Move Well, Live Well October Newsletter

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com Protecting Your Body During the Fall Season Rachael Herynk, DPT The therapists at Sapphire Physical Therapy want to help you avoid injuries associated with fall activities, such as raking leaves.

Wear gloves to protect your hands from blisters. When holding the rake, place one hand at the top of the handle and the other hand down the handle far enough so that your elbow is bent.

Stand up as straight as possible, keeping the natural curve in your spine, and use the power in your arms and legs to rake. Gently engage your abdominal muscles.

1 Move Well, Live Well October Newsletter October 13, 2016 Volume 4, Number 10 In This Issue: Protecting Your Body During the Fall Season Proprioception for Ankle Sprain Rehabilitation Strength Training Benefits for 99% of Runners Sign up for the Sapphire PT enewsletter at sapphirept.com Links to Related Sites: SapphirePhysicalTherapy.blogspot.com Protecting Your Body During the Fall Season Rachael Herynk, DPT The therapists at Sapphire Physical Therapy want to help you avoid injuries associated with fall activities, such as raking leaves. Below are some suggestions and tips for avoiding injury. RAKING AND BAGGING LEAVES 1 Before starting yard work, take a short walk to warm up your muscles. Wear gloves to protect your hands from blisters. When holding the rake, place one hand at the top of the handle and the other hand down the handle far enough so that your elbow is bent. Switch leg and hand placement on the rake every two to three minutes to help minimize stresses to your arms and trunk. Stand up as straight as possible, keeping the natural curve in your spine, and use the power in your arms and legs to rake. Gently engage your abdominal muscles. Do not reach so far away with the rake that it forces you to bend your back. Rake/sweep in smaller motions. Avoid twisting your spine. Step to the side as you rake, allowing your stronger leg muscles to take up stress. Rake with the wind to avoid working harder than you need to. When bagging leaves, avoid bending in your back. Kneeling down onto one knee or sitting on the ground can be helpful in reducing stress. You can also use a foam knee pad to kneel, alternating which knee takes the pressure. If you rake leaves onto a tarp, be sure to avoid rounding your back. Instead, squat down slightly and lock your lower back into its normal curve. You can then pull your tarp while walking forwards or backwards. Consider making more frequent and lighter trips. When lifting bags of leaves, be sure to keep the bag close to you. Lift from either a squat or kneeling position, shifting your weight onto the forward leg and stand up slowly using the muscles in your leg and buttocks. Be sure to continue breathing normally, avoiding holding your breath.

www.runnersedgemt.com www.momentumat.com www.irunfar.com www.ratpod.org www.apta.org Related Sites: www.runnersedgemt.com The Runners Edge: Missoula s hub for running gear, information, and races www.

From beginners to elite athletes, Momentum classes will increase your strength and reduce your injury risk. Find us on Facebook: www.facebook.

2 Related Sites: The Runners Edge: Missoula s hub for running gear, information, and races Run Wild Missoula membership promotes running, training, and racing in Missoula Missoula s choice for core strengthening and ski conditioning. From beginners to elite athletes, Momentum classes will increase your strength and reduce your injury risk. Find us on Facebook: For more information on the services provided by Sapphire Physical Therapy or to read more related articles, see our website or give us a call at Sign up for the Sapphire PT enewsletter at sapphirept.com Contact Us: (406) Us: John Fiore, PT: john@sapphirept.com Rachael Herynk, DPT: rachael@sapphirept.com Jesse Dupre, DPT: jesse@sapphirept.com Holly Warner, DPT: holly@sapphirept.com Allie Molnar, DPT: allie@sapphirept.com Jennifer Dreiling: jennifer@sapphirept.com Improper body mechanics Proper body mechanics PREVENTING FALLS WHILE WALKING OUTDOORS 2 In the evenings, walk where there is plenty of light to help you see where you are going. If you see a tree ahead in your path, look for fallen leaves or tree roots that might push up the sidewalk. Watch out for cracks in sidewalks, holes, and changes in sidewalk levels. Be extra careful during and after stormy weather. Rain, snow, and ice can make any surface slippery, especially if leaves are on the ground. Be sure you are wearing the correct eyewear while walking. Bifocals or reading glasses make it harder to see hazards on the ground. Wear sunglasses on bright days to reduce glare. Get your yak tracks or shoes with good traction ready for winter weather. For trick-or-treaters, ensure your home is free from fall risks. DRIVING AND PREVENTING CAR ACCIDENTS As it such a lovely time to be outdoors, be alert for people walking and riding their bikes. Use sunglasses to reduce glare so you are better able to see pedestrians. It is extra important to watch for pedestrians trick or treating on Halloween! Use good body mechanics when scraping windshields and windows. Squeeze your shoulder blades together and down before lifting your arms to stabilize the muscles around your shoulder blade and prevent shearing forces at your shoulder. MAKING YOUR HOME SAFE FOR HALLOWEEN 3 - If you expect trick-or-treaters, you should ensure your property is safe. Remove fall hazards such as ladders, bikes, garden hoses and toys from sidewalks, walk ways, and porches. - Wet leaves or snow should be removed from sidewalks and steps.

Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT 59801 Map: References: 1.

This fact sheet was distributed by the Fall Prevention Coalition - Los Angeles (FPC-LA), supported by the Kaiser Foundation; and created by the Fall Prevention Center of Excellence (FPCE), supported

3 Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT Map: References: 1. Tips courtesy of Matt Seabrook, PT, MS Dresher Physical Therapy; Photo courtesy of The Atlanta Back Clinic 2. This fact sheet was distributed by the Fall Prevention Coalition - Los Angeles (FPC-LA), supported by the Kaiser Foundation; and created by the Fall Prevention Center of Excellence (FPCE), supported by the Archstone Foundation. For more information, visit call (213) , or info@stopfalls.org. Last updated: June Proprioception for Ankle Sprain Rehabilitation Allie Molnar, DPT Our Services: Orthopedic injuries Functional strengthening Pre and post-operative rehabilitation Core strengthening & conditioning programs Back and neck pain Running overuse injury and prevention High speed 2D video running gait analysis Work related injuries Functional Capacity Evaluations Work Hardening & Functional Conditioning Programs Cycling injuries & biomechanical bike fitting Women s health services All insurance accepted & billed Cash payment option If you ve been hiking or running the trails in Missoula, chances are you ve encountered some uneven terrain. Whether or not you ve thought about it, your body is relying heavily on its sense of proprioception to maintain your upright position and prevent a stumble, wipeout, or ankle sprain. Proprioception is the body s ability to transmit a sense of position, analyze that information and react (consciously or unconsciously) to the stimulation with the proper movement. 1 In other words, it s the knowledge of your body position without having to look. When your ankle changes position due to a rock or tree root, the receptors in your ankle must be able to detect these changes and your nervous system must compensate accordingly, or you may sustain an ankle sprain or other ligamentous injury. Ankle sprains are one of the most common injuries in the foot and ankle. The severity of ankle sprains varies, and symptoms can range anywhere from no loss of function to extreme swelling, bruising, and near complete loss of function. Often the swelling, pain, and bruising will subside on their own within a few weeks. However, individuals often manifest deficits in postural control, dynamic balance, joint reposition/movement awareness, as well as anticipatory and compensatory adjustments made by muscles of the lower leg. In addition, literature has cited a decrease in hip abduction and trunk strength in those with instability of the ankle. These deficits may contribute to re-injury (rates can be as high as 70-80%), and often lead to the development of chronic ankle instability. 3 Studies have shown that 64-77% of individuals with chronic ankle instability also sustained injuries of the lateral leg (fibularis tendons), and associated cartilage

4 damage. 2 Because of this damage it is also theorized that repetitive ankle sprains may lead to posttraumatic ankle osteoarthritis. 2 In order to avoid subsequent injury therefore, a thorough rehabilitation is recommended. Your physical therapist will help direct your rehabilitation based on the current stage and severity of your ankle injury. For those in the more acute stage of the sprain, or for those with severe limitations, research most strongly supports bracing, ice, therapeutic exercise, and manual therapy techniques such as joint mobilization and soft tissue mobilization techniques. For those individuals in the post-acute period of rehabilitation (those with lingering ankle weakness, instability, poor balance, and intermittent edema) research found the best evidence for manual therapy techniques such as joint mobilizations and manipulations to improve ankle range of motion, prioprioception, and tolerance to weight bearing (CPG). In addition, a systematic review performed by Postle et. al found that, Proprioceptive exercises may reduce subjective instability and improve functional outcomes when included as part of the rehabilitation of people following ankle ligament injury. 2 If you ve suffered an ankle sprain, or are subject to chronic ankle sprains, your local physical therapist can help address your current rehabilitative needs, and decrease your chances for re-injury to keep you actively pursuing your outdoor goals. References: 1. Houglum, P.A Therapeutic Exercise for Athletic Injuries. Champaign, IL: Human Kinetics. 2. Martin, R. L., Davenport, T. E., Paulseth, S., Wukich, D. E., & Godges, J. J. (2013). Ankle Stability and Movement Coordination Impairments... Retrieved October 12, 2016, from /Ankle_Sprain_Guidelines August_2013 JOSPT.pdf 3. Webster KA, Gribble PA. Functional Rehabilitation interventions for chronic ankle instability: a systematic review. Journal of Sport Rehabilitation 2010; 19: Strength Training Benefits for 99% of Runners John Fiore, PT A September 27, 2016 Outside.com article by David Roche (Nike Trail Elite team member) reminded me of the vast amount of misleading information found online regarding strength training for runners. While the article did list both pros as well as cons of strength training, the take home message of the article was if you want to become a better runner, then just run, and run a lot. Not only will this advice increase one s injury risk, but it only truly applies to approximately 1% of the running population.

The other 99% of us balance family, full-time jobs, injury history, and less than perfect running biomechanics. For us, simply running, and running a lot increases our injury risk.

5 The other 99% of us balance family, full-time jobs, injury history, and less than perfect running biomechanics. For us, simply running, and running a lot increases our injury risk. An individualized, targeted running-specific strength training program is an excellent way to improve performance while reducing injury risk. Fortunately, the research supports the importance of strength training for endurance runners and now is the time of year to focus on strengthening in preparation for a successful, enjoyable, injury-free 2017 running season. A 2010 research article in the Journal of Orthopedic Sports Physical Therapy showed a correlation between impaired muscular control of the hip, pelvis, and trunk and increased knee pain in runners. i A strength training program aimed at providing functional stabilization of the hip and pelvis in multiple planes is, therefore, a vital part of a knee rehabilitation program. A 2009 Journal of Orthopedic Sports Physical Therapy study analyzed the hip stabilization mechanics of twenty-one female runners with patella femoral knee pain compared to the twenty pain-free female runners. ii The study confirmed increased hip/gluteal muscle weakness with associated femoral internal rotation (knee collapses inward) in the group of women experiencing knee pain. Finally, a 2015 research article in the International Journal of Sports Medicine looked at factors which contribute to the high incidence (19.4% to 92.4% of runners will experience a running injury) of running injuries. iii The study concluded that in addition to training errors, changes in the joint mechanics due to poor muscular strength increase injury risk in runners. Running form can be modified in subtle yet crucial ways to reduce joint impact force through resisted double and single leg gluteal, hip, core, and lower leg/foot strengthening. Now that we agree that strengthening is important for runners, what is the best way to strength train? Should I do body weight resistance exercises only, or should I lift weights? If I lift weights will my muscles bulk up and slow me down when I run? While body weight resistance exercises are a great way to isolate single leg stabilization, weight resistance exercises (dumbbells, kettlebells, weighted bars) are necessary to build power and durability for endurance runners. Exercising on machines while seated will not build strength specific to

running as balance and weight bearing are absent. If you are presently injured or have an injury history, consult a physical therapist training specifically to work with runners.

6 running as balance and weight bearing are absent. If you are presently injured or have an injury history, consult a physical therapist training specifically to work with runners. The number one predictor of a future running injury is a prior running injury history. It is important, therefore, to have a physical therapist analyze your running biomechanics. At Sapphire Physical Therapy, our on-site 2D video running gait analysis system allows us to detect compensations which impact performance and perpetuate your running injury risk. Fall and winter are the seasons to address compensations and weaknesses through an individualized strength training program. Sapphire Physical Therapy is here for the 99% of runners for whom this article applies. The following are links to three Sapphire Physical Therapy videos. Each video emphasizes proper exercise technique, the target musculature of each exercise, and proper demonstration. Copy and paste each link to learn how to begin incorporating running-specific strengthening exercises into your training program: iv *Beginning Strengthening for Runners video: *Advanced Strengthening for Runners video: *Dynamic Warm-up for Runners video: i Powers C. J Orthop Sports Phys Ther 2010;40(2): doi: /jospt ii Souza R, Powers C. J Orthop Sports Phys Ther 2009;39(1): doi: / jospt iii dos Santos AF et al. The E ects of Forefoot... Int J Sports Med 2015; 36: 1 5

Move Well, Live Well September Newsletter

Move Well, Live Well September Newsletter September 15, 2016 Volume 4, Number 9 In This Issue: Eccentric Strengthening to Improve Flexibility Complete Rehab for Ankle Sprains Living with Chronic Pain: