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.

If you care to support New York Tisch Multiple sclerosis center through Beyond Basics Physical Therapy and Fiona McMahon’s running efforts please click here to help contribute to the ground breaking work they are doing for people with multiple sclerosis.

Pilates Blog: Balanced Muscle Development

Denise Small  PT, DPT

In today’s Pilates’s blog, we will discuss another of the eight movement principles, Balanced Muscle Development. Using the example of the Pilates swan, we can see how both the front and back of the body are benefitting from the movement.  As we inhale and move our spines into extension, the back of the body, including the spinal muscles, glutes, and hamstrings are lengthening down toward the feet, while the abdominal muscles are lifting in and up towards the breast bone.  Both the back and the front of the body work in opposition to create balance in the body.  We give this exercise often in our practice at Beyond Basics to counter the shortening of the abdominal muscles that occurs with prolonged sitting. When the abdominal muscles shorten, they pull on the fascia of the external genitalia and pelvic floor muscles, contributing to their tightness. Have your PT take you through this exercise on your next visit to feel the full effects of the exercise. Or make an appointment with me for a one-on-one Pilates session.  Your body will thank you!

 

Swan
Jessica Babich PT, DPT demonstrating the swan

Beyond Basics’ Marathon Prep Program: The Evaluation

marathon-image.gif

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:

IMG_3011
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:

 

 

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

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

denise

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

Beyond Basics Physical Therapy: Free Movement Classes are Here

Summer Movement ClassFiona McMahon PT, DPT

It’s summer in the city and maybe the air isn’t the only thing that’s a little stagnant? Could your workout routine use some updating? Are you itching to try something new like yoga, pilates, meditation, or tai chi? Have you been hesitant to try something new because you are nervous because of a past injury or pain condition? It’s time to take the leap and broaden your workout horizons with classes taught by practitioners with decades of combined experience in working with patients with acute and chronic pain conditions and sports and dance injuries. Take some time to read a little bit about this summer’s offerings and see if there is a right fit for you!

On July 6th at 7pm we will be offering gentle Pilates with Denise Small PT, DPT. Denise is a physical therapist at Beyond Basics Physical Therapy, who specializes in the treatment of orthopedic conditions and pelvic pain. She also is a certified Pilates instructor and combines both physical therapy and Pilates to help patients move throughout their world with increased strength and endurance, and with less pain. Denise is also a frequent contributor to the blog. Take some time to check out her recent articles,  on the Coordination of Breath and Movement, the use of Breath in in the Pilates MethodThe Benefits of Pilates with Pain Conditions, and check out our Pilates program here.

On July 13th at 7pm, Dr. Deborah Coady MD will be leading a gentle Tai Chi class designed to reduce stress, improve balance, and improve many other health conditions. Dr. Coady is a pioneer in the treatment of chronic pelvic pain and has a keen interest in the power of movement in aiding healing.

On July 20th at 7pm join Anne Taylor for Yoga. Anne teaches all over New York City and has worked with Beyond Basics Physical Therapy for years to offer private and group restorative classes for men and women with pelvic floor dysfunction.

Our last class is on July 27th at 7pm and will be lead by Ryanne Glasper PT, DPT. Ryanne will be offering a medication class to help you learn how to focus and calm the mind. Ryanne works at Beyond Basics specializing in orthopedics, dance medicine, and pelvic floor dysfunction. Ryanne is also a certified yoga instructor and has studied the Franklin Method through the Feldenkrais Institute.

If any of these classes interest you, click here to register today!