INERTIA

Exercises I Love - Part 2

Mon, 13 May 2013 14:43:20 GMT

It's time for the next exercise in my list of exercises that I love. I hope everyone has had a chance to do the first one from last week. The next one is another one for the lower extremity, and works a lot of different muscles at once which is what I like. If you don't have a resistance band to use at home, you can also do it with a cable column machine at the gym.

Steamboats: I’m not sure where this one got its name, but as far as I know, it has always been called this. I love this exercise because it addresses many issues and most of my patients with hip, knee, or ankle problems will do this at some point in their rehab. It’s also great one to give as part of their home program. Basically it is a balance exercise on one leg while the other leg kicks against a resistance band. It can be repeated in multiple directions to address stability and strength in all planes of motion.

Secure one end of a theraband to an immovable object. Tie the other end to ankle of UNINVOLVED leg. Balance on the slightly bent INVOLVED leg. Keeping the knee of the uninvolved leg straight, wave it back and forth as fast as possible while maintaining balance on the involved leg. Keep tension on the theraband. Perform a set of “kicks” facing each direction; North, South, East West.

Exercises I Love

Mon, 06 May 2013 18:48:06 GMT

I have had a student with me for the past 8 weeks which has given me the opportunity to share some of the insight and knowledge gained in the last 11 years of practicing as a PT. It opened my eyes a little to the fact I tend to do a lot of the same exercises with patients. I guess there are just some exercises that I gravitate to for different reasons. Some address areas that are often forgotten, some work many different muscle groups so you get more bang for your buck, and some translate easy to a home program for the patient to continue with when his or her therapy is done. It gave me the idea to do a series on exercises that I love. I’m sure other physical therapists might argue for some other exercises, but these were the first ones to come to mind. So here we go with the first one, check back soon for the others.

Step Up with Rotation: This is an exercise that I use a lot with patients after an ACL injury as part of the post operative rehab. Once they are able start doing some higher level strengthening, this is a good one to work on balance and leg alignment. After they perform the normal step up, I have them hold the other leg up and then do some trunk rotation while keeping the knee pointed over the toe. You can have them hold onto a medicine ball also to make it a little harder to control the motion.

View the video.

Public Opinion

Wed, 24 Apr 2013 17:33:53 GMT

Recently a patient brought me a newspaper article that talked about the difference between doing surgery and physical therapy for a mensicus tear in the knee. Not surprisingly, she was in this predicament herself as she had been diagnosed with a meniscus tear and was wondering if PT was going to help or if she should have surgery done.

This is a common question that we address here. Meniscal injuries are quite a regular occurrence in sports due to the cutting and pivoting demands of the activity. Physical therapy is often prescribed prior to doing surgery, and sometimes people are upset as they figure if there is a tear, then just go in and fix it. The recently published study referenced in the newspaper article found that there was not a big difference in outcomes at 6 and 12 months for patients who had surgery or those who only did a comprehensive PT program.

If you look only at those results, it would make sense that doing PT is a good option at a significantly decreased cost to the patient and insurance companies. As a PT, I like these results. It will help me to answer my patients' questions and be able to justify what I do.

However, it is important to note that this study does have some flaws to it, and we can't make too many generalizations from it. If we do, then some patients may not get the appropriate care that they need. There are many factors to consider and because of this, a team approach with an orthopaedic surgeon, physical therapists and the patient, should guide the decision, rather than basing it solely on the public opinion from a newspaper article.

Ware Where You?

Thu, 04 Apr 2013 15:50:05 GMT

Naturally, at this time of the year, there is a lot of discussion in the clinic related to sports. Conversations about March Madness basketball and the beginning of the Brewers' season are everywhere this week.

As a Marquette fan, I have enjoyed the run they made in the tournament and spent a good amount of time talking about their surprising run to the Elite 8. However, the thing most people wanted to talk about was the injury to Kevin Ware, the Louisville player whose leg exploded during their game against Duke over the weekend, resulting in a compound fracture.

I was driving and listening to the game on the radio, and even without seeing it, I could tell from the commentators it was pretty serious. The fact that the arena fell silent and even the Duke players and coaches began to cry meant that it was not good.

They started speculating on the radio that his career may be done. My wife felt terrible and couldn't stop saying how horrible it was. I agreed with her for a moment, but then I let my medical background and experience as a PT take over. Then I started to feel a little callous to the situation because I know he'll be able to come back.

I know this because we get to see it every day here at the Sports Medicine Center. We see horrible injuries where people come in distraught that they won't be able to return to their favorite activities, but after going through rehab, life starts to return to normal. It's long and hard at times (like it will be for Kevin Ware), but ultimately our clients can achieve their goals. It's the part of the job that we all love.

Shake Down

Wed, 13 Mar 2013 14:21:19 GMT

I have always been one to stay away from all the crazy trends out there. So I wasn't shocked that I had never heard of the "Harlem Shake" when I overheard someone discussing it in the clinic a couple of weeks ago. I was shocked when I realized they were talking about doing it here in the clinic.

After turning to YouTube to figure out what it was all about, we all showed up with crazy costumes and made a 30 second video that shows we can have a little fun around the clinic as well.

Special thanks to our different contracts to supply some of the costumes to make the video a success.

(If you're looking for me, I'm the one in the back waving my arms around and trying not to fall off the stationary bike I was standing on).

Enjoy the video.

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Performance Reviews

Fri, 15 Feb 2013 14:50:10 GMT

Just yesterday, a mother of one of my patients asked me what was going on in our gym. I don't blame her for asking. She was watching me work on her son, who was injured and on crutches, while there were 15-20 high school girls doing different jumping and agility drills just 20 yards away. She wanted to do know if they were rehabbing an injury, too.

I quickly explained that they are part of our PEP, or Performance Enhancement Programs. These girls are preparing for volleyball, and wanting to learn exercises and form drills to improve their ability as well as prevent injury. Earlier in the day, I saw a former college football player working with our athletic trainers preparing for some upcoming professional tryouts.

It's good to know that these young athletes are turning to medical and fitness professionals to learn the best way to improve performance, rather than seeking out alternative pharmaceutical options. With performance enhancing drug usage leading the sports highlights almost every day, whether nationally or even locally, I often wonder what our young athletes' mind-set is regarding banned substances.

From what I saw in the past couple of days in our clinic, I feel there is hope for the future of sports. I'm glad that we have qualified staff and the programs to offer those interested in making gains.

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Resolutions

Wed, 02 Jan 2013 18:17:45 GMT

The New Year is upon us, which for many people means that it is time to make their resolutions. Every year a common theme that exists in people's resolutions has to do with improving his or her health: Lose weight, stop smoking, work out more, drink less.

Since we are next door to the Wisconsin Athletic Club, we see the parking lot more full and a fairly constant stream of people on their way to do their workouts. For about a month. Then it's back to the same old, same old.

Why do people stop so quickly and not continue to press on toward their goals? Is it lack of interest? Is it not seeing enough results right away? Or is it an injury that surfaces from doing something new?

We at the Sports Medicine Center are here and eager to help you all enjoy 2013 and meet your fitness goals. Whether you are in need of some rehab of an injury or interested in one of our performance programs, feel free to contact us for some guidance so this year can be full and healthy.

Always Learning

Wed, 05 Dec 2012 16:50:53 GMT

I am really happy to work somewhere that places a strong emphasis on education. In addition to the time set aside for the monthly inservices and journal club meetings that we do in our clinic, continuing education and learning the current research is encouraged.

Earlier this week, another physical therapist and I attended a seminar at Marquette University in which the students were presenting research projects that they had done. We were not only able to learn from them, but we were also able to provide them with some practical knowledge to prepare them for their upcoming clinical rotations.

It is this committment to learn from current clinicians and the desire of the graduating physical therapy students that is going to help our profession to grow as we constantly work to improve our skill set.

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Injury Clarifications

Wed, 24 Oct 2012 11:28:35 GMT

Fall is officially here. The leaves are falling and the temperature is dropping. For the many in this state, that means one thing: Time to watch football.

One of the things that is bound to happen with football is that there are going to be some injuries. We have seen a bunch of knee, ankle and shoulder injuries here in the clinic with our local high school athletes. However, football injuries also hit the national sports news when high profile professional athletes are involved. I often get questions about what these injuries really are, so I thought I would talk about a couple that have been in the news lately.

Lisfranc injury: This one hit close to home with Packer RB Cedric Benson out for many weeks with this diagnosis. Basically, this injury is a sprain or dislocation, depending on severity, of the midfoot. Instead of spraining the ligaments at the ankle joint, the injury occurs where the metatarsal bones attach to the small foot bones in the arch. When someone is in a plantar flexed position (toe pointing down) and a force is applied (like another player landing on them in a pile up), then the foot is twisted causing the injury. The long recovery is due to the fact treatment involves non-weight bearing for around six weeks to allow the ligaments to heal. If really unstable, then surgery may be needed which can also affect the recovery time.

High Ankle Sprain: This injury happens more often but can be just as debilitating as a Lisfranc depending on the severity. These injuries are referred to as "high" ankle sprains because of the location being above the ankle at the ligaments that connect the tibia and fibula. More common ankle sprains occur below the ankle, usually at the ligaments coming from the fibula attaching to the talus or calcaneus bones of the foot. High ankle sprains are often caused more when the foot is turned out and a significant amount of rotation is involved. Due to the need for that stability between the tibia and fibula, these take longer to heal and at times might need surgery with pins placed to provide the stability while the ligaments heal. Either way, it is usually a long recovery of six to eight weeks before someone is able to get back to playing sports.

I hope this helps when you hear about these injuries as the season wears on. Hopefully your favorite players can avoid these difficult injuries.

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Olympics Follow Up

Thu, 23 Aug 2012 11:26:39 GMT

I saw this article last week when I was reading up on some of the final Olympics coverage, and it piqued my curiosity. Kinesio tape is used fairly often in the clinic, although not by me personally. I was definitely curious to read what was being written about it after seeing it all over the Olympic athletes earlier this month.

It seemed it was on athletes in all different sports. Could this be something I should be incorporating more into my practice? I have never had much success with using it. Instead, I often use tape if I want to provide a patient with increased support. Kinesio tape is very stretchy (which is why you can do all those cool patterns), and therefore it is not as good for support.

I think Kinesio tape probably does provide a little neuromuscular feedback to athletes without being too restrictive, which is probably why they like to use it. Or, perhaps it's just that they like the way it looks and want to make it part of their uniform. Honestly, with some of the taping patterns I saw, I couldn't see how it would benefit them in the ways I know the tape to be helpful.

I suppose Kinesio tape is just another tool we have to offer patients, and for some, it may be just the thing to get them feeling like an Olympic athlete.

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It's All in the Hips

Fri, 06 Jul 2012 14:55:26 GMT

Around this time of year, we often will see an influx of runners coming into our clinic with a variety of ailments. One of my first questions when I find out they are a runner is, "Have you changed anything recently with your workouts?" They will often tell me their mileage has increased as they are training for either a half or full marathon.

Many of these longer distance races will take place in the fall and the training regimens often call for an increase in the distance of the long runs starting around now. This increase in time on the road or treadmill leads to a decrease of time in the weight room.

I totally understand this as I have also done a marathon in the past and know the time sacrifice that has to take place. However, what I frequently see in the clinic when evaluating these runners is weakness in the hip abductor muscles. These muscles are on the outside of hips and are really important for pelvic stability. When they are weak, it causes increased stress to the hip and knee causing conditions like bursitis, IT band tendinitis or patellofemoral syndrome.

It's really important to continue working on strengthening these muscles and not just relying on running to be your strength training. You don't always have to do a lot of heavy weights. Just adding some exercises like side leg lifts, clamshells or bridging can be really helpful to help maintain your hip strength.

If you are someone who has noticed some increased pain as your running volume has increased, or have some other questions or concerns regarding your training, feel free to contact our Sports Medicine Center Runner's Clinic hotline at 414-805-8602 for help.

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Hitting the Road

Mon, 04 Jun 2012 10:17:14 GMT

Alright, I admit it. I was a little skeptical, like many other folks were, when I heard that our favorite Brewer catcher was going on the DL with a broken hand from a falling suitcase. Jonathon Lucroy told us all that he injured his hand when his wife knocked the suitcase off the bed onto his hand while he was on the floor searching for a sock.

His injury, a broken fifth metacarpal bone, is known commonly as a "boxer's fracture." The reason for the name is the most often cause of injury is punching something hard causing a fracture at the knuckle of the pinky finger. The last person I treated with this injury was a police officer who was injured while wrestling a culprit to the ground.

However, I have known others to get this type of injury in freak conditions. Most notably me. Several years ago, I thought it was necessary to dive for a ball in a recreational kickball game, and I ended up with a boxer's fracture. The doctor's first question to me was "Who did you punch?" Goes to show why there was skepticism with Lucroy's injury.

Remember, injuries happen in all different ways, and I'm sure Lucroy would rather have been injured diving for a ball or getting hit by a pitch if he had to suffer an injury. I have been in this business for many years and have heard all types of stories about the cause of injury. So let's cut him, and his wife, some slack. I'm sure he'll hear about it the rest of the year from the road team fans. If all goes well, he should be back out there with the team soon.

Fortune Teller

Thu, 17 May 2012 11:35:13 GMT

Back in October I wrote about an article that I had read documenting the increased number of preseason injuries in the NFL. They were speculating that the labor dispute may have been a factor due to the shortened season training.

I ended that by suggesting that we may see the same thing in the NBA as well. I found it pretty interesting a couple of weeks ago that rather than talking about the outcome of the playoff games, all the ESPN talking heads were commenting about was how the shortened schedule may have been a cause of some of the season-ending injuries to some big name stars in the league.

Was I able to tell the future? If so, it might be the first time in my life. It is more likely that the sports reporters out there needed something to talk about all day long. After all, it started after Derrick Rose, the 2010-11 NBA most valuable player, tore his ACL.

My opinion is that ACL injuries are not usually a wear and tear injury, as was suggested during these discussions. The Brewers lost two starters to ACL injuries last week that happened on freak plays early on in the season, not from wear and tear after a long season.

I caution people to question the source of information when it comes to injuries and rehabilitation. Just because someone played professional sports does not make him an expert on rehab. I hope I can use this blog as an outlet for quality information and recommendations.

Spring Break

Wed, 28 Mar 2012 11:18:58 GMT

We recently had a little Spring Break here at the Sports Medicine Center. No, we didn't head off to Florida for some fun in the sun. This is the time of the year we host our annual Froedtert & The Medical College of Wisconsin Sports Medicine Symposium.

It was a great two days of continuing education from some great guest speakers. This year's lecturers included Dr. Elizabeth Arendt from the University of Minnesota, Dr. Robert Dimeff from the University of Texas, Southwestern, and Paul Reuteman, a physical therapist and athletic trainer from the University of Wisconsin, La Crosse. Combined with our own staff presentations, a lot of great information was offered to a large number of attendees this year.

A good portion of the sessions dealt with hip and knee pain, which is something that we see in the clinic on a regular basis. As always, we were able to come away with some very practical tips on treatment to better address these issues with our patients. I have already been able to incorporate some of the exercises into my patients' programs with good results.

As with other spring breaks, it's great to get back in the clinic more energized with new information and ideas. I'm already looking forward to next year's symposium.

Getting Back to Play

Tue, 14 Feb 2012 14:49:45 GMT

One of the more common injuries we see in the Sports Medicine Center is ACL tears of the knee. A lot of interesting research has been done on the topic, and there are plenty of continuing education courses dedicated to rehab following the reconstructive surgery. Many physical therapists will also debate when it is best to allow someone to return to sports.

I just came across an interesting article published in the British Journal of Sports Medicine that looked at how many people following ACL surgery return to playing his or her sport. The reason this caught my eye was that it discussed other factors we don't always address in PT. Ninety percent of the participants showed good functional outcomes, but many of those cited other reasons for why they didn't return to playing sports. Those included psychosocial issues like fear of reinjury, unable to take leave from work if reinjured, changes in living situations, etc. It is great we have improved the post operative rehab to have 90% returning to normal, but surprising so many choose not to return to competitive sports.

These non-biomechanical factors seem to be appearing more in research for all areas. Previously it was more often discussed relating to low back pain. Perhaps there is something more that needs to be included in the rehab process to make sure our patients have the confidence to return to their activities as desired.

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Golf Presentation Information

Wed, 28 Dec 2011 10:13:22 GMT

So Christmas has come and gone with no snow on the ground. The temperatures are up, which has made many people very happy. There are some who are even taking advantage of the (somewhat) warmer days to go play some golf.

Normally this is the time of the year where we take a break from hitting the course and can spend time hitting the gym instead to get our bodies ready for a full summer of golfing.

If you are interested in finding out some stretches and exercises to help improve your golf performance, come join us at the Sports Medicine Center on Jan. 18. Paul Mindel, a golf professional from the National Golf Center, along with Mike Ribar and me from the Sports Medicine Center, will be talking on this topic.

Here are the details:

When:	Wednesday, Jan. 18, 2012
Where:	Froedtert Sports Medicine Center 8700 W. Watertown Plank Road Milwaukee, WI 53226
Cost:	Free

Please call Mike Ribar at 414-805-7114 to reserve your spot as seating is limited.

Turkey Time

Wed, 23 Nov 2011 10:16:10 GMT

I have several friends who have a holiday tradition of getting a good workout in before they sit down for the big feast. I guess it's their way of justifying the overindulgence on food that occurs throughout the day.

For all of you who have similar traditions of a Turkey Bowl football game with family and friends, or even if you are just going to go for a short run, remember that the temperatures are a little cooler so it might not be a bad idea to do a little warm up and stretching session beforehand.

Hopefully, you then can enjoy the holiday weekend, (and not end up on one our schedules with an injury next week).

Another One Bites the Dust

Tue, 25 Oct 2011 12:55:06 GMT

As I was watching football games this last Sunday, I saw another player on my fantasy football team go down with an obvious injury. While I didn't now exactly what he had done, I knew right away it was a serious one and he likely would not be playing again anytime soon.

I started complaining to my wife (as if she cares about my fantasy football team) that there seem to be so many injuries in the NFL this year. Am I the only one who has been noticing this?

Well, apparently not. The newest edition of the Journal of Orthopedic and Sports Physical Therapy has an article about the impact of the NFL lockout on the increase in Achilles injuries so far this year.

I found this really interesting and wonder if we will see the same situation happen with the NBA if they end up having a season this year. Check it out for yourself.

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Rocker Bottom Shoes

Tue, 20 Apr 2010 14:31:10 GMT

Sorry it took so long to get back to this topic. I thought I'd discuss these here as I seem to get more and more questions about rocker bottom shoes from patients.

If you are not familiar with rocker bottom shoes, they otherwise look like athletic or casual shoes with a thicker sole that is rounded on the bottom in an arc like the bottom of a rocking chair. The shoe companies that make these promote them as being a way to work your leg muscles without exercising as well as a way to promote better posture.

I've been a bit skeptical, and have not been able to recommend them when asked about them as I have not had any personal experience with them. I still have not had any personal experience but have had several patients swear by them. I did look up a few research studies that have been conducted to try to get a feel for them. Here is a synopsis of some findings and interpretations that seem to be consistent among several studies.

may provide benefit for running related conditions at the ankle without increased risk to knee and hip
reduced knee pain and improved balance in patients with osteoarthritis
changed movement patterns particularly at the ankle and increased muscle activity of the lower leg

This is based on a few research studies that I'd be happy to share the citations to for anyone that would like them. I'm still not sure if I'm ready to endorse them as I'm not sure if the benefits justify the cost of the shoes. I've yet to find any person or research that has concluded them to be harmful.

If you have used these, let me know what you think.

The following is feedback received for this blog:

I have been using this type of shoe for a few months. Before I tried them on, I was skeptical about their benefits and concerned about feeling unbalanced. I put a pair of the Scetcher brand on at Kohls and walked about for ten minutes to try them out. Almost immediately, I had a "where have you been all my life" moment. I love them! I am a lymphoma patient with various aches and pains and peripheral neuropathy. I find these shoes exceptionally comfortable and supportive, and they ease my joint pains. When my husband saw me literally running around in them, he said "Get another pair!" For me, they have been a great investment for my comfort and health. I feel energized in them and have encouraged others to try them as each person's experience may be different. I wouldn't expect to suddenly start losing weight, but if you find them comfortable and they cause you to enjoy walking more, you probably will get into better shape.

(no name given)

I have read (research-wise) that although the shoes have benefits initially, the person will eventually accomodate to the rocker bottom shoe and will no longer feel the benefits of the muscle toning after a month of wear. There is also an increased incidence of hallux stiffness due to the lack of push-off during gait, which can lead to even more problems.

(no name given)

Thank you both for your recent feedback. The couple of studies that I briefly summarized are really only scratching the surface. There are many more studies out there and the shoes are still relatively new on the market. I would anticipate more research to come. With respect to accommodating to them, as with anything that probably is true to a point. The first toe stiffness referenced by one reader could certainly be a possibility. I have not seen that cited in the research I have read. I will continue to look at research on these and pass along any interesting new information that I find. Thanks again for the responses and discussion!

- Jeff Wilkens

I am not sure whether rocker bottom shoes can cause hallux limitus/rigidus but I started using them because I already had that condition and walking was painful and awkward as I tried to avoid flexing my toes. Surgery was offered but meanwhile at a foot clinic it was suggested that I might find these shoes helpful. I bought MBTs (all that was around at that time) and found them a huge help. In addition to helping me walk without toe pain, my knees and hips appreciate the extreme cushioning that the soles offer especially going down steps. Yes they were expensive but there are nearly always last year's styles reduced in price.

- Jane

I woudl have to argue against the Rocker bottom shoes. Although they may have increased cushion that decrease pain for some individuals, the cost of losing normal body mechanics and proprioception is too high. At initial contact during normal gait, there is something called the heel rocker (our body's own version of transferring downward force into forward force), the rocker-bottom shoes tend to eliminate either the use/ timing of this natural rocker. This poor timing may lead into the other rockers along the foot. Also, proprioception needed for proper mechanich is also altered due to the large soles. Therapists might benefit from "Gait Analysis: Normal and Pathological Function" by Jacquelin Perry.

(no name given)

Heads Up

Thu, 01 Sep 2011 14:30:16 GMT

Now that football has started up again, our athletic trainers are not in the clinic as much, and instead are out at their schools covering athletic events. One of the big things that will keep them busy this fall is screening athletes for concussions.

I just wanted to write something to remind people that concussions and head injuries have the chance to become very serious, and it is important to pay close attention to these situations. If an athlete has suffered a head injury, then he or she should not return to the game, even if it seems like he or she is fine a few minutes later. They need to be checked out and cleared by a medical professional to prevent further damage.

Our athletic trainers are awesome and very knowledgeable so it is great to have them out on the field when injuries happen, but they can't be at every event. Therefore, it is on all of us as coaches and parents also to make sure we are protecting these young athletes so that they do not have a more serious injury.

Please feel free to contact our clinic if you have any questions.

Kids These Days

Wed, 29 Jun 2011 15:58:06 GMT

Summer is here in the Sports Medicine Center which means we have a lot more young athletes in the clinic either rehabbing injuries or starting PEP programs to get ready for the fall sports season.

Most of the time, these kids come in with concerned parents who have plenty of questions about their child's injury and what they can do to prevent it from happening again. One common question we get is what age is appropriate for starting weight training.

When I was a kid growing up, most people felt you shouldn't start weight lifting until after puberty. It was thought that starting too soon could stunt your growth.

Current research has not found any evidence to support that thinking. Instead, they are finding the biggest risk for injury is improper technique. With that in mind, the National Strength and Conditioning Association's recommendations on resistance training for youth revolves first and foremost around qualified supervision and instruction. The goal should be to teach youth about their bodies, and get kids excited about physical activity along with increasing muscle strength.

Below are some guidelines from the NSCA on starting resistance training once the above criteria are met:

A child may be ready to do resistance training once they have the emotional maturity to accept and follow directions. This usually is around age 7-8 when they are in other sport activities.
Begin with two days per week performing one set of 10-15 repetitions. Focus on the major muscle groups to build confidence before advancing.
Eventually work towards performing 1-3 sets of 6-15 repetitions with a variety of exercises 2-3 days per week on nonconsecutive days.

I hope this helps if you're trying to decide when to start some resistance training with your children.

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The following is feedback received for this blog:

Griffin, If my memory is correct, there was a very young kid that lifted weights like crazy. I think they called him "little hurcules". What ever happened to him? Does he have any side effects from lifting so early?

Thanks
Richard

The Alter-G has Arrived

Mon, 28 Feb 2011 14:55:23 GMT

As a physical therapist, I get asked all the time for my opinion on different exercise equipment or workout programs. I am always happy to give my advice, but most of the time I have to report on what I have heard or read because I don't usually have the chance to try it out.

I didn't want that to be the case when I started getting questions about the newest piece of equipment in our Sports Medicine Center: the Alter-G Treadmill. This anti-gravity treadmill has been the source of many inquiries in the clinic since its arrival earlier this month. So in order to better answer the questions, I threw on a pair of the special shorts and zipped myself into the "cockpit" last week to go for a run.

Due to the amazing technology of this machine, you are able to adjust the pressure of the large plastic bubble that inflates around you to decrease your body weight while walking or running. Even when running at 80 percent of my body weight, I had the feeling of floating along (which is not what I normally feel like while running). I could even increase the speed to much faster than I would normally do.

We are excited to have this in our center now because of the many ways we can use it: speeding up rehab protocols to allow a quicker return to sports, training for long distance runners to decrease the impact on the joints for injury prevention, or overspeed training for athletes in our Performance Enhancement Program. We're also looking forward to finding other ways that our patients and community members will benefit from this revolutionary piece of equipment.

Watered Down

Wed, 08 Jun 2011 10:59:03 GMT

After several weeks of hearing myself and other people complain about the weather not cooperating to allow for our favorite activities, the summer heat has officially descended upon us.

I thought I would take this chance to send a reminder to make sure you are properly hydrated to reduce the risk of heat exhaustion or heat stroke. Adequate hydration can also decrease fatigue and chances of poor performance in your events.

Here are a couple of quick tips:

1. Make sure to drink plenty of fluids (a sports drink can help increase fluid retention and prevent dehydration) the day before strenuous exercise. Drink at least 8 cups (64 oz.).

2. Slowly drink 2-3 cups of fluid a few hours before activity and another 1-2 cups just prior.

3. During exercise, it is important to continue to drink 1/2-1 cup for every 15 minutes. This number may need to increase if you sweat excessively.

For most people who exercise at a low-moderate activity level, water or flavored water is sufficient. For those who exercise more than an hour or sweat heavily, supplementing with a sports drink is a good idea. A sports drink provides about 40-100 calories from carbohydrates to help improve fluid absorption.

I hope this information if helpful. Just remember to use common sense as well and limit outdoor activity when the temperature and heat index get too high.

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Stretching Out

Fri, 29 Apr 2011 10:50:32 GMT

Sorry for my absence from the blog world. My life has changed a little over the past month, as my wife and I welcomed a baby girl into our lives 3 weeks ago. Everyone says parenthood is a great gift and I can't argue with them at all.

Watching her stretch out in the morning after taking her out of the sleep sack is one my new favorite things. It reminds me of how much we should be stretching daily. She doesn't know much yet in this world, but she instinctively takes a couple minutes to stretch her little arms and legs.

Even though the spring weather hasn’t been cooperating as we would like, I have still seen several golfers out on the courses as I drive around. Despite what some people think, golf is a great physical activity. Did you know you can walk more than 5 miles during 18 holes of golf if you don't use a cart? Combine that with maximally rotating the body 50-65 times, and you will get a good workout while golfing.

So why not take a few minutes to stretch out before jumping up to the tee? I see most golfers run from their car, throw on their shoes, pay the greens fee and rip the driver from the bag.

Here are a couple good stretches to do before starting to play golf this year with some slight "tweaks" to mimic the backswing and follow through.

Hamstring Stretch
Place your leg up on the bench or cart with a slight bend in the knee. Flex forward from your hips, keeping the back straight until you feel a pull in the back of the leg. Add some rotation to the right and bend trunk to the left. Then, do rotation to the left side and bend right.

Lateral Side bend Stretch
To stretch the right side, stand with your left foot in front of the right. Side bend to the left and use your left hand to pull up on the right wrist. Then, rotate to the right and side bend to the left. If you want a little more stretch, you can add trunk flexion by bending forward for your trail side (right side for right-handed golfers), or trunk extension by leaning back for lead side (left side for right-handed golfers).

Posterior Shoulder Stretch
Stand in your golf stance and use your right hand to grab behind your left elbow. Rotate trunk to the right and add a shoulder stretch by pulling with your right hand. Add side bending to the left side. If stretching trail shoulder (right side for right-handed golfer), add some trunk extension, or when stretching lead shoulder, (left side for right-handed golfer) add trunk flexion.

Hold these stretches for 20-30 seconds and repeat 2-3 times on each side. Taking an extra 5 minutes before you start can help you prevent injury. You may even notice an improvement in your score!

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Spring Training

Fri, 11 Mar 2011 15:47:21 GMT

In my opinion, March is the best month of the year. As a sports enthusiast, there is so much going on. College basketball tournaments are in full swing and dominate conversations. Spring training has started for baseball players, and this year brings a lot of excitement and expectations for the Brewers. PGA events are beginning again with anticipation for the Masters tournament.

And with the weather warming up and the snow finally melting, it means that it's not just the professionals who are starting their seasons. After a lot of rest in the winter months, people are out running, biking and getting ready for their sports.

It's important to realize that just like the Brewers take a month to prepare for the long, grueling season, we also have to prepare our bodies for all of our activities. Many injuries can occur if we try to jump right back into what we were doing last summer without training or warming up.

Depending on your sport, hopefully, you kept up with your training during the winter. The best time to make gains in the weight room with strength and power is during the offseason. If not, now is the time to start with some light conditioning exercises and a good stretching routine so that you can be ready to play again. My advice: Start with some warm up throws of 30 feet and gradually increase the distance before the game or when playing catch with your kids. Use a 7-iron first at the driving range, and save the driver until you've hit a few balls. Do some jogs out to the fence and back before sprinting to 1st base. I'll be posting some more sport specific exercises and stretches soon which should help you get more prepared for the season.

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A Different Therapist's Thoughts

Fri, 18 Feb 2011 13:12:46 GMT

I have to say that I am excited about being asked to write this blog on behalf of Froedtert & The Medical College of Wisconsin and the other great therapists within the organization. Jeff has done a great job with it so far, and I hope that I am able to continue to provide information on a variety of topics and be a resource for those who have questions.

Check back often to the blog where I will be posting exercises, workout tips, and recent research that I find interesting. I will also be drawing on my clinical experiences with patients and discussing what we can learn from them. A lot of the inspiration will likely come from FAQs that I hear in the clinic, but I would love to hear from the readers as well to make the blog as interactive as possible.

Thanks for checking the blog and keep your eye out for my next posting soon about a revolutionary piece of new equipment in our department.

Griffin Ewald, MPT, OCS, CSCS

Passing the Blog Torch

Thu, 17 Feb 2011 16:12:05 GMT

I want to start by thanking all of you for reading over the past two years or so. This has been a fun and educational experience for me. However, at this time I have decided to step aside from the blogging world and let one of my collegues have a shot at it. I realize that recently I have not been able to devote as much time to it as I would have liked, largely due to other clinic and life responsibilities that take always seem to come first. Rather than do something half way, I've decided to let someone else do it all the way.

Griffin Ewald, MPT, a physical therapist also at the Sports Medicine Center, will be taking over this blog very soon. Griffin will bring a high degree of experience to the blog and a different perspective, which is always refreshing. I have no doubt that he will do a fantastic job! Good luck, Griff, and thanks again. - Jeff

Griffin Ewald, MPT

Mix it up this Winter with Cross Training

Thu, 20 Jan 2011 13:34:21 GMT

Many runners get the doldrums this time of year because they can't stand running on a treadmill for longer than 10 minutes due to boredom, redundancy or the fear of falling off! That makes winter a perfect time to mix in some cross training. Cross training provides benefits because it forces you to use muscles in a different way. Simple examples of cross training are biking/spinning, elliptical, swimming or stair stepping.

If you want something a bit more exciting, I would suggest taking an interval class at your local health club. Interval classes incorporate aerobic exercises along with strength exercises designed to keep your heart rate elevated and your body guessing. A common component of interval classes are plyometric exercises which challenge the muscles to contract quickly both during the shortening and lengthening of the muscle. This provides a great workout with strength benefit and better muscle response time.

Another option is incorporating lateral or side-to-side movement activities into your workout. Running is a straight-ahead, single-plane activity. Always working in one plane of movement can lead to breakdown, injury and weaknesses in other muscle groups like the gluteals and hip adductors.

If you have additional questions or comments, drop me a line.

Newton Running Shoes

Tue, 03 Aug 2010 15:53:20 GMT

Newton running shoes are a relatively new brand of running shoes on the market that seem to becoming increasingly popular. I have recently had a few patients/clients ask me or talk to me about these shoes. That's when I know its time to do a little digging and write about it. I'd welcome any comments as I like to hear what others opinions are on this topic.

These shoes have a relation to my two previous posts because they claim to promote a "more natural form" or a forefoot striking. As I discussed previously, increasing your cadence or decreasing your stride length works to achieve a similar goal of decreasing impact-loading common with rearfoot strikers. So I asked myself the question of what role do Newton shoes have in the average recreational runner? After researching them a bit and discussing the topic with collegues and an elite runner who wears these shoes, I conclude that these shoes are not for everyone and should not be looked at as an easy form-fix for the average runner.

The Newton shoe seems to work best for the runner who already is a natural forefoot/midfoot striker or someone who has successfully made this transition and find them comfortable in this running style. Most commonly, that runner will be someone who has refined their form to a point that they are a very efficient runner, has a lean body type and has good to excellent lower extremity muscle strength. The shoe tends to be overall less supportive, thus I believe works best for the person that fits the above description.

If you are thinking about making a footwear change and are interested in becoming a more serious runner, it is always best to consult with a professional before making the switch. I've seen a number people who have injuries simply because they make the wrong and uneducated footwear choice.

Tennis Elbow

Tue, 19 Oct 2010 14:21:24 GMT

I seem to have had a rush of tennis elbow recently in the clinic. Since it is on the forefront of my mind while caring for my patients, I thought I'd share a few tidbits on it.

Usually tennis elbow or lateral epicondylitis is very easy to diagnose. Pain is usually present to the outside of the elbow or upper forearm over the area where the outside forearm muscles converge towards the bony prominence on the outside of the elbow area. There is almost always point tenderness to an area about the size of a quarter or less with continued lesser soreness down further into the muscle. Stretching the muscle by bending your hand down from a palm down start position can be painful. Resisted wrist extension and particularly middle finger extension (bringing wrists up from palm down position) are predictably painful.

In my experience, tennis elbow rarely causes symptoms into the upper arm above the elbow or down into the hand below the wrist.

Tennis elbow is a repetitive trauma or overuse type injury. The best course of initial treatment includes rest and ice. Depending on your occupation or sport, rest can be hard to come by as even using a mouse or keyboard can make symptoms worse. If you have such symptoms and they don't resolve in a week or two with rest and ice, seek advise from your physician, physical therapist or athletic trainer.

Runmeter App

Mon, 27 Sep 2010 09:38:18 GMT

Yes, I'm an iPhone geek as one of my coworkers so affectionately called me the other day. That's fine, I'll admit it. But I'd call myself a borderline geek because I know there are millions out there 10-100x worse than me!

Let's face it though, there are some really great and useful applications that truly make that thing super-useful. I thought I'd share one that has health, fitness and training benefits. Probably my most favorite app is Runmeter by Abvio. Using GPS, this app keeps track of your distance, route, pace, elevation, splits, caloric expenditure and those are just some of the most useful training related functions.

The downside is that it has an addictive quality to it. Typical for anything related to the iPhone, right? If it keeps me somewhat addicted to running, I'll take it.

Running Stride Drill

Tue, 13 Jul 2010 14:25:40 GMT

As a follow-up to my previous post, here is a sample drill that can easily be performed to help shorten your running stride and increase your cadence.

The goal is to reach the ideal cadence of 95, which is 30 right (or left) foot strikes in 19 seconds. Ideally, these strides should be at a fairly swift pace but not your max speed. Be sure to be well warmed up and not fatigued, like at the end of a run.

Here is the process for the stride drill:

Time how long it takes you to run for 30 right (or left) foot strikes
Walk back to the starting point and recover completely
Repeat the stride, working towards a goal of 19 seconds for the 30 foot strikes without increasing your speed significantly
Complete the set of 6 to 8 intervals of 30 foot strikes

Let me know what you think if you'd like.

Reduce Running Injuries With a Shorter Stride

Thu, 10 Jun 2010 18:17:20 GMT

This is the time of year that I notice a definite increase in running-related injuries in the clinic. When I do treadmill analysis on runners, injured or not, I commonly find that recreational runners overstride or have a cadence that is too low.

To explain a few terms, the stride is a distance measured from the time one foot touches the ground until the time that same foot touches the ground the next time. The stride is basically two steps (one by each leg) and is measured in length. The number of strides over a certain time is the cadence. The ideal cadence is commonly referred to as 85- to 90-strides per minute. In recreational runners, 70- to 80-strides per minute is common. The lower the cadence the more a runner over-strides.

What is the problem with over-striding? The longer the stride the harder the heel strike, which results in greater impact that must be absorbed by the body. The more impact loading, the greater the chance for overuse and injuries.

How do you find your cadence? At your normal running pace, time yourself for one minute and count the number of times your right or left foot touches the ground. Repeat two or three times and take your average. That number is your cadence.

Check back later for ideas on how to change your stride length and increase your cadence.

Forward Head Posture

Fri, 28 May 2010 09:35:16 GMT

One of my collegues, Becky Kohl, forwarded me a link to a blog article about forward head posture posted by Dr. Mark Wiley. I checked it out and thought it was full of useful, easy-to-use information about a very common problem. I would say a large majority of people that I see, myself included at times, struggle with forward head posture. I believe it has become more pervasive the more we are attached to our computers, electronic devices and smartphones.

Check it out for yourself here.

Thank you, Becky, for sharing!

Online Medical Reference Web Sites

Thu, 20 May 2010 11:04:35 GMT

In the information age, I have found that more often than not patients will come in to therapy having already researched their diagnoses, injuries or ailments on the Internet. This can be both good and bad. It's good if people are more informed and educated. It's bad if the information comes from an unreliable source.

I recently asked a reference librarian for an opinion on the most reputable online medical reference sites and this is what I received. I have used many of these sites personally and professionally and agree that it is an excellent and reliable list.

National Library of Medicine/National Institutes of Health
WebMD
Merck Manuals Online Medical Library

Just remember, information gleemed from a Web site is never a substitution for a diagnosis and treatment from a physician or other qualified healthcare provider. Use with caution and happy surfing!

Ice Packs at Home

Thu, 13 May 2010 08:28:14 GMT

In therapy, I often recommend that a patient use ice when recovering from various types of injuries, especially a recent or acute injury. The acronym RICE is often cited for treatment of an acute injury: Rest, Ice, Compression, Elevation.

Ice is an excellent natural anti-inflammatory as it helps to constrict blood vessels and reduces blood flow to the injured area thereby reducing the swelling that soon follows acute injury. As a general rule, place on the area for 10 to 15 minutes. For more chronic injuries that flare up after activity, ice after the activity, not before.

My patients often ask the question, "What's the best way to ice at home?" Or, "What's the best way to make an ice pack?" Here a couple of good options for use at home.

Buy a big bag of frozen peas and use them, mark them as ICE so you don't eat them!
Use the ice massage method — Freeze water in dixie cups and then rip off the top edge of the cup, rub the ice directly on the skin but keep it moving constantly for 5 to 10 minutes at the most; this works particularly well for small areas that are closer to the surface
Make your own reusable gel ice pack with the following recipe: Mix three parts water to one part rubbing alcohol and freeze in a plastic locking bag

What Are the "Eccentrics?"

Thu, 06 May 2010 09:40:47 GMT

Eccentrics are a type of exercise or more specifically a type of muscle contraction. I use eccentrics in therapy with my patients but have found more people seem to be "aware" of them without a complete understanding of them.

Simply put, an eccentric muscle contraction is when a muscle is generating force while it is lengthening. Conversely, a concentric contraction occurs when the muscle generates force while shortening. For example, with a biceps curl, during the upward movement of the curl the biceps contracts in a concentric fashion and the downward or lowering motion of the curl is eccentric.

Eccentrics are commonly used to help with recovery and rehab of tendinitis and muscle strains. In the case of Achilles tendinitis, one might use eccentric heel raises during the rehab. Eccentric heel raises could be done by doing heel raises on two feet and then lowering back down on one foot which is the eccentric phase of the exercise.

Fueling Up for Exercise

Thu, 18 Feb 2010 17:42:22 GMT

Kate Pollock, our registered dietician provided this info for our clinic. I thought it was very informative and useful. I get questions about this kind of stuff all the time so I thought I would share it!

Proper dietary intake for two to three days prior to exercise can affect performance!!! Proper hydration in the two to three days BEFORE exercise is ESSENTIAL! Drink an extra 4-8 cups (32-64oz) of fluid the 2 days before strenuous exercise — especially if you are a heavy sweater.

During the 3 to 4 hours before event/strenuous exercise (IDEAL TIMING):

200-300g carbohydrates; 800-1200kcal
Sufficient fluids (at least 2-3 cups (16-24oz) of fluid)
Example: 2c Frosted Mini-Wheats with 2c milk, 1 large banana and 2c grape juice (259g)

During the 2-hours before:

At least 2-3 cups (16-24oz) of fluid
1 gram carbohydrate per pound of body weight (about 100-250g carbs; 400-1000kcal)
Example: 1 large baked potato, 1c corn, 4oz chicken breast, and 2c lemonade (149g)

During the 1-hour before (keeps you from getting hungry):

-SUFFICIENT FLUIDS – 1-2 cups (8-16oz) of fluid
Moderate complex carbohydrates (50-125g)
Relatively low in fat (<20g – especially saturated fat) and fiber (<10g; fat & fiber delay gastric emptying)
Moderate in protein (10-25g; red meat is especially difficult to digest)
0.5 grams carbohydrates per pound of body weight (about 50-125g carbs; 200-500 kcal)
Example: Yogurt-covered granola bar with 1c low fat chocolate milk and 1 large apple (82g)

5-10 minutes before:

1-2 cups (8-16oz) of fluid
Simple sugars are OK (if consumed alone, should only be consumed a short amount of time before exercise to avoid insulin spike)
Example: Sports Drinks or 100% fruit juice

Thanks for the great info Kate!

In my next post, I plan to discuss the new "rocker bottom" shoes that you are starting to see more of. I'm getting quite a few questions about those as well. If you have specific questions or info about them I'd like to hear it.

The following is feedback received for this blog:

I was thinking about getting some "rocker" shoes and my husband says they're dumb. What do you think?

- Brenda K

Therapeutic Balance Training with the Wii

Wed, 27 Jan 2010 17:31:43 GMT

The emerging popularity of the Wii Fit gaming system over the past year has brought about the question as to whether such a system actually has a therapeutic application or not. I have only played with one once and found it to be quite challenging, especially the balance components. Based on my limited experience, my conclusion is that the Wii could provided a real improvement in functional balance.

I can now offer a more definitive answer thanks to a research article recently published in the January 2010 issue of Journal of Orthopedic & Sports Physical Therapy. The article is titled, "Effects of a Wobble Board-Based Therapeutic Exergaming System for Balance Training on Dynamic Postural Stability and Intrinsic Motivation Levels."

The idea of the study was to determine if such video game-based balance activities would improve a patient's willingness to perform such tasks at home and thus yield the desired improved balance. Essentially the end result was that exercise-based video games that incorporate balance, like the Wii Fit board, did yield an improvement in dynamic postural stability. Even better, the subjects had more fun while doing it!!

Response to Question Regarding Five Finger Shoes

Mon, 11 Jan 2010 16:36:36 GMT

Carrie Truebenbach provided the following response to a reader's question,

"I am not especially familiar with this shoe yet. That being said, it is a "shoe" with minimal to no cushion. For most people this style of footwear (mimicking barefoot running) would be difficult to adjust to, as the majority of runners (85 percent) are heel strikers to some degree. This pattern of gait is facilitated by the typical styles of shoes, including running shoes that we wear daily. To tolerate a shoe such as the Five Fingers, without getting injured, your running style would need to be very neutral and efficient — even if you were wearing it for competition only. So I would likely not recommend this style of footwear for many runners ..."

Thanks Carrie!

New Year ... New Shoes

Thu, 07 Jan 2010 11:10:49 GMT

The new year may have you focused on some new fitness goals. To help achieve your goals, it is important, if not imperative, to use the right equipment. A fundamental piece of exercise equipment is the proper shoe. At the Sports Medicine Center we treat many athletes with lower body injuries related to exercise and sporting activities. Unfortunately in the recipe for overuse injury, one key problem tends to be the wrong footwear. So how does one go about finding the right running shoe?

To begin with, consider the right shoe a small investment, knowing that the right investment will reap big rewards. Purchasing shoes at a local running specialty store, or online site is important. Name brand shoes from department stores and discount retailers are often composed of slightly different materials than those of the same brands sold by running-specialty retailers. The economy version running shoes, found at discount and department stores, are often made of slightly different materials that are typically less durable. So, if you are committed to getting the most of your shoe investment, and your fitness goals, do yourself a favor and seek the optimal shoe for you.

And how does one know what is the best shoe amongst the hundreds of styles, colors, and comfort-guaranteed gizmos that compose a running shoe? Well, fortunately, all of the bells and whistles really boil down to three or four basic running shoe styles that each company then individualizes. These styles include: neutral cushioned shoes (for the lightweight performance runner); stability shoes (beneficial for most runners); and motion control styles (for the low-arched, flexible foot, or heavier runner).

Depending on your level of experience, there are a number of ways to make an informed decision. Certainly the Internet can offer loads of information regarding shoe styles and even how to help determine your running style. But ultimately, receiving individualized attention to your needs and foot type is best. Local running shoe stores can be helpful and offer a variety of brands for you to try. But for expert advice in these decisions, consider pursuing an evaluation and shoe wear prescription here at the Sports Medicine Center’s Runners’ Clinic. This experience will provide you insight into your lower body posture and alignment, foot type, and basic information about your running style. This is the type of information that can optimize your shoe purchase and give you a strong start for achieving your 2010 fitness goals.

For more information about the Froedtert Sports Medicine Center’s Runners’ Clinic visit our site or call 414-805-8602.

Information submitted and provided by Carrie Truebenbach, MSPT. Thank you, Carrie!

The following are comments received for this blog post:

What are your thoughts on the new Five Fingers shoes made by Vibram? I'm thinking about getting a pair but worry about the lack of cushion.

- Steve P.

Vitamin D: The Athletes Choice

Wed, 25 Nov 2009 13:46:53 GMT

I received this information from my collegue, Kathryn Pollack, and thought it would be good to pass along. Kathryn is the Sports Medicine Dietitian at the Froedtert & The Medical College of Wisconsin Sports Medicine Center and wanted to pass along this excellent information regarding supplements. Thanks, Kate, for the info!!

Vitamin D is often called “the sunshine vitamin.” And although you can consume foods that contain Vitamin D to help increase the amount circulating in your system, it is almost impossible to consume enough Vitamin D in your diet without a supplement. Your body makes the majority of the Vitamin D circulating in your system when UVB rays hit your skin. Many factors can affect the effects of UVB rays on your skin …

Low UVB exposure and therefore low Vitamin D levels are often a result of:
- Latitude (above 35 degrees)
- Season (usually highest exposure in summer; lowest in winter)
- Time of day
- Melanin in skin (darker skinned individuals may need 10 times the exposure than lighter skinned individuals)
- Use of sunblock / sunscreen
- Age
- Clothing or coverings over face and body
Benefits of adequate Vitamin D levels:
- Maximal calcium absorption in the gut to prevent bone loss
- Adequate bone growth
- Reduction of inflammation
- Healthy immune function – especially helpful in reducing the risk of respiratory infections
- Help cells develop properly to decrease the risk of cancer
- Athletes should be ESPECIALLY concerned as adequate Vitamin D levels are associated with increased speed in running and cycling, increased cardiovascular and muscular endurance and increased choice reaction time!
How do I know if I am Vitamin D deficient?
- Your doctor should test your 25(OH)D or 25-hydroxy-vitamin D levels
- The results are usually measured in ng/mL
What’s enough?
- <20 ng/mL = deficient
- 21-31ng/mL = insufficient
- >32 to 100ng/mL = “optimal”
- Some studies show that the “ideal” level for athletes should be >50 ng/mL
What can you do if your levels are below “optimal”???
- See a Dietitian!!!
- Based on your lab results a dietitian can recommend a dose and a Vitamin D3 supplement
Can’t I just get Vitamin D from the foods I eat?
- Unfortunately, unless you are consuming large amounts of cod liver oil everyday you probably are not consuming enough Vitamin D from only the foods you eat
How much Vitamin D will I have to take?
- In May of 2010, the Institute of Medicine will release new Vitamin D recommendations
- More than likely at least 800-1000IU (or as much as 2000IU) of Vitamin D will be recommended to maintain healthy Vitamin D levels (much more will be recommended if you are found to be deficient)

For more information on sports nutrition, contact Kate Pollack, RD CD at 414-805-7461.

ACL Rehab: 1st Day Post Op

Tue, 01 Sep 2009 14:48:41 GMT

Sorry, I'm back. Not sure where I was but time gets away from me! I thought I would start a series of posts following the progress of a patient who recently underwent anterior cruciate ligament (ACL) reconstruction surgery. I plan to do this with weekly posts to provide you with inside look of what ACL rehab is like at our facility.

The ACL is one of four primary stabilizing ligaments within the knee joint. It is definitely the most often injured ligament in the knee and thus something that we see hundreds of per year at the Sports Medicine Center.

The two most common graft types are patellar tendon and hamstring tendon autografts (taken from the individual's own body). This particular patient received a patellar tendon autograft to replace the damaged ACL after an attempted hamstring graft was aborted due to poor condition of the hamstring tendon.

I first saw this patient one day after surgery (post-op day one). That may seem a bit soon, but I really like this approach and have found patients to do very well when they get an early start on their rehabilitation. The earlier patients start to bend their knee and work their quadriceps muscle the quicker they progress to normal walking. In most cases, the physical therapy visit one day post-op is fairly minimal. I help the patient bend and straighten their knee some and instruct them on how they can do this at home. We also initiate quad sets to start to “waken” that muscle from the deep sleep of anesthetic. If the patient does well with quad sets, straight leg raises are started. We then cover some simple weight shifting and proper use of crutches for walking and putting some weight on the injured leg.

Yes, most ACL reconstructions are weightbearing as tolerated (WBAT) this soon after surgery and do quite well with this. Lastly we finish with ice and elevation to help reduce the edema from surgery. The patient will be icing frequently each day during the first week while at home.

Next week, I'll summarize the post-op one week visit and see how our patient is progressing. I'll also discuss how we organize rehab to protect the ACL graft.

ACL Rehab: One Week Post-Op

Tue, 15 Sep 2009 13:56:28 GMT

Sorry for the delay on the progress of our ACL case. Life and work tends to get away from me bit and one week easily turns into two or three.

I next saw this ACL patient six days later or one week after surgery. At this visit, the patient had the bandages removed by the surgeon’s office and steristrips were placed over the incisions. The patient had two small scope incisions and one larger incision over the front of the knee where the patellar tendon graft was harvested. The incisions generally appeared to be healing well without excessive redness or drainage present.

On this date the patient presented to the clinic walking with one crutch on the left side of the body. Definite progress was made from the first visit in which the patient could hardly put any weight on the affected leg. The patient complained of some pain and pressure especially behind the knee, which is a typical report because of the presence of increased swelling within the joint.

Treatment today consisted of soft tissue mobilization to the back of the knee and hamstrings to help resolve tightness. The hamstrings were also gently stretched and the patient was instructed on how to do this at home. Patellar mobilizations were performed in which I manually glide the kneecap in all directions to help restore normal joint play which will assist in regaining full motion and quadriceps muscle function. The exercises from the first visit were reviewed. I particularly noted a much better quadriceps contraction this visit.

I then added three new exercises to the program. I first added side-lying leg raises to address gluteal strength. The gluteals help to provide stability and assist with knee control during weightbearing activities. I also added single leg standing to improve balance and proprioception, which is the body’s position sense. Lastly, I started the patient on standing minisquats with body weight. The patient will add these exercises to the ones given on the first visit. I finished the day's treatment with ice and electrical stimulation for pain and edema control. The patient’s knee flexion measurement today had increased to 118 degrees.

Overall from one day to one week post-op the patient demonstrated the following progress: walking improved with one crutch instead of two, increased knee flexion from 35 degrees to 118 degrees, and improved quality of quadriceps contraction.

Stay tuned for week two to see what progress is made.

ACL Rehab: Two Weeks Post-Op

Fri, 09 Oct 2009 10:35:27 GMT

Our ACL patient is now two weeks removed from surgery. On this date, the patient reported that her knee still "feels tight but there is not much pain." The patient presented to the clinic wearing a compression stocking to assist in controlling the swelling in the knee. At this point, residual swelling is still very normal after an ACL reconstruction and will be one of the primary reasons for continued discomfort be it pain or tightness in the knee. The swelling is also the main reason that knee range of motion is not yet normal.

On this date, the patient presented to the clinic no longer using crutches. The patient's walking gait was not quite normal yet but close enough to ditch the crutch. The patient presented with improved knee range of motion. The knee flexion measurement increased to 127 degrees (normal being 140-145 degrees) and knee extension was 0 degrees or completely straight, which is normal. The patient demonstrated improved isolated quadriceps contraction again.

At this visit we were also able to progress the strengthening exercises quite a bit. I had the patient start using the leg press, which is like a squat machine, using both legs at first and then some with just the repaired knee. The patient also progressed with balance activities including the use of a balance board and increased holds on single-leg-standing to further progress proprioception. We also initiated the use of the stationary bike for light aerobic conditioning. I continue to use ice and electrical stimulation at the end of the treatment to help decrease remaining swelling and inflammation.

Overall the patient is progressing well and as expected. Next week a few new exercises will again be added.

ACL Rehab: Three Weeks Post-Op

Thu, 22 Oct 2009 16:24:38 GMT

With the patient now three weeks removed from ACL reconstruction, we are continuing to see steady progress. During this appointment, the patient reports the knee feeling a little warm and still a bit sore. Both are not unusual complaints at this point as some effusion or joint swelling is still present from surgery. Looking at the knee, we see the incision is healing well, swelling is minimal and there are no signs of active infection. OK to proceed.

After a brief bike warm-up, a few manual therapy techniques are used to work the scar and to mobilize the kneecap. I then do a few range of motion exercises for knee flexion and extension. A new measurement is taken and we record further progress: The patient's knee flexion has increased to 135 degrees. The patient's knee extension or straightening has also increased so that now there is actually about 2 degrees of hyperextension. Most people have at least a degree or two of hyperextension with some having as much as 10 degrees. So this finding is completely normal.

The same exercises performed at the last session were again repeated with progression of either increased weights or repetitions. The patient progressed with balance exercises to include the use of resistive bands to provide additional challenge. In addition to these progressions, we added both forward step ups on a 6" step and side step downs on a 2" step. Both the step ups and step downs are excellent functional exercises as they closely relate to the task of climbing and descending stairs and work on quad strength and hip control, both important concepts in ACL rehab.

ACL Rehab: Four Weeks Post-Op

Wed, 04 Nov 2009 08:50:23 GMT

At about four weeks removed from surgery, this patient presented as doing and feeling fairly well. At this point, regular daily tasks return to normal for the most part. The patient is walking normally and is feeling less overall soreness and discomfort. The patient presented today with completely normal range of motion in the surgically repaired knee.

Knee flexion increased to 145 degrees and extension increased to 5 degrees. We will no longer focus on range of motion during treatment but rather check it quickly each week to make sure that normal motion is maintained.

As far as exercises and strengthening goes, the next month or so is kind of the doledrums of ACL rehab. I say that because the type of exercises don't really change much but rather are progressed in weights/repetitions (reps) and patients get eager to do more. It is my job to vary things just enough to keep the patient sufficiently challenged and interested.

The goal for the next two months is gaining muscle strength and mass. To that end, with each workout, the goal is to fatigue the quadriceps primarily and the hamstrings to a lesser degree. The overload principle is applied with strength exercises where each exercise should be done at an intensity (weight/reps) that induces fatigue. Ideally the number of reps should be three sets of 8-10 reps and the weight adjusted accordingly to achieve that number of reps. This will result in the greatest strength gains.

The patient is given instructions to continue with the prescribed exercises two additional times beyond the therapy session each week with a rest day in between workouts.

Below is a list of strength exercises performed by the patient during this visit:

Double leg press 9pl 2x10
Two up, one down leg press 7pl 2x10 (eccentrics)
Single leg press 6pl 3x10 (involved leg)
Steamboats for balance x 20 reps each direction
Lateral step downs 4" 3x10
Forward step ups 12" 3x10

Hamstring strengthening for this patient is still avoided because of the surgical procedure to attempt to harvest a hamstring tendon graft. Hamstring strengthening will begin in two weeks.

In general this patient is progressing very well and certainly faster than some.  Each patient progresses at his or her own rate so what is shown here may be somewhat different for another patient depending on a number of factors.

In coming posts, I may fast forward a few weeks because what I described above does not change much in activities and exercises. Looking forward, our goals are to light impact at weeks eight and nine and interval jogging possibly as early as week 10.

The Value of Athletic Trainers

Wed, 29 Jul 2009 09:41:28 GMT

I have decided to dedicate this post to athletic trainers. At the Sports Medicine Center, we are very fortunate to have eight highly skilled athletic trainers as a part of our team that are licensed by the state of Wisconsin. The involvement of athletic trainers in our clinic often brings up with question: What is the difference between athletic trainers and personal trainers?

Athletic trainers, at a minimum, complete a bachelor's degree program in an accredited athletic training program and must pass a national exam. But that's a minimum. In fact, 70 percent of athletic trainers have gone on to receive a Master's degree. Personal trainers are not required to have any degree nor are they licensed by the state.

Athletic trainers work very closely with sports teams in the areas of on-field emergency care, injury prevention, treatment and rehab of injuries, and developing conditioning programs for athletes. In the clinical setting, athletic trainers are a valuable resource and part of the rehabilitation team. They provide another perspective to rehab and conditioning, especially when dealing with an athletic population. The involvement with sports teams affords them a unique insight to the demands and requirements of athletes participating in organized sports. As a result, given their education and experience, athletic trainers are much more qualified in preventing injury and dealing with individuals that are recovering from injury.

An Active Vacation

Wed, 15 Jul 2009 13:06:51 GMT

I will be out on vacation from July 20th til July 27th. I will hopefully be enjoying golf, waterskiing, swimming and fishing. All that capped off with a sprint distance triathlon the final weekend. I'll get back when I return with any injuries that I may have sustained. Have a good week!

The Proper Bike Fit

Tue, 30 Jun 2009 14:13:18 GMT

As a follow-up to a previous post regarding Bike To Work Week and being that it is peak riding season, I wanted to share some very useful information regarding the proper fit of a bicycle to the rider. One of my collegues at the Sports Medicine Center, Mark Lydecker, provided me with this information to share. Mark is a physical therapist and athletic trainer. He also oversees our cycling program at the clinic. Thanks, Mark, for sharing your insight!

Mark makes the important distinction that the bike should be adjusted to fit you. The rider should not have to make adjustments to fit the bike. Here are a few tips that he gives that riders can try at home to achieve a better bike fit.

Seat Height: Stand next to the bike and eye up the seat. It should be about the level of your hip. Adjust the seat and get on the bike. When your feet are at the lowest part of the pedal crank (6 o’clock) your knee should have a slight bend, around 25-35 degrees.
Seat Angle: Start with a neutral position. Begin pedaling and watch your knees when your foot is towards the front of the bike (the 3 o’clock position). Your knee cap should be right over the pedal axle.
Reach: With your hands on the shifters, your shoulders should be around 90 degrees from your body and your elbows should have a slight bend.

If you would like further information or individualized help with your bike fit, contact Mark Lydecker at the Sports Medicine Center at 414-805-7111.

Shin Splints Uncovered

Thu, 18 Jun 2009 11:39:51 GMT

A reader asked me to write about shin splints in relation to running, an excellent topic and question. Thank you!

Shin splints is a relatively generic term describing pain in the shin area or front of the lower leg. This shin splint pain can have multiple causes that are quite different, some common and others not so common.

Probably the most common cause of shin splints would be a tendonitis, or inflammation of one of the muscle tendon complexes that attach to the shin bone or tibia. The two most commonly involved muscles being the anterior tibialis and posterior tibialis. Both have extensive attachments to the tibia and overuse or repetitive trauma/stress to these muscles can cause a diffuse but sometimes sharp pain especially with use or running.

A tibial stress fracture is another potential cause of shin splint type pain. Tibial stress fractures are not rare but not as common as the previously described tendonitis. A tibial stress fracture or reaction is also caused by repetitive trauma or stress, but in this case that microtrauma has caused a small and sometimes difficult to detect fracture in the bone. This is a bit more serious than tendonitis and will require some significant rest and possibly immobilization.

Lastly, and least common, shin splint pain can be caused by a compartment syndrome. This is when one of the compartments of lower leg muscles develops increased pressure within it which can impair blood flow and ultimately result in significant pain.

With all cases of shin splints, an appropriate medical examination is recommended to determine what is the cause of the pain. In most cases, physical therapy can be helpful to address issues including stretching overly tight musculature and retraining possible strength deficiencies. In most cases, footwear should be addressed to determine if proper support is present and if a change in running shoe style or possibly the addition of an orthotic (e.g., arch support) is warrented. With most the patients who I see with shin splint pain, a fair amount of time is usually spent addressing the biomechanics of the lower extremity. This usually begins with gait analysis during walking and often running on the treadmill when the patient is able to resume those activities. If you are interested in an assessment of your gait or running mechanics, contact the Sports Medicine Center at 414-805-8656.

The following is feedback received for this blog:

Jeff,

Thanks for the article. When I suggested it, I didn't think it would be written that quick. I appreciate your timely response, and hopefully this will help others. I have invested in a quality pair of running shoes, and though I still have pain from time to time, it seems like the pain is not as severe with good shoes. Again, I appreciate the quick response.

Dave

Bike To Work Week

Thu, 04 Jun 2009 12:51:23 GMT

The week starting Sunday, June 7, is Bike to Work Week. Bike to Work Week helps to promote cycling as a form of exercise following a long winter, and it increases environmental awareness. If more people join the Bike to Work Week team we can cut down on emissions and gasoline consumption while getting a bit more fit in the process. Be safe, wear your helmet.

I personally plan to ride at least two times next week. From previous experience, it does not take me much longer to bike than it does to drive. It just requires a bit of preplanning and possibly a change of clothes depending on your profession.

For more information on bike to work week, check out the Bike Federation of Wisconsin Web page.

If you would like more information on improving your cycling performance or how your bike fits to your body, feel free to check out our Performance Enhancement Programs.

The following is feedback received for this blog:

Write on the topic of shin splints, something everyone trying to be healthy and run deals with.

What's in The Core?

Tue, 26 May 2009 15:15:59 GMT

In the worlds of physical therapy, sports medicine, personal training and fitness, the issue of core strengthening or core stabilization has become increasing popular in recent years.

So, exactly what is "the core"?  The core refers to the collection of muscles that surround and support the lower trunk, back and pelvis. This grouping of muscles of course includes the abdominals (rectus, obliques, and transverse), extensor muscles of the spine (multifidi, erector spinae), pelvic floor, diaphragm, quadratus lumborum and latissimus.

The core functions to provide local stability to individual vertebra of the lumbar spine as well as global control of the trunk as a unit.  The core muscles are particularly important for improving and maintaining health of the lumbar spine. Functionally, the core provides a stable base from which all extremity movement originates.

In working with patients, it is rare to find someone who does not need some training in this area. Given its relation to function, it is common to prescribe core exercises to hip, knee, ankle, and shoulder patients.  Many healthclubs now offer specific classes focused on core strengthening but be sure to get some individualized instruction if this type of exercise is new to you.

Alter G Treadmill Update

Wed, 22 Apr 2009 09:03:04 GMT

In follow-up to a recent posting on the Alter G treadmill, I thought I'd provde an update on its use and benefits.

The ACL/microfracture patient that I mentioned in the previous post, used it for about three weeks and successfully progressed to full gravity running and plyometric exercises. He is doing very well at this point. I definitely feel that the Alter G allowed him to make a smooth and successful transition without pain or setbacks. Gradually progressing the weightbearing allowed his joint surface to get used to the increased joint compression forces slowly without flare-ups.

I would estimate that we have had at about two dozen patients use it to help their rehab. I would give it a solid "A."

MRSA Update

Wed, 01 Apr 2009 13:26:01 GMT

I recently attended the annual Sports Medicine Symposium here at the Medical College of Wisconsin and thought I'd pass along some nuggets of info. Craig Young, MD, a Medical College of Wisconsin orthopaedic surgeon, gave a talk on Methicillin Resistant Streptococcus Aureus (MRSA) that I thought contained some useful information for the general public, which I will pass along. Dr. Young deserves the credit for researching this topic. I am just spreading the word.

MRSA is a bacterial infection that is becoming more prevalent because of its resistance to common antibiotics. MRSA has emerged more frequently with sports teams, most notably an outbreak with the St. Louis Rams in 2003 in which 9 percent of the players tested positive for the bug. In that case, MRSA was found to be present in common places like the whirlpool and taping gels.

MRSA most commonly presents as a skin infection that resembles a pimple or boil that patients often refer to as "spider bites."
Additionally but less common, MRSA can present as necrotizing fasciitis, which is a very serious, life-threatening infection of the skin, soft tissue and fascia.

Risk factors include: 1) contact with infected individuals or items, 2) young healthy patient from ethnic minority in low socioeconomic group, 3) recent use of antimicrobial agents, 4) shaving of body hair.

Since MRSA is resistent to some antibiotics the best treatment is prevention. First, use good hygiene — don't share razors, keep nails trimmed, change underwear daily, clean equipment after using. Second, minimize antibiotic use. Overuse of antibiotics or antimicrobial soaps can contribute to an MRSA proliferation because they can kill other bacteria that help stop MRSA from multiplying.

As with all topics in this blog, the information here should not be a substitute for diagnosis or treatment from a physician. If you suspect that you may have MRSA, contact your physician immediately!

Stretching Tips for Coaches and Young Athletes

Mon, 02 Mar 2009 15:13:47 GMT

A collegue of mine recently told me about a coach who was asking him questions about the best ways to have his team stretch. My collegue thought this would be a good topic for my blog, and I could not agree more! Youth and high school coaches are individuals that have the most contact and in some cases the most influence over young athletes. They need to have this information to aid them in keeping athletes healthy and in preventing injuries.

I have on many occasions been surprised to find out from young athletes that I've worked with that their coaches don't have them stretch or warm-up adequately as a part of the normal practice or game routine. Let's answer some of the most common questions regarding stretching.

When is the best time to stretch? Always warm-up before stretching! Do 5-10 minutes of light aerobic exercise to get the muscles warmed up and get a light sweat started first. Muscles are elastic tissue that will be more responsive to stretching after being warmed up. You are more likely to cause injury stretching a cold muscle. After the warm-up, stretch before and after your exercise or activity, whether it's running, lifting weights, practicing or playing a game. In particular, dynamic stretching can be useful before activity (arm circles, walking lunges, deep squats) not only because it will reduce muscle tightness but also because this excites the muscle a bit, getting it ready for more vigorous activity. Lastly, regular daily stretching has been found to be more beneficial than occasional stretching.

How long should I hold my stretches? After 10 seconds of stretching, the nervous system will sense the change in muscle tension and begin to relax. Only then can the true stretch begin. I recommend to my patients that they hold their stretches for a minimum of 30 seconds but up to one minute. This stretch should be mild in intensity such that 30 seconds is easily tolerated. If the 30 seconds is agonizing and very painful, your stretch is overly aggressive and too intense.

Why should I stretch? First, stretching does help to prevent injury and keeps the muscle from becoming chronically tight. A muscle can become chronically tight if it is regularly asked to perform the same action repeatedly without being stretched. If you play a certain sport often, it is likely that you have muscles prone to becoming tight from that repeated action. Secondly, stretching improves your body's potential for performance and function. An athlete that is flexible will likely have better range on the field or court than one that is not.

Those are some basics. Let me know if you have any specific follow-up questions and I'll get them answered.

Jogging on the Moon? The Anti-Gravity Training Experience

Wed, 11 Feb 2009 21:24:30 GMT

Anybody up for a jog around the moon?

Last week I had the opportunity to experience something very similar to a jog on the moon. The Froedtert & The Medical College of Wisconsin Sports Medicine Center received on loan an Alter G G-trainer treadmill to try in the clinic. It is quite the experience and a potentially useful technology in the rehab setting. The Alter G allows me as a therapist to unweight a patient to 20 percent of their body weight — very similar to the moon which has a gravitational force of 17 percent of the gravitational force on Earth. At 20 percent of body weight, a 150 pound individual would effectively weigh only 30 pounds.

The Alter G allows therapists and athletic trainers to work on gait training and return to running gradually at an amount of weight bearing that is well-tolerated and with hopefully less compensations. I can see applications for returning athletes to activities (ACL reconstructions, Achilles tendon repairs, stress fractures) as well as for other post-op orthopedic procedures like hip and knee replacements.

How does it work? The Alter G uses positive air pressure to lift the subject partially off the tread. The patient dons a pair of lycra bike-style shorts that create a seal in the balloon portion of the treadmill. This allows the Alter G to create a chamber that has greater air pressure than outside the chamber which provides a relative decrease in weight. The Alter G can provide from 20 percent to 100 precent weight-bearing in 1 percent increments and at speeds from 1 mph to 18 mph up to a 15 percent grade.

I had an individual use it this morning who is recovering from an ACL reconstruction and microfracture surgery. He really liked it and said it felt very natural while providing a good running workout at 60 percent body weight. I'll keep you posted on how else we use it and what kind of reviews it gets.

What is Myofascial Release?

Wed, 28 Jan 2009 12:02:21 GMT

A reader had responded to a previous post asking me to address myofascial release therapy in a future blog. So here you have it:

First off, I am not an expert in this particular therapeutic modality or approach. I have taken some continuing education in this area so I do feel comfortable talking about it. I do use this type of therapy some in my practice but not as much as in the past because of the type of caseload I typically carry.

Myofascial release is a type of manual therapy that utilizes fairly light hands on contact with light pressures and fairly slow, gentle, sustained movement of the tissues. Myofasical release was founded and made popular by John Barnes. It is based on the premise that restrictions (tightness, scar tissue, decreased play) can be found in the fascial tissues or connective tissue between muscle layers and surrounding most structures in the body.

This fascial tissue is very similar to what you would find between and surrounding the different segments of a chicken breast before its cooked. Restrictions in that fascia tissue will affect the ability of the muscles, tendons, nerves, ligaments, blood vessels to glide on each other with dynamic movements. Those restrictions can impair function by causing limited mobility or pain.

Of interest, fascia tissue is continuous throughout the body and can be thought of like the woven threads of a sweater or the strands of a spider web. If you pull one fiber or strand, it can have effects on the entire structure, at least in theory.

I hope this helps explain it. Keep the questions coming.

The following is feedback received for this blog:

Would you be able to perform Myofacial release to help prevent incontinence?

- Mark D.

Time for Golf?

Wed, 14 Jan 2009 09:49:21 GMT

On these dark, cold days of winter after the holidays have passed I find myself longing for activities of spring and summer. For me, one of those activities is golf. One way to deal with these cravings, is to start preparing for the upcoming season. Now is a good time! You don't have the lush green fairways calling your name so you have time to "work" on your game. In addition, the off-season work done now will pay dividends come June and July.

As Tiger as shown us, golfers are indeed athletes and training like one can certainly help. No, I'm not saying that you have to devote the amount of time and effort to golf conditioning and working out that he does. That's unrealistic for those of us who have to do real work. But even a small amount of conditioning for the average golfer can really pay off.

A basic golf conditioning program can consist of a combination of stretches, light resistive strengthening, balance activities and aerobic exercise. Most of which can be done in the comfort of one's home with very little equipment or the equipment you already have in as little as 30 minutes per day.

What are the benefits of such a program? First, you will reduce the chance for injury when you really don't want one ... during the season. Second, the improved strength and flexibility that can be obtained will allow your body to work better for you within the golf swing. You can achieve greater efficiency, range of motion, and power which can equate to better accuracy and distance in your shots.

I have been lucky in my current position as a physical therapist at the Froedtert & The Medical College of Wisconsin Sports Medicine Center to be able to combine my passion for golf with my physical therapy knowledge. As a result, we developed a Golf Swing Program to assist golfers improve their physical abilities. If you are interested in seeing what a golf conditioning program can do for you, I am co-presenting a seminar on the topic being hosted at the Sports Medicine Center on Wednesday, Jan. 28th from 7:00 to 8:30 pm. If you're interested, sign up through our online class calendar. Hope to see you there.

Hit 'em straight!

The Proper Lifting Technique ... What Toddlers Can Teach Us

Tue, 23 Dec 2008 10:18:29 GMT

'Tis the season! For shoveling snow that is. So I thought this would be an appropriate time to discuss proper body mechanics for lifting.

I was reminded of this issue while, of all things, watching old videos of my kids when they were just toddlers. You may ask, what does silly home movies have to do with shoveling snow? My wife is also a physical therapist. Yes, its fairly common for PTs to marry PTs. Since we share the same profession, we will often observe something in everyday things that reminds us of work.

Back to the family videos ... we were watching a video of our daughter from when she was about 18- 24-months-old. In the video, we observed how she squatted down to pick up a toy. We realized then that toddlers seem to use perfect body mechanics when picking up an object off the floor. They use their legs to squat down and keep their backs relatively straight. A toddler tends to use this technique to compensate for the weight of their head and developing balance. But it is interesting to watch as it is an innate behavior that doesn't need to be taught.

Adults on the other hand, often need to be taught this behavior later in life after bad habits have developed. Poor body mechanics and improper lifting technique can be a major risk factor for lower back injuries. Given the time of year, physical therapists can usually count on a few snow shoveling-related back injuries every year. In an attempt to prevent those injuries, let's review some main concepts especially as they relate to shoveling snow.

Lift with your legs, not your back — keep your back straight and bend using your knees and hips. The quads, glutes, and hamstrings are large muscles that are well-equipped for heavy lifting.
Avoid twisting of the spine — instead turn with your legs and hips. The twisting motion of the spine especially with a large compressive load (i.e., shovel full of snow) is hard on the intervertebral discs.
Take breaks and pace yourself. If you feel yourself getting winded or short of breath, take a break. Don't take more than you can handle on the shovel, especially with a wet heavy snow.
Try a crooked shovel. Those funny looking crooked handles on shovels do serve a purpose. The angle in the handle improves the ergonomics of the shovel so you don't have to squat as far.

Be careful when shoveling! Merry Christmas!

A New Journey: Entering the Blogosphere

Wed, 19 Nov 2008 13:31:53 GMT

I have to say that as a physical therapist, I never quite thought that "blogging" is something that would become part of my professional being. But here we are, and I am excited about it! I would be remiss if I did not acknowledge fellow Froedtert & The Medical College of Wisconsin blogger Dr. Bruce Campbell for helping me stumble upon this opportunity. I first came to know the blogs on my employer's Web site when I found Dr. Campbell's by happenstance. I thank him for his words of encouragement that physical therapy and sports medicine would lend itself well to blogging. I hope that I prove him correct!

I truly feel that physical therapy is a highly rewarding profession as it affords me the opportunity to meet and interact with hundreds of different people each year. My interactions with patients are by nature intimate in that I use my hands during treatment and work directly one-on-one with patients for a minimum of 30 minutes per visit. Each patient who crosses my path inevitably teaches me something that I hope makes me a better clinician as well as a better husband, father, son and friend. I intend to take some of my experiences and observations as a physical therapist and share them through this forum to help others be more physically fit, reduce injury, and enhance enjoyment of physical activities.

I invite responses and feedback at anytime. If you have suggestions for topics also pass those along.

Until next time, get out there and do something you enjoy! A body that's in motion ...

Jeff

The following is feedback received for this blog:

Can you tell me more about Froedtert Sports Medicine and how you rank with other sports medicine facilities around town? Would it be appropriate to come there for a work related injury?

- Mark D.

Hi, would you plese address "myofascial release therapy" in a future blog? Thanks!

Mark,

In response to your question, if you are looking for a facility in town there are a few questions that you should ask. The things that come to my mind that I would pay attention to are as follows: experience and expertise of the clinicians, communication with your physician and level of personal attention provided.

What I can tell you about the Froedtert & The Medical College Sports Medicine Center is that we are a state-of-the-art facility with very experienced and highly trained therapists with little turnover. We routinely treat professional, collegiate and high school athletes. Our physicians are all fellowship-trained and board-certified, so they are specialists in their respective areas. I and my collegues have the good fortune to work very closely with our physicians on a daily basis. Thus, it is truly a team atmosphere in which customer service is a top priority.

With respect to a work-related injury, it may be appropriate to come to our facility for such an issue. We certainly do treat work-related injuries. Most of what we treat at the Sports Medicine Center are extremity injuries (shoulder, knee, foot/ankle, elbow, hip). I stress that picking a facility for your care is a personal decision that you should discuss with your physician. If you would like more information on our facility I direct you to our Sports Medicine Center Web site.

It is also very important that I mention that the content of this blog is not intended to be specific medical advice. I will not offer specific medical advice or attempt to diagnosis through this blog. If you have a medical condition or injury, please consult your personal physician.

I hope that answers your questions.

- Jeff Wilkens

I plan to continue reading your blog. Question: Are you the same PT who treated me in Madison at Dean Clinic (East) after I irritated or tore my rotator cuffs? I'm sure you treated lots of folks like me, but what made my situation unique is that all the while you were following protocol shooting cortizone into my shoulders and getting my muscles to relax and reduce inflammation, I wasa still unable to comb my hair or reach to do any number of ADLs. And then, during cooldown after my step aerobics class one evening in October, the instructor had us lie supine on the bench, repeatedly reaching fists straight up, then back down (leading with elbows), reach partway up, then down; and also doing flies partway out, in, all the way out, and in, to strengthen the shoulder girdle muscles. (The next day my pecs and lats were sore, but the shoulder muscles were strengthened, there was less weight pushing on the tender tendons and I was able to DO things again with my arms

. I recall teasing my PT about this. So, are you the same PT? If so, it's good to know you're now at Froedert the next time I need an EXCELLENT therapist!

- Barbara Ingalls

Thank you for reading!

First off, I am not the physical therapist you had worked with in the past. Given that I don't know you, it is not possible for me to comment on any particulars of your case or condition.

I am comfortable saying that each and every physical therapist is unique and will have subtle differences in treatment style including exercises prescribed. This is due to different schools, continuing education, mentors, and experiences which shape a respective physical therapist's career. In addition, not all exercises are appropriate for all patients. I always make an effort to personalize the program for each patient as this is what has provided me and my patients the best outcomes.

Lastly, it is unlikely that one specific exercise is the end all and be all in treating a condition. A comprehensive physical therapy evaluation followed by an individualized treatment is mostly likely to provide success. Good luck in your quest to find a new physical therapist!

- Jeff Wilkens

Time to Buy New Running Shoes

Tue, 02 Dec 2008 14:54:25 GMT

I am a fairly avid runner. I don't run competitively much but more for fun, fitness and to be able to eat a little more of what I want. I usually run about 3 days per week.

As a runner, I now find myself in the same position as a lot of patients I treat ... needing new running shoes! Over the last month or so I have had more aches and pains after running. I notice that within 10-15 minutes after running the front of both of my knees ache. My feet and ankles get more sore the day or so after a run also. Another major clue that I've been ignoring is that I feel every crack or bump in the pavement.

Simply put, my shoes have lost their ability to help absorb some of the shock of running. The ground reaction forces transmitted up the leg from running can be as high as four times body weight. The amount of the ground reaction force is widely accepted and described further in this research abstract.

In addition to the symptoms that I have personally been experiencing and describe, other common signs that running shoes have exceeded their useful life could include: increased muscle fatigue, onset of shin splints or plantarfascitis (arch pain), increased and uneven wear pattern on soles and decreased structural integrity of the shoe (easy to bend or twist). The typical lifespan of running shoes is 400-500 miles or about 4 months of running 25 miles per week.

Buying new shoes is not as simple as running to your nearest big box store and grabbing a pair in your size off the shelf. I am going to go to a store that specializes in running shoes and get my foot measured to ensure the proper fit. A specialty store is also more likely to be able to assist you in picking out the style of shoe that best fits your foot and running style. The three main types of shoes are: motion control, stability, and cushioning. Don't just try them on: Try jogging in them a bit. Some stores have areas or treadmills set aside for you to do this. For a good pair of quality running shoes that fits properly, expect to pay a little more. I feel that it's worth it if you run regularly.

As a physical therapist, I am a bit embarrased that I've let it get to this point because I know better. That's a bit of human nature and also a bit of an attempt to economize, as many of us are doing these days. Well, off to buy my new shoes. I'll let you know later how this worked out.