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Most of what we know about stretching is either a myth or based heavily on outdated science.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.

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

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

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

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.

https://www.ncbi.nlm.nih.gov/pubmed/20054188

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

https://www.ncbi.nlm.nih.gov/pubmed/9415946

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

https://www.ncbi.nlm.nih.gov/pubmed/20585000

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

"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.

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).

The State of Rehab 2018

by Sally Fansler, PT It is hard to believe that I have been in the physical therapy industry for more than three decades. Over the course of my career as a physical therapist, I have seen our profession flourish in many different settings. We are able to fundamentally help patients by learning the science of the human body and connecting our skills to restore dysfunction and freedom of movement. There are few experiences more rewarding than to see the pain disappear and the musculoskeletal system change based on the skills we share with our patients.   One of the best ways to grow as professionals is to learn what obstacles we face: based on a physical therapy industry survey with more than 5000 participants, recent trends revealed several stumbling blocks that have cropped up in the field of P.T. One of these is that the trend toward consolidation of clinics to larger companies continued in 2017, which can impart a financial struggle for the one-on-one care business model to compete in a market that is more and more saturated. The study also revealed that for many clinics, the average daily volume of patients increased with more use of assistants and techs. This obviously translates to less time physical therapists can actually put their hands on each patient. Not surprising with the current health care climate, the study noted an intensifying squeeze in insurance reimbursements. The insurance companies have ever-changing rules and regulations, which puts stress on each clinic and each provider. And lastly, the survey noted that each physical therapist spends 20% more time on documentation over the past 10 years due to compliance demands and insurance requirements.   It is not surprising that these factors could change the overall vibe of an outpatient physical therapy clinic. But this same survey also revealed that the number one reason people pursue a career in the field of physical therapy is to help people. That fact translates into genuinely good people with a solid dedication to patient care in our field. I am confident that no amount of frustration over declining reimbursements, increased regulations, or time-consuming documentation can stifle the passion engrained in physical therapists and the physical therapy profession as a whole. Study cited: "The State of Rehab" WebPT

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!

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!

Antioxidants 
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 lizc@lakeshoresf.com.