Head pain

The Answer Is Load, What’s The Question? by AJ Sobrilsky, DPT, OCS

By AJ Sobrilsky
aj@excelptmt.com

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.

The Balancing Act of Avoiding Running Injuries by AJ Sobrilsky, DPT, OCS

By AJ Sobrilsky
aj@excelptmt.com

While it’s become a common flex in the running community to log lots of mileage, vertical gain, or cherry picking all the local strava segments (I mean if you don’t post about it, did you actually run it?) it’s important to make sure we’re doing so responsibly.

Lifts are closed, the days growing longer and the weather improving, not to mention, most of us have more time to recreate on our hands due to a global pandemic. We at Excel PT, like most of the local community, have taken to putting in some time on the pavement and trails. However, despite all this new found time and psych, it’s essential we harness our urges and make sure we don’t push beyond our capacity landing ourselves in a needed/forced time off of running because of an injury. We’ll discuss some of that balance required in order to be smart about our training, and make sure we’re all ready for when we can once again gather as a community at a start line or beer tent (hopefully both) after a local race.

We’re all guilty of it. That common belief that running more will make us faster. While there is truth to some degree in that statement, there does become a point of diminishing return and a balance between running more and running better is required. Unfortunately in the even that we decide to just run more, and more, we’ll eventually exceed our tissues capacity to tolerate that amount of running. Capacity in this situation is reflected in our bodies ability to tolerate loading, more specifically: how much running can we perform before we have an injury?

Let’s start by pointing out that our bodies are incredibly smart and adaptable. Let’s also be sure that we all understand that running is a skill, and skills require practice. Practicing skills with poor form and technique will only reinforce those poor patterns. In the case of running, sometimes our lack of skill leads to a pattern that overloads a tissue. It is true that lack of skill can be adapted to, but at some point of the loading process, we exceed the capacity for adaptation and a painful reaction occurs = injury. 

The trick in this whole equation is finding the balance between loading and our capacity. So what all goes into determining the amount of load: volume, duration, frequency, intensity, rate of change, lifestyle habits, etc.,? What determines our own unique individual levels of capacity: strength, control, mobility, skill performance, previous injury, training history, sleep, life stress, diet, etc.,? As you can see, there is A LOT to account for and when we stack up lots of load, we have a potential to exceed our own bodies physical limits of capacity: injuring tissues. 

So how do we mitigate overloading these tissues and work towards preventing running injuries? We work to improve our own modifiable individual capacity factors while strategically and gradually loading. Here are some of our top tips to make sure you’re appropriately managing your running:

Keep a log: this is a great place to write down distance, intensity/effort, vertical changes, who you went with, what the weather was like, and even if you started to feel a little pain or ache. This is also a great outlet for a runner to reflect and be mindful about their training. We are big on mindfulness here as a team.
Vary your running pace/intensity: adding in tempo runs, intervals, or hill workouts is a great way to slightly add variance to the loading/demand on tissues. This will make sure their stress isn’t always constant and also make sure the tissues are ready for the demands of upcoming runs and races.
Vary your terrain and routes: running the same loop everyday might be your thing but I know for me personally and my body, that if I’m providing it some different stimulus not only am I mentally relieved but again my body is prepped for variability in the future. If you’re primarily trail running, throw a few road miles in. If you’re a road running, throw a few single track miles in. 
Listen to your body: this is probably the most important one. Making sure your body gets the sleep, nutrients, and care it requires is essential to long term running and mental health. I continually need to remind patients (and myself a lot of times) that the only time we can actually adapt and recover is when we are resting. So to go out and chase the Strava records, while being at max effort everyday, you will only be left in a hole/deficit. You will be unable to tolerate the day to day stresses and your body won’t function at its highest level.
Gradually load: strategically increase volume. Common rule of thumb is no more than 10%increase in volume from the week before and allowing for a “down” week following 2-3 weeks of increased volume. If you don’t feel you’re capable or able to do this there are a lot of great running coaches and physical therapists out there who can help build, guide, and modify for your individual needs.
Improve your skill set: “Sharpen your sword”. There are a lot of modifiable factors that can be addressed to improve your capacity – stay tuned for upcoming posts with specifics on these!

If you were looking for the answer to the holy grail question of how to avoid getting a running related injury here it is: don’t run. But since you made it this far in this article, I doubt that’s an option for your nor do we at Excel PT want that to be the answer to your questions.

Unfortunately this singular article probably won’t answer all the questions about running injuries, form, and training that you have. At Excel Physical Therapy there are many physical therapists who are professionally and personally invested in understanding, managing, and treating running related injuries and we are here to help you with any question or concern. Please feel free to reach out for a running evaluation in our running lab, or discuss a running related complaint via an in-clinic or telehealth appointment.

Stay tuned for more blog posts to come. Leave a comment and let us know what topics you’d like to learn more about!

When AJ isn’t working he is usually pursuing his next adventure: rock climbing, skiing, mountain biking, or running.

Treating Chronic Pain by Megan Kemp, DPT, ATC, CSCS

By Megan Kemp
megank@excelptmt.com

Are you currently living in pain? Have you in the past? If so, you are not alone. 50 million American adults have chronic pain and chronic low back pain is the leading cause of work limitations in the United States. It is generally well known that physical therapy is used following surgery or an injury. Unfortunately, it is much less commonly known that physical therapy is an effective and successful option for treating chronic pain.

Typically, when people are in pain their first thought is to stop moving. This is often magnified when an individual has been in pain for months, or even years. So, if movement hurts, how can you reduce pain by moving? In order to understand this, it is important to first outline some important principles.

Our bones and soft tissue structures operate under two important laws: Wolfe’s law and the SAID (Specific Adaptations to Imposed Demands) principle. These laws both imply that our body will adapt to the specific loads you place on it. If you overload the structures, you will have pain. However, if you optimally load the structures (e.g. bone, muscle, tendons), they will improve in strength. By improving your body’s strength, you will in turn be able to move with less pain.

Physical Therapists are also the experts on identifying faulty movement patterns. Everyone has specific ways they move to accomplish basic daily tasks – walking, getting up from a chair, etc. Unfortunately, our movement patterns are not always optimal. This may be due to muscle imbalances, poor motor control of stabilizing muscle groups or pain. By optimizing your body mechanics, you will be able to reduce microtrauma on certain structures and in turn reduce your pain.

The physical therapists at Excel Physical Therapy are highly trained in manual therapy techniques. For certain types of pain, a hands-on approach of soft tissue massage and joint mobilization and/or manipulation is indicated to reduce your pain.

Regardless of the type of pain you may have, we take on an active role in helping you achieve your goals in reducing your pain. Our goal is always to empower every patient that walks in our clinic and help them achieve their goals of pain-free living. We provide a specialized approach to physical therapy that provides the most effective treatments, allowing our patients to return to their highest level of function as quickly as possible.

We have been proudly serving the Gallatin Valley in both Bozeman and Manhattan since 2001. Call us today to schedule an appointment so we can help you too.

Megan Kemp, DPT, ATC, CSCS is a Physical Therapist, Certified Athletic Trainer, and a Certified Strength and Conditioning Specialist in our Manhattan clinic. She’s a Gallatin Valley native and graduate of Manhattan Christian High School and 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 specializes in the treatment of upper and lower extremity athletic injuries, with clinical experience treating both high school and collegiate athletes. Megan is passionate about helping athletes of all ages return to their desired activity and strives to use the most current evidence-based practice medicine coupled with her knowledge of biomechanics to help her patients reach their goals.

COVID-19 - our updated policies and Virtual PT Visits Now Available

By Tiffany Coletta
tiffany@excelptmt.com

We are committed to you now and always since 2001.

Dear valued clients and community partners,

Our leadership team continues to monitor the COVID-19 situation on a daily and often, hourly basis to make decisions regarding our practice. Our promise to you is to keep a safe and clean environment for those who need our services the most. We understand this is a very difficult time for everyone.

Our Bozeman clinic is OPEN in agreement with the March 26th directives from the Gallatin Valley Health Department and the MT Office of the GovernorPhysical Therapy is considered an essential critical infrastructure and massage therapy-when provided in a physical therapy clinic-are under this directive. As a healthcare facility, we are currently one of the few options for those who are suffering due to cancelled surgeries, chronic pain, and other issues during this unprecedented time where healthcare has suddenly become a precious commodity.

In the state of Montana, we have direct access for physical therapy care, which means a patient can be treated without needing a doctor’s prescription. Almost all insurance plans cover PT under direct access. Call our friendly front office team and we can check your plan for you.

Virtual Physical Therapy Appointments Our goal is to make sure to we are available for our patients and anyone else who needs us at this time while options remain limited. We are offering virtual physical therapy appointments for those who are unable to come into the Bozeman or Manhattan clinics. Virtual PT appointments involve easy video conferencing on your computer, tablet, or smart phone and Switchback Healthcare to seamlessly deliver your custom exercises in a video format. It’s as simple and secure as clicking on an email link from us. Some insurance companies are paying for telehealth and, for those that are not, Excel is offering a discounted prompt pay rate of $70 per virtual PT visit. Our therapists and patients are finding online appointments very useful in efforts to provide a “next best option” to in-person appointments.

Our Precautions and Prevention Policies We have implemented COVID-19 policies per CDC guidelines to further increase precautions and prevention. All policies apply to both staff, patients and anyone entering our facility. Thank you to all for your patience and accommodation with these polices, which include the following:
We are:

Screening patients on the telephone when making appointments and in the clinic before an appointment regarding illness and travel. Anyone having returned to Gallatin Valley after visiting a CDC community spread state or country with a CDC travel warning is asked to self-isolate for 14 days before attending in-clinic appointments.
Often checking temperatures.
Not allowing any individuals to enter our clinic with ANY illness symptoms or symptoms of the virus.
Not allowing any individuals to enter our clinic with concerning potential exposure while in Bozeman or with recent travel.
Having our patients and therapists wash their hands thoroughly before and after each visit.
Spreading out our patient appointments and reducing in-clinic staff to have a very low-flow clinic environment.
Not allowing visitors to attend in-clinic appointments with any patient (unless the patient is a minor).
Tirelessly disinfecting patient and therapist contact surfaces.

We are here for you!  As always, your physical therapist is available through email or phone and we encourage you to communicate with them regarding your care. Our PT team is able to schedule a virtual visit for you directly as well. Reach out to our front office team too with any questions at info@excelptmt.com or to also schedule a virtual PT visit.

Please be safe, stay active and healthy. We are here for you as we navigate this situation. Let us know if you have any questions.
With much love and appreciation,
David, Jason and Tiffany
along with the whole Excel PT and Massage team

Bozeman team: 406-556-0562
info@excelptmt.com

Physical Therapy as a Means for Prevention

By Matt Schumacher, DPT, MTC, CAFS, CSCS
matts@excelptmt.com

What do you think of when you hear physical therapy? Most individuals may have experienced or know of someone who experienced physical therapy with a past injury or surgery. This is the bread and butter of what we do as physical therapists through rehabilitating individuals back to what they love to do; however, most people do not know the benefits of seeing a physical therapist for “prehabilitation” or “wellness checkups” prior to a possible or potential injury from occurring.

Just as one goes to the dentist for a biannual checkup for prevention of possible future dental issues, physical therapy has and can be an option for the public in addressing possible musculoskeletal impairments, muscle strength deficits, and range of motion deficits in the body. As most of us all know, exercise has been suggested to aid in multiple health benefits such as preventing chronic disease, boosting mental health, increasing overall longevity, reducing risk of cardiovascular disease, and improving bone health – just to name a few. As orthopedic physical therapists, we are trained and knowledgeable in rehabilitation and appropriate exercise prescription following injury and/or surgery, but we are also trained in injury prevention by providing patients and clients resources for reducing their chance of an injury.

As spring is approaching and we are gearing up for the beautiful Montana summer, physical therapy may be of benefit to you or someone you know to increase your chances of a healthy, active, and injury-free year. It is typically easier to address these possible impairments before an injury may emerge versus after an injury has occurred. Most everyone, including you, may benefit from a “biannual checkup” with physical therapy!

Matt Schumacher, DPT, MTC, CAFS, 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. Following graduation, he received training from Gray Institute with a Certification in Applied Functional Science (CAFS). Matt also 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 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.

Noisy Necks

By Matt Heyliger, DPT
matt@excelptmt.com

I am frequently asked about whether it is normal for a neck to make a lot of noise. Some of the more common adjectives I hear from patients describing these sensations are creaking, grinding or crinkly noises…the kind of noises you hear on the inside but are not generally audible to others. The short answer is yes, some increase in neck noise is to be expected as we age. However, certain noisy necks deserve a bit more attention.

To clarify, the noisy necks described above should be distinguished from other common neck noises including popping, cracking, clicking or snapping sensations in the neck. The importance in this distinction is that the former is most likely associated with normal wear and tear as long as there is not pain associated with the noise, where the latter may indicate some problems brewing in your noisy neck. Necks that tend to pop a lot, especially those that need to pop to relieve tension or pain, are likely experiencing increased stress in the joints and/or disc at the level of the popping. This should be seen as a warning sign. For the owner of that noisy neck, there is likely some degree of asymmetry in the mobility of the joints in the neck. This can lead to degeneration of those segments of the cervical spine that may lead to more problems than just neck noise down the line.

If your noisy neck is associated with pain and/or ever increasing stiffness and loss of mobility then you should consider consulting with your Physical Therapist. While some loss of motion in you neck is common with aging, especially in your later 60’s and beyond, earlier onset of a significant loss in mobility could be a tipping point for your neck. Many folks who bring this up during a physical therapy appointment are relieved to learn that certain neck noise is normal. In situations where neck noise may be indicative of a neck that’s going south, taking action and making a plan may really make a difference in your quality of life a few years around the bend.

Matt Heyliger, DPT of Excel Physical Therapy completed his Doctorate in Physical Therapy at Eastern Washington University in Cheney, Washington. He has a particular treatment focus in the relationship of cervical/thoracic spine mechanics and upper extremity conditions. An avid rock climber, telemark/backcountry skier and mountain biker, Matt regularly practices yoga and enjoys frequent adventures in the mountains with his family and their two labs.

Book a Massage Therapy appointment at our Bozeman office

By Tiffany Coletta
tiffany@excelptmt.com

"What Is That Ringing In My Ears?" by David Coletta, MPT, CMPT

By David Coletta, MPT, CMPT
david@excelptmt.com

Although tinnitus, or ringing in the ears, can be a sign of serious brain pathology, tumors, and hearing loss, this condition can also be often diagnosed by your physician as idiopathic tinnitus. Such a diagnosis indicates no known or verifiable cause to the ringing in your ears. Ruling out the more concerning problems through brain imaging, neurological testing, and hearing tests is helpful, but often leaves the patient with no real answers about how to decrease or eliminate the annoying sound. One theory regarding the source of idiopathic tinnitus centers on the musculoskeletal system as a trigger for ear ringing. (more…)

"Conquering Neck Pain" Seminar | 12/3/2014 6:30pm

By David Coletta, MPT, CMPT
david@excelptmt.com

Community Education Series – free and open to the public – join us!

“Conquering Neck Pain: Self-Help Techniques & Treatment Options”

Presented by David Coletta, MPT, CMPT, Certified Manual Therapy Specialist

Wednesday, December 3, 2014

6:30pm-7:30pm

Bozeman Public Library Community Room

What You Will Learn:
How neck pain develops and becomes chronic.
What the anatomic sources of neck pain are.
How a specialized physical therapist utilizes manual therapy, patient education, exercise, and dry needling techniques to treat neck pain.
How improving posture can alleviate neck pain.
Which exercises are most effective in self-treatment of neck pain.
Other self-treatment techniques.
There also will be time at the end of the seminar to speak with David regarding your specific neck problem.

David Coletta, MPT, CMPT has specialized in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions for over 15 years. David received his masters in physical therapy from Mount St. Mary’s College in Los Angeles, California. He enjoys finding long-term solutions for his patients — solutions that involve a fine-tuned combination of manual manipulative therapy and a targeted exercise program that address even the most difficult patient presentations. A considerable amount of David’s training from leading physical therapy clinicians has occurred through the North American Institute of Orthopedic Manual Therapy (NAIOMT). He has completed advanced certification in manual therapy (CMPT) with NAIOMT and has received advanced training in dry needling techniques for the spine and extremities. David is also a Certified Clinical BikeFit Pro Fitter.

David Coletta's Personal Bout with Acute Neck Pain: The Onset Part 1

By David Coletta, MPT, CMPT
david@excelptmt.com

My Personal Bout with Acute Neck Pain: The Onset ~ Part 1 of 3

The Onset

Evaluating and treating individuals with neck pain has been my specialty over the past 15 years. I have literally treated over a thousand people suffering from this affliction. Recently, neck pain became a much more personal issue, as I experienced the sort of agony which some of my patients deal with. For the past 20 years, my neck has been intermittently stiff, with the occasional inability to turn my head for a day or two and what felt like an acute muscle spam, but there has been nothing of serious concern. This was different. While still in bed, I opened my eyes in the morning and noticed neck stiffness when turning over. Could this be one of those mornings where there would be trouble turning my head? Better to get up slowly. I sat up and immediately felt a rush of nauseating pain sweeping into my low neck and then shooting into my left shoulder blade. I don’t have time for this I thought. Into the shower for some hot water on the neck and down the hatch with 600mg of Ibuprofen. I drove to work applying traction to my neck with both hands and steering with my elbows and knees. A smarter man would have just stayed at home and called in sick. But I had patients that depended on me.

Luckily, this was my short day of the week at work. My neck pain steadily grew worse and by 2PM I was stuck with my head down and turned to the right, avoiding the worst ache. I utilized a home traction unit from work and had to go very slowly and gently not to aggravate my symptoms. That night, I managed about 2 hours of sleep, constantly readjusting to avoid pain.

The next morning, I called a physician friend of mine and he prescribed me a round of oral steroids. After 3 days, my neck pain slowly started to improve and within 1 week I was 75% better and training on my road bike for short periods. Unfortunately, this progress did not last.

8 days after the initial onset, my symptoms suddenly returned in the morning and were even worse. At this point I had to be honest with myself about the serious nature of my neck problem. My symptoms included weakness in the left arm, severe pain behind the left shoulder and into the shoulder blade, severe neck pain, numbness in the left hand, and I could not extend my neck or turn to the right. This was a very familiar presentation, a cervical radiculopathy. It had to be a disc bulge in my low neck that was inflaming and compressing one of the spinal nerves. Megan Peach, DPT, here at Excel PT did a great job at treating my acute problem, but my presentation was too severe to benefit from PT at that time. I decided to make an appointment with a local orthopedic specialty physician.

Click Here to read My Personal Bout with Acute Neck Pain: Recovery ~ Part 2 of 3

Click Here to read My Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3

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