Physical Therapy: What to Expect

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Marathon training has picked up and your Achilles tendon has been bothering you on your long runs. Or maybe you played golf this weekend and your back has been sore ever since. Perhaps work has gotten busy and your neck has been sore for a week. Whether it’s a friend or your doctor, chances are, if you ask around, someone will suggest you see a physical therapist.

So what should you expect?

During your first visit your PT will work to understand your injury and develop a treatment plan. We will ask you questions about your pain or discomfort—when did it start, what makes it better, what makes it worse? We will ask you about your work and the things that you do for fun. Sure, we want to get to know you, but, more importantly, that info also helps us understand how to best help you and keep you as active as possible while you’re recovering.

We will watch you do certain movements and collect some information by taking measurements and conducting particular tests. Often we will even look at different areas of your body that may not seem to be related to your injury.

Once we feel like we have enough information to create your treatment plan, we will likely get started that first day by teaching you an exercise or two to work on until your next appointment.

You should expect to work with the same PT at each session. Occasionally, two PT’s will work together as a team during your course of treatment, but our goal is to maintain consistency from visit to visit, and we find this harder to accomplish when more than two PT’s are involved.

When you return for your first follow up visit, expect to get to work! Your PT will have developed a plan that may include a variety of manual therapy techniques (‘hands-on’ work) and will definitely include exercise. We might ask you to do some things that seem silly—feel free to ask us why. It is not uncommon to see our patients blowing up balloons during their appointments, or crawling across the gym mat. It’s actually fun and we laugh a lot! At each session we will check and recheck some of the same tests we performed on day one, to understand the effect of the treatments we have been providing.

When you leave our studio, you will be expected to do your homework. We will provide resources to help you remember your exercises and yes, we will know if you’re doing them. Patients who are active participants outside of the PT clinic almost always heal faster than those who aren’t. A physical therapist can’t make you better alone. Physical therapy is a team approach and we need your help!

How often you come to PT is part of the treatment plan that you and your therapist develop together. Among our patients, there is a wide range of plans that change over time (i.e. once per week, once every other week, twice per week, etc). There are several factors we consider when planning your PT schedule. From the rate of healing and the body’s adaptation to new activities, to being swamped at work or due to financial constraints, treatment schedules will be specifically recommended to fit your needs. However, you should expect to attend at least 3-5 sessions in order to get the full benefit of working with your PT.

Once you are back to your marathon training, out on the golf course, or are able to sit at your computer without neck pain, it’s probably time to graduate from physical therapy! Some of our patients choose to continue to work with their PT for exercise as part of one of our wellness programs while others reach out the next time they need us.

Let us know how we can help you stay as active as possible!

How to stay motivated to exercise during the foggy days of a San Francisco summer

Come December, almost every fitness magazine or blog features an article about how to stay motivated to workout during the winter months. The Internet is full of fitness tips for winter, while retailers push the latest in coldweather gear.

San Francisco is a city with little variability in our temperatures, making these articles virtually irrelevant to our fitness buffs. Yet, we do have one weather phenomenon that can be a buzz kill for outdoor recreationalists. While the rest of the country enjoys warm summer days, we often host an unwelcome guest named Karl the Fog. Karl is active on social media, with his very own Twitter, Facebook and Instagram accounts. Don’t get me wrong, some people welcome Karl and appreciate the cooling blanket he provides. It is easy enough to escape his presence with a quick trip inland. Plus, it’s pretty amazing to see his fingers of fog creep across the skyline, hiding the sun and its warmth in a matter of minutes. Others, myself included, are easily affected and develop feelings of fatigue and sluggishness. We may need a little push to get outside for exercise. On my first day of graduate school at UCSF almost 15 years ago, a professor told us to be sure to escape the city on weekends to avoid developing SAD—Seasonal Affective Disorder, a type of depression that often occurs during winter conditions…or, in our beloved city, during the summer when the sun doesn’t shine. I still get a burst of energy when I wake up to a clear, sunny morning. On those perfect days, I can’t wait to get outside and don’t want to waste a rare, beautiful day. Those kinds of San Francisco days make even the foggiest worth it.

So how can you stay motivated to exercise during the foggy days of a San Francisco summer?

      • Appreciate the cool- While the fog may be lingering in your neighborhood, just a few miles in any given direction the temps may be soaring, making a morning workout intolerable. Last weekend I was visiting my hometown and got out for a fairly early run…in 85 degree heat (and loved every minute of it). Yet, friends in hotter climates complain of having to workout at 5:00 am to avoid the heat, or worse, they have to stay in an air-conditioned gym for their daily dose of exercise.
      • Wait it out- Depending on the day, it may actually burn off. But, as soon as you see a glimpse of clear sky, head on out. You never know when Karl will return. It may be a matter of a couple of hours, or might stay clear the rest of the day.
      • Or don’t…There’s a strong chance that he’s here to stay for the day. Embrace the cool climate and know that you’ll have a sunny day soon enough. According to a 2011 study of 229 students conducted at sunny Santa Clara University (1), exercising outdoors was more enjoyable and resulted in less tension and stress, compared to indoor exercise.
      • Try a different neighborhood- In a city known for its microclimates, you can almost always find a sunny spot in San Francisco. Venture to a different neighborhood for some exploration and, fingers crossed, maybe a little sun. Some of the sunniest neighborhood in San Francisco include the Mission, Noe Valley, DogPatch and Potrero Hill.
      • Appreciate your surroundings- The outdoors take on an entirely different look and feel under the cover of fog. Views you have seen a million times, suddenly become new, taking on a different type of beauty. Have you ever seen The Presidio under cover of fog? Or heard the foghorn sounding under the Golden Gate Bridge? The trails in Glen Canyon become beautifully mysterious when shrouded in fog.
      • Take it indoors- There are a ton of great indoor fitness options, if you just can’t drag yourself outside to face the fog. Some of my favorites are TRX, yoga, Pilates, and circuit training workouts in the gym or at home.
      • Grab a friend or play some music- Can’t get out the door? Grab your iPod or call a friend. Both have been linked to increased motivation for exercise. In fact, a 2013 article in Scientific American (2) reports, “Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency. When listening to music, people run farther, bike longer and swim faster than usual—often without realizing it.”

Tips for exercising on foggy days:

      • Don’t overdress- While wet, foggy weather isn’t always cold weather. You’ll learn your lesson if you head out with too many clothes into the often warm, humid air. Your best bet is to dress just like you do for any SF day—layer, layer, layer (preferably in a sweat wicking fabric).
      • Don’t forget the sun protection- Sunscreen and sunglasses are a must on even the foggiest of days. According to dermatologists, 87% of the sun’s rays penetrate through clouds, fog and mist. While these can block sunlight, they don’t effectively block harmful UV rays.
      • Warm up appropriately- Depending on the temps, you may need more of a warm up on a foggy day. I recommend a dynamic warmup and light start to your workout.

Ahh…the sun just came out—time to hit the trails! See you soon, Karl.

 

References:
1. Plante, TG, et al. Exercising with an iPod, Friend, or Neither: Which is Better for Psychological Benefits? Am J Health Behav.™ 2011;35(2):199-208.
2. Jabr, Ferris. “Let’s Get Physical: The Psychology of Effective Workout Music”. March 20, 2013. http://www.scientificamerican.com/article/psychology-workout-music/.

The Top Five Reasons Why You Should Get To Know Your PT

A few years ago I hosted a get together with a bunch of friends. At some point in the evening, after everyone had figured out how we were connected, someone remarked, “It’s a good thing you’re a PT. You wouldn’t have any friends otherwise.” As I looked around the room at my guests, two were physical therapy colleagues, while the rest were former patients turned friends. While I understand that some PT’s prefer not to develop personal relationships with current patients, I truly believe in the importance of developing a long-term professional relationship with one.

If it’s not a good fit, find one you trust and with whom you can connect. If they turn into a good friend, even better!

Here are The Top Five Reasons Why You Should Get To Know Your PT:

We’ll be spending quality time together.
During the course of your treatment, you’ll be seeing us regularly. I am fortunate to spend 45 minutes with patients, often once, maybe twice a week. Compare that to the amount of time you spend with your doctor during a scheduled appointment, or even how often you see your best friend in any given week. Several years ago, I attended the wedding of a patient-turned-friend after knowing her only a few weeks because, as she told me, “The only person I spend more time with during the week is my fiancé.”

You can confide in us.
Because we will be spending time together working on improving your health, there may be certain things that come up during our time together. Human are complex creatures. There are many factors that can contribute to health, some of which may not be that easy to bring up. As healthcare providers, we are bound by law and ethics to maintain your privacy, and need to know about factors that may be affecting your healing. During any given week I talk to people about such potentially uncomfortable topics as depression, intimacy, problems in relationships, and other sensitive things. We talk about frustrations with treatment and health concerns seemingly unrelated to their physical therapy treatments. Often, the things we discuss are vital to my success as a PT though occasionally I need to refer out to someone better equipped to handle the issue. You need to feel comfortable enough with your PT to be able to discuss the uncomfortable.

We can help ease your fears.
Perhaps you’ve just received a new diagnosis that is troubling, even scary. Sometimes the medical jargon associated with an MRI report or after a doctor visit can be overwhelming. Chances are, we’ve worked with other patients with similar problems and can help explain things in ways you’ll understand. It is not a normal week if I don’t have a friend or family member reach out with questions about a particular diagnosis. The discussion this weekend was about Jason Day at The US Open, his struggles with vertigo, and how PT can help…did you know that?

We can let you know when it’s time to get serious about your health.
There is a reason your back hurts. Ignoring it isn’t the answer and it is likely a symptom of a larger problem. The good news is, you’re willing to invest a little time and energy, and maybe a few little changes to your daily routine, we can make a huge impact. Sometimes a friend or PT who knows you well is the best person to impress upon you the importance of taking your health seriously. You only get one body in this life, treat it well.

We can help you navigate the confusing world of medicine AND fitness.
There is so much misinformation and conflicting advice floating around out there. Who can help you differentiate fact from fiction? A PT with a good clinical experience who has continued to grow professionally and is able to critically evaluate research is good person to have on your team. Well-meaning but incorrect advice is commonly dispensed from people who don’t have the same training and expertise as PT’s who work in musculoskeletal medicine every single day.

We really do care.
My colleagues and I talk about this all of the time. It is not uncommon for us to say to a patient, “I was thinking about you on my walk to work.” I often develop new treatment plans in the most unlikely of places. This is why my showers are sometimes a little longer than necessary. We PT’s are generally so invested in our patients that we take it to heart when someone doesn’t seem to value or appreciate our care. This is also the reason we are exhausted at the end of the week. Don’t expect your PT/friend to want to get together for Happy Hour on a Friday evening!

Welcome to the TPSF Team-Michelle Cotter, PT, DPT

Dear Friends,

I’d like to take a moment introduce myself as I am so grateful to be the newest member of the TherapydiaSF family. My name is Michelle Cotter and I’m a physical therapist. While I specialize in pediatrics, I love treating adults as well. 

My passion for helping people heal began as a youngster when I volunteered in the athletic training room at my high school while rehabilitating my own injuries.  It was further strengthened when I spent the summer of my junior year in high school helping my mom recover from heart surgery. I received my Doctorate in Physical Therapy from Samuel Merritt University in Oakland, California and completed my final internship at Lucile Packard Children’s Hospital, where I learned the intricacies of proving excellent patient care to children and their families. My experience working on the UC Davis Athletic Training team, as well as over 5 years of clinical experience, has helped me develop expertise in identifying movement dysfunction and choosing the best treatment methods for a variety of injuries for all ages. 

Over the past 3 years, I have also been treating infants and children, assisting in their gross motor development, so that they are able to play and participate in age-appropriate activities with their peers. I have had particular success in developing effective rehabilitation programs for children with developmental delay, positional plagiocephaly and a variety of sports-related injuries.

My goal as a physical therapist is to provide an individualized framework for healing based on current research and patient education.  I aim to facilitate the recovery and prevention of injuries for each patient, no matter what age, so that they may achieve their mobility goals.

I love educating patients about how their body moves and teaching them strategies to change dysfunctional movement patterns. I emphasize educating patients and families on their specific condition and how they will take an active role in the recovery process for optimal health and function. This approach to an interactive plan motivates me to be the best physical therapist I can be. I get great satisfaction in building collaborative partnerships focused on the achievement of life-long health and wellness with my patients

I am very excited for the opportunity to work in such a collaborative and interactive environment that promotes long-term health and wellness and I look forward to meeting each of you! Please feel free to contact me if you would like more information.

Sincerely,

Michelle Cotter, PT, DPT
Doctor of Physical Therapy

Top 5 reasons we are out-of-network with your insurance…and what that means for you

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I sat down earlier this week to write a piece with the title above, but very quickly realized there really aren’t that many reasons. The only reason we are out-of-network with most insurance plans comes down to one simple fact:

We want to offer physical therapy treatment on our own terms, the way physical therapy was intended to be provided.

Most plans have out-of-network reimbursement. Many people think that if a practice is not in-network with their insurance, they can’t seek services at that clinic. The truth is, in most cases, you can work with a PT who is out-of-network. All it means to be in-network is that a physical therapy provider has signed a contract with a health insurance company that allows the insurance company to decide on the value of the physical therapy provided. Sadly, the current climate of physical therapy insurance reimbursement often has providers being paid less than the cost of a personal training or Pilates session, haircut, or full tank of gas.

A few things you need to understand about physical therapy:

  • We have extensive education, training, and are licensed by the state in which we practice (see The Educated Therapist).
  • All physical therapy is not created equal. PT’s do not receive a handbook on graduation day that tells us how to treat a specific diagnosis. Treatment should be customized, taking into consideration an individual’s activities, lifestyle, home and work demands, and even emotions related to the injury or pain.
  • All physical therapists are not created equal. Some PT’s further their education by taking classes and additional training beyond what is required by our governing board. Some PT’s look for every opportunity to expand their knowledge and stay current with studies and treatments. Good PT’s know that there is not one treatment to help everyone and, while we may not be able to cure all, we have a network of additional resources who might.
  • All components of physical therapy, from hands-on treatment to exercise, should be delivered by physical therapists.

We have chosen to stay true to our ideas of how physical therapy should be delivered. We find that our 45-minute treatment sessions, spent entirely with a physical therapist, help us form relationships with our patients, allow us to address multiple components of pain and injury, and often expedite treatment.

While out-of-network benefits vary, we have discovered that out-of-network reimbursement is often comparable to in-network coverage.


 

What does this mean for you?

We will:

  • provide excellent customer service from the first call.
  • check your benefits and discuss these with you before your first visit so that you have an understanding of the payment and reimbursement process.
  • help you find the best PT fit.
  • follow up with your insurance company on outstanding reimbursements.
  • reimburse you as soon as we receive payment from your insurance company.

What’s different?

  • Your PT may structure a different plan of care than used in traditional PT.  Do you really need 2 times per week for 8 weeks? Maybe not. Your PT will work with you to develop a plan that will help you recover effectively, while keeping in mind schedule and financial concerns.
  • We expect you to be actively involved in your own recovery.  We can’t make you better by ourselves.
  • You will have homework. We may ask you to modify some of your activities (Thought you knew how to sit?? Think again). We make these recommendations not to put a wrench in your lifestyle, but because we know they will help expedite the healing process.
  • We will be available to encourage and support you along the way.
  • You can access your PT via email in between appointments if you have questions or concerns.

Please let us know if we can help you learn more about your physical therapy benefits.  We will gladly call your insurance to verify your coverage and provide you with the information we receive.  We look forward to helping you on your path to recovery!

 

The Educated Therapist

Let’s face it. Most physical therapists aren’t winning any sales and marketing awards. Most of us have don’t have a business background and typically enter this profession based on a love of health, exercise and helping others. In school, we don’t really have time to cover anything beyond examination and treatment of our soon-to-be patients. We graduate, enter the world of health and wellness as practitioners of physical therapy, and soon realize the competition is fierce. In San Francisco, a city with something for everyone, there are individuals providing health and wellness services that seem in direct competition with everything we offer. There are personal trainers, massage therapists, Muscle Activation Therapists, Sports Therapists, Neurokinetic Therapists, Core Activation Therapists, and more. Have you ever stopped to consider who is best trained to help you heal? While these practitioners may indeed be skilled at the services they offer, based on our level of education and training, physical therapists are in a league of our own.

The other day, I had a pleasant conversation with a gentleman who was interested in learning more about the field of physical therapy. A seemingly intelligent man, he’d also had personal experience as a recent physical therapy patient. At some point in our conversation, he stopped me and asked, “Do you have to have some sort of certificate to be a physical therapist?” My jaw dropped.  It was then and there I realized how physical therapists have done such a terrible job of informing the public of what we do, what we can offer, and why we should be considered the practitioners of choice for musculoskeletal health.

So here’s what you should know: physical therapists go to school for 7-8 years. This includes 4 years of undergraduate education, heavily based in science (physics, chemistry, microbiology, exercise physiology, etc.), and 3-4 years of graduate-level education. Students graduating from physical therapy programs in the United States today earn a Doctor of Physical Therapy. The first Doctorate program in Physical Therapy was started in 1993 at Creighton University in Nebraska and, as of 2015, all accredited and developing physical therapist programs are DPT programs. Often part of a medical school, PT programs teach physical therapy examination and treatment, as well as courses in Anatomy, Neuroanatomy, Pathology, Pharmacology, Radiology and Differential Diagnosis (how I determine if a symptom may be something more serious—and outside of my scope of practice—than run-of-the-mill back pain). In fact, when I attended UCSF in the early 2000’s, the physical therapy students were the only students who performed full cadaveric dissections. Other programs used the cadavers we spent our first foggy summer in San Francisco dissecting. It was also the start of our collaboration with the first year medical students, where we 2nd year PT students helped teach the medical students musculoskeletal anatomy. Most recently, residencies and fellowships after graduation have grown in popularity to provide advanced training for physical therapy school graduates.

Beyond our formal education, physical therapists are licensed by the state in which we practice and are held to a high level of professional conduct that includes requirements for continuing education every year. Most courses are held on the weekends and many physical therapists travel great distances to take courses of interest. This year alone, PT’s from TherapydiaSF will take courses in San Francisco, San Diego, Montana, and Las Vegas. Some physical therapists also opt to enhance their degree and training by completing board certification in different areas of practice, including Orthopaedics, Pediatrics, Women’s Health, Neurology and 4 other areas of specialty practice.

The next time someone suggests physical therapy, please consider our extensive training and education and know that we have the education, expertise and dedication to help you work, play and move without pain.

 

 

Navigating Nutrition Part One: Processed Food

“Avoid processed foods” is common nutrition advice given out these days. It is a well-intentioned, sound suggestion that seems easy enough to follow…assuming you know what the term “processed foods” means. As it turns out, there is no easy definition of “processed foods”. Most foods we eat are processed in some form or another unless you’re eating it straight out of the ground.

The degree of processing is what most people are talking about when they use this term, and even then, there is no set list of things to avoid, and some processed items are better than others. Generally speaking, this refers to anything that comes in a package, but doesn’t usually apply to things such as milk or whole beans in a can. Confused yet? Who can blame you?

So why is this advice out there? One reason is that it can be very easy to overeat packaged goods. A box of cookies can disappear in an instant, and no time was taken to prepare them. Another reason for this advice is the number of unfamiliar ingredients used in our “food” these days. For example, maltodextrin, soy lecithin, and artificial flavors are all common ingredients found on nutrition labels. Do you have any idea what they are? This isn’t some big exposé, I’m just pointing out that you might not know what you are putting in your body. Lastly, processed foods tend to have a lot of sodium or sugar added in, which isn’t good for us.

It might not feasible to go “package-free”, so here are some rules of thumb to simplify things:

  • Only choose foods with 5 ingredients or less.
  • Make sure you know what each ingredient is, and how it’s made (knowing that something is made “from corn” or “from soy” doesn’t tell you how it’s made).
  • Check the nutrition label for the amount of sodium (look for items with 150mg or less per serving).
  • Choose items with no added sugar. That means NONE of the following ingredients: sugar, corn syrup, fructose, high-fructose corn syrup, agave nectar, honey, brown rice syrup, dextrose, maltose, sucrose, molasses.

Do your best to buy whole foods and do the processing yourself, but when you need to buy things in a package, be sure to check the labels!

The Holidays: A Time of Love, Laughter and Overeating

You know the scene, you swear you’re going to have just one drink at a holiday party, and the next thing you know you’ve lost count and have a killer headache the next morning. Or maybe you show up to the party thinking there will be dinner only to find out they are only serving apps, so you start taking down every bacon-wrapped scallop in sight. Or perhaps your Aunt Margaret swears you’ve lost too much weight and starts handing you a snack every time you walk by. Or hey, maybe it’s just the holidays and you only get this food once a year, so you cram as much as you can onto that plate…and then make a second trip. The holiday season is packed full of healthy eating obstacles (some more fun than others!). If you want to stay healthy through the holidays without adding “lose holiday weight gain” to your New Year’s resolution list, it takes a bit of planning and mindfulness, and we’ll tackle some of the big ones here.

Booze

Without a doubt, the biggest contributor to holiday weight gain is all the extra alcohol consumed throughout the season. We see friends and family we haven’t seen in a while, and every occasion seems like a real good reason to celebrate. Not to mention in addition to the beer, wine, and regular cocktails, eggnog, hot toddy’s, and mulled wine make their way onto the menu this time of year, and hey, it’s been a while since you’ve had one! Here are some tips to keep holding the reins on your alcohol intake:

  • Give yourself a weekly allotment for alcohol and plan it out. If you have several events in one week, decide ahead of time where you would like to spend your “booze dollars”. If you find yourself having trouble sticking to it, you might need to make some events alcohol-free.
  • Keep track – a serving of wine is 5 ounces, which is less than half of most wine glasses. If you fill it up to the top, that’s two drinks. If someone comes around and tops off your glass, count it as another drink. We frequently have the equivalent of 6 drinks in one night, thinking we only had two.
  • Watch the higher calorie drinks – eggnog, cider, and most mixed drinks have a lot of extra calories in addition to the alcohol. If you need to have one for the season, keep it to just one.

Hors d’oeuvres

These tasty little morsels seem so innocent, but do a lot of damage. Typically crowd-pleasing fare, these items tend to be mini-calorie bombs, and if you show up hungry one after another will slide right down, adding up to more than a meal’s worth of calories…before you even get to dinner. So what can you do?

  • If you know the party will be appetizers only, make sure you eat a small healthy meal before you go. This will take the edge off any alcohol you have, and prevent you from stalking the waiters circulating the apps.
  • Only try 1-3 appetizers, and only if they look worth it – the point is for you to get a small taste of an amazing dish, not to substitute for a meal.
  • If it’s a dinner party, try having a small snack with protein beforehand so you can hold out until dinnertime.

Buffets

Buffets are a popular, convenient way to serve dinner, and are generally a healthy-eating nightmare, especially if it’s a potluck. It’s as though someone thought of every food you were trying to avoid and put it all on one table. You’re sure to see at least a few of these this holiday season.

  • Take a tour of the buffet before you get in line. See what’s available and decide ahead of time what you want to put on your plate.
  • Only fill up one dinner plate, and only go through the line once. No, you cannot start stacking the food vertically to get more to fit.
  • Try only small portions of the heavier items and fill most of your plate with the healthier options.

Family

This section could take up its own blog post, or even its own book, and could probably be co-authored by a psychotherapist, but we don’t have room for that here, so we’ll only cover the basics!

  • Stress – is there a lot of tension at your holiday gatherings? Meditation and therapy are more productive solutions, but in the interest of time, try this quick fix: instead of eating to drown your sorrows or avoid talking to someone, bring a large plate of pre-cut veggies to share as hors devours. When you’re feeling frustrated, grab a small plateful of veggies – the crunch will help get your aggravation out and keep your mouth full so you don’t have to talk!
  • The pushers – the ones pushing high-calorie although made-with-love food. Quick fix: small portions, big fanfare. “This is so delicious! You’re such a fantastic cook! No, I can’t fit anymore, I’m so full. It’s so good, but I also want to save room for XYZ too, I wouldn’t want to miss that!”
  • Look for healthier recipes of old favorite foods. If your family resists, stick to a serving the size of a ping-pong ball. The first 3 bites are where you get all the taste and flavor, after that your taste buds become accustomed to the food and you spend the rest of the time trying to “chase the taste”.
  • Bring your own healthy dish so you know there is something there you can fill your plate with.

The holidays should be a jubilant time of year, where you enjoy the company of friends and loved ones. Although everyone has different ways of celebrating during the holiday season, we hit on some common pitfalls here that frequently trip people up. There are certainly challenges we didn’t cover here. If you need a little help figuring out how to enjoy the holidays without damaging your waistline, head on down to see your friendly neighborhood Registered Dietitian. You can get your own customized plan that still allows you to have fun! Happy Holidays!  Bethany is seeing clients at TherapydiaSF, located on Maiden Lane in downtown San Francisco.

On the Run with TPSF: How to Avoid Running Injuries

This issue of On the Run is written by Lindsay Haas, PT, DPT, OCS.  Lindsay is a physical therapist at TherapydiaSF and enjoys working with runners, dancers, and all athletes for rehabilitation from injury and improved sport performance.

The good news is that you signed up for a race.  It may be your first or your twenty-fifth, but you are ready.  Of course you want to stay healthy.  Especially when you are gearing up and looking forward to completing your upcoming race!  The bad news is that rates of injuries in runners is high, and its even higher when training for an event.

The #1 risk factor for injury in running was a history of injury, usually within the past 12 months (1).  Most injuries in running are caused from overuse, which is defined as repetitive microtrauma to the musculoskeletal system.  Increased training loads (such as running more when training for an event) can exacerbate an old injury.  Also, you may have changed your running pattern to compensate for your previous injury and as a result overloaded another part of your body and created a new injury.

The second highest risk factor was the weekly distance.  Runners who complete more than 40 miles per week were found to be more likely to sustain an injury (2). When you run more, you can overload the musculoskeletal system to the point where it can’t recover, thus creating an injury.

So how do you stay healthy throughout your training?

1.  Change it up.  Since most running injuries are caused by overuse and repetitive strain, its important to introduce variety to your training.  You should already be active in strength training (shown to decrease the risk of injury and improve performance!) but you should also be changing up your runs.  Try running on trails, or try altering your pace.  Even if you’re not participating in a training program that incorporates tempo runs and speedwork, there should be some variety in your runs.

2.  Watch your form. It is important to have good running form.  Your cadence is the number of steps taken per minute, and should be more than 170 steps per minute on both feet.  If its too slow, you may be putting too much stress on your body.  Increasing your cadence will help with over-striding.  Focus on taking short quick steps and keeping your feet under your hips.

3.  Treat injuries before they start.  Don’t wait until something hurts.  Using ice and self-myofascial release (such as the foam roller) are good tools for when you are sore, but there are ways to be proactive as well.  Listen to your body, if you need to adjust your workout or take a day off its okay.  When you are running keep track of your heart rate and level of fatigue to know if you need to slow the pace or even stop for the day.  If you are feeling sharp or stabbing pain, you need to stop. Avoid the ‘three too’s’: too much, too soon, too fast.  Pushing yourself too hard can compromise your ability to recover.

Still worried about getting injured while training?  Schedule a Fitness Screen with one of TherapydiaSF’s physical therapists.  We will identify any potential risk factors to injury or decreased performance and create a customized exercise program to help you meet your training goals.

(1)http://sprunig.net/wp-content/uploads/What-are-the-Main-Risk-Factors-for-Running-Related-Injuries_2014.pdf

(2) Walter SD, Hart LE, McIntosh JM, et al. The Ontario cohort study of running-related injuries. Arch Intern Med. 1989;149:2561–4.

 

Fit as a…fiddle?

run-rehab-featured

 

Body image has been a hot topic over the past several years. Recently, many companies have run advertising campaigns to promote healthy body types in reaction to the extremely thin models who have been so prevalent in the media.

The recent video of dancer Misty Copeland has had a huge impact on the dance world and has made us think about the concept of an ideal dancer’s body.  I remember not too long ago, when “athletic body type” was considered a euphemism for “thick” or “heavyset.”  I hope you agree that while Misty is certainly athletic, she is neither thick nor heavyset.

Beyond the notion of an ideal body type, I’ve recently been thinking about the concept of fitness. I blame this partly on recently reading The Sports Gene by David Epstein, and also having just returned from a continuing education class filled with practitioners who each work with a different clientele, including college athletes, golfers, yoga practitioners, and the general population, some more active than others.   As I thought about the baseball pitchers, cyclists, runners, and CrossFit participants with whom we each work, I could easily identify ways they are fit, but I also thought of areas where they may be deficient.  I began to wonder about fitness.

When someone is decribed as “fit”, what does that really mean?  Does it mean the same thing to everyone?  There are different dictionary definitions of fitness, some of which brought a smile to my face:

1. The condition of being physically fit and healthy (I’m going to need a little more here…).

2.  Good health or physical condition, especially as the result of exercise and proper nutrition (ok, we may be getting somewhere…).

3.  The capacity of an organism to survive and transmit its genotype to reproductive offspring as compared to competing organisms (well….I bet you know plenty of people who have the capacity to transmit their genotype to reproductive offspring who you would not call fit).

So, we’re back to the drawing board with defining fitness.

Is a body builder with bulging biceps and massive quads more fit than a marathon runner?

Is Tiger Woods more fit than Serena Williams or Michael Phelps?

What does it mean to be fit?  Ah…what I would do to take a camera out onto the streets of San Francisco and ask people this question (stay tuned…).

As we think about each of the athletes and their respective sports, it quickly becomes clear that fitness is hard to define and describe.  While the bodybuilder might have larger muscles that allow him to lift heavy weights, the marathon runner would certainly show greater cardiovascular endurance across those 26.2 miles.  Tiger Woods and Serena Williams both demonstrate amazing muscular development and precise hand-eye coordination, but if he had to run around the golf course like she does the tennis court, could Tiger keep up with Serena?  Michael loves the game of golf and, like Tiger, has an amazingly strong core, yet I wouldn’t want either one of them representing the other’s sport in competition.

This is an important topic to me both personally and in my work with athletes of all ages, skill levels, shapes and sizes.  To me, there is no one definition of fitness.  I believe that fitness is a balanced combination of strength, stability, balance, flexibility, and endurance…and maybe even mindfulness.  What the general population thinks of as an ideal of fitness may actually be a person who excels in the sport in which they train, but has severe and potentially harmful imbalances in some of the categories mentioned above.  The fittest people with whom I work are those who enjoy a variety of exercise and sporting activities.  These are the folks who are rarely in our studio for treatment, except for the occasional tune up after having changed their routine. Often, the people who appear most physically fit are those who are plagued with injuries related to imbalances in overall fitness.

I’ve learned that there is no one ideal body type just as there may be different ideas of fitness.  I encourage my clients to be successful in their rehab and develop and improve their fitness by recommending a three key steps:

1. Move well and move often.

2. Find something you enjoy doing.

3. Mix up your routine—your body will thank you for it.

So, what does fitness mean to you?

And, in case you were wondering where “Fit as a fiddle” came from…