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Dizziness, lightheadedness, vertigo? Here is how a physical therapist can help.

Dizziness, lightheadedness, vertigo? Here is how a physical therapist can help.

Molly Gries, PT, DPT
Board-Certified Orthopaedic Clinical Specialist
Certificate in Vestibular and Balance Rehabilitation Therapy

When you are experiencing dizziness, lightheadedness, or vertigo, a physical therapist might not be the first practitioner you consider consulting.  You might not have known that a physical therapist is someone who can provide a differential diagnosis and treatment of an array of conditions that can cause dizziness. The treatment performed by a physical therapist can often provide significant, and in some cases immediate, relief.

The role of the inner ear

Most dizziness is caused by dysfunction or disorders of the inner ear called the vestibular system. This is the part of the inner ear that helps control balance, gaze stabilization and orientation. When the vestibular system is not working well, it can cause dizziness, nausea and vomiting, fatigue, brain fog, unsteadiness, and general decreased confidence in movement. This can lead to decreased physical activity levels, limited quality of life, and sometimes, anxiety and depression.1 Fortunately, a physical therapy who has specialized in vestibular therapy can assist with compensation of the inner ear and return to normal daily activities with improved confidence.

What is Vestibular and Balance Rehabilitation Therapy (VBRT) and how does it work?

Vestibular rehabilitation is a specialty that physical therapists can choose to develop. A physicl therapist who specializes in VBRT helps relieve dizziness that results from primary and secondary vestibular disorders. This form of treatment uses exercises and maneuvers to help improve balance, gaze stability, dizziness, and vertigo. The goals behind VBRT are to promote vestibular adaptation and substitution to help people return to full function. Repair of vestibular function after developing a disorder can be limited, however return to full function can be accomplished via compensation, substitution by other visual or sensory pathways, and habituation.

VBRT uses a few key principles of treatment to achieve the goal of adaptation and habituation of the vestibular system. Exercises are focused on head-eye movements with challenges to balance and postural orientation pathways to allow for compensation and adaptation. The main pathway that is used during these exercises is the Vestibular-Ocular Reflex (VOR) which is the connection between the vestibular system and the eyes that helps stabilize your gaze and tell you where you are in space. During vestibular dysfunction, the VOR can often be slightly offset which causes a mismatch of information from both sides of your inner ear. 3

Oftentimes, the vestibular system naturally compensates for the dysfunction and people can return to normal with no symptoms. However, there are times when the system does not compensate by itself and this requires additional specific exercises to help. VBRT uses a problem orientated approach to help address specific problems for each person. There are few key principles in treatment: Habituation, Gaze stabilization and/or Balance training. 1,3

Habituation exercises are used to treat symptoms of dizziness that occur when you move around or have symptoms with increased visual distraction. These may include watching TV, being in busy environments, like grocery stores, walking or quick movements. The two main goals of these exercises are to help desensitize the vestibular system to misfiring during relatively normal daily activities, and help improve overall daily functioning by provoking mild, not lasting symptoms, that lessen overtime. 2

Gaze stabilization exercises help to improve control of head-eye movement. Theses are commonly used when you find it difficult to maintain a steady visual field while moving, or identifying objects when moving or during quick head movements. The goal of these exercises is to help retrain the eyes and inner ear to work together to maintain a steady view of the environment when moving your body or your head. 1,2

Balance training works to improve steadiness and confidence in movement during daily activities. Exercises are designed to address individual deficits with the goal of being moderately challenging, but not unsafe. Usually balance training is done by manipulating variables of balance including, visual or balance cues, static or dynamic movements, dual task training and/or coordinating movements patterns. The goal of balance exercises is to return to normal daily and recreational activities with full confidence 1

But I was told I just needed a maneuver to fix my dizziness.

Yes, there is one vestibular condition that is treated with repositioning maneuvers to help move the crystals in your inner ear (Otoliths) back to the correct position. This is called Benign Paroxysmal Position Vertigo (BPPV) and is a common cause of dizziness, especially acute onset room spinning dizziness that lasts for a few seconds to minutes and usually occurs with positional changes. This is identified by a clinical exam and treated by the physical therapist via specific repositioning maneuvers.1,3

Dizziness is not something you need to live with and accept

Overall, dizziness is a multi-factorial problem that requires a skilled clinician to carefully examine your movement system to help identify the underlying root causes and determine the best treatment to help you return to your full life activities and goals. Seeing a physical therapist that specializes in VBRT can be life changing and get you back to doing the things you love!

  1. Farrell, L. (2021, May 21). Vestibular rehabilitation TherapyLis. VeDA.
  2. Han, B. I., Song, H. S., & Kim, J. S. (2011). Vestibular rehabilitation therapy: Review of indications, mechanisms, and key exercises. Journal of Clinical Neurology, 7(4), 184.
  3. Herdman, S., & Clendaniel, R. A. (2014). Vestibular rehabilitation (4th ed.). F.A. Davis Company.

What to Look for in a Physical Therapist: Evidenced Based Practice

What to Look for in a Physical Therapist: Evidenced Based Practice

By Erin Ward, PT, DPT
Board-Certified Orthopaedic Clinical Specialist

The New York Times published an article on July 6th offering some tips on what to look for from a physical therapist. A physical therapist should guide your rehab journey; therefore, you have the right to make sure you feel comfortable, confident, and supported by your clinician.

During your primary consultation with your therapist, take time to tell your story and dialogue with your clinician. Someone who uses open ended questions and practices active listening will allow more time and space for you to explain your history thoroughly in your words. You may have experienced persistent pain issues for months or years, and by the time you enter the clinic, you might be feeling exasperated to repeat the same story. Perhaps you experienced a traumatic injury you’d rather not re-live. Nevertheless, it is important that you explain. This enables a good physical therapist to understand and delve deeper with follow up questions about your workout routine or job demands so that they can identify potentially contributing factors to your problem. Someone who takes stress levels, sleep hygiene, or nutrition into account will better see the ‘big picture’ and recognize other lifestyle adjustments to help you feel better.

Today, Physical Therapists obtain a Doctor of Physical Therapy Degree.  Programs in physical therapy focus on three prongs of evidence-based practice:

  1. Best available evidence / research
  2. Practitioner’s clinical expertise;
  3. Patient values / preferences

Best Available Evidence/Research

The field of medicine changes as researchers perform more studies and meta-analyses. That means your therapist should stay up to date with published literature and continuing education opportunities and adapt their treatment techniques to best practice. Current trends in healthcare suggest a more active approach to rehab using exercise, movement training, and functional training as primary interventions as opposed to relying on more passive modalities such as ultrasound, electric stimulation, heat/cold packs. An active approach to your health leads to better outcomes. This should come as good news to everyone: it is all about building self-efficacy, the confidence to move in a safe and healthy manner. We control whether we stretch, strengthen, and move; the power for change is in our hands.
Physical therapists educate clients about potential helpful and harmful activities and behaviors and advise how to modify accordingly. If your body seems cranky you may need to temporarily pause or reduce certain painful activities to allow your body to calm down and recover. But research shows that graded exposure to load is vital to help the body build up resiliency and better load capacity. A skilled clinician can explain this process to you in a way that makes sense, using simple language. They will also help you titrate your dosing of activities so that you can make progress over time, see the fruits of your labor, and eventually return to the sports, hobbies, or positions you have been missing. The concept of behavior modification and lifestyle change remains crucial to developing self-efficacy and empowerment. In general, a physical therapist has done his or her job when they’ve taught you how to manage your symptoms independently, so you can reduce your frequency of visits over time as you become more self-reliant. By creating good habits, you will likely maintain and even continue to improve your strength and activity capacity because you have been set up for success. At Movement Systems Physical Therapy, your physical therapist will guide you to better health with diagnostic and treatment expertise in movement and pain science. You are never “discharged” from your physical therapist’s care – rather you are “discontinued” from an episode of care once you obtain independent management or have fully recovered from your injury or surgery – much like your PCP after an ear infection. We are here for you for all your movement related health care needs

Practitioner’s Clinical Expertise

A physical therapist will initially serve as a coach for the client, but the partnership should also function as a team collaboration. The knowledge of the therapist will enhance your treatment because of their familiarity with the anatomy, kinesiology, and physiology of your problem. They will also likely rely on anecdotal evidence based on previous clients with similar complaints as yours. Your therapist’s past experiences and strategies can help guide your future plans, especially when navigating complex cases or presentations that may not respond to more traditional or predictable interventions. A therapist’s critical thinking skills and willingness to re-assess and change course of action speaks volume about their awareness, humility, and adaptability

Patient’s values & preference

What you think and care about matters. A good physical therapist will help create a plan that incorporates the types of activities that you find important. Maybe you hate running but recognize you are missing cardio in your weekly routine — how about considering biking, swimming, hiking, a short HIIT routine, or even walking into your day as an alternative? If you are a yogi maybe your physical therapist can give you a 5-10 dynamic flow to start your morning. If you play a certain sport maybe drills can simulate an athletic environment. If you avoid the gym and have never lifted a dumbbell in your life, your therapist should meet you where you are at and can use basic daily tasks like picking up grocery bags or getting on/off the toilet as opportunities to practice certain skills. The best types of exercise are the ones that you will complete, so work with your therapist to find a mode that excites you.

The rapport you develop with your physical therapist will likely impact your treatment experience and outcome, so make sure you feel heard, validated, and understood by your clinician. The environment should foster respect and honesty, so you feel comfortable voicing concerns or frustrations. At Movement Systems Physical Therapy, sessions last 60 minutes with your physical therapist which gives them time to listen, educate, teach, coach, motivate, and inspire. At the end of the day, the time you spend with your physical therapist should be enjoyable and well worth the investment of time and healthcare dollars. You should be “forever better” for having spent the time together. Time flies when you’re having fun!


Infographic. Benefits of Physical Therapy. The Centers for Advanced Orhopaedics website. Published September 27, 2019. Accessed July 16, 2021.

Smith D. What to Look for in a Physical Therapist. The New York Times. Published July 6, 2021. Accessed July 7, 2021.

Components of Evidence Based Practice. American Physical Therapy Association website. Published March 23, 2020. Accessed July 8, 2021.

5 Reasons to see a Physical Therapist on your Pregnancy and Post Partum Journey

5 Reasons to see a Physical Therapist on your Pregnancy and Post Partum Journey

by Corley McBeth, PT, DPT

Why should you include a Physical Therapist in your pregnancy and postpartum journey?  Here’s 5 important reasons:

  1. Seeing a physical therapist at the beginning of your pregnancy (or even before a positive pregnancy test) can be helpful in establishing a baseline and making sure you have the tools you need for a strong and healthy pregnancy
    • Your physical therapist can make recommendations and adjustments to your current exercise routine (or help you safely get started!)
    • Your physical therapist can help you develop good postural habits and strategies to reduce potential aches and pains later
    • If you have concerns regarding diastasis recti (i.e. abdominal separation, which is common & normal during pregnancy), your PT can measure and monitor the progression
  2. Pregnancy related pain is treatable through physical therapy
    • During pregnancy, you might experience pain in the hips, low back, and pelvic girdle
    • This is common because of the ligamentous laxity that results from hormonal changes, and because your center of gravity and body mass are changing
    • Any muscle weakness or joint dysfunction that you had coming into the pregnancy makes it harder for you to meet the increased demands of your changing body
    • Your physical therapist can work with you to develop an individualized treatment plan to keep you feeling your best
  3. It is better to address symptoms of urinary incontinence (the dreaded leaking) sooner rather than later
    • Preventing or improving upon leaking before childbirth can reduce the potential for problems postpartum – women who have stress urinary incontinence during pregnancy are at risk for the incontinence to continue postpartum
    • Your physical therapist can help you retrain the pelvic floor muscles and incorporate better strategies for core stability (breathing is key!)
  4. Exercise during pregnancy is healthy
    • Your physical therapist can help guide you in terms of what you can safely do
    • The American College of Obstetricians and Gynecologists recommends 30 minutes of moderate- intensity exercise most days of the week throughout pregnancy
    • Your physical therapist can teach you proper body mechanics as well as appropriate exercises for core and back strengthening
  5. Every woman should have a physical therapy pelvic health checkup postpartum
    • Physical therapists have the skills to examine, test, and find what activities you are capable of doing to allow for safe return to prior level of exercise and activity
    • Your body is recovering from a major event and progressing gradually is important to allow the tissues appropriate time to adapt
    • You can talk with your physical therapist if you have concerns about prolapse or symptoms of heaviness, pressure, or discomfort in your pelvis
    • Your physical therapist can also assist with positioning recommendations for breastfeeding and baby carrying/holding


Corley McBeth, PT, DPT is a Doctor of Physical Therapy and certified Personal Trainer at Movement Systems Physical Therapy who specializes in injury rehabilitation and improving athletic performance of individuals from all levels to help them achieve their health and fitness goals.


You Are Not Alone – Physical Therapy And Mental Health

You Are Not Alone – Physical Therapy And Mental Health

By Julianne Simpson, PT, DPT

My patient stood while I gave cues on posture and breathing mechanics, trying to help improve diaphragm and abdominal mechanics. “Try to let go of your abs,” I said. The room went quiet. The mood shifted very quickly. I looked and my patient was holding back tears.

I put my hands on my patient’s hips to help cue squat mechanics. The patient froze and appeared to stay checked out for the rest of the session.

These are both examples of physical contact or physical cues triggering strong emotions, possibly related to prior trauma. While these stories are non-specific, experiences like these are not uncommon during a session of physical therapy when working with trauma survivors. A recent student of mine, Katie Sturtevant, SPT, saw examples like the above and presented an in-service on mental health statics and physical therapy treatment of mental health conditions. The bulk of the information below is pulled from her research. She graciously allowed me to use her research.

Mental health dysfunction is common. The most common types of mental illness are anxiety disorders, depression, PTSD, and dual diagnoses. (1) 1 in 5 US adults experience mental illness. (1) 12 month prevalence of mental illness all US adults is 19%. (1) As we break down the data, we see higher rates in white (20%), American Indian/ Alaska Native (22%), mixed race (27%), and LGB (37%) adults.(1) Among transgender adults, the rate is about 50%. (2) In fact, 48% of transgender adults have considered suicide in the past 12 months. (3)

These high rates mean that a LOT of patients receiving physical therapy care have or have had mental illness. Can physical therapy care or exercise help improve the mental health of those with mental illness? Katie Sturtevant, SPT, researched this topic and found research supporting:

– Anxiety reduction for 24 hours following exercise (4)
– PTSD :
        * Aerobic exercise may be helpful when prescribed as part of an      interdiciplinary treatment model (5)
        * This study’s exercise protocol improved neck pain, and those patients also had a statistically significant reduction in depression symptoms in participants with PTSD (6)
– Depression
        * From a qualitive study where participants participate in aerobic exercise guided by physical therapists “Exercise in a physical therapy context can improve the patients’ perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient’s vulnerability and ambiguity in an empathic and perceptive way.” (7)
        * From a study about exercise as an add-on intervention for major depression: “Exercise in a physical therapy setting seems to have an effect on depression severity and fitness, in major depression. Our findings suggest that physical therapy can be a viable clinical strategy to inspire and guide persons with major depression to exercise.”

In sum, if you are experiencing mental illness or mental health challenges, exercise and/ or physical therapist led aerobic exercise may help. The physical therapists at Movement Systems Physical Therapy would love to help you get moving!

Remember – You Are Not Alone.

If you or someone you know is in crisis and needs immediate help, call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)

You can find additional resources here, thanks to Seattle’s KEXP.

Julianne Simpson, PT, DPT, holds a BA from Oberlin College and a Doctorate of Physical Therapy from Eastern Washington University. A general orthopedic and pelvic health therapist, she is passionate about helping people move more and empowering her patients to live healthier lives. She dreams of raising kind children, cycling over the Alps and surfing in Alaska.


(1) Infographic You Are Not Alone. Published 2020. Accessed August 25, 2020.

(2) Budge SL, Adelson JL, Howard KA. Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. J Consult Clin Psychol. 2013;81(3):545-557. doi:10.1037/a0031774

(3) Report from the 2015 Transgender Survey. Published 2020. Accessed August 25, 2020.

(4) Morgan, W. (1979). Anxiety Reduction Following Acute Physical Activity. Psychiatric Annals,8(3), 36-45. doi:

(5) Tibbey, J.; Davenport, Todd E.; and Mansoor, Jim K., “Exercise for posttraumatic stress disorder: systematic review and critical synthesis of the literature” (2014). School of Pharmacy and Health Sciences Faculty Presentations. 80.

(6) Park, S. D., & Kim, S. Y. (2015). Clinical feasibility of cervical exercise to improve neck pain, body function, and psychosocial factors in patients with post-traumatic stress disorder: A randomized controlled trial. Journal of Physical Therapy Science,27(5), 1369-1372. doi:10.1589/jpts.27.1369

(7) Danielsson, L., Kihlbom, B., & Rosberg, S. (2016). “Crawling Out of the Cocoon”: Patients’ Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression. Physical Therapy,96(8), 1241-1250. doi:10.2522/ptj.20150076

(8) Danielsson, L., Papoulias, I., Petersson, E., Carlsson, J., & Waern, M. (2014). Exercise or basic body awareness therapy as add-on treatment for major depression: A controlled study. Journal of Affective Disorders,168, 98-106. doi:10.1016/j.jad.2014.06.049

The ‘N-E-W’ Normal: Working From Home and Basic Ergonomics

The ‘N-E-W’ Normal: Working From Home and Basic Ergonomics

By Jessica Hutchinson, PT, DPT, OCS


Coronavirus is making working from home the ‘N-E-W’ normal here in Seattle.

 At Movement Systems Physical Therapy, we are here to help you adapt to be the most productive, and more importantly, reduce injury and pain while working from home.


Setting up your office workstation is as easy as remembering the acronym: N-E-W

N: Neutral Posture

  • Use the best and most comfortable chair around the house.
    • You can add a pillow or rolled up bath/beach towel for back support.
    • Raise your chair if your table or desk is too high. Use a pillow as a seat cushion if needed. Aim for a 90-degree angle of your hips.
    • Support your feet on a phone book or step stool so that they firmly touch the ground while sitting. Aim for a 90-degree angle of your knees.

E: Eye and Elbow Height

  • Raise your monitor using books, old shoe boxes, paper reams, amazon boxes, etc. The top of the monitor should be at or slightly below eye level.
  • Shoulders should be relaxed with the elbows bent around 90-degrees and wrists straight.

W: Workstation

  • Use an external keyboard and mouse.
    • The mouse should be placed at elbow level.
    • Make sure the edge of the table is not too sharp, which causes pressure points on wrists and forearms, otherwise line the table with an edge protector.
  • If standing (ex- at your kitchen counter), keep your legs, torso, neck, and head approximately in line and vertical – avoiding slouching or placing more weight on one side. Be sure to still have monitor at or slightly below eye level.
  • Do not sit or stand for too long – set a timer to take regular micro-breaks away from your laptop.


Give us a call at (206) 405-1864 if you have any questions or need help reducing pain as a result of working from home!


Jessica Hutchinson is a Doctor of Physical Therapy and Board-Certified Clinical Specialist in Orthopedic Physical Therapy who strongly believes in a ‘patient first’ mentality for long term success. She has special interests in overhead athletes, pre- and post-operative surgeries, and repetitive injuries.




The Unexpected Magic of Telehealth Physical Therapy

The Unexpected Magic of Telehealth Physical Therapy

By Rachel Morin, PT, DPT


2020 has been a doozy of a year so far – and while I sit here writing this in late May we are seeing some sign of hope that this pandemic may be slowing. However, with social distancing as the new normal and many people with compromised immune systems continuing to need to shelter in place we have needed to become more flexible in the way we provide care to our community.

In PT school, we had a course one day on Telemedicine. We all felt that this was a little ridiculous – “when will I ever be providing healthcare through a screen? PT is a hands-on sport!”. Little did I know that just a few years later I would be seeing up to 80% of my caseload via telehealth, and even better I would be enjoying myself.

Is practicing telehealth physical therapy more challenging? Yes.
Is it at times harder to see things that would be obvious in person? Absolutely.
Does it also provide unexpected opportunity? Surprisingly yes.

What makes practicing telehealth at times frustrating?

  • Limited equipment – I am only able to work with what the patient has at home
  • Physical distance – I am not able to “feel” what is going on, nor can I reach in an “fix” it
  • Viewing angles and video quality – I often have to find new ways to evaluate a system or movement that I would otherwise be able to see easily up close in the clinic 
  • Technical difficulties – everyone has different ability levels with technology and internet connectivity is not always consistent. While some days telehealth is as easy as chatting on FaceTime with family, other days connection issues can mean obstacles

Where is the magic?

  • Limited equipment – Whatever we work on together as an exercise my patient is guaranteed to be able to continue perform at home because it uses what they have in their space
  • Access to care – visits from home help reduce barriers related to travel, including traffic and physical disabilities
  • Eliminated need for PPE – it’s a lot easier to breathe without a mask while exercising at home
  • Limited exposure to both patients and providers – telehealth is often ideal for people with high risk conditions, including people with compromised immune systems who still need care that allows them to keep moving
  • Fostering self-efficacy – Teaching patients manual techniques that they can perform on themselves and helping them strategize exercises solutions in their own space better helps them apply the concepts from physical therapy to the rest of their daily life

I have specifically found telehealth to be helpful with my older patients who often need help exercising and managing transfers in their home. One patient comes to mind who prior to this pandemic would come into our clinic and we would do some exercises and mimic transfers he was having difficulty with, but he never managed to do his exercises at home. Then came the pandemic and he lost access to his gym and was no longer safe to leave the house due to his compromised immune system. The unexpected upside was that we were able to tailor his program so that it worked for him in his home and I also was able to help him work through transfers that had been causing his falls. He has since made huge improvements in his balance, his strength, and his ability to navigate his home. For this patient I would argue that telehealth has made more progress for him than an in-clinic visit would have been able to.

Now does this mean I am jumping on the telehealth bandwagon for all of my patients? The short answer is no. People need different things from physical therapy and often an in-patient visit is needed in order to suss out symptoms with a more complex diagnosis, manage an acute condition, or provide some manual intervention for a patient who is really struggling with self-applied techniques.

However, if you have been waiting to get back to physical therapy for a cranky back, an ankle sprain or a sore neck that just won’t go away and you don’t want to come in to the clinic, give telehealth a try! You will be amazed at what can be done without your PT ever laying hands on you.



Rachel Morin, PT, DPT



Image References:

What You Can Do To Improve Your Bone Health

What You Can Do To Improve Your Bone Health

Bettiann Wing, PT


Bone health is not a subject many ever think about.  However, the sequalae of bone disease is associated with a high incidence of morbidity (injury) and mortality (earlier death).  Let us start with some background.

Osteoporosis: What Is It and Who Has It?

Osteoporosis (OP), the most common bone disease, is a progressive loss of bone density and deterioration of the bone microarchitecture weakening the bone tissue leading to an increased risk of fracture.  According to the surgeon general OP is the most common cause of fractures.  OP is almost twice as common in women as in men and is typically asymptomatic until a fracture occurs.  There is an increasing prevalence of OP worldwide with hundreds of millions affected and an estimated 9 million osteoporotic fractures every year, 1 occurring every 3 seconds.  40% of women with fragility fractures will lose the ability to walk, twice that will lose the ability to perform one task of daily living.  Men also experience reduced bone formation and thinning with aging, but at a decreased rate compared with women.

Osteoporosis: How Does It Develop?

Bone is living tissue that is continuously renewing itself, a process that is dependent on many factors including nutrition, hormonal balance, and physical loading.  When this process is upset bone loss can develop.

Osteoporosis: What Are the Risk Factors?

  • Poor diet, including calcium and vitamin D deficiency;
  • Nutritional and hormonal compromise due to unhealthy eating behaviors (ie: self-induced vomiting, binge eating, laxative abuse);
  • Sedentary lifestyle;
  • Smoking;
  • Sequala of other diseases and treatments such as diabetes, hyperparathyroidism and use of glucocorticoids;
  • Hormonal imbalances as occur in menopause;
  • Late first menstruation cycle;
  • Female;
  • Caucasian;
  • Older age;
  • Genetic/familial history

Osteoporosis: What Are the Signs & Symptoms?

OP is primarily asymptomatic until a fracture occurs.  However, bone deformities, kyphosis and loss of height can be a sign that the integrity of the bone is compromised.

 Osteoporosis: How Is It Diagnosed?

OP is diagnosed via X-ray densitometry (DXA) to determine Bone Mineral Density (BMD).  Despite the high prevalence, morbidity and mortality associated with OP screening and treatment rates are low.

“Osteoporosis and the broken bones it can cause are not part of normal aging. There is a lot you can do to protect your bones throughout your life. You are never too young or too old to improve the health of your bones. Osteoporosis prevention should begin in childhood. But it shouldn’t stop there. Whatever your age, the habits you adopt now can affect your bone health for the rest of your life. Now is the time to take action.” (National Osteoporosis Foundation,

Lifestyle Optimization Strategies to Improve Your Bone Health:

  • Weight bearing exercise:
    • High impact exercise such as jumping, multidirectional hopping, jogging, climbing stairs and dancing are best for improving bone health;
    • High impact exercise effects all fracture parameters including fall risk, fall impact, and overall bone strength;
    • Weight training;
    • Low impact exercise including walking provide less improvement in bone health than high impact exercise but is better than a sedentary lifestyle;
    • It is best to exercise at least 30 minutes a day including warm up and cool down, at least 2-3 times / week;
  • Healthy diet:
    • Adequate calcium (best through foods vs pills) and Vitamin D intake;
      • Calcium rich foods including cheese, yogurt, milk, sardines, dark leafy greens (like spinach, kale, turnips, and collard greens), soybeans, fortified soymilk;
      • Vitamin D rich foods: salmon, herring, sardines, cod liver oil, canned tuna, egg yolks, mushrooms.
    • Polyphenol-rich foods including olive oil, fruits and vegetables, tea and soy;
    • Bone Health Recipes:
  • Smoking cessation
  • Limited alcohol consumption
  • Limited caffeine consumption

by Bettiann Wing, PT


Berry, M. E. (2019). Preventing and Treating Osteoporosis. Radiologic Technology, 90(3), 286–293.
French, K. D., & Emanuele, D. (2019). Osteoporosis: Increasing Screening and Treatment for Postmenopausal Women. Journal for Nurse Practitioners, 15(5), 347–350.
Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011(7):CD000333.
Kalkim, A., Daghan, S., Ercan, E., & Ibci, S. (2018). Use of Complementary and Alternative Medicine by Osteoporosis and Osteopenia Patients. International Journal of Caring Sciences, 11(3), 1546–1556.
Matzkin, Elizabeth G. MD; DeMaio, Marlene MD; Charles, Julia F. MD, PhD; Franklin, Corinna C. MD, Diagnosis and Treatment of Osteoporosis: What Orthopaedic Surgeons Need to Know, Journal of the American Academy of Orthopaedic Surgeons: October 15, 2019 – Volume 27 – Issue 20 – p e902-e912
McCance, K. L., & Huether, S. E. (eds.). (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). St. Louis, MO: Elsevier/Mosby.
Nuti, R., Brandi, M. L., Checchia, G., Di Munno, O., Dominguez, L., Falaschi, P., … Isaia, G. C. (2019). Guidelines for the management of osteoporosis and fragility fractures. Internal & Emergency Medicine, 14(1), 85–102.
Orr, Sarah BSN, RN, Osteoporosis, Otterbein University, Ohio
Tabatabaei-Malazy, O., Salari, P., Khashaya, P., & Larijan, B. (2017). New horizons in treatment of osteoporosis. DARU, 25, 1–16.
Polyphenol-Rich Foods and Osteoporosis, Current Pharmaceutical Design, Volume 25, Number 22, 2019

Online Fitness Recommendations – Stuck at home? Workout online!

Online Fitness Recommendations

by Terri Sullivan, PT, DPT, Orthopedic Clinical Specialist



You’re at home due to COVID-19.  You’re going stir crazy.  You can’t go to the gym.  You’ve been exercising outside acknowledging the 6 foot social distancing rule, but you want something more.  Something you can do at home when the weather is crummy or it’s dark outside.  Here are several blogs and free apps that are available to help keep yourself active and in shape. 

This was recently recommended to me by a fellow practitioner and they thought the women who created it does a great job with providing several levels and modifying exercises to help those remotely.  Initially, it’s free, but you can pay for more. 


This is also a more female based workout app and you have to pay to sign up, but they have several options depending on your needs. 


7 Minute Workout
I’ve had several patients recommend this app to me.  Granted, you have lots of time right now, but this is a great way to fit exercise while working from home and taking care of family matters.  Oh, and it’s free! 


Are you lonely at home and want to feel a part of an exercise community?  This is another great exercise app that is also free and has options to pay for more services. 


As for yoga, here is one app and one streaming option: 

Down dog
This is a wonderful, free app that I’ve recommended to many patients.   You can choose the level of expertise, the length of time you have, the type and what you want to target.  It’s awesome because you can download it on your phone and do it anywhere! 


Yoga with Adriene
I stream this women’s website often for my own practice and I recommend this all the time.  She is very mindful about cues, she goes slow, and there are a multitude of free videos available online.   Plus, I love her dog Benji! 


Stay healthy and safe out there!   


Best Water-Based Lubricants – Use chemistry to pick the safest and most comfortable water-based lubricant for you and your Valentine

Best Water-Based Lubricants –

Use chemistry to pick the safest and most comfortable water-based lubricant for you and your Valentine

By Julianne Simpson, PT, DPT


Happy Valentine’s Day! You and your valentine may use lubricant during intercourse to increase glide and comfort or to decrease the risk of a condom breaking. There are three main types of lubricants on the market: water-based, silicone, and oil based. (Side note – oil can make condoms break. Don’t use oil with condoms!). This blog post focuses on water-based lubricants.

There is a wide array of lubricants on the market of varying quality and comfort. How on earth do you select the best lubricant? As a pelvic physical therapist, I use water-based lubricants for exams and treatment and have turned to chemistry to help me select the best and safest lubricants for my patients.

Two main chemistry factors play into lubricant’s ability to work well with your body: osmolality and pH. I will discuss osmolality first. Osmolality has to do with water crossing membranes and molecules dissolved in that water. A higher osmolality fluid has more solutes dissolved in it. If you are thinking of a cup of muddy water, a darker, muddier cup has higher osmolality than a cup of clearer water with just a small amount of mud in it. In the blue image, the drop on the left has higher osmolality. Osmolality governs the movement of fluids across a membrane. If the amount of solutes is the same on either side of a membrane, fluids won’t cross the membrane. We don’t want water to leave the cells of the epithelium (the top layer of tissues) in the vagina or rectum.

If a lubricant is hypo-osmolar, it causes water to move into cells which could cause bursting. If it is hyper-osmolar, it causes water to leave cells and can reduce the size of individual cells and therefore reduce the thickness of protective membranes in our vagina or rectum. If a lubricant is iso-osmolar, no fluid will cross cell walls. Ideally, lubricants would be iso-osmolar. See image with pink cells to illustrate osmolality.

Hypo osmolar lubricants can cause cells to swell and possibly burst.

Aaah isoosmolar lubricant. Fluids stay where they should.

If your lubricant’s osmolality does not match the osmolality of the tissues that it will be touching, skin irritation, burning, or micro trauma can occur. Vaginal, rectal and semen osmolality is about ~300 mOsm/kg, so ideally lubricants match this. The problem is that a LOT of the most common commercially available lubricants are hyper-osmolar which can cause disruption of the protective membranes inside our vaginas or rectums. See here for a list of lubricants with osmolality (and pH).

Going back to high school chemistry, pH is a measure of how acidic or basic something is. A low number means more acidic, a high number is more basic. The range is 0 to 14 with 7 being neutral. The pH in the vagina and rectum aid in

Hyper osmolar lubes cause water to leave cells and can damage our protective layer.

maintaining the microflora colonies which are critical for vaginal or rectal health. The microflora live best in a consistent pH. For the vagina, this is between 3.5 to 4.5. (slightly acidic). This rises to 6-7 post-menopausally. For the rectum this is ~7 (neutral). This means that it may make sense to use a different lubricant for vaginal vs rectal use.

So which lubes are the best? You can find tables on the web with several commercially available lubricants on Women’s Voices. For vaginal use, my current choice, what I use in the clinic, is Good Clean Love’s Almost Naked. For rectal use Yes But is my current favorite. Osmolality and pH are appropriate for rectal use. Slippery Stuff is slightly hypo-osmolar (26) but pH (6.7) is good for rectal use.

Which lubes should I avoid? According to the WHO, anything with an osmolality of 380 or less is OK to use until more iso-osmolar lubes are available.5 This pamphlet by Smitten Kitten has great graphics to show visually where lubes fall in terms of osmolality and pH. Generally, avoid anything warming, anything with fragrance or flavor.

Remember – it is not normal to feel pain or discomfort during sex! If you are feeling pain or discomfort during sex, one of Movement System’s Pelvic Health Physical Therapists may be able to help. See our Physical Therapists in our South Lake Union/ Seattle, Mercer Island or Gig Harbor locations.

Enjoy your Valentine’s Day with safer and more comfortable lubes!


Julianne Simpson, PT, DPT, holds a BA from Oberlin College and a Doctorate of Physical Therapy from Eastern Washington University. A general orthopedic and pelvic health therapist, she is passionate about helping people move more and empowering her patients to live healthier lives. She dreams of raising kind children, cycling over the Alps and surfing in Alaska.



  1. Begay O, Jean-Pierre N, Abraham CJ, et al. Identification of personal lubricants that can cause rectal epithelial cell damage and enhance HIV type 1 replication in vitro. AIDS Res Hum Retroviruses. 2011;27(9):1019–1024. doi:10.1089/AID.2010.0252
  2. Cunha AR, Machado RM, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, das Neves J, Palmeira-de-Oliveira R. Characterization of commercially available vaginal lubricants: a safety perspective. Pharmaceutics. 2014;6(3):530–542. Published 2014 Sep 22. doi:10.3390/pharmaceutics6030530
  3. Ayehunie S, Wang YY, Landry T, Bogojevic S, Cone RA. Hyperosmolal vaginal lubricants markedly reduce epithelial barrier properties in a three-dimensional vaginal epithelium model. Toxicol Rep. 2017;5:134–140. Published 2017 Dec 16. doi:10.1016/j.toxrep.2017.12.011
  6. All images except photographs come from here.




Beyond Injury Recovery or Post-Operative Rehabilitation – A Physical Therapist Can Help Keep Your Heart Healthy

Beyond Injury Recovery or Post-Operative Rehabilitation –

A Physical Therapist Can Help Keep Your Heart Healthy

February is American Heart Month!

Jessica Hutchinson, PT, DPT



Did you know:

  • Heart disease is the #1 killer of women in the US. 1
  • 1 in 3 deaths in the US are due to heart disease. 1
  • Heart disease kills roughly the same number of people in the US as all cancers and accidents combined. 1
  • Heart disease is considered a lifestyle disease and is largely preventable through lifestyle changes, such as increased physical activity. 2
  • Walking just 30 minutes/day, 5 days/week can reduce the risk of heart disease by 50% and reduce stress, cholesterol, and blood pressure. 3
  • About 3 out of every 10 U.S. adults report being inactive during their leisure time, and only half of U.S. adults report levels of aerobic physical activity consistent with national guidelines. 4

The Physical Activity Guidelines for Americans recommend that adults get at least 150 minutes of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity physical activity, or an equivalent combination each week. 5


Add moderate to high intensity muscle strengthening at least two times per week in addition to above.

  • Moderate intensity: 50-70% of maximum heart rate. You’ll be able to talk, but not sing the words to your favorite song.6
    • Examples: Walking fast, water aerobics, yardwork, riding a bike on level surfaces, doubles tennis.
  • Vigorous intensity: 70-85% of maximum heart rate. You won’t be able to say more than a few words without pausing for a breath.6
    • Examples: Jogging and running, swimming, basketball, singles tennis, riding a bike fast or uphill.

3 Ways a Physical Therapist can help:

  1. Address mobility issues
    Physical Therapists (PTs) are experts in movement science! A PT can help get you moving and keep you moving. Your PT will evaluate and diagnose impairments in range of motion, muscle flexibility, muscle strength, speed of movement, muscle and aerobic endurance, accuracy of movement, and coordination that may impact your ability to participate in physical activity.  Additionally, your PT will assess your baseline vitals such as heart rate, respiratory rate, and blood pressure and identify any possible risk factors or barriers to increasing physical activity.
  2. Promote independence with managing healthy lifestyle habits
    Most importantly, a PT will help you maximize your ability to move and provide you with the tools for long term success. A PT will educate you on current, best-practice guidelines, moving with correct form, preventing injury, and provide you with the resources to stay active to prevent heart disease. We will also educate and provide resources to address stress, sleep, nutrition, and smoking cessation to keep your heart healthy for years to come.
  3. Prescribe an individualized exercise program
    Based on their evaluation and diagnoses, a PT will design a tailored program that is structured, safe, and effective and help you set realistic goals while addressing any perceivable barriers for long term success. This program will include aerobic activities such as walking, jogging and swimming.  Your physical therapist will also include strength training, which further decreases the risk of heart disease and improves your overall health – here’s how:
  • Strength training can speed up the body’s metabolic rate, which can decrease fatty tissue in the body.
  • It can also decrease the amount of visceral fat, or belly fat that sits around vital organs, including the heart. Excess visceral fat can contribute to health problems including heart disease.
  • Studies have shown that strength training twice a week, especially combined with regular cardiovascular activity, can have profound positive effects on heart health and overall health.

Movement is Medicine!
Call your local Movement Systems Physical Therapist today to help you get moving!
Now serving South Lake Union, Mercer Island, and Gig Harbor



Jessica Hutchinson is a Doctor of Physical Therapy and Board-Certified Clinical Specialist in Orthopedic Physical Therapy who strongly believes in a ‘patient first’ mentality for long term success. In an alternate universe, she would be a wine sommelier. She practices at the South Lake Union clinic.