By Jess Kehoe

This is a yummy bean and pasta salad with a deliciously creamy dressing!  This was a hit in my house, and a great meal with easy, minimal cooking, and as a bonus, great for lunch leftovers.  This is a vegan recipe full of flavor, and avocado is the secret ingredient in the dressing that gives it a great creaminess.  You can also make this salad with mixed salad greens instead of pasta for something a little lighter, or gluten free.  

Ingredients:

1/2 cup thinly sliced red onion
1 ripe avocado, pitted and roughly chopped
1/4 cup cilantro 
1/4 cup lime juice
2 tablespoons extra-virgin olive oil
1 clove of garlic
1/2 teaspoon salt
1 lb pasta
1 pint grape tomatoes, cut in half
1 green pepper, cut into bite sized pieces  (I also used 1/2 red pepper in addition for nice color!)
1 15 ounce can black beans
1 15 ounce can sweet corn

Instructions:

Cook the pasta as directed and while this is going you can make the dressing.  Combine the avocado, cilantro, lime juice, oil, garlic and salt in a mini food processor, I used an inversion blender, and process until smooth and creamy.  Drain the pasta and place it in a large bowl.  Add the remaining ingredients and toss to coat with the dressing.

Enjoy!
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It's fall, it's Montana, it's time many start their push to "fill the freezers".  A couple of our PT's here at Alpine are big hunting enthusiasts and look forward to the yearly trek into the backcountry.  In fact, Colter Brown, DPT from our South office, is currently somewhere in Wyoming scrambling around the high country looking for big horn sheep.  Fortunately, before he skipped outta town he graciously put together some thoughts and exercises that would be helpful preparing for safely getting out in the woods, and bringing home enough game to fill the freezer.  
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1. Start now, don't wait any longer to begin training.
2. Working unilateral (PT speak for single leg) loading exercises (step-ups, lunges, single leg balance, single leg RDL, etc.) will be better than traditional squats, deadlifts, etc.
3. Do some heavy pack training, don't avoid this. Start with a lighter load and build the load as the season nears.
4. Get a good quality backpack and train with that pack.
5. Build and work on mental toughness. The difference with backcountry hunting relative to most sports is the multi-day demands potentially followed by a heavy pack out. This will be difficult, get ready.

Here are some exercises that Colter suggests for prepping your body for a backcountry hikes and hunts.  If you find you need some more guidance, or are having trouble with them due to joint(s) pain, give Alpine PT a call.  Any of our therapists can help you work on a fitness program specific to backcountry hunting or rehabilitating after a weekend warrior injury.

By Jess Kehoe

Real fresh tomatoes are so amazing, it makes me wonder why I ever even by a tomato from the grocery store in December!  Combining them with crusty bread, basil and cucumbers is such a great combo.  I would like to thank a friend for sharing this recipe with me, and since it was so delicious and easy, I had to share it with all of you as well. 

​Enjoy! 

Ingredients:
​1 clove of garlic, diced 
1 loaf of 2 day old crusty bread cut into bite size pieces (if your bread is too fresh, toast it a little before mixing into the salad)
1 cup chopped tomatoes
1 cup cucumber, peeled and chopped
1/2 cup thinly sliced red onion
1 cup fresh basil, chopped
1/2 cup fresh thyme, chopped
1/4 cup olive oil
2 tablespoons balsamic vinegar

Instructions:
Combine all the ingredients into a salad bowl, toss and enjoy!

By Jess Kehoe

I don't know about you, but it has been too hot to cook these past few weeks!  Now, I'm not saying this smoothie is a great option for dinner, but it sure is refreshing in the afternoon, after a morning run, or following some yardwork in the sun.  My family is a big on smoothies.  When my kids were really little it was a great way to "sneak" lots of veggies into them, without them even knowing, and this is by far the most requested combo.  The dates are a great way to add sweetness to a smoothie without using a sweetener, but I do think a high-powered blender is best for really pulverizing them.  The avocado adds healthy fats and really adds a nice creaminess to the consistency.  For this particular version I had kale, but it's also great to use spinach.   

Ingredients:

1 cup water
1 ripe mango, peeled and pitted.  (If using frozen, 1-2 cups will work)
juice of one lime
1/2 avocado
2-3 dates, pitted
1 cup kale, hard stems removed (for spinach you can put in even more 2-3 cups)
1 cup ice cubes

Instructions:

Place all the ingredients into your blender, usually I put the ice in last, and blend on high for 30-60 seconds.

​Enjoy!

WHAT IS AQUATIC THERAPY? 
Aquatic therapy is a type of physical therapy treatment that takes place in the water. Aquatic therapy can be valuable for a variety of different patients to address specific impairments and challenges and is not limited to certain diagnoses. 

WHO IS A GOOD CANDIDATE FOR AQUATIC THERAPY?
Anyone! Aquatic therapy can be helpful when initiating an exercise program and addressing muscle strengthening, cardiovascular fitness, balance, mobility, and function. It is especially helpful for individuals with high pain levels as pool exercises decreases the amount of stress and compressive forces placed on joints by gravity as well as aiding in the ease of movement throughout the body.
 
WHY AQUATIC THERAPY IS HELPFUL?
The reason aquatic therapy is such a beneficial environment to begin exercise is due to the mechanics of the water and the effect it has on the body as you move. Here are the different ways the water can help you get moving again:

• Buoyancy: Decreases the amount of compressive forces placed on joints. Compressive forces through the joints in your body are reduced by 50% when in water up to your waist and 90% when in water up to your neck. Water helps support and assist movement allowing the body to move through improved range of motion with more ease and improving mobility. 
• Pressure: The pressure of the water can help reduce swelling, especially in the joints of the legs and feet.
• Resistance: The resistance produced as you move through the water allows for muscle activation and strengthening.
• Cardiovascular: Aerobic conditioning can often be performed in the water even when it may be too soon or too difficult to do on land.  Aqua jogging can produce cardiovascular results with less impact on your joints.
• Balance: Staying stable in the water challenges your core and balance in a safe and supported environment. 
• Warmth: A supportive, warm-water environment helps relax muscles and is sometimes the best place to start for people with pain, as it allows them to begin moving and exercising without aggravating their symptoms.

AQUATIC THERAPY AT ALPINE SOUTH:
Our location within the Peak Health and Wellness Center on Blue Mountain Road gives Alpine’s physical therapists the opportunity to work with our patients in an 82° competition sized pool with both a shallow and deep end. When needed, patients access the pool with a conveniently located patient lift chair or stairs with two railings. A large and comfortable therapeutic 105° hot pool is also available to help calm sore joints, perform stretches, and do relaxation exercises.  When you are scheduled for the aquatic therapy program, be sure to bring a bathing suit, towel, and lock with you to your session. Know that you can opt to wear a t-shirt and shorts while exercising. 

TEAM MEMBERS:
Brace Hayden, Gary Gales, Jess Kehoe, and Aspen McHugh are members of the physical therapy staff at Alpine that can assist with an aquatic therapy program. They are proficient in aquatic therapy and the transition from an aquatic environment to land-based therapy, helping clients return to normal activities and achieve their goals. Contact the team at Alpine Physical Therapy South, (406) 251-2323 or go online to schedule today! 

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By Jess Kehoe

It's July and even though we've had pretty mild weather so far, July can get hot.  And when it's hot I'm not interested in doing any cooking that heats up my kitchen!  Summer is also when we have more access to fresh, local veggies, my family has a share with Garden City Harvest, so we have more greens than we know what to do with right now.  A trip to the farmers market and you easily have a full salad to be made.  When I make salad for dinner, I really like to load it up, to make it feel like a full meal.  I add whatever veggies I have on hand, often steaming up some broccoli or green beans for added interest.  I also like to include a protein.  These day's I like to avoid the pricy meat isle and go for a can of beans and a hard boiled egg, maybe some seeds or nuts as well.  As for dressing, sure the dressing isle has so many choices, but really a simple vinaigrette is so easy to make at home, you should try it!  It's a great back up for when all your store bought dressings are nearly empty (this seems to happen to me a lot!).   I've found, even though my kids are pretty flexible eaters, salad for dinner usually gathers some moans.  But croutons save it for them!  We buy the big bag at Costco, because making croutons is NOT that easy, and not last minute enough, but that Costco bag is perfect.

In general I like to toss my salad with the dressing, but I also have a great hack for your lunch salad, because soggy day old salad is not that enticing.  Grab a pint size mason jar, put your dressing in first, add some veggies that won't get soggy sitting overnight in the dressing, then add the lettuce.  Leave it in the fridge overnight, ready to grab for the next day.  At work, or home, when you dump it into a nice big bowl it's still fresh. 

​Enjoy!

Ingredients:

For the salad, toss together the following in a large bowl (feel free to choose your own veggie adventure, this is just what I had on this day in the fridge!)

4-6 cups of lettuce, cut into bitesize pieces (any kind will work, this one is iceberg and romaine combo)
Two small carrots, sliced
Two radishes, sliced
1/2 kohlrabi, sliced
One small head of broccoli, cut into bite sized pieces and steamed for 3 minutes
One sliced red pepper
Two sliced mushrooms
4 hard boiled eggs
1 can garbanzo beans
Two handfuls of pre-made croutons


For the vinaigrette:  Place the ingredients in a jar and shake vigorously
​
3 tablespoons red wine vinegar
3/4 cup extra-virgin olive oil
1 garlic clove, minced
1 teaspoon Dijon mustard
Salt and pepper to taste

On the road this summer?  Car accidents happen a lot in the US, so if you have just experienced one, you've joined the multitude of unfortunate others with a new wreck in their hands. According to the National Highway Traffic Safety Administration, car accidents happen at frequent intervals estimated at one every 60 seconds. That equates to about 17 thousand car accidents each day and 5.25 million accidents across the nation on a yearly basis. Whoa!!  That’s a lot. At Alpine PT we see many clients who have recently been in a car accident and it’s not uncommon to have some lingering aches and pains from such an event.  We asked our PT’s to weigh in on some helpful advice if you find yourself a new member of this club this summer.
 
Brace Hayden reminds people of these statistics, as they're quite common and can upset our lives in many ways. He understands that there are usually hassles with body damage to your car, haggling with insurance companies, the police and the other driver, and the aftermath of contusions and whiplash-related injuries. His advice to start is to “take a deep breath, harness your inner-calm, as this will get better...but I get it that at the present time it wasn't fun being in the wrong place at the wrong time.”
 
If you notice some aches and pains coming on after a car accident, Dennis McCrea recommends that you get a referral to a Physical Therapist, of course.  “Then I would recommend they use heat or ice, perform gentle movements of their neck, brief rest breaks and gentle massage until they see the PT and avoid a lot of looking down as with reading and looking at their phone.”
 
Gentle movements immediately following a car accident and for the next few days is a common recommendation from our PT’s.  Angela Listug-Vap has this advice “Know that delayed soreness is totally expected and normal. You might feel stiff with movement but don't be afraid to do light movement, walking and gentle rotations in the neck and back - it'll actually help even if it's sore in the moment.”  Matt Schweitzer concurs, advising “gentle walking or gentle activity to keep moving help the blood circulate through the body.  Listen to your body to not over do the intensity or duration.”
 
Another piece of advice from Angela includes drinking extra water and icing sore areas.  Water is an essential component of healing and an easy thing to try, and unfortunately many of us are already chronically dehydrated.   Ice can be a miracle pain reliever without harsh side effects.  All you need is 15 to 20 minutes, a few times per day.
 
Advice from Leah Versteegen is along the same lines, reminding us how common it is to be sore, but that gentle movement is safe and helpful. “Onset of pain a few days after a car accident is pretty common. This delayed onset muscle soreness is similar to how your body may feel sore 2-3 days after running a marathon for the first time or that first day of ski season when your body isn't quite in shape. Your tissues are not prepared for the impact of a car accident and let you know by creating that feeling of stiffness and soreness for days and even weeks after. Getting in to see a PT for an assessment and some advice on how to best help your body recover is essential during this time period. Everyone's body is different, and every accident is a little different so making sure that your recovery plan is catered to your specific needs is important. Your body will heal and with the guidance provided by your PT, you can get back to doing what you love most just a little faster.”
 
Bottom line is that as long as you have no severe injuries, be ready for some delayed soreness.  Don’t hesitate to seek referral to PT, stay hydrated and get some gentle exercise and movement going.  You can call us at (406) 251-2323 to get scheduled and safe driving this summer!  

By Samantha Schmidt, PT

COVID-19 hit hard and fast. The daily news feed tells the stories of the pandemic’s detrimental impacts to our communities, country, and world.  Yet, during some of our country’s toughest times we have been gifted with innovation and opportunities.  COVID-19 has proven to be a pivotal springboard for our health care system in providing greater access to Physical Therapy services especially for rural Montanans. 

During the lockdown, Telehealth Physical Therapy gained support from third party payers, the government, and the tech sector to provide online care so patients could continue their rehabilitation safely.  Initially, both physical therapists and patients were apprehensive about this type of access; however, very quickly the results of online physical therapy sessions demonstrated powerful positive impacts in overcoming pain and limitations.  

As reopening and a return to a new norm occurs, Physical Therapists will continue to provide Telehealth options for those who need it whether related to a public health crisis, out of town travel for work, or a lack of local services.  It is a new norm in which the Physical Therapy profession is excited to not only embrace but to grow.

Just this week, Sam Schmidt, PT, with Alpine Physical Therapy, evaluated a USFS trail crew member who had an acute Achilles tendonitis episode while shed hunting.  The trail crew member is stationed in a remote Montana town, and after a week of acute management was advised by her doctor to seek PT.  As a PT, Sam took a detailed history of the injury and current symptoms then observed and evaluated the trail crew member’s foot and ankle function all via online.  From there, specific guidelines of returning to activities, modifications for work, and appropriate prescribed exercises were given . . . all from the trail crew member’s bunk house.  This saved time away from work while allowing the trail crew member to be proactive in taking care of the most important tool for work – the body!
“It was really convenient and super beneficial to get good professional advice and diagnosis during my work week. I think folks like me who are living away from their normal places can really benefit from this type of access to PT.” M. K. USFS Trail Crew Member

Last week, a patient in Lewistown, MT, was able to seek the expertise of Lymphadema PT Specialist, Antara Quiniones, DPT, of Alpine PT in Missoula, MT.  This patient is facing ongoing oncology treatments that resulted in lymphedema issues that required a specialist like Antara to help.  “It is great that patients can access this type of specialty care without travel or really leaving the comfort of their home,” reports Antara.

“We are seeing more and more patients from outlying smaller communities starting to seek the specialties of our team of PTs at Alpine PT through this new type of access – online physical therapy,” states Alpine PT co-owner and staff PT, Sam Schmidt. In addition, Sam describes several of the other specialists in her company. “We have pelvic health specialists, a vestibular specialist, persistent pain specialists, and many of our PTs focus on high level athletes from youth sports to those aggressive Pickle Ball players out there! It has been great to see how many more people we can help through these online sessions thanks in part to COVID-19 pushing this innovation.”

Physical therapists are specialists in evaluating painful movement dysfunction to address limitations people might experience in everyday activities, work related tasks, or recreational pursuits.  PTs use their keen sense of observation in combination with specific questions and testing to understand how to best help patients get back to an active pain free life.  Online physical therapy is a natural and easy way for technology to help rural Montanans live a better life through better movement.

Call to book an online visit and experience this new option for accessing PT from the safety and comfort of your home.  (406) 251-2323 or schedule an appointment online at  alpineptmissoula.com.

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By Jess Kehoe

Summer is upon us, time for light meals, and BBQ side dishes.  A fresh pasta salad, with very minimal cooking is perfect for either.  The recipe is vegetarian, but feel free to switch out the garbanzo beans for grilled chicken if that is your preference.  When I made this, we ate it at room temperature and it was perfect.  This would also work as a great make ahead dish, just take it out of the fridge an hour before serving.

Ingredients:  Serves 4-6
1 clove garlic, minced
1 tablespoon fresh lemon juice
2 tablespoons red-wine vinegar
1 teaspoon dried oregano
1/3 cup extra-virgin olive oil
2 cups chopped celery
1/2 cup pitted and sliced in half Kalamata olives
1 can (15 oz) garbanzo beans, drained and rinsed
1/4 cup grated Parmigiana cheese
1 cup packed spinach leaves
1 lb pasta, I suggest using a bite size type of pasta such as rotini, fusilli or farfalle.

Directions:
In a small bowl, add the oil, lemon juice, vinegar, oregano and garlic, whisk together.

Cook the pasta as directed on the package.  Drain and place in a large bowl.  Add the beans, celery, olives, spinach, and cheese.  Toss with the dressing and season with salt and pepper to taste.

Enjoy!

By Kristina Pattison, DPT, OCS, CSCS

Spring is here! And Run Wild Missoula runners are preparing for the next event of the season: Run for the Trees 5km and 10km on April 23rd. This time of year, as volumes are increasing in the marathon and half training plans, and runners try their mettle at shorter courses, questions start rolling in about injury prevention. Particularly, how to incorporate strengthening exercises into the routine to help prevent overuse injuries. 

Strength is defined as the body’s ability to create force to perform work. For runners, this includes production of propulsion force to move the body forward with every step. Strength also means the ability to withstand force or pressure, which translates to being able to absorb nearly 3-4 times the force of the body’s weight with each step. Heavy weight training is associated with improved performance in short distances.1,2  It also leads to improved running economy at submaximal intensities, such as during endurance runs.3 These changes are believed to be related to changes in muscle fiber composition, improved neuromuscular coordination, and increased musculotendinous stiffness. 

Realistically, strength training must be employed carefully during the running season. For example, heavy strength training prior to a running workout can increase the cost of running and reduce running performance that day and into the next.4  Also, it takes at least 6-8 weeks to learn appropriate movement patterns for strengthening safely prior to loading with heavier weights or explosive movements. For these reasons, it may be best to start introducing traditional progressive resisted exercise in the fall or winter, while directed by a professional, such as the certified personal trainers at the Peak Health and Wellness.

However, you can absolutely use some variations of traditional lifts during the season to work on conditioning the core, hips, legs, and arms for improved running performance.5,6  These variations include variations of the single leg deadlift, the single leg squat, and lunges, with or without arm movements to work on upper body posture and arm swing. 
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Kristina Pattison is a Missoula, Montana based ultra-distance trailrunner. Locally, she works as a physical therapist for Alpine Physical Therapy at the Peak Health and Wellness Center Downtown. She is board certified in orthopedics and certified as a specialist in strength and conditioning. Formerly, Kristina worked as a wildland firefighter and Missoula Smokejumper. She is passionate about helping athletes dream big and achieve their goals. Contact Kristina today about Physical Therapy through Alpine Physical Therapy or coaching through Flight Phase Coaching. 


References 
1. Rønnestad, B.R. and Mujika, I. (2014), Strength training and endurance performance. Scand J Med Sci Sports, 24: 603-612. https://doi.org/10.1111/sms.12104 
2. Storen, O., Helgerud, J. A. N., Stoa, E. M., & Hoff, J. A. N. (2008). Maximal strength training improves running economy in distance runners. Medicine and science in sports and exercise, 40(6), 1087. 
3. Guglielmo, L. G. A., Greco, C. C., & Denadai, B. S. (2009). Effects of strength training on running economy. International journal of sports medicine, 30(01), 27-32. 
4. DomaKenji and DeakinGlen Bede. The effects of strength training and endurance training order on running economy and performance. Applied Physiology, Nutrition, and Metabolism. 38(6): 651-656. https://doi.org/10.1139/apnm-2012-0362 
5. Sato, K., & Mokha, M. (2009). Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners?. The Journal of Strength & Conditioning Research, 23(1), 133-140. 6. Schmitz, A., Russo, K., Edwards, L., & Noehren, B. (2014). Do novice runners have weak hips and bad running form?. Gait & posture, 40(1), 82-86.