Beyond Basics’ Marathon Prep Program: The Evaluation

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Fiona McMahon PT, DPT & Jessica Babich PT, DPT
Fiona: Hello everyone, for those of you who didn’t get a chance to catch my blog a few weeks back, Beyond Basics Physical Therapy is joining forces with the Tisch Multiple Sclerosis Research Center of New York to raise money to support multiple sclerosis research, through Team Tisch MS NYC, in this year’s New York City Marathon. Our goal is $2,500  and WE ARE SO CLOSE, if you care to donate, please click here. I will be running the marathon in November, and Beyond Basics Physical Therapy is working to support my fundraising endeavors as well as showing the running community the invaluable benefits of having a sharp, perceptive, thorough and expert physical therapist on your side during training; and that goes for ANY sports training!

I just had my first evaluation with Jessica Babich, PT, DPT,  who is both a pelvic floor physical therapy expert as well as a functional movement specialist with an extensive background in orthopedics and sports-related injuries. Jessica was super thorough, she took an extremely detailed history, she looked at my posture, joint mobility and mechanics, strength, core function, and even how my shoes were constructed to see if they were good enough to run in! The shoe part was super wild!  In this blog you will see where I stand from a physical therapy perspective, and where I hope to go. Both Jessica and I are authors in this blog so keep an eye on who is talking so you can get the full scoop from both the physical therapist and the patient perspective

3 pillarsJessica: When I look at runners,  I first assess the individual as a whole and identify which area in their body seems to be driving inefficiency. I look at the 3 pillars of functional efficiency, (Mechanical, Neuromuscular, and Motor Control) when examining my patients. Within the mechanical capacity, I examine which structures such as joints, muscles, viscera, neurovasculature, etc.,  that could inhibit optimal functional performance.  Specifically with a runner, I am interested in his or her alignment as well as range of motion through their rib cage, spine, pelvis, and lower extremities.  Looking at a patient’s posture in both walking and running, allows me to determine the momentum driving the patient forward. This can be helpful in finding out what and where a dysfunction may be that could affect a runner’s performance. With a runner, I am interested in how he or she initiates his or her run.  Are they able to drive force through their lower extremities into their trunk without spinal compensation.  Does the runner have adequate strength and endurance to maintain appropriate form and movement strategy throughout their run?  I also examine what happens to the patient’s form during walking when you slow him or her down. Breaking down the whole movement pattern and looking at individual parts helps to further expose any problem areas. I examine dynamic stability and controlled mobility to ensure my patients are moving efficiently. From there, I examine the basics, is there a lack of movement (is something stuck or tight) that can affect a runner’s ability to powerfully push off the ground when they run and absorb force when they land.   Lastly, I am evaluating Motor Control.  If the mechanical capacity and neuromuscular function is present, how does this individual choose to move, or what is his or her strategy to get from point A to point B.  This is where a lot of the training comes into play.

 

History

Fiona: I told Jessica about my previous injuries, almost all have occurred secondary to decades of running (It truly is my favorite activity), currently I am feeling some left sciatic pain, which has become fairly bothersome.

.Orthopedic Injuries

  • Right hip labral tear
  • Right knee pain (patellofemoral pain syndrome), which comes and goes but is currently under control
  • Occasional left knee pain (patellofemoral pain syndrome), much less bothersome than the right side
  • Mild to moderate left calf pain, which also comes and goes
  • Right ankle sprain, from a failed handstand (don’t ask), no longer bothersome, but not properly rehabbed

Medical

  • Largely unremarkable, neural tension secondary to Arnold Chiari Type I malformation. Chiari occurs when part of the brain  (the cerebellum) herniates through the skull opening into the spinal cord. It sounds pretty awful, but for me, it’s not too bad and I only experience occasional dizziness as a symptom.

Current Exercise Routine:

  • I’m pretty regimented and break most of my workouts into 2 daily sessions. I run in the morning, currently I am working on speed training and run something between 3 and 8 miles daily, 5-6 times weekly. I am following one of my favorite marathon gurus, Hal Higdon’s plan, which you can see for yourself here.  I have used Hal’s plans for 2 of the 4 previous marathons I’ve run, and I really like how he organizes his plans. I would advise anyone thinking of trying a marathon, to use a training plan.  It allows you to ease yourself gently into upping the mileage, rather than panicking at 5 weeks before the race that you haven’t taken your long runs over 20 miles.  Following my run I do a mixture of stretches, use my stick ( it’s like a foam roller) and a trigger point ball to roll out my muscles. 4 nights a week I do PM weightlifting sessions, which last about 40 minutes. I split my lift into upper body and lower. I do a mixture of stabilizing and traditional exercise. When I’m done I’ll stretch again and this time roll out on a foam roller. In order to support all that exercise I drink a ton of water and try and fill my diet with lots of whole grain carbs, lean protein, and healthy fats (I’m looking at you avocados!)

The Evaluation:

Posture:

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Jessica examining my posture and my ability to tolerate load through the spine using the Vertical Compression Test

     Fiona has a posterior/posterior alignment.  ( This terminology comes from the Institute of Physical Art (IPA), and is a wonderful training program for PTs) Meaning, her ribcage is set posterior in relationship to her pelvis and her ribcage is tipped posteriorly.

Range of Motion (ROM):

 

  • Poor lumbar spine ROM, with an inability to reverse the curve in my lumbar spine
    • Why this is important: my spine should have motion in order to absorb the shock from repeated foot falls, also an immobile spine may inhibit the core stabilizers from firing properly
  • HISL testing ( another IPA test): Positive  at the right (hip) at 90 degrees, with poor glide of the femur down on the left side. Positive at left  (hip) at 100 degrees.
    • How do we translate this into non-physical therapy speak? First of all the HISL stands for Hip, Innominate, Sacrum, and Lumbar. It measures the relationship between the bones of the upper thigh, pelvis, and low back. What my results tell us is that my hips are stuck and cause my innominate (bone in the pelvis) to move too early. This is not so great because it causes the bones further up to have to move extra to compensate. We have to clean this up.

 

Strength and Function :IMG_3010

  • Instead of testing muscles one-by- one, which is commonly done in traditional physical therapy practices,  we decided to take a look at functional movements. Who gives a hoot if I have strong quadriceps while sitting on an exam table, if they can’t function properly during actual running, right?
  • LPM (Lumbar Protective Mechanism)( another IPA test) : absent in all quadrants
    • Dang! Lumbar protective mechanisms refers to the ability to stabilize your spine and protect your core in response to bumps and jostles. I didn’t stabilize at all. This is important because running is essentially a series of bumps and jostles, running on an unstable spine and core can increase your chances of injury as well as reduce your power during push-off in running leading to slower times (HORRENDOUS!).
  • Sagittal Plane Lunge: I have deficits with initiation and weight acceptance on both sides. I compress my arms in prayer position to create stability and when taken away I have a loss of trunk control. My right ankle more unstable than the left.
  • Runner’s Start Jump: difficulty coordinating movement on both sides, but significantly worse with initiation from right side at the ankle.
    • Remember my ankle sprain? Well, apparently that’s still holding me back and decreasing my ability to push off the ground. You could imagine how this could become a problem over the course of 26.2 miles. Moral of the story, see a PT after you hurt your ankle!
    • Also we see deficits in core control again.  I think addressing this with Jessica will really improve my time.

Shoes and wear:IMG_3000 (002)

  • Apparently my shoes were good! Jessica told me that sometimes right and left sneakers can be made in different factories and have different densities, which can really mess you up while running. Also if the back part of you sneaker extends too far it can make your brain think your foot is larger than it is, leading to injury. The wear of the shoe is also important to see if one foot pronates or supinates more than the other. If this was the case, Jessica could work on the alignment of the bones in my feet, ankle and foot strength, as well as teaching me how to tie my shoes in a way that better support my feet.

 

Assessment and Take Away:
Jessica’s Assessment: Fiona, like a majority of our athletes presents with deficits in the 3 major pillars leading to functional inefficiency. The goal of physical therapy, isn’t always to reduce pain, it is to get you to function better, which in turn will decrease wear and tear that contribute to common pain patterns.

Fiona: I can’t say I am surprised by much of what we found. I am slightly disappointed with my core activation finding, because I had been focusing on that particular issue for months and months in the gym. Jessica told me she thought part of my issue was that my lower (lumbar) spine was so rigid, it might be hard for me to get into a place where my deep core muscles can work to facilitate stability. It goes to show, even as a physical therapist, you need someone else to literally watch your back. As a physical therapist, my evaluation showed me that now is the time for help. Although I am strong and spend hours working out, my core stability is something I need more help with, and I simply cannot work my way out of my weakness alone in a gym. I’ve tried long enough. I need gentle manual therapy and proprioceptive neuromuscular feedback to wake my lazy deep stabilizers out of their hibernation and orthopedic work to allow the joints of my spine and pelvis to move more efficiently and effectively. Although this body has its deficits, I’m really proud of what it has done so far, and I’m really excited to see where Jessica will help me go!

 

Plan:

  • Improve the movement of: right foot, trunk, and cervical spine
  • Improve core stability and strength to allow for more power and reduction of injury risk
    • We will achieve these goals through manual work, neuromuscular re-education in order to teach the muscles to activate better and a strong home program to maintain changes made in physical therapy.

 Goals

Jessica: My goal is to treat the mechanical deficits inhibiting her neuromuscular system and then functionally reintegrate the parts into the whole system to enhance performance efficiency.

Long Term Goals:

  • 1: (12 Weeks) | Patient to demonstrate core first strategy with transitional movements to improve stability, energy efficiency and decrease risk for injury
  • 2: (12 Weeks) | Patient to demonstrate optimal ribcage over pelvic posturing for automatic core engagement and decrease mechanical load on system.
  • 3: (12 Weeks) | Patient to improve R foot positioning for stability and push off in gait

 

Home Exercise Program:

So far I have one addition to my workout routine. It is a split stance at the wall designed to wake up my stabilizers before I go running. I stand at the wall with one leg fully extended on my toes and the other bent at the knee and the hip, with my toes pointed up. I hold for 30 seconds per side and then I get going. It has been a couple days since this exercise was assigned, and I’ve done it on about 50% of my runs. Remembering to do your home program is one of the biggest challenges of physical therapy. My strategy to combat this is to leave a sticky note on my door reminding me before I leave the house. I will report back on future blogs to let you know how my strategy worked out.

That’s it for now:

Check out more info and pictures on our instagram and facebook pages

Click Here to Donate to support Team Tisch MS NYC:

 

 

Pilates Blog – Concentration

DeniseDenise Small, DPT

Every Wednesday the PTs at Beyond Basics are fortunate enough to listen to lectures from medical professionals who specialize in pelvic pain.  One of my favorite lectures was given by Melissa Farmer, PhD,  a clinical psychologist who specializes in how the brain changes overtime in response to chronic pain.  Melissa spoke about a lot of wonderful things that are being found through research; however the thing that was most interesting to me, was not only that the brain can change in response to persistent pain, but, that the brain can change back to its pre-pain functional self! One of the ways that this can be done is through focused movement.  That is, thoughtful, pain- free movement focused around the area that normally causes pain.  This revelation was very meaningful to me, as one of the basic Pilates movement principles is Concentration.  Pilates believed that if your mind was fully focused on performing the given exercise, you would only need to perform a few repetitions to feel the benefit.  This is very important for patients suffering from chronic pain, as they do not need to exercise to the point of pain to see the benefits. One of the exercises that exemplifies this belief is the Pelvic Clock. The pelvic clock both mobilizes and lengthens the pelvic floor muscles while simultaneously bringing tone to the abdomen. In addition, the movement is very small and specific and requires one’s full concentration. So, it is a great way to directly address the potential causes of pelvic pain, without causing pain in the process!

To begin, lie on your back with your knees bent. See, in your mind’s eye, the pelvis as the face of a clock with the top of your sacrum being 12 o’clock and your tailbone being 6 o’clock. Slowly move from each number as smoothly as possible, while seeing your sitz bones widen as your tailbone drops to 6 o’clock and your sitz bones narrow as you move to 12 o’clock. You can also combine the movement and breath as we have in our other Pilates blogs by inhaling as you move to 6 o’clock and exhaling as you move to 12 o’clock.  If you have any questions, have your PT take you through this exercise on your next visit, or come see me for a private Pilates session. Your Body and Brain will thank you.

Meditation with Ryanne Glasper, PT, DPT on July 27

 

Fiona McMahon PT, DPT

July 27th marks our final movement class in this summer’s round. Join Ryanne Glasper PT, DPT from Beyond Basics Physical Therapy, for a meditation class that will introduce you to the practice of mediation and help you discover its broad ranging benefits. The class will be at Beyond Basics at 7pm on July 27th, 2017.

In addition to her interest in meditation, Ryanne is a certified yoga instructor as well as a phenomenal physical therapist with extensive background in orthopedics, dance medicine, and pelvic floor rehabilitation. Don’t miss this excellent chance to meet her in person and experience the calming and clarifying effects of meditation. Mindfulness practices, including meditation, tai chi, yoga, and qi gong have been proven to calm the nervous system and help with persistent pain conditions.

Register here below and keep your eyes peeled for our next series of classes!

Summer Movement Class

Yoga with Anne Taylor on July 20th

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Fiona McMahon PT, DPT

Join us on Thursday, July 20th at 7pm for a really special treat: Yoga with Anne Taylor. Anne Taylor’s approach to yoga, which integrates movement, breath awareness, opening, and grounding to recalibrate the neuromuscular system, to help decrease pain and increase function has been a mainstay of Beyond Basics’ multi-disciplinary approach to improving the health and well being of our patients for nearly a decade.

Join us for a chance to explore the practice of yoga, without the pressure of trying to learn in an overcrowded class in a trendy yoga studio. Learn poses and breathing techniques you can take with you anywhere to help improve your quality of life. Sign up here today.

Summer Movement Class

Gentle Tai Chi with Dr. Coady on July 13th!

 

Fiona McMahon PT, DPT

On Thursday July 13th, 2017, Beyond Basics Physical Therapy will be hosting the second of its 4 free movement classes: Gentle Tai Chi with Dr. Coady. Explore the smooth and graceful movements of Tai Chi with long time friend of the practice and pelvic health expert, Dr. Deborah Coady.

Tai Chi has been shown repeatedly to benefit its practitioners in multiple ways. Multiple studies gathered in this data analysis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085832) demonstrate the myriad ways Tai Chi can improve health, from bone health, to cardiopulmonary function, to overall quality of life, and fall prevention). Don’t miss this fantastic chance to see if Tai Chi is the right addition to your healthcare routine.

Register here today!

Summer Movement Class

Pilates Blog: Centering

Denise Small, PT, DPT

In today’s Pilates blog, we are going to discuss the basic principle of Centering.  Pilates used the word centering to refer to the “core” musculature.  He believed that all movements should radiate out of the core for maximum stability.  There is a lot of use of the word “core” in exercise literature. However, no one ever discusses what that actual means. In the Pilates method, the “core” refers to the diaphragm, the pelvic floor, the deep spinal muscles, and the transverse abdominus.  The transverse abdominus is a deep abdominal muscle that is attached to our pelvic bones in a horizontal fashion, from one hip bone to the other. One way to find these muscles is by breathing, as all the core muscles are attached to the diaphragm and ribs via fascial connections.

Try this exercise to find your “core.”  Lie on your back with your knees bent. If you need, you can have a small pillow under your head for support.  Now, imagine that you have a small, helium filled balloon in your abdomen behind your navel.  As you inhale see the balloon expand. As you exhale, imagine the balloon being hugged by your navel and your spine, simultaneously.  On your next exhale keep that image of hugging the balloon as it floats up into your ribcage.   This image incorporates the three dimensions of our torso, aka the “core” of our body.

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There is no need to think of contracting individual muscles. Just keep this vision in mind and you will have a wonderfully functional core.  Go over this exercise with your PT in your next session, or come see me for a private session at Beyond Basics. Your body, and your core, will thank you!

Join Denise Small PT, DPT on July 6th for a Free Pilates Class

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Fiona McMahon, PT, DPT

Denise has not 1 but 2 hats here at Beyond Basics Physical Therapy. Not only is she a Doctor of Physical Therapy, specializing in functional manual therapy, orthopedics and pelvic floor conditions, she is also a certified Pilates instructor. Through the years she has worked to combine her passions to produce an outstanding Pilates program tailor made for individuals suffering from any pain condition and to help them become more functional and back to their exercise routine.

On July 6th at 7pm, Denise will be sharing her expertise with the public by offering a FREE gentle pilates class here at Beyond Basics. In this class participants will “ examine the interconnectedness of [their] own functional anatomy to move through and around [their] current fitness barriers”

To get a flavor of what Denise has to offer check out her blog posts bellow. If you are interested in attending the class, please RSVP here. Learn more about the Pilates program and the physical therapy program by clicking here.

Check Out Denise’s Blogs Here:

Pilates Blog- Rhythm- Coordination of Breath and Movement

The use of Breath in the Pilates Method 

Benefits of Pilates with Pain Conditions

Summer Movement Class