Friday, December 7, 2018

The Home Stretch

by James Bansberg, PT
Some of the most common advice we receive when we complain about a newly discovered ache or pain is to just “stretch it out.” But what does that even mean? How long do I hold it? When should I do it? Do I just throw my leg up on a table for a couple of seconds and beg the pain to go away?

Most of what we know about stretching is either a myth or based heavily on outdated science. Worse yet, when speaking to various health professionals, their recommended duration for stretching can vary greatly, which can be confusing and sometimes discouraging for their clients. Luckily, a 2018 study by Thomas et. al has helped answer some of these questions. The study focused on most effective form of stretching for improving range of motion, as well ideal stretch duration and frequency.

Despite its vilification in recent media, the researchers found that static stretching was more effective than other forms of stretching for improving range of motion long term. This doesn’t mean that static stretching should be the only form of stretching utilized in a regular workout program, however. Other studies have discovered the benefits of other forms such as dynamic and ballistic stretching, especially prior to activity.

As for duration, there’s good news for the more impatient types: a 30-60 seconds hold was as beneficial as other, longer durations (60-120 seconds and over 120 seconds). Consistency, however, was key: the research showed stretching more than 5 times a week was more effective than 2-3. Interestingly, 7 days of stretching per week did not yield better results than 5 days, making the sweet spot between 5-7 days per week.

The final portion of the study looked at optimal time spent per week stretching to maximize mobility changes. Surprisingly, a minimum of 5 minutes was required for significant changes, with the ideal time being anywhere between 5-10 minutes.

Ultimately, some stretching is better than no stretching, and recent studies have found benefits to other forms of stretching as well as foam rolling. However, even stretching has a proper dosage, so it is important we utilize available evidence to guide our decision-making so that we are able to reap the greatest benefit. 

References: 
Thomas E., Bianco A., Paoli A., Palma A. The Relation between Stretching Typology and Stretching Duration: The Effects on Range of Motion. Int. J. Sports Med. 2018;39:243–254. doi: 10.1055/s-0044-101146.

Friday, November 9, 2018

Keeping Knees Healthy this Fall

by Constance Taras, PT
 As fall is now upon us, so too is the season of football. For a few unlucky players, however, the season is already over, with preseason injuries benching them for the rest of the season. In the NFL, an average of 23 ACL injuries occur before the first game of the season is even played, and it doesn’t stop there: according to the ACL Recovery Club, a total of 51 players tore their ACL during the 2017 season. The good news is that current evidence strongly supports the use of knee and ACL injury prevention programs to decrease the risk of injury and ensure a successful (and long) season for any athlete.

The knee joint is a hinge joint held together statically by 4 main ligaments: anterior cruciate
Side-by-side comparison of a normal knee (left) and a knee with a torn ACL (right)ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Although there are many, the main dynamic stabilizers of the knee consist of the quadriceps, hamstrings, calf, and gluteal muscles. The knee is meant to move in one plane of motion creating both flexion (knee bent) and extension (knee straight). It does, however, allow our bodies to move laterally, pivot, and change directions quickly when healthy. If the knee demonstrates decreased strength, muscle imbalance, range of motion, or flexibility in the surrounding tissues, it can be predisposed to injury.

To help prevent injury, the literature cites a combination of dynamic stretching, running drills, strength training, plyometric drills, and core exercises that should be included in knee injury prevention programs. These should be completed for at least 20 minutes several times a week, starting in the preseason and carrying through the regular season. Examples of each are outlined below.

Dynamic Stretching 
High knees, butt kicks, font/side leg swings, Frankenstein walk

Running Drills 
Forward running, backward running, zig zag cone drills, bounding

Strength Training
Double- and single-leg squats, banded hip strengthening, Nordic hamstring curls

Plyometric Drills 
Skater jumps, double leg and single leg hops, box jumps

Core Exercises
Front planks, side planks, bridges

Make sure to tailor your program to be sport-specific and elicit the help of your local physical therapist for ideas on your personalized knee injury prevention program!

Sources Cited:
“Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention” (J Orthop Sports Phys Ther. 2018;48(9):A1–A42.

JOSPT Perspective for Patients Knee Injury Prevention: Exercises to Kepp You From Getting Sidelined” published in Journal of Orthopaedic & Sports Physical Therapy, 2018 Volume:48 Issue:9 Pages:734–734 DOI:10.2519/jospt.2018.0509

Friday, October 12, 2018

Direct Access for Physical Therapy in Illinois!

by Lauren Sweeney, Office Manager
August 17 was a day like any other in our office: we treated patients, we answered billing questions, we scheduled future appointments for care. But it was unlike any other day in one very important regard: we no longer had to ask patients, “Do you have a prescription from your doctor?”

Up until last month, Illinois state law required patients to have a doctor’s prescription prior to seeking treatment from a licensed physical therapist. On August 16, however, Governor Bruce Rauner signed into law a bill that allows patients in the state of Illinois to have direct access to physical therapy treatment. Patients seeking physical therapy may now simply book an appointment to do so, no differently than they would with their GP or dentist.

This is hardly a revolutionary idea, either. Illinois was one of the last states in the nation to adopt the bill, which is expected to reduce the need for unnecessary X-rays, MRIs, and opioid prescriptions. According to a recent BlueCross BlueShield study, direct access to physical therapy led to a 31% reduction in total health care costs and a 90% reduction in opioid use.

Research also reveals that patients who visited a physical therapist directly for outpatient care had fewer visits, leading to lower overall costs. A study published by the Journal of Orthopedic and Sports Physical Therapy discovered that patients who decide to choose physical therapy as their first treatment option for spine management saved an average of $1543 in their overall care as compared to patients who chose the traditional medical referral route. Both groups showed similar clinical improvement in their symptoms. 

That said, the law does come with stipulations: a physical therapist must refer a patient to a health care professional if the patient does not demonstrate measurable or functional improvement after 10 visits or 15 business days, whichever occurs first. Additionally, this law does not affect Medicare patients, who are still required to have a prescription for physical therapy prior to treatment per federal law. Most patients, however, now have the ability to seek treatment that is safe, effective, non-addictive, and non-invasive for many painful conditions.

Our physical therapy community is confident that with fewer barriers, the patient can choose physical therapy as a first treatment option, leading to a speedy, safe and less expensive recovery.

Resources:
https://www.jospt.org/doi/abs/10.2519/jospt.2018.7423

Friday, September 21, 2018

Improving Fitness with a Good Night's Sleep

by Chase Irons, Personal Trainer
This month, we've invited LSF personal trainer Chase Irons to be our guest blogger.

In my 10 years of personal training I’ve heard all sorts of bizarre and unusual questions and comments about health and fitness. A question that I get far too often, however, is something along the lines of, "How little sleep can I get by with while still being able to function optimally?" It isn't a question limited to personal training, either: at one point or another, all of us have likely wished we didn’t have to sleep so we'd have more time in the day to get things done. More than that, there are even all kinds of products on the market that claim to be able to help us keep going longer on less sleep. 

Luckily, scientific research on sleep and its effects on the body are plentiful. In a 2010 study, researchers sought to determine whether a combination of sleep deprivation and a moderate caloric deficit would affect results in body composition. For 14 days 3 women and 7 men were instructed to stay in bed for either 8.5 hours or 5.5 hours per night, and their meals were standardized at about 1,450 calories per day. Three months later, the study was repeated for another 14 days with the same participants.

At the end of the study the researchers found that both groups had a nearly the same weight loss of around 6.6 pounds. However, the 8.5 hour group had lost equal amounts of muscle mass and fat mass, while 80% of the sleep-deprived group's loss was lean mass while only 20% was body fat. That means that with all other factors held the same, only a fifth of the sleep-deprived group's weight loss was actually from body fat.

So what exactly is going on in the body to cause this phenomenon? In sleep-deprived individuals there are a few hormones that get knocked out of balance: they produce less leptin, more ghrelin and more cortisol. Decreased production of leptin can make the stomach feel empty. Increased ghrelin production triggers the body's tendency to store fat, reduce the amount of calories it burns, and stimulate hunger. Cortisol is a stress hormone frequently associated with fat gain and muscle wasting, and it also makes us crave sugary and fatty foods. To successfully lose fat we need to optimize leptin, ghrelin and cortisol, but sleep deprivation will make that nearly impossible.

Even if we stick to our diets and hit the gym, sleep deprivation makes it so that the calories we burn come from more from stored energy and less from stored body fat. Because of the muscle-wasting cortisol and the increased hunger because of the lowered leptin and raised ghrelin, it's going to take that much longer to see a positive change in our bodies.

So make it easy on yourself! Get the sleep your body needs so that you aren't working against your goals.

Additional Resources:
Insuffient sleep undermines dietary efforts to reduce adiposity, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951287/

Impact of Five Nights of Sleep Restriction on Glucose Metabolism, Leptin and Testosterone in Young Adult Men
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0041218

Influence of partial sleep deprivation on energy balance and insulin sensitivity in healthy women.

Sleep loss results in an elevation of cortisol levels the next evening.

Sleep restriction for 1 week reduces insulin sensitivity in healthy men.

Monday, July 23, 2018

Postural Restoration

by Stephanie Korso, PT
Although the human body may look symmetrical to the naked eye, the right and left sides of our body are actually asymmetrical. For example, we have a heart on the left side of our body and a liver on the right side. Our right hemi-diaphragm is larger and more domed than the one on our left, putting it in a better position to function. The left side of our brain controls the right side of our body and vice versa. Since the left side of the brain is primarily responsible for motor planning, most people are right side dominant, regardless of hand dominance. These asymmetries are balanced through integration of system imbalances. If the asymmetries are not balanced, then postural patterns can emerge. These postural patterns may then contribute to weakness, instability, and various pain syndromes. 

So…what’s a postural pattern? This is when our body gets stuck in a certain position. But we’re not just talking about bony alignment and how we look when we stand up tall or sit at our desks: we are referring to our body at any given moment in time. Posture involves coordination of multiple systems, not just the musculoskeletal system, and is constantly changing. Ideal posture involves a homeostatic state when nothing is working harder than anything else and where our overall body system can shut down. In this state of neutrality, we efficiently balance our various asymmetries. 

The Postural Restoration Institute has developed three main stages to restore optimal posture:

  1. Reposition – this involves muscle inhibition
  2. Retrain – this involves muscle facilitation
  3. Restore – this involves restoring reciprocal and alternating function
Diaphragmatic breathing is often a key component in achieving a neutral posture. When learning to optimally use your diaphragm, fully exhale, ridding yourself of all the air in your lungs. Your exhale should last longer than your inhale. Then, attempt inhaling into your right chest wall and into your back without allowing the bottom of your rib cage to flare open. This full exhale allows your diaphragm to dome into its resting position so that it can efficiently work upon inhalation. 

Think you got it? Challenge your diaphragm by blowing up a balloon! 
Nail it? Then try a common repositioning technique developed by the Postural Restoration Institute! Click on the following video for instruction.



References:

Postural Restoration Institute. www.posturalrestoration.com

Wednesday, June 27, 2018

"Do Simple Better"

by Sally Fansler, PT
In the few short years he has been in our city, Chicago Cubs manager Joe Maddon has become a beloved figure.  His earthy, straightforward slogans, often referred to as “Maddonisms,” delight everyone from the most hardcore sports fans to the most casual observers. “Do simple better” is a particular favorite: in short, making the routine play, staying focused on the basics, and getting the job done. It’s meant to keep the players from overcomplicating their jobs, and Maddon regularly wears a t-shirt that bears this quote. 

We apply this at Lakeshore Physical Therapy by making every interaction with our patients easier and more streamlined. In the complicated flow chart of the healthcare arena, we know how refreshing it is to have an experience that is simple: allowing the patient to talk to a human being whenever possible, smiling throughout the day, and thanking our co-workers. We focus on the fundamentals of solid patient care and goal setting, making each customer service experience stand out.

Joe Maddon expresses succinct words of encouragement and a unique philosophy.  “Do simple better” can be a great lesson for a sports team and all business professionals, inspiring good ol’ fashioned hard work.

Friday, May 4, 2018

Plantar Fasciitis: More Than Just a Footnote

by James Bansberg, DPT
Feet: so far away and often overlooked…until you wake up one morning and realize it’s impossible to place any weight through your foot. Feet are our foundation - our body’s connection with the earth - yet we place them in tight, uncomfortably angled, or worn down shoes, and refuse to maintain them the way we do other body parts.  Considering that plantar fasciitis is the leading cause of heel pain, and affects more than 2 million people in the US, it may be time to give this hard-working appendage a little more love.  

The plantar fascia is made up of thick fibrous bands of connective tissue that act like a cable between the heel and toes. These bands work hard, acting as shock absorbers, foot stabilizers, and arch supporters. Since we can be so unforgiving to our feet, there are multiple impairments that can lead to aggravation of the tissue. So what kind of risk factors should you be looking for in order to get to the root of the cause?
  • Poor ankle and toe mobility
  • Ramping up activity too quickly (marathon training!)
  • Obesity
  • Age (typically 40+)
  • High or low arches
  • Stiff/cramping calf muscles
  • Prolonged daily standing on hard surface
  • Improper footwear (worn, poor fitting, high heels, low support)

The presence of any of these risk factors can lead to plantar fasciitis, and many of us have more than one. Fortunately, there are just as many options to reduce risk: stretching and strengthening muscles that may be cramping or that don’t get much opportunity to be fully stretched often helps, as does rest. Proper shoe fitting (as well as replacing stressful footwear with more supportive options) can dramatically reduce risk, and if obesity is a factor, weight loss may help as well. Depending on the severity of pain, your doctor may recommend other options, such as night splinting.

If you have foot pain, however,evidence suggests that physical therapy will help you recover faster and cost you less than if you do not receive treatment. Experienced therapists at Lakeshore Physical Therapy will administer a comprehensive evaluation to determine impairments and utilize current evidence and proper treatment to help lower pain and improve function.  


Resources:
“Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States” (J Orthop Sports Phys Ther 2017;47(2):49–55. doi:10.2519/jospt.2017.6999).