by Jane Milliff, MMSc, PT

“Hiking downhill is harder than going up– I’m always on guard and if there’s any scree, I slip.” says my friend.

“Besides, my back gets tight and sore. If only I could hike uphill for an hour or so, then paraglide down, “she says laughing.

“Try leaning forward a bit.” I say.

“What?? That seems counter-intuitive.”

Hiking downhill can be harder than it seems. You may be so afraid of falling, that you lean back, trying to avoid careening down the hill. Your back is arched so your shoulders end up behind your center of gravity. This is exactly what not to do. This is exactly what puts you on the backs of your heels and makes it likely you will land on your backside. In an attempt to slow yourself down, you actually decrease control. With your weight on the heels, you are stepping on the proverbial banana peel and setting yourself up for a fall.

Try this instead: Tune in to your sternum, (breastbone). Where is it? Is it pointed up towards the sky or angled down, perpendicular to the ground? If your chest is out, your back is arched and your weight is on your heels. A little loose gravel will be your undoing.

Keep your chest perpendicular to the ground as you descend so your weight is evenly distributed on the soles of your feet and your back is neutral. Now you have control. Now you will feel more comfortable – in all ways – as you hike.

by Jane Milliff, MMSc, PT

No matter what I do, the Bolder Boulder kicks my butt. I did fine until I decided to really get serious (topic for another day) – that was when all my troubles began. One year, I ended up in the medical tent after staggering for the last 2 miles – low blood sugar. Then, I thought joining a training group was the answer. Apparently I made it into the stadium, but I don’t remember … and was taken directly to the medical tent. In fact, I don’t remember anything after running by McGuckins.

I gave up running the Bolder Boulder after that, but now I have new information that has me thinking about trying again. (Yes, you can say glutton for punishment).

5 minutes a day of additional training will lead me to a Bolder Boulder victory – which now means staying out of the medical tent! I recently learned the secret to lowering my times without any elaborate changes in my running program. I know it sounds too good to be true, but it’s about training smarter.

What’s the secret?

Train your breathing muscles. The breathing muscles are critical during a race. They account for approximately 16% of the total energy you use and they can be your limiter in any race. Just witness all the athletes, leaning on their arms after a race, trying to “catch their breath.” But until recently, no one thought you could actually train your breathing muscles to improve performance. Now, several studies have shown that breathing training, just 5 minutes per day for 6 weeks, can improve performance by as much as 5%.

Here’s why those muscles are so important:

When breathing muscles become fatigued, and they are less able to buffer the lactic acid, levels of metabolites increase in the muscles. The build-up of metabolites causes receptors in the respiratory muscles to signal the cardiovascular control center to register distress. Your brain registers distress, something any runner can remember as extremely uncomfortable. That sends a reflex to your legs to cut the blood flow – you are in crisis and your autonomic nervous system takes over to prevent you from “blowing up.” No matter how much you want to run faster, your body’s natural protection holds you back. Your legs get heavier and everything slows down.

When you train your breathing muscles – just 5 minutes a day- the increased stamina of those muscles allows you to work harder without sending the “MAY DAY” signal to your brain, so the blood flow to your legs is wide open and you race better and faster.

Join us for “Breathe Strong For Better Performance” a clinic at Fleet Feet on Thursday, April 26th at 7:15 pm.

by Russ Overy, PT, DPT, FAAOMPT

FOOSH – or “fall on an outstretched hand,” something I experienced first hand in October while mountain biking. I have fallen before while biking (many times), onto my hand, but this was different. The impact was greater and the landing was on rock, not dirt. I have sprained my wrist before in similar falls, but no fractures. This time my wrist motion was quickly limited, however, my sense of denial was stronger. I ignored the pain and limited motion and continued to ride. I went to work the next day and treated patients. Finally after poking around on my wrist I gave in (and after lectures form colleagues) and called a physician. Diagnosis: Fracture of the left triquetral bone (2nd most common fracture of the carpal bones) and immobilization for 6 weeks. So much for that first cross race that I registered for.

What was different this time?

1. More pain after impact.
2. Pain at end range continued.
3. Significant tenderness on the bone.

by Russ Overy, PT, DPT, FAAOMPT

My children have reached an age where we can ski as a family for a few runs. The runs tend to be cruisers – easy-going groomed green and blue trails. So I found this was a great opportunity to work on technique. I unweighted one leg and skied on the other to check for symmetry.  My left leg felt strong and stable and I was able to change directions and hold an edge. Immediately after switching my weight to the right,  I almost collapsed.

What? As hard as I tried, I couldn’t stabilize my right leg. Turns out I am very weak in my right glutes  – so weak that I couldn’t control that knee on a single ski. My risk of injury is high. If I lose it in the bumps,  how am I going to recover? 

I have been reading articles on hip strength and knee control for sometime and I’m quick to point out these weaknesses in clients and give  them exercises to get stronger.  Deep down I have known about my own right hip weakness, yet I continue to ignore it.  It’s more fun to play than work on getting stronger.  BUT, I am finally ready to admit that I am a timebomb.  If I have time to ski, bike, run, and play volleyball,  I’ll  find  the time to perform the exercises that will keep me active and injury free.

If you start to waiver on your exercises, give me a call.  Don’t let your motivation get in the way of having an active injury-free spring.

The length of your list of New Year’s Resolutions is inversely proportional to your success in making them stick. REALLY?? Hard to imagine, but the longer the list, the less likely you are to have success. So say Baumeister and Tierney in the book Willpower. We are almost half way through January. How’re you doing so far? Is your resolve starting to wane? If so, keep reading to find out how to keep your determination strong.

We each have a finite amount of willpower and using a little bit in a lot of places gets you right back to square one, and more discouraged than ever. So, choose one thing you want to change. My advice? Change your exercise routine, because, when it comes to your health, the right exercise changes everything. Don’t believe me? Check out this must-see video on exercise. It could change your life. If you are already hooked on exercise, send it to your favorite couch potato. Oh, and don’t forget to throw that list of New Year’s resolutions away.

23 And A Half Hours – A Must-See Video

For the Exercise Addict:

I may be preaching to the choir for a large fraction of Boulderites. For many, exercise is a vital part of most every day and if something gets in the way of enjoying it, you get cranky, but still, you keep going. Don’t do it. If you start to feel a little niggling pain in your knee as you descend the Sanitas Valley trail, figure out what it is. The sooner you address stiffness (often the first sign of a problem) or pain during or after exercise, the more quickly we can help you resolve it and get you back on track.

The Hidden Secret to Getting Regular Exercise:

If exercise is not something you enjoy, you’ll need all the help you can get to make it happen. You need GLUCOSE. Sounds absurd, but it’s true. Having enough glucose in your brain when you are wavering will help keep the resolve going. So planning to exercise during lunch hour or at the end of the day, when glucose reserves are low, might sabotage your efforts. If those are your only available times, have a snack an hour before you head out the door and you won’t as easily find an excuse not to go.

We asked nutrition experts Lisa Lanzano & Jane Reagan of Essential Nutrition for ideas to keep glucose levels stable and therefore keep you motivated to exercise.

To keep blood glucose levels stable throughout the day, it is best to consume smaller, more frequent meals that consist of the following three components:

1. Fiber-rich carbohydrate (to slow digestion and supply your brain with a steady source of glucose)

2. Protein

3. Healthful Fat. These latter two also help slow digestion for more sustained glucose delivery to the body and brain over time.

Some examples of healthy meals that can help keep your blood sugar stable include:
1. Fish tacos with guacamole (gluten-free, dairy free)
2. Grilled chicken over pastaprimavera
3. Tofu and vegetable stir fry over brown rice (gluten-free, vegan)
4. Open-face grilled turkey sandwich with miso mayo
5. Black bean soup with wholegrain roll (vegan)

However, if time gets away from you and you realize it’s only 1/2 hour or less before your workout, reduce the amount of fiber, fat and protein at the meal/snack so the carbohydrate can be more quickly absorbed and available for your brain and working muscles.

1. Fruit smoothie with hemp milkor soymilk (vegan, gluten-free)—liquids are digested more quickly than solid foods.
2. Whole grain crackers with a slice of deli turkey and low-fat Babybel cheese spread
3. Toasted whole grain bread with a light spread of peanut butter (vegan)
4. Granola bar with small handful dried fruit (vegan)
5. Plain yogurt (regular, soy, coconut or Greek) and fruit (gluten-free)

Lastly, make sure you eat enough day-to-day, as well as throughout the day. Just a few bites of a well-balanced meal on one day, or inadequate intake the day before, can lead to lower blood sugar levels in the end. So be sure to eat enough to feel content, but not overly full.

Written by Lisa Lanzano, MS, RD and Jane Reagan, MEd, RD, our neighbors at Essential Nutrition.  http://www.essentialnutrition.com/

Originally posted on February 22, 2012

by Scott Swann, PT, OCS

Do you have pain at the bottom of your heel as you step out of bed in the morning? Is your running impeded by a nagging ache in your heel? If so, these are two very common symptoms of plantar fasciitis. Plantar fasciitis is the most common foot pain condition treated by health care providers.

What is it and how can I fix it?

Plantar fasciitis is actually an inflammation and micro-tearing of the ligament that supports the arch in your foot– the plantar fascia. When your foot hits the ground, the plantar fascia stretches to accommodate your body weight and the ground reaction forces generated by walking and running. During walking, up to 3 times your body weight is taken through your arch; when running, up to 9 times. If the condition develops, the person usually reports a sharp pain under their heel that may spread into the arch of the foot. The onset is typically not from an injury, but develops gradually and, if left untreated, gets worse over time. Many causes can contribute to plantar fasciitis:

• Standing on your feet all day with poor foot wear

• Increasing running intensity or distance too quickly

• Shoes inappropriate for your foot type or shoes that have excessive wear

• Poor foot mechanics (foot is too flexible or too stiff)

• Weakness in your core, hips, and lower leg

• Tight legs, especially calves

• Low back pathologies with nerve root irritation

• Poor running mechanics

What to do about it:

There are numerous ways to treat plantar fasciitis and some you can easily initiate yourself. Try the following strategies:

• Ice massage: Rub an ice cube directly to the area of discomfort in a circular motion for 5-7 minutes.

• Stretch: Calf stretches against wall: straight and bent knee, plantar fascia stretch – see following videos on YouTube:

Plantar Fascia Stretch

Plantar Fascia Morning Routine

Gastroc-Soleus Stretch

• Proper shoes are essential. Fleet Feet does a superb job of fitting you with the right shoes.   Be sure to replace shoes after 300-400 miles of running, depending on your size.

• Self-massage to plantar fascia with tennis/golf ball or tubing

• Deep tissue massage to calves

• Decrease training intensity and cross train if possible

• Strengthen core and overall lower extremities

• Wear a Strassburg sock at night. Available at Fleet Feet

What’s the next step?

If you have done all you can and still have pain, what’s next? How do you get back on the trail, back up to your running intensity, on skis again, or simply walking around the block without pain?

A recent study in the Journal of Orthopedic and Sports Physical Therapy looked at 60 patients suffering from heel pain. Half were given the stretches mentioned above; the other half underwent the stretches and received manual therapy. The group that received both manual treatment and self-stretching experienced greater improvement in physical function and a greater reduction in pain compared to those performing self-stretching alone.

Manual treatments can include such things as trigger point dry needling, myofascial/deep tissue release, joint mobilization and manipulation, and manual stretching. All of these, in addition to various taping techniques, specific strengthening exercises addressing foot impairments, and weakness of the hip and low back will help eliminate pain.

Also, your therapist can determine the need for a foot orthosis to improve the biomechanics of your lower leg, decreasing strain on the plantar fascia. A full biomechanical evaluation by your therapist will determine the cause of the irritation, so you can eliminate the factors creating the aggravation. Getting to the CAUSE of the tightness is the key to its resolution and is what keeps it from coming back. Physical therapy is the detective work that teases out all contributing factors and helps you recover.

Below is a short note from a patient I treated this fall. He had never heard of plantar fasciitis until coming to physical therapy:

“After suffering severe pain in my left foot I was referred to Alta by my doctor. My physical therapist Scott Swann diagnosed the source of my pain as plantar fasciitis. In weekly sessions he worked with me to lessen the pain through various exercises, manual therapy, taping, and cold laser therapy. He recommended that I get over the counter orthotics for my shoes from my local shoe store. I was assigned home exercises. In a few weeks my pain was reduced and finally I was free of pain. I am very grateful for this successful therapy.” Tom

If you find yourself suffering from nagging heel pain on one or both feet, try some of the suggestions we have provided and see how it goes. If, in a week or so, you are not seeing an improvement, make an appointment —- we will help you figure it out.

Originally posted on February 14, 2012

by Guest Blogger, John Tribbia

Today, I finished atop the podium, in third place, at the Teva Winter Games Vail Uphill race. This year was the first year the Vail Winter Uphill offered prize money to the top-4 and the caliber of racers that turned out definitely showed. The course takes athletes on an ascent of 2,200 feet in roughly 2 miles, from Lionshead up to Eagle’s Nest, finishing at 10,328 feet in elevation. The two runners ahead of me were ahead by 27 and 9 seconds, respectively. And each of us ran the 2nd, 3rd, and 4th fastest times ever behind Rickey Gates’ course record. Although I was close to the win and am disappointed that I could have trained better for this event, I’m happy and will enjoy this result since, only 6 weeks ago, my training was compromised by an unfortunate accident.

6 weeks ago, I was involved in a scooter crash.

You’re wondering – “why are you riding a scooter in the middle of winter in Colorado?” On the Front Range in Colorado, winter has multiple dimensions: 60 degrees, sunny and calm; mild temperatures with 70 mph winds; subzero temperatures; and snow (lots of it). I was driving a scooter in the first mentioned winter dimension and who wouldn’t want to cruise around town (with the amenity of free parking) on two wheels in that? The only problem, the streets were well covered with gravel and sand after a snowstorm earlier in the week. Did I mention that Colorado has multiple dimensions of winter? Ok, enough with the rhetorical questions…

The crash. I was driving up Ninth Street, west of Pearl Street towards North Boulder Park. The car in front of me stopped quickly to make a turn while I was checking my rearview mirror. I quickly realized that I was going to crash into the rear of the car. Instincts told me to stop quickly and turn away from the stopped vehicle, which I did. But, with the sand and gravel on the roads, I did not keep the bike upright nor did I stop completely. In a split second, I was air born and the scooter was sliding across the pavement. The hard gravelly pavement broke my fall and the focus of impact was my left hip.

A few x-rays later, I came away from the accident without a broken bone or a head injury (yes, mom, I wore a helmet), thankfully. It could have been a much more serious crash. Still, I was nowhere near in the clear. Along with a severe bone contusion on my left hip, I had damaged the cartilage in my front pelvis (the Pubic Symphysis) and, as a result, my right and left pelvic structure was misaligned. Bone bruises usually last 4-6 weeks and are relatively easy injuries for athletes to overcome. Still, I still needed to be cautious about returning to running, because the area of bone bruise can be weakened while running on hard surfaces and can lead to more serious injuries like fracture of the bone. These latter two problems have an unclear prognosis and healing times can vary anywhere from 2 months to 1 year (for a runner who needs healthy joints and connective tissue to pound the pavement, trails, and snow, like myself). Oh boy, I was in for a long winter.

After a few days of downtime, I quickly experimented with forms of exercise that could replace my regimen of running without stressing the injured area. I found that cycling and the elliptical machine were quality substitutes while I wait to heal from the injuries. Next up, get treatment because I hate just waiting for injuries to heal.

I consulted Scott Swann at Alta Physical Therapy to help me improve the prognosis. First up, needles. We wanted to realign my pelvis by alleviating the tension around this area using Trigger Dry Point Needling techniques. Let me say, “this area” is incredibly sensitive and not the most fun place to insert dry point needles. My first session of needling around the “bread basket” was uncomfortable, to say the least. At the end of the session, my pelvis was evenly aligned thanks to Scott’s strategic placement of needles in previously tense areas in my groin, hips, lower back, spine, and glute. Just one day following, I was off crutches and walking slowly at a normal gait. Fast forward a few days later and I was able ride strong, out of the saddle, on my bike. Talk about speeding up the prognosis!

Soon, my focus shifted to getting healthy in 5 weeks’ time for the Uphill in Vail. So, along with the needling, Scott gave me some strengthening and stretching exercises to increase mobility and flexibility of my “bread basket” region (keep your mind out of the gutter, please). Despite the improvement, there were a series of setbacks that forced me back to limping and crutches or feeling inferior on the bike. These setbacks took place when I got too greedy by trying to run too much and too soon. Over the 5 weeks leading up to the race, Scott helped me recover from these setbacks with more needling and some manual therapy to regain the mobility and flexibility that was lost. Meanwhile, I was putting in some consistent training on the bike and elliptical machine that helped me gain more strength where strength was lost, as well as, build and maintain my fitness from before the accident.

Although I am not currently running 100 percent volume (or anything close to what I was doing prior to my accident), I believe the therapy and instruction that I am receiving from Scott at Alta is helping me get there faster. Moreover, I ran today’s race pain free, which is a far cry from where I was just one week ago. Not to mention, I finished the race a whole 5 minutes faster than the time I ran last year! I truly believe the strong race I ran was partly due to the treatment I receive at Alta partnered with Scott’s attention to the source of my injuries as well as his patience and persistence. Here’s to more improvement and a healthier 2012 – thank you Scott and Alta!

Originally posted on December 21, 2011

We’ve all heard the stories of people laid up after shoveling snow. Maybe you’ve experienced an injury yourself.  Shoveling is a strenuous and repetitive activity that can cause strains to the lower back and shoulders. Back injuries due to snow shoveling are more likely to happen to people who are out of condition.

Following these tips can help you avoid injuries:

•        Lift smaller loads of snow, rather than heavy shovelfuls.

•        Bend your knees and lift with your legs rather than your back.

•        Use a shovel with a shaft that lets you keep your back straight while lifting. A short shaft will cause you to bend more, but    using a shovel that’s too long makes the weight at the end heavier.

•        Step in the direction in which you are throwing the snow to prevent twisting and  “next-day back fatigue.”

•        Take frequent breaks. Stand up straight and walk around periodically to extend the lower back.

•        Backward bending exercises help balance the excessive forward bending of shoveling.  Stand straight and tall, place your hands toward the back of your hips, and bend backwards slightly for several seconds.

Check out this video!

If you or anyone you know is experiencing back pain, consult a PT.

Originally posted on November 17, 2011

Research has shown that gratitude leads to happiness and is associated with lower levels of the stress hormone cortisol. But what does that have to do with physical therapy?

As physical therapists, we are forever in search of ways to loosen tight muscles. And, knowing what causes muscle tightness is important in determining an appropriate treatment. Many situations cause tight muscles, and they all have some relation to stress. Whether mechanical or perceived, stress causes an unconscious and reflexive contraction that is designed to protect the individual.

A brief explanation of muscle and nerve physiology helps to understand how this works. For example, when you have a thought to open a door, your brain sends signals through the spinal cord to nerves that activate the appropriate muscles to initiate a movement. The muscle contraction is voluntary, a conscious action. Your arm moves to open the door.

But when the nervous system perceives pain or danger and there is not enough time to think about it, the unconscious reflex system is activated. It sends signals to the spinal cord, which activate muscles to protect the body from danger. Flinching is a good example of this reflex, as is moving your arms to shield your face from a ball. The reflex is unconscious because there is no “decision” made by you to move; your muscles create a contraction to protect you and the process circumvents your conscious mind.

The unconscious reflex system also responds to long lasting stress. Stress is simply a perceived or anticipated danger. When the body’s “danger” response is activated, nerves send those same signals down the spinal cord to the muscles, and the muscles contract. The muscles have no action to perform if the contraction results from an anticipated danger, but they continue to contract as long as the perception of danger is present. So if stress is present at a certain threshold, those muscles will remain tight and contracted.

Since gratitude has been associated with lower levels of stress, we can imagine that gratitude, by decreasing stress, can allow your muscles to relax. Happiness and tension just don’t go together. Happiness, in fact, is a wonderful stress reliever which can lead to lower blood pressure, better sleep and looser, more relaxed muscles.

Enjoy your holidays and may the gratitude you feel resonate through every muscle in your body!

Happy Thanksgiving from all your friends at ALTA

Originally posted on October 25, 2011

Since we started using MRI routinely to help treat back problems in 1994, success in treatment actually decreased. How can that be? For most orthopedic pathologies, the MRI (magnetic resonance imaging) is the diagnostic tool for physicians to determine the existence and severity of a problem. It is a non-invasive medical test that can help doctors diagnose and therefore know how to treat a variety of medical conditions. It can detect problems that traditional x-rays and CT scans cannot by providing images of soft tissue structures like discs and cartilage. So why then are we having less, not more success in treating back problems?The reason success in treating back pain has gone down is because we see pathology on the scan and feel eager to fix it. And though the surgery takes care of what looks offensive, it often does not solve the core problem, or it creates another set of problems.

MRI, though used routinely has a few shortcomings: First, it’s very expensive. Second, it only focuses on one region of the body- usually the region of pain – and when the area of pain is not the cause of pain, we can be misled. Third, MRI does not look at the body in motion, which is when many problems present themselves. And maybe most important of all, when one can see so much, and so much that looks pathological, who really knows what the culprit is?

Could the same be true for MRIs of the knee? Take George for instance….

I met George some months ago when he first visited me for left knee pain. He had seen his orthopedist for a gradual onset of pain on the inside of his left knee that was preventing him from hiking, his favorite pastime on weekends. His surgeon ordered an MRI of his knee that came back with the result: “likely a tear in the medial meniscus” and “mild degenerative changes”. The meniscus is a cartilaginous ring in the knee. We all have two of them in each knee and it helps with proper joint mechanics, shock absorption, and nutrition and lubrication of the cartilage in the knee. The surgeon told George that surgery was likely inevitable but he could try some physical therapy if he wished. George was scheduled for surgery in three weeks. He also figured that trying some physical therapy prior to his surgery would only help his recovery, so he scheduled with me at the end of that week.

During our first visit, I did an entire biomechanical evaluation of George from his back down to his feet. I looked at his movement in various scenarios to address all things contributing to his knee pain. And we found some interesting findings. On his intake, he noted that he had a history of back pain. And upon examination, I found malalignments throughout his pelvis and significant tightness in his left hip. In analyzing his walking, George’s left foot turned out more than his right, which was likely caused by poor alignment and hip tightness. He also had a fair amount of muscle weakness around his left knee compared to his right. When testing balance on his left leg, George was about as half as efficient as he was on his right. He did not show positive signs when testing his meniscus but those are very inconclusive (accuracy is about 67%). He had tenderness all along the inside of his left knee.

At the end of our first visit together, I corrected malalignments in his pelvis, gave him stretching and strengthening exercises for his lower legs and core muscles, balancing drills, and sent him to the local shoe store to trade out his 2-year-old walking shoes for a pair of proper biomechanical fitting shoes. We continued to work together for 3 additional visits to address hip flexibility, make sure his pelvis stayed in proper position, and to progress his exercises. He noted continued improvement each time we met so that by our 4th visit, he was able to hike with only very mild discomfort towards the end of his hike. His surgery was scheduled for the following week and he very gladly called to cancel. He then came in for 3 additional visits and was able to hike without limitations at the time of discharge. He diligently performed his strength and flexibility exercises on his own throughout the course of treatment.

It is not completely clear whether George, in fact, had a tear in his meniscus. Maybe he did, but other factors clearly contributed to his pain: imbalances in his pelvis and hip, weakness around the knee, a decrease in his left leg balance, and poor shoes all increased stress and discomfort on the inside of his knee. If he had not come to therapy and continued with surgery as his primary intervention, there is a very good chance that without the corrections he received in therapy, he would have continued to have some level of discomfort.

The MRI has been a very valuable tool for physicians in diagnosing orthopedic pathologies. Yet, to get the entire picture of how you are moving and to learn how to take stress off painful areas, have a thorough physical therapy evaluation of all areas involved; make sure everything is working together as it was designed to work. This can allow for optimal healing if surgery is inevitable, and it may prevent invasive procedures altogether, as it did for George.