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What Does It Mean To Be “Out of Alignment?”

“My body feel out of alignment.”

“My <insert healthcare professional here> said that my hips are off.”

“I think I just need to be adjusted.”

These are examples of a few of the comments that patients may express in physical therapy or other injury rehabilitations settings.

The belief that we are like a vehicle that needs to be re-aligned is often the fault of the healthcare industry, including physical therapy.

In the past, healthcare providers would tell their patients that a part of their body is out of alignment and needs to be adjusted to put it back in place. They explain that this is the reason for any discomfort that may be present.

Thankfully, this is no longer taught by most healthcare providers as this thought process has been disproven.

Our bodies are incredibly resilient.

Our joints do not simply fall out of alignment. In fact, our bodies are designed to move and if we were constantly “in line”, it would be impossible to move anywhere!

So, what is happening when an area of our body feels “off”?

As we perform a movement repetitively, compensations and movement limitations become more noticeable.

One area of the body may be moving excessively, while another area of the body may be moving too little.  For example, if your ankle mobility is limited during a squat, you will move excessively at the hips to pick up the slack, causing more stress in that area. As a result, pain, or the feeling of being out of alignment may occur in the hips/pelvis.

If you feel “off” or have been told that you are out of alignment, the solution is likely to begin with discovering what movement limitations may have led to this feeling in the first place. This information can then be used to teach you strategies to move and feel better!

Are you interested in discovering what solutions may be right for you? Contact us to find out more about our physical therapy services!

An Alternative to X-Rays and MRIs

This week’s article is written by Dr. Michael Auriemma, a member of Regenerative Orthopedics and Sports Medicine. He is a key member of our physical therapy team here in Bethesda and Chevy Chase and has helped many athletes, active adults, and runners overcome injury in conjunction with a comprehensive physical therapy plan. Dr. Auriemma specializes in sports and musculoskeletal medicine, and has received extensive training in the use of sports ultrasound for both diagnostic and interventional procedures.

He is the perfect person to tell us about an alternative solution to X-rays and MRIs that also happens to be a lot easier, quicker, and more pleasant to use!




Regenerative Orthopedics and Sports Medicine (ROSM) is a growing private practice centered in the DMV.  It is comprised of physicians who specialize in non-operative orthopedic and sports medicine. 

ROSM physicians strive to provide a higher quality of care through extended patient visits (ie. more 1 on 1 time with patients) and the use of diagnostic musculoskeletal ultrasound, a bedside tool that allows for real-time imaging of muscle injuries, tendon and ligament injuries, fascia injuries, arthritis, and nerve entrapments. 

In certain situations, ultrasound can eliminate the need for X-rays or MRIs, while other times it serves as a complimentary imaging modality. 

In addition to advanced diagnostics, ultrasound can also be utilized to guide targeted treatments to enhance recovery.  These include prolotherapy, platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and microfragmented adipose transfers (MFAT). 

ROSM physicians help patients choose appropriate treatments through a combination of evidence-based research and individual patient needs.

Visit our website to learn more!

-Dr. Michael Auriemma, MD

Why Mouth Breathing Can Be a Problem

There are a variety of circumstances that can contribute to increased levels of stress. Some common examples include work pressures, family problems, money issues, and health concerns. But in recent years, athletic physical therapy has proven that a lesser-known stress contributor is actually how you breathe.

According to Seth Oberst, DPT, there are two primary ways humans breathe — either through the mouth or the nose. When mouth-breathing is your primary mode of respiration, you are actually stressing your system more than if you were to breathe through your nose.

When you breathe through the mouth, your head is forced to move forward to maintain an open airway. Unfortunately, this causes a cascade of negative effects that can put even more stress on the body:

  • Taking air in through the mouth isn’t effectively mixed with nitric oxide, so you have to inhale more air than necessary.
  • This over-breathing increases your sympathetic nervous system (fight or flight) activity.
  • As you inhale more and more air, your heart rate increases, along with muscle tension and stress levels.
  • While you may be physically or mentally exhausted at night, you end up tossing and turning — waking up feeling more tired because your brain is starving for oxygen.

All this to say, how you breathe is important. While you can certainly survive by mouth-breathing, it will be difficult to thrive. If nose breathing is difficult for you, start by doing 3–5 minutes of dedicated nose-breathing per day to increase your comfort levels.

If you want to learn even more about proper breath-form and reducing stress, our experienced athletic physical therapy team in Bethesda/Chevy Chase can help!

Why Individualized Health & Fitness Programs Are Crucial to Injury Rehabilitation

Health and fitness have never been more prevalent than they are today. From the popularization of “superfoods” like kale and avocado to the birth of new exercise routines like CrossFit and HIIT — the desire to stay healthy and fit is at an all-time high. As a physical therapy clinic in Bethesda and Chevy Chase, this is a positive change that we’re happy to see.

Now more than ever before, people are eating healthier, exercising more, and living a more balanced, holistic lifestyle. While this is a welcomed change, there’s one significant aspect of someone’s overall health that’s often neglected — the individualization of diet and exercise.

Although there are many standard practices for eating healthy and exercising correctly, each person on this planet is unique and has different health needs. For example, someone could eat what most people consider “healthy foods” — such as spinach or broccoli — but it may not be healthy for that individual or their physiological needs.

There is no straightforward, one-size-fits-all approach to health and fitness. Even a seemingly “healthy” program for nutrition or exercise may not be suitable for everyone.

Take someone who exercises regularly and eats a clean, well-balanced diet. While they may be in shape, their diet or exercise might not be a great fit for the individual’s biology, history, medical needs, or genetic makeup. If they were to switch to a program specifically designed to their needs, they would experience a significant improvement in their overall wellness.

This is not to say that eating healthy and exercising more is bad. Instead, to maximize the health benefits, an exercise program should be customized to the individual. This is why injury rehabilitation programs in Bethesda and Chevy Chase are designed specifically for the patient or client. To improve health or recover from an injury effectively, a program must be customized to a patient’s unique fitness level, physiology, and body requirements.