Pronation

October 28, 2014 by Leave a Comment

It is important to understand pronation and the way your foot moves when you run. Some people pronate more or less when they run. Learn about normal pronation, overpronation and underpronation, and how you can prevent injuries in this article published on Runnersworld.com. For more questions, call or visit our studio at 619-756-7500!

 

 

Pronation

Pronation is the inward movement of the foot as it rolls to distribute the force of impact of the ground as you run. The foot “rolls” inward about fifteen percent, comes in complete contact with the ground, and can support your body weight without any problem. Pronation is critical to proper shock absorption, and it helps you push off evenly from the front of the foot.

Although pronation is a natural movement of the foot, the size of the runner’s arch can affect its ability to roll, causing either supination (underpronation) or overpronation. If you have a normal arch, you’re likely a normal pronator, meaning you’ll do best in a stability shoe that offers moderate pronation control. Runners with flat feet normally overpronate, so they do well in a motion-control shoe that controls pronation. High-arched runners typically underpronate, so they do best in a neutral-cushioned shoe that encourages a more natural foot motion.

 

Normal Pronation

IThe outside part of the heel makes initial contact with the ground. The foot “rolls” inward about fifteen percent, comes in complete contact with the ground, and can support your body weight without any problem. The rolling in of the foot optimally distributes the forces of impact. This movement is called “pronation,” and it’s critical to proper shock absorption. At the end of the gait cycle, you push off evenly from the front of the foot.

Runner’s World Video: Normal Pronation

Normal Pronation: What is it?

We show you, in slow motion detail, how to determine if you have this gait pattern.

 

Overpronation

As with the “normal pronation” sequence, the outside of the heel makes the initial ground contact. However, the foot rolls inward more than the ideal fifteen percent, which is called “overpronation.” This means the foot and ankle have problems stabilizing the body, and shock isn’t absorbed as efficiently. At the end of the gait cycle, the front of the foot pushes off the ground using mainly the big toe and second toe, which then must do all the work.
Preventing Overpronation Injuries 
Overpronation causes extra stress and tightness to the muscles, so do a little extra stretching. Too much motion of the foot can cause calluses, bunions, runner’s knee, plantar fasciitis, and Achilles tendinitis.
If you’re an overpronator, here are a few tips to help you find the right shoes for your feet.
  • Wear shoes with straight or semi-curved lasts
  • Look for motion-control or stability shoes with firm, multidensity midsoles and external control features that limit pronation
  • Use over-the-counter orthotics or arch supports

 

Runner’s World Video: Overpronation

Overpronation: What is it?

We show you, in slow motion detail, how to tell if you have this gait pattern.

 

Underpronation (Supination)

Underpronation (or supination) is the insufficient inward roll of the foot after landing. Again, the outside of the heel makes initial contact with the ground. But the inward movement of the foot occurs at less than fifteen percent (i.e., there is less rolling in than for those with normal or flat feet). Consequently, forces of impact are concentrated on a smaller area of the foot (the outside part), and are not distributed as efficiently. In the push-off phase, most of the work is done by the smaller toes on the outside of the foot.
This places extra stress on the foot, which can lead to iliotibial band syndrome, Achilles tendinitis, and plantar fasciitis. Underpronating will cause the outer edge of running shoes to wear sooner. To see if your shoes are unevenly worn, place them on a flat surface. If they tilt outward, supination is the culprit. Runners with high arches and tight Achilles tendons tend to be supinators.
Preventing Underpronation Injuries 
Supinators should do extra stretching for the calves, hamstrings, quads, and iliotibial band. Wearing the right type of running shoes and replacing worn shoes will also help avoid injuries.
If you’re an underpronator, here are a few tips to help you find the right shoes for your feet.
  • Wear shoes with curved lasts to allow pronation
  • Look for lightweight trainers as they allow more foot motion
  • Check for flexibility on the medial (inner) side of the shoe
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Chiropractor vs. Physical Therapy: Effective for the Back

October 21, 2014 by Leave a Comment

Learn the difference between chiropractic and physical therapy treatments, and their effects for back problems. This article is from LIVESTRONG.com and written by Jessica McCahon. For more questions call our studio at 69-756-7500!

Chiropractor vs. Physical Therapy: Effective for the Back
Photo Credit BananaStock/BananaStock/Getty Images
Physical therapy and chiropractic sessions both treat back pain without drugs or surgery. 

Chiropractic sessions and physical therapy are two different ways you can treat back pain, but they essentially have the same end goal: to alleviate tension and nerve compression and restore mobility without drugs or surgery. Chiropractic treatment involves a trained practitioner manipulating your spine and surrounding muscles, while physical therapy involves a trained practitioner designing a program of exercises and assisting you in certain movements and massage techniques to relieve pain and restore strength and mobility. How effective each of these treatments is depends on the type of injury you have and your unique response to the therapy.

Chiropractic Adjustments

A common cause of back pain is a slipped, or subluxed, disc which can pinch the nerves in your spinal column. Chiropractic treatment involves the practitioner manipulating the slipped disc or pinched nerve back into its correct position with force and speed, says Steven G. Yeomans, DC, on the spine-health website. At the point where the tension is released, you may hear a cracking sound as gas is released from the pressure-filled joint. For this treatment to be fully effective, you need to be very relaxed, so your practitioner may massage or apply ice to the affected area before performing the adjustment.

Chiropractic Benefits and Side Effects

After just one chiropractic session you may feel reduced pain in your back and be able to move more freely, says Yeomans. This tension release can also ease compression of blood vessels and, therefore, improve the circulation of nutrient-rich blood to the injured area. It is common for the manipulated part of your back to feel sore for about 24 hours after a chiropractic adjustment, but applying ice to the treated area usually reduces these symptoms.

Physical Therapy Treatment

This type of treatment for a back injury can involve a range of techniques including heat therapy, ultrasound, massage, mobilization and exercise, says the Nicholas Institute of Sports Medicine and Athletic Trauma website. In particular, your therapist is likely to focus on strengthening and stretching the muscles and connective tissues around the affected area to improve posture and support and enhance flexibility and movement. As a result of this program, you should experience reduced pain and tension.

Physical Therapy Benefits and Side Effects

According to Dana L. Davis, MPT, on the spineuniverse website, physical therapy focuses on gradual recovery and maintaining the results. So, while the effects may not be felt as quickly as those of a chiropractic session, you may learn techniques that mean you can continue with treatment in the long term on your own. The time it takes to start feeling the benefits of physical therapy is different for every person and the type of injury you have, but Davis says two weeks is the average time it takes to notice a difference. No matter what your situation is, patience and a commitment to performing the prescribed exercises is essential for physical therapy success.

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Physical Therapist’s Guide to Rotator Cuff Tear

October 14, 2014 by Leave a Comment

Take care of your shoulders, and learn more about rotator cuff tears in this article from the American Physical Therapy Association, written by by Charles Thigpen, PhD, PT, ATC and Lane Bailey, PT, DPT, CSCS. For more questions, call our studio at 619-756-7500!

 

The “rotator cuff” is a group of 4 muscles that are responsible for keeping the shoulder joint stable. Unfortunately, injuries to the rotator cuff are very common, either from injury or with repeated overuse of the shoulder. Injuries to the rotator cuff can vary as a person ages. Rotator cuff tears are more common later in life, but they also can occur in younger people. Athletes and heavy laborers are commonly affected; older adults also can injure the rotator cuff when they fall or strain the shoulder, such as when walking a dog that pulls on the leash. When left untreated, this injury can cause severe pain and a decrease in the ability to use the arm.

What is a Rotator Cuff Tear?

The “rotator cuff” is a group of 4 muscles and their tendons (which attach them to the bone). These muscles connect the upper-arm bone, or humerus, to the shoulder blade. The important job of the rotator cuff is to keep the shoulder joint stable. Sometimes, the rotator cuff becomes inflamed or irritated due to heavy lifting, repetitive arm movements, or a fall. A rotator cuff tear occurs when injuries to the muscles or tendons cause tissue damage or disruption.

Rotator cuff tears are called either “full-thickness” or partial-thickness,” depending on how severe they are. Full-thickness tears extend from the top to the bottom of a rotator cuff muscle/tendon. Partial-thickness tears affect at least some portion of a rotator cuff muscle/tendon, but do not extend all the way through.

Tears often develop as a result of either a traumatic event or long-term overuse of the shoulder. These conditions are commonly called acute or chronic:

  • An acute rotator cuff tear is one that just recently occurred, often due to a trauma such as a fall or lifting a heavy object.
  • Chronic rotator cuff tears are much slower to develop. These tears are often the result of repeated actions with the arms working above shoulder level—such as with ball-throwing sports or certain work activities.

People with chronic rotator cuff injuries often have a history of rotator cuff tendon irritation that causes shoulder pain with movement. This condition is known as shoulder impingement syndrome (SIS).

Rotator cuff tears also may occur in combination with injuries or irritation of the biceps tendon at the shoulder, or with labral tears (to the ring of cartilage at the shoulder joint).

Rotator Cuff Tear-SmallRotator Cuff Tear: See More Detail

How Does it Feel?

Rotator cuff tears can cause:

  • Pain over the top of the shoulder or down the outside of the arm
  • Shoulder weakness
  • Loss of shoulder motion

The injured arm often feels heavy, weak, and painful. In severe cases, tears may keep you from doing your daily activities or even raising your arm. People with rotator cuff tears often are unable to lift the arm to reach high shelves or reach behind their backs to tuck in a shirt or blouse, pull out a wallet, or fasten a bra.

 

How Is It Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests designed specifically to help pinpoint the cause of your shoulder pain.

Physical therapists perform specialized tests–such as the Hawkins-Kennedy impingement test, Neer’s impingement sign, and the external rotation lag sign– to diagnose an impingement or a tear. For instance, your therapist may raise your arm, move your arm out to the side, or raise your arm and ask you to resist a force, all at specific angles of elevation. These tests may cause you to feel some temporary discomfort, but don’t worry—that’s normal and part of what helps the therapist identify the exact source of your problem.

In some cases, the results of these tests might indicate the need for a referral to an orthopedist or for imaging tests, such as ultrasound imaging, magnetic resonance imaging (MRI), or computed tomography (CT).

 

How Can a Physical Therapist Help?

Once a rotator cuff injury has been diagnosed, you will work with your orthopedist and physical therapist to decide if you should have surgery or if you can try to manage your recovery without surgery. If you don’t have surgery, your therapist will work with you to restore your range of motion, muscle strength, and coordination, so that you can return to your regular activities. In some cases, your therapist may help you learn to modify your physical activity so that you put less stress on your shoulder. If you decide to have surgery, your therapist can help you both before and after the procedure.

Regardless of which treatment you have—physical therapy only, or surgery and physical therapy—early treatment can help speed up healing and avoid permanent damage.

 

If You Have an Acute Injury

If a rotator cuff tear is suspected following a trauma, seek the attention of a physical therapist or other health care provider to rule out the possibility of serious life- or limb-threatening conditions. Once serious injury is ruled out, your physical therapist will help you manage your pain and will prepare you for the best course of treatment.

 

If You Have a Chronic Injury

A physical therapist can help manage the symptoms of chronic rotator cuff tears as well as improve how your shoulder works. For large rotator cuff tears that can’t be fully repaired, physical therapists can teach special strategies to improve shoulder movement.

 

If You Have Surgery

Once a full-thickness rotator cuff tear develops, you may need surgery to restore use of the shoulder or decrease painful symptoms. Physical therapy is an important part of the recovery process. The repaired rotator cuff is vulnerable to reinjury following shoulder surgery, so it’s important to work with a physical therapist to safely regain full use of the injured arm. After the surgical repair, you will need to wear a sling to keep your shoulder and arm protected as the repair heals. Once you are able to remove the sling for exercise, the physical therapist will begin your exercise program.

Your physical therapist will design a treatment program based on both the findings of the evaluation and your personal goals. He or she will guide you through your postsurgical rehabilitation, which will progress from gentle range-of-motion and strengthening exercises and ultimately to activity- or sport-specific exercises. Your treatment program most likely will include a combination of exercises to strengthen the rotator cuff and other muscles that support the shoulder joint. Your therapist will instruct you in how to use therapeutic resistance bands. The timeline for your recovery will vary depending on the surgical procedure and your general state of health, but full return to sports, heavy lifting, and other strenuous activities might not begin until 4 months after surgery. Your shoulder will be very susceptible to reinjury, so it is extremely important to follow the postoperative instructions provided by your surgeon and physical therapist.

Physical therapy after your shoulder surgery is essential to restore your shoulder’s function. Your rehabilitation will typically be divided into 4 phases:

  • Phase I (maximal protection). This phase lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. During this phase, your arm will be in a sling. You will likely need assistance or need strategies to accomplish everyday tasks such as bathing and dressing. Your physical therapist will teach you gentle range-of-motion and isometric strengthening exercises, will provide hands-on techniques such as gentle massage, will offer advice on reducing your pain, and may use cold compression and electrical stimulation to relieve pain.
  • Phase II (moderate protection). This next phase has the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will become more challenging. Exercises will be added to strengthen the “core” muscles of your trunk and shoulder blade (scapula) and “rotator cuff” muscles that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but will still avoid any heavy lifting with your arm. Your physical therapist may use special hands-on mobilization techniques during this phase to help restore your shoulder’s range of motion.
  • Phase III (return to activity). This phase has the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will advance the difficulty of your exercises by adding more weight or by having you use more challenging movement patterns. A modified weight-lifting/gym-based program may also be started during this phase.
  • Phase IV (return to occupation/sport). This phase will help you return to sports, work, and other higher-level activities. During this phase, your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves, or instruction in raking, shoveling, or housework.

 

Can this Injury or Condition be Prevented?

A physical therapist can help you decrease your risk of developing or worsening a rotator cuff tear, especially if you seek assistance at the first sign of shoulder pain or discomfort. To avoid developing or progressing to a rotator cuff tear from an existing shoulder impingement, it is imperative to avoid future exacerbations. Your physical therapist can help you strengthen your rotator cuff muscles, train you to avoid potentially harmful positions, and determine when it is appropriate for you to return to your normal activities.

General Tips:

  • Avoid repeated overhead arm positions that may cause shoulder pain. If your job requires such movements, seek out the advice of a physical therapist to learn arm positions that may be used with less risk.
  • Apply rotator cuff muscle and scapular strengthening exercises into your normal exercise routine. The strength of the rotator cuff is just as important as the strength of any other muscle group. To avoid potential detriment to the rotator cuff, general strengthening and fitness programs may improve shoulder health.
  • Practice good posture. A forward position of the head and shoulders has been shown to alter shoulder blade position and create shoulder impingement syndrome.
  • Avoid sleeping on your side with your arm stretched overhead, or lying on your shoulder. These positions can begin the process that causes rotator cuff damage.
  • Avoid carrying heavy objects at your side; this can strain the rotator cuff.
  • Avoid smoking; it can decrease the blood flow to your rotator cuff.
  • Consult a physical therapist at the first sign of symptoms.

 

Real Life Experiences

Over the past 3 weeks, Jonathan has felt pain in his shoulder while repainting his house. Now, every time he raises his arm overhead, it hurts. He notices that the pain has been steadily getting worse.

What should he do?

  • Rest. Avoid activities that require reaching overhead and rest his elbow on an armrest when sitting. This may allow the irritated muscles and tendons to heal.
  • Ice. Apply ice to the shoulder to help decrease any irritation and swelling.

Jonathan has stopped reaching overhead to paint and puts ice on his shoulder in the evening. But he still feels pain and stiffness in the area, and he can’t move his arm without pain or weakness. He contacts his physical therapist, who prescribes exercises to strengthen his rotator cuff muscles and improve postural habits, and provides education to avoid exacerbating activities.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat patients who have a rotator cuff tear, but you may want to consider:

  • A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with an orthopedic focus.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedics physical therapy has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with labral tears.
  • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
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Physical Therapy for Shoulder Impingement & Tendonitis

July 24, 2014 by Leave a Comment
Shoulder inflammation can be painful, and should be taken care of. It is common among swimmers, or sports where arm swings and shoulder rotation are used consistently. Here are a few exercises explained by Jessica Wellons in an article posted on Livestrong.com, to help strengthen your shoulder and thus prevent shoulder impingement and tendonitis. For questions, call us at 619-756-7500!
Physical Therapy for Shoulder Impingement & Tendonitis

The rotator cuff consists of four muscles and tendons that cover the head of the humerus and attach it to the shoulder blade, or scapula. They provide stability and strength during rotational movements in the arm. Shoulder impingement refers to mechanical compression or inflammation of the rotator cuff tendons. This occurs when the space in the shoulder joints narrows and the rotator cuff tendons or bursa, lubricating sacs located over the rotator cuff, become compressed, irritated or damaged, resulting in pain, inflammation and reduced mobility. Exercises that target the rotator cuff will strengthen the surrounding muscles and tendons, improve circulation to the joint, flexibility and range of motion.

External Rotation

Stand with your back against a wall, ensuring that your torso and shoulders remain straight. Bend your right elbow to form a 90-degree angle and bring your arm across r youabdomen, remembering to keep your thumb upright and flattening your palm against your stomach. Perform an external rotation by moving your arm and forearm away from the abdomen, remembering to keep your elbow bent. Continue this external rotation until the back of your arm is flat against the wall. Hold this position for five seconds and rotate your arm back to the starting position. Perform one set of 10 repetitions on both arms, once daily.

Supraspinatus Stretch

You will need two dumbbells to perform this exercise. Standing upright, holding a dumbbell in each hand with thumbs pointing down. While keeping your elbows straight, slowly bring your arms outward to form a 45-degree angle. Hold this position for five seconds and slowly return to the starting position. Perform three sets of 20 repetitions, once daily to strengthen the muscles and tendons in the rotator cuff, thus stabilizing the shoulders and restoring mobility.

Triceps Stretch

Stand upright and bend your right elbow to form a 90-degree angle. Raise your right hand so that your forearm forms a 90-degree with your shoulder and place your opposite hand over your elbow. Using your left hand, grab the opposite elbow and gently pull that arm down behind your head. Continue this gentle pull until you feel a stretch in your shoulders. Hold this stretch for five seconds and relax. Perform one set of 10 repetitions on both arms, two to three times daily to stretch the tendons and joints in the shoulder and help restore your range of motion.

Scapular Squeezes

Lie on your back and bend both knees. Plant your feet firmly on the ground and extend your arms away from your body, with palms up. While maintaining contact between the ground and your lower back, begin squeezing your shoulder blades together, downward and toward your spine. While performing this exercise, try to not shrug your shoulders and remember to relax your neck. As your perform this exercise, the lower muscles between your scapula should be contracting. Hold each shoulder blade squeeze for five seconds and relax. Perform one set of 20 repetitions three times a day to strengthen the muscles in the shoulders and prevent further injury.

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Exercise Ball Therapy for Lower Back Pain Relief

July 22, 2014 by Leave a Comment

Lower back pain seems to be a common issue. Here is one way to relieve lower back pain using an exercise ball. This article was posted on spin-health.com, a forum for thousands of doctor written, doctor reviewed articles on back pain, neck pain, and related disorders. For more questions give us a call at 619-756-7500!

 

The exercise ball is an exercise treatment option for back pain sufferers and is designed to help prevent or minimize further episodes of low back pain as part of a rehabilitation program. The exercise ball is effective in rehabilitation of the back because it strengthens and develops the core body muscles that help to stabilize the spine.

With the exercise ball, also called a Swiss ball or physio ball, an element of instability is introduced to the exercise that one would not normally get in a floor exercise. The body responds naturally and automatically to this instability to keep balanced on the exercise ball. Over time, the muscles used to keep in balance on the exercise ball become stronger. In essence, individuals build strength in important back muscles and abdominal muscles without knowing it.

The exercise ball also uses what is called “proprioception,” an awareness of where one’s hand or foot is in relationship to space. The instability of the exercise ball provides the body with constant opportunities to evaluate its orientation in space, developing and training the body’s natural awareness. Enhanced proprioception provides the body with increased balance and stability.

In addition, it is theorized that the type of spinal movement induced by using the exercise ball (small range, adjustment of balance) may help reduce pain by stimulating the body to produce increased amounts of natural pain inhibitors.

The benefits of exercising on an exercise ball for people with low back pain include:
•Simple and versatile way to start moving again after a back pain episode
•Improved muscle strength
•Greater flexibility and range of motion of the spine
•Enhanced balance and coordination of core muscle groups used to stabilize the spine and control proper posture while using the exercise ball, which in turn reduces stress on the low back
•Increased tendency to maintain a neutral spine position during exercise
•In particular, many Swiss ball exercises are designed to bring movement to the spine in a controlled manner to help keep the discs nourished. Moving the vertebrae helps nourish the discs in the spine by increasing blood flow around the disc and by causing the water to flow in and out of the disc

The exercise ball has additional applications in areas such as general fitness, strength or weight training, as well as exercise for pregnant women.

For all forms of exercise, it is advisable to see an appropriately trained and licensed spine specialist, such as a physical therapist, occupational therapist, chiropractor, exercise physiologist, or physical medicine and rehabilitation physician (also called a physiatrist). Depending on the specific diagnosis and level of pain, the exercises with the ball will be different, and appropriately trained spine specialists (e.g. certified in exercise ball technique) play a critical role in both developing the right exercise program and providing instruction on correct form and technique.

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Physical Therapy Exercises for Core Stabilization

July 17, 2014 by Leave a Comment

You probably use your core more than you realize. Core strength is extremely important and necessary balance, it is the base of your body that ultimately keeps you stable. Helen Mitchell, a physical therapist assistant, offers some great exercises written for Eastpoint Health & Fitness to strengthen your core. For more questions give us a call at 619-756-7500!

Core stabilization, or core strengthening has been around for many years and has been incorporated into sports performance training programs, exercise programs such as Yoga, Pilates and Boot Camps. In Physical Therapy and rehabilitation, core stabilization means that activation of the trunk muscles must occur first in order for us to create a stable base of support that allows us to move our arms and legs. Making the trunk muscles stronger keeps the spine stable and helps the body stay balanced with movement; preventing falls and injury.

Most people think of the “core” as just being the abdominals (stomach muscles) when in fact the “core” muscles run the entire length of the torso from the hips to the shoulders. When these muscles contract, they stabilize the spine, pelvis and shoulder girdle and create a solid base of support. This allows us to stand upright and move on two feet, shift our weight and move in any direction. This distribution of weight protects the back from injury. An effective core conditioning program needs to target all muscles of the core to be effective.

Benefits of Good Core Strength:

A strong core:

• Reduces Back Pain and Prevents Injury
• Improves Athletic Performance
• Improves Postural Imbalances

Exercises that Build Core Strength:

The most effective core strengthening exercises work the torso as a solid unit with both front and back muscles contracting at the same time. The most basic core strengthening exercise is Abdominal Bracing where you try to pull your navel in toward your spine without holding your breath. Most core strengthening exercises don’t require equipment and include:

• Planks: Position yourself face down on hands and balls of feet. Straighten arms. Tighten stomach muscles and lift hips to form a straight line from head to toe. Hold 15-30 seconds. Do not let hips sag to the floor.

• Basic Push Up: Position yourself face down with hands under shoulders and on balls of feet. Tighten stomach muscles and bend elbows to lower chest towards the ground. Keep neck in neutral by gazing towards floor. Straighten elbows to complete one repetition. Do not let hips sag to the floor.

• Bridging: Lay face up on flat surface, knees bent and arms by sides. Slowly raise buttocks and hips, keeping stomach tight. Slowly lower hips again. This completes one repetition.

• Supermans: Lay face down on flat surface with arms stretched overhead and straight legs. Tighten stomach muscles and simultaneously lift arms and legs into the air a few inches then slowly lower them.

Other exercises include the use of stability balls, medicine balls, kettlebells, wobble boards, yoga and pilates. These particular exercises should only be performed under the supervision of a trained professional and when beginning any type of exercise program, always consult your physician first.

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Skip the Running: Alternatives to High-Impact Exercises

July 11, 2014 by Leave a Comment

When it’s time to get back into the gym, running always appears to be one of the best forms of cardio. However, it get be very stressful on your joints. Adrienne Santos-Longhurst gives us some great cardio alternatives in this article posted on Livestrong.com. For additional questions, give us a call at 619-756-7500!

Give your joints a rest and test your meddle with these high-intensity/low-impact alternatives—not for beginners.
Written by Adrienne Santos-Longhurst
Medically Reviewed on June 5, 2013 by George Krucik, MD, MBA

Those who have felt the proverbial “runner’s high” will tell you that there’s no other activity that even compares to running. As intoxicating as a hard run can be, running can take a toll on your joints even if you’re in tip-top shape. Finding alternatives to running will help keep you active while giving your joints a much-needed break. According to a 1994 study conducted by the Exercise Science Unit at the University of Tennessee at Knoxville, cross-training is highly beneficial to your overall health and an effective alternative for athletes who are taking a break because of physical injury, overtraining, or fatigue.
Whether you’re in need of some recovery time from an injury or just looking for high-impact alternatives to mix things up and give your joints a break from the pavement pounding, these alternatives to running fit the bill.

Cycling
Cycling offers runners the perfect alternative to running. Just like running, cycling can be enjoyed indoors or out thanks to stationary bikes and bike trainers. Cycling allows you to maintain and improve your fitness but without the same stress on your joints and shins. Hop onto a road bike, a stationary bike at home or at the gym, or try an advanced Spin class for a high-intensity workout that just might offer runners a new kind of high.

The Elliptical Trainer
Love it or hate it, the elliptical trainer offers an excellent training alternative for runners who are injured or looking to rest their joints. Elliptical machines allow you to mimic the motion of running, and though a weight-bearing activity, it is low-impact for your joints so that you can get a workout comparable to jogging with less impact on your joints and no knee pain, according to Mayo Clinic physical medicine and rehabilitation specialist Edward R. Laskowski, MD. Focusing on motions that are as similar as possible to your usual running form and sticking to a similar training schedule will help you make the most of this activity and maintain your fitness level.

Water Running
Runners who need a change but are reluctant to try anything other than running are likely to find water running, which is also referred to as pool running, to be a good compromise. Just as the name suggests, water running is performed by running in water, often the deep end of a swimming pool. This great alternative to running lets you enjoy the benefits that come from the motion of running without any impact on your joints. To get the most out of pool running, focus on your form, staying consistent with your regular running motion. Following a training schedule similar to your running one will also help you get the most from this unique alternative while still allowing your joints a break.

Walking
Contrary to popular belief that walking isn’t nearly as good a workout as running; walking is in fact an effective alternative for runners who want the same health benefits but without the impact on their joints. A study published by the American Heart Association in their journal, Arteriosclerosis, Thrombosis, and Vascular Biology, found that walking was just as effective as running in lowering the risk of hypertension, diabetes, and high cholesterol. The key is to walk for twice as long as you would run in order to get the same benefits as you would from running. Along with the health benefits, you also get to enjoy the fresh air and scenery that makes running so appealing.

Step Aerobics
Taking a step aerobics class or working out to a step video offers a high-intensity and low-impact workout that is easier on the joints than running but still effective in improving muscular strength and cardiovascular endurance. A 2006 study published in the British Journal of Sports Medicine found that step exercise offers a workout with a biomechanical load that falls between what you would get from walking and running. The key is to perform the moves properly and safely to avoid injury.

Read more: http://www.healthline.com/health/osteoarthritis/knee/alternatives-to-high-impact-exercises#ixzz37Alz0m00

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Physical Therapy Exercises for Runner’s Knee

July 3, 2014 by Leave a Comment

Running is a popular form of exercise, but can be very hard on your body. Keith Strange offers some good exercises to help with “runner’s knee” in this article posted on Livestrong.com. For more questions give us a call at 619-756-7500!

Runner’s knee is an overuse injury that can result in pain when bending your knee.

Runner’s knee, or patellofemoral pain syndrome, is a condition that causes a dull or aching pain around or under your kneecap, according to the American Academy of Orthopaedic Surgeons. This condition can be aggravated by walking up or down stairs or when squatting down or bending your knee for an extended period of time. Treatment for this condition often includes exercises designed to help you build strength and flexibility in your thigh muscles.

Standing Hamstring Stretch
Stand in front of a chair or stool that is about knee height. Place the heel of your injured leg on the stool with your toes pointing toward the ceiling. Lean forward at your waist until you feel a stretch in the back of your thigh. Hold this stretch for up to 30 seconds and relax. Repeat. Be sure that you keep your shoulders positioned directly in line with your hips when performing this stretch.

Standing Quadriceps Stretch
Stand in front of a counter or wall for support. Place the hand of your uninjured side on the wall with your uninjured leg farthest away from the wall. Bend your injured knee and reach down with your other hand and grab your foot around your ankle. Use your hand to pull your ankle toward your buttocks until you feel a stretch along the front of your thigh. Hold this stretch for 15 to 30 seconds and relax. Repeat.

Quadriceps Sets
Sit down on the floor with both legs extended in front of you and your toes pointing toward the ceiling. If necessary, you can place a rolled-up towel under the back of your injured knee. Press the back of your knee into the towel by contracting the muscles along the front of your thigh. Hold this contraction for about five seconds and relax. Repeat. You can ensure that you’re performing this exercise correctly by placing your hands on the front of your thigh to feel your muscles contract.

Straight Leg Raise
Lie down on your back with your injured leg extended and your toes pointing toward the ceiling. Bend your other knee and place the sole of your foot on the floor. Keep your injured knee straight and lift your heel about eight inches off the floor. Hold this position for a few seconds and use a slow and controlled motion to lower your heel back to the floor. Repeat.

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Benefits of the Use of Ultrasound in Physical Therapy

June 26, 2014 by Leave a Comment

If you have ever thought of using ultrasound for physical therapy, take a look at this article by Erica Jacques for more information. Give us a call at 619-756-7500 if you have any additional questions!

Ultrasound can help to prepare a muscle for stretching.
Ultrasound, according to Alain-Yvan Belanger, is the most commonly used modality in physical therapy today. Its use dates all the way back to the 1880s. Ultrasound machines generate sound waves that are higher than the frequency we can hear. The effect of these sound waves on the body’s tissues produces a number of benefits.

Deeper Heat
According to Belanger, the way ultrasound generates heat is through the vibrations caused by the sound waves. When tissues vibrate, this increases friction all the way down to the molecular level, causing the temperature of the targeted tissues to rise. This is a benefit of ultrasound over a traditional hot pack, which cannot penetrate into deeper musculature or joint tissues. Ultrasound heads are available in a variety of frequencies that can target a variety of depths, which gives a skilled therapist the ability to send heat exactly where she wants it to go. Some conditions that may benefit from this deeper heat, according to Belanger, include osteoarthritis and phantom limb pain.

Deeper Stretch
The deep heat generated by ultrasound can help to relax a tense or strained muscle. According to Spine Universe, this can help to minimize muscle spasms and shortening often associated with tension or injury. Spine Universe reports that ultrasound therapy has the added benefit of increasing range of motion.

Tissue Healing
Ultrasound’s deep heat is thought to have a healing effect on deep tissues. According to Belanger, ultrasound actually affects the metabolism of soft tissue cells. In addition, these cells often become more receptive to healing fluids, which are present in the increased blood flow generated by ultrasound. Because of this, Belanger goes on to report that ultrasound’s healing benefits may be useful in treating surgical wounds and soft tissue lesions.

Scar Tissue Control
Another benefit of ultrasound is its acoustic effect. The waves generated by ultrasound cause tiny vibrations in the cells of the soft tissues. These microvibrations, as Belanger describes them, have an effect on the fibers that form scar tissue. Over time, ultrasound used in this method can actually prevent some scar tissue from forming, and may be able to break some scar tissue down. Examples of success in scar tissue management are episiotomy scars as well as Dupuytren’s contracture, which is caused by excessive scarring in the tissues of the palm. As with its thermal effects, ultrasound used to break up scar tissue can also maintain and increase range of motion.

Reduced Pain
Some of the pain control from ultrasound comes from the mechanical results of the treatment itself. These include the decreased muscle spasms and muscle tightness as well as tissue healing. However, an added benefit of ultrasound comes not from what it does, but what it can help a physical therapist do. Combining the heating and healing powers of ultrasound prepares muscles for other therapeutic treatments that reduce pain, including stretching and strengthening.

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The Effects of Pronation Distortion Syndrome and Solutions for Injury Prevention

January 23, 2014 by Leave a Comment

Issues starting at the foot and ankle can cause distress to other regions of the body. Read this article by Scott Lucett, MS, NASM-CPT, PES, CES who is a Senior Research Director for the National Academy of Sports Medicine for great insight on this topic! Then come see us at San Diego Sports Physical Therapy for great exercises. 619-756-7500

Dysfunction at the foot and ankle complex can lead to a variety of musculoskeletal issues in other regions of the kinetic chain that can eventually lead to injury. In this article, we’ll review the common postural distortion pattern, Pronation Distortion Syndrome, its effects on the kinetic chain, and corrective solutions to decrease injury risk.

Introduction

Pronation distortion syndrome is characterized by excessive foot pronation (flat feet) with concomitant knee internal rotation and adduction (“knock-kneed”). This lower extremity distortion pattern can lead to a chain reaction of muscle imbalances throughout the kinetic chain, leading to foot and ankle, knee, hip and low back pain.

It has been shown that excessive pronation of the foot during weight bearing causes altered alignment of the tibia, femur, and pelvic girdle (Figure 1) and can lead to internal rotation stresses at the lower extremity and pelvis, which may lead to increased strain on soft tissues (Achilles tendon, plantar fascia, patella tendon, IT-band) and compressive forces on the joints (subtalar joint, patellofemoral joint, tibiofemoral joint, iliofemoral joint, and sacroiliac joint), which can become symptomatic (1,2). The lumbo-pelvic-hip complex alignment has been shown by Khamis to be directly affected by bilateral hyperpronation of the feet. Hyperpronation of the feet induced anterior pelvic tilt of the lumbo-pelvic-hip complex (3). The addition of 2-3 degrees of foot pronation lead to a 20-30% increase in pelvic alignment while standing and 50-75% increase in anterior pelvic tilt during walking (3). Since anterior pelvic tilt has been correlated with increased lumbar curvature, the change in foot alignment might also influence lumbar spine position (4). Furthermore, an asymmetrical change in foot alignment (as might occur from a unilateral ankle sprain) may cause asymmetrical lower extremity, pelvic, and lumbar alignment, which might enhance symptoms or dysfunction. An understanding of this distortion pattern and its affects throughout the kinetic chain becomes particularly important for recreational runners and walkers as the accompanying stressors to the soft tissues and joints can lead to Achilles tendonitis, plantar fasciitis, IT-band syndrome, and low back pain.

Assessment

When assessing for pronation distortion syndrome, both static and dynamic assessments can be done. When performing either a static or dynamic assessment, have the individual take their shoes off and make sure you have the ability to see their knees as well. During a static assessment, from an anterior and posterior view, look to see if the arches of their feet are flattened and/or their feet are turned out. When performing a dynamic assessment, such as the overhead squat, look to see if the feet flatten and/or turn out and if the knees adduct and internally rotate (knee valgus). These compensations can also be assessed both from an anterior and posterior view. For many, it’s easier to see excessive foot pronation from a posterior view in comparison to an anterior assessment, so assessing in both positions can help in confirming your findings.

Corrective Exercise Strategies for Pronation Distortion Syndrome

Functionally tightened muscles that have been associated with pronation distortion syndrome include the peroneals, gastrocnemius, soleus, IT-band, hamstring, adductor complex, and tensor fascia latae (TFL). Functionally weakened or inhibited areas include the posterior tibialis, anterior tibialis, gluteus medius and gluteus maximus. Following NASM’s Corrective Exercise Continuum programming strategy can help address these muscle imbalances that may be contributing to the distortion pattern (5). First, inhibit the muscles that may be tight/overactive via self-myofascial release. Key regions that should be addressed would include the peroneals, gastrocnemius/soleus, IT-band/TFL, bicep femoris and adductor complex.

The next step is to lengthen the tight muscles via static stretching. Key muscles to stretch include the gastrocnemius/soleus, TFL, bicep femoris and adductor complex. Hold each stretch for a minimum of 30 seconds perform 1-2 sets of each stretch.

Once the overactive muscles have been addressed, activate the underactive muscles. Key areas to target with isolated strengthening are the anterior tibialis via resisted dorsiflexion, posterior tibialis via a single-leg calf raise, gluteus medius via wall slides and gluteus maximus via floor bridges. Perform 1-2 sets of 10-15 repetitions.

Finally, perform an integrated exercise to improve muscle synergy to enhance neuromuscular efficiency and overall movement quality. An example integration exercise would include a multiplanar single-leg balance reach while maintaining neutral foot and knee alignment. Perform 1-2 sets of 10-15 repetitions.

Summary

Pronation distortion syndrome is a common lower extremity postural distortion pattern that can lead to other movement dysfunction patterns throughout the kinetic and ultimately injury. By incorporating static and dynamic assessments of the foot and ankle complex can help to identify this distortion pattern. Once identified, following a systematic corrective exercise strategy can help to improve functionality and movement quality, leading to decreased risk of injury.

References

Powers, C.M. (2003). The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. Journal of Orthopedic & Sports Physical Therapy, 33:639-46.
Powers, C.M., Chen, P.Y., Reischl, S.F., & Perry, J. (2002). Comparison of foot pronation and lower extremity rotation in persons with and without patellofemoral pain. Foot & Ankle International, 23:634-40.
Khamis, S., & Yizhar, Z. (2007). Effect of feet hyperpronation on pelvic alignment in a standing position. Gait Posture, 25:127-34.
Levine, D., & Whittle, M.W. (1996). The effects of pelvic movement on lumbar lordosis in the standing position. Journal of Orthopedic & Sports Physical Therapy, 24:130-5.
Clark, M. C., & Lucett, S. C. (2011). NASM Essentials of Corrective Exercise Training. Baltimore, MD: Lippincott, Williams and Wilkins.
– See more at: http://blog.nasm.org/fitness/the-effects-of-pronation-distortion-syndrome-and-solutions-for-injury-prevention/#sthash.l1qfwl4p.dpuf

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