October is Physical Therapy Month, and we're offering a steal of a deal -- a 1-hour session with a PT to perfect your exercise habit! Normal cost for this is $125-$250, but all month long that hour will be $85, or get two 1-hour sessions for $120! That's the rate of a personal trainer, but with the expertise of our fabulous PTs. Call us to schedule! 858-457-8419
If sitting is the new smoking, how do you reverse it? - By Kira Shurtz, DPT
Since February I have been climbing at an indoor rock climbing gym. I do it because I really enjoy the challenge, but I also do it because I found I wasn't able to perform equal work with my upper body compared to my lower body. I wasn't loading my shoulder joints or requiring upper back stabilization during many of my exercises. Rock climbing has proven to be very beneficial for me; my grip strength is improving (great for preventing fatigue as a manual therapist), my hip mobility is increasing again, and my upper body strength has made huge strides. I no longer fear awkward reaching behind me or long reaches to pull heavy items towards me. All this is great, and I intend to continue to climb. However there are a few things I did not think about when I began to climb.

1. Most climbing positions are in flexion or forward bending.

2. Rock climbing is often an endurance sport. This means you learn new postures while climbing or belaying, and not all of those postures are good for you to maintain in everyday living.

3. Just like most other exercise, we only stretch what hurts when we should really be focusing on strengthening the opposing muscles to prevent over strengthening of one muscle group.

Why write about climbing if most people don't climb regularly? Most of us do perform flexion based movements and exercise most of our lives. Most people have heard that sitting is the new smoking. Well, sitting is flexion of the hips, spine, and often the shoulders if you are slouching. You are flexed anywhere from 5-10 hours a day if you perform desk work, drive, or sit frequently on couches or chairs of any kind. If you lift weights working your chest, biceps, or if you perform lots of squats, your body is working in flexion for most of the exercise. If you perform burpees, pushups, ride a bike, walk on an incline on the treadmill or walk outdoors on hills, you are working with many of your muscles in a flexed position. Prolonged flexion of the body shortens the muscles on the front of your body and weakens the muscles on the back side. You begin to hunch, stick your chin forward, round your shoulders, slouch with standing, and hinge slightly forward at the hips with standing. The muscles on the back of the body become weak and are no longer able to counter balance the muscles on the front of the body.

So if sitting is the new smoking, the first thought is to just, "STAND UP!" Stretch out your arms and legs. However the problem is, you've spent so many hours practicing flexion that your body does not have the strength or flexibility to fully extend. If standing up isn't the simple solution to all our problems, what is?

Work on strengthening extensor muscles = strengthen the muscles along the back of the body.

As you strengthen the extensors of the body, you will find your pain in the front of your shoulders and hips will go away. Your neck pain will decrease. You won't feel nervous about throwing out your back if you lift an object off the ground or pick up your 3 year old who has just had it with walking. Think of the following exercises the same as you think of brushing your teeth. Regular exercise is the best way to prevent pain and reduce health care expenses. It is much easier to perform 3-5 reps of a few exercises than attend doctor's appointments, physical therapy twice a week, take pain relievers, and cut out activities you enjoy just to reduce pain. Here are a few easy exercises that don't take long to perform and will help to increase strength along the back of your body. Some of these will require a theraband. Many of you have them from when you were in physical therapy, but if you don't have one, they can be bought online or at some sports stores. Start with lower repetitions, and work up to higher repetitions as you become stronger.

1. Start with your arms against the wall, palms facing out. 2. Slowly slide them up towards the head and back down to the side. Each rep should take between 20-40 seconds to perform and should be done 3-5 times. This may take a few weeks for your arms to be able to fully perform the movement depending on strength, and thoracic spine flexibility. Stop when you can no longer keep your lower back and forearms on the wall (2a). Your flexibility will increase with time (2b).

Start in sitting or standing with a neutral posture. The theraband is wrapped around the palms of the hands. 1. Start with a 90 deg bend in the elbow, 2. then both arms externally rotate (rotate out) from the shoulders about 70degs while also rotating the palms up. 3. Straighten your elbows. Reverse the steps until you are at the beginning.

Wrap the theraband in front of the shins, behind the thighs and then wrap the ends around the hands. Make sure your fingers are extended. Bend your knees to 45 deg as though you are going to sit back in a chair and hold the position. With the static stand, your goal is to activate your posterior muscles. Start with a static hold for 20 seconds, 3-5 reps. Work up to 60 second holds for 3-5 reps. In order to progress your time, you need to be able to stay in a mini squat without lower back or knee pain.

1. Start with feet hip width apart, draw in abdomen/activate pelvic brace. 2. With core activated, keep forearms parallel to ground and bring elbows behind ribs. Shoulders remain relaxed and move down and back during the row. Return to the starting position. Repeat 10 times, 2-3 sets.

Kira Shurtz, DPT

Psychobiotics: 260 Million Neurons - By Maureen Mason, MS PT, WCS, CCI, PYT-C

The American Psychiatric Association had a nutrition session for the third year in a row presenting findings on "Food and the Brain". This field is an emerging treatment paradigm that studies the influences of nutrition and gut health on behavior and disease risk.


What is important for you to know regarding nutrition, health, and self care?


1) There are 260 million neurons that connect the gut and the brain.


2) The gut bacteria make neurotransmitters and communicate with the brain via the vagus nerve.


3) Dr. Deans of the American Psychiatric Association has coined the term "Psychobiotics" and stated, "There is considerable overlap between irritable bowel syndrome and depression and anxiety.


My contention is that they are the same pathology that are expressed in different phenotypes. Gut pathogens cause inflammation and increase factors like IL-6 and interferon gamma-findings also seen in depression-ultimately reducing the conversion of tryptophan to serotonin."


Key points from the study are listed below, as well as references. Consider these tips to improve your digestion and emotional and physical health.


1. Oysters and other mollusks are high in omega 3 fatty acids, B12, and other nutrients needed for brain health. These help to make brain derived neurotrophic factor, in other words, helping brain and nerve tissue to grow.


2. You could reduce your risk of developing depression by 40-60% by following the Mediterranean diet. See additional references for guidelines.


3. Seafood such as sardines, anchovies and herrings are an optimal source of vitamin D and have less risk for mercury contamination compared to other larger species.


4. Kale, mustard greens and bok choy are great sources of calcium, magnesium, vitamin A, K, and C, and are an important part of an optimum diet. Jump on the kale bandwagon now!


5. Nuts and legumes are part of a healthy diet and, and provide key dietary nutrients as well as fiber. Nuts have good fats and feed brain health.


6. An optimum microbiome produces by products of digestion that appear to protect against cancer. In as little as 2 weeks, a population of Americans was able to alter their gut biome to exhibit cancer protective substrates, as found in a South African population.


7. Eat good fats and do not strive for a fat free diet. High blood triglycerides are associated with increased risk for cardiovascular disease and dementia and may be triggered by excessive carb consumption such as bread, rice, and potatoes. See your MD or nutritionist for clarification as needed.


In summary, nutritional medicine is becoming mainstream psychiatry as the title of Lancet Psychiatry reference 2 indicates, and the author states:


"The emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology."


Maureen Mason, MS PT, WCS, CCI, PYT-C



1. Am Psychiatric Meeting 2015 Food and the Brain summary on Medscape more »
2. Sarris J, Logan AC, Akbaraly TN, et al. Nutritional medicine as mainstream psychiatry. Lancet Psychiatry. 2015; 2:271-274.
3. Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry. 2009; 66:1090-1098. Abstract
4. O'Keefe SJ, Li JV, Lahti L, et al. Fat, fibre and cancer risk in African Americans and rural Africans. Nat Commun. 2015;6:6342. 

Additional references and resources

Beom Jae Lee and Young-Tae Bak Irritable Bowel Syndrome, Gut Microbiota and Probiotics, J Neurogastroenterol Motil. 2011 July; 17(3): 252-266. Published online 2011 July 13. doi: 10.5056/jnm.2011.17.3.252 PMCID: PMC3155061
Heart-Healthy Diets Deciphered, With Dr. Stephen Devries - more »
Mediterranean diets beat low fat for CVD prevention - more »
Dementia, Is gluten the culprit? Bret S. Stetka, MD, David Perlmutter,
MD (Grain Brain Reference) - more »
Paleo diet: What is it and why is it so popular? - more »


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Community Education plays a meaningful role to the members of our CTS family. We strive to do our part and provide top notch education and information. Here's how:

Cindy Furey - Teaches at St. Augustine and San Diego State University

Crystal Hazelton - Blogs on pelvic floor with post-partum issues

Mandy Johnston - Teaches core activation at Mesa College PTA program. - Presents using Pilates for rehab at San Diego District Chapter Meeting for the APTA

Elizabeth Leeds - Teaches pregnancy/post-partum topics at the YMCA

Maureen Mason-Cover - Clinical trial on Diastasis Recti intervention


Comprehensive Therapy Services focuses on great traditions to heal, educate and empower patients, family and friends. Take advantage of our programs to help you meet your wellness goals.  

Take advantage of our Pilates classes and private instruction, Massage and Acupuncture - what a combination to help you meet your health and fitness goals! Check out our class calendar - CLICK HERE» 
Pilates Reformer Group 

CTS also offers Mindful Meditation with Jim Cahill. During these sessions, Jim will work with you to enhance your physical and emotional well being while teaching you techniques you can use for self practice. For more information, CLICK HERE»   

As always, the therapists and staff at CTS strive to offer you the best Physical Therapy in town. We promise to provide the most up to date treatment techniques. Let us empower you to make NOW your time to shine!

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