Dr. Joel's Earns his RN.

VIMG is pleased to announce that Dr. Joel Dekanich recently completed his registered nurse (RN) degree from the Institute of Health Care Professions in Boynton Beach, FL. https://www.ihpedu.com/

He is now a board certified RN in the state of CO and will be working in collaboration with our physician assistant Rachel Segerdahl, PA-C on various medical and physical medicine procedures. “I am excited to further my education in the medical field and expand my scope of practice to better serve our patient’s needs” says Dr. Joel. Congrats Dr. Joel!!

Graston technique - Improving Tissue Healing

When the body suffers a spinal or extremity injury, there are often concurrent structural changes within the muscles as they recover.  In a healthy body, examined under microscope, the individual connective tissue fibers in muscle look well organized, intertwining and running side by side in the same direction. Following an injury, the scene looks much different. The individual fibers scatter in random directions, and the rope-like structures look frayed.  Structures that should easily glide past each other   become stuck, or adhered together, which can affect one's normal movement patterns in the neck, back, and/or extremities.

Muscles that show this kind of change tend to experience more problems than just restriction of motion.  These muscles often exhibit painful trigger points along with weakness or inhibition.  These issues can then create a situation where surrounding tissue is also damaged while it overcompensates for the already injured tissue.  In this way, a small injury can spread and significantly worsen over time.

Luckily, there are several treatment options to help remodel the injured tissue back to its original state. Among these treatments, the Graston technique is one of the most effective. Graston incorporates a set of stainless steel tools to work on these damaged tissues with two goals in mind. From a physiological perspective, the shearing forces generated by the tools help to destroy the fibers that are poorly aligned. The normal, well-aligned fibers remain intact due to their inherent structural strength. Additionally, at the cellular level, laboratory studies have confirmed that this treatment increases the number of fibroblasts in the area for about two days after Graston is administered. The job of the fibroblasts, the repair cells of connective tissue, is to break down damaged fibers and rebuild new ones in their place. In this way, Graston technique can be used to focus the body's normal repair mechanisms to the areas that need it the most.

The best outcomes with Graston technique are produced during a course of 6-12 visits spread out among 3-6 weeks.  Treatment can be somewhat uncomfortable and may leave some bruising, but it should always be within the tolerance of the patient. Graston works best when combined with other therapies such as joint manipulation, stretching, and targeted exercise.  More information on this treatment can be found on the Graston Technique website: www.grastontechnique.com/

Ryan Azeltine DC

Welcome to Ken Wheeler PTA/LMT

Ken came to the Vail Valley from North Carolina after living in several states east of the Mississippi.  In North Carolina Ken started his career in healthcare attending Southwestern Community College to become a Physical Therapist Assistant then the Center for Massage in Asheville North Carolina to become a massage therapist and also has a degree from the University of Phoenix in Health Care Services.

 Ken has worked in a variety of settings, always in the field of health promotion. His work in North Carolina ran the gamut of helping develop restorative care programs in skilled nursing facilities, to in and outpatient Physical Therapy at Highlands Cashiers Hospital, to being program director for the Wellness Center and Outdoor programs for the Cullasaja Club in Highlands, North Carolina, a private country club.

 Ken returned to Southwestern Community College where he earned his Degree in Physical Therapy be the director of the Massage Therapy program while also teaching Functional Anatomy and Manual Techniques for Physical Therapist Assistants.

Ken has a deep love of outdoor pursuits and you may run in to him on a mountain or road bike, inbounds or back country skiing or just enjoying a hike or run on a mountain trail. His love of the sports in these mountains, as well as his daughter's ski racing brought Ken  from North Carolina several times a year for the past few years so he and his wife came to the conclusion that living and working in the Vail Valley would be incredible. 

 Ken has also worked with the National Ski Patrol for 10 years and is a Red Cross Certified Life Guard.

 Ken's diverse life experience is a good analogy for how he approaches the human body. "I like problem solving and will throw everything I have at a problem until we find what works best." Ken learned Active Isolated Stretching and Strengthening from the developer Aaron Mattes by working with him in his clinic in Sarasota, Florida. 

 He has been trained in Cranio Sacral, Myofascial Release, Neuromuscular therapy as well as other modalities. He has 16 years of experience in treating orthopedic and neurological conditions in both Physical Therapy and as a personal trainer.

Jackie Inducted into College Hall of Fame

Jackie Plesha is the College of St.Scholastica women’s basketball program’s leading scorer with 1,686 points. She is the only player in program history to break 1,600 points. She also holds career records for 3-point field goals (152) and free throws made (458). She not only scored a ton, but also distributed the ball as she ranks third all-time in career assists (271). Plesha led the team in scoring all four seasons of her career and led the team in assists in three of those four seasons. She ranks third in career steals (290) and fifth in career blocks (59). Plesha holds the program record for points in a game (37) and points in a season (526). She was named the NAIA Independent Player of the Year in 2005, a three time NAIA Honorable Mention All-American and a three-time UMAC Player of the Year. Plesha was a three-year team captain and was named a NAIA Scholar-Athlete in 2004

Hyperbaric Oxygen Therapy now Available in Vail and Edwards.

HBOT is a non-invasive therapeutic treatment that delivers an increased dose of oxygen to cells in your body.

Why Hyperbaric Oxygen Therapy?

All living creatures require air, water and food - and nothing is more vital than oxygen. Your body's tissues need an adequate supply of oxygen to function. When tissues are injured, they may require more oxygen to heal. An overall increase in oxygenated blood improves oxygen delivery for vital tissue function to help promote healing, minimize injury, improve symptoms of altitude sickness, and fight infection.

How does HBOT work?  

"Hyperbaric oxygen therapy increases the amount of oxygen dissolved in your blood," says Nayan Patel, a biomedical engineer in FDA's Anesthesiology Devices Branch. The treatment exposes your body to higher atmospheric pressures than normal which drives more oxygen into your system, ultimately tripling the oxygen concentration in your blood! The available oxygen then travels through your blood to be delivered at oxygen-deprived tissues.

Why Would You Use Hyperbaric Oxygen Therapy?

The FDA and Medicare have approved the use of Hyperbaric Oxygen Therapy for thirteen conditions, including diabetic ulcers, neuropathies, wound healing, anemia, and compartment syndrome.  In addition, current research shows that HBOT is a viable treatment for the growing list of “off-label” conditions including various symptoms of brain injury and concussion, sports injuries, altitude sickness, chronic fatigue, and stroke. Though these conditions are not yet formally approved by the FDA, research regarding the effectiveness of HBOT is quickly expanding. Two of these conditions are of particular interest to the group of patients that are commonly treated in our clinic.

First, HBOT is very effective for acute mountain sickness. This is a common occurrence for both locals and guests to the Vail Valley when traveling from sea level. The initial symptoms of altitude sickness can include headache, lethargy, decreased performance, lack of coordination, insomnia, appetite loss, dizziness, nausea, and vomiting. A session in the hyperbaric chamber will create even higher oxygenation levels than what you would experience at low elevation, helping your body to recover quickly from acute altitude sickness.

Another exciting use for HBOT is helping to increase the healing rate of injuries. This is of particular interest to our athletes in the valley, both locals and those visiting. The working speed of the body's repair cells is limited by their ability to produce energy, and the amount of oxygen at the injury site determines how much energy can be produced. While you are being treated in the hyperbaric chamber, all four oxygen-binding sites on your hemoglobin (the portion of your red blood cells that carries oxygen) will be filled rather than the 2-3 sites which is normal for this altitude. Additionally, the higher pressure will allow oxygen to also dissolve into the plasma (the liquid component of your blood) so that it can easily be transported to the injury site. HBOT works synergistically with rehabilitation to help injuries resolve faster so that our patients can return to their active lifestyles.

In order to try HBOT at VIMG, you will need a brief physical first to make sure you are an appropriate candidate for this treatment. If you are interested in a complimentary session in our chamber, give us a call at 926-4600 today!  

Vertigo

Dizziness and vertigo are common yet debilitating problems. Dizziness is defined as feelings of unsteadiness and imbalance, sometimes associated with fainting. Vertigo is the sensation that you or your surroundings are moving, often described as spinning. Vertigo can be associated with nausea and vomiting. These issues are often difficult to diagnose due to their many possible causes. Though more serious health issues such as central nervous system and cardiovascular disorders can cause symptoms of dizziness and vertigo, there are several less serious and treatable causes. This article focuses on two sources of dizziness and vertigo that can be successfully treated by a rehabilitation specialist – benign paroxysmal positional vertigo (BPPV) and cervicogenic dizziness.

BPPV is a disorder caused by changes in your inner ear that confuse your vestibular system, or your body's way of sensing your movements and orientation in space. This confusion can create intense vertigo, nausea, and vomiting with movements of the head. As the most common vestibular system disorder, it is estimated that 2.4% of all people will experience BPPV at some point in their lives.  As you age, this disorder becomes even more prevalent. Approximately nine out of every 100 older adults is diagnosed each year with BPPV. The mechanisms of this disorder occur inside your inner ear where live small crystals called otoconia that help you sense the position of your head in space. These otoconia can become dislodged, either due to head trauma, infection, increased fluid pressure inside the ear, vascular occlusion, or without a known cause. The dislodged otoconia travel into one of the semicircular canals inside the ear and settle in the fluid that surrounds the canals. With head motion, the otoconia shift and stimulate the sending of false signals to the brain about where your head is in relation to gravity. When this occurs, intense and significant symptoms of dizziness and vertigo persist with head motion until the otoconia are replaced. Many rehabilitation specialists such as physical therapists and chiropractors are trained in diagnosis of BPPV and methods for repositioning the otoconia which typically result in a quick recovery.

Cervicogenic dizziness is defined as dizziness secondary to neck pain or injury, with the caveat that all other causes of dizziness have been ruled out.  With frequent dizziness or any neck or head injury, it is important to see a medical doctor or rehabilitation specialist to rule out any indications of serious medical complications. With cervicogenic dizziness,

head movement or sustained positions of the head can elicit symptoms of dizziness that are often associated with neck pain and headaches. Patients with this disorder typically improve with sole treatment of the neck problem, though others may require additional vestibular rehabilitation. Vestibular rehabilitation includes eye exercises, balance training, and techniques for adjusting to environments or activities that trigger dizziness. For best results, these types of exercises should be administered by a trained professional, such as a physical therapist that has a background in vestibular treatment.

If you have persistent dizziness or vertigo, do not hesitate to see a medical professional. These symptoms can make a large negative impact on your life, yet they are very treatable. The sooner you seek treatment, the sooner you can enjoy life again without the debilitating symptoms of dizziness and vertigo.

Sara Bentley DPT

Doctor of Physical Therapy

Vail Integrative Medical Group

vailhealth.com

Posture Related Neck and Back Pain

Neck pain can be…well, a pain in the neck. Neck and upper back pain is easily one of the most common reasons that people present to our offices. There are a lot of possible causes for neck and back pain, so getting a good evaluation is essential to uncovering the underlying reason for the problem. One of the more common underlying contributors to neck and upper back pain is posture related muscle imbalances.

Whether it’s sitting at a desk reading or working on a computer, texting or driving (and not at the same time people!), most things we do are out in front of us. For short periods, this may not be a problem. For hours on end, day in and day out it will lead to muscle imbalances that can result in pain and dysfunction.

Upper Crossed Syndrome

If our head is allowed to come forward and our shoulders protract (droop forward), we put a great deal of stress on the musculature at the back of the neck. As the head drops forward, we do not look at the ground, we look out in front of us and the skull extends where it meets the neck. This engages the muscles just below the skull (the suboccipital musculature), which become overactive. The deep neck flexors weaken and destabilize the neck.  

As the shoulders protract, our shoulder blade stabilizers (scapular stabilizers) become inhibited and weak. Muscles that are normally quiet are recruited to help stabilize the shoulder girdle. The pectoralis minor, upper trapezius and levator scapulae muscles all become overactive. Rehabilitation pioneer, Vladimir Janda, called this collection of imbalances an “Upper Crossed Syndrome”.

These imbalances often lead to neck and middle back pain, but the change in the upper extremity mechanics also makes shoulder impingement, and thoracic outlet syndrome (a common reason for hand and finger numbness) more likely.

Prevention:

The first step in prevention and treatment is identifying there is a problem. If you work on a computer, drive a car or watch TV, chances are good you need to think about preventing upper crossed syndrome. Better ergonomic setup is important if long hours are spent in front of the computer. Preventative stretching and exercise to offset the postural stresses will be especially important in preventing symptoms from occurring.

Treatment:

If the imbalances have already set in and simple self care exercises are not helping, or symptoms are progressing and getting more severe, then evaluation and treatment by a professional is certainly warranted. There are many different treatments for neck and middle back pain. What treatment is most appropriate and effective depends on the diagnosis, presentation of the problem and the particular patient. If the underlying cause is related to posture and upper crossed syndrome, then conservative treatment with chiropractic and physical therapy and soft tissue work can be very effective.

Spinal manipulative therapy or joint mobilization at the thoracic spine can decrease the middle back discomfort and increase the available range of motion. With increased range of motion, thoracic spine self mobilization exercises on and off the foam roller will be more effective. Spinal manipulative therapy may also be used at the cervical spine to address specific joint restrictions, but typically an overall increase in stability will be needed in the cervical spine. Active Release Technique^® and facilitated stretching to tight or overactive trapezius, levator scapulae and pectoral muscles is often performed in the office. Stretching for these muscles will also be taught and part of a home exercise program.

It should however be remembered that these overactive muscles are overactive for a reason and may be contributing (albeit poorly) to stability because the prime stabilizers are not. Stretching without strengthening the neck and scapula stabilizers will offer temporary relief. Strengthening exercises and drills to improve scapular control will also be an important component to that home exercise program.

Like with many problems we see, neck pain associated with poor posture is not simply a muscle problem, or a joint problem, or a ligament problem. It’s how those different tissues interact, how we move and the compensation patterns that develop that shapes the symptoms we see. Addressing all those components - the muscle and tissue quality, joint mobility and the movement patterns with a balanced approach to care will yield the best results.

Dr. Mark Pitcher DC, MSc is a chiropractor and exercise physiologist at Vail Integrative Medical Group in Vail, Edwards and Eagle, Colorado. 

Learn more at www.vailhealth.com or follow Dr. Pitcher's Blog at www.markjpitcher.com 

McGill's Big Three Stability Exercises

Good News! We are back IN Network with Cigna for Chiropractic. There was some confusion with the insurance company, but effective 04-30-2012 we are officially in Network.

Give us a call at the Edwards office (970-926-4600) if you have any questions or to schedule a chiropractic appointment.

Condition of the Week - Ilio-Tibial Band Syndrome

Condition of the Week - Ilio-tibial Band Syndrome

View more PowerPoint from Mark Pitcher DC, MSc

Rest Recovery and Regeneration

Article Today in the Vail Daily:

Living With Vitality: Rest, Recovery and Regeneration 

What are the most important days in your workout schedule? Heavy lifting days? Long run days? High intensity interval days? No; most important are your rest and recovery days.

We sometimes forget that exercise stresses and fatigues our system, and it is during the recovery period where the real training effect occurs. This is where our body repairs and adapts to exercise.

Supercompensation model:  Training temporarily decreases fitness level. With recovery, our fitness level increases to and above baseline. It is during this period of  supercompensation when application of exercise can make additional gains. If no additional exercise is added we return to baseline.  

When we recover from exercise our tissues adapt returning not only to baseline but beyond, resulting in a positive training effect. If exercise is added during this period of “super compensation” further improvement will result. If no additional exercise is applied, our tissues will return to baseline levels. If exercise is applied too early in the recovery phase, the tissues with further break down and impaired performance may result. If this cycle is allowed to continue, tissue quality will decline.

Although true overtraining syndrome is rare in recreational athletes, under-recovery is common and can negatively affect tissue quality leading to overuse injury. Many factors affect recovery, but the rest period is the easiest to manipulate. Despite this, athletes, coaches and trainers often overlook the importance of building appropriate rest into workout programs.

In addition to managing rest periods, the following strategies also can aid in recovery:

Nutrition – Exercise creates micro-damage in muscle and depletes the glycogen stores. Research shows replenishing protein (0.2g-0.4g/kilogram of body weight) after exercise helps in muscle recovery. Replenishing carbohydrates (0.8g-1.2g of carbohydrate per kilogram of body weight) stimulates insulin response and maximizes glycogen synthesis, aiding in protein repair. Keep in mind, when exercise is of shorter duration, excess carbohydrates could be converted and stored as fat. Carbohydrate intake closer to the 0.8g/1kg body weight will get results while preventing excess fat gain. Post exercise nutrition is ideally taken in liquid form (a recovery shake) for faster utilization by the body. It is generally considered most effective to refuel within 30-60 minutes after exercise.

Active Recovery – This method is well supported by research and involves following bouts of hard or high volume work with low intensity, low-to-moderate duration exercise. Applied within specific exercise sessions, it can decrease lactate levels by maintaining enough blood flow to allow enough recovery to perform high intensity interval training. Used between exercise sessions, low intensity exercise, like a light run, moderate hike, or easy bicycle ride, can help speed recovery and net better results.

Contrast Water Therapy – Research remains mixed on the effect of cold water immersion and contrast water therapy (alternating hot and cold) on recovery. Cold water immersion has been shown to have acute effects on recovery from distance running, but can have a negative effect on recovery from anaerobic exercise; resulting decreased blood flow can hinder removal of waste products. However, using contrast water therapy can help create an anti-inflammatory effect, while maintaining blood flow to adequately remove metabolites.

Replace Fluids – You’ve heard that you are mostly made up of water. Beyond that, water is linked with every metabolic function in the body and is essential for distributing nutrients throughout the body. You lose fluid during exercise, which should be replaced during exercise. Drinking water after exercise is an easy way to boost recovery.

Sleep – Although seemingly obvious, a surprising number of adults live in a constant state of sleep deprivation. The restorative power of sleep is required to recover and rebuild tissues that are broken down during the day.

Sometimes great results don’t always come from maximizing your strengths, but from reducing your weaknesses. If inadequate rest and recovery is your weak link, try these recovery techniques to improve performance and get better results.

Mark Pitcher is a chiropractor, exercise physiologist and TRX instructor with Vail Integrative Medical Group at Vail Vitality Center located at Vail Mountain Lodge and Spa. He specializes in rehabilitative medicine. For information visitwww.vailvitalitycenter.com or follow Dr. Pitcher’s blog at www.markjpitcher.com

http://www.vaildaily.com/article/20120402/AE/120409979/1078&ParentProfile=1062 

The Effect of Kinesiotex Taping on Back Muscle Endurance Among Patients with Low Back Pain: A Randomized Controlled Crossover Trial

Dear research participant,

We invite you to participate in a research study looking at the effects of different therapeutic taping procedures on back muscle endurance.

Nature and Purpose of the Study

When treating patents with low back pain, it is common practice among physical therapists and chiropractors to improve back muscle function and endurance.  One way to accomplish this is through the use of therapeutic taping procedures. However, little is known about the effectiveness of different taping procedures. 

Therefore the aim of this study is to compare for differences in back muscle endurance under three treatment conditions: when two different types of tape are applied to the back and when no tape is applied.

If you consent to take part in this research study, it is important that you understand the purpose of the study and the tasks you will be asked to complete. Please make sure that you ask any questions you may have, and that all your questions have been answered to your satisfaction before you agree to participate.

What the Study will Involve

Potential research participants will be considered for inclusion in this study if they are between the ages of 18 and 60 years of age and are currently experiencing low back pain.  You would be excluded from participating in this study if:

1)     Your back pain radiates into the leg and beyond the knee

2)     You exhibit signs or symptoms which may indicate a potentially serious condition

3)     You have had surgery to your lower back

4)     You are currently pregnant

5)     You have a history of tape or adhesive allergy

6)     You do not think that you could tolerate the muscle endurance test.

If you decide to participate in this study, you will be asked to complete the following tasks

·         Complete 4 questionnaires that ask about:

1)     Your demographic information (e.g., age, height, weight), and details about your history of back pain.

2)     The effects of back pain on your daily activities.

3)     The intensity of your back pain.

4)     Your attitudes about the relationship between your back pain and your work related and physical activities.

Perform a back muscle endurance assessment.  This assessment will require you to lay prone (i.e., face down) with your upper body over the end of a padded examination table, and then extend your upper body against gravity until you reach a “neutral position” meaning that your back is straight. We will use three cloth straps to secure your hips and legs to the table.  These straps will be placed over your hips, knees and ankles and towels will be placed at each level to ensure that this set up is comfortable.  Once this is accomplished, you will maintain this position as long as possible while being timed by a research staff member. Before starting this assessment, the research staff member will demonstrate the test for you.  It is estimated that the questionnaires will take approximately 30 minutes to complete and the back muscle endurance assessment will take 5 minutes to complete in addition to your travel time to and from the clinic. 

  

You will be asked to complete the back muscle endurance assessment on three different occasions, each one to three days apart.  Prior to the assessment, you will be treated using one of the previously described options (Kinesiotex tape, athletic tape or no tape).  The tape will be applied to specific muscles on your back and will be removed upon completion of the back muscle endurance assessment.

Voluntary Participation and Withdrawal from the Study

Your participation in this study is entirely voluntary. You may withdraw at any time without discrimination or prejudice. If you elect not to participate or to withdraw from the study, such actions will in no way influence quality of healthcare you receive or the relationship with your healthcare provider(s). All information is treated as confidential and no names or other details that might identify you will be used in any publication arising from the research. If you withdraw, all information you have provided will be destroyed.

Benefits of the Study

It is possible that there may be no direct benefit to you from participation in this study.

While there is no guarantee that you will personally benefit, the knowledge gained from your participation may help others in the future. For example, if one of the taping procedures appears to be more effective, future patients with low back pain may benefit from this understanding.

Possible Risks

We have identified two potential risks which could be associated with your participation in this study.  First, while this type of back muscle assessment is routinely used by clinicians caring for patients with low back pan, it is possible that you may experience some discomfort either during or following the assessment. This type of response is rare, and the discomfort is typically mild and self limiting in nature.  The second risk would be the result of a tape or adhesive allergy which had gone undetected.  This would represent a very remote risk which will be minimized by only keeping the tape in contact with your skin for short durations of time. You will be monitored closely during the study and you are free to withdraw at anytime during the sessions. If you experience any unwelcome symptoms associated with your participation in this study, we will assist you by helping to arrange an appointment with your primary medical provider.

If you have any questions about this project please feel free to contact either myself, Dr. Jeffrey Hebert in Australia on +61 8 93602566 and J.Hebert@Murdoch.edu.au or, Dr Joel Dekanich in Colorado, on 970.479.6262 and Joel@vailhealth.com.  We are happy to discuss with you any concerns you may have about this study. 

Once we have analysed the information from this study we will put on our web site (http://vailhealth.com) a summary of our findings.  You can expect to receive this feedback in approximately six months.

If you are willing to consent to participation in this study, please complete the Consent Form.

Thank you for your assistance with this research project.

Sincerely

Jeffrey Hebert, DC, PhD

This study has been approved by the Murdoch University Human Research Ethics Committee (Approval xxxx/xxx).  If you have any reservation or complaint about the ethical conduct of this research, and wish to talk with an independent person, you may contact Murdoch University’s Research Ethics Office (Tel. 08 9360 6677 (for overseas studies, +61 8 9360 6677) or e-mail ethics@murdoch.edu.au). Any issues you raise will be treated in confidence and investigated fully, and you will be informed of the outcome.

Stay Strong and Injury Free all Ski Season Long

When thinking about exercises to improve lower extremity strength for skiing, quadriceps (quads), and dominant movements such as lunges and plyometrics, typically come to mind. While quad strength is important, you need to look beyond this if you want to stay strong and injury free all season long. 

Many athletes, especially skiers, are quad dominant. This means their knee extensors are much stronger than their knee flexors. Also, these athletes will often have imbalances, including weak glutes and overactive or tight hip flexors. A frequent mistake in strength training is to over-emphasize the exercises targeting the most commonly used muscles. To create more balance and stability, we need to strengthen the muscles and movements that oppose those primary muscles to keep from making an established imbalance worse.

Exercises that target the posterior chain (muscles that include the back extensors, glutes and hamstrings) can help offset some of the common imbalances. The hamstrings have a direct effect on stabilizing the knee by decelerating knee extension and reducing the shearing forces on the anterior cruciate ligament (ACL). This results in more stable knees and hips, stronger skiing and decreased injury potential. 

There are many exercises that address the posterior chain. Squats and lunges are exercises used in most ski conditioning classes, however depending on how they are performed, they are exercises that can be very quad dominant. Simply keeping a more erect posture and maintaining balance through the mid foot to heel will help shift the emphasis to the glutes and back extensor muscles. When performed correctly, other exercises such as dead lifts, glute-hamstring raises, hamstring curls and bridging can effectively target the muscles of the posterior chain.         
Some exercises, like hamstring curls, body weight side lunges (with attention to weight distribution) and bridging can be done with little or no equipment and still yield excellent results. Hamstring curls done on hardwood flooring while wearing socks or having a towel under your feet is a great way to increase resistance with your own body weight. Bridges, specifically single leg, can address both flexibility of the hip flexor and end range extension of the hip.   

To view these exercises and to learn more about how to address the posterior chain for keeping you skiing strong all season, visit www.vailhealth.com and click on the “Spine & Sport Health Tip” link. 

Mark Pitcher is a chiropractor, exercise physiologist and TRX instructor with Vail Integrative Medical Group at Vail Vitality Center located at Vail Mountain Lodge and Spa. He specializes in rehabilitative medicine. 


http://www.vaildaily.com/article/20111219/AE/111219801/1078&ParentProfile=1062

The Benefits of Active Release Technique

Active Release Techniques® (ART) is a technique that is utilized in our office on a daily basis. There are many frequently asked questions regarding ART. I will try to answer some of these common questions and give a more clear understanding of what ART is, what it is used to treat and what kind of results you may expect.

            

ART is a patented, state of the art, soft tissue movement based system. It can effectively treat soft tissue injuries which do not respond to other traditional treatment methods. Soft tissues include muscles, tendons, ligaments, fascia and nerves. Some of the common conditions we treat using ART include headaches, low back pain, IT Band Syndrome, shin splints, plantar fasciitis, knee pain, and sciatica.

            

The goal of ART is to restore optimal texture, motion and function of the soft tissue. This is accomplished through the removal of adhesions or fibrotic tissue through specific protocols. These adhesions can occur as a result of an injury, repetitive movements and constant pressure or tension. Through the specific protocols our trained ART professionals have learned, we are able to eliminate the pain and dysfunction which is associated with these conditions.

            

Every treatment with ART is patient specific. It will consist of examination and treatment of the entire kinetic chain, not just the area of pain. Usually, it is also combined with various treatments of chiropractic and physical therapy. The ART provider will evaluate the tissue looking for any abnormalities in texture, tightness and movement. Any abnormal findings will be treated with varying degrees of directed pressure and tension on the tissues, as the tissues are taken through specific movement patterns. Often, patients will describe the treatment as a “hurt so good” feeling. Every patient responds differently to treatment. However, utilizing ART has given our patients tremendous results. Typically, results are seen in a few treatments and may include decreased pain, improved tissue quality, improved range of motion and better functional movement capabilities.

For an informational video on the benefits of this technique or how it is performed, please visit our website at www.vailhealth.com and click on the Spine and Sport Health Tip Link (on the left).  

Dr. Joel at the Parapan American Games

This past summer, I had the honor and privilege of being selected by the United States Olympic Committee (USOC) to be part of the medical staff with Team USA for the Parapan American Games in Guadalajara, Mexico which concluded last month.  The Games (the 4^th) are an international multi sport event for Olympic-caliber athletes with various physical disabilities and is a qualifier for the Paralympic games this upcoming summer, in London.

A total of 1300 athletes (200 athletes from the United States) from 24 different countries competed in 275 different events in 13 sports.  The national governing body (NGB) I worked with was track and field. Our sports medicine “team” consisted of a multidisciplinary group including a medical physician, physical therapist, athletic trainer, massage therapist and myself (sounds like VIMG!). 

A typical work day would average between 16-18 hours and include covering track and field practices, clinic treatment time, Team USA and medical staff briefings and hopefully (but not always) a quick bite to eat.  The days were long but incredibly rewarding. The opening and closing ceremonies were remarkable and Mexico put on a great show!  One of the highlights of my trip was meeting and speaking with Mexico’s first lady, Margarita Zavala.       

Each athlete (and their disability) is ‘classified’ early in their athletic career with a very specific process. This ensures the events and competitions are equally fair.  For example, you have similar athletes, with similar disabilities, competing against one another.  While Brazil beat us in the overall medal count, Team USA recorded 51 gold, 47 silver and 34 bronze over the 8 days of competition.       

If having an opportunity to work on some of the best US athletes wasn’t enough, watching them compete with their physical disabilities was a very moving experience (try to picture a blind athlete performing the long jump).  There were Iraqi veterans who had lost limbs, spinal cord injuries, traumatic brain injuries, cerebral palsy, stroke and blind/visually impaired athletes to name a few.  Not only have these individuals become world class athletes, they are the most positive and ‘can do’ people I have ever met. 

The only draw back to the entire experience was being away from my wife and children.  I learned how to Skype like a pro while I was gone!

To see more photos from my trip to Guadalajara, please visit our gallery 

Dr. Joel Dekanich

Miki Blanchard Helping Children in Uganda this January

“Being unwanted, unloved, uncared for, forgotten by everybody, I think that is a much greater hunger, a much greater poverty than the person who has nothing to eat”

~Mother Theresa

In January, I will be joining Visiting Orphans and Sixty Feet on a mission trip to Uganda.  I cannot begin to tell you the impact this is making on my life.  As a physical therapist, I will have the opportunity to work with some of the most severely disabled and handicapped children who are imprisoned there.  I will have the privilege to teach the  Sixty Feet staff,  who volunteer their time and go into remand centers every day, how best to facilitate any recovery or rehabilitation in these children.

Thousands of children in Uganda live behind bars, not knowing if someone will ever come for them.  They are there because of petty theft, or they were picked up off the street, or they were abused or unwanted by family, or simply abandoned at the Police Station.  Sixty Feet is working towards moving the most vulnerable children out of remand centers and into family style structure where they will have the opportunity to really live and maybe someday, lead.

Please visit the Sixty Feet website at www.SixtyFeet.org to read their story and the work they are doing for the imprisoned and forgotten children in Uganda.  If you are willing, you may donate to Sixty Feet (they have a list of items can donate), to our trip (Uganda Jan 2012) or donate a bottle of Gummy Vitamins at any of the VIMG offices.  If you donate money at one of our office locations, I will use it to purchase Gummy Vitamins, games, toys, pencils and other supplies the children need when I am there in Uganda.

Thank you, and have a blessed Holiday Season!   Miki Blanchard, MPT

Free Golf Fitness Class at the Eagle Ranch Fitness Center this Thursday!

Foam Rolling to Improve Tissue Quality

Foam Rolling to Improve Tissue Quality

View more presentations from Mark Pitcher DC, MSc

Train Your Abs and Back the Right Way

Are you sure you are training your abdominals and low back in the correct way? For years fitness professionals have been prescribing  sit-ups  and crunches as the means for building a strong core, but recent research shows that these exercises put unneeded stress on the lumbar spine (low back).  Here are three exercises that spare the low back from unneeded stress and actually activate your abdominals more than a simple sit-up or crunch.

Before beginning these three exercises, one abdominal technique must be explained.  This is called an abdominal brace and it involves activating the abdominal musculature before beginning the exercises listed below.  Without drawing in or pushing out the abdomen, contract or stiffen all of the muscles around the abdomen.  Many describe this motion as what you would do if someone were to punch you in the stomach.  While maintaining the abdominal brace be sure to keep breathing throughout the exercises.

1)      

      1) Curl up- The starting position is laying on your back with your hands placed on the small of your back.  Next, flex one knee to 90 degrees while the other leg stays relaxed on the floor.  While keeping your head, neck and upper back in a neutral position perform an abdominal brace and raise your shoulders off the floor approximately 1-2 inches.  The head and neck should remain elongated in a straight line without poking or tucking the chin.  Hold the position for 5 seconds.

      2) Side Bridge- Start on your side with your legs extended and elbow directly under your shoulder. Place your opposite hand on the opposite shoulder, pulling down on the shoulder for added support.  With legs straight on the floor, place the top leg in front of the bottom leg.  Activate the abdominal brace while keeping the spine in a neutral position and raise the hip off the ground until the entire body is in a straight line.  Hold the position for 5 seconds. 

3)      Bird Dog- Begin in a four point stance on your hands and knees with your hands placed directly under your shoulders and knees directly under the hips. Maintain a neutral spine, perform an abdominal brace and raise the right arm and left leg in a sweeping motion.  Do not raise the arm or leg past horizontal.  Hold the position for 5 seconds and repeat on the other side.

Depending on the level of fitness for the individual performing these exercises they can be performed in a wide variety of sets and repetitions.  A beginner could start performing the exercises once a day for 5-10 repetitions and an advanced person could perform the exercises two to four times a week with multiple sets and reps.  By performing these exercises with proper form and technique you should notice increased abdominal and spinal stability, while also decreasing the strain on your low back commonly associated with the sit-up and crunch exercises. 

Jonathan Weimer DC, MS

TRIGGER POINT DRY NEEDLING

What is trigger point dry needling? Trigger point dry needling or (TDN) is a treatment technique which uses small filament or acupuncture type needles to release tight muscles. The goal is to permanently reduce muscle pain and dysfunction. Physical therapists are now using this technique around the world to effectively treat acute and chronic orthopedic and musculoskeletal conditions. Dry needling uses a small needle for deactivation and desensitization of a myofascial trigger point. This technique should stimulate a healing response at the tissue and reduce the biomechanical stress of the muscle treated. TDN can help patients reduce muscle spasms and combined with other therapies, can eliminate mysofascial pain.

What is myofascial pain syndrome? Myofascial pain syndrome is a disease of the muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and a sensory abnormality (tenderness and referred pain). Myofascial pain syndrome is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes or a secondary disorder that occurs as a consequence of some other condition. This is a treatable condition which can respond well to manual and injection techniques but requires attention to postural, ergonomic, and structural factors.

What is a trigger point?  The term “trigger point” was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

• Pain related to a discrete, irritable point in skeletal muscle or fascia not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
• The painful point can be felt as a tumor or band in the muscle and a twitch response can be elicited on stimulation of the trigger point.
• Palpation of the trigger point reproduces the patient’s complaint of pain and the pain radiates in a distribution typical of the specific muscle having the trigger point.
• The pain cannot be explained by findings on neurological exam.

 Overall, TDN is a treatment that addresses dysfunction of the neuromuscular system. Trigger points develop in the muscle secondary to various stresses (i.e. postural, repetitive motion, psychological, emotional etc.) and are more likely to develop in tissue that has neurological dysfunction. Most dysfunctions are caused by compression, disc dysfunction, facet joint dysfunction, vascular compression, metabolic stress, biomechanical stress, and postural abnormalities. When muscles develop trigger points, they neurologically remain tight causing local compression of vascular, neurological and joint/biomechanical structures hampering the normal function of that tissue. All tissues away from the involved nerve will likely be involved. If you adequately release the muscle, the tissues are then allowed to resume normal function with improved neurological conduction and vascularity.

Lastly, TDN is a treatment that uses acupuncture needles but that is where the similarity to acupuncture ends. Acupuncture tends to be a more superficial treatment that focuses on restoring energy or “Qi” to the body. It is thought there are blockages that can be restored by properly placing needles along energy channels called meridians. TDN directly treats the neuromuscular system affecting muscle tightness, joint mobility and symptoms of pain and irritation. Testing active trigger points with an EMG needle has shown there is increased spontaneous electrical activity causing the nerve muscle connection to trigger the muscle to be tight. This tightness can cause a decrease in joint movement and many times will restrict the joint enough to limit normal functional activities of the whole body. Relatively new research has reported that there are numerous inflammatory and pain producing chemicals at an active trigger point causing pain and dysfunction of the muscle, consequently affecting the local nerves and joints.

TDN has been shown, when causing a twitch response in the acute trigger point and muscle fiber, to decrease or completely reduce that spontaneous electrical activity and eliminate the irritating chemicals in that active trigger point. This release can immediately improve range of motion, decrease pain and improve function. Patients often feel a significant cramping sensation from the twitch response but then feel an immediate improvement of their symptoms.

Finally, utilizing TDN in physical therapy allows the patient a hastened return to strengthening and exercise, which in turn, results in an accelerated return to function and improved maintenance of that dysfunction.

Dave Blanchard MPT
www.vailhealth.com