Active Seniors Enjoy Life More

September 19, 2013 by Leave a Comment

It’s no secret that being active and moving helps with longevity! Here’s an article from ACE Fit Tips about exercise and the benefits from working out at an older age. Come see us at San Diego Sports Physical Therapy for help and tips about staying healthy longer.

Good news for older adults: part of the prescription for a healthier, better retirement is exercise. Physical activity protects against declining health and fitness and adds years to your life. Join the growing number of older adults who are actively demonstrating that exercise helps keep a body strong.

The Best Retirement Is an Active One

Did you know that moderate-intensity physical activity can help you live longer and reduce health problems? Regular exercise helps control blood pressure, body weight and cholesterol levels, and cuts the risk for hardening of the arteries, heart attack and stroke. It conditions muscles, tendons, ligaments and bones to help fight osteoporosis, keep your body more limber and stabilize your joints, thus lowering the risk of everyday injury. It also improves digestion and is good for managing low-back pain, arthritis and diabetes. Regular physical activity helps you maintain your independence. And recently, there’s been more research that suggests an active lifestyle lowers the risk of some cancers. But perhaps the best reason for incorporating regular exercise into your life is that you’ll feel better. Exercise helps you sleep better and manage stress better, and gives you more energy to enjoy work and play.

Fitness Is Golden

A good exercise program includes cardiovascular exercise, muscular conditioning and flexibility exercises. The best cardiovascular exercises for seniors are non-jarring, such as walking, swimming and cycling. Start with a light regimen and gradually build up to a total of at least 30 minutes of activity on most, preferably all, days of the week. Playing with children, gardening, dancing and housecleaning are other ways to incorporate activity into your daily routine.

Strengthening exercises such as lifting light weights (or even household items such as canned foods or milk jugs) help to maintain your muscle mass and promote bone health. Plus, research suggests that adults older than 50 years who do not perform resistance training lose nearly 1/4 pound of muscle mass per year. Since muscle mass is directly related to how many calories your body burns each day, resistance training is important for weight management. And strong leg and hip muscles help to reduce the risk of falls, a cause of considerable disability among older adults. Aim to participate in resistance training at least two days per week, making sure to exercise all major muscle groups through a full range of motion.

End each workout with stretching exercises to help maintain your mobility and range of motion and decrease your risk for injury.

A Few Safety Tips

Always remember to keep safety in mind when exercising.

Wear comfortable, well-fitting shoes.
Avoid outdoor activities in extreme temperatures.
Drink plenty of fluids to stay well hydrated.
Listen to your body when determining an appropriate exercise intensity (and keep in mind that monitoring intensity using heart rate isn’t accurate if you are on heart-rate-altering medications such as most medications for hypertension).
Be aware of danger signs. Stop activity and call your doctor or 911 if you experience any of the following: pain or pressure in your chest, arms, neck or jaw; feeling lightheaded, nauseated or weak; becoming short of breath; developing pain in your legs, calves or back; or feeling like your heart is beating too fast or skipping beats.
Discover the Exercise You Like Best

The best way to keep fit is to choose exercises you enjoy. Favorites among some older adults include aqua aerobics, yoga, Pilates, tai chi, line dancing, square dancing, ballroom dancing or simply walking the dog. You may enjoy group exercise classes, since they offer an opportunity to socialize and develop friendships.

When you’re deciding on a class or program, make sure the instructor is certified by an accredited professional organization such as the American Council on Exercise and has completed specialty training in senior health and fitness. And remember the other elements that contribute to good health in your golden years: A well-balanced diet, not smoking and seeing your doctor regularly.

Look at your retirement or senior years as an opportunity to do things you have never done before. Most of all, enjoy yourself!

Additional Resources

National Institute on Aging: www.niapublications.org/exercisebook/ExerciseGuideComplete.pdf

NIH Senior Health: www.nihseniorhealth.gov

Medline Plus—Exercise for Seniors: www.nlm.nih.gov/medlineplus/exerciseforseniors.html

International Council on Active Aging: www.icaa.cc

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The 8 Best Physical Therapy Methods Explained

September 17, 2013 by Leave a Comment

Here’s a key to understanding best physical therapy methods from Jeremy Duvall. If you’re experiencing any pain, contact us at San Diego Sports Physical Therapy to move forward with your health!

From breaks to bruises to bursitis, physical therapists have a special knack for assessing the human body and helping restore it back to optimal performance. Armed with cutting edge equipment and a huge background of knowledge, PTs can help diagnose and treat many common ailments and movement disorders. But despite having a slew of cool toys (laser therapy anyone?), their most useful tool for treatment may be their hands. Read on for the need-to-know on the most popular treatment options for whatever injury might come along.

LET’S GET PHYSICAL — THE ASSESSMENT

The first step in the treatment process of any good physical therapist is evaluation. Expect therapists to ask detailed questions about how the injury came about, but also do some expert sleuth work (since the injured area may be a result and not the starting point of poor movement). According to Dr. Mike Reinold, a Boston-based PT and therapist for the Red Sox, therapists may be able to reduce the pain quickly, but that will only be temporary unless they address the root cause of the problem.

Although patients may come to see therapists for a variety of causes, low back aches, knee pain, and overuse injuries are among the most common complaints. Following a thorough investigation, therapists will begin to lay out a treatment plan, which will commonly include passive modalities (ice, heat, laser therapy, and electrical stimulation to name a few). But more often than not, manual therapy — a term that includes many methods of restoring tissue function like massage, stretching, and exercise — is the foundation for the assessment and treatment of an injury, Reinold says. Just don’t anticipate hopping (or running, swimming, or lifting) back into activity right away. According to Dr. Eugene Babenko, a physical therapist based in New York City, the average length of care for musculoskeletal (read: bone and muscle injuries) can be anywhere from four to six weeks.

PUTTING THE PIECES TOGETHER — THE TREATMENT

Physiotherapy Feet
Ready to get going on the road to recovery? Before heading to your local PT office blindly, Greatist consulted with Reinold and Babenko to break down the most effective treatment methods for a variety of ailments, big and small. Note: The following section covers general assessments, not meant to take the place of professional medical advice, which will vary on a case-by-case basis.

Manual Therapy
Best for: Any injury
This hands-on approach separates physical therapists from other health practitioners. Although manual therapy may refer to many things, therapists usually employ common tactics like stretching, massage, and hands-on strengthening exercises to reeducate the body into proper movement and mechanics. “Manual therapy is a prime method to removing movement restrictions and helping patients move better,” according to Dr. Reinold. He also advises that manual therapy should form the backbone of any treatment plan, not modalities like ice and electric stimulation.

Ice
Best for: Injuries involving inflammation and swelling
Ice can be a major component of injury treatment. By constricting blood vessels after application, ice is an effective way to reduce and even prevent inflammation immediately following an injury. Cold therapy can also leave the joint more mobile and enhance manual therapy. Although it’s difficult to nail down the most effective protocol, applying cold packs to inflamed areas has been shown to significantly reduce swelling in soft tissue injuries [1] [2].

Heat
Best for: Injuries involving muscular spasms and tightness
Applying heat has been shown to decrease pain and increase mobility after some injuries — mainly those involving soft tissue like muscles, tendons, and ligaments [3] [4] [5]. By making the tissue more pliable, the therapist can better stretch the affected area. Note: Heat is just one tool to help the therapist be more effective, Dr. Reinold says, it shouldn’t be the main focus of a treatment plan.

Ultrasound
Best for: Connective tissue injuries
By using sound waves (undetectable to the human ear) to generate heat deep in the body, ultrasound therapy can help loosen up tissues in preparation for manual therapy or exercise. How it works: Therapists use a wand (unfortunately not the magic kind!) to apply the sound waves directly — and safely — to the skin. Ultrasound has also been shown to increase ligament-healing speed in our furry counterparts (read: rats), though more studies are needed to show whether the same holds true for us [6].

Low-Level Laser
Best for: Muscular or connective tissue injuries
Laser therapy uses specific wavelengths of light to stimulate healing (well below the skin so you don’t feel a thing). Best-case scenario: The treatment can help reduce inflammation, muscle fatigue, and pain [7]. It can also allow the therapist to move the affected joint around easier with less discomfort.

Traction
Best for: Disc herniation
When we stand, our spine is consistently bearing our weight making recovery from back pain difficult, Dr. Reinold says. Traction involves separating vertebrae to allow more space for nerves and less compression on disc cartilage. Some research shows that traction can be effective for reducing pain and enhancing quality of life in patients with a herniated lumbar disc [8]. And since it doesn’t involve going under the knife, this can be an effective treatment option for those who can’t afford a long recovery.

Functional Electrical Stimulation
Best for: Restoring muscular strength
It’s electric — no really. Electrical stimulation, also referred to as ESTIM, is a common treatment option to restore muscular function following a traumatic injury. By applying a minor but steady electrical stimulus, therapists can cause contractions from muscles that may otherwise remain dormant. This leads to restoring proper movement and function sooner than relying on exercise alone. While ESTIM can’t restore movement in every case, research shows it can speed recovery following ACL and total knee replacement surgery over the course of a few weeks [9]. Additional research confirms the use of ESTIM as an effective treatment option to restore function in hemiplegic patients (those with one side of the body paralyzed) [10].

Exercise
Best for: Any injury to stay healthy after treatment
It may sound obvious, but exercise is a go-to strategy to treat and prevent pain. But these aren’t just any old run of the mill exercises — they’re hand-picked to help patients move better by strengthening targeted muscles and addressing any muscular imbalances that may exist, Dr. Babenko says. Also, keep in mind that many injuries can crop up (or recur) from a sedentary and repetitive lifestyle, Dr. Reinold explains. (Think: hunching over the computer or obsessing over that Instagram feed.) By performing any sort regular exercise, those with even the most sedentary day-to-day can avoid common nagging aches and pains.

Ready to get checked out? Many patients can be referred to therapy by their primary care physicians after an initial checkup. Additionally, new state-by-state direct access laws now allow those in pain to head straight to their local therapist (check your state guidelines for specifics).

Disclaimer: Remember that none of this information should substitute professional medical advice. Always check with a doctor or physical therapist first once those aches and pains arise!

Special thanks to Greatist Experts Dr. Mike Reinold and Dr. Eugene Babenko for their help with this article.

Have you tried any of these therapies? Got any others to add? Share them in the comments below, or get in touch with the author on Twitter at @JeremeyD.

ABOUT THE AUTHOR JEREMEY DUVALL
Jeremey is a personal trainer and fitness writer based out of the outdoor mecca of Boulder, Colorado.

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KNEE OSTEOARTHRITIS PHYSICAL THERAPY

September 12, 2013 by Leave a Comment

Our knees get a lot of wear and tear, so here are some exercises and information about osteoarthritis in the knee by Ashley Misitzis PT, DPT. If you have any questions, come to San Diego Sports Physical Therapy today for help!

Knee osteoarthritis is one of the leading causes of disability among adults.

Osteoarthritis, known as OA, is characterized by degeneration of cartilage and bone, which cases pain, stiffness, decreased motion and weakness that can lead to difficulty with daily activities. There is no cure for OA, but effective treatment involves managing symptoms and addressing functional limitations. Physical Therapists are licensed health care professionals who are experts in the way the human body moves. Physical therapy uses researched treatment techniques to improve mobility, reduce pain, restore function and prevent disability. Want to improve your health? Learn more about LIVESTRONG.COM’s nutrition and fitness program!

RANGE OF MOTION
According to the CDC, Approximately 80 percent of patients with OA have some degree of movement limitation. Normal knee range of motion is zero to 135 degrees, though there is some variation from person to person.

Your knee must get all the way straight for typical walking mechanics, and must bend normally to allow for sitting and going down stairs. A Physical Therapist will improve your range of motion through direct measures, such as bending and straightening your knee, and will give you home exercises to focus on movement. Indirectly, helping to decrease pain and restore normal joint mechanics also improve your range of motion.

STRENGTHENING
When your joint is damaged, your body needs as much support as it can get from muscle strength. The first step is making sure the muscles directly surrounding the affected knee joint are strong. If you only have arthritis in one knee, then it is also important to strengthen the muscles in the other leg to help support the injured side and to prevent excess force on the healthy knee.

Your hip and ankle strength is also important to provide support to the knee with OA. During your physical therapy evaluation, your physical therapist will determine what muscles need strengthening. The earlier you seek treatment, the less likely you will have muscle strength changes, which improves the outcome.
STRETCHING
Many muscles in the leg cross over the knee joint, so ensuring they are flexible is an important part of the physical therapy process. When pain causes a decrease in your range of motion, it is normal for your body to change how it moves in order to compensate for weak muscles or lessen the pain. This compensation can cause tightness in muscles surrounding the knee including the calves, hamstrings, and quadriceps.

Other muscles may also need stretching depending on what the physical therapist finds during her evaluation.
MANUAL THERAPY
Manual therapy is a physical therapy treatment that involves skilled, specific hands-on techniques that mobilize the joint. These can be used to decrease pain, increase range of motion, lessen soft tissue swelling and improve tissue extensibility. In recent studies, the addition of manual therapy to an exercise-based physical therapy program resulted in dramatically improved function and less pain.
MODALITIES
According to the Arthritis Foundation, both heat and cold treatments are effective for pain management. Heat is best before an activity or in the morning to increase blood flow and decrease stiffness. Use cold treatment after exercise or at the end of each day to lessen swelling and pain. Use each modality for 10 to 15 minutes at a time.

REFERENCES
Centers for Disease Control and Prevention: Osteoarthritis Arthritis Today: Osteoarthritis: Using Heat and Cold for Pain Relief Move Forward PT: Facts Annals of Internal Medicine: Article by Deyle, G. American Academy of Family Physicians: Physical Therapy and Exercise for Osteoarthritis of the Knee
Article reviewed by Helen Holzer Last updated on: Aug 16, 2013

Read more: http://www.livestrong.com/article/178813-knee-osteoarthritis-physical-therapy/#ixzz2e88YONSq

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PHYSICAL THERAPY EXERCISES FOR PLANTAR FASCIITIS

September 10, 2013 by Leave a Comment

You’re on your feet all day, so it’s nice to give them a break once in a while. Here are some physical therapy exercises by James Patterson to help rehab your feet. Then come visit us at San Diego Sports Physical Therapy for more exercises.

Plantar fasciitis is a condition where the plantar fascia — a band of tissue running from the heel to the ball of the foot — becomes inflamed through overuse, injury or other trauma. Certain physical therapy exercises may be beneficial in easing the pain associated with plantar fasciitis so you can get back to doing the things you’re used to.
BENEFITS
Physical therapy exercises can prove useful not only for reducing plantar fasciitis pain but also from preventing it from coming back in the future. Stretching helps warm up the tissue as well as encourages blood flow to the area, which can help prevent strains and tears in the tissue.

PLANTAR FASCIA STRETCH
The most simple and common way to exercise the tissue of the plantar fascia in order to prevent or lessen the effects of plantar fasciitis is through a simple stretch. Start by facing a wall or other sturdy object you can brace yourself against. Put both hands on the wall and step forward with your left foot. Keep your right foot back and flat on the ground. Bend your right knee so your leg moves towards the wall, but keep your right foot flat. You will begin to feel a stretch in your right heel. Hold this stretch for 10 to 15 seconds. Switch feet and do the same stretch for your left heel. Stretch each heel two or three times each as part of your physical therapy exercise routine.
BALL ROLL
The ball roll helps soften and relax the plantar fasciitis tissue and can be done while sitting down to the computer or watching TV. Find a small ball the size of a tennis ball. Place it on the floor and put your foot on top of it. Slowly roll the ball along the arch of your foot and your heel. Apply downward pressure on the ball to increase the massage effect on your plantar fasciitis. Perform the ball roll for 30 seconds at a time, stopping in between to let your foot rest.
STAIR DIP
Another effective exercise that helps stretch out the plantar fascia, the stair dip only requires the use of a stair or other elevated surface such as a curb. Stand with one foot on the step and the other in the air. Place your foot so your toes are on the step, with the rest of the foot hanging off the edge. Use your toes to lift your body up so you’re on the tiptoes of your foot. Hold this position for 10 seconds, then lower your body back down so the heel of your foot is slightly below the edge of the step. Hold for another 10 seconds. Repeat three to four times as part of your exercise.
CONSIDERATIONS
If you have a serious injury to your plantar fascia or Achilles tendon, these exercises may cause extreme case. If that is that case, contact your doctor immediately, who may need to examine you for more serious injury that might require further therapy or even surgery.

References
Sports Injury Clinic: Stretching for Plantar Fasciitis
American Academy of Orthopaedic Surgeons: Plantar Fasciitis and Bone Spurs
Family Doctor: Plantar Fasciitis

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Gardening

September 5, 2013 by Leave a Comment

Summer is one of the prime times for gardening, especially fruits and veggies. Although it may be relaxing, it can take a toll on your muscles and joints. Take a look at this article featured on MoveFowardPT, and then come visit us at San Diego Sports Physical Therapy if you experience pain or discomfort.

Common gardening tasks, such as digging, planting, weeding, mulching and raking can cause stress and strain on muscles and joints, especially for seniors or those who are normally sedentary. The shoulders, back, neck and knees are prime targets. Following these tips can help you minimize the risk of injury:

Warm up before you begin. Get your heart rate up by taking a 10-minute walk followed by some stretches for your upper and lower back, neck, arms and legs. Roll your shoulders back in a circular motion and slowly move your head from side to side a few times to loosen up.
Don’t over do it. Be mindful of how the body feels. If you experience an aching back or neck, slow down and stretch or stop and switch to a different task.
Use a garden cart or wheelbarrow to move tools and heavy planting materials.Don’t kneel on both knees. Keep one foot on the ground to give your back more stability. If you have to kneel use knee pads or a pillow to absorb some of the pressure.
Change positions frequently to avoid stiffness or cramping.
Practice proper body mechanics. Bend at your knees when you grab something or pull a weed, bend your knees and contract your abdominal muscles to avoid straining your back.
End your gardening session with a short walk or some light stretching. Take a warm bath or shower to help prevent next-day soreness.
If you experience pain, contact your physical therapist.

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9 Tips to Perfect Your Walking Form

August 29, 2013 by Leave a Comment

Perfect form is key to avoiding pain and injuries! Read this article from ACE Fitness by Michele Stanten about good walking form.

Good posture will make it easier to go the distance. Here are some posture pointers for stronger striding during your next walk.

Tip #1: Stand up tall. Imagine that a wire attached to the crown of your head is gently pulling you upward. Walking erect will keep you moving at a brisker pace.

Tip #2: Keep your eyes on the horizon. This will help you to stand taller and avoid stress on your neck and low back.

Tip #3: Lift your chest and tighten your abs. Using muscles in the front of your body to straighten up will take pressure off your back.

Tip #4: Bend your arms. You’ll be able to swing your arms faster, which helps increase your speed. It also prevents swelling caused from blood pooling in your hands as you walk longer distances.

Tip #5: Relax your shoulders. Your arms will swing more freely, and you’ll avoid upper back and neck tension.

Tip #6: Maintain a neutral pelvis. Don’t tuck your tailbone under or overarch your back.

Tip #7: Keep your front leg straight but not locked. You’ll have a smoother stride and be able to propel yourself forward more easily.

Tip #8: Aim your knees and toes forward. Proper alignment will reduce your chances of injury.

Tip #9: Land on your heel. This facilitates the heel-to-toe walking motion that will carry farther and faster than if your foot slaps down on the ground with each step.

That may seem like a lot to think about, but you don’t have to do it all at once. Start from the top of the list and focus on one tip at a time. Pay attention to this area of your body at the beginning of your walk, and then periodically check about every 15 to 20 minutes (don’t constantly focus on it) to see if you’re maintaining good posture. If not, simply get back in alignment. Do this for about a week and then move onto the next tip. Some changes may happen quickly while others may take some time to become habit.

Walking coach Michele Stanten is the author of Firm Up in 3 Weeks and Walk Off Weight, co-author of Walk Your Butt Off, and creator of mywalkingcoach.com. As the former Fitness Director of Prevention magazine, she created a marathon walking program and coached thousands of readers to walk full and half marathons. Michele has also created walking and fitness programs for leading brands and organizations such as Avon and Reader’s Digest. She is also an ACE board member, ACE-certified group fitness instructor, and member of the Every Body Walk Collaborative. Michele has also produced and appeared in more than a dozen exercise DVDs and created numerous walking audio workouts.

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Pilates for Stretching and Strength

August 27, 2013 by Leave a Comment

What’s so great about Pilates? Read this article from ACE Fitness to find out! Come visit us at San Diego Sports Physical Therapy to see if Physical Therapy and Pilates are right for you.

Pilates Primer

Are you wondering what all the fuss over Pilates is about? Used traditionally by dancers for deep-body conditioning and injury rehabilitation, Pilates (pronounced Pi-lah-teez) is an 80-year-old exercise technique first developed by German immigrant Joseph Pilates. Only in the past decade has it migrated from its long-held position at the fringes of traditional fitness methods such as aerobics and weight training. Hollywood has been a key factor in turning the spotlight on Pilates, as numerous models and actresses pay homage to Pilates for their beautifully toned, fit bodies.

Focusing on the Core

The abdominal, hip and back muscles are often collectively referred to as the body’s core. Pilates exercises are designed to strengthen this core by developing pelvic stability and abdominal control. In addition, the exercises improve flexibility and joint mobility and build strength.

How can one exercise technique claim to do so much? The Reformer, a wooden contraption with various cables, pulleys, springs and sliding boards attached, lies at the foundation of Pilates. Primarily using one’s own body weight as resistance, participants are put through a series of progressive, range-of-motion exercises. Despite the appearance of this and several other equally unusual-looking devices, Pilates exercises are very low impact. Instructors, who typically work one-on-one or with small groups of two or three participants, offer reminders to engage the abdominals, the back, the upper legs and buttocks to stabilize the body’s core. Exercise sessions are designed according to individual flexibility and strength limitations.

Pilates exercises are not limited to specialized machines, however. In fact, many gyms across the country now offer Pilates mat-based classes that feature exercises that also stress the stabilization and strengthening of the back and abdominal muscles.

Connecting With Pilates

The mind/body connection associated with yoga and meditation also plays an integral part in Pilates. Unlike exercise techniques that emphasize numerous repetitions in a single direction, Pilates exercises are performed with very few, but extremely precise, repetitions in several planes of motion.

What will all this focus and stabilization get you? Well, according to its adherents, Pilates can help you develop long, strong muscles, a flat stomach and a strong back, and improve posture. Of course, these changes are dependent upon other lifestyle factors, such as a well-balanced diet and regular aerobic exercise. (Though some may claim that Pilates is all you need to develop stamina and endurance as well, an additional cardiovascular component is advisable.)

An initial Pilates session typically includes a body assessment, which allows the instructor to pinpoint strength and flexibility weak spots. This is also the time to become familiar with Pilates’ unique breathing patterns, which don’t always follow the exhale-on-exertion pattern of traditional exercise. Sessions typically run 60 minutes, at a cost of $50 or more for private sessions, and $10 to $30 for group sessions. If you’re more comfortable exercising at home, there are numerous Pilates and Pilates-type videos currently available.

Several home versions of the Reformer also are currently available on the market. Whether you work out at a studio or on your living room floor, Pilates is an excellent way to challenge your muscles, improve flexibility and incorporate the mind/body element into one effective exercise session.

Additional Resources

American Council on Exercise—Pilates Mat Training by Shirley Archer: www.acefitness.org/acestore/p-290-pilates-mat-training.aspx
WebMD Video—Yoga Pilates Studies: www.webmd.com/video/yoga-pilates-studies

Selecting a Pilates Instructor

Finding a fitness instructor who is a good match for your goals and personality can be challenging. The Pilates Method Alliance suggests asking the following questions of any instructor with whom you are considering working.

Was the instructor trained through a comprehensive training program?
Did that training program require a written and practical test, lecture, observation, practice and apprentice hours?
How many total hours were spent in the training program? (The Pilates Method is a knowledge-based method of exercise and training. Time spent in certification training produces qualified teachers.)
Does the instructor have any other movement-related teaching experience?
How long has the instructor been teaching Pilates?
What is the instructor or studio’s philosophy and specialty? Are they able to handle special needs, injuries and rehabilitation?
Does the instructor or studio teach the full repertoire of Pilates on all types of apparatus?

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Heat vs. Ice

August 20, 2013 by Leave a Comment

You have an injury, but you’ve heard to both heat and ice it? So which is better? Take a look at this article by Lindsey Balint, PT, DPT, featured on Sports Physical Therapy Institute to find out which will be more beneficial to you!

Ice and heat are common modalities used to help heal orthopedic injuries but how do you decide which is best to use? There are several things to take into consideration when deciding which modality will best help achieve your treatment goals.

Is the injury Acute or Chronic?

Acute: Recent onset of an injury (< 48 hours). During the acute phase of an injury the body's inflammatory response is active and ice is the preferred modality to prevent swelling that can cause pain. During the first 24-48 hours following an injury, the RICE principal should be followed and is described later in this article.
Chronic: Injuries that continue for a long period of time. During the chronic phase of an injury both ice and heat may be used depending on the treatment goals. Typically heat would be used prior to exercising to loosen tissues and prepare for activity. Ice is typically used after exercise to decrease inflammation following the activity.

What is RICE?

RICE is an acronym to help you remember what to do following an acute injury. RICE stands for Rest, Ice, Compression and Elevation.

REST: Immobilize to limit motion, and decrease the amount of weight you put through the injured body part.
ICE: Apply the cold modality of your choice to help reduce swelling, and decrease pain.
COMPRESSION: Apply a compressive bandage to reduce swelling to the area. When applying a compressive bandage it should be snug but not tight. Applying a compressive wrap too tightly can cut off blood supply and cause further damage.
ELEVATION: Raise the injured body part above the level of the heart. This will help the body decrease swelling to the area.

What are the goals of treatment?

Ice Heat

Decrease Swelling/Inflammation X
Decrease Pain X X
Increase Tissue Extensibility X
Decrease Stiffness X
Decrease Muscle Spasm X X
Increase Joint Range of Motion X

Are there any situations in which heat should not be applied?

Over an open wound
Over areas of skin where there is decreased sensation
Areas where circulation is impaired
Over tumors
Acute injuries

Are there any situations in which ice should not be applied?

Over an open wound
If you have hypersensitivity or intolerance to cold
Peripheral Vascular Disease
Over areas of skin where there is decreased sensation
Raynaud's disease

How long should heat or ice be applied to an injury?

Ice and heat can be very helpful in treating orthopedic injuries but overuse of these modalities can be too much of a good thing. Apply heat or ice for only 10-15 minutes at a time to prevent burning or frostbite. If you have any additional questions about when to use heat versus ice, feel free to contact the physical therapists at Sports Physical Therapy for additional information.

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Shoulder Injury Prevention – Causes and Solutions

August 15, 2013 by Leave a Comment

Do your shoulders give you problems? Read this article by Joe Heiler PT, CSCS for some background on how to prevent shoulder injuries!

Joe Heiler is a physical therapist specializing in sports medicine and orthopedics in Traverse City, Michigan. Joe is also a highly sought after strength and conditioning coach working with athletes at all levels in football, baseball, hockey, track, and power lifting.

Chronic shoulder pain is nothing new to lifters or overhead athletes. It can range from something you just live with and work around to debilitating and career ending. It is not something you mess with. If you currently have shoulder pain, go have it looked at. If you haven’t experienced it to this point then pay close attention to the following.

Shoulder pain that is chronic in nature is often the result of an “impingement syndrome”. In a nutshell, the soft tissues between the head of the humerus and the acromion and coracoid are literally pinched during throwing, striking, pressing, and other high speed or weighted activities. Those soft tissues include the rotator cuff tendons, the subacromial bursa, glenoid labrum, and even the biceps tendon. Ask an orthopedic surgeon and they will tell you the rotator cuff will look like someone took sandpaper to it and just wore a hole into it. These chronic type symptoms can also lead to acute tears of the cuff, labrum, and biceps tendon which in many cases means surgery and a long, painful rehab process.

So how does one get to that point? There can be any number of causes, the most common of which I will touch on here because they are preventable.

Poor posture – Sitting is a necessary evil for many of us. From sitting in front of a computer all day, to driving for a living, and for students who must sit in class all day. God forbid they’re given a physical education class to run around in and undo what institutional learning has done to them physically. Over time prolonged sitting leads to muscle adaptations. Some muscles become short and tight while other become lengthened and weak. Anyone familiar with Janda’s upper crossed syndrome will recognize this: the tight pecs and levator along with weak rhomboids, serratus anterior, and deep cervical flexors.

What these muscle adaptations do is alter scapular mechanics and gleno-humeral rhythm. The humeral head then rides up into the acromion and/or forward into the corocoacromial ligament causing impingement.

Volume of pressing is greater than pulling – What this does is reinforce the anterior dominance of the pecs in relation to the scapular stabilizers of the upper back. Again, posture and shoulder girdle mechanics suffer.

A lack of stability through the trunk and hips – We have known for some time that poor trunk and hip stability is a prominent cause of shoulder and elbow injury amongst pitchers. This is well documented. More and more research is coming forth looking at these factors with other athletic populations and finding the same results. A study is underway right now looking at swimmers with and without shoulder pain. To this point the leading indicator of shoulder pain is single leg balance (side opposite the painful shoulder). The shoulder will only be as stable as the rest of the body.

Exercise selection – There are just certain exercises that should be avoided by overhead athletes, powerlifters, and Olympic lifters. In particularly bodybuilding type exercises. Heavy shrugs and upright rows, flyes and pec dec for the chest, and front and lateral deltoid raises really should be excluded. It’s rare to see someone performing them correctly and they all increase the risk of impingement through various mechanisms. Little reward for such high risk. If you are a bodybuilder then I understand you must do them but please use a weight that allows you to maintain perfect posture and form.

GIRD (Glenohumeral Internal Rotation Deficit) – This involves the overhead athlete more so than lifters but they too should test themselves (see picture). A difference of 25 degrees dominant shoulder to non-dominant indicates a positive test. GIRD develops because throwing or striking from an overhead position requires a great deal of shoulder joint external rotation. Over time, the athlete develops excessive external rotation at the expense of internal rotation. Physiologically what happens is the posterior shoulder capsule tightens and thickens resulting in superior/posterior translation during the cocking phase, and superior/anterior translation during the follow through. In both instances, impingement can occur as well as significant shear on the labrum.

Sleeper Stretch

So now that we have discussed the causes, what should you be doing about it? The following list consists of seven strategies aimed at maintaining shoulder health while maximizing performance. Note: The order of the solutions does not correlate exactly with the order of causes above. The first three solutions are aimed toward improving posture and gleno-humeral rhythm.

Increase thoracic spine extension and rotation – The faulty posture we see so much of is due in part to the rounding of the thoracic spine. The scapulae must be seated properly for normal gleno-humeral rhythm to occur, and this cannot happen with a kyphotic t-spine.

Thoracic spine extension mobilizations can be performed lying over a foam roller. Start at the top of the shoulder blades and work down to just below the inferior angles about an inch at a time. Take 2-3 deep breaths as you relax back over the roll at each level.

Thoracic spine rotation begins sidelying with the top hip at 90 degrees pressing the knee into a ball or the ground, depending on how mobile you are. Roll the shoulders back toward the floor, reach with the down arm, and give a pull on the ribs with the top arm to take the t-spine as far as possible. The goal is to get the shoulders flat on the floor. You will probably see a difference side to side especially if you are a thrower. Work the limited side twice as many sets as the other.

These are great preventative exercises to use as part of the warm-up.

Thoracic Mobility

Decrease tone and lengthen overactive muscle groups – A foam roller and/or the massage stick are great for decreasing muscle tone. The main targets in this case are the pecs, upper traps, and levator. Follow up with flexibility work to lengthen the muscles. To get the levator, retract and depress the shoulder blades, tilt your head toward your shoulder, then rotate in that same direction. You will feel the opposite side stretching. Optimal length is chin touching the clavicle. If you know a good manual therapist, take advantage. There are many techniques they can use that you really can’t do well to yourself.

Activate under-active and lengthened muscle groups – Targets in this case would be the lower traps, rhomboids, and serratus anterior. T’s, Y’s, L’s, and W’s are great for strengthening the scapular stabilizers and rotator cuff musculature simultaneously. Be sure to lock the scapulae into retraction and depression before lifting, and go light. It is easy for the upper traps to start taking over especially once fatigued.

W’s

Y’s

Push-ups with a plus are great for activating the serratus. Turkish Get-Ups with a kettlebell is just a great way to put it all together. This is a fairly technical lift and unfortunately a single picture will not do it justice. Those of you who have tried these know how difficult they can be, but are the ultimate shoulder stability exercise.

Adjust training volume front to back – At a minimum, training volume should be 1:1, meaning for every set of bench press, you perform a set of rows. Shoulder press – chins. Flies – reverse flies (posterior delt raise). And so on. Superset the exercises or do them on separate days. It doesn’t matter as long as it evens out in the end.

I know Mike Boyle and others are now advocating kicking it up to a 1:2 ratio as they have seen fewer shoulder injuries using this strategy.

Improve trunk stability – Perform prone and lateral pillar bridges to engage the trunk and scapular muscles simultaneously. Do these in place of crunches during your core work. Yes, I said replace crunches. The only things crunches are good for are increasing thoracic kyphosis, pulling the scapulae into a more protracted and elevated position, and putting undo stress on the cervical spine. All things we are trying to prevent.

Improve hip stability – Single leg squats and deadlifts will force greater hip stabilization versus the traditional squat and deadlift. I’m not saying to replace these, but use the single leg versions of these exercises instead of hitting the leg press and hamstring curl machine. Y can’t go wrong with exercises that challenge everything from the ground up.

Use the sleeper stretch – The test is the cure in the case of GIRD. This can be done before or after training. Just do it daily.

So there you have it. The causes and the solutions. While prevention takes some time and effort, it is always easier and less painful than the rehab. Don’t let your shoulders get in the way of your gains in the gym or your performance on the field.

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Proper Lifting Technique

August 13, 2013 by 1 Comment

Having proper technique is important in order to avoid injuries. Here’s an article from MoveForwardPT about how to lift heavy objects with proper form.

Improper lifting technique can cause neck, shoulder and back pain and possibly even more serious injuries. Learning the proper way to lift will help you minimize the risk of pain and injury.

Plan ahead before lifting heavy objects. Make sure you have a clear path. This will help you avoid any awkward or sudden movements that can strain your muscles.
Test an object’s weight before lifting by pushing it with your foot. If it seems too heavy, ask for help.
Lift with your legs, not with your back. Don’t lean over an object to lift it. Face the object you intend to lift and avoid twisting. Instead, stand close to the object, bend your legs and keep your back straight, then lift.
Keep feet shoulder-width apart and maintain your balance by distributing the object’s weight equally on both sides of your body.
If a back injury does occur, seek help from a physical therapist. What starts as a minor back injury can progress to a chronic condition without early intervention.

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