Congenital Muscular Torticollis

What is it?

Congenital Muscular Torticollis (CMT) is a term used for a situation in which an infant has a tightening in their neck muscles, primarily on one side. This will cause them to often have their head rotated and tilted to one side, and is most easily seen when your baby is lying in their crib or in their stroller.


What causes it?

While doctors aren’t 100% sure what causes CMT, there are several factors that may  redispose a baby to developing the condition. Babies born at higher birth weights and/or to more petite mothers, as well as multiple births are most at risk, due to crowding in the womb. However, these factors do not guarantee that a child will have CMT. In short, you have done nothing wrong, as these factors are usually outside of your control.

What should I do if I suspect my child might have CMT?

Ample amounts of tummy time are vital to helping your child minimize, or even prevent developing CMT. Current recommendations advise a total of one hour of tummy time, broken up throughout the day. Younger infants might only be able to tolerate a few minutes before getting tired, but frequent practice will quickly help a child develop a stronger neck.

If you’re concerned that your child might have a preference with which side they turn to, you should talk to your child’s pediatrician and follow up with a trained physical therapist. Early intervention is the best step to prevent the problem from getting worse.


What does physical therapy for CMT involve?
At Brill Physical Therapy, we are trained to treat infants with CMT. Your first session will be comprised of a comprehensive evaluation to determine your child’s individual needs. Sessions usually include a combination of stretching and massaging tight muscles, as well as positioning exercises to help your child get stronger. All families receive a home program to make sure all parents and caregivers are comfortable performing necessary exercises at home. Earlier treatment usually results in shorter treatment times, so don’t hesitate to contact us if you have any concerns!

Brill Physical Therapy Treats Pelvic Floor

Although it is hidden from view, your pelvic floor muscles can be consciously controlled and therefore trained, much like your arm, leg or abdominal muscles. Strengthening your pelvic floor muscles will help to improve bladder and bowel control, and reduce the likelihood of accidentally leaking from your bladder or bowel. Brill Physical Therapy adds pelvic floor training with all our core strengthening exercise to prevent future problems for our patients.

In order to understand how physical therapy helps pelvic pain or incontinence one needs a quick introduction to the pelvic floor. The pelvic floor is literally the floor of the pelvis and like any floor, it needs to be strong enough to support anything that is resting on it. In women it is the bladder, uterus and bowel and, in men it is the bladder, prostate and bowel. The added complication of this floor is that it has to be both strong and flexible at the same time.  In addition, it has to be able to relax to let urine and bowel movements through, and perform important functions during sexual activities and orgasm. Finally, for women, it has to be able to stretch an incredible amount during childbirth.

Benefits from pelvic floor training:

  • Improve bladder and bowel control

  • Reduce risk of prolapse

  • Faster recovery from childbirth

  • Quicker rehabilitationafter gynaecological surgery

  • Improve recovery after prostate surgery

  • Increase quality of life and social confidence

Risk Factors and Groups:

  • Pregnant or Postnatal

  • Ever had a baby

  • Menopause

  • Gynaecological Surgery

  • Prostate Surgery

  • Elite Athletes - doing high intensity/endurance training

Signs of a pelvic floor problem:

  • Accidentally leaking urine when you exercise, laugh, cough or sneeze

  • Needing to get to the toilet in a hurry or not making it there in time

  • Constantly needing to go to the toilet

  • Accidentally losing your control of your bladder or bowel

  • Finding it difficult to empty your bladder or bowel

  • Pain in your pelvic area or

  • Pain with sexual intercourse

  • Prolapse

    • In women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping

    • In men this may be felt as a bulge in the rectum or a feeling of needing to defecate but not actually needing to go

Common Misconceptions:

  • The only group who need pelvic floor training are women after childbirth
    The truth is that pelvic floor training can help with patients experiencing a big variety of symptoms: urinary incontinence, difficulties in urination, bowel incontinence, constipation, abdominal pain, low back/Sacroiliac Joint pain, sexual dysfunction, pelvic or coccyx pain, vaginal or rectal pain, penile or testicular pain, as well as men and women prior to or after having pelvic surgery.

  • Pelvic floor muscle exercises are done by stopping the flow of urine over the toilet
    The truth is this is not an exercise, but merely one way to identify your pelvic floor muscles.

  • If a person has already had surgery or is planning to have surgery, pelvic physical therapy won’t help them.
    Brill Therapists usually work closely with surgeons to help patients achieve optimal recovery. Surgery will often correct an anatomical problem, but it is important to have improved muscular control and function to help a person attain optimal outcomes after surgery. Research has shown that physical therapy prior to and after surgery improves patient outcomes as well as reduces the need for future surgery.

  • I don’t have any of these problems, so I don’t need to do pelvic floor exercises
    Everyone (including women who haven't had a baby, and men) can benefit from doing pelvic floor muscle exercises.
    For women, pelvic floor muscle training is important to control incontinence which may or may not start during pregnancy. Pelvic floor muscle exercises done during pregnancy will help the recovery of pelvic floor muscle function and bladder control after giving birth as well as assist in efficiency of deliver your baby.
    For men, pelvic floor muscles not only help to control the bladder and bowel but they also assist in sexual function.

  • Strong Pelvic Floor muscles are making birthing more difficult
    Research shows that strong pelvic floor muscles may ease the birthing process and aide in a quicker recovery from both vaginal and caesarian delivery.

What to expect and how can Brill Physical Therapy help?

The first appointment at Brill Physical Therapy includes an interview and discussion about your experience, including your symptoms as well as medical history and lifestyle. Pelvic floor therapists are trained to be sensitive to how personal and intimate these topics and this part of your body can be. The therapist will then evaluate your posture, back and hips and they also explain how Brill Physical Therapy can help.
To complete the assessment, your Physical Therapist may need to conduct an internal exam. Internal examination helps to get a full sense of the strength and flexibility of your pelvic floor muscles, ligaments and fascia. For women, this will be through the vagina. For men and also some women, the exam is done rectally.  In some cases an internal exam is not necessary or possible.
Brill Physical Therapy has 22 years of experience success fully treating pelvic floor and our therapists consider pelvic floor function with every exercise they prescribe.

Call Brill PT today at 212-333-7224 or 212-325-0961 or email

What Can Physical Therapy Do For Spinal Cord Injuries?

This article in the Wall Street Journal exhibits the power of physical therapy and the positive, life-changing, effect it can have on someone’s life.

A new study shows that people paralyzed by spinal cord injuries can regain some voluntary movement in their legs with a combination of electrical stimulation and intensive physical therapy.

Read this extraordinary story in the Wall Street Journal.

What Does A Hip Replacement Cost You?

As of July 2013, according to the Centers for Disease Control and Prevention, a total of 332,000 hip replacements are performed each year.  Therefore, Brill Physical Therapy thought this NY Times article comparing costs of hip surgery may be of interest to many of you.

Check out this great article published in the New York Times on August 4th 2013.  Can you believe these numbers!

Tips For Ski Season!

With ski season well under way, and the increased popularity of skiing drawing more and more skiers to the slopes, here is what you need to know to help decrease your risk of injury.

  1. Novice skiers are 33% more likely to be injured compared to intermediate or expert skiers; therefore taking a lesson is advised.

  2. Keep yourself conditioned during the off season.  Skiing requires sustained contractions of large muscles which can really tire you out and increase your chance of injury.

  3. Update your ski equipment.  There have been a lot of advances over the past 30 years and with that a drastic drop in injury rates.  The developments of wider and shaped skis have been found to be easier to use, especially by a beginner, since they require less energy to turn.  The boot design allows the ankle to be better secured and bindings to be adjustable based on your skill level (novice skiers should wear bindings that easily release from the boot to prevent injury).

  4. Know the terrain and ski within your ski level.

Despite adhering to the above recommendations, a ski injury may occur.  Most injuries occur to the ligament located on the inner side of your knee called your MCL (medial collateral ligament).  It can be sprained from a twisting fall or when a beginner snow plows for a long time.  Another knee ligament that is commonly injured is the ACL (anterior cruciate ligament) due to a backward fall or twist as in “catching an edge”.  If you rupture the ACL you will probably need surgery to repair it followed by physical therapy.  There has been some literature recently which has shown that if you mildly tear it, with the appropriate treatment, surgery can be avoided.

Some common upper extremity injuries include shoulder dislocation and injury to a ligament of the thumb (ulnar collateral ligament) which is second in frequency of injury to the MCL.  Using poles with straps are recommended to avoid this thumb injury.  PT can help strengthen the shoulder complex after a dislocation but surgery maybe needed if dislocation reoccurs.  The thumb can most often be treated with a protective cast.

Be careful on the slopes! If you do have an injury, make sure to ice, use compression, elevate, and seek medical help if necessary. Now that you know all the essentials, you are ready to hit the slopes. Have an amazing and safe skiing season!

Common Knee Surgery Does Very Little for Some, Study Suggests

Physical therapy is becoming more and more recognized nowadays.

Physical therapy can mobilize the knee for better alignment which often allows the meniscus to heal.

On The Dr. Oz Show, Dr. Oz talked about how he was unable to tolerate standing while performing surgery  because of his severe knee pain.  Ten days prior to his scheduled knee surgery for his meniscal tear, he had one visit to physical therapist, Peggy Brill, and received immediate relief, did his three prescribed exercises, and never had the knee surgery.   These results are more common than you would think.  Make sure to visit your physical therapist at Brill Physical Therapy.

 Make sure to check out this great article in the NY Times!

Curious about shoulder pain and impingement?

Read this article written by Brill’s own Sarah Sittenreich

Why am I having shoulder pain when I reach above my head?

It may be a condition known as shoulder impingement. The shoulder joint is formed where the humerus meets the shoulder blade (the “ball” meeting the “socket”). There is a space where this connection is made, allowing several tendons and burase to lie here. Several factors, such as poor posture and excessive time at the computer can cause this space to narrow, putting pressure on these structures. This in turn leads to inflammation, pain, and weakening of the muscles that are meant to prevent this compression. These muscles, known collectively as the rotator cuff, are necessary to properly stabilize your shoulder as you reach overhead.

Symptoms of shoulder impingement may include pain when reaching behind your back or overhead for high shelves, as well as pain with carrying heavy objects and lying on your side.

What can I do to manage my shoulder impingement?

In order to calm down the aggravated tissue, we need to open up the space in your shoulder. First, start by resting your arms on arm rests at your desk. When lying down at night, place a small towel roll or pillow under the arm that is causing you pain.

Lastly, here is a simple exercise to start opening up the space in your shoulder:

Scapular Retractions

Slowly pull back, activating the muscles in between your shoulder blades. Try to relax your neck muscles while performing this exercise. Hold for 3 seconds, perform two sets of 10.

Brill Physical Therapy Self-Test

Check Your Balance

Balance is very important in everything you do. This self-test will help reveal the power and strength of the muscles in your lower extremities. Here is a quick test to see how good your balance is.

1)    Place a piece of paper on the floor as your mark.

2)    Stand on one foot and jump up and down 10 times. (Make sure that you land with a slightly bent knee.)

3)    Switch to the opposite foot and repeat.

Evaluate your results!

Did you miss the paper when landing or have other trouble completing this jumping? This means your balance is not as good as it could be. Balance requires strong feet and ankles and motor control, as well as abdominal and overall leg strength.

Alert! Stop sitting; it may just lengthen your life.

Sit Less, Live Longer?

We at Brill would like to reach out to all of our patients (especially those of you who sit and work at a desk for a living, which is… all of you?) to let you know about a very enlightening article that was printed in the New York Times on September 17 (by Gretchen Reynolds). It tells of a Swedish medical study that links the two ideas of lengthening cell life and sitting less. This study was published in the British Journal of Sports Medicine, and it set out to correlate between exercise, non-exercise-daily-activities and the length of telomeres in the white blood cells. “Telomeres?” you may ask, “Of what importance are they to me?” We generally understand that our bodies grow older through a long process of the cells of our bodies aging. One particularly recognizable marker of cell aging is the breakdown, or fraying, of our DNA strands. These strands have special bindings at the ends (like your shoelaces) called telomeres. The breakdown of the telomeres does not always progress linearly with time. Some poor health habits or other stressful conditions can hasten the early breakdown, while more healthy activities may actually preserve telomere length or even possibly promote lengthening – in essence postponing the onset of the aging process.

In the experiment the Swedish scientists (Sjogren, P., et al.) used a group of 49 people, all aged 68, and described as being sedentary and overweight. They measured the length of the telomeres in their white blood cells, and then split them into two groups. In one group, the volunteers began a specific exercise program, and were advised to sit less. The other group were to continue with their normal activities, but were asked to try to lose weight and lead as healthy a lifestyle as they could. Six months later all the subjects were brought in to fill out a detailed questionnaire about their activities, and they had a second blood draw.

The outcome was predictable in some ways. It showed that the group that was asked to just lose weight and live more healthily showed shortening of the telomeres. But interestingly, the subjects in the other group who reporting sitting much less showed significantly longer telomeres, in some cases the cells even seemed to have grown younger than on the first measure. However, in that same group, the subjects who reported exercising the most did not show specific lengthening of the telomeres, and in some cases had shortening of the telomeres when compared to those who exercised less but stood up more.

Now we in the physical therapy field all have learned that the position in which the spine takes the most pressure through it is the sitting position. We are actually putting an axial compressive force through our spines when we sit, which the spine was not originally made for. So this makes a certain sense to us. Now when we ask you to take breaks throughout your day from sitting at your desk, and either to stand or walk around, you have yet another reason to follow our advice.


Check out Andrew’s Youtube video:

Having Back Pain? Get Instant Relief

Check out this great article about back problems.

Everybody either has or will have back pain in their lifetime.

Peggy Brill has had recurring back pain since the age of 13 and has suffered 5 herniated discs but never had back surgery.  Her pain motivated her to write The Core Program. This book is filled with exercises to help relieve pain and has already helped hundreds of thousands. Make sure to grab a copy! Relief can be yours. 

Here is a simple exercise that can help you get some instant relief from back pain.

Standing Backward Bend

  1. Stand with your legs shoulder-width apart.

  2. Place your hands on your buttocks, with your fingers pointing downwards.

  3. Stretch back as far as you comfortable can, with our face lifted towards the ceiling.

  4. Return upright slowly

  5. Repeat 10 times. Try to bend a little farther with each repetition.

Brill PT Helps Parkinson’s Patients

What is Parkinson’s Disease?

Parkinson’s Disease is a chronic and progressive neurologic disorder, however, research has shown that early intervention with physical therapy can be helpful in slowing the progression of symptoms. While the exact cause is unknown, scientists believe that certain genetic and environmental factors lead to the damage of the dopamine receptors in the brain responsible for movement control.  Brill Physical Therapy offers smart care for the best results of restoring mobility and addressing the effects of Parkinson’s.


What are the symptoms of Parkinson’s Disease?


There are currently an estimated one million individuals living with Parkinson’s Disease in the United States, with approximately four percent receiving their diagnosis before the age of 50.  Symptoms differ greatly from person to person, however, the most common movement symptoms are:

  1. Resting Tremor in Hand or Foot

  2. Slow Movement of Facial Expression and Walking

  3. Tight Muscles and Trunk Stiffness

  4. Bent Over Posture

How can Brill Physical Therapy help?


Brill Physical Therapy can help patients with Parkinson’s Disease by enhancing walking, balance, strength and flexibility.  We design a customized 5-15 minute home exercise program (supported by evidence) to fit each patient and target the areas affected the most since each patient presents differently.


Here at Brill Physical Therapy, we have developed a treatment regimen to help patient’s cope with Parkinson’s Disease and help slow the rate of  symptoms.  Since trunk mobility can be such a big issue with patients, we would like to share one simple exercise to help keep you moving:


Lying Spinal Twists

Lying on your back with both knees bent, slowly let your knees fall to one side as you exhale.  Hold for 10 seconds, then slowly let your legs fall to the other side.  Repeat 3 times on both sides alternating.  This will help you stretch your back safely.