Physical Therapists and Exercise

Why work with a physical therapist for fitness? 

PT’s are trained in movement:

We are healthcare professionals trained in optimal patterns of movement, posture, and form and will provide a safe and effective workout.

PT’s are experts in anatomy:

We will design a full body program to address strength, flexibility, cardiovascular health, and balance.

PT’s understand injury:

We will design a program that takes into consideration current and previous injuries, muscle imbalances, and current goals.

At TherapydiaSF, we offer a full selection of wellness services including:

  • Pilates
  • yoga
  • TRX training
  • general fitness training
  • small group classes
  • Fitness Screen: complete assessment of strength, flexibility, balance and independent program design.
  • RunRx: complete assessment of strength, flexibility, and video of running mechanics

An Open Letter to Well-meaning Physicians and Well-educated Patients: Volume 1, Pilates

pilates“My doctor said I need Pilates.”

“I have a prescription for Pilates.”

“I’ve been doing Pilates for months and I’m not getting any better.”

Well-meaning physicians and motivated, educated patients frequently make this assertion without a full understanding of what Pilates really is.  My hope with this post is to explain a bit more about Pilates and why the method may or may not be the best treatment for you.

1.  Pilates is an exercise method 

Joseph Pilates, a German medic who trained in boxing and gymnastics, developed Pilates as a form of exercise in the early 20th century.  As a child, he suffered from asthma, rickets and rheumatic fever. Though he had no formal training, Pilates was dedicated to improving his physical fitness and fascinated with the study of human movement.  He believed that postural dysfunction and inefficient breathing techniques contributed to poor health. Seems like he was onto something here, right?  (see Breathing and Low Back Pain: Is There a Correlation?)  When he emigrated from Germany in the 1920s, Joseph and his wife Clara developed a following in the dance community in New York City.  As its  popularity grew,  The Pilates Method became mainstream, offered in gyms, studios and often taught as an adjunct in physical therapy clinics.

2.  Pilates is not synonymous with core stabilization

When physicians write “Pilates” on a prescription for physical therapy, it is likely that they are recommending core stabilization for their patient.  However, Pilates is too broad a term to use when making suggestions regarding a patient’s rehabilitation without a full understanding of all of the factors that may contribute to a person’s injury.  Not everyone with back pain has a weak core (GASP!) and not everyone has tight hamstrings…more on this in a future post.

3.  Pilates is not synonymous with rehabilitation  

Several years ago I sat in on a meeting of a group of local Pilates instructors to discuss forming a collective. During the meeting, I was surprised to hear such disagreement between instructors about what they actually do.  One in particular was adamant that she provided rehabilitation for her clients.  Another well-known instructor was equally vocal stating that Pilates instructors teach a method of exercise that may be helpful as clients work to rehabilitate an injury, but they do not, in fact, provide injury rehabilitation.  As a physical therapist who is Board Certified in Orthopedics, I use my Pilates training to enhance my educational foundation in anatomy, kinesiology, and pathology.  In the United States, there is a fairly large discrepancy in the training involved to qualify as a Pilates instructor.  Some instructors train with Master Trainers and participate in educational programs that include a basic study of anatomy with observation and practice hours.  These programs may also involve education about specific injuries and assessment of abnormal movement patterns and provide information on what types of exercises should be avoided.  Many instructors, like myself, are licensed physical therapists looking to expand their exercise instruction techniques.  On the other end of the spectrum are those who take a weekend class, or do some training on their own to teach Pilates. A physical therapist is best trained to perform a full physical examination to determine the most appropriate routine of core stability exercises, or whether stabilization is even the correct treatment for the patient.

4.  Pilates is not appropriate for everyone

Unfortunately, as its popularity has increased, Pilates as a method of exercise has become less defined over the years. Now, virtually any type of movement performed on a Pilates Reformer or mat can be labeled Pilates and without experience working with a qualified instructor, you may never know the difference.  When a physician recommends the method, a coworker suggests Pilates because, “it worked for me,” or you choose to do Pilates independently with a video, you are applying a very broad exercise method to a condition that may require a little more specificity and individualization.  In fact, many Pilates exercises, both mat-based and on the equipment, are flexion-based and not only inappropriate for some patients, but actually contraindicated (e.g. herniated disc, osteoporosis).  Exercises that promote strengthening the back of the body (posterior chain) may exacerbate other conditions (e.g. stenosis, spondylolisthesis).

Take home message:

Pilates is too broad a term to use when making suggestions regarding a patient’s rehabilitation.

Pilates should never replace work with a qualified rehabilitation specialist trained to treat injury.  Nor should someone with an injury attempt to use self-guided Pilates exercises to treat or manage their injury.  A successful treatment strategy often includes work with both a physical therapist and a Pilates instructor open to collaborating in order to best help their client.

If your physician has recommended Pilates, or you need a specialized program, find a physical therapist with training in Pilates.  You will receive a thorough examination that will help the therapist develop a treatment plan and determine if you are appropriate to begin work with a Pilates instructor, or if you should start with Pilates-based physical therapy.  

It’s Beginning to Look a lot Like…already??

Maiden LaneReady or not, the holiday season is upon us!  The days are shorter, the air is crisp and, believe it or not, decorative snowflakes already adorn San Francisco city streetlights. As our calendars fill with holiday dinners, work celebrations and parties with friends, it can be hard to maintain our normal eating and exercise routines.  Yet, all it takes is a little bit of planning to make it through the season and still fit into your favorite pants come January.

1. Schedule your workouts: Just as you would with any meeting, add your daily workout to your calendar and treat it as you would any other commitment.  Everyone has a preferred time of day for a workout, but when the days get busy, it’s great to have your workout done first thing.  Another benefit of exercising early was shown in a 2011 study at Appalachian State University when researchers discovered that morning workouts are best to help provide a good night’s sleep.  Early morning exercisers slept longer and spent more time in the reparative or deep sleep cycle at nigh

2. Make exercise easy:  If you’re heading out for some shopping, park farther away to get a little extra walk in.  Take a breather from close quarters with family to take a run or walk through the neighborhood.  Almost 13 years ago I started my Birthday Run tradition.  I was born on Christmas and have the good fortune to spend most of my day surrounded by loved ones.  As a way to start to my new year and have some time on my own at the beginning of the day, I take a run the length of my new age wherever I am.  This may be a problem when I hit my 70s, but for now I enjoy the time by myself.  I tried to skip it once on a rainy Christmas Day a few years ago.  Fortunately, my cousin Jordan shamed me into going and, thanks to him, I haven’t missed a Birthday Run in 13 years.  If you can’t head out by yourself, make it a family affair and enjoy some fresh air and exercise with them.

3. Have someone to keep you accountable:  Just like Jordan was my conscience, sometimes it is helpful to enlist a friend to meet for a workout.  If you need a bigger push, schedule time with one of the therapists at TherapydiaSF who can design a program and help you stick with it.  Trained in movement and experts in musculoskeletal anatomy, physical therapists work with both injured and healthy clients.  At TherapydiaSF more than a quarter of our clients take part in our Wellness Programs including group classes, Pilates, TRX, or RunRx.

4. Everything in moderation:  Can’t pass up mom’s mashed potatoes at Thanksgiving or your friend’s toffee at her holiday party?  Feel free to sample, but watch your portions.  My friend and I had a rule around the holidays when we worked together at another PT clinic.  If we were going to indulge in a treat, it “had to be worth it”.  This generally included various homemade and gourmet treats.  Sometimes we disagreed on whether it was worth it, but just asking the question made us stop to think.  Some believe that the Law of Diminishing Returns applies to eating–the more you eat of something, the less enjoyment it provides. At parties, know what you’re eating by making one trip to the food table to fill a small plate versus sampling from passed hors d’oeuvres or revisiting the buffet over and over…and make sure it’s worth it!

A Collaborative Effort: Acupuncture for Athletes

Guest post by Vita Yee, L.Ac.

Vita Yee, L.Ac.

Vita Yee, L.Ac.

Acupuncture Helps Athletes Like You!

Whether you’re a weekend warrior or an Olympic athlete, whether you dance for the SF Ballet or for fun, as long as you move, you’re going to put your body to work under stressful and challenging conditions.  We all juggle extremely full lives, and want to perform at our very best in all situations.  Acupuncture can be a powerful tool to help keep us tuned for optimal health so we can continue to do what makes us happy!

Acupuncture is part of a comprehensive natural health care system that has been used for thousands of years to preserve health as well as diagnose, treat and prevent illness.  According to Chinese medicine theory, optimal physiological function and health depend on the proper circulation of nutrients, substances and energy through a network of “channels” or “meridians” in the body.  Like a very complex and extensive roadmap, this network connects every organ and part of the body, providing balance, regulation and coordination of anatomy and physiological processes.  By inserting very fine needles into specific acupuncture points along these channels of circulation, we can influence the physiological functioning of the body.  Acupuncture activates the natural, self-healing abilities of the body through the stimulation of  “acupoints.”

In my clinic, I use acupuncture for a variety of conditions, including traumatic injuries, post-surgery rehab, and musculoskeletal and constitutional imbalances.  It is often effective for relieving pain and muscle spasm and improving circulation to tense or injured tissues.  I find acupuncture especially effective for acute injuries (like sprains and strains) as well as chronic injuries which have responded poorly to other types of treatment.

Here are some good reasons to try acupuncture!

1. Acupuncture relieves pain:  According to Chinese medicine, energy is constantly moving through the body. When it is circulating properly, we feel balanced and strong. When energy is blocked or stagnated, we experience it as pain, dysfunction and disease. Western Medicine studies have shown that acupuncture leads to the release of endorphins1, natural painkillers that help reduce pain2 and promote an increased sense of wellbeing.

2. Acupuncture reduces inflammation: Acupuncture sends signals through the peripheral and central nervous systems to stimulate a healing response.3 Reducing inflammation and improving the circulation of oxygen and nutrient-rich blood flow into the injured tissue allows for increases in range of motion, helping us move better!

3.  Acupuncture restores homeostasis: Athletes train hard and for extended periods of time, which can lead to muscular and physiological imbalances.  Treating specific acupoints of injured or imbalanced muscles resets the communication between the muscles and the brain, reducing pain and restoring proper muscle function.4 Restoring balance to complimentary muscle groups releases pressure on joints and nerves, which allows the body to move more freely and efficiently and, ultimately, prevents extreme wear and tear on the body.

4.  Acupuncture enhances sports performance:  The Journal of Strength and Conditioning Research reports that the use of acupuncture in resistance and endurance sports activities increases muscular strength and power.  The study also suggests acupuncture improves the hemodynamic parameters of endurance athletes.5

5. Acupuncture improves blood flow:  Blood flow decreases as we age and can be impacted by trauma, injuries, and disease.  A study from UCLA Medical Center concludes that one reason acupuncture is effective is due to its ability to increase the release of nitric oxide throughout the body.6 Nitric oxide is a vasodilator, which opens up the arteries and allows for more blood flow to your heart and other internal organs.  This is significant because everything the body needs to heal is in the blood, including oxygen, nutrients that promote good tissue health, immunity support, hormones, natural analgesics, and anti-inflammatories. Restoring proper blood flow is vital to promoting and maintaining health.

6. Better quality of life:  Perhaps the most important systemic effect of acupuncture is its ability to reduce stress. Research from Georgetown University Medical Center suggests that acupuncture significantly reduces levels of a protein linked to chronic stress, which may help explain the sense of well-being that many people receive from acupuncture.7 A preliminary report in 2004 found that acupuncture increased nighttime melatonin production and total sleep time.8 The patients who received acupuncture fell asleep easier, were less restless at night, and were less stressed.  The body repairs itself at rest, so sleeping well is vital for improved athletic performance!

Chinese medicine requires us to look at health with a different perspective. It operates under the premise that our bodies are constantly seeking balance and strength naturally.  In this context, health is a dynamic result of nurturing, supporting and cultivating the inherent intelligence of the body to do its own job.  Whether you are experiencing a chronic problem, a recent injury or want to achieve optimal health, restoring balance is the key to your well-being.

If you’ve got more questions, you can find me at v.acupuncture@gmail.com!

BONUS: Acupuncture + Physical Therapy:  A study published in the American Journal of Chinese Medicine showed that the integration of acupuncture and physical therapy to treat frozen shoulder led to a better outcome than using only one method.9

1 http://www.ncbi.nlm.nih.gov/pubmed/22965186

2 http://www.ncbi.nlm.nih.gov/pubmed/15135942

3 http://www.ncbi.nlm.nih.gov/pubmed/20512135

4 Callison, M.  “The Effect of Motor Point Needling on Painful Shoulder Conditions: Range of Motion and Manual Muscle Testing.” [Unpublished] 1997.

5 http://www.ncbi.nlm.nih.gov/pubmed/20386479

6 http://www.ncbi.nlm.nih.gov/pubmed/19468961

7 http://www.ncbi.nlm.nih.gov/pubmed/22156045

8 http://www.ncbi.nlm.nih.gov/pubmed/14990755

9 http://www.ncbi.nlm.nih.gov/pubmed/17080543

Healthy Hydration

ImageGuest post by San Francisco-based Nutritionist, Bethany Pianca:

We have all heard that staying hydrated is important.  It is also widely known that the body is mostly made up of water (approximately 60% in adults).  So what’s the big deal?  Many of the reactions that take place in our cells require water.  That can be hard for us to visualize, but it results in things we can see and feel.  When dehydrated, our skin can be dry, as opposed to plump and healthy looking.  Our brain doesn’t work as well when we are dehydrated, and slower thinking and headaches can result. It even makes a difference in the world of sports.  Dehydration can affect our muscle strength and endurance, and even our aerobic performance.  An additional undesirable effect of dehydration – it can make you think you’re hungry, when really you’re thirsty, resulting in often-unwanted weight gain.  Even with this knowledge, some people still have a hard time staying hydrated throughout the day. So how much water should you have each day?  The Adequate Intake set by the United States Department of Agriculture is 3.7 liters per day for adult males (15-16 cups) and 2.7 liters per day for adult females (11-12 cups).  Keep in mind that it is possible to drink too much water, so it is important never to force yourself to drink too much.  Here are some tips for staying optimally hydrated.

  • Weigh yourself before and after you exercise.  For every pound you lost while exercising, drink 16oz of fluid to replace it.
  • Keep a water bottle with you throughout the day and take small sips so you don’t feel like you have to drink a lot at a time.
  • Keep caffeine and alcohol to a minimum as these both act as diuretics, which can dehydrate you further.
  •  If you don’t like plain water, try putting a little lemon in it, or drinking an herbal tea (Note: make sure to fully research an herbal tea before consumption, some can have dangerous side effects).
  • For exercise lasting longer than 60 minutes, you may need to replace electrolytes in addition to water.  This can be accomplished by having a snack (such as a banana) along with your water, or by consuming a sports drink (careful though, sports drinks can be tough on teeth!).

Bethany Pianca is a Nutritionist with a B.S. in Dietetics from San Francisco State University.  She is currently an intern at San Francisco State University working towards becoming a Registered Dietitian.  With experience counseling those looking to lose weight, boost energy, or just improve their diet, Bethany focuses on making changes that fit the client’s lifestyle.

What is Wellness?

Seems like everyone I know is a Wellness Coach these days.  Sounds great, but what exactly does it mean?  As much a buzzword in the health, fitness, and nutrition industry as local, organic, and artisanal are to the food and beverage industry, the term wellness may need a little more explanation.

On January 1, 2005 new legislation was passed to allow physical therapists in California to practice “wellness”.  What exactly did that permit us to do?  We could now see clients for “the promotion and maintenance of physical fitness to enhance the bodily movement related to health and wellness of individuals through the use of physical therapy interventions.” It is perplexing that physical therapists, healthcare professionals with extensive training in anatomy, physiology and pathology, had been previously relegated to treating only the injured.  There is no legislation to limit access to personal trainers and massage therapists.  Funny that it took a Senate Bill to allow CA PT’s to work preventatively with healthy adults.

I have always enjoyed my role as Wellness Provider (see definition above).   I believe that physical therapists are best poised to fill this role beyond formal rehabilitation.  Physical therapists have the training and formal education to help you before an injury occurs. You see your doctor and dentist on a regular basis.  Why not schedule an annual exam with an expert in neuromuscular health?

In addition to the Wellness Screen that many clients schedule annually, we offer a range of Wellness Services at TherapydiaSF.  Many clients have continued working with me following rehabilitation for a specific injury because of my training as physical therapist.  For those who wish to schedule Wellness sessions, we offer customized single and partner Pilates or TRX sessions as well as small group classes that are limited in size to provide attention to form. Injured or healthy runners benefit from RunRx, our program to evaluate run form and provide a custom, progressive training plan for improved performance and prevention of injury.

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The label “Wellness Provider” is not exclusive to physical therapists.  Other professions use this term though it’s meaning may be different from industry to industry.   If you are interested in working with someone who calls him or herself a Health or Wellness Coach, ask them what it means.  Do they have specialized training in a particular skill beyond their primary occupation?  How are they unique compared to another massage therapist, personal trainer, nutritionist or life coach?

Don’t be fooled by labels.

Pain IS the perfect excuse…

…to call your physical therapist.  I get it.  I’m the one who cleans the apartment BEFORE the housekeeper comes. But waiting to schedule because you’re in too much pain is like telling your dentist, “my teeth are too dirty”, your personal trainer, “I need to lose weight before I start ” or your therapist, “I’m too down in the dumps to see you today.”  I can understand the fear that a PT may make you move, but being in pain is exactly why you should see a PT who will assess your movement and choose a treatment to alleviate your symptoms.  

Suspension Training 101

ImageYou’ve probably seen the black and yellow “straps” hanging in your gym or, if you live in San Francisco, you’re just as likely to have seen them anchored to a stop sign at a busy intersection.  Developed by former Navy Seal and Stanford graduate Randy Hetrick, TRX is a San Francisco-based company that is sweeping the nation with a new form of fitness training.  Used in the military and found worldwide in professional sports team training facilities, TRX Suspension Training is a tool that allows individuals to use their own body weight to develop strength, stability and flexibility.

TRX can be used to make exercises more challenging by adding instability to a movement, make exercises more manageable by assisting the movement, and allows participants to work multiple areas of the body in all planes of movement.   By simply adjusting your body position, you can change the resistance of an exercise, and control how challenging the workout is. But before you start thinking TRX is only for the elite athlete, read on…

I have been working as part of the TRX team for over two years, originally as a client.  I knew of the product and even had one in the clinic where I worked, but it wasn’t until a patient told me that his goal for physical therapy was to get back to using his TRX that I started to wonder how it might be beneficial for my clients.  A case of perfect timing, TRX was just releasing their Sports Medicine Suspension Training Course for healthcare practitioners and I was asked to become an instructor.   Over the past two years I have presented the one day course around the country and have had the opportunity to meet and engage with some of the best and brightest in the rehabilitation and fitness industries.

While TRX is not the only tool I use in my treatments, I can’t think of any client for whom it would be inappropriate. So why exactly do I use TRX in my practice?  TRX is a tool that allows me to:

  • Teach proper movement
  • Assist movement that a client might otherwise have difficulty performing
  • Unload healing bones, joints, ligaments, tendons, and muscles during the rehab process
  • Combine balance, stability and strength work into challenging full body exercises.
  • Provide a workout to the entire body during the rehab process
  • Save space and improve compliance due to easy set up and portability

If you would like to learn more about how TRX might be useful in your rehabilitation or are looking for a new form of exercise contact us today!

415.765.1502

info@therapydiasf.com

Join our Matrix Mashup class!

Led by physical therapist, Master Instructor for TRX and Pilates instructor Sydney James, this 6-week strength & conditioning circuit class incorporates a wide variety of exercises and equipment.  Experience a full-body workout to improve fitness and enhance your current exercise routine. With the class size limited to 10, participants can work at their own pace and will receive individual attention.

Join us Tuesday evenings 6-7 pm June 11-July 16.

Drop-in (based on availability) $35
6 week series: $150

Contact info@therapydiasf.com or call 415-765-1502 to sign up.

Solving the Footstrike Puzzle

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It seems that just about everyone has an opinion about running.  A few years ago most of the questions I’d get were about the effect of running on joints.  Now, the talk is focused on footstrike patterns–what part of your foot you should land on when running.  Some state that we should be landing on the ball of the foot (forefoot) and that modern running shoes have created generations of heel strikers.  Many of these passionate advocates proclaim that heelstriking is bad for the body and can cause injury.

Turns out, the argument is not so cut and dry.  According to continued research, there may not actually be one right way to run.  This is music to my ears.  I’ve always held firm to the belief that there is more than one way to get something done, including parking the car in the garage…ahem.

The question comes up frequently these days, though appears in many different forms-

“Should I switch to barefoot running?”

“Isn’t landing on your heel bad for you?”

…and much more commonly as a statement,

“So, I tried to change to a forefoot strike…”

“Heelstriking is bad for you.”

“If you run without shoes, you will land on your forefoot”

“Landing on your toes prevents injuries”

Seems like everyone knows all there is to know about running and running form.  Which is actually quite funny considering the researchers and clinicians are all still trying to wrap their heads around the footstrike puzzle.

When I evaluate a runner who wants to change their form, the first question I ask is, “why?”.  We live in an age with endless information at the tips of our fingers and connect with people and groups we don’t even know through social media, many who have strong opinions, seemingly supported by research. The runners with whom I work are tech-savvy, bright, educated, curious, motivated, and sometimes even obsessed.  They collect information from various sources and have other influences–friends, coaches, personal trainers, and other healthcare practitioners who may be suggesting one form over another. It is important I understand the motivation for wanting to become a forefoot striker.  My general recommendation is that unless a runner has an injury that may be helped by modifying form, there really is no reason to try to change how they are running.

A very famous and often quoted research study became gospel truth in 2010 when it was published in Nature.  Harvard researcher Daniel Lieberman studied 5 different groups of runners, including some who had never worn shoes and others who had always worn shoes but ran barefoot.  He evaluated their footstrike patterns as they ran at an average pace of 5:00/mile on a track fitted with a forceplate.  The study concluded that those who had never worn shoes ran with a forefoot strike pattern, implying there would be a difference in the running style of people who wear shoes.  The study also showed a decreased rate of loading and lower collision forces in barefoot runners when compared to shod runners.  However, while the media (need reference) boldly claimed, “running barefoot was less likely to cause injury as a result of the lower impact forces it caused,” the article concludes with a more accurate statement, “controlled prospective studies are needed to test the hypothesis that individuals who do not predominantly rearfoot strike either barefoot or in minimal footwear, as the foot apparently evolved to do, have reduced injury rates.”

A more recent study published this January evaluated the footstrike patterns in a different group of Kenyans.  Though this group is not known for distance running, they are still physically active and, like the participants in the earlier study, do not wear shoes.  Similar to the 2010 study, these runners ran barefoot along a track fitted with a forceplate but at a comfortable, distance-running pace, averaging around 8:00 per mile.  Contrary to the results of the earlier study, 72 percent landed on their heels, 24 percent on the midfoot, and only 4 percent on the forefoot.  However, when the participants were asked to run at a sprint, many landed closer to the forefoot while only 43 percent landed on their heels.  The results of this study seem to indicate that pace may dictate footstrike patterns more than choice of footwear.

One interesting observation that may surprise some is that running barefoot does not necessarily create a forefoot landing pattern.  In my assessment of hundreds of runners over the years, I quickly learned that this commonly held belief is false.  Many runners who think they are landing on their forefoot are actually landing in the middle of their foot or even continuing to strike heel first.  Another important consideration when working with injured runners or those interested in trying barefoot running is that while loading of the knee is decreased with a forefoot landing, loads and the foot and ankle are actually increased.  This may be a reason why someone attempts to modify their landing pattern, but the recommendation must be specific to the runner, depends on many other variables, and should only be made after a thorough assessment by a qualified professional.

TherapydiaSF offers running analysis through our RunRx program.  Call 415.765.1502 or email info@therapydiasf.com for more information.

References:

Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG (2013) Variation in Foot Strike Patterns during Running among Habitually Barefoot Populations. PLoS ONE 8(1): e52548. doi:10.1371/journal.pone.0052548

Kleindienst, F.I., Campe, S., Graf, E.S., Michel, K.J., & Witte, K. 2007. Differences between fore- and rearfoot strike running patterns on kinetics and kinematics. International Society of Biomechanics in Sports. Ouro Preto, Brazil.

Lieberman, DE, Venkadesan, M, Werbel, WA, Daoud, AI, D’Andrea, S, Davis, IS, Mang’Eni, RO, Pitsiladis, Y. Foot Strike Patterns and Collision Forces in Habitually Barefoot Versus Shod Runners. Nature. 2010; 463(7280):531-535. 12.