Avoid Travel Stiffness with Easy Stretches and Movements

These tips and easy stretches will get your blood circulating and keep your muscles from stiffening up on long rides, so you can arrive at your destination ready to move.

First Things First: Stay Hydrated

While you may tend to try avoiding trips to the restroom while traveling, it is actually very important to stay hydrated and avoid potentially harmful fluid retention during long periods of inactivity. Drinking water before a trip oxygenates your muscles and helps keep all your systems working properly.

Bottled Water: A Traveler's Friend

Next: Walk Whenever You Can

If you’re able, be sure to take breaks from the seated position. Whether you need the restroom or not, use every opportunity to get up and move.


Try These Movements and Stretches

Upper body circles to stretch during a long trip by car or plane.

Start with your hands on your knees and your feet shoulder width apart. Keeping your head in a fixed position, circle your ribcage slowly as if you’re using your upper body to clean out a giant jar of peanut butter. Circle to the left 5 times, and then to the right 5 times.

Crunch twist exercise for car or airplane seat.

Start by pulling your abdominal muscles in toward your spine. Keep your feet flat on the floor, shoulder width apart. With your hands behind your head, slowly bring one elbow together with the opposite knee, lifting your foot off the floor. Exhale as you twist down. Inhale and sit tall. Switch to the other elbow/knee. Complete 8-10 twists on each side.

Seated calf raise exercise for travelers.

Start with your feet flat on the floor, then raise your heels up until your toes are pointed. Repeat 8-10 times, with both feet together or alternating left/right.

Hip adduction knee squeeze exercise.

Place your fist between your knees, gently engage your pelvic floor muscles (like stopping the flow of urine) and then squeeze your legs together, pressing against your fist. Hold for 5-10 seconds, then release completely. Repeat 8-10 times.

Hip abduction knee push-out exercise.

Tuck in your abdominal muscles, lean forward to wrap your arms under your legs, and clasp your hands together. Hold this pose as you push your knees outward, pressing into your arms. Hold for 5-10 seconds, then release completely. Repeat 8-10 times.

Seated Neck Stretch

Shrug and release your shoulders. With your chest up and shoulders level, hang your head to one side so your ear is toward your shoulder. Relax there for 2-3 breaths. Gently straighten up, slowly shrug and release both shoulders, and then switch sides. Alternate and repeat 4-6 times.

Ankle Circle Travel Stretch

Roll your shoulders back and pull one knee up toward your chest and hold. Rotate your foot, drawing 5-6 circles with your toes in each direction (start small, and go wider, staying fluid with the movement). Gently switch position and repeat with the other ankle.

Ankle Pump Travel Stretch

After circling your foot in both directions, and with your leg extended, point and flex your foot as though you’re pumping a pedal. Repeat 8-10 times with each leg.

Arm Shakeout for Travelers

Relax your arms, breathe deeply and, starting on one side, gently shake out all the joints of the hand for 4-6 seconds. Work your way to gently shaking out your (relaxed) elbow, using your shoulder to mobilize that joint for 4-6 seconds. If that’s working well, try using the movement of your whole rib cage to shake out your (relaxed) shoulder joint.

Glute stretch for airplane or car seat.

Roll your shoulders back, sit up straight, and draw one knee toward your chest. With your opposite hand positioned on the outside of your knee, pull your knee toward your opposite shoulder. You should feel a stretch in your gluteus muscle.


Stretch for Piriformis Muscle

Cross one leg over the other so that the outside of your foot is resting on your other knee. Push down on the knee of the leg that is crossed over until you feel a good stretch in your hips and glutes. Hold for 8-10 seconds, leaning forward very gradually from the waist, and then switch sides.


You Might Also Be Interested…

The Secret to Effective Stretching

Piriformis Syndrome: That Pain in the Butt

Dynamic Stretching



A Reflection on Health

by Billy Cioffredi, PT

“John, how are your classes going this semester?”William J. Cioffredi, PT - Founder

“Hey Dad,” my son answered, “Most are really interesting. This one required class in health education seemed like a dud, but then something really piqued my interest. The professor asked our class, ‘What do you feel are the top 2-3 problems in the country?’ and my classmates answered with obesity, racial injustice, sexual assault, the opioid crisis, and the like. I said community building.”

My son’s response really struck me; but why? It took me a moment to process the concept.

“John, I think you hit on something that is really important.”

There are many challenges in today’s world. I sometimes feel like there are so many different issues and special interest groups that there can’t possibly be enough time, energy, or resources for us to adequately address them all. Community building is just one thing, but it touches all the others—and it turns out that it’s also connected to our overall health.

In order to build community you have to build relationships. To build relationships you have to communicate and understand your neighbor’s point of view. While we have commonalities within our group, we are each different. We have different histories and we have our own unique perspectives on the world, and so we need to have tolerance for another’s viewpoint if we are going to develop relationships.

Each of us belongs to a variety of groups—communities with a common interest—like our family, our local Image depicting a positive relationship.church, our exercise buddies, or the town we live in. Each of these “belongings” provides a common sense of purpose, as well as a responsibility to provide help or support, such as by supporting others physically or emotionally, helping animals, or caring for the environment. One of my communities is our company, Cioffredi & Associates, and through it I have the privilege to help not only our clients, but also my colleagues, as well as people from other organizations that refer clients to us. The relationships I build and the support I provide in this community bring me a tremendous sense of purpose.

It should be no surprise that research is now indicating that our happiness is related to having strong, rich relationships, and having purpose. This, in turn, is reflected in better physical health.

Now imagine if each of us could be active and constructive participants in all of our groups (small or large), sharing a common sense of purpose and tending to avoid destructive intentions. And what if we considered ourselves part of the community of humankind? Maybe acting on this one thing, building community, would resolve so many of our challenges.

What groups do you belong to?


Getting Out of Our Own Way
Pain and Resilience: What I’ve Learned
Achieving Work-Life Balance
Happy, Healthy New Year
Dawn of a New Era

A Guide for Parents and Students

Practical Advice to Prevent Injury

BACKPACK “WORST CASE SCENARIO”improperly worn backpack

According to doctors and physical therapists, backpacks that are overloaded or worn improperly can, over time, cause painful misalignment and harmful compression of the spine. Excessive weight (defined as more than 10-15% of body weight) and unevenly distributed loads can prevent disks from working properly as ‘shock absorbers’ for vertebrae, and can result in shoulder, neck, and back pain. Studies have also confirmed that heavy backpacks can actually alter the shape of a young person’s spine.

Research published in the journals Spine and Science Daily confirm that repeated use of heavy backpacks may result in disc compression, lower back asymmetry or curvature, and injury to the soft tissues of the shoulder that can lead to nerve damage. The harm caused to nerves may range from simple irritation to impeding movement of hands and dexterity of fingers.

SIGNS OF TROUBLEchildren boarding school bus with backpacks

  • struggling to get the backpack on or off
  • increased forward head posture, rounded shoulders
  • strained muscles and pain in the shoulder, neck, and lower back
  • numbness or tingling caused by straps
  • headaches


Large, overloaded backpacks create safety hazards in tight spaces (like school buses), where children’s movement and balance are impeded, and they can cause tripping hazards both on and off students. Smaller, lighter backpacks are better all-around choices for school kids.Properly worn backpacks with both shoulder straps


A backpack should be worn with both shoulder straps to distribute weight evenly, and it should fit close to the body, resting in the middle of the back (not sagging toward buttocks). It’s best to place heavy items closer to the body or at the bottom of the bag, rather than in outside pockets.

Rule of Thumb for Maximum Loads

Student Weight (lbs.) 40 60 80 100 120 140
Max Load (lbs.) 4-6 6-9 8-12 10-15 12-18 14-21



  • Encourage kids to use their cubby, desk, or locker for items that don’t need to go home—including textbooks that are not needed for homework.
  • Create a weekly routine for sorting through backpacks and eliminating excess cargo.


Boy wearing backpack correctly

Choose a backpack that meets these criteria:

  • lightweight
  • two wide, padded shoulder straps
  • a padded back, and hip/chest belt (for larger packs)
  • multiple compartments to distribute weight.
  • reflective material for added visibility

Keep in mind that a smaller pack will be less likely to collect extra “stuff” that adds to the burden, and that while wheeled bags are great for airports, they are generally heavier, and can often be difficult to use on stairs and in buses.

Rucking? Not for kids!

heavy military backpackSoldiers must often march (or even run) while carrying packs weighing from 40 to 90 pounds or more, which can mean loads of as much as 25-50% of their body weight. That’s extreme, and soldiers commonly suffer injuries to shoulders, neck, and back as a result.


ABCs of Smart Backpack Use (APTA)
Backpack Safety (National Safety Council)

Other Cioffredi Resources

Pediatric Physical Therapy
Pediatric PT Success Story: Sofia Tomek

JOIN US: Carrying Sports Through Life

Community Speaker Series Event – Wednesday, November 1, 2017


112 Etna Road, Lebanon, NH

Cioffredi & Associates


Join us for our FREE Fall Speaker Series event, co-presented by Dr. Daniel J. O’Rourke, MD, MS, M.Ed (Chief of Cardiology at the VA Medical Center, and Hanover HS Girls Varsity Basketball Coach) and Billy Cioffredi, PT (Founder of Cioffredi & Associates). The entire community—parents, coaches, sports fans, and youth athletes alike—is invited to join the conversation about Coaching for Life Lessons and Ethics and Safety in Sports. Light refreshments will be served.

Carrying Sports Through Life

Mind Over Matter

Placebo, Confidence, and Certainty: Are They Related?

William J. Cioffredi, PT - FounderMike Pauletich believed he had undergone surgery to alleviate Parkinson’s symptoms during a trial at Stanford University in 2011. Parkinson’s disease is a difficult degenerative disease that has no cure, where current treatments simply try to retard the progression of the disease. The Stanford study involved both an actual and a “placebo” surgery in which a drug was or was not administered, and Mr. Pauletich not only had a good result from the study procedure, his outcomes far surpassed expectations. Many of the chronic effects he had experienced were actually reversed, such that you could hardly tell he had the disease at all. When the results came in at the conclusion of the research trial, those who received the actual treatment, on a whole, didn’t improve any better than the control group who had received a sham surgery. A researcher looking at the data afterwards noticed something remarkable: Mike had received the sham surgery!

“Mind over Matter,” a recent National Geographic article, caught my eye… (Healing Power of Faith, December 2016) You can read it at Cioffredi.com/NatGeoPlacebo

Numerous studies have revealed and supported this “placebo effect.” A significant portion of people improve when they receive an intervention (some form of care) that should have no physiological effect on them—a placebo. On a fairly consistent basis, if we think we’re going to improve, we do. Healing happens through an idea, a thought.

Bill treats a PT client for headaches.The power of “positive thinking” is a generally accepted concept as an influence on one’s performance. Our ability or competence in something is, to a large degree, based on an idea, a thought. We call it confidence. Conversely, anxious thoughts, or the idea that we don’t know what will happen to us (or whether we’ll have the ability to handle what might happen to us) stresses our system and causes physical responses that can harm our health. Prolonged stress (anxiety) results in elevated levels of cortisol and causes the body to break down. Think high blood pressure, ulcers, cancer.

So, if our thoughts can cause our bodies to be ill, can our thoughts cause our bodies to be well? Thinking positive thoughts doesn’t seem to be enough, but where do we start? Perhaps we start with confidence. I’m not talking about cockiness, arrogance, or false pride. Confidence is not a “yes I have it” or “no I don’t.” Rather it’s a spectrum: “I hope I can…, I believe I can…, I know I can…, I will…” (Maybe Mike Pauletich “knew” something that others didn’t?)

Intention is a direction of force. It’s just a thought, an idea—but it may have tremendous power. What if we each had a continuous strategy to develop our own self-confidence? What if we interacted with our friends, family, colleagues, clients, community in a way that enhanced their confidence? And what if we avoided interacting in ways that would cause them self doubt, like invalidating their beliefs or viewpoint? Hey, it’s just a thought.

If you want to learn more about building one’s confidence, consider coming to listen to Dan O’Rourke, M.D. at our Speaker Series on November 1.

Billy Cioffredi, PT


Pain and Resilience: What I’ve Learned
Getting Out of Our Own Way
Happy, Healthy New Year
Humanities and Health


Iliotibial Band (ITB) SyndromeIliotibial Band (ITB) Diagram

Pain and Tightness Along the Thigh

Having pain and tightness along the side of the thigh is quite common, especially for athletes. When the pain encompasses the lower half of the thigh towards the outside area of the knee, it often carries the diagnosis of Iliotibial Band (ITB) Syndrome. For many people it can be persistent or unresponsive to typical treatment. The IT band is a stiff layer of tissue that blends from a broad attachment of muscles from the side and back of the hip. The band becomes narrower as it descends toward the knee where its attachment broadly blends with tissues about the knee cap and into the tibia bone.

Stretch for Tensor Fascia Lata Muscle

Standing stretch for TFL and ITB.

The condition is frequently described as the ITB being ‘tight,’ and typical treatment often includes attempts at ‘stretching’ the ITB.  But when you look at the tissue of the band and how it attaches, it becomes difficult to understand how the band itself could get ‘tight’ in the first place. The tissue is relatively rigid and doesn’t have the quality to length or shorten. Then what could possibly have an effect to cause the band to functionally shorten or cause the pain?

Three Overlooked Components

In these cases, I see three major components that sometimes get overlooked. First, what does have the tendency to tighten up are the muscles that the band directly attaches to; a relatively small muscle coming off of the front and side of the hip called the tensor fascia lata (TFL), and the large gluteus maximus (the outer part of the major muscle of the buttock). These muscles can be stretched effectively with the following technique, among others. First, standing with the right leg crossed behind the left, then side-bending the trunk to the left (this stretches the TFL of the right leg and ITB). Also, lying on your back and pulling your right knee towards your chest would stretch the Gluteus Maximus. In my experience, however, these stretches are often not successful by themselves.

Stretch for Gluteal Muscles

Stretch for gluteus maximus.

A second influencing factor for ITB Syndrome are muscles that attach to the pelvis, spine, and thigh that have shortened. The iliopsoas, gluteus minimus, and deep hip rotators such as the piriformis, once shortened, cause the thigh bone to be rotated on the pelvis. Some signs that this condition may exist may be seen in the following: When standing erect, does one foot’s arch appear noticeably flat compared to the other? When lying flat on your back with legs relaxed, does one leg appear turned out noticeably more than the other? While these situations are not the only reason that may cause an arch to be flat or a leg to be turned out, it is a hallmark of a muscle imbalance that I see regularly in clients who have ITB pain. This condition is quite amenable to targeted stretching. It could include stretching the hip flexors (iliopsoas) as seen in a forward lunge stretch or similar modification, and a deep hip rotator stretch or the “pigeon pose” stretch. (See photos.)

Forward Lunge and Pigeon Pose

Forward Lunge and Pigeon Pose

Finally, there is a large and significant muscle that runs immediately underneath the IT band, the vastus lateralis. It is the outside muscle of the four quadricep muscles in the front of the thigh. This muscle can get irritated and develop trigger points. A trigger point (TP), is a small band of hypersensitive muscle fibers that, when pressed, can give rise to pain in characteristic patterns, in this case along the ITB, and can involve the outside of the knee. This component can be treated effectively with deep tissue mobilization.

Iliopsoas Muscle Group Diagram

Deep Tissue Rolling

Some people perform their own deep tissue mobilization by rolling the side of their thigh with a foam roller or ‘stick.’ (See photos.) For some, this can be quite effective, but I don’t believe it is ‘rolling out the ITB’ that is being effective; it is the muscle underneath. And sometimes deep tissue rolling and massage are not fully effective and the TP requires deactivation with dry needling.

Check out our VIDEO: Foam Rolling Techniques for Runners

Trigger Point Dry Needling

Dry needling is a technique used by certified clinicians that uses a very thin, solid filament needle that is placed directly into the TP within the muscle. They are the same needles used in acupuncture, though this is only for the purpose of deactivating the TP. (See photo.) Again, the IT band itself does not have the ability to contract or lengthen to any substantial degree. When these deep tissue techniques or dry needling are effective, I believe it is predominantly due to the effect on the vastus lateralis muscle.

In the case where the pain is only in a small, local spot where the ITB attaches just to the side of the knee, ice can help reduce the pain temporarily. But the source of the problem is usually elsewhere, like the some of the faulty biomechanics described above, and it can include how and where a person might train. For example, the curved elements of a track will increase the strain on the left leg if you are running clockwise. Indoor tracks have tighter turns, and increase loading further if the turns are not banked. Even if you routinely jog on the road, always facing traffic results in an asymmetrical strain on the left and right legs due to the crown design for roads to shed water.

Deep Tissue Rolling

Deep Tissue Rolling

Customized Orthotics and Kinesiology Taping

Orthotics, or inserts for shoes that customize the arch for the individual, as well as specialty elastic tape (Kinesiotape or Rock Tape®) can be helpful components for selective individuals. I recommend you consult a professional trained in orthotics or taping application.

Note that while I have described the IT band condition as it presents on only one leg, it is possible that some folks have the pain on both legs, though the same principles apply.

Finally, the challenging part of ‘persistent’ IT Band Syndrome is in knowing how many of these components are contributing to the individual’s condition, and which ones are the predominating factors. The good news is that clinicians well trained in these conditions can help you if needed.

I hope you have found the information helpful.

Billy Cioffredi, PT/founder

Cioffredi & Associates

Trigger Point Dry Needling

Trigger Point Dry Needling


Overview of the Knee

Runner’s Knee (Patellofemoral Pain Syndrome)

Common Running Injuries

Trigger Point Dry Needling: Applications & Evidence

Piriformis Syndrome: That Pain in the Butt




Nancy 1Our next FREE Fall Prevention Screenings are taking place on

Thursday, September 28, 2017

10:30 a.m. – 12:30 p.m.

There is still time to register for this event! Call us at 603-643-7788 to register today.

This free one-on-one screening with one of our physical therapists will evaluate your balance and mobility, provide valuable insight into fall prevention, and offer solutions to decrease your risk.

Participants will need to complete a medical history and balance scale prior to their screening. The therapist will review your history, and put you through a series of test to evaluate your balance and determine your risk of fall. You will leave the screening with some tools that you can use to improve your balance.

The screening will take approximately 30 minutes, and openings are by appointment only. Space is limited, and pre-registration is required. Call us at 603-643-7788 to register. 

Bill Cioffredi, PT - Founder

In the bodywork and exercises that we use in our work, I often feel we are simply undoing what people have done to themselves. Most of our clients didn’t have an accident. Rather, they developed a painful condition gradually, often times without a known reason. Postural pain, as well as joint and muscle pain, are often the result of unknowingly tensing or activating muscles that don’t need to be working or are working too much for the demand. Herniated discs, sciatica, arthritis pain, and rotator cuff problems are all just examples that are influenced by this issue. To a large degree, our work in helping people to restore pain-free movement involves freeing up stiff tissues in joints. But then we need to teach people how to “relax” their muscles. “Release” may be a better term, as we want our clients to release the excessive tension and muscle activation—not have muscles go totally soft.

“Good posture” is not a held position; it is free of excessive tension. You can see this kind of freedom in action in a master glassblower. They move smoothly and effortlessly, free of excessive tension as they work with the glass. We are often involved in teaching people to “release” their excessive muscle tension and “get out of their own way.” It can be learned. To that end, we have added a Qigong movement class on the weekends taught by Peter Payne, who is a master at teaching people how to “get out of their own way.” Check out the videos at Cioffredi.com/Qigong.

Best Wishes,
Billy Cioffredi, PT

Related Articles

Pain and Resilience: What I’ve Learned
Treating the Cause of Tension Headaches
Why Qigong?


Back on the Job: Hanover Firefighter Jack Emerson

Jack Emerson, Hanover Firefighter and Cioffredi Client

“When I hurt my back at work I was unsure if I would ever be able to return to work at the firehouse. The staff here was so encouraging and motivating. I had to put the hard work in, but Zac kept me focused and on track. The entire staff knows your name, it feels like they are all in your corner. I had heard I might be out for 4-6 months, at best, but 2 ½ months later I’m back on shift working full duty.” –Lieutenant Jack Emerson, Hanover FD



Did You Know?

Low Back Pain is Responsible for 33% of Workers’ Comp Claim Costs

Low back pain is one of the most frequent and disabling conditions affecting workers in their productive years. Quality of life and job selection are limited, and recurrence is a major reason for early retirement and disability claims. Low back pain is responsible for 16% of workers’ compensation claims, and a disproportionate 33% of total claim costs.
-Garg et al. BMC Musculoskeletal Disorders 2013, 14:84

How Can We Help?

Learn more about the benefits of physical therapy for low back pain.


Dawn Famiglietti: A Story of ResilienceDawn Famiglietti: A Picture of Resilience

When Dawn Famiglietti of Sunapee reached out suddenly to break someone’s fall one day in late 2011, she was acting on instinct. She had no idea that this quick action would change her life forever, sending her on a journey of pain and healing that would test her to the core. Today, with rods and cages fusing together seven vertebrae in her lower back, Dawn shares inspiration and encouragement with everyone she meets.  Her message: “Don’t stop moving!”


The scope of Dawn’s back injury did not become fully apparent for several months after the incident. During that time her life became a waking nightmare of unbearable pain. “We tried everything at first: steroid injections, chiropractic adjustments, massage, the pool,” but relief just wouldn’t come without increasing doses of narcotic pain medication—and then with greater frequency.  She suffered headaches, couldn’t sleep, and the pain that shot down her leg like an electric current was unrelenting. She found herself constantly lying on the floor, and away from her loved ones. “Standing was difficult, driving was almost impossible, and I couldn’t sit long enough to even have dinner with my family.”


To hear her explain it, Dawn fought hard against the idea of being disabled, but the pain and the growing distance between living and merely existing took their toll. “I tried to stay positive in front of my family, but when they were gone I had panic attacks and anxiety. I was depressed.” Like so many people, Dawn found it hard to share her pain or ask for help, but it became too much. “I reached a point where I stopped caring, and I felt very desperate.” When the Christmas decorations didn’t even come out of storage in 2012, she knew she had hit bottom.

SURGERY AND REHABSeven-Vertebrae Lumbar Fusion X-Ray

A surgeon in Boston was finally able to repair Dawn’s severely damaged spine with a multilevel lumbar fusion, a procedure that took two days to complete. Then more than a year since her injury, he challenged her to take charge of her own care. “You can do anything you want,” he told her, “the question is only whether you want to do it.” Right away she knew that her top priority was to get back to normal living, and to move as pain free as possible with minimal use of medications.

Dawn arrived at Cioffredi  & Associates with a limp and still hurting from her initial recovery rehab, but determined to get back her life and her sense of herself.

“When you have back pain, people can’t see it. It’s not like there’s something obviously wrong with you. I had a hard time when I went back to work, because I think I felt like people wouldn’t believe that I was really injured—that they would think I was soaking the system.”


Physical Therapists Marsha Wykes and Anna Hinman worked with Dawn during her rehabilitation. “They were wonderful,” Dawn reported. “They made me feel important, and that I wasn’t there for no reason. They gave me good information to follow; they educated me, and when I didn’t do my exercises the way I was supposed to,” she explained sheepishly, “I was gently prodded. I almost didn’t want to leave.”


Dawn’s PT experience helped her to be constantly thinking about her posture and the way she does things, and even today she misses no opportunity to stretch or move. Most of her coworkers have no idea of the ordeal she has gone through since 2011, but they might just notice how energetic and positive she is. She always takes the stairs, often two at a time, and sometimes takes an extra set just to push herself. In her office, which is equipped with both a standing desk and a yoga mat, she’ll take a break and do a few stretches. If her door is open and someone sees her bending over in a forward fold, “l just tell them I’m looking for my contact lens. I don’t want anyone to say ‘Poor Dawn,’ I just know that I’ve got to keep moving, just keep those muscles moving.”

POSITIVE OUTLOOKDawn Famiglietti Back on Her Horse

While Dawn’s outcomes are remarkable, she will likely always have good days and “not-so-good days,” when back pain intrudes. She’s determined to keep her positive outlook, but on the tough days she allows herself a break—and occasionally even some Tylenol—and acknowledges that there are things she will always need to approach differently. There won’t be any sit-ups or back bends in her daily fitness routine, for example, but her doctors have cleared her for “everything but skydiving.” Mostly she just wants to keep on gardening, caring for her horses, taking her dog for longs walks, and filling the wood box.

“I set goals for myself that aren’t huge. I look at my behavior and I try not to get down on myself; to go easier for the big things and just always keep moving.”

Her next big goal has to do with her daughter’s wedding in September 2017, she explains bashfully, pointing to her feet. “I want to be able to wear shoes with a little heel.”

LEARN MORE about the kind of excellent physical therapy care that Dawn received at Cioffredi & Associates.

This article appeared in the Cioffredi & Associates July 2017 newsletter. View the entire issue online.