Exercise for Osteoporosis

August 8, 2013 by Leave a Comment

Bone health is an important aspect to healthy living! Look at this article featured in WebMD reviewed by James E. Gerace, MD to learn more about exercising for Osteoporosis. Visit us at San Diego Sports Physical Therapy for more PT information today!

One of the best ways to strengthen your bones and prevent osteoporosis is by getting regular exercise. Even if you already have osteoporosis, exercising can help maintain the bone mass you have.
Super Foods for Your Bones

The Reason for Exercise for Osteoporosis
Why do health experts recommend exercise for osteoporosis? When you exercise, you don’t just build muscle and endurance. You also build and maintain the amount and thickness of your bones. You may hear health professionals call this “bone mass and density.”
Three types of exercise for osteoporosis are:
• Weight-bearing
• Resistance
• Flexibility
All three types of exercise for osteoporosis are needed to build healthy bones.
Weight-bearing Exercise for Osteoporosis
Weight-bearing means your feet and legs support your body’s weight. A few examples of weight-bearing exercise for osteoporosis are:
– Walking
– Hiking
– Dancing
– Stair climbing
Sports like bicycling and swimming are great for your heart and lungs. However, these are not weight-bearing exercise for osteoporosis. That’s because you are being held up by something other than your feet and legs, such as the bicycle or the water.
Walking as little as three to five miles a week can help build your bone health. For general health, most experts recommend that everyone get at least half an hour of moderate to vigorous exercise five times a week. Forty-five minutes to an hour is even better.
Resistance Exercise for Osteoporosis
Resistance means you’re working against the weight of another object.Resistance helps with osteoporosis because it strengthens muscle and builds bone. Studies have shown that resistance exercise increases bone density and reduces the risk of fractures.
Resistance exercise for osteoporosis includes:
• Free weights or weight machines at home or in the gym
• Resistance tubing that comes in a variety of strengths
• Water exercises — any movement done in the water makes your muscles work harder.
You can find instructions for safe exercises online. Once source is the CDC http://www.cdc.gov/nccdphp/dnpa/physical/growing_stronger/). Another source is the National Institute on Aging (http://www.niapublications.org/exercisebook/chapter4_strength.htm).
For best results, do resistance exercises two or three times a week. Make the exercise more challenging by gradually adding weight or repetitions. Work all your different muscles — including arms, chest, shoulders, legs, stomach, and back. Be sure not to do resistance training on the same muscle group two days in a row. Give each muscle group time to recover.
Flexibility Exercise for Osteoporosis
Flexibility is another important form of exercise for osteoporosis. Having flexible joints helps prevent injury.
Examples of flexibility exercise for osteoporosis include these:
• Regular stretches
• T’ai chi
• Yoga

Making Exercise for Osteoporosis Safe
Many people worry about the safety of exercise later in life. You may be concerned if you already have osteoporosis or osteopenia. Perhaps you have never been very physically active. Whatever your concern, you can choose from a range of safe exercise options.
To ensure your safety during exercise for osteoporosis, keep these guidelines in mind:
– Talk to your doctor before beginning any exercise program. This is especially important if you know you have bone loss or osteoporosis.
– Weight-bearing exercise does not have to be high impact. Running, jogging and jumping may put stress on your spine. These high-impact activities may lead to fractures in weakened bones. If you already have bone loss, choose gentler weight-bearing exercise like walking, dancing, low-impact aerobics, and gardening.
– If you already have osteoporosis, be careful of exercises that involve bending and twisting at the waist. This motion can put you at risk of fracture. Exercises that involve waist twisting include sit-ups, toe touches, and rowing machines. Golf, tennis, bowling, and some yoga poses also include some twisting at the waist. Talk to your doctor before choosing any of these activities.

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Biking: Safety and Fitness

August 6, 2013 by Leave a Comment

If you bike on the regular, then you may be aware of the injuries that are associated with the sport. Here are some tips from Eric Moen, PT to help you stay safe when you bike!

Bicycle-related pain and injuries are commonly associated with poor bike fit. Following these tips will help you minimize the risk of injury:
Postural Tips

Change hand position on the handlebars frequently for upper body comfort.
Keep a controlled but relaxed grip of the handlebars.
When pedaling, your knee should be slightly bent at the bottom of the pedal stroke. Avoid rocking your hips while pedaling.

Common Bicycling Pains

Anterior (Front) Knee Pain. Possible causes are having a saddle that is too low, pedaling at a low cadence (speed), using your quadriceps muscles too much in pedaling, misaligned bicycle cleat for those who use clipless pedals, and muscle imbalance in your legs (strong quadriceps and weak hamstrings).
Neck Pain. Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain.
Lower Back Pain. Possible causes include inflexible hamstrings, low cadence, using your quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars.
Hamstring Tendinitis. Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat for those who use clipless pedals, and poor hamstring strength.
Hand Numbness or Pain. Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle.
Foot Numbness or Pain. Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat for those who use clipless pedals.
Ilio-Tibial Band Tendinitis. Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals.

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Workplace Wellness

August 1, 2013 by Leave a Comment

A lot of us have to work, but how can we stay healthy while on the job? Take a look at this article from MoveForwardPT in order to help improve your posture and mobility at work! If you’d like to see a physical therapist today, come visit San Diego Sports Physical Therapy in Liberty Station!

Working at a computer work station all day can take a toll on the body. Repetitive activities and lack of mobility can contribute to aches, pains, and eventual injuries.

Sitting at a desk while using the keyboard for hours on a day to day basis can result in poor circulation to joints and muscles, it can also create an imbalance in strength and flexibility of certain muscles, and muscle strain. These issues can be easily remedied by taking frequent short breaks, or “micro breaks,” throughout your day.

Get out of your chair several times a day and move around—even for 30 seconds
Roll your shoulders backwards
Turn your head side to side
Stretch out your forearms and your legs

Additionally, specific guidelines for your work station can help maximize your comfort and safety.
Your chair should have the following:

Wheels (5 for better mobility)
The ability to twist freely on its base
Adjustable height
Adjustable arm rests that will allow you to sit close to your desk
Lumbar support
Seat base that adjusts to a comfortable angle and allows you to sit up straight

The position of the keyboard is critical:

The keyboard should be at a height that allows you to have your forearms slightly below a horizontal line—or your elbows at slightly more than a 90 degree angle.
You should be able to slide your knees under the keyboard tray or desk.
Avoid reaching for the keyboard by extending your arms or raising your shoulders.
Try to avoid having the keyboard on top of your desk. That is too high for almost everyone—unless you can raise your seat. The elbow angle is the best test of keyboard position.

The position of your computer monitor is important:

The monitor should be directly in front of you.
The top of the monitor should be at your eye level, and at a distance where you can see it clearly without squinting, or leaning forward or backward.
If you need glasses for reading, you may need to have a special pair for use at your computer to avoid tipping your head backward to see through bi-focals or other types of reading glasses.

How can a physical therapist help?

Many physical therapists are experts at modifying work stations to increase efficiency and prevent or relieve pain. Additionally, if you are experiencing pain that isn’t relieved by modifications to your work station, you should see a physical therapist who can help develop a treatment plan to relieve your pain and improve your mobility.

Here are a couple of exercises you can do right at your desk!

Desk Exercises

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Solving Anterior Knee Pain

July 30, 2013 by Leave a Comment

Knee pain is common because it is something that we use everyday. Read this article we found if you’re curious about what may be giving you pain, and then come see us at San Diego Sports Physical Therapy if you have any questions!

by Joe Heiler PT, CSCS

Pain in the front of the knee is becoming an epidemic amongst serious weight lifters, athletes, and weekend warriors. It once was one of those injuries we associated mostly with females and blamed on their alignment, but no longer. I see almost as many men now with diagnoses like patellar maltracking, patellar tendonitis, IT band syndrome, and just general ‘anterior knee pain’.

There are multiple factors at play here that interact with one another to eventually cause pain and limit performance. Male or female, the causes can be traced back to poor joint mobility, tight and overactive muscle groups dominating stretched and weak muscles, synergistic dominance, and just plain sitting too much. In this article I will explore them all.

There are a number of common causes of anterior knee pain but some are more directly related to weight lifting and training for athletics.

1) Increased compression forces at the patello-femoral joint. Compressive forces are greatest at 90+ degrees of flexion especially open chain. This is one reason I recommend to my patients and athletes to stay off the leg extension machine. It is unbelievable how many people come in to rehab and specifically name that machine. Unless the patient is a body builder, they don’t need it. If they happen to be, then think about limiting the range of motion.

Performing squats with a wider than normal stance and high bar position has also been shown to increase compressive forces. The thought is that the trunk is in a more upright position which increases quad contribution (while decreasing the load on the glutes) and creates more compression. Many athletes and serious lifters will be hesitant to change their stance and bar position but enough pain may convince them. For those who use a Smith machine to squat (or leaning against a stability ball on the wall), I would reconsider just for that reason. Besides, nobody really moves or lifts like that in real life.

2) Increased stress on the patellar tendon as the knees go past the toes. There are times in life and in the weight room where the knee will make its way out past the toes, especially with squats and lunges. If the heels are down and hips are contributing properly then no problem. Once the heels come off the floor you can kiss any glute contribution good-bye. It’s all quad from there on out which means greater stress on the patellar tendon, shearing forces, and those nasty compressive forces again as well.

3) Increased knee valgus angle is another popular one. Once thought to be limited to females with wide hips, it’s surprising the number of men who now demonstrate this pattern. It may not show up until they squat heavy, or landing from a big jump, but that just tells me they’ve got strong quads and they’re lacking elsewhere. It’s fairly common to see numbers 2 and 3 together because once the heels come up the knees buckle in.

This valgus angulation at the knee is often what is behind the patellar maltracking issues. The patella is supposed to glide friction-free with knee extension – flexion. When the knees cave inward, the patella will track laterally and come into contact with the femur. The result is a roughing up of the cartilage under the patella which will become painful in time. This is a very common problem in the sedentary population when going up and down stairs, lifting, or trying to kneel down. For weight lifters, it’s squats and lunges.

So why do these things happen? All three of these issues (increased compressive forces with greater knee flexion angle, shearing forces as knees go over toes, and knees going into valgus) probably happen hundreds or thousands of times per day as we go through our normal daily activities. The key is limiting the amount of force and excessive movement in these directions during training and athletics. To do those things we must first look at what structures, when not functioning properly, can get us into trouble.

1) Soft tissue restrictions. The hip flexor muscles and TFL are frequently short and overactive. The problem is they are in opposition to the glutes which can then be inhibited (I’ll be ranting more about the importance of the glutes and knee control later).

Anterior/lateral knee pain can also be caused by trigger points in the glute medius and maximus pulling on the IT band. The IT band transmits forces from the glutes to the patellar tendon.

2) Restricted ankle dorsiflexion. This one is often over looked but it can cause an anterior weight shift during squatting and lunging activities resulting in the knees over the toes and valgus positions. To check ankle mobility, start in ½ kneeling position and the ankle in neutral. Bring the knee out over the foot as far as possible, use a stick to drop a line from the knee to the floor. The knee should be at least 4 inches past the foot without the heel coming up or the foot rolling in.

3) Poor glute function. The glute complex is responsible for hip extension, abduction, and external rotation. When functioning in the closed chain, as with squatting, they resist femoral adduction and internal rotation (knee valgus) and thus decrease stress at the knee (Ireland et al, 2003 and Bolgla et al. 2008).

4) Poor trunk control. Lack of control through the trunk will increase forces at the anterior knee during squatting, lunges, and deadlifts. Excessive lumbar lordosis (partially the result of weak glutes) will limit the ability to sit back into the squat thus creating an anterior weight shift and quad dominant movement. Not to mention increasing the possibility of back pain.

So how are we going to solve the problem of anterior knee pain?

1) Foam Roll the hip flexor group and TFL to inhibit tone and allow for a better stretch to these overactive muscles. Be sure to roll glute max and medius to reduce stress on the IT band.

2) Improve ankle dorsiflexion through mobilization and mobility work. My favorite technique is from Brian Mulligan using mobilization with movement to free up the ankle. To work mobility, the patient assumes the test position I discussed earlier, and places the stick just inside the knee but it should be touching the floor next to the 5th toe. Glide the knee forward keeping it outside the stick. This keeps the ankle supinated as it goes into dorsiflexion. Do not allow the heel to leave the floor.
Ankle DF with Supination

3) Work hip extension. Poor glute function does not necessarily mean poor glute strength. It can be a matter of the lifter using a quad dominant strategy over a glute dominant strategy. In a quad dominant squat, the lifter begins the movement by flexing the knees vs the hips. It’s more of a straight down descent vs sitting back then down. This movement pattern automatically recruits more quad and leaves out the strong, powerful hip muscles. Not only will this increase knee stress, it also results in less than optimal squat numbers.

The ability to sit back first depends on the ability of glute max to eccentrically control the hip. If the patient can sit back simply by thinking about it, or by warming up with some light box squats, then it’s a patterning issue vs strength. If they cannot sit back effectively without feeling like they will fall over then it’s more of a strength issue.

Bridge variations are a great way to teach patients to recruit the glutes and build strength. The patient start with both heels pressing into the floor and lifts the hips until a straight line could be drawn from the shoulder through the hips and to the knees. The hamstrings should be doing very little to assist. If you can feel them tightening or the patients is cramping then they are substituting hamstrings for glutes. This is known as synergistic dominance but that is for another article. Just have them pre-contract the glutes before lifting and be sure to have them press through the heels. Progress to single leg bridging.
Single Leg Bridge

Don’t forget about deadlifts and/or single leg deadlifts. These are great exercises for overall hip development.

4) Activate/strengthen the outer hip. The glute complex and some of the smaller hip external rotator muscles play a crucial part in maintaining knee alignment. Knee valgus and patellar maltracking are not necessarily caused by a weak VMO as we once thought. It is actually the inability of these hip muscles to prevent adduction and internal rotation of the femur. The knees should be aligned with the mid to outer foot during squats and lunges for proper tracking of the patella.

The question comes up again: is it poor muscle activation/patterning? Or is it weakness? If I have an athlete that cannot break parallel with good form performing a body weight squat, then I will apply pressure to the outside of the knees pressing inward. The athlete is instructed to squat and press the knees out as hard as they can. Many times athletes will recruit the hip musculature enough that they drop right down into a full squat with perfect technique. If this is the case, they have the strength to do it but are not activating the hip muscles appropriately.

Overhead squat with valgus
Overhead squat with valgus

Overhead squat using Reactive Neuromuscular Technique
Overhead squat using Reactive Neuromuscular Technique

Strengthening the hip abductors and external rotators can be done several ways but must be done correctly as trunk substitutions can take over the movement. The first two exercises would be used with someone who could not squat even with the activation technique described above. They can progress to exercises 3 and 4 once the first two are mastered. The athlete that can squat with the activation technique can start with 3 and 4 as part of their warm-up.

Clamshells are a very basic exercise designed to target the external rotators of the hip in an isolated fashion. Be sure the patient keeps the trunk stable and resists rolling back as the knee comes up. Add band or tubing resistance around the knees to progress the exercise.
Side lying hip abduction is another very basic exercise but requires strict technique. The top leg should be slightly extended at the hip and in a neutral to slightly externally rotated position. When lifting the leg you must be sure the hip is initiating the movement and not the trunk.
Lateral band walks are done with a band or tubing around the knees for beginners and progressed to the ankles for a greater challenge. The athlete will abduct the lead leg then eccentrically control the back leg as it adducts back in (effectively working the abductors on both legs simultaneously). Watch for trunk compensation here as the QL can laterally flex the trunk to throw the hip into abduction. Perform one set right and left standing relatively straight and the second set in a quarter to half squat position.
Lateral Band Walk
Squats with tubing around the knees uses a reactive neuromuscular training technique designed to activate the hip musculature and prevent valgus collapse at the knees. Much like the test I described above, use a good amount of resistance and instruct the patient to push the knees out while squatting down. Athletes can use this technique during their training warm-ups as well.

I cannot stress enough the importance of performing single leg squats. When on one leg, the hip muscles are working harder yet to maintain proper lower extremity alignment. Single leg squats will not only maximize protection at the knee joints, but are also great for speed and power. Don’t worry, I won’t get on my single leg training soapbox here.

5) Don’t forget to train for core stability. Core ‘stability’ exercises, like prone and side planks, bird dogs, and fire hydrants, work the trunk muscles by resisting excessive motion through the spine while simultaneously getting in some extra hip work. Core ‘strengthening’ on the other hand involves motion through the spine. Crunches, leg lifts, and back hypers would be examples of strengthening exercises. Squats, deadlifts, and lunges require a rigid, stable spine to protect the knees, put up big numbers, and for effective carry over to sports.

So there you have it. The common causes of anterior knee pain with lifting and training, and strategies to correct the weaknesses. Take a close look at what exercises or activities are causing pain and where the knees are aligned when it happens. Work these five corrective strategies into the patient’s workouts to keep the knees healthy and keep them playing.

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. He is also the owner of http://www.sportsrehabexpert.com.

1. Ireland ML, Willson JD, Ballantyne BT, Davis IM. Hip Strength in Females With and Without Patellofemoral Pain. J Orthop Sports Phys Ther. 2003;33:671-676
2. Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip Strength and Hip and Knee Kinematics During Stair Descent in Females With and Without Patellofemoral Pain Syndrome. J Orthop Sports Phys Ther. 2008;38:12-18.

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Bone Health

July 25, 2013 by Leave a Comment

Whether or not you know this, bone health has a lot to do with mobility! Take a look at this article from MoveForwardPT to learn more about the different aspects of bone health and how to prevent injury.

Physical therapists are experts in improving and restoring mobility and play an important role in ensuring optimal bone health. Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For healthy bones, it is important to maintain a physically active lifestyle and eat a balanced diet with plenty of calcium, vitamin D, and perhaps other supplements as needed. Physical therapists can design a unique program for you to help keep your bones healthy.

Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone mass and thinning of the bone structure, making bones fragile and more likely to break.

Some people are more at risk for osteoporosis than others. Not all risk factors can be changed, but healthy habits and a proper exercise routine designed by your physical therapist can keep bones healthy and reduce risk. Risk factors* include:

Age: More common in older individuals
Sex: More common in women
Family History: Heredity
Race and Ethnicity: Affects all races. In the US, increased risk for Caucasian, Asian, or Latino
Weight: Low body weight (small and thin)
Diet, especially one low in calcium and vitamin D
History of broken bones
Menopause
Inactive lifestyle
Smoking
Alcohol abuse
Certain medications, diseases, and other medical conditions

Physical therapists can help prevent osteoporosis and treat its effects by designing individualized exercise programs to benefit bone health, improve posture, and enhance core stability and balance. Most of these exercises are simple and can be done at home with no special equipment.
Fight Fracture with Fitness

Inactivity is a major risk factor for osteoporosis. The right exercises and good habits can keep bones strong and prevent or reverse the effects of osteoporosis. Weight-bearing exercise, such as walking, is an important way to build and maintain healthy bones. Muscle strengthening exercises have been found to stimulate bone growth and can help prevent and treat osteoporosis. These types of exercises are best if started early in life and done regularly. However, it is important to remember that you can begin exercising at any age and still reap great benefits.

If you have osteoporosis, are at high risk for a fall or fracture, or have a medical condition, affecting your ability to exercise, do not begin an exercise program without first consulting your physician and a physical therapist.

Avoid exercises and daily activities, which round the spine, such as sit-ups, crunches, bending down to tie your shoes, exercise machines that involve forward bending of the trunk, and movements and sports that round and twist the spine.
Benefits of Good Balance

Preserving balance and stability with exercises can help reduce falls and resulting fractures. Exercises that improve posture, core stability, balance, and coordination, can also protect the spine against compression fractures. An individualized program may include a walking regimen, Tai Chi, and other exercises geared toward conditioning, balance, and coordination.
Bone Health Begins With Good Posture

Physical therapists recommend good posture and safe movements to protect bones from fracture during daily activities. Using proper posture and safe body mechanics during all activities protects the spine against injury. Here are some tips:

Keep your back, stomach, and leg muscles strong and flexible.
Keep your body in alignment, so it can be more efficient when you move.
Do not slouch. When sitting, keep your spine and head straight. Put a small pillow behind your waist to keep your spine in a good position.
Use good body positioning at work, home, or during leisure activities.
When lifting or bending forward, bend your knees, keep your back straight, bend forward at the hip crease, and lift with your legs. Keep the load close to your body.
Ask for help or use an assistive device to lift heavy objects.
Maintain a regular physical fitness regimen. Staying active can help to prevent injuries.

*National Osteoporosis Foundation

Acknowledgements: APTA Section on Geriatrics

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Posture Tips for Moms

July 23, 2013 by Leave a Comment

If you’re a busy mom with little ones running around, the stress and activity may wear you down. Don’t let your back suffer! Take a look at this article and video from MoveForwardPT so you can maintain the best posture and prevent back injuries! If you would like to learn about more tips on how to prevent injuries, come visit us at San Diego Sports Physical Therapy today!

Lifting and carrying a child, picking up toys off of the floor, and pushing a stroller are normal daily tasks for mothers. The American Physical Therapy Association (APTA) offers tips to help moms and other caregivers accomplish these daily feats without aches and pains.

Physical therapists are experts in movement and function, especially when movement involves a change in “normal” patterns of movement.
Lifting Your Child From the Floor

When picking your child up off the floor, you should use a half-kneel lift. First, stand close to your child on the floor. While keeping your back straight, place one foot slightly forward of the other foot, and bend your hips and knees to lower yourself onto one knee. Once down on the floor, grasp your child with both arms and hold him or her close to your body. Tighten your stomach muscles, push with your legs, and slowly return to the standing position. To place your child onto the floor, the same half-kneel technique should be performed.
Carrying/Holding Your Child

When holding or carrying your child, you should always hold him or her close to your body and balanced in the center of your body. Avoid holding your child in one arm and balanced on your hip. When using a child carrier, be sure to keep your back straight and your shoulders back to avoid straining your back and neck.
Picking up Toys From the Floor

As a mother, you will find yourself cleaning up after your child often. When picking toys up from the floor, keep your head and back straight, and while bending at your waist, extend one leg off the floor straight behind you.
Lifting Your Child Out of the Crib

If your child’s crib has a rail that lowers, you will want it in the lowest position when lifting your child out of the crib. As you lift, keep your feet shoulder-width apart, knees slightly bent. Arch your low back and, while keeping your head up, bend at your hips. With both arms, grasp your child and hold him or her close to your chest. Straighten your hips so you are in an upright position, and then extend your knees to return to a full stand. To return your child to the crib, use the same technique and always remember to keep your child close to your chest.
Pushing a Stroller

When pushing your child in a stroller, you will want to stay as close to the stroller as possible, allowing your back to remain straight and your shoulders back. The force to push the stroller should come from your entire body, not just your arms. Avoid pushing the stroller too far ahead of you because this will cause you to hunch your back and shoulders forward.

Posture Tips Video from MoveForwardPT

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Improve Mobility & Motion

July 18, 2013 by Leave a Comment

Physical Therapy is beneficial for numerous reasons, but MoveForward tells us how it can “Improve Mobility and Motion.” Come visit us at San Diego Sports Physical Therapy to see how physical therapy can benefit you today!

No matter what area of the body ails you – neck, shoulder, back, knee – physical therapists have an established history of helping individuals improve their quality of life.

A physical therapist can help you move freely again without pain and discomfort and feeling renewed and ready to move on. They can even help you prevent an injury altogether.

For instance, a study of 1,435 NCAA Division 1 female soccer players demonstrated that those who participated in a physical therapy program had an overall ACL injury rate 41 percent lower than those who did only a regular warm-up prior to practice.1

Because physical therapists receive specialized education in a variety of sciences – physics, human anatomy, kinesiology (human movement), to name a few – they understand how the body works and how to get you moving again. They know how to manage all four of the body’s major systems – musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary (skin) – to restore and maximize mobility.

Whether you are living with diabetes or recovering from a stroke, a fall, or a sports injury, a physical therapist is a trusted health care professional who will work closely with you to evaluate your condition and develop an effective, personalized plan of care. A physical therapist can help you achieve long-term results for many conditions that limit your ability to move.
Reduce the Risk of Injury

While playing a round of golf or picking up around the house may seem harmless, but these everyday activities can result in injury due to abnormal movement, stress on joints and strain on muscles.

Because physical therapists are experts in knowing how the body works, they are able to design personalized treatment plans to reduce the risk of injury whether in everyday activities or sports.

For example, women perform athletic tasks in a more upright position, putting added stress on parts of the knee such as the ACL, resulting in less controlled rotation of the joint. While men use their hamstring muscles more often, women rely more on their quadriceps, which puts the knee at constant risk. To combat these natural tendencies, your physical therapist may develop a treatment program to improve strength, flexibility, and coordination, as well as to counteract incorrect existing patterns of movement that may be damaging to joints.
Improve Balance and Prevent Falls

Falls among the elderly are prevalent, dangerous, and can diminish their ability to lead an active and independent life. According to the National Aging Council, about one in three seniors above age 65, and nearly one in two seniors over age 80, will fall at least once this year, many times with disastrous consequences. A physical therapist can help you prevent falls by designing an individualized program of exercises and activities with an emphasis on strength, flexibility, and proper gait.

Balance may be improved with exercises that strengthen the ankle, knee, and hip muscles and with exercises that improve the function of the vestibular (balance) system.

Once a physical therapist has reviewed a complete medical history and conducted a thorough examination, he or she will develop a personalized plan of care. This may include a walking regimen with balance components such as changes in surfaces/terrains, distance, and elevations; Tai Chi (which emphasizes balance, weight shifting, coordination, and postural training); and aquatics classes geared toward balance and coordination. The physical therapist also may teach specific strengthening and balance exercises that can be performed at home. If necessary, the physical therapist will refer you to other medical professionals, such as an ophthalmologist or neurologist.
Recover From Stroke

Stroke is the number three cause of death in the U.S,2 and the leading cause of serious long-term disability. If stroke strikes you or a loved one, a physical therapist can help you regain function and cope with physical losses associated with stroke, such as decreased ability to move.

Rehabilitation begins as soon as the stroke survivor is stable, and the health care team works to match patient and family desires with patient abilities. The majority of survivors of stroke will receive physical therapy as part of the rehabilitation process. Your physical therapist will develop an individualized treatment plan which may include prescribing exercise and other activities to improve movement, help facilitate independence, and regain your quality of life after stroke.

Recent advances in neuroscience have had a significant impact on rehabilitation for stroke survivors. As part of research funded by the National Institutes of Health, scientists who are physical therapists are determining how new techniques can help promote motor recovery after a stroke. For example, physical therapists are using methods such as restricting the arm that was less affected by the stroke to encourage more effort from the affected arm. Treadmill training with the use of body-weight support and the assistance of a physical therapist can help people recover walking ability.

If you have problems with movements of the arm or leg that affect your everyday function, a physical therapist can help determine if you are an appropriate candidate for these and other innovative physical therapy interventions.
Live With Diabetes

Diabetes is a growing health issue that affects approximately 24 million adults and children in the United States.3 If you have diabetes, a physical therapist can work with you to design a program that helps control your glucose and fight complications such as loss of movement. While aerobic exercise is often recommended for the treatment of type 2 diabetes, a recent study found that adding high-force strength training to an aerobic program offered significant advantages, helping to improve glucose control, increase strength, and reduce the risk of falls among study participants.

People with diabetes often have reduced muscle mass, and, as a result, mobility. Adding resistance training to a diabetes treatment program leads to improved thigh lean tissue which, in turn, may be an important way to increase resting metabolic rate, protein reserve, exercise tolerance, and functional mobility. As experts in motion, physical therapists are ideally suited to help people with diabetes safely and effectively address their loss of movement.

References

1 American Journal of Sports Medicine August, 2008

2 American Heart Association

3 American Diabetes Association

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All About the Hips

July 16, 2013 by Leave a Comment

The knees and hips take a lot of impact on a day to day basis. Take a look at this article by Nelson Marquez, PT, EdD, and come visit San Diego Sports Physical Therapy for your knee and hip pain today!

As a weight-bearing joint, the knee sustains the most overuse injuries, making knee dysfunction the most commonly referred condition to orthopedic physical therapy practices. During the American Physical Therapy Association Annual Conference & Exposition here in June, Christopher Powers, PT, PhD, and Amy Sanderson, PT, OCS, presented biomechanical evidence that supports their assertion that knee injuries are linked to proximal factors that can influence knee loading.

A focus on these factors may hold the key to an effective knee injury rehabilitation program compared to current traditional treatments that do not take into account any proximal muscle weaknesses, they pair said.

Compensation factors

Powers and Sanderson said that hip muscle weakness and impaired trunk proprioception and deficits in trunk control are predictors of knee injuries. They provided a thorough functional biomechanical analysis of the pelvis, hip and knee during walking and running in order to show a link between abnormal hip mechanics and knee injuries.

“The most interesting part of the discussion is the focus on running and its biomechanical demands on the body,” said Shannon Ryals, PTA, academic coordinator for clinical education at Polk State College, Winter Haven, Fla., an attendee at the presentation. “Specifically, the speakers’ analysis of mid-foot strikers versus heel strikers and the shock absorption of each running style provides helpful information that can be used when you work with runners, athletes engaged in sports that require a lot of running, or those who would like to take up running.”

Powers, associate professor at University of Southern California’s Division of Biokinesiology and Physical Therapy, emphasized that during normal gait, there is a pattern of hip flexion, adduction and internal rotation during the loading response phase of walking. However, during higher-demand activities, such as running or jumping, these patterns are increased significantly, causing the knee joint center to move medially relative to the foot, which is in a fixed position on the ground. The inward movement of the knee joint causes the tibia to abduct and the foot to pronate, resulting in what the speakers called dynamic knee valgus.

Excessive knee valgus has been shown to be linked to diminished hip muscle strength, particularly the hip extensors, and overuse of the quadriceps, they said. “These factors contribute to numerous knee injuries, such as anterior cruciate ligament injuries and patellofemoral joint dysfunctions,” Powers said.

Powers pointed out that with a concomitant hip abductor weakness, pelvic stability is compromised. To compensate, patients with hip abductor weakness tend to elevate the contralateral pelvis and lean the trunk towards the stance limb. This tendency is called compensated Trendelenburg gait. It tends to have a negative consequence to the knee, increasing the valgus moment at the joint and tensile strain to the ACL and medial collateral ligament.

The speakers also traced the link between weakness of the gluteus maximus muscle and overuse of the hamstrings and adductor magnus muscles to compensate for the weakness. Biomechanical analysis revealed that such weakness results in increased hip adduction. The speakers also presented an analysis of the overuse of the tensor fascia lata to compensate for the weakness of the gluteus medius, resulting in increased hip internal rotation. Powers mentioned that these combinations of muscle weaknesses and compensations contribute to the medial collapse of the knee during high-demand activities.

Evaluation and treatment implications

The speakers presented evidence that impairments at the hip may adversely affect knee joint mechanics. They proposed that physical therapists conduct dynamic evaluations of patients with various knee conditions, assessing the entire lower chain and paying close attention to both proximal and distal kinetic and kinematic factors that may contribute to patients’ symptoms and dysfunctions. In addition, they proposed that therapists evaluate the conditions under which the symptoms arise. This entails taking into account the influence of speed and fatigue to when symptoms arise or get exaggerated.

As far as clinical implications, two general principles were presented that can be incorporated in the design of a knee injury intervention program: pelvis and trunk stability and dynamic hip joint control.

Powers theorized that improving hip abductor muscle performance will result in optimal alignment of the pelvis during single-limb activities and protect the knee joint from excessive varus moments created by trunk compensations due to hip abductor weakness. He also emphasized that the development of core programs should consider dynamic pelvis stability as an integral aspect of the training protocol. In addition, the gluteus maximus, shown to be well-suited to protect the knee from proximal movement dysfunctions, should also be considered in the training protocol. “Improving its use may serve to unload the knee by decreasing the need for compensatory quadriceps action to absorb impact forces,” Sanderson said.

Ryals said he couldn’t agree more. He said Powers and Sanderson provided newer dimensions on how to assess and manage knee injuries. He said that the general principles that the speakers suggested to incorporate in the treatment of knee injuries is a departure from commonly selected treatments for knee injuries, which consist of heat or cold modalities, vastus medialis oblique retraining and strengthening, as well as knee taping. “It makes knee dysfunction treatments truly evidence-based rather than based on a recipe or a trial-and-error approach and waiting to see what works best,” Ryals said. He also said that he learned that the emphasis on quadriceps strengthening, without addressing hip extensor muscle weakness, may facilitate increased quadriceps overuse that can be detrimental rather than therapeutic for patients with knee problems. •

Nelson Marquez, PT, EdD, is physical therapy editor of Today in PT.

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Jumper’s Knee

July 15, 2013 by Leave a Comment

Are you highly active and participate in high impact activities? Check out this article shared by San Diego Sports Physical Therapy and come see us for help with your injuries!

By Dino Pinciotti, PT

The knee joint is one of the most frequently injured areas in the human body, especially for those involved in any type of athletics. Classified as a hinge joint, the knee is much more complicated than this description suggests. This joint is heavily dependent on the soft tissue that surrounds it – muscles, tendons, ligaments, capsule, and cartilage, which serve to straighten, twist, and rotate the knee and leg.

Jumper’s Knee is common among those who participate in jumping sports such as volleyball and basketball. It is an inflammation of the tendons that attach the quadriceps muscle above and below the knee to the femur and tibia respectively. The tendon above the knee is known as the quadriceps tendon and the one below as the patellar tendon. In conjunction with the quadriceps muscle, these tendons play an integral part in walking, running, jumping, and climbing stairs.

Putting constant stress on the knee over time can cause micro tears in the tendons causing pain and inflammation, which results in swelling, loss of motion, and weakness. Patients most commonly complain of pain with stair climbing, squatting, kneeling, jumping, running, and walking. Ascending stairs is usually more painful than descending stairs.

Treatment consists of immediate reduction of the inflammation via cryotherapy (ice), medication, and rest. Physical therapy should begin as soon as the pain has diminished. After a thorough evaluation by a physical therapist, an appropriate treatment specific to the injury will be implemented. A skilled therapist will prescribe a program consisting of modalities, manual techniques, and therapeutic exercises to control pain, reduce inflammation, and increase strength, flexibility, and muscle endurance of the injured area. Stretching and strengthening the quadriceps muscle is the key to successful rehabilitation of Jumper’s Knee. Those individuals at risk for developing Jumper’s Knee can benefit from a preventive program to help avoid this injury, as well as other common knee problems.

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Pilates for Exercise

July 11, 2013 by Leave a Comment

Pilates may be a good way for you to get fit if you’re looking for exercises with less impact to protect your joints and your body. Here’s an article shared by San Diego Sports Physical Therapy all about Pilates.

The Pilates Method
By Kristen Schott, PT, MPT

Making the decision to become more physically fit is an easy choice to make. The tough part comes when deciding how to go about it, especially in a time where there are so many fitness programs available to us. One school of fitness that requires consideration is the Pilates Method. This fitness program, although gaining relatively new publicity, was created in the early 1900s by Joseph H Pilates. It is a renowned method of improving one’s muscle tone, flexibility, strength, posture, balance, and body-mind connection. Today, some of the basic principles and exercises of the Pilates method are used by many fitness experts and healthcare professionals, including physical therapists.

Historically, the Pilates method has helped athletes as well as injured individuals attain their fitness and rehabilitation goals. It can also be used as a preventive measure to gain postural awareness and core stability which can help reduce the risk of everyday repetitive strain injuries. Pilates is safe and appropriate for a variety of people of all fitness levels as it focuses on engaging the body’s central musculature around the spine, torso, hips, and shoulders. By focusing on these core muscle groups, individuals build a stable base or core from which progressively skilled upper and lower extremity movements are derived.

The Nine basic principles incorporated in every Pilates exercise:

Concentration: focus on the contraction of core muscles and be conscious of the body’s position in space or in relation to its environment.

Control: Maintain postures and positions- outside forces, such as gravity, should not influence or disrupt deliberate and slowly controlled movements.

Center: All Pilates exercises are initiated from proper central or core positioning about the spine and torso and then flow outward to coordinated movements of the extremities. A strong stable base is needed to effectively move the limbs repetitively without injury.

Fluidity: movements are slow and graceful as opposed to quick and jerky.

Precision: focus on obtaining accurate positions and movements.

Breath: utilize full inhalations and exhalations during exercise, never hold your breath while exercising; the body needs oxygen to nourish the tissues of the working neuromuscular system.

Imagination: use visualization or metaphors to enhance movements or to improve body’s response to the mind’s messages

Intuition: listen to your body- if a movement hurts, stop.

Integration: utilize the entire body, (central core and peripheral extremities), as well as the mind’s concentration and visualization to successfully complete an exercise.

Exercises:
These are a few basic mat exercises which target the core muscles of the spine, torso, hips and shoulders. These exercises do not represent the entire Pilates method, but are great for beginners.

Breathing:

Lie flat on back with knees bent, feet resting flat on floor, and arms at side or resting on lower abdomen. Pull torso muscles in and upward while exhaling. Place hands on lower abdomen just below navel and feel a mild abdominal contraction. Muscles of pelvic floor (used for bladder control) should also tighten. Release contraction on inhalation. Repeat breathing cycle 5-10 times.

Pelvic Bowl:

Lie flat on back with knees bent, feet resting flat on floor, and arms at side. Exhale and roll hips under drawing navel to floor and pelvis toward ceiling (keep back flat on floor). Inhale and reverse motion- pulling pelvis to floor and lifting navel toward ceiling. Repeat 5-10 times. Now try side to side- rotate one hip bone up toward ceiling, dropping other hip down toward mat. Imagine that the pelvis is a bowl filled with water sloshing back and forth. Repeat 5-10 times. Now try “swishing the water” in a circular motion, combining all movements. Repeat 5-10 times clockwise and counterclockwise. Return to rest position.

Cervical Nod/Chin Tuck:

Lie flat on back with knees bent, feet resting flat on mat, and arms at side. Using a small motion, “tuck” chin using the motion you would to look at your chest. Imagine a string is pulling from the top of your head to lengthen the vertebral bones of your neck.

Shoulder Flexion and “Angel Arms”:

Lie flat on back with knees bent, feet resting flat on mat, and arms at side. Pull shoulder blades down toward mat (scapula setting). Lift one arm up overhead, keeping opposite shoulder blade against the mat. Alternate arms. Repeat 5-10 times each side. Now try bringing arm out to side and up overhead while setting opposite scapula against the mat. Alternate arms. Repeat 5-10 times each side.

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