Friday, March 16, 2018

Staying (David) Wise on the Slopes

By Jill Jonda, PT
The 2018 Olympic games have come and gone! As we sat in front of our television screens, watching elite athletes perform with skill, speed, and drive to win, a lot of us tend to want to get out there and try to channel our own Olympic skills. As we saw athletes like Mikaela Shiffrin, Lindsey Vonn, and David Wise swiftly ski down a slope or half pipe without missing a beat, we may have thought, “I can do that!” Those athletes make complex arduous maneuvers look effortless. Unfortunately, when people who may not be as skilled try things that Olympic athletes make look so easy and natural, we tend to see more injuries. Before you hit the slopes, it’s important to be aware of common injuries and how to prevent them.

Because of the structure of the ski boot, the angle it puts on the knee, and of course the variability in the terrain of the snow, one of the more common body regions injured while skiing is, in fact, the knee.  Some of the most common knee-related injuries associated with downhill skiing include medial collateral ligament (MCL) sprain, anterior cruciate ligament  (ACL) sprain or tear, and meniscus tear. An injury to all three of these areas is often referred to as the “unhappy triad.”

That may sound pretty intense, but it’s no reason to cancel your trip and try to get your deposit back on your skis and helmet. If you want to have a good time and avoid the risk of injury, follow these steps listed below:

First, you want to understand your skill level.  All too often injuries occur because we end up doing too much too soon and get ourselves into quite a pickle.  If it’s your first time out in a while, take it easy and stay on the easier hills. Better yet, schedule a training session with one of the professionals and get a tune-up on your skills.

Second, it’s always important to warm-up before any type of physical activity, and is especially important for a demanding activity, such as downhill skiing.  A dynamic warm up will help to increase blood flow, prepare the nervous system for increased activity, and improve overall range of motion which all helps to reduce the risk of injury.

Third, it’s important to strengthen key muscles that help prevent aberrant movement of the knee. The hip abductor muscles (specifically, the gluteus medius muscle) help to stabilize the pelvis when weight is shifted onto one leg, which, in turn, prevents inward and torsional stresses on the knee.  If the femur bone becomes internally rotated and adducted (or “knock knee”), this causes a valgus force at the joint, which is the setting of most of these knee injuries. In the same way, the abdominal musculature is also essential in maintaining control and stability while skiing.  A strong core can help to block too much trunk displacement over one leg if you happen to “catch an edge” or lose your footing over a patch of ice and can prevent a fall.  Strong quadriceps and hamstring muscles also assist in demonstrating proper knee joint mechanics, especially as you squat closer to the ground to pick up speed as you ski down the slope.

Here are some options for strengthening exercises you can try before your next ski adventure:

Remember to always be safe and know your limits if you want to stay injury-free on the slopes.  If injury does occur, however, go see your physical therapist!

Wednesday, March 7, 2018

Fighting Inflammation with Food

by Liz Cascio,
Nutrition Specialist 
In honor of National Nutrition Month, we've invited LSF nutrition specialist and personal trainer Liz Cascio to be our guest blogger.

Inflammation is the body’s automatic security system: it activates when it recognizes anything that is foreign, such as an invading microbe, plant pollen, or chemical. It can also be triggered by tissue trauma, like an ankle sprain or a scrape - the body sends white blood cells and other immune chemicals to help keep the injured area clean and promote healing. In healthy individuals, inflammation is a good thing!

However, sometimes inflammation occurs even when the body is not under threat - the body responds as if normal, healthy tissues are infected or somehow abnormal. As a result, the body's normally protective immune system can cause damage to its own tissues. Fortunately, studies have shown that the solution to chronic inflammation might just be in the produce section of your grocery store. Below you’ll find some of the most powerful inflammation-fighting compounds and the foods you can start incorporating today to reduce your risk of inflammation and other chronic diseases!

Powerful phytochemicals (or plant chemicals) – such as Vitamin C and E, lycopene, lutein, beta-carotene, and polyphenols – protect the cells from exposure to free radicals and can also inhibit resulting inflammatory reactions in the body. A good rule of thumb is to fill 2/3 of every plate with an assortment of brightly colored fruits and veggies, like leafy greens, bell peppers, citrus fruits, berries, sweet potatoes, and tomatoes. Eating this way ensures you will get all the antioxidants you need to fight inflammation while also leaving less room for the processed, nutrient-poor foods that promote it.

Omega-3 and Essential Fatty Acids
Experts recommend no more than a 4:1 ratio of Omega-6 (which increases inflammation) to Omega-3 (which decreases inflammation). To keep the right Omega-6 to Omega-3 balance, reduce or eliminate the use of vegetable oils, margarine, saturated and trans fat and choose whole plant sources of fat (avocados, nuts, seeds, and olives). Reduce or eliminate refined grains, choose grass-fed meats and wild caught fish whenever possible and load up on leafy greens and berries. For an extra boost of omega-3, skip the fish oil supplements and instead add 1-2 tablespoons of ground flax seed, chia seed, or English walnuts to get a day’s worth of Omega-3 and the added benefit of fiber and protein.

Nitric Oxide
Nitric oxide is a powerful vasodialator (or blood vessel opener), increasing blood flow throughout the body and protecting the blood vessels from oxidative stress and inflammation. Beets and leafy greens like kale, Swiss chard, arugula, and spinach, are rich in dietary nitrates and nitrite, compounds that stimulate the production of nitric oxide in the body. Other nitric oxide-promoting foods include whole grains (brown rice, quinoa, and oats) legumes (lentils, beans, and peas), citrus, watermelon, and garlic.

Alkaline Balance
Studies have shown that foods high in acid – such as proteins – may promote inflammation and force the body to work harder to maintain its optimal pH of 7.4. Avoid low carb, high animal protein diets: limit animal protein consumption to 4-ounce servings 2-3 times daily. Opt for plant-based protein sources like legumes instead of meat regularly. Choose intact whole grains and starchy vegetables (potatoes, sweet potatoes and hard winter squashes) instead of processed carbs. Fruits and vegetables (especially those that grow in the soil, like root vegetables and leafy greens) are high in minerals, making them generally high-alkaline foods.

Keep it whole, keep it healthy 
The bottom line is that the guidelines for an anti-inflammatory diet are the same as those we’ve all heard over and over again: fill your plate with brightly colored fruits and veggies and unprocessed carbs, and pass on the processed and junk foods, unhealthy fats, and too much meat. In the words of nutrition and food journalist Michael Pollan, “Eat food, not too much, mostly plants.”

For more information or personalized nutrition support, email Liz at

Friday, February 9, 2018

Tape on Me: Kinesiology Tape and Physical Therapy

by Jill McCormick, PT
If you’ve watched sporting events recently, you may have noticed professional athletes sporting cool-looking tape on their shoulders or knees. It’s not some obscure form of body modification – it’s kinesiology tape. Believe it or not, kinesiology tape has become so mainstream lately that you may have even seen someone standing next to you in line at the grocery store with this unique-looking application.

Unlike the old-school athletic tape, kinesiology tape has both stretch and memory. This allows for unlimited movement of the joint or limb while keeping it in place. It is designed to stay on for days at a time, even in the shower or pool. While you may remember first seeing it on the US Women’s Volleyball player Kerri Walsh, t’s not just for athletes or sports injuries. This tape is used in physical therapy to treat all kinds of pain and injuries, including shoulder tendonitis, hamstring strains, low back pain and running injuries.

Upon application, it lifts the skin, allowing for increased circulation and reducing inflammation. The recoil effect helps support muscles, ligaments, fascia and even bones. Furthermore, the sensory effect of the tape on the skin can reduce pain signals to the brain, bring the brain’s attention to muscles that are atrophied or underutilized, and calm a muscle that is overactive or in spasm. Seemingly like magic, patients often see an improvement in range of motion and decreased pain immediately!

In summary, kinesiology tape can be used on sports and non-sports injuries alike and it often helps reduce pain and increase range of motion on the spot. While it isn’t magic, it certainly can seem like it and it can be a very valuable and effective adjunct to your physical therapy program. If you are unsure about whether kinesiology taping is a good option for treating the injury you have, Lakeshore Physical Therapy has therapists with expertise in the taping technique and can provide recommendations to help you to heal properly.

Monday, January 15, 2018

Swimmer's Shoulder: What You Should Know

by Stephanie Korso, PT
Swimming is a phenomenal way to improve cardiovascular fitness, burn lots of calories, strengthen muscles and prevent disease. As a non-contact sport, there is little risk for acute and catastrophic injuries, but there is still risk for injury. Prevention, early recognition and early treatment are key to managing swimming injuries and remaining active.

The most common swimming injury is swimmer's shoulder, which refers to any shoulder pain related to swimming. Up to 90% of swimming injuries involve the shoulder, and as many as 73% of swimmers may report shoulder pain during their career. The repetitive nature of swimming contributes to overuse and predisposes swimmers to shoulder injury.

Although swimmer's shoulder can involve any shoulder dysfunction, such as tendinosis or impingement syndrome, shoulder instability is the most common. This is because the same factors that improve swimming performance also contribute to shoulder instability:

Increased Shoulder Range of Motion
Increased shoulder range of motion helps reduce drag and allows for greater stroke length, both of which contribute to increased swimming speed. However, increased range of motion also contributes to increased ligament laxity and increased strain on rotator cuff muscles, which contributes to decreased stability.

Increased Shoulder Adduction and Internal Rotation Strength
Up to 90% of forward propulsion in swimming comes from the upper body. The pectoralis major and latissimus dorsi muscles, responsible for shoulder adduction and internal rotation, are the primary muscles that create the propulsive force needed in swimming. Increased strength in these muscles contributes to increased swimming speed, but it also leads to muscle imbalance and further instability.

Prolonged, Fatiguing Shoulder-Intensive Training
An experienced swimmer knows that swimming involves both shoulder strength and endurance. Training involves long work-outs that fatigue muscles. As rotator cuff and scapular muscles fatigue, shoulder instability increases.

The primary goals in management of swimmer's shoulder are to reduce inflammation, increase stability and return the athlete to full activity as soon as possible. Initially, the athlete will need to modify activity so that no pain is experienced. During this time, the athlete will implement exercises to decrease muscle imbalances, improve rotator cuff and scapular strength, and improve muscle endurance. The athlete may then gradually increase activity as pain decreases. Physical therapy is often helpful not only to guide progressions of strength exercises, but to also improve spine mobility and help release overworked pectoralis major and latissimus dorsi muscles.

As the saying goes, prevention is better than the cure. Therefore, incorporating exercises to strengthen the rotator cuff and scapular muscles into training regimens prior to onset of pain is optimal.

Weldon EJ III, Richardson AB. Upper extremity overuse injuries in swimming. Clinical Sports Med. 2001; 20(3), 423-438.

Weiss Kelly A. Non-contact sports: Running, swimming, and dance - identifying common injuries. Pediatric Annals. 2010; 39(5), 279-285.

Khodaee M, Edelman GT, Spittler J, et al. Medical care for swimmers. Sports Med. 2016; 2(27).

Friday, December 22, 2017

Sailing the Seas of Insurance Coverage: Deductibles, Copays and Coinsurance, Ho!

by Lauren Sweeney, Office Manager
When last we left our intrepid pirate Sue, she had figured out what it meant for a service to be covered by insurance, and she understood what it meant if a provider was in or out of her network. Being a pirate, however, Sue is concerned about the bottom line. What is all this going to cost?

Like most companies, all of Pirate Health Network's plans have a deductible, an amount that a patient is expected to pay for their healthcare in a calendar year (in addition to the monthly premium). While this amount can vary enormously by plan, higher-deductible plans seem to be an increasing trend. According to a recent CNBC study, the average deductible for a Bronze-level plan on the Exchange is around $5000, and 44% of employers planned to offer high-deductible plans as the only option for employees over the next three years.

Let's say Sue's plan has a $2000 deductible - does that mean she needs to pay $2000 before she gets more than just her in-network discount?

Maybe, but maybe not. Remembers those rules we talked about previously when we discussed covered services? There are three that insurance companies tend to make:

  1. Deductible and coinsurance - Sue will have to pay the allowed amount per PHN's contract until she has paid $2000. After that point, her insurance will split the allowed amount with her. She'll have to pay at most half, but usually less (10-20% is pretty standard).
  2. Deductible and copay - Again, Sue will have to pay the allowed amount per PHN's contract until she has paid $2000. After that point, however, her insurance will tell her that she only owes, say, $30 each time she comes in.
  3. Copay - PHN would say that Sue just owes $30 each visit and doesn't have to meet her deductible first. This is probably the rule that people most often think go when they think of health insurance.
Here's the catch, though - each covered service is usually treated differently. Sue may have a copay for visits to a general practitioner, but have a higher copay to visit a specialist, and may need to meet her deductible before a coinsurance applies for physical therapy services. It's no wonder there can be so much confusion about benefits!

Luckily, Sue's been paying attention. She knows that physical therapy is a covered service, most of the providers in her area are in her network, and she's called Pirate Health Network to find out how physical therapy is covered. Her physical therapy provider has also called to verify her benefits - just like we do at Lakeshore PT - so both she and her provider are on the same page as to what she can expect to pay and what PHN will pay. Because she doesn't have to stress over understanding her coverage, Sue can focus her energy on strengthening her shoulder (and dreaming of the day she can finally get those gills).

Friday, December 8, 2017

'Tis the Season to be Stressful

by Joni Modaff, Office Coordinator
The month of December brings cold temperatures, crowded shopping malls and much anticipation for the holidays. We tend to put ourselves on the back burner in order to find the right gift or fruitcake to buy, and we frantically try to make sure we make it to every event, even our third cousin's best friend's party.

With all this hustle and bustle, our bodies can react to stress in ways that can be overwhelming and unhealthy. Since our expectations for ourselves run high during this time, it's important to prioritize what we really need to accomplish.

The following stress prevention tips can bring some relief during the most wonderful time of the year:

Exercise: Work out at least 20 minutes a day. Not only can it help burn off some of the delicious treats the season brings, it can boost mood and energy level.

Hydrate: Drink an average of 8 glasses of water a day. Minimize alcohol intake, especially during holiday parties - while it may be tempting to indulge in holiday cheer during parties, your body will thank you for your moderation later.

Nap: Listen to your body when it tell you to rest. Sleep helps your body to rejuvenate both physically and emotionally.

Volunteer: Give your time and energy to a charity, or help out someone you know who needs an extra hand.

Reach Out: Write a letter to a family member or friend that you haven't talked to or seen in a while. Connecting with people we care about can give us peace.

Think Positively: Remaining optimistic can help keep your blood pressure in check.

Laugh: Lots of laughter can reduce stress hormones, so laugh long and loud!

Less is more, a colleague once told me. Enjoy the now and what the season is about: being with family and friends. Overbooking ourselves with holiday parties can cause us to lose that focus - according to psychologist George Pratt, PhD, it's important to "take care of yourself by saying no at least once - and maybe more."

Holiday stress may be inevitable, but incorporating the tips above will be a nice holiday gift to yourself!

Cleveland Clinic, Managing Holiday Stress 5/23/17
25 Ways to Fight Holiday Stress, Laurie Pawlik-Kienlen 11/1/16

Friday, November 10, 2017

Sailing the Seas of Insurance Coverage

by Lauren Sweeney, Office Manager
Since the introduction of the Affordable Care Act, medical insurance has been a hot topic of discussion. Overnight, seemingly, people had to go from having passive knowledge about how insurance works to becoming their own insurance brokers. As our healthcare landscape continues to shift, it's easy to feel out to sea.

So let me introduce you to Sue the Pirate:
Sue is insured through the Pirate Health Network (PHN), and she's got some questions about her plan.
  • What services are covered through her insurance?
  • Which practitioners are in or out of her network, and what does that mean?
  • What can she expect to pay when she seeks out various medical services?
In insurance terms, a service being covered just means that the insurance company has rules in place regarding payment for that service - for example, it may go toward deductible, or the patient may have a copay. Most insurers have rules in place about how they pay for physical therapy, since it's a common evidence-based treatment. If Sue wants to have experimental surgery to have gills installed in her neck so that she can breathe underwater, chances are that her insurance company doesn't have rules about that and she'll be on the hook for the ENTIRE cost.

Okay, so Sue's going to wait on getting those gills, but she is having shoulder pain that she wants to get checked out. She knows that physical therapy is a covered service under her policy, and she knows some providers are in-network with PHN and some are not. Does that make a difference?

Yes and no. If a provider is in-network with a carrier, that means that the carrier has a contract with the provider that helps to manage patient costs. When Sue goes to her doctor to check out her shoulder, her doctor may say that the billed amount of the visit was $100, but if her doctor is in-network with PHN, they may have a rule that states that doctors can only charge $75 for an office visit (this is called the allowed amount). Essentially, Sue is guaranteed a discount for going to an in-network provider.

Just because a provider is out-of-network, however, doesn't mean that a patient shouldn't go there. While it's probable that Sue will pay a little more out of pocket (and some plans have no out-of-network benefits at all, so it's important to know if yours does), out-of-network benefits aren't ALWAYS that different from in-network benefits. Some plans even have a shared in- and out-of-network deductible, which means that the patient only has to meet one deductible for insurance to begin paying expenses.

Oh, that's right - we haven't even gotten to deductibles, coinsurance and copays yet, or what all that might mean for Sue. Don't worry - we'll get to that in our next installment.