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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

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!   


High Intensity Resistance Training for Osteoporosis: Are we playing it too safe?

High Intensity Resistance Training for Osteoporosis:

Are we playing it too safe?

By Carrie Hall PT, MHS


The CDC and Surgeon General, along with many researchers1 have proposed that exercise plays a role in prevention and treatment of osteoporosis, but the effect has been perceived to be moderate at best. Debunking this myth, a preliminary study in Australia has shown that high-intensity resistance and impact training (HiRIT) may improve bone and muscle strength in healthy postmenopausal women with osteoporosis.2

Maybe we have been playing it too safe?

It is known that bones respond preferentially to high magnitude weightbearing loads, but most physical therapists prescribing exercise are hesitant to apply high loads to persons with osteopenia (thinning bones) or osteoporosis (low bone density) for fear of risk of injury or fracture. This study aimed to demonstrate that high intensity resistance and impact loading is both safe and effective in improving bone mass and overall physical function.

What did this study do differently?

Researchers analyzed data from the larger Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation (LIFTMOR) Trial on 101 postmenopausal women age 58 or older. For eight months, half of the women did twice-weekly 30-minute sessions of supervised HiRIT that included deadlifts, overhead presses, squats and jumping chin ups with drop landings. The other half formed a comparison group, and for eight months they did unsupervised, twice-weekly 30-minute low-intensity exercise at home.

The graduated loading, close ongoing supervision, and focus on correct technique were key to safety and overall adherence to the program (low drop-out rate). The 2 time per week dosage was also very appealing to this demographic leading to high compliance (participating with expected dosage).

All the participants had bone mineral density testing with a special type of X-ray called a DXA scan before and after the eight-month training program to assess changes in their bone mineral density (BMD), or bone health, at the spine and the femoral neck at the very top of the thigh bone that connects the long bone to the head of the femur.

By the end of the study, the HiRIT participants increased BMD in their spines by an average of about 3 percent and increased hip BMD by 2.2 percent. In the comparison group, women lost an average 1.2 percent of spinal BMD and lost more than 2 percent at the hip, researchers report in the Journal of Bone and Mineral Research.

The benefits of bone density improvements at the femoral neck and spine translate into stronger hips and backs. Women in the resistance group also had a 40 percent improvement in back and leg extensor strength, which helped improve their posture and reduce their risk of falls.

Close ongoing supervision is key!

The researcher of this study felt this demographic has traditionally been held back from high intensity resistance training for fear of fracturing fragile bone with heavy loading, but that this overly conservative approach has led to stagnation in the field. This study demonstrates preliminary evidence for safety and effectiveness of a HiRIT program for otherwise healthy postmenopausal women with low to very low bone mass.

Key to the success of this program is that HiRIT training should be supervised by adequately trained and educated professionals such as a physical therapist, to ensure correct technique and appropriate progressions, as well as to minimize injuries.

WE DO NOT RECOMMEND INDIVIDUALS WITH LOW BONE MASS TO UNDERTAKE THIS PROTOCOL IN AN UNSUPERVISED ENVIRONMENT, even after notable training, because it is not possible to self-monitor technique or self-prescribe dosage.

Despite misconception to the contrary, high intensity resistance training can be safe and has proven to be effective in improving bone mass.

Consult your PT if you are interested in beginning a program such as this.

Happy lifting!


  1. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011(7):CD000333.
  2. Warson SL, Weeks BJ, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The LIFTMOR Randomized Controlled Trial. JBMR. 2017.


Carrie Hall PT, MHS – President

4 Tips to Maintain Your Exercise Routine During the Holidays

4 Tips to Maintain Your Exercise Routine During the Holidays

By Erik Bies, DPT MS

The holiday season can be a challenging time for maintaining exercise habits. The days are shorter, the weather cold and wet. Work deadlines are due. Food patterns change as heavier and warmer comfort foods invade our homes creating lethargy. Also, the holiday season usually means travel or hosting family and friends that may not share the same exercise habits. So how can one overcome these challenges, embrace the dreary weather and keep active during the holiday season?

Here are 4 tips to maintain your exercise habits:

#1. Equip yourself for the elements. 

If you are equipped to get outside to walk, run, hike, or bike, it eliminates the excuse that it is too dark, too cold, or too wet. Key basic equipment for these activities include moisture wicking base-layers, a water-proof jacket or vest with reflective properties to enhance safety, warm tights / pants / water proof layer for leg warmth, a headlamp to light your path, and appropriate footwear for your activity. Eliminate whatever excuse you have by equipping yourself to brave the elements.

#2. Create routine cues and prioritize exercise.

It is easy this time of year to sleep late and replace the time you have for yourself with time donated to others. You are much better at serving others if you can take care of yourself too. A primary strategy to trigger a habit of daily exercise is to exercise early in the day. If you struggle to rise early in the morning because it is dark, consider a sunrise or dawn simulation alarm clock. These are designed to gradually allow you to wake with increasing daylight simulating the sunrise. Another option is to sleep in your exercise clothes, so when you wake, you are at least partly prepared to exercise. Other cues would include setting out your exercise attire the night before.

#3. Set a 3 to 6 month goal and/or make a significant commitment.“Invest” in something meaningful. Perhaps that investment involves a financial-based, time-based, friendship-based, and/or effort-based commitment. In any case, it needs to be a commitment where failure to participate in the process has a meaningful consequence or sense of loss to deter you from blowing off the commitment. Maybe that means signing up for a goal race with a friend. Perhaps, that commitment involves meeting 2 days per week with that person to train. Another idea may be paying upfront for 10 sessions at a yoga facility to be used in 5 weeks.

#4. Reinvent yourself.  Starting a new activity may trigger the positive reinforcement you are looking for. New experiences can reinvigorate your mood and desire to stay active. If you are getting bored with your exercise routine, change it up. If you are not a committed cyclist, runner, or walker year-round, try something else. Winter activities abound in the mountains of our region from downhill and Nordic skiing to snowshoeing. Perhaps a weekend of challenging new physical activity reminds you that getting out for a brisk walk or run mid-week feels better than not. If you are not a fan of the outdoors and cooler weather, look to a new indoor activity that you have never tried. You could be as aggressive as trying rock climbing, joining a spin group (stationary cycling with a leader), or a mat class such as yoga or pilates.