While it is true that every person who comes into our clinic has a unique story, there is one commonality that we see month after month, year after year.
Signs of degeneration in MRI results.
For most who receive this diagnosis from their primary care provider, degeneration can feel like an impending doom looming over them. “When will I have surgery?” or “How long before I have trouble getting out of bed?” are concerns we hear all too often from patients in fear of their MRI findings.
But what is degeneration exactly? What does it actually mean?
Here we seek to shed more light on this subject, uncover the realities of this common diagnosis, and reset years of misleading language.
The medical definition of degeneration is at its most basic ‘the state and process of decline’. And contrary to popular belief, it is the natural changes that our tissues experience as we age. “A colleague of mine calls degenerative tissue 'the wrinkles on the inside”, says physical therapist Leah Versteegen. “That paints such a clear picture for many of my patients.”
There is research that indicates that certain muscle fibers begin their decline in our 30s, and other tissue decline begins in our 40s and 50s. In regards to surgery, degenerative changes that show up on your MRI certainly don't always require surgery. Just like wrinkles and saggy skin on the outside don't require surgery.
“Research has shown us over and over again that there is very little relationship between degenerative changes on imaging and the pain you are experiencing”, says physical therapist Angela Listug-Vap. “Imaging is mostly used to rule out significant problems but it's very sensitive so it shows us all the changes of normal aging as well.”
“...there is very little relationship between degenerative changes on imaging and the pain you are experiencing”
So what is to be done? How can our healthcare system be better about educating our patients?
“Good clinical reasoning has to be used by a skilled healthcare practitioner to match the clinical presentation with the results of your image”, says Listug-Vap. “Degeneration on an image may mean nothing at all”.
“We need to advocate for treating patients and their symptoms, not their MRIs.”
In short, We need to advocate for treating patients and their symptoms, not their MRIs. There is a certain level of human decency in not allowing patients to spiral into uncertainty after a diagnosis such as common degeneration, and we need to hold that to a higher standard. Healthcare professionals are not only responsible for the identification of conditions, but education about the condition as well.
Jess Kehoe, DPT
I love having some recipes that are flexible. This is one that fits any mood, be that meatless Monday or left over chicken. Whatever veggies you have in the fridge with chicken, tofu, beef, chickpeas, or just all veggies, it all turns out good. Traditionally you would find carrots, bell peppers, and broccoli as a good combo, but I have used cabbage, zucchini, snow peas, or green peas as additions or replacements with good results. It’s also a nice addition to add a handful of cashews at the end if you like, or some sesame seeds. This teriyaki sauce is so easy and so delicious, it will make any combo you can throw together delicious. Don’t forget to make the rice, quinoa, soba noodles or lo mein noodles. So many options!
1 ½ tablespoons corn starch
1 tablespoon chopped ginger
3-4 medium cloves garlic, minced
½ cup water
⅓ cup tamari or soy sauce
3 ½ tablespoons maple syrup or honey
1 tablespoon lemon juice
Place all ingredients in a food processor or blender to puree.
Veggies: 1-2 cups of each veggie you choose
If using meat, cut 1-1.5 lbs into bite size pieces. Use 1-2 tablespoons of oil in a pan over medium heat, and saute until fully cooked.
Using a saute pan or wok over medium-high heat add 2 tablespoons of water and the carrots. Reduce the heat to medium and cover to steam the carrots for a few minutes. Remove the cover and add the remaining vegetables. If using zucchini put that in next to let it sear slightly for 2-3 minutes. Then add peas, cabbage, peppers, broccoli. Cook, stirring frequently for another few minutes, you can cover and steam with a little more water if using broccoli.
Add the teriyaki sauce and the meat (if using) to the vegetables. Mix to coat then let the sauce come to a boil over medium-high heat. When the sauce is thickened add the cashews and combine. Serve over your favorite rice or noodle choice.
Whether you're a pro athlete, or just recreationally active, a proper warmup routine can be the difference between performing your best or setting yourself up for injury.
But what is the best way to prepare for physical activity? This week, our PTs discuss the latest evidence surrounding dynamic warm ups, static stretching, and the most appropriate execution and timing for each.
There is solid evidence in the research, especially before performing a sport event, that warming up for 5-10 minutes, then performing a series of dynamic warm up drills that simulate some body movements of your sport in a progressive (slow to faster) fashion are quite beneficial. Dynamic warm ups can reduce stiffness & joint pain gradually, prevent some types of sport-related injury and improve your athletic performance by increasing the warmth to the joint, blood flow to the musculature and thus 'pre-stretch' your joints and connective tissues.
Static stretching (holding a stretch >10 seconds) prior to sport has actually been found to be detrimental before some competitive sports by temporarily stunning the muscle into a lower level of athletic performance. Otherwise, static stretches, especially after a 5-10 minute warm up, are wonderful and can be similarly helpful for improving joint mobility and reducing soft tissue tension. Static stretching tends to take longer and is often more of an intense stretch, which isn't preferable for some peoples' allocation of time toward fitness goals. The most important take-away is to adopt either static or dynamic stretches into your fitness routine and experiment with what feels best for your body, sport preference and dedicate the time to routinely performing a series of stretches twice daily.
- Brace Hayden, PT, DPT, OCS, CSCS
Dynamic warm ups are recommended prior to exercise and/or running for gradually getting the joints moving through a greater range of motion. These movements include, slow continuous movement through range without static holding or bouncing. Static stretching, or holding a position for an extended period, allows the muscles to relax into a lengthened position so the joints can again move through a full range. This type of mobility is better after the workout is done or at the end of the day. I recommend both for about ten minutes each as part of a pre- and post- workout routine.
- Kristina Pattison, PT, DPT
I think this argument has been pretty well settled with the research favoring a dynamic warm-up as there has been some research to suggest that static stretching can actually decrease athletic performance. That being said it all depends on your sport and your body (some sports require high levels of flexibility while many do not). The way I approach warming up is by breaking it up into two components. The first component is a general warmup where I am just trying to get the heart rate gradually up, increasing blood flow to all relevant musculature. Typically, this can be as short as 3-5 min and involve one or a few different movements depending on what you are about to do. The second part of the warm up is the specific portion and should focus on what your body needs to prepare for what you are about to do. Again the specific part can be as short as 2-5 min but it should focus on prepping the parts of your body that will be doing the most work and addressing any restrictions to movement that are specific to you while progressively recreating the types of movements you are about to do. The whole thing can take 5 min or 30 min depending on the demands of the sport, your injury history, and how much time you have available. In general, if you are doing it right if your warm up gets the heart rate up, addresses any restrictions in movement you may have and progresses toward the type of activity you are about to do.
- Francisco Quinones, PT, DPT
Dynamic warmup or stretching is moving multiple muscle groups to prepare for more vigorous activity, while static stretching is generally to relax and lengthen muscle to its optimal and normal length. Usually static stretching is done after vigorous exercise as part of a cool down and important to relax muscle after exercise. Having said that: it is probably more important to focus on your specific body type. And are you generally a stiff person who likes lifting wts and power sports and sprints, or are you someone who would rather do yoga and show your extreme flexibility? We tend to gravitate toward what we are naturally good at, but avoid things that are harder to us. What we really all need is full mobility. Full mobility is, full range of motion and strength throughout this range. So if you are extremely flexible but weak you need to work on strength, and if you are stiff you need to work on getting full range of motion. The stiff person may want to spend more time on their static stretching following vigorous exercise to prevent injury and get full range of motion. The flexible person may want to spend more time working on dynamic warmup ex to have full strength and control.
- Gary Gales, PT, DPT, CMP
Kinesio tape, KT tape, Rock tape, whatever you call it you’ve likely seen it or used it before. Popular among runners, the tool claims it “helps in reducing pressure to the tissue, which may reduce discomfort or pain. In addition, it is also believed that correct taping can help provide support to muscles by helping the muscle to not over-extend or over-contract.”-KTTape.com
The use of kinesio tape during competition has become widely popular, particularly within the running community, with athletes claiming they can really “feel the difference” and citing improvements in their performance/recovery.
Companies who sell it however, are careful to not over promise, using language like “It is believed that…” or “It may…”. Even going as far as to post disclaimers such as “Not Clinically Proven…”.
This week we hope to separate the fact from fiction when it comes to the use of kinesio tape amongst athletes. We asked our team of expert PTs for their opinion on the subject, here’s what they had to say.
“Always question something that claims to do everything. KT tape is one of these things. It is effective in the following ways:
1. Helping clear out swelling and bruising more quickly. This is because the tape stretches the skin in such a way that supports the lymphatic system. The results are typically visible.
2. Creating "proprioception." Any contact or stimulus with your skin will help your brain better identify where your body is in space. Because of this, KT tape is great for providing a little reminder to sit up straighter or can provide a little cue to move a little better through a joint's active range of motion--i.e. shoulder during overhead throw. That being said, however, does it protect a joint under the forces of quick, powerful load? Not really. Does it help "hold a joint together?" No. Can it provide a little relief to an overworked muscle? meh, debatable. Can it provide a nice placebo effect that helps you feel like you're doing something? Sure. And, if it does no harm and helps provide comfort, why not.”
- Antara Quinones, PT, DPT, CLT-LANA
“I think we can make the argument that kinesio tape or the like is not something that will provide a lot of support or stability but it can affect the neuromuscular system and provide increased feedback to a system that may be impaired by injury. An athletic trainer once said about KT tape..."It's like a hug" for the injured area!”
- Jess Kehoe, PT, DPT, CSCS
“I definitely think that KT tape is a legitimate tool for athletes to help unload their tissues and allow them to play/practice during the season while recovering from mild sprains and strains. Sure, there is probably some mental aspect to using KT tape, of feeling like you are 'doing something' to help your body heal but that is true for most every treatment and is also a part of recovering from an injury. It takes both physical changes and the right mental approach to heal and return to play. I don't think KT tape is a long term solution. It should be used in the short term to unload injured tissue. The real recovery comes in recognizing why those tissues were injured in the first place and working to fix the underlying cause.”
- Leah Versteegen, PT, MS, DPT
“The one theory of how KT tape works is that it lifts the superficial tissues away from the muscles and allows for normal blood flow and helps decrease swelling and helps with healing and another is that it provides support to strained muscles. Both which have value. However it does have a placebo effect because it does feel good and it also looks good with all the patterns of taping and variety of colors. So in the end it is a little bit of both legitimate value and placebo which is not a bad thing.”
- Dennis McCrea, PT, MPT
Jess Kehoe, DPT
I made it through the holidays! And like most of us, enter into January promising myself (as a rule I avoid resolutions!) to try to eat better. Really this means less sugar filled treats. As much as I love cookies, by the time January rolls around I’m ready to throw out the last few Christmas cookies and candy (don’t tell my kids!!). This recipe has been a favorite at my house for years, and always a go to when I feel I need to sneak some healthy eating in. It’s also easy to make a double batch and freeze for a crazy week day in the future, or share with your friends, these days with a less than satisfying, but likely still greatly appreciated drop off.
Also, a note about blended soups. All the recipes instruct you to transfer in parts to a blender for puréeing. But at the risk of sounding like an advertisement, I doubt I would ever make any blended soups with that method...so much mess! I have discovered that a stick blender was made just for this purpose Just use it in the pot when it’s all cooked. SO EASY.
1 onion, diced
2 cloves garlic, minced
1 large celery rib, diced
1 large carrot, diced
1 baking potato, peeled and cut into 1 inch pieces
1 rounded cup of red lentils
1 1/2 quarts stock (I’ve used vegetable and chicken here with equally yummy results)
1/2 teaspoon ground cumin
1/4 teaspoon cayenne
2 tablespoons fresh lemon juice
Salt and pepper to taste
In a large soup pot heat up 2 tablespoons olive oil over moderate heat. Add the onion and garlic and sauté until fragrant, about 2 minutes. Add the celery and carrot and continue to cook for about 5 more minutes. Add the potatoes, lentils and stick; bring to a boil. Cover and lower the heat to a simmer until veggies are tender, 40 minutes. Purée the soup (either in batches or with your stick blender). Add the cumin, cayenne, lemon juice, salt and pepper. Serve and enjoy! We like to have some good crusty bread to accompany this soup.
North Clinic Giving Tree
Please join Alpine in spreading the cheer this holiday season for one of the following charities. Take a tag that you wish to purchase and return items (unwrapped) under the tree (at the North Clinic) by no later than December 21st. If you choose a tag with a monetary donation, please visit this charity's webpage to make your contribution.
Soft Landings: https://softlandingmissoula.org/act
More than 68 million people worldwide have been uprooted by conflict and natural disaster. A group of concerned Missoulians came together to be a small part of alleviating the suffering for these families and provide a "soft landing" for them in their new community of Missoula, Montana. Soft Landing Missoula focuses on building a sustainable effort to engage the community in being a welcoming, supportive and informed place to help refugees and immigrants integrate and thrive.
United Way: https://missoulaunitedway.org/
United Way wants to celebrate this season of giving by sending a little extra hope to our community’s Healthcare Heroes. Join us in thanking all of Missoula’s healthcare workers on the front lines of the COVID-19 pandemic and letting them know that their hard work has not gone unnoticed.
We’re asking for a $30 donation, which will be matched by United Way and sent to our Healthcare Heroes in the form of a Visa gift card for dinner to-go, a tank of gas, a holiday treat or whatever else they may choose.
My Student In Need: https://www.mystudentinneed.org/Missoula-MT
My Student In Need is a nonprofit designed to fulfill teacher's requests for students in need. Currently in the Missoula area there are 4 students who are in need of instrument rental fees for the spring semester ($75.) If you can provide even part of this fee, it is helpful. Please remove a tag and go to MyStudentInNeed.org and click on fulfill a need at the top of the screen. Find Missoula County to find the students and fulfill a request.
South & Downtown Clinic Food Drive
Jess Kehoe, DPT
Are you a cook from scratch, geek like me? If so you roast a pie pumpkin around Halloween to have puree for Thanksgiving. You have also learned that usually you wind up with more puree than that pie calls for....in steps pumpkin bread to save the day. This is also completely unnecessary and a can of pumpkin puree sure does the trick also!
This recipe was easy to make and turned out pretty yummy. Of course I added chocolate chips (my kids insisted) but you could add pecans, walnuts, raisins or nothing. You can also substitute canola oil, olive oil or even apple sauce for the coconut oil. Often my coconut oil begins to solidify when I mix it with the eggs and other cold ingredients, but this recipe had a slick fix that I will remember to use in the future again. Simply warm up your mixing bowl, I put mine in the oven for a few minutes as it was pre-heating. Problem solved!
Made for a great toasted snack with peanut butter this week. Enjoy!
⅓ cup melted coconut oil
½ cup honey or maple syrup
1 cup pumpkin puree
¼ cup milk of your choice
1 ½ tsp of pumpkin spice blend (OR ½ tsp cinnamon, ½ tsp ground ginger, ¼ tsp ground nutmeg, ¼ tsp allspice or ground cloves)
1 tsp baking soda
1 tsp vanilla extract
½ tsp salt
1 ¾ cup whole wheat flour
As the percentage of the population affected by COVID-19 increases it becomes more important to understand some of the long term effects of this virus. There is building evidence that the novel coronavirus can cause cardiovascular damage during the course of the infection. Data is currently being collected about the prevalence of cardiac injury due to a bout with COVID-19. In reports earlier this year from hospitalized patients, it has been shown to be greater than 20% demonstrating cardiac injury. However there is much variety in symptoms and severity with COVID-19 and we are still learning much. For athletes and the general public frequently engaged in fitness pursuits, cardiovascular damage can be a cause of sudden cardiac arrest. Based on the ongoing uncertainty about the cardiovascular risk of returning to sport following a COVID-19 diagnosis there are some new recommendations being put forth for returning to sport activities.
In general, listen to your body! Take it slow, and if an athlete is reporting more fatigue than usual during their gradual return to sport, referral to MD for cardiovascular screening is recommended.
Reference: Jonathan H. Kim, MD, MSc; Benjamin D. Levine, MD; Dermot Phelan, MD, PhD; et al. “Coronavirus Disease 2019 and the Athletic Heart Emerging Perspectives on Pathology, Risks, and Return to Play” JAMA Cardiol. Published online October 26, 2020. doi:10.1001/jamacardio.2020.5890. Accessed November 23, 2020.
Research article link: https://jamanetwork.com/journals/jamacardiology/fullarticle/2772399
Jess Kehoe, DPT
My kids see the buttermilk container in the refrigerator and know that is the necessary ingredient for pancakes, so all last week they incessantly were asking for them on Saturday.
Whether it's just a regular weekend morning or you're celebrating the holidays with only your quaran"team", sometimes it's nice to have a good pancake recipe. I'm a huge fan of basic buttermilk pancakes, but when I think I need to sneak some more health into my morning meal this is my go-to.
These cakes still turn out fluffy, the key to this being separating the and beating the egg whites. This batter is a little thicker than the average pancake batter and the beaten egg whites injects a ton of air into the cakes. However, if this is too much, you can simply mix the whole egg in and they are still quite tasty.
I'm also not terribly strict with the different kinds of flours. You can use any combo, as long as the total amount is the same. This weekend I used Kamut and Oat flours instead of rye and barley and I have flax in a huge Costco bag, and have substituted this for the wheat germ.
I'm also reading "Cooked" by Michael Pollan and spending time with my daughter, aka "little mixer" in the kitchen, making something yummy seems like just the right kind of thing to be doing in late 2020.
Four-Grain Fitness Pancakes
1/2 cup all-purpose flour
1/2 cup whole-wheat flour
1/2 cup rye flour
1/2 cup barley flour
1/4 cup cornmeal
1/4 cup toasted wheat germ
2 tsp baking powder
1/2 tsp baking soda
1/4 tsp salt
2 large eggs, separated
1 1/2 cups buttermilk
1/2 cup milk
1/4 cup canola oil
2 tbsp honey or maple syrup
In a large bowl, whisk together the buttermilk, milk, oil, honey and egg yolks. Mix the dry ingredients into the buttermilk mixture until just combined. Beat the egg whites until soft glossy peaks form, then fold these into the batter, try not to over mix.
Heat a griddle over medium heat, grease lightly. Spoon batter on to the griddle. Let them cook until bubbles appear on the surface and the edges look dry, about 2 minutes, flip and cook about 1 more minute. Serve immediately with any pancake toppings you enjoy.
LEAH VERSTEEGEN, DPT
Sciatica is a term that is widely used to refer to pain that seems to be spreading or radiating into the back of the hip and sometimes down the leg. Where does this pain come from?
Technically the term 'sciatica' means that the sciatic nerve itself is the source or cause of the discomfort, but that is not always the case. The sciatic nerve is a thick nerve that courses through the buttock area and is formed from a combination of several nerve roots that originate in your low back and sacrum.
The nerve roots from the lumbar spine that are a part of the sciatic nerve are L4, which exits between the lowest two vertebrae in your back, and L5 which exits between the last vertebrae and the tailbone. Other nerve roots that make up the sciatic nerve are S1-S3 which all exit from the tailbone or sacrum.
What this anatomy tells us is that sciatica often stems from irritation of a nerve root at one of these levels and not necessarily from just the sciatic nerve itself. The pain that you are feeling in your buttocks or down your leg could be originating from inflammation or stiffness in your low back just above your tailbone. It could also be from inflammation of the sciatic nerve itself as it courses through stiff or thickened musculature in the buttock region, but this is less often the source of the symptoms.
To effectively treat sciatica, it is important to determine the underlying cause of your symptoms. Are they coming from the sciatic nerve in the hip, from the nerve roots in the low back, or from a combination of the two? Why is there inflammation, tension or stiffness in your hip or low back? Are there other structures, such as tight hip flexors or loss of mobility in the upper spine, that are contributing to the symptoms?
Once the true underlying cause of your sciatica is identified then you can choose the correct exercises, mobility work or stretches to help treat the cause of the symptoms and not just chase the symptoms themselves.
Don't let sciatica prevent you from having fun and definitely don't settle with the thought that you 'just have to live with it'. It can be treated with simple daily movement when done with the correct intention and aimed at the structures that are the true source of the problem.
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