Lone Tree Physical Therapy

09/21/2015

Exercise can change the anatomy of tendon, muscle, articular cartilage, bone.

The amount of “load” happening in the tissue can actually stimulate a cellular response, and stimulate tissue repair and remodeling in tendon, muscle, cartilage and bone. This process is called “Mechanotransduction.”

Below are some examples:

Tendon: think Achilles tear: often scar tissue builds up and you can actually feel bumps of scar tissue in the tendon area. “Eccentric” loading especially loads the tendon area, and is basically the tissue lengthening while under a load (think if you perform an arm-curl with a weight to strengthen your biceps, the “concentric” part of the contraction is the lifting of the weight, the eccentric part is the lowering of the weight: your muscle has to control the decent, or else your arm would just flop back down …) Research supports the fact that Achilles tendons respond favorable to eccentric exercise after injury, and actually remodel and remold the tendon structure to become more “normal.”

Muscle: This one is a little more obvious, but if you work out, your muscles get bigger! Research supports that after injury, controlled loading lead to improved alignment of muscle fibers, faster and more complete healing, and the minimizing of muscle fibers wasting away.

Cartilage: studies involving the knees in persons with “bad cartilage” show that people who underwent a rehab program early on with continuous movements and loads responded better than the ones that didn’t. The cartilage has special cells (chondrocytes) that respond to loads!

Bone: research supports that after fractures, bone introduced to appropriate early loading responded significantly better for strength, and range of motion, than those that were not loaded. The bone has special cells (osteocytes) that respond to loads!

If this info tells you anything, it should be that the structures of the body are ADAPTABLE and actually physically change with the load they are presented with, over time. Whether your injury is a new one or a chronic one, this should give you hope! A big part of the physical therapist’s job is helping determine the appropriate load to start stressing the tissue with. These loads may start off as simple exercise, but the intent is to get the tissue able to better- tolerate the demands of day to day life, as well as sport specific needs.

-Tal Blair DPT

Reference:
Khan, et al. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med 2009: 43: 247-251

08/14/2015

Donor Dash 2015

04/29/2015

Benefits of simple movement

Have you ever tried to sit completely still prolonged? Eventually, you will have pain. Our tissues and joints like movement: movement allows a chance for fluid and nutrients to exchange, acidity levels built up in the tissue to decrease, and mechanical forces of both compression and tension across the tissues to get a break and change. Try frequently moving as a preventative exercise (before your onset of pain with sitting for example) or make a mental note to perform some simple pain-free motion across the given joint, every hour. A physical therapist can help you also determine the best directions to move in, as well as other facets of rehabilitation to address your pain.

03/18/2015

“Diaphragmatic Breathing / Belly Breathing”

What is it, and why would it help?

You may have heard of the term “belly breathing”, as a relaxation technique. I often teach this to patients who have excessive “tightness” feelings or muscle tension, as a way to relax, and often patients find it helpful.

The general technique: you can be in any position, but for starters, lie on your back, with knees bent and feet resting on the floor.

Place your hands on your abdomen, and as you slowly breathe in/out, monitor how much your belly “inflates” with each breath in, and “deflates” with each breath out. Also pay attention to how much your chest/ribs elevate as you breath in, near your sternum.

To emphasize “diaphragmatic” breathing, try to breath in deeply and pull the air into your belly, having your belly maximally “balloon out” or “inflate” as you breath in (like a Buddha belly). As you exhale, have your belly deflate. Try to focus on ONLY moving from your belly as you breathe, and NOT your chest, sternum, or upper ribs.

The Science:
The Diaphragm is a muscle, that attaches to your lungs and is situated below your lungs and a under your lower ribs (if you follow your sternum down to its’ point, and grip inward as if digging fingers under the ribs above your belly button, you may hit a tender spot which is likely the diaphragm). As you breathe, the diaphragm contracts and pulls downward, pulling the lungs downward with it allowing more air to enter the lungs. It is a more efficient, and better way of breathing, and doesn't involved the excessive activity of neck muscles and chest muscles as the more shallow chest breathing does.

The “Deeper” Science:
Our nervous system involves “parasympathetic” and a “sympathetic” activity, at all times. You may remember from bio or physiology class that the parasympathetic is the “rest and digest”, while the sympathetic is the “fight or flight” system of the body. When we are involved in a threatening situation (a man is charging you with a knife, with a wild look in his eye), our body kicks into “sympathetic overdrive” and we have very shallow breathing, increase in muscle tone, perspiration and are “ready to escape”. Our nerves are on high alert and are telling our brain everything that is going on inside, to an excessive degree, as a means to be better at removing that dangerous situation.

This is actually the SAME thing often going on when you are in pain, as your brain sees the situation as threatening (your muscles tighten up, protect, guard, and you have excessive response to all stimulus). Your nerves are being way too active, and getting way too much info to the brain. This facilitates more and more protection, and often more tightness and pain, which often isn’t helpful. This mechanism DOES help us survive (we need to KNOW if we get bit by a poisonous spider, or have a fractured femur), but unfortunately we can get stuck in this “sympathetic” state, while in reality the “threat” or “issue in the tissue” is long gone (google CRPS or complex regional pain syndrome). Pain is PROTECTION produced by the brain, sent to a vague, general area, based on the information the brain is getting from the nerves (which can be way too much information at times). The pain experienced is and OUTPUT, from the brain downward to the tissue (but happens so fast it feels like it is coming from the tissue). Interestingly, the tissue doesn’t even need to be there to feel pain (if a person steps on a landmine and blows off their foot, and later has the leg amputated, they will often feel pain in where their foot WAS), as we actually register and “feel” things, within the tissue of our brain (more on this later).

GETTING OFF TRACK a little, but belly breathing can help us shift from a more “ready to fight or flee” body mode, to the more chill sister mode “rest and just maintain the vital things in my body” mode. This is a better place to reside. Although you can’t flip off the nerves like a switch, attempts should be slowly made to get them to quiet down (and this may be a component that can help).

-Tal Blair, DPT

03/10/2015

3 tips for anterior knee pain during running:

If you are experiencing knee pain during running, here are a few things to try:

1) Check your “ankle dorsiflexion” mobility (just how much it is able to bend), by placing your toe 3 inches from the wall, and leaning your knee toward the wall while keeping your heel down. If you cannot touch, you may need to work on this mobility by repeating this as an exercise, as well as calf stretching.

2) Check the mobility of your patella (knee cap): seated with your knee straight and relaxed, grip both sides of your knee cap and slowly transition it left to right (keep quad muscle relaxed). Check for tightness on the painful knee, and if you find restrictions, you can mobilize just by slowly pushing the knee cap through its full range left to right, 1-2 minutes.

3) Try changing your stride length: take slightly shorter strides while running, this can change the way your knee is loaded during your jog.

Other factors may include hip weakness, lateral tissue tightness, as well as your training schedule. For persistent pain, try consulting with a physical therapist to discuss your issues, and formulate a plan to get you back to pain-free running.

02/04/2015

3 simple tips for avoiding shoulder pain in the gym:

1) avoid "internal rotation" and elevation exercise (for instance, if you raise your arm straight up while keeping your thumb pointed down, it is common to get a pinch pain at the top of the motion because it places the shoulder in a compression position) This is commonly seen when people are elevating kettle bells; instead try to lift with more of a "palm up" position

2) when you bench press, don't let your elbows lower past your body as you bring the weight close to your chest (keep them in the peripheral vision) - this will avoid excessive strain on the anterior capsule and stabilizing ligaments of your shoulder.

3) dont for get about the little guys (rotator cuff exercises). Too often we focus on the showcase muscles (pecs, biceps) and neglect the stabilizing rotator cuff muscles. There are a ton of good resources online for "rotator cuff stabilization" and "scapular stabilization" exercises. Ask a PT about ways to isolate the rotator cuff during exercise.

12/11/2014

Does your pain involve inflammation or ischemia? Knowing the answer may guide you towards improving your treatment strategy:

Examples of inflammatory pains may include acute sprains, muscle strains, post-activity muscle pain, or a "flare up" of arthritic pain. Cardinal signs of acute inflammation include redness, heat, usually irritable tissue surrounding the site (hurts to push on the muscles, or load the joint), a diurnal pattern of pain and stiffness may exist (worse in AM, and overnight), and the pain often responds well to NSAID medication (ibuprofen).

Ischemic pain, on the other hand, is pain due to a lack of blood flow. When you sit on a hard seat, and your bottom begins to hurt, you subconsciously shift and in your chair to unload the tissue. This brings blood flow to the area and ends the prolonged compressive force that was causing lack of blood flow, and you forget that the area was hurting… This type of pain is more associated with symptoms after prolonged or unusual postures, a decrease in symptoms with moving into the opposite direction to which you are in prolonged, symptoms more toward the end of the day and often no evidence of actual trauma.

If you feel your pain pattern falls more toward the inflammatory side, and has been persisting for months, it may be useful to talk to your doctor about a cortisone injection (a strong anti-inflammatory) or course of oral anti-inflammatories per recommendation of your MD. Shorter term inflammatory conditions should be assisted with ICE and elevating the area. A physical therapist may also help you identify why the area is prone to inflammation (is there a corresponding weakness or restriction that causes increase in stress at a particular area).

If you feel your pain is more ischemic, frequent movement may be beneficial. Simple aerobic exercise such as walking, cycling or swimming can often be of help. Try to pay attention to the positions you are in daily, then ask yourself how you may be able to frequently move in the opposite direction (i.e. if you are always slouched, every 30 minutes try to slowly move in the opposite direction 20 times, allowing the tissues and joints of your body experience some loading in the opposite spectrum of what they are always in). A physical therapist may help you determine ergonomic changes to assist with this, or assist you in strengthening muscles that may offer improved postural endurance and support.

-Tal Blair, DPT

03/19/2014

In transition from Winter to Spring, many of us are becoming more active; running again, playing sports outside, and getting back into the outdoor lifestyle.

With the advent of any new activity, it is important to get our bodies accustomed to all the new sensations that are being felt by our joints, muscles and tissues. Having a proper program that slowly introduces new activity without “overloading” our bodies is a good start. Whether it is running, hiking, or cycling, it is best to pace yourself early on to ensure that the tissue of your body adapts well to the onset of new stresses. For starters, do a little less early on, and make sure you feel good the following day. Acclimating your body in this way will avoid excessive soreness or inflammation. If possible, start with low impact exercises first (pool, biking, elliptical) and progress to more loaded activity (running, tennis, hiking).

A good time to stretch is when your muscles are warmed up. Aerobic exercise has been shown to be more effective in warming of deep muscles, as opposed to superficial hot packs, so after your exercise session is a good time to relax and stretch for a bit.

If you do experience consistent pains with activity, talking to a physical therapist can help guide you regarding what to avoid, what to promote, and how to safely increase your activity. Lone Tree Physical Therapy wishes you the best in this transition, and is here for you if you need us!

03/12/2014

Getting Active This Spring http://wp.me/p4meaC-6

In transition from Winter to Spring, many of us are becoming more active; running again, playing sports outside, and getting back into hiking. With the advent of any new activity comes potential for adverse symptoms. This is because our nervous system…

02/17/2014

Welcome to Physical Therapy BlogFebruary 17, 2014UncategorizedtalblairShare this:TwitterFacebookGoogleLike this:LikeLoading...

02/11/2014

08/09/2013

Donor Dash 2013