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Ankle Sprain: Is Status Quo Enough?

Most of us have tweaked our ankle at some point or another. Typically we’re told it’s best to either stay off of it or brace it for a few weeks and it will heal. However, all too often there is an underlying process lurking deep down in the tissues that isn’t going to allow your ligament to heal fully, and leave you predisposed to chronic sprains. 

Ankle sprains affect people young and old, in any population, and whether athletic or not. It may happen while playing – or cutting – during a sporting event; when walking on uneven ground or into a small hole in the yard; or you might miss-step off of a sidewalk. Sprains generally affect the outside of the ankle when the ankle rolls, making the anterior talofibular ligament (ATFL) the most commonly injured tendon – which attaches from your outside ankle bone to a bone in your foot.

Once an ankle sprain occurs, there is tissue damage. This can range from a few fibers tearing – causing minor discomfort for a day or two – to a full-blown tear. Unfortunately, with status quo treatments re-sprains are far too common.

We have sensors in all of the muscles, tendons, ligaments – and even in the joint capsules surrounding the joints. Sensors provide our brain with important information about stretch, muscle activation, and joint position. This information allows the brain to form an internal picture of how the joint is doing at that moment. When the initial injury occurs, these sensors get disrupted and stop working properly. When this happens, the brain is unable to create an accurate picture of how the joint is functioning. This altered picture causes the ankle to be less responsive to demands put onto it, preventing your brain to effectively stabilize the ankle. As a result, something simple you may have done thousands of times – like jumping and landing on a volleyball court – may be the cause re-injury. Minor re-sprains can also happen without you knowing. These small injuries usually occur with simple activities like walking in grass. Unfortunately, these minor injuries will continue the cycle of chronic ankle sprains and may delay healing.

So, bracing and rest may not always be the best treatment for ankle sprains.

Of course they have their place with more severe sprains. However, in the case of minor to moderate sprains, braces can actually decrease proprioception and strength, making the ankle more prone to even more sprains! Physical therapy – to build up strength – is often the best treatment for a patient with this condition.

Physical therapy in ankle sprains will help guide you through progressive exercises that will improve ankle muscle strength as well as retrain the joint sensors to perform their job properly. Treatments generally consist of balance and proprioceptive drills on a variety of surfaces and with targeted strengthening exercises. Treatments should be tuned to specific tasks that will be encountered often whether in sports (cutting) or in daily life (walking on uneven surfaces). This is the best route to train the ankle to react to different challenges and prevent chronic sprains.

Bryan Esherick PT, DPT

Spring Training and Reducing Risk of Injury

The official start to Spring is just days away and with it comes spring training. For some of us that means races and triathlons and for others it means golf, baseball, softball and tennis. Whatever your sport or activity, enjoying the warm Spring air and getting your body moving after the long, cold winter may be what you’re looking forward to the most. 

Increased activity can bring injury – and while there is no such thing as injury “prevention”, there are measures you can take to reduce your risk of injury. Reducing risk is mostly about planning and timing.  You want to give your body ample time to adapt. Your risk of injury goes up when you make sudden large changes in activity or load over a short period of time.

Check out these tips to help you enjoy and injury-free season:

  • Don’t increase more than 10% a week. Don’t increase overall work capacity more than 10% whether you are training distance, or weight increase in strength training.
  • 4-6 runs a week is optimal, more frequent runs are better than less frequent longer runs.
  • Your shorter runs through the week should total more miles than your longest run
  • If you have pain during activity, stop and reset, then try again. If you have pain again, you should finish for the day.
  • If you have pain after your workout or the next day, don’t increase your miles/weight/repetitions until you are performing that day’s workout WITHOUT symptoms.
  • Get enough sleep! If you aren’t getting enough sleep, your risk of injury increases significantly. You should be getting at least 8 hours.
  • If you are taking anti-inflammatory medication to avoid/reduce muscle soreness your risk of injury is actually going UP. Inflammation is very necessary for healing and NSAIDs interrupt that process so you sacrifice long term gains as well as increase your risk of a muscle strain or tendinopathy.  The soreness you felt is your body’s way of limiting you so it has time to adapt to the forces you are asking it to handle. Listen to your body!
  • Your body systems adapt at different rates. Your cardiovascular system may adapt more quickly than your bones, muscles, joints and ligaments. Be willing to change your program to give your body more time to adapt.
  • Remember, the point of exercise is to be fun and to keep you out of the doctor’s office, not put you into it!

If you liked this, please feel free to share it. If you’ve got any questions about your spring training plan, feel free to ask questions: [email protected]

Samuel S. Spillman, DC

Cardio Health for a Longer Life

As heart health awareness month comes to an end, we want to highlight the wonders of cardiovascular exercise – help clarify exactly what it is – and remind you to keep your heart healthy all year long. 

Cardiovascular exercise – or cardio – is defined as any activity that gets your heart rate up. Now, that’s a pretty wide definition which is great because that means you can choose from a ton of different activities – some that you might enjoy more than others, and that means you’ll be more apt to get your body moving more. You could choose anything from: running; dancing; using the elliptical; rock climbing; swinging a kettlebell; playing tennis, basketball, soccer, football; practicing martial arts; taking classes like zumba, kickboxing, or jazzercise… and the list goes on and on – even sex can count! The idea is to choose activities you enjoy, and shift your mind from thinking it needs to be something you don’t like doing.

The benefits are cardio are huge. Most people immediately associate cardio as a weight loss tool, and it’s true that it is a big benefit. But there are so many other wonderful benefits to highlight as well.

Here is a list of health benefits you may have not have associated with cardio:

  • Mental Health:
    • improves mood
    • fights depression
    • relieves anxiety
    • improves cognitive function
    • stimulates nerve creation
    • boost self esteem
    • builds social relationships
  • Physical Health:
    • improves cardiovascular health
    • lowers risk of all causes of mortality
    • decreases risk of heart disease
    • improves blood pressure
    • lowers cholesterol
    • relieves pain as exercise increases pain tolerance

There is also some evidence to suggest that regular exercise effectively slows how quickly our bodies age by helping to repair the little proteins at the end of our DNA strands – called telomeres – which can help to keep us younger and fitter longer. Perhaps we have found the Fountain of Youth after-all!

The secret is to find something you enjoy and like doing, and stick with it. For me, it is martial arts. I’ve trained in it my whole life and get my cardio from Brazilian Jiujitsu and running. Bryan plays hockey and likes to use the rowing machine, while Dongjin plays soccer and Megan opts for aerobic dance. Think about what gets you moving – and of you’re not moving, give us a call and let us help you get started. Who knows, you just might find a new passion or hobby that will help keep you fit for life.

–Sam Spillman, DC

Tennis Elbow: What You Need to Know

If you’ve ever noticed an ache around the outside of your elbow that just doesn’t seem to go away, you might be experiencing a condition commonly known as tennis elbow. Once it starts, this type of injury can affect your strength and function in your arm. So, if you’re feeling that ache and haven’t done anything about it, now might be the time. 

Despite its name, this condition rarely affects tennis players.

It’s most common in sports and occupations that require repetitive movements – think computer work, climbing, heavy labor jobs, etc.  Tennis elbow is a form of a tendinopathy – affecting the tendons of the forearm muscles – classically called tendonitis.  The tendons undergo a degenerative process as a result of highly repetitive stresses. This process causes: increased blood to flow to the area; collagen creating cells; and ground substance. This cascade of changes can lead to pain and discomfort in the area – as well as poorly formed tendon structure which is then vulnerable to further injury.

Due to the nature of the injury, and the general inability to stop activities that aggravate the condition, it can take from a few months to up to two years for the tendon to fully recover and for pain to subside. It is possible for the condition to subside on its own, but there are steps you can take to decrease the duration of the symptoms.

Treatments for this condition vary greatly from surgery at the most extreme end, and to wait-and-see on the other, with everything in between. At Balanced we focus on rehabilitating the tendon through gradual loading of the tissue to reorganize collagen; and soft tissue work to relax overactive muscles; and education to empower our patients to heal quicker. We generally recommend avoiding bracing, cortisone shots, and surgery. By optimizing the environment for the tissue to heal, our patients often obtain quicker results and are able to return to normal activity and reach their goals within a more predictable time frame.  

Bryan Esherick PT,DPT

Recipe for Love

A good recipe can help you cook your way to one’s heart. Someone also once told me that the key to a happy life, is a happy wife. So, for this Valentine’s Day, I decided to put the two together and share this idea for your special holiday planning this week. h/t to Mark Bittman of the NYT for this inspired meal.

Black miso cod, miso soup, salad, rice, and chocolate ganache covered strawberries for the ever-coveted dessert. 

This is a great recipe for someone who is not an experienced hand in the kitchen. It’s amazing, and tastes like the most complicated and delicate dish ever prepared. But, as it turns out, is really easy!

Miso Cod

  1. Combine 1 cup of miso paste with 1/2 cup of sugar and 1/2 cup of sake and simmer in a small sauce pain. You can bring it to a boil but then let it cool.
  2. Lay out your Chilean Sea Bass or Black Cod (they are very similar) in 6-8oz pieces.
  3. Fire up your broiler. Place the rack 4-6 inches from the top.
  4. Generously coat the fish in the miso sauce.
  5. Broil until done, typically about 5 minutes per 1/2″ of thickness.
  6. Remove from the oven, plate and enjoy!

Pair it with some miso soup (also easy to make):

  1. Bring 4 cups of water to a boil with 1 tablespoon of dashi.
  2.  Add 1/3 cup of red or white miso paste and stir.
  3. Add 6-8 oz of shiitake mushrooms and you’ve got a simple and flavorful miso soup in about 10 minutes.

I’d consider a simple tossed salad with Japanese style ginger dressing.

Lastly no Japanese meal is complete without a bowl of steamed rice! Any Japanese short grain will do, I usually choose Calrose.

Finish it off with chocolate covered strawberries, with fresh ganache:

  1. Destem and wash large, fresh strawberries
  2. Melt 8 oz of dark chocolate chips in a small pan inside of a larger one filled with water
  3. Slowly and steadily stir in ½ cup of heavy cream until fully mixed.
  4. Dip the strawberries and leave them to cool on some wax paper in the refrigerator.

*If you don’t mind a little corn syrup you could add a splash to the chocolate mixture (just a splash) and it will give the ganache a nice shine.  But this is optional. Make as many as you’ll think you’ll eat.

Voila – simple to make, decadent and romantic Valentine’s dinner!

– Sam Spillman, DC

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

A Balancing Act: How Does Balance Work?

The balance system is one of the most important systems the body uses. Throughout the day it helps us to drive a car without getting dizzy; slip on a slick surface without tearing ligaments; go up and down stairs without looking at every step; and walk down the sidewalk without tripping on uneven cracks. Balance is a complex masterpiece that can be honed to help every person function at their highest level. Have you ever wondered how gymnasts balance on the balance beam, or hockey players skate on ice while handling the puck, or how skiers tear manage to slalom downhill without falling? It all has to do with practice and creating a balance set to fit their unique sporting needs. There are three different balance systems that work together to create a wholly balanced world.

Somatosensation

This is the feeling that we have in our feet, and is sometimes intertwined with proprioception. Somatosensation and proprioception are defined as how the sensors within the skin on our feet, joints, muscles and tendons sense where we are in space. These sensors constantly give feedback to different parts of the brain and brain-stem to correct movement, and ensure that the proper muscles are contracting to stabilize and move our body. This system can be disrupted by nerve damage (often called peripheral neuropathy), which often occurs with diabetes and some artery diseases. It can also be disrupted by pain, which is why anyone who has had an ankle sprain will tell you that they sprain the ankle over and over after the first injury. This is because the system is disrupted in the presence of pain so the ability of the ankle muscles to contract and prevent further sprains is impaired. When this system is disrupted due to lack of sensation or pain, the body relies on the other two systems below.

Vision

Simply put, vision gives us our picture of the world and integrates with the other systems to adjust muscle activity and movement to match what we see. We rely most of our vision during balance.

Vestibular function

The vestibular system is an integral part to the balance system. It activates postural muscles throughout the day and also helps us move our eyes independent of head movement. This allows us to focus on one thing while there may be a lot of other things going on around us – think about reading a street sign while driving on the highway, for example. If both of your vestibular systems were non-functioning (you have two, one in each ear), the horizon would bounce up and down instead of being still when walking. Mismatches in information within this system is usually what causes motion sickness. The reason people get nauseous with motion sickness is that the brain has trouble with deciding which input to use – vestibular, somatosensory, or vision. Nausea is your brain’s way of saying: we need to sit down and take a break so I can figure this out. When this system is not functioning correctly, patients generally experience dizziness – defined as feeling off, light-headed, or spacey – and vertigo, which gives the sensation that the world is spinning around you. This system is most important for balance at night when vision can be eliminated.

Balance may not be as straightforward as it seems. It requires a lot of input and processing within our nervous system to work well. The good news is that our balance system can adapt to use one part of the system more than the other through training and practice. The bad news is that as we age, we generally lose sensation in our feet and vision leading to increased risks for falls.

We can help you find your balance before issues develop. Give us a call for your balance screening today!

Bryan Esherick, DPT

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

Backpack Safety Tips

Backpacks. They’re necessary, but they also need to be safe. A child may lug to school more than 10 percent of his or her body weight which can be a serious pain in the back!

Here are some backpack tips to lighten the load:

  1. Choose a backpack that has two wide straps with good padding to distribute the load evenly.
  2. Adjust the height. Tighten straps so the bag is centered on the back, ideally above the lower curve of the spine.
  3. Use both straps. The one-shoulder method may be cool, but it adds serious pressure and throws body alignment out of whack.
  4. Weigh the bag. It should weigh no more than 10% of the child’s weight. If your child regularly has to carry more than that then you should get them one of those rolling backpacks that they can pull.
  5. Have your child checked. If your kid complains of back pain-even if it seems minor-talk to your doc. No amount of achiness is normal, and a physician can recommend strengthening exercises to help ease it.

Happy backpacking!