What’s a Movement Diagnosis?

prescription-padMedical diagnoses don’t need much of an introduction;  you get one from your doctor when you are sick.  Examples would be influenza, diabetes, or hypertension. They describe the underlying problem that is causing your symptoms.

When people feel sick, they know they need to go to the doctor and find out what’s going on to get treated. Do we treat movement the same way? If you have pain when you move, cannot do things you used to be able to – like get on and off the floor easily – or cannot do things you want to do – like go for a bike ride or pick up a grandchild – then you need to get a movement diagnosis!

A movement diagnosis does the same thing as a medical diagnosis; it describes what’s causing your difficulty with movement. Some examples would be difficulty standing from a chair secondary to decreased force production or scapular downward rotation pattern.  Diagnoses set the roadmap for treatment, so getting them right is crucial. Human movement is complex and is influenced by more than just your muscles and joints. According to the American Physical Therapy Association, movement is impacted by the following systems:

● Endocrine
● Nervous
● Cardiovascular
● Pulmonary
● Integumentary
● Musculoskeletal

Because of the complexity and interplay between these components of the movement system, establishing an accurate movement diagnosis can be challenging. Physical therapists are experts in human movement with doctoral level training and should be your first stop for movement issues.

Not only can a physical therapist provide an accurate movement diagnosis, they will also design a treatment plan to correct the underlying issues and help get you moving well again!
References:
http://www.neuropt.org/docs/default-source/default-document-library/movement-systemdiagnosis-in-neurologic-physical-therapy-where-are-we.pdf?sfvrsn=0
https://journals.lww.com/jnpt/FullText/2018/04000/White_Paper__Movement_System_Diagnose
s_in.9.aspx
http://www.apta.org/MovementSystem/
http://www.apta.org/MovementSystem/Template

Redefining Human Potential

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By Ake Paramadilok, PT, DPT

October 12th, 2019 marked an historic day in the world of marathon running and athletic achievement. Eliud Kipchoge, the reigning 2016 Olympic marathon champion and current marathon world record holder from Kenya, redefined human potential once again by running a sub-two-hour marathon in Vienna, Austria. Kipchoge completed the 26.2 mile run in 1 hour 59 minutes 40 seconds, making him the fastest human to ever run a marathon and the first to break the elusive 2-hour barrier.

During the run, Kipchoge wore a pair of unreleased Nike running shoes that have become a hot topic as of late. At first glance, they seemed to be the third iteration of Nike’s highly sought after Vaporfly 4%, which were named for their ability to increase running efficiency by 4%. These shoes were first introduced in conjunction with Kipchoge’s first attempt to break the 2-hour marathon record in 2017.

Since that time, the second generation, Nike ZoomX Vaporfly Next%, has hit the market and are flying off retail shelves. Independent scientific studies confirm that these shoes help you run faster, along with a plethora of professional and amateur YouTube reviews. In fact, almost every single elite runner lined up at the start line at the start of this weekend’s Chicago Marathon, was wearing either the Nike Vaporfly 4% or ZoomX Vaporfly Next%.

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So, what is the hype about? How do these shoes improve your running efficiency?

Before this question can be answered, let’s briefly journey into the world of running biomechanics. In its simplest form, running is essentially repetitive jumping from one leg to another with the purpose of traveling forward as quickly as possible. Each time the foot lands, the muscles in the legs contract to control our landing and transfer energy to the ground in order to propel our bodies forward into the next stride. The force created against the ground as we land and push off is called the “ground reaction force”.

Studies have shown that the larger the ground reaction force a runner generates, the faster they will run. However, the ground reaction force generated is only a percentage of the total energy we put into generating it due to energy losses that occur with each foot strike in the form of deformation, heat and sound. The Nike Vaporfly 4% and its successors are designed to improve the energy transfer from the runner to the ground by minimizing energy losses due to deformation. This allows the runner to generate higher ground reaction forces and speed for similar effort, or increased running efficiency.

There are two main features that allow the shoe to accomplish this to such an unprecedented magnitude. First, the ZoomX foam used to construct the sole is designed to not only be effective at absorbing impact as you land, but to also return more energy as you push off (imagine bouncing against an exercise ball rather than into beanbag chair). Second, the shoe has a carbon fiber plate embedded within the sole. As a runner’s weight rolls from the mid-foot to their toes, the plate deflects slightly and stores energy like a leaf spring. As the foot comes up and the runner pushes off, the carbon plate unloads and provides additional propulsion. While subtle, these two features enhance the runner’s ability to transfer energy to the ground, resulting in an approximately 4% improvement in running efficiency.

So, are these shoes right for you? Well, there are many other factors that need to be considered when buying a new running shoe, and if you run regularly, you should have your running biomechanics analyzed to understand what type of shoe would be best for optimizing your running efficiency and supporting your musculoskeletal health. Also consider your goals — a casual runner might be better off in a more entry-level shoe, replaced twice as often when compared with the cost of the Nike Vaporfly!  If you are interested in a running analysis, please visit us at PhysioPartners!

Dr. Ake Paramadilok is a physical therapist at PhysioPartners.

References:

https://www.runnersworld.com/uk/gear/shoes/a29455211/eliud-kipchoge-nike-shoes/

https://link.springer.com/article/10.1007/s40279-017-0811-2 

https://www.chicagotribune.com/sports/chicago-marathon/ct-chicago-marathon-womens-race-20191013-lsfb7swaajbpphtqd4p2pdzpwa-story.html

 

Using Mindfulness to Ease Pain

calm daylight evening grass

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By Mary Schuster, PT, DPT

Whether we like it or not, fall is here, which means it’s the perfect time to reset good routines to round out the last few months of the year. Summer provided time to soak up the sunshine and fresh air outdoors, but you might notice a shift in your physical and mental energy as the fall months progress. How can you keep your body and mind healthy as the seasons change? September is the perfect time to start a mindfulness practice — something you can do indoors, anytime and anywhere. Mindfulness practices have dominated the conversation lately, especially in regard to their impact on easing pain.

What Is Mindfulness?

Mindfulness is the ability to be fully present and aware of your surroundings. It is a non-judgemental awareness of what you are experiencing in the present moment. Mindfulness doesn’t require training or meditation, although practicing meditation can help you to become more mindful because it gives you something to focus on. There is growing evidence showing that mindfulness-based meditation can help ease pain and restore a healthy connection between the body and mind.

How To Get Started

Many people think they do not have time for a mindfulness practice, but even a few minutes a day can make positive changes. Additionally, it has been shown that one week of meditation training for mindfulness can reduce the intensity of pain. The easiest way to get started is with a mindful breathing exercise.

  1. Sit in a quiet space in a comfortable position.
  2. Close your eyes and notice how you are breathing. Is it fast or slow? Take a few breaths to become aware of your natural breathing pattern.
  3. Now focus more on your breathing. Try to inhale for 3 seconds and exhale for 5 seconds.
  4. Do this for 1-3 minutes and notice how your body feels afterwards. As you become more comfortable, increase the amount of time to 5, 10 or 15 minutes.

For more on breathing, check out our recent blog post Just Breathe!

Multiple apps and guided meditations can help support you in your new mindfulness practice.  Calm, Headspace and Insight Timer are popular apps that offer free meditations available for all levels.

Mind & Body Exercise

Another way to practice mindfulness is through mind and body exercises, such as Pilates and Yoga. These classes are rooted in principles to help you move intentionally and mindfully. Many Pilates and Yoga classes are designed to help you create focus and awareness as you connect your breath and movement together. Gentle, mindful movement is important to keep all the tissues of your body healthy and moving together. Considering scheduling a private Pilates session or joining the group Pilates Mat class!

Dr. Mary Schuster is a physical therapist at PhysioPartners.  She can be reached at maryschuster@physiopartners.com.

References

Zeidan F., Vago D.; Mindfulness meditation-based pain relief: a mechanistic approach; Annals of the New York Academy of Science, 2016

www.mindful.org

Why Do My Muscles Hurt After Exercise?

man raising his right arm

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Getting to the Bottom of Delayed Onset Muscles Soreness

By Katrina Sholeen, PT, DPT

 Whether you know it or not, you are probably familiar with the feeling of delayed onset muscle soreness, also known as “DOMS”. To athletes, weekend warriors or even people with physically demanding jobs, sore muscles may seem routine. However, if you’ve only recently started exercising, made changes to the type or intensity of your exercise, or even took up a large gardening project over the summer, it may feel unexpected and unwelcome. This soreness is normal, but knowing what to expect beforehand and how to manage it can help to keep you on track with your fitness goals! 

What Causes DOMS?

 Delayed Onset Muscle Soreness occurs following starting an exercise program that is new to your body due to microtrauma and irritation to the muscle tissue at the microscopic level, which causes inflammation and soreness that is greatest at 24-48 hours after the exercise before resolving on its own. This results stiffness and can temporarily reduce your strength and flexibility. This initial soreness will get better on its own, usually within 48-72 hours. As your body adapts to the new exercise and becomes stronger, the soreness will also occur less frequently. DOMS has been found to be more common after eccentric exercise, which involves a slow, controlled lowering after the “lift” phase of the exercise. This type of exercise is commonly recommended by physical therapists because of the functional training benefits, which is why you may feel sore even if it didn’t feel like a “hard” workout.

What Can I Do About It?

Time has been shown to be the only cure for DOMS, so it is important to build rest and recovery time into your schedule when starting a new program. In this case, rest does not have to mean lying down or avoiding activity.  “Active rest” includes light exercise such as walking or even just exercising a different area of the body.  For example, you can work on strengthening your arms when your legs are sore. Other treatments like foam roller exercises, massage therapy and the use of gentle compression garments have been shown to help manage the soreness, but they will not resolve it altogether. The use of heat and ice to improve soreness has also been debated, with many studies showing favor to one, both, or neither to reduce symptoms of DOMS.

 Recognizing the difference between soreness and pain is important if you are either recovering from an injury of if DOMS is a new experience for you. Though DOMS causes a dull, achy, sore or stiff sensation, it should never cause sharp, intense pain.  If you are currently seeing a physical therapist, DOMS should feel different than the pain that led to you seeking care. If the soreness lasts longer than the typical 48-72 hour recovery period, it may indicate that the exercise was too challenging and needs modification, so be sure to mention lasting soreness to your physical therapist or trainer so they can adjust your exercises to be a good fit for you and your current fitness level!

Unfortunately, delayed onset muscle soreness is a normal part of starting a new exercise routine, but it is also a sign that your body is adapting and getting stronger along the way!

 

References:

Gregory E. P. Pearcey, David J. Bradbury-Squires, Jon-Erik Kawamoto, Eric J. Drinkwater, David G. Behm, and Duane C. Button (2015) Foam Rolling for Delayed-Onset Muscle Soreness and Recovery of Dynamic Performance Measures. Journal of Athletic Training: January 2015, Vol. 50, No. 1, pp. 5-13.

Petrofsky, JS, Khowailed, IA, Lee, H, Berk, L, Bains, GS, Akerkar, S, Shah, J, Al-Dabbak, F, and Laymon, MS. Cold vs. heat after exercise—is there a clear winner for muscle soreness. J Strength Cond Res 29(11): 3245–3252, 2015

Petrofsky, Jerrold Scott et al. “The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness.” Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 27 4 (2017): 329-337 .

Do You Know Your Movement Vital Signs?

black and white blood pressure blood pressure monitor close up

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Most people think of heart rate or blood pressure when they think of vital signs. It is common to use numbers to quantify health and risk of disease. The American Heart Association encourages people to “know their numbers” referring to blood pressure, blood cholesterol, blood glucose, and weight. However, research is now showing the importance of moving properly for health. Let’s take a look at some of the numbers you can use to quantify your movement health:

Walking Speed
Walking speed has been called the “sixth vital sign” in medical literature recently. It is easy to measure, and takes into account strength, balance, coordination, confidence, cardiovascular fitness, tolerance to activity, and a whole host of other factors. It has also been shown to be predictive of future hospitalizations, functional decline, and overall mortality. Normal walking speed is considered to be 1.2 to 1.4 meters per second.

Push Ups
Push ups are popular to build strength, but a recent study found that they can show us a lot about your heart too. Researchers found that men who could do 40 or more consecutive push ups were at a 96% lower risk for cardiovascular disease than were men who could do less than 10. The push up test was also more useful in predicting future cardiovascular disease than aerobic capacity measured on a treadmill.

Grip Strength
Hand grip strength has been shown to be strongly correlated with health. The stronger your hand grip is, the less likely you are to suffer from cardiovascular disease, respiratory disease, COPD, and all types of cancer. In the study, muscle weakness was defined as grip strength <26 kg for men and <16 kg for women. Grip strength below these numbers was highly correlated with an increase in disease.

Standing From the Floor
If you can’t easily get down on the floor and back up your health might be in trouble, according to a study that looked at more than 2,000 people. The study asked people to go from standing to sitting on the floor and back up with as little support as needed. They found that if you need to use more than one hand to get up and down from the floor that you were 2 to 5 times more likely to die in the next 7 years than someone who can do it with just one hand, or even better, no hands at all.

Moving well is obviously important to overall health and longer life. These tests can give a snapshot of how you’re doing. If you’re having trouble with any of them, considering seeing a movement specialist – your physical therapist.

Just Breathe! How Your Breathing Patterns Affects Your Posture, Your Physiology & Your Pain

Breath RestorationBy Jennifer M. Nelson, PT, DPT, DScPT

Breathing is an automatic function that people often overlook and underestimate the influence it has on our lives. However, breathing plays a vital role in not only bringing oxygen to our bodies, but regulating our nervous system, general posture and mobility.

The diaphragm is a dome-shaped muscles that separates the chest and abdominal cavities. When we breath in, the diaphragm contracts, and the center of the dome is pulled down, making the chest cavity larger and pulling air into the lungs. When we take large breaths in our chest, shoulder and neck muscles will also contract to help increase space for our lungs and air. As we breath out, the diaphragm relaxes and recoils back into the dome, pushing out of the lungs. Breathing out is usually passive unless we need to force air out for activities such as exercises or speaking. When the air needs to be forced out with more pressure, we use our abdominal muscles to compress the abdominal cavity and pull the ribs inwards to help push the air outwards.

We are cued to breath by our bodies need for oxygen (O2) and the build up of carbon dioxide (CO2), which is one of the waste products our body produces. The oxygen is delivered to the body via red blood cells, but they will not release the oxygen if there is not enough CO2 in the blood. We take in O2 when we breath in and blow out CO2 when we breath out.

Breathing is the primary function of the diaphragm, as it is needed for survival, but the diaphragm is also a postural support muscles since it can help regulate interabdominal pressure. If you think of the abdomen as a soda can, the diaphragm is the top. Working together with the abdominal muscles and pelvic floor muscles, the sides and bottom of the can, the diaphragm can control how “stiff” the can is. Just as when you open a soda can, squeezing the can will push the contents of the can out the top and you no longer have a strong can.

There are a variety of reasons breathing can become less efficient and effective, including poor posture, stress, smoking, constricted airways such as asthma and breathing through your mouth, as well as many others. There is no single “right way” to breathe, and we need to be able to use the different breathing patterns depending on what we are doing, but we often get stuck utlizing just one of the breathing patterns, which becomes problematic. People who breath with their mouths open blow off more CO2, which will lower the CO2 levels in the blood and the red blood cells will not release the O2. The body will then tell the brain it needs O2, so you will start to breath in more air. This will lead to hyperinflated lungs and cause you to overuse the accessory breathing muscles in your neck, shoulder and chest. It also flattens your diaphragm, making it harder to push the air out, and you may start to overuse your abdominal muscles to push the air out.

Another common pattern is impaired diaphragm use caused by sitting in a hunched forward posture.  When you cannot use your diaphragm muscles to help you take a larger breath, you will start to use your neck muscles more. Stress breathing is another common pattern seen. When we are stressed, we take shallow breaths with our mouth open and use our accessory muscles to breath. When we breathe in short, shallow breaths, it also stimulates the sympathetic nervous system, the “fight/flight/freeze system” of our body, and increases our stress and promotes guarding patterns in our body and movements. Breathing out long and slow activates the parasympathetic system or the “rest and digest system”, which is why people are told to take a deep breaths when the are stressed or angry.

These are just a few of the ways that we can make breathing more difficult promote the development of inefficient and painful patterns.  Each change in breathing pattern can cause changes in our blood chemistry, making it more acidic, which promotes increasing the sensitivity of our bodies to changes and has been associated with persistent pain conditions, such as fibromyalgia and chronic fatigue. These breathing changes also promote stiffness in the ribcage, which alters how you activate your shoulder and core muscles.

A physical therapist can help with many of these conditions and patterns by evaluating your breathing patterns, helping you become more efficient at breathing, and encouraging your body to change to optimal patterns, improving your ability to function every day.  A commonly recommmended breathing exercise is abdominal breathing, which is best performed lying on your back with your knees bent, but can also be performed almost anywhere and in any position once it is eaiser.

Abdominal Breathing:

  • Close your lips and keep them closed through the whole exercise
  • Put 1 hand on your belly and the other on your chest
  • Keep the belly relaxed as you breathe in, trying to fill your belly with air and keep your chest still
  • Breathe out and gently pull your belly in towards your spine
  • Try to breath in for 2 seconds and out for 4 seconds without pausing at any point
  • Try this for 5-10 min a day and slowly increase the time as it gets easier

At PhysioPartners we take a comprehensive approach to your treatment and will screen your breathing pattern to see if it is a contributing factor or barrier to your function and limiting your ability to reaching your goals. Schedule a complimentary phone or telehalth consultation today to see if we can help you.