The Art of Gratitude

Good morning, and Happy Monday everyone!!

So disappointingly, I didn’t win the Powerball this past weekend… sigh… so as a typical Monday morning goes, my alarm woke me before the sun arose…


Or is it really???

The sense of hearing the alarm go off (admitting, not the sweetest of sounds… but a sound heard regardless).  The reaction of opening your eyes and waking up each morning.  The ability to move your body to begin your day.  The freedom to make the choice of what to do with your day.  And yes, you may say “I don’t have a choice, I have to work!  I need the money.”  While very true, it is still a choice you have… you can choose what type of job you pursue… you can also choose not to work and not make money to live… they are all choices.

What if we can recognize this wonderful ability to choose… to get to see, feel, taste, touch, and live each day we have.


A beautiful word, and one I have been thinking about a lot lately.

Gratitude – The acknowledgment of kindness and thankfulness.  Robert Emmons, one of the world’s leading scientific researchers of gratitude, points out two of its key elements – “First,” he writes, “it’s an affirmation of goodness.  We affirm that there are good things in this world, gifts and benefits we’ve received.  And secondly, we recognize that the sources of this goodness are outside of ourselves… we acknowledge that other people – or even higher powers, if you are of spiritual mindset – gave us many gifts, big and small, to help us achieve the goodness in our lives.”

Studies have proven that gratitude makes us happier, more positive and uplifting to others, strengthens our emotions, increases productivity in work and day-to-day living, makes us more optimistic, helps develop our personality, and improves sleep… along with providing so many other benefits!

But Jacquie, this is a PT blog!!  What does gratitude really have to do with health and wellness??

Well, if those above facts don’t already sell you on the benefits… according to research gratitude DOES in fact improve overall health and wellness!!

According to a study entitled “Counting Blessings versus Burdens” in 2003, keeping a gratitude journal caused patients to report 16% fewer physical symptoms, 19% more time spent exercising, 10% less physical pain, 8% more sleep, and 25% increase in quality of sleep.

In another study from 2004 entitled “The Grateful Heart”, the emotions of appreciation and gratitude were shown to induce the body’s relaxation response, leading to reports of decreased levels anxiety and feelings of depression and sadness.

To correlate with the above, in 2005 a study titled “Positive Psychology Progress” reports that a gratitude visit reduced depressive symptoms by 35% for several weeks, and keeping a gratitude journal lowered depressive symptoms by 30%+ for as long as the journal was continued.

And in 2007 a study entitled “Gratitude: Effects on Perspectives and Blood Pressure”, patients with hypertension were instructed to keep record of their blessings and gratitude once a week for 12 weeks.  Results proved a significant decrease in their systolic blood pressure.

There are no ill-effects of gratitude.  It doesn’t cost us anything to practice… and it is a practice.  We live in a hustle and bustle world, where we often don’t take the time to recognize all of the blessings and the good we encounter and we have each day.

So why not???

And it’s a perfect day to begin!!!  At approximately 2:40pm today NYC will be witness to a solar eclipse!! The result of an alignment of the sun, the Earth, and the moon!!  And while we are not in the path of totality, we will still have the opportunity to see a 71% eclipse!!

In my eyes (not looking directly at the sun during the eclipse, of course!), that’s not a bad percentage!!

So I challenge you to join me… keep a gratitude journal, or even type your blessings in the notes portion of your cell phone… stop and smell the roses… notice a smile… maybe even smile back… take appreciation for what your body allows you to do today and every day.

Be grateful with me… today, and every day.


Jacqueline Mendelsohn, DPT, CLT

Hearing vs Listening

Are you hearing or listening to your patient?

That’s an interesting question, no?

As one who is in the beginning of my PT career, I do have to say I have grown immensely in the first year of practice. I have taken a plethora of continuing education courses to learn more advanced treatments and evaluations. Being that Monday morning physical therapist, you know, the Monday after your weekend course where you learned some cool new evaluations and treatments, you are eager to apply everything you learned as soon as possible. You get through your subjective and jump straight into the objective portion. A big part of our role is to help our patient’s with their physical ailments. Our eyes and hands tend to be what guides us. Over the past year I learned that the right questions can get you to where you need to be in a more efficient manner.

So what’s the difference between hearing and listening? I came across a quote that sums it up nicely. “Hearing is through the ears, listening is through the mind.” While hearing is one of the basic senses we as humans possess, it is a passive process. You hear someone talking on the phone or to a friend. Listening requires some higher level thought process to interpret what you heard.

Now I’ve been making mention to things that are heard through our ears, however communication occurs even without someone speaking. Body language is a crucial thing to pay attention to as well.

So while we are all eager to improve our physical abilities, it is equally important to hone in our higher level listening skills. It can be a game changer to what happens during your sessions with patients.


Thank you

Stavros Vouyiouklis PT, DPT, CMPT

We Turned One!!!

Ok, that’s not entirely true. Symbio was actually founded in November of 2015 but this past Thursday we celebrated our first year in the beautiful clinic that we call home. This post is really about gratitude. Thank you for supporting us in this first year and for continuing to believe in what we believe.

Symbio was founded with the crazy notion that we exist because of each other and that we get better together. We believe that we are at our best when patient and therapist facilitate the growth of one another. Our goal was to create a community of people nurtured by these meaningful symbiotic relationships. If we had it our way, the whole world would be living this way!

Over the course of the past year, your feedback and love has helped to keep us going and let us know that we were heading in the right direction. Nothing has highlighted how extensive our community has grown into quite like our anniversary party. Past and current patients filled our clinic space and illuminated why we consider you family. We love our jobs and love you guys! Thank you for making Symbio what it is today. We could not have done this without you! Here’s to hoping for many more years of caring relationships, community and growth. Here’s to hoping for many more years of Symbio.

Stress and It’s Effects on Our Bodies

Hi all!

So I had a great long relaxing 4th of July weekend. What it made me realize is that we as New Yorker’s tend to deal with very high stress levels. But did you know that psychological stress can actually have a physical effect on our bodies as well?

Many studies have even shown that psychological stress can have an effect on wound healing and perpetuate the pain cycle in the body. And that is why I feel us as physical therapists, have a duty to also inform our patients on strategies to help manage their stress levels.

Stress releases a hormone by the name of cortisol that is produced by our adrenal glands. Here are some negative effects cortisol can have on our bodies:

– Cortisol causes an increased storage of weight leading to unwanted weight gain

– Cortisol reduces inflammation in the body, but if secreted over prolonged periods of time it actually suppresses our immune systems making it easier to catch a cold or other diseases

– Cortisol causes a release of glucose into our system, which for prolonged periods of time can increase your risk of developing Type II Diabetes

– Chronic fatigue, insomnia, depression, etc can also be caused by increased levels of stress and cortisol


Thankfully, there are measures we ourselves can take to prevent these things from happening!

How many of you wake up in the morning and the first thoughts going through your head are “I have so much work to do today”, “the weather looks horrible outside”, “I’m so tired I just don’t want to do anything today”, etc. I know I am guilty of this probably more often than I would like to be.

It is important to avoid negativity and replace it with positive thinking. If we start our day off with a negative thought it can set the mood for our entire day. What if you were to wake up in the morning and the first thing you would do was think a happy thought. I encourage you ALL to think of 3 things that you are grateful/thankful for before you start your day and see the difference it makes in your day. Also, take the word “can’t” and “if only”out of your vocabulary. You are responsible for your own actions and you can do anything you put your mind to.

Other ways to manage our stress levels and decreased cortisol levels are:

– Exercise

– Meditation, yoga, deep breathing exercises (Dr. Datta wrote an amazing blog that talks about meditating. Check out our previous blog entries to find it)

– Getting a good night’s sleep or taking naps throughout the day

– Follow a good nutritional diet


Now go and try to release some of your stress levels, and don’t be discouraged to talk to a medical professional if any of you need a little extra help in managing your stress!


Veronica Cherne PT, DPT, CMPT

On a Mission!!

Habarigani! (meaning “Hi, how are you” in Kswaheli!)


The weather is getting hotter, and it’s a great time to plan for the summer vacation!  What does your summer plan look like?  Any traveling on the horizon?
This year I spent my vacation in a very special place, doing special things that I wanted to share with everyone here.
I recently had the opportunity to travel to Tanzania for 2 weeks. The purpose of my trip was to serve the underprivileged – to provide medical necessities, to teach English to children, and to share the gospel to local villages.  As excited as I was to leave and provide service, as day of departure was coming closer I began feeling nervous about the trip (especially after hearing a story about a friend who nearly died of Malaria during his recent trip!).
But despite my worries, departure day arrived on June 5th and after 3 months of preparation our team took off for Tanzania!!
How was the trip???  Was it worth it???
To make long story short – it was the most amazing experience I have ever had!!!
 I also learned a lot about life and myself, and wanted to share some memorable moments I experienced in Tanzania:
1) Life without electricity and electronic devices!!
Our team stayed in a very remote village where there was absolutely no electricity, and the western concept of time really didn’t apply here!  When sun goes down, it was time to go to sleep… When sun rose, it was time to wake up! And life without a cellphone and computer – devastating one may think!!  However, this was the best feeling I’ve experienced in a long time!! No texts, no emails, and no crazy political news… I didn’t have to think about future schedules… I was able to enjoy and live in every moment, scene, and genuine conversation – without distractions!
In Tanzania, corn and sweet potatoes were two of their main food resources.  I think I ate more corn and sweet potatoes in past 2 weeks than I ever consumed in my entire 30 years of life!!  And though I do love them both, I think I’ll be fine without either for the next several months!!
3) The bathroom situation!!
Ok, I know, a little personal!!  But regarding the bathroom situation – it took me several days to get used to use their toilet!  Why, you wonder??
Because there were no toilets!!!
So to give you a mental picture – I had to dig a hole, then work to aim accurately while maintaining a squat position until the business was finished!!  Though difficult and uncomfortable in the beginning, I was able to master the techniques like a pro!!
4) The community!!
Lastly, as I mentioned above we went to Tanzania with a clear purpose – to help those who are in need of help. Our medical team encountered hundreds of village people, and some people walked over several hours to see our team. Although I was physically exhausted at the end of each day, emotionally and spiritually I couldn’t be any happier.
To sum up my experience in Tanzania – this year’s vacation trip was the best trip I have ever had!!
Wishing all of you a wonderful summer full of discovery, too!
Joshua Park, PT, DPT

Rolling Into Summer

Hello Symbio universe!

It’s almost summer and that means beach weather, sunshine, and finally being able to get out and get active! While it’s super important to workout in a safe and efficient manner, with an emphasis on good and proper form, did you know rest and what you do to recover are just as important as the exercises you do? Repetitive, overuse injuries stemming from inadequate rest and poor recovery strategies are not just extremely common, they are also a major precursor to recurring chronic injuries in many individuals.

Now, as bad as this might sound, there are several simple steps that can be taken to avoid this from happening in the first place. In addition to proper nutrition and training key muscle groups, regularly using a foam roller can go a long way in terms of maintaining optimal muscular health.
In short, using a foam roller helps to release tight muscles and helps to restore proper muscle activation as well as pain-free range of motion, thereby improving functional movement patterns and overall performance. Not only does this help us recover quicker, we are less prone to developing abnormal compensations that may lead to injury in the future.

In other words, by consistently using a foam roller, you can get back to kicking butt in the gym sooner!
Here are a few simple foam rolling positions to try out on your own. The key to using a foam roller effectively is to pinpoint a sensitive muscle group and allow the body to sink into the foam roller. If you find yourself tensing up, try easing the pressure a bit and gradually ramp up the force as you can tolerate. Sustained pressure or small, gentle oscillation are both appropriate. Avoid big, jerky movements to allow the body to get accustomed to the foam roller.

Hamstrings (The back part of your thigh)
• Start with both legs resting on the foam roller (FR)
• Cross one leg over the other to bias one side
• Slowly shift your weight towards the uncrossed leg


Iliotibial Band (ITB) and Lateral Quadriceps (The side of your thigh)
• Start in a side-lying position on a FR
• Rest your elbow on the ground for support
• Cross the top leg over the other and plant it firmly on the ground


Piriformis (Near the Glutes)

• Start by sitting on a FR with both knees bent and feet flat on the floor
• Cross one leg over the other
• Rotate towards the bent leg
• Gently shift weight to the same side


Adductors (Groin/Inside of your thigh)

• Start with one leg perpendicular to a FR
• Rest elbows on the ground for support
• Gently rotate the body away from the bent leg


Quadriceps (Front part of your thigh)
• Start by laying both legs on a FR
• Cross one leg over the other to bias that side
• Gently shift weight towards that side


There you have it folks! Just a few easy positions to try. I hope you enjoy the burn as much as I do!

Have a great week everyone!


Michael Oakes, PT, DPT, CMPT

Thirsty For Exercise

The warmer temps have FINALLY appeared!!!  After what has felt like endless grey skies, rain, and chilly/I can’t believe I am wearing a jacket in May and June weather consuming our days, we are at last seeing the sunshine and feeling the warmth!!

And we can FINALLY be outside… getting our runs and our exercising in outdoors!


But with this surge of excitement, when talking about exercising in these warmer summer months, we must discuss a very important factor – hydration.

We have all heard the advice over the years… be sure to drink your eight glasses of water per day.  However, as is the case with much in life, there is never one cookbook/one-size-fits-all recipe for what each individual body needs.  Especially the body of an athlete.

Water is an extremely important nutrient, and makes up approximately 50-60% of an individual’s body weight.  It is not only essential to maintain overall life, fluid intake is an important part of training and athletic performance.  The benefits of adequate fluid and electrolyte intake before, during, and after exercise are enormous and include lower heart rate, improved blood flow and circulation to muscles and organs, improved body temperature control, prevention of low sodium levels (hyponatremia) thus reducing muscle cramping and fatigue, and overall lower levels of perceived exertion.

So how much should you be drinking to take full advantage of these benefits??  Research has shown that most recreational athletes actually require approximately 11-15 cups of water (8oz each) with added electrolytes daily, however factors such as climate, muscle mass of the individual, type of physical activity being performed, and diet make that total required intake vary from person to person.  Further research conducted on athletes participating in various sports including running, cycling, walking, and playing group sports and fitness classes such as basketball and aerobics contested that in hot weather when an athlete loses as little as 2% of his/her fluids through sweat, overall athletic performance may decline by as much as 10%!!

That’s a serious percentage, and a huge disadvantage to performance!

When exercise is involved, proper hydration is achieved by consuming fluids and electrolytes at regular intervals.  Remember, distractions may prevent you from recognizing thirst… but if you feel thirsty, you may already be dehydrated.  Several sports studies have shown that it is wise to consume approximately 16oz of water/electrolytes about 2 hours before activity, then another 8-16oz about 15 minutes before exercise… then anywhere between 4-16oz of water/electrolytes every 20 minutes depending on tolerance and climate (heat/humidity)… and finally another 16-24oz per pound of body weight post exercise to re-gain all fluids lost.  Researchers also recommend consuming sodium chloride (salty foods such as pretzels or from sports drinks) following exercise in extreme heat and humidity to speed up the rehydration process.

Dehydration occurs when your body loses more fluids than you have consumed.  Symptoms can include dizziness/lightheadedness, nausea, vomiting, dry mouth/lips, increased heart rate, muscle cramping, lack of sweating, and extreme thirst… and if it gets to the point of severity one may experience mental confusion, weakness, and loss of consciousness.

Not fun!!

I know, I know… but all of those fluids!?!?  How is my bladder going to handle all of that?!?  I’m going to be running for the restroom all day!

Possibly a little more than usual… but an inconvenience and annoyance I would rather experience than to have any organs including my kidney suffer, or possibly fail… or experience extreme lethargy and lack of muscle energy… or muscle cramping… or terrible athletic performance… all due to lack of hydration.

You get the picture!

Take home message… your body needs fluids/electrolytes to function optimally.  Be sure to replace all you lost when sweating… your overall performance and well-being depends on it!

Jacqueline Mendelsohn, DPT, CLT

A Vegan’s Life For Me???

Can I please start this by saying that I am not vegan.  On the contrary, I am usually the guy in the office who makes good-natured jokes with our vegan team members about things like their malnourished bodies and difficult childhoods leading them to a life of deprivation and starvation.  It’s all good fun…

For me, my most consistent dietary choices are either Paleo diet or Bulletproof diet, both relying quite heavily on animal proteins and, in the latter case, fats.

And while it might start a heated debate, I still believe those to be extremely healthy choices as ways of eating.  I truly believe that a diet based on grass-fed beef, wild caught seafood, farm fresh free-range eggs, and responsibly grown pork and poultry is the way our ancestors thrived.  We are predisposed to being able to achieve maximum health on a diet of the proteins and fats listed above along with a nice mix of veggies, fruits, and nuts.

The only problem: we can’t sustain that diet.  It’s impossible.

No, not because of willpower, but because it is logistically impossible for all of us to have a healthy diet consisting of grass-fed beef.  There isn’t enough grass in the world to support the livestock it would require for us all to eat that way.  We are literally out of space to grow.  Instead the cows we eat are mostly fed poorly farmed grains and soy, a diet that cows were not built to eat, which is making them massively unhealthy.  When humans eat massively unhealthy animals, humans then become massively unhealthy too.  If you don’t agree, read the news on the declining health of our country.  It isn’t a mystery.

Let me back up.  Let me remind you that I am NOT vegan, nor am I a damn hippie.  That being said, a dear friend of mine loaned me his copy of a horrible and nasty book called THRIVE Foods by Brendan Brazier.  I hate this book and I’m still pretty sore with my friend who put it in my hand.

Why the anger, you ask?  This book got into my head in a big way.  In a few short chapters, I learned a lot about our food supply and how it works.  I learned about the unbelievable environmental damage done by raising livestock for food.  I learned about the tremendous natural resources required to raise a cow for slaughter.  I learned how the over farming of land, in an effort to feed and fatten that livestock, is resulting in a substandard product and therefore a substandard animal for consumption.  I learned how our inadequate food system leaves my body in a state of stress and desperation, which is affecting my sleep quality and alarming need for more coffee that I care to admit to needing.  I learned how this way of life is just unsustainable.

Crap…  I really like a nice juicy ribeye.  I love butter so much I am one step short of rubbing it on my body after a morning shower.  I have always been a heavy carnivore and wore the badge proudly.


But this damn book starting making some sense.  I starting asking some questions.  Here they are:

-What would happen if I went vegan for a full month?

-How would eating vegan for a month affect me as an athlete and my performance?

-How would my symptoms of chronic fatigue (poor sleep, always tired, weight gain despite exercise, intense sugar cravings, depression…) change if I did this stupid thing for a month?

-Would this finally be the diet that helped me lose the muffin top and man-boobs?

-If after a month, would I chase live animals down the street with teeth gnashing and mania in my eyes?

-And lastly, if after a month of going vegan, what would be the change I would have made for the environment?

Get this: Brazier give some scientific evidence to show that the most impactful and meaningful thing we can do for our planet as a people and as a country is not to switch to hybrid cars and efficient light bulbs.  It’s not even to stop driving completely.  You guessed it…  Switching to a plant based diet would have a stronger positive impact on carbon emissions and global warming than all the recycling and good choices you have ever made.

Another side note: I am a scientist and have a degree that says I’m really good at asking questions.  Imagine how annoyed I was when this irritating book cited incredibly strong evidence citing the statements above.  I am great at arguing opinion and philosophy, but when there is strong evidence brought forth from the scientific community, I bow my head and listen.

I have done such with the information I have learned.

And while I don’t know that I like it, I can’t unlearn what I learned from this book.  It is because of that I have decided to go vegan for the month of June 2017.  Being a scientist, healthcare practitioner, and researcher myself, I have to find answers to my questions.

What will happen at the end of the month?  I haven’t the foggiest.  I might love it, I might hate it, I might decide to continue regardless, or I might just throw caution to the wind and sprint to the nearest NYC steakhouse.  I really don’t know.

What I know is that I have to try.  I have to see how I do.  I have to answer these questions.

I promise to write another entry by month’s end to let you know the results.  But right now I wonder, would anyone do this with me?  Are you stupid enough?

I’ve ordered another one of his books that gives a 12 week food plan, Thrive: The Vegan Nutrition Guide to Optimal Performance in Sports and Life, which is something I know I’ll need to keep me out of the rut of eating weird fake meat things in the frozen aisle and a side of cardboard with a glaze of spicy mustard.

This is going to suck…  Who’s with me?

Residency – Where My Journey Has Begun

Hey everyone out there in internet land. My name is Stavros Vouyiouklis, and I am one of the Resident Physiotherapist at Symbio Physiotherapy. I have been a practicing clinician for a total of 6 … months. Yup that’s it. I have worked within PT practices for over 10 years prior to getting into PT school as an aide. I learned to have an appreciation for what it takes to make a clinic run optimally, and work with individuals on an individual basis.

The road to get to where I am after PT school has been long, daunting, and far more rewarding than I could have ever possibly imagined. Years of studying, examinations, practicals and finally passing my boards was all I needed to prepare myself for the real world. Or was it?

I began my position at Symbio in January of 2017. The program at Touro College prepared me better than I could have possibly imagined alongside all of the continuing education that I have done both during and after PT school.

So what happens at the residency program at Symbio?


Wait What!?

That’s right. Learning.

School prepares you and gives you the cold hard facts, yes. However, because Physios deal with individuals and their individual health needs, things aren’t always textbook. THIS is what makes the residency experience worthwhile. Having a mentor who you have time with and excellent communication with to discuss those patients who may have you stumped, or are just not getting better as quickly as you would have hoped. Furthermore, having a skilled and experienced set of eyes sitting in on your evaluations and treatments while getting critical feedback following these sessions is invaluable. Watching the very same skilled clinician tap dance his way through an evaluation and treatment is like watching a symphony orchestra play a masterpiece. It’s all of the components coming together to provide one uniform art piece that you truly have to get a firsthand experience to appreciate.

Now, I chose to apply to this residency program and was fortunate enough to be one of the physios selected. I think that I have learned more in these last 6 months than if I was just set free to figure things out on my own. I feel that anyone who truly wants to excel at any field they are in should seek out a mentor and residency program to get the most out of their first year fresh out of school. It’s not easy. It is a lot of work. Lots of one-on-one meetings, skill development labs, continuing education courses, personal growth, and monthly readings. But hey, you don’t work this hard to just cruise through life right? You keep on pushing. I keep on pushing. That’s how I got here in the first place.

To Move or Not To Move

“Movement is Medicine”. This is an expression we often hear but don’t always adhere to. It is almost instinctual for us whenever we suffer an injury to go into protect mode and stop moving. Ever have an episode of low back pain and decide a day or two of bed rest would fix all? Or avoid moving your arm after injuring your shoulder? What is the best approach after an injury? Should you continue to move and groove or allow yourself a couple days of R+R? Unfortunately the answer isn’t quite so cut and dry and the best answer is always to see a medical professional. But in the meantime, there are some guidelines that can be helpful for those who are injured.

An acute injury is a sudden injury that occurs during activity or as a result of a traumatic incident. Immediately following the injury, inflammation occurs and causes pain, swelling and redness. This is the body’s natural response to help protect and heal the body. A helpful acronym we use to treat these injuries is PRICE (Protect, Rest, Ice, Compression and Elevation). At this stage of an injury it makes sense to avoid moving the injured area. An injury is no longer acute once this inflammatory response has subsided and the body starts laying down new tissue to replace the damaged ones. At this point, the redness, swelling and heat have greatly subsided and we can now categorize the injury as “sub acute”. Once an injury reaches this stage, movement becomes key for healing. In fact, prolonged disuse or bed rest can lead to things like excessive scar tissue formation and contractures. Activities like regular stretching, gentle range of motion exercises and avoiding prolonged positions help to safely restore pain free movement.

Sometimes knowing what stage of healing an injury is in can clue in how therapeutic movement will be. Even in the acute stage of injury, prolonged bed rest can be detrimental by slowing healing. Instead small gentle movements have been found to be effective in “pumping out” inflammation. Thus, we see that even in the most severe of injuries that some sort of movement can be effective in promoting healing. Movement is indeed medicine!

Karan Datta, PT, DPT

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