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July 22, 2010
After a long wait, we finally got our Alter G installed. this morning we treated our first patient on the device. She is a 25 year old runner who has a race coming up, but her ITB syndrome is preventing her from running.
By reducing her weight by 50% and having her run up a 4% grade, we were able to see her run PAIN FREE!
She ran for 30 minutes smiling the whole time, grinning from ear to ear actually. When we asked her how she felt, she said “THIS IS GREAT!!! (her emphasis).
If you would like to try the Alter G you can find a card for a free trial on our website.
My son who is a college runner ran on it yesterday just after we installed and learned how to operate the device. He said that it helped him improve his form and that it felt like he could “run 100 miles without hurting” his joints.
This is amazing technology. You can see a good image of it here.
June 22, 2010
I am a huge advocate of ice rather than heat, especially for sports injuries.
Heat depends on a cutaneous relax to relax the muscles and inhibit pain. The problem is that as the skin heats up., the nerves accommodate to the sensation and the nerve receptors stop firing which means that in order for the inhibition to continue, the temperature has to get hotter and hotter. Also as soon as you remove the heat, he inhibition stops. Period.
On the other hand, ice decreases swelling, inhibits muscle guarding, and reduces pain in a manner that lasts for up to two hours (assuming a deep icing).
The trouble with ice is that our freezers are usually colder than freezing and we are at risk for a frost bite injury secondary to an ice burn. this makes it important to use ice and water together.
I also advocate ice after exercise. Especially for runners who I often ask to take an ice bath following a long run. One excellent ideas that I have seen applied is to use a large garbage can filled with ice and water to stand in to cool the legs joints and muscles.
I also recommend Active Wrap products for post exercise cooling off. These are form fit products for various body parts that you can easily wrap around your heated muscles and joints. What i like about these products is that you can target a particular joint and have a spare ice pack available to keep the area cool for extended periods while you are actively moving around.
This is the Active Wrap elbow product as an example.
In our clinic, we use crushed ice out of a freezer plus a splash of water in a plastic bag that we wrap around the part. Of course, the patient is pretty much stuck on one place for 30 minutes in that case, which makes the Active Wrap product appealing.
April 12, 2010
 As a sports physical therapist dedicated to helping athletes perform at their best, I am excited to post this guest article by David Damron. David is a life-time competitive body builder who has extensive personal experience and knowledge about the use of the so called “performance enhancement” drugs. In my conversations with him, it became apparent to me that he has a lot to say about it, and the words he offers are words that young athletes need to hear. The intoxication of young athletes looking for that elixir is well known. In the clinic, I both see and take questions about performance enhancing drugs from many young athletes. I think it’s important to share what David has to say:
“I remember when I was 20 years old. 40 was a lifetime away. I will be 45 in August this year (2010). I have been a serious bodybuilder for more than 25 years. I have been using anabolic drugs for most of that time.
I competed from age 19 to 33.
At the time I started drug use, I had been working out with weights on and off for about five years. I also have many friends who are professional athletes, so I am writing this with some authoritative knowledge.
The medical community now refers to anabolic drugs as “performance enhancing.” I regret that their name is misleading. The fact is, no drug will enhance performance. A drug can only enhance physiology. The drugs are only a factor in the equation that produces performance. Neglecting the other factors that result in improved performance will render anabolic drugs useless.
To state it simply: Without proper training, rest, and nutrition, use of steroids (and all anabolic drugs) will be of no benefit to an athlete. Any drugs you take will be of no benefit unless the athlete is following a scientific regime to increase muscle mass. Yes, muscle mass. That is all anabolic drugs will do at their best. Let me say it again, only proper training, rest, and nutrition will improve an athlete’s performance.
Anyone who chooses to use drugs should first dedicate themselves to a lifestyle that promotes fitness and an anabolic metabolism. Understand how the drugs affect the body. Don’t just take advice from the biggest/ strongest guy in the gym — or from professional athletes. It is up to you to educate yourself on drug use.
Most importantly, athletes should understand the risks associated with drug use. I know at least ten people who have died because of steroid use. They have all had stokes or heart attacks – and all were under 50 years old! They all looked to be in great shape. Once drug use begins, the outward appearance of the body is no longer indicative of the health or functioning of the body’s internals (liver, kidneys, cardiovascular). Blood tests should be performed on a regular basis to check for silent killers.
There is one side effect that no one will avoid. That is the psychological effects of steroids. I cannot over emphasize the danger that steroids present to mental health. And no one is more at risk to the psychological risks than the young athlete. Let me try to articulate one such scenario. With puberty comes a rush of testosterone. That is when most young men get into trouble and probably why juveniles are subject to a different set of laws than an adult. Well, imagine increasing that testosterone level 100X. It does not take much imagination to predict the results. By the same token, imagine shutting that hormone level off. Depression is very common in athletes coming off steroids.
It is up to each athlete to educate him or herself on all the implications of drug use in sports – especially the potential adverse effects — and to decide for themselves if the risk is worth the reward.
If you chose to use drugs, educate yourself first and understand that no one avoids the side effects. Age 40 may seem like a lifetime away, but it will come. And with it will come the long term side effects of the drugs.”.
March 8, 2010
As a sports physical therapist, I sometimes encounter patients suffering from pain in the groin, the testicle, the high adductors, or the lower abdominals. If you experience sharp pain in the lower abdominal region that prevents your participation in sports and seems to be gone at rest, you might have athletic pubalgia. If you play field sports, you are at risk, and in the event you have the sort of pain in the groin that makes you back off from your running , then you should seek medical help. As Dr Meyers points out “Pain can be minimal at rest and begin unilaterally or bilaterally. It may be fleeting, appearing and disappearing on one or the other side or involving both abdominal and adductor components. There may be pain with coughing, sneezing, turning over in bed at nighttime, sprinting, kicking, sidestepping, and performing certain maneuvers specific to your athletic activity.”
Athletic Pubalgia, sometimes (incorrectly) called Sports Hernia, is a complex injury involving the abdominal muscle insertions, the adductor muscle (of the legs) insertions and sometimes both of them at the pubic insertion. The injury can affect one or both sides of an athlete. The pain is thought to be caused by osteitis (inflammation) of the pubic bone that itself occurs when the muscles are torn off the bone.
The pain typically will subside with rest or conservative treatment, but it will reoccur almost immediately that activity is resumed. When an athlete continues to participate in their sport once the injury has occurred, the Adductor muscles begin to undergo compensatory changes that can result in torn groin muscles.
The key to understanding the athletic pubalgia is the anatomy. The pubic symphesis is sort of like a joint in that it has many complex insertions of muscles from above and below (the abdominals and the adductors) that insert into a cartilagenous plate near the pubic symphesis. When the tissues tear, the athlete can suffer what used to be thought of as a career ending injury. Now with advanced surgical techniques, this injury can be repaired, and the athlete back on the field in 3 short weeks!
This injury occurs as a result of the tension developed between the lower abdominals and the adductor muscles of the thigh. The typical athlete tends to have stronger legs than their stomach, and over time the lower and thin wall of the abdominal muscles tear creating the athletic pubalgia and the pain that follows. The surgery simply ties the torn structure back onto the cartilagenous plate, and once the surgical entry wounds are stable, the athlete can return to play. Occasionally, the surgeon will also perform an adductor release or fasciotomy to aide in the recovery.
There are just a few doctors I know who perform this sort of surgery.
This injury is common in soccer, hockey, football, and rugby players as well as lacrosse and other sprinting, cutting, stop/start sports such as gymnastics and ice hockey and ice skating.
Several “types” of Athletic Pubalgi have been identified, each requiring a slightly different surgical approach. The more common variants are listed on Dr. Meyers Athletic Pubalgia or Sports Hernia Site
Occasionally, conservative measures, like physical therapy are useful in treating early signs of AP, but once the structures are torn, surgery is the treatment of choice. Physical therapy that follows the surgery can often help a player return to unrestricted athletic participation in as few as three weeks.PT involves soft tissue work directed at the adductor muscles and direct treatment of the surgical scar, and progressive exercise designed to challenge the functional tolerances of the adductors to athletic loading.
February 10, 2010
I know we are all struggling to get everything done every day. Life is busy. But, the back pain you have needs attention too. OK, so here is my favorite exercise that is designed to help the back on many levels. Pretty simply, it goes like this…
- Stand in the “athletic ready” position, feet shoulder width apart, slightly flexed forward at the hips, back straight
- Wrap your arms around your shoulders, one over and one under to really wrap up the thoracic spine.
- Then from the ground, using your feet to push and grip, rotate the shoulders in a short arc going back and forth relatively fast in a pain free range of motion.
- Continue for 3 to 5 minutes.
- Do this every hour.
OK, so now that you have done so, and feel good, what is actually going on?
First of all, the athletic ready position is a weight bearing posture that gives you proprioceptive input from many joints and muscles.
Second, the spine is protected from over rotation in the lumbar spine because facet joints allow only one degree of rotation per segment.
Third, the localized motion into rotation back and forth causes the deep spinal muscles to contract and relax rapidly improving blood flow and allowing those muscles to relax rather than guard.
All this leads to a happy back. I call this exercise “Aspirin for the back”.
Now it is possible to reduce the load by half sitting on a table or counter. You can also reduce the load by moving through a smaller range of motion. And you can reduce the load by moving more slowly.
Good luck!
January 20, 2010
I have seen several patients this month already who present with what can only be described as “goofy” symptoms. By this I mean symptoms that don’t seem to add up. For example, yesterday I evaluated a gentleman who’s primary complaint was of non-specific general knee pain that he really had a hard time describing. He had previously had an MRI and x-rays, and has been evaluated by an orthopedic surgeon. The physician found nothing wrong with his knee. Structurally, he is intact and his joint surfaces are good. He is 42 years old.
His painful knee demonstrates slightly more laxity than the uninjured knee when the ACL is stressed, but not enough to account for his complaint. This stress test is not painful or even abnormal. He has no point tenderness, and his meniscus checks out under both compression and with torque.
The functional movement screen identified a few interesting facts:
- He has restriction of his calf length
- He has world class restriction of his hamstrings
- He has restriction of his quads
- His hip Abductions and Adductors are also restricted
- His hip rotators are restricted
The theory we perform a functional movement screen against is this:
You stand on a stable foot
You have a mobile ankle
Stable knee
Mobile hip
Stable core
Mobile T-spine
Stable shoulder girdle
Mobile c-spine
Well this fellow demonstrates restriction of his calf (ankle ROM is functionally less) – which transfers movement demands to his next motion segment – his knee.
His hip is grossly restricted, and while he does have some core instability, it is knee that is painful.
So, there you have it. We picked up several areas of restriction in the functional movement screen that would otherwise not make themselves clear to us in evaluating his knee. The functional screen allows me as the therapist to find a starting point in his rehab. I like to think of the process as a reorienting of the health status “compass” such that the day-by-day movement patterns we teach lead the person to a healthier state over time. Clearly something is wrong with this gentleman’s knee. He went to a surgeon after all, and even after being told that all is well, he still sought my help.
The functional movement screen gives us a starting point. It is the very best evaluation tool I have used in my career. You can read more about this approach here.
January 14, 2010
Friends, the devastation in Haiti is mind boggling. I heard it referred to as “Katrina times 1000″. to help right now, Text “Haiti”
to ’90999′ and a donation of $10 will be given automatically to the Red
Cross for relief efforts in Haiti. Cheap and fast! See other ways to
help:
Here are a few links that offer help:
The American Red Cross is accepting donations through their International Response Fund
UNICEF who supports relief for children is accepting donations through their Haiti Earthquake Fund
Operation USA is requesting bulk donations of health care materials, water purification systems and food supplements. You can reach them through their website
The Save the Children Fund is oriented to helping children affected by the earthquake and its aftermath.
The International Medical Corps‘ Emergency Response Team is in Haiti, providing lifesaving medical care and relief to survivors of this devastating earthquake.
You can find other ways to help at the NPR website as well.
Or you can donate through The Clinton Foundation or by texting “Haiti” to 20222
Thanks for your help!!!
January 13, 2010
Friends, let me pose a few questions:
The USDA has recommended that we eat between 13 and 17 servings of fruit and vegetables daily for good nutrition
Disease prevention occurs when we eat raw foods. Do you eat 13-17 servings of nutritionally dense raw fruits and vegetables do you eat each day?
The health benefits provided us by eating raw fruits and vegetables accrue when we eat a wide variety of nutritionally dense fruits and vegetables. Considering your diet, how many different raw fruits and vegetables do you eat each day?
Do you already take vitamin or mineral supplements?
How much do you spend per month on these supplements?
The USDA recommends that we consume a wide variety of fruits and vegetables because of the phytonutrient antioxidants that these foods provide us, and the important role that these micro-nutrients play in disease prevention.
Would you like to learn about a convenient and cost-effective way to add the nutritional benefits of raw, vine-ripened fruits and vegetables to your family’s diet every day?
December 29, 2009
Friends, I wish you all a very Happy New Year – I hope that your new year is filled with peace, prosperity and good health!
Neil  Happy New Year!
December 10, 2009
The Achilles Tendon is made up of two major muscles and one insignificant muscle. The two muscles are the Soleus, which does not cross the knee and the Gastrocnemius which does cross the knee. The distinction is important because most people only stretch the Gastrocs (see the typical runners stretch with the knee straight). Very few people I treat regularly stretch their Soleus. The best way to do this is to be on the floor in a sprinters start and you will feel the stretch in back of the calf in the forward leg- this will be the Soleus that is stretching.
Sometime in middle age, around age 35 or so, I often see calf strains. The situation is typically one where the muscle is fatigued, and the person steps backwards, like on a tennis court or basketball court, and they feel like they have been hit or kicked in the back of the leg. Typically, it is the medial third of the Gastrocs that gets strained. this is a muscle/tendon junction injury and can be easily treated, with a good outcome for return to sport.
At other times, the tendon actually ruptures. This can be the same move that causes the muscle strain, but the injury is felt further down, and feels more like a gunshot to the leg. The rupture of the tendon is the last event following many more minor events that lead to the gradual thinning and weakening of the tendon.
A rupture such as this requires surgery for repair. Then the PT that follows the surgery needs to both restore ROM, and also balance as well as explosive strength.
For whatever reason, I have several Achilles tendon injuries in the clinic at the moment. Among my present population is an acute Gastroc strain, a very irritated and strained tendon, a recently ruptured and repaired tendon and a tendon that was repaired a long time ago. Each of these situations offers lessons for prevention and for recovery.
The medial third Gastroc strain illustrates the importance of both stretching and hydration. Not hydration in therms of how much water you drink, but hydration at a tissue level. More on this later. Pre-game stretching will help prevent this injury as will stopping when you have become fatigued before the injury stops you!
The pre-failure tendon illustrates the consequence of multiple injuries to the tendon that lead to a thinning of the tendon (called “necking” in the physiology text books). The progressive failure of a dense connective tissue goes through several stages before a rupture. One of the last stages before the rupture is this necking stage. If you grab your Achilles tendon and pinch it, and it hurts, then damage has occurred in the tendon to the dense connective tissues and you are on the way to further damage that might eventually lead to rupture.
The recently repaired tendon needs good rehab to stimulate the best and strongest possible repair. The rehab needs to take into consideration the repair characteristics of the scar that is growing. Then the strength needs to be restored. My patient with recently had a repair, for instance, cannot actively recruit the Soleus at the moment. This will pass, but we need to pay attention to the restoration of strength as well as to the other issue such as balance and ROM before we start thinking about activities like running and certainly before sprinting.
The post surgical tendon – a year or two out, reveals that not enough energy was spent in the rehabilitation cycle. The loss of power of the injured leg has left the leg in a state of sub-optimal performance ability. We now need to help this person build muscle mass and restore the Type II muscle mass especially.
I think that the best treatment for the Achilles Tendon is prevention of injury in the first place. So three things come to mind:
- Stretch the Gastrocs AND the Soleus
- Strengthen the two muscles as well. to strengthen the Gastrocs, do heel raises with a straight leg. To strengthen the Soleus do heel raises with your knees bent. You should do 40 continuous heel raises on both legs with both positions and then do 40 continuous on EACH leg.
- Use THE STICK to work the tissue regularly.
Finally, a word about water binding in the dense connective tissues. If you are middle aged, you need to take a supplement like COSAMIN DS or MOVE FREE that provides molecular support to the production of GLUCOSAMINOGLYCAN – a long mucopolyscharide that binds water in the connective tissues and makes it both more elastic and also tolerant of tensile forces.
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