Preparing for the Marathon with Physical Therapy at Beyond Basics!

JHO-Muscogee Moms Contest-Blog

Fiona McMahon, DPT

Hi all! If you have been following our blog, you should be aware that Beyond Basics Physical Therapy and I are teaming up to raise money the Tisch Multiple Sclerosis Research Center of New York with Team Tisch MS. I’m hoping to raise $3,000 dollars to support multiple sclerosis research.  We have currently raised approximately $1,500!. Please support us and click HERE to donate. What puts the fun in this fundraiser ( sorry, not sorry about the pun) is that we get to get donations through running the New York Marathon, which I will be running in November.

I have run 4 marathons before including New York, and even though my timed goals were not lofty ( I really only cared about dragging my body from A to B 26.2 miles later), I relied on PT every single time, to keep my body whole and prevent me from sustaining race ending injuries. This year is no different and this week I will be having my first appointment with Jessica Babich, at Beyond Basics.

 

Why go to Physical Therapy if you are not injured?

No matter how you cut it, physical therapy is an investment. Based on your insurance, co-pays can vary to very little to more expensive, and no matter how much you are paying, the time it takes to go to physical therapy and diligently do your exercises is a finite resource. So why add more tasks to an already arduous training schedule? For me, the answer is easy, I want my body to not only run a faster marathon this fall, but I want to do so in a health way to protect my joints, ligaments and muscles, so I can not only continue to run, hike, ski, and play outside, but also so I can continue working without pain.

But aren’t you a PT, can’t you just PT yourself?

One of the most powerful and surprising lessons I’ve learned through being a physical therapist is, it is really hard to be objective about your own body. Physical therapists are trained to see large scale impairments like weak hip strength, which I know for a fact is something I need to work on, but also small scale impairments in movement, like slightly more pronation on the right foot than the left, those are things another practitioner needs to observe from the outside to diagnose and treat. Having an objective movement analyst ( aka a physical therapist), can help you see weaknesses, and alignment issues that even the most expert observer may miss on themselves. Long story short, you don’t know what you don’t know.

Why someplace like Beyond Basics Physical Therapy

I work at Beyond Basics, so full disclosure, it is the most convenient place I could go. That being said, it is also the best place I could go. Physical therapy clinics come in “flavors” and for someone hoping to truly optimize their performance, Beyond Basics Physical therapy and clinics with the same “flavor” are where to go. What makes Beyond Basics physical therapy so special is the hour one-on-one treatment they offer. This allows us to address all three pillars of movement, efficiently, effectively, and completely. The three pillars are mechanical, ( tightness, or lack thereof, of muscles, joints, fascia and ligaments as well as bony alignment), strength (how strong is a particular muscle and is it strong enough to do it’s job), and finally neuromuscular control, ( do your muscles do the right thing at the right time, this is really important to stabilize the joints of the leg and back, and is often overlooked in some busier physical therapy practice). Other physical therapy practices have a slightly different flavor. They may have a one physical therapist treating 4 patients and hour. Even if time is divided up perfectly equitably between patients, this allows the therapist of only 15 minutes on hands-on treatment to correct mechanical and neuromuscular issues, therefore leaving 75% of the time doing exercises with other patients. That flavor of physical therapy can work for some people, especially those who like to socialize with other patients during treatment, but for me, marathon training is too hard to only get 15 minutes of hands on time and spend 45 minutes doing exercises in a crowded gym. I feel that I am perfectly capable of doing my assigned exercises regularly as part of my home program. I would much prefer to work with a therapist who can tailor my treatment to suit my needs, not one who has to juggle the time constraints of treating multiple patients at once.

How are you preparing for PT?

Beyond Basics Physical Therapy is based out of New York. Like most states in the USA, New York has direct access, so I don’t need to have a prescription to come in. I will be bringing a few things to my appointment that I think are essential: health history, attire, and attitude.

Health History: Health history is a big one. In physical therapy a complete health history includes your current medications, and medical conditions, past injuries ( this is really important, and things like an ankle sprain a few years ago can clue us in on a lot ), and other factors like stress, amount of sleep you typically get, how much you work out and what you do, and diet.

Attire: Another important and sometimes overlooked item on the list. Your physical therapist will have to examine different areas on your body, as well as have access to treat those areas. Loose fitting shorts and an athletic top are a good bet. Even if you are going to physical therapy, for a condition like pelvic floor dysfunction, your therapist may ask you to do exercises, so it wise to bring workout clothes to your appointment. If you are a runner, bring in your shoes. The wear pattern on used pair of running shoes can provide heaps of valuable information.

Attitude: This is super important. Physical therapy is a partnership between you and your physical therapist. For me I already, foresee finding time to do the exercises that Jessica will prescribe to be a challenge. But the fact is, home exercise is part of the deal, and I won’t get nearly as much benefit from physical therapy alone, versus physical therapy with home exercise. Like I said before marathon training is simply too hard to just go through the motions at physical therapy.

 

What are your goals and what do you expect to gain from physical therapy?

Like I said before, I want to stay as healthy for as long as possible, but I would be lying if I said my primary goal wasn’t to increase my time. I want to put my money where my mouth is and put all my old times out in the open. So you can know where I am starting from and where I hope to go.

Here are my past times:

Mount Desert Island 2010: total time 3h 56 minutes 18 second: 9 min per mile pace

Mount Desert Island 2011: total time 4h 05 minutes 21 second: 9 min 22 seconds per mile pace

Sugarloaf 2011: total time 3h 52 minutes 25 second: 8 min 51 seconds per mile pace

New York City 2013: total time 3h 52 minutes 25 second: 8 min 51 seconds per mile pace

Here’s my dream goal for this race:

3 hours and 45 minute at 8: 35 pace.

As you can see, it’s 7 whole minutes faster than my fastest race over 7 years ago . To get there, I can’t get injured and I certainly can’t waste any precious energy during the race running inefficiently. I know that Beyond Basics will give me the best chance to meet my goals.

If you are looking to increase your performance in your sport of choice come see us to make sure you are getting the most power out of your serve, swing, or stride. Click here to access our home page and make an appointment today.

Continue to follow us here, on Instagram, and on Facebook to see my progress in physical therapy as well as my progress towards my goal of raising $3,000 dollars for MS research. If you care to donate please click here to donate to this worthy cause

BBPT Health Tip: Happy Baby Yoga Pose

Fiona McMahon PT, DPT

Guys! This is one of my favorite stretches ever. Both for myself personally and also for my patients. It’s called the happy baby pose, which comes from yoga. I mean, how cute is that. If you’ve ever seen a baby try and stick his feet in his mouth you know where the name comes from. This stretch is awesome because it stretches a ton of muscles at once, even the pelvic floor. It is an integral part of my stretching routine and I hope it becomes part of yours.

Muscles involved: Hamstrings, glute (butt) muscles, pelvic floor,

Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold muscle, because unwarmed muscle doesn’t stretch as well as warmed up muscles.

Caution: If you feel pinching in your hips or pressure or discomfort under your kneecap, move your hand position to back of the thighs. If you still feel pain while attempting this modification, it is definitely time for a physical therapy appointment.

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

Directions: Lying on your back, grip your feet on the outside of your feet and bend your knees up towards your armpits. If this is too difficult, grasp your legs at the calves. Make sure that your neck is relaxed and hold for 60-90 seconds and repeat. Add deep breathing to enhance the relaxation. Enjoy!

 

Check out our student showing off her great happy baby pose!

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 . 

Spring Pelvic Health 101 is Coming

Fiona McMahon, DPT, PT

Pelvic Health 101 is back with some old favorites like, “Something’s wrong with my what?” and “Why is pooping so difficult?” We have also added a new course on pediatric pelvic floor issues.

If you have questions, we have answers. Join us for lectures and question and answer opportunities with expert pelvic health physical therapists, childbirth educators, and nutritionists. Please reserve your spot early at pelvichealth-101.eventbrite.com. Remember spots fill up quickly. As always, light refreshments will be served.

pelvic-health-101-spring-2017

BBPT Health Tip: HOT or COLD? That is the Question

bigstock-illustration-of-thermometers-w-49787687

Fiona McMahon, DPT.

 

What’s better, heat or ice? This is a question that most medical/health type professionals get all the time. The answer is, it depends. Both have fabulous benefits for different sets of circumstances. Let’s explore these cheap, safe and effective pain relievers.

Heat

In the biz, ( no one calls physical therapy “the biz” yet, but if I try hard enough, it may stick) we call heat, thermotherapy. Fancy, right? Thermotherapy is great for pain that is a result of a trigger point, or muscle spasm. Think deep neck, back pain, or pelvic pain. It’s great for menstrual cramps and can  create a nice soothing effect.

For any active inflammation or infection however, heat can be harmful and can actually make it worse. You do not want to place heat over joints affected by autoimmune disease like rheumatoid arthritis. It’s also not good for new, fresh injuries, like a muscle strain or a injury from a fall. Heat is really good for chronic long standing pain conditions.

Heat comes in types, dry and moist. Dry is the kind that’s emitted from like an electric heating pad or a microwaved heating pad. Sometimes people may find that dry heat, dries out the skin. Moist heat comes from things like moist towels or moist heating pads (these are the kind we use in our clinic). Moist heat tends to penetrate deeper into the muscles.  

 

Safety Considerations for Heat:

  1. Don’t over heat. Sounds simple, but in the throes of severe pain, many people may find themselves with the more is better mantra.  It’s not.
  2. Don’t apply to open wounds, on individuals with peripheral vascular disease, deep vein thrombosis, or on people with reduced sensation or ability to remove the hot pack.

 

Cold

Physical therapists have a fancy name for this one too. It’s cryotherapy. Sounds super futuristic doesn’t it? Ice is awesome. It really is. It is great for acute (recent) injuries like a sprain or a strain. There are actually studies that show that ice within 36 hours of injury speeds recovery better than heat. Ice can reduce pain in the area it is applied, reduce guarding and spasm, and reduce swelling.

 

Safety Considerations for Cold:

  1. Never use on people with reduced sensation, ie. Raynauds, actively healing wounds, circulatory issues, or hypertension
  2. Less is more. Keep cold packs on for 20-30 minutes once every 2 hours on newly injured body parts. Keeping the ice pack on for longer can cause increased blood flow to the area which will reduce the helpful effects of the ice.

When in doubt as to if you should use cryotherapy or thermotherapy, consult with your physical therapist or healthcare provider.  At Beyond Basics we treat injuries beyond those to the pelvic floor and we can help with your injury questions. You can also find a physical therapist with the APTA’s PT finder tool

BBPT Health Tips: Let’s Roll!

Fiona McMahon DPT,

Foam rolling. I certainly have a love hate relationship with my foam roller. My IT bands (the tissue on the side of your leg) hate it, but I love how it keeps my knees and joints happy. Foam rolling is a method to release knots in muscle and improve the mobility of tight muscles and joints. If you are a gym rat, runner, or athlete of any kind, consider giving foam rolling a try. In a review published in the International Journal of Sports Physical Therapy in 2015, foam rolling was shown to reduces delayed onset muscle soreness (DOMS), and temporarily increase range of motion.

First of choose your weapon…. I mean roller.

 

White roller: Great for starters: gentle, but can deform over time because it is softer.

white-foam-roller

foamroller6x36fsBlack roller: This roller is not for the faint of heart, it’s the toughest one of the bunch. It’s not a great place to start, nor is it good if you bruise easily, but for the foam roller aficionados out there, it is really great for a tight IT band and hamstring.

 

 

21nc-kpj2l-_sy300_Grey roller: This is a nice in between roller for those of us who need a little more than the white roller, but aren’t quite ready for the black one. It is actually a composite of both rollers.

 

 

 

Artisanal Foam Roller: This one retails for about 120$ on Amazon and is good if you are super fancy. I haven’t tried it because I’m not very fancy.13187983_252069785150011_953005372_n

 

The Stick and other hand rollers:

 

48d2a548-59cd-437f-b9a1-7a145ae1e592This one is good for those who travel often, because it occupies relatively low amounts of space in carry-on luggage. It is also great for people with tight inner thighs and tightness closer to the pelvic bone, which can be difficult to get to using regular foam rollers. Retail names include: “The stick”, “the tiger tail”, and others.

Other Rollers:

There are other rollers that come in a variety of fun colors and designs. These rollers are less standardized so you may want to experiment if you feel like opting for one of the less classic varieties.

 

Now that you’ve picked your roller, let’s get rolling!

When foam rolling, you can adjust the weight you place on the roller by reducing the amount of support you give yourself. The more of your body weight you put on the foam roller, the more intense it will be.  If you find a particularly tender part oscillate your body on that spot to facilitate release. In addition, you can flex and straighten the area that you are working on to help with additional lengthening of the tissue.   Attempt 10-15 passes for each body part to help improve your function and tissue mobility.

 

ITB band rollingitb
Quad rolling

quads

 

Hamstring rolling

hams

 

Back rolling

rolling-back

 

Adductor rolling with stick

the-stick

 

Sources:
Cheatham S, Kobler M, Cain M, et al. The effect of self-myofascial release using foam roller or roller massager on joint range of motion, muscle recovery, and performance: a systematic review. Int J Sports Phys Ther. 2015 Nov;10(6):827-38

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