What’s in your trunk: The story of the Gluteal muscles!

Junk in the trunk! Buns of Steel! Thigh-master! All these are phrases/exercises that emphasize society’s struggle with their backsides and desire to minimize it’s size, improving it’s tone.

The Gluteal muscle group is made up of 3 muscles; the gluteus maximus, gluteus medius, and gluteus minimus. The largest and most powerful of these 3 is the gluteus maximus. It is the meat of your behind. It is responsible for controlling the extension and rotation of the femur. Due to it’s size and job requirements it is important for lifting, squatting, jumping, climbing, etc. The Glut Max is our power muscle of the leg. The gluteus medius is the middle glut. The medius is important especially for runners. It works on pelvis stability during impact activities and femur internal rotation/abduction. The smallest of the Gluteal group is the minimus. It assists the gluteus medius and tensor fascia latte with hip internal rotation and hip abduction. These 3 muscles provide the major stability of the hip and lower extremity.

Much of our exercise routines overlook the importance of hip strengthening, especially the gluts. There are squats but if not done properly they will do a much better job of strengthening the hamstrings, quads, or low back. The hip extension machine at the gym ends up being again a low back exercise due mostly to poor technique and form.  Leg press and hamstring curls again focus on legs not hips and more importantly gluts. We have core classes and tapes that spend so much time on abdominal muscle groups. What are we really doing for our gluts? Why should we care?

As explained above the Glut max is a large muscle group. If it is working properly research has shown that injury risk is diminished in all lower body joints especially knees. When the glut max and glut med are working efficiently to control femur rotation and hip mobility then running injuries are decreased in their rate. In fact, some in the biomechanics field of study hypothesize that hip strength (i.e. Glut max strength) has a much greater impact on lower extremity injury prevention than shoe inserts or footwear.

So what can we do about strengthening the gluts? Some great exercises are as follows: the clam, bridge, single leg squats (with correct form), step ups/downs, squats (correct form), etc…Please set up an appointment to go over specifics of each of these exercises for the most effective and safe addition to your routine. But the key to injury prevention may just be toning up that junk in your trunk.

Massage a helpful recovery tool

A mainstay to physical therapy treatment is massage and soft tissue release. This helps damaged tissue to heal more quickly. The benefits of massage and tissue recovery have been established once again in new research out of McMaster University in Hamilton, Ontario. Below is a link to an article on  runnersworld.com that reviews the study. Take a look and feel good scheduling your next massage or therapy appointment.

http://peakperformance.runnersworld.com/2012/02/does-massage-enhance-recovery-new-study-hints-yes/

Illusive knee pain: what is the deal?

The story I hear more than any other in my office regarding the knee goes something like this:

My knee hurts. It is not really bad but it is sore. I am not sure exactly what caused it or when it started. It hurts when I exercise hard. It hurts when I get up after sitting for a long time. I have pain when I go down stairs. None of it is horrible but it just is not right.

Although this is story, most people think of knee problems being associated with falls, sports injuries, or a major trauma/event which results in a ligament tear or meniscus injury and surgery. NOT TRUE. Most of my clients that I treat for knee problems are just as described above. Why???

The knee is anatomically a joint stuck between two other joints. Its basic movement is to bend and straighten. In reality it is a bit more complicated but we are going to keep it simple. Below the knee you have your foot and ankle, which are responsible for force distribution up the leg and for adapting to the surface that you are on. The hip is above the knee joint. The hip is a major weight-bearing joint and shock absorber for the spine. It is a big stable joint, where as the ankle is smaller and less stable. The knee, in the middle, is affected by the control, strength, and ability to control the forces from above and below being applied to the leg from all our activities. Pain arises when the relationship between the 3 joints is not appropriate or effective.

Historically, to treat this type of knee pain we have really worked on quad strength. This is because the quadriceps are the muscle most responsible for knee movement and control. We have prescribed shoe inserts for foot control and stability, and we have modified a person’s activity to less impactful (i.e. elliptical, walking, change in running surface, swimming).  This was successful but generally people would return with pain or still have some pain but not as bad.

Current thought as to treatment for knee pain is changing. If you look at the treatment list above there is only 2 joints being addressed. As we discussed the knee, ankle AND hip all affect the mechanics of the knee. So the hip joint was being over looked. The force of the body and movement of the body that the hip controls was not even being considered in the problems at the knee. The hip is a big strong joint. If it is imbalanced or weak then the knee theoretically will be impacted. Now treatment may include less of a focus below the knee and a greater focus being applied to the hip and the knee.

Physical Therapy is helpful in determining what approach may be appropriate for your knee pain. It is important to consider all the factors that may be involved in knee pain in order to reach a successful resolution and full return to pain free activity.

EXERCISE FOR PREVENTION!

We know that exercise is good to ward off chronic diseases such as heart disease, diabetes, lower blood pressure, possibly decrease cancer and Alzheimer’s risks and the list keeps going. New research coming out also now shows it can be effective in helping to manage migraines. The following is a link that describes a couple recent studies.

http://well.blogs.nytimes.com/2011/11/14/really-the-claim-exercise-can-ward-off-migraines/

We think so often of exercise as something reactionary. Reaction to drop the weight gained over the holidays. Reaction to the results from our yearly physical exam at the doctor’s office. Reaction to our clothes not fitting well anymore. Too often we do not consider the power of exercise. The ability to decrease the need for medication. The ability to prevent disease from developing. The ability to increase our good moods and decrease our bad. The ability to have a sense of accomplishment from reaching new goals. Exercise is powerful and is a great tool for prevention!!! Lets not get stuck just reacting but actively exercise for a healthy YOU!

Shoe Insert Overview

For a long time we have been encouraging our patients to buy and use shoe inserts. We being the collective medical community. Why? Shoe inserts are useful to help with foot control. Foot control is important because poor foot bio-mechanics have been shown to lead to many lower body overuse injuries. Primarily, but not limited to posterior tibialis tendinitis, plantar fasciitis, or Achilles tendon injuries. With poor foot mechanics, it is thought that the force of impact from walking, running, and jumping is not efficiently distributed up the full lower extremity. Now that we know what shoe inserts help to control and prevent injuries, what do we need to know about them?

1)Custom foot orthotics versus over the counter shoe inserts: This answer might surprise you but research is mixed on this. A growing body of research shows that an over the counter insert may be just as effective at controlling foot motion as much more expensive custom made shoe inserts. The good news is that you can assess your need  and benefit for an insert/orthotic with much less financial burden. However, in my experience if you have a foot that is an extreme pronator, supinator, or very rigid a custom orthotic may provide more benefit for you.

2) How often do I need to have my insert or orthotic redone? Again I am speaking in general terms. Typically a custom orthotic will last 3-5 years and is much more adjustable than over the counter inserts. Over the counter inserts usually should be changed every 6-8 months. If you wear them daily inserts need to be changed more frequently. The materials used in over the counter inserts breaks down more quickly and are not as rigid as the custom made variety. If you have had either type of insert near it’s shelf life and develop foot or leg pain it may be time to change them out.

3)Myth: There is a type of insert being billed as semi-custom which can be obtained over the counter. I would offer just a bit of caution when using these. It is difficult to get a good self cast for these to be mailed away or to obtain a good fit. If you cast with the foot out of a neutral position the insert may not provide the control that your foot needs.

4) Work up to wearing inserts full time: Remember we are changing the mechanics of the foot. Sometimes this will cause some discomfort as your body gets adjusted to the change. I encourage you to make sure to be stretching your calve daily. Second, begin slow. Start by wearing them just an hour a couple times a day and progressively add time until you are comfortable wearing them all day.

I hope that this helps to inform you on the benefits of shoe inserts, while saving you time, money, injury and worry concerning them. For more personalized information please set up an appointment with a physical therapist or other medical professional.

The mind-body connection

http://vitals.msnbc.msn.com/_news/2012/01/10/10093725-all-that-stress-is-shrinking-your-brain-new-study-finds

A good reminder of the connection between mind and body. It goes back to the nursery rhyme discussing the head bone being connected to the neck bone and so forth. Tuck this article into your brain for use on a later occasion.

Resolution caution!

Here we are the start of the 2nd week in January. It is the point in time when resolutions are either dropping by the wayside or the dedicated are digging in. New habits are being developed. New goals are being set. How do we reach our fitness goals without injury? Below are some pointers to safe, healthy resolution integration and a link to the NY Times which ilustrates injury risk very well.

1) Start Slow: Unlike our cars we are not designed to go from 0-60mph in no time flat and sustain it. Therefore if you are a couch potato that has just started to workout it will take time to introduce cardiovascular and weight routines. It is recommended to increase your activity by no more than 10% each week. This means if you started with zero minutes of aerobic activity then 10 minutes is a good starting point. If you were running 30 minutes already at 6 mph, 3 days per week then increase your pace to 6.6mph. Lastly, your muscles need time to recover so leave a day between work outs for this recovery time if you are new to exercise.

2) Set realistic goals: If your reolution is to lose 10 lbs realize this will take time and break it down into smaller goals. For example, this week your goal could be to drink more water throughout the day. This will help you to stay hydrated which will decrease your body’s desire for food and snacking. Next week you could add a vegetable in at lunch and dinner while decrease your other portions. If you change a old behavior every week to include a healthier option soon the weight will come off without you being so focused on the number itself. In addition you will feel proud for developing healthy behaviors along the way.

3) Have fun! The number one reason people stop their fitness routine or resolutions is they are bored or not excited about them. Therefore if you are more successful with a person to workout with grab a friend for a walk or hire a personal trainer. Exercise does not have to be in a gym on a machine. Join a hiking group, running club, and/or recreational sports league. These will help to keep you accountable and have fun. Other options are skiing or ice skating this time of year.

4) If you suspect you have developed an injury seek help out early. This will allow the problem to be addressed and healed quickly. When you have an injury and spend months compensating for it you have a higher risk of a related injury/compensation developing. In D.C. you are able to go directly to a physical therapist who is able to perform a screen and see if you need further medical intervention. If not, the therapist will start to treat your injury directly. In the end your return to exercise and obtaining your goals will be faster than waiting for it to heal on its own in most cases.

5) http://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html?_r=1&pagewanted=all

Good luck with your goals and resolutions in 2012. May it be a healthy, happy, injury free year for all!

Fun Holiday activities in DC!

This time of year is busy for all. SET Physical Therapy encourages you to make time to experience some seasonal fun. Below are a couple activities that can be taken advantage of this time of year.

1) Ice Skating: There are 3 fun ways to do this. The National Gallery of Art has opened an outdoor ice rink that is just off the National Mall. This is a fun way to take a break from a museum or before you tour the memorials. The second location is on Pentagon Row. Pentagon row is fun because you can skate and then grab a bit to eat from the local restaurants. Finally, if you have hockey fans the Kettler Capitals Iceplex in Arlington is a year round ice rink. At the Iceplex they offer skating and hockey clinics. What a way to be apart of our local hockey team!

2) Walk down to the National Christmas tree or Menorah. This is great because you can not only enjoy the beauty of this season but experience the beauty and design of the lit monuments as well.

May these 2 activities spark lots of fun and memories for you. We hope that you, your family and friends have a great Holiday season. Happy Holidays from your SET Friends!!!

Barefoot running: A Physical Therapist Perspective

If you are a runner the popular question or discussion currently is most likely related to barefoot running. I have been asked several times my thoughts about barefoot running. So what follows is exactly that, my opinion. The disclaimer is that it is loosely based on research, but not completely, and it is fluid. I reserve the right to change it as more research on barefoot running is published. I urge you to continue reading if this subject interests you. If for no other reason than a few good points may be raised.

In my profession of Physical Therapy, you will find a mixed opinion on barefoot running. I am not willing to fully endorse it but I am just as adamant not to condemn it either. Barefoot running is certainly something that our ancestors practiced and were very good at. This argument for barefoot running is limited in my eyes due to the change in life expectancy over time. Did our ancestors have less joint trouble and pain limitation due to a shorter life expectancy? We know that we are built to last for only so long. So does barefoot running decrease the load on the joints enough that the increase in use over time will not matter?

Another issue I see with beginning barefoot running is, our feet are used to wearing shoes. Research has shown that shoes require the muscles of the foot and ankle to work differently in shoes versus barefoot. Therefore it is necessary to transition to barefoot running. The injuries I see as a result of barefoot running are from improper transition to and improper training in barefoot styles of running. Lets address improper training first. When a person initially begins running barefoot it is important to start with a mile or less of running. This means when you buy the vibram 5 fingers, or the equivalent of, you should run just a few blocks at a time for at least the first week. Then very slowly increasing your time and distance in the shoes. The problem is that we as a society wear shoes all the time. This means our feet and calves are not used to working as hard as they do when not in traditional shoes. Second, when you transition into barefoot running, my personal position is that you limit your time on concrete. I have seen several stress fractures as people try to  transition. Again in my opinion, this relates to muscle strength and foot control.

Now, there are positives to barefoot running as well. Barefoot running puts the foot strike at mid-foot or forefoot. Research has shown this to decrease injury risk. This decreased injury risk, is related to the limited time in the flight stage of running. If you spend less time in the air then, the force at which your foot strikes the ground is significantly less. Therefore, your body has less force of impact to absorb on foot strike.

Another positive of barefoot running is foot and ankle strength. The mid to forefoot strike of barefoot running requires the calve to absorb shock and to push off at a greater measure than traditional running. This means that it is the primary muscle group used and therefore it is strengthened to a greater degree. However, just as you would train muscles with traditional running it is very important to train this type of running pattern slowly as well. Otherwise there is a greater risk of tendinitis or injury.

So I do not count out barefoot running. I do make the following recommendations:

1) Train and ramp up slowly–time, frequency, and distance

2)Make sure you stretch and strength your calves and gluteal muscles

3) Train on varying surfaces–limit concrete running

4) If you have a history of joint problems be very aware of joint limitations

5)The research body, excluding testimony, is limited considering the long term implications of barefoot running

I certainly have only taken a snap shot of the demands and arguments for and against barefoot running. There are many other issues that may come into play as you consider barefoot running. Should you have specific questions or concerns please do not hesitate to contact SET Physical Therapy and we can continue this discussion together.

Direct Access: What does it mean?

Historically, physical therapy services have been utilized when prescribed by physicians. In several states across the U.S. and the District of Columbia physical therapists have petitioned and obtained the legal ability of Direct Access to their care. This means is that you, as a client or patient, are able to go directly to a physical therapist for a injury without having to see a physician first. Physical therapists are trained to screen injuries and functional limitation for medical severity and appropriate treatment intervention. Specifically making a decision as to whether medical versus therapeutic intervention is necessary. Direct access has been shown to decrease costs of treating musculoskeletal and orthopedic injuries by reducing office visits and medicine costs.  In addition, by decreasing the time before reaching a therapist results are positively affected with decreasing recovery time frames for many injuries.

Below is a link to a study that describes the positive affects of direct access. The study can be found in Health Services Research journal first published online 23 Sep 2001 “A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy”

http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01324.x/abstract

Next time you sprain an ankle, experience knee or back pain, and/or have a shoulder injury (to name a few) exercise your right of direct access to Physical Therapy services.