Molly completes the NYC Marathon!

On November 3rd 2019, Molly Caughlan completed the New York City Marathon for the very first time! We at Beyond Basics are so proud and overjoyed for her! She ran to raise money for multiple sclerosis research. Read her last update before the big race, here!

I sit here writing this blog with just 6 days left to go before the big race. I’ve been tapering down milage, taking time to rest, stretch, and strengthen. The forecast, fingers crossed, is looking very ideal with highs in the mid 50s and looking like sunshine all day. I’m nervous, excited, and feeling confident that I’m going to cross that finish line.

Since my last blog, I’ve hit just a few bumps in the road with my training. In September right before a critical long run (my first 18 mile run), I had an acute onset of posterior tibialis tendonitis that made it difficult to even walk on. I was devastated and had to hold on running any distance all together. I was feeling incredibly anxious because of how close I was getting to the big day and at the thought of skipping such an important training notch. While I was healing, I did a Hot Vinyasa class that I hadn’t done in a while that help me hit a reset button and set up a strategy to manage these symptoms. I took a whole week off from running and had two sessions with Tina as well as doing some self treatment with modalities (ice/heat). I also had an acupuncture treatment with something called dry needling to my calves with a treatment for chi energy deficiency. With ALL of these treatments combined, the first run I did I was FLYING! I had so much energy and was going at such a fast pace that I shaved a few minutes off of my traditional 5 mile run. Things have been looking up since that week in September and looking back now, resting was the most important treatment I could have done.

As part of my training, I ran the New York Road Runner’s Brooklyn Half Marathon October 19 and had such an amazing time. The end of the race was in Prospect Park, which is essentially my back yard and where I’ve been doing a lot of my training. This helped me to finish strong and break my own personal record for a half marathon with a time of 2:07.

As the days wind down, I’m looking forward to having some of my family members come visit just so they can support me on Sunday. I’ll have support from my local friends on the sidelines and, with the help of modern technology, will have the spiritual support from friends across the country. I’m eager to see all of the other anonymous supporters with their signs and I’m excited to have all of this energy boost me across the finish line.

Last but not least, I must say that I am still working on my $5000 fundraising goal and I’m 71% of the way there. I’m sponsored by an organization called Team Tisch MS​ that performs groundbreaking research to discover the cause of Multiple Sclerosis, understand disease mechanisms, optimize therapies, and repair the damage caused by MS, as well as offering patient access to the best and most advanced treatment possible. Support Team Tisch MS by donating to my fundraiser!

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Marathon Training and Racing Wellness: Why I Chose Tina

Molly Team Tisch MSMolly Caughlan PT, DPT

I am very excited to announce that I will begin training soon and will be running the New York Marathon for the first time. I will be running as part of Team TISCH MS alongside my awesome and inspirational co-worker, Fiona McMahon. We are working together to raise a combined $10,000 dollars to support multiple sclerosis research. You can donate to my personal fundraising page here. This is an incredible opportunity that I feel so honored to be a part of. I decided to run the marathon as part of my New York and life bucket list. I see marathon training as a perfect way to get to know all of the five burrows. Running has always been my way of getting to know the city I’m living in.

I have trained for several 5K, 10K and half marathon races, but only one full marathon. My first (and only) marathon I call my “almost marathon” took place in Savannah, GA in November, when the weather should be sunny and 70s. Unfortunately, due to a heat index of 105 and with several hundred participants fainting due to heat exhaustion, they cut the race short and made everyone turn around at mile 14. I was relieved, frustrated, exhausted, and incredibly HOT. My 6 months of training in the hot Atlanta summer had not prepared me for the intense humidity that made me feel as if I were swimming and not running.

Beyond Basics Physical Therapy has generously offered physical therapy services to me to help me meet my marathon training goals. First and foremost, I’d like to complete my training and marathon without any major injuries. In previous races, I’ve been fortunate to not have any serious injuries and just minor aches/pains. My main problem areas are my right sacroiliac joint and right foot feeling occasionally unstable and achy. Second, I’d like to finish in under 4 and a half hours, meaning little to no walking breaks. My pace is on the slower end (around 10 min/mile) and I’m hoping to increase my pace. My third goal is to get the most out of my training and to fully enjoy the whole process.

My co-worker Tina Cardenia will be my physical therapist and I could not be more thrilled to be working with someone so incredibly talented, intelligent, and experienced. Tina has an extensive background working in an orthopedic setting and has completed the intense certification process in Functional Manual Therapy (CFMT). Tina uses this strong framework to look at the body as a whole and bring its function to optimal capacity.

These next 6 months will be intense, but I’m excited to push my body to new limits and finally cross “marathon” off the list. With the help of Tina, Team TISCH, and Beyond Basics, I am excited to take on this new challenge. I’m confident that I’ll meet all the goals I’ve set out for myself and look forward to November as they come into fruition.

Both Molly and Tina work in our Midtown Location.

PT Molly

 

Marathon Training: Two Perspectives

sneaker.pngAs we creep closer and closer towards marathon weekend, our very own Tina Cardenia PT, DPT, CFMT and Victoria LaManna (Vicky) PT, DPT, CLT, PRPC were kind enough to share their stories about preparing for the 2018 New York City Marathon. Vicky will be running her first marathon on November 4th, 2018 in order to raise money for Multiple Sclerosis Research. Tina was gracious enough to volunteer her expertise in orthopedic physical therapy to help Vicky have the best run possible for a great cause. If you are interested in donating to support MS research, please donate here and read more about their stories below. If you are interested in hearing more about our orthopedic and sports program here at Beyond Basics Physical Therapy, give us a call at 212-354-2622.

From the Runner’s Perspective

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Victoria LaManna (Vicky) PT, DPT, CLT, PRPC

This year I am participating in my first ever marathon in the NYC Marathon for Team TischMS. Truly, this is my first ever 5k, Half Marathon, or Full Marathon. I am traditionally an anaerobic, (short bursts energy) exerciser. I have played soccer, dabbled in Muay Thai kickboxing, yoga, and weight lifting for exercise. The mind-body challenge of running a marathon (and doing it all for a great cause!) appealed to me. But where to start?

Luckily, I am in a profession that specializes in exercise, injury screening, and prevention, as well as injury rehabilitation. One of my co-workers has also run a few marathons and pointed me in the right direction for a training schedule. To further help ensure success in my training process, I also started physical therapy and made sure I got on my co-worker Tina’s super busy schedule.

vicky.pngShe first tested my core strength, checked hip mobility and strength, as well as spine and rib cage mobility. All areas that are important for efficient running. Tina found that I had poor core-first responses to outside forces, meaning that every time my foot hit the ground while running, my core was not firing to connect my lower extremities to my trunk. This could definitely be why I was experiencing right low back pain with running, and it could actually lead to further injury and result in not being able to RUN at all! Tina also found limitations in my breathing, rib cage, and thoracic mobility. Other than back pain, my first main complaint a few weeks into training was that I could not breathe. While you could chalk that up to poor conditioning, it was something that was felt immediately in runs – as if I just did not have the capacity to take a breath in. This is where we started our treatment – rib cage and thoracic spine mobility.

From there, Tina continued treating based on observation of my running pattern. She continued to work on hip, spine mobility and core control based on what she saw was insufficient in my running. My breathing improved greatly, as well as my mobility. I began to run completely pain-free with ease.

About 2 months away from Marathon Day, I injured my right foot trying to complete a 16-mile training run. I was unable to walk without pain and was limping around the office. Tina quickly observed that I had a bone in my foot and ankle that were compressed and out of alignment. Her work to align my foot and ankle, working all the way up again through my hip and trunk helped me to get back to pain-free running.

I am all set to run the NYC Marathon Sunday, November 4th! I am incredibly thankful to Tina for helping me to get through my training pain-free, manage an injury along the way, and quickly get me back on track for race day. And I am thankful for Team TISCH for allowing me the opportunity to join their team and support a great cause that affects many men and women.

Are you training for a marathon? Looking to improve your running form? OR even improve your golf swing? I would highly recommend seeing a physical therapist for an injury prevention screen for any and all sports, recreation or exercise. Setting yourself up for optimal movement and mechanics will enhance your activity, as well as reduce the risk of injury. It worked for me!!

 

From the Therapist’s Perspective:

Tina Cardenia PT, DPT, CFMT

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Victoria LaManna is such an inspiration. She volunteered to run the NYC marathon this year with little to no running experience and I was lucky enough to help prepare her! I have been working with Victoria for the past 6 months and I am amazed by how far she has come and how much she has already accomplished. Each week during our PT sessions there were a couple of things that I would look at to monitor her progress. I would observe her running, assess her core with tests called the Lumbar Protective Mechanism* and the Elbow Flexion Test*, her standing posture, her single leg stance, double leg squat, single leg squat, her glut and hamstring strength and how it connects to her trunk, and trunk rotation range of motion.

I saw that Vicky’s main limitations when I was observing her run were her limited trunk rotation towards the right, poor landing control on both of her legs especially her right one, and running with her feet turned out. One of the main things I looked for when observing Vicky run is the force transfer through her body from her feet to her trunk, and how the force translates through the rest of her body. It looked as though the force transfer wasn’t as efficient as I would have liked and this repetitive stress through her back and legs could potentially lead to injury.

tina and vickyVicky’s limitation with trunk rotation correlated to one of her complaints of having difficulty breathing during her runs. It seemed as though she was only able to get a good breath through only one side of her body. Upon examination, I found that she was limited into rib cage expansion especially on the right side. After some rib mobilization and breathing inhalation retraining and working thoracic spine rotation Victoria was able to rotate more symmetrically and reported an increased ease of breath with running.

Vicky’s lack of control with landing while running meant that she had a lack of eccentric (the motion of an active muscle while it is lengthening) control through her pelvis, causing compression through her back every time she lands. This could explain the low back pain Vicky has been experiencing. To address this, I worked on increasing the mobility and range of motion through her hips, pelvis, and back. I then worked on retraining her body with specific neuromuscular techniques called Proprioceptive Neuromuscular Facilitation (PNF) and specific exercises to help Vicky create a core first strategy with her running. This means, with every step and every movement Vicky is able to initiate with her core muscles first, which prevented her from overusing her bigger muscles which tend to fatigue quickly and can lead to injury and pain.

Vicky was running with her feet turned out causing poor force absorption from her feet up to her body. This style of running can also result in muscle overuse injuries and pain over time. This could have also been contributing to her complaints of shin splints while running. To work on this, I evaluated Vicky’s foot and ankle mobility, her knee tracking with squats, and single leg squats. With knee tracking, I noticed that she went into valgus with both of her knees, but it was worse on her right. Valgus means that her knees were “knocking in” which was an issue of having weak hip strength as well as lack of mobility and flexibility through some of her leg muscles and joints.  I did a lot of manual work to restore good range of motion and mobility and a lot of muscle retraining and drills to train Vicky to use those muscles appropriately and to be able to carry it over into her running.

After all this training and all the hard work that Vicky has been putting into running, Vicky’s running form now looks great! She has much more mobility through her trunk, is able to control her landing much more efficiently and is able to connect her feet for a better push off during running! Even as Vicky increased her mileage, she kept reporting to me how much easier her runs have been feeling, how much easier it was to breathe and how much more ease of motion she had through each run, and I couldn’t be more proud of her hard work!

*The Lumbar Protective Mechanism and the Elbow Flexion Test are special tests that come from the Institute of Physical Art. If you would like to learn more about their approach to PT, click here.

Marathon Update: Shaving Time off my Race with Physical Therapy and Doing Good in the Name of Multiple Sclerosis Research

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Fiona McMahon PT, DPT

Hi everyone! It’s Fiona from BBPT. I am writing the day after the 2017 NYC Marathon sore, tired, but happy. It was a great training season, in which I pushed myself harder than I had before and had a great physical therapist, Jessica Babich PT, DPT looking after me the whole way.

Let’s not bury the lead any further. As of today, we managed to raise over $3,500 to support research for multiple sclerosis (MS) through NYC Team Tisch MS and as a group Team Tisch raised over $100,000 dollars to further the goal of making TISCH MS history.

finish timeALSO…. physical therapy definitely payed off. I shaved over 17 minutes my last NYC marathon in 2013, going from a time of 4 hours 0 minutes and 4 seconds, to 3 hours 43 minutes and 2 seconds. Not only was it a personal record for the course, but it was 8 minutes faster than my previous all time best at Sugarloaf in 2011.

This was my first time getting physical therapy during training for a race, rather than having to turn to it when some type of disaster struck, be it a rolled ankle, irritable knee, etc. This is the first time I’ve had someone care not only about my core, but whether or not it engaged when it was supposed to.

I would advise anyone who is considering engaging in an athletic endeavor, especially a new one, or when competing in a sport for time, to strongly consider getting an experienced physical therapist with expert skills in manual therapy and a keen eye for function. They can evaluate problem spots from head to toe (literally, in my case, Jessica worked on both my neck and ankles). They can help you tailor your training to get the most out of your exercises to allow you to perform at higher levels. Jessica kept me healthy and motivated, and her work allowed me to train safely and effectively at an intensity I hadn’t yet explored independently.

Thank you all for your support. If you still care to donate you still can here.

If you think you would benefit from PT at Beyond Basics, click here or call today.

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
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These are the big screens I was talking about!
Zacary and Zoe
My Kids, Zachary and

Marathon Training Update

Fiona McMahon PT, DPT

Hello everyone! Here’s a brief little update from physical therapy land about progress for the marathon! We are actually a little less than a month away from race day. We are close to our donation goal, but really need your help to make it. Please click here to support research to end multiple sclerosis. This is go time. It’s where the rubber hits the road and you have to put a little more muscle in your hustle. Typically this is the point at which you start to approach 20 miles training runs and things can go right, which is great, or things can go wrong and you learn from them. I will also give you a quick update on what’s been going on in physical therapy.

Nutrition Mistakes

I had a pretty good learning experience a couple of weeks ago that I want to share with you, so you don’t end up making the same mistakes I made. On my first mega mile run, which I consider anything over 15 miles in this category, I hit the wall so hard I think I might have left a Fiona shaped impression in the brick. I started out a 17 mile run fast, doing about 8 minute miles. I also neglected to do my usual carb load for breakfast. On top of that, I forgot to bring any glucose replacement supplements with me. You know where this is headed. At mile 13 I crashed. I sat on the side of the road and contemplated calling an uber. I managed to make it back but average a 9:30 pace, no where close to my goal pace.

This just goes to show how important it is to have the right fuel whether you’re pounding the pavement. My subsequent two runs 18 and 20 miles respectively went much better. I tried out GU, a glucose replacement gel versus glucose tablets. I’ve use GU a lot, but it has a thick consistency, which can only be described as gnarly, but the stuff works and you certainly aren’t eating it for taste. The glucose tablets were delicious, if you like sweet tarts candies, which I do. The only drawback is I can imagine the dry powder of them to be a little rugged to get down on days where you might end up more dehydrated. I have one more 20 miler to pound out before the big day, so I’m going to try a mixture of both and see how I feel. What’s so beneficial about long runs is not just the physical training, but also learning what works for your body. It allows you to foresee possible problems that could occur on race day and address them before they arise.

Physical Therapy

As I alluded to in my last blog, this fall has been a bit tough with colds and stomach bugs. Jessica was good to incorporate some visceral mobilization work into treatment to allow more sore little digestive organs a chance to heal. She also worked on my sacrum, the bone above your tailbone, to make sure that I had enough range of motion to run efficiently. She then made me work! We did work to activate more core muscles and at the end of treatment, there was a real increase in my core strength!

This fall has been full of surprises health/training-wise, but with Jessica’s help I was able to immediately feel a little better, without taking my eye off my goal of a 8:35 mile pace! If you could use someone like Jessica in your corner, call us at BBPT today.

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Marathon Update: Sickness When to Run and When to Take a Break

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Fiona McMahon PT, DPT

Hi everyone I am writing you from week 22 of training for the NYC marathon. This year I am running the marathon, sponsored by Beyond Basics Physical Therapy, in order to support New York’s Team Tisch in raising money for multiple sclerosis research. Currently, we are only about 1000$ from our goal, time is getting tight so don’t forget to donate today. Click here to donate to Team Tisch MS NYC Marathon to support research for treatment and prevention of multiple sclerosis.

Today, I want to write about a fact of life for almost every human being, illness. Getting sick can be vexing for just about every marathon runner. It puts us in this nearly existential running dilemma, “Do you run and risk getting more sick?” or “ Do I take the rest, and miss a potentially race making run?”. The question can sometimes make you feel even more lousy than whatever you are actually sick from.

In my training for this marathon, I have been confronted with this question way too many times. I’ve been sick 4 times in the last 22 weeks, total bummer, but I live in a super crowded city and work with children so I am not surprised. P.S. Working with kiddos is the best thing ever and is totally worth whatever puke, snot ridden illness I get, so I am definitely not complaining.

A lot of runners have “the neck rule”. I first came across this rule as a high school runner, and I see it all over running publications. It has been a useful tool for me for years in determining when to take a knee and focus on feeling better. The neck rule is not necessarily running exclusive, so feel free to apply it to most workouts. Basically it goes like this, if your symptoms are above the neck, i.e. congestion, sore throat, etc, you are generally safe to run. If your symptoms are below the neck, i.e. fever, vomiting, diarrhea, muscle aches, etc, it is time to give your body a rest and let your immune system do its thing. It can be so frustrating to skip a run, especially when your illness falls on a major training session, but in the long run, you will end up healthier and you will be able to return to your prior level of performance sooner. This doesn’t necessarily mean that head only symptoms mean you absolutely should run. It’s a basic guideline: if you are feeling too run down and fatigued to run, listen to your body, it’s pretty smart.

When you are starting to feel better go back into things slowly. Once your fever has been gone for about 24 hours without fever reducers, vomiting or diarrhea have cleared, and you can eat and drink normally, ease back in. Plan your next run on a treadmill or in short loops by your home so you can cut it short if need be. You don’t want to be stuck 8 miles out from home, finding you are still really worn down from being ill. Been to that show and got that T-shirt.

Marathon training is as much mental as it is physical. The mental challenges can present themselves in surprising ways. One of the biggest pitfalls runners “run” (oops, not sorry about that pun) into following an illness, is the desire to cram all of the mileage they have missed into a few days following an illness. Don’t do it. Most training plans are designed to challenge the body at a level it can tolerate as well as provide enough rest to build up strength and functional reserves. Adding a huge glut of extra miles in the middle of it, can really throw things off and put you at a greater risk of injury or even additional illness. Let those miles go and be confident in the fact that you allowed your body to heal and get to full strength.

Please click here to donate to TISCH Multiple sclerosis research.

Additionally, check out my progress in physical therapy here:

 

And for more on training while sick, click here.

 

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.

Beyond Basics’ Marathon Prep Program: The Evaluation

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

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

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

 

History

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

.Orthopedic Injuries

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

Medical

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

Current Exercise Routine:

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

The Evaluation:

Posture:

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:

 

 

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 4h 0 minutes 47 second: 9 min 11 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