Do you leak when you lift?

By: admin Published: July 14, 2017

Here is an article written by our former student, recently graduated: Erin Brunelle, PT, DPT

CrossFit has developed a loyal following of fitness enthusiasts. An often-cited benefit of CrossFIt is that it develops functional fitness skills, meaning that what you learn to do in CrossFit (e.g. lift weights) helps you perform better in everyday life (e.g. lifting boxes when you clean your garage). However, CrossFit seems to miss the mark on training a very important yet rarely-discussed component of the core – the pelvic floor.

Realistically, most fitness regimens don’t address the pelvic floor. Most people think only of the abdominals when someone refers to their “core”. But the core is actually a cylinder of muscles that includes the pelvic floor. The abdominals make up the front of the cylinder, the deep back muscles are the back of the cylinder, the top of the cylinder is the respiratory diaphragm, and the bottom is the pelvic floor. See this video of Amy Flory, PT, giving a short explanation of this concept HERE.

Because this cylinder is pressurized, it is often compared to a soda can (see diagram).

Core=soda can

The “core” is a pressurized cylinder

So think about this: if the inside of the cylinder is pressurized (what we would call intra-abdominal pressure) and the only way out is through the pelvic floor, what is likely to happen in instances of increased intra-abdominal pressure, such as when we lift heavy objects? That’s right. Urine leakage, or what we would technically refer to as stress incontinence (not psychological stress, but mechanical stress).  Sometimes, that increased pressure can also result in dropping or bulging of the pelvic organs.

And here’s the thing: stress incontinence should not happen, even when you’re setting a new personal record in the power clean! The pelvic floor muscles are skeletal muscles, meaning that they can be trained and strengthened like your quads or biceps. You just have to learn how to contract them (think Kegels) and get in the habit of engaging them when you’re lifting or jumping. For help on training your pelvic floor muscles and reducing long-term tissue damage that result in stress incontinence and pelvic organ prolapse, make an appointment with a pelvic floor physical therapist.  There are two of them at CoreBalance: Amy Flory, PT, and Colleen Gest, PT.  If you live outside of northern Arizona, they can help you find a specialist close to you as well!

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CoreBalance Therapy welcomes Tiana Tallant, MA, PT, DPT

By: admin Published: June 22, 2017

CoreBalance Therapy is delighted to announce the addition of Tiana Tallant, MA, PT, DPT to our staff!

We’ve known Tiana for years, as she was an employee prior to completing her doctorate in physical therapy, and we could not be happier that she has decided to come back and work with us now that she holds her physical therapy license. She brings a wealth of knowledge and skills as well as a delightful and empowering personality to our clinic.

Tiana holds a Master’s degree in Health Psychology, which helps her to better understand how people’s behavior interacts with their health conditions. That background fits perfectly into her interest in the management of persistent pain conditions, where treatments such as behavioral modification, meditation and cognitive therapies offer great potential for improved management and function. Tiana also has been a registered yoga therapist (RYT) for years, teaching in the community, and brings that expertise to exercise programming and design of home exercise programs for her patients. Finally, Tiana is an accomplished athlete, competing in CrossFit competitions and distance running events at a statewide level.

We asked Tiana to write something about herself, so you can all see why we’re so excited about having her:

“We are not a singular thing-we are built to change.” -unknown

This is one of the fundamental principles that I operate from in my everyday life and in how I treat patients. My name is Tiana Tallant and I am the newest physical therapist at CoreBalance. I graduated from the NAU DPT program earlier this year and am incredibly grateful for the opportunity to begin my career at CoreBalance. Before entering PT school, I completed my MA in Clinical Health Psychology which allowed me to dedicate time and effort into understanding the human relationship with change- what drives us to change, what barriers we have to overcome, and how we use our environment and/ or relationships to create those changes. In my perspective, coming into the clinic for Physical Therapy is another scenario that asks us to change. It takes us out of our normal routine and for the short term or the long term asks us to do some things differently. Whether you are seeking therapy for an acute or chronic condition, I will ask you for a commitment to try something different- maybe completing exercises at home, being more active, or trying to engage in a certain movement pattern differently. Whatever it is, you will have the opportunity to create meaningful change through your experience with Physical Therapy. I so look forward to being by your side throughout the process!!

Tiana is seeing patients at our University location. Her areas of particular clinical interest are musculoskeletal injuries of all types, patients with persistent ongoing pain conditions, and patients who are experiencing difficulty developing an exercise routine for the management of chronic health conditions such as diabetes, high blood pressure, or long-term weight management.  You can learn more about Tiana and the rest of our provider team by clicking here, or call us at 928-556-9935 to make an appointment to see any of us.

Graston Technique

By: admin Published: May 6, 2014

by Holly Nester, PT, MPT

What is Graston Technique?

Graston is a respected form of instrument-assisted soft tissue mobilization used to effectively treat pain and restricted mobility.   Therapists specially trained in the Graston techniques utilize uniquely designed stainless steel instruments to break down fascial restrictions and scar tissue that impair normal movement.

Graston

 

What are the benefits? 

  • Assists with faster recovery by addressing the restricted tissues that are causing dysfunction
  • May reduce need for anti-inflammatory medications
  • Is effective for both acute and chronic conditions
  • Increases tissue mobility resulting in less pain and stiffness

What types of patients are treated with Graston?

Graston is appropriate for those who would benefit from manual therapy and lengthening of restricted tissue.  While I continue to have great results with direct hands-on treatment, Graston techniques offer an alternative approach that is especially beneficial for deeper or long standing restricted areas where fibrotic tissue is contributing to injury and/or pain.  Diagnoses that I have successfully treated with Graston include:

  • Neck/back pain
  • Carpal tunnel syndrome
  • Tendinitis/epicondylitis
  • Hip/knee disorders
  • Plantar fasciitis
  • Scar tissue

What to expect?

The internet has pictures of people horribly bruised following Graston techniques, but this is not the norm.  While Graston is used for professional and Olympic athletes who may tolerate that type of extremely deep work, most people treated in our physical therapy clinic can anticipate a much less severe response.  Typically we warm up the tissues so that they are less tender and more responsive to lengthening.  Hands on techniques may be used in conjunction with Graston instruments to lengthen the injured tissue and allow for more normal movement patterns and reduced pain.  There may be reddening of the skin, tenderness, and some light bruising depending on the individual and depth of pressure used.  It is always done to the patients’ tolerance and with their consent.  Exercise and ice are often included as part of treatment following Graston techniques.

Click here for a printable information sheet on Graston technique.

What research is available?

If you are interested in reading available research articles, please visit www.grastontechnique.com for more information.

What Do Patients Say?

“Before receiving Graston, I had repeated injuries of various sorts (e.g. pulled hamstring and chronic tension).  With Graston, Holly was able to get to areas connected to the “tight spots” that ultimately got to the root of the issues.  I am so grateful for her wisdom and the Graston technique!  Now I know that what was once chronic pain does not have to be normal for me any longer.”

 

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Staying Active While Injured

By: admin Published: November 24, 2013

by Katie Pierce, PT, DPT

Has being laid up with an injury gotten you down?dog play and knee scooter 073 (956x1280)

Dealing with a physical injury, chronic pain, or other health condition can be a real game-changer. Activities which used to be easy (like walking across a room, let alone taking your dog out for a run), now seem almost impossible.  Even if the condition is short-lived (such as I faced this fall when I injured my ankle while running, and had to wear a cast and use crutches for several weeks), plummeting physical activity levels can be a real downer. But with a little determination and some creativity, an injury or health condition doesn’t have to be a sentence for house-arrest. Here are some tips to help you find ways to safely engage in physical activity while dealing with an injury or other health condition:

Alter your workout: Change mode, intensity, frequency, or duration:

The mode (how you are exercising) may be the first thing that needs to change while you’re recovering from injury. No matter how much I would love to deny the fact, I was NOT going to be able to run while my leg was in a fiberglass cast and I was non-weight-bearing on crutches. Arghh… But I could don my water-proof cast cover and get in the pool.  Or ride a “New Step” seated stepper machine at my local community center  by peddling with both arms and my left leg only.

Your favorite activities may be out-of-reach for awhile, but there are other creative ways to keep your activity level up. And “New Stepping” with the folks at the local senior center, I learned, no matter how much it’s NOT running, is much better than staying home and skipping the day’s exercise altogether. Why? Because I crave those exercise-induced endorphins! Any exercise which gets the heart rate up and keeps it there for a period of time, can effectively boost feel-good neurotransmitter levels in the brain, such as serotonin and epinephrine  (DG Amen, 2010).

Other, more subtle changes to your exercise routine may do the trick. Reducing intensity, for example , may be all it takes to allow a less serious injury to heal. Or reduce frequency of the offending activity (e.g. biking 5 times a week was nagging at your knee, so you reduce to twice a week), while choosing a different mode of exercise on the days off. Or duration: simply do the activity for less time. Your Physical therapist can help you decide which changes need to be made to your typical exercise program to help you heal, while still meeting your needs for physical activity.

winter crutch outings

Disclaimer: Special equipment is being used to keep me safe in this photo (Yak Trax on the boots, metal spikes on the crutches… Don’t try this without proper gear! See next section, below)

Nature has been called “Vitamin N,” because outdoor time is so essential to our well being as homo sapiens (Louv, 2012). Getting outside can be key to boosting mood, especially if your primary mode(s) of physical activity before your injury involved the out-of-doors.

Meeting your cardiovascular exercise needs outdoors may not  be possible, depending on your injury or health condition. But just “being” outside can still provide a needed lift to your spirits.  Earlier this fall, while non weight-bearing on crutches, and nursing a sore shoulder, I could literally only propel myself a few hundred feet at a time.  But I still made plans to drive up with a friend to the edge of the National Forest almost daily. We’d park, and I’d crutch out several yards and sit on rock, listening to the sounds of Nature and feeling the warmth of the sun on my skin. I couldn’t exercise outdoors, but I could still enjoy the gifts of beauty of it.  And then I’d go to the pool for my aerobic exercise. It took some planning and extra time, yet I could feel the mental boost it gave me to spend time outdoors every day.

Be creative:  Special tools and equipment can help you do what you love

Sometimes the limitations of an injury make certain forms of exercise unsafe (think rubber crutch tips on snow and ice) or impractical (a fiberglass cast in the swimming pool?).  My clients with dizziness and imbalance, for example, just can’t safely ride their bikes when dealing with a flare in their symptoms.

But a little creativity – and some special products – can help solve problems like these. “Crutch tips for snow and ice,” (my actual Google search terms) for example, were my best friends last winter, and turned seemingly treacherous situations into an easy crutch-walk. Can’t get a cast wet? No problem: Waterproof vacuum-sealed cast covers are at your service. Just search online, you’ll be surprised at what’s for sale.

jog belt

Ask to borrow a blue “aqua jogging belt” at a local aquatic facility – You can use it in deep water, or if you can bear some weight, in chest-high water with your feet touching bottom…

But what about more complicated conditions, like spine pain or dizziness? Spine pain can be a tricky injury for those wanting cardiovascular exercise, because many motions can trigger pain – twisting, flexing, bouncing, etc.  But what about deep water jogging?  Aqua Jogging belts are designed to allow you to move in deep water without sinking, and allow you to maintain good postural alignment while moving your limbs and raising your heart rate. Here in Flagstaff, you can borrow an “Aqua Jogger” at no extra charge with your day pass to both the Aquaplex or NAU’s Wall Aquatic Center.

Dizziness and imbalance can be tricky, too. A few of my clients have returned to their love of biking while still healing from vestibular disorders, by setting up a stationary bike trainer and getting those wheels turning, safely.

Rental products for mobility can help with leg injuries: my “knee scooter” and I, below, had a great time participating in a “Splash 2 Dash” race at NAU.  So what if I didn’t finish the 5K run (OK, so I scooted about 400 meters then called it a day)? I still had a blast, and I rocked the swim portion, waterproof cast protector and all.

 So the moral of the story?  Exercise is good for the body, and for your spirits, too. Your Physical Therapist can help you design an exercise program to keep you as fit [and happy] as possible while you let your body heal.

Contact the expert physical therapists at CoreBalance Therapy, for evaluation for an injury or mobility condition, and learn how to stay active while you recover.

You just might see this active P.T. crutching around the clinic, for a few more weeks…

Yours,

Katie

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Iliotibial Band Syndrome

By: admin Published: September 2, 2013

Well, it’s ITB season, that time every year in Flagstaff when runners have ramped up their hill work to compete in the Imogene Pass Run, a 17.1 mile race up and over the Imogene Pass in Colorado.

Iliotibial Band Syndrome is characterized by pain and focal tenderness in the lateral knee. Specific aggravating activities include sprinting, running down hills or stairs, cycling up hills, and walking or hiking two or more miles. Usually discomfort increases as subjects continue to perform the implicated activity and pain usually stops with cessation of activity. Though runners and cyclists are the most affected by this condition, it can also rear its head with other high volume activities such as aggressive walking, hiking and any activity involving repetitive flexion and extension of the knee.

Anatomy:ITBS

The iliotibial band (ITB) is a thick band of fascial tissue taking its fibers from the gluteus maximus in the back of the hip, and tensor fascia lata muscle on the outside of the hip. The ITB then travels down the outside of the thigh and knee and inserts into the lower leg. Biomechanically, bending and straightening the knee causes the ITB to move over the bones at the outside of knee.

Cause of injury:

Functionally, high mileage, quick ramping up of training and repetitive flexion and extension about the knee predispose a susceptible individual to this injury. Genu varum (“knock-knees”), greater body mass and height and ITB tightness have been implicated as possible anatomical causes of ITB syndrome. Some sources also implicate excessive mid-foot mobility (sometimes referred to as over-pronation) and hip abductor or rotator weakness as predisposing factors. It has also been suggested that leg length discrepancy, either structural or related to muscular imbalance in the pelvis or lower extremity, might create a pelvic tilt that puts excess stretch on the band of the longer leg.  In addition, weakness of the large gluteus maximus muscle may allow the ITB to migrate forward on the outside of the thigh; this migration leads to shortening of the ITB and increased compression or friction at the knee or hip bones.

Treatment:

In the acute phase of injury, activity modification is advised and includes decreasing mileage/activity and resting, local ice massage, anti-inflammatory medication, and corticosteroid injection have proven effective in reducing symptoms. In the subacute phase, stretching and myofascial release are helpful to increase tissue length and decrease muscle tension. There is a small study of Graston Technique (using metal instruments to treat limited soft tissue mobility) that showed immediate improvement in symptoms.  Holly Nester, PT, at our east clinic, is one of the few certified Graston practitioners in Flagstaff.  During the recovery phase, it is advised that the subject introduce progressive strengthening exercises for the hips and core stabilization exercises to improve coordination and control about the hip, knee and trunk. Return to activity includes easy sprints and gradual increase in distance and frequency. Recovery may take 6-8 weeks, if symptoms are suppressed well enough in the beginning, so be patient and understand that too-rapid return may cause recurrence of symptoms. Return to activity may also be facilitated by orthotic consultation and implementation if structural or anatomical contributions are a factor predisposing some individuals to this condition.

If you want to read more about Iliotibial Band Syndrome, have a look at this article published in 2011.  It gives a lot of detail about the condition and treatment, but really it says the same this this blog post does – treatment requires a careful examination to identify the biomechanical cause of the condition and correct it.  If you are looking for a physical therapist with the time and expertise to perform that kind of assessment, please contact us!

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