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

foot

By, Amy Stein, DPT and Fiona McMahon, DPT

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

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

Things we look at

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

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

Spring Pelvic Health 101 is Coming

Fiona McMahon, DPT, PT

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

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

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

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Fiona McMahon, DPT.

 

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

Heat

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

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

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

 

Safety Considerations for Heat:

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

 

Cold

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

 

Safety Considerations for Cold:

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

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

BBPT Health Tip: Seated Hamstring Stretch

Fiona McMahon DPT, PT

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Fenitra Fuchs, of BBPT shows the correct way to perform this stretch. Notice how she doesn’t curve her back forward in order to perform the stretch

Seated Hamstrings Stretch

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

Why seated you ask? In selecting this stretch over other hamstrings stretches, I wanted to pick something that most everyone can be able to do. This stretch is particularly beneficial for those of you who have difficulty getting on and off the floor. Although if you do have difficulty getting off of the floor, it is important to go to physical therapy and get the training to do so, as being able to independently get up off the floor is imperative for maintaining independent function as you age.  Another point: if you have any sciatic pain or sitting pain, please seek a physical therapist before attempting this stretch.  

Muscles involved: Hamstrings, gastroc soleus complex ( your calf) and to some extent your sciatic nerve

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

Caution: It is possible to overdo it. Stop the stretch or ease up if you feel tingling in your legs or pain in your low back.

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

 

Directions:  Sitting in a sturdy chair, ( don’t do this on a rolly stool or office chair, please!). Straighten knee of leg to be stretched and point toes up. Lean forward at the hips until you feel a gentle stretch in the back of your leg. Don’t round your back. Keep in mind, for those of us with tight hamstrings, you will feel the stretch without too much of a forward bend.  So take it slow!

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Fenitra demonstrates a straight knee and pointed toe while performing her stretch

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Fenitra demonstrates this stretch

BBPT Health Tips: Let’s Roll!

Fiona McMahon DPT,

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

First of choose your weapon…. I mean roller.

 

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

white-foam-roller

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

 

 

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

 

 

 

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

 

The Stick and other hand rollers:

 

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

Other Rollers:

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

 

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

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

 

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Quad rolling

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Hamstring rolling

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Back rolling

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Adductor rolling with stick

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