Q: I fell yesterday walking and I have fallen a lot. All I can think of is, I am not picking up my feet enough? When I hit a crack or something I hit my toe and fall forward.
A: Sometimes that can be a strength thing, maybe your body is not strong enough, not that you can’t do it, but as you fatigue when you’re walking, you’re not lifting your feet as high because you are getting tired. So, your endurance might not be there in the lower extremity. It can be a multitude of factors…it could be your proprioception in the bottom of your feet aren’t picking up the cracks. A physical therapy evaluation can assess exactly what is causing your balance issues. As we get older, we tend to have balance issues that happen a little easier. We definitely don’t want you falling, especially outside on the hard concrete, that’s not a great place to be falling. Definitely worth a mention to your doctor or physical therapist about what you are experiencing so a plan can be put into place to help address this issue for you.
Q: I am someone who is dealing with peripheral neuropathy in my legs and feet, what do I do? Also, I am not able to lift my feet high enough when walking due to peripheral neuropathy.
A: So what you will want to do is uptrain like we talked about in that pie chart. We talked about a third, a third, and a third for vision, vestibular and peripheral neuropathy. The pie chart section that focuses on peripheral neuropathy is closing because you don’t have the sensation in your feet anymore. So you have to uptrain those other systems in order to compensate for the proprioception loss. Yes, it’s absolutely trainable. Not being able to lift your feet high enough is a strength thing, with peripheral neuropathy, you’re not going to change the peripheral neuropathy, you’re going to uptrain those other systems. It’s like a muscle making those other systems stronger, so you aren’t worried about the peripheral neuropathy impact as much.
Q: Is there somewhere we can access the charts that you were talking about?
A: The whole presentation will be loaded onto the Facebook page and the Excel website with the slides. (coming soon)
Q: What would you recommend as a call assist company for around your neck so if you fall you can get assistance?
A: With a little research online or by talking with family or friends, you can find one that will work with you. Recommendation given about Apple watch that asks if you have fallen and sends GPS tracking on where you are at if you don’t answer.
Q: Is there a booklet or something we can get with a detail view of different exercises we can build on for helping with resistance to falling?
A: A physical therapist can help determine a customized exercise program to help you with this. Also, tai chi, like yoga, is a great program to help with significant help on falling, some research showing up to 3 times a week has helped. Talk to your physical therapist, because we can have different deficiencies because you may be deficient in your quads and hamstrings somebody else may be deficient in their glutes. You may struggle with lifting your feet up and somebody else will struggle when they start doing head turns so getting a really specific exercise program is probably the best advice, so you’re not wasting your time so you’re not working on exercises you don’t need to work on.
Q: Does Medicare cover balance training?
A: Yes, Medicare does cover balance training during a physical therapy appointment.
Q: Do you have suggestions on footwear?
A: Making sure you are in a footwear that you are comfortable walking in. Something that isn’t bulky or has a high heel on it or has a big thick sole on it where you can get it caught on cracks in sidewalks. Flip flops, sandals in the Summer time are going to be hard to justify because they can slip on feet and effect balance. Specific footwear would be something to talk to your physical therapist to get headed in the right direction.
Q: Height of chair seat for a sit to stand desk?
A: There is a standard height, generally the measurement is dependent on height of the person using the desk. A physical therapist can help you determine the ideal measurements best suited for your positioning needs.
Q: Balance with a new hearing aid?
A: Vestibular system is a big part of our balance system that contributes to balance and having a new hearing aid can throw of your balance because things are different for you.
Jackie Oliver, DPT, OCS completed her Doctorate in Physical Therapy at the University of Utah in Salt Lake City, Utah, one of the top Physical Therapy schools in the nation. She was fortunate enough to complete her clinical rotations and begin her physical therapy career within the University of Utah system, which is consistently ranked near the top in healthcare. Exposed to a wide variety of orthopedic conditions, Jackie is confident when assessing and treating a broad range of orthopedic impairments. Jackie is a certified dry needling provider with advanced training from Evidence in Motion and KinetaCore. Jackie achieved the Orthopedic Clinical Specialist advanced certification after extensive advanced training coursework and a stringent examination process from the American Physical Therapy Association.
Jackie has an intense passion for helping and educating others as well as preventative medicine. Because of her college sports background, Jackie loves working with athletes and has experience with biomechanical training and injury prevention in sports. She is also trained as a Diabetes Lifestyle Coach and has worked for the University of Utah and CDC helping individuals decrease their risk of developing diabetes.
Prior to completing her Doctorate in Physical Therapy, Jackie played basketball for Carroll College in Helena, Montana, while also obtaining a Bachelor of Arts degree in Health Science. Jackie was Academic All-American her last two years at Carroll.
Complimentary injury consultation sessions will help determine the best injury treatment options & plan to help return the injured student athlete back to the game healthy & strong.
Includes:
Thorough history of athlete and review of injury
Injury screen looking at strength, mobility, stability and impairments
Education for athlete and parent/guardian on nature of symptoms and best course of treatment (PT, referral to MD, home rehabilitation program)
Call 406-284-4262 to schedule your complimentary student athlete injury consultation.
What Goes Up Must Come Down — Jason and AJ will be covering injuries in backcountry skiing & split boarding, how to minimize your risk of injury, and how to maximize your performance this winter.
Tune in this Thursday (10/22), 6pm as we broadcast live from Uphill Pursuit’s Instagram and Facebook pages – see you soon!
Bring your questions! Jason and AJ will be answering questions in the IGTV comments section under the broadcast.
Coming in November – Live on Zoom
In case you missed the live Uphill Pursuit collaborative broadcast – Simply click on the image above to watch Excel PT Climbing Lab’s awesome Transition to Climbing discussion. There’s a lot of very useful information to help you navigate the change of seasons as well as the change in loading and demand that shifting from outdoor to indoor climbing or rock to ice will introduce.
Excel Climbing Lab Doctors of Physical Therapy AJ Sobrilsky and Matt Heyliger offer insights on how to maximize training yields while minimizing injury risks.
The Excel Team extends support to you during this challenging season. Enduring together and drawing on resilience will help us get thru this COVID-19 time together. We are here for you in many ways –telehealth and in-clinic appointments, by phone or email–to help you anyway we can. #enduringtogether
Please enjoy Consilience with John Onate’sPart 2 podcast with Nikki Kimball: Maintaining A Love For Running through Injury and Adversity.
Nikki uses a combination of humor, friendship, medical advice and compassion to overcome injury, aging and now the pandemic. As John Onate says, there is a lot to learn from Nikki Kimball. The Excel PT Team completely agrees!
Nikki Kimball is one of the most competitive and successful Ultra-Endurance Athletes in the history of Road and Mountain-Trail-Ultramarathon racing:
2nd place, Hardrock 100, 2018
2nd place, HURT 100m, 2017
2nd place, Big Horn 100m, 2016
1st place, Marathon Des Sables, 2014
Western States 100 Champion 2004, 2006, 2007
Ultra Trail du Mont Blanc 108 Mile,Champion, 2007
Member of United States 100K Team 2001-2006; 8th overall and 1st American at World Cup 2003, Tainan, Taiwan; 7th at World Cup 2005; scoring member of gold medal 100K team at World Cup 2005
We are honoring National Suicide Prevention Week by sharing this podcast episode from Consilience with John Onate who features Nikki Kimball from the Excel PT Bozeman running clinic team. Nikki is one of the most competitive and successful Ultra-Endurance athletes in the history of Road and Mountain-Trail-Ultramarathon racing (and one of the kindest and smartest people we know).
In this episode from the keynote presentation to the Central California Psychiatric Society Annual Meeting in 2016, Nikki discusses how depression, medicine, doctors, running and physical therapy have impacted her life, career and advocacy mission. Mature themes discussed.
As John Onate says, We all can learn and be inspired by Nikki Kimball. We completely agree!
AJ Sobrilsky, DPT, OCS is a Physical Therapist and Orthopedic Clinical Specialist in our Bozeman clinic. AJ specializes in the rehabilitation and prevention of orthopedic sports related injuries with a specific interest in the management of those involving the upper and lower extremities. AJ received his Doctor of Physical Therapy Degree from Carroll University (Waukesha, WI). Following the completion of his DPT degree he participated in an Orthopedic Residency through Evidence in Motion at Bellin Health in Green Bay, WI providing him with advanced training in orthopedic manual therapy, clinical decision making, and patient centered treatment. Following completion of his residency AJ became an Orthopedic Clinical Specialist (OCS) through the American Physical Therapy Board Association and received advanced training in dry needling for spine and extremities.
AJ has been a lifelong athlete, competing in cross-country and track through college and then racing competitively post collegiately. As a result of his personal experiences and passions, AJ has focused his continued education and clinical development around the athletic individual with an emphasis in: running, skiing, and climbing related injuries. AJ has had the opportunity to provide care for an array of athletic populations including youth sports teams, high school and collegiate athletes, and those competing at professional and Olympic levels.
AJ’s treatment philosophy emphasizes a collaborative patient centered approach. Structured around the patient, supported by current best evidence, and coupled with specialized exercise/techniques, AJ hopes to educate the patient on their current issue and provide them with the best course of treatment to return to their previous/desired level of activity.
When AJ isn’t working he is usually pursuing his next adventure: rock climbing, skiing, mountain biking, or running.
Excel Physical Therapy’s Bozeman and Manhattan clinic COVID-19 Precautions for us all to stay safe and healthy.
Thank you for your patience and accommodation.
All physical and massage therapy patients are asked to wear a face covering (mask, bandana, or scarf) when attending in-clinic appointments effective June 22.
This requirement does not apply to individuals who are unable to wear a mask or face covering due to a medical condition or to children under the age of 2. If you are hard of hearing, deaf and read lips, please notify us at check-in so we can accommodate you. We have transparent face masks arriving soon for our staff members to wear for you.
If you do not have a face covering upon arrival to the clinic, we will provide one for you. Please wear a face covering for your next in-clinic appointment so we can reserve supply for staff and patients in most need.
We are wearing face masks as staff members each day.
We are disinfecting patient, therapist and staff contact surfaces vigilantly on an hourly basis and after each patient interaction. We have a dedicated team member who is disinfecting the clinic and equipment constantly.
We ask our screening questions when scheduling appointments on the phone and as soon as you arrive for your in-clinic appointment.
We are checking patient temperatures before each in-clinic appointment check in.
We are checking staff temperatures before each shift.
We are not allowing any individuals to enter our clinic with ANY illness type symptoms or symptoms of COVID-19: fever, cough, difficulty breathing, flu-like symptoms like chills, fatigue.
We are having our patients and therapists wash their hands thoroughly before and after each visit.
We have staggered patient appointments for social distancing practices.
Visitors or guests are not allowed to attend in-clinic appointments with a patient (unless the patient is a minor, then only one parent/guardian please).
If you have been diagnosed and recovered from COVID-19, please provide our front office team with your health provider’s clearance letter before attending your in-clinic appointment.
Please do not come to your in-clinic appointment until you have received health provider clearance if you have experienced virus exposure in the following ways (we are happy to do a video telehealth appointment in the meantime):
Diagnosed with COVID-19 that has not been classified as “recovered”
Close contact with an individual confirmed to have COVID-19 by lab testing or with a presumptive diagnosis of COVID-19.
Living in a house with anyone having symptoms consistent with COVID-19
Please let us know if you have any concerns or questions as we all proceed together through Governor Bullock’s phased reopening of Montana. Your feedback and suggestions are welcome and appreciated. Please direct inquiries and comments to info@excelptmt.com.
Who’s ever picked up a golf club and tried to knock it stiff from 130 yards out? That’s a tough feat to accomplish; a skill one might say. In fact, I’d argue that consistently hitting a golf ball where you want it to go and how you want it to look is one of the most difficult skills to develop.
That’s probably why most professional golfers, and high caliber athletes across the sports world, spend more time practicing and developing the skills of their specific sport than they do truly competing and playing. In fact, in David Epstein’s book “The Sports Gene,” there is a lot of discussion about practice, talent, and the genetics surrounding athletic performance. This is a highly recommend read or listen to if you’re looking for a good new book and it might help us all understand a little better our true capabilities and athletic realities (He also has a lot of podcasts as well as a Ted talk.Click here to listen.
In the running world, there are those few individuals born with a unique physiological make up and a somewhat specific set of anatomical ingredients that lend them performance capabilities. But, that doesn’t mean there aren’t specific contributors to performance and skill development that can’t be modified, practiced, and fine-tuned to become your own best version of yourself. Sure the best runners are the ones spending a lot of time running and logging a lot of miles. Which leads a lot of us to come to the conclusion that in order to be our own best we need to run a lot. While increasing volume will improve your economy and times to some degree, it’s ultimately not the best solution.
The old fallacy of more is better doesn’t hold true, at least not always. We can put time and effort into developing a bigger engine (cardio system, stronger muscles, more resilient mental game), but if we can’t control that engine and the forces it’s willing to produce, it’s useless. For instance, it’d be a bad idea to strap a jet engine onto a paper airplane or try to shoot a cannonball from a canoe. We need the right structure, skillset, and control to put these ingredients and tools to effective use.
What do the best athletes in the world have in common (beyond the best genes)? They train, refine, retool, and practice the skills required for their specific activity. Unlike a lot of other sports, running doesn’t have a whole lot of diverse movements like soccer or climbing. This ultimately confines our exposure to different movements and limits our breadth of exposure and adaptability to forces outside the confines of the running gait. On the other side it also means we have a pretty consistent recipe or set of instructions for developing the best gait pattern and running movement strategy (all relatively dependent on our own unique set of factors).
Jay Dicharry, a leading physical therapist and biomechanics researcher, delivers this message well when he says, “There are a lot of things that all runners of all abilities should be doing outside running to improve their running. If you want to run better, you need to move better”. Essentially that the winner isn’t always the one who stacks up the most Strava KOM/QOM’s but rather the ones who have put time into developing and practicing the essential movement skills; allowing them to avoid injuries and ultimately providing optimal consistency in training.
Running is essentially a fluid series of single leg jumps. The ability to produce enough force to drive your leg into the ground and propel yourself up and forward. To then coordinate the appropriate movements in the flight phase (while you’re going from step to step) in preparation for landing. And to then absorb 2-3 times your body’s weight through one leg, restoring that energy, and preparing to do it all over again in less than 0.4 seconds for each and every step throughout the duration of the run.
So yes, running is a skill. What can you do to move better and become a more skilled runner?
Before we dive into the specifics on the ingredients and tools required to address the skills of running, here are a few key essential components to practice during your next few runs:
Don’t Overstride: A lot of runners make the mistake of overstriding: putting their foot out too far in front of their center of mass. When a runner overstrides or reach, they increase their braking impulse and essentially slow themselves down with each strike. This is an inefficient way to run and significantly increases the amount of impact your body has to absorb. Therefore, overstriding can often lead to injury. To avoid overstriding, avoid reaching your leg forward and try to strike just in front of your center of mass.
Cadence: Cadence is the number of steps you take while running. A slower cadence (or taking fewer steps per run) can be indicative of overstriding. Therefore, working on your cadence can be one way to improve your efficiency and reduce overstriding. Every runner will have a different cadence, but in general efficient runners run with a cadence between 176-188 steps/min. To work on your cadence, use a metronome app or setting on your watch and try and time your foot strikes to the beat of a metronome for 2-3 minutes. Then relax into your run for 2-3 minutes. Repeat 3-5x throughout your run. Remember this is a drill to improve skill, so use it as a drill and don’t perform with every run or for your entire run.
Try not to bounce: Much like overstriding, a bouncy gait is inefficient and can lead to injury. If you have a bouncy run, you are wasting energy pushing up rather than pushing forward. This also means your mass is landing from a higher height, increasing impact. To avoid a bouncy gait, drive your leg back pushing you forward and not up. Centering your gaze on a landmark ahead of you and as you run try and keep the landmark as still as possible .
Drive from the hip and push from the ankle: The gluteus maximus is the biggest muscle in the human body. This is a big ingredient in the recipe to effectively and efficiently drive us forward with each step. Sometimes runners rely too much on their calves and quads to propel them. This typically leads to overstriding and the bouncy gait described earlier. Therefore maximize your running efficiency by driving from the hip using the gluteus maximus; making sure not to arch at the lower back. Practice striding by driving/pushing from the glutes while stabilizing through your core to avoid your back from arching.
Here at Excel PT, Our running physical therapist team works with runners every day in our Running Clinic. It’s like a specialized clinic within a clinic. We’re here to help you develop these strategies to help improve your running skills and performance as well as help you prevent injury.
AJ Sobrilsky, DPT, OCS is a Physical Therapist and Orthopedic Clinical Specialist in our Bozeman clinic. AJ specializes in the rehabilitation and prevention of orthopedic sports related injuries with a specific interest in the management of those involving the upper and lower extremities. AJ has been a lifelong athlete, competing in cross-country and track through college and then racing competitively post collegiately. As a result of his personal experiences and passions, AJ has focused his continued education and clinical development around the athletic individual with an emphasis in: running, skiing, and climbing related injuries. AJ has had the opportunity to provide care for an array of athletic populations including youth sports teams, high school and collegiate athletes, and those competing at professional and Olympic levels.
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 in our Bozeman clinic. Jason is a Specialist in Sports Physical Therapy and serves as a physical therapist for the US Snowboarding and US Freeskiing teams, along with the US Paralympic Nordic Ski Team, and is a local and national presenter on sports rehabilitation and injury prevention topics. Jason is a Certified Clinical BikeFit Pro Fitter and co-owner of Excel Physical Therapy.
credit: Consilience_podcast Instagram
“Push & Pull…Essential ingredients for Running and Climbing” is AJ Sobrilsky’s latest article in the 
