As a physical therapist who works with runners, there is one consistent area I find weakness even in very fit & strong runners – lateral (side) motions.
Running involves muscles to move you in a forward direction on flat ground, up hills, and down hills. The majority of strengthening most people focus on in legs is quads, hamstrings and calf muscles, which is helpful for running but not the only muscles a runner should focus on. While running is not done sideways, the muscles that function in side motions are important stabilizers to help keep you balanced and decrease the stress that occurs in lower back, hip, knee, foot and ankle.
As many runner head into their slower race time of year, it is a great time to begin to work on strengthening for the demands that running requires.
So continue to work on the strength needed to move you forward, but add in strengthening in the lateral motions. Some exercises to address this area are: sidelying clamshell, side stepping with theraband tied around ankles (keep feet parallel), side planks (adding in arm and leg lifts as you gain strength), side step ups or hops, jumping side to side, grapevine/carioca.
Also as you work on balance exercises make sure you keep your pelvis level and challenge your balance by being on unstable surfaces (ie. BOSU balls, foam, cushions, or pillow). So make a change to work your body in new directions!
Kristi Moore, MSPT
Alpine Physical Therapy, North
2965 Stockyard Rd.
Missoula, MT 59808
10/22/2014 0 Comments
Antara Quinones, Brace Hayden, Leah Versteegen and Jess Kehoe of Alpine Physical Therapy jumped (literally) into a collaboration with Missoula’s Freestyle Ski Team’s dry land preseason training the past 2 weeks at Bitterroot Gymnastics.
In an effort to reduce training and competition injuries that keep these young athletes off the slopes, Alpine PTs worked with Freestyle Ski Team coach Donovan Powers and Bitterroot Gymnastic’s coach and owner David Stark on a dynamic warm up, core stabilization exercises and proper jump landing drills.
It was a great experience to work with these talented athletes and their coaches to improve their sport performance and reduce potential injuries. Seeing these kids land amazing jumps like double back flips and 540 degree spins with good form was an awe-inspiring evening of PT community outreach. (Photo Credit of Antara, Brace, and Jess (L to R) thanks to Leah Versteegen, DPT)
Last weekend, several of Alpine’s physical therapists attended an excellent course here in Missoula on helping patients with persistent pain issues by way of mobilizing their nervous system.
Brent Dodge, Gary Gales, Dennis McCrea, and Brace Hayden took a two day continuing education class designed to help people with chronic pain and irritable back, neck, and extremity issues move and feel better.
Re-educating the body that ‘movement is good medicine’ is a helpful approach for those in pain that avoid healthy mobility. The course was a thorough approach to assessing and treating this patient population with a lot of dynamic interventions to optimize their return to a higher level of activity.
Here Gary Gales mobilizes the radial nerve path in the arm of our co-worker Dennis McCrea.
For more information about the approach Alpine Physical Therapy takes to help people with persistent pain, visit our webpage describing our Pain Clinic by clicking here.
10/8/2014 0 Comments
Special thanks to star physical therapist Antara Quiñones of Alpine Physical Therapy for providing this write up on a recent article from the Journal of American Academy of Orthopedic Surgery.
Osteonecrosis of the femoral head most frequently affects 30 to 50 year olds, with 20,000-30,000 new cases diagnosed annually. Although the actual pathology behind femoral osteonecrosis is not yet understood, the disease typically follows a progression to eventual femoral collapse, which results in the need for a total hip replacement.
Osteonecrosis literally translates to bone death. There are several reasons why this can occur. Ischemia, or lack of blood flow, is one. This can happen from trauma, (like a hip dislocation or fracture), a blood clot blocking blood flow, or high blood pressure at the level of the bone tissue from excessive alcohol or corticosteroid use. Some genetic blood clot formation mutations have also been linked to femoral osteonecrosis. Disruption to the bone cells themselves by irradiation, chemotherapy, or the presence of excessive free radicals, also causes osteonecrosis. Primary risk factors include corticosteroid use, alcoholism, trauma, and coagulation disorders. They have found, however that a risk factor alone does not determine the onset of osteonecrosis, but that there must also be a genetic factor present.
The earlier the disease is diagnosed, the better the outcome. The most frequent symptom is deep groin pain that can radiate to the buttock or knee on the same side. The gold standard for femoral osteonecrosis detection is an MRI, which can give insight into the amount of bone death present, its location, and the amount of swelling in the bone. All of this information can help physicians treat the problem and predict whether or not the femoral head will “collapse.” which then means a need for a total hip replacement.
Nonsurgical treatment of femoral osteonecrosis is limited to smaller, symptom free lesions for a period of no weight bearing to see if symptoms do occur. Little evidence exists backing shockwaves and electromagnetic field treatment. Pharmacologic agents are also not strongly backed in the literature for prevention and treatment of femoral osteonecrosis.
Surgical treatment is the primary treatment option for femoral head osteonecrosis and consists of femoral head preserving procedures or total hip replacement. The type of femoral head preserving procedure is subject to debate and dependent on the extent and location of the bone death. Femoral head sparing procedures are also indicated for the younger patient.
Charalampos G. Zalavras, M.D. and Jay R. Lieberman, M.D. Osteonecrosis of the Femoral Head: Evaluation and Treatment. The Journal of American Academy of Orthopedic Surgery. July, 2014. Vol. 22, No. 7. Pp 455-464.
For more information, visit our topic module on this topic on our clinic website by clicking here.
Special thanks to star physical therapist Brace Hayden, DPT, CSCS of Alpine Physical Therapy for providing this write up on a recent article from Spine.
The incidence of “slipping a disc” in your low back or herniating an intervertebral lumbar disc, in the medical vernacular, while attempting to move that heavy filing cabinet is not uncommon. The ensuing low back pain and often accompanying radiating leg or buttock pain from a bulging disc putting pressure on your spinal nerves is also unfortunately, quite common. Dr. Jon Lurie and a collaborative team of researchers based out of Dartmouth’s Department of Medicine, Orthopedics, Health Policy and Clinical Practice set forth to assess the data of 8-years of outcome research from operative versus non-operative treatment for this debilitating back issue.
Decompression surgery to relieve disc-related spine pain is a well-researched and a highly-accepted indication for spine surgery. While in the throws of an episode of raging low back pain, the quick fix of going under the knife seems like a logical decision, but spine surgery comes with plenty of costs and risks. The questions Dr. Lurie’s team set to answer was: why does the rate of surgery vary so greatly geographically in the U.S, if the surgical option is more effective and faster to provide relief? They also aimed to add to the body of knowledge of high-quality, multiple-testing sites, with randomized controlled trials of prospective surgical (or conservatively managed) effects on patients over the long term.
This study was considered a ‘concurrent prospective randomized and observational cohort study’, as each of the 1,991 eligible participants chose either a route into randomized study (surgery vs nonsurgery) at one of 13 spine clinics participating in this Spine Patient Outcomes Research Trial (SPORT) or the observational group. The observational group got to choose their not-so-random, treatment route of surgery vs nonsurgery. There was plenty of lenience in the eight-year study for either group to opt in or crossover to the other group as their back issue and provider deemed necessary. The nonoperative group was tracked over the course of the study and received the “usual care” recommendations. These treatments were customized to the individual and included at least: physical therapy, back pain education and counseling, and medication management.
All of the enrolled participants received thorough screenings and imaging tests for eligibility (such as >6 weeks of radiating low back pain with a confirmatory MRI), outcome measures and assessments on a regular basis (6 weeks, 3 months, and 6 months, and annually thereafter). Most surgical participants had the standard bulge trimming or ‘open discectomy’ and exam of their pinched nerve root. The study gets highly complicated statistically, as the analyses were multifactorial and convoluted to best capture the longitudinal comparisons of the randomized and observational groups. Lurie et al. provided plentiful and excellent flow diagrams cited in the original paper for those that want to peruse the detailed statistical intricacies behind such analyses as “intent-to-treat” versus “as-treated” groupings.
The results reiterated the hypothesis that usually, effective and selective surgery relieves radiating low back pain. Over the course of this 8-year study, more measurable improvements were “clinically significant” in all of the main outcome measures (ie. bodily pain, physical function, perceived disability) for the surgical group than those who remained nonoperative. However, both groups experienced heavy amounts of statistically challenging “crossover”, as humans tend to change their mind on the question of: Should I Get My Sciatica Relieved Surgically, Or Should I Wait? The common exception for both groups was neither returned to prior work status. Or once you ‘blow a disc’ hoisting that filing cabinet up the stairwell, you’re less likely to return to moving heavy office equipment regardless of choosing surgery or conservative care for your back. The study goes on to throw the conclusive bone to those deliberating this costly surgery, that “even among patients with strong surgical indications, many (34%) remained in the nonoperative group out to 8 years”. Take comfort in conservative rehabilitative care and do your core stabilization exercises and spine stretches if surgery doesn’t sound like your calling, as improvements in “sciatica bothersomeness” happened in both groups.
Jon O. Lurie, MD, MS, et al. Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation – Eight-Year Results for the Spine Patient Outcomes Research Trial. In Spine. 2014, Volume 39, Number 1. Pp. 3-16.
For more information, visit our patient guide on this topic by clicking here.
Falls are a big deal to many older adults with over a third of the +65’ers falling annually. According to the Centers of Disease Control and Prevention, a fifth of these falls results in a traumatic injury, and many of them (like one every 29 seconds) leads to their demise.
We’re not only paying for these falls with our lives, but medical expenses from falls cost over $28 billion per year.
Alpine Physical Therapy makes an effort to be a part of the good news on this threatening topic by reaching out to reduce falls in our community. We participated in a multi-agency collaboration (MonTECH of the Rural Institute, UM’s School of Physical Therapy, and the National Council on Aging) again this year for National Falls Awareness and Prevention Week.
We offered free balance and falls-risk screens to all interested this year at the Peak Health and Wellness Center’s first annual health fair last Friday evening (9/19/14). The event was a success with over 10 older adults screened and subsequently educated on local falls prevention classes, physical therapy options, balance and strength exercises and their relative risk.
Alpine PT is pleased to be a part of Missoula’s falls reduction network and reminds the community that we offer free balance/falls-risk screens year round at our three locations.
For more information on this important topic, visit our clinic website on the topic of our Vestibular and Balance Clinic by clicking here.
Brent Dodge is the founding owner of Alpine Physical Therapy and is a board certified orthopedic specialist. He holds additional certifications in Functional Dry Needling, Manual Physical Therapy, and Strength and Conditioning.
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