Age to Age We Fall

By: Karen Carlson, PT

A few years ago I missed the bottom step carrying a plate of cookies to the lower level in my home. I fell and fractured a metatarsal in my right foot. Besides the embarrassing fact that I fell in front of a room full of people and the cookies were plastered all over the wall, the fall came at a very unfortunate time, as do most injuries. I was in the middle of planning my daughter’s wedding and this was just something I did not need. So, why did I fall? First of all, I forgot to remove the reading glasses I was wearing to read the cookie recipe. Yes, my eyes are not as good as they used to be and I can no longer brag to my husband about my many years of 20/20 vision. Secondly, slippery socks on carpeted stairs is never a good idea. Lastly, I just don’t think my balance recovery time is as good as it used to be.

Many changes happen to our bodies as we age: body parts that used to be higher are now lower; smaller parts are now larger; larger parts are now smaller; we lose hair where we want it to grow and grow hair where we never expected it to be. Our daily activities change, resulting in a gradual loss in flexibility, strength, and balance. This all sounds awful; but it doesn’t have to be. Some things we just have to embrace and other things are fixable or at least maintainable. As of late, I have been paying particular attention to balance and this has carried over into the pursuit of a good balance program for our clients at Grand River Physical Therapy.

Recently, all of our therapists have become certified in the Otago Balance Program. This program is designed for the older adult, but we can help people with balance problems at any age. If you are concerned about your balance or have fallen or are fearful of falling, give us a call. Set up a free 15 minute assessment with one of our therapists to hear more about this program and to see how we can help.

Let’s all age as gracefully as we can and prevent those fall related injuries.

Stay safe and enjoy every day.


Did I just tear my Roter Cup? Or is it Rotary Cuff? What is it anyways? Who Knows? WE DO!

By Jen Brown, DPT

You are helping your mom move furniture so she can clean the floors. One more piece of furniture needs to be moved before you can sit down to enjoy a homemade lunch. You bend down, lift, and feel a sharp pain in your shoulder. Could you have injured your Rotary Cuff?

You have spent the whole weekend repainting your house. Sunday night comes and your shoulder is throbbing in pain. Maybe it is your Rotator Cup?

We have heard it all; anything from Roter Cuff to Rotator Cup and everything in between.

It is actually your Rotator Cuff and is a fairly common injury seen in our clinic. The rotator cuff is a complex of four tendons that extend off muscles in the shoulder. Tears of these tendons are called Rotator Cuff tears. The four muscles are the subscapularis, supraspinatus, infraspinatus, and teres minor.Rotator cuff

– Subscapularis works to internally rotate the arm. It is the motion that allows you to reach behind your back to tuck in your shirt. It is located deep inside on the front of the shoulder blade.

– Supraspinatus works to help raise the arm out to the side. It is located on the top of the shoulder blade and is the most common tendon affected.

– Infraspinatus and Teres Minor work together to externally rotate the shoulder. It is the motion that allows you to reach behind your head. They are located on the bottom of the shoulder blade.

Together the muscles of the rotator cuff work to stabilize and compress the humeral head. The shoulder is a ball and socket joint. The shoulder jointshoulder blade provides the socket and the humeral head is the ball. The rotator cuff’s primary purpose is to hold the humeral head in place when you move your arm.

Signs of a rotator cuff injury include pain, decreased mobility of the shoulder, and weakness. These are often secondary to inflammation deep in the joint from the injury.
⦁ PAIN – Rotator cuff injuries often can cause pain in the front, back and side of the shoulder. The pain is usually described as a dull ache at rest and sharper with overhead activity. It can also be severe at night.
⦁ DECREASED ROM (Range of Motion) – Inflammation in the joint can lead to pinching of the tendon making it hard to move the arm.
⦁ WEAKNESS – If there is detachment of the muscle from the bone during the rotator cuff injury, the shoulder will be weak, especially with overhead activity.

overhead activityCauses of rotator cuff injuries vary from falls, to repeated overhead activity, to chronic wear and tear or degenerative changes. As we age our tendons lose blood supply and quality and are therefore more prone to tear.

PT Can Help!

Whether you have had surgery for a rotator cuff tear or have experienced a strain of your rotator cuff Physical Therapy can help. Improving motion and strength in the shoulder can significantly help improve symptoms.

Other treatment options include anti-inflammatory medication, steroid injections, ice, and possible surgery. Surgery is typically recommended if conservation measures fail or if there was a traumatic or acute tear of the tendon.

Typical Rehab for Rotator Cuff Repairsshoulder pulleys

Patients typically begin physical therapy at 2 weeks post-operative. You are usually in a sling for 6 weeks and are allowed to begin to move the arm on your own. Physical therapy lasts 12-16 weeks.
⦁ Phase 1: 0-6 weeks post-op – passive motion only; meaning the therapist moves the arm, the patient does not.
⦁ Phase 2: 6-12 weeks post-op – active motion phase in which the patient is moving their own arm through exercise.
⦁ Phase 3: 12-16 weeks post-op – focuses on strengthening of the rotator cuff. Despite being discharged from physical therapy at 3-5 months following surgery, final complete healing is not completed until near 1 year post-operative.

PT Is Important!
Physical therapy is vital following a rotator cuff repair of any degree. Even if you find that your pain is minimal and you feel your motion is good, physical therapy is still important. Passive range of motion (PROM) of the shoulder, performed by the physical therapist is essential to prevent the patient from developing stiffness or adhesive capsulitis (AKA Frozen Shoulder) of the shoulder. When there is a lack of movement in a joint, scar tissue and other adhesions can build up and block movement.
Attending physical therapy for the first 6 weeks allows for someone in the medical profession to monitor the incision site, supervise the correct use of the sling, as well as educate the patient on exercises to perform at home. In addition, regular physical therapy appointments also results in immediate feedback, continued modification to home exercises, and motivation which are all vital for optimal recovery.

BBBFRO: A Reflection from Brooke

As I’m fast approaching my retirement date I am dealing with a variety of feelings and questions: how will I deal with not doing something that I’ve loved doing for the past 35 years? How will I get through my days without seeing the people that I’ve grown to love – that have become my friends, my family? How will I manage not being called “Princess” or “Precious”? Then there are the more obvious questions: Will we manage financially? Will I get bored? Will I be able to earn Kohl’s cash? Will I need to donate plasma every week? My pending retirement also causes me to reflect on what lead me to get into physical therapy and my experiences during the past 35 years. It began in 1957 when I was involved in a serious car accident with my parents and one of my brothers. My mother suffered a C6-7 spinal cord injury leaving her paralyzed, a quadriplegic. I grew up helping my dad take care of her and unsurprisingly developed a desire to go into nursing. In high school, I enrolled in an allied health program which not only trained me to be a nurse’s aide, but allowed me to spend time in the various areas of the hospital. It didn’t take long for me to realize that physical therapy was what I really wanted to do. For awhile I thought I might go into research, so I got a degree in physiology at UC Berkeley. Subsequently, I was accepted into the PT program at the University of Washington in Seattle. While going to school, my summer job involved working in a research lab at the Hanford Nuclear facility. I dealt primarily with rats, literally, and evidently held the record for the most rat bites! Those mean buggers scared me and they knew it. Between the bites and the mounds of calculations involved, I determined that research was not for me!

After graduating, I was hoping to work in a rehabilitation facility seeing spinal cord injured patients, but God had different plans for me. My first job was in an acute care hospital in Orange, CA which involved primarily orthopedic cases – I never enjoyed orthopedics when I was in school, but gradually developed a love for the field.

My husband and I moved from CA to Denver, CO where I was employed in a private practice clinic and also did home health care. My family and I moved to MI in 1997. I spent 5 years homeschooling my two children before returning to work. While looking for a new job in 2006, I stumbled upon Grand River Physical Therapy Specialists, called the clinic to see if they needed a therapist, was interviewed and soon hired. Except for an 8 month “respite,” I’ve worked there ever since. As my career in physical therapy is winding down, I can say without hesitation that GRPTS is the best place that I have ever been employed. The caliber of the staff is outstanding! The owners, Karen and Gail, treat their staff exceptionally well. The focus there is to provide our clients with great care while in a compassionate, friendly (and often entertaining) environment. I am so thankful that the Lord brought me to GRPTS. I will miss working regularly with such an amazing staff and treating those who come there for therapy. Hopefully, I will be able to fill in when needed … or when allowed!

My new campaign: BBBFRO!!! (Bring Brooke Back From Retirement Occasionally!)

With gratitude and love,
Brooke Cheney, P.T.

A Therapist’s Recovery

By: Sandy Herron, PT

18 months ago I had foot surgery. I know – really. A healthcare professional with an illness or injury. Unheard of! Healer heal thyself! Well I tried. As a physical therapist I knew there was a lot that can be done to improve foot pain. I stretched. I exercised. I wore good shoes (even when they didn’t look great with my outfit). I used ice, heat and took medication. They all helped for awhile but eventually they didn’t. My foot hurt from the moment I got out of bed in the morning until I got back in at night. The fact is I had a structural problem that PT couldn’t fix. It happens. We can’t fix everything.

So, I had surgery. My foot was very flat and unstable. My ankle rolled inward. I had a huge bunion. My surgeon was great and explained what would be done and what to expect. I was in the cast for 8 weeks and in a boot for 4 more to allow proper healing.

When that phase was done I began physical therapy myself. My foot was very swollen. It hurt. It was stiff. It was weak. Ice and elevation as well as compression socks helped limit the swelling and pain. I began range of motion exercises to get my foot moving again. Moving my foot in circles, up and down, side to side everyday three times a day to help loosen it up. Strengthening with resistance bands and balance exercises helped me to stand and walk easier. Concentrating and walking without a limp or turning my foot outward helped return me to walking normal. Reminders from my fantastic co-workers helped too since sometimes I didn’t even realize I was limping.

Yes, there were days I would get discouraged. This was not going fast enough. I have a lot to do – get back to work, take care of my house and my kids. I don’t have time to be laid up! But with a little determination and hard work as well as patience I told myself I could do this. That’s what I tell my clients after all. And I did.

As I got back better I got back to work and I began walking for exercise. At first it was painful but not like it was before surgery. This was muscle soreness. It ached and burned when I did too much. But using ice helped. At first, I could only walk for short distances but gradually I could go further. By 6 months I was walking 2 miles 3 days a week. Yes! I did it!

But now I had a new goal. In high school and college I had been a distance runner. I had given it up 15 years ago because it hurt my foot. Now my foot was good as new. Why not try? So when my surgeon said OK I began running. Again, it was slow progress and at times painful. But again with patience, determination and hard work I was going to do it.

But I need good shoes to get started. proper footwear is so important not just for running but any activity and even daily work and household chores. Good shoes protect your foot from injury. They cushion your joints when you stand, walk and run. But I had special needs feet. I needed someone who knew good shoes to recommend a good model. I went to a sporting goods store where they measure for a proper fit. I told them what my goals were and the problems I had had in the past. They helped me choose a good supportive shoe. Good shoes should support your arch (whether it’s high or low or medium – whatever your shape is). It should fit the width of your foot. It should bend where your foot bends but not be floppy and bend every direction. It should not be overly stiff either to strain your other joints. It should be comfortable even if it is not pretty. Mine were orange. But OK – silver lining, I wouldn’t get hit by a car running because surely everyone will see those bright orange things!

So out to the road I went to run. I followed a training plan and gradually improved my distance and my times. It was exhausting. I was sore. But it got better each time I tried. There were times that I overdid it. I strained my quad. I developed tendinitis in my ankle. but again following my physical therapist advise – I used ice. I stretched. I strengthened my weak spots. And back to the road I ran.

Soon I was running a 5K for the first time in 15 years! I did it! Over the first year I ran five 5K races. Each time it is easier and my time improves. I am not as sore. I do not fatigue as easily. My mental health has improved too. I have more energy and feel happier. Life is good! With a little hard work, determination and a good pair of shoes I am now fully recovered and have achieved my goals. Physical therapy has been a big part of my accomplishment. I still have to do my stretches and watch my form but consistency counts. And with that I am sure I can accomplish more goals. Like running my first 10K ever.

How We Started And Why We Keep Going

By Gail Braun, PT

My name is Gail Braun and I am one of the owners of Grand River Physical Therapy Specialists. This is my first time putting my thoughts out there on a blog, so please bear with me.

The year was 2000, and circumstances were setting me up to make the choice to seek a new job, or go out on a limb and start my own private practice with a close friend from physical therapy school. This was definitely Not on my bucket list, but after weeks of talking and praying Karen and I decided that the opportunity of continuing to practice therapy in my hometown was to important to both of us to not push forward. We knew how we wanted to treat patients, but needed to find the where to fit our needs. My husband kept saying, “why don’t you look at the old racquetball club”, but for some reason I continued looking everywhere but there. I had to admit a couple weeks later that he was absolutely right. We spoke with the owner, initiated the lease, started cleaning the building (sat empty for a few years), and pretty much on my 40th birthday we opened our doors! The first few years kept us extremely busy, between setting up insurances, treating patients, designing forms and more forms, fixing a leaking roof, fixing freezing pipes, and shoveling icy sidewalks. We had two therapists, a front office person, and a PT technician out in the gym. We sometimes were flying by the seat of our pants, but had a passion for helping people that seemed to keep us going. The UPS driver that delivered to us those first 3 years informed us on the day of his retirement that he thought day one we would never survive. (80% of start up businesses fail) He decided that when we were still going strong year 3, he knew that we were here for the long haul!

Fast-forward 16 years! We now have seven therapists, 2 front office people, four PT technicians, and an athletic trainer. Wow. We are responsible for 12 other people and their families. This can be scary, and also exciting at the same time. We never actually advertised to fill these positions, but somehow the right people kept showing up at the exact time that we needed them. I like to think this is something that Karen and I caused to happen, but we truly feel there was a higher power involved in putting together this team! We are therapists and support staff who come from a variety of settings, from different backgrounds, and with different strengths and gifts, but have the common goal of working with patients to achieve their maximal potential and mobility to resume life as they envision!

People often ask what is the worst part of this job, and for me that answer is definitely the paperwork. I did not go to school to write notes 50% of my day, but I went to learn evaluation and treatment techniques to assist patients along their journey to wellness. People also ask what I like most about my job. I get to spend each day helping empower people to be the best they can be, and return them to their activities of daily living. I help promote a culture of positivity and happiness which seems to be infectious. We use hands on techniques, education, and plain old kind words to motivate and inspire people.

I am sure that we have made many mistakes along this journey, but we have made decisions from our heart, and I think that keeps us along the right path. We want to make each day better for our patients, our staff, and our community. We promise to persevere and keep evolving to meet the needs of you, our “neighbors.”

The 3 R’s

by Lisa Jonker, PT

It is that time of year again! The kids are headed back to school and learning all about the 3 R’s – Reading, wRiting and aRithmetic. As a Physical Therapist, I also teach about the 3 R’s, however, mine are a bit different – Recliners, Riders and Rest. My husband has a passion for my 3 R’s. He desperately wants all of them, but I have held my ground and our home only has one. Which one is it? Here is my view.


Recliners, ever the chosen seat in the living room. The comfortable lounge for relaxing, watching TV, sleeping, and hanging out with our phones, tablets and other tech devices. The valued chair of many that I do not have and here is why.

forward headMost recliners are large and overstuffed causing your head to be in front of your shoulders. To be in correct posture your ear should be right over the tip of your shoulder, if it is not, the strain to your upper back increases by 10-20 pounds and can result in neck and upper back pain.


While sitting you should have a small inward curve to your low back. A common sign of poor lumbar (low back) posture is pain in the low back or hips after sitting > 30 minutes. Sitting sitting postureincreases the pressure in the low back area and if you are unable to maintain that inward curvature the result is even more pressure. Check your chairs. Is your head over your shoulders and do you have an inward curve? If so, you are fine, but if you have pain when coming to stand or if you have pain down your leg after sitting for awhile, then you are not in the proper alignment. Rule of thumb for all sitting: Do not sit for more than 30 minutes at a time without getting up to move around for a couple of minutes.

My husband thinks he wants a Recliner. If you saw his posture while sleeping on the couch, you would probably go out an buy him one yourself. Fortunately he is married to a Physical Therapist who gives him “gentle advice” on postural improvement! I am not advocating to dump the Recliners you do own, but maybe you need to place a small pillow or rolled up towel behind your low back to give you a better sitting position. Your back will thank you!


What is better after a long day of work with many demands than sitting by yourself in the great outdoors on your beloved Riding lawn mower? Nobody will bother you, it’s riding lawn mowerrelaxing and satisfying. Big lawns offer ample opportunity to escape from the regular daily grind, however, large lawns require a lot of sitting and usually take more than 30 minutes to cut. Like the Recliner, the 30 minute limit to sitting applies to mowing. You need to watch the lumbar spine and take frequent breaks. Often the seats on Riders are short and have very little support to the back. Can you maintain the inward curve of your lower back while mowing? The vibration of a riding lawn mower also fatigues the back muscles which can lead to slouching. Your pain may not appear while you are using the Rider, but if you have pain a couple hours after spending an extended period of time on your mower, then you can be pretty sure your mowing posture was not good.

People complain that they don’t have the money or the time to join a gym or they cannot fit a 30-45 minute walk into their day. Our lawn takes us 45 minutes to mow using our self-propelled mower. What a great opportunity for my husband (and me) to exercise once or twice a week!


At this point, I know what you are all saying, “Wow, she does not like people to sit and relax inside in their Recliners for more than 30 minutes. She is not even happy when restpeople are outside and sitting on their Riders. She makes her husband go without the 2 most important R’s there are! When does she allow Rest?” Well I do recommend Rest. Rest is the one “R” that we do have in our home. Everyday we need to Rest. We need to have consistent sleep of 6-8 hours every night. We need to Rest from doing what we do all day at our jobs. We even need to Rest if we do regular daily exercise. If you do the same activity at your job day in and day out you need to Rest those muscles that you use, exercise the ones you don’t use and stretch the ones that get tight. If you do the same exercise routine every time, you will end up with an overuse injury. You have heard that too much of a good thing is no longer a good thing. It it true! We need moderation, variety, strength, flexibility; we need balance in our lives and that is built on Rest. Rest means different things to different people. Some people read, others take a hike, I love to bake to relax.

Recliners and Riders are not inherently bad, but too much of either one can cause you harm. Rest from your Recliner and take a walk. Rest from your Rider and weed the garden. As the kids go back to school and learn their 3 R’s, I will take the one R that we have in our home and enjoy it. Our Rest this fall is sitting on bleachers watching soccer games….did I ever mention bleacher sitting…. another important sitting event to discuss for another time….I now need to Rest.

P.S. The above comments are not fully supported by the all of the GRPTS staff, no wonder my husband likes some of them better than me! 🙂