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May 1st, 2013

by Total Food Service

Physical Therapy for Metro New York’s Chef’s Aches & Pains


When you think of physical activity, the life of a Chef may not come right to mind, but in actuality a Chef’s life requires standing all day long, with very little time to rest your muscles.


This means it’s easy to injure yourself in the kitchen. Physical therapist Karena Wu specializes in treating Chefs. From Wylie Dufresne to (WD-50 & Top Chef, Iron Chef) to Seamus Mullen (Tertulia & Chopped judge) Karena has treated Chefs for conditions like arthritis and general wear and tear from the life of a Chef.

Chef Dufresne sums it up great; "Working in a kitchen for twenty years takes the same toll on your body as being a stuntman.” Point being any sort of respective physical activity is going to do some wear and tear. “We are lifting lots with our hands, I would bet there's some kind of common problems between almost all Chefs. Lots of bad posture, bending over. I think lifting heavy things takes a toll. We don't have a good history of taking care of ourselves when we aren't working,” noted Dufresne.

When I met Karena Wu, I couldn't even shake her hand my arms hurt so badly. Knee problems, back problems, shoulder problems. This would be the kind of thing (physical therapy) virtually any cook would benefit from." Seamus Mullen states, "I think the biggest problem I have in working in a kitchen is that I stand in the same position for a long time and then go right home and go to sleep in the same position all night.

Standing on one position for 8 hours non-stop over time creates natural compression. Then to go right home and go to sleep, I wake up stiff because I'm in the same position again." "Hardest thing for me working in a kitchen is that you bend over so much.  Last week I had an event that wrecked me for a couple days where I couldn't even bend over at all.” Total Food Service sat down with WD-50’s Wylie Dufresen, Tertulia’s Seamus Mullen, and their Physical Therapist Karena Wu to discuss how Karena has helped both Wylie and Seamus and what chefs and restaurant professionals can do to stay fit and prevent injury.

Karena Wu Questions


What are the most common injuries that you see with chefs?
Neck and low back pain from chronic posturing and standing all day; Tennis elbow from repetitive stress of whisking, mixing, holding pans/sauté; Shoulder pain from lifting heavy items, OH reaching; Hip/Knee/Ankle pains from slips, missteps, prolonged standing, deep squats and sports play (if they participate).

Diagnoses
Cervicalgia, Lumbago, Herniated Discs; Lateral Epicondylitis, Wrist sprains; Shoulder Rotator Cuff Tears/Tendinitis, Labral Tears; Hip Labral Tears, Knee Meniscal/ACL/Ligament Tears, Patellofemoral Pain Syndrome, Chondromalacia Patella, Ankle Sprains, Plantar Fascitis

A chef's day can be very stressful. Do you have suggestions for how a chef can stretch or strengthen their core to prevent injuries?
Daily dynamic stretching when on the job to bring blood flow to the tissues/joints, move the muscle tissue. I know they really can’t do much when standing at their station, but when they hit the head and it’s more private, they can do a couple leg stretches. At their station, they can do neck and shoulder stretches (during prep) and hip and ankle active range of motion movements. Continuous postural correction, engaging abdominals to support lumbar spine, utilizing correct body mechanics and THINKING before they just act/react.

You specialize in Joint mobilization, what exactly does that mean?
It is the application of the hands on the bones to produce a passive movement in the joint. Its benefits are that it moves the bone ends passively which allows for segmental mobility and helps loosen the surrounding soft tissue without direct application onto those soft tissues. Having each joint move independently of each other (which is normally how the body should move) is important in avoiding tightness and stiffness and potential injuries. It is correction of the joint dysfunction (very common in complaints of pain and tightness) so that it as well as the overlying tissues can withstand stresses better and be used more appropriately.

What is the cause of those injuries for a chef and how can they be avoided?
Prolonged positioning and lifting/carrying heavy loads or being put in awkward positions with/without additional load. They can avoid injuries by learning about their proprioception (awareness of the body in space) with postural awareness and knowledge of long-term damage if they think they are invincible. They must think before they move or perform a task.

You offer a couple of different types of Taping. How did those evolve and how can they help the chef?
Became Certified Kinesio Tape Practitioner in 2005 because of my interest in the product and the application and its benefits. The longer I’ve worked, the more I’ve seen patient’s abilities and patient’s limitations-both physically and psychologically. We use this as an adjunct when in an acute phase (significant pain or sudden injury) or if they need additional assistance for chronic issues or poor compliance with HEP and avoidance of aggravating activities. It is an adjunct, not something that corrects the underlying dysfunction.

What is Myofascial release and how does that impact the chef?
It is a type of soft tissue mobilization that affects the fascial (connective tissue with a 3D matrix with no orientation) more than the muscle tissue. Like a massage without lotion. Anyone can get and pay for a cheap massage. Feels good temporarily but if you don’t correct underlying joint restrictions or fascial restrictions, stiffness/tightness/pain will come back guaranteed. This affects superficial AND deep tissues. Like an over microwaved plate of food with saran wrap. When overdone, it binds down on the underlying structures, which restricts blood flow, circulation and movement. Release it and there is movement and flow, which allows for better muscle activation and range of motion.

Talk about what a chef can expect to find at your facility in Midtown?
Intimate care from start to finish. One-on-one hands on application and individualized manual therapy and exercise prescription for home exercise program (HEP), especially taking into account the occupational demands. Exercises in-house are on Pilates equipment and all treatment and exercise have a more holistic emphasis.

Do you take the place of a chiropractor?
No. Chiropractors are healthcare professionals with an emphasis on spinal alignment. They can do joint manipulations on the spine as well as extremities, although in NYS, they are supposed to be limited to the spine. They also do high velocity low amplitude (HVLA) thrust manipulations (the ‘crack’) versus lower grade mobilizations.

PT’s do high grade as well as low grade joint mobilizations. Benefit here is that if someone is acutely painful or extremely stiff, the HVLA might be too traumatic to the joint so a lower grade would be easier for a patient to handle.
PT’s also focus on exercises as well as the hands on joint and soft tissue mobilization. We treat all joints/body parts without the legal restrictions. We also emphasize specific activities for return to higher level function as well as sports-specific agility drills/plyometric exercises/balance and proprioceptive activities.

In your years of working with chefs, do they eat properly and if they don't can you help them build a nutrition program to help them get the most out of their day?
Yes and no. It really depends on the individual. If they are constantly trying food and dishes that are full fat and heavier in nature and don’t exercise on top of that, then they’re probably not getting the proper nutrition. We are not nutritionists. We can refer them to one and we can guide them in the common sense knowledge of eating healthy and in moderation and to research it online themselves. Our take is that we have to look at the work, psychosocial demands, fixed ideas as well as the patient’s own knowledge base about nutrition and habits and overall health and see what the best method of instruction would be for them.

What's the first step for a chef that would like to find out more?
They can go to our website: www.bestptnyc.com, email us at staff@bestptnyc.com, or just call us at 212.777.4374.

Wylie Dufrense Questions


How did you find out about Karena Wu and the Activecare Team and why?
Karena came in for dinner and noticed I was wearing a brace on my arm. And she said, “You need help!”  She started working on me right then and there and I said, “I’m in!”
 
What type of therapy or PT do you go through and how has it helped you?
In the 8 years I’ve seen Karena, she has treated me for tennis elbow, golf elbow, 2 torn hamstrings and 2 torn biceps, lower back problems, shoulder surgery, neck stiffness, knee pain, Plantar Fasciitis … and whatever else I’m forgetting or have yet to suffer from.  My PT included a laundry list of exercises, which have enabled me to keep working the line after 21 years of cooking professionally. 
 
What are some fitness and wellness tips you’ve learned through Karena Wu that you can share with chefs and foodservice professionals to prevent injuries?
I’ve learned a lot! But probably the most valuable thing she’s taught me that I can do myself is the power and value of stretching. I would say staying limber and fluid at my age is more important than working out with weights.
 
Do you perform any exercises or stretches before, during, or after work hours to prevent injury?
I try to, yes!

In your opinion, what is the most physical part of your job that does the most damage to your body?
The life of a cook is a long, slow grind.  It is hard over the long haul and it taxes the entire body, from head to toe. So I think if you are in it for the long term, it is about maintenance.  I’d say chefs and cooks are prone to stiffness, tightness, and generally taking very poor care of themselves. But the stretching, the foam rolling, using a heating pad before work and icing down after work… All these things I wish I’d been educated about and known much sooner.  I wish these methods and exercises could have been more voluntary than mandatory. I’d be better off!

Seamus Mullen Questions


How did you find out about Karena Wu and Activecare Team and why?
I met Karena through my friend Wylie Dufresne, he knew that I had gone through a lot of back pain, in fact I was scheduled to go to Japan on a trip with Wylie, but I ended up having spinal surgery and wasn't able to go. I think that's when he suggested I contact Karena.
 
What type of therapy or PT do you go through and how has it helped you?
I do mostly core stabilization exercises and mobility work. It has helped me from feeling too locked up during service, made it easier on my back to stand long hours.
 
What are some fitness and wellness tips you’ve learned through Karena Wu that you can share with chefs and foodservice professionals to prevent injuries?
Mobility! As chefs we stand a lot and most of us aren't standing properly so we end up hunching our back, our pelvis and hip flexors get really crunched up and that in turn causes a lot of low back pain and leg pain. Karena also encouraged me to get a good kitchen mat for the area I work in. Standing on a concrete floor all day is really tough on the body. Karena has also helped me understand that because I have rheumatoid arthritis, I have systemic swelling throughout my whole body. Movement helps me deal with that swelling, as does mobility work.


 
Do you perform any exercises or stretches before, during, or after work hours to prevent injury?
On more than one occasion, Karena has stopped by the restaurant during service and helped me stretch or gain some mobility if I happen to be feeling particularly bad. I don't know ANY PT practitioner that would do that! I stretch every morning and every night and during service I do standing pelvic tilts and sometimes I'll do some body weight squats if I'm feeling particularly crummy.
 
In your opinion, what most physical part of your job does the most damage to your body?
I think the fact that we are standing all day is the most challenging part of the job. It takes a toll on every part of the body, from joints to muscles, there's no way around it. The better our posture and looser our muscles, the easier it is to get through a long day. I don't know many chefs that DON'T have back problems. Most of us work like dogs in our 20s and 30s and don't really think about the long-term importance of strengthening our core and developing flexibility and then in our mid 30s we all develop back problems. I try to tell the younger guys to take care of themselves and work on flexibility and strength; otherwise all those long hours will catch up with them inevitably.

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