Building Strength

Mitchell Fromm (UW-SP) and Bryan Stuettgen, MPT

Strength is a necessary component of daily living.  Our bodies are designed to respond to stresses placed on them.  The higher the activity level, provided adequate recovery, the more they will adapt to overcome those stressors.  As we age it becomes increasingly important to maintain the recoverable level of stress that will promote growth and maintain strength to reduce injury and prevent muscle loss.

Need for Strength

Within the next 10-15 years, an estimated 30% of the US population will be elderly, putting them at greater risk of health problems and loss of function.  The US National Center for Health Statistics reports the average person spends about 15% of their life in an unhealthy state due to disability, injury or disease occurring in old age (Hunter, 2004).

Age is a major contributing factor to the loss of musculature.  At age 30 muscle breakdown begins to exceed muscle growth.  At age 50 1% of total muscle strength can diminish annually and by age 65 the rate has been found to be around 3% per year (Kennis, 2013).  This age-related loss of muscle contributes greatly to the risk of falling and injury as well as muscle strains and other injuries.  Age-related strength loss is generally characterized by reduced muscle mass and strength and is manifested by preferential type II myofiber atrophy (Hunter, 2004, Van Roie 2013).  It has been considered type II fibers are not able to be activated as well in older populations due to this atrophy and denervation.  Type II muscle fiber type responds better to weight training for strength and power for growth and maintenance over type I which is characterized by its endurance properties.

There are multiple approaches to building strength.  The muscle can advance by recruiting more of the available muscle through training.  Weight lifting or similar activity teaches the muscle to recruit more of the available fibers that exist.  To recruit and utilize muscle a nerve pathway must be available.  Weight training also builds and improves this neuro-muscular connection allowing for more muscle fiber recruitment and better precision of movement.  Another training goal could be hypertrophy or the enlargement of muscle.  Creating more muscle allows for a larger pool of recruitment, which can lead to increased strength through training.  Training cycles targeting both strength and hypertrophy should be included to maximally stimulate muscle fibers and best improve overall growth potential.

Power is lost at an even faster rate than strength.  This loss is directly related to functional ability in daily living.  A study by Pereira (2012) led to findings suggesting that training cessation up to 6 weeks is sufficient to induce significant losses in dynamic strength in 1RM (1 rep maximum weight).  To some extent, functional capacity, and especially explosive force, may be preserved after high-speed power training.  As the older population is more susceptible to detraining from missed activity due to injury or illness, power training should be considered when building an exercise program.

Loss of power generation may also be attributed to the lowered ability to create creatine-kinase during aging, a fuel the body creates and uses to generate power. Calcium release also decreases with age limiting the contraction-relaxation cycle of muscle, and inadequate protein has proven to limit growth potential as it is a staple of building and maintaining muscle.  As they say, the temple cannot be created without the bricks.  Detailing appropriate nutritional adaptations is outside of the scope of this paper, however, proper nutrition must be considered to achieve training adaptations and individual recommendations should be sought by a qualified trainer or nutritionist.

Strength in everyday life

Strength is a necessary component in the completion of daily tasks. Walking, maintaining an upright posture, and balance all have strength components where failure in any of the mechanisms may lead to compounding injuries.  Motions beyond them such as bending, lifting, squatting, and transporting items have requisite strength requirements for completion without injury.  The need for strength is apparent and crucial for those seeking to maintain their independence.  Being able to complete tasks unaided reduces or eliminates the need for assisted living while reducing or eliminating those associated costs.  Strength training extends the length of time a person is able to maintain independent motion barring other complicating factors.

Implementing strength training programs can have long-lasting effects.  A long term strength study by Kennis (2013) found that increases in muscle strength and muscle power after a 1-year strength-training intervention theoretically can compensate for age-related losses over 3 to 5 years. Moreover, 7 years after their enrollment in the study, participants of the {strength training intervention} group experienced a significantly lower loss in basic strength compared with the {control} group. 

Protocol

Muscle reductions from age are found to be due to multiple factors.  Training both the nervous system as well as targeting the muscle fibers are necessary for a successful strength program.  It is commonly accepted that strength training should be conducted by lifting above 80% of the 1 rep maximum with sets of 6 or fewer repetitions, and hypertrophic training with weights between 67-80% for sets of 6-12 repetitions.  Though these current standards are accurate for those goals, they are not entirely definite and certainly are not exclusive.  Studies conducted and compiled by Van Roie (2013) have examined the growth ability utilizing low weight high rep protocols and found hypertrophy was achievable when the training sessions achieved momentary muscular failure.  Henneman's size principle of motor unit recruitment indicates that, when a submaximal contraction is sustained, initially recruited motor units will fatigue, creating the need to additionally activate larger motor units. When the exercise is repeated to the point of muscle failure, (near) maximal motor unit recruitment will occur, regardless of the external resistance used (Van Roie, 2013).  Expanding on this, one study was conducted in which a highly fatiguing protocol of 60 repetitions at 20–25% of 1RM was immediately followed (no rest) by a set of 10 repetitions at 40% of 1RM. This mixed low-resistance exercise protocol showed interesting benefits on the dynamic strength and speed of movement of the knee extensors (Van Roie, 2013).  Those studies further showed promising results on speed of movement at different resistances, even though training was performed at a moderate speed. 

Studies conducted by Schoenfeld et al (2016, 2017) led to findings indicating that maximal strength benefits are obtained from the use of heavy loads while muscle hypertrophy can be equally achieved across a spectrum of loading ranges.  This is backed by Dr. Mike Israetel when explaining the time under tension can be equal across a range of weights, so long as the muscle fibers are brought close to or achieve fatigue.  As long as all three components (concentric, isometric, eccentric) of the working muscle are achieved through the majority of the range of motion, muscular gains have been found utilizing as little as 30% of the 1RM.  Schoenfeld’s studies contrasted volume with the analysis using binary frequency as a predictor variable revealed a significant impact of training frequency on hypertrophy effect size (P = 0.002), with the higher frequency being associated with a greater effect size than lower frequency (0.49 ± 0.08 vs. 0.30 ± 0.07, respectively).

 Methods such as these or bodyweight protocols are effective for those who are adverse to weight training or unable to due to contraindications, however, volume was the decisive factor in how much could be achieved wherein multiple sessions per week were superior to a single intense session.  Factors that must be considered when using any program or weight is the proper form and control.  Utilizing improper body mechanics can put extreme stress on the joints and swinging weights around with momentum often relates to injury.  It is paramount to only use weights that can be used in a controlled fashion.  This will not only lessen or eliminate an injury risk but subsequently result in better muscular growth as each phase of the muscle contraction and lengthening phases are used appropriately through the entire lift.  Especially in newer lifters, this means that using a lighter weight for more repetitions is the most appropriate choice.  For experienced lifters, incorporating light-weight can allow for an increase in total volume, leading to additional strength gains and improving muscular endurance.  This approach also trains the nervous system to achieve precise motion to achieve a better neuro-muscular improvement.

It can be overwhelming to begin a strength program with a vast amount of information that seems to be ever-changing.  Experts exist in these areas to assist in setting and reaching goals.  Personal trainers specialize in strength and conditioning while ensuring proper form to prevent injury.  When choosing a personal trainer be alert to their credentialing as the field is largely unregulated and there are “internet experts” who claim experience they may or may not have.  Physical therapists are experts in the non-surgical treatment of injuries or conditions.  As such they are great assets in program creation while considering prevention and treatment of injuries, especially for those with a prior history of injury.  Both the physical therapist and personal trainer should have a great working knowledge of anatomy and physiology which is critical for accurate and individualized program creation.  They often work together for the best possible patient outcome.

Overall

The need to maintain strength training is clear.  It is highly transferable to everyday life, the amount of which will be directly affected by the effort put into training and the program design.  Multiple programs can be implemented to retain strength, but the secondary and tertiary effects of training must be considered for the best individual approach.  The coach-client relationship should not be overlooked as it is often the largest contributing factor determining compliance and exertion in training, as any properly implemented program will have benefits over the stagnation of not completing any program at all.

Contact our skilled physical therapy team if you’re unsure where to start. They will work with you to determine what type of strengthening program you should follow based on your needs. They may also recommend manual therapy, therapeutic cupping, or dry needling to decrease pain and improve mobility to complement your gains further.

References:

Csapo R, Alegre LM. Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: A meta-analysis. Scandinavian Journal of Medicine & Science in Sports. 2015;26(9):995-1006. doi:10.1111/sms.12536.

Hunter GR, Mccarthy JP, Bamman MM. Effects of Resistance Training on Older Adults. Sports Medicine. 2004;34(5):329-348. doi:10.2165/00007256-200434050-00005.

Kennis E, Verschueren SM, Bogaerts A, Roie EV, Boonen S, Delecluse C. Long-Term Impact of Strength Training on Muscle Strength Characteristics in Older Adults. Archives of Physical Medicine and Rehabilitation. 2013;94(11):2054-2060. doi:10.1016/j.apmr.2013.06.018.

Schoenfeld BJ, Ogborn D, Krieger JW. Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy: A Systematic Review and Meta-Analysis. Sports Medicine. 2016;46(11):1689-1697. doi:10.1007/s40279-016-0543-8.

Schoenfeld BJ, Grgic J, Ogborn D, Krieger JW. Strength and Hypertrophy Adaptations Between Low- vs. High-Load Resistance Training. Journal of Strength and Conditioning Research. 2017;31(12):3508-3523. doi:10.1519/jsc.0000000000002200.

Roie EV, Delecluse C, Coudyzer W, Boonen S, Bautmans I. Strength training at high versus low external resistance in older adults: Effects on muscle volume, muscle strength, and force–velocity characteristics. Experimental Gerontology. 2013;48(11):1351-1361. doi:10.1016/j.exger.2013.08.010.

October is National Physical Therapy Month!

By Adam Wirtz, PT, DPT

In celebration of Physical Therapy month, I thought it would beneficial to share some facts about our profession:

Physical therapists (PTs) are movement experts who optimize the quality of life through prescribed exercise, hands-on care, and patient education.  PTs and the licensed physical therapist assistants (PTAs) may team up to provide care across the lifespan to anyone of any ability.

There are many benefits to physical therapy. Some of these include the following:

Ø It can maximize your movement. PTs can identify, diagnose, and treat movement problems.  Pain-free movement is essential for good quality of life, your ability to earn a living, and your ability to remain independent.

Ø Personalized care that meets your specific needs.  PTs design individualized treatment plans to address each patient’s needs, challenges, and goals.  PTs and PTAs improve patient mobility, manage/decrease pain and other chronic conditions, recovery from injury/surgery, and aim to prevent future injury and chronic disease.

Ø Accessibility.  PTs and PTAs provide care in a variety of settings, including hospitals, private practices, outpatient clinics, homes, schools, sports and fitness facilities, work settings, and nursing homes.  During these uncertain times during the pandemic, choosing to see a PT first can help to reduce patient traffic in physician offices.  This can allow physicians to focus more on caring for patients that are more critically ill or are at risk of becoming critically ill from COVID-19 or other illnesses such as influenza.  It also means that you do not have to risk being around patients at a hospital or clinic that may possibly be ill with a contagious pathogen.

Ø Active participation in care.  PTs and PTAs empower and motivate people to be active participants in their care.  They also work in collaboration with other medical professionals to make sure patients receive high-quality care.

Ø Reduces the use of opioids.  In certain situations, when dosed appropriately, prescription opioid medications can be an appropriate part of medical care.  However, current CDC guidelines are urging medical providers to consider safer alternatives to opioids like physical therapy for most long-term pain.  Opioids have several risks including depression, overdose, and addiction, plus withdrawal symptoms when stopping use.

Ø Avoid surgery.  Before undergoing expensive or invasive surgery, consider physical therapy first.  There is mounting evidence that physical therapy can be as effective or in some cases even better than surgery for conditions such as meniscal tears and knee osteoarthritis, rotator cuff tears, spinal stenosis, and degenerative disk disease.

Now that you are aware of some of the benefits of PT, let’s address the topic of direct access.

Did you know that you have the freedom to choose your own physical therapist?

Ø  Currently, you may be evaluated by a PT without a physician’s referral in all 50 states and the District of Columbia.  In addition, all 50 states and the District of Columbia allow some level of treatment by a PT without a physician’s referral.  This is referred to as “direct access” to physical therapy services.

Ø  Some insurance policies may require you to see a primary care provider or physician prior to seeing a physical therapist.  Also, some insurers may limit your access to preferred providers only.  Contact your insurance company to make sure you are aware of any of these policies.

Ø  If you have Medicare as your primary insurance, you are able to see a PT for an evaluation without a physician’s referral.  The PT would then send the plan of care to the patient’s physician for signature.  Once this is signed treatment can be continued.

Ø  Your physician may refer you for physical therapy that is provided in the physician’s office, or to a facility in which the physician has a financial interest.  However, you are not obligated to attend PT in any specific facility or location.  You can choose where you would prefer to attend physical therapy and which licensed physical therapist you would like to see if you have a preference.

Now that you know all about the benefits of PT and your ability to choose your physical therapist, the next time you have an aching knee, a bum shoulder, a sore heel, or an injured lower back, consider finding a physical therapist first to help you get back to moving well!

Our clinics are low traffic, safe environments that allow for continuity of care for those individuals that may not be able to get into their doctor’s office, especially during the COVID-19 pandemic.  We have implemented deep cleaning protocols and patient screening procedures to minimize the risk of infected individuals entering our clinics.

You can find a physical therapist by name or location.

Best Way To Get Rid Of Back And Neck Pain… Physical Therapy!

Written by: Dennis Kaster, PT-- Stevens Point North

Physical Therapy is one of the most effective and cheapest ways to treat back and neck pain, but few people know that. 

Most back and neck pain is caused by muscle weakness, tightness, poor posture, or poorly set-up workstations that put extra stress on the body. 

A Physical Therapist will assess which of these issues is causing the pain and help you get rid of it by doing specific stretches, strengthening, improving posture, performing treatment to decrease pain or swelling, using better lifting mechanics, or helping you set up your work or home workstations to put less stress on your body. 

The typical process in the past has been that when someone injures their back, they go to a medical doctor.  The doctor would decide what to do next, which many times included rest, medications, or expensive imaging. 

Several years ago a large medical organization, Virginia Mason, broke down the process of medical care for back injuries, looking for the quickest, most effective, and cheapest way to treat low back pain.  In the end, they found that people who saw a physical therapist first for lower back pain recovered much quicker, returned to work sooner, and experienced a much lower overall cost of care.  

This is because Physical Therapists specialize much more in the anatomy and mechanics of how the back works and how to stop and prevent pain.  Physical therapists also do not prescribe opioid pain medications.  Many times medical doctors prescribe opioid prescriptions, advise patients to rest until the pain goes away, or order expensive medical imaging, which many times is not necessary.  Many other research studies have found the same results.

As a result of the findings of multiple research studies, many insurance companies no longer require a physician referral to cover physical therapy, as they realize that people with mechanical low back pain respond much quicker and better if they see a Physical Therapist first.  Most people are not aware of this. 

Several studies have shown that as little as 7% of people with low back pain see a Physical Therapist.  This is crazy…..when Physical Therapy is one of the most effective ways to treat low back pain. 

Also, Physical Therapists have the expertise to recognize more serious medical issues that would require a referral to a medical doctor. 

So, if you see a Physical Therapist first and your pain is due to a medical issue, you can rest assured that the Physical Therapist will recognize it and direct you to the appropriate care. 

PLEASE HELP US TO GET THE WORD OUT!!  IF YOU HAVE BACK OR NECK PAIN, SEE A PHYSICAL THERAPIST FIRST.  IF YOU OR SOMEONE YOU KNOW HAS BACK OR ANY MUSCLE OR JOINT ISSUE, LET THEM KNOW THAT PHYSICAL THERAPY MAY BE THE BEST FORM OF TREATMENT FOR IT. 

If you have questions, please give us a call and we can answer them for you or check with your insurance to make sure our treatment is covered.

References

• Furhmans V. Withdrawal Treatment: a novel plan helps hospital wean itself off of pricey tests.  The Wall Street Journal. January 12, 2007

• Pendergast J, Kliethermes S, et al, A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Research and Educational Trust DOI:10:1111/j.1475-6773.01324.x, Oct. 2011

• Mitchell JM, de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997;77: 10-18

• Moore JH, McMillian DJ, et al. Risk determination for patients with direct access to physical therapy in military health care facilities. J Orthop Sports Phys Ther. 2005;35:674-678

• Leemrijse CJ, Swinkles I, Veenoff C. Direct access to physical therapy in the Netherlands: Results from the first year in community based physical Therapy. Phys Ther 88;8:936-946

• Kenney. Transforming Healthcare, Virginial Mason Medical Center’s Pursuit of the Perfect Experience.  CRC Press, 2011

Why do you make physical activity a priority in your life?

Dean J Sondrol, PT

Why do you make physical activity a priority in your life? This question was a recent topic of discussion one day between myself and some of my clients at Advanced Physical Therapy and Sports Medicine, and then later on between some friends and I. It was sparked by a recent article I read on the APTA Website- see article below. 

Here are some of the responses that came up:

-to stay’ healthy (was the most common)

-to keep up or stay with my children (one of my main reasons)

-to enjoy the outdoors; hiking, kayaking, and biking

-to dance at my granddaughter’s wedding

-my wife tells me to, or my kids tell me I need to

-so I look good

-cause of my heart attack or new hip or knee

-So I can play high school sports (from some of the younger people)

-in case I get COVID (a more recent reason)

-so I can fit into that dress or pair of jeans

-my high school reunion is coming up

-so I can drink more beer, or eat more food

-it just feels good

Of course, this also led to a discussion on why we don’t make physical activity a priority in our life, (that is a topic for an article in itself).    The benefits of physical activity are well documented, we all have heard reason on TV, at the Dr office, from social media and from family and friends.  So I won’t lecture you in this article but I would encourage you to find the one or two reasons why you should make physical activity your priority.  Write it down if you want, post it on your phone, or just think about it from time to time.  I will also think of my reasons why I’m doing that activity and it makes that walk or work out all the more meaningful.  So if you see me out running, biking, or walking and ask what I’m thinking about I would probably tell you my children or how many more miles I should run so I can eat that jelly doughnut.    

You may have some of the same or have your own reason.  Please feel to share your reason with me…. Remember to keep making physical activity your priority!

From: Top 10 Benefits of Physical Activity.  From Choose PT August 2020

https://www.choosept.com/resources/detail/top-10-benefits-of-physical-activity

Most Americans do not move enough. The good news is that regular physical activity is one of the easiest ways to reduce your risk for chronic disease and to improve your quality of life.

Make physical activity a priority to:

1.    Improve your memory and brain function (all age groups)

2.    Protect against many chronic diseases.

3.    Aid in weight management.

4.    Lower blood pressure and improve heart health.

5.    Improve your quality of sleep.

6.    Reduce feelings of anxiety and depression.

7.    Combat cancer-related fatigue.

8. Improve joint pain and stiffness.

9. Maintain muscle strength and balance.

10. Increase the life span.

Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. Physical therapists treat people of all ages and abilities and empower you to take an active part in your care. After an evaluation, your physical therapist will create a treatment plan for your specific needs and goals.

Choose more movement. Choose better health. Choose physical therapy.

Speed and Agility Training

David Reybrock, MPT

Speed and agility are primarily associated with athletes training for sport; but it also occurs in our everyday activities. We are all athletes in one form or another. Whether you are in a sport, involved in recreation, participate in regular exercise, walk a dog, or play with your children; speed and agility training can help enhance your movement skill acquisition and functional mobility.

As movement specialists, Physical Therapists can use speed and agility training to provide stability by varying speeds of motion and body position.  Everyone can benefit from improved balance, quicker feet, and faster reaction time.  Speed and agility in youth can be used for injury prevention, promote exercise participation, and improve physical fitness.  Speed and agility in elderly can be used to improve coordination, prevent falls, and maintain independent living.  Adding speed and agility to an exercise routine or treatment program can help you move more efficiently and effectively.  

What is Speed, what is Agility?

Speed is defined as the ability to move the body in one direction as fast as possible. Training for speed requires strength in the arms and legs to propel your body forward. The muscles in the back of the thigh and leg create triple extension- forceful extension of the hip, knee, and ankle joints. The gluteus maximus muscle of the hip; hamstring muscles of the knee; and gastroc-soleus muscles of the ankle are the muscles used to run faster.

Agility on the other hand, is the ability to accelerate, decelerate, stabilize, and quickly change directions with proper posture. Agility training focuses on performing a variety of movements in a quick manner. It is not simply going as fast as you can, but rather adjusting movements while going as fast and as steady as possible. Training for agility requires good balance and a strong core to support the body as it moves through all three planes of motion.

The combination of speed and agility training should be used to develop movement skills that include acceleration, deceleration, dynamic balance, and change of direction. In developing these skills, appropriate stability, mobility, and sequencing of movement patterns is important for training athletes and treating patients in physical therapy.

Here are some examples of speed and agility drills that can be used to train athletes and treat patients to be able to speed up, slow down, and change direction more efficiently:

Sprints or walking. Run or walk as fast as possible from a standing still position. The distance will vary based on ability and sport specificity. Add change of speed, stop and pivot turns, head movement, inclines or declines to incorporate agility.

High knees wall drill. With arms extended forward and hands on a wall for stability, alternate knees to hip level up and down as fast as possible. For agility, remove hands from the wall and perform with opposite arm swing and change of speed.

Static balance. Sit on a stability ball, stand with a wide or narrow BOS, or single limb stand.

Dynamic balance. Seated balance with arm and leg movement. Tandem forward walking, side-stepping, and carrying objects while walking.

Cone drill example:

Pro-Agility: 20-yard line sprint, 5-10-5
Purpose: Improve the ability to change direction by enhancing footwork and reaction time.
Procedure: Place each cone 5 yards apart. Start in a two-point stance at the starting line, the center cone. Sprint to the end line and touch with your hand. Turn back and sprint to the far cone (10 yards) and touch the line. Turn back and sprint 5 yards through the start line to the finish.

Image- https://mishockpt.com/speed-and-agility-training/

Agility Ladder drill example:

2 feet out, 1 foot in.

Image- https://i.pinimg.com/564x/97/db/15/97db15d22b150e4585a1caa89056b39a.jpg

Plyometrics: Jump, leap, and hop.

References:

Clark, M.A., Sutton, B.G., Lucett, S.C. (2014). NASM Essentials of Personal Fitness Training, 4th Edition, Revised. Burlington, MA: Jones and Bartlett Learning.

Better going into surgery, better coming out.

Briana Wasielewski, PTA, CCCE, BS

Having the best rehab after surgery is one of the top priorities of all surgical candidates. Many spend a lot of time getting the best surgeon in place, getting their place to rest in order, and thinking about who can help them with daily life and getting to and from appointments once the surgery is done. While these are all things one should think about prior to surgery, many do not think about what they can do to ultimately increase their chances of having a better surgical outcome: exercise prior to surgery. 

Exercise comes in many forms and is something everyone can do before surgery. If done appropriately, exercise before surgery will likely improve recovery. Who better to help figure out your unique pre-op exercise plan than a physical therapist? 

First, a physical therapist will discuss and evaluate your reason for surgery. Many times the reason a patient is thinking about having surgery is that they have pain or their movement is affected. Exercise is usually not something surgical candidates think they can or should do before considering surgery. Prehab exercise is specifically designed by physical therapists to improve the outcome of patients’ post-surgical rehab. The idea here is “the better going into the surgery, the better coming out”. Whether that means breathing exercises, simple strengthening, flexibility work, or practicing how to use crutches, seeing a physical therapist before surgery can help the healing process in the long run.  

A physical therapist prehab visit also gives the opportunity for surgical candidates to ask questions specifically about the most dreaded part of having surgery: the recovery. Physical therapists are experts in rehabilitation and can tell you exactly what to expect in recovery, and how to prepare yourself with pain management tools.  

If you are thinking about having surgery or know someone who is, make sure you prepare yourself and your body by seeing one of our physical/occupational therapists.

Head to our location page to find a clinic near you!

Does Selecting the Right Running Shoe Help Prevent Injury?

Josh Zilm PT, DPT

Does Selecting the Right Running Shoe Help Prevent Injury?

It’s spring and time to strap on those shoes and get outside.

There has been an entire industry built around providing runners with the best possible shoe.  When answering the question, “Does selecting the right running shoe help prevent injury?” one often has to tread lightly as there are many opinions.  As physical therapists, we like to turn to the scientific literature to answer a question.  Can a running shoe offer a return on energy? Is it better to run barefoot?  Are minimalist shoes better? What about orthotics?  Those are topics for another time.  This post will focus only on the running shoe’s ability to reduce injury and not attempt to answer any of those other questions that can often muddy the waters. 

The industry

The running shoe industry dates back to the mid to late 1800s, but most credit the start of the modern-day training shoe to the founder of a little company called Nike when he started selling shoes out of the back of a van in the 1960s.  Since that time running and shoes have grown into a multi-billion dollar industry.  Did you know that the first New York City Marathon was held in 1970 and had 127 competitors?  That is quite a contrast from 52,812 finishers in 2018.  As the sport has grown so has the market for better shoes with an attempt to meet the needs and demands of the runner.  Research, technology, science, expert opinion, and business has delivered a vast shoe market that boast a variety spanning barefoot the ultimate support and cushion.  So with all the shoes available today, is there a shoe for your foot type that can reduce injury associated with rigors of the sport?

The Amazing Foot

The foot is designed to help our bodies absorb energy as we impact the ground in an action called pronation.  The foot and ankle accomplish these amazing feet through a team effort.  We have muscles from our trunk to our feet that actually fine-tune how the body absorbs shock and then in a split second prepares to propel us forward with each step.  Running injuries are most often associated with the loading phase of running and more specifically the rate at which we load.  Don’t be afraid I won’t get too technical, but it is important to understand that the primary focus on injury reduction regarding the shoe is slowing the rate of loading, that is how fast our bodies have to accept the load with each strike of the foot on the ground. 

Foot Type

The hard part about designing the perfect shoe is that there are 7.66 billion people on the planet with a lot of different foot types (I know they are not all runners).  Thankfully, the orthopedic and running world has been able to classify foot type to offer some order to our attempts to best categorize the variety of feet that walk or run into the clinic.  Foot type does offer some predictive value to the injuries that we typically experience.  Nature(genetics) and nurture(lifestyle) lend way to a spectrum of people have rigid high arched feet, flat feet flexible feet, and everything in between.  The shoe industry has tried to match foot type with the appropriate shoe.  For example, the rigid high arch foot type should consider a softer shoe, while the flat flexible foot could use a more supportive shoe. 

The Shoe Spectrum

The soft shoe would be categorized as a “cushioned” shoe while the more supportive shoe is given the name “motion control”.   It would be intuitive to think that a person with a poor ability to control the position of the foot would benefit from added support and the person with a rigid high arch foot may need a little more cushion because they hit the ground harder.  (funny that studies show that joint reaction forces are actually higher in a cushioned shoe versus minimal support.  The working theory is that runners hit the ground harder with a cushioned heel simply because it’s cushioned.)  This could be a multiday conversation, but my attempt is to explain the basic shoe spectrum that starts with no support(barefoot/running sandal) to motion control(high degree of pronation control).  There are many variations within this spectrum that attempt to meet the needs of the runner, but the question we are trying to answer is can we reduce injury by pairing the runner with the right running shoe?   What does the research say?

Theisen et at 2014 Br J Sport Med completed a study looking at over 200 runners.  They found:

1.      Midsole Hardness and Injury rates: no different.  The amount of cushion had no significant difference in injury rates.

2.      Energy absorption and injury risk have no scientific correlation.  A shoe that absorbs energy does not reduce injury rates.

3.      Shoe wear does not appear to have an effect on biomechanics.  You cannot correct your biomechanics by running with a shoe.

4.      1% increase in metabolic cost for every 3.5 ounces of shoes.  Heavy shoes require more energy.

The recommendation:   Promote light shoes.  Refrain from claiming that shoes reduce injury through cushion or biomechanical changes.

Ryan et al. (2011) Br J Sport Med found;

• Shoe assigned by foot posture index(match the shoe with the foot type).  Static foot type should not be the determining factor for shoe selection.  The highest rate of injury was in runners wearing a motion control shoe that were appropriately matched based on foot type. 

The recommendation: Don't use the algorithm alone in an attempt to match foot type and shoe type to dictate the choice of running shoe.

Nielsen et al. (2014) Br J Sports Med.

• Foot pronation was not associated with increased injury risk in novice runners wearing a neutral shoe.  The “Over pronator” did not experience a greater rate of injury when left unsupported versus supported.

The recommendation: Let comfort dictate.  Give the runner a starting point in shoe selection, but do not feel locked into a shoe, especially motion control. 

Conclusion

Shoe type may offer a good starting point for a new runner when selecting shoes.  Based on the current literature I would recommend starting your search with a shoe that matches your foot type, but don’t feel boxed into a certain type of shoe.  Look for something that is comfortable when you run.  In more recent literature motion control shoes have been associated with higher rates of injury which gives rise to concern for recommending a motion control shoe.

Also, a lighter shoe consumes less energy.  The weight of the shoe does matter.   

One of the questions I often ask in the clinic is, “Do you run to get stronger or get stronger to run” (Dr. Chris Powers, USC).  I see a lot of runners try to compensate for bad mechanics through shoes and more running, but the truth is many people lack the strength to support the activity of running.  A physical therapy running evaluation can be a great tool as you begin or return to running.  Injury reduction comes from improved biomechanics something that we are all capable of with the right instruction.  Like many things in running, there are no short cuts.  Consistent effort = results.  The right running shoe may do a lot of things for the athlete, but with the exception of protecting the bottom of the foot and toes, there does not appear to be evidence supporting the claim that they reduce injury rates in runners.

The Most Common Cause of Vertigo is also the Most Treatable

Chris Hupf, PT, DPT, CSCS

Do you ever feel a sense that you or your surroundings are spinning or moving? Do you experience bouts of sudden unsteadiness or dizziness? Vertigo is a type of dizziness defined as an illusory sensation of motion of either the self or the surroundings in the absence of true motion (1).

According to the National Institute on Deafness and Other Communication Disorders, it’s estimated that close to 40% of the population will experience dizziness or balance problems over the course of their lifetime(2). 

One of the most common causes of vertigo is a condition called benign paroxysmal positional vertigo (BPPV). In fact, of the 5 million people in the United States who seek care for complaints of dizziness every year, between 17% and 42% end up receiving a diagnosis of BPPV.1 

BPPV is a type of positional vertigo caused by a disorder of the inner ear. Those who have it experience repeated “spinning” sensations or unsteadiness when they move their head in a certain direction. This could occur when rolling over or getting out of bed or tipping the head back to look up. A feeling of lightheadedness and nausea can occur as well. 

It’s widely understood that BPPV is caused by small calcium carbonate crystals that become dislodged from their normal resting place and end up free-floating within one of three semicircular canals used by the inner ear to sense movement. With changes in head position, these crystals migrate within the fluid-filled canal, causing movement of fluid and subsequent pressure changes that result in an abnormal sensation of rotation or spinning.

In the clinic, a physical therapist can assist in diagnosing BPPV through physical examination and understanding your history. This includes observation of involuntary eye movements that occur when the patient is placed in specific positions that provoke their dizziness. Depending on the canal affected, treatment involves a sequence of specific maneuvers designed to clear these crystals from the canal. These maneuvers are highly effective, with studies showing a complete resolution of symptoms 74-95% of the time in as little as one visit. (3-6) 

Almost 90% of people with BPPV will experience some interruption to their daily lives, including anxiety, depression, an increased risk for falls and impaired performance at home or at work.1,7 And, because most people who seek treatment are unaware that physical therapists can help, many ultimately end up undergoing expensive and unnecessary diagnostic testing and treatment first. (7) 

Physical therapists quickly and easily treat BPPV. Many of our therapists have undergone additional training to diagnose and treat BPPV, so please don’t hesitate to reach out and schedule an appointment. It could be your next and final step in ending this debilitating condition, allowing you to live life uninterrupted once again.

References: 

1. Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., ... & Seidman, M. D. (2017). Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1-S47. 

2. National Institute on Deafness and Other Communication Disorders. (2005). Strategic plan (FY 2006-2008). Retrieved from http://www.nidcd.nih.gov/StaticResources/about/plans/strategic/strategic06-08.pdf [PDF]. 

3. Wang, Y. H., Chan, C. Y., & Liu, Q. H. (2019). Benign paroxsymal positional vertigo–recommendations for treatment in primary care. Therapeutics and clinical risk management, 15, 719. 

4. Fyrmpas, G., Barkoulas, E., Haidich, A. B., & Tsalighopoulos, M. (2013). Vertigo during the Epley maneuver and success rate in patients with BPPV. European archives of oto-rhino-laryngology, 270(10), 2621-2625. 

5. Helminski, J. O. (2014). Effectiveness of the canalith repositioning procedure in the treatment of benign paroxysmal positional vertigo. Physical therapy, 94(10), 1373-1382. 

6. Bruintjes, T. D., Companjen, J., van der Zaag‐Loonen, H. J., & van Benthem, P. P. G. (2014). A randomised sham‐controlled trial to assess the long‐term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo. Clinical Otolaryngology, 39(1), 39-44. 

7. BPPV: Experts Update Best Practices for Diagnosis and Treatment. (2017, March 1). Retrieved from https://www.entnet.org/content/bppv-experts-update-best-practices-diagnosis-and-treatment

Image of Inner Ear: Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work.

Keeping your Resolution & Physical Therapy

Kris Tebo, PT, DPT

With the new year people begin to set goals and make resolutions. Losing weight, getting to the gym more often or getting into "better shape" are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly can lead to pain, injury and disappointment if your body isn't ready for it. Your physical therapist is an expert in movement and can help you safely reach your fitness goals.

People think of physical therapists as the people to see after an injury, but a visit before you change your activity level could prevent injury in the first place. An evaluation by your PT will include assessment of your strength, range of motion, and functional movement patterns - think jumping, running, squatting, carrying. Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your assessment. They can then prescribe exercises to address the issues found and get you safely moving toward your goals.

The other common way people get injured working towards their resolution is over-training, or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble. So stop only thinking of your PT after you're injured. In this case, it's true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist early on can keep you on track, injury-free, and help you reach your goals for the new year!

Check out one of our earlier blogs here to learn about what you can be doing to reach your goals.

APTSM does offer performance training, bridge training (for those transitioning out of therapy and into a more intensive exercise program) and FREE 15-minute consultations. So call us today and schedule your appointment and get back on track with your resolutions. 920-991-2561

Some material in this blog is provided by the Prive Practice Section of APTA

Start the Year Right, Prevent and Treat Shoulder Pain

Phil Sorensen, PT, CSCS

From Thanksgiving through Christmas & New Years I have had more friends and family members ask me about their painful shoulders than any other body area. Not one had a specific injury. Pain developed with use/reaching, exercise, work and in most cases was interfering with their ability to sleep. The good news for them was their condition is very treatable and responds well with physical therapy. The longer you ignore symptoms and the repetitive pain with daily use, reaching, etc. the more challenging it can become to relieve. Structure of the Shoulder: In most parts of the body, the bones are surrounded by muscles. In the shoulder region, however, the muscle and tendons are surrounded by bone. If you tap the top of your shoulder, you can feel bone immediately under the skin, this is called the acromion of the scapula. Directly under this bone is the rotator cuff, a group of four muscles and tendons. In the image below, the supraspinatus is one of the tendons that are most commonly involved. It along with the bursa (a fluid-filled sack) is positioned right between the humerus (upper arm bone) and the acromion that you tapped. This structure of muscle-tendon between bones is a contributing factor to the development of impingement syndrome (shoulder bursitis, rotator cuff or biceps tendinopathy).

Muscles of the Shoulder: Proper rotator cuff (RC) and scapular muscle strength is critical in both preventing and treating shoulder pain/impingement. The RC role is to keep the ball of the humerus in the correct position with the scapula. The rotator cuff enables the other major muscles of the arm, the deltoid and Latissimus dorsi (“lats”), to properly perform their job during reaching, lifting, pushing, or pulling. Balanced strength around the shoulder blade, in the lower & middle trapezius, rhomboids & serratus anterior (scapulothoracic) muscles, is crucial for shoulder blade movement and shoulder mechanics. Weakness and imbalance in these muscles and/or the RC is another primary factor with impingement syndrome, shoulder bursitis & rotator cuff tendinopathy. Corrective Measures: Learning proper technique to balance the previously mentioned muscles in various positions then progressing to movements can be complex and is where the skills of a PT are of great benefit to optimize your time and efforts. Below is a link to a video demonstrating a great shoulder stability exercise that engages these muscles using a small looped band while doing a small forward reach. CLICK HERE

In addition to developing proper rotator cuff & scapulo-thoracic muscle strength, it’s important to address adequate shoulder, rib cage & thoracic (upper back) mobility. Your physical therapist will assess, treat and instruct you in things you can do to improve your mobility. In most cases, shoulder impingement, bursitis, &/or rotator cuff tendon injuries can be completely rehabilitated and should leave no residual effects once a person has recovered. Shoulder pain can be debilitating by limiting your ability to exercise and perform daily tasks. Start the year out right, be proactive in the care of your shoulder. Call and set up an appointment to see a PT today. The longer a condition is left untreated, the more potential for harm and tissue damage which may lead to a longer recovery process.

Contact us to start your recovery or prevention journey today!