Q: I fell yesterday walking and I have fallen a lot. All I can think of is, I am not picking up my feet enough? When I hit a crack or something I hit my toe and fall forward.
A: Sometimes that can be a strength thing, maybe your body is not strong enough, not that you can’t do it, but as you fatigue when you’re walking, you’re not lifting your feet as high because you are getting tired. So, your endurance might not be there in the lower extremity. It can be a multitude of factors…it could be your proprioception in the bottom of your feet aren’t picking up the cracks. A physical therapy evaluation can assess exactly what is causing your balance issues. As we get older, we tend to have balance issues that happen a little easier. We definitely don’t want you falling, especially outside on the hard concrete, that’s not a great place to be falling. Definitely worth a mention to your doctor or physical therapist about what you are experiencing so a plan can be put into place to help address this issue for you.
Q: I am someone who is dealing with peripheral neuropathy in my legs and feet, what do I do? Also, I am not able to lift my feet high enough when walking due to peripheral neuropathy.
A: So what you will want to do is uptrain like we talked about in that pie chart. We talked about a third, a third, and a third for vision, vestibular and peripheral neuropathy. The pie chart section that focuses on peripheral neuropathy is closing because you don’t have the sensation in your feet anymore. So you have to uptrain those other systems in order to compensate for the proprioception loss. Yes, it’s absolutely trainable. Not being able to lift your feet high enough is a strength thing, with peripheral neuropathy, you’re not going to change the peripheral neuropathy, you’re going to uptrain those other systems. It’s like a muscle making those other systems stronger, so you aren’t worried about the peripheral neuropathy impact as much.
Q: Is there somewhere we can access the charts that you were talking about?
A: The whole presentation will be loaded onto the Facebook page and the Excel website with the slides. (coming soon)
Q: What would you recommend as a call assist company for around your neck so if you fall you can get assistance?
A: With a little research online or by talking with family or friends, you can find one that will work with you. Recommendation given about Apple watch that asks if you have fallen and sends GPS tracking on where you are at if you don’t answer.
Q: Is there a booklet or something we can get with a detail view of different exercises we can build on for helping with resistance to falling?
A: A physical therapist can help determine a customized exercise program to help you with this. Also, tai chi, like yoga, is a great program to help with significant help on falling, some research showing up to 3 times a week has helped. Talk to your physical therapist, because we can have different deficiencies because you may be deficient in your quads and hamstrings somebody else may be deficient in their glutes. You may struggle with lifting your feet up and somebody else will struggle when they start doing head turns so getting a really specific exercise program is probably the best advice, so you’re not wasting your time so you’re not working on exercises you don’t need to work on.
Q: Does Medicare cover balance training?
A: Yes, Medicare does cover balance training during a physical therapy appointment.
Q: Do you have suggestions on footwear?
A: Making sure you are in a footwear that you are comfortable walking in. Something that isn’t bulky or has a high heel on it or has a big thick sole on it where you can get it caught on cracks in sidewalks. Flip flops, sandals in the Summer time are going to be hard to justify because they can slip on feet and effect balance. Specific footwear would be something to talk to your physical therapist to get headed in the right direction.
Q: Height of chair seat for a sit to stand desk?
A: There is a standard height, generally the measurement is dependent on height of the person using the desk. A physical therapist can help you determine the ideal measurements best suited for your positioning needs.
Q: Balance with a new hearing aid?
A: Vestibular system is a big part of our balance system that contributes to balance and having a new hearing aid can throw of your balance because things are different for you.
Jackie Oliver, DPT, OCS completed her Doctorate in Physical Therapy at the University of Utah in Salt Lake City, Utah, one of the top Physical Therapy schools in the nation. She was fortunate enough to complete her clinical rotations and begin her physical therapy career within the University of Utah system, which is consistently ranked near the top in healthcare. Exposed to a wide variety of orthopedic conditions, Jackie is confident when assessing and treating a broad range of orthopedic impairments. Jackie is a certified dry needling provider with advanced training from Evidence in Motion and KinetaCore. Jackie achieved the Orthopedic Clinical Specialist advanced certification after extensive advanced training coursework and a stringent examination process from the American Physical Therapy Association.
Jackie has an intense passion for helping and educating others as well as preventative medicine. Because of her college sports background, Jackie loves working with athletes and has experience with biomechanical training and injury prevention in sports. She is also trained as a Diabetes Lifestyle Coach and has worked for the University of Utah and CDC helping individuals decrease their risk of developing diabetes.
Prior to completing her Doctorate in Physical Therapy, Jackie played basketball for Carroll College in Helena, Montana, while also obtaining a Bachelor of Arts degree in Health Science. Jackie was Academic All-American her last two years at Carroll.
Complimentary injury consultation sessions will help determine the best injury treatment options & plan to help return the injured student athlete back to the game healthy & strong.
Includes:
Thorough history of athlete and review of injury
Injury screen looking at strength, mobility, stability and impairments
Education for athlete and parent/guardian on nature of symptoms and best course of treatment (PT, referral to MD, home rehabilitation program)
Call 406-284-4262 to schedule your complimentary student athlete injury consultation.
Please enjoy Consilience with John Onate’sPart 2 podcast with Nikki Kimball: Maintaining A Love For Running through Injury and Adversity.
Nikki uses a combination of humor, friendship, medical advice and compassion to overcome injury, aging and now the pandemic. As John Onate says, there is a lot to learn from Nikki Kimball. The Excel PT Team completely agrees!
Nikki Kimball is one of the most competitive and successful Ultra-Endurance Athletes in the history of Road and Mountain-Trail-Ultramarathon racing:
2nd place, Hardrock 100, 2018
2nd place, HURT 100m, 2017
2nd place, Big Horn 100m, 2016
1st place, Marathon Des Sables, 2014
Western States 100 Champion 2004, 2006, 2007
Ultra Trail du Mont Blanc 108 Mile,Champion, 2007
Member of United States 100K Team 2001-2006; 8th overall and 1st American at World Cup 2003, Tainan, Taiwan; 7th at World Cup 2005; scoring member of gold medal 100K team at World Cup 2005
We are honoring National Suicide Prevention Week by sharing this podcast episode from Consilience with John Onate who features Nikki Kimball from the Excel PT Bozeman running clinic team. Nikki is one of the most competitive and successful Ultra-Endurance athletes in the history of Road and Mountain-Trail-Ultramarathon racing (and one of the kindest and smartest people we know).
In this episode from the keynote presentation to the Central California Psychiatric Society Annual Meeting in 2016, Nikki discusses how depression, medicine, doctors, running and physical therapy have impacted her life, career and advocacy mission. Mature themes discussed.
As John Onate says, We all can learn and be inspired by Nikki Kimball. We completely agree!
AJ Sobrilsky, DPT, OCS is a Physical Therapist and Orthopedic Clinical Specialist in our Bozeman clinic. AJ specializes in the rehabilitation and prevention of orthopedic sports related injuries with a specific interest in the management of those involving the upper and lower extremities. AJ received his Doctor of Physical Therapy Degree from Carroll University (Waukesha, WI). Following the completion of his DPT degree he participated in an Orthopedic Residency through Evidence in Motion at Bellin Health in Green Bay, WI providing him with advanced training in orthopedic manual therapy, clinical decision making, and patient centered treatment. Following completion of his residency AJ became an Orthopedic Clinical Specialist (OCS) through the American Physical Therapy Board Association and received advanced training in dry needling for spine and extremities.
AJ has been a lifelong athlete, competing in cross-country and track through college and then racing competitively post collegiately. As a result of his personal experiences and passions, AJ has focused his continued education and clinical development around the athletic individual with an emphasis in: running, skiing, and climbing related injuries. AJ has had the opportunity to provide care for an array of athletic populations including youth sports teams, high school and collegiate athletes, and those competing at professional and Olympic levels.
AJ’s treatment philosophy emphasizes a collaborative patient centered approach. Structured around the patient, supported by current best evidence, and coupled with specialized exercise/techniques, AJ hopes to educate the patient on their current issue and provide them with the best course of treatment to return to their previous/desired level of activity.
When AJ isn’t working he is usually pursuing his next adventure: rock climbing, skiing, mountain biking, or running.
Who’s ever picked up a golf club and tried to knock it stiff from 130 yards out? That’s a tough feat to accomplish; a skill one might say. In fact, I’d argue that consistently hitting a golf ball where you want it to go and how you want it to look is one of the most difficult skills to develop.
That’s probably why most professional golfers, and high caliber athletes across the sports world, spend more time practicing and developing the skills of their specific sport than they do truly competing and playing. In fact, in David Epstein’s book “The Sports Gene,” there is a lot of discussion about practice, talent, and the genetics surrounding athletic performance. This is a highly recommend read or listen to if you’re looking for a good new book and it might help us all understand a little better our true capabilities and athletic realities (He also has a lot of podcasts as well as a Ted talk.Click here to listen.
In the running world, there are those few individuals born with a unique physiological make up and a somewhat specific set of anatomical ingredients that lend them performance capabilities. But, that doesn’t mean there aren’t specific contributors to performance and skill development that can’t be modified, practiced, and fine-tuned to become your own best version of yourself. Sure the best runners are the ones spending a lot of time running and logging a lot of miles. Which leads a lot of us to come to the conclusion that in order to be our own best we need to run a lot. While increasing volume will improve your economy and times to some degree, it’s ultimately not the best solution.
The old fallacy of more is better doesn’t hold true, at least not always. We can put time and effort into developing a bigger engine (cardio system, stronger muscles, more resilient mental game), but if we can’t control that engine and the forces it’s willing to produce, it’s useless. For instance, it’d be a bad idea to strap a jet engine onto a paper airplane or try to shoot a cannonball from a canoe. We need the right structure, skillset, and control to put these ingredients and tools to effective use.
What do the best athletes in the world have in common (beyond the best genes)? They train, refine, retool, and practice the skills required for their specific activity. Unlike a lot of other sports, running doesn’t have a whole lot of diverse movements like soccer or climbing. This ultimately confines our exposure to different movements and limits our breadth of exposure and adaptability to forces outside the confines of the running gait. On the other side it also means we have a pretty consistent recipe or set of instructions for developing the best gait pattern and running movement strategy (all relatively dependent on our own unique set of factors).
Jay Dicharry, a leading physical therapist and biomechanics researcher, delivers this message well when he says, “There are a lot of things that all runners of all abilities should be doing outside running to improve their running. If you want to run better, you need to move better”. Essentially that the winner isn’t always the one who stacks up the most Strava KOM/QOM’s but rather the ones who have put time into developing and practicing the essential movement skills; allowing them to avoid injuries and ultimately providing optimal consistency in training.
Running is essentially a fluid series of single leg jumps. The ability to produce enough force to drive your leg into the ground and propel yourself up and forward. To then coordinate the appropriate movements in the flight phase (while you’re going from step to step) in preparation for landing. And to then absorb 2-3 times your body’s weight through one leg, restoring that energy, and preparing to do it all over again in less than 0.4 seconds for each and every step throughout the duration of the run.
So yes, running is a skill. What can you do to move better and become a more skilled runner?
Before we dive into the specifics on the ingredients and tools required to address the skills of running, here are a few key essential components to practice during your next few runs:
Don’t Overstride: A lot of runners make the mistake of overstriding: putting their foot out too far in front of their center of mass. When a runner overstrides or reach, they increase their braking impulse and essentially slow themselves down with each strike. This is an inefficient way to run and significantly increases the amount of impact your body has to absorb. Therefore, overstriding can often lead to injury. To avoid overstriding, avoid reaching your leg forward and try to strike just in front of your center of mass.
Cadence: Cadence is the number of steps you take while running. A slower cadence (or taking fewer steps per run) can be indicative of overstriding. Therefore, working on your cadence can be one way to improve your efficiency and reduce overstriding. Every runner will have a different cadence, but in general efficient runners run with a cadence between 176-188 steps/min. To work on your cadence, use a metronome app or setting on your watch and try and time your foot strikes to the beat of a metronome for 2-3 minutes. Then relax into your run for 2-3 minutes. Repeat 3-5x throughout your run. Remember this is a drill to improve skill, so use it as a drill and don’t perform with every run or for your entire run.
Try not to bounce: Much like overstriding, a bouncy gait is inefficient and can lead to injury. If you have a bouncy run, you are wasting energy pushing up rather than pushing forward. This also means your mass is landing from a higher height, increasing impact. To avoid a bouncy gait, drive your leg back pushing you forward and not up. Centering your gaze on a landmark ahead of you and as you run try and keep the landmark as still as possible .
Drive from the hip and push from the ankle: The gluteus maximus is the biggest muscle in the human body. This is a big ingredient in the recipe to effectively and efficiently drive us forward with each step. Sometimes runners rely too much on their calves and quads to propel them. This typically leads to overstriding and the bouncy gait described earlier. Therefore maximize your running efficiency by driving from the hip using the gluteus maximus; making sure not to arch at the lower back. Practice striding by driving/pushing from the glutes while stabilizing through your core to avoid your back from arching.
Here at Excel PT, Our running physical therapist team works with runners every day in our Running Clinic. It’s like a specialized clinic within a clinic. We’re here to help you develop these strategies to help improve your running skills and performance as well as help you prevent injury.
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 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.
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 in our Bozeman clinic. Jason is a Specialist in Sports Physical Therapy and 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 and co-owner of Excel Physical Therapy.
Nikki Kimball ‘s PT training at home advice: Don’t forget the core! We are lucky in Bozeman, Montana to have enough space to continue walking, running, biking and skiing, at safe social distances, outside. That said, our ability to perform outdoor sports and activities can always be improved through exercises that can be done at home. Use this time to make a lasting habit of core exercise, sport-specific drills or body maintenance work (think foam rolling).
For runners, Molly Huddle has some great ideas in a recent Runner’s World online article: https://zcu.io/vPQ0
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.
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 pastinjuryor surgery. This is the bread and butter of what we do as physical therapiststhroughrehabilitating 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, reducingrisk 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 clientsresources 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-freeyear. 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.
credit: Consilience_podcast Instagram
“Push & Pull…Essential ingredients for Running and Climbing” is AJ Sobrilsky’s latest article in the 
