Help, my baby only turns her head to one side!

So, you just had a baby, (we'll call him, "Jimmy")...say 3-4 months ago, but being that he was your first, you're busy with the daily stresses of being a new parent. One day, a friend of yours comes to visit you and see the new baby. After the "oh, how cute" conversation, she looks at Jimmy with an eyebrow raised and mentions, "hey, why is Jimmy's head stuck to the left like that?" Then, you notice it yourself, and a surge of panic...and guilt comes on. "How could I have not seen this?!" In a single swoop of the arm, you rush out the door while grabbing li'l Jimmy, throw him in the car seat, leave your friend behind, and manage, somehow, to speak to your pediatrician en route to his office. "My God, Dr. Smith, I have an emergency! Jimmy's head is stuck on his left shoulder!" You get to the office, and in tears tell Dr. Smith about li'l Jimmy's head. He take a glance and dispassionately says, "oh, looks like torticollis". More tears stream down your face as you consider the worst case scenario- Jimmy is gonna be wheelchair-bound, live in a bubble, or be stuck with needles day-in/day-out. "Doesn't look too bad, he says. Let's send him to physical therapy."


You arrive at the physical therapist's office 10 minutes later. The physical therapist, with his trained eye, says," Yeah, definitely a left muscular torticollis." You finally gather the courage to ask, "What exactly is torticollis?"

Torticollis, or "wry neck" is a problem that affects the SCM muscles of the neck (see image above). Often times, infants with torticollis demonstrate limitations in turning their head in one direction as well as presenting with their head tilted to one side. Along with torticollis, often times infants will present with "plagiocephaly", which is a flattening of one side of the the head.

So, what causes torticollis and how is it diagnosed? The answers are not clear. Some incidences may be related to larger babies in utero who have less room to maneuver their bodies during the third trimester, in particular. Other incidences of torticollis may be a result of favoring one side, leading to a flattened side of the head (plagiocephaly), making it easier for the child continue preferring one side, especially when on his/her back. The formal diagnosis usually comes from the pediatrician or pediatric physical therapist, though parents, friends and fam may also point out the odd tilt to one side.

How is torticollis treated? The first step is ruling out other possible diagnoses (superior oblique nerve palsy, Sandifer's Syndrome, hemarthrosis, e.g.). The next step is extinguishing the harmful behavior- positioning activities and strategies are simple interventions, but VITAL in diminishing your child's tendency to one side. Stretching exercises, often performed by physical therapists, are reviewed with parents to be performed with their children at home.

Does it go away? Does it ever come back? 80-90% of the time, after 2-3 months of treatment and monitoring, torticollis will full resolve. The key point is getting infants earlier in the game than later!

More questions on torticollis? Contact Dr. Jerry Yoo at 201-977-4441 or via email: info@mavenpt.com

Tri season cut short?!?!

Oh man, my knee has been hurting. Sorry to say that unlike my business partner, Dr. Taylor Lee, who had a 24 hour "miraculous recovery" from his debilitating shoulder pain a few weeks back (check out Taylor's blog- www.jatofitness.blogspot.com), I am still suffering...3 months later. Oh, Lordyyyy.

Yes, even the most invincible and careful DPTs may succumb to injuries. During my first 15k last November, I felt a little stiffness/pain in my knee during the last 3 miles of the race, but of course, I was stubborn and decided to bite the bullet and persevere....well, I was rewarded for my tenacity; let's just say that my L knee has not been the same since. I'm my own best patient.

My symptoms? Pain on the outside of the knee when I run...and only when I run! I can skip, jump off of a plyo box, perform deep squats, jump in place on one leg, do knee extensions, heel raises, BUT, running more than 1/2 a mile causes my knee to really, really hurt. Yeah, I guess Runner's knee (IT band syndrome) may be the working diagnosis, but I'm not so convinced that it is. I'm gonna have my associate, Dr. Murphy, and my graduate student Bhairvi, take a closer look. As good as I am a physical therapist, I can't always treat my own body!

Knee injuries are rampant among runners. Meniscus injuries, patellofemoral syndrome, muscle strains, Achilles tendonitis and tears are just a few of my favorite things to treat. Most of these are biomechanically-driven, ie., the way you run is causing stress to structures over time.

I feel thwarted, and frankly, a bit frustrated, as even with active rest, I have not been able to run without pain...I hope it's not a sign that I'm actually getting...OLDer or WORSE yet, that I won't be able to complete, let alone just compete in my triathlons this year. = (

What a way to start of the new year.....Stay tuned.

Medicare or MediCUT?

Maybe you're still under the age of 65 and things regarding Medicare are an afterthought and don't really concern you...yet. Maybe you ARE a bonafide senior and have Medicare and wondering how Mr. Obama and his administration have been "reforming" our healthcare system....or, perhaps you have a parent or grandparent who has Medicare and may need a medical service, like physical therapy. How does the Medicare CAP affect you and your loved ones?
Well, for starters, $1,860/year (regardless of how many body parts need to be treated at any given time) is simply NOT ENOUGH. You really can't expect the best quality care or enough of the best care to be covered under less than $2,000 per year!

Case in point, I knew of a Medicare patient with a knee replacement who was discharged (though he needed the therapy) from out-patient physical therapy because his CAP amount was met for the year. Unfortunately, this poor chap, a few months later, fell and broke both his wrists and needed rehab...but guess what, because his CAP ran out, he was unable to afford rehab for this new problem(s). Sad, but true.

"APTA is discouraged and disappointed that Congress is allowing an arbitrary annual cap on outpatient rehabilitation services to be placed on Medicare beneficiaries on January 1, 2010. This is clearly inconsistent with efforts by President Obama's administration and the Democratic majority to reform health care by eliminating arbitrary limits imposed by private insurance companies. (www.apta.org)"

Need I say more? Well, ok, maybe just one more question to pose- Can someone explain to me why our beloved senators, congresspeople, etc are not subject to the same restrictions for their own healthcare?!?! For cryin' out loud, Mr. Obama, gimme THAT plan!

Jan 9, 2010- Back to Tri-training!

In a previous blog, I wrote that I would be setting my goal of completing a 1/2 Ironman and several other triathlon races this year, and I intend on doing so. So, how's my training going? Well, I had a shoulder injury from swimming in late November, which proved to be a longer-than-expected set-back to my training (yeah, can you believe it?! The irony....), then I hurt my left knee (IT band pain, if you're curious) last month. I felt somewhat defeated, and searched for a good divine reason as to why my joints were falling apart when I've been injury-free for the past few years. I decided to listen to my body and rested (at the expense of my formerly trim waistline).

FINALLY, last week, I started up in the pool, I fixed up my knee and shoulder during the rest time, and now I'm getting back on my training schedule.

So far, I'm scheduled for a 1/2 marathon in Asbury Park this coming April. Wyckoff is coming up again in June as well as the NJ State olympic distance triathlons. Hoping to get into the Eagleman 1/2 Ironman as a charity participant, but not guaranteed. Thankfully, the sport is growing and more and more races are popping up each year.

More on tri-training next time....

"Always keep in mind what's really important"

Of all the things I could do on Christmas morn', the Yoo clan decided to check out, "The Princess and the Frog". Man, what a heart-felt flick. Didn't expect the Adam's apple flutter while watching a cartoon! Anyway, the one line that moved me was when Tiana's (the heroine) late father emphasized in a loving way to "always keep in mind what's really important." It was obvious that he was alluding to the fact that while life may be busy as we pursue our all-consuming ambitious endeavors, we cannot and must not discount the relationships we have in our lives and, of course, love. The last three years were truly a blur for me when I think out my family life.

Working part-time jobs to make ends meet in the first year of business and doing my best to accommodate patients at wee-early and way-late hours were trying times back then. Fast forward two years and here I am, two practices later, working on getting the patient to get our two locations flowing and growing, yet not seeing my kids and wife for days at a time had become a source of conflict in my personal life- wanting the professional and financial success, but sacrificing the quality life with the fam, is not a path I desire to take any further. 2010 is starting off on the right foot. Learning to be more efficient at work while making a conscious effort to be present (mentally, physically, spiritually) at home is the plan for this year.

Now, how exactly do we fit in triathlon training?!?!

Swimming is an easy sport? Hardly!

I consider myself an avid swimmer , and I hear this comment on occasion. Of all the sports I've ever participated in, by far, swimming has been the most challenging as far as cardiovascular and coordination demands. Swimming well is HARD! Stroke efficiency, for the average terrestrial being, is not natural, I can attest. Yeah, if I were a more efficient swimmer, sure, it would be a little easier, but do take note that a man my size burns about 511 calories/hr. of lap swimming. That's more than a decent number of calories burned with far less pounding on the joints than say, running. However...

Swimming, contrary to popular opinion, is far from stressful on the joints. In fact, swimming-related injuries are deceivingly high- back, shoulder, groin, and knee issues plague competitive swimmers. When I hear swimming prescribed as an alternative to land-based exercise, I always pay close attention to the patient's diagnosis and their range of motion limitations.

For example, I might steer away from prescribing the freestyle or breastroke to a patient with lumbar spinal stenosis since extension typically worsens symptoms. In fact, these patients would be better off with the sidestroke or backstroke or even just treading water in the deep end. Patients with a torn medial meniscus would not benefit from using the breastroke kick and yet, others with shoulder impingement should certainly get their stroke analyzed and focus on non-overhead drills and land-based rehab while their symptoms subside.

On the aside...if you're a swimmer out there, just remember that you could take on a 250 lb. lineman in the deep end of the pool any day of the week!

For more information on swimming injuries and how to prevent them, contact Dr. Yoo at jerry@mavenpt.com.

Winterizing your shoulder: preparing your shoulder for the spring season

So, you're an athlete who specializes in playing overhead sports (baseball, tennis, lax, softball, etc) and you've finished fall ball, itching for the spring season to come sooner than later. How exactly do you keep your shoulder safe and sound?

Work on Your Posture! Huh? What does posture have anything to with the shoulder? It has EVERYTHING to do with keeping your shoulders working at its best. Practicing good posture while incorporating seated rows, bent over rows, and scap retraction exercises may be helpful in keeping the coast clear of potential shoulder injuries.

Back to Basics- You may THINK you know everything there is to pitching, serving, shooting, and throwing a ball, but now is a GREAT time to get some seasoned eyes on your form and technique to make sure you're recruiting the right muscles for your sport's demands.

The Rotator Cuff: To Strengthen or Not To Strengthen? I see many overhead athletes using preventative shoulder injury exercises emphasizing rotator cuff strengthening. Great. I like seeing more and more people utilizing these exercises in the gym setting as well. However, if you have a shoulder injury, strengthening the rotator cuff muscles may not be the best thing and, in fact, may worsen your shoulder pain. Conversely, incorporating rotator cuff strengthening exercises may be a great way to keep your muscles ready for the upcoming season.

If you have pain during overhead activities, you should first seek medical attention before attempting to do these types of exercises.

Dynamic Trunk Stabilization: What's that? In layman's terms, working "the core" muscles. However, physical therapists and other healthcare and wellness professionals try to refrain from using the term, "core strengthening", because it has been erroneously equated to exercises used to develop the six-pack (or, rectus abdominus), which is far from the truth.

We're talking about getting the deep transverse abdominus muscles (which aren't visible) to work synchronously with the hip/pelvis muscles to provide a dynamically stable base of support, hence, dynamic trunk stabilization.

A dynamically stabilized trunk provides better power and improved stamina to your shoulder muscles during repetitive, overhead activities; in essence, you're creating a powerful "slingshot" effect by having your shoulders launch an object from a stabilized platform (deep abdominal muscles, hips, and pelvis). If you compare the relative size of your shoulder muscles to that of your hips, abdominals, and pelvis, you can appreciate why dynamic trunk stabilization is important in protecting your shoulders for the long haul.

That all said, exercising the right muscles, the right way, will help you keep your shoulder well- prepared for the spring onslaught!!

If you want more specific advice about your shoulder and exercises to help prevent shoulder injury, please contact Dr. Yoo at mavenoffice@gmail.com.

Dr. Jerry Yoo
Clinical Director/Co-Owner of Maven Sports Medicine