Without Happy Ankles and Feet, We Don’t Have a Leg to Stand On!

foot

By, Amy Stein, DPT and Fiona McMahon, DPT

Our ankles function to help us do simple tasks from walking down the hall, climbing stairs to advanced tasks like cutting during a high level soccer game. Ankles need two things to do their job well. They need stability to allow us to transfer our weight onto them and mobility to absorb forces, like little shock absorbers when we move. A deficit in either one of these area’s can affect our ability to efficiently do certain activities and may cause pain in the foot and ankle itself or further up the leg.   As physical therapists we evaluate and treat ankle and foot issues to get the athlete or non-athlete back to optimal function.  

Get this, the foot has 26 bones, 33 joints and 100 muscles in it. There is a lot to look at and unfortunately, a lot that can go wrong with the foot. As physical therapists and especially here at Beyond Basics Physical Therapy, we like to use a systematic approach when evaluating the foot and ankle. We look at the foot’s range of motion (how far it can move), its strength, it’s ability to move well (motor control), and whether or not something’s not moving well when it comes to the soft tissue or the joint of the foot. If something’s up with any of these categories we open our tool box and treat using functional manual therapy, neuromuscular and postural re-education and self care!

Things we look at

  • In standing we assess the patient’s baby squat ( or plié, as our former dancers would call it) we are looking to see if there is an issue with the tissue of the foot’s ability to stretch and fold
  • Heel raise: We look at our patient’s’ ability to go up on their toes, aberrant or weird motions tell us about motor control, strength, and joint mobility.
  • Arm Swing: We promise this isn’t to make our patients look silly. It allows us to assess pronation and supination, which are super important motions of the foot.
  • End feel: We will passively move the patient’s foot and ankle through its range of motion to assess how the joint feels. It can tell us a lot about what’s wrong and where it’s coming from.
  • Palpation: We pride ourselves on our hands at Beyond Basics Physical Therapy. One of our PT’s calls it our “brain hands”. Palpation can reveal a ton about what’s going on in the foot.

These are all pretty basic first steps when assessing our patients. They are the starting point, but by no means the finish line. Once we get the big picture we will refine our examination to see what’s going on when our patients are doing their specific sport or activity. Once we get a good handle on  what’s going on we select the most appropriate techniques for our patients. Each patient is different and one basic protocol for everyone isn’t how we roll at BBPT. If you think your ankles or feet could use a little extra TLC, book an appointment today. To get the ball rolling, check out our blog written by our therapist, Denise Small . 

Exercise, The Female Athlete, and the Pelvic Floor

active-image

Fiona McMahon PT, DPT

In honor of National Women’s Health and Fitness Day ,September  28, we are exploring the benefits of regular exercise for women as well as addressing some pitfalls (pelvic floor included), that female athletes can fall into too. It is far too often that women find themselves sidelined from their favorite sports and fitness routines secondary to issues like orthopedic or sports-related pain or incontinence. Although all the issues outlined in this blog can occur to both genders, many of these conditions are more likely to happen to females, secondary to their pelvic structure and physiology.

 

Exercise and Its Benefits

heart-health

 

The benefits of exercise are too numerous to discuss every single one here and span the physical to the emotional. There are a number of conditions that have profound effects on the health of women nationwide. Let’s explore some of exercise’s specific benefits for these conditions together.

Heart Disease

According to the American Heart Association, Heart disease is the number one killer of women in the US and is responsible for 1 in 3 female deaths.  Exercise and a healthy lifestyle have been shown to reduce the risk of heart disease by 80%. The American Heart Association recommends 150 minutes of moderate activity or 75 minutes of vigorous activity to stave off heart disease.

Osteoporosis

Osteoporosis is unfortunately a common affliction among white and asian urban dwelling females.  It is characterized by reduced bone density, which causes bones to be fragile and increases the risk of fracture in individuals that have osteoporosis. Exercise has been shown to be helpful in both reducing the risk of osteoporosis as well as improving the bone mineral density of those who already have osteoporosis.

Other benefits of regular exercise include:

  • Reduced risk of diabetes
  • Reduced risk of colon cancer
  • Improved psychological well being
  • Maintenance of healthy body weight

Remember, it is important to consult with a trained healthcare professional before commencing a new fitness routine.

 

The Female Athlete Triad- Aka the Downside

All things in moderation. Although exercise is beneficial it is easy to over do it. It becomes easier to slip into an unhealthy relationship with exercise, especially in women who are training at elite levels, have eating disorders, or body dysmorphia issues.

The  female athlete triad consists of three disorders that can have severe health consequences in both the near and long term. The three disorders that compose the female athlete triad are:femaletriad

  1. Disordered Eating
  2. Ammenorrhea (absent periods or periods that are irregular)
  3. Osteoporosis

The female athlete triad is often attributed to the expectation that women keep a slender appearance. Girls and women who have body image issues may be at greater risk. The female athlete triad is dangerous and has the potential to be deadly. Osteoporosis can result  in fractures and eating disorders can seriously impact fertility, or even throw off the delicate balance of electrolytes in their system, putting them at serious risk for a cardiac event.

Warning signs of the female athlete triad include:

  • Yellowing of skin
  • Stress fractures
  • Rapid fluctuations in weight
  • Development of baby hair over skin
  • Daily vigorous exercise to an excessive level

 

The female athlete triad requires a multidisciplinary approach from medical, to psychological to nutrition.  It is important for someone who is suffering from the female athlete triad to seek help in order to safeguard their health and emotional well being.

 

Athletics and The Pelvic Floor

d14e2-tipsforahappyandhealthyvaginaLike any muscle, the pelvic floor can get fatigued, strained, or even go into a painful muscle spasm. The thing about the pelvic floor muscles, is that they have to work in almost every athletic pursuit. They work in partnership with the multifidus of the back, the transverse abdominus of the belly, and the diaphragm to stabilize and protect your spine. They also contract with every step during running activities to prevent your pelvic organs from dropping down in your pelvic cavity and to prevent urinary and or fecal leakage. Things can go wrong when the pelvic floor or other core muscles don’t function properly. Athletes’ pelvic floors can become tight and restricted, preventing closure of sphincters and support of pelvic organs. They may go into spasm from working too hard to stabilize the spine, if one of the other core muscles is failing to pull its weight.

Recently there has been more work to investigate the link between athletes and pelvic floor dysfunction. A recent study found that self identified female triathletes suffer from urinary and fecal incontinence at rates as high as 37.4% and 28.0%, respectively. Similar results were also found on a group of runners. Of the triathletes studied, nearly a quarter of them fit the criteria for female athlete triad, discussed earlier in this post.

Does this mean you have to give up your penchant for running? NO! (hellooooooo the author of this post is a runner), but if you find yourself experiencing incontinence, pain, constipation, and or painful sex, something is wrong and you must intervene in order to protect your long term health and your ability to participate in your favorite sport. At Beyond Basics Physical Therapy we combine orthopedic and pelvic expertise to help return athletes to their sports in a more functional and less painful condition. We relax tight muscles of the pelvic floor, train the core, including the pelvic floor if needed, to do its fair share, and return normal postural and structural alignment to our patients. We work one on one with you to develop a home exercise plan to help you reach your goals and prevent a reoccurrence of your pelvic floor or core disorder.

 

Please come see us so you can return to your sport in a better and more optimal condition than when you started: http://www.beyondbasicsphysicaltherapy.com/

 

 

Sources

American College of Sports Medicine. Information on … the female athlete triad. https://www.acsm.org/docs/brochures/the-female-athlete-triad.pdf. Accessed September 19, 2016

 

American Heart Association. Facts About Heart Disease in Women.  2016. https://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/. Accessed: September 6, 2016

 

Bø, K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine, 34(7), 451-464. 2004.

 

Illinois Department of Public Health: Women’s Health. Facts about  women’s wellness exercise . http://www.idph.state.il.us/about/womenshealth/factsheets/exer.htm Accessed: September 13 2016

 

Loyola University Health System. “Female triathletes at higher risk for pelvic floor disorders.” ScienceDaily. ScienceDaily, 23 August 2016. <www.sciencedaily.com/releases/2016/08/160823165743.htm>.

 

Stampfer M, Hu F, Manson J, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. The New England Journal of Medicine. 2000; 343(1). 16- 22
Todd J, Robinson R. Osteoporosis and exercise. Postgrad Med J. 2003; 79:320-23

Beyond Basics’s Pro-Bono Clinic for PT Day of Service!

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Victoria LaManna, DPT

October is around the corner! And a busy month for many. Whether you are getting back into the swing of school or work after summer vacation, preparing your Halloween costume or getting ready for all the upcoming holidays right around the corner – there is a lot going on!
This time of year is also an opportunity to do good and give back. October is National Physical Therapy Month, where physical therapists celebrate their amazing field of healing and getting people back to optimal function. In addition, many of the PT’s throughout the U.S. give back to their communities during this month. This year we are taking it up a notch. Physical therapists WORLDWIDE are getting involved for the second annual Global PT Day of Service Saturday, October 15th. Whether it is by hosting a pro-bono clinic, serving in a soup kitchen, participating in a 5k for a cause, or cleaning up a community garden – physical therapists globally as a profession are coming together to make a positive impact on the world around them.
At Beyond Basics, we have decided to host a pro-bono clinic Saturday, October 1st to give back to those in the New York City area who may not have insurance or access to physical therapy. We are providing 30 minute one-on-one evaluations and recommendations for home programs to up to 30 participants. For more information and to sign up please visit: http://signup.com/go/Nu1T4Q
You can also check out PT Day of Service here and follow on twitter (#PTDOS) to see how the day unfolds! http://ptdayofservice.com/
The American Physical Therapy Association (APTA) is also involved in hosting National Physical Therapy Month. This year the APTA’s focus is on it’s national public awareness campaign, #ChoosePT. This campaign lets consumers know about the risks of opioid use and that physical therapy is a safe, non-opioid alternative for managing pain.
I encourage you to check out educational resources provided by the APTA (www.apta.org) and Move Forward PT (http://www.moveforwardpt.com/Default.aspx). Learn all about how physical therapy can help you overcome pain without the use of opiods, improve mobility and maintain independence throughout your lifetime.

day-of-service

BBPT Health Tips: Quadriceps Stretch

Quadriceps Stretch

 

Hello folks! Beyond Basics Physical Therapy’s latest health tip is the quadriceps stretch!

IMG_3827
Victoria LaManna, DPT, PT, CLT at Beyond Basics

Muscles involved: The quadriceps. The quadriceps are a muscle group that has four separate muscle heads, (quads (four), ceps (heads), get it?). If you walk, you put these guys to work everyday. They work to extend (straighten) the knee and one of the heads, (the rectus femoris) works to flex (bend) the hip.

Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold (unwarmed up) muscle.

Caution: This stretch is not advisable for those with balance issues

As always: No stretch should ever be painful. If a stretch is painful, stop and consult your physical therapist for modification.

Directions:  Standing with support in front of you if you need support. Bend your knee and hold your leg at the ankle. Be careful not to abduct your leg (or let your knee move laterally away from the body).   Hold this pose for 30 seconds to a minute on each leg and repeat.

Learn more about Victoria here!

Welcome to Beyond Basics Physical Therapy’s monthly “Tip from your Physical Therapist!”

Fiona McMahon, DPT

We are rolling out a new tip monthly to help you increase your fitness and general health. Today we will be going over a stretch. Before we get started, let’s go over some basics.

The most common question I get asked when I give people a stretch to do is, “ should I do this stretch before or after I work out?” My answer usually is, whenever you are most likely to remember to do it. The best stretch or exercise is one you actually do”. I then go on to explain that you get a little more bang for your buck if you do it after exercise. In a Cochrane review, researchers show that stretching before exercise typically reduces delayed onset muscle soreness (DOMS) by ½ point on a 100 point scale and stretching afterwards reduced muscle soreness by 1 point on a 100 point scale.

Reading that last paragraph, you probably thought, “small potatoes, Fiona, 1 point is not worth disrupting my routine for”. But stretching has many other benefits. The Mayo Clinic Reports that regular stretching has been shown to improve athletic performance, improve blood flow to the muscle, and reduce risk of injuries. Do I have your attention yet?

Let’s introduce July’s stretch:

Adductor Stretch

Adductor Stretch- melissa Stendahl
Staff Physical Therapist, Melissa Stendahl demonstrates

Muscles involved: The adductors, or inner thigh muscles. These muscles primarily serve the function to bring your legs together and are commonly involved in “groin tears”

Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold ( unwarmed up) muscle.

As always: No stretch should ever be painful. If a stretch is painful, stop and consult your physical therapist for modification.

Directions: Hold this pose for 30 seconds to a minute; repeat. You may increase the intensity of this stretch, by hinging at the hips and bringing your torso forward over your legs. Remember, to keep your back straight and that this should be a gentle stretch and should not be painful.

Learn more about Melissa Stendahl here!

Sources:

 

Herbert R, de Noronha M, Kamper S. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Review.  2011.
Mayo Clinic Staff. Stretching: Focus on Flexibility. Mayo Clinic. 2014. http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931?pg=1. [Accessed: July 23,2016} 

Happy Marathon Training Season! Preserve your Performance with Beyond Basics Physical Therapy!

Fiona's Marathon photo

Fiona McMahon, DPT

Marathon training season is just around the corner! If you are competing in the New York Marathon, it’s about time to lace up those sneakers and set off on your 18 or 20-week training plan. As an experienced marathon runner, I know personally the frustration and anxiety that can accompany being sidelined from the action. Prior to my days as a PT, I accumulated ankle injuries, knee injuries (both of my knees), and hip injuries while training for various races. These injuries were so upsetting, I had given up my weekends with my friends to wake up for 20 mile long runs on Sunday, I had gone through more sneakers than I care to think about, and coughed up $300 a race in entry fees. Total bummer.
At the time of my first marathon, I was not a physical therapist; rather I was working in a genetics lab in Maine. I was fortunate to have two physical therapists that worked for my company help me when my knee became so painful I could not stand to work at my lab bench, let alone run 26.2 miles. Through weeks of work, they returned me to my old self and I successfully completed my first marathon in Mount Desert Island, Maine. Since that time, I have run 4 marathons and sought the help of physical therapists to help stave off injuries and allow me to train at my top capacity as I push closer towards a Boston Marathon qualification time.
Physical therapy helped me gain a critical awareness of my deficits as a runner. I found out I had a weak butt, tight iliotibial bands, and hamstrings. Who knew?! There is a lot as runners that we tend to overlook in terms of physical fitness. Many of us believe that putting in the mileage alone will prepare our bodies to endure the stress of months of training on hard pavement. It won’t. We need a strong core and hip stabilizers to reduce the impact on our joints. We need long and strong muscles to help generate enough force to efficiently move your body the length of the race. If you are only thinking cardio with marathon training, chances are good you are missing something that could help your overall time and health.
If you are starting out on your first 26.2 mile journey (or any athletic journey), or completing your 30th, don’t ignore your body’s signals that there might be an injury that needs attention. Treating an injury early with good physical therapy treatment is often much easier than treating one later on. Early treatment also minimizes disruption to your original training plan.
At Beyond Basics Physical Therapy, we go beyond what is offered in many physical therapy clinics. Our clinicians are orthopedic experts and spend an hour with their patients in one-on-one treatments, creating specialized plans to keep you in tip-top shape and return you to training faster. We are trained to look at the athlete holistically to determine the specific cause of a patient’s injury/deficit rather than a cookbook “one size fits all approach).
As clinicians, our goal is not only to heal our patients but to empower them to know more about their own bodies and to be able to take control of preventing future injuries. We take pride in our specialized home exercise plans, which a runner or any athlete for that matter, can take with them for the rest of his or her athletic career. I encourage you as a runner, to check us out and learn more about your running needs.