Side Planking for Scoliosis

Side Planking for Scoliosis

by Dylan Bartley, MSPT, CMP

Researchers at Columbia College of Physicians and Surgeons in New York produced some promising results in the treatment of scoliosis with just one simple exercise: a side plank. This common yoga pose was performed on the convex side of the curve. So if your scoliosis bows out to the right, you should put your right arm down and lift your right hip up off the floor. They offered variations to accommodate varying levels of fitness and different types of curves. The poses were held for as long as possible, once a day, starting at 10-20 seconds.

To measure the success of their intervention, they took x-rays before and afterwards and measured the degree of curvature in their subjects. After 6 months, they found a significant improvement of an average of 41%. They tried to see if there was a difference between younger subjects and older subjects with more degenerative changes and both groups responded well with no significant difference between the two groups.

Scoliosis is a problem of imbalance and asymmetry that tends to progress as we age and can lead to debilitating arthritis and muscle spasm if it goes unchecked. Over the years doctors have tried to stabilize it with complicated surgeries involving rods or uncomfortable braces. Physical therapists have tried to correct it with stretches and strengthening the core and spinal muscles. It would make sense that to treat this problem of asymmetry one would need to attack it with a set of asymmetrical exercises. Unfortunately, there has been little research to back up these hunches until now.

If you are interested in getting an assessment of your spine to see if you have scoliosis or if you’re ready to treat a scoliosis you’ve always known you’ve had, physical therapy is a great place to start. We can set up a custom protocol that would match your current level of fitness and show you how to progress things as you get stronger. Furthermore, structural factors such as a leg length discrepancy or pelvic/sacroiliac dysfunction can be the driving force behind your scoliosis and may be treatable with physical therapy.

To see the original article, click here

A Modern Take on Rotator Cuff Injuries

A Modern Take on Rotator Cuff Injuries

by Cindy Dehan, MS PT 

The shoulder is considered to be one of the most intricate joint systems in the entire human body, with interactions between the upper arm (the humerus), the scapula, and the thoracic spine, in addition to the complex neurovascular system. The rotator cuff plays a vital role in proper shoulder function. Specifically, the rotation cuff system consists of the interaction of four major muscles: the supraspinatus, the subscapularis, the teres minor and the infraspinatus. The primary roll of the rotator cuff is to center the shoulder joint and allow for proper joint motion.

Identifying the reasons for shoulder pain can be just as complex as the shoulder system itself. Similar to the spine, it is difficult to determine a true pathoanatomical “culprit” for shoulder pain, and it may be more beneficial to conceptualize issues found in the shoulder with regards to functional limitations. The American Physical Therapy Association recently published a clinical guideline article regarding the shoulder and outlined three separate types of classifications that shoulder issues may fall into. Shoulder pain and mobility deficits/adhesive capsulitis (frozen shoulder), shoulder stability and movement coordination impairments/dislocation of the shoulder joint, and shoulder pain and muscle power deficits/rotator cuff syndrome. Any of these conditions can impact the rotator cuff, but for the purposes of this article, we will focus on the muscle power deficits/rotator cuff syndrome (RCS) classification.

Traditionally, pathology of the rotator cuff was thought to be almost always be related to issues with impingement, where compression and high levels of friction were associated with the pain and dysfunction often reported by patients. More recent evidence suggests that mechanical loading of the tissue may cause changes to the tendon quality and contribute to the sensitivity of the tissue. Overhead movements such as throwing, can increase tensile load. Reaching overhead can increase the compressive forces in part of the shoulder complex. It is not uncommon to find pain while catching at midrange when lifting the arm. In fact, pain and weakness are common when performing movements that place any stress onto the rotatory cuff system.

Very few things in life have a specific protocol that you can follow from start to finish without having to adjust a little. Managing rotator cuff issues is no different. Given the fact that underlying cause of shoulder pain and dysfunction can be multifactorial the interventions should be selected to treat the impairments, not necessarily the diagnosis. Specific exercises which address the scapula and rotator cuff, in conjunction with manual therapy, has been shown to be beneficial for patients with RCS. It is also of benefit to look at the mechanics and relationship of the thoracic spine to the shoulder, as treatment to the thoracic spine may improve certain shoulder impairments. Core/midline stabilization can also contribute to issues seen in the shoulder based upon the specific activities someone participates in.

In an ideal world, we could develop a series of movements, exercises or hands on treatment that could fix everyone just the same. But the challenge is that we all are very unique and while we might share a common complaint of shoulder pain, the underlying cause is very different from person to person. That is why it is important to have a thorough, comprehensive exam so that the individual characteristics associated with your shoulder can be addressed and a detailed, personalized approach can be implemented.

The Infamous and Irritable Iliotibial Band

The Infamous and Irritable Iliotibial Band

by Dylan Bartley, MSPT, CMP

Iliotibial Band Syndrome (ITBS) is one of the most common overuse injuries among runners, cyclists, and athletes alike. It can manifest in pain on the outside of the knee or hip. Maybe you’ve seen one of the many rollers or massagers on the market designed to loosen up the IT Band. But do you know the anatomy and biomechanics behind the IT Band? Understanding why it can become such a problem helps guide us in treating it comprehensively and making sure we can run and climb stairs well into the golden years.

ITB

The IT Band is the body’s largest tendon, connecting the muscles gluteus maximus in the back and the tensor fascia latae in the front of the hip down to the knee. It passes past the outside of the knee to attach on the outside of the upper tibia. As it passes over the outside of the hip near a protrusion called the greater trochanter it can cause friction and irritate the trochanteric bursa. Bursae are designed to reduce friction, but they can only take so much before they get inflamed and become a source of pain. Further down the line, as the IT Band crosses the knee there are more bursae that can become irritated and cause you knee pain.

 

A big question we ask next is, “Why does it get so tight”?  , If the abdominals, gluts and/or hip flexors are weak and not supporting the body when standing on one leg mid-stride, the IT Band steps in and says, I’ll do it! When there is too much load through the IT band, it can become scarred down and the friction and pain begins. At the knee, when the inner quads are weak, the IT Band has no opposing force. It pulls the patella too far to the outside. This causes breakdown of the cartilage on the outside of the patella. The patella rides like a train moving on one rail. Of course, things aren’t always so simple. Pain in the outside of the thigh may not be from the IT Band at all. A physical therapist can assess the situation and make sure that the pain is not referred from a pinched nerve in your back or a stress fracture. Alternatively, you may have great strength but there may be errors in footwear, the fit of your bike, or just how you have learned to run over the years.
How do we treat it? In the short-term, massaging it with a foam roller or other massage tool will help break up the adhesions and bring some circulation to the tendon. This can often produce immediate relief in knee and hip pain. Long-term, however, you need to strengthen the muscles around the IT Band. Squats, double- or single-leg bridges, side leg lifts, and clamshells are just a few exercises that your physical therapist may recommend to strengthen some of the hip and quadricep muscles. We will do an assessment of your movement patterns and identify areas of specific muscle weakness to help develop a routine that will address your unique deficits.

Running in Minimalist Footwear

by Dylan Bartley, MSPT

You may have heard of the class action lawsuit against the Vibram FiveFingers that resulted in a settlement. If you’re a runner who tried the iconic FiveFingers shoes and developed an injury such as plantar fasciitis or achilles tendonitis, this may be sweet validation for you. If you’re one of the many people who used them and loved them either casually or as a running shoe, then maybe you’re left wondering, is it just a matter of time before I develop an injury? Should I go back to those cushy, supportive Brooks shoes my Podiatrist said I should use? Are all minimalist shoes such as the Nike Free and the New Balance Minimus risky to run in? In 2013 we saw sales of minimialist footwear stop their climb and begin to decline, replaced, of course, by sales of motion control shoes and stability shoes.

Well, let me shed a little light on some of those questions. Let’s start with anatomy: there is a variability in the morphology of our ankle bones that predisposes one towards having a low or a high arch. Structurally some of us have the type of arch that wants to collapse and pronate while others are just blessed with a normal or high arch that supinates well. And there is a fourth category: those that have a structurally normal or supinated foot but when they stand and move, they pronate and collapse too much. Let’s call them functional pronators. A knowledgeable physical therapist should be able to assess what kind of foot you have exactly and guide you through the process of choosing footwear.

If you are in the first category of structural pronators, then you may not fare well in your attempt to run in minimalist shoes. There are just too many biomechanical forces to overcome when your foot hits the ground and eventually your tendons and ligaments get strained. Using a stability shoe or motion control shoe or orthotic placed in a minimalist shoe will reduce your risk of injury. Your level of strength and conditioning (or simply personal preference) determines which of those shoes will work best for you. If you are genetically blessed enough to have a neutral, supinated, or functionally pronating foot, then you may be able to slip some minimalist shoes on and get your foot in shape. You can rely on your foot’s ability to naturally pronate and absorb the shock of landing without over-taxing your soft tissues.

By the way, I say “get your foot in shape” because the wean-in process with this kind of thing is real. That is, of course, why even people with perfect arches often get injured when wearing Vibram FiveFingers. Those of us with sedentary jobs or feet that have been living the life of luxury supported by rigid orthotics and supportive running shoes will have an even greater challenge. Functional pronators may need extra time to strengthen their foot muscles. It can take anywhere from 6 months to a year to really build up enough strength to wear a minimalist shoe for an entire 10k or just walking around town all day. There are so many fine motor intrinsic muscles in your foot like the flexor digiti minimi brevis that you probably have never been asked to use unless you were a modern dancer or you grew up walking barefoot in Africa. So be patient as you gradually increase the distance of your runs in minimalist shoes. Wear them half the day at work, and bring a cushy old pair of shoes to switch into at lunchtime. Alternate wearing your minimalist shoe on short runs while wearing supportive shoes on long runs. And listen to pain. See a physical therapist to help diagnose and treat even minor injuries before they become chronic, severe ones. Stretch after your runs and employ a little self-massage and strength training to help your body through any strains. Your new and improved feet will thank you.

Enhance Your Balance

by Dylan Bartley, MSPT, CMP
  • Falls are the leading cause of death from an injury in persons over 65
  • 75% of emergency visits are fall-related
  • 40% of hospital admissions in persons over 75 are the result of fall-related injuries

Technical Stuff

Definitions:

  • Balance is a complex process involving the reception and integration of sensory inputs, and the planning and execution of movement, to achieve a goal requiring upright posture. It’s the ability to control the center of gravity over the base of support in any given sensory environment.
  • Reflexes are automatic responses by the peripheral or central nervous system to help support postural orientation; they occur rapidly enough to not be under volitional control

Balance comes from 3 places

  • Visual System: helps us see things in the environment and orient us to the hazards and opportunities presented
  • Vestibular System (the inner ear): provides the brain with information about the position and motion of the head in relation to gravity; it contributes directly to postural stability
  • Proprioceptors/somatosensory receptors: located in joints, ligaments, muscles, and the skin

Balance is also dependent on:

  • Strength
  • Good flexibility
  • Reflexes and motor planning

When Things Go Wrong

  • The Brain needs input from all 3 systems (visual, vestibular, proprioception) to distinguish motion of the self from motion of the environment
  • Nausea, vomiting, dizziness often result as a mismatch in inputs
  • It takes the brain a little “extra work” to deal with mismatches
  • Example: When sitting in car at a stoplight and seeing car next to you creeping forward, you slam on your brakes
  • Example: When you are boating, proprioceptors perceive a rocking boat under your feet, but your eyes just see a steady horizon
  • there may be medical reasons why one of the three systems are not functioning like a stroke or diabetes or just poor vision. Make sure you are getting the help you may need to address these problems whether it is from a Physical Therapist, Doctor, or Optometrist

Treatment

Use it or lose it! Through practice and repetition, you can help the brain get used to these mismatches and be able to distinguish when the mismatch means trouble, or when it’s OK.

Do your routine 3 times a day, 10-20 reps to get your brain reprogrammed.

It may be a quick routine that only takes 5-10 minutes.

Extrinsic Risk Factors to Address

  • Check your environment: loose cords and rugs can pose threats
  • Does your home have adequate lighting, adequate space?
  • More injuries and falls are likely in crowded situations

Exercises

Minolta DSC

Single Leg Stand

tandem standing

Tandem Standing

BOSU02

Stand on BOSU or Wobble Board or Trampoline

Ways to increase the difficulty with the above exercises:

  • Close the eyes
  • Swing the arms, Spiraling, Reaching outside of your center of gravity
  • Tossing an object with a friend or bounce one against a wall
  • Scanning your eyes and turning your head from side to side

Vestibular Exercises

  • Walk and read
  • Walk while reading a moving book
  • Walk and turn head while reading
  • Walk and turn head with eyes closed

 

As always, we are here at Active Marin to help you through an individualized program to enhance your balance, whether to prevent another potentially debilitating fall, or improve your performance in your favorite sport. 

call us at 415 385 3755 or email us at info@activemarin.com for an appointment or more info

Preventing Back Injuries

Image

Low back pain is so common because it is one of the most vulnerable parts of our body, absorbing lots of torque and strain during the multitude of repetitive movements or static postures we place ourselves in throughout the day. Above you can see examples of the most common pathologies of the lumbar spine. 

What do you do to treat or prevent low back pain?

  • For the first 3 days after the onset of pain: relative rest, ice and gentle, pain-free movement
  • Avoid twisting, rounding, side-bending. Move from your legs/hips more, such as squatting with a flat back to bend or pick something up from the floor, and move from your feet when turning
  • Think “Opposite”: will this movement arch my low back or round it? Then flatten or arch your back with pelvic tilt to do the opposite.
  • Strengthen the deep abdominal muscles or core: this should be done by finding “neutral spine” (position of the back where you feel the least amount of pain or discomfort). The concept here is to STABILIZE the trunk while moving the arms and legs…this puts the focus on an entirely different area. It’s no longer about how big a movement is or how much weight you can lift when doing leg or arm work, but about not moving the trunk by engaging your abdominals.
  • Think about your ergonomics and posture and what position your back may be in while you sit or drive. Use a pillow behind your low back when sitting.
  • Avoid any prolonged positions…if your low back is starting to feel tighter, it’s time to change position!
  • Talk to a physical therapist to walk you through these concepts and develop a customized program that will be specific to what kind of back pain you have.

by Ravi Lescher, MPT

Ski Tips From Jonny Mosley

Skiing with Olympic gold medalist, Jonny Moseley during a “ski with a pro” day in Tahoe certainly shines as a highlight for 2013. Hopefully, you too can benefit from these helpful tips our local ski star.unnamed1. “Be one with your ankles” Control your skis through your ankles rather then using the brute force of your knees and hips.
2.  Arm positon: Swing your arms in front of you as you jump up in the air.  When you land, notice how your arms land in front of you in an active position.  This is where your arms belong when skiing.
3. When you plant your pole, “flick your wrist” out at a 45 degree angle (Jonny learned this from another fellow ski Olympian).
4. Pull your uphill ski back with your hamstring, keeping your tip in contact with the snow.
5. “Thrust” your pelvis through the turn to prevent sitting back on your skis.
6. Keep the tibia angles the same on both skis.