MASKS: Another Hurdle for Businesses to Overcome During Covid-19

MASKS: Another hurdle for businesses to overcome during Covid-19 - Hampton Physical TherapyBy KATE SERODIO, DPT – Owner/Physical Therapist Hampton Physical Therapy & Rezilient

No one is spared personal hardships during this difficult pandemic. From the fear of contracting the virus to the tough convalescence of those who do, not to mention the devastation of losing a loved one to it. There’s so many new adjustments to deal with, like working from home, or being laid off. Having to home-school kids is a huge challenge too. For those of us ‘essential workers’ it’s been extremely trying as well.

As a business owner, I have experienced the complete shutdown of a non-essential business (Rezilient) as well as the struggle of remaining open as an essential business (Hampton Physical Therapy). It’s been nothing but endless hurdles. The struggles of a complete shutdown then reopening is basically like starting a business from scratch. While remaining open during the pandemic with a skeleton crew certainly had its own challenges. From battling with the ever-changing CDC guidelines, to the additional work needed to provide a safe environment, to the laying off /rehiring of staff (with some pushback due to the unemployment stimulus funds they were receiving). Unfortunately, my businesses just aren’t Pandemic Proof.

Sadly, the continued emphasis from patients hasn’t been about how great a service we provide, but instead whether our business is safe and clean and worth the risk. The fear is understandable. Many months into Covid-19 and I still find there is still so much time and energy devoted to this virus, that the true goal of the business has lessened.

As we treat patients and clients daily, there is one other elephant in the room that is hindering us from connecting, yes, the MASK! The mask obviously has its purpose to prevent the spread but it is affecting us on a whole other level, a mental and emotional level. The mask is a constant reminder that we are in a pandemic. When a primary part of a business is about connecting with people, the facial emotional barrier of masks is yet another hurdle that we must overcome.

A huge part of providing a Great service is the ability to connect with people. Whether you’re a greeter, a waitress, a hairdresser, or a doctor you need facial visual input in order to read their reaction to your questions or comments. Their response is what drives the direction of a conversation. The mask in effect, makes you feel as if you’re talking to a wall. Yes, the eyes are expressive, but I’m finding the mouth is what I often check for nonverbal cues as to how my patient is doing. Consequently, this is a huge barrier to business as this is a fundamental of great customer service. What was once transparent is now a guessing game, an added obstacle on top of accomplishing your job.

Since the first day I started wearing a mask back in March while treating patients, I have personally felt less emotion. Perhaps even less empathetic to my patient’s needs. I believe this is because I can’t see their feelings or pain or smile, and I know they can’t see mine, so why bother. The lack of this input easily makes you have less emotion. Not only does this affect the provider but it also affects the client/patient. Research supports this: a BMC randomized control study in 2013 “Effect of facemasks on the empathy and relational continuity” found that “patients perceived doctors who wear masks as less caring and empathetic.”

Another interesting article that supports our struggles with masks and emotions is from Trends Neuroscience Education: “Masked Education? The benefits and burdens of wearing face masks in schools during the current virus pandemic.” This is an interesting article on many levels. One topic they discuss is how the face provides a universal language for communication, in particular, the communication of emotions. The mouth region on a face conveys information that is crucial for smiling, i.e., a positive emotion, which can work as social glue and facilitates positive social cognition and action. Not seeing the bottom half of the face makes it particularly difficult to recognize a mask-wearer’s positive emotions – pleasure, joy, happiness, amusement, sociability, and friendliness – as they are basically communicated by a smiling mouth. Therefore, face masks impair mainly our positive social interactions and our ability to understand, and empathize with one another.

Some other added struggles that the mask unfortunately results in is a muffled voice. Many people with hearing impairment are having an even harder time communicating because of the muffled voice as well as the inability to read lips.masks muffle voices during covid - Hampton Physical Therapy
Many people that don’t even have a hearing problem are finding that they suddenly can’t understand anyone. A number of my patients are misinterpreting what I’ve said, its often like we’re playing a game of telephone where the message is completely distorted by the end of the conversation. Who knows how many people I’ve somehow offended! There are many times that I assume someone didn’t hear me and I go to repeat myself, only to find out that they did hear me but were making a thinking face that I wasn’t able to pick up on. The normal conversation just simply doesn’t flow as it used to or should, leaving a feeling of complete disconnect.

In my line of work, recognizing feelings is extremely important. In a profession where you provide hands on services, you’re no longer able to gauge from their facial expression if you’re physically hurting them. So many cues that we have all become accustomed to are no longer available. The inability to see feelings on someone’s face and the inability to express my own feelings with a smile is a huge hurdle for me and my business.

So, whether you’re a business owner or an employee trying to provide a service, and make sure you’re able to continue to connect with your clients, you need to overcome ‘the mask’. Since March these are some of the things I’ve found useful:

1) Focus on the eyes. Attempt to read theirs and utilize your own when smiling.

2) The mask sometimes feels like the elephant in the room, so just get it out there, and talk about it. Talk about the mask and how it creates a disconnect, people will agree with you and you’ll connect. Having a conversation about how the mask affects your peripheral vision will open up a possible connection. I actually fell off the treatment table because I couldn’t see down. Have the mask be your first thing in common. It will open doors up for further discussions.

Another good topic is talking about all the great things the masks do:

– don’t have to stress about food in your teeth
– if you have bad breath, no one will know
– only need eye make up
– the obvious… less germs spread
– this list hasn’t gotten that long… we all agree it’s short but have a fun time trying to come up with positives-send them my way if you have more

3) Mask fitting: make sure your mask doesn’t hit your lips, this muffles your voice even more and makes it difficult to hear which will complicate connecting even more.

4) Give people a visual of yourself-perhaps a business card with a picture of yourself. This will allow them to feel more connected as they’ll be able to build a mental image of you

5) Wear a clear fitted mask: A clear mask for you would eliminate ½ of the problem. You’ll still struggle getting visual feedback from them, but you’ll at least be able to smile with them knowing and allow for a connection and better communication. This would also assist with someone who often needs to read lips.

*FYI this is not a shield, these do not provide the level of protection most are seeking.

6) More gestures! Air hugs: I used to give hugs, now I tell them I would love to give them a hug but I suppose an air hug will do. Hand Air Shakes: handshakes are definitely out but an air shake and just a big greeting will do. Thumbs up or head nods, all are useful to connect.

9) Discuss the need to Communicate: if you have a business that you need to know if you’re hurting someone, have a discussion about communicating. Make sure they understand their role is to speak up if they’re not happy.

10) Try harder: you have to simply try harder, dig deeper to connect. Know it and own it.

11) Mask messages – purchase one with a smile on it or a positive quote. Believe it or not, this can be powerful and allow a connection.

12) Encourage people to buy clear masks-this will allow us to feel as normal as we can in the present.

We all need to be resilient. We must accept that this is potentially our new reality and you must figure a way to overcome it. Hurdle after hurdle, whether small or big, we must move forward.
I encourage you to Be Rezilient!

Trends Neurosci Educ. 2020 Sep; 20: 100138.
Published online 2020 Aug 11. doi: 10.1016/j.tine.2020.100138

PMCID: PMC7417296 Masked education? The benefits and burdens of wearing face masks in schools during the current Corona pandemic
Manfred Spitzer1


Needing a Knee Replacement? What to expect…

After knee replacement - physical therapy at Hampton PTby KRISTIN KEAFER DPT, Hampton Physical Therapy

Osteoarthritis is a degenerative process over time where the cartilage at the ends of your bones starts to “wear and tear”. Many different joints throughout your body may be affected with age related changes and the knee joint is commonly a symptomatic area. This involves the break down of cartilage at the end of the femur (thigh bone) and the end of the tibia (shin bone). Typically, an x-ray and a severe decline of your daily function will determine if you are in need of a joint replacement surgery. In the United States alone, 4.7 million individuals (3.0 million women and 1.7 million men) were with a total knee replacement in 2010.2 Signs that you may be ready for a knee replacement are significant swelling around the knee, tenderness, stiffness, pain with inability to straighten knee, deformities such as knock- knee or bow legged, and severe functional limitations. Physical therapy is the first line of defense to address pain and function, however if conservative methods are not working, it may be time for a joint replacement. All non-surgical treatments will be exhausted before moving forward with a surgical intervention. This can be discussed with both your physical therapist and your doctor.

What is a knee replacement?

The worn cartilage at the ends of the bones are surgically removed and replaced with a combination of metal and plastic implants. Typically, a knee replacement will last up to 20 years, however this can vary based on wear and tear of the components placed. In some cases, the doctor will only replace one side of the joint called a uni-compartmental replacement because the other side of the joint is still healthy. In these cases, the surgery is quicker, hospital stay is shorter, and rehabilitation process is faster.

Pre-Operative Treatment

Pre-op knee replacement - physical therapy at Hampton PT

Usually, your surgeon will refer you to physical therapy for pre-operative treatment prior to your knee replacement. Research indicates that it can improve early post-operative pain and function.1 A physical therapist will evaluate your range of motion at your knee, your strength, and your overall function with daily activities. This will further justify need for the surgery to your insurance company and will allow the therapist to work with you to increase strength and range of motion as much as possible to improve your post-operative outcome.

Pre-operative treatment is unique in the fact that you can meet with your therapist prior to undergoing your surgery to ask any additional questions and learn more about the rehabilitation part of this journey. Many of the range of motion and strength exercises that are prescribed to you before surgery will be similar to those after surgery. This always helps to make you feel more comfortable with what to expect.

Post- Operative Treatment

After surgery, typically you will spend 1-2 days in the hospital. You will work with a physical therapist in the hospital who will help you out of bed and start moving. They will show you how to use a walker or crutches and they will give you some exercises to work on while you are in bed. It is important to move after surgery to avoid a DVT (blood clot). Your plan for discharge depends on how functionally limited you are and what your home situation is like. Sometimes you will be discharged directly to home, and other times you may go to a skilled nursing facility if you need more help after surgery. Once at home, a physical therapist will come to your home to help you. As soon as you are able to safely leave your home, you will transition to outpatient physical therapy for continued rehab.

Outpatient rehab… this is where Hampton Physical Therapists’ are essential in this process!

Post-op knee replacement - outpatient physical therapy at Hampton PT

You should expect your therapist to be working hands on to reduce swelling and pain in the early stages. We also help to properly transition you off of a walker, crutches, and/or a cane to return you to normal walking mechanics. Manual stretching is implemented to improve your range of motion into flexion (bending the knee) and extension (straightening the knee). You will be given exercises to work on in the clinic and at home. It is imperative that you work as a team with your therapist to reach the best outcome. Gradually the focus will transition from range of motion exercises to strengthening exercises to improve all of your functional activities.

Post-op knee replacement - outpatient physical therapy at Hampton PT, Hampton NHBelow are guidelines for reaching functional goals post operatively to get you back to living a normal life!

Reaching Your Goals!

Day 1- 2 weeks
0 degrees of extension and 65-90 degrees of knee flexion. You will be able to stand, walk, go up and down stairs with assistance. Decrease swelling and keep pain under control!

2- 6 weeks
0 degrees of extension and greater than 90 degrees of flexion. You will be able to walk without an assistive device, sit and stand more comfortably, and do stairs with minimal support.

6-12 weeks
0 degrees of extension and 115 degrees of flexion or better. You should be able to move around normally, bend down to pick things up, sit comfortably, stand for longer periods, and tie your shoe laces.

12+ weeks
0 degrees of extension and 115-135 degrees of flexion. The first 90 days are definitive in your recovery. You should have little pain and be able to do most daily activities with ease. You will be working towards walking longer distances and getting back to normal life.

Range of Motion Milestones

0 degrees of extension to walk normal without a limp
65 degrees of flexion to walk on even surfaces
70 degrees of flexion to lift an object from the floor
85 degrees of flexion to climb stairs
95 degrees of flexion to sit comfortably and to stand up from being seated
105 degrees of flexion to tie shoe laces comfortably
115 degrees of flexion to squat or sit cross legged comfortably
135 degrees of flexion to get into and out of a bath tub without limitation

Hampton Physical Therapy is here to help with your journey before and after joint replacement surgery! Please contact us at either our Hampton or Seabrook office with any additional questions or to schedule a FREE discovery visit!


    • Li Wang, et al. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2016; 6(2): e009857. Published online 2016 Feb 2. doi: 1136/bmjopen-2015-009857
    • Maradit Kremers H, et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am.2015 Sep 2;97(17):1386-97. doi: 10.2106/JBJS.N.01141.
    • Rowe PJ, et al. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life? Gait Posture.2000 Oct;12(2):143-55.

Is losing your balance normal as you age?


At some point we start to notice things are not quite as easy as they used to be. Reactions feel slower, standing on one foot feels like an acrobatic trick, and changing positions requires a moment to regain our orientation. There are multiple reasons for these changes, and we have the opportunity to get ahead of them right now! Our body’s balance is determined by three systems, the vestibular system, the visual system, and somatosensory system. Throughout our lives our body relies on different systems to create stability. Here’s why.

From infancy to approximately 3-6 years of age, we depend highly on vision, as this system develops and matures first.1 Our eyes have the goal of staying in line with the horizon, and if our vision doesn’t show us this, we know something is “not right” and our body will physically try to correct to reorient the image.

Children learn and gain stability and strength in their environment by exploring, sometimes falling, and making mistakes. What may seem clumsy in young age between the ages of 4 and 7 is actually a developing proprioception system. 2 Proprioception is the feeling in your joints. They tell us if we are in alignment, if there is abnormal pressure, or if we are in need of stepping to regain our balance. By 7 years old this proprioceptive system is most dominantly relied upon.2 However, at this young age, if we are to challenge ourselves with uneven surfaces or a narrow base of support, vision is again depended upon.

The last component of our balance system, the vestibular system, matures between the ages of 15 and 16.3,4 Our vestibular system is made up of a series of small bones and organs in our inner ear that tells via the movement of fluid in the inner ear where we are in space with relation to gravity. The vestibular system is very important, as when we experience a conflict in information (such as when your car is not moving, but the car next to you starts pulling forward or backwards), this is the system that corrects our experience and tells us what movement is truly happening.

As we age, neurons in our brains used to communicate information about our body’s special position lose dendrites (communicating branches), myelin sheaths (nerve coating that increases signal speed) degrade, cilia in the ear become damaged, and different pathologies including diabetes, neuropathies, unilateral vestibular hypo function, etc. can exponentially negatively impact all 3 systems.

The good news is, we are not helpless in this scenario! Numerous studieshave demonstrated the benefits of staying physically active as we age to improve our central nervous system (brain and nerves) as well as our muscle spindle function. In fact, a study by Duke- NUS Medical demonstrated that a tailored physical therapy routine for balance and gait challenges reduced patients’ risk of falls by 50%.6 What we can learn from this is that YOU have control over your balance and safety, and physical therapy has been scientifically proven to help you achieve reduced fall risk and improved mobility.

If you are concerned about your balance, Hampton Physical Therapy is here to help. Call for an evaluation. We can get you scheduled ASAP!

  2. 1 Lear S. Pediatric Balance Assessment. BA Accessed January 4, 2020.

2 Sá CDSCde, Boffino CC, Ramos RT, Tanaka C. Development of postural control and maturation of sensory systems in children of different ages a cross-sectional study. Brazilian journal of physical therapy. Published 2018. Accessed February 10, 2020.

3 Cherng RJ, Chen JJ, Su FC. Vestibular System in Performance of Standing Balance of Children and Young Adults under Altered Sensory Conditions – R. J. Cherng, J.J. Chen, F. C. Su, 2001. SAGE Journals. Accessed February 10, 2020

4 Ralli G. Maturation and evolution of the vestibular system. GiovanniRalli. .compressed.pdf.

5 Ribeiro F, Oliveira J. Aging effects on joint proprioception: the role of physical activity in proprioception preservation. European Review of Aging and Physical Activity. 2007;4(2):71-76. doi:10.1007/s11556-007-0026-x.

6 Keeping the Elderly Safe. Science Daily. March 2017.