Do we all have to move the same way?

When we are exercising, there is often a perception of the “ideal” way we are supposed to move. This may be an internal model, an instructor in front of the group, or instructions to make sure the movement is precise.

These models are very helpful, especially when learning a new skill, but do we all have to perform a movement the exact same way we see a professional athlete perform in the video we see online? The short answer is no, because we all have different anatomy, muscle control, and background.

Let’s use a squat as an example, because this is a movement we all perform often every day without really thinking about it (picking up something from the floor, standing up from a chair, etc). People with different body types will have to perform this movement differently, and it may not match the “ideal” movement that is taught or demonstrated. Individuals with relatively shorter femur (thigh bone) length compared to their torso are going to have an easier time getting lower while keeping their shoulders over their center of gravity. Compare this to a person with longer femurs compared to their torso who will have to move their hips further back and shoulder further forward to maintain their shoulders over the same center of mass. Other variables likely to affect squat form include the angle of the hip joint, ankle mobility, strength through glutes or quad, shoulder mobility (especially if lifting with barbell), balance, and others.

Another movement with wide variations is throwing a ball. Everyone develops their own strategy that is most effective for their individual needs. No two people throw the exact same way, and the exact strategy may change depending on what we are throwing, or how we want to throw it (throwing a fastball vs. throwing a basketball.) Although we are all different, there are some basic skills and fundamentals we need to be able to support our body and stabilize to propel the ball in the desired direction.

There are many things that can affect how we move with certain movements or tasks.

· Anatomy

· Training status

· Experience

· Pain

· Energy levels

· And many more

Whether you are in pain, or looking to be more effective, reach out so we can help you with an individualized program to get you back moving and participating in the activities you enjoy.

Returning to Activity After a Pandemic

During the COVID-19 pandemic, activity levels dropped for a lot of people. Between stay at home orders, gym closures and working from home, people became more sedentary. On top of that, there were shortages of equipment like dumbbells and bicycles, making staying active at home difficult even if you wanted to.

But this summer, things looked different; vaccines are widely available, restrictions are loosening and people are looking to get active and enjoy the warm weather. That's all good news, but if you had a long break from activity, your body might not be ready to jump right back in. We have had a lot of patients in the clinic recently that are experiencing this exact issue. Here are a few tips to help you get more active without getting hurt: 

Start slow

● If you're a runner, think about a walk to run program

● If you're a weight lifter, start with lighter weights and less reps.

● Whatever your activity of choice is, start with short periods of activity and gradually work your way back up.

Warm up and cool down

Warming up gets your heart and lungs ramped up and prepares your muscles and tendons for the increase in activity about to come. Include some light cardio like jogging, calisthenics, or cycling, followed by active stretching like butt kicks, high knees, or yoga.

Cooling down transitions your body back to a lower state of stress - it brings your heart rate and breathing down, decreases blood flow to your muscles and back to places like your digestive system, and helps you relax. It's also a great place for static stretches if you need some work on your flexibility. Hold your stretches for 30 seconds and target the areas where you generally feel stiff. 

Take a day off

Rest days let your body recover and keep you from getting burned out. Not enough exercise isn't good for you, but too much of a good thing can cause problems too.

Watch for early signs of injury

Some soreness for a few days after activity is normal, especially if you've had a long break. But there are a few common issues to watch out for as you return to activity:

● Swelling or bruising

● Joint pain, especially in the knees or shoulders

● Foot pain, which could be a sign of plantar fasciitis

● Muscle strains - particularly common in the hamstrings

● Sprains - most common in the ankle

Any of these issues justifies a call to your physical therapist. Getting checked out early can prevent an injury that derails your attempt to return to activity. PTs see all of the issues just mentioned on a regular basis and can help safely guide you back into a more active lifestyle.

Exercise for Health

We’ve all heard that we should include physical activity and exercise as part of a healthy lifestyle. However, only a small percentage – less than 25% – of people actually meet the physical activity guidelines. Those guidelines suggest 150 minutes of moderate intensity (or 75 min of vigorous intensity) exercise with two sessions of muscle strengthening per week. We know we are supposed to do this, but why?

There are a multitude of benefits from a single bout of exercises, and even more benefit when we exercise on a regular basis over a long period of time. Scientists have been searching, and will continue to search for a pill that has all the benefits of exercise. If there was a pill with the same benefits, we would almost all take it every day despite the cost. The good news is that exercise is free or very inexpensive compared to taking a medication daily. Sometimes the biggest hurdle is simply prioritizing the time for it.

A single bout of exercise may:

• Help with energy levels

• Release endorphins to help with mood

• Improve sleep

• Increase alertness

Regular exercise helps:

• Prevent many different chronic diseases (type II diabetes, cardiovascular disease and at least 40 different chronic conditions)

• Maintain mental health

• Improve sleep quality

• Improve energy stores

• Control weight

• Improve cellular metabolism

• Increase longevity and life expectancy

• And much more

You may need assistance and guidance to achieve the recommended amounts of physical activity in a safe way. Physical therapists are the optimal practitioners to assist with appropriate modifications, progressions, and appropriate exercises to get and keep you moving. We help people after surgery, injury, or musculoskeletal pain. In addition, we are able to develop a plan to address balance, strength, mobility, and overall movement. We will also help you coordinate with appropriate professionals as needed if there are other areas to address beyond just physical activity/exercise to help you live a long and healthy life.

Plantar Fasciitis Pain

As the weather warms up over the next few weeks, people are starting to enjoy the outdoors more than we’ve been able to over winter. It’s now flip flop and sandals weather, and it’s so much easier to walk, run, or hike outdoors.

With that, we tend to see an influx of people with foot pain right around this time of year. You may have heard of or experienced plantar fasciitis before.

The plantar fascia is a piece of connective tissue that goes from the heel up to the toes. It was originally thought that this became inflamed, and caused the pain. What we know now is that over time, the structure of the plantar fascia can actually change (it adapts to the stress it experiences, both good and bad). Thickening of the plantar fascia and degenerative changes occur at the heel. The good news is this can change back to a more normal state with the right exercises.

So what do we do about it?

Many patients feel relief by having some arch support in their shoes. This means limiting use of flip flops and finding a pair of supportive shoes. Some patients are fine with shoes that have good support in them whereas others feel best with an insert. A good place to start is an over the counter insert as they are usually cheaper and just as effective as a custom orthotic. Our local running stores can help you pick the pair that is best for you.

Sandals are not off the table, but look for a pair that has better arch support and a strap around the heels.

As far as physical therapy exercise goes, calf strength is king. A recent study confirmed that being able to perform fewer calf raises was associated with plantar fascia pain. As people worked to improve their calf strength, they noticed a decrease in their heel pain. Calf strengthening, calf stretching, and ankle mobility are all helpful in alleviating symptoms of plantar fascia pain. (See chart below from Hebert-Losier et al 2017.) Improving strength and control at the hips (glutes) and quads can improve how much stress your foot muscles encounter with walking and running and can also improve balance.

The tricky thing with plantar fascia pain is that it can take awhile to feel better - sometimes as long as 6 to 12 months. That seems like a long time, but know that there are things you can do to help manage your symptoms while it is healing. A few favorite exercises include: Standing calf raises, seated calf raises, toe yoga, calf mobility with a stick roller or rolling pin, and plantar fascia stretching.

If you have specific questions regarding plantar fasciitis or would like to see one of our therapists, contact us at info@keprospt.com to set up an evaluation.

Is Your Life in Balance?

How is your balance? How fast do you walk at a comfortable pace? Are you able to stand from the floor without your hands? Surprisingly, the answer to all three of these questions may correlate to your likelihood of survival if you are over 50 years old. Although none of these are solely related to longevity, all three of these questions are correlated cardiovascular health, and thus may be related to mortality or likelihood of survival over the course of 10 years.

When it comes to balance, a group of more than 5,000 people between the ages of 50-80 were screened using the Modified Romberg test (see video above), and those individuals without a balance deficit were significantly more likely to survive 10 years than those with a balance deficit. This held true for all-cause mortality, death due to cardiovascular disease, and cancer death. Based on the current studies available it is not known whether or not the balance deficits cause the issues, or if there is just a correlation in the group of people that were studied.

One aspect of balance is strength, and a simple test that will test your strength, power relative to your body mass, flexibility, and balance is the sit and rise test. To perform this test, you will start standing, transition to sitting on the floor with your legs crossed, and stand back up without bracing with your arms, hands, or other appendages (see video). If you are able to perform the test as prescribed, you score 10/10. One point is lost for every time you support yourself with a limb or appendage that is not allowed. People who score 8-10 points were 5-6 times more likely to survive during the study period than those that score 0-3 points.

Who knew how fast we walk is correlated to our overall health? In a study examining data for more that 50,000 people, those who walk at an average or brisk/fast pace were significantly more likely to survive the full study period than those walking at a slower pace. For every 0.1 m/s of speed increased, a decrease in mortality from all causes and cardiovascular disease was noted. A common number reported is 1 m/s, or a little faster than 2 mph. If you are walking at least this fast without an assistive device such as a cane or walker, that may be a good indicator for greater longevity. There is one caveat with gait speed as a slower speed it is not as correlated with mortality for individuals who meet the recommended duration of exercise/activity on a weekly basis which is 150 – 300 minutes weekly (link to previous post?).

Although these tests are not perfect and may only give a small picture of your overall health, these are three quick assessment to check the health of your musculoskeletal system which we all know has a large impact on our overall health. If you do not meet the criteria mention for one or all of these, does that mean you are doomed? Absolutely not. It is never too late to get started with exercise and balance to improve your ability to move throughout our world. If you feel like you need some guidance, give us a call and we will help get you moving.

Stay on Track

Track is back! 

As the season starts, we wanted to provide some tips to stay healthy for the whole season. 

With track season in Iowa starting in February and March, the first few practices are often held in weather that is not ideal for running. Many coaches turn to running inside in the halls. This is a great option for shorter duration running, but hall running for weeks or for prolonged periods can lead to shin splints or shin injuries. Halls are usually concrete, and for some athletes, this is the first time they’ve done a lot of activity since their last sports season. That combination can be the perfect recipe for shin discomfort. Some alternatives to early season running can be work on agilities, strength, and power with less actual running time. 

Research shows that strength training for 15 minutes, 2-3 times per week is enough to gain strength and this strength may help prevent injuries as well. 

For track athletes, it is important to be doing some activity in the offseason, particularly for distance runners. A base mileage of about 10-15 miles per week is a good place to start, so that you are not going from no activity to 2 hours of practice per day. Again, that doesn’t leave a lot of time for your body to adapt to these new activities, and may lead to an overuse injury. 

So what happens if you get an injury midseason? Do you keep running? An easy way to think about this is the stoplight system. 

• Green light: no pain, you can complete your full mileage, keep going! 

• Yellow light: some discomfort with running (staying at or below 4/10); soreness goes away within an hour of stopping practice and you are back to your baseline the following morning. Modified practices. 

• Red light: Pain at or above 5/10; can’t run without limping - will need to stop running for a time. 

Our goal is never to take you out of sport unless safety requires it - for example, with a stress fracture or severe muscle strain you are at risk for hurting yourself further if you continue to run. Otherwise, we very much want to work within your limitations to keep you running even to some extent so that you don’t miss out on competitions. 

You may think of only your teammates and coach as part of the team, but we want to make sure we communicate with your care team too - that includes your athletic trainer, family doctor if you have one, and your physical therapists. Your athletic trainer is a great entry point to getting something checked out - they are there to help you! Letting them know sooner than later is always best - it’s easier to manage little aches and pains before they develop into worse injuries. 

Lastly, keeping track of your sleep, hydration, and nutrition is important for keeping you fueled for practices, meets, and recovery from hard workouts. Aim for 8-9 hours of sleep per night, and try to put screens away at least 30 minutes before bed time. A good goal for hydration is about half your body weight in ounces of water. A balanced plate of fruits, veggies, high quality protein, and healthy fats is important to provide you with enough energy to get through those longer practices. 

If you’re looking to check if you have sufficient strength (or what to work on if you don’t) check out the end of our webinar video for more information on this, and to see some self checks on your strength and some training tips!

Do I really need to get 10,000 steps per day?

By now, we have all heard the recommendation to get 10,00 steps every day.  If you have an activity tracker, that is also generally the default setting for the daily goal.  Have you ever stopped to think where that recommendation came from, or how necessary it is to hit that goal?  Interestingly enough, it is not clear where this recommendation came from and there is not currently research to support this as a magic number to reach.  Despite this, it has become the default goal around the world for daily activity level. 

This information leads to the natural question, what should my goal number of daily steps be?  The answer to that question is going to be different for everyone and their own situation.  If you are looking for goals to help overall health and fitness, your daily step count may still be an option so you can track progress over time.

According to a recent study , older individuals who walk for at least 4,400 steps daily are better off than those people who walk less than 2,700 steps daily.  The gains continue to increase until a threshold of 7,500 daily steps have been reached, with no additional health benefits noted above this point. This study was focused on older individuals so is not likely applicable to younger and middle-aged people, but it does shed some light that 10,00 daily steps may not be required.

If 10,000 steps seem daunting, you can still improve your health by increasing your activity, and tracking steps can still help you reach your health goals. Track the average steps over the course of one week, and use that as a baseline to increase from there. Over the course of 12 weeks, you can set a goal to increase average daily steps by a small amount each week. Over time, this will add more and more steps over time. 

Some easy ways to increase your daily step count include:

·       Parking further from the door

·       Taking the stairs

·       Walking a slightly longer route to your destination

·       Taking two trips to carry objects to destination instead of one

Other ways to monitor activity levels are to track active minutes and intensity.  The World Health Organization recommends at least 150-300 min of moderate intensity activity, or 75-150 min of vigorous intensity each week.  One study demonstrated that men were able to lose weight and demonstrate improved cardiovascular health over the course of a 12-month study without decreasing time spent sitting or increasing the overall activity time or number of steps per day.  One way this is possible, is to increase the intensity of the activity you are already doing. They were shown to walk faster and be more deliberate about the activity throughout their typical day.

Overall, we know we need to increase our general activity duration and intensity along with a healthy diet to improve overall health and risk for disease, although 10,000 steps may not be necessary for everyone as has been advertised.

Body Weight Supported Treadmill: Exercising Longer, Faster & With Less Stress

Have you been told you should start a walking program or other form of cardiovascular exercise, but joint pain is preventing you from starting? Are you recovering from an injury and need to start putting in miles but are limited with weight-bearing status? One option for you may be to use a treadmill with a system to support your body weight. These systems allow for more exercise with lower impact on your joints, and can help assist with recovery from injury, stepwise return to walking or running, as well as provide a way for people to maintain speed while lowering demands on the heart and cardiovascular system. 

At KPT, we use a Lightspeed Lift with our treadmill to provide body weight support through use of a bungee system. This an easy system to set up and use as you can see from the video below that allows a variety of training and rehab purposes. When using this system there is a significant decrease in ground reaction force (the force through the joints in your legs) for both walking and running when compared to running on a treadmill without the extra support (1). This extra support allows for a range of uses (2).

Injury rehabilitation: Allow a safe environment to start a gradual return to weight bearing, walking, and/or running. The extra support allows for earlier weight bearing and gait training following surgery such as with total knee/hip replacements, ACL reconstructions, Achilles repairs, and microfracture procedures to name a few. Training with bodyweight support may also assist with recovery from a variety of injuries/conditions while allowing you to maintain some training.

·       Management of arthritis pain – decrease loading through the joints

·       Stress fractures/stress reactions – limit force transmission through the injured tissue

·       Low back pain – especially with stenosis

·       Any other injury/condition preventing full weight bearing on one or both limbs

Neurologic recovery: Safe gait training that is effective for greater repetition to work on specific impairments. 

Geriatric: Safe training to work on cardiovascular endurance and improve overall gait speed.

Cardiovascular: Allow people who may be deconditioned to participate in a walking program

General training: Tempo training with lower cardiovascular/metabolic demands and overspeed or HIIT training.

If you are recovering from an injury, were told you need to walk more, or curious how you may be able to incorporate this into your training, please reach out. Our therapists will work to build and supervise a plan to get/keep you moving based on your individual needs and goals.

Direct Access to Physical Therapy

Picture this: you just got done with your workout for the day and feel a little twinge in your back. You didn’t change anything from your workout, so you push it to the back of your mind and carry on with your day. By lunch time, your back is hurting pretty badly and it’s hard to sit at work. What should you do? Call your doctor? Go to urgent care?

We’d like to present another option: call your physical therapist. In Iowa, most insurances do not require a referral from a doctor to be seen by a physical therapist. We can often see a new patient on the same day or next day.

When you come in for an initial evaluation, we take a full history, do a head to toe physical examination, and can provide education on what to do, what not to do, and a prescription for exercise that will get you on your way to feeling better.

Physical therapists’ training requires a doctoral degree. That means six to seven years of school and training before we start to see patients. We are taught to recognize if a patient has any red flag signs or symptoms that would need a referral to a doctor or another provider. If you do have a primary care physician, chiropractor, massage therapist, or athletic trainer that you work with, we are happy to coordinate your care and communicate with them about your progress.

Direct access to physical therapy saves patients time and money. Patients with low back pain who receive physical therapy when their pain starts can decrease their total cost of care by about 50% (1). It typically takes about 40 days to go from injury to your primary care, to orthopedic specialist, to physical therapy. A Health Services Research study found that the average cost of care was almost $5000 more if a patient had an MRI first versus seeing a physical therapist first. Get a jump on the time and come straight to PT.

Physical therapy has been found to be as effective for surgery for conditions like meniscus tears, knee arthritis, and low back pain (2).

 Additionally, physical therapists’ diagnostic accuracy is on par with orthopedic surgeons (75-80% for musculoskeletal injuries) whereas non orthopedic providers was about 35% (defined by agreement between clinical diagnosis and MRI) (3).

It is important to note that some insurance carriers like Medicare do require a physician referral, so be sure to check with your insurance first. In many instances, if you’ve seen your physician for an annual physical, they can write you a referral to PT without having to wait to be seen.

So the next time you start to feel an ache or pain, come straight to your physical therapist. It will save you time, save you money, and get you back to what you love sooner!

Exercising in Cold Weather

2021 is right around the corner and for many of us that means New Year’s resolutions.  We are all looking forward to turning the page on 2020 and getting a fresh start. Many of us will be making resolutions to lose weight or get in shape, which is more challenging now than ever.  With shorter days, colder weather, and everything else in life, we may need a little pep talk to get the motivation to get outside to keep moving.  Exercising outside has some great benefits for all of us, even in the winter, including:

·      Increasing metabolic rate (burn more calories)

·      Mental health benefits (improve mood with natural light)

·      Enjoying nature (the beauty of a fresh snowfall)

·      And many more

Getting outside to exercise in the cold does require a little more thought and preparation than it may during other times of the year. Here are a few tips to consider getting the most out of being outside.

·      Clothing – A good rule of thumb can be to dress as though the temperature is about 10 degrees warmer than the windchill.  The heat given off by your muscles will help to keep you warm. At the same time, make sure your hands, feet, and head are appropriately covered and warm as blood flow will be reduced the most to the extremities.

·      Warm up – As the temperatures get colder, our bodies may feel stiff to conserve energy, and a proper warm up will slowly increase your heart rate, help joints loosen up, and get your body ready to work. This is more important when it is cold outside to minimize the risk of injury. A gradual increase of your heart rate and mobility are very helpful, and you can see a great option for a dynamic warm up in the video below. This should take 3 to 5 minutes to get through properly and you’ll be ready to go.

·      Drink Water – It is important to stay hydrated just as with exercise in any other environment.  We still sweat and lose water in our breath when we exhale.  The difference with cold weather is we may not notice as much sweat because of the dry air leading to the moisture to evaporate faster.  Make sure to drink enough fluids before, during, and after your workout.

·      Cool down – Once you finish, keep your body moving for 5 minutes to allow heart rate to come down. It can be tempting to get inside to sit and curl under a blanket or next to a fireplace, but this cool down period is very helpful to minimize stiffness and to allow the body to acclimate to decreased movement again. If you are someone who likes to use the foam roller or static stretching, this is a great time to incorporate these into your routine.

If you have any questions about this or if you’d like to know more how you may be able to safely start a new exercise regimen, contact us at info@keprospt.com, and we will help get you moving. Happy New Year!

Stretches for Musicians

We all know stretching is important for athletes and gym-goers alike, but what about stretches for musicians? If you are a musician, you more than likely do a lot of sitting for a long period of time as you’re trying to master your craft. This is all wonderful and takes patience and dedication, but it can really take a toll on your body.

Being a musician myself, I have seen the first hand physical effects of long practice sessions, studio sessions and performances. As a guitar player, a lot of my discomfort comes from sitting and looking down at my instrument, which often manifests itself as neck, back and shoulder pain. And whether you’re a pianist, saxophonist, drummer or guitar player — this all may sound very familiar to you. These aches and pains will come and go, but I largely avoid these with just a simple dynamic stretching routine. 

Dynamic Stretching

Research has shown that dynamic stretching, or “stretching with movement,” is the best way to avoid injury and get your body warmed up for whatever activity you are about take on.  You will be doing these more for the postural component, but this will help you stave away that nagging neck and back pain that we so often complain about with long term playing. 

Below are five simple and effective exercises that will keep us out of that forward head/rounded shoulder posture that can often be the catalyst to chronic issues in musicians.   

• Diaphragmatic breathing: Begin sitting in an upright position with one hand on your upper belly and your other hand on your chest. Take a deep breath in, feeling your stomach expand against your hand, then breathe out. Repeat. Tip: You should not feel any movement in your chest as you breathe.

• Press up: Begin lying on your stomach, with your hands by your shoulders resting flat on the ground. Push against the floor with your hands, bending your back upward.

• Seated thoracic rotation: Begin sitting upright in a chair. Cross your arms in front of you, placing one arm on each shoulder. Bend forward, hinging at your mid-back, then slowly rotate your trunk to one side, then return to center and rotate to the other side.

• Chest openers: Begin in an upright standing position with your arms by your sides. Bend your elbows to approximately 90 degrees with your palms up. Slowly rotate your forearms out to the side. As you do so, pinch your shoulder blades down and back together. Pause briefly, then return to the starting position and repeat.

• Cervical retractions: Begin sitting in an upright position with your feet flat on the floor. Gently draw your chin in, while keeping your eyes fixed on something in front of you. Make sure that you do not look down as you do this exercise, or bend your neck forward. 

Performing just one set (8-10 repetitions) of these stretches before and after practice and performance sessions can really make a difference in how your body feels and mitigate any chronic musculoskeletal issues.  And who knows, maybe it will improve your playing!  

If you have any questions about this topic, feel free to reach out to us at info@keprospt.com.

Garrett Testroet, PTA

Is Telehealth Physical Therapy Right for You?

Virtual physical therapy has quickly moved from a niche offering to the mainstream. Having more options is great, but it can also complicate decision making. Having an understanding of the benefits of both can help make clear which one would best help you meet your goals.

IN PERSON PHYSICAL THERAPY

The main advantage of traditional "brick and mortar" PT is that the therapist is in the room with you. That means they can move around to see how you're moving from different angles, physically adjust your position or movement as you exercise, and physically examine you – testing your strength, measuring your range of motion, etc. They can also use things like manual therapy, electrical stimulation or ultrasound when you're in the clinic. In person PT may work best for:

• New patients – the ability to physically examine you makes it easier for your PT to accurately diagnose what's going on.

• Less active patients – if you're not used to exercising and moving, having someone physically present to coach you along can be a big benefit.

• People with complicated or chronic conditions – if your back has been hurting for the last five years and you've been ignoring it, providing a diagnosis and treating it totally virtually will be difficult for your PT.

• Less motivated patients – virtual PT requires you to do most of your exercises by yourself. If you need someone watching over you to make sure you do them, in person PT might work better for you.

VIRTUAL PT

The main benefit of virtual PT is convenience. Because virtual PT relies on you doing most of your exercise and treatment on your own, appointments can be shorter. This also means that motivation is a prerequisite to choosing virtual PT. The fact that you don't have to travel to the clinic makes it easier to squeeze a visit into a busy schedule. Below is a short video with an example of some examination and treatment via virtual PT that we initially posted back in April to demonstrate how this can be a useful tool for your care.

Virtual PT works well for:

• People with common injuries – things like tendonitis, sprains, strains, plantar fasciitis, and overuse injuries are commonly treated by PTs. Because of that, there is a template for treatment that is easily adapted to individual needs.

• People who are comfortable with technology – you don't have to be a technology whiz, but having some familiarity with skype, facetime, or zoom helps!

• Existing and returning patients – if your physical therapist knows you, it's easier to treat you virtually

Both options have benefits and limitations. One or the other might be right for you and your needs, but they're not mutually exclusive. Combining the two can work well for many people. Doing an in person visit for your initial evaluation and perhaps a follow up visit or two will let your therapist provide an accurate diagnosis and get you started on your exercise program. Once you're comfortable with your exercise program, you can transition to virtual visits.

If you have further questions or would like to schedule a visit in-person or virtually, please contact us to get started.

Source

Concussions – What They Are & How to Handle Them

Football season is upon us! One of the most talked about injuries in football is a concussion. And while football is not the only sport you can get a concussion, it is the most common (followed by girls soccer, then boy’s soccer).

We wanted to take a moment to talk about what exactly a concussion is and what to do if you or your child gets a concussion.

A concussion is categorized as a mild traumatic brain injury resulting from a direct or indirect blow to the head. This means that a fall that causes a whiplash type injury could still give you a concussion, even if you did not hit your head. Many times, a concussion results from the brain moving inside the skull when the head is hit – for example if you hit the back of your head on the ground after being tackled, the brain will contact the back of the skull, then move forward where it contacts the front of the skull before settling – a “coup contrecoup” injury. This blow to the head causes a metabolic reaction in the brain – it changes in glucose metabolism (needed to provide energy), alters blood flow to the brain, and disrupts how well the axons (nerve cells) communicate with each other.

Concussions are no longer graded by severity –a concussion is a concussion. That’s why it is so important to know the signs and symptoms of a concussion. You may or may not lose consciousness, and the severity does not depend on whether you lose consciousness or not. Immediate symptoms may include:

• Loss of consciousness

• Headache

• Neck pain

• Dizziness or blurry vision

• Disorientation

• Loss of balance

• Amnesia – unable to recall what led up to the injury or what has happened since the injury

• Uncoordinated movements

• Vomiting/nausea

Most times, just a few of these symptoms will be present. A certified athletic trainer or sports physical therapist is the best person to evaluate you for a concussion in an athletic setting, and most high schools and colleges should have athletic trainers on the sidelines.

A big concern for parents is what to do after their child has been told they have a concussion. The on-field athletic training staff will help you decide. There is no one test or imaging that can determine if you have a concussion – it is a clinical diagnosis (based on symptoms). Most times, you do not need to go to the hospital to diagnose a concussion. However, reasons to go to the hospital would include:

• Severe headache

• Deteriorating condition (starting to lose consciousness after the injury, slurring words, uncoordinated movements)

• Suspicion of neck fracture

• Continued vomiting

• Vision changes

 If you don’t have any of these red flag symptoms, the best thing to do is to go home and rest. You do not need to wake someone up every hour – continuous sleep is best for brain rest and recovery. You should rest in a dark room with minimal noise, eliminate screen time, reading, and strenuous activity for the first three days[1] , which may include time off from school or work. Tylenol is a good option for controlling headaches and muscle pain. Taking ibuprofen or other NSAIDS is not recommended as they can thin the blood and increase the risk of worsening an undetected brain bleed. On the third day after the injury, it is okay to try some light aerobic activity as long as it does not worsen your symptoms (walking or stationary bike only).

A physical therapist or athletic trainer can provide more specific guidance to each individual person, but our recent research is showing that early aerobic activity improves healing times after a concussion. Exercise will progress through light aerobic exercise (walking, cycling) to more strenuous aerobic exercise (running, cutting) and then to sport specific activities including contact sports. This will occur over a period of time based on your symptom response.

 Our last blog reviewed tissue healing times, but unfortunately the brain does not have a “standard” healing time like muscles and ligaments do. The younger you are, the longer it takes to recover as your brain is still developing. This is why it is important for middle and high school students to take a concussion seriously. A second impact before your brain has recovered can be a devastating injury. A standard return to play protocol for college and NFL athletes is not appropriate for younger athletes because it doesn’t account for younger age and developing brains – trust your expert athletic trainer and sports physical therapist to make the best decisions for you and your children. A concussion can take a lot longer to recover from than you, your coach, or your team mates expect, and each person has a different experience. It may be a few weeks of down time, or even up to a few months if you try to return too soon.

Lastly, a concussion can affect more than the brain. Some people will have lingering neck pain, dizziness, or vision changes. Physical therapists are trained in treating neck pain, dizziness, and can guide you through appropriate return to play progressions. If needed, we can refer to an appropriate provider to address any visual impairments.

If we can answer any more questions about concussions or if you need treatment for a concussion, let us know!

Why is Recovery Taking So Long?

We all want to recover quickly following an injury, but there are certain limiting factors that determine the timeframe for full healing to occur.  Tissues heal in three distinct, yet overlapping phases, and different tissues may take longer to heal. The recovery time is dependent on the type of tissue (bone, tendon, ligament, muscle), the severity of the injury, age, and overall health status. Here is a list of expected timeframe for healing to occur based on different tissues. 

Source

The three primary phases of tissue healing are inflammation, proliferation, and remodeling.

Inflammation (4-6 days):

This is the immediate phase following an injury with an increase in swelling which may or may not be visible. Swelling around the ankle/foot after an ankle sprain or swelling around the knee following an injury to the ACL are two common examples. For less severe injuries, the inflammation may be less obvious and primarily present as stiffness.  Inflammation serves as a protection mechanism to protect the adjacent area and minimize risk of further injury. The increase in swelling likely leads to increased sensitivity, and we are likely to limit the use of that body region, muscle, or joint (think holding your arm at your side following a shoulder injury or limping after a leg injury). 

Proliferation (4-24 days) –

During the later phases of the inflammation phase, the body will start to rebuild the injured tissue. The inflammation signals the cells in the area to start rebuilding the injured tissue. As the new tissue is built up, it will be different than the previously uninjured tissue. The new fibers will be disorganized and will not be able to function as efficiently with exposure to stress as uninjured tissue would be.   This decrease in strength is likely to persist unless we work to specifically reorganize this tissue.  No matter how much work is done, there will always be some difference in the new tissue compared to the original, and this is what is often referred to as scar tissue.

Remodeling (21 days – 2 years) –

Once the new tissue is in place, the building blocks are there to begin remodeling so the tissue can withstand all the forces it needs to tolerate for usual function. Our joints, bones, muscle, tendons, and ligaments are constantly adapting to the stresses we expose our body to. The primary goal during this phase of healing is to introduce exercise, movements, and activities that promote strengthening and realignment of the tissue. This is the longest phase of healing and recovery, but the most important to ensure return to full functional ability following an injury. 

These phases of tissue healing guide what we can do at any given time point during rehab. We use this understanding to help guide when it is appropriate to return to your activity or sport, and these decisions are based on research and are not arbitrary. Our goal is to make sure you make a full recovery to safely return activity. As always, if you are experiencing pain or an injury, give us a call and we can help guide you through an individualized process to meet your goals.

Am I Ready to Return?

When we experience pain or injury that prevents participation in sport or usual activities, there are many questions that arise. One of the first questions that comes up is how long will this take or when will I be able to return to my sport or activity? The answer to this depends on many variables such as nature of the injury, tissues involved, healing times, surgery vs. no surgery, intensity and demands of the desired activity or sport, and numerous other factors that are likely to differ between individuals. 

We help guide you through a stepwise process to work back towards your desired activity. Once you are able to start a progression back to activity, we start with a full body movement screen to find the movements, mobility impairments, and motor control factors to work on that will help facilitate a gradual return. To learn more on this screen, see our previous post on this subject.

How do I know if/when I am ready or cleared for full participation?

At a basic level, we are constantly assessing ability to perform the necessary tasks required for participation. Through a variety of tests and measures. The more complex/intense the desired activity, the more steps will be required to fully return without restriction. We utilize test and measures to ensure appropriate strength through testing strength and function. Whenever possible, we use data and researched based cutoffs to determine if a patient has met the criteria to pass a test. This allows for definitive goals to be set and it is clear if those goals have been met for safe return to activity. 

When returning following injury and/or surgery, there is a step by step process we follow (protocol) that will vary slightly based on the doctor, and the specific procedure. The general progression is listed below and the tasks will become more challenging as strength, control, and endurance improve.

• Regain appropriate mobility and active control – can work legs if shoulder or arm injury, and work arms if leg injury as soon as it is safe to do so

• Building strength – in all planes of motion for the joint and limb effected

• Gradual progression towards desired activity with an understanding of the physical demands

  • Basic capacity and endurance for walking and running

  • Cutting and change of direction

  • Reactive movements

  • Powerful movement

• Full return to performance

The testing for the lower body includes different tests with different demands. When testing only a single leg, the goal is to reach 95% strength of the uninvolved leg. The upper extremity testing for full return to sport is very similar to the lower extremity although the exact strength requirements may be compared to another movement at the same joint, and the expectations compared to the opposite side will depend on which side is dominant:

• passing scores on full body movements screens

• strength and stability

• multiple functional tests to assess application of strength, stability, and control with different demands   

Our overall goal is to help each person return to their desired activity or sport as quickly and safely as possible. We never want to hold people out of an activity unless necessary as there can never be zero risk. However, we have these protocols in place to ensure we are working to minimize this risk while maximizing performance. 

Inactivity Leads to Deconditioning

The lazy days of summer combined with social distancing, and stay at home orders due to the COVID-19 pandemic have led many people to reduced levels of activity. Gyms are closed, races are cancelled and for most people running or biking alone isn't as much fun as a group run or ride. However, just as exercising changes your body to be more healthy and fit, not exercising does the opposite. This process is called deconditioning.

Use it or lose it

Without regular doses of exercise and activity, the body will decondition. Typically, cardiovascular fitness is reduced first, followed by muscular strength. As people become less fit and activity becomes harder, they do less, leading to further deconditioning and down into a vicious cycle. Deconditioning can also lead to more aches and pains, illness and disease. It only takes two weeks without exercise to have significant loss of cardiovascular fitness. Two to eight months of detraining can erase virtually all of your gains.

Reversing the loss

The best way to deal with deconditioning is to prevent it in the first place. If you're just undergoing a period of increased time commitments at work or with family, using a shortened exercise routine can help minimize your losses. Even one session a week will help you keep most of what you've gained. Other options are to use shorter but more intense interval training sessions, or breaking up your activity into multiple short chunks during the day. If your layoff was longer, it may take just as long to retrain as it did to make the gains initially. A physical therapist can help get you back on the right track if you're having trouble getting started, or if aches and pains are making it difficult to get moving again. For people who have reduced their activity levels because of injury or illness, a PT can not only help you recover faster, but they can also find activities to maintain your fitness while safely working around an injury or illness.

Source: ppsapta.org.

Just a sprained ankle?

In a single year, almost 1 million Americans will sprain an ankle. Most ankle injuries occur in young people (aged 25 or younger) and more females sprain their ankles than males (57%). It’s such a common injury that by the time you are 25, it’s almost rare to find someone who has never sprained an ankle. But just because it’s a common injury doesn’t make it an easy injury to recover from.  

There are two kinds of ankle sprains — a lateral ankle sprain ( 90%) and a high ankle sprain. Lateral ankle sprains account for most ankle injuries — the kind where you roll your foot in or under. A high ankle sprain can be more serious initially with a higher incidence of fracture, but occurs much less frequently.  

For any sprain, there are three degrees of severity. A grade 1 sprain involves minor tearing of some of the fibers of the ligament, but isn’t severe enough to cause any laxity, or looseness, in the ligament. There will be some swelling, but not very severe. A grade 2 sprain involves tearing of more ligament fibers, and there will be some laxity present. Expect to see much more swelling with grade 2 sprain and likely a lot of bruising. A grade 3 sprain involves a complete rupture of the ligament.  

With any grade of ankle sprain, the initial treatment is to POLICE it — Protect, Optimal loading, Ice, Compression, and Elevation. For a grade 1 sprain, you might not need a brace, but for more severe sprains you may need a brace, boot, or crutches. Because the ankle is the first joint that takes any impact when you take a step, it is critical to address it early. If not addressed properly, you may experience pain at the knee, hip, or back further down the road, especially if you’re returning to high level sports.  

Early physical therapy will focus on reducing swelling, pain, and getting you to walk normally. We can start balance and strengthening early on as well, and this improves long term function and reduces injury risk. Once you can walk and swelling is more stable, the focus shifts to sport specific activities — running, jumping, and directional changes. Starting back on these too early may cause compensations that hurt the knee or hip so it is helpful to have some guidance with your form.  

Many people have sprained an ankle more than once, which can sometimes lead to what is called a chronic ankle instability. At this point, the ligament may be torn fully or partially, but you can still perform similar exercises — strength, balance, and control exercises — to improve stability without undergoing surgery. For active individuals, it is especially important to work on balance and control at the ankle so that no further injuries occur at the knee or hip.  

Another common question we hear is: should I wear a brace to prevent an ankle sprain? While no brace can truly prevent a sprain, if you’ve had a recent sprain it is recommended to wear one for the duration of the current sport season while also working on rehab exercises. Research shows that ankle braces and ankle taping have the same efficacy. Bracing or taping for the duration of a season will not decrease strength or control at the ankle. Generally, we recommend wearing a brace only for activity, that way your muscles have a chance to work on their own. If you’ve never sprained an ankle, you don’t need to wear a brace for prevention.  

Let us know if you have more questions on ankle sprains or if we can help you recover from one!  

What to expect in a pelvic floor physical therapy appointment

Renee Bullis, PT, DPT

Renee specializes in pelvic physical therapy, and treats women for a variety of issues related to pelvic health.

Maybe your doctor referred you to pelvic floor PT. Maybe one of your friends or family members recommended it. Maybe you Google searched your symptoms and pelvic floor PT came back as an option. Whatever the case may be, you are wondering exactly what to expect in that appointment, let alone what pelvic floor physical therapy can do for you. 

A few weeks ago we shared a post about urinary incontinence in women and how pelvic floor PT can help, but pelvic floor physical therapy can be beneficial for women experiencing a variety of pelvic floor issues, including the following:

• Pelvic pain

• Pelvic organ prolapse

• Musculoskeletal pain, posture changes, mechanics in pregnancy

• Postpartum care

• SI joint pain and pubic symphysis dysfunction

• Constipation

• Fecal incontinence

• Overactive bladder

• Overactive pelvic floor

• Pain with intercourse

• Bladder pain/Interstitial cystitis

• Menopause-related pelvic floor concerns

If you are experiencing any symptoms not listed above but feel as if pelvic floor therapy may be an option for you, please reach out to us!

Your first visit to Kepros PT will primarily be a visit to chat about your symptoms, your concerns, and to begin the physical examination to establish a plan of care moving forward. Some of you may have heard that pelvic floor PT consists of an internal pelvic floor muscle exam. This is not normally done on the first day for a few of reasons: 1. Time; 2. We discuss what that entails and give you the option; 3. We want to establish a relationship with you and allow you to be comfortable with it first.

Some women think that with pelvic floor PT you have to do an internal exam , but that’s not the case. I never want anyone to be turned away from pelvic floor PT just due to fear or anxiety about the internal exam. I want you to tell me your concerns on the first day and know that we will only proceed with the internal pelvic floor exam if it seems medically necessary and with your consent.

Hip strength, core function, breathing patterns, movement patterns, and functional tasks (think sit to stand, squat, lifting, walking, running, etc.) will all eventually be assessed based on what information you tell us, when you notice your symptoms, and other parts of your medical history you provide. There is a lot we can look at, and we definitely don’t get through all of it on the first day. We weigh which pieces will give us the most information and proceed accordingly to begin your rehab program to start to get you feeling better.

There are several reasons why doing an internal pelvic floor exam can be beneficial and give us important information that will be used for your rehab program. Here are just a few of the main benefits from an internal pelvic floor exam: 

• Obtain an accurate assessment of pelvic floor muscle coordination and strength

• Locate any trigger points that could be a referral source of pelvic, abdominal, back, or hip pain

• Identify any compensation patterns that could be contributing to poor pelvic floor coordination or your symptoms

• Assess if the core and pelvic floor work together (ideally they should!)

An internal pelvic floor exam is not like what you have done at your doctor’s or OB/GYN visit. There are no speculums and we don’t feel around for organs in your pelvic cavity. Since we are musculoskeletal specialists, we assess for muscle function like mentioned above. This is done with one gloved finger with lubrication in a private room where you are draped appropriately (no paper gowns!). Just like we would test shoulder strength and coordination, we will test pelvic floor strength and coordination, but the difference is the most accurate way to do that is intra-vaginally. Most women find this internal exam to be beneficial, but if at any point you feel uncomfortable or want to stop, that is always an option. Yes, it can give us great information, but there are other things we can do and assess to still work towards your goals.

If you have any other questions on how pelvic floor physical therapy may be beneficial to you, what to expect in a visit, or any other concerns, please reach out to us!

-Renee Bullis, PT, DPT

Questions? Contact us at 319.200-6102 or info@keprospt.com.

Movement, Pain & Becoming Better

When we see a new patient for the first time, we try to answer these three questions:

1. What is going on?

2. How long will it take to go away?

3. What can I do to help?

The first question is usually the most important one the patient has as well, and we can’t answer the next questions without an answer to the first.

Some patients might expect to come out with a diagnosis of patellar tendonitis (knee pain) or a sprained ankle, and sometimes that is the case with a recent, true injury. However, many patients have a slow onset of pain that can’t be explained by one thing and doesn’t fit the “textbook diagnosis” of any certain condition.

What then?

Physical therapists are the movement experts, and in these cases, we will often arrive at a movement diagnosis. We like to use a systematic approach to qualify how well a person can move through some basic motions, including how well your neck can turn, can you touch your toes, lean back, twist? Is there pain with these motions? Regardless of what you come in for, you can expect us to look at your movement patterns from head to toe. The reason for this is that an injury usually does not only affect one body part.

Let’s look at an example of a runner with an achy knee after increasing mileage. If we only look at her knee and ignore limited ankle mobility or weakness in her hips, chances are her knee pain is going to return as soon as she starts running again. In this case, her “diagnosis” might be patellofemoral pain (kneecap pain) but her movement diagnosis would be limited ankle motion and limited strength in the hips.

A systematic approach to qualifying movement patterns also helps us decide if a problem is because of lack of mobility or lack of control. If we look at a dancer, they are some of the most flexible people we see. Their concern usually isn’t lack of motion, but could be that they have a hard time controlling all of that mobility. This is where we can give exercises to work on muscle control as well as muscle strength. 

All this to say: when you come to physical therapy, we need to look at you as a whole person, not just the parts that hurt. You never run with just your knee, so it doesn’t make sense to just rehab your knee. In the same way, we always want to know your specific goals — you might want to run a race or maybe play with your grandkids, but the path there looks a little different for each person.

Let us know how we can help you move better!

Stretching For Pain Relief

What stretches should I be doing to help by pain?

This is a common question we get in the physical therapy clinic. Although we do utilize stretches at times, mobility work will often supersede stretches. The rationale for this comes down to some important definitions of two words that are often used in the same context, but have different meanings when it comes to our ability to control our bodies to improve function and decrease pain. 

Flexibility is an individual muscle or muscle group’s ability to lengthen passively (how well someone can stretch a muscle).

Mobility is the ability of a joint to move or be moved freely and easily actively through a range of motion (how well you can move through a range of motion).

The exact definition used for stretching is also important.

Stretching in this context is placing a muscle or group of muscles at the available motion, and holding the position statically. Think – reach down and touch your toes, hold. There are other forms of exercise that may be described as stretching (dynamic stretch, proprioceptive neuromuscular facilitation (PNF) stretching, etc)., but most involve some an active component to the movement. For the sake of this discussion, stretching is considered as the classic stretch and hold techniques.

The best exercise or movement to prescribe/perform comes down to what your individual goals are. Most movement strategies and consistent plans lead to improved range of motion while static stretching for at least 5 minutes a day for 5 days a week will lead to greater increases in range of motion than other stretching protocols (1). This would demonstrate improved flexibility. The mechanism for this improved range is not necessarily increasing the length of the muscle, as there are many other factors involved, such as our nerves and the available motion based on the anatomy of the joint.

While increased flexibility and range of motion are great, that is not usually the primary goal we are working towards with our prescription of different interventions. The goals are much more often along the lines of controlling the motion to improve function and decrease future injury risk. Consider the differences between being able to bend down to touch your toes vs a deadlift. Both movements require a considerable amount of hamstring flexibility to perform, but the deadlift will require a much greater control to generate appropriate force to move the weight safely. 

A deadlift requires many component movements throughout the whole body, each requiring appropriate control and stabilization through a large range of motion for the given joint. The starting position of a deadlift requires ankle dorsiflexion over a stable foot, knee and hip flexion with abdominal control to stabilize the low back, shoulder blade and shoulder stabilization with strong grip on the weight. The movement component requires coordinated movements of the ankles, knees, hips, and trunk while maintaining stability through shoulder, core, and grip.

With that in mind, you will likely find we often use interventions geared towards mobility versus strictly flexibility (although this may be a necessary first step depending on your individual situation) as you progress throughout your physical therapy journey. The more you are able to control your body through the movement available, you will experience more freedom, improved performance, and a decrease likelihood of future injury.