Assistive Device: Walkers

There are three major categories of ambulatory assistive devices: canes, crutches, and walkers. This post is the last of the series, and we will talk about walkers. Visit our previous posts about canes and crutches.

Assistive devices are prescribed for a variety of reasons, including problems of balance, pain, fatigue, weakness, joint instability, excessive skeletal loading, and cosmesis.  Another primary function of assistive devices is to eliminate weight bearing fully or partially from a lower limb. This unloading occurs by transmission of force from the upper limbs to the floor by downward pressure on the assistive device.


Walkers are used to improve balance and relieve weightbearing either fully or partially on a lower extremity. Of the three categories of ambulatory devices, walkers afford the greatest stability. They provide a wide base of support (BOS), improve anterior and lateral stability, and allow the upper extremities to transfer body weight to the floor.

Walkers are typically made of tubular aluminum with molded vinyl handgrips and rubber tips. They are adjustable in adult sizes from approximately 32 to 37 in., with children`s, youth, and tall sizes available. Several design variations and modifications to the standard design are available and are described below.


Glides are small, plastic attachments placed on the posterior legs of walkers typically in combination with wheels on the front legs. They promote a smooth forward progression without having to lift and place the walker with each step. They are typically made of high-density plastic in an inverted mushroom-shape. Other common glide designs include a 1-in. diameter “disk” with a central stem that slides into the tubular leg and is tightened into place with a screwdriver; and a fitted cap that is placed directly onto the walker leg (in the same manner the rubber tip is attached). Another style of glide incorporates a tennis ball within a fixed housing.

glide walker

glideball walker

Folding Mechanism

Folding walkers are particularly useful for patients who travel. These walkers can be easily collapsed to fit in an automobile or other storage space.

walker collapsed

Handgrips (Handles)

Enlarged and molded handgrips are available, and may be useful for some patients with arthritis. Some walkers offer a second set of handles to assist with sit-to-stand transitions.

handgrip walker

Platform Attachments

This adaptation is used when weight bearing is contraindicated through the wrist and hand (described in the crutch post).

Wheel Attachments

This adaptation to walkers (often called rollators or rolling walkers) includes the addition of wheels (either to the two front wheels only or to all four wheels). The addition of wheels frequently allows functional ambulation for patients who are unable to lift and to move a conventional walker (e.g., frail elderly). Swivel wheels turn freely in a complete circle. Fixed wheels rotate around a central axis. Wheels are generally available in 3-, 5-, and 6-in. diameters. Eight-inch diameter wheels are also available and can be used to add height for tall users.

Swivel wheels

Swivel wheels

fixed wheels

Fixed wheels

Braking Mechanism

A braking system is an essential feature of walkers designed with wheels. Walkers with four wheels frequently include handbrakes that lock the rear wheels. Posterior pressure brakes are effective when wheels are placed only on the front walker legs.

brakes walker

Tripod Rollators 

Three-wheel collators incorporate a tripod design. A major advantage of this device is ease of maneuverability and turning. Height adjustments are made at the handles; the unit folds for storage and travel.

Tripod Rollators wlaker


Sitting Surface

A variety of seat walker designs are available that fold out of the way when not in use. The structural design of many walkers also includes a contoured back support. Seats are an important consideration for individuals with limited endurance (i.e., post-polio syndrome) as well as for community ambulatory who require periodic rest intervals. Walker seats should be carefully examined for stability and safety with respect to individual patient needs. Patient practice in use the walker seat should be provided.

Sitting Surface walker

Reciprocal Walkers

These walkers are designed to allow unilateral forward progression of one side of the walker. A disadvantage of this design is that some inherent stability of the walker is lost. However, they are useful for patients incapable of lifting the walker with both hands and moving it forward (in situations in which a rolling walker might be contraindicated).

Advantages: Conventional walkers provide four points of floor contact with a wide BOS. They provide a high level of stability. They also provide a sense of security for patients fearful of ambulation. They are relatively lightweight and easily adjusted.

Disadvantages: Walkers tend to be cumbersome, are awkward in confined areas, and are difficult to maneuver through doorways and into cars. They eliminate normal arm swing and cannot be used safely on stairs.

reciprocal walker

Measuring Walkers

The height of a walker is measured in the same way as that of a cane. The handgrip or handle of the walker should come to approximately the greater trochanter and allow for 20 to 30 degrees of elbow flexion.

Gait Patterns: Conventional Walkers

Prior to initiating instruction in gait patterns using a conventional walker (4 points of floor contact without wheel attachments), several points related to use of the walker should be emphasized with the patient:

  • The walker should be picked up and placed down on all four legs simultaneously to achieve maximum stability. Rocking from the back to front legs should be avoided because it decreases the effectiveness and safety of the assistive device.
  • The patient should be encouraged to hold the head up and to maintain good postural alignment; forward flexion of the trunk, neck, and head should be avoided.
  • The patent should be cautioned not to step too close to the front crossbar. This will decrease the overall BOS and may result in a fall.

There are three types of gait patterns used with conventional walkers. These are the full, partial, and non-weightbearing gaits (rolling devices are not recommended for patients with altered weight bearing status). The sequence for each pattern follows.

Full Weightbearing Gait

  1. The walker is picked up and moved forward about an arm`s length.
  2. The first lower extremity is moved froward.
  3. The second lower extremity is moved forward past the first.
  4. The cycle is repeated.

Partial Wightbearing Gait

  1. The walker is picked up and moved forward about an arm`s length.
  2. The involved lower extremity is moved forward, and body weight is transferred partially onto this limb and partially through the upper extremities to the walker.
  3. The uninvolved lower extremity is moved forward past the involved limb.
  4. The cycle is repeated.

Non-Weightbearing Gait

  1. The walker is picked up and moved forward about an arm`s length.
  2. Weight is then transferred through the upper extremities to the walker. The involved limb is held anterior to the patient`s body but does not make contact with the floor.
  3. The uninvolved limb is moved forward.
  4. The cycle is repeated.

Note: Rolling walkers generally allow use of a reciprocal gait pattern as the walker can be rolled forward while walking. As the need to lift the walker forward following each step is eliminated, a smoother forward progression can be achieved.

Assuming Standing and Seated Positions with Walkers

Coming to Standing 

  • The patient moves forward in the chair.
  • The walker is positioned directly in front of the chair.
  • The patient leans forward and pushes down on armrests to come to standing.
  • Once in a standing position, the patient reaches for the walker, one hand at a time.

Return to Sitting 

  • As the patient approaches the chair, the patient turns in a small circle toward the strong side.
  • The patient backs up until the chair can be felt against the patient`s legs.
  • The patient then reaches for one armrest at a time.
  • The patient lowers to the chair in a controlled manner.

Source: Susan B. O`Sullivan, Thomas J. Schmitz. Physical Rehabilitation.

Posted in Knowledge, Rehabilitation | Tagged , , , , , , , , , | 1 Comment

Assistive Devices: Crutches

There are three major categories of ambulatory assistive devices: canes, crutches, and walkers. In this post, we will talk about crutches. Stay tuned for the next post about  walkers, and visit our previous post about canes.

Assistive devices are prescribed for a variety of reasons, including problems of balance, pain, fatigue, weakness, joint instability, excessive skeletal loading, and cosmesis.  Another primary function of assistive devices is to eliminate weight bearing fully or partially from a lower limb. This unloading occurs by transmission of force from the upper limbs to the floor by downward pressure on the assistive device.


Crutches are used most frequently to improve balance and to either relieve weight bearing fully or partially on a lower extremity. They are typically used bilaterally, and function to increase the base of support (BOS), to improve lateral stability, and to allow the upper extremities to transfer body weight to the floor. This transfer of weight through the upper extremities permits functional ambulation while maintaining a restricted weight bearing status. there are two basic designs of crutches in frequent clinical use: axillary and forearm crutches.

Axillary Crutches

These assistive devices also are referred to as regular or standard crutches. They are made of lightweight wood or aluminum. their design includes an axillary bar, a handpiece, and double uprights joined distally by a single leg covered with a rubber suction tip (which should have a diameter of 1.5 to 3 in.). the single leg allows for height variations. Height adjustments for wooden crutches are accomplished by altering the placement of screws and wing bolts in predrilled holes. The design of most aluminum crutches incorporates a push-button pin mechanism for height adjustment similar to those found on aluminum canes. Both the overall height of the crutches as well as the height of the handgrip typically adjust in 1-in. increments. Axillary crutches are generally adjustable in adult sizes from approximately 48 to 60 in., with children`s and extra-long sizes available.

Advantages: it improves balance and lateral stability, and provide for functional ambulation with restricted weight bearing. They are easily adjusted, inexpensive when made of wood, and can be used for stair climbing.

Disadvantages: Because of the tripod stance required to use crutches and the resultant large BOS, crutches are awkward in small areas. For the same reason, the safety of the user may be compromised when ambulating in crowded areas. Another disadvantage is the tendency of some patients to lean on the axillary bar. This causes pressure at the radial groove (spiral groove) of the humerus, creating a situation of potential damage to the radial nerve as well as to adjacent vascular structures in the axilla.


Several methods are available for measuring axillary crutches. The most common use a standing or a supine position. Measurement from standing is most accurate and is the preferred approach.

Standing: From a supported standing position, crutches should be measured from a point approximately 2 in. below the axilla. The width of two fingers is often used to approximate this distance. During measurement, the distal end of the crutch should be resting at a point 2 in. lateral and 6 in. anterior to the foot. A general estimate of crutch height can be obtained prior to standing by subtracting 16 in. from the patient`s height. With the shoulders relaxed, the handpick should be adjusted to provide 20 to 30 degrees of elbow flexion.

Supine: From this position the measurement is taken from the anterior axillary fold to a surface point (mat or treatment table) 6 to 8 in. from the lateral border of the heel.

Forearm Crutches

These assistive devices are also known as Lofstrand and Canadian crutches. They are constructed of aluminum. Their design includes a single upright, a forearm cuff, and a handgrip. This catch adjusts both proximally to alter position of the forearm cuff and distally to alter the height of the crutch. adjustments are made using a push-button mechanism. The available heights of forearm crutches are indicated from handgrip to floor and are generally adjustable in adult sizes from 29 to 35 in., with children`s and extra long sizes available as well. The distal end of the crutch is covered with a rubber suction tip. The forearm cuffs are available with either a medial or anterior opening. The cuffs are made of metal and can be obtained with a plastic coating.

Advantages: The forearm cuff allows use of hands without the crutches becoming disengaged. They are easily adjusted and allow functional stair climbing activities. Many patients feel they are more cosmetic and they fit more easily into an automobile owing to the overall decreased height. They are also the most functional type of crutch for stair climbing activities for individuals wearing bilateral knee-ankle-foot orthoses (KAFOs).

Disadvantages: Forearm crutches provide less lateral support owing to the absence of an axially bar. The cuffs may be difficult to remove.

Standing is the position of choice for measuring forearm crutches. From a supported standing position, the distal end of the crutch should be positioned at a point 2 in. lateral and 6 in. anterior to the foot. With the shoulders relaxed the height should then be adjusted to provide 20 to 30 degrees of elbow flexion. The forearm cuff is adjusted separately. Cuff placement should be on the proximal third of the forearm, approximately 1 to 1.5 in. below the elbow.

forearm crutches

Gait patterns for use of crutches

Gait patterns are selected on the basis of the patient`s balance, coordination, muscle function, and weight bearing status. The gait patterns differ significantly in their energy requirements, BOS, and the speed with which they can be executed.

Prior to initiating instruction in gait patterns, several important points should be emphasized to the patient:

  1. During axillary crutch use, body weight should always be borne on the hands and not on the axillary bar. This will prevent pressure on both the vascular and nervous structures located in the axillary region.
  2. Balance will be optimal by always maintaining a wide (tripod) BOS. Even when is a rest stance, the patient should be instructed to keep the crutches at least 4 in. to the front and to the side of each foot. The foot should not be allowed to achieve parallel alignment with the crutches. This will jeopardize anterior-posterior stability by decreasing the BOS.
  3. When using standard crutches, the axillary bars should be held close to the chest wall to provide improved lateral stability.
  4. The patient should also be cautioned about the importance of holding the head up and maintaining good postural alignment during ambulation.
  5. Turning should be accomplished by stepping in a small circle rather than pivoting.

Three-point gait

In this type of gait three points of support contact the floor. It is used when a non-weightbearing status is required on one lower extremity. Body weight is borne on the crutches instead of on the affected lower extremity.

Partial Weightbearing Gait

This gait is a modification of the three-point pattern. During forward progression of the involved extremity, weight is borne partially on both crutches and on the affected extremity. During instruction in the partial weight bearing gait, emphasis should be placed on use of a normal heel-toe progression on the affected extremity. Often the term partial weight bearing is interpreted by the patient as meaning that only the toes or ball of the foot should contact the floor. Use of this positioning over a period of days or weeks will lead to heel cord tightness.

Four-point gait

This pattern provides a slow, stable gait as three points of floor contact are maintained. Weight is borne on both lower extremities and typically is used with bilateral involvement due to poor balance, incoordination, or muscle weakness. In this gait pattern one crutch is advanced and then the opposite lower limb is advanced. For example, the left crutch is moved forward, then the right lower extremity, followed by the right crutch and then the left lower extremity.

Two-point gait

This gait pattern is similar to the four-point gait. However, it is less stable because only two points of floor contact are maintained. Thus, use of this gait requires better balance. The two-point pattern more closely simulates normal gait, inasmuch as the opposite lower and upper extremities move together.

Two additional, less commonly used crutch gaits are the swing-to and swing-through patterns. These gaits are often used when there is bilateral lower extremity involvement, such as in Spinal Cord Injury. The swing-to gait involves forward movement of both crutches simultaneously, and the lower extremities “swing to” the crutches. In the swing-through gait, the crutches are moved forward together, but the lower extremities are swung beyond the crutches.

Assuming Standing and Seated Positions with Crutches

Coming to Standing 

  • The patient moves forward in the chair.
  • Crutches are placed together in a vertical position on the affected side.
  • One hand is placed on the handpicks of the crutches; one on the armrest of the chair.
  • The patient leans forward and pushes to a standing position.
  • Once balance is gained, one crutch is cautiously placed under the axilla on the unaffected side.
  • The second crutch is then carefully placed under the axilla on the affected side.
  • A tripod stance is assumed.

Return to Sitting 

  • As the patient approaches the chair, the patient turns in a small circle toward the uninvolved side.
  • The patient backs up until the chair can be felt against the patient`s legs.
  • Both crutches are placed in a vertical position (out from under axilla) on the affected side.
  • One hand is placed on the handpicks of the crutches, one on the armrest of the chair.
  • The patient lowers to the chair in a controlled manner.

Stair-Climbing Techniques

Crutches: Three-Point Gait


  1. The patient is positioned close to the foot of the stairs. The involved lower extremity is held back to prevent “catching” on the lip of the stairs.
  2. The patient pushes down firmly on both handpicks of the crutches and leads up with the unaffected lower extremity.
  3. The crutches are brought up to the stair that the unaffected lower extremity is now on.


  1. The patient stands close to the edge of the stair so that the toes protrude slightly over the top. The involved lower extremity is held forward over the lower stair.
  2. Both crutches are moved down together to the front half of the next step.
  3. The patient pushes down firmly on both handpicks and lowers the unaffected lower extremity to the step that the crutches are now on.

Crutches: Partial Weightbearing Gait


  1. The patient is positioned close to the foot of the stairs.
  2. The patient pushes down on both handpicks of the crutches and distributes weight partially on the crutches and partially on the affected lower extremity while the unaffected lower extremity leads up.
  3. The involved lower extremity and crutches are then brought up together.


  1. The patient stands close to the edge of the stair so that the toes protrude slightly over the top of the stair.
  2. Both crutches are moved down together to the front half of the next step. The affected lower extremity is then lowered (depending on patient skill, these may be combined). Note: When crutches are not in floor contact, greater weight must be shifted to the uninvolved lower extremity to maintain a partial weight bearing status.
  3. The uninvolved lower extremity is lowered to the step the crutches are now on.

Crutches: Two- and Four-Point Gait 


  1. The patient is positioned close to the foot of the stairs.
  2. The right lower extremity is moved up and then the left lower extremity.
  3. The right crutch is moved up and then the left crutch is moved up (patients with adequate balance may find it easier to move the crutches up together).


  1. The patient stands close to the edge of the stair.
  2. The right crutch is moved down and then the left (may be combined).
  3. The right lower extremity is moved down  and then the left.

Source: Susan B. O`Sullivan, Thomas J. Schmitz. Physical Rehabilitation.


Posted in Knowledge, Rehabilitation | Tagged , , , , , , , , | 1 Comment

Assistive Devices: Canes

There are three major categories of ambulatory assistive devices: canes, crutches, and walkers. In this post, we will talk only about canes. Stay tuned for the next posts about crutches and walkers.

Assistive devices are prescribed for a variety of reasons, including problems of balance, pain, fatigue, weakness, joint instability, excessive skeletal loading, and cosmesis.  Another primary function of assistive devices is to eliminate weight bearing fully or partially from a lower limb. This unloading occurs by transmission of force from the upper limbs to the floor by downward pressure on the assistive device.


Most canes used in current clinical practice are constructed of lightweight aluminum. The function of a cane is to widen the base of support (BOS) and improve balance. Canes are not intended for use with restricted weight bearing gaits (such as non- or partial-weightbearing). Patients are typically instructed to hold a cane in the hand opposite the affected extremity. This position of the cane most closely approximates a normal reciprocal gait pattern with the opposite arm and leg moving together.

Contralateral positioning of the cane is particularly important in reducing forces created by the abductor muscles acting at the hip. During normal gait, the hip abductors of the stance extremity contract to contract the gravitational moment at the pelvis on the contralateral side during swing. This prevents tilting of the pelvis on the contralateral side but results in a compressive force acting at the stance hip. Use of a cane in the upper extremity opposite the affected hip will reduce these forces. The floor (ground) reaction force created by the downward pressure of body weight on the cane counterbalances the gravitational movement at the affected hip. Thus, the need for tension in the abductor muscles is reduced, with a subsequent decrease in joint compressive forces.

Standard Cane

This assistive device also is referred to as a regular or conventional cane. It is made of aluminum, wood or plastic and has a half circle (“crook”) or a straight (or offset) handle . The distal rubber tip is at least 1 in. in diameter or large. It can also be adjustable to the patient’s height using a push-button mechanism (adjustments within the range of approximately 27 to 38.5 in.).

Advantages: This cane is inexpensive and fits easily on stairs or other surfaces where space is limited.

Disadvantages: If it is not adjustable, it must be cut to fit the patient. Its point of support is anterior to the hand, not directly beneath it.

standard cane

offset cane


Quad (Quadruped or Four-Prong Cane)

The characteristic feature of these canes is that they provide a broad base with four points of floor contact. each point (leg) is covered with a rubber tip. The legs closest to the patient’s body are generally shorter and may be angled to allow foot clearance. On may designs the proximal portion of the cane is offset anteriorly. The handpick is usually one of a variety of contoured plastic grips. A telescoping design allows for height adjustments.

Advantages: This cane provides a broad-based support. Bases are available in several different sizes.

Disadvantages: Depending on the specific design of the cane, the pressure exerted by the patient’s hand may not be centered over the cane and may result in patient complaints of instability. As a result of the broad BOS, some quad canes may not be practical for use on stairs. They also warrant use of a slower gait pattern. If a faster forward progression is used, the cane often “rocks” from rear legs to front legs, which decreases effectiveness of the cane. Patients should be instructed to place all four legs of the cane on the floor simultaneously to obtain maximum stability.

quad cane

Rolling Cane

This cane provides a wide wheeled base allowing uninterrupted forward progression. it includes contoured handholds, easy height adjustment from 28 to 37 in., and a pressure-sensitive brake built into the handle engaged using pressure from the base of the hand.

Advantages: The wheeled base allows weight to be continuously applied as the need to lift and place the cane forward is eliminated. This also provides for a faster forward progression. The second and third handles placed between the uprights can assist in rising to standing (brake engaged).

Disadvantages: it is more costly than standard quadruped canes, and requires sufficient upper extremity and grip strength to engage the braking mechanism. This cane is not suitable for patients displaying a propulsive gait pattern (e.g., Parkinson’s disease).


A general consideration relevant to all canes is the nature of the handgrip. There are a variety of styles and sizes available. the type of handgrip should be judged and selected primarily on the basis of patient comfort and on the grip’s ability to provide adequate surface area to allow effective transfer of weight from the upper extremity to the floor. The more common types of handgrips are:

  1. The crook handle
  2. The straight or offset handle
  3. The shovel handle, and
  4. The pistol handle, which conforms to the patient’s hand.

it is useful to have several handgrip styles available for examination and trial with individual patients.

Measuring Canes

In measuring cane height, the cane (or center of a broad-based cane) is placed approximately 6 in. from the lateral border of the toes. two landmarks typically are used during measurements: the great trochanter and the angle at the elbow. The top of the cane should come to approximately the level of the greater trochanter, and the elbow should be flexed to about 20 to 30 degrees. Because of individual variations in body proportion and limb lengths, the degree of flexion at the elbow is generally considered the more important indicator of correct cane height.

This elbow flexion serves two important functions. it allows the arm to shorten or to lengthen during different phases of gait, and it provides a shock-absorption mechanism. Finally, as with all assistive devices, the height of the cane should be considered with regard to patient comfort and the cane’s effectiveness in accomplishing its intended purpose.

Gait pattern for use of canes

As discussed, the cane should be held in the upper extremity opposite the affected limb. For ambulation on level surfaces, the cane and the involved extremity are advanced simultaneously. The cane should remain relatively close to the body and should not be placed ahead of the toe of the involved extremity. These are important considerations, because placing the cane too far forward or to the side will cause lateral and/or forward bending, with a resultant decrease in dynamic stability.

When bilateral involvement exists, a decision must be made as to which side of the body the cane will be held. This question is most effectively resolved by a problem-solving approach with input from both the patient and the therapist.

gait pattern with cane

Assuming Standing and Seated Positions with a Cane

Coming to standing

  • Patient moves froward in chair.
  • Cane is positioned on uninvolved side (broad-based cane) or leaned against armrest (standard cane).
  • Patient leans forward and pushes down with both hands on armrests, comes to a standing position, and then grasps cane. With use of a standard cane, the cane may be grasped loosely with fingers prior to standing and the base of the hand used for pushing down on armrests.

Return to sitting 

  • As the patient approaches the chair, the patient turns in a small circle toward the uninvolved side.
  • The patient backs up until the chair can be felt against the patient`s legs.
  • The patient then reaches for the armrest with the free hand, releases the cane (broad-based), and reaches for the opposite armrest. A standard cane is leaned against the chair as the patient grasps the armrest.

Stair-Climbing Techniques


  1. The unaffected lower extremity leads up.
  2. The cane and affected lower extremity follow.


  1. The affected lower extremity and cane lead down.
  2. The unaffected lower extremity follows.

Source: Susan B. O`Sullivan, Thomas J. Schmitz. Physical Rehabilitation.

Posted in Knowledge, Rehabilitation | Tagged , , , , , , , , | 2 Comments

Is warming up and cooling down a waste of time?

You must have seen athletes warming up before their competitions. Why do they do it? Well, it has multiple benefits. If you have ever struggled with muscle soreness after exercise, maybe it was because you skipped the warm-up.

The warm-up depends on the sport, your age and level of activity. However, at minimum you need to spend 5 to 10 minutes of activity (longer in winter) involving the muscles you are about to tax in your workout. A warm-up should always begin gently, gradually building up to the level at which you train or play.

warm up

So what does a warm-up really do? Well, it raises your body temperature where the warm muscles can be stretched safely. It prepares you for action. It raises your breathing and heart rate, so that your muscles and other organs receive extra oxygen and nutrients to cope with a bout of strenuous work.

When you stretch gently, it makes your muscles more flexible. This prevents muscle injury due to a sudden stress on an unprepared muscle. The slow pace also helps you to concentrate on good form before you actually start exercising.

A warm-up could be a short walk or ride on an exercise bike. Follow up with another 5 to 10 minutes of gentle stretches, keeping within your activity range. Be sure you know how to stretch safely. If you need some help, please contact our friendly staff.

Cooling down after your workout is just as important. Here, you allow your muscles to relax slowly. As the body winds down, the lactic acid which has built up in your muscles dissipates. This makes sure your intense muscular activity doesn’t upset your body’s functioning. Cooling down also helps your mind come back to its normal routine. A few static stretches help your muscles reach their maximum flexibility while they are still warm. They can then relax to their resting length instead of remaining cramped and knotted.

Cooling down can be as simple as continuing to run at a slower pace for another 5 to 10 minutes, or using the exercise bike at walking pace.

A word about stretches might be useful:

  • Never stretch to the point of pain
  • Stretch only after warming up.
  • Stretch actively during the warm-up: do static stretches when you cool down.
  • Stretch all muscles that you intend to work out.
  • Use your breathing to ease your stretching: inhale deeply while getting into position, exhale during the stretch.
  • Stretch slowly and listen to your body.
  • Never bounce or stretch rapidly if you don’t want to hurt your muscles or tendons.
  • Hold your stretch as far and long as your comfort level.

We can teach you to stretch and warm-up safely, and add value to your exercise routine. Get in touch with us if you are planning to start an exercise routine. You’d be amazed what a difference warming up and cooling down can make to your workout.


When your physiotherapist needs an X-ray

Physiotherapists are health professionals trained to recognise and treat various conditions that make movement difficult or painful, and restrict your functioning. We use a wide range of skills to restore function to the affected part. They also assess your posture and look for any other issues. They work with you to devise and help in carrying out plans to prevent and correct harmful lifestyle patterns. This could include exercise plans, joint mobilisation and physical treatments like massage.

We are trained to diagnose your condition through careful physical examination. However, physiotherapy may not be not suitable for all conditions. In some situations, we may need X-rays to confirm a diagnosis or to refer you to another professional better qualified to deal with your situation.



Quick tip

When you decide to increase the length of your workouts, do so gradually, no more than 10% at any time. Ease your body gently up to the next level and you will reap the rewards without injury.



I wouldn’t say anything is impossible. I think that everything is possible as long as you put your mind to it and put the work and time into it.

~ Michael Phelps



Posted in Advice, Encouragement, Exercise, Knowledge, Rehabilitation | Tagged , , , , , , , , , , , , , , , , | 1 Comment

Better rehabilitation starts in the mind

If you’re in rehabilitation, you probably had a major surgery, an accident which knocked you out of action for some time, or you’re suffering from overuse injuries. Or you may be trying to get back to active sports from a ligament tear or other serious injury.

The most important thing about rehab is that it takes time, patience and commitment. Rehabilitation is no magic bullet. When your body is injured, it takes time to heal.

Physiotherapy is a keystone of rehab for some very good reasons. One is that therapists provide an interface between the patient and the doctor. For many reasons, physicians often cannot take time for an extensive discussion of the patient’s condition. The therapist, however, takes time to completely assess flexibility, the presence of painful spots and tight soft tissues, balance and coordination at various joints. Once this is over, your therapist will be able to prescribe the right balance of exercise and healthy lifestyle to relieve pain, enhance flexibility, and restore normal function.


However, this is optimised when your mind is confident and cooperative. This is really where it all starts. Resistance to a therapy limits its effectiveness. If you have already written off your recovery, your body gets the message. Nothing but terrific determination on the part of your therapist can produce even a little improvement in such cases.

So, the first step in successful rehabilitation is to assure yourself of great results. Your attitude matters. You are the one going to work with the physiotherapist. You cannot be passive, or expect something to be done for you. It’s your willingness to work hard and consistently that succeeds.

Look one step beyond. Read success stories. Reassure yourself that this pain will result in your good health. See yourself walking, taking care of yourself, enjoying life. Hold this picture before your mind to make lighter work of your rehabilitation.

Make sure you know how much progress you should expect at a minimum — and see yourself well beyond that! Let your friends and family support you. When you feel anxious, talk it over with someone. They can identify unrealistic fears — a real lifesaver if you’re headed for depression.

This kind of support also helps when pain and low motivation put you off. At such times, it’s marvelous to have someone nudge you through with some wisdom and practical strategies on getting moving when you don’t want to!

Your physiotherapist can also help you with stress-relief and relaxation techniques. Less stress means greater ease during therapy, and fosters the healing power of your body. As it becomes a habit, you’ll see its benefits in every area of your life!

So upgrade your thinking. While unrealistic thinking is no virtue, positive attitude is a wonderful asset which can take you forward on your journey. Harness the power of your mind and get well faster!


Aerobic Vs anaerobic exercise

Aerobic exercise includes jogging, swimming and cycling. It uses oxygen to convert stored body fuels to energy for movement. Aerobic exercise can be sustained over long periods. Lactic acid is not produced in your muscles. It boosts your long-term stamina by getting your heart to pump better and stronger with a slower rhythm as it strengthens. It improves overall quality of life as it burns fat, increases fitness, improves mood and reduces risk of diabetes.

Anaerobic exercise is more intense and demanding, such as weight lifting and sprinting flat out. It runs on stored as fuel. Anaerobic exercise helps build lean muscle mass since calories are burned more efficiently in bodies that have more muscle. During anaerobic exercise, the body builds up lactic acid in the muscles which lead to soreness and need for recovery time. Overtraining, stress and burnout or injury are its chief drawbacks.

Which one is right for you? Visit us for an assessment and exercise program. We can help you reach your health goals, whether that is fitness, weight-loss, flexibility or strength.



Quick tip

Pull in your stomach muscles when you walk. This is a great, but simple way to help tighten those stomach muscles.



Running is one the best solutions to a clear mind.

~ Sasha Azevedo

Posted in Knowledge, Rehabilitation | Tagged , , , , , , , , , | 1 Comment

Guide to exercise equipment: Part 2

The pitfalls of buying “infomercial” exercise equipment

The desire to get physically fit sometimes drives people towards impulsive, silly and expensive purchasing decisions. Unfortunately, the fitness industry is rife with gimmicks that not only fail to produce the claimed results, but are also dangerous and pose serious health hazards.

The right exercise equipment can really enhance your well-being. However with skyrocketing prices on the latest machines, it’s very tempting to look for shortcuts and “knock-off” products to save a few bucks.

Nobody is more conscious of consumer tendencies than online shopping channels and their infomercial creators. Their marriage to fitness and nutrition corporations is long established and the formula for selling fitness equipment to viewers is pretty simple:

  • Bring out a noted fitness expert to praise the latest, “state-of-the-art” product.
  • Have sexy professional models showcase their beach body physiques, which they do not owe to the product.
  • Use “before and after” testimonials from so-called average folks to demonstrate credibility to the viewing audience.
  • Finally, provide a “too good to be true” offer with easy monthly payments to clinch the sale.

infomercial fitness equipment

These seduction tactics produce millions of dollars in annual sales, but judging from user feedback, many people continue to be left frustrated and unsatisfied with their purchases. Why? It may all come down to not asking yourself the golden question before pulling out your credit card, i.e.:

“Is that shiny product or home-exercise video the right choice for me?

Many buyers are seduced by unrealistic fitness expectations, ignoring issues like:

  • Shipping and handling costs.
  • Guarantees and extended warranties.
  • Assembly details and technical support.
  • Ongoing maintenance issues and costs.

Top of the line home gym systems usually have a 3-4 year payback period versus an average monthly gym membership, assuming regular use. If you are new to physical fitness, it may be better to join a local gym just to avoid the aggravation of bulky equipment ownership, at least in the short-term.

We all want to lead healthy lives, but buying expensive equipment is often a big gamble that we can easily do without. Sometimes, a smaller investment (e.g. yoga or Pilates set, resistance bands, skipping rope, some free weights, etc.) is more advisable, especially for beginners in lifestyle fitness.

The bottom line is this: While many legitimate shopping channels and internet websites sell exercise equipment, it is always “buyer beware”when it comes to your health. Do not buy fitness equipment through late night infomercials, internet marketers and auction sites unless you have thoroughly researched essential product and performance details from several independent sources.

It’s the only way to expose the fine print, especially facts that are conveniently omitted from infomercial sales pitches. Plus, it will help you avoid scams and keep you from collecting or trashing unused, unsatisfactory equipment.

Another point of concern is that inventors are continually coming up with newer equipment and machines, with more “interesting ways to move” during exercise. However correct form and movement technique when exercising is crucial. Using poorly engineered equipment that promote bad form is a recipe for injury.

Before making a major gym equipment purchase, discuss your needs with your physiotherapists during your next appointment. We have a wealth of experience when it comes to exercise products and our advice will be invaluable on the road to a better workout experience.


Quick tip

Put your knife and fork down between mouthfuls. This will slow down your eating and help your digestion. It will also stop you shovelling in mouthfuls without really thinking what you are eating.



It is health that is real wealth and not pieces of gold and silver.

~ Mahatma Gandhi


Funny thought of the day

The brain is the greatest organ in the body because it is the one telling you that it is.


Posted in Advice, Encouragement, Knowledge | Tagged , , , , , | Leave a comment

Guide to exercise equipment

Everyone wants to get into great shape, but it feels like only a select few actually achieve their fitness goals while exercising at home.

One reason may be the difficulty people experience when selecting and using exercise equipment. Thanks to a growing number of fitness centres and home exercise enthusiasts, global equipment sales exceed billions of dollars annually. However, is it really worth your time and money? How do you choose?

In this two-part article, we’ll discuss what to look for in popular exercise equipment for the home.

Treadmills and other cardio machines

Treadmills are arguably the most popular exercise machine. They allow you to walk or run in one place, thanks to a conveyor belt platform that’s powered by an electric motor. The treadmill has evolved over the years to remain a favourite choice for convenient exercise.


Exercise bikes, elliptical trainers, rowers and step (stair) machines are other cardio machine options. Although we focus on treadmills, the points below are relevant for these machines too.

While treadmills can play an integral role in fitness, weight management and toning, you should be aware of some common disadvantages like:

  • Boredom and monotony (i.e. less fun than outdoor exercise).
  • Less natural movement (i.e. develop bad running habits, risk of injury).
  • Long-term costs (i.e. purchase, warranty, electricity, repairs, etc.).

If you are already a gym member or enjoy the outdoors, you will want to spend your fitness dollars elsewhere. On the other hand, buying a basic treadmill can serve as an ideal entry point for regular, moderate physical activity.

You will need to decide where you will place your treadmill within your home. The garage is a safe bet, but may not provide you with inspiration. Living rooms are great for motivation in front of the TV (and staying within your mindspace), but take up your family space.

With costs ranging anywhere from a few hundred to few thousand dollars, it’s important to focus on basic features before bringing a treadmill into your home. Choose a machine that suits the space avilable; very few machines are easy to move around the house. It needs to be solid-built. On a tighter budget, you could easily opt out of features like computerised programs and heart-rate monitors. As long as you can easily control your exercise intensity, you will get a good work out. Also consider things like delivery, setup and warranty.

Treadmill injuries are a thing! Make sure you know how to use your equipment safely. If in doubt, ask us for advice.

Home gyms

D.I.Y. home gyms are popular where:

  1. People don’t have access to a neighbourhood gym.
  2. Commercial gyms are too expensive, too crowded or not open at suitable hours.
  3. People prefer to workout in the privacy of their own home.

Home gyms are to muscular strength, as treadmills are to cardio and fitness. The range of options is astounding. For a couple of hundred dollars or less, beginners can get going with a set of resistance bands and some free weights; throw in some Pilates or yoga gear for balance and flexibility exercises. However, if you’re looking to get muscular, your equipment should be able to cover all the major muscle groups.

Depending on your goals, you could get away with a bench, barbell rack, barbell bar, various weights (plates) and several pairs of dumbells of various weights. Expect to spend a several hundred dollars. You could always purchase more weight plates and dumbells as you get stronger.

For a more complete setup, you can purchase machines with cables, pulleys and pin-loaded weights. However these are not cheap. They also take up significant room in your home. Some “all-in-one” machines are ok, but most of the budget versions are not worthwhile. Unless you have unlimited space and funds, you should steer away from machines that target specific exercises or muscles. As you gain experience, you will better understand your changing needs. So it’s best to keep your initial purchases to timeless essentials.

Here are some general purchasing tips to consider for any type of exercise equipment:

  • Research, research, research: Avoid in-store sales pressure and extra charges by defining your needs first (budget, essential and “nice to have” features, maximum space requirements, etc.). You can always get advice from your physiotherapist.
  • Compare reviews: Chances are that hundreds, if not thousands of people have purchased the exact equipment you’re considering right now. Look at what actual buyers have to say and note of the differences in features between your preferred choices.
  • Look online for special deals: You can often find free shipping, assembly help and great discounts with a little Internet research. Buying direct from the manufacturer is usually a great option.
  • Search local classifieds: People quit weight training all the time for whatever reason. You could pick up a bargain, as long as you know exactly what you need and what you’re getting.

NB: You should seriously consider getting advice from a physiotherapist or personal trainer first, if you are new to weights training and have little idea about such equipment, exercises and movement form. It is very easy to seriously injure yourself with these machines.

Also remember that motivation and injury are possibly the biggest barriers to exercising. You can boost your motivation in many ways. However if you are injured, you should seek professional advice before starting an exercise routine and getting hurt even more. Give us a call and make an appointment.

Quick tip

Replace bad fats with good ones. Get rid of vegetable oils, such as corn and sunflower and replace them with olive oil and almond oil.


A healthy attitude is contagious but don’t wait to catch it from others. Be a carrier.

~ Tom Stoppard

Funny thought of the day

Candles are just pet fires.

Posted in Encouragement, Exercise | Tagged , , , , , , , , | 1 Comment

7 fitness blunders – and how to avoid them

Even if you don’t have a perfect body, you need to be healthy enough that you can live and move with ease and efficiency. But the path to fitness is littered with obstacles. Read on to find out some of the most common roadblocks and how you can get over them. Then call us – we’d be delighted to help you deal with them!

Lack of time

Include movement and activity into your daily routines. Don’t drive when you can walk. Take the stairs. Do squats while watching TV at nights.

You don’t like exercise

Grow flowers, walk your dog or do whatever gets you moving. Paint a mental picture of the level of health and enjoyment that you’d love to have.


Lack of money

It doesn’t cost wads of money to get fit. Anyone can tone up with minimum fuss and no special equipment. Focus on right exercises and technique, rather than tools. We can help you get started.

Boring routines

Enjoy your playtime! Get the fun back into working out. Change up your routine every few weeks. Learn new exercises or do more reps. Join a group class or challenge a friend. Don’t get stuck in a rut.

Expecting instant results

Health won’t come overnight. Fitness is not a fix, it’s a lifestyle. If you cut out the excuses and resist the craving for instant gratification, you’ll learn a new way of living. And don’t try to do too much too soon. Start easy and concentrate on good technique first.


Do you head for the gym on weekends just because you don’t really feel like household chores? Bursts of weekend activity are never going to get you to where you want to be. Instead, commit yourself to regular and frequent activity, no matter how small you start.


Lack of motivation

Think of one activity you always longed to do but never had the strength or courage for. Re-imagine it over and over. Can you actually see yourself doing it? Now you know what you’re aiming for. Set your workout steps to achieve it. And savour the glow of wellbeing that comes with each workout.

If you’re still struggling to get fit, give us a call (480) 335 2747.

We’ll help you understand what’s going on and how to get results!


Posted in Advice, Encouragement, Exercise | Tagged , , , , , , , , , | Leave a comment

Carbohydrate myths

food myths

When it comes to weight control, carbohydrates get a bad rap. In the past, fats were the bad boy, driven mostly by misinformation. However, the truth is in finding the right dietary balance; not indiscriminately excluding a key macronutrient.

The real problem with carbs is that we often don’t know what a portion should look like. So we eat way too much of it. If you’re not pairing carbs with fats or proteins, you probably won’t feel full.

Bread and pasta are not the enemy. Again, it’s the portions and the type of grains you pick that kill your weight-loss goals.


Pick a whole-grain option whenever possible, which has more fiber to keep you feeling fuller for longer. Whole-wheat bread, brown rice, ancient grains like quinoa and bulgur are good options. At the store, choose bread with five grams of fiber per slice.

Get the right kind of carbs by cutting out processed goods, sugary drinks, sweets, and packaged / convenience foods from your diet; they’re all packed with empty carb calories. Starchy veggies (potatoes, sweet potatoes, squash, corn, and lentils) and fresh fruit have more fiber.

Unless you have specific dietary requirements or allergies, carbs are a good source of fuel your body. Don’t throw them out; instead, focus on healthy carbs and a balanced diet.

Posted in Advice, Knowledge | Tagged , , , , , , , , | 1 Comment

Repetitive Motion Injury

What is a repetitive motion injury (repetitive stress injury)?

Repetitive motion injuries, also called repetitive stress injuries, are temporary or permanent injuries to muscles, nerves, ligaments, and tendons caused by performing the same motion over and over again. A common repetitive motion injury is carpal tunnel syndrome. This disorder occurs when the median nerve, which travels from the forearm to the hand through a “tunnel” in the wrist, is compressed by swollen, inflamed ligaments and tendons. It is often seen with people who use computer keyboards or work on assembly lines.

The injury can be quite painful and can also cause numbness, clumsiness, and a loss of motion, flexibility, and strength in the area. It can worsen over time without treatment, and can result in a complete loss of function.

  • Facts about carpal tunnel syndrome

According to the National Institute of Neurological Disorders and Stroke, the dominant hand is most commonly affected and renders the most severe pain. Women develop carpal tunnel syndrome three times more frequently than men. Carpal tunnel is likely more common in people with a congenitally smaller tunnel space. Trauma or injury to the wrist, thyroid disease, rheumatoid arthritis, diabetes, and pregnancy can also contribute to the disorder. It usually occurs only in adults.

carpal_tunnel-300x285 carpal-tunnel-syndrome

Rehabilitation for repetitive motion injuries

A rehabilitation program for repetitive motion injuries is designed to meet the needs of the individual patient, depending on the type and severity of the injury. Active involvement of the patient and family is vital to the success of the program.

The goal of rehabilitation after a repetitive motion injury is to help the patient return to the highest level of function and independence possible, while improving the overall quality of lifephysically, emotionally, and socially.

In order to help reach these goals, repetitive motion injury rehabilitation programs may include the following:

  • Exercise programs to stretch and strengthen the area
  • Conditioning exercises to help prevent further injury
  • Occupational therapy
  • Heat or cold applications
  • Use of braces or splints to immobilize the area
  • Pain management techniques
  • Patient and family education, especially regarding proper ergonomics for the workplace (ergonomics is the science of obtaining a correct match between the human body, work-related tasks, and work tools)

The rehabilitation team for repetitive motion injury

Rehabilitation programs for repetitive motion injuries are usually conducted on an outpatient basis. Many skilled professionals are part of the repetitive motion injury rehabilitation team, including any or all of the following:

  • Orthopedist/orthopedic surgeon
  • Neurologist/neurosurgeon
  • Primary care doctor
  • Sports medicine doctor
  • Occupational medicine doctor
  • Physical therapists
  • Physiatrist
  • Occupational therapist
  • Vocational counselor
Posted in Advice, Knowledge | Tagged , , , , , , , , , | 2 Comments