Not All Exercise is Good Exercise

Exercise has been shown to have a huge list of benefits and little to no downside. It’s common to hear that if exercise was a medication, it would be the greatest wonder-drug ever created. But “exercise” is a broad term that covers a lot of specific movements and activities, not all of which are right for everybody. Getting a program specifically designed for you and your goals can be the difference between progress and frustration or injury. What goes into program design and where can you get a good one? Let’s take a look:

Exercise Selection

There are a lot of things to think about when choosing exercises. Machine vs. free weights, isolation vs. compound lifts, cardio vs. strength and more. Each one of these factors is important, so making the wrong choices could lead to wasting time working on the wrong things, limit your results or cause an injury.


Volume is a way of thinking about how much work you’re doing during a workout. Doing a few reps with a heavy weight or a lot of reps with a light weight could end up being the same volume. Same goes for running a shorter distance quickly uphill vs. a longer run at a slower pace on a flat trail. If your volume is too great you won’t recover well between workouts and create the possibility of injury. Too little volume and you won’t see results.


If you’ve been doing the same exercises with the same weight and the same number of reps and sets, you’re not progressing. Same goes if you jump on the treadmill for the same amount of time with the same settings. To make progress, things have to change. The program that works for your first 6 months won’t work for you 2 years down the road.

Designing an exercise program is a complex challenge with a lot of factors to consider. Most people have a history of injuries and don’t have perfect movement in every joint which further complicates things. If you’re not getting what you want out of your workouts or just want to make sure they’re as effective as they can be, have your physical therapist take a look at your program. Your PT can help design an individualized program to help you reach your goals while keeping you safe and injury free.

How Physical Therapy Helps People with Parkinson’s Disease

How Physical Therapy Helps People with Parkinson’s Disease 

Parkinson’s disease (PD) is a progressive neurological disorder that affects movement, balance, posture, and coordination. It can also cause non-motor symptoms such as pain, fatigue, mood changes and cognitive impairment. While there is no cure for PD, there are treatments that can help manage the symptoms and improve the quality of life of people living with PD.

Physical therapy is one of these treatments. PT can help restore or maintain physical function, mobility, and independence. Physical therapists are trained professionals who can assess, diagnose, and treat movement problems related to PD. They can also provide education, advice, and support to people with PD and their caregivers.

Benefits of Physical Therapy for People with PD

Physical therapy can help people with PD in many ways, such as:

Improving muscle strength and endurance. Both age and PD can weaken and decondition muscles. A physical therapist will prescribe exercises using light weights or resistance bands to improve strength. More strength helps with balance and mobility.

Enhancing amplitude of movement PD can cause people to reduce the size and speed of movements. This can affect walking, speech, facial expressions, and gestures. Physical therapy can help increase the amplitude of movement by teaching overexaggerated physical movements, such as high steps and arm swings. This is a way to retrain the muscles and brain to compensate for the reduced movement that Parkinson’s can cause. The LSVT BIG program is a specific set of exercises and activities that has been shown to improve mobility and quality of life.

Reinforcing reciprocal patterns. Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. PD can affect these patterns, which makes walking slow and unstable. Physical therapy can help to reinforce reciprocal patterns by using machines like a recumbent bicycle or elliptical machine. Practicing walking with arm swings is another activity that can help restore reciprocal movements. This can improve coordination, rhythm, and fluidity of movement for people with Parkinson’s. Dance and tai chi are other activities that involve reciprocal patterns.

Improving balance and posture. PD commonly impairs balance. Your brain uses a complex mix of what you see, your inner ear and sensations from your feet and joints to maintain balance. Physical therapy can help to improve balance using exercises that challenge stability, such as standing on one leg or walking on uneven surfaces. PT will also focus on specific components of the balance system by doing things like having a person close their eyes to focus on the sensations from the feet and joints. Physical therapy can also improve posture by correcting any muscle tightness or weakness that may cause stooping or learning sideways.

Increasing flexibility and range of motion. PD also often causes muscle stiffness and rigidity. Physical therapy can help increase flexibility and range of motion with stretching exercises that target specific muscles. Common areas of issue are the hip flexors, hamstrings, and calves. Stretching regularly can also help to reduce pain and spasm.

Providing education and self-management advice. Physical therapy can help people learn more about PD and how it affects their movement. A physical therapist can provide tips on how to maintain safety when exercising, how to cope with fatigue or pain, how to use assistive devices if needed, and how to prevent or manage complications such as falls or freezing.

Sounds Great. Is There Proof?

Yes. Research backs up all these claims. One meta-study (a study that combines the results of many other studies) that covered 1827 participants found that when compared to no intervention, PT significantly improved:

  • gait speed
  • two- and six-minute walk test scores
  • Freezing of Gait questionnaire
  • the Timed Up & Go test
  • Functional Reach Test and the Berg Balance Scale

These results indicate improvements in mobility, endurance, strength, and balance. Gait speed is an especially important measurement. Physical therapists often consider gait speed a “vital sign.” This is because low gait speed has been linked to:

  • declines in functional mobility
  • higher rates of hospitalization
  • higher fall rates
  • cognitive decline
  • increased disability,
  • and higher risk of death

A larger meta study that included 191 studies with 7998 participants found that PT significantly improved motor symptoms, gait, and quality of life. Specifically:

  • Resistance and treadmill training improved gait.
  • Strategy training improved balance and gait.
  • Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.


Physical therapy is a valuable treatment option for people with PD, as it can help to improve or maintain their physical function, mobility, and independence. Physical therapy can also enhance their quality of life, confidence, and well-being. If you have PD or know someone who does, consult with our physical therapist’s who specializes in PD to see how they can help you.



(1) Physical Therapy for Parkinson’s Disease – Johns Hopkins Medicine.

(2) Physical Therapy and PD | Parkinson’s Foundation.

(3) Physical and Occupational Therapy for Parkinson’s: What to Expect.

(4) Parkinson’s Disease Treatment Physical Therapy.

(5) Physical, Occupational & Speech Therapies | Parkinson’s Foundation.

(6) Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities –

(7) Physiotherapy versus placebo or no intervention in Parkinson’s disease –

Going For Short Walks Can Improve Blood Sugar & Blood Pressure

Physical activity is essential for maintaining optimal overall health and exercising regularly is known to reduce the risk for heart disease, diabetes, depression, some cancers, and numerous other health–related issues. Yet despite this, it’s estimated that over three million people worldwide die prematurely each year because they are not getting enough physical activity.

One important factor that contributes to this issue is that many individuals spend a large portion of their days sitting, which is called a sedentary lifestyle. Following a sedentary lifestyle and sitting for too much time each day is now recognized as a dangerous habit that can lead to a variety of health problems, including obesity, heart disease, diabetes, and cancer. Evidence even suggests that individuals who are physically active and meet the recommended guidelines for activity are still at risk for certain health complications if they spend too much time sitting.

Researchers conduct a study to examine the effects of occasional breaks from sitting

Physical activity guidelines typically make general recommendations for individuals to reduce their sedentary time, but they have not yet provided specific guidance on how often and how long sedentary time should be interrupted. With this in mind, a study was conducted to investigate whether taking occasional breaks from sitting had an effect on heart– and metabolism–related risk factors, and if so, how these effects changed with varying frequencies and durations.

Researchers selected 11 middle– and older–aged adults to participate in the study and instructed them to complete each of the following 8–hour conditions on 5 separate days:

  •  One uninterrupted sedentary condition (control intervention)
  • Four acute trials that involved different frequency/duration combinations of sedentary breaks, which involved light–intensity walking (experimental intervention):
      • Sedentary breaks every 30 minutes for 1 minute each
      • Sedentary breaks every 30 minutes for 5 minutes each
      • Sedentary breaks every 60 minutes for 1 minute each
      • Sedentary breaks every 60 minutes for 5 minutes each

After each patient completed one intervention, they switched and completed the other intervention. Glucose levels were measured every 15 minutes and systolic blood pressure was measured every 60 minutes during these interventions.

Results showed that all intervals of sedentary breaks led to significant decreases in systolic blood pressure. The largest reductions in systolic blood pressure occurred in the group that took sedentary breaks every 60 minutes for 1 minute and every 30 minutes for 5 minutes. Similarly, glucose measurements also decreased after sedentary breaks, but the only significant reduction occurred when participants took breaks every 30 minutes for 5 minutes.

This study shows that taking sedentary breaks for different intervals is effective for reducing systolic blood pressure and glucose levels. Higher frequency and longer duration breaks (every 30 minutes for 5 minutes) appears to be most effective for targeting glycemic response, while shorter breaks may be sufficient for lowering blood pressure.

Therefore, if you currently spend most time of the day sitting, it appears that simply getting up for short, light–intensity walking breaks could counteract some of the negative effects of sedentary behavior by improving your glycemic control and blood pressure. But there’s a rule of thumb that also applies here: some is better than none, and more is better than less.

So if you’re interested in becoming more physically active but feel that you can use a boost, a physical therapist can help you get there by designing a personalized exercise program based on your body type, abilities, and goals.


this piece also appeared in our news page:

Perspective: Breaking Through Four Barriers to Better Addressing Men’s Pelvic Health Needs

It is rare for a group of men to sit around a table together and openly discuss problems with their pelvic floor function. Sadly, it is just as rare for that conversation to happen in a medical setting, not to mention a physical therapy setting.

It turns out, dysfunction of the pelvic floor in men is a lot more common than we once understood. But too many men aren’t seeking treatment for a variety of reasons, and that’s a problem. Here are four of the main reasons.

Taboo. Culturally there are taboos around discussing the male pelvic floor. While this is changing, we find that many men are afraid to even discuss their symptoms with their medical providers in the worry that those discussions will be labeled as inappropriate.

Sensitivity. These are delicate topics and deeply meaningful systems for men. Many don’t want to admit things aren’t going right “down there.” Pelvic floor function is often correlated to male status and functionality. Admitting imperfection can feel incredibly vulnerable.

Misdiagnosis. Many men are being misdiagnosed and not getting the relief they need. Pelvic floor dysfunction in men mimics other medical conditions, which can understandably confound the treatment. But when that treatment is not successful, we find that many of our patients feel dismissed as a “hopeless case” or are felt to believe the condition is all in their heads. These failed attempts naturally increase anxiety about the symptoms in many, worsening the problems even further.

Access. Across the country men are finding it challenging to connect with providers trained and able to treat them. Many men find clinics that treat women but do not employ providers comfortable or trained to treat men.

More male patients have pelvic health conditions but won’t tell — and they won’t unless asked. “Do you experience any urinary urgency or dribbling?”  Starting a conversation with a question can open the door to discuss concerns that they might not mention otherwise and allow them the help some men need.

Could you benefit from Pelvic Floor PT? Challenge yourself to set aside your own potentional discomfort and find out.


This piece originally appeared in APTA American Physical Therapy Association

Perspective Authors: Jake Bartholomy, PT, DPT, Grant Headley, PT, DPT, Daniel J. Kirages, PT, DPT, and Chad Woodard, PT, DPT



The Benefits of Physical Therapy After Stroke

Stroke is a serious medical condition that occurs when the blood supply to a part of the brain is interrupted, causing brain cells to die. Stroke can cause a variety of symptoms like weakness, paralysis, speech difficulties, memory loss, cognitive problems and emotional changes.

Physical therapy is an important part of recovery from a stroke that aims to help stroke survivors regain their functional mobility and independence. PT helps stroke survivors stimulate damaged nerves and muscles, promote circulation to affected areas of the brain to promote healing, learn to move and use their affected body parts as much as possible, regain mobility and strength, as well as to prevent or reduce complications such as muscle stiffness, spasticity, pain and falls.


Physical therapy usually begins as soon as possible after the stroke, ideally within two days. The duration and intensity of PT depend on the severity and type of stroke, the medical status of the patient, as well as the individual’s goals and needs.

Stroke recovery doesn’t just involve a physical therapist, though. It takes a team of professionals, including a physiatrist (a doctor who specializes in rehabilitation), a neurologist (a doctor who specializes in brain and nervous system disorders), nurses, an occupational therapist, a speech-language pathologist, a dietician, a social worker, a neuropsychologist and a case manager.

The physical therapist will assess strength, balance, coordination, range of motion, sensation, pain and functional abilities. Based on the assessment and the individual’s goals, the physical therapist will design a personalized treatment plan that may include interventions like:

Exercises to improve muscle strength, endurance, and flexibility

Activities to improve balance, posture, gait and mobility

Training to use assistive devices such as walkers, canes or wheelchairs

Education on how to prevent falls and injuries

Manual therapy to relieve pain and spasm

Electrical stimulation to activate muscles and nerves

Biofeedback to enhance awareness and control of muscle activity

Hydrotherapy to use water resistance and buoyancy for exercise

Constraint-induced movement therapy to encourage use of the affected limb by restricting the unaffected one

Mirror therapy to use visual feedback to stimulate movement of the affected limb

Physical therapy after stroke can take place in different settings. It usually starts in a hospital. The survivor may then move thought a subacute care unit and/or an inpatient rehabilitation unit before being discharged home. The person will then usually receive home health therapy or continue treatment in an outpatient clinic depending on their level of function and needs. The physical therapist will work closely with the stroke survivor and their family to determine the best path for their rehabilitation, and to ensure continuity of care.


Physical therapy has lots of benefits for stroke survivors, such as:

Improving functional mobility and independence

Enhancing quality of life and well-being

Reducing disability and dependence on others

Increasing self-confidence and motivation

Preventing or minimizing complications such as contractures, pressure sores or infections

Reducing the risk of recurrent stroke or other cardiovascular events

Physical therapy after stroke can also have positive effects on the brain itself. Research has shown that physical activity can stimulate the growth of new brain cells, formation of new connections between brain cells and growth of new blood vessels in the brain. These processes can help with healing and recovery after stroke.

Physical therapy after stroke is not a one-size-fits-all approach. It requires individualized assessment, planning and evaluation. It also requires active participation and collaboration from the stroke survivor, their family and their caregivers. Stroke recover is a long-term process that requires patience, perseverance and dedication.

However, physical therapy can be rewarding and empowering for stroke survivors. It can help them regain their functional mobility and independence, improve their quality of life and well-being, prevent or reduce complications and make the most of their recovery.


Rehab Therapy After a Stroke | American Stroke Association.

Physiotherapy after stroke | Stroke Association.

Stroke rehabilitation: What to expect as you recover.

A Simplified Guide To Physical Therapy For Stroke Patients – Saebo.

Home-Care Physical Therapy for Stroke – Verywell Health.

PT working gait after stroke |

PT working gait with cognitive impairment |

Physical Fitness for Stroke Patients |

Physical rehab for stroke patients in low income countries |

Evidence in PT poststroke |

Encompass Health Stroke Rehab |

Physiopedia – Stroke Rehab |

APTA – PT Guide for Strokes |

5 Ways to Prepare Your Body for Pregnancy

Is your body ready to carry a baby? You can ensure it is by addressing any pain, posture, or muscle weakness before getting pregnant. Here are five tips to help prepare your body and guard against pain and other problems during and after pregnancy.

1. Make sure your pelvic floor muscles can contract, relax, and stretch properly.

Many women may be doing Kegels incorrectly. It is helpful to see a physical therapist for an assessment. Some people cannot do proper contractions because their muscles are too tight, and they need to relax them before strengthening them.

During birth, the pelvic floor muscles need to be able to relax and stretch. This allows your baby to pass through the vaginal canal. Being able to stretch these muscles without bearing down is just as important as strengthening them.

Consult a physical therapist before beginning any exercise program during or after pregnancy. A physical therapist specializing in women’s health physical therapy or the pelvic floor can teach you how to do these exercises safely and correctly.

2. Prepare for “baby belly” by focusing on your core.

As your belly grows, the muscles that run vertically along either side of the belly button stretch. Sometimes these muscles stretch too much and separate, which is called diastasis recti.

The right core exercises can help prevent or improve a wide variety of issues, including conditions such as:

A physical therapist can design the right exercise strategy for you to build a strong core. Every person is different in their abilities and strength. Your physical therapist will tailor a program to your needs.

3. Take a breath!

A physical therapist can help you learn proper breathing and relaxation techniques. Proper breathing will help prepare your body and mind for a healthy pregnancy, birth, and recovery. It is important to learn how to breathe during exercise and movement patterns. With proper breathing, your core and pelvic floor muscles will contract naturally to help give you the most stability and protection from injury.

4. Begin a regular fitness routine.

The Journal of the American Medical Association reports that around 45% of women begin pregnancy overweight or obese. Regular physical activity aids in weight management. It also can benefit your physical, mental, and social health and prevent or improve many chronic conditions, such as:

Mild to moderate physical activity, such as brisk walking, lowers your risk for bladder leakage (incontinence). Exercise also helps to reduce the amount of cortisol (stress hormone) in your body. It also boosts muscle and heart (cardiovascular) strength.

You will need to be strong for pregnancy and after giving birth (postpartum), as your body goes through some amazing changes. Consider doing low-impact activities before and during pregnancy, such as:

  • Swimming.
  • Walking.
  • Biking.

All pregnant women, including athletes, should be aware that hormones during pregnancy and postpartum can change the amount of laxity (looseness) in muscles and ligaments. When the muscles and ligaments that support your pelvic organs loosen to accommodate a growing baby, it changes how your body handles weight-bearing activities. In some cases, laxity may make you more prone to injuries.

Some people develop pelvic organ prolapse due to repeated stress on the ligaments of the reproductive organs. A physical therapist can recommend ways to help you continue exercising and prevent further laxity or injury.

Pregnant and postpartum women should do at least 150 minutes per week (30 minutes per day) of moderate-intensity aerobic physical activity (as long as they have clearance from their physical therapist and/or physician). It is best to spread aerobic activity throughout the week.

5. Prepare for body changes.

Your posture and how your body disperses your weight will change throughout your pregnancy. Also, changes in hormones, posture, and your ability to move during pregnancy can significantly affect every part of your body. Sometimes these changes can lead to pain.

A physical therapist can evaluate your posture and strength and suggest exercises that are best for you. They can educate you on lifestyle changes to improve your posture and strength. Examples include:

  • Showing you a better way to carry groceries.
  • Educating you to limit how much time you stand or sit in one position for long periods.
  • Possible recommendations to use a support belt if you have discomfort.

Laying the groundwork for healthy habits — prebaby — will prepare your body for the strength you need for pregnancy and after your baby is born. It also increases your chance of having a smoother pregnancy.

Physical therapists are movement experts who use the best available evidence to design treatment plans for each person’s needs and goals. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact Carousel PT directly for an evaluation.




Movement is Medicine: Physical Therapy & Arthritis

In addition to Women’s Health month, May is also national arthritis month. Arthritis may seem relatively benign – everyone knows someone who has arthritis. But here are some numbers that help put the problem of arthritis into perspective:

  • Arthritis is the leading cause of disability.
  • Arthritis affects 1 in 5 adults and 300,000 children
  • 1/3 of working-age people with arthritis have some kind of limitation in their ability to work
  • Arthritis costs $156 billion each year in medical expenses and lost wages
  • Nearly 1 million hospitalizations happen each year due to arthritis

It’s a serious condition, and a serious problem. The good news is that physical therapy is one of the most effective treatments for arthritis.

The Benefits of Physical Therapy for Managing Arthritis Symptoms

Arthritis comes in 2 forms: osteoarthritis and rheumatoid arthritis. Osteoarthritis occurs because of wear and tear on the joints over time. Rheumatoid arthritis is an inflammatory, autoimmune disease. It occurs because of the immune system attacking the joint lining. Physical therapy can reduce joint pain, improve mobility, and help to prevent further damage to the joints. Using individualized exercises, physical therapists help people manage their condition and reduce discomfort. Physical therapists often combine advice on lifestyle modifications with exercise to maximize improvement. Let’s look at the types of exercise that can help manage arthritis symptoms next.


These gently move affected joints through their entire range of motion. This can help reduce stiffness and improve mobility. Examples would include things like gentle stretching, tai chi, or gentle yoga.


Aerobic exercise creates repeated motion, moving the synovial fluid in the joints. It also increases blood flow and releases endorphins which reduce pain. Aerobic exercise also helps to control weight. Weight loss is proven to reduce the stress on your joints, which can reduce pain. Aerobic exercise for people with arthritis should be low impact. This would include things like walking, cycling, or swimming.


Strength training is an important part of managing arthritis. It decreases pain, improves strength, and function. Stronger muscles around the affected joints provide better support and protection.


Exercising in a therapeutic pool can be a great way for people with arthritis to get started. The buoyancy of the water helps to relieve some of the body’s pressure on the joints. The water pressure also provides compression on the joints. This offers some stability and pain relief. The movement of your body through the water creates resistance for your muscles. This allows them to get stronger in a protective environment.


Besides designing a custom exercise program, a physical therapist will educate people with arthritis on lifestyle modifications to help mange their symptomsSome suggestions might include weight loss, getting enough sleep, eating a healthy diet, and managing stress. A PT can also modify daily activities to help protect joints affected by arthritis. This can slow down or prevent progression of symptoms.

Physical therapy is a safe and effective treatment for arthritis. Current clinical guidelines for treating arthritis include strong recommendations for exercise and other physical therapy treatments. If you’re one of the 53 million Americans with arthritis, give us a call. We are a great provider to help you reduce pain, manage your symptoms, and move better.




  1. Research (peer-reviewed)
    1. Knee osteoarthritis: key treatments and implications for physical therapy-
    2. Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation –
    3. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice –
  2. Articles and Content
    1. May Is National Arthritis Awareness Month – News
    2. Benefits of Exercise for Osteoarthritis | Arthritis FoundationHow Can Physical Therapy Help to Avoid Surgery? – Tucson Orthopaedic Institute

As Pandemic Emergencies End, People Battling Long Covid Feel ‘Swept Under the Rug’

Lost careers. Broken marriages. Dismissed and disbelieved by family and friends.

These are some of the emotional and financial struggles long covid patients face years after their infection. Physically, they are debilitated and in pain: unable to walk up the stairs, focus on a project, or hold down a job. Facing the end of the federal public health emergency in May, many people experiencing lingering effects of the virus say they feel angry and abandoned by policymakers eager to move on.

“Patients are losing hope,” said Shelby Hedgecock, a self-described long covid survivor from Knoxville, Tennessee, who now advocates for patients like herself. “We feel swept under the rug.”

The Centers for Disease Control and Prevention estimated in March that 6% of U.S. adults, or about 16 million, were experiencing long covid, or ongoing health problems that continue or emerge after a bout of covid-19. Researchers estimate that 1.6% of U.S. adults, or about 4 million, have symptoms that have significantly reduced their ability to carry out day-to-day activities.

While patients are no longer contagious, their health issues can stretch on and affect almost every system in the body. More than 200 symptoms and conditions, including fatigue and depression, are linked to long covid, said Linda Geng, a physician who treats patients at Stanford Medicine’s Post-Acute COVID-19 Syndrome Clinic.

The severity and duration of long covid vary. Some people recover in a few weeks, while a smaller number have debilitating and lingering health issues. There is currently no test, treatment, or cure. There’s not even an accepted medical definition.

“When you don’t have any tests that show that anything’s abnormal, it can be quite invalidating and anxiety-provoking,” Geng said.

The physical and emotional toll has left some feeling hopeless. A 2022 study of adults in Japan and Sweden found that those with post-covid conditions were more than twice as likely to develop mental health issues, including depression, anxiety, and post-traumatic stress, as people without them.

“One of my friends committed suicide in May of 2021,” Hedgecock said. “She had a mild covid infection, and she progressively had medical complications continuously pop up, and it just got so bad that she decided to end her life.”

In Los Angeles County, 46% of adults who contracted covid were fully recovered a month later, but the rest — a majority — reported one or more continuing symptoms, according to a 675-patient study by the University of Southern California’s COVID-19 Pandemic Research Center. The researchers found chronic fatigue topped the list of health issues, followed by brain fog and persistent cough, all of which affect people’s daily lives.

Among the respondents who identified as living with long covid, 77% said their condition limited daily activities such as going to school or work or socializing. One-quarter reported experiencing severe limitations.

Taking antivirals cuts the risk of developing long covid in people who are newly infected. But for people already suffering, medical science is trying to catch up.

Here’s a look at Hedgecock and two other patients who have had long covid for years.

A Debilitating Brain Injury

Before contracting covid during spring 2020, Hedgecock’s life revolved around fitness. She worked as a personal trainer in Los Angeles and competed in endurance competitions on the weekends. At 29, she was about to launch an online wellness business, then she started having trouble breathing.

“One of the scariest things that happened to me was I couldn’t breathe at night,” Hedgecock said. “I did go to the emergency room on three different occasions, and each time I was told, ‘You’re up and you’re moving. You’re young; you’re healthy. It’s going to be fine.’”

Her primary care physician at the time told her she didn’t need supplemental oxygen even though her oxygen saturation dipped below normal at night, leaving her gasping for breath and crying in frustration.

Her condition kept her from one of her favorite hobbies, reading, for 19 months.

“I couldn’t look at a page and tell you what it said. It was like there was a disconnect between the words and my brain,” she said. “It was the strangest, most discouraging thing ever.”

Months later, under the direction of a specialist, Hedgecock underwent a test measuring electrical activity in the brain. It revealed her brain had been starved of oxygen for months, damaging the section controlling memory and language.

Since then, she has moved back to Tennessee to be close to family. She doesn’t leave her apartment without a medical alert button that can instantly call an ambulance. She works with a team of specialists, and she feels lucky; she knows people in online long covid groups who are losing health coverage as Medicaid pandemic protections expire, while others remain unable to work.

“A lot of them have lost their life savings. Some are experiencing homelessness,” she said.

In Bed for a Year

Julia Landis led a fulfilling life as a therapist before she contracted covid in spring 2020.

“I was really able to help people and it was great work and I loved my life, and I’ve lost it,” said the 56-year-old, who lives with her husband and dog in Ukiah, California.

In 2020, Landis was living in an apartment in Phoenix and received treatment via telehealth for her covid-related bronchitis. What started out as a mild case of covid spiraled into severe depression.

“I just stayed in bed for about a year,” she said.

Her depression has continued, along with debilitating pain and anxiety. To make up for her lost income, Landis’ husband works longer hours, which in turn exacerbates her loneliness.

“It would be nice to be living somewhere where there were people around seven days a week so I wouldn’t have to go through days of being just terrified to be alone all day,” Landis said. “If this were cancer, I’d be living with family. I’m sure of it.”

Landis refers to herself as a professional patient, filling her days with physical therapy and medical appointments. She’s gradually improving and can socialize on occasion, though it leaves her exhausted and can take days to recover.

“It’s terrifying because there’s just no way of knowing if this is going to be for the rest of my existence,” she said.

‘I Felt Betrayed’

Linda Rosenthal, a 65-year-old retired high school paraprofessional, has long covid symptoms, including inflammation in her chest that makes breathing difficult. She has found it hard to get medical care.

She called and set up a treatment plan with a local cardiologist near her home in Orange County, California, but received a letter five days later telling her he would no longer be able to provide her medical services. The letter gave no reason for the cancellation.

“I was so surprised,” she said. “And then I felt betrayed because it is terrible to get a letter where a doctor, although within their rights, says that they don’t want you for a patient anymore, because it causes self-doubt.”

Rosenthal found another cardiologist willing to do telehealth visits and who has staff wear masks in the office even though the state rule has expired. The practice, however, is more than an hour’s drive from where she lives.


This piece originally appeared in St. Louis Post-Dispatch.

Physical Therapies for Parkinson’s Disease-An Exerpt

This piece originally appeared in Parkinsons’s
When you live with Parkinson’s disease (PD), symptoms can change as the disease progresses. Allied health professionals are medical experts from a variety of fields who can help manage your symptoms at every stage. Having an allied healthcare team is critical to living well with Parkinson’s, as they can help guide exercisenutrition and medications. Rehabilitation is defined as a set of treatments and therapies that can help people with Parkinson’s maintain or improve activities for daily living and independence. Rehabilitation professionals include physical and occupational therapists and speech-language pathologists skilled in PD who can keep you moving well, engaging in activities you love and communicating with the people in your life.

Rehabilitation & Parkinson’s

Research shows that rehabilitation can play a crucial role in prevention of injuries and help enhance quality of life. Most often, people with Parkinson’s are only referred to rehabilitation services when recovering from an injury, such as a fall. However, it is recommended that people with PD should begin rehabilitation at diagnosis and consistently every six to 12 months.

Rehabilitation therapies and exercise can:

  • Slow disease progression
  • Address movement symptoms
  • Improve daily functioning
  • Enhance mood and mental health

Despite mounting evidence, only 14% of people living with PD use speech, occupational or physical therapy as part of a treatment plan. Some medical centers and doctors’ offices incorporate rehabilitation and exercise into care regimens, but many do not.

Building Your Rehabilitation Team

Rehabilitation professionals are medical experts who can help manage your symptoms at every stage and maximize your quality of life. Those skilled in PD can keep you moving well, engaging in activities you love, and communicating with the people in your life. Rehabilitation specialists include:

  • Physical Therapists help people with PD keep moving well, as long as possible, while enhancing the ability to move. Research shows that physical therapy — including gait and balance training, resistance training and regular exercise — may help improve or hold PD symptoms at bay.
  • Occupational Therapists help people with PD continue pursuing the activities that make life meaningful and focuses on remaining independent — whether in work, hobbies, social life or in daily activities.
  • Speech Language Pathologists evaluate speech, voice, communication, swallowing and memory/thinking function. They establish a treatment plan that is consistent with personal goals, such as improving specific communication skills, swallow function and thinking skills.

Physical Therapy

Why Physical Therapy:

A physical therapist is uniquely trained to design an exercise routine that targets specific motor impairments. Physical therapists also have an opportunity to provide frequent, direct feedback to help make you aware of how to exercise most effectively and safely.

A physical therapist can provide:

  • Education and self-management advice.
  • Exercise routines that have been associated with improvements (or slower declines) in mobility, quality of life and disease severity.
  • Answers to questions about the type, intensity, frequency or duration of exercise that is best for you.
  • Ways to maintain safety when exercising.
  • Help with:
    • Normal physical activity routine
    • Walking (slowness, small steps)
    • Freezing of gait (feeling glued to the floor or difficulty getting started)
    • Balance or stability
    • Posture
    • Pain
    • Moving around the house (getting up from a chair, moving around in bed)
    • Getting around (in/out of a car or bus, elevators, stairs and uneven ground)
  • Address fear of falling, fall prevention or worries about your safety.
  • Other health problems that affect mobility, including joint or muscle pain from arthritis, problems with endurance due to a heart or lung condition or a broken bone or surgery.

When To Find a Physical Therapist:

Physical therapists can be helpful at all stages of PD. Movement impairments in the early stages of the disease may not be obvious. By engaging a physical therapist with neurological specialization as part of their medical team, people with Parkinson’s disease can address bothersome symptoms and learn ways to prevent falls before they happen. Talk to your doctor about getting a baseline physical therapy evaluation and then continue with periodic re-evaluations.

According to the Parkinson’s Outcomes Project, the largest clinical study of Parkinson’s disease through our Global Care Networkincreasing physical activity to at least 2.5 hours a week can slow decline in quality of life. The Parkinson’s Foundation has identified specific care approaches associated with better outcomes across people who seek expert care at our designated Centers of Excellence. Among others, best practices include early referral to physical therapy and encouragement of exercise as part of treatment.

Setting Movement Goals with your Therapist:

Each individual works with their physical therapist to set personalized movement goals. Physical therapists can help you optimize your exercise routine based on the latest research, re-learn challenging tasks or stay safe and independent in the home.

Some of the most common movement goals for people with Parkinson’s include:

  • Learning about exercises
  • Improving walking, balance or posture
  • Addressing fall risk
  • Treating pain

Before your first visit, think about your movement goals and write down your problems and questions. This will help you organize your thoughts. You can do this for future visits, too.

Finding Expert PD Physical Therapy

It is important to find a physical therapist who has specialty training and experience working with PD, like LSVTBig. You may find experienced physical therapists working in hospital outpatient departments, home health agencies, nursing homes or within the community close to your home. Ask your neurologist for a referral at your next appointment.

Training Future Physical Therapists in Parkinson’s

Did you know the Parkinson’s Foundation is working to better educate physical therapy students across the country to ensure better PD care for everyone?

The Parkinson’s Foundation Physical Therapy Faculty Program is improving Parkinson’s physical therapy care by training faculty leaders across the U.S. so they can, in turn, educate physical therapy students. The intensive course allows physical therapy educators to immerse themselves in learning the latest evidence-based findings in Parkinson’s research and care. Physical therapy educators can make a great impact on the lives of people with PD by bringing this knowledge back to their students, our future practitioners.

For more information on other therapies for Parkinson’s, please click below.


this excerpt originally appeared in

Parkinson’s Disease: Activities of Daily Living

Advanced Parkinson’s disease (PD) often complicates the daily activities a person with living with Parkinson’s. Below we highlight how care partners can help their loved ones adjust to these changes.

Standing and Sitting

When at home, make sure your loved one uses a chair with sturdy arm rests and a stable base. Avoid soft, low seating or upholstery such as velour or velvet, which can make it more difficult to move.

Tips for helping your loved one safely sit and stand:

  • Remind them to scoot their hips forward to the edge of the chair when attempting to get up.
  • Check that your loved one’s feet are placed firmly underneath before standing. You may need to help with proper foot placement.
  • Use cues like “nose over toes” to provide a goal for leaning forward and transitioning to a standing position.
  • Avoid pulling arms or legs when helping them stand.
  • Use chairs with arm rests. Ask them to put both hands on the arm rests and lean forward before sitting. The backs of both legs need to be against the seat before attempting to sit. This helps maintain smooth, controlled motion and avoids “crash landings,” which can be dangerous.
  • Use a transfer belt to lift your loved one if your loved one cannot get up independently. This often makes aiding safer (for both of you) and easier. These belts can be purchased at a medical equipment store.
  • Remind your loved one to continue to use their walker when turning to sit down.


Walking changes are common in Parkinson’s and can become more difficult to manage as PD progresses. Tips for helping your loved one to walk safely:

  • Avoid distractions when walking. Attempts to do more than one thing at the same time make walking and balance more difficult.
  • Remind them to take big steps. People with PD often need reminders, or “cues,” to take long steps as automatic motions become more difficult to perform. Keep cues short and simple, for example, “Big steps.” People with Parkinson’s often take smaller steps, which are more unstable than bigger steps.
  • Watch out for pets in the home. Pets provide physical and mental benefits, but they can also be a tripping hazard. Work with your pets so that they learn not to spend too much time “underfoot.”


  • People with Parkinson’s sometimes experience “freezing” episodes (feeling like your feet are glued to floor). Freezing is a significant cause of falls, so it is important that you understand what is happening and what you can do to support your loved one.
  • Avoid tight turns when possible. Instruct your loved one to make wider turns as freezing often happens while turning around in close quarters.
  • Count aloud or clap a rhythmic beat can sometimes help, some care partners will even put on music that is in the style of a “march” when their loved one is frozen.
  • Try a visual cue. Some people respond better with a visual cue, such as asking them to step over your foot.

Helping Your Loved One Up from a Fall

Even with safety precautions in place, sometimes falls occur. It is important to have a back-up plan before a fall happens.

Mealtime and Swallowing

Advanced Parkinson’s frequently causes difficulty with eating and drinking because of movement and swallowing problems. Making some adjustments to mealtime can help your loved one eat and get the nutrition they need.


Advancing Parkinson’s can make getting dressed a more challenging activity, where care partners often need to help. Changes to clothing and the dressing routine can improve safety and reduce frustration.

Dressing tips for care partners:

  • Ensure adequate time for dressing. Stress can make PD symptoms worse, so your loved one may not be able to help as much if you are rushing.
  • Dress at the right time. Consider waiting to dress until your loved one’s PD medications are working and they are more mobile.
  • Be prepared. Gather all necessary clothing items before beginning to dress to eliminate multiple trips to the closet or dresser.
  • Choose the right clothes. Opt for clothes that is soft and stretchy with an elastic waistband, front openings and bras that hook in the front. Tube socks may be easier to put on than dress socks. Explore more clothing tips.
  • Offer choices. Giving your loved one a voice in a process that may make them feel discouraged can make a big difference. For example, ask them to choose between a red or blue shirt.
  • Encourage participation in physical movement. Allow your loved one to be involved in the dressing process as much as possible. Find ways to encourage extra arm or leg movement for your loved one during dressing to keep muscles flexible. This also builds range of motion and flexibility exercise into the daily routine.
  • Stay safe while dressing. When possible, ask your loved one stay seated or lying down while putting on pants, socks and shoes. This will help reduce loss of balance and falls, and help you reduce back strain.

Safety in the Bathroom

Bathing, using the toilet, personal hygiene and grooming are basic activities of daily living that advanced Parkinson’s can make more challenging. The following tips will help make these activities easier, and safer, for you and your loved one.

Safety in the Bedroom

Parkinson’s can create many challenges to getting a good night’s rest, both for you and your loved one. If your loved one is not sleeping well, it is highly likely that your sleep will be disrupted as well.

Travel and Transportation

Leaving the home for appointments, family events or other activities can be difficult for a person with advanced Parkinson’s. These outings are often necessary, and can add to quality of life, so it is important to consider methods that promote safety and decrease care partner stress.

Medication Management

Getting medication on time is key to managing Parkinson’s at any stage, but especially in advanced Parkinson’s. PD medications are scheduled at a particular time of day to try to avoid a “wearing-off” effect before the next dose.

Some PD medications, like carbidopa/levodopa (Sinemet), only last for three to five hours (or less), and then symptoms usually return, making it harder to move. Help your loved one stick to medication timing by keeping everything organized.

  • Keep an updated list (name, dose, frequency and purpose of the medication). Download our Medication Form and share it with your doctors.
  • Set up medications in a weekly pill box with a secure lid.
  • If taking medication four times a day or less, you can purchase a weekly pill box with four compartments per day. Try to find one with a removable strip for each day, so the day’s medications can be easily carried with you when you leave home.
  • If dosing is more than four times daily, consider purchasing seven weekly pill boxes, using one box for each day. Tape over the days of the week and write down medication dose times.
  • Place all medications into pill boxes, including over-the-counter medications.
  • Some pharmacies can package medications and will send them to your home on a monthly basis. All medications are organized into individual packets labeled with medication day, date and time to be taken. Check with your pharmacy to see if they provide this service.
  • Store all medication bottles and pill boxes in a secure place where they will not be mistaken for food.
  • Set a reminder for pill times. A smart phone works well and is easily programmable. When the alarm rings, provide the medication right away.
  • When away from home, carry your loved one’s daily pills with you. A long wait at an appointment, heavy traffic or other delay could mean that the next dose is needed before you get home.
  • If you loved one takes an MAO-B inhibitor (rasagiline, selegiline), talk to the PD doctor before adding new prescriptions or over-the-counter medications. Some over-the-counter medications may not be safe. Ask the doctor about cold medications.

Skin Care

An often-overlooked symptom of Parkinson’s is the effect on skin. People with PD have an increased risk of developing melanoma, a type of skin cancer linked to sun exposure. The person with Parkinson’s may also have more difficulty changing position, which can result in skin breakdown.

  • Avoid hot, mid-day sun and seek shade when outside. Be sure to apply sunscreen and a sunhat.
  • Help your loved one change position every two hours. If your loved one is in a wheelchair, get a cushion to lessen the risk of pressure sores. See an occupational or rehab therapist to make sure the right cushions are used.
  • Check skin regularly for redness, blisters and/or open sores. Report any changes promptly to their doctor.
  • Avoid skin contact with plastic coating and tapes from incontinence products; these can irritate the skin.
  • Use lotion to prevent dryness.
  • Consider an eggcrate or alternating pressure mattress pad to reduce pressure points.

Physical Therapy

People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.

LSVT BIG trains people with Parkinson disease (PD) to use their body more normally. So, conisder this 4 week program because LSVT BIG trains people with Parkinson disease (PD) at any stage to use their body more normally.


This piece originally appeard in the Parkinson’ blogs

Physcial Therapy exerpt included by staff of CPT