Manage With Movement

#ManageWithMovement on Instagram is a Yoga Challenge that helps to bring awareness to the public about the benefits and role of Physical Therapy in managing pain as well as various facts about opioid use.

“Specifically in the US in 2012, 259 million prescriptions were written for opioid pain medication. Stats show that as many as 1 in 4 people who receive these prescriptions long-term for non-cancer pain in primary care settings struggles with addiction.
We want to educate and talk about how PT, exercise (yoga, running, weightlifting), and holistic approaches to help safely manage pain amidst the environment of the opioid epidemic can be explored.”

Be sure to follow along and check out info from our first yoga challenge #ManageWithMovement as well as our second #ManageWithMovement2 for all the facts!

Want to join in on our next one!? *Yes, you are eligible for prizes for participating! 😉

Keep an eye out on my Instagram account for #ManageWithMovement3 – coming to you sometime Mid-2018!

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NPS (Nail Patella Syndrome) – General Clinical Presentation

Hey Everyone!

Rare diseases – there are a ton of them, right? They can often times be difficult to treat just because they are not as common, the population may be widespread, and there just simply hasn’t been much research done to effectively help the people and remain “evidence-based.”

I’ve decided to try to undergo a little series here in regards to helping people with a rare genetic disease called “Nail Patella Syndrome.” Why, you may ask? Oh wait, because I have it too! While this syndrome varies widely in presentation, many factors and things seen are similar.

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Those of you who have NPS may not need this brief overview, but I’ll just summarize some typical physical clinical findings and a general presentation. Please remember that EVERYONE with NPS varies in presentation – there is not just “one” type of presentation. Due to other co-morbidities, health conditions, lifestyle factors, etc., nobody presents exactly the same.

Nails – people will generally have abnormal looking fingernails and toenails, especially the thumbnails.

Elbows – people may be unable to fully extend the arm at the elbow, they may also be unable to supinate fully at the forearm due to an increased growth of the radial head (this made it SUPER easy for my partners to palpate my radial head during PT school, ha). On the other hand – people may have underdeveloped bones in the elbow, leading it to be easily dislocated.

Shoulders – not usually talked about, but due to the inability for some to turn the palms up (supinate), the shoulders may become more unstable and demonstrate increased external rotation. Think about it – if you can’t turn your palms up all the way, you will compensate and use what you have next up the chain — your shoulder! Many also present with underdeveloped scapulae.

Back – Generally, people with NPS present with increased lumbar lordosis – meaning a little more curve in the lower spine. This may make the buttocks appear more prominent. This extra curvature could also make gaining weight in the stomach region and pregnancy even more painful in the lower back. With weight in the stomach, gravity naturally pulls your body more forward, creating an angle in your lumbar spine. Already having an angle there may just make the pain a little more evident.

Hips – When I asked my professor about “iliac horns” in PT school, she looked at me like I had 2 heads. Yes, these are talked about being present on diagnostic imaging; however, they generally do not affect anything. Hips, as with most people, may tend to be stiff and inflexible. At times, people may complain of pain in the groin area due to a muscular imbalance in the hip and core region which may cause a hip impingement.

Knees – People may present with abnormally small kneecaps, or at times, no kneecap at all. This can predispose these people for dislocations if there is decreased musculature around the surrounding areas. The small size of these kneecaps and easy dislocation ability may also then cause pain under the kneecap where it improperly glides and/or partially dislocates in/out of place.

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General appearance – It may be difficult for this population to gain weight, particularly muscle, especially in the proximal musculature (upper arm and upper leg). While difficult, it is not impossible by any means. It certainly just takes more work and dedication and the proper exercise program.

Fatigue – Many will note chronic fatigue syndrome. Many times this may be due to lack of activity due to abnormal kneecaps, other underdevelopments of the musculoskeletal system, or even fear of getting involved due to social reasons with the abnormality. The more active you are – whatever it may be – over time, your body will build up endurance, allowing you to participate in more activities and feel more energy.

Pain – Many will also complain of general pain, chronic pain, etc. especially at the knee joint and other joints in the body. While people with NPS have a different musculoskeletal makeup, it is at times not all that different. To feel more stable in your joints, you must have more musculature supporting them. The issue here is that it tends to be more difficult to gain muscle when you have NPS.

So, you get a general picture, right? Some people have things worse, some better. The word syndrome defined, per good ole Merriam-Webster, “a group of signs and symptoms that occur together and characterize a particular abnormality or condition.” Meaning NPS is mainly a collection of signs and symptoms that tend to present together and make up this condition. Having NPS doesn’t mean NPS will cause something necessarily, it is just the makeup of the body with NPS (the genetic mutation, the other parts of your genetic history, your diet and exercise habits) that then may cause other things to happen. Don’t get me wrong, obviously abnormal kneecaps and fingernails were caused from the genetic mutation – but you must be careful when talking about certain symptoms that may not be associated directly with NPS.

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If you’d like to read up more about the disease, I have provided a few public links below. Again, these are just a few. A quick google search will give you more available links:

https://rarediseases.org/rare-diseases/nail-patella-syndrome/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1735400/pdf/v040p00153.pdf

https://www.nhs.uk/conditions/nail-patella-syndrome/

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So..you have NPS. What next? Stay tuned as I write up a few exercise programs, tips, tricks, and adaptations to help you manage your pain, improve your function, and hopefully improve your quality of life! Not to mention helping you understand NPS and your body a little better 🙂

 

Keep an eye out for the first blog — NPS and Knee Pain!

Until next time,

Jen

LennyLarry

The Generalist PT

It’s 2018. I’ve been out of PT school for about 2.5 years now. Time flies, right? I can’t believe it. I’ve been working in acute care mainly, a little PRN help in SNFs and outpatient facilities… Ya know, the typical post-grad-need-to-pay-off-my-loans thing. Meanwhile, I feel like everyone around me is getting certified in a million different things. I mean, I’ve been doing my continuing ed (and some extra), but I still feel like I’m behind because I don’t have any certifications…

But do I want any? I’m honestly not sure. Each certification is hundreds to thousands of dollars, and of course certain ones require that you get approved before you can sit for the exam. It’s a lot of time and money to dedicate to something that I’m not 100% sure and confident that I want. But what do I do then? Am I falling behind? Am I going to be able to keep a job without adding letters to my name? Am I overreacting? Probably, but maybe not. I truly feel like so many PTs around me are doing residencies and fellowships and publishing articles and doing these amazing things. And for that, I applaud them (and you if you’re one of them). Frankly, I think I’m a little jealous that others know exactly what path they want to take in this career. I want to make a difference, but I want to be in it 100% – not just to add some letters or pad my resume. Not to mention I’m still drowning in over 100k of student loan debt.. and trying to experience life a little here and there..

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These questions and thoughts go through my head on a very regular basis. I have looked at various certifications that I think would be good for my “life goals” but continue to have a difficult time deciding which one I want to choose (commitment issues, much?). Truthfully, I feel like I want to continue learning and improving my skills as a “General PT.” I think I made this up – but basically, I want to be like the “family practitioner” of PT. I want to learn as much as I can about a variety of things so that I can be that primary care PT who can help with differential diagnosis so that the patient can get the appropriate treatment – whether that be from me or not.

I want to work with a team of nurses and physicians and other healthcare workers to derive the best plan for a patient – whether they are a pediatric patient or geriatric patient, total knee replacement or post-CVA. I want to understand and learn as much as I can. I want physicians to look at me and ask me questions when they are deciding the best plan of care, so that they have my respected perspective on it too. I want to collaborate, I want to help.

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I want to keep taking continuing ed on clubfoot and the Ponseti method and then next month take it on traumatic spinal cord injuries… and then in a few months on treating Parkinson’s. I want to confidently know the difference between an allergic reaction and cellulitis when a patient walks into my clinic. I want to understand the McKenzie method and other ways to treat low back pain – never settling with using only one tool, one technique, or one specific method.

I want to be able to read diagnostic imaging, maybe hopefully down the road (pending the state), even order it. I want to be able to determine if someone just had a stroke or if they just have facial droop from Bell’s palsy. I want to be able to notice that a patient’s back pain is caused by something that needs medical treatment instead of physical therapy treatement. I want to be an expert in differential diagnosis. Not just good, but great.

I essentially want to be that New Grad PT… but better. I want to not be pigeonholed into one category – afraid that I may lose my manual skills (which truly has already happened only 2.5 years out after mainly working in acute care), afraid I might forget how to talk to a 2 year old and be creative during treatment, afraid I may only want to do repeated extensions for everything musculoskeletal, afraid I may keep repeating the same treatment for every older person who has a fall without personalizing it.

I want to interact with people all over the world in the PT profession. Because even though I know I will always want to stay up to date generally, maybe there is something else out there, somewhere else, where my skills are in need and can provide the greatest benefit. Maybe I just haven’t found it yet.

But how? How do I demonstrate this on my resume? How do I keep improving as a generalist PT? Are there any certifications for differential diagnosis and understanding pathologies at this primary care level? Are there any interdisciplinary courses that are offered that involve all members of the healthcare team? So that we can learn and grow together?

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I think this is okay to feel like this. Again, I’m not sure, but I think so. But how do we change this? How do we make these thoughts and notions about being a generalist PT feel okay? I’m simply not ready to step into the neuro world, or the ortho world, or the pediatric world, or becoming a yoga therapist… I’m not ready to fully dedicate my life to one area. And, yes, I know this doesn’t mean I can never take courses in those again, but it does mean I will be characterized by the OCS, CSCS, COMT, or the GCS or whatever letters appear behind my name. People may feel that because I did a residency with the geriatric population that I am only equipped to treat them – and completely leave out my love for the sports population. I don’t want that.

This blog isn’t meant to have answers. Mainly questions and insights for us as a profession (and other professions) to build and grow together. And for other “generalist” PTs that may feel lost to know that you are not alone. I’m not advocating for certifications or not – I’m simply saying I am personally not ready to commit, and I’m not sure when I will be. But until then, I want to keep improving my skills to show that we, as PTs, can be great as generalists.

It shouldn’t be frowned upon to be a generalist, as long as we are improving ourselves in whatever way will lead us towards our goals. And again, I’m not saying it is frowned upon necessarily, but I do know that I personally feel pressure all of the time from the advancing PT world to pursue one specific area. I’m not ready for that, and it’s okay. I’m allowing myself to feel okay about it. I know I will do my best to make a difference however I can.

Until then, I will keep seeking opportunities, progress a little, fail a little, and learn as much as I can. And I hope you will too.

– Jen

LennyLarry

Frostbite on the way up, Sunburn on the way down: Mt. Fuji Night Hike

Hiking Mt. Fuji is one of the main reasons younger tourists come to Japan nowadays. As my husband and I began our research, we found there were a decent number of blogs, youtube videos, and lots of Instagram posts describing each person’s experience.

While my husband had hiked it once before, I had not. And to be honest, he didn’t even remember much of it as he did it with a tour group. We looked up and researched as much as we could. We noticed the average time is 6-7 hours to hike up the Yoshida Trail, with about 3 hours down. We are fairly active people; however, just before our hike, we had a 2 week vacation in the states where we did almost nothing other than eat and drink a lot of horrible things. And by horrible, I mean, horrible for your body. Taking all of this into consideration, we assumed it would probably take us around 7 hours to get up the trail, especially with the altitude difference. Plus, we didn’t really see anybody writing about how “easy” it was to hike.

We decided to hike through the night so that we could see the sunrise when we got to the top. After reading and seeing a few Instagram posts, we noticed that it was dropping to the 30-40s at the top, so we made sure to pack adequately (hat, gloves, scarf, jackets, and I even packed sweatpants to go over my thicker leggings). We bought headlamps off Amazon for about $10 each to wear as we hiked, since it would be dark the entire time.

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Our journey to the mountain started off a bit rocky. We left from Yokosuka around 2 PM with an assumption to get to the mountain around 6-7, according to Google Map and the directions we had screenshotted from my phone. We decided to head to Shinjuku to catch the bus that takes you straight to the 5th station. Of course, after arriving to the station, we realized the bus was completely booked for the rest of the evening. Poor planning on our part for sure. From here, we had to re-screenshot directions and we ended up missing one train and waiting 30 minutes for another, which was the wrong train. Luckily, a super nice Japanese lady wrote everything down for us and told us when to get off so that we could get to the right train station (Otsuki). We ended up waiting another 20-30 minutes for another train, and after hopping on there, then getting off at Otsuki, we hopped on yet another train and made it to Kawaguchiko just before the last bus left for the 5th station. Basically, it was a whirlwind of a day. I, of course, was freaking out but luckily Scott kept it cool the whole time.

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From Kawaguchiko station, the bus ride to the mountain is about 45-50 minutes. We were exhausted, not only from traveling the whole day, but also from jet lag from the day before) and finally were able to catch a short 20-30 minute power nap. The bus left the station at 8:10 PM and arrived around 9 PM, which was definitely later than we were hoping. We were a little nervous we wouldn’t make it to the top for the sunrise (around 5 AM), but we were just happy to at least FINALLY make it to the mountain.

At the 5th station, they are able to lend you a lot of things and you can even buy oxygen for when you reach the higher altitudes. We didn’t end up buying or renting anything, so we can’t really speak to it, but it’s available!

We began our hike around 9:15 PM with hopes to make it by 5 AM, just a little less than 8 hours. The beginning of the trail is all pretty flat and even a little downhill. You actually start above the clouds already – I felt my ears pop on the way up on the bus! We arrived at the 6th station fairly quickly and took a very quick rest/bathroom break along with plenty of other hikers. Determined, we didn’t rest long and kept on our way. Between the 6th and 7th station (if I remember correctly) is basically just a lot of zig-zagging and walking up ash at a steady, slow incline. In our opinion, this was the worst part. I’m not sure if it’s because we like climbing more or if it was just the beginning, but we ended up stopping every 2-3 full zig-zags to catch our breath. We ended up making it to the 7th station by 11 PM…Only 2 hours!

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When we got to the 7th station, we realized we had been passing just about everyone and recognized nobody else around us. We heard others saying that it takes about 2.5 hours to get to the top from the 7th station. At our pace, that was probably accurate.. AKA we needed to slow down, especially as we climbed the altitude. It was starting to get colder at this time, so I put on my sweatpants and another jacket. We ended up taking a 50 minute power-nap/rest, again, with other hikers nearby, at this station. We decided it was only going to get colder at the top and we might as well just relax for a little because we were pretty confident in our ability at this time.

Once we woke up – around 11:50, we decided to begin ascending the trail again. We got to the next little mountain hut and saw they had cup of noodles and hot tea. We didn’t really want to stop again – but hey – what the heck! So we each got some hot, lemon tea. I swear it was the best tea I’ve ever had. That’s probably because I was so cold, but it was so worth it. We sat for about 10-15 minutes finishing our tea and warming up a little before we really began again.

Between the 7th-8th station is where we really “took off.” It’s basically rock climbing/really big rock steps that you have to climb up. We were passing people right and left. It was the booty workout anybody could dream of.. so much hip extension (nerd alert). But seriously, this part was fun. We got a little tired and would take breaks, but it was way better than the first part, in our opinions. We got to the 8th station pretty quickly, but I can’t remember the exact time.

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We took a solid 10 minute rest at the 8th station. Once you get past the 8th station, it’s almost like a combination of part 1 and part 2.. Long zig-zags with slow inclines but smaller rocks that aren’t really climb-able, if you know what I mean. It’s definitely tougher/more annoying, plus you start to hit 9-10,000 feet and your breathing starts to become more shallow. We took a 5+ minute break at each mountain hut, and as we got higher up, we took a break just about every 1-2 minutes.

While we didn’t necessarily feel nauseous, super dizzy, or pass out.. I can definitely say I had a headache when I first started; however, I tend to get headaches when the weather is colder, even in the 50s. Once I put my headband/ear-warmer on, I was fine the rest of the way. Our hearts started pounding with just a few steps when we got to the top, but again, we tended to move faster than others. We really started taking a lot of rest breaks because we knew we still had plenty of time.

We made it to the top just before 3 AM, so it took us a little less than 6 hours to get to the top. Don’t forget our 45-50 minute nap in the middle also! Overall, it was definitely tough, but it’s obviously doable in 5 hours if you’re in shape, especially if you’re more conditioned to higher altitudes (we flew from the east coast of the USA to Yokosuka, which is just above sea level.. then hiked).

Once at the top, we rested for a little. There is a mountain hut; however, it wasn’t open. We thought it may not open until 5, but it actually opened around 3:30 AM for food/drinks. It was kind of confusing and didn’t help because everybody swarmed in. You kind of just sat in a few rows and they took your order for simple things. I got a coffee for me and a corn soup for Scott. In case you haven’t had the corn soup before, it does come in a can. Some people around me were kind of weirded out by this. They actually sell the corn soup at train stations, which is where we first tried it.

Scott and I ended up taking turns getting up and walking around, because since we were up there around 3, we had a front row seat for the sunrise! We obviously didn’t want to lose our spot, but it was so cold that we had to get up and move a little. Once 5 AM rolled around, there were tons of people surrounding us, and the sun began to rise!

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It ended up being a little cloudy, but it was still such a beautiful sight. We were still freezing, but also mesmerized by a sunrise above the clouds. We hung out for about 45 minutes watching it rise until we walked further over to check out the crater.

We probably stayed up on the mountain until about 6:30 AM, then began the trek back down. Our fingers and toes were numb and everything else was just cold. It was a beautiful sight on the way down, though. Especially since we were unable to see the scenery on the way up in the dark. We took breaks walking down also, not because of fatigue, but because it was definitely tough on our knees/ankles (are we that old?).

You’re literally sliding down ash and rock in a zig zag pattern, but lots of people were actually slipping too. I think I would have rather climbed back up, to be honest.

It took us about 3 hours, as predicted, to get back down. There definitely were people who passed us, but again, I guess we just have old and achy bones.. Back at the 5th station, we checked out a few shops and then got in line for the bus to take us back to Kagurachiko station.

We were exhausted, I was legitimately concerned for Scott because he had barely slept on our flight over and the jet lag was pretty crazy. We got back to the station, went to grab some food, and then came back to make sure we got bus tickets for the next day. We were able to get tickets from Kawaguchiko to Yokohama station, which is so much closer to where we live. And way more convenient.

Finally, we headed off to our hotel. Check-in wasn’t until 3PM, but we got there around 1PM. We waited in the lobby for about an hour and they brought us our room key an hour early! They probably felt sorry for us, but hey, we took it.

The hotel was super nice and I definitely wish we could have spent a little more time there. We ended up showering and then going right to sleep. We woke up once around midnight, but then slept in again through until around 6 AM. We slept at least 12 hours total, it was amazing.

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The breakfast at the hotel was included in our stay. Everyone was wearing their robes from their rooms, it was pretty cool. I definitely would have worn mine if I had known. The breakfast was a buffet-style, but still pretty fancy.

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As it was a spa, resort-style place, they also had private and public baths that could be used. We checked them out but ended up just heading back to the room to relax a little longer instead. The hotel does have a shuttle bus you can schedule, and it’s free! We just didn’t know that ahead of time.

Our trip home was, luckily, uneventful and much quicker. It was a great trip overall! Very rewarding, fulfilling, and then relaxing. 🙂

Hope this helps you plan your future Fujisan hike!! Or I just hope you enjoyed reading this 🙂

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Until next time,

Jen

 

The Safe Way to Improve Your Shoulder Flexibility: A Self-Study

As many people may know, I recently began participating more in yoga. One of my goals in 2016 was first to run a half-marathon, and then to get more flexible (and do a cool handstand with the sunset in the background like one of those super cool yogis). While we are taught in physical therapy school the different ways to lengthen and “stretch” a muscle, I have now started to actually experience it, because I want to. Nothing like putting your knowledge to work and getting a better perspective, right?

While there are many viewpoints in regards to muscle extensibility, I feel the article by Weppler and Magnusson describes it well. A muscle’s length tends to be measured one-dimensionally; however, there are many factors that come into play when increasing a muscle’s length and extensibility. We are not one-dimensional humans, we have joint capsules, various tissues and fascia pulling in different directions, muscles overlapping one another, ligaments holding our joints together. We are by no means one-dimensional, and neither is our ability to move. According to the science of biomechanics, we already know and understand that muscle length is multi-dimensional, so why do we keep attempting to stretch and measure it in only one way? (This is a segway to another future write-up…) There are many different theories and reasons behind why our muscles appear to lengthen after a short-term stretch including an alteration in pain and sensation, a short-term relaxation due to neuromuscular reflexes, etc. Anyway, knowing that there are many factors that come into play with stretching allows us to take a step back, breathe, and realize this is going to take time (if you want to do it effectively and appropriately). Without patience, you risk greatly injuring yourself, and maybe not even at the site of the stretch due to all of the overlapping tissues in your body. Let this be a reminder to you that our bodies are pretty amazing (and also insane, but still amazing).

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While I have not yet reached my perfect handstand (with the sunset in the background), I have come to find and critique each one of my movements so that I may focus on different aspects of stretching, strengthening, and balancing in order to achieve that “perfectly aligned” handstand. As a physical therapist, this opportunity and goal setting has been an amazing learning experience. As a beginner yogi, this has also been a wonderful learning experience. Let me break it down for you a little in some pictures.

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From a Beginner Yogi: This was my first documented (on Instagram) “wheel pose” back in May 2016. I used to do this known as a “bridge” when I was younger. I didn’t fully understand the concept of how to improve my form yet, nor did I have the flexibility for it. But the water was cool and it was a sunny day, so why not yoga?

From a Physical Therapist: Lacking full shoulder flexion – do we need to test that in standing just against gravity first before we do things like this? There’s a little thoracic extension here, but that could use some work. I can see tight hip flexors and a compensation of a heel raise to allow for more flexibility and space to open up. Just need to be careful not to overcompensate and start using the lumbar spine to make up for the lack of shoulder and thoracic flexibility.

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Second documented wheel pose in August 2016, while I was participating in a “yoga challenge” ..also at a Goo Goo Dolls concert (lol, what).

From a Beginner Yogi: Cool lighting, cool background, at a concert, cool. Plus I need to do my yoga for the day, right!? I didn’t have time for a warm up at all here, just kind of whipped this one out. Thanks for the pic, Mom! Hope you aren’t too embarrassed!

From a Physical Therapist: Am I starting to compensate using my lumbar spine? Is that safe? And wait, no warm up? I hope I don’t injure something, even holding these prolonged stretches can damage you. Wow, those hips flexors are still tight, definitely a (+) Thomas test, if you know what I mean. And still compensating with the heel raise? Hm. And yeah, we definitely need to work on that full shoulder flexion and elbow extension… what exercises can we do? (And by we, I mean me, myself, and I).

(Minimal disclaimer: My elbows don’t actually extend fully due to being born with a rare genetic disease that causes bone abnormalities. In my case, it is a large radial head which limits my ability to fully supinate as well as fully extend my elbow. BUT I think the yoga has actually slowly been helping, a little. Long story short, I am not going to target them, because it’s more of a bone on bone end range and is just silly to try to realistically change that.)

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So from this point on, I am looking at myself in these pictures and thinking… Wow, I really need to be careful, I could really injure myself. Luckily, I see this. Not every patient will. Many will continue to push through the pain to get that “perfect picture.” Or work harder to be able to get back on the playing field, or back to work to support his/her family, or back to just being able to play with his/her friends. This is key. Education is key.

Overuse, improper stretching, and pushing through pain make up a great deal of the injuries out there. It is our jobs, as physical therapists, yogis, athletes, humans, to educate ourselves and others on these risks. There is nothing wrong with setting goals and trying to achieve them, we just need to make sure we do it safely.

So where did I start? Well, I’d say back in September 2016 is when I really started focusing more on stretching my shoulders and my thoracic (upper back) region. It is still very much a work in progress, and will certainly continue to be. These are the main exercises I perform below:

  1. Foam roller for improved thoracic extension or “Fish Pose” on a foam roller: To perform this, I initially start with my hands behind my neck to support my head, elbows in for additional support. I roll myself a few times over the foam roller along my upper back from the base of my neck to the end of my ribcage or so. After a few reps, I begin breathing and arching my back a little more and holding the pose to allow for an additional static stretch. I also will perform this without a foam roller as I feel comfortable.
  2. “Puppy pose” for improved shoulder flexion and thoracic extension on the floor and on the foam roller. I perform this a few different ways and hold it for a few breaths (anywhere from 30 seconds to 2 minutes pending how I’m feeling). Make sure not to compensate with your lower back here – really focus on breathing and pressing your shoulders and chest forward and down.
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    2. img_20170113_070842196 Not exactly puppy pose here, but still working on pressing the shoulders into the ground.
    3. img_20170113_074717866 More of an “extended” puppy pose, really trying to push the chest forward and down.
  3. Doorway stretch: 2 different ways
    1. Pec Stretch: Arms up, parallel to the floor. Gently lean in with a lunge. You should feel a stretch on the front of your arm/chest area. (Sorry for the hair – thanks 1 Mission Fitness for the cool shirt, though).
      1. Shoulder Flexion: Similar set up to the pec stretch, but I would extend my arm up higher. Allow your shoulder to sink into the wall while you lunge.
  4. Hanging shoulder flexion stretch (Not sure what else to call this): I would generally hold onto something above me, whether it be at the gym (a pole or something), a doorway, etc. Again, gently lean in without compensating using your upper or lower back. By performing such a compensation, you are only cheating yourself! And no, this isn’t me, but during the pictures, I couldn’t reach 😀 so I had to use my model substitute 😉

Additionally, I would do these a few times with a hold of 30-60 seconds, then perform some sort of yoga pose that utilized the new “space” I achieved from my short-term stretching. After all, mobility before stability, right?

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October 2016. (Saulita Skull Leggings from AltarEgo Apparel – they have a Gandhi quote on the front inside of them!)

As I analyze myself these next few pictures, I definitely notice a difference in my overall flexibility. Some of it may be from the warm up I did before the picture, some of it may not, I’m not totally sure how to differentiate. What I do know is that stretching the proper way and progressing the safe way is saving me from an increased risk of injury (specifically lower back here).

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January 2017

The above 2 pictures are from the same day, very recently, in the beginning of January. This was the first time I felt I could safely go into the wheel pose on my forearms. As you can see, my shoulder flexion is improving, slowly but surely. Again, still a work in progress and I still need to do my own home exercise program, maybe even add on a few other different stretches to challenge the multiple dimensions of my joints, but I am getting there. My point here again is that this takes time, it is not going to happen overnight, or even in a few weeks. Whether you are trying to improve your general flexibility (like me) or your patient is recovering from a torn ACL, the emphasis is the same. The most important thing is patience so that you are not placing yourself or your patient at an increased risk of injury.

Anyways, I hope my journey thus far has taught you something, inspired you to teach something to someone else, or just been fun to read/laugh at my experience. 😀

Until next time,

Jen Strack

P.S. Because I’m a “beginner yogi” and obsessed with cool pants.. Here are the links and codes for discounts to some of the pants I was wearing in the pictures above. Because they’re awesome and I like to reward myself sometimes and I think you should too 😉

1 – The Saulita Skull Leggings from October 2016 are from Altar Ego Apparel -> http://www.altaregoapparel.com/ – An all female run company. Code “JNS” gets you 15% off.

2 – Red Bohemian pants are from Bohemian Pants.com -> Bohemian Pants. Code: “x3jennyfur10” gets you 10% off AND they donate 10% of your purchase to help save the environment !

Citations:

Cynthia Holzman Weppler, S. Peter Magnusson; Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation?. 2016; 90 (3): 438-449. doi: 10.2522/ptj.20090012

Who said shoveling had to be boring?

In honor of my first snow day this year, I decided that shoveling needed to be spiced up a little bit. Therefore, I decided to make this half-serious, half-kidding post. Shout out to my mom for not being super embarrassed and filming this short clip (you’re awesome!) I’m seriously wondering if my neighbors were watching and laughing out their windows. Or questioning if they should move sometime soon… Anyways, this is just a fun little snippet of some things you can do to have a little fun and get a little extra burn during your snow day shoveling extravaganza 😉 Yes, I was being a little goofy, but working out needs to be fun if we want to keep doing it, right!? 🙂

I know I barely shoveled any of that snow in the video, but that’s because we already shoveled it. Trust me, there is more to shovel now 😦

Then, you need to reward yourself..because you just shoveled your driveway and you are awesome. Just remember dancing is never frowned upon and can be an excellent cardio boost. Don’t hold back, get your groove on and burn some calories! 😉

Oh, and don’t forget that snowball fights are encouraged to help build up your arm strength and to help pay back your friends and siblings for all those embarrassing stories they’ve ever told about you.

In all seriousness, be careful in the snow, everyone! Don’t trip and fall, otherwise you might be going to see a physical therapist soon (and maybe you’ll meet me?) But really, you can get some very life-altering injuries from a slip! Drive safe and be careful!

Until next time..

-Jen

Dynamic Stretching: Part 1… “The Basics”

If you’re like me, you’ve been doing dynamic stretches practically forever. I grew up always performing “high-knees,” “butt kicks,” and “toy soldiers” before every practice and game. Of course, in college I actually had an idea of what I was doing, compared to when I was younger, but nobody ever told me why I was doing these. My coaches would just tell me to stretch and that it was good for me and I, as well as my teammates, accepted that. Lucky for me, I got into a profession where I can finally figure out why I am doing these sometimes-crazy-looking-stretches and how they are going to affect my performance. Let’s start off with the basics… but, beware, this is part of an in-service presentation I am giving, so it can get a little science-y.. (I left a “bottom line” portion at the end of each paragraph or so, if that helps)

What is dynamic stretching?

Dynamic stretching is a form of stretching that incorporates whole body movements in an active manner. Dynamic stretching does not involve bouncing movements that exceed comfortable ranges of motion. This type of stretching would be known as ballistic stretching and is not to be confused with dynamic stretching.1

What is the difference between dynamic and static stretching?

Static stretching is a prolonged, passive stretch that is generally held for a few seconds up to about 90 seconds. Static stretching is said to acutely depress the reflex activity of a muscle and increase muscle compliance. The increase in muscle compliance then increases the time to and decreases the force of a myofibril contraction during muscle performance. 1 In a comparison, dynamic stretching is said to help preserve this muscle-tendon unit stiffness in order to enhance muscle performance instead of stunt it. In a systematic review, static stretching of the upper body was shown to have neutral effects on power, whereas it was shown to negatively affect physiological outcomes (Ex: heart rate, vO2). 2 It is important to include static stretching in sports that require static flexibility; however, 90 seconds of static stretching has been shown to produce impairments on dynamic movements. 3

Bottom Line: Static stretching is okay to improve passive motion; however, it can impair activities that involve strength and power.

Why does it work? (#science)

One theory behind dynamic stretching is known as postactivation potentiation (PAP). PAP increases cross bridge cycling via an increase in myosin phosphorylation of the regulatory light chains. 3 In more basic terms, by performing similar muscle contractions, you are conditioning the muscle and its contractility so that it is more, in a sense, “ready” to perform more contractions. Essentially, you are progressively warming up the muscle so that it may contract more efficiently in the exercise that follows. 4 PAP is said to increase the rate and ability of a muscle to develop force; therefore, it influences and increases a muscle’s mechanical power. 4

Some other thoughts behind dynamic stretching include its ability to increase heart rate and increase core and muscle temperature. By doing so, the blood flow is increased throughout the body so that the body may move more efficiently during activity. 4 In addition, dynamic stretching is said to improve kinesthetic awareness and enhance motor unit excitability. 1

 Bottom Line: Dynamic stretching can enhance your performance in activities that follow by improving a muscle’s effectiveness and efficiency during muscle contractions. It helps get your muscles ready for the important stuff!!

How will this benefit me?

If you are performing any sort of active motion, you will want to initiate dynamic stretching instead of static stretching. While static stretching has been shown to improve static flexibility, most required functional tasks and/or exercises involve active movement, which requires dynamic stretching to improve.

Types of dynamic stretching are important to consider based on the tasks/activities performed after the warm up. 2, 4 The velocity and intensity of lower body dynamic stretching has been shown to impact and improve both vertical jump and long jump performance. 4 In a study by Chatzopoulos et al, dynamic stretching was shown to improve balance on a stability board whereas static stretching was shown to harm balance. This is attributed to the quick movements needed to maintain one’s balance.

It should be noted that if a person already has a way they like to warm up or some sort of stretching routine involving static stretching that they are not willing to change, static stretching deficits should not exceed 5% in comparison to no stretching. 6

 Bottom Line: When you move, you use your muscles differently than when you stand still. So why warm up by standing still? Get out there and MOVE to warm up! Also, just remember that some people are stubborn and won’t change their ways – they shouldn’t be negatively affected greatly by static stretching before exercise, but they will be affected (and YOU will be better than them, duh).

Does it affect the upper and lower body differently?

Currently in the literature, there are no articles to investigate the effects of dynamic stretching of the upper body and its impact on injury prevention. High-load dynamic stretching in the upper body (anything greater than 20% of maximum effort, ex: plyometrics) has been shown to improve strength and power with good evidence, flexibility, and delayed onset muscle soreness with moderate evidence . 2 In the upper body, there was also no benefit in performing low-load dynamic stretching (Ex: repetitively gripping a sponge) prior to exercise. Specifically for those who play baseball, dynamic task-specific warm-ups (swinging a bat) at the standard weight has been shown to improve swing speed more than using a heavier or lighter weighted bat. 2

One study of the upper body also demonstrated that a low-volume dynamic stretch of the pectoralis and triceps brachii muscles showed a decrease in the maximal isometic peak force during the bench press exercise. There was also no short-term effect on the time to maximal isometric force or the rate of force production following dynamic stretching. In the same study, there was a negative effect induced by static stretching when performing upper body tasks after. This must be taken with caution, again, as we do not know the proper load and duration to perform dynamic stretching. We must also consider that there are articles out there that say otherwise (that dynamic stretching improves performance). Additionally, the 2 dynamic stretches performed in this study may not have been appropriate in fully stretching or warming up the muscles in a dynamic, task-specific manner. 7

In regards to the lower body, a study by Curry et al. compared static vs. dynamic stretching in females in their mid-20s and its effect on lower body balance, force production, reaction time, and power output. In these females, who were recreational athletes, time to peak performance improved with both 10 minutes of dynamic stretching and a 5 minute bout of light cycling. These improvements were seen 5 minutes after stretching had occurred. 30 minutes after stretching had occurred, time to peak force began to increase with the basic cycling; however, it remained fairly steady in those who performed the dynamic stretching routine.

 Bottom Line: There is little to no research out there to show any evidence in dynamic stretching decreasing a risk of injury in the upper or lower body. While there is more research on the lower body, both the upper and lower body generally seem to have impairments of power and strength following static stretching while there are enhancements following dynamic stretching. Wade cautiously, though, some studies don’t have many subjects.. There definitely needs to be more research.

How long should I stretch?

For upper body dynamic stretching, there has been no research to determine proper load and duration that provides maximal effectiveness to improve strength and power. 2

In regards to lower body dynamic stretching, a study by Ryan et al. compared 3 groups who performed different warm-up activities: A-5 minute jog and 6 minutes of dynamic stretching, B-5 minute jog and 12 minutes of dynamic stretching, C-5 minute jog only. Those in group B who performed a longer duration of dynamic stretching showed a decrease in muscular endurance, attributed to a decrease in high-energy phosphates and a repeated high-intensity contraction to failure. Both groups A and B showed an increase in vertical jump height and velocity. Group C, who did not perform any dynamic stretching, had no effect on the vertical jump; however, did show an increase in flexibility. Overall, the most appropriate volume, as concluded by this study, indicates that 6 minutes of dynamic stretching after a 5 minute jog is adequate in stretching the hip and thigh musculature, improving vertical jump performance, and not affecting muscular endurance. To be noted, this study was performed with recreationally active men in their mid-20s.

 Bottom Line: Don’t stretch too little because you won’t see a great effect. Don’t stretch too long because then you’re going to have tired muscles. Simple as that. 6-10 minutes is most likely adequate; however, it will depend on how “in shape” or well-trained you are. The higher training you have, the more it will take before you fatigue.

But I’m not a young, 20 year old, competitive athlete?

This will still help you!! While most of the literature focuses on high-school aged to mid-20s recreational and competitive athletes, a study by Behm et al. recognizes the similarities and differences in dynamic stretching effects in regards to young and middle-aged men. The study mentions that dynamic stretching provides similar improvements to static flexibility as static stretching does. It also notes that static stretch-induced impairments and dynamic stretch-induced enhancements of the countermovement jump are not affected by the difference in age, meaning they respond similarly as the younger counterparts. The article also mentions previous literature that discusses that older, untrained women experienced a deficit in strength training following static stretching, similar to younger female athletes studied. While these demonstrate similar effects on middle-aged people, we must keep in mind the elderly and frail have not yet been studied in regards to effects of dynamic stretching.

Bottom Line: It doesn’t matter how young or old you are, dynamic stretching still works the same! Age is not an excuse!!

Is there anything I should be cautious about?

Caution should be taken when performing dynamic stretching prior to any activity that may have a higher risk of knee injury in regards to an improper hamstring:quadriceps ratio. 8 In a study by Costa et al, an overall decrease in hamstring:quadriceps ratio was seen, suggesting that the hamstrings may respond to this type of stretch differently than the quadriceps. The hamstrings provide a great deal of eccentric control in the last 3rd of the swing phase during running as well as assist the anterior cruciate ligament (that darn ACL everybody hears about..) in decreasing anterior tibial translation. As this study shows a decrease in peak torque of the hamstrings, caution must be taken in order to maintain a proper balance between muscles. While this is not a true contraindication and more of a precautionary measure, clinical judgment should be made before introducing dynamic stretching. As this is only one study, there should be further research to determine if there is a higher risk of injury in certain regions after performing dynamic stretches of particular muscles or if this study is merely an outlier.

Bottom Line: There is one study that says to be cautious performing dynamic stretching before activities that cause a higher risk of knee injury (basketball, soccer, etc.) HOWEVER, this is ONE study and to be conclusive to the larger population, there needs to be more standardization, subjects, and further research in general. Proceed with the same caution you would proceed with when performing any activity.. just use your noggin!!

So… now you know the basics. Stay tuned for some upcoming posts with different examples and what they are targeting, etc.

Have a great day! 🙂

-Jen

References

1Curry B, Chengkalath D, Crouch G, Romance M, Manns P. Acute effects of dynamic stretching, static stretching, and light aerobic activity on muscular performance in women.Journal Of Strength And Conditioning Research / National Strength & Conditioning Association [serial online]. September 2009;23(6):1811-1819. Available from: MEDLINE, Ipswich, MA.

2McCrary J, Ackermann B, Halaki M. A systematic review of the effects of upper body warm-up on performance and injury. British Journal Of Sports Medicine [serial online]. February 18, 2015;Available from: MEDLINE, Ipswich, MA.

3Samson M, Button D, Chaouachi A, Behm D. Effects of dynamic and static stretching within general and activity specific warm-up protocols. Journal Of Sports Science & Medicine [serial online]. June 1, 2012;11(2):279-285. Available from: MEDLINE, Ipswich, MA.

4Ryan E, Everett K, Fiddler R, et al. Acute effects of different volumes of dynamic stretching on vertical jump performance, flexibility and muscular endurance. Clinical Physiology And Functional Imaging [serial online]. November 2014;34(6):485-492. Available from: MEDLINE, Ipswich, MA.

5Chatzopoulos D, Galazoulas C, Patikas D, Kotzamanidis C. Acute effects of static and dynamic stretching on balance, agility, reaction time and movement time. Journal Of Sports Science & Medicine [serial online]. May 1, 2014;13(2):403-409. Available from: MEDLINE, Ipswich, MA.

6Behm D, Plewe S, Button D, et al. Relative static stretch-induced impairments and dynamic stretch-induced enhancements are similar in young and middle-aged men. Applied Physiology, Nutrition, And Metabolism = Physiologie Appliquée, Nutrition Et Métabolisme [serial online]. December 2011;36(6):790-797. Available from: MEDLINE, Ipswich, MA.

7Leone D, Pezarat P, Valamatos M, Fernandes O, Freitas S, Moraes A. Upper body force production after a low-volume static and dynamic stretching. European Journal Of Sport Science [serial online]. 2014;14(1):69-75. Available from: MEDLINE, Ipswich, MA.

8Costa P, Herda T, Herda A, Cramer J. Effects of dynamic stretching on strength, muscle imbalance, and muscle activation. Medicine And Science In Sports And Exercise [serial online]. March 2014;46(3):586-593. Available from: MEDLINE, Ipswich, MA.