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.

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!

The serratus anterior – the ‘forgotten muscle’ in shoulder and neck pain

By: admin Published: August 30, 2012

by Jay McCallum, PT, DPT, OCS

Board Certified Specialist in Orthopaedic Physical Therapy

What the heck is the serratus anterior?

Because the serratus anterior is largely hidden from view underneath the shoulder blade, it is remarkably easy for both patients and clinicians to forget about this vital muscle.  It originates from the underside of the shoulder blade near the inner edge and has a broad attachment to the ribs.  It gets its name from the way that it is serrated, like a knife blade, as it attaches into the ribs, and is anterior (forward to) the shoulder blade.  Even though the serratus anterior is not visible on most people’s bodies, it is normally a very strong and fairly large muscle.

Serratus Anterior side view

Okay…so what does it do?

And here is where the confusion REALLY sets in.  The serratus anterior has historically been though of as performing two primary functions.  The first is to hold inner edge of the shoulder blade against the ribs, preventing ‘winging’ of the shoulder blade, as shown here.

Winging of the shoulder blade due to serratus weakness or paralysis

However, winging of this type is fairly rare, occurring mostly with injuries to the nerve that supplies the serratus anterior, the long thoracic nerve.  The second commonly thought of function for the serratus anterior is ‘protraction’ of the shoulder blade, pushing it forward relative to the body  in a punching motion.

So, the reader is thinking at this point, if my serratus anterior is weak then my right hook isn’t what it used to be, and I have a funny looking shoulder blade.  Tell me again why this is important?  Turns out that the serratus anterior does two other things that are a bit more functionally useful to us.  The first is that it is the strongest, best positioned muscle to create upward rotation of the shoulder blade, basically aiming the socket up.  In order to reach higher than about shoulder level the shoulder blade must upwardly rotate.  If the serratus is weak, then the shoulder blade literally can’t get out of the way of the arm, and that leads to pinching at the top of the shoulder, frequently known as subacromial impingement syndrome or subacromial bursitis.  Over time, it can even lead to development of a rotator cuff tear.  The other really important function of the serratus is to solidly anchor the shoulder blade to the thorax with use of the arm.  If the shoulder blade doesn’t have that stability, then the rotator cuff must work much harder, rather like walking in sand rather than on a hard surface makes your legs work harder.  That can, in turn, lead to rotator cuff tendinitis.

What does this have to do with my neck pain?

The serratus anterior isn’t the only upward rotator of the shoulder blade, it’s just the best one.  If it’s weak, the body goes looking for another way to accomplish the movement, and the next muscle in line is the upper trapezius.

The upper trapezius - look familiar?

Unfortunately, the upper trapezius is not particularly good at creating upward rotation of the shoulder blade, so in this role it has to work extremely hard, and so can become quite painful.  It also attaches into the skull and upper neck, and so significantly compresses those structures when it is activated.

How would I know if my serratus is a problem?

Anybody with shoulder pain should certainly have their serratus anterior strength assessed by a physical therapist, as serratus anterior weakness and/or inhibition is extremely common to a range of painful shoulder conditions.  The serratus anterior should also be examined for most patients with neck pain, particularly those who find that their pain is brought on by use of their arms – i.e. experiencing neck pain with lifting, carrying, cleaning, etc.

What can I do about it?

Like most muscles, serratus anterior strength is very activity-specific.  A common pattern is that a patient may be able to generate significant force into protraction – the ‘punching’ motion, but have much less strength with upward rotation of the shoulder blade.  And if there is a strong compensatory pattern already in place it can be quite difficult to re-establish a more efficient movement pattern.  So, while the internet has many serratus anterior exercises a short Google search away, people with symptoms are best advised to seek the guidance of a physical therapist, who can identify the specific pattern of weakness that may be present and design an individualized exercise program to address it.

If you’re in Flagstaff or northern Arizona and want this type of evaluation, then please call us at 928-556-9935 or email us for an appointment!

 

Treating Low Back Pain Part 2 – Stabilization Exercises

By: admin Published: April 18, 2012

  By Lauren Shafer PT, DPT

 

 

Treating Low Back Pain is Not One Size Fits All

The second subgroup for treating low back pain is stabilization exercise. I find this to be an interesting category in the way it has evolved and what we are finding through research. It is commonly thought that “core training or stabilization” is the best way to treat low back pain, but this isn’t always the case. The literature over the past several years has prompted popularity in the prescription of stabilization exercise, however, results on its true effectiveness are inconclusive. While strong abdominal and back muscles definitely can help prevent and manage low back pain, it isn’t always the correct intervention for someone with low back pain.

The criteria for this subgroup include:

  • Age < 40
  • Greater general flexibility (straight leg raise >91°)
  • Positive prone instability test (locating a relatively more mobile segment of the lumbar spine that also reproduces symptoms when direct pressure is applied. The test is positive if pain is no longer reproduced while the patient performs a movement eliciting lumbar muscle contraction)
  • Aberrant movement when actively bending forwards and backwards, referred to as an “instability catch”, and the patient may perform “thigh climbing” when coming up.

 Is this the right intervention for me?

A person who meets at least three of the four criteria is 80% likely to report at least a 50% decrease in symptoms when a core stabilization program targeting both deep and superficial trunk muscles is utilized. What I find even more interesting is that when at least three of these factors are negative, the person is 86% likely to FAIL to improve with a stabilization program. If you currently have back pain and just can’t seem to get better no matter how strong you get, this may shed some light as to why! There is also an additional set of factors to identify women with pain who are postpartum and likely to benefit from a stabilization program.

For more information about classifications of low back pain, you can read the article here.

Call or e-mail CoreBalance Therapy to schedule an evaluation with a physical therapist so that we can determine the best approach for you!

928-556-9935

[email protected]

“Extreme” Exercise and Pregnancy

By: admin Published: February 20, 2012

by Amy Flory, PT, MPT

My fellow physical therapist and expert rock-climber, Aimee Roseborrough, recently had a brush with fame when she was featured on Good Morning America in a segment about “extreme” exercise during pregnancy.  Considering that the “top-roped” climbing she has been doing in her second pregnancy is generally safer than, say, driving to the climbing location, the only “extreme” part of the whole thing was the hateful commentary by an uneducated audience (and the naïve expectation by the field reporter that he should try climbing for the first time without bringing proper equipment—see Aimee’s blog)

However, the situation does illuminate the fact that there are still many people out there that believe some old wives’ tales about pregnancy and exercises—and, that not everyone posting on internet sites knows much about climbing techniques.

Now, don’t get me wrong; there are times, such as higher-risk pregnancies, when exercise should be very carefully monitored, and sometimes restricted.  And, there are some women, me included, that simply cannot exercise at all during pregnancy.  I could scarcely climb off the couch without vomiting, let alone be in a moving vehicle on the way to climb a big rock.  The startling lack of cooperation on the part of my body shattered any pre-pregnant preconceptions I had about being one of those women who would run miles and miles during their glorious, relatively-pain-free pregnancies.

Prenatal Exercise Guidelines

The American College of Obstetricians and Gynecologists publishes a working list of guidelines on exercise during pregnancy; it is updated at times based on the most recent studies.  Over the past decade, these guidelines have become more broad and general; I’ve summarized them below.

  • For women with normal pregnancies, 30 minutes of moderate exercise daily provides many benefits (this is the same intensity and duration recommended for non-pregnant women).
  • If you’ve been engaged in a certain activity or sport before pregnancy, you probably can continue it during pregnancy (as long as you’re not getting injured, and it’s not a contact sport).
  • You need to avoid lying on your back after the first trimester.

Yoga mama? Maybe not…

Contrary to the serenity suggested by ethereal music and deep breathing in a yoga class, prenatal yoga can actually be very stressful to the maternal joints and ligaments, especially in asymmetrical stances.  If you’re not experiencing low back or hip pain, by all means continue your yoga classes!  However, if you are getting sharp shooting pains in the low back or buttocks, you may need to significantly alter your routine, or discontinue it altogether.

These kinds of pains usually indicate a need for physical therapy intervention.  Talk with your physical therapist about your exercise activities during pregnancy for recommendations on how to keep active without causing lasting injury to your body!

Posted in Pregnancy | Tagged Tags: , , | No Comments

Return to Top of Page