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So you tore your ACL…now what?

Anterior Cruciate Ligament (ACL) ruptures are one of the most common injuries in sport. Most occur without contact, and occur far more often in female athletes than in males. There are many ways to injure the ACL; maybe you’re a soccer midfielder who got into a 3-way tackle at practice. Maybe you’re a goalie who went to clear the ball and felt your plant leg crumble underneath you. Or maybe, if you’re really unlucky, you stepped in a pothole walking home from a game. Regardless of the scenario, when an ACL ruptures you will feel a pop, likely feel your knee “go inward”, and experience immediate swelling.

While there are several clinical tests that a physical therapist can use to determine the status of your ACL, the gold standard for diagnosis is MRI. Once an ACL tear is confirmed on imaging, the gold standard of treatment is still surgical reconstruction.  Research is coming out now suggesting that some individuals can “cope” with intensive rehab, but what we see in the literature is that this only occurs for about 25% of patients who sustain an ACL rupture. If you are going to return to a high-level contact sport – and especially if you’re female and under 30 – your best bet for returning to optimal performance is a reconstructive surgery. 

While it’s a common injury in sport, it’s also an emotionally difficult one; it’s likely your season will be over. Athletes will usually feel grief grief over suddenly not being able to do the thing you love,  anger at watching your teammates continue to thrive and perform in your sport, and fear that you’ll never be the same again.  

 These are all normal feelings to have, but in excess, they’re actually going to prevent you from making a solid comeback. So, here are some steps to take to get your head back in the game, and some information for you so that you know exactly what to expect after you’re wheeled out of the operating room. 

First: Know that it’s going to be okay. 

While an ACL rupture is likely a season-ender, it doesn’t have to be a career-ender if you find the right orthopedic surgeon and a physical therapist who specializes in sports. How many of you watched Megan Rapinoe this year in the world cup? Did you know she tore her ACL – for the THIRD time – in 2015, and was back on the field for the Rio Olympics? . Yes it takes a long time and a lot of hard work, but know this: you WILL play again. 

 Second: Learn about what’s going to happen in the Operating Room.

Surgeries are scary,  but the good news is that sports medicine surgeons perform this operation all the time. Choosing your surgeon is important – you want someone who is board-certified in sports medicine and who does this operation regularly. It is more than okay to ask your surgeon how many ACLs they have reconstructed! Choose your surgeon well – make sure they have LOTS of experience with this operation and make sure that they share your goal of getting back with your team – and you will be just fine. In the operating room, the surgeon will make a small incision and will first debride, or clean up, the inside of your knee. She will likely remove the torn portions of your old ACL.  Then, she will take a portion of one of your tendons – either your patellar tendon (front of your knee), hamstring tendon (back of your knee) or quad tendon (just above your kneecap) and creates a “graft” by re-inserting the tendon into the joint, such that it will act like a new ACL. 

 Third: Get your dang knee straight!

 After you wake up from surgery and make it home from the hospital, you’ll likely be sore, but it’s important to get that knee moving. Check with your surgeon about specific precautions and limitations, but in most cases physical therapy should begin 1-5 days after your surgery. The most important thing in the early phases of rehab is to regain full range of motion, especially extension. Without full range of motion, strength gains will be hard to come by. The earlier you start working on this, the less painful and difficult it will be over time! 

Fourth: Train Hard. 

Find yourself  a physical therapist who specializes in sports rehabilitation. Your physical therapy sessions should feel progressively harder and harder, and your PT should be stressing your cardiovascular systems in addition to getting you strong. If you’re not sweating during your sessions and have mild DOMS afterward – and if you’re not eventually doing things that look and feel like your sport – find a new PT.

Lastly: Be Patient. Play the Long Game. 

 You’re six months out from surgery, running intervals, doing box jumps, and feeling GOOD. So…why can’t you play? The sports medicine and rehab research overwhelmingly and unequivocally shows that for every month you wait to return to play after that 6 month mark, you decrease your risk of reinjury by 50% . That’s huge. Even if your ligament has healed and you’re passing your return to sport tests, the extra three months to get fitter and stronger matter so much to keeping you in the game.   You can reduce your risk of re-injury by waiting until you are stronger and fitter than you were even before your injury. Your physical therapist should be guiding you there and encouraging you every step of the way.

If you have questions about how to prevent ACL ruptures, or whether we’d be a good fit for your pre- and post-operative rehab following this injury, reach out to our sports specialist Dr. Wason: [email protected]

What You Need to Know about Stress Fractures

A more accurate term for a stress fracture is “bone stress injury” (BSI).  This is because bony stress injuries occur along a continuum based on how much loading the bone is being asked to sustain.  When caught early, that dull ache at the front of your shin, for example, might just be what we call a stress reaction: there is edema (fluid) in the bone marrow, but no visible fracture line.  If a stress reaction isn’t caught in time and/or the athlete continues to run through the pain, the bone can be stressed to the point of a partial fracture, what we call a “stress fracture”. Usually, pain with a stress fracture is significant enough that the athlete cannot continue to run through it. However, in cases where the bone continues to be loaded beyond what it is capable of tolerating, a stress fracture can widen and deepen and eventually progress to a complete break in the bone. Again, this is rare because most athletes will voluntarily stop their training due to intolerable pain with a stress fracture. 

Who gets stress fractures?  Bones respond to impact. Moderate amounts of impact activity, such as walking, running, and jumping – when progressed appropriately – are actually GOOD for your bones. Bones actually cannot get strong and dense (aka, strong enough to resist fractures and stress fractures and reducing the likelihood of osteoporosis in your later years) without some impact loading.  The best way to go about this – if you’re not already a runner or involved in a running/jumping based sport like basketball or soccer – is to schedule a visit with a sports physical therapist who can help create a program for you to safely and effectively load your bones. 

 

However, when it comes to loading your bones, it’s very easy to have too much of a good thing.  HIgh volumes of load, or increasing your load very suddenly, will “stress” the bone and eventually cause it to crack. Generally, stress fractures occur in athletes who run – cross country, track, marathoners, as well as running-based sports like soccer and lacrosse – and in athletes who jump.  They also occur commonly when an athlete is transitioning from a nonweightbearing sport like cycling or swimming into more running. A stress fracture is typically preceeded by a significant increase in impact activity beyond what the athlete is used to. 

 

Stress fractures can also occur in the absence of an increase in training load. However, the reason is always due to an increase in stress on the body.  This can be physical stress in the form of training load, but can also be emotional/psychological stress (for example, making the transition from high school to college), or metabolic stress from not eating enough. Bones, just like muscles, need fuel to build themselves up and keep from breaking down. For more information on the relationship between energy balance and bone health, see our last post on relative energy deficiency in sport! 

 

A clinician will usually be able to determine whether or not they suspect a stress fracture based on the patient’s history and on several clinical tests. However, imaging is necessary to rule these in or out. Despite being a bony injury, most stress fractures will NOT show up on X-Ray; MRI is the gold standard for diagnosis. 

 

Following diagnosis, a stress fracture will usually require a period of unloading depending on severity. Stress fractures in the foot and ankle will usually require a walking boot; stress fractures higher in the leg will require crutches. THe length of time on crutches is entirely dependent on the severity of the fracture.  During this time, most athletes will be allowed to cross-train in the pool (swimming or deep-water running) or on a stationary bike – again, depending on the severity of the injury. 

Most stress fractures take 6-8 weeks to heal. A common misconception, however, is that once the bone is healed the athlete is clear to resume running.  While it’s true that after the bone has healed, the athlete can resume LOADING the bone, this does not mean they are ready to run. With every step you run, your leg has to absorb forces that are FIVE TIMES GREATER THAN YOUR BODY WEIGHT. Starting at this amount of load will likely just lead to a second fracture.

 

This is where physical therapy comes in! A sports specialist will be able to design a gradual loading program for you, involving progressing walking speed and distance, improving global lower body and core strength, and eventually, progressing plyometric activity in order to guide you safely back into running. This way, you can return to your sport stronger than you left it, and with full confidence that you will not experience an injury like this again anytime soon.  Additionally, a female athlete specialist (like Dr. Wason!) can help coordinate the resolution of any risk factors you may have, such as your training volume, your fuel intake,body image issues, and your menstrual cycle status (for more on how your menstrual cycle affects your bone health, see our previous post on RED-S). 

 

If you are a runner or running athlete and you: 

-have been diagnosed by a physician with a stress fracture

-have had a bone stress injury in the past and are struggling to return to training

-are having pain with training and suspect you might have a stress fracture

-just want to avoid a bone stress injury

 

Send an email to Dr. Kate with any questions or concerns or to set up an appointment!

[email protected]

Relative Energy Deficiency in Sport

Most everyone reading this has heard of eating disorders. Somewhat less of you, but still a lot, will also have heard of the Female Athlete Triad.  But likely few will know what RED-S is. RED-S, or Relative Energy Deficiency in Sport, actually encompasses and expands on the female athlete triad and is essential for you to know about if you are an athlete, a parent of an athlete, or work with athletes in a coaching or healthcare capacity. 

 

 

 

 

 

 

 

 

 

 

 

 The Female Athlete Triad describes three inter-related health issues that occur specifically for female athletes when their food intake is not enough to support their activity levels. Oftentimes, this imbalance occurs due to disordered eating; intentionally restricting food intake in order to achieve leanness or small-ness which, for better or worse, can be advantageous in sports like distance running, triathlon, gymnastics. Over time, this lack of fuel triggers the body to essentially curl up in a ball and protect itself via shutting down the reproductive system. Your body will always prioritize survival over reproduction; this is why most women with eating disorders will lose their period due to low energy availability. The way this occurs is through alteration of hormone production and circulation in the body. In women, bone health is directly tied to reproductive hormone levels.  Estrogen and progesterone levels are altered, which then has a cascade effect on your bone health. In sum: disordered eating leads to menstrual cycle disruption/hormone dysregulation and sad bones. 

 It seems fairly comprehensive, right? But it actually leaves a lot out, and that’s where RED-S comes in.  This is the new term that we’re using instead of the “female athlete triad” for the following reasons: 

Relative Energy Deficiency in Sport affects men too. 

  Men certainly don’t menstruate and don’t have the same link between bone health and sex hormone profile that women do, but they do still suffer the consequences of not eating enough. As we’ll talk about later, not eating enough can affect ALL your body systems, not just bones and reproduction.  This is one of the main reasons for the change in terminology!

 

The “ED” in RED-S stands for “Energy Deficiency” and not necessarily “Eating Disorder” 

 It’s true that eating disorders are a massive problem in sport. The vast majority of women and girls will at some point and in some way, struggle with their body image and their relationship with food. However, it is also common for athletes to under-eat simply because they don’t know any better. Young women and girls are especially unaware of how many calories they actually need.  I blame diet culture for this – many of us are lead to believe through the media that 1500 calories a day are sufficient. In reality  if you’re active and/or still developing, it most definitely is NOT appropriate. Most female athletes need between 2,000-3,000 calories per day. (If you are curious about your own personal needs, I encourage you to get in touch with a Registered Dietician). As an example, consider the following scenario:

 You’re a college freshman and you’re trying to balance 1) being a member of a sports team 2) classes and homework 3) finding your way around campus 4) making friends 5) being homesick 6) oh and the dining hall doesn’t have anything you like, ugh. 

 It isn’t hard to see how this young woman – and thousands just like her – are not getting enough calories. And it doesn’t mean she has an eating disorder. So that’s another reason for the change in terminology – being energy-deficient isn’t always due to restriction. This is where healthcare providers and coaches can play a huge role in educating girls and young women about what they actually need to consume and how to do so conveniently!

RED-S affects MUCH MUCH MORE than bones and sex hormones

Low energy availability affects every system of the body. It absolutely can lead to low bone density which increases an athlete’s risk of stress fractures.  It will also shut down a woman’s menstrual cycle because with limited resources the body needs to choose between reproduction and survival. However, it also has effects on:

 Mental health: poor regulation of serotonin/dopamine = bad moods, irritability, lashing out, and increased feelings of depression and anxiety. Your body needs fuel to appropriately store and release hormones too!

Energy levels: The term “energy deficiency” says it all. Feeling sluggish, foggy, sleeping excessively or having difficulty with sleep are all potential symptoms of RED-S. Additionally, athletes will often struggle to complete workouts or will feel that a volume/intensity of work that has been typical for them has suddenly become challenging

Cardiovascular health: Your heart is a muscle, and it uses carbohydrates and fats for fuel just like all the other muscles of your body. Without enough fuel, your heart muscle will not be able to work as efficiently. This can change the electrical conductivity of the heart leading to things like arrhythmias – which will disqualify an athlete from participating in sport. It also leads to feelings of fatigue – workouts suddenly feel hard because the heart is having to work with less fuel!

Your musculoskeletal system: If you’re not putting in enough fuel to allow your body to recover, it breaks down more easily. This is true

In summary,  Relative Energy Deficiency in Sport is the new term we’re using to describe when athletes of all genders don’t eat enough to support their activity.

Motor Control, Part 2

Our bodies are built to do what our brains ask it to do. If you ask it to move in a particular way, it will do it, but it may not always be exactly how we imagined it. Think about watching people pick up an object from the ground: There are many different ways to do this, and your body will choose the best one suited for you. If you read part one of this series, you should now have a better understanding about what motor control is. Here in part 2, we’ll discuss how motor control may cause and be affected by pain.

 

Issues in motor control may be a likely culprit if part of a certain motion is pain free but other parts painful. From an observational standpoint, issues are usually evidenced by “jerky” or “ratchety” motion: Compensation patterns are also usually noted like moving from the hips when asked to flex in the lower back. Not everyone with these issues present with all of these characteristics, but it is likely to see at least one if this is contributing to the painful experience.

 

Now that you know a little more about what  motor control is and how to spot it, you may be wondering how it can lead to pain and dysfunction. Depending on who you ask, you may get a different explanation! In my opinion, there are two different schools of thought on the subject: Pain causing motor control issues, or motor control issues causing pain. I’m personally a believer that motor control issues are caused by pain via a complex interplay of different systems. 

We know that pain can affect a lot of things including activity level, social interactions, movement, mood, etc. When pain is present in an area it begins to affect proprioception and muscle activation, both of which are required for pain free control of movement. When the muscles and nervous system aren’t communicating optimally, pain and movement difficulties begin to occur. This leads to a cyclic pattern between pain and movement. Rather than put it in words, there is a graphic below that describes this cycle. Keep in mind, the arrows can go in both directions on the graphic, and one does not necessarily cause the other.  So although it may be a case of which came first, the pain or the motor control issue, either pathway leads to a continuous cycle of pain and discomfort and needs to be disrupted with intervention. 

 

So although motor control exercises should be a component of treatment in some conditions, it is not the magical cure to any musculoskeletal issue. It should be combined with other treatments including active therapeutic exercises and manual therapy.  When we work with clients that we believe have issues with motor control, we focus on performing slow purposeful movements. It’s like taking baby steps and learning how to walk, or move your shoulder, properly again. Purposeful thoughtful movement allows the nervous system to begin communicating with the muscles more efficiently. Overtime, this will begin to improve motor control and break the pain cycle above. 

 

Unfortunately, without a specific injury or examination, we cannot go into much more detail than that in terms of treatment. Please reach out if you have any questions on this topic and check out our instagram and facebook for some motor control exercises you may be able to do if you are experiencing pain. 

 

Bryan Esherick PT, DPT

[email protected]

Motor Control

Motor control: What is it and how does it affect you?

 

Aching shoulder or neck? Feeling a catch when you move that causes pain?  Motor control issues may be affecting how you are moving without you even knowing it. It can affect people of all ages and can affect many different parts of the body from head to toes. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


I want to preface this blog with the comment that there is no one right or wrong way to move! Generally, movement variability is necessary to maintain a healthy movement system. Motor control is a buzzword that gets thrown around a lot by movement professionals today. It describes how the body, through a complex link between the nervous system and muscles, is able to control movement through a range. Motor control is not how accurately a movement, like a squat, deadlift, or lifting a box is performed.

 

All the movements that we perform throughout the day require fine tuning by the nervous system. For example, as you raise your arm, for every 1 degree of arm movement your shoulder blade needs to rotate 2 degrees as well as tilt forward and move away from your rib cage. In addition to this your rotator cuff needs to contract just enough to keep your shoulder in its socket. You can imagine that to control this small amount of movement, there needs to be a constant feedback loop supplying the brain with a barrage of information.This is just one example of how amazing and precise our movement has to be to create movement.

 

So how does this feedback loop work? Your brain gets information via nerves carrying signals from proprioceptors and other specialized sensors hidden throughout different tissues. These cells are specialized receptors found in muscles, tendons, ligaments, and even the joint capsule. They generate and relay information about stretch, tension, muscle activation, joint angle and positions to give your brain a representation of what the body looks like in space. The brain then uses this information to finetune and adjust movements as needed. 

 

Now that you know a little more about what motor control is and how it may be affecting you, you may be wondering how to spot it and what you can do to fix it. Stay tuned for the second part of the blog which will be posted in mid-January 2020. 

 

Bryan Esherick PT, DPT

Hip Pain

If you’re young and athletic and are experiencing pain at the front of your hip, know that you’re not alone. Anterior hip pain is actually a very common experience among runners, triathletes, soccer and hockey athletes, as well as dancers and gymnasts. 

 

Like other parts of the body, pain at the front of your hip can mean a lot of different things.  For runners and soccer players especially, repetitive impact activity can lead to a stress fracture of the femoral neck or shaft – which presents as pain at the anterior hip with running, walking, and jumping. Soccer and hockey players are also susceptible to groin strains, or pubic bone pathology due to the strain on the inner thigh during that sport. A diagnosis that’s common among all of these sports, and many more, is femoroacetabular impingement (FAI) and labral pathology.  

 

The hip is a ball and socket joint, formed by the acetabulum – the “socket” – on the pelvis -and the head of the femur, on your thigh bone.  The joint is surrounded by a rim of cartilage called the labrum (heard this term before? There’s one on your shoulder joint too!), which helps the joint absorb shock and also deepens the socket, creating more stability through the joint. 

 

hip painFemoroacetabular impingement – FAI – can be diagnosed with an x-ray.  Essentially what impingement means is that ball-and-socket joint isn’t fitting together perfectly, and there are three ways this can occur. First is “pincer” impingement, which means that there is an outgrowth of bone on the socket. This leads to the acetabulum and femur coming into contact too early in the range of motion.   Second, there is “cam” impingement, which means there is a bony growth on the head of the femur, meaning that it cannot glide in the socket without “catching” or “pinching” on the labrum. Lastly, it is actually most common to have a combination of these. 

 

FAI can occur without labral pathology, and labral pathology can also occur without FAI; but, frequently, they do occur together. Labral tears can cause a significant amount of pain, however it must be said that just because a tear is seen on imaging does NOT mean this is the source of pain. There have been several studies showing that when imaging the hips of young, active individuals who don’t have hip pain, up to 70% of them have labral tears. 

 

SO…you’ve been diagnosed with FAI and/or a labral tear. Now what? 

 

Luckily, there has been an explosion of medical interventions for hip pain, as well as significant improvement in the way rehab professionals treat.  

 

Injection Therapies: An orthopedic surgeon may choose to inject the joint with a corticosteroid to decrease any inflammation in the joint. Alternatively, some surgeons can do “regenerative injections” – either Platelet-Rich Plasma (PRP) or bone marrow aspirate concentration (BMAC), both of which serve to stimulate healing of the labrum and cartilage. 

 

Surgical Interventions: There are several arthroscopic surgical techniques that can be used to correct FAI and repair labral tears.  For FAI, the surgeon may perform an osteoplasty – essentially shaving down the bony outgrowths so that the joint surfaces can roll and glide on each other smoothly.  Surgeons can also use sutures or anchors to secure torn portions of the labrum back to the acetabulum; this can significantly decrease painful clicking and catching. In more involved cases, the surgeon can also take cadaver tissue and create a brand new labrum for the patient.  

 

It is important to note that these medical interventions, advanced as they are, do not guarantee pain relief.  Surgery in particular CAN be extremely helpful, and as such it is still considered the gold standard treatment – but like we talked about earlier – pathology does not always equal pain. Therefore “fixing” or eliminating the pathology does not guarantee elimination of pain.  Surgery should be considered a last result option, if injection therapy and high-quality sports rehab do not help. 

 

Speaking of sports rehab….stay tuned for our next article to learn how we help our athletes with hip pain back to the playing field – with or without surgery!  Have questions?Email me at [email protected]

Kate Wason, PT, DPT

Exercise Is For Everyone

Exercise. Some of us love it, some of us don’t. But we all need it. Truth. It was part of daily life for previous generations before technology stepped up and made simple functions far easier. So, now we need to be more intentional about getting our bodies movie for good mental and physical health.

The US Department of Health and Human Services established recommended guidelines for exercise activity to include 150-300 minutes of moderate activity or 75-150 minutes of vigorous/intense activity per week. That’s about 2.5-5 hours of moderate activity and 1.25-2.5 hours of intense exercise per week. Moderate exercise, like a brisk walk or hike, should keep your breathing labored but you should still be able to talk.  Intense exercise should have heavy breathing and you shouldn’t be able to talk.

We believe movement is medicine. That’s why we focus on it with our patients. Research tells us it’s good for your heart, brain, and body. It can boost your immune system, balance your emotions, increase your productivity, and helps you maintain a healthy sleep schedule. Exercise brings all of this good for you, but also takes time and many of us find precious time in short supply these days.

So, here are a few of my top tips to help you get your exercise on!   

Walk – Take the stairs and park at farthest from entrances. Those extra few minutes of walking will really add up by the end of the week. This is a kind of exercise snacking (see below).

Have a “snack” – Research suggests that even very brief bouts of activity can accumulate to meaningful benefits. The New York Times shares ways you can fit these “snacks” into your daily routine.

Chores – Doing chores like vacuuming and scrubbing the bathtub is great exercise. You can add mowing the lawn to that list as well. So combine those chores with exercise needs and burn 165-200 calories/hour – and you can swap out that yoga class. 

Micro workouts  – We’re huge fans of the NYT 7-Minute Workout. This high intensity workout takes only a few minutes a day, and can be modified if the intensity is too challenging for your fitness level. We even gave it a try right here in our clinic!

Do something you like or find something new – I love jiujitsu and my love for it motivates me to exercise to keep up with my training partners. There are so many activities that speak to a number of different personalities and interest – martial arts, tennis, basketball, salsa, rollerblading, yoga, hiking, climbing, you name it. If you enjoy doing it, you’re more likely to make time doing. We’ve pulled some local resources together to help you find your groove.

 

Workout with a friend – It’s a great way to catch up on the latest, and get some good emotional well-being at the same time. Exercise partners help keep us honest with our commitment, and can make that accountability a little more fun at the same time.

Staying in good health is important for physical and mental. So make exercise a priority, because there is no better medicine for life!

Sam Spillman, DC

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