Not sure why your feet are hurting? Or which kind of shoe will help? Join us at Schnee’s Boots Shoes & Outdoors, Thursday April 14th from 7-8pm for a Foot Health Seminar. Megan Peach, Chad Yoakam and Jason Lunden of Excel Physical Therapy will be discussing “Foot and Arch Myths and How They Impact Your Movement”. Special Guest, Scott McCoubrey of Scott Footwear. Bring your questions for Q&A after the talk. See you at Schnee’s Montana!

Outside Bozeman Spring 2016Check out the latest issue of Outside Bozeman for Jason Lunden, DPT, SCS’ article, “Hip to Be Cool” to review the principles of running injury prevention to keep your running season injury-free.

http://www.outsidebozeman.com/magazine/archives/spring-2016/hip-be-cool

Why wait until after you are injured to see a physical therapist? Did you know that a great time to see a physical therapist is before you are injured? I recently evaluated a patient who wanted to see a physical therapist to learn a home exercise program to prevent future episodes of low back pain. Orthopedic physical therapists are trained in injury prevention and recognizing range of motion or strength deficits that may lead to a future injury. A comprehensive home exercise program can address deficits, ensure proper mechanics, and build strength to reduce the risk of future injury especially for those involved in athletics or repetitive movements. Runners, soccer players, skiers, and people who frequently lift heavy items are all great candidates for a physical therapy evaluation before an injury occurs!

Megan Peach, DPT, OCS, CSCS specializes in manual treatment of spinal dysfunction, as well as knee and shoulder pain. After receiving a Bachelor of Science in exercise science from Montana State University, Megan earned a doctorate in physical therapy from Duke University. Post-graduation, Megan became a Certified Strength and Conditioning Specialist and is a member of the National Strength & Conditioning Association. Shortly thereafter, Megan completed the Kaiser Permanente Residency program in advanced orthopedic manual physical therapy in San Francisco, California. Megan received the advanced Orthopedic Certification Specialization (OCS) after passing a rigorous exam from the American Physical Therapy Association’s American Board of Physical Therapy Specialties. If you have specific questions about how to strengthen, restore, or get back to what you love to do, contact us at Excel Physical Therapy, 406.556.0562 in Bozeman, Montana or 406.284.4262 in Manhattan, Montana. #excelptmt

Due to the repetitive stress from poling, Nordic skiers can develop overuse injuries of both the elbow and/or the shoulder. The most common of these are medial epicondylitis and shoulder impingement syndrome.   The underlying cause of the development of these injuries is multi-factorial: poling technique, pole length, and poor strength and conditioning.  

Shoulder impingement syndrome is caused by underlying weakness of the rotator cuff and muscles around the shoulder blade.  This underlying weakness causes impingement or pinching of the rotator cuff between the humerus and glenoid (ball and socket of the shoulder joint), which can be further exacerbated by poor poling technique.  Therefore to prevent developing shoulder pain during your Nordic ski season, make sure you incorporate strength and conditioning of your rotator cuff and periscapular musculature.

Medial epicondylitis is an irritation of the tendon of the wrist flexors and presents as pain on the inside of the elbow.  This irritation is caused by repetitive stress to the tendon mainly from poor poling technique, but also from underlying weakness of the wrist flexor muscles.   Thus prevention of medial epicondylitis can be achieved through working on your poling technique and ensuring you have proper forearm strength.

See More Injury Prevention in Nordic Skiing: Knee Pain

See More Injury Prevention in Nordic Skiing: Lower Back Pain

See More Injury Prevention in Nordic Skiing: Technique

 

Jason Lunden, DPT, SCS specializes in the rehabilitation and prevention of sports-related injuries, with a particular interest in the biomechanics of sporting activities – running, cycling, skiing, snowboarding and overhead athletics. He has published on the topic of shoulder biomechanics and the rehabilitation of knee injuries and has a strong commitment to educating others. Jason serves as a physical therapist for the US Snowboarding and US Freeskiing teams and is a frequent, well-received local and national presenter on the topics of sports rehabilitation and injury prevention. If you have specific questions about how to strengthen, restore, and get back on the slopes and trails, contact us at Excel Physical Therapy, 406.556.0562 in Bozeman, Montana or 406.284.4262 in Manhattan, Montana. #excelptmt

Low back pain has been found to be more common in cross-country skiers, than non-athletic controls1.   Compared to skate skiing, low back pain is more prevalent in classic skiing because of the repetitive flexion-extension loading pattern of double poling.  In addition to making sure your technique is sound, it is important to make sure you have adequate core abdominal, hip, and spinal extensor strength.  So make sure you incorporate proper core and hip strengthening in to your training.  Furthermore, improving hip flexibility has been shown to decrease the rate of low back pain in Nordic skiers2.  Hip flexor flexibility is especially important, so make sure to incorporate hip flexor stretching as part of your normal routine.

1Bahr R, Andersen SO, Løken S, Fossan B, Hansen T, Holme I. Low back pain among endurance athletes with and without specific back loading–a cross-sectionalsurvey of cross-country skiers, rowers, orienteerers, and nonathletic controls. Spine (Phila Pa 1976). 2004; 29(4):449-54.

2Alricsson M, Werner S. The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study. Br J Sports Med. 2004;38(2):148-53

See More Injury Prevention in Nordic Skiing: Technique

See More Injury Prevention in Nordic Skiing: Elbow & Shoulder Pain

See More Injury Prevention in Nordic Skiing: Knee Pain

 

Jason Lunden, DPT, SCS specializes in the rehabilitation and prevention of sports-related injuries, with a particular interest in the biomechanics of sporting activities – running, cycling, skiing, snowboarding and overhead athletics. He has published on the topic of shoulder biomechanics and the rehabilitation of knee injuries and has a strong commitment to educating others. Jason serves as a physical therapist for the US Snowboarding and US Freeskiing teams and is a frequent, well-received local and national presenter on the topics of sports rehabilitation and injury prevention. If you have specific questions about how to strengthen, restore, and get back on the slopes and trails, contact us at Excel Physical Therapy, 406.556.0562 in Bozeman, Montana or 406.284.4262 in Manhattan, Montana. #excelptmt

I have recently been thinking quite a bit about the importance of joint mobility, not strictly for function, but for joint health. In manual therapy, assessment of a given joint in the body always consists of consideration of joint mobility. Is there enough mobility? If not, why not? Does the joint itself have a motion restriction? Or is there perhaps some tissue outside the joint, like a tight muscle, that is limiting mobility? While it makes sense that a certain degree of motion is important for functional tasks, like bending your knee a certain amount to ascend stairs, mobility is also critical for joint health.

Joint pain is often accompanied by some loss of joint mobility. While it may be possible to get by with a small loss of motion this may be taking its toll on your joint. Taking a joint though it full available motion is critical to providing nutrition to a joint. Nutrients and metabolic waste products are housed in a joint’s synovial fluid and are moved in and out of a joint through motion. Each joint has a position, either fully bent or fully straight, that provides the most narrowing of the joint space. This position in physical therapy is called the close-packed position which allows the joint to excrete waste products. This in turn provides room to draw nutrients into the joint through the joint capsule. When one loses the ability to close-pack a joint it can lead to a slow degenerative process resulting in conditions like osteoarthritis and pain.

This principal applies to the smallest joints at the tips of the fingers, to the joints in the spine, as well as to larger joints like the shoulder and knee. If you have a joint that seems to be getting stiff consider having this assessed by an orthopedic professional. Preserve the motion of your joints and you will be taking an important step to promoting good joint nutrition and health.

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About Matt Heyliger, DPT: Matt completed his Doctorate in Physical Therapy at Eastern Washington University in Cheney, Washington. During his clinical experience with the Sports Medicine and Extremities team at The Orthopedic Specialty Hospital in Salt Lake City, Matt was exposed to a wide variety of surgical and non-surgical conditions and developed a solid foundation for the assessment and treatment of orthopedic conditions related to the extremities. Prior to completing his Doctorate of Physical Therapy degree, Matt obtained his Bachelor’s Degree in in philosophy at the University of California, Santa Barbara.

 
Matt has developed a specific interest focus in biomechanics and how impairments at one level or joint affect other body structures. More specifically, he has a particular interest in the relationship of cervical/thoracic spine mechanics and upper extremity conditions. Matt is an avid rock climber, telemark/backcountry skier and mountain biker. Matt regularly practices yoga and enjoys frequent adventures in the mountains with his wife and their Alaskan Malamute.
 
Matt treats patients out of the Excel Physical Therapy offices in Bozeman and Manhattan, Montana offices. You may schedule an appointment with him at 406.556.0562 (Bozeman) or 406.284.4262 (Manhattan).

Excel PT Matt Spire Climbing Injury Screens Facebook JpegClimbing unquestionably takes a toll on the body and many if not all climbers end up dealing with some type of injury each season. When our bodies tell us a break from climbing is mandatory, we often make the mistake of not correcting the biomechanical factors that made us vulnerable to injury in the first place. Often times these predisposing factors are easy to correct with proper assessment and the right treatment plan.

Screening includes:

Each screening will be approximately 15-20 minutes long so please be prompt.

Sign up online at the following link: www.spireclimbingcenter.com/onlineregistration

Scroll to Events and select the FREE Injury Screening link and fill out the appropriate information.

Matt Heyliger, DPT is a physical therapist with Excel Physical Therapy and an avid rock climber.

 

 

 

 

There is no doubt that leg length differences (LLDs) exist, but a lack of agreement exists about diagnosing the condition, their functional importance, and how to treat them.  How many of us have been to the physical therapist, massage therapist, or chiropractor and were told that our legs were not of equal length?  Lying face up on the exam table, we ponder what to do about this recent revelation.

Most experts agree that 0.5 centimeters (1/8 inch) or less of leg length difference is not significant.  Furthermore, most clinicians agree that mild to modest discrepancies should not be corrected in the absence of pain or dysfunction.  If it doesn’t hurt, then don’t fix it.  But what if the difference is causing problems?  How reliable is a clinician’s assessment of your LLD?

LLDs can be either anatomical or functional.  An anatomical LLD is present because of a structural (bone; cartilage) difference, comparing one leg to the other.  For example, an individual may have broken a bone in his or her leg at a young age, creating a disturbance in the growth plate, ultimately leading to an alteration in that bones final, mature length.  A functional leg length occurs when a limb only presents longer or shorter because of being forced into this position by changes in muscles or other soft tissues of the low back, hips, or feet.   Tight muscles in the right side of your low back can draw up the right leg, making it present as shorter. 

Clinically, physical therapists can pick up a LLD by looking at your leg lengths in standing and lying down with the use of visual inspection and tape measurement.  There have been several studies looking at the accuracy of LLD clinical assessment and the evidence seems to point towards our ability in picking up these discrepancies.  However, clinical accuracy is limited.  I can say “Mrs. Jones, your left leg is around 1 to 1.5 centimeters longer on the right.”  I cannot say “Mrs. Jones, your left leg is exactly 1 centimeter longer on the right.”  Only obtaining an x-ray or CT-Scan of the legs can give you a fairly accurate number on LLD.

Most of us are walking around with some type of LLD, which is more likely functional, rather than anatomical.  Don’t be surprised if someday you are told that one leg is longer or shorter than the other.  In the presence of pain, a LLD can be addressed by placing a heel lift in the shoe or adding to the sole on the outside of the shoe.  Use caution when correcting a LLD.  A good rule of thumb is to correct for no more than ½ of the suspected LLD and only make an alteration of 3 to 5 millimeters at one time.  Wait several weeks to month a month before trying additional lift height.  Your physical therapist or other health care professional can assist you in this process.

To reach David Coletta, MPT, CMPT with any LLD questions, please contact him at “david at excelptmt dot com” or call our Excel Physical Therapy Bozeman office at 406.556.0562.

Do you have patellofemoral knee pain? A recent study by Christopher Powers et al. in the Journal of Orthopaedic & Sports Physical Therapy suggests that knee angle during quadriceps strengthening exercises affects patellofemoral joint stress. Because excessive joint stress may contribute to patellofemoral pain, the author’s purpose was to determine which exercises were minimally stressful to the knee.

                                                                                                       

During the squat exercise, joint stress was the least in the standing position, and increased as a subject descended into the squat position, peaking at 90 degrees of knee flexion. In an open chain seated leg extension exercise the joint stress was variable depending on the type of weight used, however joint stress was generally greater when the leg was fully extended.

 

The authors suggest that a squat exercise from standing to 45 degrees knee flexion coupled with an open chain seated leg extension from 90 degrees to 45 degrees knee range of motion is the best combination to minimize patellofemoral joint stress and therefore strengthen the quads without increasing pain.

 

We can help you if you suffer from patellofemoral knee pain. Call us at 406-556-0562 (Bozeman) or 406-284-4262 (Manhattan). 

Plantar Intrinsic Training

by Matt Heyliger, DPT, Excel Physical Therapy

Over-pronation (the inward roll of the foot while walking or running) is a common contributing factor in the development of several lower extremity injuries including plantar fasciitis, Achilles tendinopathy, patellafemoral knee pain and other overuse conditions. Recent research addressing the contributing factors to the development of plantar foot pain (pain at the bottom of your foot) has emphasized the importance of training the muscles of the foot to keep the arch from collapsing inward. It has been proposed that the intrinsic plantar muscles of the foot play a similar role in arch preservation as the core muscles play in the stabilization of the trunk and spine. This concept provides a great foundation for direct treatment of conditions associated with over-pronation.

 

A recent study by Mulligan and Cook, published in the journal “Manual Therapy,” presented this concept and sought to test if the performance of a series of exercises (named “Short Foot Exercises”) directed at isolating the recruitment of the plantar foot muscles could decrease pronation after four weeks of training. They discovered a small, but significant difference in arch height and these differences were preserved after eight weeks without continued training. While these exercises are tedious and initially challenging, our patients here at Excel Physical Therapy are responding well to these exercises. If you have been dealing with plantar foot pain and are not responding to other therapies or orthotics, consider training the “core” of your feet with Short Foot Exercises.

 

Be sure to contact a licensed health professional before starting any exercise plan and for a thorough evaluation or diagnosis of your issue. We can help. Call us in Bozeman at 406.556.0562 or in Manhattan at 406.284.4262.

 

About Matt Heyliger, DPT:

Matt completed his Doctorate in Physical Therapy at Eastern Washington University in Cheney, Washington. During his clinical experience with the Sports Medicine and Extremities team at The Orthopedic Specialty Hospital in Salt Lake City, Matt was exposed to a wide variety of surgical and non-surgical conditions and developed a solid foundation for the assessment and treatment of orthopedic conditions related to the extremities.
Matt is an avid rock climber, telemark/backcountry skier and mountain biker. Matt regularly practices yoga and enjoys frequent adventures in the mountains with his wife and their Alaskan Malamute.

 

"Just when I thought that no one and nothing could help me take away the numbness in my fingers and neck pain, enter David Coletta and his treatment plan for me. A combination of dry needling, manipulation and mobilization treatments and several exercises have increased my range of motion and eliminated my neck pain and finger tingling. I couldn't believe this could actually work but it truly has. All the good things I've heard about David are true--he really is a master! Thank you to this entire group of great people at Excel PT for helping me feel much better." --Bozeman neck patient

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