Tag Archives: low back pain traverse city

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 October Newsletter – Therapist Spotlight: Lydia Case

I can’t believe another month has flown by and it’s time for another newsletter.

Here is what you’ll find in this month’s issue:

  • Therapist Spotlight:  Lydia Case ATC
  • Back Pain and Sciatica Workshop has been moved to November 4th
  • Sports Medicine Clinic for High School and College athletes

Therapist Spotlight
Lydia Case joined Elite Physical Therapy back in July of 2015 and has been an invaluable part of our team ever since.  She works full time in the clinic plus during the school year she goes out to Kingsley High School two afternoons per week. She has been the athletic trainer at Kingsley for 11 years now.

Lydia has been practicing Athletic Training since 2006 in physical therapy and high school settings. She received her Bachelor’s degree from Northern Michigan University, where she had experience working with the Men’s football and hockey teams. Before transferring to NMU Lydia ran track & field at Aquinas College, but also worked with the Women’s volleyball and Men’s basketball teams at Aquinas. Lydia is a certified Kinesio Taping Practioner(CKTP). She believes that every patient and athlete is unique and that their treatment and workouts should be tailored specifically for their individual needs in order to achieve their best outcome.

1)  What got you interested in athletic training?

My love for sports is what initially got me interested in athletic training- I thought what a great fit- you work with athletes out in the field and can also work with the general public in a PT clinic- NO day is ever the SAME.

2)  What do you like best about being an athletic trainer?

I get excited about helping people and seeing how each patient/athlete is unique. I have worked with people from ages 3 to 98 and everything in between and have so much fun because everyone is so different as well as their injury.  I find it so rewarding to help someone accomplish their goals.

3)  What do you do for fun other than just work at Elite?

I enjoy spending time with my family – we love to be outside especially tubing down the Boardman River, taking our dog Gus for a walk in the woods, and riding 4-wheelers. I also like to play games, mostly card games like euchre. I also enjoy running with my friends and have completed 5 half-marathons, but prefer to run the 10k distance. I have been married to my husband Dave for 11 years and have two kids, Delaney (8) and Owen (5).

Testimonial:

“When I first came to Elite PT I was devastated because I had a running injury that literally prevented me from doing anything.  I was going from exercising 6 days a week, running 3-4 days per week, to barely being able to walk!

I felt like Lydia and Kristy were as excited as I was to get started with strengthening exercises.  I experienced such relief from my treatment, and the exercise plans they put in place for me helped support rebuilding my strength.

I felt like I had my own cheering squad every step of the way.  I am now back to my regular exercise program!”  – L.T. Traverse City

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Back Pain and Sciatica Workshop moved to November 4th!

We will be hosting our first workshop on back pain and sciatica on Saturday November 4th from 10 – 11am.  If you know someone who has been suffering from back pain and/or sciatica then be sure to let them know about this workshop!

Lower back pain is a huge problem in this country, but unfortunately most people feel like there is no ‘cure’ and they just have to live with it.  Check out this short video for more information on the workshop and to listen to how this is one of the biggest ‘myths’ in the health care industry.

The workshop is technically for those who have not been clients of ours in the past.  Past clients receiving this newsletter are welcome to call us with questions ANYTIME!  We are more than happy to answer any questions you may have and set up a time to get you in for a free screen if that is what is necessary.

Like I said, call us anytime!  231 421-5805
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NEW Sports Medicine Clinic Tuesday Afternoons

Many schools in our area don’t have access to athletic training services or team doctors at their games, so many young athletes with injuries don’t get the medical care they need.  We currently provide the athletic training services at Kingsley High School which has been extremely beneficial for our athletes.  The goal is to treat them early to keep them playing and also to keep them from more serious problems and costly treatment down the road.

Unfortunately, we can’t be everywhere, so on Tuesday afternoons we’ll be offering free screenings to athletes with nagging injuries affecting their performance or keeping them from playing altogether.  We can diagnose the injury and get the athlete started down the road to recovery.  Athletes with more serious injuries should see their family physician!

Appointments will be available between 3 – 5pm.  Parents should call to make the appointment as we will need your contact information and at least verbal permission to examine your child. We prefer that a parent be able to make the appointment especially if the athlete is under 18 years of age.

Give us a call at 231 421-5805 to schedule a time.

See you next month!

Joe Heiler PT

Solving Lower Back Pain – Find the Pain Relieving Direction

Just a reminder we’ll be hosting a Back Pain and Sciatica workshop November 4th from 10-11am.  If you are suffering from lower back pain and/or symptoms that go down your leg then this is for you!

One of the topics we will be covering is what we call finding a directional preference.  Many folks with lower back pain, including symptoms down one or both legs, will have a direction that their back prefers to move in.  It could be flexion (forward bending) or extension (backward bending).  Finding a definite preference can often lead to a significant reduction in symptoms on day 1.

What is also true on many occasions is that moving in the opposite direction will make their symptoms worse.  So avoiding activities that increase pain, or just adapting them to avoid certain movements, can also reduce symptoms quickly.

Check out the new video for more information including a mini-case study on how it can work.

At Elite PT we are trained to determine if there is a directional preference and then how to best take advantage of that for a quicker recovery.  This is just one strategy that we will discuss at our Back Pain and Sciatica Workshop.  For more information or to sign up just give us a call at 231 421-5805.

 

Elite PT Newsletter September 2017 – Back Pain Workshop + Meet our new PT!

In this month’s edition you’ll meet our newest addition to Elite Physical Therapy: Allie Hoyt DPT, ATC and learn about our first ever Back Pain and Sciatica Workshop.  Here we go:

 

I can’t believe another month has flown by. It’s an exciting time of the year with kids going back to school (although my son would disagree) and high school sports getting started again.

Meet our new Physical Therapist

We are extremely blessed to be able to bring on a new PT and to find one as bright as Allie Hoyt.

Allie, DPT, ATC, graduated from Grand Valley State University’s doctorate of physical therapy program in 2017 where she completed clinical rotations with EXOS and The Ohio State University’s Performing Arts Medicine program. She graduated from Hope College’s athletic training program in 2014, where she gained experience working with men’s soccer and lacrosse, women’s basketball and volleyball, as well as cross-country and tennis.

Since 2014, she has been working as an athletic trainer and was one of the primary athletic trainers for the professional company members of the Grand Rapids Ballet. Through this, she continues to have a special interest in the performing arts, and more specifically with dancers. Her passion for movement started at a young age when she began dance classes that continued through high school and college.

Allie believes that everyone has the right to optimize their ability to move and she is happy to be able to help individuals reach their specific movement goals. She is extremely excited to join the Elite family!

Q: So how did you become interested in athletic training and physical therapy?

A: I started dancing at a young age and it was through dance that I first learned to love movement. I also ran cross country and track throughout middle school and high school. I was definitely NOT the star athlete, but because of my dance background everyone knew if they needed a muscle stretched I would be able to help. One day I was stretching my friend Liz’s hamstring and she bluntly said “Allie, you should be a physical therapist”. I laughed and thanked her, but I had no idea what a physical therapist was or did. I turned to Google that night and realized physical therapy sounded like a really cool profession. That summer I found myself shadowing a pediatric physical therapist and fell in love with rehabilitation.

Q: What excites you most about being a physical therapist?

A: I love the human body. It is amazing what our bodies are capable of and how they work! Being able to help others realize their body’s potential and reach their movement goals is why I enjoy this profession. I get to love and serve others through physical therapy and that is what excites me most.

Q: What types of things do you like to do outside of work?

A: I love to be outdoors, so hiking, biking, kayaking, and other modes of adventuring bring me joy. I also love good coffee and like to try out new coffee shops as well as brew my own cup of coffee using different methods. I have a dance background so you might find me trying out a dance class here and there as well.
Q: Who is your favorite college football team?

A: Notre Dame (I had to ask and no we didn’t hire her because she is a Notre Dame fan)

Allie has been through clinical internships at some pretty elite facilities around the country so she’s ready to take on the world of orthopedics and sports medicine. She’ll be seeing all types of cases from lower back pain, neck pain, sports injuries, shoulder pain, hip pain, and more. She has quite a background in dance medicine as well which is a very under served population in this area. She has a special interest in working with dancers to recover from injuries as well as prevent them. She’ll be putting together some special programs for dancers in the near future.

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Back Pain and Sciatica Workshop

We will be hosting our first workshop on back pain and sciatica on Saturday September 30th from 10 – 11am. If you know someone who has been suffering from back pain and/or sciatica then be sure to let them know about this workshop!

Lower back pain is a huge problem in the medical field and in this country. In fact we see more folks with lower back pain (and the resulting leg pain) more than any other diagnosis.

Unfortunately many people feel like there is no ‘cure’ and they just have to live with it. Check out this short video for more information on the workshop and to listen to how this is one of the biggest ‘myths’ in the health care industry.

The workshop is technically for those who have not been clients of ours in the past. Past clients receiving this newsletter are welcome to call us with questions ANYTIME! We are more than happy to answer any questions you may have and set up a time to get you in for a free screen if that is what is necessary.

In other words, we don’t want you to wait! If its not going away after a couple weeks it may not go away at all without some sort of treatment. The sooner we get you pointed in the right direction, the sooner you get better!

Like I said, call us anytime! 231 421-5805

Have a great month of September!

Joe Heiler PT

Elite PT July 2017 Newsletter: Lower Back Pain, Employee Spotlight – Jesie Bott, Exercise Tips and more…

Hope you’re having a great summer and surviving the craziness that is northern Michigan in July.

This months newsletter features:

  • Employee Spotlight – Jesie Bott
  • Lower Back Pain – 80% of us are going to have it!
  • Exercise Tip of the Month

Employee Spotlight
Jessica “Jesie” Bott was our very first employee starting back in 2012.  She took a bit of a hiatus after giving birth to her daughter but she’s been back a couple years now and we love having her around as much as possible.  Jesie home schools her two children and works Fridays during the school year but in the summer we’re blessed to have her 2.5 days per week.  She’s got a ton of energy and really loves to get to know her patients and clients.  She does a great job for us here at Elite Physical Therapy so we wanted to tell her story.

Jesie is an Athletic Trainer and licensed massage therapist, graduating from Grand Valley State University in 2005.  Jesie has worked in the outpatient orthopedic setting since graduation, and also worked as the athletic trainer at Kingsley High School for 5 years.  Jesie is a Graston Technique Certified Clinician, and trained through Functional Movement Systems giving her the ability to critically analyze a person’s movement ability and develop exercise programs that really work!

Why did you become an ATC/LMT?
“I had an inclination toward sports and health and wanted a career that kept me physically active and challenged me mentally.  Athletic training was a perfect fit!”

What do you enjoy most about the job?
“What I truly like best about my job is helping people feel better. I’m passionate about it.  I want to see people get results and I’m happy to be a part of that.  At Elite, I enjoy the one on one experience with each patient as well as having the freedom and ability to use my knowledge and creativity to problem solve and do everything I can to help someone feel better.”

What do you do for fun?
“Other than working at Elite….:)  I enjoy spending quality time with my family.  We love to be outdoors, camping, playing in the water and playing with our sweet puppy.”

Jesie has been married to David Bott for 13 years and have two great kids – Chase and Clare.  Jesie also owns Freedom Massage Therapy and currently sees clients at Elite PT on Tuesdays and Fridays. You can call her at 231 357-0151 for more details.

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Did you know that lower back pain will affect at least 80% of us at least once in our lifetimes.  Depending on the research article, once you’ve had a back pain episode, chances are between 60-80% that you’ll have recurring episodes beyond that.  Not great odds at all.

Here at Elite PT, lower back pain is the most common diagnosis that we treat.  There are numerous causes of lower back pain – some easier to fix than others, but it’s our job to figure that out.

One of the more common causes is Spinal Stenosis.  Stenosis literally means ‘narrowing’ and in this case the narrowing can cause compression and irritation to the nerves that leave the spinal cord and go out to the lower back, hips, and legs.  This causes pain across the lower back and can also produce symptoms into one or both legs.

spinal stenosis

How do you know that you may have Spinal Stenosis?

  • 50+ years old
  • Standing and walking increase symptoms
  • Sitting and lying down relieve symptoms
  • Leaning on the cart at the grocery store allows you to walk with less back pain

Spinal stenosis, like most types of lower back pain, is something that can absolutely be treated in physical therapy.  Certain muscles being ‘tight’ can create more compression and narrowing and therefore must be address using soft tissue techniques like massage, Graston Technique and dry needling.  Exercises must also be incorporated to stretch those tight muscles and improve how our joints move around the back and hips.

Other muscles tend to be ‘weak’, specifically the abdominals and glutes.  When strong and working with the right timing these muscles can reduce damaging forces across the spine.

A comprehensive physical therapy program that addresses all these factors can be extremely beneficial.

Here is what one of our former clients with spinal stenosis had to say:

Patient Testimonial
“I came to Elite taking medication to numb the pain in my back and legs so I could make it through the day.  Thanks to Jesie I have no more pain and know how to strengthen the muscles to help prevent the pain from returning.  She is a great therapist and I will use her again in the future if the need arises.”
– D.B. from Traverse City

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Exercise Tip of the Week

Child’s Pose is a common yoga pose that produces flexion through the hips and spine.  For someone with spinal stenosis this movement frequently decreases or eliminates the person’s symptoms.  If it relieves your pain, then do it whenever you need relief!

Child's Pose

Try to sit back on your heels – unfortunately my knees don’t bend that far!

In the bottom position, take 4 breaths in through the nose and out through the mouth.  Breathing in this manner decreases tone through the back muscles and also calms the nervous system bringing further relief.

For those with knee pain who can’t perform this exercise, try the seated floor press below.  It’s basically the same movement but with more body weight (usually fine but can be too much if you’re really sore).  Use the same breathing technique but be sure to put your hands on your knees to push yourself back up when you’re done.  This just takes some extra pressure off your back.
Seated Floor Press

You may find these simple exercises can make a huge difference in how you feel and how long you can be on your feet throughout the day.  If so, just keep doing them and you may just be able to keep yourself out of pain.

If you have all the signs and can only get temporary relief with the exercises then you probably would benefit from physical therapy.  Call us if you have questions (231 421-5805) and we could tell you if PT is for you.
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Have a great month of July with hopefully more warm weather to come.

We can be reached at 231 421-5805 or through email:  Joe@elitepttc.com if you have questions or if you just want to let us know how you’re doing.

Back Pain and Sciatica – Part 2

Last month I posted a case study showing how we treat back pain and associated ‘sciatica’ like symptoms here at Elite Physical Therapy in Traverse City.  You can find that article here:  http://www.elitepttc.com/back-pain-and-sciatica-physical-therapy-treatments/

This month’s case study is a little different in that the presentation and location of the pain were quite different but it still comes down to playing detective to determine where the patient’s symptoms are really coming from.  Before we get started here, I’m re-posting the picture of the dermatomes of the body (basically the sensory distribution of the nerves from the spine) so be sure to check that out.  Pretty cool how we were created for sure!Dermatomes

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with Graston Technique (GT) to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and GT.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

A little detective work plus effective treatment tools like dry needling and Graston Technique can make a huge difference in patient outcomes especially in these ‘sciatica’ cases.  If you have similar types of symptoms or pain that just doesn’t ever seem to get better then give us a call!  If you have any questions feel free to email me:  joe@elitepttc.com

Back Pain and Sciatica – Physical Therapy Treatments

This month I figured I’d post on a couple case studies related to back pain and sciatica, and how we evaluate and treat cases like this at Elite Physical Therapy.  We’ve had a lot of great success with these folks so thought I’d share a couple examples.

Back pain, and associated leg pain, can be difficult to treat but we like a challenge!  Playing detective can be fun if you know what to look for.  Check out the pictures below that show the paths the spinal nerves take throughout the body.  Leg pain (or what many people like to call ‘sciatica’) can follow a number of paths down the leg and sometimes that can be a dead give away to identify exactly where the pain is coming from.

dermatomes

***The letter and numbers above correspond to a particular spinal nerve, i.e. L4 means lumbar spinal nerve #4 ***

There are other ways to narrow down the location of the problem as well:

  • the muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve #4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So here’s a great example of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Pretty simple exercises that are beyond the scope of this article but lots of bang for your buck when they only take 5 minutes 2-3 x per day.

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Final Thoughts

Sometimes it just works that well but I certainly won’t make that guarantee in every case!  Back pain and ‘sciatica’ cases can be quite complex but knowing how to put together all the puzzle pieces definitely helps.

That’s probably enough to wrap your head around for this time.  Next month I’ll post another case study but with a different symptom presentation.  In the meantime if you have any questions just shoot me an email:  joe@elitepttc.com or call 231 421-5805.

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.

 

When Pain Happens

Great blog post from my friend and former PT student Greg Schaible on understanding pain.  This is an exciting new area of study and lots of potential here to help folks overcome pain and restore function.  Enjoy!

Greg Schaible PT, CSCS – On Track PT and Performance in Ann Arbor.

Here’s a riddle.  Nobody wants it, but everybody has experienced it at some point in time. It acts oddly and seems to come on for no rhyme or reason.  It is vastly misunderstood by the general population as well as healthcare professionals from all fields.

You guessed right, the answer is pain.

If you are reading this post and currently in pain, I genuinely am sorry and have empathy for your situation.  But understanding pain is the first step in combating it, so you are in the right place.  My goal is to educate people on pain. In my profession I deal with pain every day, so in order to treat it, I need to do my best to understand its complexity. I have learned a great deal about the subject of pain from books by David Butler and Lorimer Moseley. These two guys are at the forefront of the research on this subject.

So what is pain?…….  A short but loaded question.

First let’s get some context. The body is constantly gathering information from sensory receptors about the body’s internal and external environments.  It is also interpreting how these two environments are interacting and how they relate to one another. All these signals are ultimately sent to the brain to make heads or tails of the information. These inputs can range from actual tissue damage, chemical changes, past experiences, emotional/psychological distress, lack of sleep, hunger, your mother yelling at you, or seeing a snake on a plane.

Snakes on a Plane

The brain’s job is to then interpret all of these signals and determine if a threat is present. If the body perceives there is a threat, a number of different responses are possible.  One of the possible responses is pain.

Or in the case of snakes, call Sam!

Pain is felt as a survival mechanism to encourage you to take action. However, it does not always mean damage has actually occurred.

Consider this example Lorimer Mosley gives: A fractured wrist is often very painful until it is put in a cast. Once casted, the pain is almost always gone quickly thereafter.

Interesting!

The problem with this is that we know that bone will take 6-8 weeks to fully heal (depending on age and other factors).  Yet, pain is no longer present, and in some cases instantaneously gone once placed into a cast.  So why is this? Very simply, the need for protection is now gone because the cast acts as an external protective device.

In this example the pain is gone but damage is very much still present. The opposite can also be true. The body can be in pain, but no longer damaged.

We must consider other factors such as social influence, past history, fear, future consequences, stress to name a few. All these signals can trigger the body to feel it is under threat and notify you via pain. For this reason you can experience pain with no tissue damage at all.  I’m sure you have heard the term phantom limb pain.  Even though the limb is gone, the body still has the ability to sense pain in this area.  This reinforces the fact that if you can experience pain without a body limb, then tissue damage is not necessarily a prerequisite for pain. Furthermore, just because you are experiencing pain in a particular area does not mean that is in fact the source of the pain.  This is why it is important to find a clinician who does not focus solely on the area of pain, but looks for other areas of dysfunction which may contribute to the brains overall perception of threat.

Another possibility is that tissue damage could have very well occurred which initially started the pain cycle.  However, because the body is great at healing itself at the cellular level. It is also possible that the tissue may have healed. Yet the brain still has the perception of threat because non-threatening inputs were never sent up to the brain to override the previously painful threats.  This may explain why people often feel pain long after normal tissue healing time has passed. This is also why it is important to not treat pain with pain.

Here is some research that backs the theory: tissue damage does not equal pain. Jensen and colleagues performed a study titled: MRI of lumbar Spine in People without Back Pain. They found that 52% of people without back pain had at least one bulging disc or MRI abnormality.  Templehof and colleagues performed a study titled: Age-related prevalence of rotator cuff tears in asymptomatic shoulders.  The authors found that 23% of people with asymptomatic (non painful) shoulders actually had a rotator cuff tear. These are just two examples. Numerous other studies could be cited to help support that tissue damage does not have to cause pain.

So the next time you experience pain, please understand that there may be a number of contributing factors. Remember that pain is perfectly normal, it’s your body’s alarm system. Pain can be present with or without tissue damage. Providing the body with novel non-threatening stimulus’s to remove the body’s need to produce a protective response is a great place to start if you are currently experiencing pain.

Let’s take the example of elbow pain, lateral epicondylitis a.k.a tennis elbow. It’s not uncommon for lifters to experience elbow pain. I have noticed it becoming more prevalent now as people spend more time on their tablets using their fingers instead of a mouse.

tablet

Holding a tablet in one hand, and constantly using your fingers to swipe, type, navigate, etc. will place your wrist/elbow musculature on constant stress. Over a prolonged period, this can be perceived as a threat to the brain. Especially if you are lifting heavy weight in conjunction and require a high volume of grip strength for your workouts.

So applying the knowledge we learned about pain, and how it may or may not relate to tissue damage.  Here is a very simple and extremely effective solution to a lot of cases.

1st) Reduce the threat. In this example altering body mechanics while using a tablet and modify your workout routine with less grip intensive activities for the time being.

2nd) Provide a novel and nonthreatening stimulus.  In this example, I will use a wrist extensor stretch.

While this exercise may not seem like much, it’s very effective when applied correctly.  Flexing your wrist and turning it to the side obviously places a stretch on the outside of the elbow or to the wrist extensors.  In addition, you are also placing some tension and loading a nerve which flosses through the tissues at the elbow called the radial nerve.

So we now have our novel/nonthreatening stimulus.

3rd) Here is the kicker. You can do all the above, and get zero results unless you get this third step correct.  You MUST perform the novel/nonthreatening stimulus frequently.  To the tune of every 1-2 hours for best results.  Here is why it’s so important.  When the body is in pain, it is very good at making memories of pain.  This is because the body is very protective over itself, and rightfully so.  The only way to reduce the threat is to perform a stimulus frequently enough that if no longer feels the need for protection.

This example can be applied to many other pain scenarios as well if you follow the steps correctly. 1) Remove as many threats as possible while in pain 2) Pick a novel/nonthreatening stretch or exercise 3) The exercise should be simple enough so that you can perform it frequently throughout the day (in some cases every 1-2 hours).

Bio

Greg SchaibleGreg Schaible is a Doctor of Physical Therapy (DPT) and Certified Strength and Conditioning Specialist (CSCS), and runs On Track PT and Performance in Ann Arbor.  He attended The University of Findlay as a Student Athlete.  As an athlete he competed in both Indoor and 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 an avid Lions, Pistons, and most importantly a Michigan Wolverines fan.  When you don’t find Greg in the clinic treating patients, he enjoys spending time with family and friends, living an active lifestyle, coaching, and playing sports.