Is Dizziness Just a Part of Normal Aging?

Posted by | Posted in Back to Life, Education, Our Therapists, Tips & Favorites | Posted on 01-11-2016

For most of us, feeling dizzy, off balance, or like the world is spinning only happens when we’ve over-indulged in our favorite drink. But for people with vestibular disorders, these symptoms can be a frequent, and often debilitating, occurrence. Dizziness and vertigo are relatively common. In fact, as many as 35% of people over 40 years or older in the U.S. have experienced some form of vestibular dysfunction(1), and in people over 65 years and older, 80% have experienced dizziness(2). Overall, vertigo from a vestibular problem accounts for a third of all dizziness and vertigo symptoms reported to health care professionals(3).

Your vestibular system is composed of three canals and two sacs which are filled with fluid. The fluid shifts when you turn your head or change positions and stimulates hair cell receptors to tell the brain what is happening. The brain uses this information to maintain your balance and help your eyes stay focused. Problems in the vestibular system can be caused by how/when the receptors fire or by problems with the nerves that transmit this message to the brain.

The most common cause of vertigo is benign paroxysmal positional vertigo, or BPPV, accounting for about 50% of dizziness in older people.4 In those with BPPV, particles from the sacs get caught in the canals and cause the hair receptors to fire when they shouldn’t be. This causes vertigo, a sensation that the world is spinning. This vertigo can happen with changes in head position, like lying down in bed, laying on your side, looking up, or getting out of bed. In most cases of BPPV, a physical therapist trained in vestibular rehabilitation can clear these particles from the canal to relieve the feeling of vertigo in one or two sessions.

Other disorders of the vestibular system affect the vestibular structures themselves, vestibular nerves, or areas in the brain that receive input from the vestibular structures. In these cases, a patient can experience dizziness or vertigo with certain movements like turning the head quickly or bending over to put laundry away. Vestibular rehabilitation can help these patients minimize or eradicate these symptoms through specific exercises. These exercises help the patient’s brain to correctly integrate input from the vestibular system, as well as from the eyes and body to decrease dizziness and improve balance.


For most people, dizziness is not something you just have to live with. It is not a normal part of aging. And most importantly, it is something that can be improved! If you or someone you know is experiencing dizziness, vertigo, or problems with balance, I encourage you to consult with your doctor and see if vestibular rehabilitation might help.

Please visit the following link for more helpful information:

1. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009;169(10): 938-944.
2. Ator GA. University of Kansas Department of Otolaryngology Division of Otology Talk: Vertigo – Evaluation and Treatment in the Elderly.
3. Neuhauser HK, Radtke A, von Brevern M et al. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008;168(19):2118–2124.
4. Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, Hain TC, Herdman S, Morrow MJ, Gronseth GS. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurol. 2008;70:2067–2074.

Preventing Throwing Injuries: Advice from one of NYC’s Premier Sports Physical Therapists

Posted by | Posted in Baseball, Education, elbow injuries, Injuries, labral tears, ligament tears, rotator cuff tears, shoulder injuries, Sports, throwing injuries, Tips & Favorites, ulnar collateral ligament tears | Posted on 04-05-2016

Overhead throwing athletes are at a significantly increased risk for injuries involving overuse of the shoulder and elbow. These injuries can range from ulnar collateral ligament tears, labral tears and rotator cuff tears that can affect athletes at any level of their sport.

How Dramatic is the Throwing Injury Problem?

Ulnar Collateral Elbow InjuryTo visualize the prominence of baseball throwing injuries, realize that in Major League Baseball shoulder and elbow injuries account for more missed games than injuries to any other region of the body. Elbow injuries alone result in roughly 8,000 days on the Disabled List each year in the majors. Shoulder injuries account for 3,000 days.

To address this rise in throwing injuries it is imperative to identify their risk factors, which often stem from basic over-use. For instance, due to the extreme amount of stress that pitching places on the entire upper extremity, pitchers are the most susceptible to throwing injuries.

Shoulder torque during pitching can reach as high as 7500-7700 degrees per second! That is just for one pitch!

Throwing injuries are not limited to the highest level of competition

Children are also succiptible to throwing injuriesIn a survey of 500 injured baseball players from middle school to college-aged, 15% stated that future baseball performance was limited due to injury sustained during youth baseball.

In this same survey, 50% of all injures suffered were from either the elbow or the shoulder. Studies demonstrate that half of pitchers from all levels experience shoulder or elbow pain within a season.

How Do We Prevent Throwing Injuries?

Research has shown that the amount of competitive pitching, and the pressures to pitch while fatigued, are strongly linked to elbow and shoulder injury.

Other risk factors may include pitching on multiple teams, pitching year-round, playing the catcher position (which actually throws more than a pitcher) when not pitching, poor pitching mechanics, and poor physical conditioning.

Train Less

We know that training more than 16 hours per week leads to significantly higher injury risk

Pitch Less

Averaging more than 80 pitches per game may quadruple injury risk, and pitching more than 100 innings per calendar year may triple the risk of serious shoulder or elbow injuries.

Stop Sooner

Pitching with arm fatigue, which can typically be evidenced by a noticeable drop in velocity of pitches) leads to 36 times increased injury risk!

Count Pitches

Coaches, players and parents should track their children’s pitching activity and keep their kids from pitching more than the following:

Prevening Throwing Injuries

7-8 year olds: No more than 50 pitches/day

9-10 year olds: 75 pitches/ day

11-12: 85 pitches/day

13-16: 95 pitches/day

17-18: 105 pitches/day

Also, a pitcher who throws more than 41 pitches should not play catcher that day.

Screen Players

Screening can help prevent injuries. Lacking symmetrical shoulder flexion (within 5 degrees on both sides) and total arc of rotation increases injury risk by 2.5-2.8 times.

Increase Total Body Strength

Did you know that 60% of the force of a pitch is generated from the legs?

Pitching is an entire body motion that requires coordination of muscle activity for proper form and injury prevention. Total body strengthening programs can address lower extremity and functional core strength — as well as shoulder strength.

In fact, pitching ability requires a transfer of energy all the way from the lower extremity through the trunk to the arm. The legs provide a stable base for the trunk (core) to rotate and flex.

Summarizing Injury Prevention for Throwers

Pitching is a highly complex and coordinated full body movement that culminates with dynamic motion of the throwing extremity. Proper training and screening of this kinetic chain movement must be appreciated and understood to a greater depth.

Despite update guidelines and precautions (pitch counts, pitch type, rest), many pitchers are still experiencing overuse injuries that can be prevented with better training and understanding of risk factors.

SPEAR partners with NYU Langone Medical Center to help prevent throwing injuries this baseball season

Posted by | Posted in Baseball, Events, Our Therapists, SPEAR in the media, Sports, Tips & Favorites | Posted on 22-02-2016

Baseball injury prevention in NYC

SPEAR President and former pro baseball player Dan Rootenberg, PT  treats a minor league pitcher as he recovers from a throwing injury.



With the epidemic of injuries to young throwers and the significant increase in the number of Tommy John surgeries on youth baseball players, it is the mission of SPEAR President Dan Rootenberg to educate the coaches, parents and players of New York City about proper care and mechanics of the throwing arm.

Preventing Baseball Throwing Injuries NYU LangoneTo support this mission SPEAR Physical Therapy is partnering with NYU Langone Medical Center for what could be the most important talk of the baseball season for youth coaches, parents and players: a free event titled “Preventing Baseball Injuries in the Young Throwing Athlete: Everything You Need to Know.”

This is a must-see event for anyone who wants to enhance their throwing performance, prevent injury and prepare for the upcoming 2016 baseball season — and anyone is invited! Come hear four sports medicine experts speak on this exciting topic:

Dan Rootenberg, PT, DPT, CSCS, who played pro baseball on three continents, currently coaches two little league teams in NYC, and is also a board member of two New York City youth baseball organizations.

Justin Farnsworth, PT, DPT, also a SPEAR Physical Therapist and a Certified Strength & Conditioning Specialist.

Dennis Cardone, DO, NYU Associate Professor, Dept. of Ortho Surgery.

Robert Meislin, MD, NYU Clinical Associate Professor, Dept. of Ortho Surgery.

Event and RSVP details are below.


Two lucky attendees will win a brand new baseball bat from a Louisville Slugger Prime 916 youth bat, and an injury-preventing Pro Hard Maple Axe Bat!


“Preventing Baseball Injuries in the Young Throwing Athlete: Everything You Need to Know.”


Date and Time: Wednesday, March 23 from 6-7:30pm

Location:NYC physical therapy preventing baseball injuries NYU Langone Medical Center, 550 First Avenue, Alumni Hall B – First Floor, New York, NY 10016

Official Event Summary:

In an effort to prevent baseball injuries in the young throwing athlete, NYU Langone Medical Center in collaboration with SPEAR Physical Therapy will be holding an educational workshop, which will feature NYU Langone physicians Dennis Cardone, DO and Robert Meislin, MD; Dan Rootenberg, PT, DPT, CSCS president of SPEAR Physical Therapy; Justin Farnsworth, PT, DPT physical therapist at SPEAR Physical Therapy, and a special guest with Major League Baseball experience.

Audience:  Parents, coaches, athletes, athletic trainers

Price:  There is no fee associated with the event. Light dinner will be provided.


For questions regarding this event, please contact:

Jamie Bryant

Director of Business Development

SPEAR Physical Therapy


We look forward to seeing you at the event!

Marathon Month SPEARunner: Kenneth Festa

Posted by | Posted in Back to Life, Community, Events, Inspiration, Running, Success Stories, Tips & Favorites | Posted on 30-10-2014

It’s the final week of Marathon Month, a time we get to spotlight our patients who are running this year’s TCS New York City Marathon! In this entry we share the story of a special SPEARunner treated at our Chelsea location: 51-year-old Kenneth Festa.  He has battled through a torn Achilles with Laura Muzzatti, DPT to walk his 13th NYC marathon! Determined to complete 15 marathons by 2016 to qualify for lifetime entry, Kenneth is the epitome of grit and SPEARIT!

Marathoner and SPEAR Physical Therapy NYC Patient Kenneth FestaWhy do you run? I run for all of the usual reasons…health, fitness, problem-solving, family time (my wife and two sons are both runners), to get to work without having to use the subway (I live about 6 miles away from my job), and because people were just plain born to run.

How long have you been running marathons? I’m 51, and I think I did my first marathon when I was 30, so a little over 20 years. I’ve done 16 of them, in total.

Which physical therapist do you see at SPEAR and what treatments have you been doing for training? I primarily see Laura (although I’ve had others in the office work with me, and they’re all excellent!). Been doing a lot of calf raises, balance exercises, massage, and flexibility exercises. Laura has encouraged me to supplement my PT program with yoga and barefoot conditioning workouts.

Do you have any words of wisdom or training tips for anyone thinking about doing their first marathon? Words of wisdom for a first timer? Enjoy it. Enjoy every minute. You may have last-minute doubts–a little voice might whisper in your ear that you’re not meant to be a marathoner, that you should have done a couple more long runs, and more stretching, and more strength training. Know that this voice will evaporate at the start of the race, and you will feel like a superhero (at that point, don’t get too overconfident–relax and flow easily through the first half of the race). When you’re done, you’ll be a marathoner for the rest of your life!

More than earning that achievement, though, you’ll learn something about yourself… I’m planning to learn a little acceptance and humility in the 2014 NYC marathon. This past spring, I was running the best that I can remember, attaining age-graded percentages that I’d never reached in over a hundred NYRR races. I was beginning to think about (possibly) qualifying for Boston for the third time (not an easy goal for me). Then, in late May, I had a surfing accident and completely ruptured my Achilles. Even as I was lying on the surfboard just after it happened, I knew what I’d done, and I could see my marathon drifting out to sea. In the emergency room, they basically told me to forget about the 2014 NYC marathon.

I had another thought at the time–related to the fact that if you do 15 NYC marathons, then you have guaranteed entry for the rest of your life. I’ve done 13. They’re ending that program in 2016…so I’d still be able to get my 15 using the 2015 and 2016 races. But there’d be no more room for error. No more surfing accidents.

I spent a couple of days feeling sorry for myself (I’m not proud of that, but I’m human). Then I had a thoughtNYC Marathoner runner and SPEAR Physical Therapy NYC patient Kenneth Festa …if Zoe Koplowitz, who has severe MS and uses a walker, can do the marathon in 30 hours, then I can walk it in 10. If you don’t know about her, see her website at She’s a wonderful lady, a real NYC treasure and an inspiration to many.

Laura was the first person to tell me that walking the marathon this year might be possible, that it wasn’t the dumbest thing she’d ever heard. Important: She made me promise not to tell my doctor that she’d just cleared me to do a marathon, because she hadn’t. But if I could get approval from my doctor, then she’d help me work toward that goal. When I ran it by him in September, he assessed my progress (he was very impressed by the strength I’d regained in the foot), shook his head and said that no one had ever asked him if they could do a marathon 5 months after Achilles tendon repair. Then he said yes, but I need to stop if my heel starts hurting. Deal!

So, yeah, it’s been a huge amount of physical work, from taking those first few halting steps in my living room in August, to my longest walk of 21 miles, around the perimeter of most of the island of Manhattan. Just as hard, though, has been learning to accept my limitations. I’m not a great runner, and never have been, so I didn’t think it was that big a part of my ego. I learned otherwise in the 5th Avenue Mile race this past September. I needed to do a few more races to qualify for the 2016 marathon, using the NYRR Club’s 9+1 entry path.

To put it in perspective: in a race in April, I came in 20th out of over 200 guys in my age group. In the 5th Avenue Mile, I came in 3rd from last out of 5200 athletes. The sidewalks were crowded with spectators, and they were encouraging me to run (which I couldn’t) and the race course was empty, because all of the other runners in my heat were long gone. There was just nowhere to hide. I had to keep my head up, keep smiling, and keep walking. It was one of the hardest things I can remember doing. Surgery was WAY easier.

I expect that I’m going to encounter a longer, harder version of that experience on November 2nd. And I think it will be good. As Zoe Koplowitz says, you can either go through life with your arms open, or you can go through life with your arms closed. I’m going to try my level best to embrace this marathon with my arms open. It’s still an immense privilege. And that would be my final bit of advice–embrace the experience, whether you’re a 3-hour or a 5-hour marathoner. Or a 10-hour marathoner.

Marathon Month SPEARunner: Jo Ralston

Posted by | Posted in Community, Inspiration, Running, Success Stories, Tips & Favorites | Posted on 21-10-2014

It’s our second annual Marathon Month, a time we get to spotlight our patients who are running this year’s TCS New York City Marathon! In this entry we check in with 84th Street SPEARunner Jo Ralston, who has been treating with Joe Losurdo, DPT in preparation for her first NYC marathon!

Why do you run? For many reasons, and the list keeps growing.  It started as cardio at the gym and then after watching friends run the London marathon for a second time it progressed to running to and from the office to avoid the tube.  Living in London at the time it then progressed to running around Hyde Park and I realized it was an amazing way to discover parts of the city I had lived in for years but had no idea about!
When I moved to NY, a friend was training for the Philly marathon encouraged me to join the NYRR and do the Jingle Bell Jog.  After the first race I was hooked and I decided I would do a half marathon in January. After that it was the idea of completing the 9+1 to qualify for NYC just in case I felt like doing it!  It’s such an amazing way to get outdoors and explore and it definitely helped me to settle in NYC quickly. It is also insanely easy to get involved in NYC with things like the NYRR, the hundreds of running clubs and meet-ups and now the crews like the bridge runners.

Now if I don’t run it affects my mood, and while I don’t think or problem solve like some people describe, I do feel like I burn off any anger or frustration that is lurking.  My other half says that he thinks I burn off my ‘[to keep things family-friendly, let’s just say Jo wrote a word that begins with “b” and rhymes with “rich”] points’ but it definitely makes me a much nicer, calmer subway rider!

How long have you been running marathons? NYC will be my first although I trained for Philly last year and wasn’t able to compete at the last minute.  For NYC, after a year running the 9+1 to qualify, plus the training I would have been gutted had I not been able to run on Nov 2nd!

Which physical therapist do you see at SPEAR and what treatments have you been doing for training? Joe (with an e) is my therapist.  The best thing he did was tell me on my first day that I would be ready for the marathon.  I honestly had no idea what had happened and could barely stand or sit and I thought he was a madman for even suggesting I was going to be in good enough shape to run! Somehow I had inflamed my piriformis muscle which meant I felt like I had sciatica. Since then I have been doing a lot of foam rolling, monster walks, core work with planks and squats in addition to more simple stretches.  I actually believe that despite reducing my mileage I am now in better shape than ever for the marathon.

Do you have any words of wisdom or training tips for anyone thinking about doing their first marathon? I think its setting small goals.  When you look at a 16week training plan or think about 26.2 miles it is overwhelming so just go week by week or even day by day.  Be kind to yourself and be prepared for good days and bad days.  Like anything, it’s trying to make it a habit and also building things into your lifestyle to remind you why you do this crazy thing.  I am also really motivated by the idea of two or three shake shack burgers when I finish, maybe that will work for others too! Oh and Pinterest running motivation boards – strangely helpful!