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Deep Vein Thrombosis: Everything you need to know about diagnosis and prevention. 

By Jackie Oliver, DPT
jackie@excelptmt.com

A deep vein thrombosis (DVT) occurs when a blood clot or thrombus forms in one of your deep veins due to slow moving blood. Most often a DVT occurs in the calf or lower leg, however a DVT can also form in other regions of the body such as the arm. Learning what puts you at risk for developing a DVT, as well as being able to identify the signs and symptoms associated with this medical condition is important for prevention of more serious complications like a pulmonary embolism (blocking blood flow to the lungs).  

The signs and symptoms of a DVT can include swelling in the affected leg, usually in the calf. This will normally feel sore and tender to touch. You may also see redness and warmth associated with the swelling. The hallmark sign of a DVT is that the pain does not increase or decrease with a change in position. DVTs can mimic a musculoskeletal injury like a calf strain without other symptoms like swelling and redness. The thing to remember is that a calf strain would have a mechanism of injury or a specific onset, whereas a DVT would have a history of prolonged sitting or recent surgery.  

Risk factors that increase the likelihood of developing a DVT include: a recent surgery, prolonged bed rest, pregnancy, smoking, age or sitting for long periods of time like when you are driving or flying.

If you find yourself in one of these categories there are a few measures you can take for prevention: 

1.) Avoid sitting still for prolonged periods. If you do have to be sitting or immobile for prolonged periods such as long plane flights or being laid up in bed recovering from a surgery or sickness, try pumping your feet up and down to get your muscles working and the blood flowing in your legs. 

2.) Wearing compression stockings during periods of immobility can help decrease the risk of developing a DVT. Talk to your doctor or physical therapist about getting compression stockings for travel or after surgery. 

3.) Regular exercise can also lower your risk of blood clots. A new study published by the Journal of Thrombosis and Haemostasis states that participation in sports, regardless of intensity, can lower your risk of developing blood clots by up to 39%. Regular exercise also decreases your BMI, which can also lower your risk.  

If you think you have symptoms related to a DVT it is important to get it checked out at an Urgent Care or Emergency Department as soon as possible. Your doctor will be able to detect a DVT using compression ultrasonography and will treat accordingly. DVTs can be a serious health problem but knowing the signs and symptoms can help prevent complications. Discovered early, complications from DVTs are preventable and easily treatable. 

 

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Jackie Oliver, DPT has an intense passion for helping and educating others as well as preventative medicine. Because of her college sports background, she loves working with athletes, biomechanical training and sport injury prevention. 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. Jackie is a certified dry needling provider with advanced training from Evidence in Motion and KinetaCore. Jackie also leads our Work Site Solutions programs.

 

5 Things I'd Like You to Know Before Your First Visit

By Bobby Bemis, DPT, COMT, DIP. MT, FAAOMPT
bobby@excelptmt.com

What is physical therapy? How can it help me? What should I know? What role do I play in it? What if I don’t like going to the gym? Will it hurt? How do I know if I need it? What if I don’t like being touched? What if I don’t like exercising? Is it a quick fix? Maybe I should just get surgery? What if I can’t be helped? Maybe I just need to be tougher? Do I need therapy if my medication helps the pain?

I am guessing that if you are reading this article that you have asked yourself one or more of these questions before. Most of my patients have and it can be incredibly overwhelming. I am here to help you navigate the physical therapy world and maybe even a little of the healthcare world in general.  

Full disclosure. I am biased. I love physical therapy. I love that a generally non-invasive form of healthcare can benefit so many. I love that like so many things in life you often get out what you put in. I love that physical therapists, in general, are empathetic, positive, altruistic people that want nothing more than to see people walk out of the clinic in a better place than when they came in. This blog is for those of you who aren’t quite sure what to expect regarding physical therapy and how you can take advantage of what it has to offer.  

Physical therapy has undergone a major evolution over the past decades. Long gone are the years of using treatment time to primarily administer modalities (e.g. ice, heat, ultrasound, tape, etc.). No longer do we regard injuries as a purely physical experience and ignore all the other components of a person that can impact their pain and dysfunction. Physical therapists and hopefully other healthcare professionals now view patients in what is called a biopsychosocial framework. That means your pain is not only impacted by biological factors (e.g. arthritis) but psychological factors (e.g. anxiety) and social factors (e.g. a fight with your spouse). This framework continues to be supported by more and more high-level research from all over the healthcare world.  

Physical therapists are musculoskeletal experts and gateway healthcare practitioners. What does that mean? When it comes to musculoskeletal issues you will be hard pressed to find another healthcare professional that is better at diagnosis and treatment of these conditions. As gateway healthcare practitioners physical therapists have the ability to see patients without a referral and we are educated on how to screen for other medical conditions that may not be appropriate for physical therapy. In these cases, we can refer to specialists that have expertise in the appropriate area of care.  

Physical therapy can help you organize the complex and confusing world of today’s healthcare resources and options. Do you need to see a surgeon? Do you need to see a non-surgical orthopedic physician? Would you benefit from massage therapy? Would you benefit from consultation regarding a steroid injection? Could you benefit from some mental health counseling? Would a registered dietician be helpful? Or are you just where you need to be…in physical therapy?! 

Here’s 5 suggestions/recommendations regarding your first visit for physical therapy: 

  1. Come prepared. If you feel like you might be anxious, overwhelmed or nervous take the time to write out any questions you may have before your visit. That way you can refer to your notes when your mind goes blank.  
  2. Come with an open mind. Try to put aside any prior experiences you have had with the healthcare system.  
  3. Don’t get too fixated on imaging. Imaging is good at ruling things out but not great at ruling in things that are causing your pain. There is not a good correlation between tissue degeneration and pain…so be careful.  
  4. Remember that all pain is perceived in your brain…so your pain can change depending on the state of your mind. There are techniques and strategies to address neurological pathways that may have developed over time that negatively impact your pain.  
  5. Physical therapy is an active endeavor. It is very rare that a physical therapist can magically fix your pain or dysfunction in one visit. My goal is to get you back out there ASAP…but it will not happen overnight and will not be done passively.  

One of the biggest complaints I hear from patients regarding health care professionals, in general, is that most don’t listen and they lack empathy. Keep in mind that as a physical therapist at Excel Physical Therapy, I have 45 minutes to do the best I can to figure out what is going on and how to best provide you with the tools to improve and get better. To steal a line from the psychologist and author Malcolm Gladwell we must use “thin-slicing” to help us figure out the best path for our patients. That means that a good therapist or healthcare practitioner will skillfully direct the conversation to get the information that will allow them to best figure out a plan of care that can best impact the patient for the better. We want to hear your entire story and we will…over time.

One of the beauties of physical therapy is that we spend more one on one time with patients than almost any other healthcare profession. If you are honest with yourself and take into account your biological, psychological and social factors that may bias your opinion toward your healthcare practitioner and you still feel like you are being treated without empathy or by an outdated biological model, simply find a healthcare practitioner that works better for you. 

How can we help you? We are a specialized physical therapy practice that collaboratively provides the most effective manual, orthopedic and sports therapy treatments, allowing us to efficiently return patients to their highest level of comfort and functionality. 

We deliver one-on-one, direct patient treatment by our licensed, specialty-certified physical therapists to ensure preeminent physical therapy services and patient care. We have served the Gallatin Valley since 2001 and are locally owned and operated by physical therapists.

At Excel Physical Therapy, our entire team–physical therapy team, massage therapy team, front office care coordinators and patient services assistants–ALL work very hard each day to welcome, listen and help you to feel better as a result of our evidence-based treatment plans and services. Your excellent outcome is our sole mission: Superior care from expert clinicians, supported by passionate staff, impacting the Gallatin Valley and beyond.

Thanks for taking that time to read my article. I hope you find this information helpful. See you at Excel PT! 

 

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Bobby Bemis, DPT, COMT, DIP.MT, FAAOMPT is a fellowship-trained physical therapist at Excel Physical Therapy.  Bobby specializes in orthopedic manual physical therapy of the cervical, thoracic and lumbar spine. Although the spine is his specialty, Bobby has a high level of training in all regions of the body. After receiving his undergraduate degree, Bobby earned a Doctorate in Physical Therapy, became a Certified Orthopedic Manual Therapist (COMT), Diplomat of Manual Therapy (Dip. MT), as well as becoming certified in trigger point dry needling. Bobby then went on to become Fellowship trained and was then designated as a “Fellow” with the American Academy of Manual Physical Therapy (AAOMPT) after passing a rigorous oral and practical exam. Only a very small percentage of physical therapists achieve this elite status. The “Fellow” is a physical therapist who has demonstrated advanced clinical, analytical, and hands-on skills in the treatment of musculoskeletal orthopedic disorders and is internationally recognized for their competence and expertise in the practice of manual physical therapy. 

How to Build Muscle Faster: Blood Flow Restriction Therapy

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

Blood flow restriction training (BFR) is a relatively new technique being used in physical therapy and gyms to increase muscle strength.  We have been using BFR therapy at Excel Physical Therapy with promising results.   BFR therapy utilizes compressive forces from a specialized blood pressure cuff to restrict venous blood flow from a muscle group while allowing for continued arterial blood flow to the muscle.   The result of the restricted venous blood flow is a state of ischemia to the exercising muscle.  Exercising in a state of ischemia seems to cause a physiological cascade that results in increased signaling that promotes muscle growth, even at lower loads on the muscle. 

Utilizing BFR under careful supervision of a physical therapist, allows one to prevent muscle atrophy and increase muscular growth and strength while recovering from injury or surgery.   BFR is not a panacea and therefore is just one component of a proper rehabilitation program.  The ability of BFR to stimulate muscle growth at lower loads of resistance make it a perfect modality to consider for the earlier stages of rehabilitation.   To learn more about BFR therapy and to see if it would be appropriate for you, be sure to ask your physical therapist here at Excel Physical Therapy

 

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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. Jason 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.

“Understanding Climbing Injuries" Talk @ MSU Climbing Gym 1/29/2019

By Matt Heyliger, DPT
matt@excelptmt.com

Community Education Series | Free

 “Understanding Climbing Injuries: The Biomechanics Behind Acute and Overuse Injuries in Climbing”

presented by Matt Heyliger, DPT

Tuesday, January 29, 2019 | 12pm-1:30pm

Montana State University Climbing Gym in the Hosaeus Fitness Center

  • Learn about the most common contributing factors to both acute and overuse injuries in rock climbing.
  • Deepen your understanding of upper extremity anatomy and biomechanics.
  • Learn self-care techniques that are critical to injury prevention and treatment.
  • Learn how to safely re-introduce climbing after injury/rehabilitation.
  • Discuss approaches to training for climbing including safe use of a hang board and campus board. 
  • Have questions? Q&A with Matt Heyliger, DPT after the talk.

Matt Heyliger, DPT is an avid climber and mountain sports enthusiast.  His passion for climbing has taken him around the US, Canada and Mexico. Matt has a specific interest focus in biomechanics and how impairments at one level or joint affect other body structures. Matt has specialized in working with and treating rock climbers for more than 5 years. In the past year he has been able to broaden his approach to treating climbers through integrating video analysis and specialized biomechanical assessments in the Climbing Lab at Excel Physical Therapy. 

Advanced Training...we're at it again! Matt Heyliger, DPT completes lower extremity course in Seattle

By Matt Heyliger, DPT
matt@excelptmt.com

Matt Heyliger, DPT, physical therapist with Excel Physical Therapy of Bozeman and Manhattan, recently completed the North American Institute of Orthopedic Manual Therapy (NAIOMT) Level II course held in Seattle, WA with a focus on assessment and treatment of lower extremity conditions. The course emphasized assessment of the foot and ankle addressing correlations with foot and ankle biomechanics and overall lower extremity function. Many mobilization and manipulation treatment techniques were presented for the foot, ankle, and knee. Matt has now completed all Level I, II and III courses through NAIOMT, the equivalent of 231 hours of hands-on continuing education coursework in manual therapy.

Advanced Training...we're at it again! Jackie Oliver, DPT completes shoulder and knee course in Seattle

By Jackie Oliver, DPT
jackie@excelptmt.com

Jackie Oliver, DPTphysical therapist with Excel Physical Therapy of Bozeman and Manhattan, recently completed the Kevin Wilk Shoulder and Knee Course in Seattle, Washington. This advanced-training course presented the most recent, relevant and state-of-the-art treatment options for the most challenging and unusual problems of the shoulder and knee joints. This evidence-based course also focused on the most comprehensive and effective information regarding shoulder and knee post-operative treatment as well as rehabilitation tactics for general knee and shoulder pain. Kevin Wilk is our country’s leading authority in sports and orthopedic injury rehabilitation.

Jason Lunden, DPT, SCS attends US Ski & Snowboard Class at the USSA Center of Excellence

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

Jason Lunden, DPT, SCS, of Excel Physical Therapy, recently attended the US Ski & Snowboard Team Medical Emergencies in Skiing and Snowboarding (MESS) Course at the USSA Center of Excellence in Park City, UT. The course focused on concussion evaluation, management and rehabilitation, as well as athlete development for ski and snowboard athletes.   Jason is an owner and physical therapist with Excel Physical Therapy of Bozeman and Manhattan, and he volunteers as a physical therapist for the US Ski & Snowboard Teams.

Welcome Bobby Bemis, DPT, COMT, DIP. MT, FAAOMPT!

By Tiffany Coletta
tiffany@excelptmt.com

Welcome Bobby Bemis, DPT, COMT, Dip. MT, FAAOMPT to the Excel Physical Therapy team!

Bobby specializes in orthopedic manual physical therapy of the cervical, thoracic and lumbar spine. Although the spine is his specialty, Bobby has a high level of training in all regions of the body.  After receiving his undergraduate degree from the University of Colorado, Bobby earned a Doctorate in Physical Therapy from Regis University in Denver, Colorado. Post-graduation, Bobby became a Certified Orthopedic Manual Therapist (COMT), Diplomat of Manual Therapy (Dip. MT), as well as becoming certified in trigger point dry needling. Bobby then went on to become Fellowship trained through the Institute of Manipulative Physiotherapy and Clinical Training (IMPACT). Bobby was designated as a “Fellow” with the American Academy of Manual Physical Therapy (AAOMPT) after passing a rigorous oral and practical exam. Only a very small percentage of physical therapists achieve this elite status. The “Fellow” is a physical therapist who has demonstrated advanced clinical, analytical, and hands-on skills in the treatment of musculoskeletal orthopedic disorders and is internationally recognized for their competence and expertise in the practice of manual physical therapy. Bobby’s philosophy consists of using knowledge, skill and experience to provide the best physical therapy possible to help his patients achieve their goals. 

Bobby enjoys cooking, reading, yoga, and adventuring through the mountains and rivers of the west with his Newfoundland, Clarence. 

EXPLANATION OF INITIALS:

DPT: Doctorate of Physical Therapy

COMT: Certified Orthopedic Manual Therapist– A certification that focuses on advanced, localized, and specific spinal/peripheral manipulation techniques. Designed to teach therapists how to effectively manage the difficult patients that most therapists struggle with. This certification is a distinction given to Manual / Manipulative Physical Therapists around the world who have completed post-graduate specialization in the field of neuro-muscular skeletal disorders. The specialization includes “hands-on” techniques used to evaluate muscles, fascia, nerves, and joints.

Dip. MT: Diplomat of Manual Therapy – A certification demonstrating mastery in orthopedic manipulative therapy. It is an intensive training program with a comprehensive oral exam and written case reports. It requires advanced clinical reasoning, advanced theoretical knowledge and advanced technical skills. Only a very small percentage of physical therapists achieve this elite status.

FAAOMPT: Fellow in the American Academy of Orthopedic Manual Physical Therapy– The “Fellow” is a physical therapist who has demonstrated advanced clinical, analytical, and hands-on skills in the treatment of musculoskeletal orthopedic disorders and is internationally recognized for their competence and expertise in the practice of manual physical therapy. Only a very small percentage of physical therapists achieve this elite status.

What exactly is an orthopedic manual physical therapist? Orthopedic Manual Physical Therapy is any “hands-on” treatments such as moving a joint in a specific direction and at different speeds to regain movement (joint mobilization and manipulation), muscle stretching, passive movements of the affected body part, and selected soft tissue techniques used to improve the mobility and function of tissue and muscles. Orthopedic manual physical therapists treat conditions in body regions like the head, neck, back, arms and legs. Advanced examination, communication and decision making skilled that are built on the foundations of professional and scientific education facilitate the provision of effective and efficient care.

"The ladies at the front counter are wonderful, and the snow-flakes are adorable. Jason was very helpful, patient and helped me so quickly. He's great!! --J.C., Bozeman Patient

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