Vital Signs: What Are They and Why Are They Important?

The last time you saw your doctor, your nurse or medical assistant probably put a blood pressure cuff on your arm and a pulse oximeter on your finger, told you a few numbers, and then typed something in your chart. You probably knew that those gadgets were measuring your vital signs, but maybe you wondered what those numbers really meant or why they seemed to be so important to your medical team.

Vital signs can give us a quick snapshot of a person’s health and provide important information about how the body is functioning. The four vital signs that are commonly taken are blood pressure, heart rate, respiratory rate, and body temperature. Below is a short description of each vital sign and what it can tell you about your body.

  1. Blood Pressure

    Blood pressure is a measure of the force of blood as it pushes against the walls of your arteries, which are the blood vessels that carry oxygenated blood from your heart to the rest of the body. Blood pressure is measured in millimeters of mercury (mmHg) and is usually expressed as two values, such as 120/80 (read as 120 over 80). The top number represents your systolic blood pressure, which is the maximum pressure when your heart beats and sends blood out into the body. The bottom number represents your diastolic blood pressure, which is the minimum pressure when your heart relaxes and fills with blood.

For many years, the “normal” blood pressure value for adults was considered to be 120/80. However, new guidelines were released in 2017 by the American Heart Association. A normal systolic blood pressure value is now considered to be less than 120 mmHg, and a normal diastolic value is considered to be less than 80 mmHg. The chart below shows the ranges for normal blood pressure, elevated blood pressure, and several stages of high blood pressure.


High blood pressure, also called hypertension, forces the heart to work harder to pump out blood and places a great deal of stress on your heart and your blood vessels. This can lead to a hardening of your arteries and enlargement of your heart and can put you at an increased risk for heart attack and stroke. When untreated for a long period of time, high blood pressure can lead to heart failure.

  1. Heart Rate

Heart rate, also known as your pulse, is a measure of how many times your heart beats in a minute. The heart rate range that is considered normal for an adult is 60-100 beats per minute (bpm). In most cases, a lower heart rate is considered to be desirable because it means that the heart does not have to work as hard to pump blood to the rest of the body. Heart rate can be measured at multiple sites in the body, including at the wrist, the elbow, the neck, behind the knee, and at the ankle. It fluctuates throughout the day and should increase with activity and decrease with rest. A normal heart rate has regular intervals between beats. An arrhythmia, or irregular heartbeat, can be a sign that your heart is not functioning properly.

While heart rate can be easily taken manually, it can also be measured with a pulse oximeter placed on your fingertip or earlobe. Additionally, this device measures your oxygen saturation, which represents the amount of oxygen that your blood is carrying. A normal oxygen saturation is between 98% and 100%. This value can be decreased in patients that have pulmonary disorders, such as COPD.

  1. Respiratory Rate

Respiratory rate is the number of breaths that you take in one minute. To measure this vital sign, your practitioner may watch for the rise and fall of your chest over the course of a minute; often, the patient is not even aware that this is happening. A normal respiratory rate for an adult is considered to be within 12-20 breaths per minute. Like heart rate and blood pressure, respiratory rate typically rises with exercise and decreases with rest.

  1. Body Temperature

Body temperature may be the most straight-forward and self-explanatory of the vital signs. A normal body temperature can range from 97 to 99 degrees. An elevated temperature, or fever, can signify an infection in the body.

In conclusion, regular check-ups and checking your vital signs can help find potential health issues before they become a problem. When you see your doctor regularly, they are able to detect health conditions or diseases early. By getting the correct health services, screenings and treatment you are taking important steps toward living a longer, healthier life.

Do’s and Don’ts of Exercising Outside in the Heat


As we continue to practice social distancing and temperatures continue to rise, exercising outside can become a challenge. It is important to take precautions to avoid dehydration, heat exhaustion, and sunburn when exercising outside. Below are some tips to help you beat the heat and make the most out of your outdoor workouts.

DO work out early in the morning or in the evening

Try to avoid exercising in the middle of the day when the sun is the strongest. Avoid the hottest part of the day by waking up early to exercise or working out in the evening. If you choose to exercise at dawn or dusk when visibility is low, remember to let someone know where you are going, bring your cell phone, and take precautions to ensure that you are visible to traffic.

DON’T skip the sunscreen

Even on a cloudy day, you are at risk for getting a sunburn while exercising outside. Remember to wear and frequently reapply sunscreen to avoid painful sunburns and potential skin damage.

DO wear light-colored, moisture-wicking clothing

When exercising in the heat, try to wear breathable fabrics, such as cotton, and avoid dark colors that absorb sunlight.

DON’T keep sweaty clothes on after working out

If a shower is not an option right after a sweaty work out, try to change your clothing as soon as possible. Sweaty clothing can become a breeding ground for bacteria and may put you at risk for skin breakouts and fungal infections.

DO hydrate before and after your workout

To ensure that you stay well-hydrated, drink plenty of fluids the night before your workout and after you finish exercising. Be alert for signs of dehydration or heat exhaustion, which include nausea or vomiting, headache, dizziness, confusion, rapid heartbeat, chills, pale or clammy skin, and muscle cramps. If you begin to experience any of these symptoms during your workout, stop exercising immediately. If symptoms persist or if you lose consciousness, seek medical attention right away.

Dilator Therapy: What It Is And How It Can Help


What is Vaginal Dilator Therapy?

Vaginal dilator therapy will help to prevent your vagina from becoming too narrow. It can also help keep your vagina elastic.

Here is how it will help:

  • Your healthcare provider or physical therapist will assess a full pelvic exam (when a doctor or nurse looks at your vulva and internal reproductive organs)
  • Make pelvic exams more comfortable
  • Lessen discomfort with sexual activity

How long does a patient do vaginal dilator therapy?

You can do vaginal dilator therapy for as long as you need to. The amount of time you will need to do vaginal dilator therapy depends on many factors. You can discuss the length of time that’s right for you with your healthcare provider or physical therapist.

What medical conditions utilize dilator therapy?

Common conditions among women that benefit from the use vaginal dilators include dyspareunia (painful sex), vaginal changes associated with menopause, muscles spasms of pelvic floor muscles associated with pain or difficulty inserting a tampon, vaginal stenosis.  Dilator therapy is commonly used after pelvic radiation treatments.

What are vaginal trainers or dilators?

Vaginal trainers or dilators consist of a set of plastic or silicone round-tipped cylinders that range in size from small (the size of a little finger) to large (the diameter of a fully erect penis).

They are used in conjunction with physical therapy to restore depth, width, and elasticity of vagina to allow for intercourse, tampon use, medical exams, as well as other sexual health purposes.

Who do I need to contact if I think I need Vaginal Dilator Therapy?

Dr. Linda Kuserk is a Physical Therapist at FYZICAL Therapy and Balance Center of Rockville that specializes in women’s health and is an APTA certified pelvic floor therapist.

If you feel that you are a candidate for Vaginal Dilator Therapy, the use of vaginal dilators or would like to have guidance about using your vaginal dilators, give us a call at (301) 948-4395 to schedule an appointment or help answer any questions you may have.

Returning To Running After Pregnancy




Until recently there were no international guidelines or standardized practice for health professionals to guide women on return to running postpartum.

In 2019, three physiotherapists in the UK published guidelines based on the best available evidence to assist clinicians in guiding women in their return to running.


Highlights of these guidelines are listed below:

  • All postnatal women can benefit from a specialized pelvic health evaluation within the first six weeks for prevention and management of pelvic organ prolapse, urinary incontinence, and sexual dysfunction (this is supported by the highest quality of current evidence).
  • Pelvic health, load impact management and strength determine a woman’s readiness to return to running.  Other factors affecting readiness to return to running include, breast feeding, diastasis rectus, weight, fitness and breathing.
  • Gradually returning to running is acceptable starting three to six months postpartum, if signs and symptoms of pelvic floor dysfunction are not present (signs and symptoms of dysfunction include incontinence, constipation, painful intercourse or pelvic pressure).
  • Moderately returning to running by starting with walking and running intervals (Start with one to two minutes of running) and progress gradually
  • Increase distance and frequency before speed and terrain challenges.

Dr. Linda Kuserk is a Physical Therapist at FYZICAL Therapy and Balance Center in Rockville that specializes in women’s health and is an APTA certified pelvic floor therapist. She treats post-mastectomy/lumpectomy rehabilitation, pelvic pain, pregnancy or postpartum dysfunctions, pain or loss of function after gynecological or abdominal surgery and exercises for incontinence along with many other conditions.

If you would like to have your readiness to return to running assessed by Dr. Linda Kuserk, call us at (301) 948-4395 to schedule an appointment.


Returning to Running Postnatal: Guideline for Medical, Health and Fitness Professionals


Diastasis Rectus: Symptoms, Treatments And Prevention


What is diastasis rectus?

Diastasis recti is a separation of the connective tissue known as the linea alba, found between the large abdominal muscles known as the rectus abdominis, in the center of your abdomen.  The rectus abdominis runs from the sternum to the pubic bone and the separation can occur anywhere along the length of that connective tissue. The linea alba becomes softened and stretched to curve around the abdominal wall during pregnancy to accommodate the growing baby.

How common is diastasis rectus?

Nearly two-thirds of women develop a diastasis during pregnancy.



Are there things I can do to minimize my risk?

Managing intra-abdominal pressure helps to reduce stress on the linea alba.  Do not hold your breath with activities such as lifting or bowel movements.  Gentle exhale with these types of activities help to reduce intra-abdominal pressure.  Avoid activities that result in doming in the middle of your abdomen. Gentle abdominal support such as an ab-wrap, or recovery shorts immediately postpartum may be helpful.  Firm abdominal binders are not recommended.

How do I know if I have a diastasis?

One of the symptoms is doming in the center of your abdomen with lifting during daily activities or with abdominal exercises.  Some women may notice an inability to recruit their core and may experience back pain.  You can check for a diastasis postpartum by lying down on your back with your knees bent and lifting your head off the ground while palpating down the center of your abdomen for a space between the muscle bellies. You may see the doming occur midline.

How much of a separation is normal?

Traditionally, it was thought that a separation under two finger widths was not a concern, and those separations above two fingers should be addressed.  More commonly now, we are looking at function and muscle recruitment more than the actual distance between the muscle bellies to determine the need for interventions.

Does the diastasis correct itself without treatment?

A study looking following 115 postnatal women with diastasis recti showed that the greatest improvement in the distance between the two rectus muscle bellies occurred during the first eight weeks postpartum.  After eight weeks, improvement was not noted without intervention.

How is Diastasis Rectus treated?

Treatment focuses on recruiting core muscles (deep abdominals, diaphragm, and pelvic floor) without excessive intra-abdominal pressure on the linea alba. Treatment also may include soft tissue work on restricted areas and techniques to facilitate the deep abdominal muscles.

Who do I contact for additional help?

Dr. Linda Kuserk is a Physical Therapist that specializes in women’s health and is an APTA certified pelvic floor therapist. She treats post-mastectomy/lumpectomy rehabilitation, pelvic pain, pregnancy or postpartum dysfunctions, pain or loss of function after gynecological or abdominal surgery and exercises for incontinence along with many other conditions.

If you are concerned about your abdomen or would like guidance on improving your core, give us a call at (301) 948-4395 to schedule an assessment appointment.

Stress Urinary Incontinence (SUI): Symptoms and Treatment


What is stress incontinence?

Stress incontinence refers to the leakage of urine when there is increased pressure on the bladder during exercise, sneezing, coughing, lifting, or other activities requiring exertion.

Is it normal to leak when you cough and sneeze?

It may be common to leak, but it is not normal. Stress Urinary Incontinence (SUI) is when pressure (or stress) placed on the bladder causes urinary leakage. SUI, the most prevalent form of incontinence among women, affects an estimated 15 million adult women in the U.S. 


Do men experience stress incontinence?

Although it is more common in women, men also experience stress incontinence.  Men may experience stress incontinence following prostate surgery.

What are some causes of stress incontinence?

Some causes of stress incontinence includes:

  • Pregnancy and childbirth
  • Injury or trauma to the pelvic floor
  • Pelvic or genital surgery
  • Lack of exercise
  • Excessive coughing or sneezing
  • Weak pelvic floor muscles or laxity in the pelvic floor

What are some lifestyle changes that may help with stress incontinence?

Chronic constipation may contribute to urinary incontinence by placing increased strain on your bladder and pelvic floor muscles. Eating high-fiber foods — whole grains, legumes, fruits, and vegetables — to relieve and prevent constipation may be helpful.

For those overweight, losing excess pounds can help reduce the overall pressure on your bladder and pelvic floor muscles

Can incontinence be a sign of something more serious?

Any changes in continence should be assessed medically to rule out underlying medical conditions.  You should see a doctor immediately if you experience any of the following symptoms:

  • Severe pain while passing urine
  • Weakness in the legs or loss of sensation in the legs or around the genitals or anus
  • Trouble speaking or walking
  • Weakness or tingling in any part of your body
  • Loss of vision
  • Confusion
  • Loss of consciousness
  • Loss of bowel control

Who should be referred to a Pelvic Health Physical Therapist? 

Individuals who…..

  • Leak urine during daily activities
  • Leak urine when sneezing, coughing, laughing, lifting, or exercising
  • Have difficulty or hesitancy starting a urine stream
  • Have a strong urge to urinate that may or may not result in urine leakage
  • Frequently urinate during the day (more than every 3-4 hours)
  • Urinate more than once during sleeping hours
  • Have difficulty getting to the bathroom because of balance, weakness, or pain

How do physical therapists treat stress incontinence?

Pelvic Health Physical Therapists have specialized training in evaluating and treating a person’s pelvic floor muscles.  Pelvic floor muscles that are weak, tight, or not working in a coordinated fashion can cause urinary stress incontinence.  Physical Therapists provide education, advise on how to change behaviors to reduce symptoms and provide exercises to strengthen pelvic floor muscles and other important muscles.

Dr. Linda Kuserk is a Physical Therapist that specializes in women’s health and is an APTA certified pelvic floor therapist. She treats post-mastectomy/lumpectomy rehabilitation, pelvic pain, pregnancy or postpartum dysfunctions, pain or loss of function after gynecological or abdominal surgery and exercises for incontinence along with many other conditions. If you are interested in talking with her, give us a call at (301) 948-4395. We are more than happy to answer any questions you might have!


National Association for Incontinence, Facts and Statistics



The Benefits of Laser Therapy



















What is laser therapy?

Laser therapy is a form of phototherapy, which involves the use of light energy to promote tissue healing. Our Class IV laser helps us provide safe, non-invasive treatment by delivering this energy directly to damaged tissues. This can lead to a rapid reduction in pain, a decrease in inflammation and an overall improvement in healing at the cellular level. Unlike medications that may mask symptoms, laser therapy has the ability to treat the source of your pain by evoking a biochemical response within the damaged cells.

Does this actually work?

Class IV laser therapy was approved by the Food and Drug Administration (FDA) for the treatment of musculoskeletal pain in 2004. Since then, there have been numerous peer-reviewed research studies that have examined the efficacy of this treatment. These studies have provided strong evidence that laser therapy can have a beneficial effect on injured tissues. A meta-analysis that compiled the results of 22 research articles on laser therapy found that the use of a Class IV laser creates the following reactions within the body:

  • Induces photochemical responses that alter the pain threshold of nociceptors
    • Nociceptors are our pain receptors. When the threshold of these cells increases, the amount of pain that we feel decreases. 
  • Modulates inflammation by reducing the concentration of prostaglandins
    • Prostaglandins are inflammatory chemicals that are released by the body when we sustain an injury. When the concentration of prostaglandins is reduced, overall tissue inflammation decreases.
  • Enhances the release of endorphins
    • Endorphins are “feel-good” chemicals that help minimize discomfort.
  • Increases cellular oxygenation
    • Our cells require oxygen to heal and function correctly.
  • Enhances local hemodynamics
    • “Hemodynamics” refers to blood flow. Increased blood flow leads to faster tissue healing and helps to remove harmful substances from the area.

To summarize, the research has shown that laser therapy can help to decrease pain, reduce swelling and improve circulation, which may result in faster tissue healing.

Is laser therapy safe?

Studies have not identified any negative short-term or long-term side effects of laser therapy when it is administered correctly by a trained professional. This makes laser therapy a desirable alternative to taking medication or receiving local corticosteroid injections, both of which have known negative side effects. Our laser technician and exercise specialist, Kwame Dickson, is well-trained to administer laser therapy safely and will provide you with googles to protect your eyes during the session.

Is this a substitute for physical therapy?

Physical therapy provides important benefits, such as improved strength and flexibility, that are critical components of the rehabilitation process. Laser therapy does not serve as a substitute for physical therapy, but may provide substantial pain relief to allow you to participate fully in your therapy and speed up the overall rehabilitation process.

Who can be treated with laser therapy?

Just about anyone! The use of a Class IV laser has been shown to be beneficial for patients with both acute and chronic injuries and/or pain. It can be used to treat anything from chronic neck pain to an acute ankle sprain and can even be used post-operatively in some cases.

How can I find out if laser therapy is a viable option for me?

If you are interested in laser therapy, talk to your physical therapist, personal trainer or give us a call at (301) 948-4395. We are more than happy to answer any questions you might have!



Laser Therapy Pillar


Knee Pain and Weight Loss: Can Losing Weight Help Decrease Symptoms Associated with Arthritis?

Osteoarthritis, often referred to as “arthritis,” is a condition in which the layer of articular cartilage that separates your bones begins to wear down. In a healthy joint, this cartilage functions to cushion the joint, absorb shock, and prevent your bones from rubbing against one another. In a joint affected by osteoarthritis, the cartilage has begun to break down, narrowing the space inside the joint and causing your bones to rub together. This can lead to pain, swelling, and difficulty performing your daily activities.

While osteoarthritis is often treated successfully with physical therapy in its early stages, research has shown that weight loss through diet and exercise may also be effective in reducing symptoms associated with arthritis. A study published in 2018 found that a weight loss of 10% led to decreased pain levels, reduced inflammation, and improved walking speed in overweight and obese adults with knee osteoarthritis. The same study found that a 20% loss of body weight led to an even greater improvement in pain level, function, and overall quality of life.

If you are overweight or obese and have knee pain caused by osteoarthritis, weight loss can be a safe and effective way to help reduce your symptoms and eliminate the need for medication. By losing weight, you are decreasing the compressive force throughout your knee joint. This can reduce the amount of friction created inside the joint, leading to decreased inflammation and pain.

If you are considering losing weight due to pain associated with osteoarthritis, there are many resources that you can utilize to set up a safe and effective program. A registered dietician can help you develop a good nutritional program, and a physical therapist or personal trainer can help you create an exercise routine. It is important to lose weight safely and gradually to avoid causing harm to your body.

If you think you need additional assistance with your nutrition program, our registered dietitian and physical therapist, Casey Miller can help. Her expertise, training and credentials are vital for promoting lifestyle choices in order to achieve your health and wellness goals. You can request an appointment by emailing us at or calling us at 301-948-4395.

Reference: National Institutes of Health (NIH) Intensive Weight Loss Helps Knee Arthritis

Don’t Hurt Your Back! Tips for Proper Lifting Mechanics


You’ve probably heard the phrase “lift with your knees, not your back”. Even though this phrase might sound a little cliché, it is a great piece of advice that should be kept in mind when performing strenuous activities. Using good body mechanics, especially when lifting heavy objects, can help you protect the structures around your spine and avoid injuries that lead to back or neck pain.

Here are a few tips to help you develop good body mechanics:

Tip #1: Squat to pick up objects from the floor

Avoid bending forward with a rounded back when lifting objects from the floor or a low surface. Instead, bend at the knees and squat down. Remember to keep your back flat and neck in a neutral position. This is also the best way to put heavy objects down.

Tip #2: Use the golfer’s lift to pick up small, light objects

This technique, depicted in the image to the right, is useful for picking up small, light objects from the ground. Notice how the woman in the picture staggers her stance, shifts her weight onto her front leg, and hinges at the hips while keeping her back flat.

Tip #3: Hold heavy objects close to your body

Always hold and carry heavy objects close to your body to avoid placing unnecessary stress on your muscles, ligaments, and joints. Keeping an object close to your body also decreases the amount of force you need to generate, which can make the task feel easier and reduce your risk of injury.

Tip #4: Never twist your body when moving objects

This is important not only when lifting heavy objects, but also when performing activities such as transferring groceries from your cart onto the conveyor belt or moving clothes from the washer to the dryer. Instead of picking an object up, twisting your trunk, and putting it down, try taking small steps with your feet to turn your entire body.

Tip #5: When lifting from a higher surface, use a stepstool

Instead of standing on your tiptoes or arching your back to lift from or return objects to a high surface, use a stepstool. This will allow you to maintain a neutral spine and will also make the task feel easier.

Moral of the story

Work smarter, not harder. Before you attempt to lift an object, formulate a plan. You should have an idea of how heavy the object is, how you are going to lift it, and how you are going to get it to its destination. Whenever possible, try to minimize the distance that you need to carry the object. If an object is ever too heavy for you to lift safely, find a second person to help. Make sure you take your time, and don’t assume that you can’t injure yourself when using a risky technique just because you’ve done it before.

If you have any questions, we are happy to help. You can email us at or call us at 301-948-4395.

Benign Paroxysmal Positional Vertigo: Is Your Dizziness Caused By BPPV?






















What is BPPV?

If you’ve ever experienced brief episodes of vertigo when lying down, sitting up, or rolling in bed, BPPV may be to blame. BPPV, or benign paroxysmal positional vertigo, is a common condition that affects the vestibular system (the inner ear). In people with BPPV, it is thought that calcium carbonate particles become dislodged from a structure inside the inner ear. Movement of these particles, which are often referred to as “crystals,” can cause brief episodes of dizziness.

What are the symptoms of BPPV?

The classic symptom of BPPV is vertigo, a sense of spinning, that is brought on by changes in head position with respect to gravity. However, some people that have BPPV do not experience true vertigo and may instead complain of lightheadedness or imbalance when a change in head position has occurred. Symptoms typically last seconds to minutes before resolving. It is also common for people with BPPV to experience nausea and/or vomiting.

What kind of movements can provoke BPPV symptoms?

Movements that involve pitching the head forward or backward, especially when combined with head rotation, can provoke symptoms. Commonly, BPPV symptoms are provoked with lying down, sitting up, and rolling in bed, bending forward, and pitching the head back in the shower.

What causes BPPV?

BPPV occurs frequently in older adults due to the degeneration of structures within the inner ear that occurs over time. The most common causes of BPPV in people under 50 is head trauma, which can be direct or indirect (such as a whiplash-type injury). Additional risk factors for BPPV include female gender, osteoporosis, Vitamin D deficiency, family history of BPPV, a history of migraines, and a history of other vestibular disorders, such as vestibular neuritis or Meniere’s disease.

How is BPPV treated?

Because BPPV is benign, you will not cause any additional harm to your inner ear or your body if you choose not to seek treatment. It is possible for symptoms to resolve spontaneously within several months. However, because the disorder can last longer than this and may increase your risk of falling, it is often best to actively seek treatment. BPPV treatment may be performed by a physical therapist, an audiologist, or a physician.

To treat your BPPV, your health care provider will perform an assessment to determine which ear is affected and where the crystals are located within the ear. A maneuver can then be performed to remove the crystals from the affected part of the inner ear (a canal). Maneuvers typically take several minutes to perform and have been shown to be very effective in alleviating symptoms.

I think I may have BPPV, what should I do?

Come see us at FYZICAL Therapy and Balance Center in Rockville, MD! We treat this condition all the time and would love to help you or your loved ones. You can request an appointment by emailing us at or calling us at 301-948-4395.

To reduce symptoms temporarily in the meantime, you can sleep with your head elevated on several pillows and try to avoid bending forward and pitching your head backward. After sitting up in bed, try to remain seated on the edge of the bed for several minutes before you try to stand up.