6:30pm @ Spire Climbing in Bozeman, Montana – sign up to attend at spireclimbing.com
May 4 – Elbow Injury Talk with Dr. Lisa Palomaki, DPT
Lisa’s talk is full already on the Spire Climbing website – Watch on @excelptmt’s IGTV page to see her talk streamed live!
June 1 – Injury Screening with Dr. Todd Bushman, DPT, CSCS
July 6 -Wrist Injury Talk with Dr. Todd Bushman, DPT, CSCS
Aug 3-Strength Assessments with Dr. AJ Sobrilsky, DPT, OCS
Here’s what happens for each session type:
Injury Talk – Want to learn more about common climbing injuries & actively manage the situation? Don’t miss out on these quarterly presentations from an Excel Physical Therapy Climbing Lab PT. We’ll tackle some of the more common climbing injuries while discussing rehab, injury mitigation, training considerations, & the most important question of all: “Can I keep climbing?”
Injury Screening – Free 15-minute injury consultations with a doctor of physical therapy from Excel Physical Therapy.
Strength Assessment – Free assessment of specific climbing strength performance metrics: max finger strength, finger contact strength, critical force, & finger strength endurance. See where you measure up, areas that might need attention, & assess your training. Stop guessing & start assessing.
Follow us on our @excelptmt IG page for the latest updates and event info.
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.
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
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.
What unique times and circumstances we find ourselves in as climbers. The climbing gyms are closed, all the home gym products are sold out, and as a community we’ve put others best interest ahead of our passion and stayed local respecting the pleas to avoid traveling to popular climbing destinations. So it seems like no better time to take care of some essential preparation in our personal climbing dojos. What better time to begin or continue training, hone and establish an armor of strength, or finally address that “insert nagging climbing related ache here” you’ve had going on for months now. Whether you’re using a hangboard to strengthen those fingers, campusing to develop some power, or taking to the kettlebells and theraband to recover it all boils down to loading.
Loading simply is stress applied to a tissue or structure (muscle, tendon, bone) that results in some type of adaptation (stronger, stiffer, smarter). Load can be a good and a bad thing. Load in excess goes beyond the tissues capacity to remodel and adapt and could potentially result in a reactive response or injury. In fact there really is no injury; acute, chronic, or traumatic that simply doesn’t boil down to loading beyond capacity. But uniquely enough in this situation the problem or cause is also the answer and solution.
There are many types, strategies, and forms of loading depending on our desired response: rehabilitative loading, adaptive loading, stimulus loading, and reactive loading. While for the purpose of this specific post we’ll solely reference load as a physical stimulus we must remember that load stimuli is also psychological (more on that in a future post). So the answer to both improving your climbing performance, taking care of that nagging injury, and building up that armor of injury resilience is loading. Rest is not the best, and yes if you don’t use it you will lose it (however there is a caveat and exception for acute traumatic injuries: ACL repairs, grade III pulley ruptures, or Rotator cuff and SLAP repairs where we need to respect a typical tissue healing timeline). But if you’re still convinced rest is what you need here’s a simple guide to help you with that.https://www.climbing.com/skills/unsent-how-to-be-injured/
Loading isn’t always an exact science. A lot of factors and contingencies are at play when it comes to determining the amount, type, duration, and frequency of loading. For instance, your current training phase, training age, training history, injury history, and long term goals will influence how we’d load differently from one climber to another. Whether you’re 2-3wks into an acute injury or 3-4months of consistent aggravating complaints would also impact the loading program.
Hopefully, this post provided some insight to continue, progress, or adjust your current training. Or maybe it was just a quick break between burns on your home board that you’ve finally had time to finish (or start building). So with all that here is a final few tips, key concepts, and strategies to consider when loading:
Gradually and slowly progress load – Probably the most important one!
Variables to consider modifying with loading: volume, velocity, duration, loading positions (different grips)
Vary the surface or position you’re loading in: tension block, flash board, hangboard, single rungs, different board systems or walls.
Respect the recovery required to adapt from a specific training session and/or training cycle.
Develop climbing specific skills: climbing is a unique sport with an ever changing set of parameters required to complete and thus ever changing and adapting set of skills required to be successful. It’s one thing to be strong but it’s another to know how to harness that strength to achieve desired goals.
Here at Excel Physical Therapy, we are ourselves climbers and patients as well as climbing research, training, and rehabilitation specialists. So we get it. We understand what you’re going through, and we can help you figure out how to take the steps towards those climbing goals. We’d love to have you in person in the Excel Climbing Lab for a climbing evaluation, evaluate and establish a plan for that nagging injury, or consult for injury/performance questions via an in-clinic or telehealth appointment. We’re here for you and we’d love to keep providing more and more information on all things climbing so please let us know if there is anything specific you’d like to hear and learn about.
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 team is proud to welcome Nikki Kimball, MSPT to the team. One-on-one specialized physical therapy with the ultra running expert dedicated to helping people.
Nikki Kimball is a Physical Therapist, Runner’s World Health Advisory Board Member, 2008-2016, Professional Runner, and a RRCA Certified Running Coach.
Nikki specializes in the treatment in running injuries and has been treating runners since 1999. She graduated with her MS degree in physical therapy from Arcadia University in 1998 and won the school’s Health Sciences’ Alumni Achievement Award in 2017 for her work integrating professional running, physical therapy and advocacy for people with mental illness. She is certified in ASTYM soft tissue mobilization and in dry needling. She has been an expedition physical therapist for running events in Africa, China and India.
Prior to her professional running career, Nikki was a cross country skier and biathlete. She raced NCAA Division I for Williams College where she won the Alumnae Ski Award two times. In 2018 she won the Distinguished Alumni Award at Holderness School for her using her athletic achievements as a platform to provide service “for the betterment of humankind” in areas of advocacy for health care and gender equity. She is a three-time North American Ultrarunner of the Year and three-time United States Track and Field Association Ultrarunner of the Year. She has won 11 National Championship titles and has been named to 14 US National Teams across three athletic disciplines.
Nikki presents on exercise prescription and physical therapy at psychiatric and adventure sports medicine conferences on the west coast and Rocky Mountain states. She has spoken professionally about running and injury prevention on three continents and at the US Embassy in Beijing, China. She has published articles in major print sports magazines in Asia, Europe and the US, including 13 pieces on injury prevention for Runner’s World. She has appeared in various films including a starring role in the regional Emmy winning feature, Finding Traction
Her treatment philosophy is to combine her physical therapy training and continuing education with decades of practical experience as a high-level competitor and coach to achieve the best possible results, particularly in the realm of complex running injury. When not working or adventuring, Nikki enjoys archery, wire sculpting, and cooking at home with her friends and pets.
Summer is finally here and with it comes all of the fun outdoor activities we love doing. But what if your best laid intentions to get outside are derailed with sore feet? Did you know that physical therapy is an effective treatment option for foot pain?
Foot pain is generally multi-faceted. There is rarely one simple cause for the pain, nor is there often a quick fix. However, there are often some common themes that put you at a higher risk for pain. One common cause is reduced mobility at one of the multiple joints of the foot/ankle complex. Decreased mobility at one joint can lead to excessive mobility at other joints throughout the foot. It is common for hyper- or hypomobility to be a pain generator for the foot. Another common cause is decreased strength or motor control of important stabilizing muscles throughout the lower extremity. This can change the way your foot absorbs shock or pushes off, thus putting excess stress on parts of the foot that weren’t designed to take that excess stress. Altered biomechanics of the lower extremity throughout the gait cycle are another common cause of pain.
Physical therapists are highly trained experts in recognizing faulty biomechanics throughout the body. By recognizing where the faulty mechanics lie, you can then effectively treat the root cause of your pain rather than simply the symptoms. This is helpful in not only reducing your pain, but giving you the tools to treat it in the future should your pain creep back into your life. At Excel Physical Therapy, we also specialize in affordable, semi-custom orthotics that are specially designed to your unique foot structure. Orthotics can help place your foot in it’s optimal biomechanical position to reduce stress and optimize function.
If you have foot pain, the physical therapists at Excel Physical Therapy can help! We provide a specialized approach to physical therapy that provides the most effective manual, orthopedic, and sports therapy treatments, allowing our patients to return to their highest level of function as quickly as possible. We have proudly been serving the Gallatin Valley in both Bozeman and Manhattan since 2001. Call us today to schedule an appointment!
Megan Kemp, DPT, ATC, CSCS, a Gallatin Valley native and graduate of Manhattan Christian High School, received her Doctorate in Physical Therapy from the University of Montana. She graduated with her Bachelor’s degree in Athletic Training from Point Loma Nazarene University in San Diego, California and is a board-certified athletic trainer through the National Athletic Trainer’s Association. Megan also completed training from the National Strength and Conditioning Association and is a Certified Strength and Conditioning Specialist. She has served as an adjunct faculty member at Point Loma Nazarene University in their Masters of Kinesiology program. Prior to obtaining her Doctor of Physical Therapy degree, Megan worked as an athletic trainer at Point Loma Nazarene University. Megan Kemp practices in our Manhattan office.
Jackie Oliver, DPT, OCS passed the rigorous Orthopaedic Clinical Specialist (OCS) examination in March 2019. Orthopaedics is the specialty dealing with the musculoskeletal system: bones, muscles, cartilage, tendons, ligaments and joints. This examination covered everything pertaining to orthopaedic physical therapy from head to toe. In order to sit for the exam one must have completed at least 2,000 hours of direct orthopaedic patient care within the last 10 years or have completed a post-professional residency in the field or orthopaedics.
The Orthopedics Clinical Specialist (OCS) advanced certification is coordinated by The American Board of Physical Therapy Specialists (ABPTS). The organization oversees a specialist certification process from the nine different specialties one can attain within the realm of physical therapy. The ABPTS mission is “to advance the profession of physical therapy by establishing, maintaining, and promoting standards of excellence for clinical specialization, and by recognizing the advanced knowledge, skills and experience by physical therapist practitioners through specialist credentialing.”
Under the ABPTS advanced certification programs, we have 1 Board-Certified Sports Clinical Specialist (Jason Lunden) and 2 Board-Certified Orthopaedic Clinical Specialists (Megan Peach and Jackie Oliver). As of 2018, there are only 86 Board-Certified Orthopaedic Clinical Specialists in the State of Montana, making this designation a well respected and prestigious title. Excel Physical Therapy’s team values incorporate investing in and encouraging advanced training and certifications for all of our physical therapy providers to help ensure excellent care and outcomes for our clients.
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.
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.
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.
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.
"David & 'Crew': a great big thank you for everything! Kindness, great super care, respect for patients, and patience. I appreciate all of you and am so impressed!" --K.D., Bozeman patient
Climbing Lab Pop-up @Spire Climbing - 1st Wed of each month, 6:30pm in 2022
“Push & Pull…Essential ingredients for Running and Climbing” is AJ Sobrilsky’s latest article in the 
