Tag Archives: core strength

Elite PT Newsletter August 18′ – Running Injuries: Preventing Lower Back Pain

We’re continuing with our series on running injuries – this month focusing on how to prevent lower back pain.

But first:

I want to welcome our new PT student Charlie Crockatt

Charlie CrockattCharlie is in his third and final year of Grand Valley State University’s doctorate of physical therapy program, and is with us until October for hands-on clinical experience. He grew up in Livonia Michigan, playing football and baseball for the Stevenson Spartans. After high school he completed his undergraduate work at Central Michigan University, studying athletic training. After graduation from PT school, he is interested in working with athletic populations of all ages and hopes to travel outside of Michigan. In his free time, he enjoys the outdoors and also plays drums for an indie rock band called Birdie Country.

Charlie will be a great fit at Elite PT and will be here through October 5th.
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Running Injuries continued:  Preventing Lower Back Pain

Unfortunately lower back pain is a frequent problem for runners especially as distances increase.

As you’ve learned from our previous articles on running injuries, having good joint mobility and flexibility are very important for injury prevention.  When it comes to your lower back, the more mobile and flexible you are through the joints above and below – specifically ankles, hips, and thoracic spine – the better.

Another important consideration is core stability.  I prefer to use the term ‘stability’ over the more common term ‘strength’ because that’s really what we are after.  Stability, in this case, is the ability of the muscles of the trunk to maintain a safe position of the joints of the spine while you alternately swing your arms and legs to run.  In simpler terms:  to keep your lower back relatively still while the rest of you moves.

One of the best ways to train for stability is to use a variety of plank exercises to challenge the various muscle groups on the front, back, and sides of the trunk.  These are known as Bunke Planks and are pictured below:






Use a small box or chair approximately 12-18″ high (the higher it gets the easier it tends to get).

These exercises were introduced a few years back as a way of developing stability and endurance through the trunk muscles but also to compare how stable a runner was right to left.  Everything is done on one leg and compared to the opposite side.  Competitive runners should be able to hold each position 40 seconds at a minimum on each leg.  Asymmetries right to left (i.e. hold on left leg 40 seconds but only 25 seconds on the right) was thought to put runners at a substantially higher risk of injury.  Not being able to hold the full 40 seconds was not as big a deal but still thought to increase risk of injury.

So that’s the quick and dirty history of the Bunke Planks in one paragraph.  Competitive runners should be able to hold each plank 40 seconds on each leg in each position.  This can be very challenging, and very eye opening as some folks think they are quite ‘strong’ through their core until they try these!

For the rest of us, these planks can be very difficult and in some cases way to advanced.  Luckily there are a number of regressions possible that can be used to build up stability and endurance and maybe eventually work up to the full blown Bunke plank.

The easiest thing to do in some cases is just to do the plank in the pictures on both legs and work up to 40 seconds before trying to lift a leg.

From there alternate lifting legs up to 10 reps each leg.  You will only be holding a few seconds each leg before switching to the other.  If your on your side you would lift the top or bottom leg 10 time then switch sides.

The next step would be to start working in longer holds.

The shoulders can often be limiting factors in performing the Bunke planks – here are some regressions to take the shoulders out completely or at least to decrease the total amount of body weight you must hold up:

Hamstring Bridging

Single Leg Hamstring Bridge

Lift the tailbone but not the lower back!

 

 

 

 

 

 

Side Plank (from the knees)

Side Plank from knees

Hold the hips high and lift the top leg up and down

 

 

 

 

 

Front Planks (from the knees)

Kneeling Front Plank

Keep the hips high and back flat

 

 

 

 

If you have any questions at all or are suffering from lower back pain feel free to email me:  Joe@elitepttc.com

Keep running and stay healthy!

 

Joe Heiler

231 421-5805

Joe@elitepttc.com

Elite Sports Performance – 2018 Athletic Enhancement Programs

It’s nearly summer which means vacations, cookouts, and the beach.  It also means our Elite Sports Performance program is back – this is one of the few times during the year that students actually have a chance to work on maximizing their athletic abilities!

The emphasis of this program will be on the following:

–  Speed and Agility                                         – Proper Running Mechanics

–  Power Development                                   – Flexibility and Injury Prevention

–  Plyometrics (jump training)                        – Strength Training Basics

 

World renown strength coach Mike Boyle made this comment recently: “Between 9th and 12th grades, an athletes skill level in their respective sports will only improve around 10%.”  That’s not much when you think about it!

“What can improve significantly is their strength, speed, and power with the proper training – which will improve their sport skills exponentially”.

Elite Sports Performance Maria Blazejewski will be coaching again this summer.  This is her 5th year with us and she has been an intern strength coach at the University of Nevada-Las Vegas as well.  Maria plays professional basketball in Europe and helps with a number of basketball clinics and camps throughout Northern Michigan.

 

 Where – Elite Physical Therapy and Sports Performance

4177 Village Park Dr. Suite B, Traverse City (next to Wuerfel Park)

 

When – Mondays/Wednesdays (July 9th – August 1st)

9:30-10:45 am – Junior High girls

11:00-12:15 pm – High School girls

 

Registration – email Joe Heiler:  Joe@elitepttc.com to sign up or call the clinic at 231 421-5805.

Cost – $80.  Multiple athlete families: 1 full tuition then 50% discount per child after that.  Payment can be mailed to the clinic or taken over the phone.

 

This is a unique opportunity for athletes to make gains in speed, agility, and power over the summer months that will carry over to fall sports programs.  We’ve had great success with this program in the past, and look forward to working with more local athletes this year.

We will push you to become the best athlete you can be!

 

Thanks,

Joe Heiler/Maria Blazejewski

joe@elitepttc.com

(p)231 421-5805

Elite PT November Newsletter – What PT Should Look Like

Hi guys

Hope you’re having a great week so far!  It’s time for another monthly newsletter so here is what’s going on this month at Elite PT:

  • What High Quality PT Should Look Like (my rant for the month)
  • Manual Therapy – What Can It Do For You?
  • Exercise of the Month – Bird Dog for Lower Back Pain

What High Quality PT Should Look Like

This is my rant for the month.  Twice in the past week we’ve had patients come to us that have failed PT elsewhere and were pretty much ready to give up and ‘just live with it until they were talked into giving us a try by previous clients of ours.

In both cases these folks actually saw their PT’s only briefly then were passed off to the tech, were left to do their exercises on their own most of the time (since the therapist was busy with other patients), and received little to no manual (hands-on) therapy.

Needless to say the results were not what these folks were hoping they would be!

I know I’m tooting our own horn here and I don’t normally like to do this but it really bothers me when the PT factories out there give us smaller practices a bad name.  High quality physical therapy practices should look like this:

  • One-on-one treatment sessions
  • Working closely with a PT, PTA, or Athletic Trainer.  No Tech’s!
  • A healthy dose of hands on manual therapy when needed
  • Exercise is closely supervised by your therapist
  • You know exactly what you need to do at home to make the treatment process a success

At Elite PT, we guarantee all of the above.  If you’re going to spend your hard earned money on physical therapy services then it should be somewhere where the focus is on YOU!

I feel better now.  Thanks for listening!

Manual Therapy – What can it do for you?

Manual therapy can be described simply as hands-on therapy.  Most patients are familiar with massage but there are many beneficial techniques to decrease pain and improve mobility.  There are a number of hands-on techniques we use in addition to using instruments like Graston Technique and Dry Needling.

Exercises and stretching are great but often aren’t good enough to stand alone.  Manual therapies can quickly decrease pain and get you moving again much faster when combined with exercise.

Case in point:  One of our clients,struggling elsewhere, came to us with a very stiff and painful ankle post-surgery.  He was very limited with his motion which was making it difficult to walk and do stairs.  He reported only one session of light massage in his previous 3 weeks of physical therapy and the rest of the time was spent working on stretching and balancing.

Check out the picture below to see how much ankle bend (dorsiflexion) he had walking in the door on day 1:

Ankle Dorsiflexion

The knee is stuck 2″ behind the big toe!

Now check out how much ankle bend he had after one treatment session with us:

Ankle Dorsiflexion 2

The knee is a 1/2″ past the big toe now

He came back for his second visit reporting that pain was reduced significantly and he was walking much better.

This is just one example of how quickly things can change with a little focused hands on therapy and exercise with a purpose.

If you want to learn more about how we use Graston Technique (one of our favorite manual therapies) to treat the foot and ankle then click the link here:  https://youtu.be/Ah2ZUpMuUjk

Exercise of the Month – Bird Dog

The bird dog is a very popular PT exercise plus you’ll find it in a lot of Yoga and Pilates classes as well. It can be used to address strength and stability from the neck down through the hips but there are some very specific things that need to be done to make it truly effective.

Check out the video below to see how we get the most mileage out of a seemingly simple exercise (and another reason why your therapist needs to be working with you one-on-one).  The corrections in this video are specifically for those who are dealing with lower back pain but can also be used to enhance stiffness and strength through the muscles of the core.

https://youtu.be/BC7iSY9PtP4

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Have a great Thanksgiving and enjoy the rest of the month.  Talk to you in December!

Joe Heiler PT

Elite PT Newsletter August 2017 – solving lower back pain, free screenings, and more…

Hope you’ve been enjoying your summer!  We’ve got some great content covering lower back pain (plus a special offer) for you this month.

Here is what is in this month’s issue:

  • Solving lower back pain (this may sound familiar to a number of you)
  • Exercise tip of the month – fixing the ‘plank’
  • 6 years in business! Check out our special offer – its got something to do with back pain!

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“I Can’t Walk more than 10 Minutes!!!”

Sound familiar?

Last month we talked about one of the most common causes of lower back pain:  Spinal Stenosis.  Here is what that usually looks like:

  • 50 years and older
  • Standing and walking are limited
  • Sitting and/or lying down usually relieves symptoms

The title of this article is a direct quote from a frustrated client of ours at his initial evaluation.  He couldn’t stand or walk more than 10 minutes and it was really starting to effect his quality of life and ability to work around the house and yard.  We hear this stories like this one frequently and I’m sure there are a number of you reading this that are having this same experience.

In this case our client began having back pain with symptoms radiating into his hip and down the front of his left leg all the way to his big toe.  He wasn’t sure exactly how it started other than he was doing lots of walking that day.  By the time he came to see us he had been dealing with this pain for 6 months!  He fit the spinal stenosis category to a ‘T’:

  • over 50?  Check (70 years old)
  • limited standing and walking?  Check (10 minutes max)
  • sitting and/or lying down relieve symptoms?  Check

Our client participated in physical therapy for 8 visits over a 6 week time frame.  Treatment consisted of manual (hands on) treatment to decrease pain and relieve tone in the muscles of the lower back and hips as well as exercises to decrease his pain and improve the way he was moving and walking.

He is doing quite well now as he was able to walk around downtown Chicago a few weeks ago with only mild irritation in his leg (“not enough to stop me from having fun”).  He was also able to work outside for 4 hours the day prior to his last PT session without any pain.

Here is what he had to say: “I came in with numbness in my left leg from my groin all the way down to my foot that got worse any time I stood or walked.  I can do whatever I want now with only occasional numbness in my foot.  I thought for sure I was going to have surgery but now I’m doing my exercises to make sure this doesn’t ever come back.” – D.A. Traverse City

We’ve successfully treated numerous patients with similar symptoms over the years.  In fact we see more folks with lower back pain than any other diagnosis here at Elite PT.  Back pain can be severely debilitating but many times we can quickly decrease the pain and get you moving again with physical therapy.

Because of that, and as a way of saying “thanks” to you, our valued clients, I want to offer a free screen on August 24th to the first five former clients suffering from lower back pain.  If you fit the description above, call us now to get scheduled.  It’s only 30 minutes of your time but we’re confident we can get you started on the road to recovery.

The 24th of this month is also our 6th anniversary of being in business so I thought we’d do something fun.

Call 231 421-5805.  I guarantee this will fill up quickly so be sure to take advantage today!

PS – We’ve also been in business 6 years because of loyal clients like yourself referring family members and friends.  If you can think of someone this information might help, please share it with them!  I’d be happy to answer any questions they might have.  My email is joe@elitepttc.com or just call 231 421-5805.
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Exercise Tip of the Week

Planks are an extremely popular exercise but it is very often performed incorrectly.

front plank - hyperlordosis

Hint: your lower back shouldn’t arch that much!

I frequently ask patients and training clients where they feel like they are working the most… abs or  the lower back?

More than half the time they respond that they feel it more in their lower back!

I thought the plank was supposed to be an abdominal exercise?

Well it is when done correctly.  Watch the video below for a quick tutorial how to learn the proper positioning for the plank exercise and then how to immediately integrate that into the exercise itself for killer results.

https://youtu.be/gfadQYhckuQ

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Coming Soon:

  • We’re bringing a new PT on staff at the end of this month and we’re super excited to have her joining our team.  I’ll have more on Ms. Allie Hoyt in the next issue.
  • September 30th will be our first ever Lower Back Pain Workshop.  I’ll have more on this next month too but start thinking of loved ones suffering with lower back pain that may benefit from this.

Enjoy the rest of your month

Multi-Planar Single Leg Deadlift

The single leg deadlift is a staple exercise here at Elite Physical Therapy and can improve hip mobility, core and hip motor control, and also challenge balance.  Adding movement into other planes can also add value to an already excellent exercise.

Originally published on SportsRehabExpert.com by Greg Schaible
This is a great way to start exploring movement and introducing variability of motion once your typical single leg deadlift has been mastered. Start including these variations to develop better body awareness. It also can effectively be used as part of an athletes warmup.

  • Keep a soft knee and stay long through the torso
  • Torso should be in parallel with the ground

This doesn’t take the place of a progressive loading program with your standard single leg deadlift. Don’t forget the benefits that a progressive resistance program can have on tissue remodeling.

BIO

Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a Student Athlete. As an athlete he competed in both Indoor anGreg Schaibled Outdoor Track & Field where he earned honors as a 5x Division II All-American and a 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. In addition to his rehabilitation services, Greg has a passion for youth sports specific training. Follow On Track PT Performance on Facebook.

Bunke Plank Regressions

Joe Heiler PT

Originally posted on SportsRehabExpert.com

‘Core’ strengthening is always a popular topic so figured I’d highlight another set of exercises that we use here at Elite Physical Therapy and Sports Performance.

I’ve been playing around with the Bunke planks for awhile now as part of the discharge criteria for my runners and other select athletes.  It’s just one more way to gauge symmetry and in this case its looking at stability through the fascial lines of the body.  My only problem has been that the tests can be too difficult for larger athletes, older patients, and those with shoulder dysfunction so I needed to regress these planks a bit to allow all my athletes and patients a safer place to start and to give them a shot at being successful.

(Click the link below to check out the original Bunke plank series:  Bunkie Tests)

The goal of the Bunke Test is for the athlete to be able to hold each test position 40 seconds.  You’ll see in the videos below how I use some different positions to regress the planks, but you’ll also want to consider these other regressions within the positions:

–  hold the plank with both legs 40 seconds
–  perform leg lifts – either alternating or just with one leg depending on the type of plank
–  finally hold on one leg up to 40 seconds

Bunke Plank Variations – Knees

Bunke Plank Variations – Elevated

The hamstring planks can be modified by putting the forearms on a bench with the feet on the floor and then running through the progressions above.  If the shoulders are the problem, then we typically have to go to lying supine with feet up on a box or ball.

If you have any questions or want to get tested as part of our Annual Musculoskeletal Exam, just email joe@elitepttc.com or give us a call at 231 421-5805.

 

Dynamic Warm-up for Runners

I’ve made it a practice to have my PT students contribute to the Elite PT blog and SportsRehabExpert.com so without further delay this is my most recent student, and ridiculously good runner, Scott McKeel, demonstrating some of our favorite dynamic warm-up drills.  In this episode, Scott will hit on the upper body warm-ups and then in subsequent episodes we’ll work through lower body warm-ups, running technique, and ankle mobility drills.

Enjoy!

Elite PT Exercise of the Week – Landmine Front Squat to Press

Joe Heiler PT and Nick Lucius SPT

At Elite Physical Therapy and Sports Performance we’re always looking for new ways to challenge our patients and athletes.  The landmine squat to press is one of those exercises that can be used to really stress the entire system without having to utilize a lot of loading so it fits in nicely in higher level rehab and during the training process.

Reasons to use this squat variation include:

1)  Having the weight in front allows the athlete to sit deeper into the squat with a more upright trunk which is great for those dealing with, or recovering from, low back pain.

2)  Keeping both hands on the bar keeps things more symmetrical with the squatting and pressing movement.  Stability requirements are increased with the use of this exercise but are balanced right to left.

3)  Hold the bar in one hand for an asymmetrical loading pattern.  This will load the body differently demanding greater stability throughout the movement.  This is a more advanced technique so 2 hands on the bar to begin.

Technique:

1)  Do not squat lower than your mobility allows!  The weight in front often allows for a deeper movement but do not let the pelvis tuck under and low back to round out.

2)  Heels must stay flat on the floor.

3)  Elbows between the knees (this keeps the knees wide).

4)  When using the asymmetrical single arm loading pattern, you must keep the body centrally aligned – no shifting, leaning, etc.

Give this one a shot and you’ll see what we mean!

BIO

Nick Lucius PicNick Lucius SPT is completing his final year in the physical therapy program at UM-Flint.  Nick is a certified strength and conditioning specialist (CSCS) through the National Strength and Conditioning Association (NSCA), and also works as a strength coach at Barwis Method in Plymouth, MI.  After graduation Nick plans on returning to Barwis Method to work with patients affected by orthopedic and neurological conditions.

Nick played Linebacker at Grand Valley State University in his undergraduate days, and now enjoys anything active from running to weight training, and is always going through a good book.

 

 

 

 

 

Go to the Ground to Improve Your Strength and Mobility

Nick Lucius SPT, CSCS

If you were to ask anyone what constitutes someone as “strong,” most would think of the man squatting 800 pounds or the 225 bench press test. While these are great measures of raw strength, they do not paint the full picture of that individual’s ability to move in a dynamic and fluid fashion. Far too often we get stuck on the “big lifts,” including the bench press, squat, deadlift, and countless shoulder/arm workouts. While the classic strength training movements are effective and involve a great degree of motor recruitment, it does not provide a dynamic environment to make mistakes and learn better movement. If you have eight hundred pounds on your back, the room for error is small. If you are un-weighted and performing dynamic movements, a mistake is relatively pain-free and it provides you with ample information to correct the movement.   You have to move wrong in order to find out what is right.

A book I would recommend to anyone looking to improve their quality of training or to challenge their ability to move better is Original Strength by Tim Anderson. In this book he completely re-vamps the standard belief of strength, trading the bench press for rolling patterns and a heavy squat for a crawling progression. This is not to say however that you should not participate in more traditional strengthening movements. If anything these crawling movements will amplify your training, if done responsibly.

Below is a short video describing some basic progressions of the crawling pattern. In the clinic I love to incorporate these movements for patients of all physical impairments. It’s an incredibly challenging movement that can go great as a recovery day during your training week or in combination between your sets of standard lifts. In the video I begin by demonstrating the prone crawl, which will resemble the “army crawl” that some may have done in gym class. Remember how easy it was back then?

The second progression is the forearm bear crawl. Cues I keep in mind while coaching this movement is to keep your forearms at a 45 degree angle to mimic a child crawling and to maintain a slight posterior pelvic tilt throughout the exercise. A posterior pelvic tilt is best described as “tucking your butt”.   This provides a stable thoracic spine and pelvis, improving our quality to complete the movement without too much side-to-side sway.

The final progression is a full crawl. In this movement the goal is to stay as low to the ground as possible while bringing each leg forward. This crawling progression definitely tests your hip mobility and trunk motor control. Once you feel comfortable with a crawling movement forward, begin to incorporate backwards and side crawls. Maintain the same positioning and reverse your movements. This is testing not only mentally, but I can promise you it will challenge you physically.

As with any movement, if you feel any pain or instability it is recommended to consult a Physical Therapist for conservative musculoskeletal care. In the state of Michigan we now have direct access, meaning that you are able to directly seek a Physical Therapist for any musculoskeletal pain/deficit. Check with your insurance provider if your plan covers the direct access Physical Therapy Evaluation and subsequent treatment.

Thank you for reading and Nick Lucius Picgood luck!

BIO

Nick Lucius SPT is completing his final year in the physical therapy program at UM-Flint.  Nick is a certified strength and conditioning specialist (CSCS) through the National Strength and Conditioning Association (NSCA), and also works as a strength coach at Barwis Method in Plymouth, MI.  After graduation Nick plans on returning to Barwis Method to work with patients affected by orthopedic and neurological conditions.

Nick played Linebacker at Grand Valley State University in his undergraduate days, and now enjoys anything active from running to weight training, and is always going through a good book.

 

Exercise of the Week – Single Leg Row

At Elite Physical Therapy and Sports Performance in Traverse City we are always pushing to find new ways to challenge our patients and athletes especially when recovering from an injury or surgery.

So to follow up on last week’s EOW post, the single leg row is another option to bring the lower quarter into play, along with core control, to a traditional upper body exercise.

 

Couple examples of where I would use this type of movement:

1) Athlete with a lower quarter injury, i.e. ACL reconstruction, to integrate balance and hip/trunk motor control with a traditional upper body exercise.

2)  Athlete with a shoulder injury/surgery not allowed to fully load the shoulder, can only do so much weight with an activity like this but still get some good work due to the overall demands on the body.  I’m sure there are many athletes that could easily barbell row 3-4x what they could single arm row.