Wow! The holidays are upon us once again. I hope that you are feeling awesome. If not, then WHY? The purpose of this newsletter is to share as much as I can in order to get you feeling as awesome as possible.
I want to share with you what my staff and I have learned to improve your experience at OrthoWell and to remind you how awesome you CAN feel. Read on and let’s get you back on track.
HOW TO MAKE A CORE INVESTMENT
To get the best return on your investment, you want to make sure that when you go to the gym you are doing the exercises that will be most effective.
We often find that people haven’t been doing the most effective core stability exercises, or they have been doing them with incorrect form. Check out this video blog post about how to properly engage your core.
HAPPY HOLIDAYS!
Are you looking for a way to help those in need this holiday season?
Here’s how we can do it if we work together.
As a way of serving our community, OrthoWell Physical Therapy will be donating $10 for each new patient that comes through our doors through the end of 2015 to either of two awesome organizations in Beverly called Beverly Bootstraps or inAmesbury called Our Neighbors Table.
You can check out the videos on our Beverly Facebook page or our NBPT Facebook page. So come on in for a physical therapy evaluation or spread the word about our holiday initiative.
Let’s do this together!
Help us Celebrate Our 1 Year Anniversary
in Newburyport
Wow! This past year just flew by. We have had a great start in Newburyport thanks to ALL of you. As a thank you we would like to extend a special discount on the purchase of one of our maintenance packages.
You can try get one of the following: Laser, Dry Needling or our Wellness Maintenance packages at a 15% Discount thru the end of this year!
You can also purchase these packages for a loved one if you want! Tis’ the season. Just let us know by calling 978-522-4199! And THANK YOU once again for your patronage!
TEAMWORK GETS YOU BETTER…FASTER
I have been coordinating services with local chiropractors, acupuncturists and massage therapists and getting amazing results!
My goal is to improve the way that we collaborate and the way that we coordinate services with each of our patients. I have seen incredible results when we ALL work together. Why wait to start PT or chiropractic if we can get you better…faster as a team. This means better communication and better results.
Please let me know if you are using another practitioner that you think would be a great addition to our TEAM approach.
Our Commitment to YOU
by Mark Johnson,PT at OrthoWell
I have been treating patients for 1.5 years following completing my Doctorate of Physical Therapy degree from the University of New England. I have been here at OrthoWell for almost 6 months and I cannot believe how much I have grown as a physical therapist in an environment committed to education and evidenced based practice.
Over the past several months I have been noticing a trend of increased number of patients complaining of neck pain which has sparked my interest to participate in continuing education focused on neck pain in order to get the best results for my patients. I recently completed a 16 hour course focused on cervical (neck) pathology at the Institute of Manual Therapy where I was able to refine my skills and apply new knowledge to all of my patient with neck pain.
So if you or someone you know is suffering from neck pain because life can certainly be a “pain in the neck”, then come on in. You are always guaranteed the most up-to-date, comprehensive and holistic physical therapy at OrthoWell.
SUCCESS STARTS HERE!
Check out what a recent Beverly patient said about his care here at OrthoWell:
“OrthoWell PT has given me my life back, no doubt! After 3 months of knee pain with every step I took, I feared for my job as a nurse and my normally active lifestyle was severely curtailed. Surgery was an option, but without guarantee for improvement.
After just one session of PT and 1 laser treatment i was able to walk without limping. After 1 month of therapy and new orthotics, I am closing in on 100% return of function and I am thrilled with the progress.
The holistic approach used by Chris and his team is unique compared to other PT experiences I have had. I highly recommend OrthoWell PT as the best option out there!”
Doris Bailey-Jones
WALL OF FAME
We are starting a Wall of Fame at each of our clinics. We are proud of our patients and the success that they have had. If you have previously provided us with a testimonial, we would love to take your picture with your therapist and hang it with your testimonial for display it in our clinic! Seeing is believing!
Give us a call and we’ll schedule a time to take your photo so you can be one of the first patient success stories on our Wall of Fame!
For those of you who don’t know, we are offering another specialized service at OrthoWell PT. It is called Trigger Point Dry Needling. Our new PT, Katie Moulison,DPT, is certified in dry needling and she has been performing this technique for 2 years as well the past several months in our clinic. I have created a comprehensive web page devoted to trigger point dry needling. CLICK HERE. It is another one of those techniques that not everyone knows about. It is a technique that can have a profound effect on the chronic pain associated with trigger points and myo-fascial restrictions.
Here is a video that we made in-house about trigger point dry needling. It includes an explanation of trigger points as well as a demonstration of the actual trigger point dry needling technique. It will give you a much better understanding of the technique and may even encourage you to come in for a FREE session to try it out. Just give us a buzz and we will get you in the schedule. The video will be available on our trigger point dry needling web page as well as a comprehensive Q&A section. Don’t forget to share with your friends!!
My subject line is no joke. I really did find a cure for cancer!!
The realization will come as quite a shock to many of you.
I spend a lot of time reading and talking about health and fitness. I thoroughly research each and every blog post before I share it with you. Patient education is a top priority at OrthoWell and it is an integral part of our mission statement. We really DO care about you and your health. For this reason, I feel obligated to share the following information.
I was introduced to a book by one of my patients that may change or even SAVE your life! The title of the book is Outsmart Your Cancer by Tanya Harter Pierce. I have had the unfortunate experience of getting a phone call by my father that he has bladder cancer. The realization, of course, was more unfortunate for him. This came up in the conversation with my patient as we broached the cancer subject. She shared her experiences regarding her own cancer history and then she began to open my eyes, my mind, and my anger to the realization that our medical establishment is intentionally misinforming the public about cancer. Some of you may be saying “yeah, right, why wouldn’t my doctor tell me if there was a cure for cancer?” or, like my father said, “yes, I have heard these things before” but then he dispels the “myth” and decides to go through with his radiation and chemo. Don’t get caught up in the “disbelief factor”. I am telling you, from the bottom of my heart, not to be naïve and not to stay ignorant to this realization. You NEED to read this book as my words alone will not do it justice.
Outsmart Your Cancer is not a promotional vehicle for a new cancer pill or a new cancer prevention diet. As a matter of fact, the author does not promote any one single approach to curing cancer. Her objective is to share with us all that has been hidden from us. Yes, there are MANY alternative treatment options to both prevent and to cure yourself of cancer. Her introduction to cancer was the same as mine. The realization that a loved one may die from cancer! I would like to share some excerpts form the book regarding the misinformation campaign that has been waged on the public.
In the author’s words:
“I have also discovered that for many of these cancer approaches, the way they work has been proven by rigorous scientific research performed by highly respected physicians, brilliant biochemists, and Nobel prize-winning scientists. Effective alternative approaches to cancer ARE obtainable today, and they are not bogus methods developed by quacks and kooks as the public has been led to believe.’
“During my research, I spoke to over 100 people who had recovered from their cancers using the alternative treatments presented in this book.”
“The suppression (of information) has been carried out in many different ways by many different organizations and is simply the result of business economics and common unethical tactics that tend to occur when large money interests are involved in any field.’
‘Surgery, chemotherapy, and radiation involve billions of dollars of profits for the industries that supply them… the cost of developing and bringing a new cancer drug to market is close to $1 billion… A treatment made up of natural ingredients is not patentable… A natural form of treating cancer will never be pursued by a drug company… alternative treatments will always be considered an economic threat to the multibillion-dollar cancer establishment.”
If you want to watch a YouTube video to convince yourself of the misinformation campaign that has been waged by the FDA and American Medical Association, then watch this video on Dr Burzynski’s treatment for cancer. CLICK HERE.
So when should you start an alternative treatment approach if you’ve been diagnosed with cancer?
As soon as possible! Unfortunately, most people start with conventional treatment before they try alternative approaches. It is the fear and shock factor associated with “I have Cancer” that makes people decide prematurely regarding the BEST treatment option. They usually start with the big three…chemotherapy, radiation therapy, and surgery. Don’t become a statistic. Get educated!
So how do you make an educated decision on what treatment path to follow after you’ve been diagnosed with cancer?
Outsmart Your Cancer spells it out in simple terms and in black-and-white. There ARE options…successful options that have cured thousands of patients with cancer. All you need to do is read and/or listen (a DVD of patient testimonials comes with the book).
So when do you start a cancer prevention program?
NOW!!Outsmart Your Cancer will empower you to start a prevention program today. Scrutinize what you put into your body. Yes, you ARE what you eat. Don’t forget to read my post on Vitamins-To Take or Not To Take for more information.
Because I WANT to be your advocate for health and wellness and because I WANT you to stay cancer-free, I am stocking Outsmart Your Cancer in my clinic. I feel that strongly about the information in this book! I have purchased them in bulk so the wholesale cost is only $20 per book. Don’t delay! Get the facts!
Other things that could change your life that are discussed in the book include:
ACIDIC vs ALKALINE
Did you know that it has been scientifically proven that cancer cells cannot survive if the environment is alkaline enough? Did you know that the QUALITY of what you consume determines whether your body becomes acidic or alkaline? Many people, either with cancer or attempting to prevent cancer, strive to maintain their body pH at an optimal alkaline range between 7.0 and 7.5. Your body pH can be evaluated by a simple saliva test using pH strips in the privacy of your own home. So how do you do this? I’ll give you the answer even though you need to read more about it…CALCIUM. One of the most important roles of calcium is to help our bodies maintain proper pH levels. In addition, the absorption of calcium into the body is completely dependent on the levels of vitamin D in the intestinal tract.
WOMEN -THE PILL – HORMONE REPLACEMENT THERAPY
Do you really understand the effect of synthetic hormone replacement therapy? Outsmart Your Cancer discusses what every woman NEEDS to know about the effects of The Pill and hormone replacement therapy. You need to really be aware of the things that your doctor is NOT telling you. Long-term clinical studies have proven the cancer-causing effects of synthetic hormone replacement therapy. Get the facts!
MEN-TESTOSTERONE & PROSTATE CANCER
As for the men, did you realize how controversial conventional treatments are for prostate cancer? There are studies in the medical literature which contradict the current use of testosterone inhibiting drugs to lower your PSA level. It has been shown that testosterone actively INHIBITS cancer growth and that elevated PSA is actually a man’s defensive strategy for fighting prostate cancer. So then, why does the medical establishment advocate the exact opposite approach?
DENTAL FILLINGS & MERCURY
Did you know that the main component of silver fillings is mercury and that mercury is one of the most deadly substances on earth if ingested? Did you know that your dentist is not required to tell you that your filling contains mercury? Did you know that several European countries have band silver-mercury amalgam feelings for decades but they continue to be used in the United States? The toxic nature of amalgam feelings has been down-played by the American Dental Association for a century in spite of warnings to dentists to “never touch the amalgam with your fingers” and “it must be disposed of under strict toxic waste protocols.” Dentists who have been outspoken against amalgam fillings have lost their licenses to practice. Outsmart Your Cancer references a book written by one such dentist who describes the alleviation of multiple sclerosis and Parkinson symptoms as well as cancer via the removal of amalgam feelings. Once again, get the facts.
There is SO MUCH more in Outsmart Your Cancer. The rest is up to you!!
For those of you who haven’t been in to see us recently, we have been using a demo class IV laser device from Litecure since the beginning of June and have been getting some amazing results. We were so impressed with the results that we “bit the bullet” and purchased our own laser. A very worthwhile investment for OrthoWell and for the health of all of our patients.
I have added a page on our website that provides a comprehensive explanation and videos of the benefits and effects that a class IV deep tissue therapy device provides. In a nutshell, the laser uses photon energy to stimulate chemical reactions at the cellular level. Research has demonstrated an increase in metabolism, a decrease in inflammation, a decrease in pain, and an acceleration of healing at the treatment site. In other words, the application of laser in combination with our manual therapy and exercise techniques is getting our patient better even FASTER! It has also been extremely beneficial to conditions that have NOT been responsive to our traditional physical therapy interventions.
If you are interested in trying laser or if you feel that your symptoms have plateaued, then laser may be the answer that you are looking for.
***SPECIAL OFFER***
We want you to experience the benefits of deep tissue laser therapy so we are announcing a special offer. Call us now to schedule a FREE laser treatment. We will introduce you to laser therapy and provide a laser treatment FREE of charge. Let us know what works for you!
First of all, you need to understand the difference between aerobic and anaerobic exercise. Aerobic exercise requires oxygen, is low powered and lasts for greater than 15-20 minutes. Anaerobic exercise, like Cross Fit, does not require oxygen, is high powered and each exercise lasts less than 2 minutes.
The Positives: Recent studies have shown that anaerobic exercise is a vastly superior protocol for fat burning than it’s less intense aerobic counterpart. There is evidence that shows that anaerobic exercise is evenly matched to aerobic exercise with regard to cardiovascular benefits. Check out the evidence in an article in the Journal of Strength and Conditioning. More evidencethat comparable calorie burning effects can be achieved in half the time with anaerobic exercise.
The Negatives: Potential for INJURY! The article in the Journal of Strength and Conditioning also states that 16% of the participants dropped out due to “injury or overuse”. In addition, in 2011, the U.S. military, in conjunction with the American College of Sorts Medicine, advised soldiers to avoid CrossFit, citing “disproportionate musculo-skeletal injury risk.” You can read it HERE. In 2009, the US Military was encouraging training programs such as CrossFit. You can read it HERE. So what happened?
CrossFit goes out of its way to warn people that if they can’t maintain proper technique, they should back off. After all, the CrossFit mantra is “Mechanics, Consistency, Intensity”. Backing off , however, is a hard sell for many participants because workouts are viewed as a competition. The 2009 US Military study states that “Properly trained coaches are fundamentally important in both establishing an effective training program and developing proper movement mechanics in athletes.” It sounds like something, or someone, went wrong between 2009 and 2011.
So I guess the biggest question that you should ask (before joining a local Cross Fit gym) is WHO is running the classes and HOW they are trained. Make sure they at least have Level I or Level II Cross Fit training. A power lifting background is very helpful as power lifters are obsessive about proper form. Make sure you observe a class or two to witness how or if the instructor is scrutinizing and ensuring proper form. The proof is in the puddin’.
Throwing a baseball is the fastest known human movement. The speed of the throw from a professional baseball pitcher can be upwards of 7000 degrees per second. Now that’s fast! In addition to that, the shoulder is the most mobile joint in the human body. So what does this mean?
For those of you that “feel a need for speed”, you need to beware of the risks. In anarticle from the Journal of Sports Medicine, twenty-three professional pitchers were followed over three seasons. Those pitchers who were throwing at the highest maximum velocity suffered the highest incidence of elbow injuries. So how does that effect you? It is vitally important for the throwing athlete to understand the stresses that repetitive throwing places on young as well as mature joints. In the words of baseball trainer phenom Eric Cressey, “injuries occur when you ignore the things that need to be addressed, plain and simple.” In one of my previous blog posts, I talk about how it has been scientifically proven that strength training enhances athletic performance. Shoulders and elbows become problematic not only because of muscular weakness, but also from poor flexibility, poor tissue quality ie scar tissue and, of course, faulty mechanics. For example, consider the dreaded inverted or upside down “W” exhibited by the Yankees’ Joba Chamberlain or the National’s Stephen Strasburg.
Just because a joint is flexible does NOT mean that it is stable. Consider the six phases of throwing and all the potential areas of instability when throwing at maximum velocity. Our objective should be to achieve dynamic stability during ALL phases. Yes, if you are stiff we are going to stretch you and if you are loose we are going to stabilize you…but what about the gray areas? Every major league pitcher suffers from a loss of shoulder internal rotation for at least 3 days after an outing. This is a situation when you do NOT stretch. The resulting loss of motion is due to the micro-trauma of eccentric load during deceleration and needs time to heal. It has been shown that the posterior aspect (the back part) of the shoulder joint capsule actually thins out after repetitive throwing. So let me ask you, should we ever stretch the posterior aspect of the shoulder joint? Or should treatment focus more on the scar tissue that results in the decelerators?
So what are the most common upper extremity baseball throwing injuries? These injuries include the problems associated with overuse or improper training such as: • Impingement syndrome • Rotator cuff tendonitis • Biceps tendonitis • Medial elbow pain from flexor-pronator tendonitis
These overuse injuries can lead to more serious conditions such as: • Rotator cuff tears • Labral tears • Ulnar collateral ligament (UCL) tears
We have many manual tests that we can perform in the clinic to differentiate and determine what structures may be involved in YOUR specific case. In the case of impingement syndrome, I have previously posted a BLOG articleon the different types of impingement syndrome as well as a VIDEO demonstrating the tests that we use to differentiate rotator cuff versus labral dysfunction. It should be noted that a condition called scapular dyskinesis can lead to impingement syndrome. This condition is characterized by an imbalance of scapular motion relative to shoulder motion. It is the result of weakness in the muscles that stabilize the scapula during the throwing motion. I have also listed some of the best, evidence-based exercises in a previous postfor specific shoulder and scapular retraining.
It is very important for your therapist to differentiate between what we call active restraint or passive restraint structures. Active restraint structures are those things that contract and relax like your muscles and tendons. Passive restraint structures are things like ligaments ie UCL, cartilage ie labrum and meniscus, and discs ie intervertebral discs. I would like to highlight the UCL of the elbow as one example of this. For many pitchers, the first sign of impending trouble with the UCL is pain or stiffness in the flexors of the forearm. The flexors and pronators of the forearm are the active restraints and the UCL is the primary passive restraint to the extreme valgus forces that occur at the elbow during terminal cocking phase and early acceleration. Did you know that when the UCL is tested in isolation during cadaver studies that it only takes 32 newton/meters of force to rupture it? Guess how much valgus stress is on the inside part of the elbow during terminal cocking phase….64 newton/meters!! It has been shown that the UCL takes on 35 newton/meters of that force. Yikes!! So why doesn’t it rupture? It doesn’t rupture because the rest of that stress is controlled by the active restraints…your muscles in the forearm. You can probably guess what happens when you ignore your forearm muscles?
As mentioned earlier, imbalances in flexibility, tissue quality, biomechanics, or weakness can lead to stress on both active and passive restraints during the throwing motion. Invariably, the process of repetitive throwing leads to the development of scar tissue. There is a constant state of break-down and build-up that occurs during sport specific activity. I have blogged on problems with scar tissue and the debate on whether pain arises from tendonitis or not. I have also explained the benefits of the Graston Technique as a way to ensure that scar tissue does NOT inhibit your ability to throw.
Now, what blog post is complete without a little twist. After listing the most common injuries that we see in the throwing athlete, I would like to share a list of conditions that have been confirmed via MRI in athletes that have NO pain:
* 79% of overhead throwing athletes have labral tears * 34% of athletes have rotator cuff tears * 82% of athletes have disc herniations
Does this mean that you may ALREADY have a tear and that you are currently asymptomatic like the athletes in the previous studies? Yes, you may. Does this mean that your future hall of fame career is over? No, it doesn’t. Some practitioners are of the opinion that you may very well need a labral lesion to throw hard in the first place. The biggest challenge with this is ensuring that the throwing athlete develops all the things that we have talked about in this post:
It is ALL these reasons that make it vitally important to be as educated as you can about your shoulder mechanics and to be aware of the important role that training and physical therapy play in keeping you healthy. It is our role as your physical therapist and performance specialist to guide you with you in this process. Here is an example of an effective warm up program for baseball players by the former trainer for the Boston Red Sox, Mike Reinold,PT. CLICK HERE.
Understanding throwing biomechanics in combination with a thorough knowledge of the anatomy and function of the shoulder and elbow is imperative to properly diagnose and treat the throwing athlete. Your prognosis for a healthy return to competition after arthroscopic surgery or ligament reconstruction has dramatically improved especially when you are in the right hands during recovery. My job as a physical therapist is not only to effectively rehabilitate your body after surgery but, more importantly, to help PREVENT the need for surgery in the first place. Of course, this is a two way street. I can only be your coach if you are a willing and motivated player.
I have treated a lot of foot pain over 22 years as a physical therapist. Because I make custom foot orthotics, I am exposed to foot ailments much more than other PT’s. Geoff and I treat a lot of these problems in the clinic every day. One of my patients even went so far as to nickname us the “foot whisperers” and another patient coined OrthoWell as the “doctors of knotology”. Can you feel the love? I have spent a lot of time researching the BEST strategies to treat foot pain. This has culminated in the release of my Ebook entitled “Physical Therapist Discovers the Truth about Plantar Fasciitis“ as well as my self-help DVD on the treatment of Foot Pain & Plantar Fasciitis. Both of these are now available and are on my HOMEPAGE.
The Ebook includes a complete review of the literature on the treatment of plantar fasciitis as well as a description of the the most effective treatment strategies. This book is not a re-tellling of on-line information about plantar fasciitis. It is the missing link! You can read more by clicking HERE.
The DVD is a collection of videos that will “take you by the hand” and teach you specific methods and exercises to resolve your foot pain. It is designed for those people suffering from foot pain who cannot come to see us or who have not responded to other practitioners. It is a great way for our SUCCESS STORY patients to help friends and family members who have foot pain but cannot come to see us directly. You can read more HERE. Watch the intro video below. Talk to you soon!!
What do you think of when you visualize someone who is really stressed out? It sure seems like some people are wound tightly these days. I have had my own issues with stress. I’m sure you have too. I find myself talking more and more with my patients about the effects of stress and how beneficial diaphragmatic breathing and proper nutrition can be. We will discuss nutrition in an upcoming post. You also need to be aware of other possible manifestations of stress like increased muscle tone, rapid heart rate, palpitations, increased blood pressure, GI distress, mood swings, loss of appetite, and sleep disturbances to name just a few. These symptoms make living a happy, relaxed and “normal” life much more difficult.
So what about the relationship between stress and breathing? Breathing occurs at a very primal level. If you don’t breathe, you don’t live! Your body will do whatever it takes to draw air into the lungs. Instead of using the diaphragm, it may recruit other accessory muscles in your neck or low back. This pattern reinforces poor posture and causes impaired flexibility which can promote shallow, ineffective breathing. It prevents the ability to exhale fully and to perform a proper, full diaphragmatic breath. Lets review what that means.
First of all, when performing a diaphragmatic breath, your belly should expand outward. This is due to the downward movement of your diaphragm as you inhale. Secondly, your lower ribcage should expand. Thirdly, your upper ribcage will expand during a maximal inhalation. Your ribcage should expand as a unit. It should NOT elevate. Movement of your ribcage upward, shoulder shrugging, or contraction of your neck muscles are all signs of faulty breathing patterns. Remember that slouched sitting and forward head posture encourages shallow breathing and prevents full, complete expansion of your ribcage. We discussed breathing pattern disorders in relation to CORE activation during my last post and video demonstration. Here it is in case you missed it:
So what does the research say about the link between pain and breathing disorders? A very interesting phenomenon is the prevalence of pain syndromes that are NOT caused by a specific organic illness. Katon & Walker (1998) noted that patients with the most common physical symptoms (i.e. abdominal pain, chest pain, headache, back pain), are responsible for half of all primary care visits in the USA, and yet only 10%–15% of these are found to be caused by organic illness! All these symptoms are well recognized as capable of being the result of breathing pattern disorders.
Perri and Holford (2004) evaluated 111 patients attending a chiropractic pain clinic and found 56.4% demonstrated faulty breathing on relaxed inhalation, increasing to 75% when taking a deep breath. 87% reported a history of various musculoskeletal pain problems. Based on this population, they observe that: “Chances are 3 in 4 that new patients seen today will have faulty breathing patterns.”
So what does the research say about the effects of breathing exercises on stress? Remember, stress reactions are controlled by our autonomic nervous system i.e. sympathetic and parasympathetic. Fight or flight? In Pal and colleagues, breathing exercises were shown to enhance the parasympathetic (inhibitory or calming) effects and decrease the sympathetic (excitatory) effects of muscles and nerves. They improve respiratory and cardiovascular function and improve both physical and mental health. Convinced yet?
So how do you begin breathing exercises?The first step is understanding that the relaxation response has to be relearned. You need to learn how to identify and turn off the stress response. As stated by Kabat-Zinn, “you need to learn how to replace negative thoughts and physical tension with regular practice of ‘calm stillness of mind and body’ “. Buddha is in the house! The next step is to schedule regular daily practice. You need to invest 10-15 minutes at least one time every day. According to Leon Chaitow, we need to “restore an energy-efficient, low chest, nose-breathing pattern with a relaxed pause at the end of exhalation”. He calls it “low slow nose breathing”. Initially, lay comfortably supported by pillows in a quiet room. Progress to sitting once a positive outcome is achieved in lying. You need to reinforce proper posture at home, work, and car and realize that breathing and relaxation techniques only help eliminate the symptoms, not the causes of stress. Be honest about making realistic lifestyle changes. The video below demonstrates a method that uses both breathing and physical relaxation techniques.
Remember that breathing drives everything that happens, both good and bad, throughout our entire bodies. So breathe right to live right!!
It may sound like a strange question but “do you breathe properly?” Breathing pattern disorders (BPD) are surprisingly common in the general population. They remain commonly under-recognized by health care professionals and can contribute to pain, fatigue, and dysfunctions in the lumbopelvic region i.e. your CORE!
Core activation remains a hot topic in physical therapy. The problem is that there is not a universally accepted strategy to achieve optimal stability. A decade ago, we started using the “abdominal hallowing” technique which I have talked about before. The abdominal hallowing was an attempt to isolate a key core muscle called the transversus abdominis in which you would “pull your navel in and hallow out your abdoman”. The original work done by Hodges and colleagues on the transversus abdominis also demonstrated simultaneous activation of the diaphragm muscle. The diaphragm, however, took a back seat and has often been ignored during core training. So how do we correct your BPD and “wake up” your diaphragm?
Your diaphragm is attached to your lower ribcage, thoracic wall, and lumbar vertebrae. When you breathe, the diaphragm contracts and pushes DOWN into the abdominal cavity. This movement causes a pressure change which draws air into the lungs. As a result of the contraction, intra-abdominal pressure increases and lumbar spine stiffness, hence stability, also increases. The diaphragm acts in coordination with the abdominal muscles, spinal muscles, and pelvic floor to create lumbar stability in all directions. This is what some refer to as “360 degree of stiffness.” The contraction of the diaphragm creates core stability from the inside-out. When you perform an abdominal hallowing or abdominal bracing you create stability from the outside-in. Professor Kolar and colleages performed two MRI studies of the diaphragm and showed that the diaphragm can perform dual functions of inspiration and stabilization simultaneously! The activation of the diaphragm was shown to vary greatly among individuals. This variability may be the reason why one person can resolve low back pain and another cannot.
Lets take a look at HOW you can activate your diaphragm while breathing and HOW you can enhance the benefit of your core stability exercises. Check out the video below.
Yes. We treat a lot of plantar fasciitis. There is a lot of foot pain out there. While performing a literature review of heel pain in 2005 (follow this link to READ MORE), I made reference to several articles about the prevalence of heel pain. One United States study estimated that one million patient visits each year are for the diagnosis and treatment of plantar heel pain. This disorder appears in the sedentary and geriatric population, it makes up one quarter of all foot injuries in runners, and is the reason for 8% of all injuries to people participating in sports. As many of you know, all that we do regarding foot orthotic fabrication and physical therapy is with good, evidence-based reason. I fabricate custom foot orthotics based on sound biomechanical principles and evidence-based research. Patients are always asking me “so how will foot orthotics help my plantar fasciitis?” Here is the answer! I have included both a clinical description as well as a more basic description in the video. This will allow you to refer your doctor and/or PT as well as a relative who may ask WHY or HOW we made your foot orthotics. I have included references for several articles that have had a profound influence on my treatment and fabrication philosophy regarding plantar fasciitis. I would like to share my insights with you.
It has been my experience that positive results can be achieved much more quickly for cases of plantar fasciitis using the combination of softer materials to cushion the foot in combination with stiffer, denser materials to redistribute pressures on the foot. My direct molding techniques produce a total contact orthotic which reduces weight bearing pressure on both the heel and forefoot. These findings for total contact orthoses have been confirmed by both Mueller et al10,11 and Ki et al12. As you can see from my samples on the video, I utilize softer materials as a top layer with the addition of a heel pad on the bottom. I reinforce the arch in order to redistribute pressures up against the talonavicular joint (or midfoot). I utilize a forefoot valgus post (higher on the outside of the forefoot) with a slight reverse Morton extension (ledge under toes 2-5) in order to plantar flex the first ray (big toe lower than the other four toes) and unload both the fascia and 1st MTP joint (big toe joint) As I tell my patients, the foot orthotic is only as good as the shoe you put around it. Our best results with the over-pronating foot are achieved via the combination of motion control shoes and custom orthoses.
In regards to prefabricated orthotics such as ALine, it is one-shape-fits-all and only utilizes rearfoot posting “to help align the leg from foot to hip” per the website. The concept of rearfoot posting for biomechanical control is a much debated topic in the literature. Forefoot modifications are not an option. It is also a very rigid material against a painful heel. It has been my experience that prefabs such as ALine or Powerstep are a good option for the younger, athletic patient.
Don’t forget, our custom foot orthotics range in price from $120 to $165. I direct mold, fabricate, educate and issue in one hour! All adjustments included. Our WalkWell guarantee since 1997!!
Research findings continued……
Research done by Kogler1,2,3 et al has been instrumental in determining the appropriate type of rearfoot and/or forefoot posting for foot orthotics for plantar fasciitis. Kogler showed that rearfoot posting had little effect on plantar fascia strain, forefoot varus posting increased the stress, and forefoot valgus posting actually decreased the strain. Kogler concluded that foot orthotics which raised the talonavicular joint and prevented dorsiflexion of the first ray were most effective in reducing the strain on the central band of the plantar fascia. I recently made orthotics for a patient who said her doctor issued bilateral heel lifts “to take the stress off of the fascia”. Kogler actually showed no change in plantar fascia strain using heel lifts. However, heel lifts have been shown by Trepman et al4 in 2000 to decrease the compressive forces in the tarsal tunnel. Benno Nigg5, a researcher in Canada, has also published over 200 articles on biomechanics. He has stated that based on his results, custom foot orthotics, on average, control only 2-3 degrees of motion. This would be his kinematic results, however, he has done a lot of enlightening research on the kinetic effects of foot orthotics. A little bedtime reading for you!
Paul Scherer6,7,DPM has published several articles on the effects of custom orthotics on the 1st MTP joint. The concept of maintaining the first ray in a plantar flexed position unloads both the 1st MTP joint as well as the plantar fascia. Howard Dananberg8,DPM has also written several articles on this topic. Doug Richie9,DPM has been a great resource for the evidence behind the treatment of plantar fasciitis as well as posterior tibialis dysfunction. You may have heard of the Richie brace. Dr Richie states that the “most effective foot orthotic for plantar fasciitis is one that hugs against the navicular and flares away from (or plantar flexes) the first ray.”
1.Kogler, G. F.; Solomonidis, S. E.; and Paul, J. P.: Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clin. Biomech., 11: 243-252, 1996.
2.Kogler GF, Veer FB, Solomonidis SE, et al. The influence of medial and lateral placement of wedges on loading the plantar aponeurosis, An in vitro study. J Bone and Joint Surg Am. 81:1403-1413, 1999
3.Kogler GF, Veer FB, Verhulst SJ, Solomonidis SE, Paul JP.
The effect of heel elevation on strain within the plantar aponeurosis: in vitro study.
Foot Ankle Int. 2001 May;22(5):433-9.
4.Trepman E, Kadel NJ: Effect of foot and ankle position on tarsal tunnel compartment pressure. Foot Ankle Int 20(11):721, 2000
5.Nigg, B. Biomechanics of Sport Shoes. 2011
6.Scherer PR, Sanders J, Eldredge, DE, et al. Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait. J Am Podiatr Med Assoc 2006;96(6):474-481.
7.Scherer,P. Recent Advances in Orthotic Therapy. 2011
8.Dananberg HJ. Functional hallux limitus and its relationship to gait efficiency. J Am Podiatr Med Assoc. 1986; 76(11):648-52
9.Richie,D. Offloading the plantar fascia: What you should know. Podiatry Today, Vol 18. Issue 11, Nov 2005.
10.Mueller MJ, Hastings M, Commean PK, et al. Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy. J Biomech 2003;36(7):1009-1017.
11.Mueller MJ, Lott DJ, Hastings MK, et al. Efficacy and mechanism of orthotic devices to unload metatarsal heads in people with diabetes and a history of plantar ulcers. Phys Ther 2006;86(6):833-842.
12.Ki SW, Leung AK, Li AN. Comparison of plantar pressure distribution patterns between foot orthoses provided by the CAD-CAM and foam impression methods. Prosthet Orthot Int 2008;32(3):356-362.
