Shoulder Instability

Our shoulder is a ball and socket joint, the equivalent of a golf ball sitting on a tee.  Thus, the reason we are able to move our shoulder in multiple directions, or at least we should be able to (with control of movement).  

Having full shoulder range of motion is ideal, having too much motion can lead to instability.  Instability occurs when the structures around the shoulder joint do not work to maintain the ball in the socket (subluxation or dislocation).  This can happen from trauma, wear and tear on the joint or genetics. When a person experiences instability in the shoulder joint, pain and fear of movement is often associated with it.

Instability of the shoulder can be in one direction: Anterior instability (subluxation or dislocation to the front of the joint)/ Posterior Instability (subluxation or dislocation to the back of the joint) or Multidirectional Instability (subluxation or dislocation of the front and back of the joint).

Once a subluxation or dislocation occurs, the ligaments around the glenohumeral joint can become over-stretched or torn, leading to an increased prevalence of recurrence.  So, how can we overcome an injury of instability? STABILIZE! Working with a physical therapist to learn specific exercises to strengthen the glenohumeral joint, will help the shoulder to return to normal function.  

The scapula and shoulder should work together to raise the arm overhead.  This is important for the shoulder to mechanically work the right way. When raising your arm up, ⅓ of the movement occurs at the scapula and ⅔’s of the movement occurs at the glenohumeral joint. The timing and coordination of these two structures moving are critical for stabilizing the shoulder in overhead movements. 


If you are experiencing symptoms of shoulder instability or have dislocated your shoulder in the past, the Dr. Amanda DeRosa can help you and show you specific strengthening exercises to stabilize your shoulder!  Call today, 619-693-8047.

Scar Tissue Post Mastectomy

Mastectomy surgery is a common approach for the treatment of breast cancer. As with any surgery, scar tissue develops as part of the normal healing process. However, with the development of scar tissue, decreased range of motion and pain are often an un-welcomed side effect. Scar tissue can become hyper-sensitive, especially at the drain site after a mastectomy and reconstruction. Maturation of scar tissue typically happens about 3 weeks post-surgery, so early scar tissue intervention will help improve the quality of the scar and decrease pain. So, how can scar tissue be managed?

There are ways to manage the scar tissue and improve function, minimizing and often eliminating pain. Astym (Augmented Soft Tissue Mobilization) is a soft tissue treatment used by certified clinicians. Instruments designed specifically for certain body parts are used to help regenerate tissues and break up adhesions from scar tissue.


Astym can be safely used as early as 3 weeks after surgery, as long as there are no signs of infection, the scar is completely closed and the doctor approves early intervention. The ideal treatment would be 2 days/week, with two days in between sessions, for 2-3 weeks. Treatments will vary case-by case.

Patients who are also receiving radiation will benefit from Astym. Often times after a mastectomy, shoulder range of motion may be limited from scar tissue being produced. Typically for radiation treatment to the breast, the patient needs to have a minimal of 90 degrees of shoulder abduction (raising arm to side). If scarring is preventing the shoulder from abducting, the Astym will help reduce the fibrotic tissue and improve shoulder range of motion in a shorter time, allowing for earlier radiation treatment.

If you are going through breast cancer treatments, know that you can regain function and minimize pain and scarring. At On Point Physical Therapy, physical therapist, Dr. Amanda DeRosa is certified in Astym. This specialized treatment, along with proper stretching can get you back to moving and being pain-free.

To set up your FREE 20 minute consult or to start your treatment plan, call 619-693-8047.

Low Back Strengthening

I’m sure everyone has heard how important “the core” is to help stabilize your spine. But, what exactly is the “core.” Your core is made up of the muscles surrounding your spine, including the pelvic floor, deep abdominal muscles (transverse abdominis), outer hip muscles and the lumbar paraspinals (multifidi muscles) surrounding the spine. When those above-mentioned muscles are working together, your spine is stabilized. The “core” muscles are providing your spine with it’s own back-brace.

Below are basic, yet very effective exercises to strengthen your core. These exercises should never cause pain. If they do or you are in too much pain to attempt them, please consult your local physical therapist or call Dr. Amanda DeRosa at 619-693-8047 to set up your FREE 20 minute consult.

1.) Transverse Abdominis (TA) marches- To perform this exercise, lie on your back with your knees bent.  Activate your transverse abdominis by drawing your belly button towards your spine, as if you were going to put on a tight pair of pants.  While keeping your transverse abdominis contracted and your back remaining flat on the ground, slowly raise one leg up, lower and repeat on the opposite side (mimic a stepping pattern).  The key to this exercise is to always have your TA activated and your back flat on the ground while you raise and lower your leg.


Superman- Lying on your stomach with your arms outstretched and legs straight, simultaneously bring your legs and arms off the ground and hold for 5 seconds, while  squeezing your glutes at the top. Return to the start position and repeat for 2x10 reps.


Bird Dogs-  Start on your hands and knees, about shoulder-width apart.  Draw your belly button towards your spine and keep your back flat.  Reach your right arm out, while simultaneously reaching your left leg out, trying not to let your pelvis rotate.  Return to start position and repeat on the opposite side. Try 2x10 reps.


The above-mentioned exercises are a great starting point for strengthening the muscles surrounding the spine. It can take 4-6 weeks to build strength, so be patient. You hard work, consistency and dedication to making your spine healthy, will help keep you away from pain and the doctor’s office.

If you are having pain, it is best to consult with your local physical therapist prior to attempting any of the above mentioned exercises. Are you local to San Diego? Give me a call to set up your FREE 20 minute consult at 619-693-8047.

Low Back Pain

Low Back Pain

Did you know that 40% of people will have low back pain at some point in their lives?  Low back pain is only second to the common cold for loss of work and productivity, than any other injury.  In a recent 2014 study by the National Health Interview Survey, it was noted that low back pain was the most prevalent reported pain site.  If you are suffering from low back pain, you are not alone!

The low back (lumbar) region is stabilized by a series of deep core muscles.  These core muscles are essential in providing support to the low back and minimizing shearing forces to the spine.

  • Transverse Abdominis (TA).  The TA attaches at the bottom of the rib cage, thoracolumbar fascia and the top of the iliac crest of the pelvis.  This muscle stabilizes the spine prior to movement.

  • Multifidus- These muscles are very short and attach on the transverse processes (side of vertebrae) up to the spinous process (middle of the vertebrae).  These muscles provide back stability and postural corrections throughout the day.

  • Pelvic Floor & Diaphragm- These muscles work in conjunction with your TA and Multifidus muscles to stabilize your spine, but also give flexibility to your movements throughout the day.  

When the above-mentioned muscles aren’t doing their “job,” the spine takes the brunt of the force.  With time or certain movements (twisting, bending), wear and tear can start happening at the spine, leading to instability.  With enough instability, people will start to experience pain.

When the above-mentioned muscles aren’t doing their “job,” the spine takes the brunt of the force.  With time or certain movements (twisting, bending), wear and tear can start happening at the spine, leading to instability.  With enough instability, people will start to experience pain.

When the above-mentioned muscles aren’t doing their “job,” the spine takes the brunt of the force.  With time or certain movements (twisting, bending), wear and tear can start happening at the spine, leading to instability.  With enough instability, people will start to experience pain.

What Does Your Ankle Have To Do with Squatting?

Raise your hand if you have trouble squatting? Does your chest drop forward when squatting?   Difficulty in squatting can originate from poor ankle mobility. So time to take a better look at the ankle!

Your ankle should be a mobile joint, allowing full dorsiflexion (pulling your ankle up), past a 90 degree angle.  Here is a simple way to assess if you have enough ankle dorsiflexion:

Stand facing a wall and have your right foot ~4” away from the wall. Keeping your right heel flat, bend your knee towards the wall, making sure your knee is staying in line with your second toe. If you’re able to touch the wall with your right knee, you have adequate ankle flexion.  If you can’t touch the wall with your knee, then you most likely have an ankle mobility restriction. Repeat on the other side.

A general rule of thumb is that if you’re able to touch your knee to the wall when standing 4-5 inches away, you are considered to have adequate/normal ankle dorsiflexion.  What do you need to do if you can’t touch your knee to the wall? Try these couple of exercises to help you!

  1. Use a foam roller or lacrosse ball to find tight, tender spots in your calf and/or plantar fascia.  Spend ~2 minutes on each side to help loosen those tight sports up.

  2. Stand in the same position as the above test and bend your front knee towards the wall.  Hold that position for a count of 10 seconds and relax your knee. Repeat that for 2 minutes on each side or the side that was unable to touch.

  3. Perform a basic calf stretch in standing, with your back leg straight, as well as your back leg slightly bent.  Hold this stretch for a count of 30-60 seconds and repeat 2-3x/each leg.

If you were unable to touch your knee to the wall from ~4” away, while keeping your heel flat, try the above exercises daily to improve your ankle mobility.