A patient with low back pain came in the other day. Her pain started a while back and about a month ago, she came to us for treatment. Her back was improving during this time, however, it flared up on her when she tried to exercise. Her frustration at the pain and the new flare up showed. She had a follow-up appointment with her physician who offered more medication to control the pain. She declined this treatment option, as she didn’t see it having a successful outcome. 

Patient Frustration

After my patient’s follow-up appointment with her physician, she came back to see me. She expressed frustration and a sense of not knowing how to proceed. So, during the first 30 minutes of her appointment, we talked about what had happened and devised a plan. We reviewed both her medical and physical therapist diagnoses, did an anatomy review, and talked about who else might be part of the treatment program. We talked about chiropractic, acupuncture, Pilates, visceral mobilization, and how to modify sleeping and sitting positions. We discussed her diet and how that may impact her pain as well. During the last half of her appointment, I did some manual treatment, dry needling, and adjusted her home physical therapy exercise program. She stated she was pleased with our session and felt much better about things now that a plan was in place. 

Multidisciplinary Team

Daily, we see patients who, like this one, need a multidisciplinary team to treat the pain they experience. Physical Therapists have a unique role in the healthcare model. Not only can we evaluate injuries and perform treatments, we have the ability and knowledge to help manage patient’s care. Previously, a patient’s primary care physician may have assisted in this manner, but now with the workloads they have, they may not have the time or ability to work with the musculoskeletal issues many patients experience. Physical Therapists, on the other hand, have the specific training in musculoskeletal issues and also have the ability to assist patients with their care by recommending specialists and other health care professionals. The days of sending a patient back to her primary physician to manage her overall treatment should be over. Communicating with the patient’s primary is essential to keeping the lines of communication open, however, Physical Therapists should be in charge of the patient’s musculoskeletal care.

I consider myself fortunate to be part of a multidisciplinary team. As a Physical Therapist, I feel honored to be able to take care of patients. Therefore, when a patient is not progressing as planned, other specialists and individuals need to be brought into the treatment plan. I believe we can be the ones to help guide patients to the care they need.

As always, please let us know what we can do to help you.

Here is to a healthy body!

Dave

How many times have you stopped a run workout due to calf or hamstring tightness? You think one of the best things to do is to take a couple of days off to rest before resuming your workouts. The next time you run, you get a few miles in before your calf or hamstring tightens up again. You try foam rolling and taking a few more days off, but it just does not help. You try this for a few weeks and find yourself skipping more and more workouts because of the tightness and pain. If this has happened to you, dry needling may be a piece of the puzzle to getting you back to running, swimming, and biking. 

What is Dry Needling?

Dry needling is a common treatment technique in orthopedic manual physical therapy. Two dry needling approaches exist, the trigger point model and the neurologic model. From a pain science perspective, trigger points or tender points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. So, what’s the bottom-line? Dry needling is a technique used by physical therapists to decrease pain, speed recovery, and minimize downtime. The technique helps to “reset” muscles that have been damaged during training, racing, overuse, or poor mechanics in daily activities. This reset is performed on the trigger points impairing the neuromuscular and musculoskeletal performance of our bodies. 

Does Dry Needling Work?

Yes, it does! Substantial clinical evidence supports the usage of dry needling. In 2010, The Journal of the American Board of Family Medicine, published a clinical narrative indicating that dry needling reduced pain and muscle tension, and facilitated a return to function by normalizing the nerve impulses transmitted to the irritated muscles.

In a study published in the September 2013 issue of the Journal of Orthopedic & Sports Physical Therapy, a group of researchers analyzed the results of the best clinical studies that had been conducted on dry needling. Reviewing the results of the relevant studies, the researchers determined that dry needling can effectively provide pain relief. For those with chronic pain, the possibility of alleviating that pain without narcotics is a welcome option.

Would A PT Perform Dry Needling Before Or After My Competition?

A PT can actually perform it before or after your competition! It really depends on how well you tolerate the needling. Some patients are sore for up to a day after needling. Others notice that the needling has loosened them up quite a bit and like to have the needling done before a competition. 

Needling after competition can be a game changer! It can help with post activity recovery and help your tissues recover faster without the soreness typically felt

How Can Dry Needling Help Me?

When those tissues are released, it results in improved gait patterns, stronger muscle contractions, and more productive workouts.

5 common trigger point areas that endurance athletes experience issues with include:

  • Hip: glutes, piriformis, deep rotator muscles (hip bursitis, IT Band syndrome)
  • Lumbar (low back): QL (quadratus lumborum) and paraspinal muscles (sciatica)
  • Thigh: quads and hamstrings (IT Band syndrome, runner’s knee)
  • Calf/foot: gastroc, soleus, peroneals, posterior/anterior tibialis (plantar fasciitis, shin splints)
  • Neck/shoulders: traps, pectorals, lats (shoulder impingement, rotator cuff syndrome)

Addressing these points with dry needling, along with a formal assessment of your strength, range of motion, and mechanics can help you achieve or return to optimal pain free performance.

Woman sitting at desk

New Lifestyle

About a year ago, I had the typical desk job. I was working 40 hours a week at an office, and I couldn’t help but sit. My lifestyle had always been very active, and  I had previously not held office jobs. In college, I worked on multiple farms, was a server in a restaurant and, after college,  was a full time potter. Transitioning to an inactive job wasn’t easy. The toll it was taking on my body was noticeable almost immediately. My office didn’t even have one standing desk, so sitting was (at the time) my only option. My lifestyle was still active, but over time it really started to show. I biked to work, and would go for a run after work. However, I would still be tired and stiff during the day, and it was only getting worse.

I started to go on runs on my lunch break so I could break the day up from all that sitting. That spring, I was training for a half marathon, so it was a good way to log extra miles. Running over lunch became harder than I’d expected. It would take me at least 20 minutes to get warmed up. My legs and joints were stiff, and my hip flexors were tight. I was out of breath more than I was used to, and it really threw me off!

Standing desk diagramMaking the Transition

Finally I decided to get a standing desk. I’d been making faux standing desks at work for the past month or two by stacking boxes on my desk and raising my monitors, keyboard, and mouse. However, it didn’t always work well, and there was a tipping/falling hazard that my boss didn’t approve of…

I finally bit the bullet and bought a standing desk. I got a small Varidesk, but was still able to fit my 2 large monitors on it, along with the keyboard. The change was almost immediate. I wasn’t falling asleep after lunch, and my legs felt better! Before, my legs literally felt like they were dying. I told people I could “feel my muscles disintegrating” (which clearly wasn’t the truth, but some days it really felt like it.)

The Results

It probably took me 2-3 weeks to get used to standing more. Again, not moving is what causes problems. With a standing desk, I wasn’t sitting all day anymore, but I still wasn’t moving. A first, I switched between standing and sitting a lot. As I got more used to it, I would stand for longer and longer. I tried not to lock my knees, and I would “dance” around a lot to keep from getting stiff. Sometimes, I stood on something softer (a foam pad I brought in) and that helped my legs/feet not hurt too. It was definitely tiring, but that felt good. Much better than when my muscles were “disintegrating!”

The biggest thing I noticed was that running was easier. I could pop out for a quick run and be at my pace right away. It felt amazing. Hills or sprints weren’t a problem either, and I wasn’t dragging for the first 20-30 minutes anymore. All in all, it was a game changer. I recommend getting a standing desk to everybody who has a desk job!

Taking Action

Interested in your own Office Ergonomics assessment? We can help! We offer both in-clinic and in-the-office assessments, and can help get your in a better position for your body. Call us today to schedule your own assessment!

Shoveling SnowWinter is upon us and now our driveways and sidewalks are covered in snow. It’s a good time to consider how your snow shoveling routine may be impacting your physical health. The most common injuries associated with snow shoveling include sprains and strains, particularly to the back and shoulders.

There are a couple things to keep in mind as the winter season finally hits us:

  1. What snow shovel is best for me?

    • When purchasing a snow shovel a few things to look for include; the height of the shovel, the overall weight of the shovel, the width of the blade, and the shape of the handle.
      • Not too short and not too long: use a shovel that allows you to keep your back straight
      • A lighter shovel (plastic vs metal blades or fiberglass vs wood shafts) will also decrease the amount of stress placed on your back, as the snow can be plenty heavy on its own
      • A smaller blade will decrease the amount of snow removed at one time, but will lessen the load and the amount of strain on your back
      • Bent-shaft vs straight-shaft handle: a bent-shaft snow shovel can likely reduce lower back stress as it decreases the amount of motion required by the back
  2. How should I shovel?

    • When going outside to shovel, there are a few things to remember:
      • Warm-up before going out
        • A warm body/muscles work better. Your warm-up should include 5-10 minutes of light aerobic activity to get your blood moving, followed by gentle stretching.
      • Maintain good stable posture
        • Pay attention to your posture. Stand with your feet hip width apart and staggered. Hold your shovel close to your body.
        • Space hands apart to increase leverage. Bend from your knees and hips, not your back.
        • Make sure you tighten your stomach muscles and avoid twisting while lifting (push snow rather than lift if possible).
        • Preferably walk to dump snow, but if throwing, throw forward and step in the direction that you are throwing.
      • Pace yourself
        • Shovel for 5-7 minutes and rest 2-3 minutes. Start slow and continue at a slow pace. When snow is deep, shovel small amounts 1-2 inches at a time. New snow is lighter than packed/partially melted snow, so it’s better to get out early and more often.

Ultimately, TRY before you BUY. Make sure the shovel fits you and your body. And always warm up before going out! Try to avoid excessive motion to your low back by using your legs and hips more. And don’t forget to take rest breaks!


Sources

https://www.moveforwardpt.com/Resources/Detail/snow-shoveling

https://www.toronto.ca/community-people/public-safety-alerts/safety-tips-prevention/home-high-rise-school-workplace-safety/snow-shovelling/

https://www.ncbi.nlm.nih.gov/pubmed/23845725

Return to SportPRO Physical Therapy is hosting its second Return to Sport/Athlete Development Program. This athlete development program is meant to bridge the gap between rehabilitation and sport. Additionally, it will prepare athletes for a step up in competition, because we are focusing on risk of injury.

The program will be coached by a former Oklahoma City Thunder and Golden State Warriors strength and conditioning coach, and our very own Jeff Schleusner, Physical Therapist.

The class is limited to nine athletes. We are directing this towards female athletes who make up a higher risk category for injury. However, everyone is encouraged to participate if interested. The program will consist of 10 sessions that run from February 18th – March 15th. There will be two sessions per week on Mondays from 6-7:30pm, and Fridays from 4:30-6pm. The cost is $350 for all 10 sessions.

If you’re interested in learning more about our athlete development programs or registering for this course, please contact PRO Physical Therapy (608) 841-1290 to reserve your spot today!

Return To Sport

In-Season Training

Boys and Girls high school basketball seasons have kicked off and teams are into their conference schedules. Questions often arise concerning how often and how intense in-season training should be for teams. This is a topic that is worth hours of discussion.

Here are a few key things to consider:

  1. BasketballHopefully the players trained hard in the off season to build up strength, speed, and reactiveness. This will better prepare them for the season. Athletes need to be stressed in the off-season so they can adapt to handle the new workload once the season starts. It’s almost like building up a strength ‘reserve’. Players that stress themselves to the point of adapting in the off-season will likely have a larger reserve to draw from as the season begins. However, the qualities built during off-season training need to be trained in-season as well. In order to maintain qualities in-season, players need to train their bigger strength lifts every ten days. That means finding a time within the game schedule to program intense strength sessions. The players will need to lift > 90% of their maximum lifts.
  2. Recovery and response to injury drives everything. For the players getting lots of game time, overall volume needs to be lower. For players not getting as much playing time, coaches need to be careful not to let them become deconditioned. The individualization of workouts within the team will really spread out as the season progresses. There will be players who can continue to progress strengthening during the season, and others that need to be dialed down.
  3. Sleep, diet, academic stress, and mood should all be monitored for each player during the season. The best strength training plan in the world will fall apart if these four areas are draining a player’s reserve.
  4. Track RSI (4 hop test), maximum vertical jump, and even how players are handing some of their bigger lifts (squat, dead-lift). This will give a coach a decent measurement of where the team stands in terms of neuromuscular readiness. If these numbers start diving, workload needs to be adjusted.

Overall, teams that enter the season having been properly stressed to handle demands will be the strongest. Those that are given managed stress during the season to help maintain important athletic qualities are the ones who are most fresh in late February and March. They’ll likely be less injured and closer to their peak physical ability as tourney time begins.

Many clients come to us with back pain – and if you’re like 80% of Americans, you’ll experience some sort of back pain in your life time. A weak core is often the reason for this – and includes a fairly simple fix. Below we share our top 3 core strengthen exercises. Do these 3 times a week for a strong, healthy core and back!

Front Plank

Front PlankEveryone knows this move – and loves it right? Ok, front planks might not be your core strength favorite, but they are one of the all time best core exercises because they engage multiple muscle groups simultaneously. They will tighten your tummy, improved your posture, help your balance, and even lessen back pain. For a strong front plank, make sure your hips and shoulders are in line with your ankles. Your shoulders should be pulled together and down your back, and your butt should be tucked. Neutral spine alignment is key! Hold for 10-30 seconds a set, and repeat as able.

Side Plank

A sister to the front plank, side planks are equally as important. When you shift from a front plank to a side plank, you are reducing your contact with the floor. This creates a more challenging balance. The extra effort required teaches you to use stabilizing muscles around your spine, hips, and shoulders. Make sure there’s a straight line between ankles, hips, and shoulders. Then, pull against the floor toward your feet with your elbow. You might begin to shake, but that just means it’s working! Hold for 10-30 seconds a set, and repeat as able.

Paloff Press

A lesser-known core strength workout, the Paloff Press is one we should all be talking about. Many people believe that great abs result from movement-based exercises, like crunches, leg raises, etc. Instead, the core muscles are actual stabilizing muscles. Rather than just being the 6-pack we often think about, your abs extend from just below your chest all the way down and around to your glutes. Known as a “corset of muscle”, it not only gives people a defined, tight core, but also stabilizes the spine and disks, and protects them from unnatural bending or twisting. The Paloff Press works your entire core, not just the front section we often focus on.

To perform this exercise, attach a band to a door handle or table leg. Clasp both hands, palms together, on the end of the band. Place your feet hip-width apart, and make sure your knees are slightly bent. Bring the band up to the center of your chest, and keep it taught. Extend your arms slowly and fully. Your body will want to lean toward the band – don’t let it. Return your hands to your chest, and repeat for 8-12 reps on each side.

There’s a few things to keep in mind with the Paloff Press. Make sure you aren’t locking your knees. Aim to fully extend your arms, and move slowly in both directions. And brace your entire core to resist the pull from the band. Don’t forget to do both sides!

FamilyDinnerToast

The holidays can be a stressful time for everyone. Not only do all your work projects seem to suddenly need to be wrapped up before you leave, but then there’s travel plans, meal plans, gift shopping, and of course – family plans. Finding balance during the holidays can come in many forms, and is different for every person. Below are our favorite things we recommend you keep in mind as you enter the holiday season.

Vacation PlanningTake Vacation

This is very important, and often overlooked. Even from the time you start planning a vacation, your mood lifts. Studies show that adults who haven’t taken a vacation in several years have a 30% higher risk of heart issues than those who have taken a vacation from work. Get as much work done as you can before the holidays, and then take a break!

Stay Active

This is a big one. The holidays can involve a TON of sitting. Here are some fun ideas for you and your family – instead of watching TV all day!

  • Go for walks with family. You can take breaks between movies or shows on the TV and take a lap around the block. Even better, find a place nearby to hike for an hour – getting outside brightens your mood, and fresh air is refreshing! Plus, the endorphins released in physical activity will definitely come in handy later when your great uncle so-and-so inevitably tries to bring up politics over dinner…
  • Sign up for a charity run/walk as a group! Again, this will get you outside, and provides a fun social activity to do as a group. And these charity walks generally support a good cause.
  • Volunteer for a local charity. Food pantries often need help packaging holiday food baskets for local families in need. Some stores look for gift wrappers, or help with food/toy drives. Or, you can set up a caroling group and visit a nursing home! Any way you slice it, helping others while spending time with your loved ones will only make you feel better. We should all try to brighten others’ holidays.
  • Attend a donation-based yoga class. Or, if you can’t find one near you, get everyone in the living room in stretchy pants and put on a YouTube yoga video. Getting everyone up on their feet and moving will feel good, and you might even find it giggle-worthy. Light stretching and twists are helpful for those tight muscles after all the travel you might have done, and it’s also great for digestion!

Maintain Your Sleep Schedule

AlarmClockIt can be very tempting to stay up till all hours of the night catching up with family and friends that you haven’t seen in a while. However, maintaining your sleep schedule is important. Our bodies crave consistency. With regular daily activities, our various body systems are able to prepare for and anticipate events. We naturally become more alert closer to our wake-up time. Our digestive systems become activated in advance of regular meal times in order to more efficiently process food. We start to relax and become sleepy prior to bedtimes. It turns out that these regular daily events serve to anchor our underlying daily rhythms. Maintaining a normal sleep schedule will help all of your body’s system run at peak efficiency.

Say No

It’s as simple as that. Whether said to your coworkers or to your friends and family, saying “no” is an important act to practice. Only you know what’s too much for you during the holidays. Don’t be afraid to decline more work, turn down responsibility, or move meetings that will push you over the edge. You’ll actually have more to give if you’re taking the time to care for yourself and your family! Set your limits and say no as needed,

Cook Together

ThanksgivingDinnerThis one may not be for everyone, but it can still be a fun activity that doesn’t involve sitting, the TV, or being distracted by cell phones. It’s a great way to save money, and you’ll probably feel better than when you go out to eat. If you have nephews or nieces, this can be a fun way to bond and involve them. Google some recipe ideas and get started!

Take Breaks

If you’re around too many family members that you aren’t used to, this can stress anyone out, especially those with heightened anxiety. Take a walk by yourself or go to the gym if you know that might help. You’d be surprised what getting a few endorphins and some exercise can do for your patience. If you know that 2 days with your in-laws is all you can handle, plan to stay only 2 nights. Setting rules that you know fall within your limits isn’t just beneficial to you – it’s also respectful of everyone else. You’ll be more pleasant in your time together, and they’ll enjoy you more because of this.

More important than all these warning signs, have FUN! The holidays are a wonderful time for families, especially those with children. Enjoy every moment!

Exciting news!

At PRO Physical Therapy, we’re happy to announce that we have a new state of the art piece of equipment available for your runners – the AlterG Anti-Gravity Treadmill! We pride ourselves in using cutting edge treatments and technologies to provide the best possible care for our patients. As we near the end of this cross-country season, many of your athletes are trying to get through their final races. Consider the use of the Alter-G treadmill to help them stay in the game. If you’ve got an athlete fighting through nagging pain but still needs to train, please click here or give us a call today. We’d love to help you finish out the season strong.

AlterGWhat’s the Alter-G?

The AlterG Anti-Gravity Treadmill is revolutionizing fitness by allowing you to run or walk with reduced impact.

Through patented NASA technology, the Anti-Gravity Treadmill provides up to 80% body weight support to reduce the stress and strain on your body. The benefits of controlling gravity and reducing your body weight while you walk or run allow you to:

  • run without discomfort or pain
  • burn more calories by going farther or faster than you normally can
  • train through injuries
  • feel the joy of running without the impact on your joints

Give us a call to learn more about the AlterG or to schedule your first session today.

We are excited to announce that we are hosting a Lower Back Pain and Sciatica workshop at our Cross Plains location! The class is on naturally healing back pain and sciatica.

Pop Quiz:Back Pain Workshop

• Do you suffer with back pain or leg pain when you stand or walk?
• Do you have pain when sitting for long periods of time?
• Do you experience pain, numbness or tingling into your butt, groin or down your leg?
• Does your back ever “go out” if you move the wrong way?
• Are you afraid your pain will get worse if you don’t do anything about it?

If you have answered YES to any of the above questions (or have a stubborn spouse who is in denial) – the Lower Back and Sciatica Workshop may be a life changing event for you…

If you’re confused about what to do and looking for answers, here’s some of what you’ll learn:

• The #1 biggest mistake back pain and sciatica sufferers make which actually stops them from healing…
• The common causes of Lower Back Pain and Sciatica
• How to pick the right treatment for the cause of your pain
• How a problem in you back can cause pain, numbness or tingling in you leg

Each attendee will receive a special gift, and there is no cost to attend the workshop. We are limiting the attendees so please call to reserve your spot! It’s FREE! And food and beverage are included. Register today with the link below, or call 608-413-0550.

Register here


Workshop Details

Where: PRO Physical Therapy – Cross Plains
Date: October 18th, 2018
Time: 6pm
Address: 1118 Main St Suite A, Cross Plains, WI

We’re looking forward to seeing you at the workshop!