Category: General

Tips to Change Habits for Tension Relief

Don’t Be Controlled By Your Focal Vision

“Powered Peripheral Vision”, Tips to Change Habits for Tension Relief

Adapted from Dr. Heidi Wise, PRI Vision, LLC

Focal vision refers to being focused on something small at any distance, from your phone to a golf ball far away on the green. Technology is partly contributing to our society becoming more focally near-sighted. The more you focus on a bright device 6-12 inches from your nose, the stronger those brain pathways become.  Other contributors include being too busy, always striving to be faster, better, to do more, and not taking time to rest… your muscles AND your eyes.

Here are some tips to slow down, to be more mindful about what’s going on around you and to reduce eye tension and neck strain:

  • Take periodic breaks from seated tasks. Get up and move around.

  • Look away 20 feet from your computer screen every 20 minutes for 20 seconds.

  • Look around using only your eyes, not always your head and eyes together as a unit.

  • If you have to be in a small space for long hours every day (i.e. at work), get a picture of wide, open spaces and occasionally look at it noticing the distance.

  •  Consider a postural ergonomic “check up” for the spaces you work in most.

  • Notice that as you strain to see something small (close or far) your head migrates forward changing the position of your skull relative to your neck. Over time this can cause pain and other problems. Think about pulling your skull backwards on your neck. Then relax it forward just slightly. Your ear should be lined up over your shoulder.

  • If you are near-sighted (your far away vision gets blurry without your glasses or contacts), walk in safe, familiar areas without your glasses on or contacts in and be OK with the blurriness. Do not strain to try to focus.

  • Read a book, not a tablet. Try to keep it as far from your eyes as is visually comfortable. If you have to read from a light source, dim the light as much as is comfortable and increase the font size.tiny book image


(remember these?)

  • When you walk slow down, don’t focus on a narrow area straight ahead. Be aware of objects on both sides of you without having to look directly at them. Sense your body moving forward past objects and sense the objects moving behind you as you propel yourself forward.

  • If you spend time outdoors (recreationally or as a serious athlete) notice if you spend a lot of time focusing on something small very far away. If so, make a conscious effort to notice your surroundings, and peripheral vision more.

We actually spend our days thinking about and discussing these concepts (really!) and would be happy to talk with you more about your issues.  Feel free to stop by or give us a call at Advance Physical Therapy: 919 932-7266.


Lisa Mangino PT, DPT, PCS, C/NDT, PRC

The Surf Project at Advance Physical Therapy

Read about how our own Joe Belding spent his summer when he decided to take up surfing at the age of 62!

The Surf Project

Children and Back Pain

            Last week there was a story on NPR about young athletes and back pain.

The story was about children who are spending increased time with one sport, resulting in overuse injuries, particularly back pain.  With the added excitement of the Olympics this month, young people are inspired to compete and to perform to be the best they can.

            However, repetition of the same active motion without balanced, strong muscle support can set one up for injury, regardless of age.  If low back muscles are overused without the same strength of the abdominals (especially the abdominals on the side of the trunk), to hold the spine and rib cage in the proper neutral position, back pain can result. 

            Further, breathing patterns can be a factor.  If a child can only breathe with his or her mouth open, or can’t breathe efficiently without using his or her low back muscles, this might indicate weakness of the abdominals on the side of the trunk and poor breathing mechanics.  These powerful side abdominals have an important role in stabilization of the spine, pelvis and rib cage, as well as efficient breathing.  If you suspect your child’s back pain might be a result of poor posture or breathing mechanics, try this test. 90_90 peds

            Position your child with his or her knees on the wall and hips and knees bent 90 degrees. Prop up the head with pillows and watch.  You are looking to see if your child can breathe with his or her body in a bent position and low back muscles lengthened.

            Signs that this is difficult include:

·      raising arms over head

·      arching the low back

·      open mouth breathing with inability to keep lips  closed

·      yawning to try to get more air in

·      overall difficulty maintaining the position

            If any of these signs are noted, and your child is complaining of low back pain, he or she might have a low back overuse injury.

            Back muscles should be used for stability and movement not overused for breathing.  If a child can’t breathe without using low back muscles, he or she might need help with retraining muscles for breathing to relax the low back and decrease or stop back pain.

            Our pediatric physical therapy specialist at Advance Physical Therapy has the special training your child might need.  Call today!


Specialized Vestibular Rehabilitation at Advance Physical Therapy

We are so pleased to welcome Shella J. LoBianco, MSPT to Advance Physical Therapy.  Shella joins us with a wealth of experience on balance and gait/walking disorders.  Here is a little more about her:

Shella J. LoBianco, MSPT – Physical Therapyshella



Shella received her MS in Physical Therapy from the University of Alabama at Birmingham in 1994.  She has over 18 years experience in neurological and vestibular/balance therapy, treating patients with neurological impairments and multi-factorial gait disturbance. Shella’s clinical experience includes treating patients with traumatic brain injury, spinal cord injury and stroke in the acute setting including the surgical intensive care unit and also the inpatient and outpatient neuro rehab settings.  She has completed training in Neuro Developmental Treatment (NDT) for adults with hemiplegia.  Shella holds a Certificate of Competency in Vestibular Rehabilitation (2001) and in Vestibular Function Test Interpretation (2007) both from Emory University’s Department of Rehabilitation.  She has 12 years experience in the evaluation and treatment of balance and vestibular disorders.  Shella is the previous owner of a successful private practice specializing in Vestibular Rehabilitation Therapy (VRT) in Florida and has served as Program Director and Rehab Director for Vestibular Programs in New York.  She has also served as consultant to various outpatient clinics around the country, assisting them in developing Vestibular Rehabilitation programs.

In addition, Shella is certified in Tai Chi for Arthritis and incorporates many of the principals and forms into her treatments for patients with vestibular and balance impairments. She believes that all aspects of the patient’s health and well-being must be incorporated into a treatment plan in order to improve that person’s quality of life.

Scoliosis and Schroth Method of exercises:

This is a patient testimonial offered by the parent of a current patient at Advance Physical Therapy:

C is a (13 yr old female) who had a scoliosis upper curve of 51 degrees and lower one of 45 degrees in Jan 2013. Two top Ortho surgeons in Raleigh both recommended surgery ASAP. We felt that surgery for our 13 yr old should be the last resort. After much research, and a trip to the Northeast with a Schroth trained therapist, we decided to try intensive PT for C.  We were excited that 2 therapists at Advance Physical Therapy in Chapel Hill became certified in the Schroth Method. C has been seeing Susan Henning since last May. Susan is knowledgeable, enthusiastic, encouraging, supportive, compassionate, dedicated to helping in many ways and always positive in guiding patients. C loves to go to see her for therapy! The fantastic news is that her recent x-ray – Aug ’13 showed the upper curve improved by decreasing  down to 40 degrees and her lower curve to 35 degrees . C  will continue to go and anticipates her scoliosis curves decreasing even more in the next few months! We are extremely pleased with the professional  and caring treatment C has received each time at Advanced Physical Therapy. We highly recommend this practice and the Schroth based method of PT that  they offer.  

A Patients Perspective on Managing Her Scoliosis

61 Year Old Female with Scoliosis

I have been working with Susan Henning since the autumn of 2010.  I am a 61 year old female whose scoliosis was diagnosed at the age of ten during a pediatric check up.  I was most fortunate to avoid back surgery since my spinal growth stopped at about twelve years old.  I was left with an “S” curve, left lumbar and right thoracic in good balance.  Throughout my life, I have been inconsistently active, especially with regard to exercise because of my repetitive crash and burn pattern.  Just as I would achieve some level of tone, strength, and cardiovascular conditioning, my back or a leg, or hip would start hurting, become inflamed and I would stop all activity in order to heal.  My healing processes required months, despite whatever relief modalities I used.  These included anti-inflammatory, over the counter and some prescription medicatins, icing, bandaging, bracing, physical therapy, deep tissue massage, energy work.  Ultimately I spent more time not doing anything than doing.

My first contact with a Postural Restoration (PR) therapist was different.  The therapist actually knew how to diagnose what type of scoliosis I had through a simple movement pattern.  All previous therapist nodded their heads, they knew scoliosis, they understood it was quite asymmetrical and then proceeded to have me do activities that were symmetrical.  If each side of the body of a person with scoliosis is different, then the symmetrical exercise will overload one side due to the opposite side’s inability to perform comparably.  All the years of running, using treadmills or elliptical machines, or free weights or home gyms required bilateral activities that inevitably overloaded my “good” side and then the pain would start.

My PR therapists have understood what parts of my body need to be built up.  The process has been quite slow.  I came into this new approach over four years ago with a curve that was progressing to 60 degrees.  I had experienced a pinched nerve, was feeling tingling in my rib hump, left side and have been struggling with right leg pain due to a tilted pelvis.  The pinched nerve has not recurred, the rib tingling is completely gone and gradually I am building to muscle tone to correct the pelvic tilt.  Most importantly, I am able to walk again!  I was always a walker, able to go for and hour or more on weekends.  I stopped walking about five years ago and have been attempting to return to a consistent practice.  I am seeing real hope for the first time in many, many years.

Susan Henning is the finest therapist I have had in my life.  Not only does she listen, she is passionate about my improvement.  What I see in PR is the capacity to troubleshoot effectively.  If I am having pain when I come in to a session, Susan carefully assesses my neutrality and can always figure how I am out of alignment and then get me back into alignment.  When I leave that session, I know exactly what exercise I need to do to either maintain alignment or restore it.

Through Postural Restoration I have received an education about my body, its compensations, weaknesses and am learning little by little how to reconnect and rebuild neurologically and muscularly.  I am learning how to hold myself differently, whether standing, sitting or sleeping.  For the first time, many of my back and belly muscles are starting to move with breathing and regaining some tone.  I have to be diligent.  If I let too many days go by without my core group of exercise, then old pain and scoliotic postures resurface once more.  I would not and could not be where I am today without the PR therapist I have.  At this point in time, I see myself continuing to increase my strength and capability because of the work Susan and I are doing together.

Nova A Scheller – Bear Creek, NC

Upcoming November ChiWalking workshop

ChiWalking logoSee dates/times below. Let me know if you would like to sign up. Would love to have you, Beth

DatesSundays (Nov. 3 & 17)

Time: 1:30 – 3:00

ChiWalking Workshop

Instructor: Beth Elder         

            Walk and hike effortlessly and injury-free by learning how to walk biomechanically.  Attend the Small Group ChiWalking workshop I am offering.

            ChiWalking is the most exciting walking instruction available.  Walkers get injured because of being tense, walking upright, and leading with their legs.  ChiWalking has you moving from your core muscles, while relaxing the rest of your body. This, combined with engaging gravity, makes walking effortless and injury-free. This is the essence of ChiWalking – relax and let your body do what it was built to do, walk faster and easier and leave injuries behind.

            Since walking is such a basic, every day movement, when one’s walking form is improved, the benefits are far-reaching.

Workshop Information:

Open to all: all levels, any age, injured or not

Instructor: Beth Elder  (contact information:  (919) 949-6058

Dates: Sundays (Nov. 3 & 17)

Time:1:30 – 3:00

Registration no later than 5:00 pm on Friday, 10/25/13 (Space limited to 6 participants)

Fee: $70 total for the 2 sessions (Payment due at time of registration)

Location:  Advance Physical Therapy, 77 South Elliott Road, Chapel Hill, NC 27514 (between Whole Foods and Staples)

Private workshops and lessons are available by request. 

Workshop Details:

In this workshop, you will learn the basic components of the ChiWalking technique. Since this workshop is a small group format, you will get lots of personal attention. The workshop will provide you with a rich learning experience packed with good information to help you walk effortlessly and injury-free for the rest of your life.

Class Format: I will be guiding you through many exercises and drills designed to leave you with a clear sense of what the ChiWalking technique feels like in your body.  We will spend time alternating between demonstrations, fun exercises and technique drills…the nature of the workshop will be relaxed and fun.

The workshop will be held outside, so check the weather forecast and dress appropriately. Please bring snacks and water, if needed.

Scoliosis in Adolescents Needs PT Treatment – Don’t Wait!

Last night I spoke with yet another concerned parent about their teenaged child.  Like so many others, this child was diagnosed some years ago, as a preteen, with mild scoliosis.  This mother sought out the best medical help she could find and was told by a doctor, “Just wait and see what happens – there is nothing you can do about it now.”  So she waited and when she next checked in with the doctor, the curve had progressed to 35 degrees.  Too mild for surgery, so the doctor advised again – “Wait and see how it progresses.”  Indeed, without any intervention, the curve did progress.  On the next visit the curve measured 45 degrees.  Now, it is approaching the range eligible for surgery.  Does this child and family want surgery?  Under the threat of surgery, this mother began seriously researching about scoliosis and treatment of scoliosis.

This mother realized, as many others in her situation have also realized, that there are actually abundant conservative treatments available for managing scoliosis.  There is research available on many of these techniques that demonstrate a halt in curve progression.  In many cases, conservative management techniques can reverse curve progression.  The earlier rehab is initiated, the more effective is can be.  Curves of 20 to 50 degrees Cobb Angle can also benefit from specialized bracing.  Bracing, coupled with active, specialized exercise which address the 3 dimensional asymmetrical spinal changes, has been studied.  The literature indicates that this combination for more advanced curves can be very effective in halting or reversing scoliosis progression.

It is hard for me to hear the same story over and over again: a parent who knew some action was needed but were told by medical authorities to wait.  These parents, who waited and watched their children changing with anxiety and concern, had no further guidance towards immediate, conservative, helpful interventions.

I am so grateful to have the amazingly effective, conservative rehabilitation treatment of Postural Restoration and the Schroth Methodology to offer to these families.  As needed, we also recommend bracing.  We have seen some very positive responses to a tailored, disciplined exercise protocol.  Although preteen and teenage years are a difficult time for a young person to take on self renewal, it is actually an empowering and effective focus that will give life long benefits.



Screening Children for Scoliosis

What do we look for?

Does the child have natural curves at the back of the neck, middle and lower back?  The start of scoliosis is often marked by a flattening or increase in spinal curvatures, before a more obvious sideways curve develops.

When the child bends forward is there:  a flattening between the shoulder blades, a “s” shape to the spine, or a “hump” on one side of the ribs or low back?  Is one shoulder or shoulder blade higher or more forward?  We check children to see that they can balance as well on one leg as the other.  Is the child or teen overly flexible?  This “hypermobility” is a common trait among people with scoliosis.  We also check how children are breathing and how their ribs and spine move when they breath.  We often find breathing problems in children developing scoliosis.

When do we look for scoliosis?

The most common form of scoliosis (Adolescent Idiopathic Scoliosis) develops during the adolescent growth spurt.  This is generally between the ages of 9 and 16 with girls often reaching the growth spurt earlier than boys.  The 5th grade is generally a good time to start keeping a close eye on the growing spine.

What can we do?

If we have concerns with these tests, we recommend the child be seen by their doctor for further evaluation and  possibly x-rays, if needed, to help us further evaluate the extent of problematic spinal curves.  We base our treatments on the type of curves we see in testing and on x-rays.  We do not advocate AT ALL watching and waiting to see if curves will worsen – there is a LOT that can be done with conservative treatment, and the sooner and earlier during growth of the spine, the better.

At Advance Physical Therapy we specialize in Schroth based Scoliosis Treatment and Postural Restoration exercises.  These approaches encourage spinal de-rotation and postural awareness to minimize and often reverse the progression of spinal curvatures that accompany growth and development.   We often recommend bracing designed to manage the complex corrections required to lessen spinal curvatures.

Please don’t “Watch and Wait” as many of our patients and parents have told us they were advised to do.   Often you will be “watching” helplessly as a child’s scoliosis gets worse and worse.  We are here to offer treatment and support to lessen the impact of scoliosis on your child.

New York Times on Scoliosis

The July 17th, 2013 Health Section of the New York Times ran an extensive piece on scoliosis.  I pulled out a small section of the article below – as I thought it contained useful norms and guidelines.  Reference the entire article here.  We are tremendously excited about the results we are seeing in patients with scoliosis using highly individualized, conservative treatments like Schroth Based Therapy and Postural Restoration, often in conjunction with bracing.

Predicting the Extent of Curvature Progression (in Scoliosis)

In Children and Adolescents. After a mild curve is detected, a more difficult step is required: predicting whether the curve will progress into a more serious condition. Although as many as 3 in every 100 teenagers have a condition serious enough to need at least observation, progression is highly variable and individual.

Doctors cannot rely on any definitive risk factors for curve progression to predict with any certainty which patients will need aggressive treatment. Some evidence suggests the following factors may help determine patients at lower or higher risk:

·       Having a greater angle of curvature. For example, at 20 degrees, only about 20% of curves progress. Young people diagnosed with a 30-degree curve, however, have a risk for progression of 60%. With a curve of 50 degrees, the risk is 90%.

·       Curvatures caused by congenital scoliosis (spinal problems present at birth). These may progress rapidly.

·       Treatment with growth hormone. (Studies are mixed on whether this treatment poses any significant risk, although strict monitoring is still essential in young patients being given growth hormone.)

Curvatures may be less likely to progress in girls whose scoliosis was low in the back and whose spine was out of balance by more than an inch. Height also comes into play. For example, a shorter-than-average girl of 14 with low-back scoliosis of 25 – 35 degrees but whose spine is imbalanced by over an inch would have almost no risk. The same degree of curvature in the chest region of a tall 10-year old girl whose spine was in balance, however, would almost certainly progress.

In Adults. In rare cases, unrecognized or untreated scoliosis in youth may progress into adulthood, with the following curvatures posing low-to-high risk:

·       Curvatures under 30 degrees almost never progress.

·       Predicting progression at curves around 40 degrees is not clear.

·       Curvatures over 50 degrees are at great risk for progression.

Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.