Category Archives: Uncategorized

It’s Baseball Season!

With the return of our beloved Giants in an “even number year” and with the addition of a few new characters, let’s talk about some of the pro’s favorite Baseball related warm-up and strengthening exercises.

Whether or not you play, it’s always fun to look onto the field during warm-ups and test your “training” knowledge. So let’s play a round of photo-hunt and see if you can match the correct exercise to that which our favorite Giants are performing below. (Don’t worry, answers will be shown below).

Exercise #1


  1. “Hey everybody, it’s sunny”…to be happy
  2. Dynamic hug with big smiles…to open the chest and thoracic spine
  3. Dynamic lunge hip flexor stretch with thoracic rotation…open hips and spine
  4. Sleeper’s stretch… to stretch the back side of the shoulder


Exercise #2


  1. “Clean the wall”… to warm up your forearm
  2. “Sand the floor”… to warm up your hand
  3. “Wave the flag”… to warm up your shoulder
  4. “Towel Drill”… to improve follow-through mechanics


Exercise #3

Giants Spring Baseball

  1. “Buttkickers”… to warm up hamstrings
  2. “Walk like a Flamingo”… to practice balance
  3. “Jog with your teammates”… to make the fans happy






1 (C)

2 (D)

3 (A)

The Kids are going to be Upright

This picture should look familiar…it was the evenly spaced grid pattern you saw every morning growing up walking into class.  This space personified structure, QUIET, and organization.  However, it also facilitated some note passing and a good nap once in a while.  While this model worked for us, things are looking UP for the next generation.

sit down desk.jpg
Traditional Classroom Setting

If you know one thing about pediatrics, it is that they like to move.  Teachers and parents have spent an enormous amount of energy trying to get their kids to settle down and pay attention.  Workstation design is evolving to help in this process, by letting kids sit…stand…move…without compromising the learning process.  Organizations like Standup Kids and Stand2learn are leading the charge to improve pediatric health.

Here are some statistics from the website (

  • The average U.S. student is sitting an average of 4.5 hours/day at school and (for kids ages 8-18) an additional 7 plus hours/day in front of a screen, regardless of socioeconomic status. Combine that with time spent doing homework, sitting at the dinner table, and driving to and from school, and our kids are spending nearly 85% of their waking hours in sedentary positions.
  • The problem is so bad that medical experts now equate sitting with smoking, saying that sitting as little as two hours continuously increases risk for heart disease, diabetes, metabolic syndrome, cancer, back and neck pain (among other orthopedic problems) and will literally shorten your life, just like smoking.
  • It turns out that tacking on regular exercise (soccer practice, gymnastics class, etc.) to an otherwise sedentary life doesn’t overcome the negative effects of too much sitting. Accordingly, we must create ways for children to be continually moving more throughout the day.
stand desk children.jpg
Evolved Classroom Desk (Standing)

Still not convinced?  Maybe you are resistant to change?  How about if I told you that studies have also shown boosts in cognitive development and academic achievement:

Worksite Health Promoto: Sit, Stand, Learn

Neurocognitive Benefits of Stand-Biased School Desks

Here are some kid-centered designs to check out:

Ergotron LearnFit Adjustable Standing Desk
Dynamic Standing Desk with “Fidget Bar”

 So lets spread the word…because healthy kids make healthy adults!


Get Fit For 2016!

The New Year is just around the corner and those pesky New Year’s resolutions are coming up.  Improving fitness is a common resolution, however this can be challenging for people who simply do not enjoy exercise.

Fret not!  The current physical activity guidelines for Americans are 150 minutes of moderate-intensity activity each week1, which equate to 30 minutes 5 days a week. This can be broken down further to three 10 minute bouts of activity.  Exercise does not necessarily mean an exercise class or gym workout, but anything that requires movement and gets the blood pumping.

Here are some tips for people who are not cut out for the gym routine:

Simply walk!  Walking is tolerable for most people, easily accessible and does not incur extra costs other than a decent pair of walking shoes.

Dance!  Zumba is a great way to get fit but does requires a class setting.   If this still smacks too much of that dreaded exercise, try taking ballroom or swing dancing classes or just turn on your favorite tunes and move to them for 10 minutes.

Gardening.  Did you ever think that pulling weeds and planting flowers would fall into the exercise category?  Absolutely!  It requires movement and can elevate your heart rate, depending on the activity.

Housework.   For those of you who don’t mind a little cleaning, here is the perfect opportunity to keep the house visitor friendly.  Setting up a schedule that entails more vigorous activities each day (ie: vacuuming, scrubbing) can help you meet some of your daily activity requirements.

Mix it up so you don’t get bored.  The body is very adaptable—adding variety to your activities will maximize the benefits.

If you have aches and pains that hinder you from performing activities you would otherwise enjoy doing, consider speaking with your doctor about it – you may benefit from a physical therapy consultation.

  1., 12/4/2015

Pregnancy Pain!

You’re pregnant, “Congratulations” on your expected little one! What an exciting and busy time — its a shame that pain has to slow you down. You’re not alone, however, 24-90% of pregnant women experience lumbopelvic pain during their pregnancy, which is a broad term for either pelvic girdle or low back pain. For most women, the pain will go away after they give birth, but one-third of women may still have pain 1 year after delivering. Many women decide to seek medical help during weeks 34-40 of pregnancy, and many OB’s will refer them to Physical Therapy.

What can Physical Therapy offer? Treatment may include: exercise, eduction, manual therapy, bracing, and/or a combination of the above. Exercise can decrease pain, reduce sick-leave (for pregnancy related low back and pelvic girdle pain), and improve overall function. The best exercises are ones that strengthen the spinal muscles (AKA core strengthening) and the pelvic floor muscles. Water aerobics, general strength training, endurance exercises (walking, swimming), and balance work are also effective. If you are experiencing pregnancy related pain a Physical Therapist can help tailor a program specifically for you, and they may determine if other treatments such as bracing or manual therapy, may be helpful.

Try these exercises at home:


– Lift your buns in the air (not too high)

bridge startbridge in the air


– Tighten your tummy muscles like you are hugging your baby with your abdominals

– Try to keep your hips and back still, movement only with the abdomen

– It’s easiest to start laying on your back in a comfortable position, but you can do these sitting, standing, or laying down



– Pretend like you are stopping a flow of urine and hold your pelvic floor muscles for at least 5 seconds

– You can do these in any position and nobody will know!


– Take the small of your back and gently press it down to the floor below you



– Kneeling on all 4’s, extend your opposite arm and leg (you may want to start with legs only)

bird dog leg onlybird dog leg and arm

How many should I do, and for how long?

You can start with 5 repetitions of each exercise, holding for 5 seconds, 5 times per day


– Change position every 20 minutes: if sitting, stand up — if standing, sit down

– Don’t cross your legs while sitting — maintain good, upright posture!

– Wear comfortable shoes without a heel

– Invest in a pregnancy pillow and sleep on your side hugging the pillow with your knees: Leachco’s Snoogle and Back ‘n Belly are popular (

– Consider a maternity belt: ‘Gabrialla’ makes elastic supports

Doctors Discuss Knee Pain

Options for Aging & Aching Knees

Knee problems like arthritis, meniscus tears or ligament damage can worsen as you age. Join us for an evening of expert advice and Q&A discussion with CPMC orthopedic specialists.

Topics covered include:

Event Information:

WHEN:    Tuesday, September 30,  6:30-8:00 pm
Doors open & refreshments served at 6:15

WHERE:  Holiday Inn Golden Gateway Redwood Room, Lower Lobby
1500 Van Ness Avenue, San Francisco

COST:     Free but registration is required.              

Low back pain: why and what to do about it

by Thommy Chui, PT, OCS, CSCS, TPI CGFI MP2

What does it mean when someone says I threw my back out? Was it spring cleaning and this person decided, I  don’t want it anymore?

As a Physical therapist, all too often I hear the phrase” I threw my back out”, followed by… “all I’ve done for the last week is lie down, take pain medication, and rest.  I didn’t want to make it worse.”

Our human anatomy and physiology was developed to move, however our increasingly sedentary work duties and lifestyles have done quite the opposite. Whether it’s sitting watching TV, sitting in front of a computer station for hours without breaks, sitting in meetings , or traveling by car or airplane to then sit in meetings, we just aren’t moving as much anymore.

Studies have shown that prolonged sitting can contribute to decreased disc height in our lower back.  Additionally, extensive sitting produces overly tight hip muscles and weakness in the low back and gluteal muscles.   The result is an imbalance in our core stability.

The most common non-traumatic ways in which people injure their lower back is by bending, standing from a chair, turning or twisting. This is when we “throw our backs out.” What does this mean? It means that since we have an imbalance in our core stabilization, our muscles are not working in harmony. Specific muscles around our spine end up compensating and can progressively become overworked, setting the stage for injury.  The pain we feel initially is usually  tension or spasms of these overworked muscles.  Remember the root of the problem is weakness and inadequate stability caused by not moving enough.—so the last thing you should to do when your back is sore or in pain is lie down and not move!

Research shows that continued mobility in pain free ranges in combination with modification of activities helps decrease pain significantly.

Below are some recommendations for strength and mobility exercises along with safe techniques for getting in/out of bed and standing up from chairs without exacerbating your back pain. Try these the next time you have back pain and it may help avoid a trip to your doctor’s office.

LOG ROLL (4 steps):

log roll 1 crop

log roll 2 crop

log roll 3 crop

log roll 4 crop


hip hinge crop


squat crop


LTR 1 crop

LTR 2 crop


front plank crop


side plank crop


bridge crop


–          O’sullivan, K et al. “Lumbar posture and trunk muscle activation during a typing task when sitting on a novel dynamic ergonomic chair.” Ergonomics. 2012;55(12):1586-95. doi: 10.1080/00140139.2012.721521. Epub 2012 Sep 25.

–          Zemp, RIn vivo spinal posture during upright and reclined sitting in an office chair.” Biomed Res Int. 2013;2013:916045. doi: 10.1155/2013/916045. Epub 2013 Sep 24.

–          Lee SH, et al “The change of whole lumbar segmental motion according to the mobility of degenerated disc in the lower lumbar spine: a kinetic MRI study.” Eur Spine J. 2014 Mar 28.

–          Kline JB et al. “Core strength training using a combination of home exercises and a dynamic sling system for the management of low back pain in pre-professional ballet dancers: a case series.”J Dance Med Sci. 2013;17(1):24-33.

Bracing for action: Are ankle braces effective for volleyball players?

Ankle sprains are the most common recreational sports injury, with ankle injuries making up about 25% of all adult sports injuries. To combat ankle sprains, ankle braces have become popular in sports that require jumping and cutting. In volleyball, ankles account for about 40% of all injuries. Volleyball players in particular have embraced the use of prophylactic ankle braces, with some coaches making ankle bracing mandatory for their players. With rates that high, who wouldn’t want to protect their ankles? But are braces really effective in reducing the risk of ankle sprains? We’re going to answer some frequently asked questions about ankle braces, based on the most current literature available.

Do ankle braces prevent injury?

In healthy, active people without a history of ankle sprains, studies have not shown a benefit to wearing prophylactic braces (those intended to prevent injury). Most studies do not report injury severity, so it is certainly possible that braces affect the severity of sprains—unfortunately there just isn’t good data out there to support it.

Do ankle braces prevent re-injury?

It does appear that braces are effective for ankles that have been sprained before, especially within the first year after injury. Ankle sprain rates double in the 1-2 years following a sprain. Furthermore, 30-50% of people who sprain their ankle develop chronic instability. Prevention of reinjury following a sprain is therefore vital, and several studies have shown that bracing does reduce the risk of reinjury. It is less clear if long-term use of bracing is necessary for injury prevention. A combination of bracing with specific ankle exercises is likely the best course of action in preventing re-injury. Read on for further information.

Does the type of brace matter?

Probably not. However, braces may vary in the type of support they offer. For example, lace-up braces add stability both on the sides and in the front and back, while stirrup type braces (such as Active Ankle) only support the ankle on the sides. This won’t make a difference in most people– as the majority of ankle sprains are inversion/lateral sprains– but if you have anterior/posterior instability it may make a difference. The second way braces work is by increasing proprioception and feedback to your sensory and musculoskeletal systems. Proprioception is your brain/body’s unconscious awareness of a joint’s location in space. Increased proprioception helps your muscles react faster and stronger when they are needed to support your ankle against a potentially injuring force. All types of braces will help give proprioceptive input. To date, studies looking at type of brace haven’t agreed upon the superiority of one brace type over another in injury prevention.

Will ankle bracing hurt my ankles?

There is currently no evidence supportive of ankle weakness or loss of function stemming from the use of ankle bracing. Contrary to the beliefs of some avid non-bracers, braces won’t weaken your lateral ankle muscles or cause them to ‘get lazy’ and stop working.

Will ankle bracing hurt my knees?

Probably not.  There is evidence to show that ankle injury rates increase with knee bracing, however no similar conclusions have been made linking knee injury rates to ankle bracing. Some lab studies have shown slight increases in knee rotation with ankle bracing versus without. It makes sense that if you restrict movement enough at one joint, other joints may compensate with extra movement. However, current studies are not substantial enough for this to factor into recommendations about ankle bracing.

Will ankle bracing hurt my vertical jump?

It shouldn’t. Several studies have shown that ankle bracing does not impair physical performance in activities like jumping, running, or agility. In other words, no looking down at your ankle brace in disbelief after burying that perfect set into the net during your company’s picnic volleyball game.

What are some other options to prevent ankle sprains?

Training: Training is a key component of staying healthy as an athlete, but often athletes forget to train their ankles. Incorporating ankle exercises can be as easy as trying to stand on one leg and balance. Once that’s easy, try balancing while doing arm exercises, standing on an unstable surface, or closing your eyes. You can also try leg exercises like squats, lunges, or side leg lifts on a BOSU or balance board. Agility and jump training programs, including training yourself to land from jumps with good body mechanics, may also improve your ankle strength and stability. Keep in mind that even the best training programs take 8-12 weeks to show benefits. If you’re coming off of a recent ankle sprain, you may benefit from the advice of a physical therapist to progress your exercises at a reasonable pace while your ankle heals.

Footwear: There has not been evidence that high tops or other shoe designs prevent ankle sprains. However, supportive shoes without too much wear and tear are important. Some minimalist footwear and shoes like shape-ups may promote increased movement in your foot and ankle. This may help strengthen your foot muscles during regular activities or running, but may also increase your risk of injury during jumping and landing, so keep those off the court.

Taping: Taping may provide a similar effect to bracing in the proprioception department, and has been proven to be about as effective to bracing to prevent re-injury. However, the mechanical stability of taping has been shown to decrease quickly: within 10 minutes of activity after taping, it is already 40% less effective mechanically, and may provide negligible support within an hour. Taping is also time consuming and requires a trained professional for optimal results. However, if you leave your brace at home, taping may be an alternative to bracing that is helpful in preventing reinjury.

Here are a few other things to consider when deciding whether or not to use an ankle brace:

-Most volleyball players have a ‘dominant ankle’, the ankle opposite their hitting arm. This ankle is more likely to be injured because they land on it more often. Setters may be at risk for more ankle sprains on the right because that is the ankle closest to the net, increasing risk for under the net contact after jump sets.

-If you play indoor and outdoor volleyball, consider that you may not be able to use bracing on the beach or grass, but should definitely be working on ankle strengthening and stability exercises to prevent injury outdoors.

-In almost all cases, bracing is not going to provide enough support to prevent a sprain when one player lands in a bad position on another player’s foot after jumping high off of the ground. The forces are just too high for the brace to control.

Recommended Reading

Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010 Dec;44(15):1082-8.

Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport. 2010;13(3):309-17.

Study Designs (publishing date TBD)

Janssen KW, van Mechelen W, Verhagen EA. Ankles back in randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomised controlled trial. BMC Musculoskelet Disord. 2011; 27;12:210.

Janssen KW, van der Wees PJ, Rowe BH, de Bie R, van Mechelen W, Verhagen E. Interventions for preventing ankle ligament injuries. Cochrane Database of Systematic Reviews. 2011; Issue 12.

Additional References

Frey C, Feder KS, Sleight J. Prophylactic ankle brace use in high school volleyball players: a prospective study. Foot Ankle Int. 2010;31(4):296-300.

Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc. 2010;42(3):413-21.

SantosMJ, McIntire K, Foecking J, Liu W. The effects of ankle bracing on motion of the knee and the hip joint during trunk rotation tasks. Clin Biomech. 2004;19(9):964-71.

Venesky K, Docherty CL, Dapena J, Schrader J. J Prophylactic ankle braces and knee varus-valgus and internal-external rotation torque. Athl Train. 2006;41(3):239-44.

Verhagen EA, Van der Beek AJ, Bouter LM, Bahr RM, Van Mechelen W. A one season prospective cohort study of volleyball injuries. Br J Sports Med. 2004;38(4):477-81.

How to get fit…faster and safer…and no excuses

What is your goal?  Lose weight? Get toned?  Prevent injury?  Perform better in your sport?  For many people they want the whole package.   The good news is that you can achieve all of these with the same kind of training.  Total Body Fitness  (TBF).

CPMC Sports Wellness team offers two levels of TBF three times per week.  The class is one hour and consists of a variety of High Intensity Interval Training (HIIT), Tabata Training and contrast training.  See the links above for descriptions on interval training.  Contrast training incorporates strength and power exercises for faster results.  See the video of sample exercises utilized in the more advanced TBF II class.  

Not ready for running, jumping, or heavy weights?  Build your strength with a Personal Fitness Trainer or Pilates classes.  Just starting to exercise and want to make sure you stay injury free?  Try TBF 1 classes which incorporates less bounding and less aggressive weight training.  Fit For Life classes are geared for the first time exercisers or older exercisers looking to improve bone strength, balance, and functional endurance.

There is an option for everyone to start achieving your fitness goals today.  Check out the schedule for CPMC Sports Wellness classes.  For more questions contact the wellness team below.                                                                                                    415-600-5860

Attention SuperMoms (and Dads)! Playground Bootcamp…

Feeling like your super status is depriving you of time for exercise?  Well, do we have good news for you!  Next time you’re at the park with the kids, let them help inspire you to be more active.  Instead of sitting on the bench watching from afar, jump right in there with them!  Playing in the playground can burn calories, but there are also ways you can use the playground to gain that extra muscle tone.

With the kids:


Challenge your kids to see who can go higher on the swing.  The harder you pump your legs, the more calories you’ll burn, and you may even feel those abs tightening up too!

Monkey Bars:

Challenge yourself to get all the way across the monkey bars without letting your feet touch the ground.  You’ll be amazed at how strong your child’s arms are after giving this a try!

Climb up the ladder:

Follow your child up/down the ladder and in and around the playground.  You’ll be surprised at how much upper and lower body strength this requires.  Don’t be afraid to get down and dirty when crawling through tunnels or over barrels.

On your own while the kids are busy having fun:

Bench squats (works the quads, glutes):

Stand in front of the park bench, as you would if you were about to sit down.  Begin to sit, but as soon as your bottom touches the bench, stand right back up.  Repeat for 1 minute and time yourself to see how many squats you can complete.  Next time, see if you can squeeze one more in. 

Pushups (works arms, core):

Pushups can be intimidating, but the good news is this: you can do a pushup anywhere, and anyone can do it.  If you’re new to pushups, start by placing your hands on the back of the bench, or on a picnic table.  Be sure to keep your body in a straight line (from head to heels) and keep your abs tight.  Work at this level until it starts to feel easy.  Over time, work your way down to the bench level, and ultimately to the ground.  Repeat for 1 minute. 

Heel raises (works calf muscles):

Standing in place, raise heels up, then lower back down.  Repeat for 1 minute.  You can add a little challenge by standing on the edge of a curb or step just with the ball of the foot, but allowing the heels to hang off the edge. 

Plank (works core, arms):

Get into pushup position, and hold.  As with the pushup, you can make this easier by placing your hands on an elevated surface, or harder by having hands and feet on the ground. For a little variety and extra challenge, alternate between 2 surface heights (ex: start with hands on the table, then walk hands down to bench and back up).   Try to hold this position for up to 1 minute.  If you can only hold the position for 10 seconds, try to repeat 6 times so you have a cumulative minute.  If you hold for 30 seconds, you only need to repeat twice! 

If you repeat the 5 exercises above for 1 minute each, and repeat that two times, in just 10 minutes you’ll have completed a total body workout!  Now if only we could help you decide what to make for dinner…