Ask an Expert: How Can Therapy Help If I Have a Rotator Cuff Tear?

Question: What does the rotator cuff do, and how can therapy help if I have a rotator cuff tear?

Answer: The rotator cuff is a group of four muscles that work together to perform rotational movements of the upper arm, but also to maintain stability of the joint by preventing excessive sliding around of the “ball” (head of the humerus) in the “socket” (glenoid fossa) of the shoulder and scapula, and by keeping the ball centered in the socket.

There can be normal changes in the structure of the rotator cuff musculature, just as there are in the bones of a joint as we age.  Therefore, the rotator cuff is more susceptible to tears after age 50.

A partially torn rotator cuff can improve with Occupational or Physical Therapy intervention by providing treatment to reduce pain associated with a tear. Education in activity and postural modification, as well as instruction in therapeutic exercise and activity are also provided.  The purpose of this is to increase the stability of the shoulder joint, to keep the ball centered in the socket, maximize the space through which the rotator cuff muscles travel in the top shoulder joint to decrease pressure on the rotator cuff, and increase the ease of overhead reach and rotation. This can enable one to return to pain-free function of the involved arm, to perform activities such as fixing one’s hair, throwing a ball, playing golf, or casting that fishing line!

Erin Winters, OTR at Putnam County Hospital

Ask an Expert: How Long Will it Take to Recover From a Stroke and When Should I Start Therapy?

Question: How long will it take to recover from a stroke and when should I start therapy?

Answer: Every stroke is different, just as every person is different. Generally, you will see the most improvement or recovery within six months to a year. After a year, recovery and improvements are still possible, however, the rate of recovery tends to slow down.

To minimize disability and improve your recovery, therapies should begin as soon as possible. It is common for patients to think they need to rest after a stroke, but research shows greater improvements if you start therapy 24-48 hours post stroke.

There are various factors that may affect your rate of recovery including:

  • Severity of stroke regarding physical and cognitive aspects
  • Emotional factors that affect mood and motivation
  • Social environment and support of family/friends

It is normal to experience a wide range of difficulties or “bumps” along the way that could impede or slow progress including other medical complications. Once you have a stroke, you are at a higher risk to have a another stroke. It is important to continue to monitor blood pressure, blood sugar and heart rate, take all prescribed medications, follow up with doctors, and continue with therapies.

Erica Howard, PT, DPT

Ask an Expert: Can Occupational Therapy Help Me?

Q: Can Occupational Therapy help me with shoulder pain and weakness even though I had surgery over 10 years ago? 

A: Absolutely! Whether or not you had therapy following your surgery, your condition has probably changed since that time. Arthritis, joint degeneration, soft tissue overuse/damage, impingement, and joint positioning are some of the causes of inflammation and joint limitations resulting with pain and weakness.

Occupational Therapists assist in recovering from injuries and regaining functional abilities. Occupational Therapy is often referred by a doctor to address these issues for improved pain management and functional mobility of your shoulder.


Kelly van Vliet graduated from Towson State University in Maryland with an Occupational Therapy degree. She has over 30 years of experience and specializes in treating upper body limitations related to orthopedic and neurological deficits. She provides a range of other OT evaluations and treatments including pet care capability, power mobility operation, low vision needs, continence improvement, and cognitive care. Kelly is certified in LSVT BIG® to treat clients with Parkinson’s Disease.

Ask an Expert: Can OT Help My Mom Feed Herself?

Question: My mom has dementia and seems to have forgotten how to use her silverware to feed herself. Can OT help?

Answer: Yes! Sometimes, as dementia progresses, people can have more difficulty feeding themselves. OTs can figure out what’s getting in the way of self-feeding and provide the best amount of support that helps the client maintain their skills for as long as possible.

Your OT can recommend changes in things like the type of dishes used, the kind of food offered and how it is presented, distraction level, and adjusting routines and schedules. OTs train caregivers in offering the right kind of cueing and support. OTs also take into consideration other factors outside of dementia that may be impairing self-feeding.


Stephanie Grunklee, MOT, graduated from Maryville University of St. Louis with a Master of Occupational Therapy degree. Stephanie is a champion of the Wound Care Program. She is passionate about geriatric rehabilitation and understands the importance of an interdisciplinary team-based approach to help patients reach their goals.

Ask an Expert: Where Can I Find a Good Pair of Supportive Shoes That Still Look Good?

Question: Where can I find a good pair of supportive shoes that still look good?

Answer: We recommend searching within your community for a local shoe store that specializes in footwear. Shoes are categorized by features that address different foot mechanics and diagnoses. Shoes are classified by three types such as neutral, stability, and motion control.

Shoe stores often cater to walkers and runners, but others have the resources to meet the needs of a more complex population with uncommon foot pathologies. These stores offer an abundant selection of footwear spanning from running shoes to sandals to dress shoes.

Conditions such as over pronation, posterior tibial tendonitis, heel spurs, bunions, and a host of other health conditions may be relieved with appropriate footwear made of quality materials. In more severe instances, custom orthotics are also an option.

We find that if shoes do not look good our patients will not wear them. With enough research and effort our patients can often find a shoe that offers a compromise between support, quality, and fashion.

Chris Barrett, PTA

Ask An Expert: How Should I Feel After Physical Therapy?

How should I feel after physical therapy? Is it going to be painful?

Physical therapists have gained a little bit of a reputation when it comes to pain. If you’ve been through physical therapy before, chances are you initially felt like treatment was making things feel worse. BUT, if you stick with it, the gains and improvements come with time.

We, as therapists, are focused on a number of things including, but not limited to, increasing your endurance, balance, flexibility, and strength. All of those things require prescribing specific exercises almost like you would do in a gym. Improving strength is only achieved by putting an adequate amount of “stress” on a muscle group which, in turn, causes some ache, fatigue, and soreness.

That being said, the level of soreness you feel after therapy should not interfere with your daily activity. Your physical therapist will constantly be checking in on how you felt after all activities. Ask questions if you aren’t sure if what you’re feeling is normal. You’ll hear a lot of people say “no pain, no gain,” but the real saying is “consistency over intensity.” Keep your bodies moving and stay healthy!

Kim Rea, PTA

Temporomandibular Joint Dysfunction

Temporomandibular joint dysfunction (“TMD”) is a musculoskeletal problem of the jaw generally characterized by jaw pain and clicking and often accompanied by headaches, tinnitus (ringing in the ears), and neck pain. It can be worsened by poor postural habits, grinding/clenching teeth while sleeping or awake, sleep apnea, dental conditions, chewing gum, ice or other dense items, eating foods that require wide jaw opening, stress or psychological trauma, and others. Common treatment options include a bite or night guard, dental care, psychotherapy, physical therapy, and surgery.

Physical therapists evaluate and treat both the temporomandibular joint (TMJ) and the cervical spine (neck). Clinicians begin a course of care by evaluating the neck and jaw to identify patients’ unique presentation and develop customized treatment plans accordingly. During the evaluation process, neck and jaw mobility, strength, jaw opening and closing, airway clearance, surrounding tissue tenderness, muscle and ligament tightness, disc and retrodiscal tissue mechanics, signs of grinding/clenching and posture are assessed.

Physical therapy treatment often involves a combination of manual therapy, exercise, postural training, eating and chewing education, dry needling, and other modalities to address both jaw and neck pain and dysfunction. Physical Therapy is often provided in conjunction with medical management, dental care, and psychotherapy as appropriate. Treatment for TMD can range from weeks to months and is often related to complexity and chronicity of condition.

Patients who are compliant with care including self-management typically appreciate the greatest success. Your dentist, physician, nurse practitioner or physician assistant can refer you to physical therapy.


Dr. Mike Winebrenner is a 1999 graduate of the Bachelor of Science program in Physical Therapy at Daemen College and a 2008 graduate of the Master of Business Administration program from Loyola College in Maryland.  He earned his Doctor of Physical Therapy from Widener University in 2009.  Mike is Dry Needling, LSVT BIG and Bike Fit certified. Additionally, he has advanced training in temporomandibular joint dysfunction (TMD). With a strong background in spine care, his focus is on long term prevention and wellness.  Mike’s commitment to exercise and wellness is evident by his active lifestyle, including cycling, fishing, kayaking, hiking and health club exercise.

Ask an Expert: Do I Need to Stop Running?

I have been diagnosed with Osteoarthritis (OA). Do I need to stop running or participating in sports?

This is a question that we are asked regularly during physical therapy sessions! A recent 2020 meta-analysis by Zampogna et al on of the effects of activity in people with OA concluded that, “compared to controls, aquatic exercise, land-based exercise, tai chi, and yoga showed a small to high effect for improving pain, physical function, quality of life, and stiffness. Active exercise and sport are effective to improve pain and physical function in elderly people with osteoarthritis.”

Furthermore, a 2018 study by Lo et al. in The Journal of Clinical Rheumatology concluded that, “among individuals over 50 years old with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression.”

That being said, I recommend avoiding contact sports which have a higher risk of orthopedic injury, such as tackle football and rugby. I also recommend a well-rounded exercise program which incorporates mobility, balance and strengthening exercises into your regular routine.

When progressing activity, it’s a good idea to gradually increase intensity or duration of activities by no more than 10% per week. For example, if you normally run for 20 minutes on the treadmill at 7 mph and you want to progress this activity, you can either increase the time to 22 minutes or increase the speed to 7.1 mph.

If you are limited in your daily life and recreational activities due to pain, stiffness or weakness then consider making an appointment with a physical therapist to help you get moving again!

Ask an Expert: I Was Diagnosed with Moderate Hip Arthritis, Can PT Help?

I recently got diagnosed with moderate hip arthritis, but the Doctor does not recommend a hip replacement yet. Can Physical Therapy help?  

Physical therapy is a form of treatment that helps to alleviate pain and improve movement in those who have mild to moderate hip arthritis. It is a non-invasive and drug-free approach that can be very effective in managing the symptoms of this and other arthritic conditions.  Physical therapists are trained to work with people who have arthritis and can develop a personalized plan of care to help alleviate your pain and improve your mobility. They may use a combination of techniques, such as exercises, stretches, and hands-on therapy, to help you regain strength and flexibility in your hip joint.

Exercises are an important part of physical therapy for hip arthritis. Your therapist may prescribe exercises that are specifically designed to help improve the strength and flexibility of the muscles around your hip joint. These exercises may include range of motion exercises, leg strengthening exercises and balance exercises.  Stretching is also an important component of physical therapy for hip arthritis. Stretching can help to increase the flexibility and range of motion in the hip joint, which can help to reduce pain and improve your ability to move around.  Hands-on therapy, such as massage and manual therapy, can also be used to help alleviate pain and improve mobility in people with hip arthritis.

Physical therapy can also help you learn how to move and do everyday activities in a way that puts less stress on your hip joint. This can help you to reduce your risk of injury and further damage to your hip joint.   It is important to note that physical therapy can be an effective treatment option for hip arthritis, but it is not a cure. However, it can help to alleviate symptoms, improve mobility, and reduce the risk of further injury. It is always best to consult with a physical therapist to discuss if physical therapy is right for you.

Jeremy Dunker, PT, DPT, OCS

How Can OT Help with Low Vision

What is low vision?

Low vision is permanent vision loss from an eye disease or condition that cannot be corrected by standard treatments like glasses or contacts, medications, or surgery. With impaired vision, it becomes very difficult to complete tasks such as reading, navigating home and community environments, managing medications, managing calendars and appointments, managing finances, preparing meals and snacks, driving, recognizing faces for social participation, using household appliances like dishwashers, washing machines, and microwaves, and so much more.

What can one do to prevent low vision?

The best way to prevent low vision is to have routine checkups with an optometrist or ophthalmologist and, if diagnosed with an eye condition, adhere to the prescribed care plan laid out by the doctor. The three most prevalent conditions resulting in low vision are macular degeneration, glaucoma, and diabetic retinopathy. If one has a family history of eye conditions, it is crucial to have routine eye exams. It is also important to manage your health conditions, for example, controlling blood sugar is extremely important in preventing diabetic retinopathy. Once these eye conditions are present, they cannot be reversed, but further impairment can be prevented. This is why it is so important to follow the doctor’s instructions once diagnosed with an eye disease.

How can therapy help?

Since low vision is permanent, occupational therapists are not able to restore lost vision, but we can help those with low vision best utilize their remaining vision to be as successful and independent as possible. Occupational therapists perform home assessments to identify potential hazards and make appropriate modifications for safety and success. Some examples include adjusting lighting, removing clutter, and adding a contrasting color to doorways, steps, or thresholds. Occupational therapists may also modify the task, teach new skills, and utilize technology to improve daily function. Visual scanning and tracking techniques may be taught to better utilize remaining vision or, one may be introduced to adaptive tools and technology.

Each condition resulting in low vision impacts the visual field differently and have their own unique set of challenges. Occupational Therapists understand these conditions and how they impact the visual field. Occupational Therapists combine this knowledge with an individualized approach in order to provide training and modification in the client’s home and immediate surrounding community for optimal performance of the activities that are meaningful to the client.

Anna Pung, OTR is an Occupational Therapist in the Senior Living setting.  She has a Master of Science in Occupational Therapy from the University of Alabama at Birmingham (UAB) and Bachelor of Science in Psychology from Mississippi State University.  Shespecializes in low vision, dementia, fall prevention, orthopedics, and neuro rehab. Anna is very passionate about working with individuals throughout the aging process to maintain independence and high quality of life.