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Hip to be Cool: Preventing Running Injuries - Outside Bozeman Magazine

By Jason Lunden, DPT, SCS
jason@excelptmt.com

"Hip to be Cool - Preventing Running Injuries" article from Outside Bozeman Magazine

by Jason Lunden, DPT, SCS

Join Jason Lunden, DPT, SCS and Megan Peach, DPT, OCS, CSCS at our Running Experts Forum event on 3/29/2017, 6:30pm at the Bozeman Library for a lively discussion of ALL things running. Our Physical Therapists who specialize in Running Injury Treatment and Running Evaluations along with several Bozeman running expert special guests will discuss various running related topics and answer audience questions. Bring your questions or email them in advance to megan@excelptmt.com!

Advanced Training...We're at it again!

By Matt Heyliger, DPT
matt@excelptmt.com

Matt Heyliger, physical therapist with Excel Physical Therapy of Bozeman and Manhattan, recently completed a Level III Advanced Lower Quadrant Integration course with an emphasis on integrating biomechanical assessment of the lumbosacral region, hip, knee, foot and ankle. The course follows the respected North American Institute for Orthopedic Manual Therapy (NAIOMT) program for advanced certification training. Key concepts studied during this four-day intensive course, held in Seattle, included advanced clinical reasoning and assessment approaches and integrated manual therapy and join manipulation approaches for complex biomechanical presentations.

http://www.bozemandailychronicle.com/business/people/people-in-business-for-sunday-november/article_9037a164-59dd-58ac-9dd1-ca773d1927e6.html

Truing Your Frame - Fit Your Bike to Avoid Injury from "Outside Bozeman"

By Jason Lunden, DPT, SCS
jason@excelptmt.com

from Outside Bozeman Magazine

Spring 2014 Issue

Fit your bike to avoid injury

While cycling is relatively easy on your joints, because of the constrained position and

repetitive nature of the sport, it can be easy to develop overuse injuries.

These injuries are often attributed to ramping up training mileage too quickly or being improperly positioned on your bike. Training errors can be avoided by following a proper training schedule. Fitting your bike to your body—not the other way around—helps achieve proper positioning.

It’s best to see a professional bike-fitter at a physical therapy clinic or your local bike shop, but here are some tips to alleviate common pains associated with cycling.

Foot/Ankle

Achilles’ Pain
Cause: foot positioned too far back on pedal
Solution: move foot forward on the pedal by moving your cleat further back

Arch Pain
Cause: foot positioned too far forward on pedal
Solution: move foot back on the pedal by moving your cleat further forward

Knee

Anterior Knee Pain
Cause: saddle too low and/or too far forward
Solution: move saddle up so there’s a slight bend in the knee at the bottom of the stroke

Posterior Knee Pain
Cause: saddle too low and/or too far back
Solution: move saddle so there is a moderate to slight bend in the knee

Spine

Lower Back Pain
Cause: stem too short
Solution: get a longer stem

Neck

Neck Pain
Cause: bars too low
Solution: raise your bars by getting a more upright stem or moving headset spacers from the top of the stem to the bottom

Jason Lunden is a board-certified clinical specialist in sports physical therapy at Excel Physical Therapy in Bozeman and a clinical BikeFit Pro Fitter. For more information on bike fitting or injury prevention, visit excelptmt.com/bikefitting.

Rock Hard - Spring Climbing Exercises from "Outside Bozeman"

By Matt Heyliger, DPT
matt@excelptmt.com

Rock Hard – Spring exercises for climbing From Outside Bozeman Magazine

Outside Bozeman Spring 2015

by Matt Heyliger, DPT, Physical Therapist at Excel Physical Therapy in Bozeman, Montana

Click here to access this article on the Outside Bozeman website.

While some of us are still hoping to get in as much spring skiing as possible, the season is changing and the thought of warm days and dry rock is enticing. This is the time of year when climbers realize that winter has taken a toll, and it’s time to grow our forearms again. It’s also when we’re at an increased risk of injury due to de-conditioning. So how can you make this your strongest season yet, red-point last year’s projects, and move on to new objectives? To get started, let’s review some well-documented training concepts, like the “4-3-2-1 concept” developed by Erik Hörst in his book Conditioning for Climbers.

Four weeks of endurance training: rack up as much mileage below your highest on-sight grade as possible. Shoot for three to four days a week of rope climbing on a variety of rock types.

Three weeks of power training. Head to Spire and spend those rainy May days bouldering. Complement this with hang-board training, systems training, or campus training.

Two weeks of anaerobic training. This is maximum-intensity training over short periods of time with equivalent rest time. For example, climb four boulder problems (or roped pitches) consecutively without rest, then rest for the same duration of time. Repeat to fatigue. This will increase your ability to dig deep in situations where rest is not an option.

One week of rest at the end of this 10-week cycle is vital for proper tissue healing and an injury-free season.

Additionally, antagonist training provides muscular balance without adding mass where it’s not useful. We do a lot of pulling in climbing so go push on something—high repetitions of push-ups and shoulder presses are good. Strengthening forearms is important for the stabilization of the elbows and wrists. Try the following exercises:

Wrist Extension
Forearm flat on thigh, hold dumbbell with wrist flexed. Bend wrist up (extend) to feel muscle activation on top of forearm. Lower and repeat.                                            

Pronation
Forearm flat on thigh, secure band with foot tracking band to outside of hand, palm up. Rotate palm downward feeling muscles inside of forearm, slowly return to start. Repeat.

Supination
Forearm flat on thigh, lower slowly toward opposite knee, return to start position feeling burn in extensors in each direction. Repeat.

Radial Deviation
Forearm flat on thigh, lower slowly in casting motion, return to start position feeling burn in top of forearm. Repeat.

Ulnar Deviation
Arm straight at side, weight facing back, perform casting motion back, slowly raising weight to feel burn in back of forearm. Slowly lower and repeat.

Finger Extension
Theraband (or rubber band) around fingers with fingers bent. Straighten fingers and thumb and pull out and up. Hold for five seconds, return to bent finger position and repeat.

Shoulder Stabilization
Shoulder stabilization is also key. Extensive research confirms the benefits of scapular and rotator-cuff stabilization for overhead athletes. In climbing, we spend a lot of time with our hands overhead pulling on holds in awkward postures. Try the pictured exercizes to protect your shoulders and prevent overuse injuries this season.

Core Strengthening
All climbers benefit from core strengthening regardless of ability. Emphasize more static exercizes, like plank and side-plank, as these aare more specific to our sport than crunches.  

Do these exercises three times a week until you are climbing regularly, then cut back to once or twice a week for the remainder of the year to reduce the risk of elbow tendinopathies, wrist injuries, and finger injuries.

While just getting out and climbing is way more fun than training, being able to climb is also way more fun than being injured. “Roctober” is many months away, so tune your machine this spring and have an injury-free season.

Wrist Extensions (wrist flexed)Wrist Extensions (wrist extended)
 
Pronator (forearm flat)Pronator (forearm rotation)
 
Supinator (forearm flat)Supinator (forearm rotated) Radial Deviation (forearm flat)Radial Deviation (forearm rotated)
 
 
Ulnar Deviation (arm at side)Ulnar Deviation (raised)
 
Finger Extension (bent)Finger Extension (straight)
Shoulder Stabilization (start)Shoulder Stabilization (finish)
 

Matt Heyliger, DPT is a physical therapist at Excel Physical Therapy. Please call the Bozeman office with any questions at 406-556-0562.

The information in this article is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, occupational therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website

from Outside Bozeman "Tight Lines - Look Good and Ski Great"

By Jason Lunden, DPT, SCS
jason@excelptmt.com

The following article is from the Winter 2013/2014 issue of Outside Bozeman. Click Here for the full article link: http://www.outsidebozeman.com/activities/skiing/tight-lines

Here is a snapshot from the printed issue:

 

“Tight Lines – Look Gook and Ski Great”

by Jason Lunden, DPT, SCS

 

Aside from protective gear like helmets and wrist guards, proper strength and conditioning is your number-one tool for staying healthy and safe on the slopes this winter. Here are some exercises to get you ready to shred and keep you on the mountain all season long. As an added bonus, all these exercises work your glutes, helping you build buns of steel.

Hamstring Curls

Lie on your back with your heels resting on a ball. Dig your heels into the ball to contract your hamstrings, and lift our hips off the ground. Roll the ball towards you by bending your knees, while maintaining good hip and knee control. Perform 10-30 repetitions.

Tele Jumps / Jumping Lunges

Start in a lunge position with your right leg forward with your knee over your ankle, and your left leg back with your knee just off the ground. Also have your left arm forward and your right arm back. Jump up, switching your legs so you land in a lunge position, maintaining proper form. Perform for 45-90 seconds.

Star-Balance Squats

Stand on one leg and perform a single-leg squat, reaching forward with your uninvolved leg, keeping your foot barely off the ground, reaching toward Point A. Repeat on the opposite leg, reaching toward Point B. Do 3-4 sets on each leg. For an advanced version, do the exercise while standing on an unstable object (BOSU ball, balance disc, etc).

Skier Leaps

Stand on one leg and leap to the side onto your other leg. Absorb the landing by performing a partial squat, bending at the hips. Stick the landing and pause for 1-2 seconds before leaping to other side. Perform for 45-90 seconds.

The numbers of repetitions listed above serve as a guideline; ideally you should perform each set to fatigue, doing 3-4 sets every other day. Focus on proper form: keeping your shoulders and hips level, and your knee over your ankle while performing squatting-type exercises.

Jason Lunden is a board-certified clinical specialist in sports physical therapy at Excel Physical Therapy in Bozeman and a physical therapist for the U.S. Freeskiing and Snowboarding teams. For more information on injury prevention, check out his blog at excelptmt.com.

 

How Your Knees Can Predict the Weather

By Tiffany Coletta
tiffany@excelptmt.com

Our patients have found this information interesting so we are sharing the following article from the Wall Street Journal’s Health Journal:

 

How Your Knees Can Predict the Weather

Granny was right: Scientists find link between achy joints and the forecast

By

Melinda Beck
 
Oct. 14, 2013 7:12 p.m. ET

The Wolff family of Paramus, N.J., was eyeing the gathering clouds and debating whether to cancel a planned park trip when 6-year-old Leora piped up with an idea: “Let’s call Grandma. Her knees always know when it’s going to rain!”

Leora’s grandmother, Esther Polatsek, says she started being sensitive to the weather in her 20s, when a fracture in her foot would ache whenever a snowstorm approached. Now 66 and plagued by rheumatoid arthritis, Mrs. Polatsek says she suffers flare-ups whenever the weather is about to change.

“It’s just uncanny. Sometimes it’ll be gorgeous out, but I’ll have this awful pain. And sure enough, the next morning it rains,” she says. “It may be just a few drops, but it makes my body crazy.”

Do weather conditions really aggravate physical pain?

It is one of the longest running controversies in medicine.

Weathering the Pain

You can’t change the forecast, but you can lessen its impact.

  • Take a pain reliever or anti-inflammatory in advance if a storm or cold weather is forecast.
  • Dress warmly in the cold, including thermal socks, gloves and a vest.
  • Keep out drafts at home by sealing doors and windows and carpeting floors.
  • Apply heat to aching joints.
  • Use a dehumidifier to avoid spikes in dampness.
  • Consider visiting a warm, dry climate, although the benefits may wear off after a prolonged stay.
  • Maintain a healthy body weight.
  • Stay active, keeping muscles strong around damaged joints.

Hippocrates in 400 B.C. noticed that some illnesses were seasonal. The traditional Chinese medicine term for rheumatism (fengshi bing) translates to “wind-damp disease.”

But modern scholars have gotten inconsistent results in studies that tried to match weather patterns to reported pain symptoms—leading some to dismiss the connection as highly subjective or all in sufferers’ minds.

“People’s beliefs about arthritis pain and the weather may tell more about the workings of the mind than of the body,” concluded the late Stanford psychologist Amos Tversky in the mid-1990s, after comparing the pain reports of 18 rheumatoid-arthritis patients with local weather conditions for a year and finding no connection.

Still, other studies have linked changes in temperature, humidity or barometric pressure to worsening pain from rheumatoid arthritis and osteoarthritis, as well as headaches, tooth aches, jaw pain, scar pain, low-back pain, pelvic pain, fibromyalgia, trigeminal neuralgia (a searing pain in the face), gout and phantom-limb pain.

 

Bill Balderaz had a rheumatoid-arthritis flare-up last year—just before a surprise storm hit Ohio. Jason Joseph

Scientists don’t understand all the mechanisms involved in weather-related pain, but one leading theory holds that the falling barometric pressure that frequently precedes a storm alters the pressure inside joints. Those connections between bones, held together with tendons and ligaments, are surrounded and cushioned by sacs of fluid and trapped gasses.

“Think of a balloon that has as much air pressure on the outside pushing in as on the inside pushing out,” says Robert Jamison, a professor of anesthesia and psychiatry at Harvard Medical School. As the outside pressure drops, the balloon—or joint—expands, pressing against surrounding nerves and other tissues. “That’s probably the effect that people are feeling, particularly if those nerves are irritated in the first place,” Dr. Jamison says.

Not everyone with arthritis has weather-related pain, says Patience White, a rheumatologist at George Washington University School of Medicine and a vice president of the Arthritis Foundation. “It’s much more common in people with some sort of effusion,” an abnormal buildup of fluid in or around a joint that frequently occurs with inflammation.

Many patients swear that certain weather conditions exacerbate their pain. Consequently, orthopedists, rheumatologists, neurologists, family physicians, chiropractors, physical therapists—even personal trainers—report an increase in grousing among their clients when the temperature drops or a storm approaches.

“I can tell you emphatically there are certain days where practically every patient complains of increased pain,” says Aviva Wolff, an occupational therapist at the Hospital for Special Surgery in New York City, and Mrs. Polatsek’s daughter. “The more dramatic the weather change, the more obvious it is.”

Both the Weather Channel and AccuWeather have indexes on their websites that calculate the likelihood of aches and pains across the country, based on barometric pressure, temperature, humidity and wind. Changes in those conditions tend to affect joints even more than current conditions do, says AccuWeather meteorologist Michael Steinberg, which is why the Arthritis Index shows more risk the day before a storm or a sharp drop in temperature is forecast.

Some sufferers say their joints can be more accurate than meteorologists. Rheumatoid-arthritis sufferer Bill Balderaz, 38, president of a digital-marketing firm in Columbus, Ohio, recalls feeling “the worst arthritis pain I’ve ever had—I could barely move” one day last year, even though it was sunny and clear. By midafternoon, a land-based hurricane known as a derecho with 80 mile-per-hour winds unexpectedly buffeted Ohio and three other states, traveling 600 miles in 10 hours and knocking out power for 10 days. “The storm caught everyone off guard. It was clear one minute and then the skies opened up,” Mr. Balderaz says.

Tests on animals seem to bear out the impact of weather. In one study, guinea pigs with induced back pain exhibited signs of increased pain by pulling in their hindpaws in low barometric pressure.

Cold weather seems to raise the risk of stroke, heart attacks and sudden cardiac death, some research shows. Heart-attack risk rose 7% for every 10 degrees Celsius (18 degrees Fahrenheit) drop in temperature, according to a study of nearly 16,000 patients in Belgium, presented at the European Society of Cardiology last month. British researchers studying years of data on implanted defibrillators found that the risk of ventricular arrhythmia—an abnormal heart rhythm that can lead to sudden death—rose 1.2% for every 1.8 degrees Fahrenheit drop, according to a study in the International Journal of Biometerology last month.

Once blamed on physically demanding tasks like shoveling snow, the increased heart risk due to cold may be due to thickening blood and constricting blood vessels, researchers think.

And rising humidity may cause joints to swell and stiffen. In fact, tendons, ligaments, muscles, bones and other tissues all have varying densities, so they may expand or contract in different ways in changing conditions, Dr. Jamison says.

In people with chronic inflammation from arthritis or past injuries, even slight irritations due to the weather can aggravate sensory nerve cells, known as nociceptors, that relay pain signals to the brain. That may explain why some people with neuropathic pain and phantom-limb pain also report weather-related flare-ups.

“Fibromyalgia patients seem to be the most sensitive,” says Susan Goodman, a rheumatologist at the Hospital for Special Surgery. She also notes that while some people seem to be extremely sensitive to weather, others with similar conditions aren’t, for reasons that aren’t clear. That may explain why many studies find no clear association, she says.

Some weather conditions seem to relieve pain. In one study, the warm, high-pressure Chinook winds common to western Canada lessened patients’ neuropathic pain, the kind brought on by disease or injury. For other patients, the same climate increased migraines and sinus headaches.

Some pain sufferers say they feel better in warm, dry climates where weather conditions seldom change. When she went to Israel in the 1990s, “I felt like I was 20 years younger when I stepped off the plane,” says Mrs. Polatsek, the rheumatoid-arthritis patient.

But studies haven’t consistently borne out the benefits of one climate over another. “There really is no place in the U.S. where people report more or less weather-related pain,” says Dr. Jamison. He surveyed 557 arthritis sufferers in four cities in 1995 and found that more than 60% believed the weather affected their pain—regardless of whether they lived in San Diego, Boston, Nashville, Tenn., or Worcester, Mass.

Visiting a warm, dry climate may bring temporary relief, Dr. Jamison adds. “But if you live there full time, your body seems to acclimatize and you become sensitive to even subtle weather changes.”

Write to Melinda Beck at HealthJournal@wsj.com

From Wall Street Journal : http://online.wsj.com/news/articles/SB10001424052702304500404579127833656537554

Activate Your Glutes! Here's How

By Megan Peach, DPT, OCS, CSCS
megan@excelptmt.com

Did you know?

The gluteal muscles are an important muscle group for everyday functional activities. The gluteus medius muscle acts to stabilize the pelvis during single limb activity such as going up or down stairs, balance exercises, and even walking. The gluteus maximus helps to maintain trunk control & propel the body forward during walking and running. A recent study in the February 2013 issue of the Journal of Orthopaedic and Sports Physical Therapy investigated gluteal muscle activation during specific exercises to determine which exercises were most effective in recruiting the glute medius & maximus while minimizing the recruitment of other substituting muscle groups.

This particular study found that a sidelying leg lift and side step exercise were of the top three most effective exercises for strengthening the gluteus medius, and the clamshell and single-leg bridge exercises were most effective for strengthening the gluteus maximus. Of these exercises, the clamshell, side step, and single leg bridge exercises were found to be less likely to recruit other musculature such as the tensor fascia lata (TFL).

Selkowitz DM, et al. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. JOSPT 2013; 43(2): 54-65

 

If you have specific questions about these exercises or would like to incorporate them into your home exercise program, please contact Megan Peach, DPT, CSCS at 406.556.0562.

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