Why seek out a physical therapist with advanced orthopedic training? The case for CFMT and OCS

Pelvic 3By: Kaitlyn Parrotte, PT, DPT, OCS, CFMT

If you have perused our website, you might have noticed that here at Beyond Basics, we have many physical therapists who have a CFMT certification, or are in the process of completing one. Now the question lies, what is a CFMT? How is this approach unique? How can this approach be of benefit to me?

The acronym CFMT stands for Certified Functional Manual Therapist. This certification is through the Institute of Physical Art (IPA), which is an organization founded by two physical therapists, Gregg and Vicky Johnson.

With the CFMT approach, we evaluate and treat every individual’s mechanical capacity (how your tissues and joints move), neuromuscular function (how your system stabilizes itself, and the coordination of muscle activation), and motor control (how an individual moves and performs daily tasks). Furthermore, we assess and retrain how these three individual components interact to ensure each person can return to the tasks/activities they need and love to do.

What this means is, when a new patient walks through our door, we don’t just focus on one small area, such as only the knee in which you report pain. Instead, we will look at the big picture by assessing your strength, amount of limb and segmental motion available to you, posture and alignment, and movement, which can be as simple as getting out of a chair, or a higher level activity such as running, weight lifting or other sport-related activity. This will allow us to get a thorough impression of what impairments you might have, and will help us determine what the cause of your symptoms and functional limitations is (what is the driver?). From here we can figure out the most effective approach to your treatment, and will apply progressive interventions that help to ensure continued benefits from each session. We have found that this approach commonly gets you back to your activity or sport faster!

Now you may be asking yourself, “Well this sounds interesting, but why does it matter?” Looking at the whole person and treating your system overall, allows us to make lasting changes, not only to a specific body part that is causing problems for you, but also with your habits of how you hold yourself and move. By becoming more aware of your body and moving with more efficiency, you will find day-to-day activities, and even sporting activities, are easier for you to perform. Furthermore, and most importantly, if you are able to move and live in a more efficient way, you are decreasing the risk of future injury.

So whether you are experiencing incontinence, pelvic pain, low back pain, or a shoulder injury, having a knowledgeable therapist work with you, can make a significant impact on your function and quality of life. While many therapists have gone through the certification process, most of the therapists at Beyond Basics have had training in this approach, so we are all in a strong position to help address your needs. Feel free to contact our office at 212-354-2622 or at our website, or visit the IPA  for more information

 

The Scoop When Kids Have Trouble with Poop

 

Kiddo

Fiona McMahon PT, DPT

I spend a lot of my time at work talking about poop. In fact, poop discussions run in my family. My great grandmother, a nurse in the 1920’s, would always inquire about her charges and her children’s movements when they’d complain of any ailment. This scatological interest was passed to my grandfather, a civil engineer, designing and working in wastewater treatment plants, to my mother who was a nurse practitioner, who dealt with digestive issues and famously asked a guest at her parents’ dinner party when she was a child, “how are your bowel movements, lately?” This familial interest in the distal end of the alimentary canal was bequeathed unto me and I now spend much of my working life trying to help people of all ages with issues defecating to live more comfortable and full lives when it comes to bowel movements.

Anyone who has had any issues concerning their ability to poop, or to hold it, can attest to how much havoc issues with bowel movements can cause in one’s life. This is especially true when it comes to children. Children often have continence requirements to attend school, camp, and other activities. Not to mention other children may not always be very kind to another child who is experiencing difficulty with their bowels. Aside from the obvious issues of constipation and incontinence, kids with bowel issues can experience other symptoms like pain in their belly or with defecation, foul body odor, problems with their bladder, including incontinence, as well as skidmarks in their underwear or itchy bums. It really does all come down to poop.

The largest driver of bowel problems in kids is constipation. Constipation is surprisingly common and occurs in 4-36% of children. It accounts for 3% of visits to the pediatrician and 30% of visits to pediatric gastroenterologists. Constipation can be tricky to diagnose and many people who have children who are constipated, do not identify constipation as the culprit for issues like bowel and urinary incontinence, and pain. According to Afzar and colleagues, constipation would be missed nearly 50% of the time in children, if infrequent bowel movements was the only criteria used in assessing constipation in children.

So what criteria do we use to assess constipation in kiddos? We obviously look at how often a child is defecating. Two or less bowel movements a week is considered constipation, but it is important to keep in mind that a child with difficulty evacuating may move one or two small pellets multiple times a day and still be severely constipated.  Check out the Bristol Stool Chart here to determine if your child’s BM’s are normal. Types one and 2 indicated constipation. Bowel incontinence is also an indicator of constipation in children. In fact, 90% of children with constipation experience fecal soiling. Kiddos with large fecal masses felt in the rectum by a doctor or through the abdomen, those with history of painful bowel movements, and those who produce large toilet clogging poops are exhibiting symptoms of constipation. Children with constipation may also exhibit retentive posture in an effort to prevent painful bowel movements. They may go up on their toes, squeeze their butt cheeks and thighs together, cry, and rock back and forth. Retentive postures can trick parents into thinking their child is trying to defecate when in fact they are working hard to keep everything inside. If you see any of these symptoms in a child under 4 years lasting for a month, and over 2 months in kids over 4, you are dealing with constipation

Constipation can be divided into two different types, functional and constipation due to an organic or pathological cause. Around 95% of constipation in both adults and children is considered functional. Functional constipation can occur for a variety of different reasons in children. One of the most common reasons is that children can get in the habit of delaying or trying to prevent defecation. Children are often just as busy as the rest of us. They may simply be too busy in the morning to have a full bowel movement. Once they arrive at school, they are faced with bathrooms that have doors that may or may not lock, or they may have to contend with intimidating multi-stalled public toilets. Either way both are not conducive to pooping. After school is usually filled with activities and a mad dash to do homework. You can see that it may be very difficult to schedule in a good time to use the toilet. Kids also delay going to the bathroom because it hurts or may be uncomfortable to go. The more they delay their bowel movements, the more uncomfortable it can be to go. Thus creating a negative feedback loop that just feeds back on itself and worsens the constipation symptoms.

Weeks of delay whether it be secondary to pain, scheduling, or plain old distraction, can cause a big build up of poo in the very end of the digestive system, the rectum.  The accumulated fecal matter may be backed up through the  entire length of the colon. This big build up of feces in the rectum causes it to  stretch out.  A stretched out rectum is not good at holding feces in, or sensing that it is time to go to the bathroom, making the problem even worse. Furthermore, soft poo will easily slide by the hard fecal blockage and create smears or “skidmarks” in the underwear, or even more severe incontinence mistakenly labeled diarrhea. Chronic fecal impaction, and fecal withholding can alter how the muscles that control continence work (the pelvic floor), which may further worsen this constipation syndrome. Skidmarks, constipation and fecal incontinence are not anyone’s fault, especially the child’s, but it is a problem that can be solved.

So what to do about all of this? Is it too late if your child has been constipated for a long time? Tackling poo problems in kids is daunting for both parents/guardians alike. The first step is educating yourself, your doctor, and your child. My motto for the kiddos that I treat is, “Accidents are not your fault, but it is your problem to solve.” Letting children know what is happening in their body can help them further internalize this message and become more invested in the process to remedy their symptoms.

Next you have to tackle the poo situation inside of your child’s tummy, This is where a two pronged approach is key. Both physical therapy and your doctor will get you on the right track. Your doctor will screen your child for that 5% of constipation cases that are caused by organic causes like Hirshprung’s disease, thyroid issues, and notably cow’s milk allergies and gluten intolerance/ celiac disease. It is important to be screened for these allergies and food intolerance as they represent a large portion of organic constipation cases. Once organic causes are ruled out, your doctor will start medication to help clean out the bowels. Miralax (Polyethylene glycol), is a mainstay of pediatric constipation treatment and is generally best tolerated. Miralax may be first given in large amounts to clean out the bowel, and then followed with smaller maintenance and then slowly tapered off as the rectum reduces from it’s stretched out size. It is important to remember that when starting miralax, especially at “clean out”, doses will likely increase episodes of incontinence at first, so prepare both yourself and your child. Make sure to consult your doctor before attempting any sort of clean out on your own.

Next up is physical therapy. Our main goal is to keep poo moving and avoid buildups so your child’s body can heal. We will teach you ways to massage the colon through the belly to keep poo exiting and to reduce back ups and the need for laxatives. We also work to teach your child to sit on the toilet in a way that will help the poo as easily and painlessly as possible. More often than not, kiddos with constipation have pretty weak cores that make defecating difficult. As pediatric physical therapists, I humbly assert that we are the masters at dreaming up fun ways to gain a little core strength in session and at home to help make bathroom trips easier.

What Beyond Basics does that is truly unique from non pelvic floor physical therapists, is we train the muscles of the pelvic floor (the muscles that control both the the anal and urethral opening to better open and close). Kiddos with chronic constipation tend to have pelvic floors that are tight and uncoordinated. Paradoxical contraction occurs when a child tries to open their anal canal, and they truly believe they are doing so, however they are I n fact clamping it shut. We can treat this problem at Beyond Basics.

If your child would benefit from physical therapy, or an evaluation, to make pooping a bit easier, give us a call. Stay tuned for our next blog, where we will go over some practical at home tips for improving both you and your child’s pooping situation!

 

Sources

Afzal N, Tighe M, Thomson M. Constipation in Children. Ital J Pediatr. 2011; 37

 

Poddar U. Approach to constipation in children. Indian Pediatri. 2016;53(4) 319-27

 

 

The Special Care Needs of the LGBTQ+ Community

Amy Stein PT, DPT and Fiona McMahon PT, DPT

rainbow flag

Who are LGBTQ+ individuals?

At Beyond Basics Physical Therapy, we have been meeting and studying with experts about the LGBTQ + community. LGBTQ+ refers to individuals who do not identify as heterosexual or do not identify as cis- gendered (although these two categories are not mutually exclusive). Cis-gender means you identify with the genital anatomy you were born with. People who belong to the LGBTQ+ community can be cis-gendered (meaning they identify with the genital anatomy that they were born with) and be gay/lesbian/ bisexual/ questioning etc.  They can be trans-gender and heterosexual or some combination thereof. Basically LGBTQ+ is a term that includes people who are not both cis-gender and heterosexual. LGBTQ+ is an acronym for lesbian, gay, bisexual, transgender, queer/questioning, and other individuals.  

Never Assume. Listen, Ask.

We were excited to understand and learn more about how we can help, specifically with patients experiencing pain or weakness in the pelvic floor. We met with an LGBTQ + advocate and he recommended the following when it comes to treating patients both within and outside the LGBTQ+ community.  First rule of thumb:  with all patients, don’t assume and be open to any questions or discussion. Ask if your patient would like you to stay away from certain terms regarding their anatomy, as well as their preferred gender pronoun. Use language that they want us to use.

 As with all patients, we need to use a biopsychosocial approach. With any patient, Richard Green at Bellevue hospital says that we always want to know exactly what is going on with our patient. We must subjectively understand why they are visiting us.  Has there been trauma, surgery, complications, or anything that has worsened their symptoms? What hormones and medications are they on? Don’t single anyone out. These questions are important for every patient.  

We want to get the medical and surgical history during or prior to the visit. There is no standard one surgical procedure or hormonal protocol in Trans care. Hormones, either testosterone, estrogen, Lupron, puberty blocking, GNRH can be used in many patients, but are also used specifically to aid in transition in Transgender patients. Many hormones have consequences or side effects and our patients need be educated on the various options.  There is research on hormones and bodily changes, however there is no good research on how the hormones affect the pelvic region. Anti-estrogen hormones may result in vaginal drying and atrophy, more tissue tearing, and pain with penetration.  Endometriosis can be worsened with testosterone hormones.  Hormones can be administered via injection, pellets, patches, creams, gels, and pill form.  It’s important to realize side effects and risks of hormones for each patient. Dosage depends on body type, weight, previous surgeries, etc.  Hormone therapy can be given by a primary care provider or endocrinologist; however, many are not familiar with a specific protocol but at the same time each person may have different goals.  Progression of hormones can be monitored for each patient and according to patients wants and needs.  

For those who opt for surgical transition, it can result in pelvic pain and or weakness as organs are moved and or removed. Like we mentioned before, there is no one surgical protocol and it will vary from surgeon to surgeon, from changes in hormones from the removal of certain organs.  Knowing what tissues have been removed or moved and or where scar tissue could have been formed, is important to addressing a patient’s complaints. Also, it’s important to ask if the patient was having these symptoms or pain prior to any of the surgeries or hormonal medications. Surgical transition can take a long time with various surgeries and various symptoms that arise throughout. Some issues that  can occur are fistulas or fissures and when dealing with nerve implants there could be nerve damage and restrictions.

 

How is care for the LGBTQ+ community funded and regulated?

Medical coverage for the LGBTQ + community is non-regulated and different in each state. The Affordable Care Act, (ACA) covers some therapies and surgeries. You can try to appeal with each insurance which have their own policies on gender affirming care.

How can physical therapy help?

At Beyond Basics Physical Therapy, we specialize in abdomino-pelvic disorders, including pain, weakness, bladder, bowel and sexual dysfunction.  We also specialize in orthopedics and functional manual therapy.  We treat the LGBTQ+ community and we welcome any questions at desk@beyondbasicspt.com or call 212-354-2622. We are happy to help and look forward to hearing from you!
Resources: Center of excellence for transgender health.

WPATH center for care Endocrine Society

  • speaks on hormone therapy (however some information may be out of date).

 Adolescent Health Center

October is Breast Cancer Awareness Month

breast cancer awareness

Fiona McMahon PT, DPT

It’s here again. You can see pink on everything, ribbons, coffee cups, even football players. October is National Breast Cancer Awareness Month. Breast cancer is the most common form of cancer in women in the developed world. Over the years a concerted effort has been made to raise awareness for early screening and treatment of breast cancer to help save lives. We go over the basics about breast cancer screening in last year’s Breast cancer awareness blog which you can check out here.

For this year’s blog we are going to take a more physical therapy centric approach and talk about what happens from a functional standpoint, once you are finished with treatment and how you can help yourself to reduce pain, improve strength, and mobility with physical therapy.

There are different treatments for breast cancer, and based on the specific type (there are many different types) and how advanced it is, as well as personal considerations. It is important to manage recovery from your treatment as you would any other procedure. Although survival rates are improving, which is excellent news, it was found in an Australian study that 62% experienced an upper extremity impairment and approximately 27% had 4-6 impairments 6 years later. An impairment in the upper extremity can be described as loss of range of motion, which can impair one’s ability to groom oneself, clean, etc. Other impairments can include pain, loss of strength, and lymphedema. Lymphedema is a condition in which the body’s ability to filter return fluid and waste products out of a limb is impaired and severe swelling as well as permanent tissue changes can occur.

Physical therapy can be a wonderful and helpful tool in treating symptoms following breast cancer treatment and the benefit can extend beyond just symptoms following surgery. In the study cited below, hormonal and radiotherapies were the top contributors to pain. The good news is, physical therapists, especially the one’s at Beyond Basics are specially trained to recognize and treat chronic pain syndromes. Physical therapists may use techniques such as nervous system down training, gentle exercises and expert massage techniques to help lessen pain.

It may seem obvious, but if you are experiencing any difficulty with the strength or mobility of your shoulder or upper extremity, you should see a physical therapist right away. Scar tissue and fibrosis from your original treatment can severely reduce your ability to move your shoulder and the quicker it is identified and treated, the faster and easier treatment will be.

Patient’s experiencing swelling in their arm following breast cancer treatment should see a Certified Lymphedema Therapist (CLT). CLT’s are physical therapists who enroll in rigorous training to be able to treat and manage lymphedema. Lymphedema should be managed aggressively to prevent permanent tissue changes. We at Beyond Basics are lucky to have Victoria Lamanna PT, DPT, CLT working with us. She is specially trained to treat complex lymphedema cases and will be able to perform manual lymphatic drainage, fit compression garments, and provide you with lifestyle changes to help manage lymphedema.

Once you are done with treatment for breast cancer, it is important to take stock and note how you body feels. If you feel like you aren’t moving the way you used to, there is something that can be done and physical therapy is a great option from routine orthopedic care to higher level pain management and lymphedema treatment. If PT sounds right to you, give Beyond Basics Physical Therapy a call today or search the Lymphedema Education and Resource Network for a LANA certified lymphedema therapist near you.

Also check out our other blogs on lymphedema physical therapy:

Sources:

Hidding J, Beurskens C, van der Wees P. Treatment Related Impairments in Arm and Shoulder Patients with Breast Cancer: A Systematic Review. PLOS ONE. May 2014;9(5): e96748

The Day in the Life….of a Working Mom Who Loves What She Does and Would do Anything for her Family

By, Amy Stein, DPT (Founder and owner of Beyond Basics Physical Therapy; President of the International Pelvic Pain Society; Author of award-winning book: Heal Pelvic 

Amy was presenting on the benefits of physical therapy in individuals with Multiple Sclerosis(MS) . In addition to our educational outreach, we are collecting money for NYC’s TISCH ‘s MS research arm through the New York City Marathon. Please Click here to donate.  

amy2016I had an amazing, and thank goodness a positive spin during and after my talk at the TISCH Multiple Sclerosis Patient Summit on Sunday. Thank you to Dr. Sadiq, Dr. Kanter, Dr. Williams and Pamela Levin for the invitation to share my expertise. I was so honored and felt blessed to be asked to speak at this conference. There were 1,200 people registered…..no pressure! And when I walked in prior to my talk, I saw the below photos on three HUGE screens! Again, no pressure. I practiced my breathing and my confidence building. Jessica Babich, DPT met me there to set up our table. She was a huge help, considering they wanted me to mic up right away.

I had practiced the material quite a bit so felt confident that it would go well…..and it did! I ran through everything in the 20 minutes I had and then had tons of questions after, of which I could only answer 4 in the time allotted.

A couple questions:

1. Does pelvic PT still work/can it be beneficial while a person is getting botox into the bladder?

Most definitely if the pelvic floor muscles are involved.

2. Does bladder frequency change when you have MS?

It shouldn’t change too much. If it does, as  pelvic physical therapists, we teach you strategies to manage this.

3. How often should you go to the bathroom at night if you have MS?

I am not sure there are any studies on this, but I would say no more than 2 times. We give our patients strategies to help with nighttime frequency as well.

After the Q and A, I felt like I was on cloud nine, because I gave a lot of great info in a short period of time….I sat down, and picked up my phone to take photos and noticed 2 missed calls and multiple texts from my sitter and a friend (my husband was away on a motorcycle trip). I thought….uh oh, because it had only been 30 minutes. Sure enough, the call that all mothers expect at some point, but hope it never happens….My son, Zachary had fallen off the jungle gym and it looked like he needed stitches. Thank goodness for babysitters and good friends! I explained the situation to a few colleagues from TISCH and praised Jessica at her awesomeness for taking charge, and I left immediately. My boy was a champ, and didn’t cry, even when he got the 8 stitches in his head….as I almost passed out!

In the end, amazing meeting and opportunity, and a strong and brave boy. What could a working mom ask for! I count my blessings every day!

J babs and Amy Stein
Jessica Babich and Amy Stein
Screens
These are the big screens I was talking about!
Zacary and Zoe
My Kids, Zachary and

Time to PUMP SOME IRON! September is Healthy Aging Month

WeightsFiona McMahon PT, DPT

The idea of strength training can conjure up many images, like the funny images of  Saturday Night Live’s Hans and Frans, or Arnold Schwarzenegger. It can also be intimidating. The idea of walking into a crowded weight room full of young and fit people, who seem to all know what they are doing can stop a newbie in their tracks. But resistance training has so many benefits, for health, function, and longevity. It goes way beyond looking good in a swimsuit, although it certainly can help with that. In honor of September’s Healthy Aging Month we at Beyond Basics are taking a close look at how adding a safe strength training regimen to one’s daily routine at any age, can boost so many indicators of health and quality of life.

Everyone understands that muscles are essential for everyday tasks like rising from a chair, carrying your shopping, and many other instrumental tasks required for independence. The thing about muscles is they are not static, and as we start to age we lose muscle, especially if we do not work to maintain our muscle mass. Believe it or not, we slowly start losing muscle mass at age 30, (bummer, I know), but after 60 is where things get really crazy. After age 60 we start losing muscle mass at a rate of approximately 15% per year. The less active someone is in their life, the quicker this loss occurs. Low muscle mass is called sarcopenia. You will see this term a lot in this blog. The condition of sacropenia brings with it functional impairments from lack of strength and can put a person in a position where they are more likely to require assistance for everyday tasks. Furthermore, when sarcopenia and obesity occur at the same time, which we often see in the elderly, the functional impairments associated with sarcopenia and obesity are greater than either sarcopenia or obesity alone.

But there is hope. Aging isn’t a slippery slope into weakness and frailty. It is what you make it. Even sarcopenic muscle can respond and strengthen in response to proper training. In fact, it adapts to the demands of strength training at the same rate as younger muscle. Weight training can actually reduce fat and build muscle, helping to reverse the condition of sarcopenic obesity. Many studies indicate that resistance training can prevent and or reverse age related losses in function. Even with all the benefits of strength training. Only an estimated 10-15% of older folks regularly participate in strength training exercise, leaving a huge percentage of the population missing out on strength training’s myriad benefits, which we will cover in more detail below.

Benefits of Strength Training

 

Balance and Fall Prevention

Falls are a serious cause of injury, disability, and death in the elderly. People over the age of 60 have a once yearly fall rate of approximately 30%. Resistance training in combination with balance training under the care of a skilled physical therapist can go a long way to reduce one’s risk of falls. If falling is a concern of yours, please check out our other blog on falls and fall prevention.

 

Pain Syndromes

Pain symptoms in individuals with Fibromyalgia Syndrome improved following a 12 week high intensity strengthening program (Mayer).

 

Osteoporosis

Osteoporosis, a condition characterized by low bone density, increases a person’s risk of fracture. Fracture brings along with it risks of prolonged pain, depression, issues with function, subsequent fracture, and even death. Individuals with vertebral fracture have a 2.7 increased likelihood of death and are likely to have an additional fracture within a year of the original fracture.

There is evidence supporting resistance exercise as a useful tool to increasing bone density in osteoporotic individuals. With people with extreme cases of osteoporosis, there is increase risk of accidental fracture from dropped weights, poor form in transitions and adjusting weight machines. In these individuals, and all individuals for that matter, it is extremely important to work with a physical therapist to construct a safe and beneficial routine.

 

Function

Many studies have found significant improvements in function following a resistance training program. Physical therapists like to use a few specific tests when getting a general idea of someone’s function. A couple of our favorites are the Timed Up and Go (TUG) and the 6 – Minute Walk Test. They measure the time it takes to rise from a chair and the amount of ground covered in six minutes, respectively. Pretty simple, right? In all of the studies I read that were using these outcomes, both TUG and 6-Minute Walk scores significantly improved following strengthening intervention. These tests are really special because they have incredibly strong correlations to functional independence and risk for falls and hospitalization. On top of improving scores in these tests, patient’s themselves also reported improved mobility in their daily lives.

Frequency and Duration

Out of the studies examined, most advised participating in a resistance routine 3-4x weekly in order to see an increase in muscle mass in 6-9 weeks. Continued training will sustain this effect. Most recommended 3-4 sets of 10 repetitions and 65-85% one rep max. Bands and free weights have found to be effective for strength training in older individuals. As stated before, exercise machines tend to have an increased risk of fracture in those with severe osteoporosis and therefore, should be avoided unless one is certain they can adjust the machine with correct form. Repetitions should be slow and controlled. Cardio and weight training are life long commitments.

So Where To Start?

The first place to stop is at your local and experienced physical therapy office. Your PT will be able to determine if you are safe to exercise and what types of exercise will work best for your body and your goals. Will exercise bands work better for you? What the heck is 80% one rep max? When can I progress? Am I doing this right? All of these questions will be answered by your physical therapist. At Beyond Basics Physical Therapy we work to not only improve strength, but also efficiency of movement to allow our patients to get the most from their time with us as well as their time spent doing resistance training. If you think weight training is right for you and are eager to get started, make a call to us at BBPT or to your local PT, to make an appointment today!

Chen M, Jiang B. Resistance training exercise program for intervention to enhance gait function in elderly chronically ill patients: multivariate multiscale entropy for center of pressure signal analysis. Comput Math Methods Med. 2014

Giangregorio G. Papaioannou A. MacIntyre N. Too fit to fracture: exercise recomendations for individuals with osteoporosis or osteoporotic vertebral fracture

Liao C, Tsauo J, Lin L, et al. Effects of elastic resistance exercise on body composition on body composition and physical capacitiy in older women with sacropenic obesity. Medicine. 2013. 96(23)

Mayer F, Scharhag-Rosenberger F, Carlsohn A. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int 2011; 108(21):359-64

Marathon Prep with Beyond Basics: Weeks 1-3

Fiona McMahon PT, DPT and Jessica Babich PT. DPT

15 KFiona: Hi everyone! It’s been a few weeks since our last update. I am currently halfway to our $3,000 fundraising goal for the Tisch Multiple Sclerosis Research Center of New York. Beyond Basics Physical Therapy and I are raising money by running the New York City Marathon and taking donations. If you wish to donate here.

As far as training, things have gone well. The last 12 weeks of training have largely consisted of building a solid base with a whole lot of speed play to improve my lactic acid tolerance (you know, that burning feeling in your muscles, when you are really working hard). This will hopefully improve my ability to hang in there at a consistent speed throughout the race. In the next 12 weeks the amount of speed play will decrease and the mileage will slowly start to build, culminating with two 20 milers before the actual marathon.

So far my average pace has been slightly faster than goal and I have noticed that for the most part I feel stronger and more powerful than I had in the past. Also, the nagging calf pain sensation I had complained about in the past is now improving and occurs much less frequently. I’ve been doing my home exercise program that my physical therapist, Jessica Babich,  recommended on top of my pre-existing routine of strengthening, rolling, and stretching.

Here’s a little of what we worked on in our last 3 visits to help meet our goals, of running faster with less pain:

Week 1: Facilitation with theraband, core activation

On week one, Jessica worked to help get my core to fire more consistently. This is important to allow for greater push-off and power and can hopefully lead to reduced risk of injury. This stuff is hard! Jessica would put my body in a specific position and apply resistance to wake up my long dormant muscles. I broke a sweat but could definitely tell it was working.

Week 2: Ankle ( devil spawn)ankle.jpg

I hated it. But I loved the results. In my earlier blog I wrote about how I hurt my ankle doing a handstand (again, don’t ask). In my initial evaluation, Jessica noticed that I wasn’t quite pushing off well enough through my right side. Basically, I was using my left side to get my power, and the right side was just going along for the ride. No good. Not efficient. Jessica worked on getting the bones in my foot to glide the way they need to in order to improve my range of motion in that foot. Once I had the new range of motion, she gave me some exercises to help teach (we call it neuromuscular re-ed), the foot what to do. The process wasn’t exactly comfortable, but it wasn’t too bad either. I’ve definitely subjected myself to training runs that felt worse.

Here’s what was super neat about this whole deal. I had been doing some plyometric work on my own to help train power and speed. Prior to this visit, one of the exercises I was doing, was the box jump. It is what it sounds like, jump up onto this special cushy box. I started off jumping 24 inches, but I noticed I was really just doing a glorified hop, using my left leg to do all the work. Dumb, dumb, dumb, dumb. On my own I regressed myself to a 12 inch box and tried hopping onto it with each leg (to get right leg in on the action and pulling it’s own weight). IT WAS SO HARD. It was like my body had no idea how to get itself on to the box when I used my right leg, My left leg was more than happy to do single leg box jumps all day, but righty definitely wanted to take the L (that means loss, not the L -train) on that one. But after the ankle treatment with Jessica, a 12 inch single leg box jump was easy, peasy, lemon squeezy. In fact, I progressed myself to the 16 inch box the next gym session. Currently, I am doing 18 inch single leg box jumps and am back to 24 inch box jumps with both legs. Right?! Wild!

BUT THAT’S NOT EVEN ALL OF IT! I started to find on my shorter runs I could more easily keep a 8:30 pace (goal) without additional effort than I had spent on my slower runs. I eventually started doing those runs at 8 minute pace and 7:30 pace to spice it up. This past weekend I was able to do a 15K (9.3 miles) at 8:00 pace which is something I’d never dreamed of. It’s been really neat. I’ve had 3 rounds of physical therapy, and no one has ever addressed my feet which has made such a difference.

Week 3 : Myofascial release

This was the week of the monster cold(S), there were two separate colds and I was not able to run the way I would have liked. I still made my pace and snuck a couple in at 8 minute flat pace, but I did end up missing a few runs. When I saw Jessica, I was just about to slip into the terrible chasm of phelgmy awful misery for the next week and Jessica being extremely thoughtful and perceptive recognized what was afoot.

This session was the most passive of the sessions and she worked on my tight and tender leg muscles and I felt much better following the appointment.

Objective findings:

This is where we put our money where our respective mouths are and see if there is any improvement on the test we conducted during the initial evaluation.

Previous findings:

Lumbar protective mechanism (Institute of Physical Art) : We started with absent initiation in all four quadrants; meaning I had poor core control and was pretty wobbly.

Current Findings

Lumbar protective mechanism (Institute of Physical Art) : Right flexion 2/5, left extension sluggish 1/5, left flexion sluggish 1/5 right extension sluggish ⅕; what this means core is actually working to stabilize me while I run! It’s not super strong but it’s getting there.

Fiona’s impression:

So far I feel really good. I am experiencing less of my typical aches and pains and am feeling stronger and more confident in my runs. I have had several 6 mile training runs at about 7:30 minute miles, which is the fastest I’ve ever run that distance, which is so, so, so exciting. It’s hard to nail down exactly where my speed increase came from. I am doing more skilled physical therapy which has improved my core control and ankle range of motion, and I feel as though I push harder through the ground and float as I leave it. It’s an exhilarating feeling I haven’t had since running cross country in high school! And I also am much more focused in my speed workouts than I used too. Along with speed, Jessica has managed to inject a bit more joy into my running.

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