Sunday, December 23, 2012

Dehydration - not just a summer time concern

Dehydration can happen at any time, not just when it's hot outside. In fact, most cases of minor dehydration happen in the winter when we don't consume enough beverages to simply stay cool in the hot weather.

As a general rule, to figure out how much water intake you need per day, simply take your body weight and cut it in half. This is how many ounces fluid you need per day, 3/4 of which need to be pure water. (Ex. 150 lbs means 75 oz of fluid per day, of which 56 ounces need to be water. As for the other fluid, caffeinated beverages (energy drinks, coffee, soda) should not be included in your fluid total as they are diuretics and actually make you more dehydrated. Although teas do have caffeine, the amount is so low that they will not have a diuretic effect.

Try to take your fluids in a steady amount throughout the day to maintain proper fluid levels. However, you will want to stop or significantly tape fluid intake 2 hours or so before bed so that you don't wake in the middle of the night to go to the restroom.

How do you know if you're dehydrated? The signs below are taken from

Mild to moderate dehydration is likely to cause:
  • Dry, sticky mouth
  • Sleepiness or tiredness — children are likely to be less active than usual
  • Thirst
  • Decreased urine output — no wet diapers for three hours for infants and eight hours or more without urination for older children and teens
  • Few or no tears when crying
  • Dry skin
  • Headache
  • Constipation
  • Dizziness or lightheadedness
Severe dehydration, a medical emergency, can cause:
  • Extreme thirst
  • Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
  • Very dry mouth, skin and mucous membranes
  • Lack of sweating
  • Little or no urination — any urine that is produced will be dark yellow or amber
  • Sunken eyes
  • Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold
  • In infants, sunken fontanels — the soft spots on the top of a baby's head
  • Low blood pressure
  • Rapid heartbeat
  • Rapid breathing
  • No tears when crying
  • Fever
  • In the most serious cases, delirium or unconsciousness 
Also remember that diarrhea, vomiting, excessive sweating and/or fever will cause you to lose fluids so additional water intake (above the recommended daily amount) is needed to maintain your hydration level. If you're not sure if you're well hydrated, look at your urine color. Ideally, your urine should be colorless or very light in color. Dark yellor or amber colored urine indicates that you need to take in more water.


Sunday, November 25, 2012

The Do's and Dont's of Stretching

Everyone has engaged in a stretching routine at one time or another and, yet, a lot of questions remain regarding proper technique. Here's a quick run down:

  •  Perform static stretching before an activity (such as a runner's stretch, hamstring or quad stretch- where one position is held for a length of time). Static stretches elongate muscle fibers which can cause injury when done on "cold" muscles and can actually decrease your power and speed during the activity. Instead, do a warm up before your activity. For "work-out" type activities, such as running, using the elliptical, or lifting, try walking at a brisk pace a few minutes before the activity, slow lunges, or knee lifts with marching. If you're about to play a sport, practice movements that you will doing frequently during the activity, but in a slower, more controlled pace. This will prime your body to do these actions in a safe, technique-appropriate way during game time.
  • Bounce with static stretches! As previously stated, static stretching elongates muscle fibers. If you bounce you're very likely to overstretch the muscle or even tear fibers. 
  • Hold your breath. This is known as a val-salva maneuver to health professionals and can wreak havoc on your blood pressure as well as teach you bad habits that you then take into your work out or sport. You are never performing an activity to your true potential if you're holding your breath.


  • Static stretching after your activity. No matter the activity, you just performed numerous contractions which has left your muscle tight and balled up. Even after the activity the muscle fibers remain in some amount of contraction, therefore, we need to elongate them to return them to their normal resting state. This will decrease the likelihood of muscle soreness or spasm. If you're in a time crunch, at least stretch the muscle groups you used most during your activity (ie quads after lunges)
  • When performing your static activity, stop at a sensation of a comfortable stretch, NOT PAIN. Pain indicates, or may lead to, possible injury.
  • Hold your stretch for 30-60 seconds. 
  • Remember to always use good technique. If you're trying to stretch your hamstrings, be sure you're not actually stretching your back!
If you have any questions about stretching or have had repeated injury with your activity despite following these guidelines, see a physical therapist.


Monday, November 12, 2012

Weebles wobble, but they don't fall down...

Unlike weebles, we have very complex means for staying upright.  There are three main systems in the body that contribute to our ability to maintain balance.  They are vision, the vestibular system, and joint/muscle receptors.  Vision is obviously important for maintaining balance, but the other two systems have important roles as well.  The vestibular system, located in the inner ears, helps your body know which way is upright and, with vision and joint receptors, if your body is moving and how so (as in rocking on a boat).  Joint receptors, along with receptors in the muscles, tell your brain where the joint is in space and if and how your joint is moving.  Additionally, sensory input from the skin helps us feel the ground and adapt to uneven surfaces.  Processing, integration, and control from brain centers (for instance, the cerebellum, located under the base of the skull in back) play a major role in maintaining balance.  If something goes wrong in any of the systems, balance will be affected and you'll have to rely more on the other systems.

A few practical examples illustrate the contributions of the various systems.  A person who's had a knee replacement has lost joint receptors in the parts of the joint that were removed in surgery.  Sometimes the loss is significant enough that balance is affected because the person can't tell where the joint is in space very well.  People with diabetes often loose sensation in there feet due to nerve damage from the disease.  They are basically walking on two numb feet, which can be especially troublesome with walking on the lawn (which is uneven).  A person who had a blow to the head may find that they are terribly dizzy with changes in position.  This can be due a problem with the sensory apparatus in the inner ear, but is often treatable.

The balance system is really a combination of beautifully interworking systems in the body.  So, next time you take a step without falling down, be glad everything's in working order!

Sunday, October 28, 2012

Workplace ergonomics

According to The New York Times, the average American spends eight hours in front of a computer a day. The human body is not meant to spend such a large amount of time in one position, however since most jobs, classwork duties, and genres of entertainment are now based around a computer, making that space the least detrimental to your physical well being is a must. Here are a few general rules to follow:

1) Head/neck: the top of you computer monitor should be at directly in front of you at eye level and a comfortable distance away that you can easily see the screen (using computer glasses if needed). If you are doing any type of data entry, place the sheet of paper on an easel at eye level and as close to the computer monitor as possible. Do not place the paper flat on your work surface! It may not seem like much, but continuously looking down at the paper then up at the monitor will place too much tension on your neck. Use a monitor riser or even a phone book to raise monitors up. If using a laptop, place the entire thing on a riser and use a wireless keyboard and mouse.

2) Arms: your elbows should be placed at your sides bent at 90 degrees, typically resting on an arm rest of appropriate height. Your forearms should rest on the work surface with the keyboard so your wrists are not either too flexed or extended. As most standard desks are too high to allow for this, mobile work surface that you can raise and lower should be installed or you can raise your seating surface. Gel wrist supports for the keyboard and/or mouse can be helpful if you're spending numerous hours at the computer but they should be used as a cue to hold your wrist in a neutral position, not relied upon as a true support. Continuous torque on the wrist is the fastest way to develop carpal tunnel symptoms.

3) Back: your low back should be in a neutral position - not arched nor rounded. Your shoulders should be stacked on top of your hips, not hunched over. If your shoulders are hunched, see the two items above. Be wary of lumbar supports, they often put the user in too much of an arched low back.

4) Hips/legs: your knees should be level with your hips and feet flat on the floor. This can be accomplished by lowering your seating surface or purchasing a foot rest (or even a phone book!) of appropriate size.

There are numerous items on the market to help make your workplace more ergonomically friendly. Take a look at an office supply store or online if needed.

Most importantly, TAKE BREAKS! As stated earlier, the human body is not meant to stay in any position for a prolonged period. If needed, set a time every 30-60 minutes and change positions. Each break can be as long or as short as you need it to be, simply getting up for a glass of water makes a huge difference.

If you're having trouble assessing your workplace or continuing to have pain while at this position, come see a physical therapist at CORE Services, Inc. We can simply make a few recommendations as to how you can create a better environment, or assess and treat your pain if needed.


Monday, October 15, 2012

What's the noise my joints make?

There are several theories of joint "cracking" noises.  Some people think that "cracking" in the spine is a sign of excessive mobility and lack of muscle control of the joints, which if untreated could lead to arthritis.  Joint noises in the knees, hips, or shoulders is sometimes a sign of injury to the cartilage in those joints, especially if accompanied with locking of the joints.  For other explanations of joint sounds see this site.

Monday, October 1, 2012

Three simple strategies to help you lose weight

More than one third of all US adults are obese. All that unnecessary weight can cause significant medical problems like diabetes and heart disease, but it can also have a big impact on your musculoskeletal system. A larger and more protruded abdomen can cause a "sway back" posture putting excess stress on your low back, knees, and ankles. Along with regular exercise, three simple strategies are key to helping you shed some pounds: eat regular meals, journal everything you eat, and bring your own lunch!

Check out this article via to find out more.

Eating habits are only part of the struggle. Regular exercise (even walking!) is essential in maintaining a healthy weight and improve overall health! If you are having any pain keeping you from getting out there and staying fit, see a physical therapist at CORE Services, Inc for an evaluation today!


Monday, September 17, 2012

Have a headache?

There are multiple types of headaches.  Most people have probably heard of migraines.  These typically involve a throbbing pain with sensitivity to light and noise and may also include upset stomach.  Tension-type headaches are more of a dull ache with the feeling of a band around your head.  Cluster headaches are so called because they occur in groups over a period of time.  For instance, they may occur multiple times in a week and then disappear a while, only to recur later.  Oftentimes cluster headaches are felt only on one side.  Some headaches have more interesting names, like thunderclap headaches, which you can read about here.  Head pain can be caused by trigger points (tight areas in muscle) that refer pain over the top of the head, around the eyes, and other typical patterns.  You can see and example here.  Problems with the jaw joints are sometimes associated with headaches too.  With so many types and causes of headaches it is important to seek help from a medical professional if you experience them.


Sunday, September 2, 2012

Leaking is never normal

Ladies, have you ever been talking with your girlfriend and heard her say "I laughed so hard I peed my pants!"? This phenomena has become so mainstream that many women don't realize that this is a major issue. IT'S NEVER NORMAL TO LEAK! It doesn't matter if you're laughing, lifting something heavy, or "just didn't make it to the bathroom in time." If you leak urine, it's a clear sign that your pelvic floor is not working the way it should. This may be related to a previous injury like an episiotomy (traumatic or surgical) with childbirth or a consequence of another issue like low back pain.

If you have experienced urinary leakage, especially coupled with pelvic pain, rectal pain, constipation, or chronic urinary tract infection, come see the women's health therapist at CORE Services, Inc. Having a simple conversation and looking at your overall posture can give great insight as to what may be going on with your body. In many cases, this problem can be treated externally with exercise and manual therapy. If the problem does not clear with conservative measures, it may be appropriate to do an internal assessment, of course, only if you're comfortable.

Urinary leakage is the number one reason women are admitted to nursing homes, take care of this problem before it's too late!


Monday, August 20, 2012

DOs and DON'Ts of Lifting

  1. Check the load to see how heavy it is.
  2. Make sure the path you are taking is clear.
  3. Bend down using you're knees as much as possible.
  4. Pull you stomach muscles in and hold them in during the lift (like you're trying to fit into pants that are too small).  This gives support to your spine.
  5. Bring the object close to your body (waist level is good).
  6. Lift using your legs and arms, rather than getting all your force from your back.
  7. Keep the object close to your body while you move it.
  8. Put the object down by bending your knees again.
  1. Bend only at your waist when you can bend your knees.
  2. Twist your torso while lifting.  Instead, turn your body by stepping with your feet.
  3. Lift more than you can handle alone.

Friday, August 17, 2012

What is this pain in my heel?

Do you have heel pain that is worse in the morning with your first few steps after you get out of bed?  You may have a condition called plantar fasciitis.  Plantar fasciitis is an inflammation of the plantar fascia (a band of connective tissue that connects your calcaneus (or heel bone) to your toes.  Plantar fascia may be caused by poor foot mechanics, wearing the "wrong" shoes (i.e. flip flops, high heels, shoes that don't provide arch support or shoes that are worn out), standing too long on hard surfaces without adequate support or tight gastrocnmeius (calf) muscles or Achilles tendons.  If you think you may have plantar fascia, early intervention is best!  Roll your foot on a tennis or golf ball over the tender area.  Do this daily for up to 3 minutes (or the length of a TV commercial), followed by ice massage.  An easy way to do ice massage is to freeze a water bottle and roll your foot on the frozen bottle for about 5 minutes.  Stretching your calf muscles is also a good idea if you think you may have plantar fasciitis. If the heel pain doesn't resolve within a couple of weeks with these easy techniques, you can consult with a physical therapist who can evaluate your foot mechanics and provide treatment.


Monday, August 6, 2012

Shoes can affect more than just foot pain

Our clinic sees patients of all sizes, ages, fitness levels, and areas of pain. Despite all of this variation among our patient-base, we have found one constant among almost all of them - their shoe choice! If you are experiencing pain anywhere in your body, especially your low back, pelvis, hips, knees, ankles, and/or feet, chances are your shoes are part of the problem.

Pain is an indication that something is not right within your body, typically stemming from a malalignment causing secondary soft tissue dysfunction. In order to restore proper mechanics and decrease pain, these proper mechanics, and therefore alignment, need to be restored. There is no other "bang for your buck" like a good supportive pair of athletic shoes. They allow your body the external support needed to allow your joints to realign and remove the abnormal irritation of the painful structure.

Tennis shoes come in three varieties - cushion, stability and motion control. Cushion shoes are generally indicated for those with perfect foot and ankle mechanics and, most likely, no pain. Stability shoes give a moderate amount of support for your foot and are generally good for moderate pronators (those with "fallen arches"). Motion control shoes give a significant amount of support and are good for those with significant pronation.

Running stores typically offer the best selection of supportive shoes and the associates have a little information as to the specifics of each shoe. Many associates may offer to watch you walk and advise which the best shoe is for your body. Be aware, these associates have little training in gait analysis and are unable to differentiate if a particular problem is coming from the hip or knee or if the problem is compensatory or not. For a more comprehensive evaluation and shoe suggestion, seek an evaluation by a physical therapist. At the very least, throw away your $3 flip flops and put on some tennis shoes (don't forget to tie them tight enough that you cannot slip them off without untying them)! 

Here's an interesting article by discussing why flip flops are such a poor "shoe" choice.

"Flip-flops present feet with a painful problem"


Sunday, July 29, 2012

How Yoga Wrecks Your Body

In the adult body there are normally 206 bones. Depending on your definition of joints there are somewhere between 200 to over 300 joints in the adult body.  Given those numbers it’s safe to say that our bodies are built to move.

Movement is essential to maintaining a healthy pain free body. Equally important to health and pain free living is rest, good nutrition, and relaxation.  A balanced system is a healthy system. Sedentary jobs, inactivity, repetitive activity, injuries, trauma, sleeplessness, fatigue, mental and physical stress etc. are all factors that challenge our bodies ability to flow in and out of situations and remain healthy and pain free.
 "How Yoga can Wreck your Body" is an interesting article from the New York Times. It’s an easy to read story of  how an activity like yoga which is innocent, fun and healthy for many people can be or become harmful and even dangerous for others. This article could easily be titled “How running, tennis, baseball, volleyball, weight lifting, walking, or working as a grocery store checker wrecks your body.” Just because we enjoy something and it is touted as being healthy doesn’t mean it is always good for us.  Timing is everything.
We want our patients to move and be active.  However, not all activities are created equal and not all bodies are able to handle activities equally, especially if your experiencing pain.  Pain and dysfunction is a sign that something isn’t right, it’s our bodies way of saying “pay attention to me, I need help.”  

Monday, July 23, 2012

Tips for Choosing a Pillow

There are any number of options for bed pillows, both in shape and material.  And there are some unique pillows out there, take for example the Snoogle body pillow or the Travelrest travel pillow.  So what should you look for in a pillow?

You want your spine in as close to normal alignment as you can get it while you sleep.  For side sleepers this means a pillow for your head that fills in the gap between the bed and your head without tilting your head sideways in either direction.  A small pillow under your waist or a regular size pillow between your legs may be helpful as well.  For back sleepers a little thinner pillow is usually OK under your head.  There are some pillows with an ergonomic (body fitting) curve build in to support your neck, which is a nice concept.  However, I find in reality they tend to have a "drop off" that can be a bit too steep for the shoulders transitioning to the neck.  Also, if you're a back sleeper with back pain a larger pillow under your legs can take strain off your back.  Finally, stomach sleepers need a thinner pillow (since you turn your head to the side, which really isn't great for your neck) or a pillow with a cut-out for your face so you can breathe while keeping your spine in better alignment.  If you can help it, I'd recommend avoiding stomach sleeping altogether since even with a cut-out you're not going to get the best spinal alignment.

The material of which the pillow is made also plays into selection, but this area is more a matter of personal preference so long as spinal alignment is maintained.  I find that Memory Foam type pillows seem hard.  Feather pillows don't hold their "fluff" to support you as much as you might think.  The basic foam pillow isn't bad in the beginning, but then gets squashed down with use.  My favorite?  Down alternative- usually soft enough, but still supportive, and it seems to last longer than the basic foam pillow.

So, to sum it up, get your spine in good alignment and go with whatever is most comfortable to you and helps you sleep.  Sweet dreams!


Friday, July 20, 2012

How often should I replace my running shoes?

If you are having pain in your knee joints, muscle fatigue or sore feet, it may be time to replace your running shoes.  A general rule of thumb, is to replace your running shoes every 300-500 miles.  However, this number may vary depending on the type of shoe you train in, your body weight, surface you train on and your running form.  We recommend purchasing a new pair of shoes before your current shoes are worn out.  The purpose of this is to break the new shoes in so that your body can get used to the shock absorption in the new shoes.  It's a good idea to wear the new shoes in your "normal life" for about two weeks before running in them. If you continue to have pain after replacing your running shoes, consult a physical therapist at CORE Rehab for an evaluation.


Monday, July 16, 2012

Want to know a bit more about neurofeedback and some of the more unusual ways this powerful technique is being used.  Want to see why the AC Milan soccer team put a mind room at their facility.  There are many athletes utilizing these techniques to gain the edge  needed to be successful. Neurofeedback is also used  for treating more traditional problems such as ADHD, anxiety or PTSD.  I found this article that was easy to read and looked at the many possibilities to tune up that organ we call the brain.  Do something today for your control center.  Train your brain

Wednesday, July 11, 2012

Get up and move! Or at least get up...

Everyone knows that getting 30 minutes of moderate-intensity exercise five times a week is good for us, right? Turns out that sitting less can have a significant result on our health as well!

Check out this article discussing how spending a little less time on the couch can significantly lengthen your life

If pain is preventing you from meeting your exercise goals each day, see a physical therapist at CORE Services for an evaluation! In the mean time, get off the couch and go do something fun!


Monday, July 9, 2012

Welcome to our blog

We are a multidisciplinary clinic in St. Louis, MO providing physical therapy, biofeedback and psychological services.  We were founded in 1999 by a group of experienced chronic pain specialists but we treat multiple conditions.

The conditions we treat with an interdisciplinary approach include, but are not limited to, chronic pain, women's health issues, chronic headaches, jaw joint related pain, scoliosis, posture correction, athletic injury treatment and avoidance, treatment of performance artists, etc.  Our president, Julie Hereford, PT, DPT is also currently writing a book about sleep and rehab, due out in 2013. 

Biofeedback treatment is used for pain management but can also be used alone for a variety of conditions including insomnia, stress management, ADHD, depression, etc.

Keep checking our blog for information on these and related topics.

Contact us at for more information or visit our website at