Exercise to Ease Chronic Anxiety This Year 

A new year offers the potential for new opportunities and experiences. 

For those who struggle with general and consistent anxiety, however, the prospect of the new year and the expectations that come with it can be tricky to maneuver. 

It’s with this in mind that our physical therapy team reminds you of one of the most natural and effective ways to ease anxiety symptoms any time of year is through regular exercise. 

Going for a walk, taking a bike ride, hitting the gym or signing up for an exercise class … they all can be powerfully effective tools for easing anxiety and its effects on your life and health. 

Anxiety Disorders 

According to the Anxiety and Depression Association of America (ADAA), an estimated one in five adults and one in three teens experience chronic anxiety disorder each year. This disorder is defined as anxiety that’s persistent, excessive and routinely triggered by situations that aren’t actually threats. 

Though it’s a psychological condition, anxiety can take a toll on one’s physical health. 

High stress and anxiety have been linked to higher blood pressure and a greater risk of heart disease and stroke. 

Also, those who have high levels of anxiety tend to be more sedentary and avoid challenging situations, which can also have long-term health consequences. 

So, how does exercise help ease anxiety? Here are four ways this happens: 

Your brain chemistry changes. 

When you exercise, your body releases chemicals, like dopamine and endorphins in the brain, which contribute toward making you feel calmer and happier. 

General tension diminishes. 

Whether working out, competing, playing or dancing, moving your body reduces general muscle tension in the body, decreasing your general feeling of anxiety. 

You get distracted. 

Exercising can have a distracting effect, diverting your mind from the things about which you are or have been anxious. It’s also been shown that exercising outdoors, in nature, can calm your mind. 

You give your brain a boost. 

Several studies have shown that regular exercise can maintain, and even improve, cognitive function in the brain. That means exercise can actually help you strengthen your ability to weather high-stress situations. 

On its own, exercise may not completely solve your anxiety issues. Those suffering from chronic anxiety should discuss options with their personal physician. 

When possible, though, studies show that regular exercise should be part of any natural, long-term treatment for anxiety. 

Sticking with an Exercise Program 

And, if you struggle to stick with a consistent exercise regimen? 

Don’t just join a gym. Experts agree you should find an activity or activities you enjoy. 

Recruit a friend or friends for some social support, and set a SMART goal – an acronym that describes a goal that’s Specific, Measurable, Attainable, Relevant and Time-based.” 

Also, visit a physical therapist if pain, discomfort, weaknesses or chronic conditions are keeping you from exercising safely and consistently. 

Following an initial assessment, a physical therapist can develop a personalized exercise program that best aligns with your individual circumstances and goals. 

Use Fitness Apps in 2020…but Use with Caution, says Lynnwood PT

As more people continue to turn to health apps on their smartphones to help achieve goals related to exercise and weight loss, it’s important to use such tools with an element of personal caution, says Lynnwood physical therapist Nancy Mitrano. 

Tens of thousands of health and fitness apps available to consumers, with estimates between 97,000 to 325,000 in existence. These include popular apps like Strava, Lose It!, Couch to 5K, FitStar Personal Trainer, etc. – apps available to help people achieve goals related to weight loss, healthy eating, and improved fitness. 

“The emergence of health and fitness apps has definitely been a positive development in the health care world as many have been successful in engaging people and empowering them to take on a greater personal role in their health care journeys,” said Mitranoowner of Impact Physical Therapy in Lynnwood. “That said, even the best fitness apps can’t address everything that’s important when it comes to safely and effectively achieving personal goals.” 

The missing ingredient is obvious, Mitrano added. 

“Fitness apps don’t know you – your medical history, your current strengths and weaknesses … how to get you to your goals in a way that’s safe and which takes into consideration the limits of your body and current fitness levels,” Mitrano said. “Many of these apps are great for helping people track their fitness goals, holding them accountable through reminders and tips, and often providing them with an online support system. But the app’s user is the key to the entire equation.” 

With this in mind, Mitrano provides the following Do’s and Don’ts for safely and effectively using health apps: 

DO use apps to track your goals. Whether it’s tracking distance, calories consumed/burned, workout times, etc., this is one of the most effective uses of health apps and smartphones. And, tracking progress only helps in the achievement of goals. 

DON’T use apps to set your goals. Running a 5K, for instance, may seem like a great goal. But based on current fitness levels, injury history, movement limitations, etc., perhaps it’d be better and safer to start more slowly (perhaps first running a mile) or trying a different exercise (i.e., cycling, hiking or swimming). 

DO use apps for motivation. Being we’re attached to our smartphones throughout the day, apps serve as great motivational tools when trying to stick to a workout regimen. Apps can even connect the user with others for added encouragement. 

DON’T let apps push you too far. Listen to your body over your app. If something’s not feeling right, it’s OK to skip today’s Couch to 5K workout. Through pain or discomfort, your body may be telling you to rest, or perhaps get checked out by a physical therapist or physician. 

DO use apps to help you explore new activities. Apps can certainly make you feel empowered, serving as motivation to try new things – new yoga poses, new core exercises, new activities like running or cycling, etc. But… 

DON’T forget to seek professional medical advice before starting something new. As with any new physical activity, it’s important to get assessed by a medical professional, such as a physical therapist, to ensure your body’s equipped to handle the rigors of said activity.  Be safe and injury-free when pursuing your goals.

Exercise Therapy Proven to Ease Pain in Expecting Mothers

For the majority of future mothers who experience mild to debilitating back pain during and after pregnancy, Lynnwood physical therapist Nancy Mitrano offers some encouraging news: 

Education and exercise therapy have proven effective in reducing back pain for most expecting mothers. 

According to a study published in the Journal of Orthopaedic and Sports Physical Therapy, a physical therapist-directed exercise regimen that focuses on the muscles around the spine and pelvic floor – a program that includes strength training, aerobic exercise and balance training – can greatly benefit the approximately 2.5 million women who experience lower-back pain related to pregnancy each year. 

“While some back discomfort is normal during pregnancy, the pain shouldn’t keep you from your usual daily activities,” said Mitranoowner of Impact Physical Therapy in Lynnwood. “If the pain or discomfort is such that it’s impeding your ability to live your life, a physical therapist can guide you toward exercises, advice and a personalize treatment program that offers relief.” 

According to Mitrano, the added weight of pregnancy, coupled with the release of hormones that relax the ligaments in the pelvis, lead to strain in the hips, pelvis and lower-back. Diagnosing the exact cause of pain, however, is essential in determining the safest and most effective treatment paths for pregnant and postpartum moms. 

Following a thorough examination, a physical therapist may offer the following treatment options: 

Stabilization Exercises: As hormones relax the ligaments, stronger muscles can help stabilize the pelvis and lower-back. A physical therapist can teach women safe and effective exercises that specifically target the muscles in this region of the body – exercises that can often be performed at home. 

Stretching: Along with strength exercises, stretching the muscles around the hips, pelvic floor and back can also help relieve pain and discomfort. 

Aerobic Exercise: The American College of Obstetricians and Gynecologists (ACOG) suggests expecting moms exercise for 15 minutes three to four times per week, at a heart rate of 140 beats per minute. A physical therapist will help identify aerobic exercises, like walking, swimming, yoga, etc., that are both safe and effective. 

Other Options: A physical therapist may decide that other treatment options, such as manual therapy or braces, might be effective based on one’s specific diagnosis. 

“Movement is often key to relief, and as physical therapists, we not only treat expecting mothers, but we help them alter the way they perform everyday tasks in order to reduce pain,” Mitrano said. “We show patients how to improve posture and better manage their average daily activities, and we educate them on why such changes are effective.” 

Volunteering Benefits Seniors Physically & Mentally

For some older adults who live alone, life can become filled with instances of social isolation and loneliness.

Research shows social isolation can have adverse effects such as depression, reduced cognitive function, decreased activity, and many physical conditions.

For instance, we tend to see more instances of issues like high blood pressure, heart disease and obesity in people who perhaps aren’t as social as they used to be.

Why Be Social?

While it’s completely fine to be comfortable by yourself, it’s often beneficial both mentally and physically to make time for social interactions.

One great way to do this – especially this time of year – is to take advantage of community volunteer opportunities.

Studies have shown that volunteering is a great way for seniors to counter many of the effects of isolation and aging. Just getting out in a useful way to support a cause you believe in can benefit the mind and the body – from combatting loneliness to increasing levels of health and activity.

And, volunteering can take on many forms, regardless of age, health or physical limitations.

Some proven health benefits of volunteering include:

Improving Self-Esteem, Lowering Depression

Giving time to others can create a personal sense of accomplishment. When assisting others, the body releases dopamine in the brain, which has a positive effect on how people feel.

It is documented that volunteers also experience lower levels of depression.

Expanding Connections

Volunteers are surrounded by a community that’s attuned to helping – people willing to lend a hand when times get tough. And, they realize that safety nets go both ways: helping when asked and asking for help.

Combating Stress

According to a study by a Carnegie Mellon University doctoral student, volunteering reduces stress. In her study, 200 hours of volunteering per year correlated to lower blood pressure, and lower blood pressure correlated to better health outcomes.

Keeping the Mind Active

The same study speculated that mentally stimulating activities, like tutoring or helping with reading, contribute to maintaining memory and thinking skills that, in turn, reduces cognitive impairments.

Physical therapy services often work to complement these effects by working with seniors and others to keep their bodies volunteer ready.

And, in the end, once a person starts to realize all the physical, mental and social benefits of giving back to people and their communities, this can help motivate them to live healthier, more active lives. Physical therapists, then, are there to offer support that allows these efforts to extend into the long term.

Physical Therapist’s Guide to Concussion

In the past few years, concussion has received a great deal of attention as people in the medical and sports worlds have begun to speak out about the long-term problems associated with this injury. The Centers for Disease Control estimate that in sports alone, more than 3.8 million concussions occur each year. Recent scientific evidence highlights the need for proper care to prevent complications from concussion.

If you think you might have a concussion:

  • Seek medical care immediately.
  • Avoid any additional trauma to your head—don’t engage in any activity that carries a risk of head injury.
  • Limit activities of all kinds, including school and work.

What Is Concussion?

Concussion is a brain injury that occurs when the brain is shaken inside the skull, causing changes in the brain’s chemistry and energy supply. A concussion might happen as a result of a direct blow to the head or an indirect force, such as whiplash. You might or might not lose consciousness.

Concussion-SmallConcussion: See More Detail

Signs and Symptoms

There are many symptoms related to concussion, and they can affect your physical, emotional, and mental well-being.

Physical symptoms may include:

  • Headache
  • Dizziness
  • Difficulty with balance
  • Nausea/vomiting
  • Fatigue
  • Difficulty with sleeping
  • Double or blurred vision
  • Sensitivity to light and sound

Cognitive (thinking) symptoms may include:

  • Difficulty with short-term or long-term memory
  • Confusion
  • Slowed “processing” (for instance, a decreased ability to think through problems)
  • “Fogginess”
  • Difficulty with concentration

Emotional symptoms may include:

  • Irritability
  • Restlessness
  • Anxiety
  • Depression
  • Mood swings
  • Aggression
  • Decreased tolerance of stress

How Is It Diagnosed?

Concussion is easy to miss because diagnostic imaging, such as such as magnetic resonance imaging (MRI) or a computed tomography (CT) scan, usually is normal.

Because of the variety of possible symptoms that can interfere with day-to-day activity, seek coordinated medical care immediately. Your health care professionals may include a physician with expertise in concussion, a neuropsychologist, and a vestibular physical therapist (a physical therapist who specializes in treating balance disorders and dizziness).

After a concussion, limit any kind of exertion. The brain won’t have time to heal if you increase physical exertion too soon—such as returning to social activities or sports—or if you increase cognitive demands too soon, such as returning to school or work. You can slowly resume normal activities only once your symptoms have improved and stay improved.

How Can a Physical Therapist Help?

Physical therapists can evaluate and treat many problems related to concussion. Because no 2 concussions are the same, the physical therapist’s examination is essential to assess your individual symptoms and limitations. The physical therapist then designs a treatment program.

Help Stop Dizziness and Improve Your Balance

If you have dizziness or difficulty with your balance following a concussion, vestibular physical therapy may help. The vestibular system, which includes the inner ear and its connections with the brain, is responsible for sensing head movement, keeping your eyes focused when you move your head, and helping you keep your balance. A qualified vestibular physical therapist can provide specific exercises and training to reduce or stop dizziness and improve balance and stability.

Reduce Headaches

Your physical therapist will examine you for neck problems following a concussion. Neck injuries can cause headaches and contribute to some forms of dizziness. Your therapist also can assess your back for possible injuries to your spine.

As symptoms due to concussion improve, your physical therapist will help you resume physical activity gradually, to avoid overloading the brain and nervous system that have been compromised by concussion.

It’s important that you follow the recommendations of all health care professionals so that you can achieve the greatest amount of recovery in the shortest amount of time.

Real Life Experiences

You’ve just come home from a soccer game where your 15-year-old daughter was star goalie. She admits to you that she “dinged” her head during a play in the second half and did not tell anyone. She’s complaining of headache and dizziness, and she’s sensitive to light.

What do you do next?

You monitor the next 24 hours closely, seeking care immediately in the local emergency department if your daughter has or you observe any of the following:

  • Headache that gets worse and does not go away
  • Weakness, numbness or decreased coordination
  • Repeated vomiting or nausea
  • Slurred speech
  • Extreme drowsiness or cannot be awakened
  • One pupil (the black part in the middle of the eye) larger than the other
  • Convulsions or seizures
  • Inability to recognize people or places
  • Increased confusion, restlessness, or agitation
  • Unusual behavior
  • Loss of consciousness

During the next couple of days, she’s frequently in the nurse’s office due to headaches and dizziness. She reports difficulty concentrating and remembering during school and is having trouble falling asleep at night. What do you do next?

  • Have the concussion evaluated by a licensed medical professional with expertise in treating concussion. Some communities have concussion or mild traumatic brain injury clinics. Evaluation should include an assessment of symptoms, neurologic screening, testing of thinking ability (“cognition”), and testing for balance problems.
  • Do NOT allow your daughter to participate in sports or any other activity with risk of head injury until she is cleared by a licensed medical professional with expertise in treating concussion. Repeated concussions can result in many problems.
  • Do NOT allow your daughter to engage in physical activity—such as exercise, sports practice, gym class—until she has recovered from her concussion or has been advised by a licensed medical professional with expertise in treating concussion. Physical activity during early stages of concussion robs your brain of the energy it needs for healing.
  • Limit thinking (“cognitive”) activity until you have recovered from your concussion or have been advised by a licensed medical professional with expertise in treating concussion. Your brain requires additional energy to heal from a concussion, and excessive thinking interferes with recovery.
  • Get plenty of sleep and rest. This will help your brain to recover from the concussion.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

  • A physical therapist who is experienced in treating people with neurological problems. Some physical therapists have a practice with a neurological or vestibular rehabilitation focus.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with concussion.
  • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of problems related to concussion. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34:87–93. Article Summary on PubMed.

McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med. 2009;19:185–200. Article Summary on PubMed.

Centers for Disease Control and Prevention

Introducing Jake McKown

Impact Physical Therapy is excited to announce our new Massage Therapist Jake McKown. Jake has been a Massage Therapist since 1998. His specialties include: treatment for motor vehicle accidents, on the job injuries, sports related injuries, fibromyalgia, headaches, nerve pain and plantar fasciitis. He is passionate about helping people improve their quality of life.

His favorite techniques include: Deep Tissue, Myofascial Release, Neurofascial Release, Sports Massage, and Positional Release Technique.He is a Certified Member of Associated Bodywork & Massage Professionals.

He enjoys being active. He has studied Aikido, and has handled sled dogs for a long distance team, which competed in the Yukon Quest International Race. He has lived in the Seattle area since 1992 and enjoys Contra Dancing and outdoor activities especially hiking and sailing.

Meet Brie

Ever considered Physical Therapy for women’s health issues? Our Women’s Health Specialist Brie is dedicated to providing comprehensive care to her patients. Read more about what Physical Therapy can do for Women’s Health.



Women’s health issues such as urinary incontinence, osteoporosis, chronic pelvic pain, and pregnancy related pain can all be intimidating. Perhaps it is the lack of information and understanding of what’s going on in their bodies that makes women anxious about these issues. Or maybe it is the very personal and private nature of their diagnosis or symptoms that causes women to avoid treatment. It is very likely many women don’t even know that these problems can be very successfully treated with physical therapy. We want to spread the word. It doesn’t have to be scary! We are here to help.

During your initial visit, your women’s health physical therapist will take the time to get an in depth understanding of your symptoms and their history. She will also explain the physical therapy treatments available to you and address all of your concerns about this type of physical therapy intervention.

During all of your visits, your women’s health physical therapist will apply many of the same physical therapy treatments used for other parts of the body in order to help address your symptoms. These include patient education, muscle re-training, soft tissue work, and exercises.

Our women’s health physical therapist is able to address all musculoskeletal contributions to the particular symptoms you are dealing with since she treats general orthopedics in addition to having specific training in treating the issues specific to women’s health physical therapy.


Brie Oneal, DPT, graduated from the University of Washington with a BA in Business Administration and a concentration in Accounting. She later returned to school to follow her passion in physical therapy and graduated with a Doctorate in Physical Therapy from Eastern Washington University. Since graduating she has been practicing in the Seattle area focusing in manual therapy and outpatient orthopedics. She began specializing in Women’s Health Physical Therapy in 2010 and continues to expand her expertise through the Pelvic Rehab Institute, originally founded by Kathe Wallace, PT, BCB-PMD, and Hollis Herman, PT, DPT, MS, OCS, WCS, BCB-PMD. She is trained in intravaginal manual treatment and the care of patients during pregnancy and post partum. She is a member of the Women’s Health Physical Therapy and Orthopedic Sections of the APTA. Brie is dedicated to providing comprehensive care to her patients to allow them to be healthy and maintain improvements long after finishing physical therapy. She enjoys helping patients discover their own unique needs and goals and providing them with the tools and knowledge to reach them.

Outside of work, Brie enjoys spending time with her husband and two very active sons exploring, hiking, swimming, skiing, and running.