Wednesday, 11 January 2012

Forefoot vs. Rearfoot Running

There has been a lot of talk out there about different running techniques and we are constantly on the look out for the most efficient gait pattern. This month Medicine and Science in Sports and Exercise, the Official Journal of The American College of Sports Medicine provided a bit more clarity. 

The American College of Sports Medicine just completed a study that looked back at injury rates in competitive college long and moderate distance runners. They compared injuries in rearfoot versus forefoot runners and found higher stress injuries in the runners that hit the ground with the rearfoot. 

With rearfoot running, the knee is in a straighter position when the foot hits the ground and a greater ground reaction force is carried up the leg. Forefoot running requires increased flexion at the knee at the moment of ground contact and provides a built in shock absorber. 
                                                           

Traumatic injuries were not significantly different in the two groups as a whole. 74% of the runners in both groups experienced a moderate or severe injury over the year. 

You can find the article at :

Thursday, 5 January 2012

Why Sit Ups after Delivery May Not be a Good Idea

During pregnancy it is not uncommon for women to develop a Diastasis Recti or a separation of the stomach muscles. This can cause the abdomen to look softer and may lead to back or even abdominal pain. Traditional crunches or sit ups create more separation to this area. Women often kick into overdrive to get their bodies back into shape after delivery by doing repetitive crunches or sit ups. If correct exercise and abdominal bracing are not used, “mommy tummy” may be prolonged rather than corrected.



Your doctor or physical therapist can check to see if diastasis recti is present. The more abdominal strength women have prior to pregnancy, the less likely they are to develop the separation. It is more prevalent in women that gain more than 30 pounds during pregnancy and women that are pregnant with multiples.

Treatment for Diastasis Recti requires the use of an abdominal splint to pull the muscles together. I like and recommend to my patients the Diastasis Rehab Splint. A towel can also be used during exercise to pull the stomach muscles together.
                                        

It should be used at all times during the day especially during exercise. Limiting rotation of the trunk while you are treating the diastasis is important. Side crunches should not be performed until the diastasis is closed.

The following exercises are beneficial for reclaiming a strong core while allowing the stomach muscles to close and reattach.

Pelvic Tilts
                                  
Rotate your pelvis so that the small of your back flattens out on the surface where you are laying

Alternate arm and leg in quadruped
                                               
The hips should remain in the same position when the arms and legs are alternating. Keep your stomach tight to maintain this stability.

Plank Front
                                         
Squeeze you stomach and glutes to ensure your body remains parallel to the ground

Plank Side
                                                     
Make sure your hip does not sink towards the ground

Wednesday, 14 December 2011

Who should do Kegels



This is a common question that I hear from patients. Most women and  men can benefit from pelvic floor strengthening by performing Kegel exercises.

 Women should begin pelvic floor strengthening when they are pregnant with their first child and continue to include it as part of their normal exercise program. Pregnancy and delivery are very hard on the pelvic floor muscles and structures and it is important that adequate strength is maintained to stave off pelvic organ prolapse and incontinence. Most of the women I treat for these two issues are under the age of 40. 

That being said, as women age their chance of developing bladder control problems ( including urgency, frequency, and incontinence) rises and it is vitally important that post menopausal  women pay attention to the strength of their pelvic floor muscles and work to build and maintain it.
It is possible for women of any age to have what many refer to as a “weak bladder” This may include leaking a little when you laugh, cough, or sneeze, urinary frequency where you urinate more than 9-10 times a day or urinary urgency where you are unable to  put off going to the restroom once you have the urge to urinate. Anybody experiencing these symptoms can benefit from pelvic floor strengthening and should speak to the physician about starting a strengthening program.

Men can also benefit from improving the strength of their bladder control muscles. Because of the different design, men are less likely to develop incontinence without an underlying pathology. Incontinence after prostate cancer requiring prostatectomy is very common and kegal exercises can make a significant improvement in urinary leakage.  Studies also show men suffering from erectile dysfunction due to venous compromise can correct the dysfunction by participating in a pelvic floor exercise program.

It is important that if you have bladder or urinary problems, or pain, you should speak to your doctor about initiating a  pelvic floor strengthening program. You may require more specific instruction and need to see a women’s health physical therapist.  Pelvic floor strengthening should also include a rest component. So if you begin with 5 second hold, a 10 second rest period should be placed after every hold. 

Wednesday, 7 December 2011

The Two Exercises Every Women Should Do ( as featured on Oprah.com )

Women's health physical therapists swear these pelvic
workouts help forestall all kinds of female-specific problems.
One's a classic, and the other will forever change how you
look at your watch.

By Corrie Pikul


If you have never felt pelvic pain, a "little spritz" (thank you, Whoopi
Goldberg, for that phrase), or organ prolapse, you probably want to
keep it that way. The best strategy for shaping up "down there"? Yep,
that old standby, the Kegel. We know you've heard this before, but
that's because experts agree that Kegels are the most effective
exercise to improve the muscle tone of the pelvic floor. "After the age
of 35, we lose 5 percent of our muscle mass every 10 years," says
women's health physical therapist Kristi Latham. This reduction
occurs in muscles everywhere in the body—including those in our most
private regions. Here's a full pelvic workout, including Kegels and
"pelvic clocks."

Keep in mind: Just like you wouldn't run sprints with a sprained ankle,
you shouldn't do these exercises if you have a painful pelvic condition
(like vaginismus) without first checking with a women's health physical
therapist.





A Kegel Refresher Course
These wonder clenches can increase sexual arousal, improve your
ability to reach orgasm, help you master control of your bladder and,
says Latham, support your pelvic organs in avoiding dreaded conditions
like prolapse.Fitness instructor: Kristi Latham, PT, CLT, is the pelvic health and
lymphedema program director at Metro SportsMed Physical Therapy
in Brooklyn, New York.

Warm-up: When you're just starting out, it's best to lie down so that
you can concentrate solely on your pelvic floor.

The exercise: Squeeze the muscles around your vagina and anus.
These are the muscles you use to prevent gas from passing, stop the
flow of urine and the muscles that contract during orgasm. Think about
trying to pull the muscles up and in (if your pelvic floor is weak, you will
only faintly feel this contraction). You'll know you're doing these
exercises correctly if you feel the muscles tightening but don't have
movement in your abs or buttocks. Isolate your pelvic floor so if somebody
looked at you while you were doing the exercise, they wouldn't
think you were moving at all.

The routine: For healthy women without symptoms of pelvic floor
impairment, do the following three times per week: 5-second squeeze
followed by a 10-second rest period, 10 times, 3 times per day (30
total). With practice, you should be able to do them while sitting at your
desk or driving.

Advanced:
• Endurance training: Increase hold time and decrease rest time:
10-second squeeze followed by a 3-second rest period.
• Sprints: Add in what Latham calls "quick flicks": Squeeze and
relax 5 times, as fast as you can, followed by a 5-second rest
period. Do 30 per day, 3 times per week (as above).
• Form drills: Try any of the above routines while standing up.
Note: You've probably heard that you should practice Kegels by
stopping the flow of urine while going to the bathroom. Using Kegels
to frequently stop or slow the flow of urine can cause backflow, which
creates infection, and can also disrupt your pelvic muscle coordination.
Most WHPTs discourage practicing Kegels while urinating. Latham
suggests paying attention to how your muscles feel just after urination,
then follow up later with a Kegel to feel the difference between relaxed
and contracted.

Pelvic Clocks





These exercises can improve circulation to the pelvic organs; decrease
tightness, stiffness or congestion from prolonged sitting or standing;
increase pelvic flexibility; improve balance and—not enough for you?—
help you gain a better awareness of spinal stability.
Fitness instructor: Gail Wetzler, PT, EDO, is the owner of Wetzler Integrative
Physical Therapy Center in Newport Beach, California, and
instructor of pelvic physical health courses for the American Society
of Physical Therapists.

Warm-up: Lie on your back to be sure that the back side of the pelvis
has a full range of movement. Bend your knees and keep your feet flat
on the floor. Keep your spine in a neutral position. Imagine that there is
a clock on your lower abdomen, where 12 o'clock is at the bellybutton,
6 o'clock is at the top of the pubic bone and your hip bones are at 9
and 3.

The exercise: Bring the bellybutton down to the spine. This will make
the "clock" tilt, down at the 12 position (bellybutton) and up at the 6
(pubic bone). Move your hip and pubic bones to rotate your clock to
the side so that 3 o'clock hip is lower. Move around the clock, tilting
the pelvis until the 6 o'clock position is lowest. Continue around the
clock, hitting every number, until the 12 position is again the lowest
position. Repeat two or three times, then reverse to repeat the cycle in
the opposite direction, two or three times.

The routine: For healthy women without symptoms of pelvic floor
impairment, the clocks should be done once per day to keep the pelvic
girdle in shape. Those experiencing movement restrictions can try
these two times per day (a.m. and p.m.).

Advanced: Vary up the routine each day: Try going from 1 o'clock to
neutral, then 2 o'clock to neutral, and continuing like that around the
clock. Wetzler suggests repeating one movement, such as 4 o'clock
to 5 o'clock, five to six times "to really feel the pelvic activity."

Tuesday, 6 December 2011

Elle sweden

This morning I answered questions for readers of Elle sweden. Sofia Hedstrom is a running and fashion blogger for the site and we discussed readers questions about running injuries, pregnancy and exercise, and pelvic floor strengthening. Google will translate the blog for you. You just need to click "translate" in the top right had corner of the page.  Enjoy!
http://sofiaspringer.elle.se/knipovningar/?show=comments

Thursday, 24 November 2011

Can your Knee Pain be a Result of Weak "Cheeks"?

Knee pain is a common complaint among female runners. Most of the time it is assumed that the area of pain is also the origin of pain. However, this is frequently not the case and it is important that we look at the big picture. Weak "cheeks" or gluteus and hip external rotator muscles play a large role in knee pain production in females.



Because females are built with wider hips the knee joint does not fall directly below the hip socket different pressures are dispersed thru the knee joint when compared to men. The angle that is created between the hip socket, knee cap, and shin bone make up what is called the Q Angle.





Picture from: smartfeetsavannah.com





Picture from:jmaxfitness.com


You can see from the picture that the Q angle can also be thought of as the degree of "knock knees”. Due to this natural alignment, women are predisposed to abnormal pressures on the knee. To normalize pressures, strong muscles are necessary at the hips to stabilize the knees. These muscles primarily include gluteus maximus whose main function is to pull the thigh back and away from the body, and the deep 6 external rotators. The rotators are responsible for rotating the thighs and knee outwards. These two groups of muscles create movements in the direction opposite the pull of the Q Angle providing fewer abnormal forces on the knees.



Weak "cheeks" can cause:

·         Patellar femoral syndrome

·         Lateral tracking or dislocation of the patella

·         IT band syndrome

·         Over pronation in the feet

·         ACL tears



The larger the Q angle, the more likely you are to experience an injury. New mothers are also more susceptible to these types of injuries due to hormone induced ligament laxity.



In addition to regular stretching after a run, it is important to strengthen the glutes and deep external rotators as well. Below are a couple ideas for doing just that.



Bridge with knee straight and rotated out



Clam Exercise

Monday, 24 October 2011

Physical Therapists Help People of All Ages Avoid Sports Injuries

Playing sports safely is crucial to avoiding injuries that can keep you sidelined, say physical therapists from the American Physical Therapy Association (APTA).

Despite the documented health benefits of physical activity, such as improved cardiovascular endurance, muscular function, and self-esteem, the potential for sports-related injuries exists. Because physical therapists are experts in restoring and improving motion, they are uniquely qualified to help people reduce their risks for various sports-related injuries.

Foot Pain in Runners
Physical therapists can provide a detailed analysis of your running style, often using a treadmill with special video equipment. Many physical therapists have advanced skills in prescribing proper footwear and orthotics.

To reduce the risk of running-related foot pain, physical therapists suggest starting slowly and increasing your runs in increments, in both distance and speed. Consider incorporating other types of endurance exercises to give your feet a rest and bring better balance to your fitness routine. Individuals with stiff feet and high arches typically need more cushioning in their shoes; those with highly flexible feet (usually low arches) often require a stiffer shoe with more support and control.

Bicycle-Related Injuries
Bicycle-related pain and injuries are commonly associated with poor bike fit. To help minimize the risk of injury, physical therapists recommend frequently changing your hand position and keeping a controlled but relaxed grip on the handlebars. When pedaling, keep your knee slightly bent at the bottom of the pedal stroke and avoid rocking your hips.

Knee pain is common when bicycling. This can be caused by a saddle that is too low, pedaling at a low speed, using quadriceps muscles too much in pedaling, or muscle imbalance in the legs. Neck pain, also common, may also be caused by poor handlebar or saddle position. Lower back pain may be caused by inflexible hamstrings, low cadence, using quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars. To help ensure safety, physical therapists urge cyclists to wear a properly-fitted helmet and use a headlight, bike reflectors, and reflective clothing.

ACL Tears
An anterior cruciate ligament (ACL) tear is an injury to the knee commonly affecting soccer players, basketball players, skiers, gymnasts, and other athletes. Extensive research on ACL tears has been conducted with female collegiate athletes because women are 4-6 times more likely to have this injury. Physical therapists can help design a preventive exercise program that improves balance, strength, and sports performance and can help correct faulty technique in jumping, landing, cutting, and running.

Pitcher’s Elbow
Pitcher's Elbow is a chronic inflammation of the growth plate of one of the bones of the elbow, which causes pain and swelling inside the elbow. Little Leaguers who continue to pitch through the pain can eventually cause the growth plate to separate from the bone, requiring surgery to re-attach it. Youth baseball players are at greater risk because their elbows (bones, growth plates, and ligaments) are not fully developed and are more susceptible to overuse injuries.

Risk factors that contribute to elbow pain include pitching too many games, throwing curveballs and breaking pitches, and improper mechanics. Physical therapists can help young players prevent overuse injuries by teaching proper throwing mechanics and exercises to stretch and strengthen the arm. Factors that help prevent pitcher’s elbow include being physically fit, not being fatigued when throwing, adhering to pitch count guidelines, and not playing the positions of both pitcher and catcher for a team. A strengthening program focused on the posterior shoulder may also minimize risk.

Concussion
Concussion is a brain injury that occurs when the brain is shaken inside the skull, causing changes in the brain's chemistry and energy supply. Anyone exhibiting signs, symptoms, and behaviors of a concussion should be prohibited from further play or participation until he or she can be evaluated by a physical therapist or other qualified health care professional.
A physical therapist can provide a thorough evaluation and may prescribe specific exercises and treatment to reduce or stop dizziness and improve balance. Since neck injuries are common with concussion and can result in headaches and some forms of dizziness, a detailed examination of the neck by a physical therapist can help determine whether treatment to this area is needed.

For more information about how physical therapists can prevent and treat these and other sports-related injuries, please visit www.moveforwardpt.com.


Source: Article above provided by the American Physical Therapy Association www.apta.org

At Fauquier Hospital Outpatient Physical Medicine and Rehabilitation we have highly skilled, experienced clinicians who have a multitude of certifications and skills to treat your sports injuries. If you live in northern Virginia and would like more information to see if you may benefit from physical therapy, please call 540-316-2680to speak to a physical therapist. Or if you prefer to submit an inquiry via email, click on the button below.