By: Jill Doyle PT, OCS, Cert DN
Ahhh...SUMMER! Time to kick off the heels and take a stroll through the grass or slip on a pair of “barely there” shoes. But is this the best thing we can do for our feet?
Let’s discuss some normal walking mechanics. In a normal walking pattern, we first strike with the heel, roll through the midfoot, then push off the big toe. Toe push off requires the toes to go into extension. However, when backless shoes such as flip flops are worn, the toes have to grip the shoe to keep them on your foot, causing the big toe to flex instead of extend. This toe gripping affects different muscles to turn on or shut off all the way up the leg to the core. First, a tight arch forms due to overactive extrinsic foot muscles inhibiting the internal muscles of the foot required for stability in walking. Once the lower leg muscle activation changes due to the excessive toe gripping, it affects the hip’s ability to extend, limiting your walking stride. When your stride is limited, it decreases the buttocks muscle activation and strength. Walking around with improperly performing glutes can also lead to a condition called “lower crossed syndrome” where the abdominal muscles are overstretched and weak as well, causing an anterior tilt of the pelvis. In this pelvic position the lower back muscles are short, tight, overworked and back pain can occur. These muscle imbalances and improper posture can also lead to excessive pressure incurred around the joints where they are attached, such as the hips or knees, leading to joint pain or injury. The more hours spent in flip flops during the day, the more likely these compensations are to occur.
Do you have plantar fasciitis, achilles tendinitis, or low back pain issues? If so, stop wearing flip flops, or significantly reduce your wear time. Your body will thank you!
By: Jill Doyle PT, OCS, Cert DN
Have you heard of dry needling but not sure what it is, or wondering how it is different from acupuncture? Are you wondering if it can help alleviate some of your pain? Let us help clear up the mystery for you.
Dry needling is a form of intramuscular stimulation that does not inject any fluid in the body, hence the word “dry.” It utilizes fine needles inserted into painful muscles, tendons, ligaments or near nerves to help stimulate a healing response in painful musculoskeletal conditions. The needles remain in the skin for a short period of time determined by your practitioner. Confusion between dry needling and acupuncture is common, but the line between them is clear.
Acupuncture is utilized in Oriental Medicine to alter the flow of energy along meridian systems for the treatment of diseases, whereas dry needling is a modern science based intervention that treats pain in the musculoskeletal system. Although both utilize the same type of needles and can be effective for pain control, the source of the pain determines which of the two therapies would best be utilized.
Dry needling is successfully utilized to treat painful orthopedic conditions such as knee pain, shoulder impingement, back pain, tennis elbow, headaches, shin splints, and plantar fasciitis to name a few. It is very safe with few side effects and can be very beneficial for treatment of painful conditions without the use of drugs and surgery.
It should only be performed by skilled and certified practitioners with trained experience. Let our certified, trained physical therapists help you determine if dry needling would be useful in the treatment of your painful condition. Book your appointment today!
WAYS TO INCREASE RUNNING STAMINA:
The summer heat is upon us and runners everywhere are gearing up for a season of training. Many are hoping to improve their stamina in hopes of chasing the ever coveted PR (personal record). Or maybe this is your first time training and you want some advice to know how to ensure a good running experience. Either way, these tips can help ensure your best effort at gaining or improving stamina for your training and race efforts.
Unfortunately, relying on the body’s thirst mechanism cannot prevent dehydration. Most runners I’ve treated in clinic present with some level of sub-clinical dehydration or electrolyte imbalance. Caffeinated and alcoholic beverages actually contribute to this loss of hydration. Electrolytes help replace nutrients lost through sweat and help absorb water and improve energy levels. The proper way to consume water is half your body weight in ounces of water daily, without any added exercise. For example, a 180 lb. Man would require 90 ounces of water daily just to maintain proper bodily functions, NOT INCLUDING any additional fluids lost during exercise. At moderate exercise intensity, the human body typically produces .5 to 1.5 liters of sweat in one hour. During hot conditions (Hello Texas HEAT), some individuals can lose up to 3 liters in sweat. In general you should consume 16-20 ounces of fluid (water + electrolytes) for every pound lost during exercise, but the water and electrolyte consumption should occur during activity as well.
Are you drinking enough?
2. IMPROVE RUNNING FORM
Are you expending more energy than necessary due to improper running form? Do you have an excessively bouncy gait, do your hips drop side to side, do you bend forward at the waist, do you heel strike? All of these can contribute to less than ideal efficiency in terms of running gait, and can contribute to break down, excessive energy loss and even injury- especially in an endurance runner. These deficits can be due to muscle imbalances in flexibility, strength, proper motor control, or a lack of balance. You can have your running gait assessed for an individualized approach to improve your form.
3. IMPROVE BREATHING EFFICIENCY
“If breathing doesn’t work, nothing else will work.” Although we all know the overall goal of breathing is to oxygenate the body and expel carbon dioxide to sustain life, did you know that breathing also contributes to the body’s stability and mobility? It is instrumental in regulating the pressure between the trunk, pelvis, and spine. With optimal pressures created by proper diaphragmatic breathing, other muscles that are connected to the diaphragm provide stabilization for the thorax and hips without the need to compensate using the myofascial system. In addition to providing proper circulation of blood to the muscles, proper diaphragmatic breathing improves parasympathetic nervous system activity, while reducing the sympathetic nervous system activity. Sympathetic overactivity elevates both heart rate and blood pressure, producing shallow breath creating muscle fatigue and achiness, joint discomfort and anxiety. On the other hand, when in parasympathetic mode, the body is more relaxed and the nervous system can support repair and regeneration, thus reducing muscle damage and preventing inflammation.
4. WARM UP and POST RUN STRETCHING
Prior to exercise muscles can be thought of as cold rubber bands lacking elasticity. Pre-workout, a short light cardio warmup should be performed followed by dynamic stretches which stimulate reflexes in your muscles and tendons preparing it for vigorous activity and help your body recognize its position in space, as opposed to relying purely on visual cues. This will allow your movement to be more controlled and efficient, leading to greater stamina. Post workout, once muscles are warm, stretches can be static in nature, as this helps cool down the body and re-integrate into a resting state, which is required for proper muscle recovery.
5. DIFFERENTIATE RUNNING SPEEDS
There are 3 energy systems utilized for proper athletic performance. Certain sports rely on one system more than the others. Two of these energy systems are anaerobic, not requiring oxygen, and one is aerobic. All three systems should be trained to improve your stamina. Speed work increases the efficiency of the anaerobic systems, and tempo runs improve your lactate threshold. Lactate threshold is defined as the fastest pace you can run without generating more lactic acid than your body can utilize and reconvert back to energy. Even for endurance running, which trains the aerobic system, your endurance and stamina will improve when adding speedwork and tempo runs to your training. Not all runs should be run at the same speed!
6. 10% RULE TRAINING REGIMEN
In order to improve efficiency, the system has to be challenged. Most runners know and do this, but the tendency is that we tend to overdo and violate the 10% rule of progression, thinking more is better. Not true! The body can only withstand so much progression before the breakdown process outweighs the buildup process. This is an overuse syndrome and can have a dramatic impact on your injury threshold and your general stamina in the name of “overtraining.” What does this look like? Significant fatigue in the runs leading up to an injury. You can easily prevent overuse injuries by adding up your total mileage in any given week. If you ran a total of 20 miles last week, adding 10% volume would mean your body could safely withstand adding 2 miles to the following week for a total of 22 miles. This may seem like a slow process, but slow and steady prevents injury and overtraining and significant amount of lost time sidelined. Resist the urge to progress too much too soon! Not violating this rule will give your more stamina for subsequent workouts, letting your reach your peak potential.
7. CROSS TRAIN WITH STRENGTH AND PLYOMETRIC EXERCISE
Runners notoriously have weak glutes. Some specific exercises to target the glutes, and muscles on the back side of the body can be beneficial to improve stamina. Additionally, improved core strength and stability can help preserve energy and prevent injury in the lower half of the body. The more stable the core, the less accessory motion is required in the extremities. Plyometric activities for the lower leg can assist your push off mechanics when running.
This is a loaded topic, and can be divided into two main categories. Nutrition for daily food consumption when not running, and nutrition during running activity. Many runners spend countless hours perfecting their training regimens for months in preparation for a big race, but give very little thought to nutrition other than carb loading before the intended event. There are many nutrition plans adopted by athletes these days. Paleo, Keto, high carb, Mediterranean etc. Which do you choose? I am not here to debate which is best, in fact after many years of observing and experimenting myself I think there is much latitude in this area, assuming you are consuming enough calories, and what works best for one person may not work best for another. I will however comment on the QUALITY of the foods you are ingesting as it pertains to your regular daily diet. Your carbohydrate intake, your main energy source fueling your workouts, should come from complex carbohydrates and include fresh fruits and vegetables with a moderate to low glycemic index as compared to simple carbohydrates with a high glycemic index. These fresh foods contain enzymes that help act as cofactors for important bodily functions. Simple carbs will cause early burnout, were as complex carbs provide a steady source of energy with less blood sugar swings.
On race day or a long run, a full meal should be consumed 3-4 hours before the event. During the race, prevailing wisdom states your consumption of carbohydrates should be in the more digestible form of simple carbohydrates and should be 30-60 grams per hour! This can be in liquid, gu or solid food form. For reference, a 12 oz. bottle bottle of gatorade has only 21g of carbs, and a standard gu packet has 22 to 24g. But do your math, add up your training time and long run carbohydrate consumption...are you getting enough fuel?
Stamina can be improved. Review the above list to see where you can make changes, implementing one new change at a time. In a short period of time you will begin to notice improvements that will make a dramatic impact on your vigor and endurance for both your training and race efforts.
Written by: Jill Doyle PT, OCS
Yes, I said it, urinary incontinence! I know it’s not the most glamorous subject, but it is a familiar term to many men and women. Have you ever laughed, coughed, or sneezed and felt something “leak” out? Have you ever had to the use the restroom so bad, only to not make it in time?? Has this left you feeling anxious, worried, or embarrassed? If so, we have great news, a Pelvic Floor Therapist can work to relieve these symptoms, without surgery, getting you back to the things you love!
Pelvic floor therapy is a branch of physical therapy that manages conditions related to the pelvis. Just like any muscle in the body, pelvic muscles can become tight, weak, or imbalanced. When this happens, it results in urinary or fecal leakage, pelvic pain, painful intercourse and more.
Stress incontinence (SUI) is the most common form of incontinence and is typically experienced by women but it can also occur in men after a prostatectomy. Stress incontinence is the unintentional loss of urine with coughing, sneezing, running, heavy lifting or jumping and is often a result of weakness and/or discoordinated pelvic floor muscles. The pelvic floor muscles are the muscles at the base of the pelvis that provide support to the organs, aid in pelvic stability, and help maintain continence.
Physical changes that can increase the likelihood of SUI include:
Now, let's get to the good news! Pelvic Floor Physical Therapy can restore function, improve muscular support around the pelvis and retrain body movements to allow for optimal structural and organ function. We do this through a variety of techniques, which varies for each individual case based on patient history and symptoms. Please reach out to your local pelvic floor therapist for a consultation to learn more about your specific options.
What to expect during your pelvic floor therapy appointments
Due to the sensitive nature of this area, a compassionate and trauma-informed approach should be taken by your pelvic floor specialist. Your initial consultation should include a careful interview and discussion about your experience, including an account of symptoms as well as medical history and lifestyle.
To complete your assessment your pelvic floor specialist will look at posture, breathing, and pelvic alignment. With consent, they will do an external and internal vaginal and/or rectal assessment of the pelvic floor muscles . During this part of the exam they are looking for strength, endurance, tension, trigger points, and coordination of these muscles.
Treatment sessions may include myofascial and trigger point release, visceral mobilization, biofeedback, e-stimulation, and Pilates-based rehabilitation. Education on lifestyle and behavioral strategies that are shared will compliment your therapy.
Physical Therapists specializing in pelvic floor rehabilitation offer highly effective, non-surgical treatments to relieve symptoms. If you have any questions, please reach out to us at firstname.lastname@example.org.
It seems impossible these days to turn on the news or even have a conversation with a friend, without the topic of healthcare costs coming up. According to the health insurance index report from eHealth, the nation’s largest private online health insurance exchange, the average family premium (without subsidies) is $1,021 which is 23 percent higher than the average in 2016 and the average annual deductible for families was $8,352 in 2017 up 5% from 2016. Now, take into consideration that a large number of healthy families will never meet these high deductibles. We are then, receiving care based on the terms negotiated by the insurance companies and still paying out of pocket trying to reach that high deductible.
These numbers are a painful reality for many Americans and the level of care is often less than impressive. As we all come to terms with this new reality, we are forced to take a more focused approach to our healthcare needs. With that, comes truly understanding our benefits and when they are actually working for us. Today I want to talk about the questions we should be asking to make sure we are really benefiting from using our benefits!
When choosing a doctor to be a part of our healthcare team, we typically consider the 4 pillars below
The two that create the most confusion, especially when comparing in-network vs out-of-network are price and quality of care.
Price is often the trickiest of the four to determine. Have you ever had a spouse on a different healthcare plan? If so, you have probably experienced something along the lines of going to the same optometrist for the exact same eye exam and receiving significantly different bills. What you pay is dictated by how well your insurance company has negotiated that particular service with that particular provider. So, what questions do we ask and where do we direct those questions, to prevent this from happening?
If it has been recommended that you see a Physical Therapist, we suggest you contact your insurance company and walk through your benefits with them and then call the PT’s you are considering and ask the below questions:
Ask your insurance provider:
Ask potential Physical Therapists
When comparing pricing, one thing you cannot forget to consider is quality of care. For example will you be receiving a one-hour session where 100% of your time is spent with a Doctor of Physical Therapy? This level of service allows for faster healing times and less visits. Progressively worsening reimbursement rates and pressure from insurance companies are creating incomplete and insufficient care. In-Network providers have to see at least 2 patients per hour, leaving technicians and assistance to provide most of the patient care. This creates the need for more treatments, sometimes up to 3 per week. A focused treatment plan with dedicated time with your PT is almost always the most effective treatment option.
After considering these factors as well as answering the above questions, most patients find it is in their best interest to choose a provider based on quality of care and the providers reputation in the marketplace, not whether or not the provider is in-network.
In-Network does not always mean IN YOUR best interest. Quality of care should be the number one priority when it comes to your health. Coverage and pricing should not be so confusing, but unfortunately, it is the nature of our healthcare system today. If you have any questions as you determine the best avenue for care, please do not hesitate to reach out.
Dr. Jennifer McCauley, PT, DPT, OCS, is a co-owner at Inspire Physical Therapy and Wellness. She graduated from Mount St. Mary’s University in Los Angeles with her Doctorate of Physical Therapy degree in 2008. She is a Board Certified Orthopedic Clinical Specialist and has also completed advanced training in Graston technique, Kinesio taping, Pelvic Floor Therapy through Herman and Wallace and Movement Links. Jennifer is a gifted teacher and healer. Her approach to care incorporates manual therapy, pilates-based rehab, and DNS to help eliminate pain, restore function, and enhance athletic performance. She is able to treat a variety of orthopedic, sport, and pelvic health patients. Her extensive “toolbox of tricks” helps her patients to not only recover from injury, but to thrive, living life to its fullest.