March 14, 2011

Help the People of Japan

If you read this blog, please text redcross to 90999 to send $10.00 to the aid of the Japanese people after the disaster they experienced and the tragedy they face. Thank you.

December 9, 2010

Amazing Gait Analysis – What You Can Learn About Your Biomechanics

Look closely at this picture and you will see next to and between the hurdles and you will see yellow strips connected by wires. These strips are timing strips that measure the relationship between the ground and the foot, allowing real time analysis of the performance of the athlete as he clears each hurdle. This is amazing technology. We use it in our clinic to assess gait in increments of 1/1000 of a second.

If you have ever wondered about your shoes, or your orthotics, or your gait, we can now examine you with one of the most sophisticated gait analysis tools in the world.

You can read more about this amazing OPTOJUMP tool on their website, or you can call us to get scheduled for an analysis of your gait mechanics.

In addition to gait mechanics, we can assess your acceleration mechanics, your power (ability to jump), your reaction time, your and ability to decelerate normally as well. This astonishing technology was developed in Italy and is currently used by numerous professional sports teams to aide in their training. You can see the list of those teams here.

Optojump Makes it possible to:

  • to assess an athlete’s performance and physical condition
  • to rapidly identify any muscular deficiencies and measure tolerance to various work loads
  • to develop customized and diversified training based on the test results
  • to periodically check the results of training
  • to create a database of athletes in order to compare them with each other or to compare the results of a particular athlete in different periods of time in order to objectively determine the results of training
  • to examine the physical condition of an athlete after an injury, to develop specific actions for rehabilitation and check its progress
  • to motivate athletes by giving them tangible proof of the progress made, thus stimulating fruitful competition inside the group
  • to significantly reduce the trainer’s workload, at the same time allowing him/her to retrieve at any time the results of tests performed even months before
  • to make use of an objective “judgment” when talent-scouting or choosing athletes

A recent patient learned that she is better off in bare feet, that the running sheos she “finds comfortable” are in fact detrimental to her well being. That her orthotics actually make her gait mechanics WORSE…this is pretty heady stuff.

I was so impressed with the technology, that I decided to become a distributor! If you are a clinician and you want to improve your understanding of  gait mechanics so that you can help your patients with greater proficiency, then contact me at 425/643-9778 to learn how you can come to use this amazing state of the art technology.

September 1, 2010

Meniscus Tears of the Knee

I have been thinking about meniscus tears recently.

I had a patient yesterday who presented with a locked knee. In his case, he was unable to straighten his knee or even contract his quads (they were grossly inhibited).  This has happened before, on and off over 5 years, once in the past year. When I saw him earlier in the year, he presented the same way, and while examining the knee, there was an audible and palpable “click”, and the knee was suddenly able to straighten fully, and the quads were able to generate a full contraction painlessly.

In trying to figure out why this happens, two thoughts went through my mind. The first was that he had suffered bucket handle meniscus tear, where the tear had flipped up and over and was logged beneath the ACL/PCL. The second is that he has a loose body in the joint, probably a piece of articular cartilage that had dislodged and was interfering with the function of the knee.

My sense is that in his case, the issue is the meniscus tear. I say this because the movement that seemed to be most comfortable involved a varus stress, gapping the lateral compartment of the knee. In addition, his pain is along the lateral joint line. I was unable to resolve the locking manually this time, and sent him to an orthopedic surgeon for further more aggressive investigation and care. I suspect that his MRI will demonstrate the meniscus tear, and he will have arthroscopic surgery to resolve the problem. In the best of all worlds, he will be back training for his sport in short order.

How can you tell if you have a meniscus tear?

Well, for one, you will often have either locking, or giving way episodes. In the case of locking, the knee will not straighten all the way, or it might not bend all the way. Often trying to make it straight is painful, sometimes not. In the case of giving way episodes, the knee literally gives out unexpectedly where you are bending over and literally find yourself sitting on your butt on the floor wandering what happened.

In the end, if you believe your meniscus is torn, the question becomes how to treat your meniscus tear? While many meniscus tears can be treated on-surgically, more often than not a simple arthroscopic surgery is the solution. When I tore my meniscus, a scope cleaned my knee up and I was back at it in a couple of weeks. In this case, the strategy was removal of the torn bits. On the other hand, when my son had his surgery, because of his age (14) and the nature of the tear (starting near the blood supply), the surgeon decided to repair the meniscus. In adults, this is uncommon though, because meniscus tears often fail, especially in adults. My only regret about my surgery is that I did not have access to the Alter G when I had my surgery. Now, a year and a half later, with the help of the Alter G, I am once again, back running again pain free!

July 22, 2010

Alter G – Gravity? Who needs it!

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

Ice to Manage and Prevent Injuries

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.

active wrap elbow

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

Sports Physical Therapy and Anabolic Drugs

injecting steroidsAs 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

Sports Physical Therapy and Athletic Pubalgia (aka Sports Hernia)

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 have time for just ONE back exercise…”

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

The Value of a Functional Movement Screen

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

Haiti – How You Can Help Now

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!!!

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