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: Research supports a different treatment approach Eccentric Strengthening to Improve Flexibility Holly Warner, DPT Flexibility is defined as the ability of a muscle to lengthen and allow a joint/s to move through a range of motion. 1 When assessing a patient s flexibility, physical therapists look at muscle length and joint mobility to determine the cause of decreased flexibility. Impaired flexibility is a key finding as it affects muscle performance, may increase risk of injury, and causes muscular imbalances. There are many different ways to improve flexibility. There is strong evidence to support eccentric training to improve lower limb flexibility. 2 Eccentric training is strengthening the muscle by having it contract as it lengthens. An example of this would be lowering into a squat or lunge. This eccentrically loads the quads, hamstrings, and gluteals. Eccentric training has also been compared to static stretching in various studies. It has been shown to significantly improve hamstring flexibility equal to that of static stretching over a 6-week program. Another study found that one session of eccentrically training through a full range of motion improved hamstring flexibility better than the gains made by a static stretching. 1 An example of this type of training would be a single leg hamstring dead lift. This is an important finding as most injuries occur during the eccentric phase of activity. For example, most hamstring injuries occur during the swing phase of gait which requires eccentric hamstring muscle activation to slow the leg as it advances forward. The muscle cannot optimally produce force as it lengthens if it is stiff/short. Therefore, improving flexibility and strength is essential for optimizing the muscle s functional range. If we are looking to lower injury rates and improve flexibility, strengthening the muscle eccentrically seems to be an effective way to achieve both. Included are some ideas for eccentric training exercises of key muscles of the lower extremity.
Sign up for the Sapphire PT enewsletter at sapphirept.com 1 Nelson RT. A comparison of the immediate effects of eccentric training vs. static stretch on hamstring flexibility in high school and college athletes. North American Journal of Sports Physical Therapy. 2006;1(2):56-61. 2 O Sullivan K. McAuliffe S. DeBurca N. the effects of eccentric training on lower limb flexibility: a systematic review. British Journal of Sports Medicine. 2012; 46:838-845. =0ahUKEwjDxeuXmpLPAhUL7mMKHcf4BYQQjB0IBg&url=http%3A%2F%2Fwww.enjoyyourhealthylife.co m%2f2012%2f08%2f22%2feccentric-concentriccontractions%2f&bvm=bv.133053837,d.cgc&psig=afqjcnhqplokho_vwfeszhkk_iztm8pydg&ust=1474 057143728524 Links to Related Sites: SapphirePhysicalTherapy.blogspot.com 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.runwildmissoula.org Run Wild Missoula membership promotes running, training, and racing in Missoula www.momentumat.com 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. Gluteus Medius =0ahUKEwjnzIb4ppLPAhVL6mMKHTvtB6wQjB0IBg&url=http%3A%2F%2Fwww.popsugar.com%2Ffitness% 2F20-Minute-Total-Body-Tabata-Workout- 32789731&psig=AFQjCNG2MyQb5QraUBXODogQLkSqjaf3AQ&ust=1474060908211844
Find us on Facebook: www.facebook.com/sapphirept 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 406-549-5283 Sign up for the Sapphire PT enewsletter at sapphirept.com Contact Us: (406) 549-5283 Hamstrings http://www.sapphirept.com Email Us: =0ahUKEwjIyJurnpLPAhUC72MKHX47AOYQjB0IBg&url=https%3A%2F%2Fwww.pinterest.com%2Fpin%2F 109493834665755937%2F&bvm=bv.133053837,d.cGc&psig=AFQjCNF5V3NGR6jFAJMV_togp18SMbF8bw &ust=1474058417208445 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 Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT 59801 Map: Our Services: Orthopedic injuries Gluteus Medius =0ahUKEwi_87GVp5LPAhUM0WMKHUJjBVUQjB0IBg&url=http%3A%2F%2Fwww.runnersworld.com%2Fi njury-treatment%2ftreating-itbs&bvm=bv.133053837,d.cgc&psig=afqjcnglrsp-9ovyzxn7j-5onatt0vbbw&ust=1474060956038599
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 Complete Rehab for Ankle Sprains Jesse Dupre, DPT Lateral ankle sprains are one of the most common ankle and foot injuries, and occur in multiple groups, particularly in active individuals. Ankle sprains, however, do not always resolve to an acceptable level, even with regard only to pain. It is not uncommon for the rehabilitation process to end prematurely, without addressing the necessary areas required for the best recovery. Lateral ankle sprains occur when one or more of three ligaments are forcefully stretched, and can have varying levels of severity ranging from a stretching with microscopic tears of the ligament s fibers to a complete ligamentous rupture. This causes ankle pain, swelling and decreased function and ability to participate in activities. In many cases the injured tissues heal and swelling and pain typically resolve over time, especially if treated early with PRICE principles (protection, rest, ice, compression and elevation). It is important to continue rehabilitation efforts even after reduction in pain and improved function to maximize recovery. In addition to pain, ankle sprains are often associated with other deficits that can change lower extremity function. Some of these deficits include decreased range of motion, ankle instability, strength deficits and muscle function changes at the thigh and hip. Studies comparing healthy individuals with those who have suffered an ankle sprain have demonstrated decreased sensory abilities at the ankle and delayed activation of specific muscle groups including fibularis muscles, hamstrings and gluteal muscles. These mechanical and neuromuscular differences can cause impaired proprioception (the body s sense of position and movement), slowed balance reactions and mechanical compensations that can increase likelihood of re-injury. For these reasons, it is important to address multiple factors when recovering from an ankle sprain. A more complete program should address not only changes in ankle joint mechanics, range of motion, and strength, but should also include exercise to improve proprioception, balance, muscle activation and strengthen stabilizing muscles at the hip. This will allow the injured person to return to recreational or sport activities with a reduced risk of re-injury.
Living with Chronic Pain: Research supports a different treatment approach John Fiore, PT Chronic pain is is defined as a painful condition affecting one or more area of the body lasting for more than twelve weeks. i In contrast to acute pain, which is induced by tissue damage, injury, or disease process, chronic pain may be linked more to familiar sensory pain patterns or previous pain experiences. ii The complexity of chronic pain leads to costly and often ineffective treatments. Health economists from John Hopkins University estimated the annual cost of chronic pain is as high as $635 billion per year, which is more than the annual related costs for cancer, heart disease, and diabetes. iii Photo:www.medscape.com Treating a person with chronic pain must include treating the person as a whole. Rather than treating the chronic pain symptoms, a comprehensive evaluation of movement, limitation, medical history, surgical history, and current medications must be performed. Historically, traditional treatments for chronic pain have included prescription medication and surgical intervention. Applying treatments for acute pain or injury to chronic pain conditions, however, leads to poor results and frustration for all involved. Focusing treatment on restoring movement and function will not only improve quality of life, but it will also address the underlying cause of chronic pain. A recent article in the New York Times highlighted the need to change our treatment approach when working with individuals with chronic pain. The article cited a July 20, 2014 study published in The British Medical Journal which compared the results of surgery for knee meniscus tears with a physical therapy exercise. The results showed no greater improvement in the surgical group. Furthermore, knee MRI scans of pain-free individuals often revealed meniscus tears which were not symptomatic. iv Similar studies have looked at the outcomes of individuals following lumbar fusion which is a common surgical intervention for chronic low back pain due to degenerative disc disease. Again, no long-term benefit was shown between the fusion group and the physical therapy exercise group. While it should be noted that both knee meniscus and lumbar fusion surgical procedures may be the only option given certain clinical cases,
surgical procedures should not be equated with a quick fix. In most cases, proper conservative, function-based treatments and lifestyle modifications are a more effective and economical option. In twentythree years of practice as a physical therapist, I have learned that beneath the surface of every individual suffering from chronic pain, are one or more compensatory movement patterns which collectively contribute to chronic pain symptoms. Much like a detective following clues to solve a mystery or crime, a physical therapist must possess the knowledge and understanding of the human body to piece together the movement limitations and/or dysfunctions contributing to an individual s chronic pain symptoms. Once the underlying cause(s) are identified, realistic, short-term mobility and exercise goals can be established. Shortterm goal success represents progress towards freedom from the familiar chronic pain pattern. The physical therapists at Sapphire Physical Therapy will take the time to thoroughly evaluate movement patterns, joint mobility, and formulate an individualized treatment plan aimed at successfully returning an individual to the quality of life enjoyed before the onset of chronic pain. Photo: Bridger Fiore: Longs Peak, CO www.sapphirept.com i Medlineplus.gov/magazine/issues/spring11pg5-6.html ii Neurosci Biohehav Rev.2013 Dec: 37(10 0 2): 2597-2607 iii Darrel J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13(8): 715 DOI: 10.1016/j.pain.2012.03.009 iv www.nytimes.com2016/08/04/upshot/the-right-to-koe-that-an-operation-is-nest-to-useless.html