Friday, July 2, 2021

Getting into Gear for Cycling

by Lauren Sweeney, Office Manager
Whether you do it for recreation or for transportation – or both – cycling is a low-impact exercise that can be as fun as it is beneficial. I realize that as someone who bikes a minimum of 72 miles per week I might be biased, but the science backs me up: according to several studies, commuting via bike for at least 30 minutes, 5 days per week, reduces the number of sick days employees take. Studies have also linked cycling with decreased likelihood in death from cancer and cardiovascular disease. And there’s no wrong time to start: a study in the Journal of the American Heart Association followed two groups of commuters in their 40s – one who began cycling to work and one who continued to use passive modes of transportation – and found that, after 10 years, the cyclists had lower incidence of hypertension and hyperglycemia than did their bus- and train-bound counterparts.

However, all those health benefits don’t mean much if you injure yourself on the road! Here are some great stretches to keep those cycling muscles in top condition.

Shoulder External Rotation with Band: Hold elbows at your side, squeeze your shoulder blades together. Keeping that position slowly rotate hands out from each other. Should feel back of shoulders (rotator cuff muscles) and muscles between shoulder blades (middle trapezius and rhomboid muscles) working.




 

 


Standing Quad Stretch:
Standing up tall and squeezing shoulder blades back, pull ankle toward back of hip. Should feel stretch on front of thigh (quadriceps muscle).

 

 

 

 

  

Doorway Pec Stretch: Standing up stall, squeeze shoulder blades back, put one foot in front
of the other and slowly lean forward until a stretch is felt in front of shoulders (pectoralis muscle).

The pec and quad stretches will help offset the crouched cycling body position, and the shoulder external rotation with band promotes keeping the shoulder blades back for optimal positioning.

 

 

 

 Some other tips:

  • Make sure your grip on the handlebars is firm but relaxed. Change hand positions often and remember to keep your wrists straight. 
  • Keep elbows slightly flexed to reduce shoulder strain. 
  • Make sure your seat is properly adjusted to reduce knee strain. Most cycling shops offer custom fittings and can help you find the right height.

If you have other concerns about your body before you start cycling, you can always ask a physical therapist! Our therapists are always happy to offer their expert opinions to ensure that your ride is smooth and pain-free.

 References:

Ingrid J M Hendriksen, Monique Simons, Francisca Galindo Garre, Vincent H Hildebrandt. The association between commuter cycling and sickness absence. Prev Med. 2010 Aug;51(2):132-5.

Anders Grøntved, Robert W. Koivula, Ingegerd Johansson, et al. Bicycling to Work and Primordial Prevention of Cardiovascular Risk: A Cohort Study Among Swedish Men and Women. Journal of the American Heart Association. 31 October 2016; 5:e004413

Monday, April 5, 2021

When Can Physical Therapy Prevent Surgery?

by Sally Fansler, PT
While more than 1.5 million orthopedic surgeries are performed in the U.S. each year, current research is showing that surgery might not be needed as often as previously thought. According to a recent review an estimated 10% to 20% of surgeries might not be necessary and in some specialties - such orthopedics - that number could be higher. One of the most common reasons for unnecessary surgery is that conservative options simply are not tried first. For musculoskeletal problems like joint pain, sprains, and strains, seeing a physical therapist before a surgeon can help keep patients out of the operating room and get them back to their daily lives sooner. Studies have shown that physical therapy is just as good - if not better - than surgery for a multitude of conditions, and it carries far less risk. We've compiled some research here as to the benefits of seeking physical therapy first for common orthopedic problems. 

Rotator Cuff Tears 

The rotator cuff is a group of muscles and tendons that surround the shoulder joint and provide strength and stability. When one of the rotator cuff muscles is frayed or damaged, it is considered a partial tear, whereas a complete tear is more severe and can actually pull the tendon from the attachment on the bone. Tears happen over time from normal wear and tear, or they can happen traumatically with a fall or strain. 

Small- to medium-sized tears typically respond quite well to physical therapy. A 2016 review of medical literature noted that conservative PT treatment for rotator cuff tears is effective in 73-80% of patients. While this efficacy rate depends on the age and medical history of the patient, the location of the tear, and the severity of the tear, more often than not surgery can be avoided (though in the case of a massive rotator cuff tear or a retracted tendon, the positive response to physical therapy may be reduced).

Meniscal Tears 

One of the most common knee injuries, meniscal tears are typically caused by an activity that twists the knee, and often occur when underlying osteoarthritis is present. An estimated 460,000 patients in the United States get surgery each year to fix tears in this C-shaped piece of cartilage, which acts like a cushion for the knee joint. 

Researchers are currently studying the effectiveness of surgery versus physical therapy in those patients with meniscal tears and knee arthritis. In a study of 351 patients who were 45 years and older with meniscal tears and osteoarthritis, half received physical therapy while the other half underwent surgery. The research did not find any significant differences after 6 months in those who received physical therapy alone and those who had surgery. Additionally, a 2017 literature review found that arthroscopic surgery for degenerative knee disease (including arthritis and meniscal tears) did not give lasting pain relief or improved function. Often, physical therapy is the optimal place to start to address this common knee injury.

Low Back Pain 

One type of back pain, called spinal stenosis, is a degenerative disease that causes narrowing of the space in the spinal canal. This narrowing creates pressure on spinal nerves and can become increasingly painful. Spinal stenosis is sometimes treated with surgery, but physical therapy often works just as well and comes with fewer unwanted complications than surgery, according to a study published in Annals of Internal Medicine in 2015. 

 Degenerative disk disease is also a common cause of back pain and has been studied extensively. Disk patients are sometimes treated with a surgical spinal fusion. However, a 2013 study found no major difference in outcomes between patients who had surgery for degenerative disk disease and those who chose physical therapy instead. 

Physical therapy can't fix every problem, and for some patients, surgery really is the best choice. However, the research continues to demonstrate that surgery is not a cure-all, and in fact is sometimes a very expensive and risky placebo. In many cases, physical therapy is the place to start - and for some, it's the only treatment necessary. 

 

References: 

Peter Edwards, Allan Wang. "Exercise Rehabilitation in the Non-Operative Management of Rotator Cuff Tears: A Review of the Literature". Pubmed Central (PMC), 2021.

"Surgery Versus Physical Therapy For A Meniscal Tear And Osteoarthritis". Vol 369, no. 7, 2013, pp. 683-683. Massachusetts Medical Society, doi:10.1056/nejmx130035. 

Siemieniuk, Reed A C et al. "Arthroscopic Surgery For Degenerative Knee Arthritis And Meniscal Tears: A Clinical Practice Guideline". BMJ, 2017, p. j1982. BMJ, doi:10.1136/bmj.j1982. 

Kuhn, John E. et al. "Effectiveness Of Physical Therapy In Treating Atraumatic Full-Thickness Rotator Cuff Tears: A Multicenter Prospective Cohort Study". Journal Of Shoulder And Elbow Surgery, vol 22, no. 10, 2013, pp. 1371-1379. Elsevier BV, doi:10.1016/j.jse.2013.01.026. 

Barrer, Steven J. "Surgery Versus Nonsurgical Treatment Of Lumbar Spinal Stenosis". Annals Of Internal Medicine, vol 163, no. 5, 2015, p. 396. American College Of Physicians, doi:10.7326/l15-5129.

Friday, January 15, 2021

More Than Just a Pose: Yoga and Physical Therapy

by Amber Yavitz,
Front Office Coordinator
Over my past two years at Lakeshore Physical Therapy, many patients have asked me for yoga class recommendations based on which teacher is the most beginner-level friendly. I’ve been learning yoga since I was nine years old and am in the process of becoming a certified yoga instructor, but for someone who has had a previous injury or hasn’t had much experience with yoga, the practice can sound understandably intimidating. Yoga - Sanskrit for “union” - uses spiritual and physical meditation, breathing and exercise techniques to improve overall health. In fact, physical therapy often uses poses originating from yoga to help people with injuries to help them build muscular strength, balance, and flexibility.

One of the most foundational components of yoga is building an awareness of breath. Yoga instructors guide practitioners through breathing techniques, which are used to help flow through each pose and movement and aid in stabilization of a pose. While  most yoga poses and breathing techniques are used for the intention of relaxation and mindfulness, physical therapy also uses breathing techniques to teach postural awareness and emphasize controlled breathing.


If you’re new to yoga, don’t be intimidated by some of the more advanced poses you may have seen! Modifications and variations are given in most yoga classes, especially for people who are not as flexible or experienced, and your physical therapist can always work with you to modify poses that fit within your restrictions. Yoga is an ongoing practice to learn your body and improve movement, and regularly practicing yoga can help with body awareness and clearing one’s mind to center attention. If you have done physical therapy before, chances are you already know more than you think - below are some poses that you may have seen or done before!


Child’s Pose

Child’s pose is a rest pose that is used in yoga to calm and ground the practitioner. Its main benefit is increasing flexibility by creating a gentle stretch for the back and hips, which is a common goal for physical therapy programs for low back and hip pain. Deep breathing in this pose can relax the body, especially after more difficult yoga sequences or exercises.


Warrior One and Two

These standing poses help with balance and focus while opening the hips and chest. By utilizing longer holds, they can also help strengthen the shoulders, legs, and back. Note that the difference between these two poses is the arm position: in Warrior One arms are up, and in Warrior Two arms are opened wide to the side.


Warrior One
Warrior Two


Sphinx Pose

Sphinx pose is a softer back bend that can stabilize the shoulders and lengthen the abdomen. This is a beginner pose that can prepare the body for more advanced poses later in your practice. This allows the practitioner to keep the pressure off the back while still opening the chest. In physical therapy, Sphinx Pose can be a good way to work on gradual extension in the back until you are ready for an Upward Facing Dog pose.

 

Low Lunge

The Low Lunge is used in many yoga sequences and there are many variations for different comfort levels. This position stretches the hip flexors and quads, helping to  restore range of motion in the hips. Many people are very tight in their hips due to living a sedentary lifestyle and so may require modifications depending on how tight the muscles are.



If you are experiencing an injury, physical therapy and yoga together can work hand in hand to ensure optimal recovery. Once you have graduated from physical therapy, continuing yoga will help the body maintain strength gains, decrease stress, and prolong flexibility.


Friday, December 11, 2020

A Thank You to the Patients at Lakeshore Physical Therapy

by Julia Glick, PT
As we usher in December and begin to reflect on this unusual and tumultuous year, it is important to identify the facets of our lives that give us meaning. For me, the ability to continue our work as physical therapists has been the fundamental through-line of 2020. During a time with many unknowns we have been able to come to work every day and do what we know how to do best: help patients. The patients at Lakeshore Physical Therapy allow us this privilege, and for that I am eternally grateful.

Even when we are not living in a pandemic, I love my job. I get to have uplifting interactions with people daily and see them improve, progress, and transform! I still get excited each time a post-operative patient starts to walk without a limp, or to see the delight in a patient's eyes as they announce that they could go down the stairs without pain for the first time. Of course the body is full of surprises and not every patient visit is one of drastic improvement, but I am able to end each day having made a positive impact on someone’s life or having been inspired by the wonderful patients at Lakeshore Physical Therapy. 


Not only do I get to apply my passion for anatomy and biomechanics and further my understanding of the uniqueness of each body, I get to learn about our patients as they allow us to become a part of their lives, some over many years. We celebrate important milestones together - engagements, new houses, births of children and grandchildren, and most recently, the adoption of many puppies. The mutual trust and genuine regard we share with our patients extends into our lives as well: as I planned and celebrated my own wedding this year, many of our patients were eager to hear updates, and it was lovely to be able to share photos and stories with them.

 

While this year has been difficult and isolating at times, the patients who have allowed me to participate in their care have given me joy and purpose. And as we turn to brave the uncharted year ahead, I am happy as I look forward to the continued opportunity to partner with our patients for a healthy new year. 

 

Thank you to everyone who lets us do what we love – especially all of our patients! 

Tuesday, November 10, 2020

All You Knee-d to Know: the ACL

by Kelly Thomsen, PT 
That sudden “pop.” That buckling of the knee. No athlete wants experience those sensations on the playing field, yet ACL injuries are one of the most common knee injuries sustained in young athletes. It is estimated that up to 250,000 individuals sustain an ACL per year in the United States alone (CDC).

To understand how this injury can occur, it is important to understand the anatomy of the knee and the role the ACL has in the body. Three bones come together in order to form the knee joint: the femur (upper thigh bone), tibia (shin bone), and patella (knee cap). These bones are connected by ligaments, which keep the knee stable. There are four major ligaments in the knee:

  • Anterior cruciate ligament (ACL)
  • Posterior cruciate ligament (PCL)
  • Lateral collateral ligament (LCL)
  • Medial collateral ligament (MCL)

The ACL’s job is to resist excessive forward movement of the lower leg bone in relation to the upper leg. It also limits excessive rotation of the knee and functions to keep the knee stable during activities such as running, jumping, cutting, or pivoting. Given the ACL’s role in providing knee stability, most ACL tears tend to occur during non-contact activities, such as changing directions, a sudden twisting motion, cutting, pivoting, or landing improperly following a jump. While tears can happen due to a contact injury - such as a direct blow that causes the knee to bend inward - sports such as soccer, basketball, and volleyball, which require a high dynamic loading of the knee, can lead to a higher prevalence of ACL injury. Young athletes tend to run the highest risk of injury, with those between the ages of 15 and 25 at the greatest risk (Nessler et al 2017); young female athletes are at more than 3.5 times more likely to tear their ACL compared to their male counterparts.

Keeping the muscles surrounding the knee strong and flexible can prevent many ACL injuries. Research has shown that using a combination of plyometric exercises, neuromuscular training, and strength training should be utilized to reduce ACL injury risk (Voskanian, N., 2013). Focusing on single leg strength is important, as well as hip and core stability. Below are a few examples of exercises to incorporate into your routine:

Nordic hamstring curls (need a partner)!

  1. Kneel on a soft surface keeping your knees hip width apart. Have your partner kneel behind you, gripping your legs just above the ankles to secure your feet from lifting up. Slowly lean forward, using your hamstrings to control the motion. Make sure to keep your abdominal engaged and back flat. Once you can no longer hold the position, use your arms to gently lower yourself and fall into a press up position.
  2. Begin with 1 set of 5 repetitions. As you get stronger, perform 10-15 repetitions.

Walking lunges

  1. Begin with feet shoulder width apart. Take a step forward, bending your front knee. Allow your back knee to bend as well until it comes close to the floor. Continue to move forward as you bring your back leg forward to bring both feet together again. Repeat with other leg, and continue alternating sides as you move forward. Hips should stay level the entire time. Do not let your front knee pass over the front of the foot, and try to keep the knee in line with your second toe. Keep your chest up as you walk forward.
  2. Perform 20 reps with each leg. 

Single leg squats (heel taps)

  1. Standing on the edge of a step, slowly lower the opposite foot down to the floor. Tap this foot to the floor but do not put any weight through the leg. Make sure to keep hips level as you lower. The knee on your stance leg should stay lined up with the second toe as you bend it. Return back to full standing. Movement should be slow and controlled. For a challenge, perform on a higher step.
  2. Perform 2 sets of 10-15 reps.

Calf Raises

  1. Standing with feet hip width apart, push up onto your toes, lifting your heels off the ground. Slowly lower back down. For a challenge, perform this on a step with heels hanging off, or perform on one leg at a time!
  2. Perform 2 sets of 10-15 reps.
Squat Jumps

  1. With feet hip width apart, squat down keeping knees aligned with toes. Knees should not move past the toes. Use both legs to push into a jump in the air. As you come back down from the jump, lower yourself back into the squat position.
  2. Knees should stay aligned with the feet, and should not cave in toward each other.
  3. Perform 2 sets of 10 reps.

 Double-Leg Drop Jump to Stick

  1. Begin standing on an 8-10 inch box. Step down from the box with one leg, gently landing on both legs. You should land with a soft bend in the knees, keeping the knee stable and over the foot. The knee should not bend inward. Try to stick the landing for about 2-3 seconds.
  2. For a challenge, try landing on one leg.
  3. Perform 2 sets of 10-15 reps.

These exercises should be done at least 3 times per week and should take approximately 15-20 minutes each time. It is important to take rest days and alternate hard workouts with lighter workouts for your body to adequately recover (Voskanian et al 2013).  Make sure to check in with your physical therapist for feedback and education in regard to body mechanics and proper form during exercise.


References:

Arundale, Amelia J.h., et al. “Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention.” Journal of Orthopaedic & Sports Physical Therapy, vol. 48, no. 9, 2018, doi:10.2519/jospt.2018.0303.

Gokeler, Alli, et al. “A Novel Approach to Enhance ACL Injury Prevention Programs.” Journal of Experimental Orthopaedics, vol. 5, no. 1, 2018, doi:10.1186/s40634-018-0137-5.

Nessler, Trent, et al. “ACL Injury Prevention: What Does Research Tell Us?” Current Reviews in Musculoskeletal Medicine, vol. 10, no. 3, 2017, pp. 281–288., doi:10.1007/s12178-017-9416-5.

Petushek, Erich J., et al. “Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-Analysis.” The American Journal of Sports Medicine, vol. 47, no. 7, 2018, pp. 1744–1753., doi:10.1177/0363546518782460.

Runyan, Carol. “CDC - Injury - ICRCs - CE001495.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 13 July 2010, www.cdc.gov/injury/erpo/icrc/2009/1-R49-CE001495-01.html.

Voskanian, Natalie. “ACL Injury Prevention in Female Athletes: Review of the Literature and Practical Considerations in Implementing an ACL Prevention Program.” Current Reviews in Musculoskeletal Medicine, vol. 6, no. 2, 2013, pp. 158–163., doi:10.1007/s12178-013-9158-y.


Friday, October 9, 2020

Happy National Physical Therapy Month!

by Sally Fansler, PT

Every October we celebrate National Physical Therapy Month, an annual opportunity to raise awareness about the benefits of PT. We are proud of our profession and feel grateful to be able to help people move better, achieve their goals, and live pain-free every day!








Friday, September 11, 2020

Rocking the Wall

by Constance Karwandyar, PT
If you’ve ever been inside Lakeshore Sport and Fitness at the Illinois Center in downtown Chicago, the first thing you’ll likely notice is the monumental rock climbing wall. Spanning 10 stories, this wall currently sits as the tallest indoor rock wall in North America! While humans have always been drawn to scaling heights, rock climbing as a common indoor sport only dates back to the 1980s. As the sport grows in popularity, so too, unfortunately, do the number of rock climbing related injuries that often go undiagnosed and untreated.

According to a recently-published article in PT in Motion magazine, some of the most common rock climbing related injuries involve the hands, elbow, and shoulder due to the pulling nature of the sport and strong need for finger and hand holds. Landing and falling related injuries are also common in the foot and ankle. Jared Vagy, DPT - dubbed “The Climbing Doctor” due to his extensive experience in both physical therapy and rock climbing - claims that 40% of rock climbing injuries are in the fingers. Strains to the pulleys of the finger are common due to the overuse of the flexors of the fingers and wrist. The pulleys on the palm side of the fingers work to hold the finger flexor tendons close as they slide back and forth when we curl and extend our fingers (think of the rings on a fishing pole that the fishing line runs through). A strain or rupture to one could cause bowstringing of the flexor tendons, difficulty with curling and extending the fingers, swelling, and pain.

An illustration of the flexor tendons in the fingers.
By Steve Graepel, www.rockandice.com.
As with any sport, injury prevention and education is a top concern for physical therapists.
Imparting specific and proper warm-up techniques to climbers is key to making sure they prime their entire bodies before they ascend any indoor wall or mountain face. Using larger hand holds on the first ascend allows proper blood flow to enter the upper extremities, especially in the hand and fingers. Climbers can also use a “downclimb” to work these muscles eccentrically, lowering themselves in a slow and controlled manner instead of repelling down the wall on the first climb. Properly warming up “pulling muscles” such as lats, biceps, and rhomboids will also ensure proper blood flow and tissue temperature before climbers begin. 

Even with proper warm-up technique, injuries do still occur. Rehabbing a climbing injury takes some critical thinking to identify the root of the injury and not just simply treat the symptoms. For example, if a climber experiences a finger injury, it is important to assess shoulder, core, and lower body strength, as a deficit in any of these categories can cause an over-reliance on the fingers during holds and grips. Additionally, working on upper body strengthening and stability training in a closed kinematic chain (hand on the ground, wall, or rock wall) as opposed to open kinematic chain (hand free in the air such as swinging a baseball or performing a bicep curl) can mimic the way the rotator cuff and scapular muscle have to work together on the rock wall.

Another key component to prevention and treatment is training the antagonist muscle groups (or the opposing/opposite muscles). As previously mentioned, climbers tend to overuse and overdevelop the forearm/finger flexors so working on strengthening the forearm/finger extensors to improve balance is important. Below you will find a few examples of how to strengthen finger extensors at home.

(L) Half Crimp Extensor Isometric, (R) Open-Handed Extensor Isometric
Resisted Finger Extension


As with any injury, thorough assessment of strength, range of motion, and body mechanics is key to a proper diagnosis and treatment approach. No two rock faces are the same, just like no two finger injuries are the same. If you have experienced a rock climbing injury or are interested in learning proper warm up and injury prevention techniques before your next climb, come see one of our experienced clinicians. Complimentary injury assessments are also available in-person or via telehealth.


References:

Ries, Eric. “It’s Lovely at the Top.” PT In Motion Magazine, June 2020

Ries. Eric. “The Free Solo Phenomenon.” PT In Motion, June 2020 

“Taking and Analyzing Risks with the Climbing Doctor.” The Prehab Guys Audio Experience 

podcast. Episode #47. 2 May 2020.

The Rockulus: Learn the Ropes. www.therockulus.com

Vagy, Jared. Climb Injury-Free: A Proven Injury Prevention and Rehabilitation System.