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

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

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

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

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

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

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

So whether you are experiencing incontinence, pelvic pain, low back pain, or a shoulder injury, having a knowledgeable therapist work with you, can make a significant impact on your function and quality of life.

 

Shoulder Pain – What Can Be Done?

Back and Shoulder Pain

Kaitlyn Parrotte, PT, DPT, OCS, CFMT

Shoulder pain is a fairly common issue amongst adults, with a reported lifetime incidence of up to 70% in various countries and estimates of cost burden up to $7 billion a year for treatments of it.

Subacromial shoulder pain is defined as pain that originates from the subacromial space, which is a very small area between part of the shoulder blade called the acromion (“roof of the shoulder”), and the shoulder joint (the glenohumeral joint). In this area lies the rotator cuff tendons and the subacromial bursa (a fluid filled sack that helps minimize friction on these tendons). Subacromial shoulder pain is commonly located on the top and outside of the shoulder, and is often aggravated by overhead activity. The pain from this area is typically caused by inflammation and/or tearing of the rotator cuff tendons, as they are pinched/rubbed against the underside of the acromion.

There have been multiple research studies that have looked into the benefit of surgery for the treatment of subacromial shoulder pain. Today, we will be focusing on one article that looks at the effect of arthroscopic subacromial decompression (a common surgery for pain by removing tissue), as compared to a placebo surgery (no tissue actually removed), and no treatment. Here is a quick summary of the study:

313 patients were randomly assigned to treatment groups: 106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment. For the decompression surgery, surgeons removed soft tissue and other structures within the subacromial space, a nearby ligament, and removal of any bone spurs. For the arthroscopy, structures were inspected and irrigated, but nothing was removed or repaired. Following surgery, both groups (decompression and arthroscopy) received appropriate post-operative care, including follow-ups with the surgeons, as well as physical therapy. Those participants assigned to the no-treatment group attended one reassessment appointment with a shoulder specialist, 3 months after entering the study, but with no planned intervention. The pre- and post-test findings were mainly based on a functional shoulder measure.

The findings in this study turned out to be very interesting, although perhaps not what the authors originally intended. Not because both surgical groups reported higher scores on the functional measure, as compared to the no-treatment group, which is something that one can expect when an intervention is appropriately applied. The main take home message from this study is not even that researchers reported participants in both surgical groups ended the study with similar outcomes. A major plot twist in this article is that both surgical groups were given physical therapy post-operatively. Remember, the group who received arthroscopy did not actually have any structures repaired or removed, yet this group made statistically significant gains after all intervention were completed, that matched, if not bested, the results of an actual surgical intervention. How could this occur? We must consider the common denominator – physical therapy! Physical therapy is the only thing that both groups had in common, so it is safe to assert that it likely played a significant role in the improvement of shoulder pain.

If that isn’t convincing enough, let’s now focus on a research article that takes a closer look at the impact of physical therapy for patients with subacromial impingement syndrome. This article published in 2012 looked at a specific exercise routine vs generalized exercise for 102 patients in Sweden, who had already failed conservative treatments for their shoulder pain, and would likely become candidates for surgery due to their continued pain. Participants in both groups received a subacromial injection of corticosteroids two weeks prior to the commencement of any exercise. The control group received general exercises that including shoulder and neck movements and stretches. The experimental group was given six exercises to perform, which included eccentric strengthening of the rotator cuff, meaning these muscles were actively controlling resistance while lengthening, stabilizing exercises of the shoulder blade, and stretching of the back of the shoulder. After performing these exercises two times per day for up to 12 weeks, and attending one physical therapy session per week, these patients reported significant improvements in functional measures for the shoulder, as compared to the control group. The authors also reported that significantly fewer participants from the specific exercise group opted for surgery after the trial was over (20%), as compared to 63% from the control group. This study not only shows that physical therapy is beneficial for decreasing subacromial shoulder pain, but it also proves that when it is tailored specifically toward the needs of an individual condition or presentation, it can still be effective even after a person has failed conservative treatment.

In summary, subacromial shoulder pain is a very common condition, that can successfully be treated with physical therapy, even if conservative treatments have previously failed to relieve symptoms. The emphasis must be on finding the correct intervention program that meets the needs of each individual patient. If you or someone you know is dealing with shoulder pain, whether it is new or old, you could benefit from a tailored physical therapy program. Here at Beyond Basics Physical Therapy, all of our therapists have extensive training and are experts in orthopedic and sports-related injuries, and will work one-on-one with you to develop a rehab program that helps you achieve your goals, so make and appointment today!

 

 

Sources:

1. Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. 2011. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeltal Disorders, 12 (119).

2. Kulkarni R, Gibon J, Brownson P, et al. 2015. BESS/BOA Patient care pathways – subacromial shoulder pain. Shoulder & Elbow, 7 (2), 135-143.

3. Mesilin RJ, Sperling JW, Stitik TP. 2005. Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop, 34 (12 Suppl), 5-9.

4. Beard DJ, Rees JL, Cook JA, et al. 2017. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 17 (32457), doi: 10.1016/S0140-6736.

5. Holmgren T, Hallgren HB, Oberg B, et al. 2012. Effect of specific exercise on need for surgery in patients with subacromial impingement syndrome: a randomized controlled study. BMJ, 344 (787), doi: 10.1136//bmj.e787.

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

thermometer-temperature-fever-flu

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

marathon-image.gif

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

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

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

 

History

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

.Orthopedic Injuries

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

Medical

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

Current Exercise Routine:

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

The Evaluation:

Posture:

IMG_3011
Jessica examining my posture and my ability to tolerate load through the spine using the Vertical Compression Test

     Fiona has a posterior/posterior alignment.  ( This terminology comes from the Institute of Physical Art (IPA), and is a wonderful training program for PTs) Meaning, her ribcage is set posterior in relationship to her pelvis and her ribcage is tipped posteriorly.

Range of Motion (ROM):

 

  • Poor lumbar spine ROM, with an inability to reverse the curve in my lumbar spine
    • Why this is important: my spine should have motion in order to absorb the shock from repeated foot falls, also an immobile spine may inhibit the core stabilizers from firing properly
  • HISL testing ( another IPA test): Positive  at the right (hip) at 90 degrees, with poor glide of the femur down on the left side. Positive at left  (hip) at 100 degrees.
    • How do we translate this into non-physical therapy speak? First of all the HISL stands for Hip, Innominate, Sacrum, and Lumbar. It measures the relationship between the bones of the upper thigh, pelvis, and low back. What my results tell us is that my hips are stuck and cause my innominate (bone in the pelvis) to move too early. This is not so great because it causes the bones further up to have to move extra to compensate. We have to clean this up.

 

Strength and Function :IMG_3010

  • Instead of testing muscles one-by- one, which is commonly done in traditional physical therapy practices,  we decided to take a look at functional movements. Who gives a hoot if I have strong quadriceps while sitting on an exam table, if they can’t function properly during actual running, right?
  • LPM (Lumbar Protective Mechanism)( another IPA test) : absent in all quadrants
    • Dang! Lumbar protective mechanisms refers to the ability to stabilize your spine and protect your core in response to bumps and jostles. I didn’t stabilize at all. This is important because running is essentially a series of bumps and jostles, running on an unstable spine and core can increase your chances of injury as well as reduce your power during push-off in running leading to slower times (HORRENDOUS!).
  • Sagittal Plane Lunge: I have deficits with initiation and weight acceptance on both sides. I compress my arms in prayer position to create stability and when taken away I have a loss of trunk control. My right ankle more unstable than the left.
  • Runner’s Start Jump: difficulty coordinating movement on both sides, but significantly worse with initiation from right side at the ankle.
    • Remember my ankle sprain? Well, apparently that’s still holding me back and decreasing my ability to push off the ground. You could imagine how this could become a problem over the course of 26.2 miles. Moral of the story, see a PT after you hurt your ankle!
    • Also we see deficits in core control again.  I think addressing this with Jessica will really improve my time.

Shoes and wear:IMG_3000 (002)

  • Apparently my shoes were good! Jessica told me that sometimes right and left sneakers can be made in different factories and have different densities, which can really mess you up while running. Also if the back part of you sneaker extends too far it can make your brain think your foot is larger than it is, leading to injury. The wear of the shoe is also important to see if one foot pronates or supinates more than the other. If this was the case, Jessica could work on the alignment of the bones in my feet, ankle and foot strength, as well as teaching me how to tie my shoes in a way that better support my feet.

 

Assessment and Take Away:
Jessica’s Assessment: Fiona, like a majority of our athletes presents with deficits in the 3 major pillars leading to functional inefficiency. The goal of physical therapy, isn’t always to reduce pain, it is to get you to function better, which in turn will decrease wear and tear that contribute to common pain patterns.

Fiona: I can’t say I am surprised by much of what we found. I am slightly disappointed with my core activation finding, because I had been focusing on that particular issue for months and months in the gym. Jessica told me she thought part of my issue was that my lower (lumbar) spine was so rigid, it might be hard for me to get into a place where my deep core muscles can work to facilitate stability. It goes to show, even as a physical therapist, you need someone else to literally watch your back. As a physical therapist, my evaluation showed me that now is the time for help. Although I am strong and spend hours working out, my core stability is something I need more help with, and I simply cannot work my way out of my weakness alone in a gym. I’ve tried long enough. I need gentle manual therapy and proprioceptive neuromuscular feedback to wake my lazy deep stabilizers out of their hibernation and orthopedic work to allow the joints of my spine and pelvis to move more efficiently and effectively. Although this body has its deficits, I’m really proud of what it has done so far, and I’m really excited to see where Jessica will help me go!

 

Plan:

  • Improve the movement of: right foot, trunk, and cervical spine
  • Improve core stability and strength to allow for more power and reduction of injury risk
    • We will achieve these goals through manual work, neuromuscular re-education in order to teach the muscles to activate better and a strong home program to maintain changes made in physical therapy.

 Goals

Jessica: My goal is to treat the mechanical deficits inhibiting her neuromuscular system and then functionally reintegrate the parts into the whole system to enhance performance efficiency.

Long Term Goals:

  • 1: (12 Weeks) | Patient to demonstrate core first strategy with transitional movements to improve stability, energy efficiency and decrease risk for injury
  • 2: (12 Weeks) | Patient to demonstrate optimal ribcage over pelvic posturing for automatic core engagement and decrease mechanical load on system.
  • 3: (12 Weeks) | Patient to improve R foot positioning for stability and push off in gait

 

Home Exercise Program:

So far I have one addition to my workout routine. It is a split stance at the wall designed to wake up my stabilizers before I go running. I stand at the wall with one leg fully extended on my toes and the other bent at the knee and the hip, with my toes pointed up. I hold for 30 seconds per side and then I get going. It has been a couple days since this exercise was assigned, and I’ve done it on about 50% of my runs. Remembering to do your home program is one of the biggest challenges of physical therapy. My strategy to combat this is to leave a sticky note on my door reminding me before I leave the house. I will report back on future blogs to let you know how my strategy worked out.

That’s it for now:

Check out more info and pictures on our instagram and facebook pages

Click Here to Donate to support Team Tisch MS NYC:

 

 

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

Pilates Blog- Rhythm- Coordination of Breath and Movement

PilatesDenise Small, PT, DPT

Today’s Pilates blog will focus on another basic movement principle of the Pilates method, Whole Body Movement.

In the last blog, I wrote about the importance of breathing three dimensionally, both expanding and contracting your abdomen and ribcage when breathing. Joseph Pilates wanted to help exaggerate these physiologic functions with movement, to help bring better awareness of these functions to one’s consciousness. He did that by coordinating both whole body movement and breathing. For example, when one inhales, the ribs and sternum move up and out, like a water pump or the handle on a bucket. You can feel this action by placing your hands on the outside of your ribcage, or on your sternum, as you inhale. When the ribs move up and out or the sternum lifts, the spine also extends because of the physical connection of the ribs into the spine. So, when Pilates gave a movement that involved spinal extension, like cow pose, he encouraged his students to inhale.

Conversely, when one exhales the opposite happens, and the ribs move in and down. When the ribs move in and down, this helps facilitate spinal flexion, because of the ribs physical connection to the spine. So, when Pilates gave a movement involving spinal flexion, he encouraged his students to exhale.

The result is inhalation with ribcage expansion and spinal extension, and exhalation with ribcage compression and spinal flexion. By coordinating the ribcage and spinal movement with the breath, you can maximize your air intake and expulsion. In addition, by coordinating your breath and movement, your body can more easily access its natural rhythms, calming the nervous system and promoting relaxation and healing.

Give it a try in your seat at work. Or come to Beyond Basics and visit me for a Pilates private!