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.
Matt Schumacher, DPT, OCS, MTC, CSCS received his Doctorate in Physical Therapy from the University of Mary in Bismarck, ND where he was recognized as a nominee for Outstanding Student Award in his physical therapy class demonstrating excellence in academics, volunteering, and servant leadership.
Matt is a Fellow-in-Training with Bellin College in collaboration with Evidence in Motion (EIM). The Orthopedic Manual Physical Therapy Fellowship program is a 3-5-year post-doctoral program that assists physical therapists in gaining the highest level of skill in manual therapy techniques, educating students and PTs, exhibiting sound clinical reasoning skills for optimal outcomes, and conducting clinic-based research.
Matt passed an exam from the National Strength and Conditioning Association (NSCA) with the designation of a Certified Strength and Conditioning Specialist (CSCS), providing advanced knowledge and experience with designing and implementing safe and effective strength training and conditioning programs. Matt completed a rigorous year-long program with Evidence in Motion (EIM) achieving his Manual Therapy Certification (MTC) gaining advanced training in mobilization and manipulation techniques for common diagnoses of the spine and extremities. Matt achieved the Orthopedic Clinical Specialist (OCS) advanced certification after extensive advanced training coursework and a stringent examination process from the American Physical Therapy Association.
Matt specializes in assisting individuals following post-operative rehabilitation, sports medicine rehabilitation, and orthopedic injuries/ailments of the spine and extremities utilizing advanced knowledge and skill with manual therapy and appropriate exercise prescription. One of his main interests includes the concept of “regional interdependence” where dysfunction in distant regions, both extremity and spine, may contribute to a patient’s primary complaint common in more complex situations. Matt is passionate to utilize this concept with the most evidence-based practices and techniques for optimal outcomes.
Matt enjoys outdoor activities and all that Montana has to offer including hiking, backpacking, wakeboarding, paddle boarding, and various sports with his wife and dog. Matt also has a passion for volunteering, where he recently led twenty-one physical therapy students with his wife on a two-week service project in Guatemala providing rehabilitation services to the surrounding communities.
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.
With the current state of things, many climbers who have not previously set up a hang board and/or training area at home are tackling these tools up at home and getting their hang on. Many others who had a routine of hanging at home prior to COVID-19 are back at it in full force. This is a great time to develop a more systematic approach to training.
Through this experience, trial and error has revealed some key points to consider when hanging at home. First and most important, how do you pull off a proper warm up without a climbing wall? I strongly believe your home warm up needs to be systematic to properly warm up while gauging how you’re feeling on a given day. It’s vital here to let go of your expectations (and ego) and to honestly assess your recovery from your previous bout of training. Sometimes you realize you’re feeling a lot better than you thought as you progress through your warm up. And sometimes you feel heavy and weak when you expected to feel great. Listen to your body and respect the process.
The first 20-25 minutes of your session should consist of a progression with light loading on larger holds trending toward the holds the given workout will emphasize. If you have the space and ingenuity to safely anchor a pulley set to offload some of your body weight (plenty of DIY info out there on this) this can be really helpful for warming up. For many this will enable you to train safely as your connective tissue in you fingers, hands and elbows adapt to this form of loading. You can also unweight your feet to progressively increase load keeping a little body weight on the floor, perhaps progressing to both or single tippy toe position.
Start with a set of 2-3 minutes with 10 seconds on, 10 seconds off hold times on a large 4-finger pocket edge or a jug on the top of the board. This should feel fairly easy; you should feel warmth in the forearms and hands but not enough strain to develop a pump. Take an equivalent timed rest period, 2-3 minutes. During this time you should perform active warm up drills for the upper body, perhaps a few push- ups or pull-ups, anything to get the blood flowing in the shoulders and arms. Repeat another warm up set, now 3 minutes in duration, still 10 seconds on, 10 seconds off but increasing the load or perhaps starting to decrease the hold size. Change one variable at a time and see how things feel. At the end of this set, you really want to feel the forearms working, working up to 60% effort to complete the set. Rest an additional 3-4 minute while performing continued dynamic upper extremity warm up drills.
For the last warm up set, I would recommend trending your on/off time to match the workout you are doing that day. A very common work out called repeaters involves 7 seconds on followed by a 3 second rest per rep. This set should be exclusively on the holds you are training on that day. I like to extend the rest time this set using 7 seconds on and 13 seconds off for the entire set to accommodate increased load. I find this fends off burning key energy needed for a successful workout while loading closer to the time and resistance for that given workout. This set should be 3 minutes and should be followed by a 5-minute rest prior to starting you workout for the day.
If you haven’t spent much time hanging recently you may surprise yourself and start the season stronger and more durable.
The Excel PT Climbing Lab exists to keep you climbing and improve your performance. We offer comprehensive injury management, video-based climbing analysis, and training plans.
Matt Heyliger, DPT, COMTof Excel Physical Therapy completed his Doctorate in Physical Therapy at Eastern Washington University in Cheney, Washington and is a Certified Orthopedic Manual Therapist. He has a particular treatment focus in the relationship of cervical/thoracic spine mechanics and upper extremity conditions. Matt treats climbers through integrating video analysis and specialized biomechanical assessments in the Excel PT Climbing Lab in the Bozeman, Montana clinic. An avid rock climber, telemark/backcountry skier and mountain biker, Matt regularly practices yoga and enjoys frequent adventures in the mountains with his family.
"Best group of PT's and office staff. Great sense of humor, professional, sincerely cares about patients' rehab, clean environment and very welcoming! Wouldn't go anywhere else! I've been going to Excel PT for 13 years." -- S.J., Bozeman Client
credit: Consilience_podcast Instagram
“Push & Pull…Essential ingredients for Running and Climbing” is AJ Sobrilsky’s latest article in the 
