Tag Archives: Elite Physical Therapy Traverse City

Elite PT March 2018 Newsletter – Curing Headaches and Migraines

Hi Everyone

Hope you’re surviving the prolonged winter.  Luckily spring is right around the corner – I hope!

Kristy and I recently drove out to Appleton, Wisconsin to take an advanced Functional Dry Needling course with Edo Zylstra from Kinetacore.  Edo is one of the top dry needling educators in the United States – THE best in my opinion plus he’s from Michigan so that has to count for something.

Anyway, we learned how to dry needle some of the more difficult to reach muscles plus how to treat more challenging conditions including headaches and migraines.  We’ve been treating headaches and migraines all along but we’ve definitely picked up some new techniques that will only help with more tougher cases.

Unfortunately I didn’t get any cool pictures this time as Kristy and I were too busy sticking needles in one another 10 hours per day.

Headaches/Migraines

Here are some scary stats:

In the U.S., more than 37 million people suffer from migraines. Some migraine studies estimate that 13 percent of adults in the U.S. population have migraines, and 2-3 million migraine suffers are chronic.

Almost 5 million in the U.S. experience at least one migraine attack per month, while more than 11 million people blame migraines for causing moderate to severe disability.

Migraines and headaches can have multiple causes, some of which are not well understood, but one of the most common causes is referred pain from muscles that have attachments to the head and neck.  I personally think this is very often overlooked by medical professionals as its usually easier to just prescribe drugs to cover up the pain.

Check out the pictures below showing some of the main culprits (muscles) and their referral patterns:

Upper Trapezius 
Upper Trapezius Headaches

Suboccipitals

Suboccipital Headaches

Sternocleidomastoid (SCM)
Sternocleidomastoid Headaches

These are all fairly superficial muscles that are easily treated with a number of manual therapy techniques although I do find dry needling works the quickest and the results are longer lasting.  There have been plenty of cases where a client walked in the door with a headache and left without one.

Case 1
This patient was rear ended 3 years ago resulting in severe headaches (9 out of 10 on the pain scale) 2-3x per week.  Chiropractic and physical therapy in the past gave him short term relief of his neck and back pain but didn’t help his headaches.

At the first visit we dry needled the upper trapezius muscles on both sides and over the course of the next week the intensity of his headaches decreased from a 9/10 to 2/10.

Visits 2-4 included the same treatment to the upper traps plus we hit a few of the upper back muscles (not shown above).  The patient reported no headaches at all after the 4th treatment as well as no longer having neck or upper back pain.

Follow up via phone 2 months after the last visit the patient indicated he was still pain free and had no further headaches.

Case 2

This patient had headaches so painful and frequent that she had to have an MRI/CT scan of her head to rule out serious pathology.  Luckily they didn’t find anything but we did find active trigger points in her upper trapezius and suboccipital muscles that referred pain directly into her head (basically the same patterns as you saw in the pictures earlier).

We dry needled her upper trap and suboccipital muscles 3x over a 2 week period.  Over the course of the following two weeks she had one headache that lasted 5 minutes.

Dry needling was performed only once more and following up three weeks later she had remained symptom free.

___________________________________________________________

These are just two cases recently with very successful outcomes, especially considering the chronic nature of each plus all the other treatments they had been through.

I can’t guarantee that every headache or migraine has a ‘muscular’ cause, but it’s not really that hard to tell during a physical therapy evaluation if that is indeed the case.  We can apply pressure, or just squeeze the muscle, and it will often refer straight to the head.  If that’s the case then that muscle is implicated and needs to be treated.

As you can see in both cases above the results were almost immediate.  One nice thing about dry needling is that is doesn’t take more than a couple sessions to see results.  We can often get good outcomes with other manual techniques as well but in my opinion dry needling usually works the fastest and is longer lasting.

If you’d like to see a quick demo on dry needling, check out the video on our homepage here:  http://www.elitepttc.com/  The subject in the video is actually my dad.  He had intense ‘ram’s horn headaches’ that wrapped around the side of his head – which is typical of the upper trapezius trigger points.

Hope that was some helpful information.  If you suffer from chronic headaches or migraines please contact us with any questions (231 421-5805).

Have a great finish to March!

Joe Heiler PT

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

_________________________________________________________________

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

Joe Heiler PT

Occlusion Cuff

Blood Flow Restriction Training

Blood Flow Restriction training, aka BFR, has actually been around for awhile now but its finally starting to make its way into professional and collegiate sports as well as physical therapy.  Johnny Owens has been the driving force behind BFR in the U.S. after successfully using this technology with veterans recovering from devastating combat injuries.  Since that time he’s been training numerous professional sports teams in the use of blood flow restriction training including the Detroit Lions and Detroit Red Wings.

What the heck is it?

BFR training utilizes a tourniquet-like device which is placed proximally on a limb to limit arterial inflow to the limb while blocking venous outflow.

I should add a word of warning sooner rather than later.  There are commercial devices out there used by trained professionals for this type of training.  Do not make your own tourniquet and try this at home!

Benefits

I’m going to go a bit scientific on you here but just for a moment:

  • Training loads used are only 20-35% of 1 rep max, and often times are just body weight.  The same effects with weight lifting alone must be at least 70 – 85%.  Translation:  same results with less load = happier joints.
  • Higher release of growth hormone, insulin-like growth factor, and other substances known to speed tissue repair and create a positive environment for muscle hypertrophy.
  • Increased recruitment of Type II (fast-twitch) muscle fibers even with sub maximal loads
  • Increased muscle protein synthesis through the inhibition of catabolic substances.
  • Cell swelling : shift in fluid balance into the muscle cell creating a protective response to adapt and grow

Check out the chart below from Dr. Mario Novo at the LiftersClinic.com

LiftersClinic.com

Pretty cool stuff isn’t it?  Even with all the science thrown in.

How do you use it?

We work it into our rehab and training sessions closer to the end of the workout.  The build up of lactic acid will reproduce the ‘muscle burn’ sensation pretty quick causing a good amount of muscle fatigue with only body weight activities.  Body weight squats are usually a great place to start.  They are performed for 30 reps:15 reps:15reps:15 reps with 30 seconds between each set.  These will be the toughest body weight squats you’ve ever done!

The number of exercises performed and time training with blood flow restriction is gradually increased.  So far we’ve seen a rapid increase in tolerance to exercise among our athletes allowing them to do more and more work with BFR.  The results have been excellent too with quicker gains in muscle hypertrophy and strength.  If you notice the last column in the chart above – time to adaptation.  Within 2 weeks we are beginning to see positive changes compared to the traditional higher intensity training.

It might sound like I’m down playing the effects of higher intensity training regimens but I’m not at all.  There are tremendous benefits to lifting heavy and creating a great base level of strength.  BFR just offers a great way to increase training volume and intensity while decreasing load.  Over time the heavy weights will wear down your body – ask any collegiate or NFL football player – but this allows for a certain amount of unloading to happen and still reap all the benefits.

I know you want to try it!

Blood flow restriction training is safe when used with the right person at the right time and monitored appropriately.  It is also a pretty intense workout so definitely not for the faint of heart.

We are currently using BFR with athletes and patients post-knee injury, hamstring injuries, shoulder injuries, ankle sprains, and more.  Athletes that come in strictly to train have been having great success with it as well.  If you’ve struggled to make progress as a patient or hit a plateau in your training this would definitely be worth asking about.  We have a number of unique techniques to promote tissue healing and strength/power gains, and this is just one reason we have been setting ourselves apart from the competition!

Occlusion Cuff Shoulder

If you’re really into the science behind blood flow restriction training and would like to learn more, you can check out the two podcasts with Eoin Cremen (creator of the OcclusionCuff) on SportsRehabExpert.com

Questions?  Joe@eliteptt.com or give me a call at 231 421-5805

Dry Needling for Hip and Knee Pain

At Elite Physical Therapy and Sports Performance we strive to find new and innovative ways to treat pain and get you moving again.  Dry needling has been one on my go-to treatments for the past 3 years now, and the method I’m going to show you today works wonders for hip and knee pain.

The Vastus Lateralis (VL) is one of the four muscles that make up your quadricep and is the most lateral.  Trigger points in this muscle will often refer pain to the lateral knee.  Check out the photo below of the VL and corresponding trigger point referral patterns.

Vastus Lateralis Trigger Points

Even without active trigger points, the VL is often in a state of high tone which can significantly limit hip mobility in certain directions.  With it’s attachment all along the IT band, it can also create greater stress on the knee joint through that IT band.

In the video you’ll see the limitations in our patients hip adduction (her knee should hit the table when I try to lower the leg across midline).  Her right hip does this easily.  This is a fairly standard PT test, known as the Ober test in most circles.  In the video you’ll see how dramatically dry needling the Vastus Lateralis with a few minutes of muscle stimulation can change her hip mobility.

Just a quick note on the video.  This was originally created for my SportsRehabExpert.com website which is read by other PT’s, Athletic Trainers, Chiropractors, etc.  Sorry for all the medical talk but you’ll get the idea with the huge change in range of motion following the dry needling treatment.

Here are some of the common diagnoses you’ll hear from your doctor that will respond well to dry needling:

  • IT Band Syndrome
  • Runner’s Knee (distal IT band syndrome)
  • Patello-Femoral Pain Syndrome/Patellar Mal-Tracking
  • Hip Bursitis

There are many other ‘diagnoses’ that can benefit from improved hip mobility but those above are what we would see most frequently.  For those that are needle-phobic, we can get similar results using Graston Technique and other manual therapy techniques, it’s just often not quite as dramatic.

There are also a number of specialized motor control and strengthening exercises that need to be used following this treatment to maintain this new mobility.  Just because she can move her hip now on the table doesn’t necessarily mean its going to move that well when she is standing, walking, or running.  Strength must also be established in that new range.

Hope that was helpful to see plus you get a bit of a glimpse at what we do here at Elite Physical Therapy and Sports Performance.

Big thanks to our Athletic Trainer, Lydia Case, for being our ‘patient’!

Advanced Kettlebell Carries

We love kettlebell carries here at Elite Physical Therapy and Sports Performance as they have numerous benefits to our patients and athletes including:

  • improved shoulder girdle and trunk stability
  • increased grip strength
  • improved core control and strength

My current PT student, Mitch Babcock, has brought some new ideas to the table to make our carries even more challenging as far as the stability demands go so thought I’d share those with you.

Check out the videos here:  http://www.sportsrehabexpert.com/public/1181.cfm?sd=2

Bio

Mitch Babcock Kettlebell CarriesMitch Babcock SPT is a final year Doctor of Physical Therapy candidate from the University of Michigan — Flint. Mitch received his Bachelor’s Degree from Saginaw Valley State University in Mitch BabcockExercise Science and pursued his passion for movement and exercise to the graduate level. Mitch is certified in the Selective Functional Movement Assessment (SFMA) and the Functional Movement Screen (FMS), as well as a RockTape FMT Level II professional. He has also spent time with clinical rotations in a manual-based orthopedic clinic in mid-Michigan, a sports clinic in Charlotte, NC, and an outpatient neurological rehabilitation clinic in mid-Michigan. With a passion for full human optimization, Mitch is ready to help you get moving, get out of pain, and get back in the game.

Vastus Medialis Obliquus Muscle (VMO) “Isolation” Exercises Fact or Myth?

At Elite Physical Therapy and Sports Performance we take pride in the fact the we are well ahead of the curve with out treatment techniques compared to the rest of the traditional PT world, but we also acknowledge that it is important to use evidence based treatment techniques.

Evidence based practice is the buzz word in PT circles but despite this strengthening/isolating the VMO continues to be utilized as a way to decrease knee pain and improve function.   PT’s and physicians alike continue to prescribe strengthening for the VMO muscle of the quadriceps group even though the research has proven this concept to be faulty and ineffective.

This short article was written by a couple PT friends of mine in New York (one of which is in the PT and Strength and Conditioning Halls of Fame!) showing once and for all that you can not isolate the VMO, nor should you bother trying when it comes to solving knee pain.

Enjoy!

Originally posted on SportsRehabExpert.com

Robert A. Panariello MS, PT, ATC, CSCS
Timothy J. Stump MS, PT, CSCS, USAW

Professional Physical Therapy
Professional Athletic Performance Center
New York, New York

Patellofemoral pathology is a fairly common condition observed in clinical setting. The treatment philosophy of some rehabilitation professionals to resolve this painful condition may include the prescription of exercises in the attempt to isolate the Vastus Medialis Obliquus muscle (VMO). Although this VMO exercise isolation “myth” has been negated at least 20 years ago (1, 2) it continues to presently endure.  During this attempt to isolate VMO activity, some designated exercises executed include but are not limited to the following:

  • Quad sets
  • Terminal open chain knee extension exercises
  • Straight leg raises (SLR) with external rotation of the lower extremity

These exercises may or may not be performed with the adjunct application of electric stimulation.

Although these exercises will enhance the strength of the quadriceps muscles, likely assisting in resolving the patient’s knee pathology, this is not due to isolation of the VMO. The case some clinicians formulate for the performance of SLR with external rotation is based on the false premise that by externally rotating the femur will result in further activation of the VMO.

The knee is a hinge joint and during the execution of a SLR, the force of gravity will act in a perpendicular manner between the knee and ground surface. The quadriceps mechanism will now be required to resist the resultant force attempting to flex the knee as this is the only contractile soft tissue structure that is capable of resisting that force.  The quadriceps mechanism like any other dynamic structure can only resist this external force via the neural activation of the muscle group.  The external rotation of the femur gives rise to the placement of stress on medial collateral ligament (MCL), a static stabilizer of the knee.  This treatment philosophy actually removes stress from the very muscle(s) the clinician is attempting to enhance.  As an example a patient with a diagnosis of polio, a condition affecting the anterior horn of the femoral nerve or a patient with a quadriceps tendon rupture can still perform a SLR when externally rotating their femur based on the static stabilizing properties of the MCL.  Therefore one may inquire why would a clinician who is attempting to activate and enhance the quadriceps muscle group perform the SLR exercise in external rotation.

The anatomy and neuroanatomy of the quadriceps muscle group

The quadriceps muscle group is comprised of the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. The vastus medialis (VM) is located at the medial aspect of this muscle group and has been reported to consist of two separate components, the proximal vastus medialis longus (VML) and the distal vastus medialis obliquus (VMO) (4). The neuroanatomy of the quadriceps muscle complex reveals an innervation from the femoral nerve.  The femoral nerve is comprised of large motor units that innervate all four heads of the quadriceps without individual fine motor unit innervation of the separate muscle heads.  Therefore, since the VMO does not have a distinct and separate nerve innervation, it is not possible to “isolate” this muscle from the other quadriceps muscles via a specific exercise performance. The most beneficial way to enhance the VMO is to incorporate the same exercise philosophy used to improve any other muscle or muscle group, the application of unaccustomed stress. The application of unaccustomed yet safe levels of stress is simply known as the “overload principle”. This may be accomplished in two ways; expose the patient to higher levels of unaccustomed resistance or overload them by increasing the velocity of the movement. Both methods will result in a positive adaption of the entire quadriceps muscle group.

Since stress transpires throughout the kinetic chain of the lower extremity during the performance of ADL’s as well as athletic endeavors, the activities prescribed for patellofemoral pathology should also include exercises for both the hip and ankle. “Critical thinking” is a requirement for the approach to the patient’s optimal exercise selection and treatment design. The health care professional’s obligation to provide optimal treatment does not include the application of myths during the patient’s plan of care.

References

1. Cerny K “Vastus medialis oblique/vastus lateralis muscle activity ratios for selected exercises in persons with and without patellofemoral pain syndrome”, Phys Ther (8):672-83, 1995
2. Malone T, Davies G, Walsh WM, “Muscular control of the patella” Clin Sports Med 21(3); 349-362, 2002.
3. Hubbard JK, Sampson HW, Elledge JR, “The Vastus Medialis Oblique Muscle and Its Relationship to Patellofemoral Joint Deterioration in Human Cadavers”, J Ortho Sports Phys Ther 28(6):384-391, 1998.
4. Weinstabl R, Scharf W, and Firbas W, “The extensor apparatus of the knee joint and its peripheral vasti: anatomic investigation and clinical relevance”, Surg and Radiological Anat  11(2): 17-22, 1989

Robert A. Panariello MS, PT, ATC, CSCS
Rob Panariello PicRob is a Founding Partner and Chief Clinical Officer with Professional Physical Therapy presently with 44 facilities in the New York and New Jersey Metro areas and the Professional Athletic Performance Center located in Garden City, New York. He has Bachelor Degrees in Physical Therapy and Physical Education/Athletic Training from Ithaca College in Ithaca, NY. He also holds his Master’s Degree in Exercise Physiology from Queens College in Queens, NY.

Rob has more than 30 years of experience in the related fields of Sports Physical Therapy, Athletic Training, and the Performance Training of Athletes. His experience includes the study of the Science of Strength and Conditioning of weightlifters and various sport athletes in Bulgaria, the former Soviet Union, and former East Germany. He previously held the positions as the Head Strength and Conditioning Coach at St. John’s University of New York (1986-1995), the World League of American Football NY/NJ Knights (1991), and the WUSA NY POWER Women’s Professional Soccer League (2001-2002). He continues to rehabilitate, athletic performance train, as well as serve as a consultant to many NFL, NBA, MLB, NHL, Collegiate and University teams, coaches, and players.

Rob has more than 60 peer reviewed Orthopedic and Sports Medicine Research, Sports Physical Therapy Research, and Strength and Conditioning Journal Articles and Book Chapter publications. He has also presented his research at the International World Confederation of Physical Therapy in Washington, D.C. He is nationally renowned and lectures throughout the country with regard to the related fields of Sports Physical Therapy and the Performance Training of Athletes.

Rob received the 2015 APTA Sports Physical Therapy Section Lynn Wallace Award for Excellence in Clinical Education, the prestigious National Strength and Conditioning Association’s Presidents Award in 1998 and was elected to the USA Strength and Conditioning Coaches Hall of Fame in 2003.

Tim StumpTimothy J. Stump is a partner with Professional Physical Therapy, and is also a founding partner with the Professional Athletic Performance Center. He  has more than 20 years of experience in the related fields of Orthopedic and Sports Physical Therapy, Strength & Conditioning, and Performance Training of Athletes of all levels of competition. Tim’s experience includes the successful participation as a nationally ranked competitive strength athlete in the sports of Powerlifting and Weightlifting from 1990-2010. He continues to actively participate in these sports as a coach and mentor to many athletes.

Tim has published several peer-reviewed original research articles and has presented his research at the APTA National Conference and at CSM. Tim was also awarded the Jacob & Valeria Langeloth Foundation research grant for studies on ACL functional outcomes while employed at the Hospital for Special Surgery. Tim was the 2012 recipient of Columbia University’s Award for “Leadership in Clinical Education” and co-chairs Professional’s Clinical Affiliation Program with over 64 school contracts providing PT, PTA, ATC and Exercise Physiology students with quality clinical affiliation experiences.

Barefoot or not Barefoot… That is the Question

Originally posted on SportsRehabExpert.com

Andy Barker PT

Barefoot training has taken off in recent years. Whether in the gym or out on a track or field, the number of people training barefoot has increased. But why? This post will look at the benefits of barefoot training and in addition the importance of foot position when training.

Barefoot training

As the name suggests barefoot training involves wearing no footwear. This could be to lift weights in the gym or indeed used for running training. There has been many a discussion in the training community as to the advantages and disadvantages of such training, although there isn’t much decent clinical evidence on whether this type of training is beneficial or not.

Why use barefoot training?

Having bare feet ultimately is going to give you and your body a heightened level of body awareness due to increased contact with the floor. This can be
advantageous in many ways especially in drills involving foot and ankle mobility
and stability. A great example would be the use of an ankle mobilisation. I would always conduct such exercises involving the foot and ankle in a barefoot state.

Stick Ankle Mobilization

I like conducting such drills like this as you can feel the movement better in this position and in addition, if I was teaching such a movement I can actual see and feel what is happening which might not be as apparent in a training shoe.

I also at times like athletes and clients to lift, i.e. squat and deadlift variations in barefeet. In addition to the reasons mentioned above, for some, being in a barefoot position enables the foot to generate more torque and have a greater influence on knee and hip position during lower limb movement.

For example, in a barefoot stance an athlete is more easily able to generate a
lateral directed force from the foot into the ground prior to a squat. This can be cued by asking the athlete to try turn the feet outwards without the feet actually moving. That torque created enables stiffness through the foot and ankle creating a stable platform to lift and in addition pull the foot out of a position of pronation. This cue has been particularly useful for those athletes that excessively pronate. Getting out of excessive pronation also benefits the knee and hip by preventing possible knee valgus and hip internal rotation stress respectively which are detrimental to knee and hip health and movement quality.

Tripod stance

Regardless of what lift or activity that is being produced, be it a squat, deadlift or running the aim is generally to gain a neutral foot position. Having equal amounts of weight distribution between to foot is key to being able to create a stable foot position or ‘tripod stance.’

A successful tripod stance position would involve equal distribution of weight
between the three points of;

  • Base 5th metatarsal
  • Calcaneus
  • Base 1st metatarsal

If weight can be distributed evenly between these three points then the foot is
likely to favour a neutral foot position and in addition will provide a stable
platform for movement.

Tripod Foot Position

Therefore in my opinion the reason for opting to go barefoot or not isn’t the
main issue. The question is with what footwear type or barefoot style
stance will enable you to get into a neutral foot position or tripod stance. This will differ between individuals.

Getting that tripod stance is the key. As a result it doesn’t really matter what’s on your feet if anything as long as we maximise and make use of a good solid foot and ankle position for movement.

Examples

The type of activity the person is partaking will be a major determinant of
what to use in addition to the ability to gain a stable foot and ankle position to carry out such an activity.

To use myself as an example of three different activities in with I will alter what I wear on my feet. The activities include:

1. Squatting in the gym</br>
2. General wear (at work, walking, and general daily activities)</br>
3. Road running

#1

Regarding squatting in the gym I lift barefoot. The reason for doing this is that I feel that I can use the floor and my foot position to gain a strong stable base of support prior to lifting. I am able to feel the floor and use it to my advantage. By almost screwing my feet into external rotation, without actually moving my feet, I can generate torque through the floor, bringing my feet out of a position of relative pronation and thus at the same time preventing knee valgus and hip internal rotation. In addition, I feel I can sit through my hips better and in doing so I am in a stronger position and as a result can shift more weight.

#2

Conversely, I tend to wear barefoot training shoes for general activites throughout the day. I have a pathological right ankle which needs regular rehab predominately through ankle mobility drills. I have found that wearing a barefoot training shoe has enabled me to maintain my ankle range of movement in comparison to before I started wearing barefoot style shoes. This is ultimately because I am using/maximising the range at my ankles even during everyday activites and thus complements my ankle mobility rehab.

#3

Finally, for road running, I feel more comfortable in a neutral training/running shoe as opposed to a barefoot shoe. I feel as though the additional support and cushioning of the shoe provides a better and more comfortable run and therefore I use such a shoe to run. In theory a barefoot shoe might seem more advantageous given my ankle pathology however this has not proved to be in case in my example.

Conclusion

To bring it all together, using I as an example, it is clear that different
activities require different footwear types. As athletes, weekend warriors or
practitioners we should be aware of the fact that differing activities require
different provisions and going one way or the other, being anti-barefoot or pro-barefoot, is maybe not the way to do it. Maybe being aware that different
circumstances require different training equipment is the way to go and adapting
our approach in that way.

Hope this has been of interest. Any questions just post them in the discussion forum.

Thanks for reading

BIO

Andy is the current head physiotherapist for the Leeds Rhinos first team squad and has been involved with the club for the past six seasons.

He graduated in Physiotherapy from the University of Bradford with a first class honours degree which followed on from a previous Bachelor of Science degree from Leeds Metropolitan University in Sports Performance Coaching.

Andy currently works privately in addition to his sporting work and has also previous experience within National League basketball and professional golf.

Andy has a keen interest in injury prevention and the biomechanics of movement in which he is continuing his studies with the start of a MSc degree later this year in Sports and Exercise Biomechanics.

Andy is also the creator and author of rehabroom.co.uk. RehabRoom is a free    online rehab resource site aimed at but not exclusive to physiotherapists, strength and conditioning coaches and personal trainers. To visit the site please click the link:  http://www.rehabroom.co.uk

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.

2015 Sports Rehab to Sports Performance Teleseminar

In addition to owning Elite Physical Therapy and Sports Performance, I’ve also had the blessing to run the sports physical therapy website SportsRehabExpert.com.

It’s a site for physical therapists, chiropractors, strength coaches and others in those industries to learn from some of the best in the business.  Every year I run a teleseminar series where I interview 10 of the best clinicians and strength coaches in the world, and then post those interviews online for free.  A number of these interviews may appeal to you readers of this blog whether you are in the health care or training industries or not.

Here is this year’s list of speakers and topics:

Charlie Weingroff – Motor skill acquisition and long term athletic development, movement competency, and high performance programs

Donald Chu – The foremost authority on plyometric training discusses potential benefits, progressions, injury prevention, and more

Derek Hansen – Speed development qualities, hamstring injury mechanics and running rehab, front side vs. back side mechanics

Mike Cantrell – Exploring the mechanics behind sports hernia, FAI, and shoulder impingement through the PRI lens.

Rob Panariello – Single limb vs. bilateral training, Olympic lifts during performance training and rehab

Phil Plisky – Injury risk/prevention research, the state of current prevention programs, UE stability testing, and what’s new with the SFMA.

Gary Gray – Applied Functional Science (AFS) and it’s principles, functional soft tissue transformation, and functional movement screening systems

Linda Joy Lee – Thoracic Rings Approach and the Integrated Systems Model, finding the meaningful task and primary driver

Sarah MottramKinetic Control system, understanding the biomechanics of normal and abnormal function, and motor control retraining of uncontrolled movement

Chris and Jennifer Poulin – PRI principles in sports performance and injury prevention programs

Some of the topics can get quite complex but I’m sure there are certain interviews that will interest you whether you’re looking to get faster, stronger, or just get healthy!

The link to the sign up page is here:  http://www.sportsrehabexpert.com/public/982.cfm.  You’ll also find a more detailed explanation of each topic plus more info on each speaker.

Check it out and I’m sure you’ll pick up some tips that will bring you closer to your goals.

Joe Heiler PT

joe@elitepttc.com

 

 

Shoulder Pain Prevention – Should You Even Be Lifting Overhead?

This article was originally posted on SportsRehabExpert.com by Andy Barker – head physiotherapist for Leeds Rhinos Rugby team in the U.K. This article is about preventing shoulder pain, but also would fit right in with our series on preventing back pain.  Cheating with the spine to create more shoulder mobility is a great way to get hurt. 

In this article, Andy shows a great way to assess shoulder mobility with the spine locked out of the equation.  Enjoy!

by Andy Barker PT

A great quick and easy test to use to clear overhead lifting in rehab/training. Begin seated on the floor, tuck your thumb into your hand, keeping your elbows straight and lower back and head against the wall take your arms overhead to touch the wall behind you.

From this video you can clearly see the subject is able to touch the wall whilst being able to keep the head and lower back in contact with the wall. As a result this would constitute a pass and as a result the subject would be cleared to lift overhead in the gym.

A fail would include inability to touch the wall overhead and/or any visible compensation (usually lumbar extension) needed to allow increased shoulder flexion to occur.

 

I wrote a similar article on wall posture shoulder mobility exercises here:  http://www.elitepttc.com/blog/?p=362.  These are standing exercises meant to address deficiencies in the test above, but they may be a challenge to start with.  Probably should use a supine version like the one below first.  Once your arms hit the floor with good spinal control, then move to the standing versions.