Positional Vertigo

Vertigo taking you for a Spin?

Dizziness with lying flat or turning over in bed? Feel lightheaded or off balance with looking up or bending over?  Do you feel as if the room begins to spin when you change positions? These are all symptoms of Benign Paroxysmal Positional Vertigo, commonlymigraine-15528043 referred to a “BPPV” or simply as “vertigo”.  The good news is that this disorder can be completely resolved in as little as 1-2 physical therapy visits.

What Causes BPPV?

BPPV is a disorder of the inner ear, this known as the vestibular system. This system is sometimes referred to as the body’s “equilibrium”, which plays a role in regulating balance. Within the inner ear are tiny fluid filled canals, known as semicircular canals.  When your head moves, this has an effect on the movement of the fluid in the canals. The brain senses these changes in fluid movement in order to help regulate balance. In someone affected with BPPV; calcium crystals are dislodged, causing a change in fluid movement and pressure. As a result, the brain receives incorrect information, and thinks your head is moving more than it really is, which is why you end up feeling dizzy or off balance. The prevalence of this disorder increases with age, as these calcium particles are more likely to degenerate. BPPV can also be cause by trauma to the head, such as with a concussion.

How is BPPV Diagnosed?

BPPV is diagnosed by the identification of your signs and symptoms, and also by performing physical testing involving changing your head position and observation of your eyes for abnormal movement. This abnormal eye movement is known as nystagmus, proper assessment will help to determine the appropriate treatment technique.

How is BPPV Treated?

After a proper examination and assessment of your signs and symptoms, it can be determpassenger-feeling-dizzy-train-travel-traveling-headache-54997460ined which semicircular canal is affected. Your therapist or physician will help you take your head through a sequence of different movements to effectively work these crystals out of the affected area. After this simple treatment, the cause of the dizziness has been removed, and most patients no longer experience this uncomfortable sensation of vertigo.

If you think you may have BPPV, alert your doctor or call DiGiulio Physical Therapy & Wellness. This is often a simple fix and can be resolved in just 1 or 2 sessions of physical therapy.

Refer to the Vestibular Rehab Section of our Website for more information on how therapy can help with dizziness and balance disorders.

Authored by: Kevin DiGiulio, PT, DPT, COMT


DiGiulio Physical Therapy & Wellness, LLC





Neck pain is the second most common reason for doctor’s visits in the United States1,3. In fact, it is estimated that up to 70% of people will hands on necksuffer from significant neck pain at some point in their lives4.

The incidence of neck pain is increasing5, likely in part due to the increased role of cell phones, tablets, and computers in our daily lives. Use of these electronic devices tend to promote poor posture, leading to increased neck and upper back discomfort. Neck pain appears to be more common in those involved in repetitive work, sedentary work (office work), or physically demanding work. Neck pain also seems to be more common in those suffering from high stress levels, depression, headaches, and lower back pain 2. Neck pain can also result from trauma such as a fall, car accident, or sports injury. Patients often report their symptoms as feeling “tight”, “stiff”, “achy”, and many have pain radiating into their arm or hand.

Physical therapists often find that improving posture at work and during daily activities will result in long term resolution of symptoms. Other useful treatments include hands on manual therapy and therapeutic exercise. For additional relief, treatment may involve ice/heat, electrical stimulation, or ultrasound. Current research indicates that a combination of hands on care provided by a physical therapist and an individualized exercise provides the best results.

An evaluation with a physical therapist will identify which specific treatments are required to decrease your pain and restore your ability to function in your daily life.

Click Here for Neck Pain Exercises 

Authored by: Kevin DiGiulio, PT, DPT, COMT


DiGiulio Physical Therapy & Wellness, LLC



  1. Fabio, Richard P. Di, and William Boissonnault. “Physical Therapy and Health-Related Outcomes for Patients With Common Orthopaedic Diagnoses.” J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy 27, no. 3 (1998): 219-30. Accessed April 26, 2016. doi:10.2519/jospt.1998.27.3.219.
  1. Côté, Pierre, J.david Cassidy, and Linda Carroll. “Is a Lifetime History of Neck Injury in a Traffic Collision Associated with Prevalent Neck Pain, Headache and Depressive Symptomatology?” Accident Analysis & Prevention 32, no. 2 (2000): 151-59. Accessed April 26, 2016. doi:10.1016/s0001-4575(99)00117-7.
  1. “Neck Pain Treatment Based Classification.” Lecture, Department of Physical Therapy- Temple University, Temple University, Philadelphia, January 23, 2012.
  1. Childs, John D., Joshua A. Cleland, James M. Elliott, Deydre S. Teyhen, Robert S. Wainner, Julie M. Whitman, Bernard J. Sopky, Joseph J. Godges, Timothy W. Flynn, Anthony Delitto, George M. Dyriw, Amanda Ferland, Helene Fearon, Joy Macdermid, James W. Matheson, Philip Mcclure, Paul Shekelle, A. Russell Smith, and Leslie Torburn. “Neck Pain.” Journal of Womenʼs Health Physical Therapy 35, no. 2 (2011): 57-90. Accessed April 26, 2016. doi:10.1097/jwh.0b013e3182267762.


“Healing” Your Heel Pain – Plantar Fasciitis

Plantar Fasciitis

The plantar fascia is a strong band of tissue on the bottom of the foot that connects the heel bone to the base of the toes. This band of connective tissue helps to support the arch of your foot and is naturally stretched when you bend your ankle back and forth, such as is performed with walking or running1.

Plantar fasciitis is a painful inflammation of tissue on the bottom of the foot. This occurs when the tissue can become “over stretched”, or from repetitive small tears. Many patient experience plantar fasciitis a result of starting a new job or fitness program requiring increased standing, walking, or running. Factors such as tight calf and hamstring muscles, weight gain (BMI>30), or lack of arch support increases the risk for plantar fasciitis1,2.

Most often the pain will be felt upon first getting up in the morning or after long periods of sitting, and may subside as the ankle “warms up” to activity. As the day progresses, with increased standing and walking, this pain often returns. Many patients report the pain is located along the bottom of the heel and may be tender to touch. If this condition persists for an extended amount of time it can affect the way you walk, leading to problems at the knee, hip, or lower back1,2.

Most patients suffering from plantar fasciitis do well with physical therapy, with about 80% having complete resolution of their pain2. Treatments for this condition target pain control and increasing the range of motion at the ankle often limited by tight muscles.  A physician or physical therapist may recommend exercise, hand on techniques (manual therapy), taping techniques, shoe inserts (orthotics), or medication to reduce inflammation.

If you think you may be suffering from plantar fasciitis, contact your primary care physician or physical therapist. Find the sample exercise program below to view exercises commonly used to treat this type of heel pain.

Heel Pain Exercise Program

Authored by: Kevin DiGiulio, PT, DPT, COMT


DiGiulio Physical Therapy & Wellness, LLC



  1. “Plantar Fasciitis – Patient Education Library.” Medbridgeeducation.com. Accessed March 30, 2016. https://www.medbridgeeducation.com/patient-education-library/condition/88-Plantar-Fasciitis.
  2. “Soft Tissue Pathologies of the Foot and Ankle.” Lecture, Temple University Department of Physical Therapy, Pennsylvania, Philadelphia, November 28, 2011.

Solutions for Knee Pain

Limited by Knee Pain? Non-Operative Solutions

Patellofemoral pain syndrome (PFPS) is a common condition affecting adolescents and adults of all ages.  PFPS is characterized by pain, often in the fr20160330_190832ont of the knee, around the area of the knee cap. Pain is usually present when going up or down stairs, squatting, kneeling, or running. Pain may also occur when sitting for long periods of time such as in the movies or when taking a long drive in a car. For these reasons, this condition has also been known as “runner’s knee”, “secretary’s knee”, or “chondromalacia patella” 1.
Causes of PFPS involve abnormal position of the knee cap, muscle imbalances, and tight muscles of the upper leg. Other factors that may contribute to this disorder involve problems in the lower back, hip, ankle, or foot which may lead to increased load at the knee joint2.

Several treatments can be used for pain reduction such as anti-inflammatory drugs, taping, bra20160330_185930cing, foot orthotics, icing, and specific exercise programs1. Surgery is generally not recommended for this condition. Among these treatment options, exercise has shown to be most effective for long term results.

An evaluation performed by a medical professional, such as a physical therapist can help to determine the cause of knee pain. In addition to stretching muscles identified as “tight”, a therapist may recommend exercises to improve strength and control of hip muscles. A therapist may also use hands on techniques to reduce pain and restore normal function at the knee, hip, or ankle.

If knee pain is limiting your daily activity, physical therapy can help. Check out the sample exercise program below for more information.

Knee Pain Exercises

Authored by: Kevin DiGiulio, PT, DPT, COMT


DiGiulio Physical Therapy & Wellness, LLC




  1. Rodriguez-Merchan EC. Evidence Based Conservative Management of Patello-femoral Syndrome. Archives of Bone and Joint Surgery. 2014;2(1):4-6.
  2. Price JL. Patellofemoral syndrome: how to perform a basic knee evaluation. JAAPA. 2008;21(12):39-43.
  3. Heintjes E, Berger MY, Bierma-zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2004;(3):CD003470.

Shoulder Impingement

What is shoulder impingement?

Shoulder impingement, also known as subacromial impingement is the most frequent cause of shoulder pain1. This condition can result in pain in the front of the shoulder, often present with repetitive overhead motions of the arms. This pain occurssiblog1 when an area known as the subacrominal space becomes narrow, as a result of this decreased space different structures (such as tendon and bursa) can rub against each other resulting in irritation and pain in the front of the shoulder.

Commonly, shoulder impingement will cause pain with daily activity such as reaching up, reaching behind the back during dressing, or reaching overhead during work or sporting activity. If this condition persists for a prolonged period it can lead to an inflammation of structures of the shoulder resulting in conditions known as rotator cuff tendinitis or bursitis2.


How is shoulder Impingement diagnosed and treated?

Shoulder impingement can be accurately identified by a thorough physical exam performed by a physical therapist or other healthcare provider. Generally the patient will report a background of overhead work or sporting activity, anterior shoulder pain (front of shoulder), pain at night (sleeping on affected side), or a recent change in job or lifestyle activites3. Patients with impingement also commonly have a rounded shoulder posture which can result form extended sitting, such as office or computer work.  This condition can also be confirmed with imaging such as X-ray, or MRI.

Physical therapy has been proven to be an effective method of treating shoulder impingement. Research indicates that specific exercise combined with a customized manual therapy treatment program is the optimal approach for treating this condition 4.

Each exercise program and manual therapy treatment is specific to each patient’s presentation, however for shoulder impingement, a program can be expected to include:

  • Thoracic spine mobilizationsiblog2
  • Glenohumeral joint mobilization
  • Improving control and strength of scapular stabilizers
  • Rotator cuff strengthening
  • Shoulder stretching
  • Pectoral stretching
  • Posture education
  • Ergonomic and lifestyle modification


Authored by: Kevin DiGiulio, PT, DPT, COMT


DiGiulio Physical Therapy & Wellness, LLC


  1. Sizer P, Phelps V, Gilbert K. Diagnosis and Management of the Painful Shoulder. Part 2: Examination, Interpretation, and Management.Pain Practice. 2003;3(2):152-185. doi:10.1046/j.1533-2500.2003.03022.x.
  2. David Z. Shoulder Impingement Syndrome.WebMD. 2014. Available at: Available at: http://www.webmd.com/osteoarthritis/guide/impingement-syndrome. Accessed June 15, 2015. Accessed August 4, 2015.
  3. SOLEM-BERTOFT E, THUOMAS K, WESTERBERG C. The Influence of Scapular Retraction and Protraction on the Width of the Subacromial Space.Clinical Orthopaedics and Related Research. 1993;&NA;(296):99???103. doi:10.1097/00003086-199311000-00018.
  4. Bang M, Deyle G. Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients With Shoulder Impingement Syndrome. J Orthop Sports Phys Ther. 2000;30(3):126-137. doi:10.2519/jospt.2000.30.3.126.



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