Your Spine is Not “Out of Alignment” - A Holistic Approach to Pain Science

Have you ever been to a practitioner who assured you that the cause of your pain was one of the following, or some combination of these very technical sounding terms? “Your ____ (spine, hips, etc) is out of alignment.” “Your pelvis is twisted.” “Your SI joint is jammed.” “Your pain is because of your leg length discrepancy.” The list goes on and on.

These types of claims are not helpful, and can be downright destructive due to the nocebo effect.

First of all, joints don’t go “out”. If your joint was dislocated, it would be a medical emergency that you would be well aware of, and warrant a trip to the ER. Additionally, structural explanations for pain (aside from acute pain due to tissue injury) are generally unsupported by evidence. These claims (e.g. joints being “out”) have extremely low interrater reliability, meaning two different clinicians would almost never agree on them.(1)

By teaching people that these minor asymmetries are “serious”, clinicians are over-medicalizing normal human conditions. We all have asymmetries, and we do not have good evidence that asymmetries will lead to pain and dysfunction. By believing that your pain is structural, it is taking you out of the healing equation, and will consciously or subconsciously rely on external sources for healing, including surgeries, injections, and frequent chiropractic adjustments. 

Fortunately, the human body is not like a car. Because issues as complex as pain are not due typically due to structure alone, they typically do not require a structural solution. Unlike a car, the human organism has a nervous system, an immune system, and higher consciousness that allows us to think, feel, move, make decisions, and change our beliefs and behaviors. It may be convenient for some clinicians to blame structural issues as a scapegoat, as it can be easier and quicker to explain than the other contributing factors, and can also be an effective business model. Also, many patients may also be looking for some structural issue to blame, as it can be extremely frustrating and distressing to be in pain for a long time and not understand why. However, it is crucial for clinicians to educate patients on the real causes of pain, and move away from teaching people the body is a machine that breaks down, inevitably leading to pain. We need to lean in to educating people on the messier science, including physiology, neuroscience, psychology, as well as social and lifestyle factors. 

The truth is, pain is multifactorial. Sometimes it is very simple, sometimes it is extremely complex. Simple cases tend to be acute- you stub your toe, the nociceptors (pain receptors) fire, your brain registers the sensation as pain, and you say “Ow!”. However, chronic pain is a different beast. After pain persists and the initial injury is gone, brain changes tend to be what keeps the pain cycle alive. Our nervous system can get a bit confused, and the helpful pain perceiving pathways can start to run awry. We begin to get overly sensitive to stimuli that normally wouldn’t cause pain (known as allodynia), and perceive that pain is more intense than we normally would (hyperalgesia). It is very hard to turn that sensitivity back down, and it requires neuroplasticity (brain change). 

So how do we change our brain to affect our pain? We have to address pain biopsychosocially, meaning we address the biology, the psychology, as well as social factors.

Biologically (or physiologically), we rehabilitate the physical body through movement and exercise, improving efficiency of movement, decreasing unnecessary tension, and improving fitness. This might mean gradually desensitizing our body to painful movements or activities. We also want to make sure we are sleeping well, eating healthful foods, staying hydrated, and being very mindful regarding consumption of certain substances.

To address psychology, we must challenge our beliefs, improve our mental health, find appropriate coping mechanisms for stress, and change our relationship to our pain to become less reactive and more responsive.

To address the social factors, we have to make sure we are surrounding ourselves with the right people, participating in activities that bring us joy, and seeking support rather than battling with pain alone. 

Hopefully, this path to healing does not seem overwhelming. By addressing these biopsychosocial factors, we can take control of our lives and make decisions that better ourselves and improve our quality of life. We can take an active role in our own healing, and won’t be as reliant on expensive and harmful procedures. While the healing journey is not linear and will come with challenges, it is the direction to go for all of us, with and without chronic pain. 

It is our job at the Wellness Station to take the role as educator, detective, and coach. We strive to teach you about the science of pain, figure out the greatest contributor factors, and provide guidance, encouragement and support as you begin or continue your healing journey.

References:

1. https://www.painscience.com/articles/structuralism.php

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

PT Recipe: What to Look for in a Therapist

Physical therapists come in many flavors, and it can be challenging to figure out if your therapist is a good fit. It was interesting and informative to read this article by the NY Times that describes qualities to look for (and some qualities to stay away from!) in a PT. One common misconception in the public is that one size fits all, that PT either works for someone or does not. This is certainly not the case. Sometimes, there is a personality clash in which the therapist and client simply are not a good fit for each other. Other times, the therapist might not be utilizing the best treatment options, or might have difficulty with empathy, critical thinking skills, or other factors that can determine therapeutic outcomes. And of course, sometimes clients do not “buy in”, do not participate in the prescribed exercises, and perhaps may not be ready to make substantial lifestyle changes. All of these factors will determine whether the therapy is successful or not. A strong therapeutic alliance between practitioner and client is required, and the best way for this alliance to be created is for the client to have faith in their therapist.

Here are some qualities to consider when embarking on your therapeutic journey. Keep in mind that these qualities are also important for other therapeutic treatment options, including mental health therapy, chiropractic, as well as speech and occupational therapy. 

Prioritizing active over passive interventions:

Historically, physical therapy has relied heavily on passive treatment modalities, such as ice, heat, ultrasound, electrical stimulation, and laser therapy. Manual therapies could also be considered passive, in which cases the practitioner would “perform” techniques such as joint mobilizations, manipulations, and massage on the client without the client having any kind of active role. This type of therapy has a different intention and effect than a hands-on Feldenkrais-inspired lesson. In a passive manual therapy procedure, the practitioner has the mentality of “fixing” something. They may use language such as describing joints as “out of alignment” or something of that nature. This type of treatment can be harmful for several reasons, one of which is that it teaches clients that they do not have agency over their own healing, and require an external source. This differs from a Feldenkrais-inspired technique in which the client may not be participating with volitional movement, but is instead actively participating by visualizing, sensing and feeling effortless movement, and may be asked to join in as the therapist initiates various movements. In the latter case, learning will occur, as clients will begin to feel how they can improve their movement without strain.

While passive manual therapy techniques may have their place, they should certainly not be the primary intervention. Fortunately, over the past several years the field has begun to move away from these options in favor of more active interventions. The passive treatment options are generally not evidence-based, and are often no more effective than sham or placebo interventions. Additionally, relying on these passive modalities could potentially have negative impacts on client’s self-efficacy, or the belief in their intrinsic capacity to heal and improve. By feeling like you need to see a practitioner every week so you can be the recipient of passive interventions can really take away from your motivation to improve independently and trust in your body’s natural healing abilities. Active treatment options are more effective, sustainable, and help to improve your self-efficacy as well as your body’s resilience and healing response. Active interventions are typically exercise and movement based- make sure your therapist is helping to guide you towards these options rather than relying solely on passive modalities. 

Using evidence-based treatments:

Research in a field often takes up to 17 years to become implemented in clinical practice. That is why it is important for clinicians to stay as up to date on new research as possible, and not rely on outdated or inefficacious treatment options. The best evidence shows that movement is medicine. Movement and exercise should be the primary lines of treatment in physical therapy to help people move better, feel better, and participate more in life. At the Wellness Station, the primary interventions are almost exclusively movement-based, because this type of intervention has been shown to be the most effective and long-lasting. The services we provide are influenced by the Feldenkrais Method®, which is a gentle and highly effective complement to traditional physical therapy. To learn more about the Feldenkrais Method®, its application into physical therapy, and clinical research that supports its use, please read our white paper written by Paul McAndrew.

Walking the walk:

It is extremely important for a client and clinician to develop a strong therapeutic alliance that is rooted in honesty, genuinity, and integrity. Clinicians must set a positive example, and clients must be able to trust and believe in their clinicians. Perhaps the most important way to find a therapist that you can believe in is considering the question of whether they “walk the walk”. Does your therapist seem like they take their own fitness, health, well-being very seriously? In order for a therapist to be an effective teacher and role model, it is crucial that they are able to feel in their own body the recommendations and lessons that they suggest. They should be able to relate to what you are doing that could be contributing to strain, and help you devise a way to improve the efficiency of various tasks. For example, imagine a client that is having trouble looking up or reaching overhead due to neck pain or mobility restrictions. The therapist should be able to demonstrate how functional movements involve relationships between various body areas (e.g. how movement of the tailbone relates to movements of the neck), rather than isolated movements of specific body parts. If someone is having trouble with this task, the therapist should be able to feel in their own body and help teach the client that by lifting the tailbone while sitting, ease of looking overhead or reaching overhead can be greatly improved. Over the course of therapy, the practitioner should also help develop a plan to improve overall fitness using biomechanical and physiological principles in the context of the client’s individual characteristics.

Interpersonal skills:

Interpersonal skills are exceedingly important for a provider to have. Without good bedside manner, it will be very challenging for clients to feel comfortable, safe, and able to discuss sensitive topics. A therapist must demonstrate empathy, which is the ability to understand and share the feelings of others. Without empathy, the client will not feel listened to, understood, and cared for. Empathy requires the therapist putting themselves into their clients metaphorical shoes, understanding the pain they feel, and meeting them where they are at in life with sensitivity and grace. An empathetic therapist will listen, make eye contact, not interrupt, and not try to force changes. They will ask questions that demonstrate understanding of your life circumstances, express genuine interest and care, and refrain from unsolicited “fix it” advice (e.g. telling you what you “should” do).

Another factor to consider is, how do you feel during your sessions? Is your therapist encouraging? Do they help to calm you down and feel optimistic about your healing journey? Or perhaps, do they make you feel rushed? Does the therapist seem to be rushed? Unfortunately, many providers are rushed, with unrealistic productivity requirements that limit the time they can spend with each client.

At the Wellness Station, we are able to take the time needed with every client in a supportive environment to facilitate healing and enhanced lifelong fitness.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Movement Snacks

What is a movement snack, you ask? This catchy term (which I do not take credit for) describes taking brief movement breaks throughout the day. These breaks are especially important if we spend a long time sitting in the same position, such as during computer work, in the car, or on the couch. They can also be used as a way to warm the body up in the morning after sleep, or perhaps simply as something to do while waiting for the coffee to brew or the food to heat up.

Many people fall into all or nothing thinking when it comes to movement. Some less than helpful ideas out there are… “It has to be intense to be effective.” Or, “I went to the gym already today, so I checked that box.” Or, “I didn’t have time to do all my PT exercises, so I will wait to do them on a day when I have more time.” These mentalities are not so helpful, as they can contribute to moving less throughout the day, as well as equating movement to a chore that we should do as opposed to something joyful that we get to do. Rather than all or nothing, it can be helpful to shift to a mindset in which we reframe our daily movement practice into realistic, bite-size chunks, incorporating the mantra: “a little bit, very often.”

The brain and body respond well to repetition, so it is important to develop a routine that we are doing often in order to get the greatest benefits out of our practice. However, this does not mean that we have to spend a very long time all at once on our movement practices. A better strategy is to have “snacks” throughout the day in which we get our body moving in order to change positions, take strain and tension off our joints, get our blood flowing, and bring about positive changes to our mood and energy levels. Of course we want to also have “meals” regularly in which we are spending a longer period of time moving and exercising, but snacks throughout the day are an excellent way to stay moving in between these metaphorical meals, especially if we are busy.

The snacks you choose should ideally incorporate movement in more than one dimension, as well as include options for variations. Variety is the spice of life- you wouldn’t want to have the exact same snack every day! You might also choose snacks that are specifically targeted towards areas that you want to bring movement into based on what your day has been like. For example, number one below (back extension with thoracic pivot point) is an excellent way to mobilize the upper back, an area that can get stiff and stagnant after spending a long time hunched over a computer.

Here are some of our favorite movement snacks:

Back extension with thoracic pivot point-

Thigh to chest, tail wagging, circles-

Hip and shoulder extension-

Bridge gliding with figure 4 option-

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Moving is a Must: But Why?

One of the most common questions I am asked during treatment sessions as a physical therapist is “Why are we doing this?” Or “What is this doing for me?”

As the therapy provided at the Wellness Station is movement-based, it is important to understand why movement is so critical for our health, quality of life, and physical function. The movement lessons facilitated are typically targeted directly or indirectly at a biomechanical or neuromuscular issue. The specific movements may establish a refined sense of clarity and improved efficiency for someone experiencing difficulty with a daily activity, such as bending and lifting, going up or down stairs, reaching overhead, sitting for a prolonged time, and much, much more. While the rationale behind specific movement lessons may address specific individual factors (e.g. lack of muscular strength, excessive tension in certain areas, less than optimal form or alignment), sometimes overly focusing on the mechanics and the specific “benefits” of performing a movement can take away from the experience. When clients ask me those questions (e.g. “What is this doing for me?”), I often turn the question back around to them, and may ask something like “What are you feeling and sensing in your body as you do this movement? How might this relate to the issue in your daily life that you described?” For example, a lesson that involves torso side bending might make reaching overhead easier and possibly replace a prior inefficient overhead reaching movement that was a factor contributing to the discomfort. 

It might be helpful to understand a little about why we have a nervous system. While this is an extremely broad and complex topic that is the subject of many books, the nervous system can be simplified as the “control center” of ourselves as organisms. Control is necessary to achieve a preferred mode of function, and our nervous system can help correct and adapt when the preferred mode is not present (similar to the concept of homeostasis, or seeking balance). Our nervous systems allow us to react to and adjust to our environments in order to manipulate them.1 The structures of our nervous system look for order in the random, and create order when it is not present. As we move around and manipulate the outside world, our nervous system allows our muscles to move our bones, reacting to our environment to maintain order within our tissues. Our nervous systems likely evolved in the first place to allow us to move as the conditions of life required it, perhaps to move away from danger or incompatible conditions and towards resources and safety. In other words, we have a brain so we can move. Movement is a necessary condition for our life as a complex organism. If we can move more optimally, we can live more optimally.

As the modern world is an environment in which it is less of a short term requirement to move, many of us simply move less, or become sedentary. Our food? Delivered. Going somewhere? The car does it for us. Going up a level? Elevator. The cleverness of the human mind has contributed to extremely useful innovations in technology that can make our daily lives a whole lot easier, but these modern conveniences actually can rob us in the long term. If we were built to move but our environment no longer requires us to move as much, how do our bodies respond? Over the long term, not favorably! For this reason, we need to intentionally move our bodies, move for the sake of moving, and hopefully enjoy doing it!

Finding Joy

On a fundamental level, all of us can find joy in movement. Think about the sheer joy of babies, first discovering how to roll over, bring their foot into their mouth, pick up a toy, and stand up. Movement can be a richly rewarding experience. Rather than seeing exercise as a chore that we must do to strengthen certain muscles, improve fitness, etc., can we tap into the joy of movement? This enjoyment will serve as a motivating factor that will encourage us to move more often in a variety of ways, which will ultimately be more beneficial in our lives than trudging through exercises we find to be boring or uncomfortable. This might be dancing, Feldenkrais lessons, yoga, swimming, walking, lifting weights, or simply rolling around on the floor! Find something you enjoy, and do it very often.

Regulating Nervous System

As we learned, we move because we have a nervous system. Our nervous system allows us to move. Thereby, engaging in movement is an excellent way to regulate our nervous systems. Mindful movement helps us focus our attention on the present moment, increase the release of neurotransmitters and hormones that support our mood and mental health, and can help to downregulate excessive tension that we hold in our muscles. This regulation of the nervous system through movement can help bring us from a sympathetic state (fight or flight) to a more calm and pleasant parasympathetic state (rest and digest). This can positively impact our experience of pain, mental health, and the function of our organs.

Learning To Learn

Engaging in new movements is an excellent way to learn. Participating in Feldenkrais lessons is essentially learning about learning! It can be an eye-opening experience to become aware of how we react to new challenges. When we are attempting to learn something physical, are we able to maintain an open mind? An ability to be kind and patient with ourselves? Or do we have more of a tendency to push, strain, over-effort, or give up? Practicing “learning” movements can help expand our brains, which can be helpful whenever we have to learn something new whether that be a new movement, a musical instrument, a language, or something we encounter at our jobs or in school.

Nourishing Tissues

The tissues of our body are deeply dependent on movement in order to be healthy. Our joints require frequent movement in order to circulate lubricating fluid (synovium) to keep healthy, gliding surfaces with minimal friction. Our bones require weight-bearing movement in order to maintain their density. Our muscles require challenges in order to get stronger instead of weaker. Almost all tissues in our body require blood flow in order to receive oxygen and other nutrients to stay alive, healthy, and comfortable. Movement fills our muscles with fresh blood, and cardiovascular activity helps to circulate blood with more gusto throughout our entire systems. 

There are many, many reasons to move your body. It might be helpful and more rewarding to consider movement as a gift or a privilege that we get to do. Moving away from the “how is this helping me” mindset and tapping into appreciation of the miracles of movement may motivate us to move more, allow us to feel more human, and keep us healthy and mobile as we age.

References:

Feldenkrais Moshé. (1981). The Elusive Obvious. Meta Publications.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Stairs With Sore Knees: From Struggle to Success!

Stairs can be a major stressor for those of us with sore knees. Oftentimes, older adults begin to avoid stairs as much as they can, and even choose homes that are on one level for this very reason. When stairs are the only option, there may be extra difficulty, both because of issues with the knee joints, as well as the deconditioning of muscles that may have occurred as a result of not going up and down stairs as frequently (use it or lose it). The act of choosing to continue to use stairs as we age is a great way to maintain strength in the lower body, but this will only be beneficial if we can climb stairs with ease and efficiency. Rather than making stairs the enemy, how can we begin to see stairs as a healthy challenge that will help us maintain our strength and mobility?

Biomechanics of stairs:

It may be helpful to understand a little bit of the biomechanics of stairs, or the physics of the movement. Going up stairs is a concentric action, in which the muscles shorten as they contract, creating a force that overcomes resistance. Most of the concentric action occurs about the hip and knee joint, and key muscles for going up stairs are the quadriceps (front of thighs) that act to extend the knee, and the hamstrings (back of thighs) and gluteus maximus (large buttock muscle) that shorten to extend the hip.

We also require use of our hip flexors (front of abdomen to front of hip) to lift our foot to the next step. In addition, if we learn to ascend stairs using more of our body, muscles on the sides of our bodies can also help, including our gluteus medius (side hip muscle) and quadratus lumborum (side of waist/low back). We can rely on the integrity of our skeletal structure to help direct the forces required to go upstairs, as we can send our body weight over our supporting leg, thereby requiring less overall muscular effort to go up stairs.

Going down stairs is actually more difficult for many people, especially those of us with knee issues. The skeletal system of our bodies is extremely important for supporting and directing forces. Going upstairs, we are able to rely on our skeletal structure more reliably, whereas going downstairs requires the supporting knee to be very bent, which makes the muscles in the front of the thigh have to work much harder. Going down is an eccentric action, which means muscles have to lengthen while contracting, as they control against the force of gravity. In other words, eccentric contractions are kind of like controlled falling. These types of contractions are actually more difficult for our muscles, which is why eccentric training is an excellent way to improve tissue strength and resilience. However, if our muscles lack the strength to control our movement during gravity, we might notice going down stairs, sitting down into a chair or toilet, or lowering ourselves to the floor may turn into more of a “plop” than a smooth motion. This indicates that our muscles lack eccentric strength, and our joint tissues may be taking a great deal of strain as we do these activities. 

Another reason why going down stairs might be more difficult for some is that it tends to isolate the knee joint more than going up stairs. As described above, going up stairs can make great use of the muscles of the hips and core. In going down stairs, notice that the knee might travel far over the toes, and very little movement actually happens in our hip. As the knee travels over the toes and the quadriceps contract eccentrically, pressure builds up in our knee which can be an irritating factor, especially if we lack eccentric control or if there are other factors at play that are impacting our movement efficiency.

Strategies for a “bad day”:

Although practicing stairs is a great way to get better at stairs, sometimes we have to modify how we do it based on pain and discomfort. Think about an early morning. In the winter. Perhaps you “overdid it” yesterday, and your knee is speaking to you. Or perhaps, you had a knee replacement surgery not so long ago and your knee simply is not in shape to do stairs normally. If this is the case, here are some strategies for bringing more ease into your life:

1) Up with the strong, down with the sore:

This popular adage is well known for anyone who has had a knee replacement. Many will say “up with the good, down with the bad”, but why the negative self-talk if we could just say sore? This advice simply means to go up and down stairs one at a time, rather than your leg traveling past your other leg to the next step. Also, when going up, lead with the leg that is stronger, not experiencing as much discomfort, etc. And when going down, lead with the sore leg. This will make sure the strong leg is doing both the concentric and eccentric action to give the sore leg a break.

2) Try backwards, or sideways:

This tip is mainly for going down stairs. If one were to go down stairs backwards, mechanically, it would look a bit more like going up stairs in which we can use our hips a bit more rather than isolating the knee. For safety reasons, it is extremely necessary to practice this first before gallivanting down the stairs backwards. Try standing on the bottom step, holding on to the railing. Then slowly lower one foot down to the ground, followed by the other foot. Then come back up, practicing several times to get the hang of it. Similarly, when going down sideways, the knee does not have to travel so far over the toes. We are able to bend at the hip more to lower down to the next step. Going down sideways will also make it possible to hold on to a railing with both hands. On a bad day, consider going down backwards or sideways leading with the sore leg, just as described in the previous strategy.

Strategies for optimizing movement and preventing issues:

On a typical day perhaps if our knees are not a bother, and we would like to embrace the healthy challenge of doing stairs in an efficient and strain-free way, consider the following recommendations:

1) Root your heel to rise, bend side to side:

Rooting to rise means to take advantage of the force that the ground gives you, known as the ground reaction force. As we might remember from Sir Isaac Newton, every force has an equal and opposite reaction. When we put weight into the ground, the ground exerts an equal and opposite force back up into our skeleton, allowing our bodies to move. By focusing attention on our ability to harness ground forces, we might be able to navigate stairs and other movements with a greater sense of clarity. By placing our heel completely on the step when going up, we can actually push down through our heel as our body leans forward over our foot. By pushing down through our heel, we will rise up to the next step, thereby rooting down to rise up. The muscle that pushes our heel down is the same muscle that extends our thigh back, which is our gluteus maximus, the strongest muscle in our body. If our heel is dangling off the step, we cannot make as efficient use of ground force, and more force may be required from our knees.

When going up stairs, we can train ourselves to move partially in the lateral plane, rather than only the sagittal plane to take further stress off the knees. Put simply, we can let our body side bend help us ascend to the next step. This is a difficult concept to describe that must be felt in the body to understand. One way to think about it is relating the action to pushing down on a trash can pedal to lift the trash can lid. If the right foot presses down on the step, the left side of the pelvis will lift up, bringing the left leg to the next step. In this case, the right foot would be pressing on the imaginary trash can pedal and the left side of the pelvis would be the lid.
This action is accomplished mainly by the gluteus medius as well as the quadratus lumborum, which are muscles on the side of the pelvis and abdomen.  

One way to practice this feeling before doing it on the stairs is to try a slow march standing in place. Place hands on the sides of your waist. Begin to lift your left thigh up, thinking about pressing down into the ground through the right foot. Notice that the left side of your waist would get shorter, and the right side of your waist would get longer. Continue in a slow march, paying attention to the changing length of your side body. Imagine that the leg that is holding your weight is pressing down into the trash can pedal, and the side that is coming up is the lid.

2) Practice Step Ups and Downs:

As we learned, eccentric strength is necessary to go down stairs with ease, and concentric strength is necessary to go up stairs. A great way to improve this strength is to practice step ups and downs. On the bottom step or perhaps using a stool as well as something to hold on to as needed, place heel up onto the step and practice driving down through the heel to step up. Keep the same heel on the step, and lower down backwards with control until your other foot touches the ground. Repeat several times, noticing the activation of your thigh, glutes, and side body muscles.

For a more challenging exercise, practice going down a step facing forward. We have learned, this is the most difficult and likely to elicit discomfort of the knee. For this reason, it is important to start practicing by holding on to something, as well as starting with a partial range if you are having difficulty controlling this motion. Start standing on the bottom step, keep one foot where it is, and begin to lower the other foot towards the ground, but only a couple of inches. Then return to the starting position. The key is to lower down very slowly, to ensure you are maintaining eccentric control. Try a few more times, perhaps each time letting the foot travel a little closer to the ground as your other knee bends. Notice the tracking of your standing knee on the leg that is holding your weight as you lower down. Does your knee bend straight forward over your toes? Does it drop in towards the big toe side, or out to the pinky toe side? Does making a change to where your knee tracks impact the comfort and ease of this motion? Spending a little time each day practicing these movements will condition your body and your mind to be primed and ready for the next time you encounter stairs.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team