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

Avoid Overuse Tendon Injuries:

As the weather heats up, we head outside to test our athletic prowess. We hit the road and trails on bike or foot without questioning that we may have lost some of our endurance since last fall. Tendon issues may arise during repetitive activity without proper training. Tendons attach muscle to bone and “tendonitis” or “tendonosis” is a degenerative, inflamed tendon. With tendon injury, the tendon tissues become disorganized bundles of collagen, rather than in parallel orientation and no longer function properly.  The most commonly injured tendons in the lower extremity are the patellar tendon, Achilles tendon, and the posterior tibial tendon.

The patellar tendon attaches the knee cap to the shin bone and can produce anterior knee pain with overuse. The Achilles tendon attaches the calf muscle to the heel and will cause pain along the tendon or at the heel. The posterior tibial tendon supports the foot arch and attaches the posterior tibial muscle to the bottom of the foot. Injury can weaken the foot arch causing collapse.

The best way to strengthen these areas, to prevent or recover from tendon pathology, is with ECCENTRIC strengthening. Eccentric means lengthening. By strengthening the tendon in a lengthened position the tendon properties are able to re-align in the parallel orientation making the tendon inherently stronger. The eccentric motion of these tendons is the functional position of where the tendons are at highest stress during repetitive motions. Strengthening in this position is most efficient.

Eccentric strengthening for tendon pathology has been proven is various studies to be effective. The protocol that has been used in research is performing 3 sets of 15 repetitions twice a day. The exercise varies based on which tendon you are attempting to load/strengthen in an eccentric position.

Patellar tendon = Perform single leg mini squats on an incline board. The heel should be raised, toe pointing towards the ground; keep the knee aligned over the first two toes. Only squat to 45 degrees of knee bend.

 Achilles tendon = Perform single leg heel raises off a step, focusing on slow controlled lowering motion, getting the heel lower than the step.

 Posterior tibial tendon = Perform seated with a resistance band over the ball of you foot and attached to a stable surface (band perpendicular to the outside of your leg).Resistance should be pulling your foot into an outward position. Pull the band so your foot/ankle turns inward. Again, focus on the slow controlled outward motion or back motion. Also, performing the Achilles exercise will help strengthen the tendon, since it functions in both actions.

 Before you get on your bike or lace up your running shoes to enjoy the spring sunshine, make sure your tendons are ready to handle the load. ECCENTRICALLY strengthen! Happy trails.

Lindsey Fitch is a doctor of physical therapy and running specialist at Vail Integrative Medical Group. She is an Avid competitive runner, most recently winning the Salt Lake City Marathon

Vax-D Decompression Therapy for Low Back Pain

Do you suffer from low back pain? Vail Integrative Medical Group may be able to help. Approximately 5.4 million Americans are disabled annually due to back pain and up to 85% of the U.S. population will have back pain at some time in their life. And did you know that spine surgery is the second leading surgical procedure in America, with the total number in the U.S. approaching 500,000 per year. Lastly, an estimated 93 million workdays are lost each year due to back pain. What, if anything, can be done about this growing epidemic? 

               

Common conservative treatment for low back pain includes chiropractic, physical therapy, massage therapy and acupuncture. Another form of treatment is Vax-D or vertebral axial decompression. What is Vax-D you ask? It is a patented non-surgical therapy proven to be as much as 88% successful at treating chronic low back pain. This pain may be caused by bulging, herniated or degenerative discs leading to sciatica. Even post-surgical patients and those suffering from stenosis (a narrowing of the spinal canal) have reported significant pain relief from Vax-D treatments.

How does Vax-D work? Vax-D lengthens and decompresses the spine, reversing high intradiscal pressures through the application of negative pressure via a patented “slow ramp-up” process. This reversal of pressure creates a vacuum inside the discs, which takes pressure off of pinched nerves and helps to reposition bulging discs and pull extruded disc material back into place. Nutrients, oxygen and fluids are simultaneously drawn into the disc to create a revitalized environment conducive to healing.

Vax-D stimulates the body’s repair mechanism, providing the building blocks needed to actually mend injured and degenerated discs. Vax-D’s process is the only patented treatment clinically proven to decrease disc pressures to the negative levels needed to facilitate healing.

A recently completed 2 ½ year study has demonstrated that Vax-D achieved a remarkable 88% success rate in the 283 chronic back pain patients studied. The patients selected for the study had failed at least two previous non-surgical treatments. The study also used pre and post MRI’s to determine the extent of the damage to the discs and showed actual reduction in disc herniation, rehydration of disc heights and improved lordotic curve after 6 weeks of 30 minute Vax-D treatments as well as their own tailor-made exercise program.

A typical Vax-D treatment regimen consists of approximately 20 sessions (5 days a week for 4 weeks). Some conditions require fewer visits, some require more.  Many patients report relief from their pain and other symptoms during the first few treatments sessions. Most experience dramatic pain relief after completion of their full treatment.

At VIMG, we specialize in treatment of chronic lower back pain and offer a comprehensive approach to treatment. Along with Vax-D, we offer chiropractic, physical therapy, massage therapy and medical neurology. During the month of May, we will be doing a 12 session trial of Vax-D for $900. This is a 50% discount! Give us a call today at (970) 926-4600 and reserve your appointment for Vax-D. Another day with back pain is another day you are not living life to the fullest.

  

Dave Blanchard MPT

Functional training focuses on the fundamentals

From the Vail Daily March 29, 2011

The term functional training, once an obscure idea, has become a buzzword in the fitness industry. However, much like the term “core exercise,” its definition often depends on who you ask. Some people equate doing exercises, like bicep curls or squats, while standing on gym balls with functional fitness. Unless you are a circus bear, these types of exercises are not overly functional or well suited to develop purposeful strength.

Functional training is not about fancy gadgets or gimmicks but about a philosophy of training. It is based on strengthening fundamental movement patterns, which have carryover into everyday activity or athletic endeavors.

It is a common myth that machine exercises are safer than free weights. In reality, exercises performed with more freedom of movement better engage the core musculature. This means the intensity of the exercise is determined by the weakest link. When you strengthen the body, beginning with the weakest link, you reduce the risk of injury. To borrow a quote from physical therapist Gray Cook, “Having strong arms or legs without a stable foundation or core is like shooting a cannon from a canoe.” When the foundational movement improves, all other movements that follow are stronger.

Any workout program can be modified to become more functional. Simply replace seated or supported single plane exercise with more full body multi-planar exercises. Here are three simple effective substitutions to make your workout more functional.

• Trade your seated biceps curl for a chin up, pull up or TRX curl.

• Knee extension, hamstring curls and hip abductor/adductor machines are all isolation exercises. Replace with exercises such as squats, dead lifts, lunges and side lunges. These require more neuromuscular activation, are better for your joints, burn more calories and have excellent carryover to your activities of daily living.

• Again, gadgets are not necessary for functional training but some do offer significant benefit. For example, the TRX suspension trainer exemplifies functional training. Almost every exercise performed on it can be multi-planar, multi-joint with high neuromuscular demand.

Some of the best exercises for your body require proper technique to be performed safely. Movements like squats and dead lifts are exceptional foundational movements but often require some instruction to be performed properly and safely. If you wish to learn more about how to make your workout more functional or to reduce injury and improve performance, we would be happy to help.

Mark Pitcher DC, MSc
markjpitcher.com 

Vail health: Add running to your routine

From the Vail Daily March 14, 2011

March is here; the sun is shinning, the temperature is rising, and it's time to get outside and jump-start your heart rate with a run or jog.
Running is extremely beneficial to both physical and mental wellbeing. It can impact all bodily systems — from reducing your chances of catching the common cold, to lowering your risk of cancer, to strengthening your muscles and bones and reducing your chance of developing osteoporosis. Running is one of the most effective ways to improve the aerobic conditioning of your lungs and heart. As your cardiovascular health is enhanced, your blood pressure is reduced, the elasticity in your arteries increases, and your resting heart rate is lowered. All of which diminish your chance of heart attack and stroke, and improve circulation throughout your body.

Emotional benefits, though harder to prove with statistics, have been reported by runners time and again. The “runner's high” is a physiologic change in your endorphin levels, which lower the effects of depression and reduce stress. Running can literally be a mood changer as well as a life changer. Those who engage in daily exercise are more likely to make healthier food choices throughout the day. And consistent aerobic exercise, combined with a healthy diet, will result in weight loss and improved self-image, as well as reduced symptoms of depression.

But where do you start? Running is one of the easiest and least expensive hobbies/activities. All you need is a pair of shoes. And then it is just you and the road, wherever you are.

On the other hand, if you are a social person, joining a running group or signing up for local races are great ways to stay motivated and ensure you accomplish your goals. The Vail Recreation District offers a trail running series throughout the summer varying in distances from 3 to 14 miles.

A word of caution: Start slow and listen to your body. Build a running base gradually, one mile to one-half mile at a time. Never increase your total mileage by more than 10 to 15 percent per week. Your pace should be comfortable and you should be able to hold a conversation. As your endurance improves try increasing your speed so that the conversation is interrupted with heavy breathing, pushing your cardiovascular system. Lastly, get proper footwear based on your body-type, arch of foot, and type of running you plan on doing (road versus trail).

Typical running shoes are classified into four main categories: motion control shoes for heavier weight runners with flat arches who have a tendency to over-pronate ; stability shoes for medium to light-weight runners who have the tendency to over-pronate and need stiffness built into the arch of the shoe to help support their natural arch; cushion shoes for the medium to light-weight runner with high arches who stays in a neutral to supinated position as they run; and performance shoes for race day for runners who do not require additional arch support -—these shoes are lightweight and are not made for excessive mileage.

Looking for more information? The Vitality Center at Vail Mountain Lodge & Spa is hosting a running clinic in June (more information to come), including a video running analysis to provide participants with feedback on how to improve running efficiency and prevent overuse injuries.

Spring is a great time to add running to your exercise routine. So get outside and celebrate the sunshine and a healthier you.

Lindsey Fitch is a physical therapist and a doctor of physical therapy at Vail Integrative Medicine, located at The Vitality Center at Vail Mountain Lodge & Spa. She specializes in running injury prevention and running analysis.