Get Your Family Moving: Rake Leaves!

Autumn is a beautiful season with the changing of the leaves, but it also brings about some hefty yard work in removing them. Raking leaves is actually very hard work and good physical exercise at the same time. Your equipment needs are simple: your body and a rake.  Raking burns about 300 calories an hour while toning your arms and strengthening your back and legs.  Just be sure to stretch first and, to avoid muscle pulls, don’t try to do the whole yard at once.

Regular exercise no matter what type can boost energy, build strength & stamina, improve balance and even help to reduce some signs of aging.

Tips for Safe Raking

Do a pre-rake warm-up. It may not seem like a workout, but you can burn nearly 300 calories during an hour of raking!

  • Walk around a bit before you start so your blood gets flowing.
  • Do a couple of stretches to prevent straining the muscles of your shoulders, neck, and back.
  • Side bends and knee-to-chest lifts help open you up and ready you for all of the raking, bending, and lifting you’ll be doing.

Practice proper raking posture.

  • To keep your neck and back happy, stand upright and rake leaves to the side of you, alternating your dominant hand now and then.
  • Bend at the knees – not the waist – when picking up piles of gathered leaves.
  • Keep the rake mostly perpendicular to the ground (i.e. between 65 to 85 ) That will give your body easy leverage on the rake, making it easy to   move, and easy on your body.
  • Avoid twisting to toss leaves. Instead, step to the side so your whole body switches position, not just your shoulders and back.
  • Switch sides now and then and take breaks, especially if you haven’t raked since last fall.
  • Take it easy on your back. Move your whole body and not just your spine.

Take rake breaks. The repetitiveness of raking can become painful after a while.

  • Only rake small sections at a time as this will save energy. Take breaks when you get tired every 10 to 15 minutes.
  • Sip on water to stay hydrated.
  • Stretch to release tension you may have built up.

Using the proper techniques is essential. If part of your body is sore, it is probably telling you that you have overdone it or you are using the wrong technique. Rake so it’s natural and comfortable with the power of your movements coming from your legs.

So, get your family or even some of your friends involved and get your bodies moving. Also, don’t forget to look out for your pets or small children who may jump into your pile of leaves!

Meet Spencer Sheridan

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Spencer Sheridan, Manager of Finance, and hear his story of his time with Tx:Team!

The Truth About Menopause and How Pelvic Health Physical Therapy Can Improve Your Quality of Life

Physical therapists are musculoskeletal experts and should see menopause as an opportunity to use their skills to help women ease this life transition.

Menopause is a normal part of aging and is defined as the point in time 12 months after a woman’s last menstrual cycle. It generally occurs between the ages of 45 to 55 and can last for seven to 14 years. It can also be caused by a hysterectomy or surgical removal of the ovaries. Menopause can result in hot flashes, trouble sleeping, pain with sexual intercourse, incontinence, moodiness, and depression.

As a pelvic health therapist, I often treat women who are menopausal for urinary incontinence, constipation, pain with sex, pelvic organ prolapse, and pelvic pain. These women generally have pelvic floor dysfunction, which occurs when the pelvic floor muscles are not working optimally. Pelvic floor muscles function like a sling between the pelvic bones and provide support for the pelvic organs, stability for the lower back, and sphincter control for the bladder.

Let’s look at each of these concerns associated with menopause to determine how pelvic health physical therapy can you achieve your desired goals and return to daily tasks without limitations.

Urinary Incontinence

Urinary incontinence is not caused by menopause. As a woman ages, if her pelvic floor muscles are weak it can result in urinary incontinence. Many women experience leakage of urine with a sneeze, cough, laugh, while lifting, or with exercise which is called stress urinary incontinence. If urinary leakage occurs with an urgent event on the way to the toilet it is defined as urge urinary incontinence.

When a patient has both stress urinary continence and urge urinary incontinence it is called mixed urinary incontinence. Many women may also state that they have difficulty emptying their bladder, which can be related to increased tension in the pelvic floor muscles.

Pelvic floor muscle training can be an effective way to eliminate urinary incontinence and allow a patient to resume all desired activities. Typically, a patient can see improvement in one month and with consistent performance the results can be long-lasting. A pelvic health physical therapist can evaluate you to determine if you need to relax or strengthen your pelvic floor muscles to regain bladder control.


There can be many causes of constipation. It is common to experience constipation during menopause due to shifts in hormones, but it can also be related to side effects of medications, lack of physical activity secondary to fatigue and arthritis, fluid intake, and diet. Over time with excessive strain people can develop tension in their pelvic floor muscles making having a bowel movement more difficult. With excessive strain you can also put more pressure on the pelvic organs. If the pelvic floor muscles are weak, this can lead to prolapse. Seeing a pelvic health therapist can help you determine if your muscles are tightening versus relaxing with a bowel movement to reduce strain and prevent additional concerns.

Pain with Sex

With a decrease in estrogen, women can experience vaginal dryness, irritation, and pain with sexual intercourse. The use of vaginal lubricants (which are available without a prescription) can decrease friction and increase your tolerance. The use of vaginal moisturizers can help improve or maintain vaginal moisture, especially in women who have vaginal atrophy or thinning of the tissues.

Pain with sex can also be caused by low back and hip pain secondary to limitations in range of motion for positioning. A pelvic health physical therapist can perform manual therapy to ease tension and pain, prescribe exercises to increase range of motion and flexibility, and educate you on self-care techniques for desensitization to improve your tolerance.

Pelvic Organ Prolapse

With the loss of estrogen during menopause, there is a weakening of both pelvic floor muscles and vaginal tissue leading to a sensation of heaviness. This weakening can result in a prolapse of the colon, uterus, or bladder into the pelvic canal resulting in pressure and pain.

Women who have had at least one vaginal birth are 50% more likely to experience a prolapse which may or may not be symptomatic. A pelvic health physical therapist can evaluate you for pelvic organ prolapse and also determine if you have pelvic floor muscle weakness to assist you in gaining strength to further support your prolapse and prevent worsening of your symptoms.

Weight gain can also contribute to pelvic organ prolapse. Weight gain is common during menopause as the loss of estrogen results in redistribution of weight to your abdomen. Exercise can become uncomfortable leading to lack of physical activity. A pelvic health physical therapist can also assist you in creating an exercise routine focusing on gaining not only pelvic floor strength but core and hip strength to assist with an improved tolerance for both daily tasks and exercise.

Pelvic Pain

There are many causes of pelvic pain. It can be related to inflammation, infection, or trauma. It is generally caused by a combination of things. A pelvic health physical therapist will evaluate your pain for your pelvic region externally but possibly internally if consent is given to determine the cause.

Again, with menopause there is a depletion of estrogen causing the tissues to thin and get more easily irritated. Pelvic organ prolapse can also lead to sacroiliac joint pain which is pain located in your lower back to buttocks. A pelvic health physical therapist can assist you in eliminating this pain with manual therapy, exercise to strengthen the pelvic floor, core and hips for stability and stretching as needed to reduce tension. They can also educate you on proper body mechanics to reduce strain with your daily tasks including those for your home, work, sports or with exercise.

It is never too late to seek out a pelvic health physical therapist to assist you with these concerns. They can create a plan of care designed especially for you to achieve your goals during this transition. They will help you to determine which type of exercise will allow you to achieve your best outcome. Exercise has been shown to improve a person’s quality of life and help them to achieve an ideal weight which can lead to both a decrease in the severity and length of their menopausal symptoms.


Amy Hauerstein is a Physical Therapist who specializes in Pelvic Health in the outpatient clinic setting.  She has extensive experience and combines her passion for wellness with physical therapy, addressing the physical and emotional limitations of men and women.  Over the past 20 years, Amy has lived all around the US working as a physical therapist in a variety of healthcare settings. Three years ago, she changed the focus of her practice to pelvic health. She started taking courses with the APTA’s Academy of Pelvic Health and received her CAPP-Pelvic in July of 2021.  She enjoys working in this specialty and seeing first-hand how much Pelvic Health can improve someone’s quality of life.

Ask an Expert: What Do I Need for My First Appointment?

What do I need to wear for therapy?

We suggest wearing comfortable clothing to therapy as you will be doing some exercise and testing during your appointments. We also recommend bringing either shorts or t-shirt/tank top with you depending on the area we are evaluating.

For example, someone coming in post knee surgery may want to bring shorts with them as the therapist will want to take a look at the surgical site and potentially do some scar management work. If you are going to be getting into the pool we will ask that you bring a bathing suit or clothes that you will be comfortable wearing in the pool and then a change of clothes for after your appointment.

The last thing that we ask is that you wear appropriate shoes to therapy. If you are coming in to work on gait and balance, we would prefer for the patient to wear sneakers and not come to therapy in slippers or shoes that do not have traction to them.

What should I bring with me to my first appointment?

For your first appointment please bring with you your photo ID, insurance card, medication list if you have one, and the order from the doctor that is referring you to therapy. You can also bring any doctor’s notes or images that you have pertaining to why you are coming in for therapy.


Kayla is a front office supervisor in an outpatient setting in Frederick, MD. She manages systems and processes to ensure our patients are getting the best experience from the minute they walk in the door.

Safety Tips for Shoveling Snow

When the snow starts to accumulate and shoveling becomes a common household activity, injuries occur more frequently. Low back pain affects 70% of people at some time in their life, and can often be caused by unaccustomed strain or exertion like shoveling snow.

To avoid getting hurt while shoveling your sidewalk or driveway this winter, we have some simple tips for you to protect your body.

  1. Stretch before you shovel. Warming up your muscles by stretching before you go outside to shovel will help prevent injury and fatigue.
  2. Keep a wide base of support. The wider your base, the less strain you put on your back in trying to get low. Let your arms and legs do the work. Rely on your legs by keeping your back straight and engaging your shoulder muscles, pushing the snow instead of lifting by using your legs.
  3. Don’t try to be a hero! You don’t need to cover half the driveway in one shovel, take smaller shovel-fulls and work your way down. It will be easier on your body and it will take about the same amount of time. In addition, try to pace yourself and take breaks when you get tired. Don’t overwork yourself and be aware of your heart rate.
  4. Routinely switch sides back and forth. For every stroke you take on the right, swap it around and take a stroke on the left. But don’t twist and toss – twisting your back when handling heavy snow can lead to injury. Don’t forget the first tip: rely on your legs when possible.
  5. Keep the shovel close to your body as you work. The further the shovel is from your body, the heavier it will feel and the more strain it will put on your back.
  6. Have a plan. Try to get out and shovel every three inches or so to avoid the snow building up. Don’t forget to bundle up in warm layers and stay hydrated.

Watch this short video to see how Dan puts some of these tips into action while shoveling:

Posture vs Movement

Quite a few studies have tried to link posture to chronic pain and tightness, but none have been successful. That’s because our bodies are adaptable and it is hard to be in a harmful position when just sitting at a desk. However, there is evidence demonstrating that being sedentary can actually result in an individual experiencing discomfort, tension and other physical concerns.

Focusing on regular movement breaks rather than being in any specific posture is a good way to start to alleviate these issues. You should try to take these movement breaks about once every 45 minutes and they can be as simple as doing some neck and shoulder rolls or walking to the water cooler.

If you have questions about your posture or pain in general, contact Tx:Team today!

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    Come Find Out Why Working With Us is Good Therapy

    Are you a Physical Therapist who loves working in outpatient orthopedics but are tired of the double bookings and long hours? Do you want quality one on one time with your patients? We’re hiring a Physical Therapist for our employer based clinic at the Finish Line Headquarters Health and Wellness Center in Indianapolis, Indiana.

    What makes this opportunity so unique? You will be practicing on the Finish Line campus in a private clinic where you will see all your patients one on one. There is no cost to the employee for physical therapy services and therefore no out-of-pocket expenses. This position only treats employees and their family members covered under Finish Line’s health plan.

    Tx:Team is ranked in the top 4% nationally for effectiveness due to our treatment style. And we don’t just get great results for our patients; at Tx:Team, we take pride in the satisfaction of our associates as a company that was founded and is still managed by therapists.

    Dan is here to explain more about the position:

    Come find out why working with us is good therapy. Get all the details about this unique setting and apply here!

    Physical Therapy and Safe Pain Management

    No one wants to live in pain. But when it comes to treating pain, where do you turn?

    Before you fill a prescription for opioids, consult with a physical therapist to discuss your options. “Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions,” the CDC states.

    Seek Out Physical Therapy at the Onset of Pain

    When pain begins, don’t try to self-diagnose or treat yourself. Physical therapy is the most conservative and least intrusive approach to managing your pain, which makes it a great first step. Not only can physical therapy successfully alleviate most pain, but it can also keep your pain from returning. A number of studies have even shown that PT can often be as effective as surgery for providing pain relief in some patients.

    A physical therapist can help identify the injured tissue (bone, muscle, tendon), and can put together treatments to help promote healing and reduce stress on the injured area. Your PT will be able to offer advice on how you can safely return to your normal activities without further damaging the injured tissue. With the assistance of your physical therapist, you’ll be able to recover faster and minimize risk of future injury or illness.

    How Can a Physical Therapist Help?

    A physical therapist educates patients on how to prevent or manage their conditions so they will achieve long-term health benefits. A PT can help any individual who needs assistance in the following: pain management, avoiding an orthopedic surgery, improving mobility and movement, recouping from an injury or trauma, recovering from stroke or paralysis, fall prevention, improving balance, or management of age-related medical problems.

    Having pain-free movement is crucial to your quality of life, and PTs can help identify and treat your movement problems. Your PT will design a treatment plan that is tailored to your needs, challenges, and goals. Waters Anchor physical therapists work every day to improve the health, mobility, and quality of life for their patients. For an effective treatment option, choose physical therapy to manage your pain.

    Lymphedema & Physical Therapy

    Christina Kuzma, Manager of Business Development at Tx:Team, successfully battled breast cancer this year using physical therapy as an integral part of her treatment plan. She says that the one thing she would have done differently is to start physical therapy sooner. She began therapy the day after surgery with stretches and massages to target her lymphatic system. Despite her success, she thinks that her body would have been better prepared for the pain and stiffness if she had practiced therapy in the weeks leading up to her surgery. These pre-operation exercises are especially important when thinking about post-operation outcomes that can hinder a patient’s success. An example to consider, which often goes undetailed, is Lymphedema. Christina’s symptoms during radiation did not flare to become Lymphedema; however, reports show that having an extensive surgery, such as mastectomy, paired with radiation can increase the odds of facing Lymphedema six-fold.


    Lymphedema can occur from any compromise to the lymphatic system; however, Lymphedema is especially common among breast cancer survivors because it can happen when lymph nodes are missing, impaired, or removed. Swelling will ensue if this system begins to have problems draining excess fluids, waste, or toxins from the body. Most commonly in breast cancer patients, the swelling shows in the arm or hand, and sometimes in the underarm, chest, trunk, or back. It can be a very serious, debilitating, and painful problem.


    To identify Lymphedema, know that it develops gradually; however, early detection is important. Uncomfortable sensations, like tingling or numbness, in any of the listed common areas precedes visible swelling of those parts. Some patients will also report feeling full or heavy, and others report decreased flexibility and tightness. Including a Lymphedema assessment in a routine follow-up visit with a doctor at most, 6 months after surgery, could substantially decrease the physical, emotional, and financial burdens of Lymphedema on breast cancer survivors. Early detection treatment and even a pre-surgical rehab visit can vastly improve your outcome if diagnosed with Lymphedema.


    Kim Brown is a Tx:Team Physical Therapist at FMH Rehabilitation Crestwood, in Frederick, Maryland. While she did not treat Christina directly, Kim is all too familiar with the diagnosis and treatment for patients just like Christina.

    Kim is trained and certified in Lymphedema treatment. Seventy-five percent of her clients are breast cancer patients. Due to the sensitivity of this condition, which balloons the body and causes intense, uncomfortable pain, Kim treats Lymphedema with private and personal care. According to Kim, “Success is defined by the empowerment of patients, with hopes of not only regaining their strength and living pain-free, but also regaining self-esteem and authority over their condition.”

    For that reason, education about Lymphedema is a big part of Kim’s job.  “Most patients haven’t tried much besides medication to cope with their pain or persistent disability,” says Kim.  It’s likely that for that reason, many patients arrive thinking that there’s no real opportunity to improve. However, alongside the use of manual therapy and bandaging to heal tissue and reduce swelling, Kim and her team of therapists teach their patients how to exercise and manage their condition on their own.

    There are few comprehensive studies conducted on Lymphedema in breast cancer patients, and as a result, Lymphedema can often be brushed over in conversation. Christina Kuzma reports that she only knew about Lymphedema thanks to a co-worker. Otherwise, Lymphedema was only mentioned to her quickly in a doctor’s visit as a potential outcome. Despite this serious lack of information and discussion, you are not an outlier if you experience this swelling and it deserves immediate attention. One study reports that in the first 18 months of recovery from breast cancer surgery, 1 in 10 patients experience Lymphedema. By 18 months, about 30% of patients have, or have had Lymphedema. Irrespective of these odds, it is most important to educate yourself on Lymphedema and keep tabs on the changes in your body as it undergoes intense and stressful circumstances.


    It cannot be said enough how important it is to care for the health of your body and those you love. Circumstances can quickly change and you may feel out of control, but know that living comfortably is within reach. Especially to cancer patients, Kim Brown insists that there is always room for improvement. She says, “Beating cancer isn’t the end of your journey. Don’t accept weakness, fatigue, and pain as a part of your life post-cancer. Talk to your doctor and maintain that your goal is to return to the state that you were in before cancer came into your life.”

    Choose Physical Therapy as Your Option

    In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team brings you Part Three of our weekly series to share her experience making decisions about her treatment.

    The month of February was incredibly stressful for Christina. Uncertainty reigned as doctors ordered different scans to assess the lump that she found in her breast. She’ll tell you that the anxiety she experienced then was worse than any part of her treatment thereafter. When she was officially diagnosed with HER2-positive breast cancer, she was able to regain control of her path. She began studying, using research articles, blog posts about others’ experiences with breast cancer, and her coworkers’ expertise in health care to make sense of all the information available. Looking back, the information-gathering period of Christina’s first months with breast cancer was vital to the success that she’s currently experiencing as a survivor.

    At this point, we’d like to pause Christina’s story to talk about the research behind Christina’s decision to forego opioids in her treatment plan. Opioids are medications that can help manage pain, such as that caused by cancer and its treatment, by blocking pain signals from injured nerves to the brain. They vary in strength and form. In the first blog post of this series, Christina revealed that the side effects of opioids were the primary reason for her decision to opt out of using them as part of her treatment plan. The temporary and limited pain relief that they could provide was not worth relying on them. This was about deciding to be cautious with the risks and committing to a plan that was reliable and effective.


    Christina believes strongly that “addiction doesn’t discriminate.” The composition of opioid analgesics is similar to that of morphine and heroin and they act on the same parts of our brain, so they intrinsically present an abuse and addiction risk. There has been awareness of this risk for decades, but opioids continued to be prescribed because it was believed that the drugs’ benefits outweighed the risks. Numbers now show that the rates of addiction and accidental death from opioid overdoses have turned that risk into a crisis.

    The severity of the opioid crisis is underwritten by the drastic increase of written and dispensed prescriptions, the greater social acceptability of using medications, and aggressive marketing by pharmaceutical companies. Between 1991-2014, the number of opioid prescriptions has tripled. In 2016 alone, 214 million opioids were prescribed- that’s a prescription for every 2 out of 3 Americans. Of course, opioid prescriptions are often only one part of the pain management plan proposed by a provider. For breast cancer-related pain, opioids are not considered the first line of treatment. And yet, the number of opioid prescriptions among breast cancer patients has surged similarly, becoming a normalized method for pain relief.

    While opioid medications will reduce pain for a short period of time, they are predictably dangerous as extended methods of pain relief. A 2016 survey by the Washington Post-Kaiser Foundation released its findings: 34% of survey respondents who had taken opioids for at least 2 months said they had become addicted or chemically dependent, while 54% of opioid users’ household members surveyed said they thought the opioid user would struggle to discontinue use. Furthermore, opioid overdoses currently account for 2/3 of drug overdoses, which are now the leading cause of accidental deaths in the United States. In 2016 alone, roughly 115 Americans died every day from opioid overdoses. These staggering statistics should cause providers to be extremely cautious when prescribing pain medication and focused on the long-term health of the patient.


    Anxiety surrounding the pain management process can factor in to a patient’s decision-making. Pain, especially cancer-related pain, is very real. Fearing this pain, an opioid medication’s appeal for quick relief cannot be underestimated. Furthermore, especially in older breast cancer patients, there is a high correlation between the number of patients extending the use of opioid pain relievers and those who also use medication for anxiety or depression. This information indicates that opioids, when mishandled, will likely perpetuate the physical and mental pain for which they are prescribed. To avoid dependence on a medication that is unreliable, talk to your doctor about other options for pain relief. Be your own advocate and speak honestly about the concerns you have and the research you have done. Most importantly, consider the long-term health of your body and the quality of life that you desire.


    The American Physical Therapy Association (APTA) developed a national campaign, #ChoosePT, to bring awareness to physical therapy as an effective and safe treatment for pain. This is about avoiding the risk of creating a bigger life problem while trying to care for your body. On the front page of the #ChoosePT site, APTA writes, “When it comes to your health, you have a choice. Choose more movement and better health.” While treating the pain of a current problem, physical therapy will strengthen the body and reduce the risk of developing other chronic conditions in the future.

    The Centers for Disease Control and Prevention (CDC) has also recognized the epidemic of our current environment of opioid use. As the national health protection agency, the CDC released a set of guidelines in March 2016 for prescribing opioids in the United States. Within the guidelines, the CDC writes, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.” There are multiple health treatment cases cited where opioids could have been significantly reduced or avoided altogether. Additionally, “there is high-quality evidence that exercise therapy (a prominent modality in physical therapy) improves function immediately after treatment and that the improvements are sustained for at least 2-6 months.”

    When Christina Kuzma was diagnosed with breast cancer in February 2018, she was determined to save her life and preserve her health. She spent a lot of time that month researching the pros and cons of each known method for treatment. The best thing that you can do if you find yourself in a similar situation is to find a treatment plan that you are confident in and commit to that plan. To inform yourself on the topics we have covered, please include these sites and research articles in your own study:

    America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

    CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

    Move Forward. ChoosePT