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Physical Therapy

The Spirit of Yoga

What Is Correct Posture?



Physical Therapy
By Dr. Gary Welch

We’d like to thank Dr. Gary Welch, owner of Spectrum Physical Therapy in East Patchogue, for contributing information that we’re sure our readers will want to know. As we get older, or due to injuries, physical therapy is often the way back to our normal lives.



Physical TherapyOsteoarthritis (OA) affects millions of people in the United States and can cause pain in every joint in the body, however the major joints affected the most are the hips, knees, and shoulders. When the joint loses cartilage, the underlying osteochondral bone can become exposed, thus reducing the slippery surface provided by the cartilage. The result is a bone on bone situation, which increases the friction at the joint.

The most predisposing factor for OA is age. The condition primarily affects the middle-aged to elderly population, most often over 60 years (J Orthop Sports Phys Ther 2009:39 (4) A1-A25).

When the joint becomes painful and/or swollen, the person tends to reduce demand on that joint by compensating their movement or not moving the joint at all. This causes several issues: decreased mobility of the joint, decreased synovial (lubricant) production, decreased strength and stability around the joint, and decreased flexibility of surrounding musculature, all from disuse of the joint. The compensatory movements will also cause pain in other extremities and joints.

Current treatment approaches include:

- Over the counter pain medications can be taken for OA pain as well as prescription strength NSAID’S (non-steroidal anti-inflammatory drugs).

- Physical Therapy to regain lost movement, flexibility, strength, endurance, and return to normal functions.

- Artificial synovial fluid (Synvisc or Arthrovisc) injections can be administered by an orthopedic doctor to provide the patient with lost lubricant in the joint, thus reducing friction from bone on bone contact.

- Surgical interventions include arthroscopy for mild to moderate OA, unilateral compartment Osteotomy (removal of sub-chondral bone), unilateral joint arthroplasty (joint replacement of one compartment), and total knee replacement of the entire joint (arthroplasty).



Medicare Cap Repealed

Medicare Cap RepealedAfter two decades of discussion and negotiations, the Medicare Cap on therapy was permanently repealed as part of the budget deal Congress and the President recently signed into law. The 2-year funding deal includes a full repeal of the Cap on Medicare outpatient physical therapy, occupational, and speech-language pathology services.

For 21 years the Therapy Cap threatened to undermine the health and quality of life of millions of Medicare beneficiaries. Physical therapy practitioners were faced with the possibility of denying services to those who needed them. “Millions of vulnerable patients who need occupational, physical and speech-language therapy will now be protected from an arbitrary limit on how much Medicare will pay for needed therapy,” said Nancy LeaMond, AARP’s executive vice president and chief advocacy and engagement officer.

The repeal came just as some beneficiaries were beginning to hit the $2,010 Therapy Cap for the year. Because of the Cap, more than a million beneficiaries would have been at risk of losing access to essential outpatient Medicare Part B therapy services.

Be sure to pass this on to family members and friends who are in need of Medicare services!

Dr. Gary Welch, owner of Spectrum Physical Therapy, Physical Therapist Practitioner of the Year, and Stony Brook Alumnus of the Year, is offering his staff’s services to members of the Bellport, Brookhaven Hamlet, and East Patchogue communities. Dr. Welch is one of only two physical therapists in New York State who is both a certified functional manual therapist and a certified orthopedic manual therapist. Click here for more information about Spectrum Physical Therapy.

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We recently received the following article from certified Kripalu Yoga Teacher, Nancy Norman, about some of the benefits of Yoga!

The Spirit Of Yoga
By Nancy Norman

The word “yoga” means to unite, to join, to bring together. Our word “yoke” comes from this Sanskrit origin. The practice of yoga is about bringing together the various parts of ourselves, enabling us to experience wholeness. When the body, the heart, the mind and the spirit are in alignment, we live more fully, as we experience a greater sense of balance and harmony in our daily lives.

Yoga on the BayWe live within a culture and within schedules that can be rather fragmenting. For many years, as an English teacher, I lived “from my neck up,” believing that the only important things in life happened in the mind. Practicing yoga re-introduced and re-united neglected parts of myself as I “re-membered.”

When we move our awareness into the body, we are moving into sacred space. We are honoring the body and the wisdom it has to offer us. Many religions, plus our Puritanical heritage, have taught us to deny the body, cutting us off from our physical roots and grounding, cutting us off from a whole realm of intelligence.

Kripalu scholar-in-residence, Stephen Cope, writes: “Yoga begins for us when we become ready to meet ourselves, to claim our lives in their potential fullness. Yoga begins for us when we set out on our own personal journeys of discovery. In the view of the [ancient] yogis, all of life is a journey back to the Source. A reunion with our true nature. A kind of Lewis and Clark expedition of the soul.

“. . . the nourishment human beings most need is simply to take this journey. What we most need in our lives is anything that wakes us up to who we really are. Anything that calls us home.”

I invite you to take this journey and give yourself the gift of yoga.

Nancy Norman holds several weekly yoga classes in Bellport Village. Click here for more information about Village Yoga.

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We recently received a very interesting article from Dr. Joseph Merckling of Merckling Family Chiropractic in Bellport Village about something that affects all of us: our posture!

What Is Correct Posture?
By Dr. Joseph Merckling

As children, we were always told to have good posture. Sayings such as “sit-up straight!”, “pull your shoulders back”, and the ever popular “don’t slouch” sound familiar to us all. Most people though don’t know what good posture is, or how to obtain correct posture. We recognize poor posture when we see it, as it is evident in many adults. Poor posture is usually the result of bad habits that have not been corrected and are carried out over years. So, what is a good posture?

Posture is defined as the position of the body in space. Normal posture is the ideal balanced position your body should assume to counteract the force of gravity whenever you stand, sit, walk, or sleep. Normal posture positions the body so that the least amount of stress and strain is placed on the supporting postural muscles and ligaments during movement and activities. Normally, we do not consciously maintain our posture. Postural control is a reflex that is built into our Central Nervous System (CNS). The CNS controls our posture by regulating muscle tone and joint alignment. Posture is the window to the spine and poor posture can indicate there is a problem with a person’s spine and/or nervous system.

PostureOptimal posture can be assessed using a variety of methods ranging from very simple to very complex. The simplest method is to observe your posture and examining it from the front, back and sides. When you look at a person from the front typically the eyes (or top of the ears), shoulders, hips, kneecaps, and ankles should all create straight lines parallel with the ground. In other words, there should be no offset or angles created by these lines when comparing left and right (see figure 1). Analyzing posture from the front, we also look for changes in the stance, i.e. the outward turning of one or both feet/arms. When viewed from the side, a straight line (plumb line) should intersect the body equally. From the side this line should pass through the center of the ear, center of the shoulder, center of the hips, and just in front of the ankle (see figure 1). This is considered textbook normal for correct spinal posture. However, if you look around, you will find that many people do not fit into the “normal posture” model.

PostureAbnormal or poor posture occurs when your body isn't receiving proper support in its struggle against gravity (see figure 2). As you can see in figure 2, a small imbalance in one area, be it head, shoulders, or hips can dramatically affect the other areas of the body. Faulty posture increases stress on the muscles, ligaments, and joints. This increased stress leads to muscle fatigue/overuse and joint wear (arthritis). Over time your body and brain may make some compromises on what's best for you by favoring short-term positions (slouching, adapting to avoid painful movements, etc.) that feel good, but can lead to increased postural problems later on. And the longer inappropriate postural positions are maintained, the more likely they are to become your standard way of sitting, standing, walking, or sleeping.

Several factors can also contribute to the poor posture seen in most people. Most commonly seen are stress, obesity, pregnancy, weak postural muscles, abnormally tight muscles, high heeled shoes, and backpack overuse. In addition, decreased flexibility, a poor work environment, incorrect working posture, incorrect lifting posture, and unhealthy sitting and standing habits can also contribute to poor body positioning.

Computerized Postural Evaluations have become the standard for non-bias Postural Examinations by physicians. These state-of-the-art computer programs evaluate posture by using digital photography and computer software to analyze subtle positional changes from side to side, and front to back. Doctors of Chiropractic are experts at analyzing posture and spinal problems. Analyzing spinal curvatures and alignment, the doctor searches for the problems that contribute to the postural pattern he or she observes. Then the doctor can create a plan to attack the postural problem, correct the joint and muscle imbalances, and break the bad postural habits.

2. ACAtoday, Talking to Patients: Correct Posture.
3. Murphy, Donald R., Conservative Management of Cervical Spine Syndromes. McGraw-Hill Pub. 2000.
4. VentruaDesigns Posture Pro V software package.

Dr. Merckling’s office is equipped with the Computerized Posture Pro Software mentioned in the article, which can help to diagnose and show you your postural faults. Click here for more information about Merckling Family Chiropractic.


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