The Integral PT —
Dr. Priyanka Arlekar
Integrating Exercise in your Daily Life
Move Better to Heal Better
About
Dr. Priyanka Arlekar
BPTh (Mum), MHS.PT (MSK) (US), MBA (UK).
With a journey of 10+ years in the Physiotherapy field of working in hospitals, skilled nursing facility, outpatient and home health setting, I started The Integral PT with a mission to empower you to take charge of your lifestyle and integrate exercise in your daily routine. Through the Integral PT online platform I can connect with you remotely on 1-on-1 basis and we can work together to make your life PAIN-FREE so that you can get back to doing what you LOVE.
Drop me an email and I will send you out weekly newsletter on latest health updates.
If you are looking for a remote video consultation, drop me a mail or DM me on Insta.
Use the free content on my Insta and YouTube channel and let's work together to create a balanced tomorrow.
Is Stretching a waste of time ?
Over the years, stretching as well as strength training both have been effective in improving Range of motion (ROM). However, the debate goes on still about which one is better?
So before we find answer to that let's understand how each of them help in improving ROM.
How does stretching improve ROM?
While different types of stretching such as static, dynamic and PNF stretch provide varying gains in ROM , all have been effective. The gains in ROM with static stretching are mainly due to increased stretch tolerance rather than increased muscle length.
On the other hand, PNF- stretch mainly activates reflex mechanism which causes muscle relaxation and increases muscle length.
While certain studies have claimed that stretching actually acutely decreases muscle performance, some studies found no significant difference.
How does strength training Improve ROM?
Both concentric and eccentric resistance training have shown to be effective in improving ROM. Especially, eccentric training requires muscle to generate force in an elongated position which results increased muscle length and decreased sensitivity to pain. Moreover, the strength and endurance gains from resistance training are additional benefits to improved ROM.
Which one is BETTER?
If you want a straightforward answer- NEITHER.
Research shows that both stretching and strength training are equally effective with no significant difference in improvements in ROM.
A stretching program of 6-8 weeks of 15-30 sec X 2-4 reps twice/thrice weekly can be effective in improving ROM. Also, if your main exercise/workout routine includes activities that demand flexibility such as gymnastics, ballet, etc, then stretching could actually be a good choice.
Resistance training program of 5-12 weeks of 2-4 sessions weekly focussing on graded exercise progression can be effective in improving ROM, strength and endurance. So with the added benefits, strength training might have a slight edge.
Top 5 Myths for Back Pain -Decoded
20th AUGUST, 2020
Some say "rest it out"; while some say "be on the move". The more people you ask, the more opinions you will get about how to manage your back pain. So which advice is correct for you?
How I would like to approach this question is to understand : why did I get back pain in the first place?
Not all pains originate from slipped discs, not all pain are sciatica, in fact 90% of low back pain are non-specific or in simple terms without any pinpoint cause. Thus, it's important to understand that every individual is unique and experiences pain differently. So let's decode the common myths related to back pain.
#1. "You need to Rest"
Listen to your body first. If you are able to get out of your bed and do all your daily activities without any pain, then clearly your body is telling you that you don't need to rest. If you experience pain only while doing a specific activity like bending forward or in a specific position like prolonged sitting in front of the laptop, then you don't need to stop everything and rest. However some people may experience acute severe episodes of pain or even find it difficult to get out of bed; in such a scenario resting for 24-48 hours would allow the pain to subside and allow your body to self- heal. Again reiterating your doctor and your body are your best guides.
#2. "Don't Bend Forward?"
I have been hearing this time and again from my patients that if I bend forward, I will get back pain or I will aggravate my back pain, not true for everyone.
Everybody moves differently. If I tell a patient with knee arthritis to bend forward from the knees and not the back , then it's an unrealistic advice. However, if your pain aggravates with long periods of sitting or forward bending activities, then post an acute episode of back pain you may avoid forward bending from the spine for around 1-2 weeks and work on your core and back muscles strengthening. Towards the end of your rehabilitation somewhere around 4-6 weeks, forward bending of the spine should be incorporated in the rehab program to reduce chances of recurrence.
#3. "Don't Lift Weights"
Well if our spine can bear our body weight then lifting a few kgs should not be a problem provided you are able to maintain your neutral spine. Strength training is an important aspect of the low back pain rehabilitation, so it's important to differentiate between straining the spine versus stressing the right muscles to build up strength.
#4. "Be on the Move"
Well, not always , as I said your body tells you better when you should be on the move. Respect acute pain and don't push through pain. Positioning, rest and cryotherapy should be the mainstay for acute pain management for the first 24 hours.
#5. "My increased Weight is the root cause"
Probably not. Your lack of physical activity leading to increased weight is a more probable cause. It's a vicious cycle which is difficult to break and therefore, a holistic approach is necessary to manage low back pain along with lifestyle modifications.
Top 5 Tips for Osteoarthritis Knee Pain Rehab
6th August, 2020
"Walk as much as you can." "Rest it out." "I will never be able to go back to my sport." "It's in my genes." "Nothing can help me." Different people experience different emotions and perceive their Osteoarthritis Knee pain in a unique way. Hence, there is no absolute perfect Rehab plan that fits all. However, the basic principles of Physiotherapy Rehab stay consistent . So, below are my Top 5 Tips for Osteoarthritis Knee Pain Rehab which can be used as a guideline universally.
#1. Understanding Pain
"Do I feel Pain or stretch or soreness?"
"Pain" can be described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Thus, everyone perceives pain differently. While some muscle soreness is expected post-exercise, it is important to differentiate it from "bad" pain. Any sharp or unremitting pain lasting for 24-48 hours post-exercise can be termed as "bad" pain and you should seek medical advice if any such situation arises.
#2. Too Much Too Soon
"I should be running 10k on Day 1".
The most immediate response of our body to pain is tissue inflammation which results in stiffness. Consequently, targeting the key muscles and their specific activation in various load-bearing positions is of utmost importance. However, building up muscle strength takes at least 4-8 weeks to show any noticeable change. Hence, hurried progression of loading the muscles can actually be harmful and cause undue damage.
#3. Focus On Knee Only
"My problem area is the knee, so I will focus only on the knee."
While the knee is the mainstay rehab focus, ignoring the hip and ankle in rehab is the most common cause for recurring pain. Weak hip muscles, namely gluteus medius and gluteus maximus or reduced ankle mobility can lead to biomechanical alterations at the knee joint and cause exacerbation of pain.
#4. Using External Support
"I don't think walking without knee caps is safe".
Knee caps or braces are commonly used by patients as they provide support and you feel more confident. However, there is no substitute to building your internal support (muscle strength and joint function). While knee caps can provide temporary support, prolonged psychological dependency on their use can affect muscle activation and strengthening rehab.
#5. Moving In the Right Direction
"It's been 3 days and there is no improvement".
Is that really so? While conventional objective outcome measures such as pain, standing time, walking time, walking distance, etc. are often used, reduction in other markers such as SOS medication dependency and dependency on external supports also suggest that Rehab is on the right track.
From "FAT" to "FIT"
19th July, 2020
In March 2017, I brought a new life into this world and my happiness knew no bounds. Soon in the postpartum phase, I realised that I was gaining weight too quickly and that I need to start working on myself. I decided that by next year, I will get back to my previous size. I knew what I wanted to do and being a physiotherapist myself, I also knew how to do it, but still it's been 3 years and I still weigh the same.
IT'S NEVER TOO LATE TO BEGIN
So now when I reflect back as to why I couldn't do it for 3 years, I came up with several answers. The question I asked to myself was,
"Why didn't I work on my fitness?".
My first response was "It's not like I didn't try, but I just didn't have enough time".
So the next question I asked was, (you guessed it right)
"Why didn't I have enough time?"
That question opened a plethora of reasons (or you may even call them excuses). "Well all my time goes behind the baby. I decided to do my MBA when my baby was just six month old, which meant that I was juggling between home, baby and the MBA school; so there was no time left for myself. Then as soon as I completed my studies, I started working round the clock, so I couldn't set a fixed exercise routine. So how could I have possibly managed time for myself?" So basically, I blamed everyone, except me for my situation.
TIME FOR SELF-AWARENESS
Then, in April 2020, due to the imposed lockdown after the breakout of COVID-19, I was asked to take a break from work and suddenly, I had all the time in the world. So, now finally that I had time for myself, I started with a simple 20 min workout and believe me, I did it diligently for 1 week. Then on Day 8, I thought to myself that I can take a break for one day. That break extended to an entire week. This time I reasoned that I had time to Exercise, still I didn't do it. "Enough is enough, I have to Exercise."
This was the turning point, because I realised that I had to convince myself repeatedly to do something that I want to. There's something fundamentally wrong here. "If I want to do something, then why do I lack motivation? What is stopping me?"
FINDING THYSELF
So for an entire week, I completely cut off myself from exercising and meanwhile, I thought I should start looking for another job. While updating my CV, I saw a section that stated my HOBBIES- Dancing, Singing, Reading. There was no new information there, but this information awakened me to endless possibilities. I felt nostalgic. It brought back memories of the kind of books I liked reading (fiction, to be specific), the times I danced on stage, the times I could hear a song playing in my mind while looking at the rains and so on and so forth. For an hour, I was immersed in the past and I realised that it actually made me smile. Doing all these activities made me happy and I want to be happy.
BOOKS ARE YOUR BEST FRIEND
I went to my closet and took out the Kindle which was lying there untouched for almost 2 years. If I had to sell it, I would had described it as "Never Used". I started reading books on self-help or more appropriately self-improvement. After reading 2 books on self-improvement, l asked myself, "Why am I reading books on self-improvement, when I am actually interested in fiction?" The answer was very simple, "Because I need help and I need it now". I actually used some of the tips and tricks from the books that I read and it helped me to bring "FOCUS" in my everyday life. I realized that I had accepted that I need internal motivation. This insight is really crucial and instrumental in bringing about "COMMITMENT TO CHANGE".
ONE THING AT A TIME
I usually used to start my day with a cup of black tea. I switched it to green tea and it's been a month , I am able to live without black tea. So again I asked myself, "How did I do this?" The answer I got was, "Green tea is easier to make, just dip the tea bag in hot water; less effort, saves time". If I see benefits, it's easier for me to change and then I am more likely to make that change into a habit. So now it was time to apply the same principle to my goal of transitioning "FROM FAT TO FIT".
LONG-LOST LOVE
Dance not only involves physical activity, but also evokes emotional responses and challenges your mind to create new cognitive patterns. I had started my dancing journey when I was 4 year old and now I was itching to get back to dancing. On the first day, I could barely dance for 2 minutes, then a pause, then another 2 minutes, until I was gasping at 10 minutes. I realized this was not going to be easy, but was it fun? Yes of course, I enjoyed those 10 minutes. It made me happy and even though it was difficult initially, it was the fruits of fun and enjoyment that kept me at it. At the end of week 1, I was able to dance for 10 min with 3 pauses, and now, by the end of week 4, I am able to dance for 30 min with interspersed 10 sec pauses for 5 times.
NO MOTIVATION NEEDED TO BE HAPPY
The bottom line is find an activity that can keep you fit, in which you are already interested, make it fun, make it enjoyable and rewarding. This "inside-out" perspective has worked for me and I am sure this will have a positive influence on you as well.
OH HEY, FOR BEST VIEWING, YOU'LL NEED TO TURN YOUR PHONE