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Skiing: How to Prepare and Avoid Injury

The knee joint is the most vulnerable and most common snow sport related injury. The good news is there are steps you can take to condition and prepare your body for winter sports such as skiing.

Things to do in preparation for your ski trip:
  • Core and lower extremity exercises (listed below)
  • Training your cardiovascular fitness- many injuries occur as a result of fatigue
  • Proper equipment that is appropriate for your height and skill level
  • Take a skiing technique class before hitting the slopes
Preventing Injury on the slopes:
  • First off warm up your body before hitting the slopes each day
  • Proper technique: Hands and weight forward, legs parallel and hips, knees and ankles flexed equally
  • Stay on trails that are marked for skiing safely

The following are exercises should be preformed several weeks before you plan to ski. All of the exercises should be attempted for 1 minute and increase the time as you improve.

Balance

Standing on one leg reach the other leg toward an imaginary clock face. Repeat on other side.

Lateral Jumps

With both feet close together bend your knees and jump side to side while maintaining a straight spine and a flat back as well as even weight in both feet.

Rotational Jumps

Start from a squat position with feet close together jump from diagonal to diagonal landing on the balls of the feet.

Side to side skaters

Stand on one leg and take a large step to the with the other leg and then take another large step back to where you were. Make sure your pelvis stays level and your knee does not buckle inward.

Check out the full video for these fun and helpful exercises!

Rotator Cuff: Repairs and Road to Recovery

Rotator cuff is a term that many people fear when mentioned by a healthcare provider. This fear is usually warranted but, if a partial tear, can usually be treated conservatively if caught early. This fear may come from not knowing about conservative measures that can help. On the other hand, when conservative management fails or the tear is more significant, surgery is generally indicated. The goal of this blog is to help answer many of the questions you may have when a healthcare provider mentions that your rotator cuff may be the cause of your shoulder or arm pain. A brief description of the function of the cuff and the pathology will be followed by a look at the road to recovery and what to expect as you go through the weeks of rehabilitation. 

The cuff’s main purpose is to improve shoulder stability by actively pulling the arm bone into the shoulder socket with arm motion. It does this through a concert of contractions of the 4 muscles that make up the structure. Each muscle works intricately with the other to provide the most stability possible: Even when one muscle is not working properly, it can lead to issues. Without the rotator cuff, the shoulder generally becomes unstable which can lead to further tearing or other injuries affecting the shoulder joint.

Tears are fairly common and can affect people of all ages. They occur most commonly in patients in their 50’s and above, likely due to tissue deconditioning and other age related changes. Tears also occur frequently in overhead throwing athletes. Cuff injuries generally occur gradually over a period of time where symptoms begin to evolve and worsen. Warning signs of tears include deep, dull shoulder pain, trouble sleeping, and an inability to move the shoulder through its full range of motion. Labral tears and biceps tendinopathy are common concurrent injuries that may also be addressed.

Surgery vs. conservative management will generally be decided on a case by case basis and based on failure to conservative treatment, imaging results, signs and symptoms, and quality of life reported by the patient.

Here is what to expect when surgical repair is indicated.

Day 1- week 2: Surgery is generally performed at an outpatient surgical center. Most repairs are done arthroscopically meaning a small camera will be inserted with tools on the end to complete the repair. A local nerve block as well as general anesthesia is used during the procedure so you will be asleep the entire time. The nerve block will also help to ease pain for the hours following surgery and likely into the next day. This usually only requires 2-3 small incisions in your skin. You will return home the same day following the surgery. Pain killers are generally prescribed to help ease pain, and they should be taken to make you more comfortable.

The next 2 weeks are used to allow the repair to heal properly and is the maximal protection phase. During this time your arm will be in a sling and you will likely sleep in a recliner to protect the repair. Moderate pain is a normal experience during this time so be sure to ice and take any medication as prescribed.

Week 2-4 Post-op: This is generally when physical therapy is initiated, but some surgeons will wait for 6 weeks before therapy is initiated. During this period in therapy, the therapist will move your arm for you to begin regaining normal motion. You will also begin working on activating the muscles around your shoulder blades. Gentle activation of your shoulder muscles will also start.

Weeks 5-10 Post-op: The goal of this phase is to obtain good range of motion and to be able to stabilize your shoulder throughout the range with your muscles. Range motion will continue to be progressed and active motion will be progressed gradually within relatively pain-free ranges to hopefully reach full range by week 7-8. Range of motion progresses differently in different patients so don’t be discouraged if it takes longer than normal. Strengthening exercises will also progress gradually to gain strength for normal activities.

Weeks 10-20 Post-op: The goal of this phase is to continue progressing strength and stability to prepare your shoulder for return to all prior activities. You will also be expected to become more independent with exercises. Challenging functional movements will be performed later in this stage. Complex movements like throwing will be broken down into parts to practice before performing the actual movement to ensure proper shoulder function. You will likely be weaned from PT and may be discharged to continue with comprehensive home program to continue toward the end of this period. Athletes that need more intense treatment will continue with therapy into the return to sport phase.

Be sure not to perform activities that are too taxing for your shoulder at this point. Your shoulder will be feeling much better, which makes this a common time for re-injury to occur. Although your shoulder is feeling better, that does not mean it is fully healed and ready for full return to all of your normal activities.

Weeks 20+: Typically the safe return to sport phase. You will progress back into your sport or other activities. Continue with your home exercises to continue building strength and stability throughout your shoulder complex.

You can expect to be checking in with your surgeon throughout this process to insure that everything is going as planned. Your therapist should be in contact with the surgeon throughout the process to ensure you are progressing as expected as well.

I hope this blog can ease any anxiety about your upcoming procedure and give you a brief guide for what to expect following a RTC repair. Surgery can be intimidating, but the more you know going into it, the better the outcomes!

We will be following one of our patients through rehab and will post exercise videos and updates throughout his recovery. Be sure to check them out!

Bryan Esherick, DPT

New Year, New Resolution

It is that time of year again, the birth of a new year and maybe a new you. Are you making any New Year’s Resolutions? In the fitness and health care communities we tend to focus a lot on losing weight, diet, starting an exercise program.  And all those are wonderful things. But I think it is important to focus on what will make your life better. What kind of resolutions will improve YOUR life. Not necessarily what your healthcare provider would choose for you, or your spouse, or your parents.  We might want to swear less, or improve a relationship with a loved one, visit family more, get a promotion at work, get more involved with charity, and so on.

Whether you are trying to resist something that is bad for you or start a new thing that is good for you, making a change can be difficult.  

I like to start with the end result and work my way backward. For each goal, I like to make it SMART: Specific, Measurable, Attainable, Realistic and Timely. This is a commonly used business idea, but it can be applied to personal goals too. To me, using this method can help really set ourselves up for success.   

For me, less screen time in the year ahead is a big goal. You may have noticed that it is more difficult to NOT do something than it is to add a new activity. So instead of setting a screen time limit for myself, I’m endeavoring to fill up my time with other things, so that screen time is less of an option outside of work. I’m making a list of books I’d like to read, and a commitment to do more activities after work. I’ve joined a committee of a local charity and I’m going to attend one evening jujitsu class a week.

So as you make your New Year’s Resolutions, try to spend time planning out how you might achieve your goals, as well as determining what goals to set.

You’ve got this. Happy New Year!


Sam Spillman, DC

Insurance Coverage Explained

Insurance coverage can be a tricky thing to navigate. Do you know what your individual deductible is? If so, do you know about your family deductible and coinsurance for a specialist visit? For most of us, myself included, the insurance specifications have become seriously complex.  Many times I’ve intervened on behalf of patients that have met their wits-end while attempting to understand their chiropractic or physical therapy benefit coverage. In an attempt to simplify some of the frequently used insurance terminology, I put together this little cheat sheet to help in minimizing the frustration factor.

Co-insurance

A coinsurance occurs when there is cost-sharing between the insurance company and the covered member/family.  The insurance company may tell you that your responsibility is a 20% co-insurance and that they will cover the rest of the charges (remaining 80%).  Quite often a coinsurance comes in to play after an individual or family deductible has been reached.

Example: Your opthamologist visit is $400 and Optima informs you that you have a 20% coinsurance after meeting your $200 deductible.  Currently, you have met $0 of your deductible. Your responsibility would be: $200 of the deductible and then 20% of the remaining $200 specialist visit charge = $40.00. The total you can expect to pay for the visit is around $240.

Co-pay

A copay is a set fee that you are responsible for each time you visit a doctor.  There are usually tiers or copays where a primary care doctor is typically less than the copay you may have for a specialist. Some plans have a copay due in addition to a co-insurance.

Deductible

The set amount an individual or family must reach before transfering over to coinsurance coverage for medical services.  Some plans have relatively low individual and family deductibles of $200 – $500 while other plans have larger $5000 – $9500 deductibles.  Once you have met your deductible you may only be responsible for a fraction of the percentage of your medical care, referred to as a co-insurance.

Out of pocket maximum or stop loss

This is the absolute maximum a covered member or family will pay out of pocket for medical care including copays, deductibles and co-insurance for a defined period of coverage (usually a calendar or a contract year)

 

Giving Thanks for Balance

At the start of this holiday season, we’d like to give thanks for Balance(d). I named my practice Balanced because I believe in a measured approached to things – to the body, to patient care, and to life. It serves as a reminder to me as much as I hope it does for my patients. Last year I wrote about the importance of balance during the holidays, and you can read about it here. This year, I thought I’d share how I keep my balance during the holidays. Keeping your holidays stress free is great advice, but I want to talk a bit about how you actually do it.

Schedules

For me, as an introvert, I’ve learned it is really important not to over schedule myself. If I do, it can really wear me out. So I keep track of my schedule in a calendar, and when I consider any invitation I look at the time slot and see what’s around it. If attending the event doesn’t leave me any recharge time, or there’s too much travel time, or if it means I’ll miss too much of my exercise plans, it’s likely a pass for me. Of course for those with children, schedules can be more complicated. You just have to keep your mind on the balance.

Food

Another consideration around the holidays is food. I love food. You can often hear me talking about cooking, restaurants, and value-driven ingredients. To balance food around this time of year, I try to keep lunch light and very healthy – especially if I have plans for dinner or a party later. Then there are the oh-so-tempting sweets that pop up everywhere during the season. So, I eat a healthy snack before I head out since counting calories doesn’t work for me. When I am trying to relax and enjoy a party the last thing I want to think about is how healthy the food is I am eating. Filling up a little on healthier foods before I go can also help ease the guilt along with the managing how much I eat. I gain weight easily if I’m not careful, so I tend to stick with my plans.

Exercise

I’m a big proponent of exercise, as many of my colleagues in the healthcare field are. If you’re trying to keep from gaining weight, or if you’re trying to lose weight during the holiday season, you’ve got to pay attention to your diet the most. However, exercising during the holidays will also help keep your weight in check as well as help to alleviate stress and keep you in a better mood overall. Of course, if you’re on a set plan for a competition, stick with your plan. If you’re like most people, you exercise more because you should and less because you love it – or perhaps you don’t exercise at all. Time is a big factor for those who don’t, but it doesn’t need to be all or nothing. The key thing is to keep your body moving. If during the holidays, you drop from four days a week to three, that’s a good trade-off. Another way to make the most of your time is to consider high-intensity interval training to make your exercise shorter but more intense. You’ll still build muscle, improve your cardiovascular function, and get all those wonderful stress relieving chemicals – going hard for 10-15 minutes can be as useful as an hour of moderate exercise on the bike or a long walk.

So, take these tips and find your balance this holiday season:

  • Look at your calendar frequently and make sure you aren’t overloading yourself and the family
  • Stick to a healthy breakfast and lunch and have a healthy snack so you don’t have to watch too much at a party
  • Keep up with some amount of exercise, even if it’s less than you normally do

Sam Spillman, DC

Preventing Inflammation Naturally

Inflammation can strike at any time. Anti-inflammatory drugs can be helpful, especially for new injuries and certain inflammatory-based pathologies. However, our bodies experience new episodes of inflammation (both beneficial and detrimental) all the time. So, using natural remedies is a safer way to decrease those frequent bouts of non-beneficial inflammation.

Here are a few natural remedies to try before you reach for a pill. 

  • Exercise: Even just 20 minutes of exercise can have anti-inflammatory effects on the body’s systems.
  • Add powerful anti-inflammatory spices to meals: Give turmeric, cinnamon, and ginger a try. Turmeric can be sprinkled on variety of foods, cinnamon can be a great addition to your oatmeal or tea in the morning, and ginger brings a nice twist to a smoothie.
  • Reduce red meat consumption: Recent studies show red meat can actually bring on inflammatory effects on the body. Chicken, salmon, and other foods high in Omega 3’s can be great options to prevent inflammation and get the protein you need.
  • Eat more foods with anti-inflammatory properties: Fruits, vegetables, nuts, and legumes are your friends. Be sure to include multiple servings of these throughout the day to allow your body to be at its best.

Remember, your body is your greatest asset. Take good care of it, and it will take care of you for years to come!

Bryan Esherick PT, DPT

Treating Pain without a Pill

Treatments come in a variety of options. Opioids (oxycodone, hydrocodone, etc.) are often prescribed as treatment for an episode of pain patients are experiencing. If you haven’t been the recipient of these directly, there’s a good chance you know someone who has. They’ve been widely prescribed as they had always been considered both safe and effective. However, in the wake of an opioid epidemic, we want to remind our patients that there are safe and effective treatments that let you avoid the drugs – and without the side effects, That said, there are instances where these types of drugs are appropriate – post surgery or serious injury – and with proper management may be used safely. However, we want to use this platform to highlight our approach to more conservative treatments that can effectively alleviate pain.  

As physical therapists, chiropractors, and massage therapists, we look to provide that first-line treatment for acute and chronic injuries alike – including: manual therapy; joint mobilizations; massage and soft tissue release; targeted therapeutic exercise; and health education. Let’s take a closer look at these distinct areas. 

Joint Manipulation and Mobilization

Manipulation and mobilization are used throughout musculoskeletal health by chiropractors, physical therapists, and some osteopathic doctors. Despite popular belief, the aim of these treatments is not to put a bone back in place. Treatments like this work with the nervous system to affect pain (through release of endorphins), muscle tension (through reduction in pain and thus reduction in spasm), and proprioception (your brain’s sense of your joint position). In my opinion, 95% of cases require exercise to reinforce the effects of the manipulation. In other words, mobilization and manipulation gives your body a window to exercise with less pain so that you can correct the issue at fault and increase muscle tone. However, it does not correct the underlying cause of the pain independently. These are  powerful pain relieving tools that can be employed to aid in your recovery from pain, especially in the spine.

Massage

Generally massage is thought of as a relaxation and stress reducing technique, but it can also be used as a powerful pain relieving and recovery tool. Therapeutic and sports massage are given in order to improve recovery through reduction in muscle tone and improvement in blood flow. Relaxation in muscle tone allows the muscle to receive the adequate nutrition is desperately needs to heal. Think of a muscle as a sponge; when it is squeezed out (overactive) it is not able to receive the water (blood) it needs to function. We see this happen often in cases of back pain associated with sustained postures, and receiving occasional massages would help alleviate this chronic paid in a more effective and cost-effective treatment. Massage also releases endorphins through a healing touch and targeted techniques, which helps to ease pain and creates a relaxing therapeutic environment for the body to heal. Your chiropractor or physical therapist may also use targeted soft tissue techniques to promote healing and pain reduction. 

Therapeutic Exercise

Therapeutic exercise is used widely by physical therapists and chiropractors as well. Movement encourages the body to release endorphins, reduce tissue tension through increased blood flow, promote healing through cellular processes, and prevent chronic pain from fear of movement. Exercise can be used as a means for tissue to adapt and heal to specific stresses it will encounter through daily activities. We use therapeutic exercise not only as a pain relieving mechanism, but also as a way to introduce stress to healing tissues in a controlled manner. If the tissue is not properly loaded over time, it can be substantially weaker than it was prior to the injury causing recurrent injuries. The best example of this phenomenon is chronic ankle sprains. Without proper rehabilitation, ankle sprains are likely to keep occurring as the body is unable to fully heal the tissue prior to sustaining a second, third, or fourth injury. Another common misconception is with arthritis. Many people stop moving because the arthritis is causing too much pain. On the contrary, our joints need to be loaded in order to provide nourishment to the joint surfaces. Without movement, joints can continue to degrade and become more painful. Remember, movement is your friend and is ultimately what will keep you feeling happy and healthy for years to come.  

Education

Education about a particular condition should not be taken for granted. It is the responsibility of your healthcare provider to educate you on your conditions, the treatment options, and expected recovery prognosis. Please don’t hesitate to ask your provider questions – fully understanding your condition is a key element to complete recovery. Education about pain can also be invaluable for the patient, which is why our office strives to provide pain education to help contextualize thoughts and beliefs about pain. Sometimes education is the stepping stone to preventing a patient from progressing to a chronic state of pain. For this reason, our office doesn’t just treat your condition, we help you understand it.

As you can see, there are many alternative treatment options for pain relief – and with far fewer side effects – than prescription drugs. It is important when seeking care for pain, that you explore all options landing on an course of treatment. Second opinions can often be helpful when you are unsure if a certain treatment is right for you. Trying a more conservative option first may save you time and dangerous side-effects from other riskier alternatives. 

Our office uses all of the above techniques, and when necessary, uses other techniques including modalities and dry needling. Our goal is to provide our patients with the most comprehensive, evidence-based treatments to ensure the fastest and most complete recovery path from injury. We ensure that each patient is treated individually, as every patient has different needs from the healthcare system. Still have questions? Give us a call to learn more. We’d love to help you become the strongest version of  your best self!

Bryan Esherick PT, DPT

 

Five Tips for Easy and Healthy School Lunch

Try these quick lunch tips to help you AND the kids!

  1. Buy fresh produce. Sunday night prep can be 30 minutes: wash, peel and cut all carrots, celery, broccoli, cucumbers, etc. and store in large ziplock bags for the week for a quick grab-and-pack.
  2. Create your own lunchables. Sliced cheese/ham and crackers in a reusable container, grapes and carrots in another, hummus and pretzels for non meat eaters, and you’re set!
  3. Avoid sweet drinks. My kids would finish a juice pouch and eat nothing else. Keep juice and sweet treats at home as an after-school-treat. They’ll look forward to that!
  4. Provide ample food storage. Having sandwich and snack size reusable containers on hand make packing a lunch so much easier for little ones.
  5. Pack a note. Wouldn’t you want a note from Mom/Dad? (I would!) A silly joke or a ‘have a crazy day!’ can help your child (or spouse!) get through the rest of the day.

Enjoy healthy and happy lunching!
~ Angie

Concussions and a Safe Return to Sport

Concussions. They can have lasting effects later in adulthood, so prompt treatment is essential to mitigate long-term effects. While the end of summer draws near, and fall sports get underway at the start of a new school year, it’s important for parents, trainers, and coaches to remain vigilant in watching for signs and symptoms of concussion in young athletes.

Here some tips to help you recognize concussions:

  1. Your child isn’t acting quite like themselves: Look for changes in your child’s usual mood, cognition, ability to pay attention, and energy level. When your child isn’t acting like he/she normally does following a game, it’s a safe bet they may have suffered a concussion.
  2. They sustained a jarring hit: Any hit, whether it is to the head or body, has the possibility of causing a concussion. Hits to the head are obviously related to concussions, but hits to the body can also cause concussions through whiplash-like mechanisms.
  3. Nausea or sensitivity to light or sound: These are some very common signs seen following a concussion.
  4. Dizziness while using their phone or watching TV: This can be caused by a sensory issue within the vestibular system. Also watch out for dizziness or imbalance while driving and walking in busy areas.
  5. IF YOU SUSPECT A CONCUSSION SEEK MEDICAL ADVICE: Waiting to seek medical advice can have an impact on the overall time it takes for your child to recover. Seeking medical advise as soon as you suspect your child may have a concussion is key.

One of the best things that you can do for your athlete as a parent or coach is to be sure that they have baseline testing consisting of physical, cognitive, and equilibrium tests prior to participation in practice and games. Should an injury occur, baseline testing allows the coach and trainer to know when it is safe to allow the athlete to return to sport after an injury has occurred. Also be sure that the testing for your athlete is comprehensive, and not performed only using the IMPACT computer-based test that doesn’t take into account the other functions of the body that may be impacted through concussion.

When seeking medical advice, remember that advice can come from a variety of medical practitioners including medical doctors, physical therapists, athletic trainers, etc. Medical examination usually consists of some tests and measures to determine the severity of the injury. Examination is necessary to rule out other serious pathologies, including a brain hemorrhage. Usual care for a concussion is a brief period of rest (1-3 days), followed by a graded return to sport and school, and then rest. Rest is essential for the brain to heal itself in the early stages, although activity should be resumed as quickly as possible while maintaining little to no symptoms. Physical therapists can help by determining a safe level of activity for the athlete and developing a sport specific training plan. Before your child returns to sport, ensure all testing compares to baseline, that physical activity has been progressed, and that your child is symptom-free with sport specific training.

By following these key steps after sustaining a concussion, your athlete can return to sport as quickly and safely as possible.

Note: This blog is not considered medical advice that should be used if you suspect a concussion in your child. If you believe your child may have suffered a concussion or would like to receive baseline testing, contact our clinic at 434-293-3800.

Sleep and School Performance Go Hand-in-Hand

Want to do better in school? Get more, restful sleep! We all know sleep is important but we might think of it more as an “eat your vegetables” important kind of way. In reality, we should be thinking about it more in a “this could impact my life, hopes and dreams” kind of way. That’s exactly what researchers are finding as we learn more and more about sleep and the value it brings.

Sleep is vital for so many functions and processes in the body: memory, cognitive function, blood pressure, hormone regulation (cortisol, insulin, leptin, grehlin, testosterone), healing, muscle recovery, immune system, etc., etc.,. And, it is especially important for children. Sleep deprivation can significantly impact a child’s performance in school.

So, how do you know if your child is getting enough rest? Here’s a good rule of thumb:

  • Children aged 6-13 should be getting 9-11 hours of sleep each night
  • Teens should be getting 8-10 hours

While these are good gauges to check patters in your household, that’s just a starting place. Behavior can be a great clue.

Signs of sleep deprivation are similar to symptoms of ADHD. They include:

  • easily distracted
  • difficulty focusing
  • yawning
  • moodiness
  • irritability
  • fatigue
  • depression
  • difficulty learning new concepts
  • forgetfulness
  • feeling “fuzzy”
  • unmotivated
  • clumsy
  • increased appetite
  • overweight

Most likely, we could all make a few adjustments to get a better night’s sleep.

The best rules work for both children and adults:

  • keep a consistent, daily bedtime
  • avoid eating within three hours of bedtime
  • discontinue screen time at least an hour before bed
  • can the caffeine after noon
  • maintain a set bedtime routine for children

With these simple tips, you and your little ones will be sleeping sounding and reaping the benefits in no time!

Sam Spillman, DC