To Stretch or Not To Stretch?

To Stretch or Not To Stretch?

All joints are not created equal.  The joints in our body are in a constant balance of mobility and stability.   Some joints are made with more freedoms of movement than others which is often balanced out by the stability of the muscles around the joints.   Dysfunction and pain arise when this balance is disrupted.

For example, hip stiffness can be brought on by a tight hip capsule which is often a compensation of an arthritic hip joint.   If your hip is stiff and presenting with less motion, your lumbar spine will provide extra movement to compensate for the stiff hip.  This can lead to hypermobility (think extra motion) of the lumbar spine which can lead to low back pain.  

If your lumbar spine is hypermobile for compensating for your stiff hip, the muscles around your spine will often increase in resting tone or tension to protect the joint.  Specifically, your hamstrings will increase in tone and adaptively shorten (literally shorten up) to create its own sense of stability.    Unfortunately when someone has back pain, the first thing many people reach for is a strap to stretch the hamstrings which may not be what lumbar spine needs at that time.  Instead, you should be first strenghten the core, improve the mobiltiy of the hip and than think about restoring the proper length of the hamstring muscle.

To be clear, most stretches are effective however many people immediately stretch a stiff or tight joint which can be doing more harm than good.  The next time you get that urge to stretch be sure to talk with your physical therapist to analyze your movement pattern and lead you in the right direction regarding proper mobility and stability for your body.

Sole Supports Custom Orthotics Available at Mana Physical Therapy

Sole Supports Custom Orthotics Available at Mana Physical Therapy

Low back, hip and knee pain can be the result of poor biomechanics at your foot and ankle. Your body requires proper stabiity and support from the ground up.  Poor biomechanics can be the result of ineffective dynamic stability (think muscles) or can be static (think ligament) or bony faults.  Dynamic stability can be improved with physical therapy however static or bony abnormalties can be more difficult to improve with conservative skilled physical therapy- this is where orthotics  can make a huge difference.

Foot orthotics are rigid (or semi -rigid) inserts that you put in your shoes to provide improvements to abnormal biomechanic faults in your ankle or foot.  There are two types of foot orthotics:  Over-the-counter (OTC) orthotics and custom orthotics.   

OTC orthotics are not custom- you can pick these up at your local medical equipment or sporting goods store.  These can be effective however they are not fabricated from a mold of your foot and do not allow for specific adjustments.  Custom orthotics on the other hand are created from a negative inprint  of your foot which provides invaluable information of your foot type which can yield a more effective orthotic.

Here at Mana Physical Therapy, we are one of the few certified providers of custom foot orthotics through Sole Supports in the area!  The process takes ~ 10 minutes in our office and consists of us taking a detailed mold of your foot which is then sent out to be fabricated.   Your orthotic arrives in 1-2 weeks and most insurances cover at full cost

If you are curious about orthoics , think Mana first!

Check the video below for additional details:

Cycling:  Tips from Your Physical Therapist     |    Mana Physical Therapy

Cycling: Tips from Your Physical Therapist | Mana Physical Therapy

Cycling season is upon us!  

Cycling can be a safe low impact exercise for people of all ages.   It provides excellent aerobic and anerobic activity to promote cardiovascular health.  Injuries can arise often low back, hip and knee dysfunctions.  Often, poor biomechanics can lead to injury when using a new bike or biking an unfamiliar trail.    If you are starting to bike ride for the first time or are a long time rider, stop into Mana Physical Theray for a bike evaluation.

Happy Nurse Appreciation Week!!      |     Mana Physical Therapy

Happy Nurse Appreciation Week!! | Mana Physical Therapy

The American Nurse Association is promoting National Nurse Week during May 6-12th

Mana Physical Therapy would like to extend our appreciation for all the nurses in NJ and the country who provide unwaivering care, skill and professionalism in the promotion of health and wellness.  

Thank you for everything!


Reduce your Risk of Falling:  3 Balance Exercises to Perform At Home

Reduce your Risk of Falling: 3 Balance Exercises to Perform At Home

Your ability to balance is dictated by 3 main inputs from your body:  your visual system, your proprioceptive system and your vestibular system.   Your visual system provides visual input, proprioceptive system gives your joints positional sense in space and your vestibular system is part of the inner ear giving you sense of momentum, gravity and spatial awareness.

For example, walking on the beach on uneven sand and adapting gracefully is partly based on the effectiveness of your propriceptive system (and the muscles in your core and legs).    If you have been sitting in a parked car while the car next to you pulls out, your inner ear is giving your brain feedback of equilibrium, gravity and space.

As we get older, we start to lose the mass of the muscles in our core and lower extremities which can lead to weakness.  In addition, the 3 systems discussed above often start to lose effectiveness which can increase your risk of falling.    Here are 3 exercises that you can easily perform in your home to improve your balance and lower extremity strength.   

Be sure to check with your physical therapist before you attempt any exercises on your own.   In addition, perform all of these exercises in front of a sturdy and stable surface.


1. Tandem Standing/Walking

Stand with one foot in front of the other.  Hold this for up to 30 seconds.  Repeat this 5-10x. You can add a challenge by closing your eyes or performing on an uneven surface (throw pillow).

As your abiity to hold this position improves, you can start to walk along an imaginary line, heel toe walking (tandem walking).  Repeat for 10 steps, back and forth, for up to 4 laps.  To add additional challenge, turn your head slowly to the left and right as you walk forward and backward.

2.  Single Leg Standing 

Stand on one leg for up to 30 seconds.  Keep your eyes open.  Perform in your bathroom so you have the countertop/sink to hold on to.  To make it seem less like an exercise, perform morning and night while brushing your teeth.   Perform up to 5x for each leg.  

If performing with your eyes open is easy, try closing your eyes.  If this gets easy, try standing on a throw pillow.

3.  Side Walking (Karoke)

Stand in front of a kitchen counter top.    Place one foot in front the other.  Repeat with the other leg by placing behind the previous.  Repeat this for 10 steps and return back to the start point.  

If you are having difficulty coordinating this movement, perform side steps to each side and return back.  Be sure to keep your knees straight and your toes pointed forward.

For additional strategies to improve your balance and strength, reach out to your local physical therapist.  Here at Mana Physical Therapy, we strive to be your practitioner of choice regarding physical therapy care in the region.


Theragun now at Mana Physical Therapy!

Theragun now at Mana Physical Therapy!

Theragun treatment is now available at Mana Physical Therapy. Theragun works to increase blood blood, decrease tension in the muscles and to decrease pain. This is beneficial right before an athletic event or recovering from a hard workout or a long day at work. It is also useful to use right before corrective exercise strengthening exercises so you can achieve full range of motion without compensation. 

Currently, The TheraGun is being used by pro teams and athletes in the in professional football, baseball, basketball, hockey, soccer, and universities. Many of these athletes state their performance and recovery is drastically enhanced when having it applied by their trainers and physical therapists.

Come in for a free 10 minute trial to see how it can help you recover, perform better and decrease pain.

Maintaining Spine Health:  Machines To Avoid At the Gym

Maintaining Spine Health: Machines To Avoid At the Gym

Many people access local gyms due to the convenience of having large amounts of fitness equipment in one building.  Most gyms contain numerous fitness weight machines that make working out easier and (hopefully) less complicated.  The downside of weight machines are they rarely are as functional as the engineers set out to make them.  In addition, many machines create undue stress or potential for injury throughout your body.    Here are a few machines to avoid to maintain your back health.


1.       Prone Hamstring Curl Machine

The hamstring curl machine is a common staple in most gyms.  This machine comes in two main types which affects how the client is positioned, either sitting upright or stomach down (prone).

The problem arises if you have only access to the prone machine- by laying on your stomach and curling your heels to your buttocks, you are creating significant stress on your back.  Avoid this at all times especially if you have a history of back dysfunction. 

Stick with the hamstring machine where you are able to sit up- this is much safer on your spine and can still target the hamstring effectively. 

Prone Hamstring Curl

Prone Hamstring Curl

Seated Hamstring Curl

Seated Hamstring Curl


2.       Leg Press Machine

The leg press machine is a great work out for hips and knees with the ability to add increased load to your squat form.  

There are a few different types of leg press machines that are common these days:  upright and horizontal. These two types can be separated into two mechanisms- either the plate your feet is on moves up and down (horizontal) or the plate your feet is on stays static and your body moves up and down (upright).

Avoid the horizontal leg press- this machine forces your hips into excessive flexion which increases the relative bend of your spine.  This added spinal flexion with the added load through the machine can create excessive loads through your back.    Be sure to find a gym that has an upright leg press- it mimics your squat form and is less stressful on your back

Horizontal Leg Press

Horizontal Leg Press

Upright Leg Press

Upright Leg Press


3.       Abdominal Cruncher

The Abdominal crunch machine is considered a “fundamental” core exercise machine- at least many people think it is.  Do not waste your time with this.  

The exercise actually does not work on your core but instead works on the large superficial muscles in the front of your stomach.  The larger, superficial muscles (think six back abs) are the power movers and can only work effectively if your core is strong.

Core muscles are small and deep- these muscles are your postural muscles and are always firing to provide a good base of support for the larger spine muscles to work effectively/efficiently.   Core muscles respond to small, coordinated movements.  The repetitive motion of the ab cruncher targets the larger muscles which creates excessive force through your spine- this should be avoid.  

If your wondering what core exercises are ideal for your spine, ask your physical therapist!

Ab Curl Machine

Ab Curl Machine

So Your MRI Showed Something "Abnormal"?

So Your MRI Showed Something "Abnormal"?

If you have a few minutes to spare, check out the video below.

Dr. Bahram Jan, a physical therapist, explains how patients (and healthcare providers) use imaging results to link correlation and/or causality with dysfunction in their bodies.  

Clinically, it is important to understand that "abnormal" findings on imaging (i.e. MRI) may not correlate to abnormal dysfunction.  In other words, a patient who has medial and lateral meniscal tears and moderate osteoarthritis may have less pain and dysfunction than another patient who has mild osetoarhritis.    Many individuals will chose surgery to "fix" the abnormal structures that were discovered on imaging when all they needed was specific movement pattern adjustments and corrections.    

(FXNL Media)

Promoting Shoulder Health:  3 Exercises to Avoid At The Gym

Promoting Shoulder Health: 3 Exercises to Avoid At The Gym

Many patients ask us what exercises they should perform when they are ready to return back to previous lifting routines.  The best balance is a few pushing and pulling exercises to target the main movers and shakers of your upper quadrant (in addition to your corrective exericise program provided by your physical therapist). 

Here are a few exercises that you should eliminate from your routine immediately (your shoulders will thank us in the future!). 

1.       Standing Overhead Cable Curls (Crucifix Curls)

Crucifix Curls

Crucifix Curls

I see many people performing this exercise at the cable curl machine.  This exercise takes the cake as the worst exercise you can perform for your shoulders. 

By adding stress to your elbows in the start and end position, you are creating significant tension to your labrum through the pull of your bicep.    Your labrum is connective tissue that acts as a vacuum seal for your shoulder joint- if you tear or stretch this out, you will often complain of instability and dislocations/subluxations of your shoulder.

Avoid. Avoid. Avoid.  


2.       Standing Upright Row

Upright Row Dumbbells

Upright Row Dumbbells

This is a staple for many bodybuilders and fitness conscious individuals.   This exercise is performed with dumbbells, a barbell or kettlebell.   

The main problem with this is exercise is the over excursion during the end of the exercise- by pulling your elbows up to your ears you are creating significant stress in the shoulder which can lead to rotator cuff dysfunction. 

Try performing bent over rows (kneeling over a weight bench) which will target similar muscles and save your shoulder for the long haul


3.       Behind the Neck Latissimus Pulldown

Behind the Neck Pulldown

Behind the Neck Pulldown

Latissimus pull downs are a solid exercise for the upper quadrant however many people perform the exercise inappropriately.

By lowering the bar behind your neck, you are creating increase sheer in the neck which may result in cervical disc pathology or muscle strains in your neck

The hand placement in the picture is ideal (overhand grip); just pull the bar down to the top of your chest and control back up- never behind the head




Active Release Technique at Mana Physical Therapy

Active Release Technique at Mana Physical Therapy

Muscles are one of the main structures that help your body adapt to stress and tension throughout your day.  Muscles perform best when they are in optimal length, similar to the mechanics of a swing door- if there is force on one end muscle, the other end of the muscle will provide a counter force to balance the tension.  Gravity is a main force that challenges your body on a constant basis.

Take the simple task of sitting in front of a computer.   Over the span of a few minutes or hours, gravity will slowly pull your body forward.  Your shoulders will round forward, your neck will pull your head forward and your stomach will lean closer to your hips.  If this repetitive position is kept up over a period of time (months to years), muscles in the front of your neck, chest and hips will adaptively shorten (and tighten) and the muscles on the back of your neck and back and hips will lengthen to adapt to your posture.   This adaptation leads to poor muscle performance which often leads to the formation of adhesions in the muscles, tissues and nerves.   Often, this adhesion formation and impaired muscle tension will lead to pain and dysfunction throughout your kinetic chain.

Active Release Technique (ART) is a hands on manual technique that combines precisely directed tissue tension with specific patient movements (active or passive) with the goal of breaking up adhesions and promoting optimal muscle/tissue performance.     At Mana Physical Therapy, we are certified providers of ART for the spine and upper and lower lower extremities. We offer true one-on-one care consisting of highly skilled manual techniques and exercise correction to provide a unique physical therapy experience.  

Is Physical Therapy More Effective Than Narcotics for Chronic Pain?

Is Physical Therapy More Effective Than Narcotics for Chronic Pain?

Instant Gratification.   

We often want a quick fix for everything in our lives and pain is no different.   Chronic pain is typically defined as pain that is present for 6 months or longer.   The study of pain, called pain science, can be complicated and is beyond the scope of this blog, however a simple concept to understand is that chronic pain is processed differently in the brain than acute pain (post-surgical pain, pain felt immediately after a trauma, etc).   

People dealing with chronic pain often express how much it changes them- physically, emotionally and spiritually.    Unfortunately, many people use narcotics to treat pain (acute or chronic) to get relief which often results in an addictive cycle.   

Studies are consistently showing that skilled physical therapy is safer (obviously!) and more cost effective than narcotics.  Be sure to think physical therapy first before you ask your physician for medication to treat pain.

Perfect Posture:  Does it Exist?

Perfect Posture: Does it Exist?

Happy Friday!!

If you have a few minutes to spare this weekend, check out this video regarding posture.  

Dr. Greg Lehman, who is both a physiotherapist and a chiropractor in Canada, discusses his views on "perfect" posture.  He has a background in both biomechanics as well as pain science which helps provide a unique perspective.  The video is very well done and provides great insight.  



Analyzing the "Big Picture" At Mana Physical Therapy

Analyzing the "Big Picture" At Mana Physical Therapy

Relative to musculoskeletal problems, "regional interdependency" refers to the concept that a complaint of pain or dysfunction in one region of your body (i.e knee pain) may be associated to a dysfunction in an unrelated anatomical region (i.e stiff hip joint).[1]    Although this concept is not ground breaking, it is crucial that we do not underestimate "the big picture" when assessing movement dysfunction in the human body.

Take patient A for example (we will call him Kramer).  Kramer enters your office with a script for right knee pain.  Kramer reports his chief compalint is pain and weakness in his right knee while ascending and descending stairs during work at his bagel shop and when entering his home.   He has X rays of his right knee which show minimal osteoarthritis.  This pain has been on and off for 2 months but progressively getting worse and more constant.

Often, difficulty with ascending/descending stairs is due to quadriceps weakness (the muscle in the front of your thigh), however, our hip, trunk, and even ankle can limit your ability to perfrom this functional task.  For example, if our hip rotators are weak or stiff, they will not have the proper balance of strength or motion to assist the quadriceps with the task.  If your trunk is weak, it will not provide the proper stable base to perform the task.  If your ankle joint is stiff, the force transmitted up your kinetic chain will ask your knee and hip to work even harder.   

Commonly, pain in the knee is caused by poor function and weakness in the hip or trunk (and vice versa).  In addition, knee pain can also be amplified due to poor mechanics or lack of mobility in the ankle.   As a physical therapist, it is our job to assess the whole body to gain a true perspective of how your body system is performing (and not just focus on the body part that is painful!)

Here at Mana Physical Therapy, we are trained and certified in Selective Functional Movement Assessment (SFMA).  SFMA is a full body dynamic movement assessment that exposes small and large imbalances in your kinetic chain.  As a certified provider of SFMA, we will examine your whole kinetic chain and provide you with precise and specific corrective exercises to allow your body to perform at its maximum capacity. 



(1). Wainner RS, Whitman JM, Cleland JA & Flynn TW.  Regional Interdependence:  A musculoskeletal examination model whose time has come. J    Orthop Sports Phys Ther 2007; 37 (11): 658-660


Carpal Tunnel Syndrome:  Surgery or Skilled Physical Therapy

Carpal Tunnel Syndrome: Surgery or Skilled Physical Therapy

Carpal tunnel syndrome (CTS) occurs when the median nerve in your wrist becomes compressed as it courses through the carpal tunnel at the base of your hand.  The result of this compression may present as pain or numbness in the hand, wrist or forearm as well as grip weakness. 

In a recent article in the March 2017 issue of Journal of Orthopedic and Sports Physical Therapy (JOSPT), researchers found that manual therapy combined with traditional stretching exercises provided similar improvements in hand function and grip strength compared to those who received carpel tunnel surgery. 

This study compared a sample size of 100 women, 50 who had surgery for carpal tunnel and 50 who only had skilled physical therapy and no surgery.  The group who received skilled physical therapy received 30 minutes of manual therapy (joint mobilizations, soft tissue mobilization and median nerve glides).  In addition, this group were given stretches as part of a home exercise program

The research showed that after 1 month, patients who received physical therapy had better pinch strength and hand function than patients who had surgery.   At the 3, 6 and 12 month mark, patients had similar improvements regarding hand function and grip strength.   Although both groups showed similar results in the long term, the evidence suggests that skilled manual therapy in conjunction with stretching exercises can provide similar results to invasive (and at times, ineffective) surgery.

The study showed the positive benefits of manual therapy in conjunction with typical physical therapy interventions.  The key, however, is finding a physical therapy provider who not only is proficient in manual skilled physical therapy but also provides the amount of time (30 plus minutes of manual care) needed to achieve positive gains.   Here at Mana Physical Therapy, we provide all of our patients with true one-on-one care our patients to gain the most benefit out of their valuable time.    


Journal of Orthopedic & Sports Physical Therapy. Carpal Tunnel Syndrome Physical Therapy or Surgery? JOSPT Perspectives for Patients.  Published March 2017.   Accessed March 31, 2017

Fernandez-de-las Penas et al.  The Effectiveness of Manual Therapy versus Surgery on Self-reported Function, Cervical Range of Motion and Pinch Grip Force in Carpal Tunnel Syndrome:  A Randomized Clinical Trial.  JOSPT 2017; 47 (3): 151-161


Is your hip extension weak or tight?

Is your hip extension weak or tight?

The normal hip extension range of motion (backward motion) value is 10 degrees. If you lack this motion, you will most likely experience lower back pain/stiffness during prolonged walking, standing or running due to excessive lumbar extension to compensate. Many people will be quick to perform a lot of hip flexor stretching when they realize this motion is lacking, however, this tends not to be the right exercise for many of the clients we treat. Many times the client can't lift their leg off the table when in prone but the hip is easily passively lifted to 10 degrees without any tightness. Instead of wasting time stretching the hip flexors, we activate the glut max as the first course of treatment in many cases. After the hip can actively extend to 10 degrees, more advanced exercises can be added as in the picture below. 

This approach of assessment (SFMA) can drastically reduce wasting time on unnecessary exercises such as excessive stretching and manipulation. This example of hip extension can be applied to any other movement dysfunction and can be corrected quite quickly when the underlying cause is found. 

If you are experiencing difficulty or pain with certain movements come get assessed with SFMA at Mana Physical Therapy and avoid wasted time on unnecessary exercises. 

Direct Acess: Quicker Access, Quicker Improvement, Less (Logistical) Headaches!


You woke up with a stiff neck.   After your morning shower, you realize your stiff neck is now changing into achy pain at the base of your neck.  An hour later, on your drive to work, the pain continues to get more intense and is radiating into the top of your shoulders.    You call your primary care physician (PCP) to get in to be seen that day however they are booked and can only see you in 4 days.   The pain is getting more intense so you decide to go to the Emergency Room at your local hospital.  You have been sitting in in the ER for the past 6 hours with no relief in sight.


Direct access allows you to see a licensed physical therapist without a prescription or referral from a physician.   As of January, 2015, all 50 states have some form of direct access, although some states may have restrictions or provisions regarding time and amount of visitation or type of intervention (EMG, dry needling).  With direct access in New Jersey, you are able to call your physical therapist and be see within the hour (or sooner) to get relief quick without a script or referal. [1]

In the past, without direct access, you had to call your PCP and hope they could squeeze you in that day.  If you were unable to be seen that day, often you would seek help from your local emergency room or urgent care facility.  Often, with most musculoskeletal dysfunctions, your PCP or ER would refer you for physical therapy and (possibly) order imaging or futher diagonstic testing.  

The beauty of direct access is that it takes out the middle man/woman so that you can see a physical therapist immediately without the logistical trappings of getting a physician’s script or referral. 

At Mana Physical therapy, our therapists are highly skilled and trained to provide you with optimal results in the most efficient time frame.  We have same day scheduling to accommodate your needs.    Next time you have some pain, call us to schedule your appointment to get relief quick!









[1] APTA.  Direct Access at the State Level.  Updated June 29, 2016.  Accessed March 27 2017


TRX Body Weighted Suspension System

TRX Body Weighted Suspension System

Suspended Body Weight Training is a type of workout that uses your body weight to act as the resistance/tension during weight training.  This type of work out typically incorporates two suspended non- elastic straps or rings mounted to a wall or ceiling.   Loops are placed at the end of the straps from which you can hold with your hands (or placed around your feet) to perform upper, lower extremity and core stability exercises as well as full body stretching routines. 

For example, in the picture below, the exercise being performed is a bilateral high row which is part of the TRX row series.  If done correctly, this exercise targets your scapular stabilizers (specifically low and middle trapezius) and your latissimus dorsi to allow for increased scapular stability and humeral depression to improve pulling power and endurance.    Poor scapular stability often leads to rotator cuff dysfunction, directional instability dysfunctions and other upper quadrant disorders.   We can provide further challenge by narrowing your base of support, performing the exercise with only a single leg of support or adjusting the strap for an isolated single arm row.      In addition, by changing the angle and line of pull of the arms, we can further isolate specific muscle activation of the posterior quadrant.

At Mana Physical Therapy, we are a certified provider of the TRX Sports Medicine concept and use the TRX suspension system.  We use this type of work out as a supplement to your personalized corrective exercise routine.  


High Row_TRX.jpg

Do you experience arm pain, numbness, tingling or burning?

Do you experience arm pain, numbness, tingling or burning?

There are many reasons a person may experience pain radiating down their arm. This pain can include numbness, tingling and burning if the cause is from nerve compression. It could be caused from cervical bulging/herniated discs, stenosis, adhered nerve roots and thoracic outlet syndrome just to name a few. One factor that is commonly overlooked that can can play a major role is the mobility of the first rib. In the picture below, if the first rib is too elevated, the brachial plexus can be compressed. 

At Mana Physical Therapy, we are specially trained at assessing and mobilizing joints, including this first rib. If this first rib is limited with depression range of motion, we will perform joint mobilization techniques to restore normal range of motion which will result in reduced symptoms of pain down the arm.