Remember, poor posture is not a primary cause of back pain. Posture is the path of least resistance the body assumes to function within its biomechanical patterns. When you correct the biomechanics, posture corrects itself. To tell your body to "stand tall-sit up straight-pull your shoulders back" requires effort on your part if the correct biomechanics are not present to allow the movement to occur effortlessly. Next time someone says, "You need to improve your posture," think instead, "I need to improve my biomechanics." Good Luck!
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Don’t automatically eliminate stomach lying (prone) as a position of comfort for your back. Biomechanically, relief for some back dysfunctions will be obtained with stomach lying. When lying prone, position 1-2 pillows lengthwise under your torso, to support the low back to comfort. As with all positioning, it is beneficial to change positions periodically. Always position to comfort; your body will be your best guide.
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Heat or Ice?
The 48-72 hour rule for cold application does not apply in BCT. As long as there is warmth of tissue to the touch, cold is applied to decrease inflammation. The duration and frequency of application is guided by the degree of inflammation, resultant tissue swelling, the size of the involved area, and the type and temperature of cold application. Apply cold directly to the injured area while applying heat adjacent to the injury (toward the heart) to aid circulation. Heat or Ice? Simultaneous use is our best advice!
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Use of Heat or Ice?
When deciding whether to apply heat (thermal therapy) or ice (cryotherapy) to an area of discomfort, note that the temperature of the application is as important as what you chose to apply. The more heat (inflammation) an area generates, the greater the temperature variance will be when applying cold. Therefore, use a milder degree of coldness i.e. cold, wet washcloth versus a frozen gel pack. When using heat, start with a milder form of heat with gradual increase to comfort depending on response of tissues.
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Limb Length Discrepancy and Heel Lifts
The body often displays, and functions with, a discrepancy in limb length. This discrepancy is nearly always biomechanically induced and can be influenced by multiple joint changes in the lower trunk and lower extremities. A heel lift is rarely required unless trauma or surgical intervention results in an anatomical length discrepancy.
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Biomechanical Correction Technique (BCT) Evaluation
Biomechanical Correction Technique (BCT) Evaluation identifies patterns of joint dysfunction that leads to standardized biomechanical classification (Flexion, Extension or Neutral). BCT uses specific exercises and activity guidelines to negate dysfunctional patterns in its unique classification-based and treatment-based approach.

Optimal performance of daily tasks is guided by classification. Even the comfort of selected footwear, clothing design and sitting/sleep positions are predetermined by classification. Your body is a good guide to preferred activity/positions for a given dysfunction. BCT Evaluation/Classification can further guide and enhance your recovery.
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Choose the Right Shoes
More important than the style of a shoe is the fit and feel of a shoe. A good fit requires a stance angle that neutralizes the low back curve (lordosis) and centers body weight through the pelvis. The slope of the inside of a shoe midway between heel and toe is the determining factor to comfort. The greater the inward curve of the low back, a lower slope (angle) is recommended. Vice-versa, a flat low back requires a higher-slope (increased heel to toe angle). In reality, most males benefit from elevation and do so by wearing cowboy/work boots. Most females have an accentuated lordosis during or after pregnancy and find they prefer flats. Footwear needs will change when biomechanics change.
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As winter surrounds us – there’s more time available for reading. In the past year there have been numerous articles in the Wall Street Journal and other popular publications that highlight back/neck/joint pain. As a consumer, it is difficult to sort out what is worthy reading and valid information.

One of the most reliable sources on necks and backs is the Spine Journal published bi-monthly by Lippincott etal. It is available through college or public libraries or on-line at

Book information is often dated by the time it is published and gets to the consumer.
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Balance is more than centering gravity – no fooling!
Is the loss of balance clumsiness, old age, or circumstance? To feel stable standing, forces have to be centered. Centering of forces requires symmetrical weight distribution:
A. Right to left
B. Front to Back
C. Top to Bottom.

A simple home or in-store check test can be done with two identical bathroom scales. To assess weight distribution, place each foot/body part on one scale in the following positions and record findings:
A. Centered on scales placed side by side.
B. Scales placed top to bottom in a straight line: Place one foot centered
on front scale and other centered on back scale, record weights, reverse feet and compare.
C. 1. In four point – hands on one scale/knees on second scale.
    2. In four point, alternate, and put each hand on a scale, then each knee on a scale.
Is the recorded weight equal in comparison?
BCT can enhance balance through the restoration of joint biomechanics allowing for better body weight distribution. Better balance is essential to better performance, it’s no joke!
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No Pain/No Gain – No Pain/More Gain with BCT
For years, pain was just a subjective report of noxious stimulus within the body.

There were few standards to measure and compare pain. Today, there are more objective assessment tools to help bridge the barriers associated with pain.

Various aspects of “Pain” can be measured, including:
  1. Duration of Pain
        According to the Quebec Task Force, there are 3 categories:
        Acute = Pain < 7 days duration
        Sub-Acute = Pain of 7 days to 7 weeks duration
        Chronic = Pain > 7 weeks duration
  2. Frequency
        Pain can be constant or intermittent. Constant pain is present through every moment of a 24 hour period. There are various ranges of     intermittent pain, with on/off cycles ranging from minutes to hours.
  3. Intensity
    A Visual Analog Scale of 0-10, 0 being “no pain” and 10 being “pain as bad as it could be” allows for a quantifiable measure of pain range.
    BCT recognizes the above standards but places little emphasis on pain during treatment.
BCT focuses on improvement in functional movement. As function improves, there appears to be a strong correlation with a decrease in pain duration, intensity, and frequency.
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Orthotics-A Shoe In or a Shoe Out?
Bringing up the topic of orthotics and BCT’s view on it is bound to step on someone’s toes. Does the foot require added external structural support/stability or does it beg for mobility with internal stability? The foot is comprised of 26 bones – each bony segment assists in the distribution of forces from the ground up and force of body weight down.

BCT seldom sees a need for orthotics. BCT corrective exercises focus on restoring mobility and intrinsic muscular stability. It’s important to assist foot function but not replace foot function-give the body a chance to right its own wrong and go the distance.
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Bone poor no more - Osteoporosis
Osteoporosis implies a reduction in bone mass. It occurs more frequently in women - especially those who are sedentary, post-menopausal, and lacking in proper nutrition/health habits. Current medicine advocates an increase in exercise, a change in diet, and supplementation through calcium/hormonal therapy, etc.

BCT advocates specific weight-bearing exercises where forces are transferred down through the spine. Because most areas of bone loss appear in the spine (thoracic/lumbar) regions, it is important to address symmetrical force distribution throughout the vertebral bodies. Lifting weights, walking, and general exercise are most helpful, but BCT can enhance the benefit of all exercise by optimizing weight bearing load.
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Driving School
As school get underway and traffic picks up, one needs to be attentive and defensive when driving.
In conjunction with reaction time and vision/perception, there needs to be a conscious assessment of head/neck/upper trunk mobility to increase driving performance and safety. The visual field is enhanced through upper trunk mobility. All four corners need a full visual field-front/back & right/left. Seated, resting upper back against seat, can you turn just your head and view all four corners without losing seat/shoulder contact? Try it.

BCT can increase neck/upper trunk mobility, enhancing visual field and making driving safer-a valuable lesson.
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Collision Course
Now that driving is our focus – are there better ways to prepare for pending accidents if collision forces are set in motion? Studies have indicated the following:
  1. It is better to hit a car in front of you than to be rear-ended/or double impacted.
  2. It is better to impact through steering/axle mechanisms (driver’s side vs. passenger).
  3. It is better to brace for impact than relax and be thrown about vehicle.
  4. It is best to have 12-14 inches of space between chest and steering wheel to minimize force from air bag.
  5. Attempt to hit objects that are more yielding, allowing the vehicle to slow down gradually and, at the same time, distribute forces before they reach the body. For example, a bush, wood fence or sand dune are more forgiving than a telephone pole, tree or boulder.
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Accidental Education
If an accident has occurred, don't assume the status of all injuries is assessable at the time of impact. In the majority of accidents, the effects of impact to the body are felt hours/days later when the body is coming off an adrenaline rush. If in doubt, seek medical assessment first with adequate follow-up appointments to document and track symptoms and recovery time.

BCT has been known to be effective for post-accident patients, and its effectiveness is enhanced the sooner treatment can be initiated.
BCT is helpful in assessing biomechanical/functional changes that need to be addressed to assist the road to recovery. Studies are finding that rest/heat/ice/medication alone is not sufficient intervention to return to full function.

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Should Medicare Beneficiaries have direct PT access?– It’s not a taxing question!
Direct access to physical therapy services is available in most states. Yet, Medicare requires that all recipients access their physician every 30-60 days for written authorization to seek or continue physical therapy.

Congress is working on HR Bill 792/S493, Medicare Access to Physical Therapy Act. PTs want better access for patients as already allowed by many state practice acts and in-line with other health care providers who are equally or less trained.
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Re: Healthy Choice – Local heart patient delighted she contributed to landmark study
This Letter to the Editor was written by Shirley Kleiman and recently published in the Grand Rapids Press.
The press published a weekly series of community educational sessions sponsored by Spectrum Health Center in honor of American Heart Month. Having attended the presentations, I found tremendous value in the information provided, particularly on organ donations.

The article printed March 11, “Healthy Choice,” featuring Martha Douglas, conveys the difference one individual can make to medical science. Ms. Douglas understood the role her family history played in her coronary artery disease and as a retired nurse she had greater insight to appropriate interventions. Participating in the international study gave her the opportunity to receive the cholesterol lowering drugs without the annual $900 to $1400 expense. Too often, the best treatments available are not accessible due to cost. Studies like this, that are “evidence based” and support prevention, justify the up front cost if they diminish the consumption of health care dollars in treating the ramifications from cardiac disease on the other end.

Throughout the article there is an emphasis on making healthy choices, including an active lifestyle. However, the article overlooks one “healthy choice” we can make without participation in a study and without cost to us, and that is registering as an organ/tissue donor. Like Martha Douglas, we have an opportunity to make a landmark contribution. Please print future articles on the need for organ/tissue donations so we can help those who no longer have prevention as an option.
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Get Fit for Life
Join in the celebration of National Physical Therapy “Get Fit For Life”.
Aging is inevitable – but as a general rule it is not a painful process. As we reflect back over the years we need to be thankful for what we have, especially when you see the adversities many people physically struggle with on a daily basis. We have an obligation to ourselves to stay healthy and physically fit.

  • Grey hair is better than no hair.
  • Wrinkled skin is a sign of a life well-lived.
  • We did not age over night nor can we negate the effects of aging over night.
  • Aging is best defined by the ability to get up and move around. There are tests that measure the effects aging has on daily performance.
  • Physical Therapy is a great resource to access in getting and staying fit.
  • A positive attitude, personal motivation, and participation in a community based fitness program is where it is at. Good Luck!
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Heart Awareness may be your Life - Saver
Is it a heart attack?
If you experience symptoms of chest tightness/pain, shortness of breath, arm/jaw pain, abdominal upset, feeling faint/hot/clammy - then you may be suffering a heart attack. One is never taught to do CPR on themselves, so until you can get help (911), which may be longer than the 10 seconds leading to loss of consciousness, you can attempt to stay alert:
A. Take a deep breath and force yourself to cough vigorously and repeatedly.
B. Each breath should be deep and the cough forceful every 2 seconds until help arrives.
Is it a stroke?
Recognizing that someone may be having a stroke can be further enhanced by asking three questions.
  1. Ask the person to smile.
  2. Ask the person to raise both arms overhead.
  3. Ask the person to speak.
* If the person has trouble performing one or more of the above, call 911 and get help.
Physical Therapists treat both conditions after the event, but the need for rehabilitation can be decreased if help arrives sooner!
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BCT and Hiccups
Hiccups seem to be one of the most annoying bodily functions.
Through the years I tried a multitude of anecdotes with minimal success except for time.
Past techniques included:- 
- Holding ones breath
- Plugging one’s nose/mouth and swallowing forcefully
- Plugging ones nose and drinking at the same time.
- Plugging ears, nose and mouth then  swallowing.

Being scared or spooked.
Last year I created a BCT correction for the “hiccups”, and would like you to put it to the test.
Standing or sitting with the trunk supported, perform as follows:
  1. Close your mouth, take a very small amount of air in through your nose (inhale) , 1 sec. count.
  2. Blow your intake air out (exhale) through your mouth to the slow count of 5 seconds until air is completely expelled. At the end of air release, pull/draw abdomen down /in and hold.
  3. Repeat 1-2-3 for a total of 5 reps.- making sure the intake is minimal and exhale continues until all the air is out.
In most cases it only requires 3 reps and hiccups are resolved. Best of luck and let us know how you did!
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Weathering the storm, changes in weather can affect function.
With two of the worst storms in US history now making history, is it possible our bodies felt the effects of the weather before, during, and after the storm?

Weather conditions to monitor:
  1. Temperature: Extreme temperature changes or extreme temperatures can elicit ill effects on our bodies – from heat exhaustion to hypothermia.
  2. Wind: Movement of air dispersing pollutants, pollens etc. can tax the immune system, decreasing respiratory exchange affecting physical performance.
  3. Precipitation: Rain, sleet, hail, or snow are all present with humidity. Humidity coupled with changes in temperature can trigger joint pain.
  4. Barometric Pressure: The measure of the weight of air acting on our body can influence body performance. Sudden changes in barometric pressure can trigger unwanted physical responses ie. headaches.
Since changes in weather are more predictable than they were in the past thanks to technology, take precautions and plan ahead, prepare to weather the storm!
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Ring in the New.
Patient’s feedback challenges me to revise and improve the BCT program. It also makes me think about my commitment to health and life in general.

I have collected many things over the course of my life including hundreds of textbooks, journals, and health related articles I may never get to read. I have a collection of PT tools, gadgets, and gizmos that I found intriguing but may never use.

What I do plan on putting to use is one patient’s thought provoking idea for a new collection. It is a collection of “life experiences”. The collection doesn’t have to be dusted, stacked in a “to do” file, or taken out only to be put away. It can be stored in a simple life journal that logs the events that I have chosen to add to my collection.

With health a priority in my life, my journal will reflect the things I value. Plan to go all out, collect the biggest, best, and rarest experiences you can find. Make this a great year, fill it with wonderful life experiences.
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The Parental Influence
Patients often ask after an evaluation in the clinic if they can attribute their structural problems to their parents.
Parents influence the genetic make-up of bone and tissue, but in most cases, they do not directly influence dysfunctions that come with living life.

Dysfunctions, (changes in normal biomechanics and function) is an accumulative response to many forces acting on the body. Multiple traumas; car accidents, falls, and misc. injuries can wreak havoc with the best bodies. Some bodies are assembled like semi- trucks and others like mopeds.

Regardless of the structural integrity, early repair and the right repair can get one back on the road, moving again.
This month, pay tribute to your parents. Thank them for what they’ve given you. Show your appreciation by taking care of your body!
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Keepin Pace
October is National PT month. Our goal is to make this year National BCT year through educational promotion.
With the ever changing medical world, we strive to keep pace and surpass the interventions that are currently available for the treatment of skeletal muscular dysfunctions.

To meet and exceed the demands placed on health care providers, we continue our focus on individualized treatment plans that provide tools for life.

Keeping pace with aging is really keeping pace with movement. The inverse relationship of increased age with decreased mobility does not have to apply.

There’s no question from our clinical experience and that of our patients, mobility can keep up with aging with BCT.

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Laundry Tips
Here are some important things to consider about doing laundry:

It does make a difference if you use a front load or top load washer/dryer.  Current machine design can change the way forces are placed on your body. 

High, front loading machines require more upper trunk and long lever reaches putting your neck, TMJ, and shoulders at risk.

Low, front loading machines put your lower back, pelvic and shoulder girdles at risk.

Considering the required movement, along with the weight of wet clothes, puts you at risk for an injury.

Minimize the risk:
  1. Remove fewer items at a time.
  2. Remove items and place them on a transitional surface to eliminate excess body torque when making transfers.
  3. Use a sturdy platform/stool to elevate or a rolling seat/stool to lower yourself for ease when making item transfers.
  4. You can purchase extended reachers to access those items out of reach. “Don’t  Fall back into old habits, clean up your act!”
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Fall with Grace
On the APTA web site one can access information regarding fall prevention. If you can not avoid a fall try to “fall with grace”.

Graceful Steps:
It is better to fall forward than backwards. You have increased range of motion in all joints on your front side to help control the fall.
When falling forward, try to lower your center of gravity and decrease the vertical drop by bending quickly at your knees.
If possible, use the less obstructive or rigid object to break the fall. A soft cushioned chair is better than a hard wood end table.
If your hands are the first to make contact try to form a half claw hand (semi open fist versus an open flat palm).
Protect your head and keep your visual field elevated as you descend.
There is no question that BCT can help maximize your recovery if you should fall.
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