., Hsu, M. et al. Decaffeinated green and black tea polyphenols
decrease weight gain and alter microbiome populations and function in diet-induced obese
mice. Eur J Nutr (2017).

11. Schlueter A, Johnston C. Vitamin C: overview and update. Complementary Health Practice
Review [serial online]. 2011;(1):49. Available from: Academic OneFile, Ipswich, MA.
12. Kirsten T, Galvao M, Reis-Silva T, Queiroz-Hazarbassanov N, Bernardi M. Zinc Prevents
Sickness Behavior Induced by Lipopolysaccharides after a Stress Challenge in Rats. Plos
ONE[serial online]. 2015;(3)
13. Aranow C. Vitamin D and the Immune System. Journal of investigative medicine : the official
publication of the American Federation for Clinical Research. 2011;59(6):881-886.

Concussions: More Than Just a Bump on the Head


By Tara Winters  

Physical Therapist, BASI Pilates teacher

The third week of September is Balance Awareness Week! This month also marks the start of the season for America’s favorite Therefore, I thought it would be fitting to discuss a common balance related issue among athletes - concussions.


Concussions are highly prevalent, especially among the athletic population. However, information on concussions and evidence about appropriate treatment options has evolved over the years, leaving many of us confused as to what to do when someone we know is affected. 


Fortunately, we know much more about concussions today than we did 10 years ago. Let’s review some of the background on concussions, signs and symptoms, and current treatment practices.


What exactly is a concussion?

A concussion is a traumatic brain injury (TBI) that can manifest into a wide array of symptoms that can last hours, days, or years.3 Symptoms can include mood swings, headaches, fatigue, brain fog, muscular tension, vertigo and memory loss.3 These symptoms can be influenced by diet, exercise, and stress.3



Usually, a sports-related concussion will resolve within 2 weeks after the injury.3 Keep in mind that children take longer to recover as their brains are still developing at this age.3 Current evidence shows that the following may indicate a longer recovery time: 3,4

●       Immediate dizziness

●       Amnesia

●       Acute exertion after the injury

●       Repeated injuries



If the concussion occurs during sport, the player should not return to play to avoid risking a second concussion.3 A second concussion is termed ‘second impact syndrome’ and can lead to more serious issues.3 During the initial few days following a concussion, light rest is recommended.3 Avoiding strenuous activity for one to two weeks allows for optimal healing.3 That is not to say that one must avoid activity altogether, but staying in the ‘light to moderate’ range of tolerable activity is typically appropriate. If visual stimulation is an issue, avoid bright lights or busy environments.3


A visit to your local physical therapist can also be helpful to address vestibular deficits and muscle tension, both of which can occur following a head injury. Vestibular impairments may include dizziness, motion sensitivity, vertigo, and headaches. Physical therapists can also assist you in creating an appropriate, graded return-to-sport exercise plan that will not lead to overexertion. Generally, mild to moderate aerobic exercise is helpful in stimulating brain-derived neurotrophic factor (BDNF).5,6 BDNF is involved in brain development, cell growth, and affects learning and memory.5,6 Another type of therapy that can be particularly effective in traumatic brain injury recovery is craniosacral therapy (CST).7 This type of therapy is performed by a physical therapist and involves gentle pressure to areas surrounding the craniosacral system of the body.7


Stress management should also be considered. Stress can negatively affect brain activity and exacerbate concussion symptoms as the brain is less able to handle increased energy demands following injury.2,7 Stress can mean many things for someone post-concussion. Examples include emotional stress, environmental stress, and overexertion (physically or mentally).3,7 Yoga, meditation, and breathing exercises are great stress relieving options to consider. Acupuncture is another great option for pain and headache relief.1 Many studies link acupuncture with the reduction of concussion symptoms such as headache or neck pain.1,8,9


If memory issues arise, try playing memory games. Lumosity is a great cell phone application that takes users through various levels of challenging memory games. SuperBetter is another app created by a woman with a TBI and is useful in setting goals and building habits.7 Journaling about gratitude can help those with a concussion ingrain positive thoughts along their healing journey.7 


Healthcare Professionals are Here for You

Whether you’re a professional football player or a parent concerned about your child, concussions can occur at any moment. If you notice any of these symptoms following a bump to the head, remember that it is important to get assessed by a healthcare professional as soon as possible to ensure optimal recovery.


Cypress Center physical therapists specialize in vestibular evaluation and treatment as well as CST. We also have skilled acupuncturists ready to assist in the treatment of any residual deficits following a head injury.



  1. Gergen D. Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report. Journal Of Chiropractic Medicine [serial online]. September 1, 2015;14:220-224. Available from: ScienceDirect, Ipswich, MA. Accessed September 6, 2017
  2. Kozlowski K. Exercise and Concussion, Part 1: Local and Systemic Alterations in Normal Function. International Journal Of Athletic Therapy & Training [serial online]. March 2014;19(2):23-27. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed September 6, 2017..
  3. Laura Morris. Mild Traumatic Brain Injury. Presented at: Elmhurst Memorial Healthcare; June 2017; Chicago, IL.
  4. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? The American journal of sports medicine. 2011;39:2311-2318.
  5. Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012;4(2):147-154. doi:10.1177/1941738111433673.
  6. Schmolesky MT, Webb DL, Hansen RA. The Effects of Aerobic Exercise Intensity and Duration on Levels of Brain-Derived Neurotrophic Factor in Healthy Men. Journal of Sports Science & Medicine. 2013;12(3):502-511.
  7. Molly Parker. Mild Traumatic Brain Injury: how to identify and treat concussions with compassion. Presented at: University of St. Augustine; November 2016; San Marcos, CA.
  8. Gergen DM. Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report. Journal of Chiropractic Medicine. 2015;14(3):220-224. doi:10.1016/j.jcm.2015.08.006.
  9. Biçer M, Bozkurt D, Aktaş İ, et al. The clinical efficiency of acupuncture in preventing migraine attacks and its effect on serotonin levels. / Akupunturun migren ataklarının önlenmesinde klinik etkinliği ve serotonin düzeylerine etkisi. Turkish Journal Of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip Ve Rehabilitasyon Dergisi [serial online]. January 2017;63(1):59-65. Available from: SPORTDiscus with Full Text, Ipswich, MA.

Back to School, Back to Better Posture

By Tara Winters- physical therapist and BASI Pilates teacher

Let’s talk about posture. And by posture, I don’t mean the outdated notion of standing up straight, with your shoulders back and your chin down. I am talking about the way we carry ourselves as we move through our everyday activities.

Poor posture is prevalent within our society, especially among adolescents. Since adolescence is a vital time for bone and muscle development, it is important to understand the impact that posture has on our body. Cell phone and computer usage are becoming quite ubiquitous, and we seem to be spending more time hunched forward. This puts undue stress on the joints and nervous system, contributing to muscle imbalances and other possible issues down the road (arthritis, anyone?). 7,8 These static sitting postures build habits which can also translate into movements performed throughout the day, from picking something up off of the floor to throwing a baseball. Not to mention the fact that young adults also spend many hours of the day sitting at a desk and lugging around backpacks full of textbooks. Adding any load to abnormal posture stresses the system even more...and here we go again!

It’s not all bad, though. Posture is a result of habit, and habit can be changed. As we head back into the school year, it is worth our time to explore small changes we can make to improve posture and adapt to our current environment.

Backpacks matter:

One study found that backpacks positioned in the middle of the back, with shorter straps, rather than lower on the back produced better standing posture.2 Be sure to observe your child’s standing posture when wearing his or her backpack to ensure they are not leaning forward or backward. Wearing both straps, rather than one, will distribute forces more evenly along the spine. And finally, check with the school to assess how reasonable it is for students to leave books at school. This way, they won’t have to carry more than necessary to and from school. Many studies show that carrying a backpack greater than 10 to 15 percent of your body weight can have significant effects on walking, going up and down stairs, and overall load on the body.1,2,5


Children sit for 45-60 minutes per class, and they may have 6-7 classes per day (hopefully, one of these is physical education). Although it’s hard to influence adolescent sitting posture in class, we can ingrain good postural habits at home. So, let’s focus on a work station that you can control- the desk or area that your child does homework at. Ensuring that the desk is ergonomically sound can do wonders for your child during long study hours. This can also include purchasing a book stand or holding your phone at eye level, rather than in your lap, to keep the neck in a more neutral position.

Get some sleep:

Fatigue from lack of sleep, or lack of quality sleep, can manifest in our daily postures and movement.3,4 Ensuring that your teen gets some quality shut eye by turning off devices (laptop, cell phone) an hour or two before bedtime can help the natural production of melatonin, a hormone that regulates sleep.3,4 Blackout curtains or an eye mask can also be beneficial in keeping any artificial light out of the room.

Get moving:

In the end, it all comes down to movement. Changing positions frequently can help us avoid sustained pressures and stresses on our body. Enrolling in sports, taking your daughter to a yoga or pilates class with you, or walking by the beach (summer isn’t over yet!) are all great options for increasing frequency of movement throughout your child’s day. They are also great bonding opportunities.

Making small changes throughout the day makes improving posture manageable. It also sets our body up to move in the most efficient way, leading to less energy expenditure and less risk for injury. Sounds like a win-win to me.

Finally, if you have deeper concerns about your child’s posture, consider setting up a physical therapy appointment here at The Cypress Center. Cypress therapists are experts in movement analysis, postural syndromes, and injury prevention. They can provide you with further insight on posture and implement an individualized exercise plan to fit your needs.


1.    Song Q, Yu B, Zhang C, Sun W, Mao D. Effects of Backpack Weight on Posture, Gait Patterns and Ground Reaction Forces of Male Children with Obesity during Stair Descent. Research In Sports Medicine[serial online]. April 2014;22(2):172-184.

2.    ABDELRAOUF O, HAMADA H, SELIM A, SHENDY W, ZAKARIA H. Effect of backpack shoulder straps length on cervical posture and upper trapezius pressure pain threshold. Journal Of Physical Therapy Science [serial online]. September 2016;28(9):2437-2440.

3. Kayaba M, Iwayama K, Tokuyama K, et al. The effect of nocturnal blue light exposure from light-emitting diodes on wakefulness and energy metabolism the following morning. Environmental Health & Preventive Medicine [serial online]. September 2014;19(5):354-361.

4. Tosini G, Ferguson I, Tsubota K. Effects of blue light on the circadian system and eye physiology. Molecular Vision. 2016;22:61-72.

5. Minghelli B, Oliveira R, Nunes C. Postural habits and weight of backpacks of Portuguese adolescents: Are they associated with scoliosis and low back pain?. Work [serial online]. May 2016;54(1):197-208.

6. Ingraham P. Posture Correction: Does it matter? Accessed August 23, 2017.

7. Norris C. Osteoarthritis of the Knee: A Practical Treatment Approach. Co-Kinetic Journal [serial online]. April 2017;(72):14-21.

8. Levinger P, Menz H, Fotoohabadi M, Feller J, Bartlett J, Bergman N. Foot posture in people with medial compartment knee osteoarthritis. Journal Of Foot And Ankle Research [serial online]. 2010;Available from: Academic OneFile, Ipswich, MA.