Physical Medicine and Rehabilitation

Physical Medicine and Rehabilitation

Slipping on ice

By PPSM Staff

Slipping on ice is a common winter injury that can result in hip or wrist fractures typically. In order to prevent a trip to the emergency room, safety precautions are necessary during snowy and icy weather. Always make sure that your sidewalks or driveways are salted. Be cautious of black ice as it often is hard to detect. According to the IWIF, if you are walking in bad conditions, you should wear shoes with good traction and non-slip soles like winter boots. If possible stay close to a stable surface to use as support if necessary. For example, if you are getting in and out of a car, use the car for support (just not the door as it can move on you). Keep a wide base of support with your legs spread out and toes pointed out when walking. Try and keep your knees and hips slightly bent and walk flat footed to also improve your balance and stability.  Take small steps and take your time!

Source for article: with good picture as reference

Soda is a Four Letter Word

By Matthias H. Wiederholz

America has an obesity problem.  And it seems the rest of the developed world is following suit.  A question that many people wonder is whether soda consumption increases the likelihood of weight gain. The short answer is YES.

Soft drink consumption has increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons per person per year in 2010.  Simply a 1% rise in simoft drink consumption contributes to an additional 4.8% overweight adults, 2.3% obese adults, and 0.3% adults with diabetes.1  If this trend of increased consumption of caloric beverages continues, it is clear that these rates will rise drastically.

There is an alarming statistic. Consumption of sugar sweetened beverages (SSB) in the United States is increasing.2,3  About half of mothers with children age 2 reported that their children drank SSB’s at least one day per week.  Moreover, there is a much higher likelihood that children who drink the highest amount of SSB come from low-income families.  These families are the same families that likely have limited access to quality healthcare.

So what does this mean for society in general?  Well, SSB consumption is increasing and the obesity epidemic is worsening.  Insulin resistance is becoming commonplace.  Based on the studies outlined above, we can conclude that soda consumption is certainly contributing to this problem.  In fact, as mentioned earlier, soda consumption predicts weight gain.

Therefore, if you don’t want to gain weight, don’t drink soda!

don’t drink soda


  1. Basu S, et al. Relationship of Soft Drink Consumption to Global Overweight, Obesity, and Diabetes: a Cross-National Analysis of 75 Countries. American Journal of Public Health. Nov 2013; Vol 103, No. 11: pp. 2071-2077.

Treat Your Migraines (and your wrinkles too)

By Matthias H. Wiederholz

Do you suffer from migraine headaches? Migraine headaches can be debilitating and some people have more headache days than non-headache days. Migraines typically start as a dull ache and progress to a throbbing pain. You may have sensitivity to light or sound with this headache. Some people even get nausea/vomiting with this headache. The headache typically lasts between 4-72 hours and interferes with daily activities.

If you suffer from migraine headache at least 15 days of the month that last at least 4 hours per day, you may be a candidate for treatment with Botox. Yes, I said Botox. Botox is FDA-approved for the treatment of chronic migraine. If you have tried multiple medications that have failed you are likely frustrated with the lack of pain relief. In fact, sometimes taking too much medication can actually worsen your headaches!

Botox is a simple injection technique for the treatment of chronic migraines. It involves injecting the medication into specific sites in the face, head and neck. It relaxes the muscles and relieves the headaches. In patients with 15 headaches per month or more, Botox reduced the headache days by 9 or more.

The best part… Your wrinkles will disappear too! Seriously. Many of the injection sites to treat migraine also happen to be the same sites that we inject when using Botox for cosmetic purposes.

If you have more headache days than non-headache days, consider calling for a Botox consultation today.

The Functional Movement Screen By: Chris Cush, DPT

By PPSM Staff

What is it? How does it relate to an athlete’s return to sport?

More and more of today’s individuals are working harder to become stronger and healthier. These individuals are constantly working to improve their activities by increasing their flexibility, strength, endurance, and power. A large number of athletes and individuals are performing high-level activities even though they are inefficient in their fundamental movements. Without knowing it, these individuals are putting fitness on dysfunction. This dysfunction is a physical or functional limitation. In order to isolate this dysfunction, the body’s fundamental movement patterns should be considered. The Functional Movement Screen attempts to pinpoint this dysfunction and alleviate it.

The FMS is comprised of seven movement tests that require a balance of mobility and stability. The patterns used in this screen place individuals in positions where weaknesses, imbalances, asymmetries and limitations become noticeable by a trained healthcare professional. The FMS focuses on correcting mobility first because quality stability is driven by quality proprioception (your body’s ability to sense where you are in space). Once these corrections are made the health care professional will then turn their focus on improving stability to maintain the individuals newly improved mobility.

The Functional movement Screen is also a good diagnostic tool for predicting re-injury in athletes and the weekend warrior trying to increase their fitness level. One study performed to assess FMS accuracy in determining re-injury stated that if the FMS score ? 14 then probability of suffering a time loss injury increased from 15% to just over 50%. Another study indicated that a significant amount of injuries were noted in athletes with right to left sided strength and flexibility imbalances (asymmetries). The seven movement patterns performed during the FMS are the Deep Squat, Hurdle Step, Inline Lunge, Shoulder Mobility, Active Straight-Leg Raise, Trunk Stability Pushup, and Rotary Stability. Our physical therapists perform the functional movement screen so if you are an athlete with an injury or a weekend warrior looking to increase your fitness level we would love for you to come in and see us!

Boost Your Energy Levels For a Healthy Holiday!

By PPSM Staff

Boost Your Energy

Give Yourself the Gift of HEALTH this Holiday:  Knock-Out Stress  &  Get Energized!

The Holiday Season is in full force!  Parties & shopping make this the most exciting time of the year. But all of this entertaining, eating out & overcommitting can cause stress.  Fitness maintenance often times is placed on hold & energy is quickly consumed.

Resolve to make this holiday season your healthiest yet, with more energy & vitality! Learn how you can come through the next few weeks looking & feeling your best.

PSSM is a proud partner of Gold’s Gym “Extra, Extra” Wellness Series ~ designed just for you.  Join us for this FREE lecture:

THURSDAY  •  DECEMBER 12  •  6PM  •  Gold’s Gym Lawrenceville, Mind & Body Room

Learn ALL About How to BOOST Your Energy Levels:

• Get healthy advice for energy all day long!
• Learn about the benefits of physical activity than can power-boost your mind & body.
• Get tips on active lifestyle, exercise recommendations & nutrition.  Plus more!  

Get expert advice from Physical Therapist Krista Rubini, DPT.  

Krista Rubini, DPT

Everyone can benefit from this insightful lecture.

All are welcome!   Q&A to follow.

See you  next Thursday!

* Happy, Healthy Holidays from PSSM *

Rotator Cuff Tendinopathy, By Mahmud Ibrahim MD

By PPSM Staff

Rotator Cuff TendinopathyThe shoulder is one of the most mobile joints in the body. The rotator cuff is a group of muscles that attaches to the shoulder joint via tendons. These tendons not only control the movements of the shoulder, but also help to stabilize the shoulder joint. Over time, patients can develop “wear and tear” of the rotator cuff, called tendinopathy. Tendinopathy can range from slight inflammation of the rotator cuff to a tear of the tendon. Rotator cuff tears are rarely seen in patients under the age of 40. Other risk factors for rotator cuff tendinopathy include repetitive overhead movements, weak shoulder muscles, forward posture of the shoulders, heavy lifting, and a direct blow to the shoulder. Diabetics are at increased risk for developing tendinopathy. Symptoms can include shoulder pain, especially with overhead activities or reaching behind, pain when lying on the affected shoulder, popping or clicking in the shoulder, and limited motion of the shoulder. Initially, symptoms may improve with rest; however, as the degeneration continues, the pain can become constant and occur even at rest. Eventually, the pain can interfere with daily activities. In addition to a physical exam, rotator cuff tendonapathy can be diagnosed with an MRI or ultrasound of the shoulder. Ultrasound is useful as it is (1)noninvasive, (2)can be performed in the office, (3)does not involve being placed in a small tube like structure, (4)and takes only about 5-10 minutes. Ultrasound has actually been found to be more sensitive than MRI in detecting rotator cuff problems. In addition, the physician can show the patient the affected areas in real time.



First line treatment for rotator cuff tendinopathy usually includes physical therapy to help strengthen the rotator cuff muscles, correct the poor posture, and teach proper form for lifting and overhead activities. Medications can include oral anti-inflammatories as well as other pain medications. Ice is also helpful to reduce inflammation. When oral anti-inflammatories are not enough, it may be necessary to perform a corticosteriod injection into the shoulder to help reduce the inflammation. Ultrasound can also be used when injecting the shoulder as it allows the physician to directly visualize the needle and ensure the medication is being injected directly into the affected area. Newer treatment options also include Platelet Rich Plasma, also known as PRP. This treatment involves taking the patient’s own blood, spinning it down, concentrating and extracting the growth factors in the blood, and injecting those growth factors directly into the affected area. This has been shown to actually promote the healing of degenerated tendons. There are also several surgical options available, but they are more invasive and are therefore rarely considered first line treatment options.

Shoulder pain is a common problem. With the proper treatment, the pain can be significantly reduced and improve a patient’s quality of life.  For more information or to schedule a consultation, please call our office in Lawrenceville, NJ at 609-588-8600.

Anxiety and depression, making your back pain more chronic and harder to treat By, Mike Dougherty, DC

By PPSM Staff

We’ll try to keep short and sweet about what we’re reading.  Here’s an old article that resonates pretty well:  “Improved outcome after lumbar microdiscetomy in patients shown their excised disc fragments:  A prospective, double blind, randomized, controlled trail.”

This was published in the journal of neurology, neurosurgery, and psychiatry in 2008.  In this study, patients who underwent lumbar microdiscectomy, a procedure where herniated disc material is cleaned up from the spinal canal reducing nerve pressure.   The patients were put into two categories.  There were those that were given the removed fragments from their surgery and those that weren’t.  Overall, both patients experienced relief but the patients that were given their disc fragments reported improvements in leg symptoms and back pain significantly more than the control group.  There were also improvements in associated leg weakness and paraesthsia.  This group also reported a reduced need to take pain medication sooner after the surgery. 

Anxiety and depressionThese are interesting findings that demonstrate how our mental state can affect our physical state.  Anxiety and depression are common among patients presenting for back surgery and influence the duration of low back pain and the development of a more chronic condition.  Preoperative anxiety or depression and passive pain coping strategies are well established negative prognostic indicators following lumbar microdiscectomy.  Prognostic indicators are factors that influence how quick or slow someone will recover from an injury.

Unfortunately, clinicians forget this and opt to diagnose solely based on findings on MRI or X-ray.  Poorly explained MRI or X-ray findings can lead patients to assume their condition has no hope of getting better.  Think about the diagnosis, “degenerative disc disease.”  The words alone are suggestive of a “disease” that can never improve.  This leads many to assume that they “have a bad back.”  This leads to some of the passive pain coping strategies that make back pain more chronic and harder to treat.

The most important factors are what we find during our clinical examination.  Imaging does play a crucial role in the diagnosis and management of certain conditions, however, should never be solely relied on until conservative measures have been exhausted.  If you need a second opinion regarding surgery, don’t hesitate to ask.

PSSM August Fitness Challenge

By PPSM Staff

PSSM_Fitness Challenge_FLYER

PSSM_Fitness Challenge Calendar

Make August AWESOME with PSSM!


We’re holding our first Staff FITNESS CHALLENGE for the month of August!  We are encouraging staff to take their workout to the next level with exercises that will challenge the mind & body.  Check out our calendar above!  Do you think YOU think you have what it takes?  Tell us! – Log onto our Facebook page:

Team PSSM Needs YOU:  We believe in teamwork – Help your ‘favorite’ PSSM contestant earn PSSM ‘star points’ for the big Win!  You can help by simply “liking” any post they make onto our Facebook page about this Challenge.  Contestants earn ‘stars’ for every online engagement they make AND every daily exercise they complete!  Be a *STAR* & “root, root, root” for Team PSSM.  Join the FUN!!  We appreciate you!

We’s like to extend this contest to our Patients & Friends for our next challenge….with a grand prize!  Will you commit to get fit?  Everyone can benefit from daily exercise for a healthy body & mind.  Stay tuned for our contest.

Be sure to visit our Facebook page for updates & motivation to keep you inspired.

Enjoy the rest of your Summer in good health.