March Newsletter. Women s Running Clinic. In This Issue: Rachael Herynk, DPT

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1 March Newsletter March 7, 2017 Volume 5, Number 3 In This Issue: Women s Running Clinic The Role of the Psoas in Low Back and Leg Pain Muscle of the Month: A closer look at the tibialis posterior Sign up for the Sapphire PT enewsletter at sapphirept.com Links to Related Sites: SapphirePhysicalTherapy.blogspot.com Women s Running Clinic Rachael Herynk, DPT On Saturday, March 04, 2017, participants in the Women s Running Clinic enjoyed an interactive morning focused on women-specific running. We completed a rainy run through Greenough Park followed by a healthy breakfast at Runner s Edge. Courtney Babcock of Key Running, presented tips on improving running form. She discussed the importance of posture, cadence, uphill/downhill techniques, landing and push off mechanics, sprinting, and upper extremity mechanics. From there, participants visited several stations where a variety of subjects were presented, with demonstration and time for participants to receive feedback on various topics. Strengthening exercises were performed and given to address common areas of weakness including the hips and lower legs. Rachael Herynk, DPT of Sapphire Physical Therapy addressed women-specific core strengthening, including instruction and feedback on performing deep core activation with functional progressions. Individual running gait analyses were performed by Holly Warner, DPT and Allie Molnar, DPT of Sapphire Physical Therapy. Participants were given cues and exercises to improve form and reduce risk of injury. A nutritional station led by Tara Maurice, Registered Dietician, provided recipes and information on bone health and nutrient intake timing. Feedback from participants was positive, and we plan on future follow-up to assess participants progress towards improved form. Participants received a Sauce Headwear s SWIFT headband, water bottle, and discounted Sapphire Physical Therapy 2D running gait analysis. We are already discussing plans for our next clinic, so stay tuned! Please let us know if you have any topic ideas you would like to see presented. Special thanks to Runner s Edge for providing space

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) and support and Courtney Babcock and Tara Maurice for their expertise! If you are making April plans already, Sapphire Physical Therapy is planning an April Open House featuring our 2D running gait analysis and biofeedback equipment. Details will be announced soon! The Role of the Psoas Muscle in Low Back and Leg Pain John Fiore, PT The psoas is an important core muscle which stabilizes and moves both the lumbar spine and the lower extremity. Collectively, the psoas and iliacus muscles are referred to as the iliopsoas muscle group. The psoas works in conjunction with the iliacus muscle. While both the psoas and iliacus insert on the lesser trochanter of the femur (groin area), the iliacus originates in the iliac fossa and iliac crest of the pelvis and sacrum, whereas the psoas originates along the transverse processes of the lumbar spine. The primary function of the psoas muscle is to flex the hip. Secondary actions which are very important for proper lumbar spine and lower extremity function and symmetry include femoral lateral rotation, lumbar extension, and lumbar side bending. In addition, the iliacus tilts the pelvis anteriorly. Both the psoas and iliacus muscles activate unilaterally or bilaterally. Asymmetry between the right and left psoas muscles due to tightness or weakness, therefore, is an important source of one-sided low back and leg pain. While psoas asymmetry is often overlooked, proper, targeted clinical testing must be included when thoroughly evaluating low back and extremity pain and overuse injuries. The psoas muscle lifts the hip and leg forward when we walk, run, and climb. Overutilization of the iliopsoas can lead to postural and mechanical issues. Without the necessary strength in the abdominals, hips, gluteal and small stabilizing lumbar (multifidi) musculature, the psoas becomes shortened, over-active, and irritated. Gait and postural

3 Us: John Fiore, PT: Rachael Herynk, DPT: Jesse Dupre, DPT: Holly Warner, DPT: Allie Molnar, DPT: Jennifer Dreiling: Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT Map: 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 deviations may present as a laterally-rotated hip, an anteriorly tilted pelvis (unilaterally or bilaterally), or a sway back posture. An iliopsoas-dominant athlete may develop a myriad of overuse injuries including: psoas or groin pain, sacroiliac and low back pain, iliotibial band pain, and even knee and foot overuse injuries. Once a psoas imbalance or overutilization issue is diagnosed, the resulting mechanical asymmetry must be addressed through manual physical therapy techniques. Targeted active release stretching, dry needling, deep tissue release, and muscle energy techniques are effective ways to restore symmetry and proper function to the right and left psoas musculature. Manual therapy alone, however will not fix the problem. Strengthening the antagonist musculature will allow the body to maximize efficiency of movement. Strengthening the weak links in the modern day athlete can be difficult due to ingrained movement patterns. Strengthening the lower abdominal and gluteal musculature, for example, reduces our reliance on the psoas to pick up the slack in lumbar and pelvic stabilization. Functional core strengthening involves the gluteal and abdominal musculature stabilizing in conjunction with sport-specific upper and lower extremity motions. Sit-ups and crunches alone, however, may exacerbate the problem of tight or dominant psoas musculature. It is important, therefore, to include planks (prone and side positions) and single leg weight bearing core exercises to reduce habitual psoas use. Finding your lower abdominals (transversus abdominis) muscles when lifting is key to prevent the anterior pelvic tilt associated with iliacus activation as well as the lumbar sway back associate with psoas activation. Our modern day lifestyle of prolonged sitting and very little physical activity other than our workouts predisposes us to psoas muscle shortening and dominance. Sitting inherently shortens the psoas while the antagonist muscle (gluteus maximus) is unable to function the lengthened position of sitting. The most common area of weakness in present day athletes (based upon my empirical evidence of 24 years in practice) are the gluteus medius and gluteus maximus. No wonder we have difficulty contracting our gluts when much of our day is spent sitting! In addition to a physical therapy strength and postural evaluation, a video gait or running analysis will reveal muscle imbalances to address to effectively prevent and treat injuries related to a hip flexor or psoas domain state.

4 Work Hardening & Functional Conditioning Programs Cycling injuries & biomechanical bike fitting Women s health services All insurance accepted & billed Cash payment option Finally, for an aging athlete or individual, hip joint compression due to excessive sitting and associated psoas tightness can accelerate osteoarthritis. Balancing proper muscle flexibility with core stabilization and strength will decrease the impacts of prolonged sitting to permit a healthy, active lifestyle for years to come. ARTICLE REFERENCES 1. McGill,S.(2007) Low Back Disorders: evidence-based prevention and rehabilitation. 2 nd ed. Human Kinetics. Champaign, IL. P 60-61, Jones,S. Rivett,D. (2004) Clinical Reasoning for Manual Therapists. Elseier Butterworth Hinemann. New York, NY. P , 3. Greives. Grieve's Modern Manual Therapy. Harcourt Publishers Ltd Muscle of the Month: A closer look at the tibialis posterior John Fiore, PT The tibialis posterior is a small, thin, unassuming muscle which plays a vital role in walking and running locomotion. Located on the posterior aspect of the lower leg, the tibialis posterior is deep to the easily recognizable calf musculature (gastroc-soleus muscle complex). The tibialis posterior originates on the posterior side of the fibula and tibia, and inserts on the navicular, second cuneiform, and 2 nd, 3 rd, and 4 th metatarsal bones of the foot. Tibialis posterior weakness or injury can sideline even the most seasoned athlete. Evaluation of functional movement is vital to properly detecting tibialis posterior dysfunction. (Photo courtesy of: The function of the tibialis posterior is much more important than its inconspicuous location in the body warrants. It acts to invert (turn inward) the foot and ankle, supinate the foot (raises the arch) and aids in dorsiflexion (upward motion of the foot) of the foot and ankle. Without the tibialis posterior, the stability of the foot and ankle is compromised significantly. Consider for a moment a flat foot. The term flat foot has a negative connotation, but pronation (or lowering of the arch of the foot) is necessary to absorb shock and accommodate to uneven surfaces. Supination, however, is necessary to bring a pronated, flat foot into a position of stability for push-off while walking or running. Efficient, pain-free running is dependent on the ability of the tibialis

5 posterior to bring the foot and ankle into a supported position (through supination). Without the action of the tibialis posterior, the foot and lower leg are subjected to increased tensile strain during the push-off phase of gait. Injuries such as plantar fasciitis, medial tibial stress syndrome (shin splints), knee pain, hip pain, iliotibial band pain, and even low back pain can often be traced in whole or part to a deficient or weak tibialis posterior muscle. Prevention and treatment of tibialis posterior dysfunction begins with body awareness. If your calves and/or feet are tired or painful after running or weight bearing exercise, allow your body to rest, and ice for 1-3 days. If you continue to experience pain after 3 days a physical therapy evaluation may be indicated. Your physical therapist will rule out injuries such as a stress fracture, compartment syndrome, or other circulatory issues for which you will be referred to your physician for diagnostic testing. If the physical therapy evaluation is negative for serious injury, a Sapphire PT physical therapist will detect any underlying weakness and-or inflammation responsible for your symptoms. Exercises targeting tibialis posterior strengthening include single leg step downs, eccentric heel raises-drops, and band-resisted ankle inversion with emphasis on proper body position and technique. Understanding the mechanics of walking and running and the contribution of other factors such as hip and core strength and running technique will narrow the treatment plan to a concise set of rehabilitative and preventative exercises. Your physical therapist will also guide you in a progressive return-toactivity plan based upon your response to PT treatment. The take home message is to take action when foot or medial ankle pain limits your ability exercise.