What Is Direct Access?

What Is Direct Access?

Without the requirement of seeing another clinician (MD, Dentist, Nurse, Physician's Assistant) you get to physical therapy sooner. This also means less expenses and wait time to treat your area of pain.  Prior to Direct Access the doctor referral, the X-ray and MRI and other tests inhibit the start of your rehab exercises. Sometimes this process can take one or three weeks. Now, when someone has an injury they can come to Brill Physical Therapy first and get treated right away.

Why Is Posture Important?

Simply put we need posture to be well. How can we expect ourselves to sit, stand, walk or run if we can’t even find neutral posture?  The best example of why posture is important is looking at a child’s development. At every stage of progression the baby is learning to gain control of their body from a lower center of gravity to ultimately a standing and moving center of gravity. 

Posture Basics

By Dr. Clifford Yun, PT, DPT

What is good posture?

At first thought when we think of posture we think of sitting up straight. We can hear one of our parents or a teacher telling us to sit up in our chair. But posture is more than just sitting upright. Posture is about finding a center of gravity, maintaining it and then remembering to come back to posture when we forget about it.

There are different types of posture. Static and Dynamic. Static posture is the staying still posture and Dynamic posture is our body’s position with activity. 

Posture is all about positing the landmarks of the body in the right order and position from the ground up. This is important to prevent back and joint pain from when we’re sitting, standing or walking all day. Regardless of if your day is spent sitting or moving around posture starts with where you’re attached to the ground. 

Static Sitting Posture:

Feet: Start with your feet flat on the floor at about hip width apart. The arch of your feet should be right under your knee. 

Hips: You hips should be slightly higher than your knees with equal weight on each side of the pelvis. 

Spine: Your spine should stack on top of your pelvis in the following order. Pubic Bone (front of pelvis) + Navel (belly button) + Sternum (chest bone)+ Chin.

Shoulders: Roll the shoulder blades back then down to prevent them from rounding forward

*Fig 1. Posture image form  https://theacidrefluxsolution.com

*Fig 1. Posture image form https://theacidrefluxsolution.com


Static Standing Posture:

Feet:  Again the feet are flat and hip width apart but the knees should be slightly bent,  relaxed and not locked straight or falling outward or inward. The knee should be in-line with the middle of the foot.

 Hips/Pelvis: Pelvis should be level. If the pelvis is down on one side then chances are the hips are not active or strong enough to keep them stable. 

Spine: Again the spine should stack on top of each other in the mid-line: Pubic Bone (front of pelvis) + Navel (belly button) + Sternum (chest bone)+ Chin.

Shoulders: Rolled back and down 

*Fig 2. Standing Posture Image from https://www.olympiabenefits.com

Schroth, Scoliosis & Pilates

In scoliosis the spine starts to twist (rotate) which leads to a curve in 1 or more sections of the spine. This asymmetry of the skeleton is mirrored in in the muscles: some muscles are overstretched and in a constant state of tension, other muscles are underworked and may become shortened.

Creating more length between the vertebrae/in the spine starts an untwisting of the spine, which is the first step in managing scoliosis shared by Schroth and Pilates. The untwisting makes it easier to bring the muscular-skeletal system back towards symmetry.

As you can see in the video I am trying to keep equal distance between my lower ribs and hips on my right and left sides, while maintaining that equal distance throughout the entire exercise. You can also see one side is more challenging for me than the other.

Loi Kail, Certified Pilates Instructor

Watch the video described above!

Get Ready for Gardening!

With spring around the corner, many people are beginning to think of planting their gardens. Between lifting heavy bags and spending prolonged periods of time in awkward positions, gardening actually puts tremendous stress on the human body.  So Brill Physical Therapy is here to offer some pointers!

  • Gardening should be treated like exercise. Remember to warm up for 10-15 minutes before you start. This will help loosen your muscles.

  • Remember to take lots of rest breaks. Human beings really aren’t meant to stay in one position for prolonged periods.

  • Drink lots of water! As the weather starts to warm up and we exert ourselves, it’s essential to stay hydrated to keep our tissues healthy.

  • Maintain your posture. Slouching can lead to back pain, so remember to sit up tall and move from your hips, rather than your back.

  • When kneeling in order to plant your flower beds, consider using a foam kneeling pad in order to decrease pressure on your knees. This will minimize compression on your knee caps and help decrease knee pain.

  • When lifting heavy bags of soil, remember to bring the items close to you, and lift with your knees. Also consider using a cart or a wheelbarrow to decrease the amount of time you’re lifting large, heavy, or bulky items.

  • Lastly, remember to cool down when you’re done. Take some time to gently stretch when you’re done.


If you have any residual pain after gardening, don’t hesitate to contact your therapists at Brill Physical Therapy for an evaluation. Gardening can and should be enjoyable, and doesn’t have to hurt!


What Does Your Back Pain Mean?

It is estimated that up to 84 percent of adults have low back pain at some time in their lives [1,2]. For many individuals, episodes of back pain are self-limited. Patients who continue to have back pain beyond the acute period (four weeks) have subacute back pain (lasting between 4 and 12 weeks) and may go on to develop chronic back pain (persists for ≥12 weeks) [3]. Rarely, back pain is a harbinger of serious medical illness.

 The intensity and manageability of pain are very different for every person. For example, one person may have a large herniated disc and experience no pain at all, and another individual may have a simple muscle strain that can cause excruciating back pain and difficulty moving but will heal on its own in a few days.

 Also, with some conditions, the pain can flare up from time to time and then subside, only to flare up again after a few weeks or months and gradually intensify over time. Because only you know your level of pain, your treatment will most likely be more successful if you proactively participate in making decisions about your medical care.

 There are many interconnected and overlapping structures that make up the spine are capable of producing back pain. Moreover, the spine is prone to injury because it is subject to many different forces: twisting, sudden jolts, and daily stresses (such as sitting too much, moving in the same direction repetitively, poor posture) [4]. Common anatomical causes of back pain include:

  • The large nerve roots that go to the legs and arms may be irritated

  • The smaller nerves in the discs may be irritated

  • The large paired back muscles that support the spine may be strained

  • Any of the bones, ligaments, or joints throughout the spine may be injured

There is a lot of overlap of nerve supply to most of the anatomical structures in the spine (discs, muscles, ligaments, etc.), which often makes it impossible for the brain to distinguish between injury to one structure versus another. For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury [4].

The type way you describe your pain, the area of distribution of the pain, and any related symptoms are important to determine a back pain diagnosis, and the treatments will usually be different depending on the diagnosis [4]. Three common classifications of back pain include:

  • Mechanical pain. Also called axial pain, may be described in a number of ways, such as sharp or dull, constant or comes and goes, etc. Specific motions bring about this pain. A muscle strainis a common cause of mechanical/axial pain.

  • Referred pain. Often characterized as dull and achy, referred pain tends to move around and vary in intensity. As an example, in the lower back degenerative disc disease may cause referred pain to the hips and posterior thighs. Stenosis will present in both legs and thighs versus degenerative disc disease may occur in only one leg.

  • Radicular pain. Often described as deep and searing pain, radicular pain follows the path of the nerve into the arm or leg and may be accompanied by numbness or weakness. This type of pain is caused by compression, inflammation and/or injury to a spinal nerve root. Other terms for radicular pain are sciaticaor radiculopathy, and can be caused by conditions such as a herniated disc or spinal stenosis, or spondylolisthesis.

Ultimately, participating in the decision-making process about your medical care should definitely help you have a better outcome, and understanding your pain is an important element of this process. Come in for a visit today so we can help you understand, evaluate, and treat your low back pain.



  1. Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976) 1987; 12:264.

  2. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998; 23:1860.

  3. Chou R. In the clinic. Low back pain. Ann Intern Med 2014; 160:ITC6.

  4. Burke S. Understanding different types of low back pain. 2016. Available at: https://www.spine-health.com/blog/understanding-different-types-back-pain

The Core Program For Musicians

When people think of physically demanding jobs, they most commonly think of industries like construction, plumbing, or electrical.  However, professional musicians must endure tremendous amounts of physical strength in order to hone their craft. 

In particular, pianists and string musicians are susceptible to a wide variety of tendinitis, nervous, and postural disorders due to the long hours spent in specific positions.  Overall, 50-76% of professional musicians will experience a musculoskeletal injury, 70% will experience some sort of instrument-related injury, and 33% will find themselves unable to play for some amount of time over the course of their career.  Because of this, it is essential to learn how to stay strong and flexible before injuries become a problem.

Symptoms can include: pain at a single site that stops and starts with playing; pain at multiple sites that persists, accompanied with loss of coordination; weakness, stiffness, or cramping; neck/back pain; and carpal and/or cubital tunnel, accompanied by numbness and tingling.


In developing her Core Program, Peggy Brill realized that it could be adapted to help musicians play longer, with decreased risk of injury. In less than 10 minutes a day, physical therapy can help teach you how to make your body work better and keep you pain free.


If you are a recreational or professional musician, contact the team at Brill Physical Therapy to help get your best body.  Playing in pain doesn’t have to be a fact of life.


Rock Climbing Injury Prevention


Indoor rock climbing- perfect way to get a great body and brain workout, all while staying warm inside! With the increase of climbing gyms, we’ve seen an increase in climbers and wanted to cover ways to prevent injury!

We recently worked with Steep Rock Bouldering (https://www.srbnyc.com) to present an injury prevention clinic to their climbers, here are a few things we covered that could help improve your climbing and prevent injuries-

Core Strength          


Climbing challenges our bodies to reach in multiple directions so it is important that the base of our appendages that are doing the reaching is strong.

  • A strong core does not mean a solid six-pack or sculpted abdominal muscles, what it means is being able to maintain good stabilization in the core and appropriate breathing techniques. For example, “turning on” your abdominals before reaching or taking a breath out when reaching vs. holding your breath. These techniques will decrease pressure on the pelvic floor and help to provide a more stable “core”/base to move from.

Balance Training


When we think of balancing, we typically think of balancing while standing on a flat surface. For climbing, balancing means being able to keep your body balanced against a vertical surface. Since you’re moving up or down in various directions, climbing gets a little bit tricky.

  • You want to use physics to your advantage by thinking about maintaining good tension in your body when appropriate.

    • While pushing with one arm or leg, you can pull with the opposite appendage or vice versa to create the amount of stabilization you need to climb.


  • In addition to the good upper body flexibility that climbers need in their fingers, shoulders, and neck, there needs to be good mobility in the hips, knees, ankles, and toes.


We have a few exercises to introduce you to that will address all of the elements above-

Brill Chicken


Tuck in chin, pull head back to elongate the back of your neck. Pinch shoulder blades together. Bend arms, keeping elbows close to the torso with wrists pulled back.

6 seconds hold x 6 every 2 hours

Quadruped Lift Off


Align hands underneath shoulders and knees underneath hips on all fours. Tuck your toes under, lift your knees and hover 6" off the ground.

Hold x 10 seconds x 5 reps x 2 sets.

Deep Squat


Hold the inside of a door frame with your arms at shoulder height. Squat down as far as you can as your hands slide down the door frame (heels must remain flat to the floor).

Hold 10 seconds

Infant Positioning and Physical Therapy

Tripod Baby Position Raf and Rebecca 2019.jpeg

Infant positioning and physical therapy

As new parents, we quickly figure out that our babies don’t come equipped with owner manuals.  So when we hear about the importance of tummy time for newborns and young infants, it can be overwhelming to understand what this actually entails.

The problems with infant positioning

Because babies spend nine months in a fetal position, they aren’t born with sufficient control of their back muscles.  Since the introduction of the Back to Sleep campaign in the mid 1990’s, infants will spend most of their time on their backs.  While this did a wonderful job of decreasing the risk of SIDS, it has led to an increase in positional deformities and weakness in infants, because they don’t get sufficient time on their stomachs, which will help them develop their back muscles.

Why is proper positioning important?

When a baby spends excessive time on their backs, they are at risk of skull deformities.  Either the back of their skull can flatten, or they might flatten the side of their skull if they prefer to keep their head turned to one side.  If left untreated, these deformities can become permanent.  In order to prevent this from happening, it is recommended that babies spend at least one hour supervised per day on their stomachs.  This will help them develop their back muscles, and ultimately facilitate them learning to sit, stand, and walk.

 What can I do to help my child?

If you continue to notice that your infant has a side preference, or you feel uncertain how to help your child engage the world while on their stomach, Brill Physical Therapy is here to help you.  Our therapists are trained in the treatment of infant positioning and muscular tightness, and can help guide you to best help your child.  Physical therapy will often consist of guided stretching, strengthening, and play. 

Everything you need to know about Patellofemoral Pain Syndrome (PFPS) aka Runner’s Knee

Patellofemoral pain syndrome or “runner’s knee” translates to kneecap pain.  It’s the most common overuse injury among runners, but it’s important to highlight that it can occur in athletes from nearly every sport and even in non-athletes who stress the knee in their daily activities as well.

The patella (kneecap) is a sesamoid bone located within the tendon that connects the quadriceps muscle to the lower leg bone (tibia). Its function is to improve the forces through the tendon as it crosses the joint, and also to protect the tendon from wear and tear.

The pain and stiffness it causes can make it difficult to climb and descend stairs, kneel down, and perform other everyday activities. 


Overuse – In many cases PFPS is caused by vigorous physical activities that put repeated stress on the knee. It can also be caused by change in physical activity, such as increasing the number of days you exercise per week, increasing your mileage, or time you’re spending with running, etc.

Patellar Malalignment – It translates in plain language as abnormal tracking of the kneecap. In this case, the patella is pushed out to either side of the femoral groove as you’re bending your knee. This abnormality causes increased pressure between the patella and the trochlear groove, irritating the soft tissues all around. This can be caused by problems with the alignment of the legs between the hips and ankles, as well as by muscular imbalances.

Other contributing factors could be improper training technique or equipment, or change in shoes or running/playing surface.


  • Dull, aching pain in the front of the knee, increasing with stair climbing, squatting or jumping

  • Pain after sitting for a prolonged period of time

  • Popping, or crackling sounds in your knee when climbing and/or descending stairs, or standing up after prolonged sitting 

How Can I Prevent It?

First and foremost, keep mileage increases less than 10 percent per week, and gradually increase hill work in your program. Visit a specialty running shop to make sure you're wearing the proper shoes for your foot type. It’s also important to stay strong and flexible. Brill Physical Therapy’s exercises and tips are going to help you to succeed at these.

  1. Loosen up - Myofascial release of the surrounding tissues is an important component in order to relieve pain and reduce the pressure and tension through the joint. Use the foam roller for the larger muscle groups such as the quadriceps, gluteal region, hip adductors and abductors, etc.

  2. Strengthen

    1. Bridges on a Physioball

    2. Side Steps

    3. Forward and Reverse Monster Walks

    4. Heel Raises

    5. Single Leg Deadlifts

  3. Be mindful - At the first sign of pain, cut back your mileage. Take a day off, or cross train. Consider orthotics if new shoes don't fix the problem. See a doctor and a physical therapist if pain persists, to rule out any other conditions, and to start a targeted rehabilitation program tailored for your personal needs.

The inflammatory process and how to use it to our benefit

Dealing with the inflammatory process, and using it to our benefit at Brill Physical Therapy

What is inflammation?

Inflammation in the most general form is actually the first stage of the body’s natural healing process. When injury occurs, the body releases chemicals that cause swelling to protect the area, and inflammation that brings cells to promote healing. The inflammatory process brings white blood cells to help break down potential infection, and cells known as “phagocytes” to help break down damaged tissues. After this occurs, healing and repair of the damaged areas can begin.

The problem occurs when the body gets stuck in this cycle, and cannot move past the inflammatory stage. Chronic, low grade amounts of inflammation and swelling will remain in the tissues, impairing the body’s ability to heal. This is when doctors like to employ the use of anti-inflammatory medications in order to help the body heal and reduce pain. This is also why physical therapists like to use modalities such as ice to help promote healing chronically inflamed areas.

How can we use inflammation to our benefit?

As physical therapists, Brill Physical Therapy will use certain manual techniques to introduce low-grade amounts of inflammation to specifically irritated areas to help promote the breakdown of congested or scarred tissues. These techniques will introduce a controlled reaction to help encourage the start of the body’s natural healing response. While we like to finish many of our sessions with ice to help control post-treatment discomfort, you will notice that these sessions will never finish with ice. Ice is used to help prevent inflammation; in these situations, we actually need a controlled inflammation response to yield the desired result. Generally, Brill PT will recommend avoiding the use of ice or anti-inflammatory medication for several hours to allow the inflammatory reaction to break down the desired scarred areas.

How do I know if this type of treatment is right for me?

Here at Brill Physical Therapy, we are highly trained in a variety of manual treatments, and will carefully evaluate our patients to see when this type of therapy might be beneficial. Treatments might vary by session, and we will be careful to thoroughly explain how this process applies to you specifically.

New Moms get well at Brill Physical Therapy!

Did you know that physical therapy can help out post-partum mothers?

What is pelvic rehab?

Pelvic rehabilitation is a type of physical therapy that can be very helpful for postpartum moms. Pregnancy and childbirth can damage the pelvic floor muscles and connective tissue, causing all kinds of inconvenient and uncomfortable symptoms for women after they give birth.

The pelvic floor muscles stretch between the pubic bone and the tailbone and cradle your bladder, bowel, and uterus, helping you control your urine, bowel movements, and sexual functioning.

More specifically, the pelvic floor muscles enable you to keep urine and feces in – and release them – when you need to. They also help you contract and relax your vagina during sex.

When the pelvic floor muscles are tight or weak, they can cause annoying symptoms or even pain. A pelvic floor physical therapist (PT) can evaluate these muscles and determine whether they’re contributing to your symptoms.

If they are, the PT can work on the muscles and connective tissue to release trigger points – areas where the tissues are stuck together instead of sliding easily around each other. PT’s also train you to do exercises at home to help relax muscles that are tight and strengthen muscles that are weak.

SOURCE: (http://www.babycenter.com/0_pelvic-rehab-postpartum-physical-therapy-for-your-pelvic-flo_10379562.bc)

Run without injuries

The increased awareness of aerobic exercise to maintain a healthy lifestyle has made running more popular than ever. It is an excellent form of exercise, recreation, and also a great community builder for people of all age groups, interests, and activity levels. When done properly, running can improve physical fitness and coordination as well as physical and emotional development. As the number of people engaged in these activities grows, increased incidences of running injuries naturally occur.

Over the next five weeks the Brill Physical Therapy team will provide you with information about the most common running injuries, and how to best avoid them.

Walking vs. running

Running is distinguished from walking by increased velocity, or distance traveled per unit time and the presence of an airborne or float phase. Judges in race walking determine that participants are running illegally if they observe a period of time when both feet are off the ground. During a running gait cycle, there are two periods of float when neither foot is in contact with the ground.

Differences between running and walking

  • Increased velocity

  • Increased ground reaction forces

  • Float phase

  • No double stance phase

  • Decreased stance phase and increased swing phase

  • Overlap of swing phase rather than stance phase

  • Requires more range of motion of all lower limb joints

  • Requires greater eccentric muscle contraction

  • Initial contact varies, depending on speed

  • Decreased center of gravity with increased speed

  • Decreased base of support

Warning signs

  • Pain while running

  • Soreness and swelling

  • Pain at rest

  • Limping

How to prevent running injuries?

  • Flexibility is key – Whether you prefer the good, old fashioned stretching, or you’re more into foam rolling, it should be part of your training/exercise routine. Spend about 20-30 seconds on each muscle group around your hips, and lower leg. Don’t rush, take your time!

  • Strength training – It’s not just about looking good. Strength training can improve running performance, balance, and so many more! The exercises should incorporate both exercises for your upper extremities, trunk, and lower body. Weight lifting, plyometric and hill running are all effective methods of increasing strength.

  • Warm up and cool down – Yes, it’s important to start slow, and to take your time in the end. The faster your workout or race, the longer warm up needed. A 10-15 min warm up can help preventing delayed muscle soreness.

  • Hydration – We all know the feeling of the first warm days, and how good it feels to finally get out of the gym, off the treadmill, straight to the park. And most of us also know that heat exhaustion and dehydration is no joke. Take in 6-8 ounces of fluids every 15-20 minutes of exercise.

  • Take it slow – Gradually increase your mileage. Increases in training volume, duration and intensity should be around increase of 5-10% per week

  • Cross train and rest – Cross training helps maintaining your aerobic fitness while avoiding excessive impact forces from too much running. Including rest days in your training schedule allows your body to recover and adapt to a running workout.

  • Proper footwear – Last but not least, we have to highlight the importance of proper footwear. It’s common sense that nobody tries to start training for a marathon in high heels, but there is much more you need to know and consider, before you choose your shoes. The type of shoe you need varies depending upon your foot type and style of running. A store that specializes in athletic footwear can help you figure out what style might be the best for you.

Most common running injuries

  • Patellofemoral Pain Syndrome

  • Shin Splints

  • Achilles tendonitis

  • Iliotibial Band Syndrome

  • Plantar Fasciitis

Relief from Chronic Fatigue Syndrome- Finally! The Perrin Technique arrives at Brill PT

World-renowned lecturer and researcher from Manchester, England, Dr. Raymond Perrin taught his Perrin Technique again at Brill Physical Therapy. Dr. Perrin has spent years breaking ground for patients with Chronic Fatigue Syndrome.  Dr. Perrin passionately and kind-heartedly offers a cure for this daunting condition.

At Brill Physical Therapy, both Shelly Genova and Peggy Brill are now certified in The Perrin Technique and have been getting good results with the treatment.  By combining Manual Lymphatic Drainage and Craniosacral Techniques, the built up toxins in the system can begin to drain and healing can start.

Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME)

Symptoms of CFS:

  1. Generalized abnormal muscle fatigue that occurs after mild activity

  2. Sleep disturbance

  3. Headache

  4. Cognitive dysfunction

  5. Depression

  6. Increased sensitivity to light and sound

  7. Back pain

  8. Neck pain

  9. Sore throat

  10. Irritable bowel

  11. rritable bladder

  12. Chronic fatigue not relieved with rest

If you have been diagnosed with Chronic Fatigue Syndrome, Fibromyalgia, or Epstein-Barr Virus, then please seek a trained Perrin Technique Physical Therapist and read Dr. Perrin’s book, The Perrin Technique.

Life In Balance

Life in Balance with Donnie Desanti

Donnie Desanti is a certified health coach. Over the years he has helped many people identify their concerns with their eating habits and helped them create diet plans to suit their schedule, budget, and personality. Donnie helps clients set and achieve their dietary goals.

“First, when I was diagnosed with ADHD at the early age of nine, I was expected to take a daily prescription of Ritalin, a medication that made me feel embarrassed and broken. After seven years of tolerating the side effects, I decided to take matters into my own hands. By studying the effects that different foods had on my body, I changed my diet and eliminated the need for medication. I am proud to say that that “wild child” has now been medication free since 1993. “

Brill Physical Therapy is excited to announce that Donnie Desanti will be coming to our Madison Avenue office to talk to us about eating and living healthy! Join us tomorrow at 6pm to chat with Donnie about your dietary concerns.

Make sure to stay connected!

Take Care of Your Heart

“My Mother died of a heart attack at 64 years old. She had her workout clothes lying on her made-bed 50 feet away when she dropped dead brushing her teeth. And it can happen so suddenly. I treat EVERY muscle in the body except the most important – YOUR HEART so please tend to it lovingly! And know the signs and symptoms since women often experience heart attacks slightly different than men.

Stay strong and be well. Always with love,


Seven Top Heart Attack Warning Signs That Women Should Never Ignore

There are seven top heart attack warning signs that women should never ignore even though a heart attack could happen to any individual, man or woman either one at any time. In fact the American Heart Association states that one hits a person just over every 30 seconds. Even though heart attacks might not be as common in females as they are males, heart disease is the top killer of women in the United States and unless a person is on the lookout for heart attack symptoms in women and then gets to a medical facility, the consequences can be fatal.

A new research report states that over 38,100 women who are under the age of 50 are suffering from heart attacks every year in America. That is a large number so people must be alert that heart problems might be confused with numerous other issues. Because of such, it is greatly recommended that individuals learn what heart attack symptoms are in women in order to help better prepare just in case.

The top seven heart attack warning signs that women should not ignore are listed below.

Jaw Pain

During a heart attack, some individuals might have jaw pain. This is due to nerves attached to the jaw are connected to the same ones that come from the heart. If the pain comes and goes and gets worse when a person is being active, it is most likely heart related. However, if the pain remains constant, then it is most likely related to gum or tooth pain.

Burning discomfort in the chest

This is one of the most common signs of a looming heart attack. The chest starts to feel heavy or there might be a squeezing feeling along with the sensation of pressure being placed on the area. This can be caused by indigestion or heartburn but a person can never be too alert. It is recommended to go visit a doctor to make sure there is not a serious problem with the heart. Additionally, if there is nausea, then that is all the more reason to rush to a physician.

Having shortness of breath or a racing heart

Another sign of a heart attack that is common is shortness of breath, or the heart is racing. Sometimes this is a panic attack, and it can be hard to tell the difference. Women’s heart attacks tend to cause shortness of breath which begin slowly, and may linger for a while. A panic attack will only cause shortness of breath for about five minutes. Still it is best to see a doctor to be sure.

Tingling in the legs and arms

A tingling sensation in the arms and/or legs is not the best way to tell if a heart attack is coming, but it does not ever need to be ignored. In many circumstances, this is arthritis, but it could also be the sign of a coming heart attack.

Having a feeling of dizziness

If a person feels dizzy for no obvious reason, that might mean that there is not enough blood being pumped through the body by the heart. This feeling is also connected with shortness of breath, so if a person is experiencing both, the signs are very clear of what might be ready to happen at any time.

Feeling extremely fatigued

If an individual feels weak when walking, and has to rest, then it may mean that there is not enough blood being transported to the heart quick enough. This is an obvious sign of an impending heart attack, and one should get help immediately.

Having to vomit

An upcoming heart attack may lead to nausea and/or vomiting. This is usually with having a cold sweat and shortness of breath.

Even though both men and women may experience chest pressure which could feel like an elephant sitting on the chest, women may experience a heart attack without any chest pressure. Instead they might have the shortness of breath, pain or pressure in the chest or abdomen, dizziness, fainting, light-headedness, upper back pressure or extreme fatigue.

So if anyone experiences any of the above symptoms, please go get medical attention immediately. Remember that a heart attack hits a person just over every 30 seconds.

By Kimberly Ruble


The Courier Journal

Tech Times

The Spectrum

Protect Your Back When Shoveling

As another blizzard just hit New York, Brill Physical Therapy collected some useful tips to keep your back safe, while clearing the sidewalk, or your driveway.

First and foremost warm up is important, especially for muscles of your low back and hamstrings before going outside to shovel snow. The reason is that cold muscles are more prone to injury. One option is to start by placing a hot water bottle or heating pad on your lower back for 10 to 15 minutes, followed by some light exercises, such as bridges, squats, heel raises, cat-cow, etc., to increase blood-flow to the desired muscle groups. Then stretch the hamstrings gently by sitting at the edge of a chair, straighten one leg in front of the body with the heel on the floor. Then, sit up straight and bend forward. Hold this stretch for 30 seconds.

Secondly, choosing the right shovel is crucial. This can help to take some of the effort out of snow removal by allowing you stand straighter and lessen stress on your back. Consider using a shovel with curved handle. If the length of the handle is also adjustable, that’s even better. This will minimize the degree to which you need to bend forward when shoveling. The weight of the shovel is another factor to consider.

Thirdly, pay careful attention to your form. Bend at your hips and knees, and make sure that you keep your core muscles engaged, while you lift with your leg muscles, rather than your back. Avoid twisting your torso to move the snow to its new location, always pivot your whole body to face the new direction. Keep your loads light.

Last but not least, slow down. Slipping on snow or ice is a serious concern, and can lead to serious injuries, such as concussion, or spinal fractures, etc. Be sure that you spread sand, rock salt, sawdust, or kitty litter on your driveway and walkways to improve traction, and wear appropriate footwear with good treads.

Enhance your ski performance while avoiding injuries with The Core Program

Skiing is a very popular recreational winter activity.  Participation is quickly growing, and with that, ski-related injuries are also increasing.  Skiing requires sustained contractions of large muscle groups, which can quickly fatigue.  That's why it's important to properly condition yourself before you head out on the slopes.  The main muscle groups to focus on are: the quadriceps (muscles in the front of your thighs), gluteal muscles (muscles in your buttocks), and the muscles of your core (muscles that stabilize your spine). The Core Program and a few additional exercises will help you strengthen the correct muscle groups, as well as improve your ski technique and stamina.  Here are four exercises to get you started.

Squats will give you the strength you need to sustain an efficient ski posture; i.e. keeping your weight forward, skis parallel, and hips, knees and ankles bent as you're skiing down the slope. 

Start with your feet slightly wider than shoulder-width apart, and your abdominals pulled up and in.  Bend your knees, keeping your feet flat, hips back, chest up, and knees tracking over your second toes. Lower until your thighs are close to parallel with the floor and hold for 10-12 seconds, focusing on your core muscles. As you straighten, tighten your glutes and lengthen your back.  Repeat 15-20 times. To challenge yourself more, hold the squat until you fatigue, or perform power squats (adding a jump into the squat), repeating until the muscles fatigue.  

Single leg squats are just like the regular squats, except you are standing on one leg which requires good balance and engagement of your core.  

Stand on one leg and rest one hand lightly on a solid structure (a counter or piece of heavy furniture), using the hand support for balance at first then eliminating it once you're able to maintain your balance. Keeping your pelvis level (abdominals pulled in will help with this), your standing foot flat on the floor, and the standing knee tracking over second toe, bend your standing knee slowly while tightening your core. Perform 2 sets of 10 on each foot.

Lateral squats 

Start out standing with feet together. Take a large step out to the side and drop into a squat, while making sure that your pelvis stays level and your knees are in line with your second toes.  Squat down until your thighs are almost parallel to the ground then return to the starting position.  Alternate sides for each rep. Do 3 sets of 16 reps.

Push-ups with emphasis on the core

Place your fists or palms shoulder width apart, and extend legs straight out behind you.  Tighten your abdominals, lengthen the back of your neck and tuck your chin in.  Bend your elbows and bring your chest towards the floor keeping your spine straight.  Make sure to not arch or round your back. Be sure to tighten your abdominals and squeeze your buttocks to engage the core.  Do as many as you can while keeping the proper form. If your abdominal muscles fatigue, stop the exercise before your low back starts to sag. Do 2 sets of 15 reps to start, and work your way up to 3 sets.

If you experience pain with any of the exercises, perform in a more comfortable range and if pain continues, stop the exercise and consult a physical therapist.

Happy and safe skiing!


Brill Physical Therapy Treats Pregnant Women with Carpal Tunnel Syndrome

Why am I having tingling and numbness in my hands during pregnancy?

These sensations are most likely caused by carpal tunnel syndrome. Although you probably associate this condition with people whose jobs require repetitive hand movements (such as data processors, computer programmers, and assembly-line workers), it’s also more prevalent in pregnant women.

Symptoms may include numbness, tingling, pain, or a dull ache in the fingers, hand, or wrist. These symptoms tend to come and go and are often worse at night. Occasionally, the discomfort may even extend to the forearm and upper arm. In severe or chronic cases, your hand may feel clumsy or weak.

Symptoms usually affect both hands and can appear at any time, but they’re more likely to begin or worsen in the second half of pregnancy when women tend to retain more fluid. The symptoms usually go away gradually after you give birth, as the swelling from pregnancy subsides.

What causes carpal tunnel syndrome during pregnancy?

The carpal tunnel is a bony canal formed by the wrist bones on three sides and a ligament that runs across the wrist on the other. The fluid retention and swelling that’s so common during pregnancy can increase the pressure in this relatively narrow and inflexible space, compressing the median nerve that runs through it.

The median nerve gives sensation to the thumb and the index, middle, and half of the ring finger and is responsible for movement of a muscle at the base of the thumb. Pressure on this nerve causes the symptoms of carpal tunnel syndrome.

Carpal tunnel is very common in pregnant women. Here are a few exercises to help get instant relief for your wrist!