Getting in the Driver's Seat of Your Own Health: Who Should Ride Shotgun and Who You Should Kick to the Curb

YOU need to be looking out for number one. Integrity in the sales and education of the public in health, preventative medicine and pain is becoming completely extinct. There are a few brave souls out there still trying to fight the good fight. The few of us will never have as loud a voice as the people pushing the "magic pill" but if you look hard enough you will find us. When you do find that skilled clinician and advocate for real improvement, help them grow their roots stronger so that we can weather the storm of fitness myth, fat loss legend and cure-all super pills.

It has become our mission to help our clients weather the 'nonsense storm' of misinformation shielded by our years of experience and formal training. If we are not riding shotgun with you, navigation will be tough.

The first lesson in getting all the way well is in finding the people you will put in your corner to look after your health. Every prize fighter has a corner. Every race car driver has their pit crew. These teams are specifically skilled to assess problems before they can interfere with the function of the overall system and to fix problems when they arise. Why should this level of proactive care only happen at these elite levels? We are all entitled to be treated in this way and if you follow these steps, you can be.

As a general rule, a good first question to ask a potential provider is, "How much time will I be spending with you during each visit?" Another great question to ask is "How do I reach you if/when there is a problem that needs to be addressed?" Your team members should be ACCESSIBLE! After all, what is the use of a great team if when you need to see one of them you have to wait 3-4 weeks? Once you've got this info, you should be able to use the following to complete your team.

You need:
1. General Practitioner (GP)/Family Physician:
This has to be someone you really trust. Some GPs spend a lot of time explaining and educating. These are the people you must look for. 
Your GP is your go-to for all things medical 'illness' and to keep your vital medical info handy so that a problem can be picked up early. Physicians are the experts of your organs. A great resource to have, of course. You will see this physician once or twice per year at least. Bad stomach bug? Bad sore throat? Energy level takes a dip? Rapid and unexpected weight loss? Fever? Pain that doesn't resolve after a few days or with a change of body position? These are some reasons to reach out to this member of your team ASAP!

2. Specialist Physician(s):
You may find that there is an issue that needs more regular attention or a deeper knowledge of a single body system (read: kidneys, heart, joints, etc). These pros exist because of the level of depth with which they can assess and treat medical issues. In addition, these are the physicians who can perform surgery if it becomes necessary. The  best orthopedic physicians will all tell you that if an injury or pain can be treated conservatively (without surgery) then you should do that. This is how surgeons and physical therapists have formed such an amazing relationship over history.

Unfortunately, my experience has led me to believe that most physicians don’t understand the difference between PT clinics and PTs. Their understanding is similar to what the general public thinks: that all PT is kind of the same whether you go to SPARK or you go to any other physical therapy “mill”.

3. Physical Therapist (PT):
Your PT is your musculoskeletal (muscle, bone, joint, nerve, MOVEMENT) expert. Movement and pain are in OUR wheelhouse. Basically, if it hurts when you move, your PT is the person to see. The bonus about having a PT in your corner is that in most states anyone can see a PT right away and without a referral. This is called 'direct access'. SPARK Physiotherapy is a direct access certified clinic. We use this to our clients' advantage because the majority of injuries are treated most effectively when we can see folks IMMEDIATELY after the injury happens.

The other bonus is that a PT's training spans many different orthopedic body systems. Lots of times, we'll see a client for an evaluation and that client has done a lot of research on their own or consulted their GP. Many times, while the diagnosis we see from a GP may be close, the true mechanical issue requires more thorough examination. Sometimes a problem that looks and feels like a herniated disc, for example, may actually be an issue of muscular or nerve tissue tension. This is where the manual physiotherapist shines! We are able to look at the entire movement picture and truly hone our care toward the problem area and not just the symptoms. This give our clients the most relief and the best chance that this issue does not crop up again. Just as you would see your GP regularly to make sure that everything is in working order, you should see your PT regularly for what we call a 'tune-up'. We'd much rather see our clients when they are pain free and work to keep them that way instead of only seeing them when they've had an injury that could have been avoided if we would have pointed out areas of weakness and addressed them.

Clients nowadays are so well educated and come with very good questions. Always feel free to question your physician or PT. Those of us who truly value the patient education experience enjoy explaining our methods to clients who express an interest.

In addition to the high level skills, like trigger point dry needling (pictured here) and cutting edge manual techniques we use, we work hard to provide the highest level of patient education. Our patients truly understand what it is we are looking at. Our patients become very intimate in the knowledge of their pain and their issues. Not only do we see them acutely and help them relieve pain now, we also teach them markers for when they should be seeing other practitioners. Often times, because pain can be dealt with in our office, patients start to realize, “ok well if this happening I should go to Dr. Berio immediately.”

Another thing we do differently is stay in close contact with our patients so if they have and questions they can shoot us an email or give us a phone call and we respond quickly. That’s not something that is a common occurrence, unfortunately, in PT or in medicine across the board. 

This is a key to being a good advocate for yourself –doing the research, finding out what makes the physical therapist that your going to see different. Just like if you were looking for a new dentist or a new GP or if you were about to undergo surgery, you would look for the best surgeon. Once you've found your PT, make sure that your  GP, specialist physician and other pros know who they should be partnering with to ensure that all of their patients are treated the best way possible.

Our clients become better advocates for themselves because they are armed with knowledge to treat themselves or to consult with a member of their team ASAP if an issue arises.

4. Dentist:
This one is a no brainer! There is no medical professional other than a dentist that can take care of your teeth like these folks. Have tooth pain or just want to stay ahead of the curve to keep those pearly whites gleaming? Make sure to have a good dentist in your corner.
However, from what we have learned via the most recent literature, some issues that were thought to be in the dentists' wheelhouse are proving to be better taken care of by our PT colleagues.

For example, temporomandibular joint pain/disease, mostly known by it's acronym 'TMJ', is an issue that may not be related to your teeth or jaw at all! Dentists are trained in teeth and not muscle, therefore they may miss out on properly treating some of their patients with this diagnosis. According to the most recent literature, about 47% of TMJ sufferers would be better suited seeking treatment directed at the soft tissues and muscles associated with the face, jaw and neck that REFER pain to the jaw and teeth! This is the job of a good manual PT! Neat, huh?

5. Alternative/Complimentary Disciplines:
Lots of people will reserve space in their corner for acupuncturists, nutritionists, massage therapists, chiropractors or personal fitness trainers. This is also a good idea. Some people feel that having an expert in these disciplines helps to fill gaps between other professionals' knowledge.

A good team has good communication. So as long as the ring leader (YOU!) is keeping track of everything and there isn't too much confusion about what the other pros are doing, you are doing exactly what you need to.

6. Coaches??
More people are working as hard as they can to excel at sports or other activities. What an awesome situation to be in! A team of pros dedicated to making sure that you function at the highest level and then seeing it all come together in the performance of a high level task. This is where we wish all of our clients wanted to be. The thing to be sure of here is that your 'skills' expert is aware of any movement or function issues that may be preventing you from performing a drill or exercise with perfect technique.

A good example of this is one that we see a lot. We working lots with agility and power athletes. Specifically rotary sports athletes like baseball and softball players, golfers, and throwers of all kinds. The higher level athletes we see almost always have a skills coach, sometimes more than one. The common line is, "My coach wants me to be able to do this drill but no matter how many times we work on it, I can't seem to improve". This is a dead give away that this persons body is simply not allowing them to perform the task. It has nothing to do with whether this young man or woman WANTS to do it correctly. If the task is asking you to move your hips in a way that you simply cannot, for whatever reason, the coach can yell until they're blue in the face, that specific movement WILL NOT HAPPEN. At least not in the exact way that the coach would like and then this leads to a lot of compensation movement which leads to injury.

So, who do you think is the best equipped professional listed here for assessing the movement quality of all the body systems?? Of course, the PT. The only true MOVEMENT SPECIALIST. We can take into account all of the systems that combine to produce powerful, coordinated and pain free motion.

Personally, I have a GP, a dentist, a 'knee doc', a 'shoulder doc' and a 'foot/ankle doc', and a golf pro. As we all  move and excel, we transition from amateur to advanced level movements. Sometimes during this journey, we can get dinged up trying to improve. Aligning the correct professionals and maintaining an active dialogue between each of them will keep you moving at a high level.

Who should NOT be calling the shots when it comes to your care?
People speak about their health insurance the same way they speak about a friend that no one else likes. You don’t see what’s happening behind the scenes! If you had great insurance you would have an accessible doctor who doesn’t make you wait and has plenty of time to spend with you. Another thing folks need to realize is that no matter how much you pay for health insurance premiums, the professionals delivering your services are still restricted in the amount of time and scope of service they can offer you because the insurance company is ultimately going to make the call on what will be paid for. Quite the conundrum for the pro who just wants to help you!

If your insurance is so good, why are your doctors' visits still getting shorter?
The answer:

Your well-meaning physician reports to your insurance that they saw you on a given day and the reason for the visit. Your insurance company almost ALWAYS counters with a denial. This is the first line defense to having to pay for anything. Truthfully, this is enough to dissuade some pros from seeking reimbursement for that service. The problem is that after enough denials, the pro will simply stop offering that service for fear of the long and tedious process to recover their due reimbursement, regardless of how effective or important that service is for your care. Each day we see third-party reimbursement decreasing while premiums are continuing to increase. 

YOUR INSURANCE COMPANY IS LOOKING AFTER PROFITS, 

NOT PATIENTS!! 

As long as this continues to happen, we are going to see lower quality care and higher volumes of patients.

As we continue to practice, the list of practitioners that we work with and refer our own clients to grows. At SPARK, through our experience, we have developed a network of folks in surgery and in medicine who are very gifted. When you are looking around for the best people and doing your research you may not know what questions to ask. Come to us and ask, “What should I ask my knee surgeon?” Even if we cannot help you, we're more than happy to point you in the best direction so that you can get all-the-way-well.

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. In addition he holds a Master's Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. The concept of 'all the way well' in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is. 

Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, power lifting and adventure races.  He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at cjberio@sparkphysio.com.

SPARK Physio Radio: Why YOU Should be in the Driver's Seat of Your Health

In this episode of the SPARK Physio Radio Show Dr. Carlos Berio discusses why physical therapy patients need to be their own best advocates and who should be in the driver's seat of their health care decisions (and who shouldn't!).

Click on the player below to listen to the show now. 
(Also available as a free download on iTunes!)

Listen to internet radio with SPARK Physiotherapy on BlogTalkRadio

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. In addition he holds a Master's Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. The concept of 'all the way well' in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is. 

Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, power lifting and adventure races.  He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at cjberio@sparkphysio.com.

PT Mills: Why Physical Therapy Doesn’t Work Anymore

What is wrong with the state of Physical Therapy (PT) as a practice?

Physical therapy (PT) as a discipline has been changing. In the past, a client could be evaluated and treated by a licensed PT with great confidence that everything that needed to be done to achieve pain free movement was going to happen. It was a proud profession with the noble goals of bringing clients out of the darkness of pain.

Nowadays, PT clinics, and PTs themselves, have made a violent shift in focus toward high volume. Clinics are over-stuffed with patients vying for the eyes, ears and hands of fewer PTs. The therapist becomes a glorified crossing guard; managing traffic, logistics and paperwork. The high level care that we are capable of is more often passed off to aides and technicians, most of which hold no license and have minimal training. Oh, but it’s ok, because the PT is somewhere in the same building, so it’s just like the PT is providing all of the care, right? NO!

What Went Wrong? Third Party Payers (aka Health Insurance)

Quality care, patient outcomes and overall customer service are falling away. The number one reason for this shift is the increased involvement of third-party-payers (health insurance) in the making of health care decisions. People have become accustomed to rely on their health insurance to pay for these services. Patients have been trained to place a lower value on PT. Physical therapy clinics have realized this and placed untrained staff into key positions to offset costs and assist with the added volume of patients needed to operate.

The Birth of the Dreaded “PT Mill”:
The Churn and Burn Widget Factory of Physical Medicine

The goals of the PT Mill are to:

1.      Get as many people as possible through the door
2.      Highly research potential patients’ insurance coverage and maximums
3.      Take extreme advantage until benefits are exhausted
     a)  Oh, and if the patient gets a little better along the way, that’s great!

Physical therapists by nature are passionate about helping people and very highly trained to do so. However, a therapist practicing in a PT Mill, is stretched very thin. It becomes logistically impossible for each patient to get the quality care they need to get all the way well.

The Solution: Get Back in the Driver’s Seat and Get All the Way Well

It starts with doing your homework! When you call to set up an evaluation or treatments, ask:

1.      How much time will I spend with the PT each time I have a session?

     a)  Is this a PT Mill/factory?
2.      What is the blend of manual treatments to self-guided exercise?
3.      What special skills do your physical therapists possess to ensure I can get back to my favorite activities without pain?
4.      What happens after I’m done with PT? Is there a system in place to make sure my pain/issue stays fixed?
5.      What about wellness and fitness programming?
Are you seeking a PT with specific skills? Manual/hands-on skills? Dry needling? Sports specific rehab? While we may not all be athletes it’s uncommon that ALL you will need to be able to do is ‘go up and down a set of stairs’ or ‘sit quietly at your desk’.

How Physical Therapists Can Make a Difference

If you are a physical therapist that wants to be an ‘all-the-way-well’ PT you can take action too! Your patients are smarter and better informed than all who have come before them. They are connected to message boards, activity groups and other exercise and health professionals. Ask them “Who do you read for advice about X?” or “Where did you learn about that manual technique?” Use and stay current with these resources to add tools to your toolkit.

The Therapeutic Alliance

More importantly, is to place the patients’ goals and education back on top of the list of priorities.  Teach them why you are doing certain techniques and not others. Explain evidence-based practice to them. Answer all questions thoroughly. Help them understand the process! By ensuring that each treatment addresses this premise you will improve the therapeutic alliance; this is the trust that comes from your patient when they truly feel that you are doing what is best for them.

Physical Therapy that Works: The SPARK Physiotherapy Difference

We have been doing our best to stem this tide. At our clinic, SPARK Physiotherapy in Alexandria, Virginia,  all of our treatment is 100%, one-on-one work with our patients. We work hard each day to ensure that the client experience is optimized. Their PT is not a chore, but a highlight of their day. They will leave each session with less pain, more strength, more control and more confidence that they have made the best choice in physical performance and health.

Our clients are not ok with ‘good-enough’ PT. Our clients have true movement and performance goals. We rely heavily on manual techniques, trigger point dry needling (an advanced skill in soft tissue manipulation), corrective exercise for maximum functional mobility and we TEACH. We educate our patients on every type of treatment, every exercise, and all aspects of their care.

As true MOVEMENT specialists, we have created a setting where we are passionate about doing more for our patients than manage traffic.

To listen to Dr. Berio discuss this topic and how SPARK Physiotherapy is taking a better approach to physical therapy, click on the player below to listen to this episode of

SPARK Physio Radio:

Listen to internet radio with SPARK Physiotherapy on Blog Talk Radio

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. Carlos remains active in several sports and is an avid agility training, power lifting and adventure race runner.  He can be reached at cjberio@sparkphysio.com.

SPARK Physio Radio: Where Physical Therapy Went Wrong

In this episode of the SPARK Physio Radio Show Dr. Carlos Berio talks about what's wrong with the practice of physical therapy today and how patients and physical therapists can help turn treatment - and the profession - around with easy steps that will help you to get "all the way well."

Click on the play below to listen to the show now.
(Also available as a free download on iTunes!)

Listen to internet radio with
SPARK Physiotherapy on Blog Talk Radio

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. Carlos remains active in several sports and is an avid agility training, power lifting and adventure race runner.  He can be reached at cjberio@sparkphysio.com.

Tightening the "Thrower's Coil": Rehab, Prehab and Power Up Throwing Performance

Baseball players perform one of, if not, the most violent tasks in sports. The act of throwing a baseball requires the highest amounts of torque, angular velocity and power than any other single sport task. With our experience in sports rehab, strength and conditioning and coaching, we have been able to develop a great niche in treating these athletes. In this post, I’d like to point out some of the “typical” findings and how we’re getting them off the table and back out onto the field for good. 

'Tommy Baseball’: a 17 year-old, 5’11”, 180lb high school baseball player walks into your clinic complaining of right shoulder pain he recently started feeling after a tournament over the weekend. He is a right handed pitcher and has been playing for years without shoulder pain so he “doesn’t understand why all of a sudden this is happening”. He has an exercise program that he has been on for the past year. The program was written for him by his PE teacher. He received a scholarship to a DII university and needs to be pain-free and ready to play at a much higher level within the next 3-4 months.

Where do you start? Almost all rehab professionals are familiar with the tests that we would use to come to the actual diagnosis. There are also some tests that coaches and trainers could use to see if an issue is serious or not. This is a great start but how do you relate this back to throwing a baseball and MOST IMPORTANTLY, how can we get this player back to competition without increasing his risk of being back in PT  soon thereafter?

What are the most important items you need to assess and then how do you treat those limitations/dysfunctions related to throwing? If you’re just giving pendulums out to every painful shoulder that comes through the door, you’re not doing anyone any favors.

What types of things are you looking for when you watch this young baseball player move? The following is a list of common limitations we see in these young athletes:

1.      Limited internal rotation of throwing shoulder

2.      Limited thoracic spine rotation and extension toward throwing arm

3.      Limited internal rotation of opposite hip

4.      Weak, ‘knotted’ rotator cuff muscles

5.      Unstable and weak lower and middle traps of throwing arm

6.      Slackened “coil” between the hips and the shoulders

 
If you’re not closely examining these top movements you’re missing the big picture. If you do find these dysfunctions, how do you treat them so as to be specific to baseball?

1.      Manual rehab techniques to improve the soft tissue (muscle) and joint mobility  

2.      Progress exercise to involve TONS of hip extension and rotation with power

3.      Single leg stability exercises to involve baseball specific positioning and movements

4.      Rotator cuff and lower trap stabilization in varying positions specific to baseball throwing mechanics

Strengthening the shoulder retractors and depressors as well as the rotary power ‘coil’ are the keys to keeping these athletes on the diamond.

We hope that this gives parents, coaches and rehab pros another place to begin this process. We are excited to be going into great detail on all of the above and MORE during our “Elite Thrower’s Seminars” Our aim is to provide a rock solid foundation for local physical therapists, baseball/softball coaches and strength & conditioning pros to treat, train or coach these athletes for maximum gains.


Advanced Rehab and Treatment of the Elite Thrower

Interested in hosting a seminar for your coaches or athletes? We're looking forward to hearing from you. Together we can make northern VA a powerhouse of baseball and softball athlete development. For more details, feel free to contact us at info@sparkphysio.com.

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. Carlos remains active in several sports and is an avid agility training, power lifting and adventure race runner.  He can be reached at cjberio@sparkphysio.com.

Insults abound but do credible and effective solutions follow?

There is a new wave of facebook page and blog site out there. Without mentioning all of them here, they include such presences as "Awkward Gym Moments", etc. This page and the ones like it highlight the failings of normal folks who are trying to get involved in exercise but very clearly do not have the first clue as to where to begin. Here is a good example of this.

As is the case in gyms all over the world, without proper instruction, gym members are doomed from the beginning having to figure out where to begin and mostly by passive observation or cursory 'research'.

To be honest, I personally LOVE 'Awkard Gym Moments' (AGM). I spend several hours a week on facebook conversing with colleagues and friends alike. Most conversations center around our work and some new blog post we read or conference we attended. This may not be what most consider fun but there is little I like talking about more than our work. Us next breed PTs are fortunate I guess.

That said, I am always sure to check out the latest posting to AGM. It is a nice break from my work and almost always gives me chuckle fits. While the people in the videos and pictures are unwilling participants, the work that appears to be going on is so bizarre sometimes that you have to wonder: "What/Why in the world would that person be doing this?" The comments that follow the videos are also amusing but this is where the issues come up and where I think we should be more vocal as the true movement experts.

Some of the movements pictures are completely legit. They might not be done correctly or with some 'interesting' wrinkles, but the move itself is ok. Recently, I felt a great need to defend a movement and the conversation that continued simply reflected that the majority of people who are vocal in this forum may be as clueless as the people in the videos!

Another recent development is the speaking out against sites like AGM. Again, I'm not defending teasing anyone who is doing something wrong or not-perfectly. However, when someone does something in direct contradiction of readily available evidence or basic instruction, then I feel less bad about pointing it out and making a teachable moment out of it. This goes for almost anything too. I don't care if you're a grocery stacker. If there is an easy and efficient way to do that job but you chose to do it the opposite way, it should be pointed out and corrected.

Everyone: Go to the gym! Lift something heavy! But do us all a favor: Let us help you. Find the best physical therapist. Find the best personal trainer. Hell, I don't care if you just look up the move on youtube. There is no bad exercise! There are just a LOT of ways to do exercise poorly (read: dangerously/ineffectively). Just please understand NOT ALL ADVICE IS CREATED EQUAL. Do more research on the person giving the advice than on the specific move itself. You may find that you've been educating yourself in a dangerous way this entire time.

Be well.

Run for Life: Part 3

Welcome back for the conclusion of Run for Life!

Injury #3: Patellofemoral pain syndrome (PFPS)

There can be many different causes for knee pain, but one of the biggest culprits is overall faulty mechanics. In the vast majority of cases we find a significant lack of hip and trunk strength and stability as well as faulty foot mechanics, which cause more stress to be placed on the knee surfaces between the patella (knee cap) and your femur (long leg bone). Generally runners will feel pain under or around the knee cap with either a sharp or achy sensation during or after running. If these mechanics are not corrected, the cartilage behind the kneecap will eventually wear away causing even more pain and dysfunction with movement. 

Self-treatment: Trunk, hip and foot strengthening and stabilization activities as well as making sure that all of the above have the appropriate mobility are key to decreasing stress on the knee joint. Single leg activities are great and there are so many varieties available starting with balancing on one leg and progressing to single leg squats and single leg RDLs. Making sure your hamstrings, calves, quads and IT bands are at their proper length and mobility is key to creating optimal lower extremity mechanics while running.

For a runner with general knee pain we once again put them through the Runner’s Screening Exam and as an example, we find limited ankle mobility. We will then treat/improve that ankle mobility which commonly improves the entire movement pattern of the leg thereby decreasing strain on the knee and eliminating that runner’s knee pain. Again in conjunction with correcting spinal and leg mechanics in our sessions, we provide the runner with a comprehensive home exercise program for them to continue using for the prevention of re-injury in the future.

So what if these self-treatments don’t work? If your injury continues to the point where you can’t run without pain or worse, you’re starting to walk differently because of pain you may need to seek out the help of a movement professional. Find someone who will perform a comprehensive assessment of all the pieces of this puzzle to determine the cause(s) of your pain. Once you have a baseline you will be able to begin a targeted and intensive rehabilitation program to eliminate your pain and keep you running.

Who are these health professionals you ask? Some examples include physical therapists, orthopaedic physicians, podiatrists and athletic trainers. I am a bit biased of course, but a physical therapist should be at the top of your list especially one who has a running and/or competitive athletics background in treating runners.

Also, footwear is a critical component a runner needs to look at if they are having pain when running. A great resource is your local running store where the employees will be able to determine which shoe is best for you based on your body type, foot type, training regimen, etc. Our friends at Potomac River Running www.potomacriverrunning.com have in-store treadmills where they have their patrons run for a few minutes to determine which shoe will be the best fit. These stores are also great resources for finding running clubs, training programs, additional running equipment you may need and to meet other runners who share your passion for the sport.

Overall, the key point is to use self-treatments when appropriate after incurring a running-related injury, but to know when it is outside of your knowledge and to seek professional help. Make sure the professional you seek out has the most appropriate education/background for your injury, who takes the time to get to know you individually and doesn’t just give you the “typical protocol” they give to everyone else. We are all unique in our anatomy, running mechanics, motivation and discipline when it comes to running so find someone who is going to tailor the treatment to you and ultimately a person whom you trust and enjoy being around.

"If you run, you are a runner. It doesn't matter how fast or how far. It doesn't matter if today is your first day or if you've been running for twenty years. There is no test to pass, no license to earn, no membership card to get. You just run." –John Bingham

As the phoenix rises from the ashes, so too will RGIII!

Hyperbole maybe. Let's be honest; millions of people, professional athletes included, have had this procedure, had excellent physical therapy and returned to nearly, if not completely, 100%. However, Robert Griffin III holds a special place in the hearts and minds of everyone in the Metro DC area and for many in and around professional football.

 

I was recently asked to contribute to a piece on Robert Griffin III regarding his ACL reconstruction, his expected course of rehabilitation and the likely prognosis for a full recovery. I was happy to help a dear friend of mine and a friend of SPARK Physiotherapy, Fairfax Hackley with his weekly segment on WTOP (103.5FM).

 

Here is a link to the piece that was aired on Monday, 1/14/13 at 2:20PM on 'Hack's Best Body Report': RGIII ACL recovery from WTOP with Fairfax Hackley

 

The  main question asked was 'what's in store for RGIII with regard to the specifics of the surgery and his recovery'. One of the most important details here is the type of graft being used to repair his knee. For this surgery, they chose to use a patellar tendon-bone graft (PTB) which has some advantages over other grafts. 

 

RGIII did, in fact, undergo two separate procedures for this reconstruction. A PTB graft can be taken from a cadaver or from the patients own knee when it's appropriate. The PTB graft was harvested from RGIII's left knee and arthroscopically implanted into his R knee. If the right knee didn't previously have a PTB graft removed in 2009 when he first tore that ACL this surgery would only have been slightly less complicated.

 

Below is a great video that shows what this surgery looks like.

NOTE: the video depicts most of this without the skin and muscle in the way, but in fact, most of either procedures are done with minimal incisions and the entire ACL implantation is done through very small portals (.5-1.0 cm incisions) and small video cameras. 

 

 

Immediately after surgery, the main goal of the medical and physical therapy teams is to decrease any chance for infection and blood clots. No matter how young or in shape the patient, we are all susceptible to these problems if precautions are not taken. For the first week or two, blood clots are managed by gentle movement of the joint by RGIII and his physical therapist(s). He will use crutches to get around for the first week to 10 days and he'll wear an immobilizer brace that protects the surgery while he's moving around.

 

Once the initial phase of recovery is complete, at around the 2 week mark, the main focus of the rehab is to maximize the protection of the newly implanted graft. All movement will be highly controlled placing very little to no stress on the ACL. During this time the PT team will work with RGIII on exercises that will prevent weakening of his quadriceps, glutes and further decrease his swelling and inflammation.

 

The next phase of rehab, typically at 4-weeks post-op, will bring us to a stage where more care can be taken to regain range of motion muscular control over the knee, hip and foot. This is also the stage where RGIII will resume walking on his own even if it is with a slower pace but at least he'll be without the crutches or brace now. As long as his range of motion has continued to improve and the swelling has continued to decrease, the overall intensity of PT will start it's climb! Good times!!

 

As the physical therapy team approaches the 8-week mark, things get fun but they are still keeping a close eye on the intensity of movements that might place the new graft at risk. The bone that is attached to the ends of the PTB graft is fully attached to it's new place. BUT at roughly the 10-week mark, the actual tissue that the PTB graft is made of is undergoing a transformation that makes it quite a bit weaker even though he will be relatively pain free. Special care will be taken at this point to ensure everyone is on the same page about this!

 

Once we're at 12-weeks or so, we're mostly in the clear and the real fun can begin. PT becomes more about introducing plyometrics (jumping and bouncing exercises), introducing light running and intensifying his "closed-chain" training (movements like squatting, lunging, etc).

 

All told, recovery from this type of ACL reconstruction should take anywhere from 4-6 months. Everyone responds to surgery and treatment differently. RGIII has the best and brightest working with him every day to ensure he'll be back to terrorize defensive coordinators in NFC East for many years.

 

We at SPARK Physiotherapy wish him the best of luck for a full return to play.

 

 

 

Run for Life: Part 2

Welcome back to Run for Life: Part 2. We will continue with another common running injury…

Injury #2: Iliotibial band syndrome (a.k.a. IT band syndrome/ITBS)

This is another chronic inflammation issue where the IT band, which is the big band of connective tissue on the side of your leg, becomes irritated due to overuse and poor mechanics. Not only does it alter normal running mechanics, but commonly causes lateral/outside knee pain or hip pain because of strain at its attachment sites. Similar to treatment of plantar fasciitis, usually the IT band needs to be mobilized in order to break up any “sticky spots” that develop within the tissue as well as the muscle that attaches to it tensor fascia latae (TFL).

Self-treatment: A foam roll, tennis ball or lacrosse ball tends to be one of the best tools to aid in loosening the IT band. This is accomplished by lying on your affected leg on top of the foam roller/ball and then rolling up and down your leg, stopping at any tender points for a few extra seconds to break up the tissue. Hip strengthening and stabilizing exercises as well as proper ankle mobility needs to be part of a comprehensive rehabilitation program when it comes to IT band issues to restore normal mechanics of the leg.

If a person comes into our clinic presenting with IT band syndrome, we again put them through our Runner’s Screening Exam to assess their overall movement patterning. In our assessment, we usually find the IT band has restrictions, which may cause the leg to be pulled outward slightly due to the attachments of the IT band. As mentioned above, this is when outside knee pain may occur and overall running mechanics will likely be compromised. We recommend using the above self-treatment of tissue mobilization, but as physical therapists we can offer more efficient manual therapy to break up any tissue adhesions (“sticky spots”) in the IT band as well as specific techniques to develop proper movement patterns of the legs and spine when running.

The conclusion of Run for Life is coming up so don’t miss it!

"Running should be a lifelong activity. Approach it patiently and intelligently, and it will reward you for a long, long time." -Michael Sargent

Run for Life: Part 1

In this 3 part series, Dr. Ivy Roe, one of our talented Performance Physical Therapists and our resident running guru, will break down several issues
that plague runners in their quest for their next PR.

Plantar fasciitis, IT band syndrome, Achilles tendonitis, shin splints…any of these sound familiar? It is estimated up to 82% of runners will get injured at some point during their training. 82%!?!?!

This means that if you intend to run at almost any intensity, then you will run right into pain that will slow you down; then what do you do? Do you try to run through it? Take time off and rest. See a doctor? Ask your friends what they’ve done when they’ve been injured? (Because let’s face it, at 82% at least one of your friends has been/is injured…). In this three-part post I will describe some common running injuries, examples of self-treatment and what to do if you just can’t get back to your full health and running routine.

Injury #1: Plantar fasciitis

Plantar fasciitis is chronic inflammation of the plantar fascia, which is an important structural component on the bottom of the foot that helps with stability of the foot and ankle. Typically, a person will start to have pain in their heel especially with the first step out of bed in the morning as well as during prolonged standing, walking and running. If the plantar fascia is inflamed/irritated it interferes with normal mechanics of the foot and ankle, which then causes dysfunction up the entire leg, even causing issues up into the spine. So not only will a person have pain in their foot, but they may then develop compensation patterns leading to knee, hip or spinal pain…all because of your foot!! No need to throw in the towel, there are a few self-treatments that are effective in relieving a person’s foot/heel pain and allowing them to get back to their normal activities, especially running.

Self-treatment: First is to make sure the plantar fascia is moving correctly and that it’s not getting “stuck” anywhere in the foot. Cross your affected leg on top of the other, then press firmly into the sole of your foot looking for any tender or tight spots. When you find a spot keep your finger firmly pressed into it and using your other hand, gently bend your big toe upward toward your shin. This can help break up any scar tissue and myofascial restrictions that are not allowing the plantar fascia to function properly. Do this at least once a day followed by stretching your calf muscles. Also, ice the sole of your foot with either a bag of ice or freezing a Coke bottle and rolling your foot over it for 10-20 minutes daily especially after a lot of impact activity like running. 

At our clinic, we have developed a Runner’s Screening Exam which hones in on the areas of the body that are most important for efficient running form and tests specific areas needed for optimal running performance. For example: a runner comes in with suspected plantar fasciitis and we put them through the Runner’s Screening Exam. A dysfunction we may find is weak hip stabilizer muscles such as the gluteus medius, which will then cause increased stress on the plantar fascia from improper mechanics. We then design a comprehensive and individualized rehabilitation plan with a home exercise program to address the dysfunction/s we find and get you back to running. Not only do we correct the dysfunction/s which caused the plantar fasciitis in the first place, but we arm you with tools to prevent it from happening again.

Stay tuned for Part 2 of Run for Life…

"I often hear someone say I'm not a real runner. We are all runners, some just run faster than others. I never met a fake runner." -Bart Yasso