Keep Moving Forward at Your Own Pace

“I fell and landed on my shoulder,” a patient once told me. He expressed himself with a concerned look on his face. He was worried about his daughter’s birthday party. In two days, all of her friends would be over and he felt as though he was not contributing as much as he should have been in order to prepare for the event. He told me that for some reason his arm was not moving as it normally would. 

What Is Frozen Shoulder?

As this story is told, one may begin ask what could possibly be causing the gentleman’s problem. One answer is Adhesive Capsulitis, also known as Frozen Shoulder. Do you know someone who has received this diagnosis? If so, what you may not have known is that this diagnosis does not have a standard definition or classification. What it is does have are similar characteristics between the varying diagnosing parties. 

What are the Characteristics of Frozen Shoulder?

What is known for certain is that there is a progressive loss of range of motion and that the pathology progresses through different stages. Let’s begin with identifying the commonly accepted three phases of Frozen Shoulder: freezing, frozen, and thawing phase. Each of these has different pain levels associated with them. Each phase is also associated with a varying range of motion that may improve or worsen, depending on what phase the person is in. 

Photo via Mayo Clinic

In general, Frozen Shoulder can take around two years to resolve naturally. So, can you imagine presenting that news to the gentleman we were discussing before? 

Not being able to complete his normal life activities for two years would be hard to hear. The good news is that there are various interventions one can use to help manage the symptoms of Frozen Shoulder throughout the various phases. Two potential options are a passive range of motion of the glenohumeral joint (avoiding the painful range) and scapular mobilization, which are both examples of physical therapy interventions. Some physicians may choose to do a manipulation under anesthesia. 

Get Assistance with Frozen Shoulder

If you want to learn more about skilled interventions to treat Frozen Shoulder, we are here to serve you. We aim to provide evidence-based interventions and help you along your rehabilitative care. The team at Rehab At Work provides expert knowledge and patient-first care. If you’d like to schedule a consultation, contact us today.

Article by Dr. De La Cruz, DPT, PT, Lanham Clinic


What is Work Hardening and How is it Different from Physical Therapy?

What is Work Hardening?

Work Hardening is a specific therapy program for worker’s compensation clients who are injured and cannot work at full capacity. The program is designed to help injured workers get back to work by restoring their work-related function and tolerances. Those who qualify for a Work Hardening Program have an initial evaluation of tests to determine what needs to improve, and a specific treatment plan is created for the individual based on their current limitations. The Work Hardening client is supported by a therapy team that works together to plan weekly goals which help clients meet their job requirements and safely return to work. The ultimate goal is a return to their previous job or a similar occupation while decreasing time out of work.

Who Qualifies for Work Hardening?

If you’ve had an injury at work, you may be a candidate for a Work Hardening Program. Most clients have already shown improvement from Physical Therapy but need a more intensive or work-related program to get back on the job. A doctor may refer someone for Work Hardening when they are close to their return-to-work job requirements and have the potential to get better. The client also needs to be medically stable and willing to participate in the program. There are other services under the category of Industrial Rehabilitation that may be appropriate to help injured workers at other stages of recovery, such as: Occupational Therapy, Work Conditioning, and/or Worksite services.

Does Worker’s Compensation Cover Physical Therapy?

In most cases, yes, although there are reasons why Work Hardening may be more appropriate. Early treatment after an injury is very important for a full recovery. Physical Therapy is best following a recent injury or surgery when restoring function is not the main goal. In Physical Therapy, the primary objective is gradually improving strength and range of motion while managing the potential for complications that may affect recovery. Treatment in Physical Therapy is therapist-directed and injury-specific. Once a client has improved with a Physical Therapy program, a transition to Work Hardening with job-specific functional goals may be beneficial to progress into functional activities that are more similar to work. For those who need a combination of injury management and improving their work tolerance, a Work Conditioning Program may be indicated. If you are unsure which service is best, feel free to reach out to your health care provider for advice.

What Do You Do in a Work Hardening Program?

Every program is different, but it usually starts with 4-hour sessions 5 days per week Monday to Friday, and gradually increases to 8 hours per day. Clients are assigned an individual program of cardio and gym workouts, real or simulated work activities, and specific job tasks based on their job, injury, and work restrictions. Each Work Hardening participant initially receives extensive training and one on one instruction, but will eventually become more independent while practicing improved self-management. The main focus of each day is to educate the client on health, safety, and injury prevention while trying to improve the restrictions that are keeping them out of work, especially specific work tasks that are limited or restricted. The goal at the end of the program is to return to safe and productive work. A return to their pre-injury job position is the most desirable result, although some may need to find a different job or occupation if they are unable to meet their previous job requirements.

What Happens at the End of the Program?

When injured workers finish the program and are discharged, they return to their doctor for a final evaluation. If they were able to consistently perform their full duty job with no restrictions in the Work Hardening Program, the doctor can recommend a return to work. This may be the same job with the same employer, or a different job if their last job is no longer available. Clients will also receive a home exercise program with instructions on how to maintain their fitness and work readiness independently. For those who are still unable to return to work, their physician may provide other treatment options to help with recovery.

Where Can I Find More Information?

Your primary care physician knows you best and is always the first place to start for questions about your personal health, including return-to-work programs. Most clients that start a Work Hardening Program were referred by their doctor or surgeon. If you or your doctor have any questions regarding Work Hardening or other therapy services, please contact any one of our 10 REHAB AT WORK locations around the Washington DC area and ask to speak with a Work Hardening Program Coordinator.

Article by Todd Receveur, BSc, Lead Work Hardening Coordinator


12 At-Home Exercises to Improve Balance and Reduce the Risk of Falls

With the onset of middle age, many of us may start reducing the frequency of the activities that kept us challenged physically in our younger years. We no longer get onto or off of the floor or ground to play with our children, to play with our dogs, or to the garden.  As we downsize our living situations we are no longer carrying laundry baskets up and downstairs and we begin to pay to have someone else paint, hang drapes and wash our windows. As a result of this progression into a simpler and more leisurely middle age, we will rarely have the need or opportunity to get on/off of the floor, reach or work overhead, carry moderate weights up and down stairs or walk on challenging unlevel terrain. Unfortunately, we lose what we don’t use!

Without regular challenges to our balance, over time we run the risk of losing the ability to maintain our balance when it matters most.   Falls increase as we age for that exact reason and falls can result in hip fractures, concussions, or worse. Falls are the number one cause of injuries and death from injuries among older Americans. In fact, according to a report from the Centers for Disease Control and Prevention, an older adult falls every single second of each day in the United States. Nearly any activity that keeps you on your feet and moving, such as walking, can help you to maintain a good balance. But specific exercises designed to enhance your balance are beneficial to include in your daily routine as they can help improve your stability.   Below is a list of 12 exercises that you can do at home to improve your balance and reduce the risk of injury due to falls. Also included are several exercises that will help improve your leg strength so that if you do find yourself on the ground you will be able to get yourself back up again!  If you have severe balance problems or symptoms of dizziness or vertigo, you should be evaluated by a physician or physical therapist before attempting to engage in balance exercises. Dizziness is not the same as balance. Dizziness is a sense of spinning or disequilibrium that can cause balance deficits but it needs to be fully evaluated as to its cause prior to engaging in any type of balance retraining.  

1). SINGLE LEG STANDING ON LEVEL SURFACE (Goal is 30 continuous seconds)


To challenge yourself when performing your single-leg standing reach out with one leg either forward or out to the side. Repeat 10 times. As an alternative, swing your leg back and forth quickly either front to back or side to side


To challenge yourself when performing your single-leg standing reach up over the head with either arm. Repeat 10 times. Move slowly or quickly to vary the challenge.

Once you can safely manage 30 continuous seconds on a level surface, challenge yourself by attempting an unlevel surface such as a pillow. Work up to 30 continuous seconds of single-leg standing.

Stand with one foot in front of the other as above. Maintain your balance for 30 seconds then switch, placing the other foot in front, and repeat.

To challenge yourself, toss a ball with a family member or friend (or against the wall to yourself!) while attempting to maintain your balance for 30 seconds. Switch and place the other foot in front and repeat

Perform this activity in a safe location (the corner of a room, next to the kitchen counter). Begin with feet comfortably apart and close your eyes. Maintain your balance. When you can safely manage 30 continuous seconds progress yourself by moving your feet closer together and then, eventually, to standing on a pillow/uneven surface.


Perform this activity in the kitchen with your hand lightly touching or hovering above the counter in case you lose your balance. Walk heel to toe forward. Walking the length of the counter and then walk heel to toe backward. Repeat several times.

To increase your leg strength for getting up off of the floor, practice standing up from a chair without using your arms to assist you. If this proves too difficult at first, place a pillow or two in the chair when you first get started and then remove the pillows as you get stronger.

Perform this activity against a sturdy wall. With your feet away from the wall, slide your back down the wall to end up in what appears to be a sitting position. Hold this position for 3-5 seconds and then push with your legs to slide yourself back up the wall to a standing position.


Wall Sits Start Position
Wall Sits End Position
    (start position)                        (end position)

Article by Nancy David, PT, Frederick Clinic Manager


All Pain is Not The Same

What is it about pain that makes it so difficult to cure in certain cases?  

Normal Pain

Normal pain is helpful. It is protective. By causing an unpleasant feeling, normal pain changes our behavior. It teaches us how to avoid things that lead to injury or illness. It motivates us to avoid using an injured body part, to give it enough time to heal. Normal pain can be intense at the onset and should gradually decline over time, as healing occurs and we can gradually get back to normal life again. 

Sometimes pain is not helpful. Phantom limb pain is a perfect example. This type of pain is sometimes experienced after an amputation. Intense pain is felt in an area of the body that is not even there anymore. 

Why does this happen? Why does the body produce pain in this way? 

Pain is very complicated. Top researchers are just starting to understand it. Pain involves complicated biochemistry and a very complex nervous system. 

Abnormal Pain

Abnormal pain evolves due to over-sensitivity of our nervous system. There is a long list of reasons for this sensitization. Generally, the longer we have pain, the more likely it will cause nervous system sensitization. 3-months is typically the limit of what is considered normal or acute pain, after that, it is considered Chronic Pain. In this stage, pain becomes more of a problem than the actual physical injury itself. The pain is very real, but it does not have as much of a useful purpose and it becomes very stubborn and difficult to treat.  

Living with abnormal or chronic pain can cause things to spiral. Pain will discourage you from moving and this may prevent you from participating in normal family life, work and social activities. Your experience with normal pain tells you that it will fade away with healing. This may not be the case with chronic pain. So, while you wait for your pain to go away, the stress keeps adding up. Your friends and family start getting frustrated with you. Your doctor may run out of ideas to treat your pain when normal treatments don’t work. The typical medications for pain aren’t working because this is Abnormal Pain and it doesn’t respond to the typical medication the way that normal pain does. You may feel there is no option other than surgery or you may have already had surgery with limited or no benefit. You might become convinced there must be something else wrong with you that just hasn’t been discovered yet. 

The good news is that research is improving our understanding of how abnormal pain works and how to manage it. 

Get moving: When movement hurts, it becomes hard to get motivated to move. Even when you do get motivated, you may start too fast or do the wrong exercises and cause a setback, making it even harder to get motivated to move. This is when you really need professional guidance. Physical therapists and Occupational therapists are well suited to guide you through this difficult process.  

Guided Imagery: In the beginning, you may not be in a proper condition for movement. Therapists, in extreme cases, may decide to start you with Guided Imagery to prepare your brain and nervous system for movement.  

Measured Exercise: In less extreme cases, therapists will guide you through a very closely monitored and measured amount of very specific types of exercise. Once your brain starts to experience movement again without the associated pain, the nervous system will start to turn down the sensitivity. By using measured exercise, you can set and achieve specific movement goals. Achieving goals has a positive effect on your nervous system and causes the release of Dopamine, a reward and feel-good chemical working in your nervous system. This in-turn allows for further movement to occur. Again, this must be carefully measured to avoid painful setbacks. By taking small steps like this and achieving small goals in a progressive manner, you can get back to moving without pain. 

Get sleep: Chronic pain causes disturbance in your sleep patterns, which winds-up the nervous system, making it more sensitive. Movement causes the release of neurochemicals that aid in sleep. Getting better sleep soothes the nervous system. 

Get good nutrition: A very large topic for a future discussion. Just know that certain food types are inflammatory and others have the opposite effect, reducing inflammation in the body. Stay tuned for future discussions on this topic. 

Cognitive Behavioral Therapy: Pain causes negative thoughts and emotions. These negative thoughts have a negative effect on your nervous system and increase nerve sensitivity. With guidance, you can learn to recognize these negative thoughts when they occur and develop new strategies to reverse them.   

This whole process takes time and requires guidance along the way. 

Work Conditioning: For injured workers, this is a program that goes beyond traditional therapy, giving you more time and more guidance to deal with your chronic pain. Work Conditioning gives you 2-3 hours for 3-4 days per week, giving you more time to get moving than traditional physical therapy visits. If you do well with this, you can keep it going by progressing to Work Hardening which progresses even further and focuses on getting you prepared to return to work. 

If you’re ready to get started on a work hardening and conditioning regimen, contact the team at REHAB AT WORK today.

Article by Guy Seeley, PT


Who Knew Physical Therapy Can Treat Dizziness?

The vestibular system plays a critical role in maintaining the sense of balance and equilibrium. The structures within the inner ear are considered part of the peripheral vestibular system and are full of motion sensors that detect motion and send that information to the brain. The brain interprets the information and determines the position of the head in space. This blog will discuss two different pathologies that can occur in the inner ear that can cause significant dizziness and how Physical Therapists can be equipped to treat them. 

Benign Paroxysmal Positional Vertigo

BPPV is the most common disorder of the peripheral vestibular system. It happens when the otoconia, that are usually in the utricle, are forcefully displaced into one of the three semicircular canals confusing the motion sensors in the ear leading to extreme and sudden vertigo. BBPV often occurs after a traumatic event, but can also happen idiopathically or with specific head movements

“Every time I roll over in bed, I feel like the room immediately begins to spin

*Note that these patients will use the term “spinning” or “spin” to describe their dizziness.

Can Physical Therapists Treat BPPV?

Yes! A Physical Therapist might ask a few questions and conduct a few tests to establish BPPV as a diagnosis. For treatment, the therapist will guide you through a series of positions to allow the displaced otoconia to return to their correct position within the inner ear. It is usually a relatively easy and quick fix if the positional maneuver is done correctly. Only two or three additional visits may be required to ensure that all otoconia are back where they belong.

Vestibular Hypofunction

Vestibular hypofunction encompasses peripheral vestibular disorders such as neuritis, and labyrinthitis and are usually caused by infections to the inner ear or traumatic events. In this case, dizziness is usually exacerbated with head movement. The main culprit is often a malfunctioning vestibulo-ocular reflex (VOR). The VOR is crucial in stabilizing the eyes while the head is moving, and can be problematic if it is impaired. If the eyes cannot keep up with the head as it moves, it can lead to significant dizziness, and can have a detrimental effect on daily activities such as driving, reading, crossing a busy street, etc. 

“I get off balance and very dizzy every time I turn to the left, so I avoid doing so” 

*Note these patients will not use the word “spinning” or “spin” to describe their dizziness. 

Can Physical Therapists Treat Vestibular Hypofunction Too?

For the most part, yes. For treatment, the therapist will walk the patient through a series of exercises aimed at stabilizing their gaze. The goal of the exercises is to essentially re-train the brain to not get dizzy with head movements. Treatment for a vestibular hypofunction is usually longer (6-12 weeks), as it takes time for the patient to progress from simple to more complex gaze stabilization exercises. 

Final Thoughts

Dizziness can be truly debilitating and affect virtually every facet of life. It is not well known, even to fellow health care providers, that physical therapy can effectively treat vestibular disorders, yet it is well within the Physical Therapy scope of practice.  

If you’re suffering from dizziness, contact REHAB AT WORK today to see if physical therapy and rehabilitation might be a good option for you!

Article by Rebecca White, PT, DPT



Post-Workout Shakes: Beneficial or Not?

I can remember, pre-pandemic, venturing over to a friend’s house to workout together. She suggested we do an intense HIIT (High Intensity Interval Training) workout regimen. I knew right away that this workout would leave me a victim of D.O.M.S. (Delayed onset muscle soreness). Although hesitant, I acquiesced. 

The workout was as intense and laborious as I had imagined it would be, but as I reached for my water at the conclusion of the workout, she reached for her post workout recovery shake. Being a good friend and hostess, she offered me one, but I quickly declined. I have never been a fan of protein shakes and was reluctant due to my sensitive gag reflex and thoughts of a repugnant aftertaste. However, the next day, as I could barley walk or get out of bed, I laid in bed wondering, “do recovery shakes really work?” 

First you may be asking, “what is a recovery shake?” Good question. A recovery shake or drink is generally anything that you drink post-workout to speed up the body’s recovery after a workout. The purpose of it is to decrease your down time from your last workout (whether it’s due to muscle soreness, fatigue, etc.), so you’re more prepared going into your next workout. According to an article published by the University of Wisconsin, “you are able to get food and nutrition into your system fairly quickly post-workout and it can be much easier on the stomach vs solid foods. Plus, it can assist hydration.” 

What makes a good recovery drink? According to my research, for a recovery drink to be effective it should contain: 

• Protein 

• Carbohydrates 

• Electrolytes 

Some articles suggest the recovery shake should be consumed within 60-90 minutes after your workout, but doesn’t necessarily mean you need to drink one after every workout. While others believe that as long as you have it within the first 20-30 minutes after your workout you will respond well. 

So, when should you use a recovery drink? One article, written on, suggests you should consume a recovery drink, “if you are training or competing more than once in a single day, a recovery drink after your first session is a good idea. If you are riding back-to-back days of long miles (like during a bike tour, cycling camp, or stage race), then it’s a good idea as well.” 

But do they work? Well, the verdict is still out on this for me. Some articles swear by the effectiveness of recovery drinks, while others imply that your body will naturally recover as long as you are eating a healthy diet. Regardless, one thing is certain, after a tough workout your body has lost hydration and energy sources. So, no matter if you decide to drink a recovery shake or stick to your normal routine (whatever that may be), keep in mind that your body needs to be rehydrated and hydration and daily nutrients are key ingredients to living a healthy and fit life, whether consumed in liquid or solid form.

Article by Carolyn Miller  


1) UW Health Sports The Rules of Recovery Drinks Date posted: 10/11/2017 

2) Chris Carmichael Top 3 Myths About Post-Workout Protein and Recovery


Hidden Dangers of Virtual Learning: How to Prepare a Workstation for Kids

During these unprecedented times, many schools in the US and worldwide are closed, forcing students and teachers to adapt to virtual learning. But, this can be very dangerous to a child’s health in general. Most of the schools that adopt this approach have provided families with laptops and (in some cases) tablets. As mentioned in our previous blogs, problems can arise from prolonged use of technology such as neck pain, back pain, elbow pain, or carpal tunnel syndrome. These same issues could affect children, depending on how much screen time they spend doing virtual learning. There could be long term implications on a child’s physical and mental wellbeing; for example, a poor computer set-up can lead to tendinitis (inflammation of tendons) along the wrist, forearm, and elbow. Poor posture can also lead to back pain and neck pain. A previous blog, “Home office Ergonomics,” mentioned the importance of setting up a proper workstation to work from home. A well-designed work station, paired with stretching and rest breaks, can help prevent neck pain and tendinitis in adults and kids.  

Parents/caretakers are doing their best to assist their children with virtual learning. Still, many are unconsciously ignoring the importance of creating a safe and comfortable digital workstation for their children. However, setting up a workstation for kids can be slightly more difficult due to their smaller size.

 Here are some quick tips to help make sitting in front of a computer more comfortable: 

• Keep your monitor at eye level, and place your keyboard close to your body. 

• Sit in a chair with back support to avoid slumping. 

• Make sure your feet are firmly planted on the ground, or use a footstool if your feet don’t reach the ground. 

Items to consider purchasing if your child is working with a laptop: 

• Laptop Kickstand. 

• Computer mouse and keyboard. 

• Headset.

 One should take this approach when setting up a child’s workstation for virtual learning. Don’t be afraid to get creative and use seat boosters and props. Yoga blocks make for an easy, non-permanent work station modification. But most importantly, remember that they are kids, and movement is by far the most important tip for your child. Taking regular rest periods away from the screen is essential for their health. Provide your child with active options during those rest periods. For example, jumping jacks, hula hoop, jump rope, going up and downstairs, or simply just walking. Try to add the fun factor to a routine and recognize their hard work.

REHAB AT WORK staff are ready to assist you and answer any questions in setting up a safe workstation for you and your child(ren). Or if you are experiencing any of the symptoms mentioned above, then contact one of our offices and schedule an appointment so we can help you feel better.

Article by Carlos Salinas

Helpful links:

Computer Workstation Checklist

Is Your Smartphone a Pain in the Neck?


Be Proactive This Fall

The onset of fall brings with it many weekend warrior projects for a lot of us. Cleaning out flower beds, performing other landscaping projects or preparing lawns and trees for winter these are all things looming large on the “to do” list.  Additionally, we are looking ahead to what winter has in store for us in the way of snow!  We may be checking the Farmer’s Almanac to see how many substantial snowfalls our area might be likely to receive this winter season, making sure the snowblower has enough gasoline and putting those shovels and salt upfront in an easily accessible spot in the garage. One thing that should be on our minds is how to be proactive this fall to protect against injury.

Proactivity in the New Season

As we are moving into the seasons of being physical with shoveling, weeding, bending, squatting, lifting, pushing/pulling, and digging after a summer of relaxation can lead many weekend warriors to injury.   Lower back pain is very common after shoveling, mulching, repetitive bending while working in the garden, pushing and pulling a wheelbarrow, or shoveling snow.  Shoulder pain, knee pain, elbow pain, and neck pain are also very commonly reported by folks to their primary care doctors after their physical activities outweigh their level of physical FITNESS and/or preparedness. 

This year, vow to be different, be proactive……..look out for your safety and AVOID injury! The following link has some great information about how to safely perform some common fall and winter tasks.   Moving your body properly is one of the keys to avoiding strain to your muscles and joints and allowing you to have a stress-free fall and winter season.  Check out this article that explores how!

Rehab at Work Can Help You Be Proactive This Fall

If your goal to be proactive and avoid injury is unsuccessful, consider a personal consultation with a trained Physical Therapist at REHAB AT WORK. Our therapists will provide a customized approach to address the specific muscular, postural, or ergonomic concerns associated with your pain. REHAB AT WORK has 10 offices across the DC, Maryland, and Virginia areas. Contact us today for your consultation

Article by Nancy David, PT



10/14/20: Managing Stress and Anxiety Virtual Session

On October 14th at 11AM, we welcome you to join a virtual session on managing and anxiety with Mark Karolkowski, OT. This session is available to the public.

This virtual event is sponsored by the International Association of Rehabilitation Professionals – Chesapeake, and the Maryland Joint Task Force for Injured Workers.

We’re excited for this event and hope you’ll join us!


8/11/20: Desk Ergonomics & Stretches for Everyday Virtual Session

Join Matt Drzik of REHAB AT WORK Tuesday, August 11th, 2020 at 10 AM for a virtual session on Desk Ergonomics & Stretches to help you better transition to the Work From Home lifestyle. This event is hosted by REHAB AT WORK, Comp-X Medical Management, and Titan Investigative Alliance, LLC.

We hope you’ll join us for this virtual session, and we look forward to seeing you there!

When the session begins on 8/11/20 at 10 AM, please click here to join.