Pilates Class

Part 3: Improve your core endurance to improve your posture!Physical therapist guided 6 week ball and mat Pilates class focusing on core endurance for improved posture. Join us at Great Moves Physical Therapy, 1775 S. 8th St, on Monday evenings starting June 3rd through July 8th, from 6:00 to 7:00. The cost is $10 per session or reserve your spot for the whole class with $50 paid by June 3rd for the 6 week class. Space is limited. Sign up today/inquire by calling 719 477 6870.  Balls and mats are available at the class or bring your own. This particular class is recommended for those who have had prior experience with Pilates, however all levels are welcome.

Is it Really Plantar Fasciitis?

So, you have bottom of foot pain.  It hurts when you place your weight on it when you get up in the morning.  Stop right there, you have "plantar fasciitis"......or do you?  Here is a simple plantar fascia stress test to see if you truly have plantar fasciitis.

So, what if it is not true plantar fasciitis; what could it be?  What I have mostly seen is it is either a plantar weakness (arch weakness), ankle hypomobility (either from a direct joint restriction or muscular tension), or referred pain from the sacroiliac joint.  So, what can you do for these alternative problems causing your "plantar fasciitis"?

Arch weakness: Standing on the ground, barefoot, practice lifting the arch without lifting your toes off the floor.  You may either be able to do this by simply shifting your weight slightly to the outside of your foot without lifting the toes or tightening your buttocks to lift the medial foot arch.  For long term arch strength, try a minimalistic shoe in which you are esentially walking barefoot (with just a sole covering)....I know -- backwards from what you think and scary to contemplate since putting your foot on the ground hurts.  [Read "Born to Run" by Christopher McDougall.]

Ankle hypomobility: If soft tissue (therapeutic massage) alone to the surrounding foot and ankle structures doesn't alleviate your pain, a manual PT can assess whether or not you would benefit from a talocrural distraction manipulation or subtalar joint manipulation to correct the mobility of the foot and ankle and thus take the stress off the plantar fascia.

Talocrural Distraction Manipulation to increase global ankle mobility especially toe up motion.

Eversion Subtalar Joint Manipulation to increase ankle falling in motion.

Inversion Subtalar Joint Manipulation to increase ankle falling out motion.

Referred pain from the Sacroiliac Joint: By stabilizing the sacroiliac joint through a temporary belt and progressive transverse abdominal strengthening exercises, one can abolish his/her plantar fascia pain if that is what's causing his/her symptoms.  See previous posts' pictures of transverse abdominal strengthening (Pilates Leg Loading Tests) for some ideas.

Happy walking to you and your feet!  :-)

Physical Therapy after Spinal Surgery

After going through an emergency laproscopic appendectomy this past fall, I have new found respect for those going through much more invasive procedures on their spine.  Having a pretty competent core, myself, I thought getting out of bed the following morning (after a 4 pm procedure the previous day), to shower, would be no big feat.  I was wrong.  I got to pull my tooth brush out and didn't even get to putting the tooth paste on before I had to be helped back to bed.  From there, I walked hunched over, feeling quite ancient, for several days before my insides would allow me to have good posture again.  So, how can we even contemplate being able to bounce right back after major spinal surgery?
There are ways to minimize the down time!

     1) Most people plan spinal surgery.  Get into a physical therapist that knows how to delicately strengthen/balance the core as much as possible prior to surgery.  What strength we have before hand DOES help us bounce back afterwards.  Get to know what it feels like to fire the appropriate muscles so you can "turn them back on" sooner rather than later after surgery. 
     2) Obtain your surgical report and contact details of your surgery/surgeon for your PT for post surgical care.  This will help communication between therapist and surgeon of the definite DON'Ts after surgery. 
     3) Give yourself time to recover, however get back to firing some muscles supporting your core asap.
                    A ball can be a great tool to just sit on (or lightly bounce) in your brace (if you are wearing one) post surgery.  Prior to surgery, I would highly recommend acquiring one and getting confident in utilizing it in different positions.

My intern is pictured here performing a mid row on the ball. 

Without inducing much stress to the lumbar spine,

one can maintain strength in the upper back

to help with returning to upright posture post surgery. 

                    A Pilates Reformer has spared a lot of grief for my post lumbar fusion patients.  Laying on your back is usually a position of comfort (or add a pillow for greater comfort) secondary to stabilizing your spine better by simply laying on it. 

Just pushing back and forth with your feet

will increase circulation

and help alleviate pain

post surgery

without much stress to the lumbar spine. 

You can even get out of your brace (if you're wearing one post surgery)

to typically do these exercises.

 

     4) Don't overdo it!  Especially with lumbar fusions (which I greatly hope all can avoid for many reasons -- see the link below), over-firing transverse abdominis (lower abdominals) and lumbar multifidii (deep low back muscles) are usually not advocated by surgeons to simply help protect the healing phase of the fusion. 

Bottom line, research supports early movement and firing of the core muscles to prevent the laying down of adipose (fat) tissue where muscle should be to help support your back after spinal surgery for many years to come.  If you've had spinal surgery, I can only say, that it is in your best interest to maintain a regular core program for the rest of your life.  Remember, physical therapists do not specialize in surgery and must be in communication with your surgeon; a surgeon does not specialize in rehabilitation and should consider the physical therapist's expertise on appropriate exercise instruction.

More information: INFUSE Bone Graft, used commonly in spinal fusion surgery, has been linked to some severe side effects, http://www.drugwatch.com/infuse/.  Ask your surgeon about the material planned in your surgery and avoid the use of INFUSE Bone Grafts.  Thank you to Aubrey for passing this information on to all of us!

Improve your CORE to better your BALANCE!

The Denver Post recently published an article on the importance of balancing out all core muscles to prevent pain and move more efficiently.  Practicing what I have been preaching over the past 12 years, I am excited to see more press on the topic.  Using the cyclist, for example, from their article, a core specialist that is looking for true muscular balance is going to consider how the neck muscles attach into the spine (just picture the typical position of a cyclists' neck while riding), how the scapular muscles and obliques compliment each other to promote fluid rotation through the throacic spine, how the deep stabilizers of the lumbar spine (multifidii and transverse abdominis, to name a couple) are complimenting each other to provide both dynamic low back control (control during movement) and strength endurance (to maintain good postural alignment over many miles pumped out), and how the glutes and quads/hamstrings all fire correctly to help stabilize the pelvis for movement over the saddle.
If you're local and want to talk to me about your core muscle balance, contact me at Great Moves PT for a free consultation (719 477 6870).  If you are ready to promote that balance continuously, contact me at Shallyn's for private Pilates Reformer training (719 213 1588).  If you're interested in hearing more about the topic, come listen to my next seminar being held at Accolade Fitness South on March 4th (719 473 2222).
Below you will find a few exercises that I use to hit each plane of movement control for the core.

 Saggital Plane (forward backward) control.

 Transverse plane (rotation) control in sitting.

Frontal Plane (side bend control) via a modified side plank position.

Pilates and Running

ADVANCE for Physical Therapy & Rehab Medicine (www.advanceweb.com/pt October 1, 2012) recently published an article supporting Pilates for both running-related injuries and for ongoing conditioning to prevent future injury for runners of all discipline. The repetitive motion of running often leads to muscle imbalances extenuated by poor running technique, incorrect training, problems with footwear and running surfaces. The most common running injuries include iliotibial band syndrome (outer upper leg pain or outside knee pain), patellofemoral dysfunction (knee pain), plantar fasciitis (foot pain), and shin splints. Running is mostly a saggital plane motion (forward-backward) while the muscles that stabilize the spine and pelvis are supported in the transverse (rotation) and frontal (side to side) planes and are not specifically challenged when running. Research supports specific trunk stabilization, core strength, posture control, and alignment to optimize performance. Pilates exercise requires appropriate alignment, breathing and movement precision. It is designed to simultaneously strengthen and lengthen muscles, stabilize the core and promote balance, symmetry and proportionately developed muscles ultimately addressing the runner's muscle imbalances that lead to pain and dysfunction. Therefore Pilates is a "superb complement for any runner's conditioning program".

Call Great Moves today at 719 477-6870 to start your Pilates mat/ball/Reformer program with Shallyn and have your running technique and footwear analysed.

http://www.greatmovesphysicaltherapy.com/colorado-springs-return-to-running/ http://www.greatmovesphysicaltherapy.com/colorado-springs-pilates/ http://www.greatmovesphysicaltherapy.com/colorado-springs-physical-therapist-shallyn-macdonald-dpt/ http://www.greatmovesphysicaltherapy.com/colorado-springs-anti-gravity-treadmill/

These are some of my "runner" favorites to hit all dimensions of stability for the runner.

 Working the frontal plane for spinal and pelvic stability.

 Working the transverse plane for spinal and pelvic stability.

 2nd part of above exercise showing hip external rotation strengthening

with core stability in extension.

Stabilizing the upper spine for spinal control during reciprocal arm movement during running.

How Physical Therapy Can Improve Your Hip Health

I'm attaching an article forwarded to me by one of my readers that I think provides good information of how PT can improve hip health.  Enjoy and thanks again for reading and contributing!

How Physical Therapy Can Improve Your Hip Health

Physical therapy offers a number of benefits in hip health. It is often used in conjunction with medications for the relief of hip arthritis symptoms, which affect about a quarter of adults at some point in their lives, delaying or eliminating the need for hip replacement surgery.

In acute hip injuries or overuse injuries, physical therapy can help patients recover more quickly and strengthen the hip to avoid injuries in the future, and therapy can be used to correct issues with body mechanics or posture that could lead to hip injuries or chronic pain.

Hip Strength and Support

The hip joint is supported by a network of muscles. These muscles work to keep the joint properly aligned and operating smoothly, as well as helping to absorb some of the impact on the joints that occurs with normal daily activities. When these muscles become weak, the hip joint can suffer the effects of excess stress and instability, leading to joint pain or injury, and over the long run, chronic joint problems, such as hip arthritis. Physical therapists work with patients to strengthen these muscles, restoring hip support and function.

Balance, Stability and Safety

Weakness in the hip muscles can be dangerous, causing poor balance and instability while standing, walking and bending. That instability can dramatically increase the risk of hip fractures and other serious injuries due to falls. With the help of a physical therapist, strength can be restored to the hips, improving balance and safety.

Hip Arthritis

Physical therapy is used extensively in the treatment of hip arthritis symptoms. Therapists work with patients to strengthen the muscles that support hip function and stability, which can help alleviate pain and inflammation. Flexibility and range of motion are typically addressed with exercise and stretching techniques to aid in reducing painful symptoms and increasing mobility. Manual Physical Therapists use specialized hands-on mobilization techniques, supported by the research, to help obtain optimal hip mobility in hip arthritis sufferers.

Hip Replacement Rehabilitation

Physical therapy is essential to recovery after hip replacement procedures. Therapy begins almost immediately after hip replacement with the goal of maintaining motion in the new hip joint, strengthening the hip muscles, restoring mobility, restoring normal walking pattern and improving balance for successful return to prior function and community safety. Education of the patient on important differences in joint function and range of motion that can be expected with hip implants is also paramount to reduce the risk of implant dislocation and failure.

Revision Surgery Recovery

Physical therapy is even more important after revision procedures, which are surgeries done to correct implant issues, such as failure, loosening or complications. Revision procedures are often more complex than the original hip replacement and recovery times can be longer and more difficult.

The most frequent reason for revision is replacement of implants that have reached the end of their lifespan. Depending upon the type used, hip implants last about 10 to 20 years before they wear out and require replacement.

Recently, many revisions have been done due to premature failure or complications with metal-on-metal hip replacement products, issues that have led to a great many hip replacement lawsuits filed by injured patients. Several of these products have been recalled, including DePuy ASR, Stryker Rejuvenate and ABG II, and Zimmer Durom Cup.

Patients have had complications that include metallosis and osteolysis, serious conditions caused by contamination of soft tissues with implant debris, leading to pain, inflammation and in some cases, bone loss that can cause the implant to loosen or fail.

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.

References:

When is Revision Surgery Necessary http://www.niams.nih.gov/health_info/hip_replacement/default.asp
http://orthoinfo.aaos.org/topic.cfm?topic=A00510

Current Pilates Class at GMPT and Reformer training

We just started another Pilates class at Great Moves PT.  This one is concentrating on upper body stabilization and general balance.  Come join us Monday nights from 6 to 7pm for $10 a class.  Balls and mats are provided or bring your own.  All levels welcome. 
     Great Moves PT: 1775 S. 8th St, Colorado Springs CO 80905
                                  477-6870, www.greatmovespt.com
Also, if you prefer Pilates Reformer training, I offer private instruction currently on Saturday mornings.  Contact me at Shallyn's 213-1588 for more information or to schedule a session.