dog walking

Is Your Dog Walking You?

Do you know the feeling when you walk your dog and the leash is WAY out in front of you and the dog is looking back at you eagerly? Or maybe not!!  That is the sign that the dog is leading YOU down the street.

I have many patients who walk their dogs and often complain of neck and shoulder pain.  That could be a sign that the dog is walking you.  This can of course vary, depending on the size of your dog,  But a little tug here and there even with a small dog can cause some aches and pains in an otherwise healthy neck.

Patients often complain of neck tightness and generally grab the part of their neck just above their shoulders and want to massage it in the hopes that it will make them feel better.  More often than not, this area is being put on tension or elongated when the leash is in that hand and the dog is way ahead of you.  Simply put, when your leash hand is  held is out in front, it puts stress and strain on the neck and shoulder muscles on that same side.

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Whole Person Healthcare

Treating the whole person and not just a body part

The value of being treated as a whole person and not just a body part.

If you have pain in one part of your body, let’s say, your knee. The longer you have this symptom, the more you incorporate this “pain” as part of your overall body image. You identify with it. That is why it is so important that when you see a Physical Therapist you receive a clinical evaluation from head to toe. Be open to other regions of your body causing your pain . A dysfunction in the foot or hip, is not an unusual cause of knee pain.

Integrating not just the physical, the knee, but the emotional, how we deal with our knee pain, and the intellectual, understanding why we have it and finally the spiritual, knowing and believing that we will heal and get better, is the epitome of a true holistic approach to musculo-skeletal health and well being.

A patient of mine had a knee replacement about 5 years ago, and did not really get full pain relief from the surgery. In the years following the surgery, she tried numerous injections, pain medicine etc without much relief.

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Let’s put the HEAL-ing back into HEAL-thcare


When people come to you in pain, what do you do? Do you sit there and ask them a litany of questions, writing them down without making any eye contact? Or do you just listen and hope that you remember everything later?   Or do you do a bit of both?

Take yourself out of the picture and put yourself in your patient’s shoes.

Ego is big thing in health care. We have all seen it, whatever profession you are in. The ego is such a mind suck when it comes to treating patients one on one.   Leave it on the table for crying out loud. The ego will never win my friends. It is too hungry and will never get satisfied.

But your soul will. Your ego should not make your business decisions. Your soul should.

Doing one on one work as we do, we develop a special bond with our patients.   When I worked on Wall Street, I developed this same special relationship with my clients. Completely different professions but the principles are the same. It is called TRUST.

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Ballerina Foot Pain

Does your foot hurt when you go up on your toes?

Question: Are you unable to perform a relevé without foot pain?

Truth: Pushing off through the front of your foot is what happens when you walk, when you do calf raises in the gym and when you have to perform a relevé multiple times during a performance. Whether you know it or not, this type of movement requires the synergistic action of many parts of your body.  Also known as the kinetic chain in action.



Story: A Broadway show actor was referred to me with chronic complaints of right foot pain. She was unable to do a relevé. She also had problems going up stairs, wearing her performance shoes as well as standing on one leg. She had physical therapy elsewhere and a PRP (platelet rich plasma) injection with little relief.

Problem: I always check baseline posture to see if there is anything jumping out at me that I should be aware of. If there is, I then see if it changes with the movements I evaluate. For this patient, there were a few things that jumped out. She was standing with more weight on her left leg and her thorax (ribcage) was rotated to the right. This is no surprise as she most likely offloaded her right leg for months. However, this position was causing more torque in her foot, thus making the initial problem worse.

This in turn causes compensatory twists up the chain until finally the body can right itself to face forward. Compensating like this for many months tends to change our body schema and our brain maps, such that if we were to put ourselves in a better position, we would think it is not normal, or we would feel “crooked” so to speak. Trust me, there are a lot of people who feel “off”, and walk around pain free. And that’s fine.

But when it comes to high-level performance, correctness of movement and balance play a much larger role.

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kneeling on ground

Can’t kneel on the ground because of knee pain?


Did you know that if you have problems kneeling, the cause could potentially be in your hip? 


The knee is often the victim in most cases. If you don’t look above and below the knee, the source of the problem could easily be missed. Whether you can’t kneel to see the line for a putt or play on the floor with your child or even your dog or cat, looking elsewhere for the source of the problem is key!




As you can see from the above photo as well as the cover photo for this post, kneeling requires the synergistic action from both your hips and feet and the rest of the kinetic chain.

A thirty-five-year-old female was referred to me with complaints of left knee pain “behind my knee,” as she put it, or in the crevasse that is between the back of the thigh and the calf. In my language, we call it the popliteal fossa.

She felt it most with a deep knee bend while playing with her child on the floor.   In this position your thigh muscles, or quadriceps are on stretch and your hips are in almost a fully flexed position.

One of the things I honed from my time on Wall Street was how to problem solve. So I looked at how she sat on the floor to play with her daughter. She sat and knelt with her RIGHT hip forward , not her left. She also had left knee pain during this posture.

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knee pain riding bicycle

The knee bone is connected to the spine!!

The Knee Bone Is Connected to The… Well a lot!!!

Question: Did you know that stiffness in your upper to mid back could be the cause of your knee pain?

Truth: Pain is very misleading, but if we can learn to understand it’s true origin, then we can also learn how to treat it to live a more productive life.

The Story: A middle-aged man that also happens to be a tri-athlete came to me with complaints of knee pain while cycling and running. If you have every watched professional cycling, the typical posture is one that includes being hunched over with the arms tight to the body, very focused on the road ahead.


The Problem: If there were even a minor restriction in the mid back (causing a rotational shift to one side), that restriction could cause a compensatory rotation in the hip or the knee, especially when clipped in.

For example, if you are sitting in a little bit of rotation to the right, due to perhaps a fall onto the rib cage or maybe even because you sit to the right while working, in order for you to keep your gaze directed forward while cycling, you must rotate somewhere else to achieve this. And that could happen anywhere in the kinetic chain, even the knee.

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think outside of the box with pain

The source of your low back pain may not be where you think it is!

Golfers did you know that your low back pain can be coming from a restriction in your opposite shoulder?

Your back hurts after playing a round of golf. A very common scenario, I must admit.

One of my patients has chronic low back pain, is an avid golfer and has a sedentary job. Most activities are pain free except when she plays a long round of golf. After which she is sore for a couple of days.

A swing evaluation revealed that during the follow through she had difficulty rotating her torso to the left. So she compensated through her low back, which took the brunt of the rotation.

Why did she have this difficulty? Was there a restriction in her thoracic spine (mid back, thorax)?   Was there a restriction in her left or right shoulder? Were her hips not rotating during the weight shift?

weight shift2


The shoulder, thorax, and the hips as well as the feet are all joints that rotate. As you can see from the above photo, when this golfer is rotating to the left, both shoulders and forearms are rotating as well, in addition to his thoracic spine (torso), hips and feet.

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Back pain sitting at a computer

Does your low back hurt when you sit?

Does your low back hurt when you sit? 

This is a fairly common scenario not only because many people sit all day, but because back pain can be felt in the same place by many people, but you all could have different sources to your problem. Many times the back is the victim.

Consider a patient scenario: Left sided low back pain, worse with sitting and driving.

You are fine for years and then one day out of the blue, your back hurts after a long meeting. Was it the chair? Was it because you started doing the stationary bike more? Or was it because you had a long drive the weekend before?

Such was the case for one of my patients. In order to get to a sitting position, you have to squat first. So I assessed her squat.   Every time she squatted, her whole body rotated to the right. The body takes the path of least resistance. And her path was right.


sit to stand

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Golfer hip pain when on golf course

Golfers -did you know knee pain can come from your pelvis?

Does your knee hurt when you play golf?

The knee is usually the victim in most of these scenarios. I wanted to write just a short snippet about why you should consider other sources of your knee pain.

Yes, your knee hurts but is it the cause of the problem? Sometimes yes, more often no.

Consider a patient scenario: Long standing knee pain on the right, aggravated by the downswing.


As you see above, the right hip is turned in (internally rotated) and the clubface is ready to make impact. There is weight transfer from the right to the left leg and the pelvis stays level. Continue Reading…

Eliminating Pain

How Do You Explain Pain to Patients?

The healing power of touch is well publicized but how about the healing power of speech?  When patients come to me, they hurt, they are in PAIN.  As physical therapists, we employ a great deal of clinical reasoning to come up with a diagnosis as to where their source of pain lies.   But patients always ask me,  “but why do I have pain?” Continue Reading…