Pediatric Physical Therapist, Melissa Dupree, DPT Joins Ayrsley Town Rehabilitation (ATR)

Nov. 11, 2014 – CHARLOTTE, N.C. — Melissa Dupree, DPT has joined Ayrsley Town Rehabilitation bringing extensive experience in pediatrics, orthopedic physical therapy and yoga to the company.

“Adding Melissa brings a tremendous amount of clinical experience to our team. Her versatile background in pediatrics allows our company to help with what we feel is an underserved pediatric in Southwest Charlotte,” said Chris Stulginsky, PT of Ayrsley Town Rehabilitation.

Melissa was born and raised in Long Island, New York and studied physical therapy at New York Institute of Technology in Old Westbury, NY.

After graduating, Melissa was hired by the company in which she performed her final clinical residency. During her 6 years with The Hagedorn Little Village School, in Seaford, NY she developed her pediatric versatility in pediatric home care, outpatient clinic work service, and treating in the local schools.

Melissa’s caseload ranged in age, treating children from 2 through 11 years, with a variety of diagnoses and ailments.  During this time, Melissa spent significant post graduate study in general pediatrics, with specific focus on autism, torticollis, and pediatric orthotics.  During that time, Melissa maintained a part time job in adult orthopedics at Dynamic Core Physical Therapy in New York.

Wanting to place all her focus in pediatrics, Melissa became full time in July 2009 at a developmental school in New York.  In 2010, she received her Early Intervention Certification through the State of New York and began doing home care treatment focusing on a toddler population.

Wanting to further her knowledge of exercise and its beneficial effect, Melissa pursued and received her yoga certification through YogaFit in 2013. She has already implemented yoga principles into her pediatric and adult treatment plans at ATR.

Having always loved Charlotte, Melissa and her husband felt it would be a wonderful place to raise a family. They recently they moved to Charlotte with their adorable son Michael (born 2014).

In addition to treating both the pediatric and adult population at ATR’s main office in Steele Creek, Melissa is coordinating the new pediatric PT services for ATR in partnership with Achieve Therapy Services in Southeast Charlotte.

How to Combat Neck and Back Pain Due to “iPosture”

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Recently, Chris Stulginsky, was asked to comment on “iPosture”, an epidemic plaguing young people causing severe neck and back pain as the result of being hunched over mobile devices for extended periods of time. Below is a copy of the article that original appeared on Charlotte News 14:

More young people suffering back, neck pain from phone use
By: Caroline Vandergriff

CHARLOTTE — An epidemic known as “iPosture” is causing severe back and neck pain as people spend more time on mobile devices. The position is a result of looking down at a cell phone or tablet with the neck bent and the shoulders slumped over. “When somebody is holding something in front of you, you start to curl to curl your shoulders over,” said physical therapist Christopher Stulginksy of Ayrsley Town Rehabilitation. “They start to look down, specifically at their mobile devices, and it puts a lot of stress on the muscles in the back.”

Stulginsky said that type of stress overworks the muscles and creates pain.

A recent study by UK health provider SimplyHealth shows 84 percent of 18 to 24 year olds reported suffering back or neck pain in the past year. That same study finds someone in that age group spends almost nine hours a day in front of some of screen. “Think about the percentage of the day that you’re in that posture,” said Stulginsky. “So, OK, what can we change? It’s not realistic to stop using those devices, but you can change the posture, and that’s where you can mitigate the problems you have long term.” Stulginsky suggested setting an alarm on a phone for every 15 minutes as a reminder to check posture or change your position. “Put it on vibrate so it doesn’t disturb people around you, and when that goes off, in your pocket or on your desk, just momentarily change the posture,” Stulginsky said. “It will mitigate the force that you’re putting for the position you’re in all day.”

Grandparents’ advice to stand straight and sit up tall really will help alleviate problems as well, along with a healthy lifestyle and regular exercise.

Core Stabilization Exercise – The Vomit Cat

Crunches alone won’t make your core more stable. The lesser known transverse abdominis muscle is just as important, but often over looked. Chris Stulginsky of Ayrlsey Town Rehabilitation shows an easy exercise, humorously nicknamed the Vomit Cat, which works the transverse abdominis.

Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.
http://ayrsleyrehab.com/

Physical Therapy and One Very Special 8-Year Old Patient

Every profession has high-lights and low-lights, Physical Therapy is no different and often, the two extremes get blended together in many cases. I’ve asked one of our Physical Therapists, Aurora D. Smith, to tell you about one of those patients who makes us love what we do each day. Here is her story:

As a Physical Therapist, I see many patients that inspire me to continue to learn more about my profession and myself as an individual. I have treated a variety of medical diagnoses over the span of more than 10 years in this field. Recently, I have had the pleasure of getting to know an amazing young girl that has a beautiful spirit. She makes me think of butterflies… Her name is Paulina and she has gracefully dealt with issues that would be difficult for a “well adjusted” adult to handle well. Paulina is 8 years old.

On October 10, 2012, Paulina was diagnosed with a brain tumor. It took approximately one year from the time that her optometrist recommended an MRI because the doctor felt that there was an issue of vein diameter during a routine examination. They were smaller than normal. So it began… for Paulina, Rosa, her mother, and grandmother in tow (she is at every physical therapy appointment). Eventually it was confirmed. She had a tumor approximately the size of a golf ball sitting on the pituitary gland. By the end of October, she had a port and then underwent chemotherapy in November.

Rosa, Paulina’s mother, states that they are a close knit family and the entire extended group was brought together in this time of need on the eve that her parents received this life changing diagnosis. Her mother was understandably feeling “helpless” without a clue of what to do next. “I wanted to take it away from her,” she states when asked about her feelings that day. It has been a strain on the family unit in many ways, but her mother says, “we just kept God first and Paulina always had a good attitude and rarely complained.” I know that to be true – when we have sessions together, she will ask in a chipper voice: “what’s next!? How many?” and that alone puts a smile on my face. She truly is a treasure!

At present time, Paulina’s cancer is in remission. While there is uncertainty, this family and this very special little girl have decided to live life to the fullest. But who of us does not live uncertain of what the future holds? When I see her smile, it makes a lot of sense to me that we embrace the moments that we have and all of the golden nuggets along the way. She is an example of what makes my profession incredibly worthwhile.

Aurora D. Smith, PT, MS
Physical Therapist

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I am Aurora D. Smith, PT, MS originally from Columbia, SC. I am a graduate of Wake Forest University with a bachelor’s degree in Health and Exercise Science. At Wake Forest University, I had the opportunity to continue my dance studies while pursuing academic interests, and was subsequently was offered the opportunity to dance professionally with the Charleston Ballet Theatre upon graduation. I enjoyed a brief yet fulfilling career as a professional ballet dancer for 2 years prior to attending the Medical University of South Carolina to pursue a career in Physical Therapy.

Having a love of science and movement, it was the perfect fit for me! I graduated in 2002 with a Master’s in Rehabilitation Science and began my career working in an outpatient clinic located in Sumter. SC. Since that time, I have worked in a variety of settings and have extensive experience with ergonomics, work hardening, work conditioning and performing functional capacity evaluations. I have furthered my education with several manual therapy courses through the University of St. Augustine. In my spare time, I enjoy reading, visiting museums and travel to interesting and exotic places!

“Could my child have a concussion?”

It’s alarming how many times I’ve been asked this question. Concussions in kids are not always as apparent as they are in adults. Did you know a child can suffer a concussion without ever having a blow to the head?

 

If you have any questions about concussions or questions about physical therapy, give me a call.

Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.

Back to School: Load your Child’s Backpack Properly


It’s back to school time, but that doesn’t have to mean a literal pain in the back for your child.

Chris Stulginsky of Ayrsley Town Rehab shares tips on how to load a backpack to increase comfort and help prevent injury.

Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.
http://ayrsleyrehab.com/

Independence From Pain Through Physical Therapy

Physical therapy can be your answer to independence from joint and muscular pain. Chris Stulginsky from Ayrsley Town Rehab explains how treating the underlying cause of pain is the only way to be truly pain free. No more just treating the symptom, solve the problem that’s causing the pain!
Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.

Visit us online to learn more at: http://ayrsleyrehab.com/

Knee Pain Doesn’t Always Mean Surgery

As discussed in the video, chronic knee pain doesn’t always mean surgery. Our patient, Rosa Underwood’s* experience demonstrates how physical therapy helped resolve her chronic knee pain, even though she had been advised that surgery was her only option.

Patient Spotlight: Rosa Underwood*

The Issue: I had severe knee pain, constant arthritis pain in my right knee that was affecting my quality of life. The limited mobility affected my ability to shop, play with my grandchildren, garden, enjoy myself in general. I was fearful of being stigmatized professionally because of my limping and the possibility of not working due to needing knee surgery. I was miserable.

How was your physical therapy treatment? The physical therapy felt immediately empowering! I felt that I had an active role in getting better and the better I understood how muscles functioned the more I realized I was not helpless, that a lot of my pain was due to extra stress being put on my knee because of how I moved at many joints and that my knee was not going to crack in half.

The moment things changed: Chris found that I was compensating by clenching my jaw, he treated that and my knee pain decreased significantly. I thought, “What just happened?” My knee pain was decreased significantly, and I was able to garden that weekend kneeling with very little pain, I have not been able to do that in months.

The difference over the past few weeks is incredible… I am walking longer, my attitude is hopeful, I don’t describe my pain as severe…I play with my grandchildren and enjoy myself again. I have not worn a knee brace or wrapped my knee since. My doctor is pleased with my progress and so am I! The ATR team is truly outstanding!

The Therapist’s take: Rosa had significant movement restrictions in her knee, ankle, and hip which piled on top an existing arthritic condition. Her Gluteal muscles were not firing much, and her knee was not able to get straight. It is a common compensation pattern, inhibited gluts put more pressure on the muscles that surround the knee. We tested her glut, it was strong, but she was clenching her jaw. Retesting with a relaxed jaw decreased the glut strength drastically. Palpation revealed increased tenderness at her right masseter, and quick, patient-directed release resulted in the gluteal muscles firing again so they tested strong with a relaxed jaw. With the gluts back on line, it took pressure off of the knee and the patient’s squat test improved dramatically. This is a great example of how the pain is rarely problem, it is the symptom of dysfunction. This is why we examine and treat function, treating structure alone without addressing function rarely leads to long term success.

*Use of quotations and names are with permission of patient

Generic “One Size Fits All” Home Exercise Programs Can Cause More Harm than Good

Often after a visit to a medical office for pain, patients are provided with a list of exercises, a pamphlet or brochure or worse, they find a “one size fits all” exercise “cure” on the internet. Many feel these are often sufficient replacements for a skilled physical therapy evaluation and subsequent treatment, with the notion that strengthening or exercising the painful area will improve the pain in function.

The leading experts in the therapy, movement and performance field will tell you that this assumption is incorrect.

Physical therapists, with a foundation of anatomical structure, neurological pathways, and motor control are the recognized functional experts the in healthcare industry. With the proper education and approach they can easily explain to you not only what is hurting, but why it is hurting. With the proper approach, they will look at the entire kinetic chain. Many times, the pain is not the problem; it is a symptom of movement dysfunction elsewhere, putting more stress on the area that is experiencing pain. Direct, “one size fits all” programs for a painful area rarely lead to a decrease in pain and often can make symptoms worse and lead to an unsatisfied patient.

The Problem in Theory:

All too often patients receive a home exercise program with the “one size fits all” approach with the painful area being the sole focus. These programs often disregard an injury with individual characteristics resulting in improper recovery, decreasing their ability to return to prior level of function and often result in reoccurrence. The number one cause of re-injury is a result of insufficient or improper rehabilitation. Generic home exercise programs are not sufficient nor are they proper for comprehensive rehabilitation for an individual with pain.

Here are 5 reasons why a stand-alone Home Exercise Program can be ineffective.

1. A home exercise program is not self-care program; it is a component of one. Many incorrectly assume the terms are one in the same. Often important components such as patient education workplace, and home modification to name a few, are not included, to the detriment of the patient. Just as a grade school homework assignment reinforces what is taught in class:

Home Exercise Programs are NOT synonymous with physical therapy, they are an adjunct.

2. The body is designed to compensate and often does without the knowledge of the person performing the exercise. With a “one size fits all” home exercise program these issues often go unaddressed and result in compensation, decreasing the effectiveness of the exercise. Additionally, improperly performing home programs reinforce incorrect motor patterns resulting in additional stress on structures that are not designed to handle the force. The  work of Richard A Schmidt, PhD. tell us that tells us that it takes 300 repetitions to create a bad habit, and 3000 correct repetitions to undo it. That is the human condition.  Exercises given without compensation safeguards can quickly have detrimental results to one’s movement patterns and pain.

3. Generic programs are limited to a specific painful area and ignore other affected areas of the body. The “one size fits all” exercise program usually only addresses the site of pain with the assumption that the pain is the problem. In most cases the pain is the symptom of movement dysfunction elsewhere. The entirety of the kinetic chain, which is the interaction of muscle, nerves and joint to create movement, is often ignored. When this occurs, people with foot pain, for example, develop knee, back or hip pain because their functional requirements of other areas have increased, but have gone unaddressed. In this same light, if a non-painful dysfunction at the thoracic spine creates issues at the shoulder blade and in turn shoulder pain, shoulder exercises are not going to address the problem.

4. There is often no progression, increasing the chances of re- injury. Without progression, the structures are improperly prepared for the functional demands of everyday life and the end result is some level of pain, be it reoccurring or new.

5. It is an incorrect assumption that if an individual has a program that addressed the structures involved in a specific movement that motor patterns will take care of themselves. Generic orthopedic programs that do not address movement patterns may improve isolated strength, but will not improve the dysfunction that caused the injury.

The Problem in Practice:

Just this week we had a patient who had been in chronic pain for a while. She performed exercises that was a “one size fits all” and her pain had gotten worse. The patient had shoulder pain, so she was provided the “shoulder exercise program”.  The patient’s shoulder was painful, but as a result of rounded shoulders and weak shoulder blade stabilizers, not because of decreased shoulder strength. Yet, repeated the very mechanical issue that caused the pain. This program did not address the tight chest muscles and weak scapular stabilizers which were the primary causes of the painful shoulder.

All too often this occurs, resulting in an unsatisfied patient who remains in pain. There are many limitations to performing a general program. To start, the proprioceptive mechanism, which is what tells am individual where their body is in space, is not well tuned, making it nearly impossible for an individual to self-correct. Good pure movement is often altered in the non-painful population, let alone a painful one. Many won’t correct a problem unless they know there is one in the first place, if they don’t know there is a problem, the correction won’t happen.

The “one size fits all” approach is counterintuitive to all other aspects of medicine, and yet it seems to be the “go to” approach for orthopedic pain. Two people with similar health problems are rarely going to be prescribed the same prescription medicine, with regard to frequency and dosage. People are different; so it stands to reason that many factors should be taken into account. Returning to the scenario above, shoulders are not created equally, and yet, the “one size fits all” approach was the “cure.”

If you have received or given an exercise program, you should ask yourself these questions:

Does it include self-treatment education on proper use of modalities, home and workplace modification?
Does it have safeguards against compensation to protect functional movement from becoming dysfunctional?
Does it focus on multiple areas vs .one?
Does it include motor pattern correction?
Is it being performed correctly? How do I know?
Is it too easy? Is it too difficult? How do I know?
If you do not know the answer to one or more of these questions, a physical therapist will be able to answer them for you or your patient.

Fall Prevention for Senior Citizens

Did you know that 1 in 3 senior citizens fall each year? Many of these falls result in hospitalization or assisted living. Did you know that physical therapists can help prevent falls and help choose and correctly size assistive devices like walkers and canes? Chris Stulginsky of Ayrsley Town Rehab discusses ways you can help the senior citizens in your life prevent falls.

Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities. Watch the video below to learn more about fall prevention and what you can do to help protect those you love.