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Research Leads to a Better Practice

Research. It’s the core of success. In our clinic, we pride ourselves on evidence based practice.  But what does that really mean to the patient? Evidence based practice combines three things: clinical experience; research; and patient preference or values.  So how do the articles we read from the research that’s done in universities filter down to affect our actual patient care?

One way we use research is to apply what we read to inform our thinking.

For an example, the Journal of Orthopaedic and Sports Therapy published this article that looks at using the drop vertical jump task as a way to predict an ACL injury.  What we learn is that this task isn’t a good indicator of predicting a possible injury. So many variables are involved in athletic injuries that it is very difficult to predict an injury from just one factor.

However, we also learn that increasing the cognitive demand on an athlete when performing the vertical drop jump task, makes the activity more difficult – and therefore, likely increases an athlete’s risk of injury. While this isn’t a perfect simulation of what might be happening on a soccer field or basketball court, it can help guide our rehabilitation of patients.

The result? We’re adding increased cognitive demands in the rehab process for our athlete patients before returning to sport.

Just another example of how research informs on how we care for our patients, through evidence based practice, in the “real world.”

 

Spring Vegetable Challenge: What’s New to You?

While there have been several mornings that have felt like winter instead of spring, spring is indeed upon us! What comes to your mind when you think of spring? Mine is sunshine, being outdoors without a coat and my of course seasonal spring vegetables! Now is the time we will find a variety of vegetables at the farmers market. Having an abundance of fresh and local vegetables is a great time to play around and experiment in the kitchen. Having a variety of vegetables in the diet is very important for health! Your GI tract will be healthier as it will have more diverse and beneficial gut bacteria and you will also be providing your body with more micronutrients that are critical for good function. Challenge yourself this spring to try several new vegetables, or using the vegetables in a different way.

Below I have highlighted some of my favorite spring vegetables.

Radishes – Radishes have a slight spicy flavor and make a great addition to salads. Simply cut then thinly and add then to a large salad with your favorite dressings. My favorite dressing is a mix of olive oil, red wine vinegar, salt, pepper and a little bit of honey.  Radishes can also be roasted! Simply cut them in half, drizzle with olive oil salt and pepper and roast in the oven for about 20 – 25 minutes. Then just pair them with your favorite protein dish.
Rhubarb – I’m sure we have all tried a strawberry rhubarb pie, but have you ever tried making a savory rhubarb sauce?!

This delicious sauce can be used for chicken, fish and pork either as a marinade or just on top after cooking.

Ingredients: 1 onion, finely chopped; 2 cups rhubarb, chopped into 1cm lengths; 1 cup white wine; 2 tbsp grated fresh ginger; 1 tbsp honey; olive oil; salt and pepper
Directions:
1. In a medium saucepan, gently fry the onion in a little olive oil until softened.
2. Add chopped rhubarb, wine, ginger and honey.
3. Season and cook over low heat for 8 to 10 minutes until the rhubarb is cooked and the sauce is reduced.
I’ve got some leftover rhubarb from the crumble this month.
Asparagus – Asparagus are in season for a very short time, so got to catch them quickly! Asparagus are a very versatile vegetable and pairs well with most dishes. Some of the ways I like to cook with them is to cut them in small pieces and add them to a risotto, they also taste great added to a quiche, or of course you can just simply roast them and sprinkle some Parmesan cheese on top!
Beets – Beets are my favorite! I find that you either love beets or hate them. I’m hoping to convert you to LOVE them! If you find the taste too ‘Earthy’ try grating them with a cheese grater and mixing it in a salad. You won’t be overwhelmed with their flavor because they are cut so thin and will be mixed with a bunch of other veggies from a salad. Don’t forget to eat the beet greens! They are totally edible and gives any salad a great kick!
Happy vegetable shopping (or growing)!
Guest BCPT Blogger

Home is Where Charlottesville Is

Charlottesville is where my heart, and home, is… now. But it wasn’t always the case. As a native of Pittsburgh, I enjoyed opportunity to gain my education on the east coast – earning my bachelor of science in biology with a minor in nutrition from the Indiana University of Pennsylvania, before ultimately graduating from Lynchburg College with a clinical doctorate in Physical Therapy.

Lynchburg boasted far greater weather than Indiana, PA, and I found myself taking up more outdoor activities – hiking, biking, exploring Virginia and all that it has to offer. I knew then, Virginia was for me. As I wrapped up my time in Lynchburg, I took an internship at UVA’s hospital for the summer. My fiance, then girlfriend, was living in Charlottesville at the time and as we took in the sights of Charlottesville – hitting up the shops, restaurants, and events around town – I quickly realized this was where I wanted to make my home.

A few years later, and we find ourselves residents of one of the most charming towns I’ve ever been in.

From the events constantly going on; the character of the people around us; the nature trails; outdoor sports; wineries; and breweries – I couldn’t imagine living anywhere else.

– Bryan Esherick PT, DPT

Benefits of Strength Training for Runners

It has almost become cliché to say that runners should strength train. So then I ask are you a runner who is strength training consistently (2-3 times a week)? If the answer is “hmmm, no,” you might not fully understand all of the amazing benefits we get from strength training. Let me break it down for you.

Benefit #1: It Makes You Faster

Proper strength training has been shown to improve running economy, or the ability to run faster while using less energy. Let me put it this way, if you could run a 7-minute mile with the same amount of effort it takes you to run an 8-minute mile right now, you would take that deal right? Of course you would. Faster runners spend less time on the ground and produce more force when they strike the ground. You can improve your force production and ground contact time through various exercises, drills, speedwork and plyometrics that can actually train the neuromuscular system to fire faster. Make sure you are complementing your runs with all of this ancillary work. Take that deal!

Benefit #2: It Reduces Injury Risk

A strong body is crucial to tolerate the repetitive load of running. Many overuse injuries can be avoided with the addition of strength training and a variety of functional, rotational, and multi-directional movements to your regimen.  I like to explain it this way: if you have an overuse injury like plantar fasciitis, you know the plantar is working too hard. Rest is an answer, sure. But come on, you and I both know you aren’t taking more than a day off without losing sanity! If you are able to strengthen the posterior chain (glutes, hamstrings, calves) to carry more of the load that your plantar is currently taking, you will reduce the use of your plantar and improve its function.

Benefit #3: It Enhances Recovery

This is probably my favorite fun fact that many runners don’t realize. When done correctly, lifting heavier loads produces a positive hormonal response that can rev-up the recovery process AND significantly reduce the risk of over-training. Lifting heavy will improve your overall strength, and metabolism; but what’s more I guarantee you will sleep really, really well at night.   

All In All…

When done correctly and consistently, strength training and other ancillary work like drills and faster running can make you more efficient, reduce risk of injury, and enhance recovery.  You will feel stronger on your runs and in races, and you will be able to tolerate higher training loads and have more energy.

Make strength training a priority and your body and mind will thank you!

Ann Dunn, M.S., CPT
BCPT Guest Blogger

 

Cardio: 30 Minutes A Day for a Healthy Life

Cardio. Personally, I am not the biggest fan of cardio workouts. The equipment at the gym is typically crowded, running isn’t comfortable to me, and it’s hard to find the time that fits into my schedule. But, I know it’s important for my health, so I’ve found ways to incorporate it. Enjoying your cardio workouts is half the battle in making the time to stay fit and healthy.

I love hockey. I play two to three times a week, and supplement my cardio workouts with the stationary bike. The bike is great for me – I can write notes, read articles, and it helps me unwind from a long day – all while getting my workout in. I also take the dogs for longer hikes when I have a little extra free time.

Cardio gets a bad rap for being repetitive, boring, and time consuming. But, cardio doesn’t only have to be a run on the treadmill, or spin on the bike, or an hour on the elliptical.

Find a physical activity you enjoy doing, and turn it into a hobby – outdoor activities are excellent for your lungs and your heart. Here are a few ideas for activities convenient for us here in the Central VA area:

  1. Hiking. There are lots of hiking trails here with various levels of difficulty. Get out there, and make your way the top for a great view of the blue ridge mountains.
  2. Kayaking. The Rivanna river offers a great opportunity for a workout with kayak or canoe on a warm summer day.
  3. Walking. The downtown mall right here in Charlottesville is a fantastic location for a brisk walk while you check out all of the sidewalk sales.
  4. Clubs. Find a sport club through the city website or Cville social. There are a variety of sports you can try, so find one you like and stick to it!
  5. Kids. They love to play, so join them outside and get active – you’ll be surprised at the workout you get just by joining your kids for play.
  6. Dog. Grab Fido and head out for a few spins around the block. The next time your dog stands by the door and stares at you to go out, get your running shoes and extend that walk. Don’t have a dog? Did you know, people who have them generally get about 30-minutes more exercise per day than those who don’t. So, maybe head to your local shelter and adopt one today!
The possibilities for a good cardio workout are endless.

All it takes is 30-minutes a day of moderate (50-60% of your max heart rate) activity to reap the benefits (improved immunity, healthier heart, healthier blood vessels, healthier lungs).  So, find something you love and make the change to promote a longer, healthier life!

Bryan Esherick PT, DPT

Four Ways to a Healthier Heart

Did you know heart disease and stroke cause 1 in 3 deaths among women each year – more than all cancers combined. The good news is that 80 percent of those deaths may be prevented. Your heart is the engine that keeps you going – supplying the ‘oil’ for your full body machine – so it’s important to take care of your heart.

February is heart health month, and we’re celebrating by sharing tips to help you keep your ticker ticking!

  1. Exercise daily. You should get 30-minutes of moderate exercise each day – and 1-hour per day for children. Moderate exercise includes things like a brisk walk, biking, weight lifting, or recreational sports. Exercise is important to keep your heart strong, much like you would for other muscles in your body. Check out our other recent blog posts about different types of aerobic exercises and heart rate zones.
  1. Eat Right. This may be the best, but also the hardest, thing to do to keep your heart healthy. Check the labels at your grocery store and choose foods high in fiber as well as vegetables – try to pass on foods high in fat, simple sugars, salt, and cholesterol. This will help ensure arteries stay open and your ticker stays healthy.
  1. Lessen the stress in your life. Stress can create a large burden on your heart by increasing blood pressure and releasing cortisol, and other stress chemicals. This can all have a negative effect on both the heart itself and the arteries it uses to transport blood. When you can’t eliminate the stress, try to manage it with a few breathing techniques; meditation; and even exercise! Find what works for you and try to work it into your daily routine.
  1. Stay positive with friends and family. Want to live a longer life? Positive relationships with those closest to you has been linked to be the #1 factor in living a longer life – ahead of quitting smoking and drinking; exercising; and eating right. As humans, we are meant to be social animals and look for opportunities to build relationships. So when you are done reading this, pick-up the phone and call a friend or family member and set up a time to get together and reconnect.
Some of the best indicators of a healthy cardiovascular system include a normal heart rate, low blood pressure, low cholesterol and A1c levels.

So, remember to take care of yourself, and keep your heart in check!

Bryan Esherick PT, DPT

Resolutions Checklist for Health in 2018

Trying to focus on your health in 2018? According to research, almost 25% of people will abandon their New Year’s resolutions by the second week in January and almost 60% will quit before six months. Starting resolutions that are too vague, large, or unrealistic will only set you up for failure. If this has happened to you in the past, try setting up specific and actionable goals for yourself this New Year. For example, instead of saying “I want to get healthy in 2018”, break it down into smaller goals that you can attain by gradually changing some of your daily habits. Need some ideas?

We’ve rounded up a checklist to help create realistic, actionable, and attainable goals for a healthier lifestyle in 2018.

  • Decrease processed sugar intake (cookies, cakes, candy, juices, jelly, etc). Women should aim to consume less than 25g per day and men should eat no more than 37g per day.
  • Decrease refined carbohydrate intake (white flour, white pasta, white rice). Replace these unhealthy calories with whole grain bread, brown rice, and whole grain pasta.
  • Decrease red meat and dairy intake. Replace red meat with fish, and substitute almond or soy milk for dairy products. To ensure adequate protein intake, be sure to eat plenty of beans, lentils, nuts, and seeds.
  • Eat more fruits and veggies. It is recommended everyone strive for 9+ servings per day of nutrient-rich fruits and vegetables.
  • Drink more water. Reduce or cut out carbonated, caffeinated, or calorie-containing beverages and replace them with water. Aim for 6-8 glasses per day.
  • Prepare healthy meals ahead of time. Pick one morning or afternoon each week to shop for healthy foods, then prepare them in advance for more convenient meals and snacks throughout the week.
  • Practice proper portion control. Protein portions should be the size of your palm. A portion of fat should be the size of your thumb. Fruit and vegetable servings should be the largest, and roughly the size of your hand. Eat slowly and only until you are satisfied, not stuffed.
  • Include both aerobic and resistance-type exercises. Start slowly and gradually build some form of exercise into your daily regimen. Ultimately, shoot for 30 minutes each day at 4-6 days per week.
  • Stretch more. Stretch your muscles daily, especially after exercising.
  • Sit less. Sitting for prolonged periods of time is detrimental to your health. Move your body more each day, even if it means intentionally parking farther away at the grocery store or taking the stairs instead of the elevator.
  • Stress less. Carve out daily time for yourself that allows you to relax and unwind. Plan ahead and stay organized to ward off additional stresses when life gets busy.
  • Quit smoking. Consider using nicotine-replacement therapy and avoid triggers. Celebrate small successes along the way.
  • Get more sleep. Aim for 7-9 hours every night. Sleep-proof your bedroom (get rid of lights, noise, and distractions) and create a bedtime ritual to help induce quality sleep. Avoid computer, tablet, or smartphone screen-time in the hours before bed.
  • Improve Posture. Whether you’re sitting, standing, or sleeping, become more mindful in keeping your spine in its natural “S” curve. Imagine that you are being held up by a string attached to the top of your head.
Remember that you should not try to achieve every one of these goals all at once. Living a healthy lifestyle begins with one simple choice after another. Even choosing just a few of these to help you create better habits for yourself will put you on the right path.

4 Tips for Sticking to Your Resolutions

New year. New resolutions. But will we stick to them this year?

Here are four tips for helping you stay true to you.

Start by making it a habit. Habits take about 21 days to form. If you stay true to trying to achieve your goals for at least 21 days, keeping up the habit after that should be as easy as pie… well, easier anyway!

Set specific achievements. Sometimes we make resolutions that follow the trends in society – to be healthier; to exercise more; to join a gym. But, it will be far easier to stick to your goals if they are personal, and specific, to you. To set a specific goal, try thinking of those things that cause you to feel anxious when the do or don’t happen as planned. If falling behind on your work causes stress, resolve to set a goal of creating a daily time keeper tracker to help you more proactively manage your projects. This makes the goal specific to you and directly helps to address a negative feeling you have. This correction will make you feel better, and you will be more likely to stick to it as a result.

Create SMART goals. SMART is an acronym that can help us manage our personalized goals:

  • Specific. Make the goals as specific as possible to increase the likelihood of seeing it through.
  • Measurable. Make the goals measurable so that you are able to see the progress you are making along the way.
  • Attainable. Making the goals realistic and something you can attain helps to keep you on track without feeling stressed out while trying to achieve them.
  • Realistic. Make the goals realistic and your progress will follow suite. For example, if you’re not an avid gym goer, try committing yourself to going three times a week, and go from there. You can work your way up to what is realistic for you – what fits in with your lifestyle.
  • Timely. Set a time frame for your goals. This is another opportunity to be realistic. Be sure to give yourself appropriate guidelines to realistically accomplish your goals.

Finally, don’t fret if you stray from your goal occasionally.

It’s part of human nature and the society we live in. We all get busy. Life has a way of interjecting its own plans, and some days that might mean not finding the time to go to the gym or prepare that healthy meal you were planning. It’s OK to slip on your resolutions occasionally… just don’t make it a habit!

Tips for a Stress-less Holiday

The holidays. Some would say it is the most wonderful time of the year. Others might argue it’s actually the most stressful time of the year. To stress, or not to stress – that is the question.

Whatever you stance, here are my 6 tips to a stress-less holiday season:

6. Think of others in this season of giving – from your community, place of worship, family, friends, neighbors, and even those you’ve never met – give of yourself, give what you can. What you get in return will be a comfort of knowing you made a difference.

5. Plan for holiday of tradition that fits your family – introduce activities and traditions that mean the most. Remember you can’t make everyone happy all of the time, so be sure to find happiness for you as you plan your festivities.

4. Just say no. There may be some holiday events you simply cannot make. It’s OK. After all, you’re only human!

3. Prioritize your parties. As you look at the calendar of events, try organizing against opportunities to see all of your friends and family at least once. Aunt Sally’s brunch? Yes. Visit to your great-grandmother? Absolutely. Champagne with your best friend? Yes. That co-worker who invited the whole office to her holiday gathering? Maybe not.

2. Set aside time for your immediate family – your partner, your kids. Create special memories from those unforgettable moments with those closest to you.

1. Make time for yourself. To be your best self during the fun and festivities, be sure to maintain healthy sleep and exercise schedules. Take a break from the chores – maybe schedule a healing massage – and seize opportunity to steal away enjoy a little ‘me-time’.

If you stay true to yourself and manage your stress, you’ll enjoy this time of year much more and limit your personal health risks.

Happy, and Stress-Less, Holidays!

Parkinson’s Disease: Who, What, Why

What is Parkinson’s Disease?

To better understand Parkinson’s, it is first beneficial to know about the populations it affects, what part of the brain it affects, and some hallmark signs and symptoms. Parkinson’s disease is categorized as a disorder of the basal ganglia (a cluster of neurons in the brain). More than 1,000,000 people in the United States are affected by this disease and it can affect people as early as adolescence, but has an average age of onset of about 60 years old. The cause of the disease is currently unknown, but researchers think environmental toxins, genetics, and a history of depression may be factors. The disease has been found to be caused by a loss of Dopamine (a neurotransmitter) in the basal ganglia. Parkinson’s is progressive in nature and there has been no cure found to date. Characteristics of Parkinson’s include small movements, quiet speech, postural Parkinson’s affects everyone in a different way and progression usually varies from person to person.

What is a Basal Ganglia and a Dopamine?

The basal ganglia are a collection of clustered cell nuclei that control movement. They are divided into two different pathways, each with different functions. The one pathway receives input from the muscles of the body about how a movement is being performed. This information is then interpreted to determine if the movement that is being performed matches what was intended by the brain. In other words, this pathway determines if the movement is of the right amplitude (big enough or small enough) for the intended task. If the movement does not match the picture the brain wanted, the first pathway sends this information to the second pathway. In the second pathway, the nuclei interpret the information received, and send signals to the brain to adjust the movement. Areas that can be adjusted from this information include consciousness, muscle tone, and appropriate “gain” of movement (bigger or smaller movements). To make it simple this corrective information can either ramp up (increase) the intended movements or it can ramp down (decrease) unintended movements.

The two systems use a complex loop to provide a system of checks and balances. The messenger that relays information between the two systems is called dopamine. This substance is classified as a neurotransmitter and provides a way for cells to communicate. Since Parkinson’s is characterized by a loss of dopamine in the two pathways, they essentially lose their messenger and are unable to communicate properly with each other. This can lead to faulty movement patterns or small movements and quiet speech, which are often a characteristic of Parkinson’s.

Current treatments for Parkinson’s vary from pharmacological treatments to increase the amount of dopamine in the brain to exercise therapy. Stay tuned later this month for a blog post about the LSVT BIG program and how it can help decrease the rate of progression of the disease and improve overall function in the population affected by Parkinson’s.

Bryan Esherick PT, DPT