There are many ways we work with young athletes here at PRO Physical Therapy. One of the more valuable outreach activities we do as physical therapists is our Athletic Needs Assessment. These give us Athletic Baselines for our athletes.

Here is where the value rests:

  • Assessment for possible bottlenecks that could limit future training efforts
    • we use the Functional Movement Screen, TPI screen, and OnBase University screens to look at joint and full body mobility, stability, and balance
    • finding ‘Fails’ in this screen is exciting because it details a potential issue that, if cleaned up, can unlock the door to further athletic gains for the kid
    • cleaning up issues can also reduce the risk for injury in their sport or when training for their sport
  • Lower extremity injury risk with the Landing Error Scoring System (LESS)
    • this lets us quantify injury risk and assess whether an athlete has improved following a training period
  • Baseline testing for speed, power, agility, and strength
    • we test:
      • Rotational Power (both directions) with a Ballistic Medball 
      • Counter-Move Vertical Jump with both legs and single leg
      • Reactive Strength Index (RSI) with both legs and single leg
      • 5/10/5 shuttle run
      • Grip Strength

We look at the relationships between left and right legs, between double and single leg vertical jumps, and RSI. This way, we can see potential injury risks and areas for athletic improvement. If an athlete has a large left to right difference, it could signal incomplete rehab from a previous injury or an existing neuromuscular deficit. If we see higher than normal ratios of double leg to single leg efforts, this shows us a need for improved stability in knees, ankles, hips, and trunk. Comparing the tests to each other informs us of a kid’s relative ‘bounciness’ to strength ratios.

All of these combined give an athletic baseline that kids and parents can use as a backdrop to measure athletic growth, especially as training efforts ramp up during high school and college careers.

Rehabilitation

Perhaps more important than the athletic baseline is the (hopefully never to be needed) rehabilitation baseline. This comes into play should the athlete suffer a competition driven injury. Right to left comparisons are often used in Return to Sport criteria. Many health professionals want to see jumps, RSI, and strength measures within 5% when comparing the injured limb to the non-injured. This can lead to poor decisions in the case where the baseline levels were different to begin with. 

Bare with my math here:

If left vertical jump was 15.5” and right was 14” prior to injury (a commonality for right handed athletes), the decision to return a player to competition when left jump is 95% of right would subject the athlete to re-injury. Simple math shows that 95% of the right jump of 14” is 13.3”. This effort is only 86% of the pre-injury baseline, which is well below the rehabilitation green-light of 95%.

If we don’t have pre-injury baselines, we’re simply guessing on the percent of full recovery an athlete has made. 

Return to SportThe physical therapists here at PRO Physical Therapy view the assessments as essential for serious youth, high school, and college athletes. We work with top level high school, college, professional, and Olympic athletes and know the details of their training and competitive needs. We also each have kids of our own playing sports and we love helping them and their teammates reduce risk of injury and reach the heights of their athletic capacity.

Contact us today to find out when our next free Athletic Needs Assessments are scheduled!

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.

Why Proper Bike Fit is Important

Mountain Biking
We see a lot of cyclists here at PRO Physical Therapy. Let’s face it – we live in Madison! The biking community here is incredible. The trail system is far better than a lot of American cities, and you can pop outside the city quickly and be in the beautiful hills of the Driftless region in no time. How lucky are we? If you’re an avid cyclist, then you’ve probably at least considered getting a professional bike fit. People swear by them. After all, how much time do you spend on your bike? If you’re commuting or road riding, it’s probably a significant amount of time. If your bike hasn’t been properly fitted to you, chances are you’ll want to bike less, and you’ll hurt more afterwards. A proper bike fit is the difference between loving your bike even more, or never using it.

How to Get a Proper Bike Fit

Basically, if you hurt while riding, something needs to change. A proper bike fit can make you so much more comfortable, and even faster on your bike! Bike fits are for everyone – avid cyclist or new riders. A proper fit will help prevent overuse injuries from improper position, and varies from person to person. Depending on your age, style of riding, and physical attributes (flexibility, etc), your bike fit will be different than the next persons fit. While we know a bit about bike fitting and proper position here at PRO Physical Therapy, we always recommend taking your bike to a bike fit professional. In Madison, Stacey Brickson is our go to gal. She’s a Physical Therapist and PhD in Exercise Physiology, and has tailored her work to encompass her passion for cycling. She has a private niche practice here in Madison in a bike shop where she specializes in therapeutic bike fit. We often send our patients to her when they come in with bike fit questions or concerns.

At Home Bike Fit

While we think that it’s important to get fitted by a professional, that’s not always necessary for everyone. We recommend that you make the following adjustments if you’d like to try an at home bike fit first:

  • Size: make sure you’ve chosen the right size frame to fit your height/leg/torso length. There’s only so much a bike fit can do if you’re riding an improperly sized bike.
  • Seat Height: this is an easy one to mess around with. If your seat is too low or too high, this can cause major discomfort. A seat that’s too low can put a lot of strain on the knees, while a seat that’s too high can add unwanted pressure points on the saddle.
  • Reach to the Handle Bars: if this is too far or too short, this can result in a lot of upper body pain. You should be able to sit comfortably on your saddle, and reach the bars/hoods. Your elbows shouldn’t be locked, and your core should be slightly engaged.

Riding shouldn’t be painful. If it is causing you pain, consider getting a bike fit! Any pain, numbness, or tingling are signs of an improper bike fit. Some of these at-home fixes are simple, but if they don’t seem to be working, we definitely recommend calling in the pros!

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!

Dave Playing Pickleball

I know this isn’t a basketball image, but it’s a picture of me as a practicing “aging athlete” so I thought it’d do!

As an aging athlete, I know what it is like to have aches and pains. I exercise regularly so I’m used to some daily discomfort. But this time was different. Here’s what happens when the PT gets injured.

I was playing basketball with some friends and our kids recently while we were out of town. I saw a 7-foot tall hoop, and knew I had to try to dunk the ball. I took off on 2 feet, touched the rim, and then felt the worst thing I have ever felt in my life… my quad rip. After I landed, I knew exactly what I had done. Immediately, I felt for my quad tendon, because if it was torn I’d have to have surgery.

This scenario is a common thing that happens to us as we age. People get injured all the time. What I want to talk about is how I managed this. After an injury, getting into Physical Therapy RIGHT AWAY is one of the most important things you can do. I was out of town when this happened, but needed to be treated right away. Since this was a musculoskeletal injury, it was right up my alley to treat. I didn’t think there was any need to go a doctor. That being said, you may often feel the need to go to a doctor for an overexertion injury like this. That’s ok too! This hurt more than anything I’d ever done before. This time, however, I decided that I could manage it myself.

First, I used ice (right away) for 20 min on, 20 min off. I did this three different times that first night. Icing with my leg bent could keep it from scarring too much. The next thing I needed was some compression. I went to the pharmacy to find an ace bandage and crutches. They did not have an ace bandage so instead I bought some Coban Wrap. Compression can help keep the bleeding to a minimum. I used a sock and wrapped my leg with Coban Wrap.

Two days later, I returned home and started to work on it. I did a lot of soft tissue work, kept using ice, taped it, used pulsed ultrasound, and I even dry needled myself (please don’t try that at home)!

I’m about two weeks out and doing better. I’m not there yet. I can walk and bend my knee but still can’t go up or down steps very well. However, the daily treatment has helped immensely. I know that this injury may take 8 weeks to fully heal, but if not for early intervention I would be in trouble.

So, what is the morale of this story? Get in to see a Physical Therapist RIGHT AWAY after an injury. We have been through this, and we are here to help!

David NissenbaumStay well and happy healing,
Dave

We’re seeing more and more people itching to get back out on the trails as spring approaches. This can mean that we will start to see a lot of people coming in with hip pain or hip injuries…

If you’ve taken the winter off from running – be careful when jumping right back in. We recommend you prepare for running season again with some basic strength training exercises to keep yourself injury free!

In the video below, Jaime takes us through 3 exercises that we use to treat hip injuries. These exercises cover mobility, strength, and endurance.

First, you need good flexibility or range of motion. Exercise 1 above is called “the couch stretch.” Make sure your hips are square, your pelvis is tucked, and your glutes are engaged. Do this exercise morning and night.

Second, you need strength and control through that range of motion. The second move focuses on hip extensor strength and power. It also engages the core, and uses rotational control in the hip. Do these 3x a week while watching TV!

Third, you need endurance. This last exercise is a single-leg dead life variation. It focuses on hip control and endurance.  It integrates the whole limb – some people will feel it even more in the feet and ankles than in the hip! You can do these 3x a week – hold for 20 seconds and repeat 3-6 times on each side. If you’d like to wake up the hip a little before a run, you can also use this one as a warm up!

Each of these exercises starts with basic movement, but has variations that you can build to as you gain strength. Watch Jaime’s video above for a demonstration of each variation, and tips on how to get the most out of these exercises.

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

My Knees HurtWe get this question all the time. “I’m in my 40’s and want to exercise but the next day I am miserable” or “I played tennis and basketball and now my knees are really sore” or “I can’t go upstairs easily, and I’m really sore when I’m sitting for any length of time.” You may think you need knee surgery or to have a knee replacement to get this pain to go away. But this is not necessarily true. Let’s take a look at your options.

Why do my knees hurt?

Before we talk about why we hurt, we need to talk about normal anatomy first. Our knee joint contains 2 parts: the tibial/femoral joint and patellofemoral joint. The tibial/femoral joint connects the femur and the tibia together and the patellofemoral joint is the kneecap in front. We have different ligaments that connect the bones together, and a meniscus that sits between the tibia and the femur. These can get injured with trauma. The biggest thing that we have on each part of the bone is called articular cartilage. Articular cartilage is usually what wears away with age and intense physical activity. It acts as a coating for our joints just like coating on our pots and pans when we cook to protect food from sticking. As we age the articular cartilage wears down and can start to cause pain. (Ahh=articular cartilage – that’s the reason why I hurt!) So, here is the question I always get: should I stop exercising? The answer is NO – that will do the opposite of help in this situation. Instead, there are things we can do to hopefully keep you from needing surgery. Staying active with Physical Therapy is very important. With the right treatment plan and exercises, we can help you get back on track.

What can PT do to help?

There are a number of things that Physical Therapy can do to help those achy knees. Here are a few:

  • Manual Therapy – our focus is on unloading the knee and taking pressure off your joints
  • Exercises that won’t aggravate the knee
    • these include hip drills: clams, clam lifts, band walks, RDLs, planks, etc (we give examples of these on social media and in our monthly recommended exercises)
    • try to avoid exercises that will aggravate the knee (deep squatting, stepping down from something, etc)
  • Wearing a Knee Sleeve – this can be helpful during activity to keep your knee warm and calm down your symptoms
  • Taping – this is a great way to help your symptoms as well
    • we can be specific to just your kneecap, or your tibial/femoral joint too, depending on the areas affected

If you have knee pain and have been avoiding getting treatment/diagnosis, come see us. Our job is to get you back to where you belong – as quickly as possible! Schedule an appointment here.

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