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

By AJ Sobrilsky
aj@excelptmt.com

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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. 

 

excel_faviconAJ 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!

 

excel_faviconAJ 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. 

 

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.

 

excel_faviconMegan 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

Posture Matters! Seminar 10/5/2016 @ Bozeman Library

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

Community Education Series   |   Free & Open to the Public

Posture Matters! Seminarpoor posture at work

Wednesday, October 5, 2016

6:30-8:00pm

Bozeman Public Library

Large Community Room

seating limited to first 100 attendees

Presented by David Coletta, MPT, CMPT

 

What You Will Learn:

  • Learn why your posture matters, how it can lead to health concerns, and what you can do to improve yours now.
  • Please bring your older kids! Learning to optimize posture at an early age can have life changing results.
  • With the popularity of personal electronic devices, poor posture is an increasing problem. People of all ages are at risk for developing a multitude of musculoskeletal problems, including neck pain, back pain, headaches, shoulder impingement, elbow tendonitis, thoracic outlet syndrome, TMD, etc.
  • Bring your questions! Q&A with David Coletta, MPT, CMPT during and after the talk.

 

David Coletta, MPT, CMPT specializes in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, postural dysfunctions and professional bike fitting. As the founding owner of Excel Physical Therapy, David established Excel PT in 2001 on the principles of specialization, advanced education and customer service. 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.

 

"Got to Keep on Moving" by Matt Heyliger, DPT

By Matt Heyliger, DPT
matt@excelptmt.com

I have recently been thinking quite a bit about the importance of joint mobility, not strictly for function, but for joint health. In manual therapy, assessment of a given joint in the body always consists of consideration of joint mobility. Is there enough mobility? If not, why not? Does the joint itself have a motion restriction? Or is there perhaps some tissue outside the joint, like a tight muscle, that is limiting mobility? While it makes sense that a certain degree of motion is important for functional tasks, like bending your knee a certain amount to ascend stairs, mobility is also critical for joint health. (more…)

Attention Jaw Clenchers! 4/27/11 Seminar: TMJ Dysfunction/Jaw Pain: Helping Yourself with Specialized Physical Therapy

By Tiffany Coletta
tiffany@excelptmt.com

On April 27th, 2011, 6:30-7:30pm, Join Certified Manual Physical Therapist, David Coletta, MPT, CMPT at the Bozeman Public Library, Community Room for a discussion of “TMJ Dysfunction/Jaw Pain: Help Yourself with Specialized Physical Therapy”.

David Coletta, MPT, CMPT

Learn the source of your facial pain and headaches, as related to jaw muscle imbalance and joint dysfunction of the jaw and the neck.  Learn how to treat yourself with some simple exercises and techniques and how a specialized physical therapist can specifically help you.  Q&A with David to follow so you can ask specific questions regarding any jaw, facial pain or headaches.

 

David Coletta, MPT, CMPT is a certified manual physical therapist through NAIOMT and for over 14 years has specialized in treating facial pain, TMJ dysfunction, headaches, and neck pain.  Coletta is the owner of Excel Physical Therapy in Bozeman and Manhattan, Montana which is celebrating their 10th year of service to the Gallatin Valley this year.

 

To sign up for future seminar announcements, join our e-list @ www.excelptmt.com.

TMJ Dysfunction – What is it and how can it be treated?

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

TMJ Defined

Temporomandibular Joint (TMJ) Dysfunction is a disorder of the joint where the jawbone meets the skull or the muscles surrounding that region. People suffering from TMJ Dysfunction complain of popping or locking in the jaw, pain in the face with eating or opening the mouth, and headaches. TMJ Dysfunction can be further classified into joint dysfunction, myalgia, or a combination of dysfunction and myalgia. Myalgia is simply defined as intra-muscular pain. Pure joint dysfunction of the TMJ involves popping in the jaw, pain coming from joint structures (bone, cartilage, disc, ligaments, joint capsule), and a predictable and measureable loss in mouth opening or closing range of motion. Myalgia in the TMJ region relates to inflammation and dysfunction in the muscles surrounding the TMJ. These muscles can cause local facial pain, neck pain, headaches, and changes in how the jaw is actively moved. Combined joint dysfunction/myalgia of the TMJ is the most common presentation and can include all of the elements in the individual disorders previously described.

TMJ Dysfunction – What is it and how can it be treated?

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

Underlying Causes

It is important to explain some the underlying reasons for TMJ dysfunction. The most obvious cause is a serious blow to the face or jaw, disturbing the normal biomechanics of the joint.  However, more common causes include chronically poor posture, stress-induced grinding of the teeth or clinching the jaw, malocclusion of the teeth (high or low tooth), and neck pain or trauma to the spine.  My experience has been that over 90% of patients that I treat, with the diagnosis of joint dysfunction or myalgia of the TMJ, present with dysfunctions of the neck.  These patients require a careful evaluation of the neck and treatment that includes joint mobilization or manipulation, soft tissue massage, and exercise to improve posture and restore pain-free jaw active range of motion.

"Love working with Jackie, good facilities and front office staff. Thanks!" --E.C., Bozeman client

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