Wednesday, September 9, 2009
Friday, 9/11 @ noon-1PM: Jeff Giulietti, MPT, ATC, OCS, FAAOMPT
Monday, 9/14 @ 5-6PM: Joe Uhan, DPT, MA, USATF Level II Cert.
If you've got something nagging, come and get it looked at -- your last chance before Portland!
Monday, August 24, 2009
As I prepare for this weekend's Marathon Clinic, there's little time for a new post. Therefore, in the spirit of "Renew-Reuse-Recycle", enjoy this nugget I wrote a couple years back to my college guys -- a far cry from 26.2, yet appropriate given the end of the IAAF Champs that featured USA's first pair of metric mile medals in...forever?
Also, since it's fall and I'm yet again stricken by the "Coaching Bug", enjoy this non-therapeutic*, performance-related post!
(*unless, of course, your "illness" is consistently poor mile performances!)
The mile race (English or Metric) holds a special place in the hearts, minds, and guts of almost everyone. Perhaps not everyone's raced one, but most (by Executive Order!) were forced to run at least one in their lives.
As such, we've nearly all been prey to its perfectly cruel combination of distance and intensity: too long to dead-sprint, too short to "pace". On the track, four laps -- symmetry. Simplistic. Calculated.
The biggest challenge of the mile race is how one positions oneself for both optimal placing and fastest possible time. What I have found is that these two goals are not mutually exclusive.
This is a great workout because of the gear-shifting involved. It builds overall strength while also developing the ability to shift gears -- a priceless commodity in competitive racing.
A few years ago, while doing this workout solo, it occurred to me, "Why not race like this?" To me, it seemed the perfect solution to the two biggest issues of a mile race:
(1) Slowing way down after 400m
(2) Running terribly slow, mid-3rd lap, "waiting" for the race to be done
Simply put, this strategy involves two simple "moves", one at 400m and one at 1000m.
It seems simple. It seems easy. It might even seem asinine. But before closing your browser, stick with me:
A Typical Mile -- Running Fast the Hard Way
Below is a break-down of a "typical", effort-based mile performance, broken down by 200m segments (time in seconds in parentheses):
200m (31) -- out hard and quick for positioning
400m (32) -- finding a position, keying in on competition
600m (33) -- hitting the 400m "fast", you "settle in"
Stop here: do you see what is happening? With each successive lap, you are SLOWING DOWN A SECOND PER LAP!
809m (34) -- you sit behind in a pack. Half mile split is still pretty good
1000m (35) -- the guys in front of you are slowing; you don't move around them 'til the end of the lap.
1200m (34) -- THE GUN LAP. Time to play catch-up. The field is strung out and you're well behind the guys who got out really hard early.
1400m (33) -- you're passing a few people, but you feel like you're running all-out.
1609m (32) -- Last lap. All-out. Dead. The typical mile finish.
Why did this person run 4:24? Because "that's how fit they are"? No. It is because they allowed typical race dynamics to dictate their energy expenditure. Specifically, they fell into a "slow-down" gear by which they slowed 1 second per lap. And, to snap out of that and speed up, it takes an incredible amount of physical and mental energy.
Using the same first 400m, let's execute the "Shocker" strategy to see how it works:
200m (31) -- out hard and quick for positioning
400m (32) -- finding a position, keying in on competition; You also look ahead of you to monitor runners 5-10m ahead that burst out faster than you.
600m (32) -- "Move" #1 -- Using a smooth, efficient effort, you move up in the race field to the pack ahead of yours, typically 5-10m ahead. This pack ran 30-31 for the first lap, but they are now "settled in" to 32s. You settle in with them at the end of this lap
800m (32) -- let the pack drag you around, staying relaxed and composed.
1000m (33) -- you continue to lock in to this pack, but you are looking ahead to the next 1-2 competitors 5-10m ahead, anticipating your move at the 1000m mark. This keeps you focused and aggressive.
STOP. Look at this pacing. Rather than slow 1 second/lap, you have latched onto a pace-pack that dragged you along at an even pace. Through only slightly more effort, you are now FIVE SECONDS FASTER at the K.
1200m (33) -- "Move #2" -- the runners in your existing pack are slowing down. You move up in the race field to the runners you spotted earlier, running ahead 5-10m. Over the course of this lap, you reel them in and settle in off their shoulder.
1400m (32) -- time to compete. The runners you caught are faster and more competitive: they're trying to shake you, but you hold on tightly, allowing them to drag you through the penultimate lap.
1609m (31) -- you drop the hammer. The momentum of having moved up progressively through the race fuels a terrific finish
What a huuuuge difference! Eight seconds faster. Seems pretty tough, but which pacing strategy looks more smooth and less stressful?
The greatest part about the "Shocker" Plan is not simply good pacing, but the competitiveness it fuels. When you execute it well, you build up terrific momentum and confidence. Rather than "think about" when you will make your move, it is pre-determined. With 400m to go, rather than "think" and "decide", you're already rolling! Moreover, who do you think has the momentum: you -- who's been moving up -- or the other guy -- who got out hard and is dying?
Coupled by smarter pacing and progressive racing, you are already passing people, setting up a monstrous bell lap.
Sounds good, right? But how do you make it happen?
"Recover-on-the-Run" Repeat 1000s. For the runner above (whose bests might be a mile in 4:16 and a 5K in 15:00), the paces might be:
72 - 32 - 72 = 2:56
For the five-minute miler/19:00 5K:
90 - 37 - 90 = 3:37
I recommend 3x K for beginners (600m jog rest) and up to 5-6x K for advanced (400m jog rest).
- Move up in the field at 400m and 1000m laps. This keeps you from slowing down, makes you more aggressive, and keeps you focused and competitive for the end stages of the race!
Monday, August 17, 2009
On Sunday, August 30, as a lead-up to Fall Marathon Season, Eugene PT rep Joe Uhan (DPT, MA, USATF Level II Coach) will present a Marathon Clinic on all-things marathoning: peak-training tips and injury prevention, nutrition and hydration, and running gear and footwear leading up to the big event. Also addressed will be:
- "Top Ten Ways to Think Like a Marathoner"
- Essential Running Injury-Prevention Stretches
- Race-Day Gear
Sunday, August 9, 2009
It shouldn't surprise me that, among obstacles and challenges discussed, injury reports were sprinkled amongst the posts. When your training log not only lists daily/weekly mileage (often triple-digits) but also elevation, then you know they're putting more "wear-and-tear" on their bodies than the average woodchip shuffler like myself.
When guys like these (and I'll take the liberty of lumping myself into this category, for this example) get injured, I imagine the Monday morning water cooler talk goes something like this:
- Cubemate #1: "Hey Dan, what's with the ice pack?"
- Dan: "Oh, my knee's been bothering me quite a bit lately -- I had to cut my long-run short at 20 yesterday."
- Cubemate #2: "20!?! Well no wonder why your knee hurts! "
Dan, or whichever one of us this situation befalls, is left standing there, frustrated and annoyed (and with a family-size bag of frozen peas Ace-wrapped to their knee!)
Why? Because it's all relative. If a person's never run a mile (let alone 20), they cannot understand how it is physically possible to do so without crumbling to pieces. However, the Dans out there are frustrated by this simple logic:
why does my knee hurt on the 101st? "
The cubemates -- as well as most family MDs and orthopedic surgeons -- would argue the following:
- The "Your Body Can Only Take So Much" Argument (aka "The 30 Years Rule"?)
- The "You're Getting Too Old" Argument
Instead, I'll borrow from the world of structural engineering: the material stress model:
where Stress is the injury-producer and Force is how we choose to treat our bodies.
Age and genetics are the biggest determinants of the amount of Stress it takes to injure: individual bodies react differently to Stress, and the same body differently across a lifespan. It also varies in accordance to training adaptation.
And Force? A lot is said about Force. However, a ten miler's worth of "Force" may seem ridiculous to one but an easy day to another. Again, adaptation.
But the forgotten variable is Area. What is Area? In the case of a building material, it is the space through which that force is distributed. The greater the area, the more that force is "shared" amongst all parts of the material.
What's Area to a runner? EFFICIENCY.
There's a reason feet pronate and supinate, knees and hips flex and extend, trunks rotate, and arms swing -- to absorb, store and release Force toward a goal of locomotion.
EFFICIENCY is the idealized distribution of Force throughout the body. And, when all other parts of the equation are kept constant -- age, genetics, adaptation, and load -- it is the only thing we can control to impact stress.
Yet it is the Forgotten Man. Few, if anyone -- including most sports med professionals and athletes, themselves (especially runners!) -- believe that Running Biomechanics can be changed -- for the better or worse. There's a belief out there that "You're stuck with what you've got", and instead, the focus shifts instead to the Force variable:
--you’d be surprised how well you can still race on 30 miles a week!”
Here's what I say: "You might wanna consider optimizing your running efficiency!"
Injuries like Dan's occur for the following reasons:
- Too much, too soon, but more likely,
- You're doing something inefficiently, or less efficiently than you used to
It's that simple. Only The Efficient survive.
Here's where The Skilled Physical Therapist comes in: the PT, by definition is The Movement Expert. That is our job. We don't diagnose visceral disease. We don't prescribe tissue-altering medicines. We watch how you move and, if need be, we intervene to change it.
This approach can be used with running form, and has been, with great success. I am living proof. My own knee injury of nearly a year was abolished -- not with RICE, massage, ultrasound -- but with a biomechanical and motor control renovation.
It didn't happen overnight. It took a team approach between me as the patient, and my physical therapist. And, like a golfer honing his swing or a pitcher learning a new pitch, it took a ton of practice, repetition, and feedback.
But it did change, and how! Besides recovering from the knee pain, it has revitalized -- and revolutionized -- my running career. Because of my increase in efficiency, my "Area" is significantly greater. The result? My form isn't perfect, but the Force my body can take -- even as a 30+ year old -- is vastly greater than anything I could handle before, even in my early 20s.
How do we do it? Here are some nuts-and-bolts examples of what we do at Eugene PT:
- Comprehensive physical examination: What's weak? What's tight? What joints aren't moving, or moving too much?
- Real-world gait analysis
- Neurological/motor control testing: How do you control your body in space?
- Sport-specific intervention: strengthening, stretching, and drills designed to promote EFFICIENCY.
...and it won't even cost Six Million Dollars.
Sunday, August 2, 2009
Then we got more functional: controlling her newly-repaired knee in standing. We did some step-ups and -- despite her Herculean abilities on the mat -- she looked like a marionette under a rather novice puppeteer! Translation: her knee control was awful. Even with practice, a mirror, and a persistent therapist, her control remained poor, especially in the absence of those inputs.
There's a conventional wisdom in the sports med world that, in order to improve body mechanics and control -- namely at the knee -- all you have to do is "strengthen the medial quad and proximal hip". Most research studies tell us the same thing: those with good control have strong hips/quads; those with poor control are weak.
I refer to this approach as The "Magic Wand" Approach: you strengthen certain muscles and POOF! -- knee control is normal!
I wish it were true. Then our jobs would be easier, our friend and family happier, and there'd be a lot less people with knee pain in the world.
"You've got the hen...the chicken...and the rooster...Something's MISSING!"
The Sports Med world got wise. The busted out the steps, the balance boards, and the mirrors. They practiced functional movements with the patient and -- more importantly -- gave all sorts of feedback -- verbal and visual -- of their movement. The patient was able to see "right" from "wrong".
But despite this redoubled effort, we still weren't seeing ideal control. Without the mirrors and the "Don't do that!" voice to remind them, it was back to the old patterns -- the same patterns most people have used since they took their first step.
The "Don't Do That!" Approach, while better than its predecessor, still did not result in a permanent change in motor control. Perhaps this is why many that suffer ACL repairs are repeat offenders -- only with the other knee.
To change how a person controls their body in space is to change motor behavior -- or how a person uses their brain, muscles and nervous system to move. In order to have true success in changing motor behavior, you must affect all three systems.
The "Magic Wand" looked only at muscle. The "Don't Do That" did 'em one better: muscle AND brain (though only the conscious brain). But still missing was the nervous system.
The nervous system covers outputs (muscles and movement), but just as important, inputs: how it feels to position joints, activate muscles and move limbs.
This brings us to a new approach: Dynamic Proprioception.
According to motor control theories, we can only change motor patterns if we can FEEL the muscles actively work during the learning of new skills. Our conscious brain will then "integrate" that feeling into the new motor plan. In our step-up example in order to truly learn to "keep the knee over the foot" during a step-down activity is by FEELING the quad and the lateral hip while we're doing it correctly.
A treatment approach for knee control, for example, would begin with simple exercises aimed at gaining this sensory input -- first in static (no movement), then progressing to slow, controlled movement, then faster/more challenging movements, and finally, to functional movements.
Another way to put it is, you're making a motor control blueprint: "OK, here is what it FEELS LIKE to control your knee: feel your quad and lateral hip 'burning' with activation." Then, taking that blueprint, you apply it to increasingly demanding, complex, and functional activities, until it becomes automatic.
It's an approach with tremendous potential not only for injury rehab and prevention, but for optimization of control. "You're not hurt? Fine. Let's make you faster!"
If you're curious (or, more importantly, injured), come see us. And if that's not possible, when you are practicing that new skill, think to yourself: "What does it FEEL like? What are my muscles DOING?"
Thursday, July 16, 2009
Monday, July 13, 2009
A collegiate runner, several weeks into his indoor season, begins to experience heel pain. He first feels it at the end of a cold long run. It worsens throughout the week and flares badly following an intense indoor track workout spent circling the 200-m oval at high speeds and on his toes. Pain was bearable during but causes a limp on the cool-down...and walking to class following the track session.
What to do?
Everyone -- teammates, coaches, trainers, doctors, and most PTs -- would tell him to "R.I.C.E.": Rest, Ice, Compress, Elevate. Maybe some stretching and, if you have the luxury, some ultrasound and massage.
So that's what he did. All of the above. While doing so he rested, and cross-trained, and waited. And waited. And waited. Days turned into weeks, then months. Yet it was still painful to load -- and even to the touch -- and even seemed to "throb" at rest.
Then what? X-rays? MRI? Psychiatry?
How about some additional information?
- The runner had NO morning stiffness or pain. Moreover, he had very little pain doing a calf raise, and even less stretching the affected Achilles tendon.
- He also reported the heel was painful at rest -- sitting in class, or in the car on long drives between school and home -- where he reported a "burning, buzzing feeling".
- Several weeks prior to the injury, the athlete was on winter break from school, where he was able to rest and relax doing a variety of things with his free time. However, just two weeks before injury onset, school re-started. This meant 6-8 hours per day class and 3-4 hours nightly studying, slouched uncomfortably in lecture hall chairs, or hunched over a book 'til the wee hours of the night.
It is at this point when you look at the moo-ing duck and call it what it is: A well-disguised COW. In this athlete's case, the source of his heel pain was his back.
And between each of these bony vertebral segments flow the nerves controlling everything in our extremities: our voluntary motions, as well as sensations from the world around us, including pain.
"Flow" is a generous description. SQUEEZE is a more accurate description of a nerve's route from the spinal cord to their area of innervation. They tunnel their way, through tiny caves at the vertebrae, around other bones, between (and sometimes through) muscles until they reach their final destination.
And based on this description, it's no surprise that these biological powerlines often become squeeze, kinked, or otherwise aggravated -- with negative consequences.
Nerve Irritators: The Usual Suspects
The following structures are usually most responsible for nerve irritation and non-soft tissue extremity pain.
Most of us have heard of "herniated" or "bulged" discs. We tend to think that disc pathology can occur only with severe injury. However, our vertebral discs are relatively mobile. Though microscopically, they can slide around between the bones and ever-so-lightly encroach on the nerve exiting the cord -- just enough to cause nerve-related pain down the chain.
Joints connecting adjacent vertebrae lie on either side of the column, allowing for a variety of motions. If these joints become irritated -- usually by becoming too stiff -- they can affect the nerve roots that pass just millimeters above and below them. Indeed, these facet joints, themselves, can cause pain farther down into the arms and legs!
Muscles, fascia and other connective tissue can impede the smooth flow of nerves to their destination. Chronic muscle tightness -- that which comes from daily, punishing bouts of endurance training -- can compress and adhere to nerves, creating pain.
His pain description also missed the boat. While strinkingly similar to soft tissue injury -- the classic pain with weight-bearing -- there were several subtle differences that, in the end, led to calling that duck a cow.
Pain Behavior: Soft Tissue v. Nerve
Here's a list of differences (some more subtle than others) between soft-tissue and nerve irritation:
- Soft Tissue: "Point-tender" (able to point to one specific area of greatest pain)
- Nerve: large, undefined area, capable of "moving around" ("around the heel, sometimes on the inside of the ankle...")
- Soft Tissue: In the AM, first beginning exercise and/or at fatigue
- Nerve: gradually worsening, worst with spinal loading/impact
Hurts to Stretch
- Soft Tissue: YES
- Nerve: RARELY
Hurts to USE
- Soft Tissue: YES
- Nerve: Usually only in weight-bearing (putting compression on spine); RARE to have any pain out of weight-bearing (e.g. resisted dorsiflexion in sitting/supine)
- Soft Tissue: YES
- Nerve: RARELY
Pain at REST
- Soft Tissue: RARELY (unless injury is acute, or acutely flared)
- Nerve: YES
WEIRD sensations: burning, aching, pins-and-needles, hypersensitive to touch
- Soft Tissue: RARELY
- Nerve: YES
As "big picture" health care professionals, whenever we get a referral diagnosis, our first thought is, "What else could this possibly be?"
When nerve pathology is suspected, we confirm it with:
- A thorough subjective (pain onset and behavior, history of back pain, or related "odd" limb complaints?)
- Nerve/spine special testing
- Spinal mobility and stability testing
Treating Nerve-Related Pain
Our injured runner had the following problem list:
- Poor back mobility: his flexion was OK, but he was limited in extension by at least 50% (e.g. he could not do a full backbend, which a man of his age and fitness should be able to do)
- Poor lumbopelvic stability: he demonstrated poor core strength and activation during running
- Poor posture: he reported sitting, standing and lying in poor, flexed postures.
After less than two weeks of this simple treatment approach, this runner's pain reduced enough for him to resume training, and within four weeks was gone completely.
Keeping it at Bay: Tips for Good Back Health
Mobility. Spine mobility is the most important factor in alleviating -- and preventing -- back and extremity pain. Three "gold standard" flexibility milestones:
- Touch your toes. One should be able to touch his or her toes, while keeping the knees straight.
- Lying backbend (aka "the upward dog"). One should be able to come close to locking out elbows on this modified push-up, while keeping their pelvis on the floor.
- Lumbar rotations. Lying flat, flex your hip up to your waist and "fold over". One should be able to touch the knee to the ground while keeping the other arm firm to the ground.
Posture! Watch your posture in whatever you do: sitting, standing, lying. Stay out of prolonged stressful positions, especially flexing forward.
Saturday, July 4, 2009
Included in that mass was a five-some from Eugene Physical Therapy: Joe, Jeff, Peter, Michael and Chris. Congrats to Team Eugene PT for getting five across the line, and to the rest of the finishers this morning!
Joe's Race Report:
Up and at'em at 0545 this morning. Put in an easy mile around the neighborhood to loosen up before gathering my stuff and heading for downtown to catch the LTD shuttle to the start.
I found Jeff at the bus stop, and once at the start we got in an easy warm-up in the neighborhoods surrounding Spencer Butte Middle School. It was already warm -- in the mid-60s and humid -- characteristic Midwest summer conditions, but unusual for the Willamette Valley.
The starter's pistol fired a shade after 0800. The lead pack was strong up front, featuring former CU Buff Bret Schoolmeester ('08 B2B champ), Ryan Bak of OTC Elite, and former Badger/Olympic Trials veteran Matt Downin. The field was out quick, with two dozen men forcing the uphill along Donald Ave. I settled into about 20th place at the quarter mile, as the course began to show hints of the grade to follow.
The course features a hyperbolic uphill first mile, perhaps a mere 1% grade in the first quarter but progressively ratcheting the grade until you find yourself shuffling up a near 10% grade just before the mile mark. My long runs up to Ridgeline Trail the past month prepared me for this shock, and I weaved my way through the lead mass to the top ten at the hill's crest. I pushed it to the peak, knowing I'd be rewarded with a mile+ of downhill. First mile in 5:55, my first time breaking 6 on this course.
Following the crest on Donald St., a sharp left channels the field back down the butte, flying down Fox Hollow Dr. I opened up the stride and within a minute was in a comfortable, aerobic gear -- a bittersweet respite that made the ensuing flat all the more difficult. I caught a younger guy in a white singlet and floated downhill alongside him, and midway down was joined by another guy, in orange. Hit Mile 2 in a way-too-comfortable 4:58. Pedestrian for that grade.
The tail-end of Fox Hollow spit us out and left onto Amazon Parkway. Goodbye downhill, goodbye shade. And, within 400m, goodbye competition. White and Orange shifted into a working gear, and I fell off the back. I struggled to maintain contact in that 3rd mile. I felt fine enough, but the quads were mush.
Shortly before the 3rd Mile, I was surprised by the water station. My plan was to take a gel -- as practice for Portland this fall -- and to follow it up with water. Too late. Time for a digression:
Water Station Technique
THANK YOU water station volunteers, for providing precious hydration and cooling. However, recognize there is good hand-off technique, and there is bad.
POOR TECHNIQUE: Holding the glass in your palm, or from the bottom, does not allow for any "follow-through" -- or a means to cushion the impact of the receiver running 12-15 MPH. Therefore, most attempts to grasp the cup ends with the cup falling to the road. And even if you do manage to grasp it at that speed, you typically lose significant volume.
GOOD TECHNIQUE: Holding the glass from THE TOP! This allows the passing runner to grasp from the BOTTOM. And by doing so the runner can grasp the full weight of the cup without hardly any volume loss, while the giver can "follow-through" as the runner passes by. Lastly, the giver -- once they feel the runner has grasped the cup -- can then simply "let go" once the cup begins to travel forward. And viola! A perfect hand-off!
If I could give a pre-race clinic on this topic, I would. End of Digression.
Unfortunately, the water station workers at the B2B used the poor technique. At the 3rd mile I ingested roughly 15-µL of water and pressed on. Shortly thereafter I hit the 3rd Mile: 5:12 (16:06).
The last three miles were rough, winding along Amazon Parkway and its steep camber. From there on I went into "AT mode", focusing on good form. I'd been doing 3-4-mile ATs for the past several weeks so this mentality helped a great deal. By this time I was a good 50m from White and Orange -- on my own.
A right and left put us onto High Street. After the 4th mile in 5:25, my legs felt like ground meat, slowly grilling on the hot asphalt. "AT mode" turned into "Survival Mode": a steady "Left-Right-Left-Right..." north to Skinner.
My Sport Psych and coaching background helped in a time like this. I used a lot of Positive Self-Talk to grind through the last 3K, as every block I'd cover I would say aloud, "Strong! Strong! Strong!" That kept my legs from buckling under. 5th Mile in 5:32 -- definitely AT mode.
I kept the feet moving up a slight grade toward Skinner Park, and around the corner. The crowds approaching the finish were terrific. I ground out the last 2K (6th Mile: 5:35, 0.2: 1:03) and labored into the finish.
The Damage: 5:55, 4:58, 5:12, 5:25, 5:32, 5:35 (1:03) = 33:42 (unofficial), 6th place.
I was happy simply to have finished. Having no one pass me in the last 4 miles was another bonus.
After several cups of water, I circled back to find Jeff, and I ran the last 600m with him. He gave his characteristic 100% effort -- but not dry (or wet)-heaving this time -- with a terrific finishing straight.
By 8:40 it was legitimately HOT. I downed several more glasses of water, and furnished Jeff with a few, before joining Downin, women's race winner Jane Rudkin, and Shane, who was just a few seconds behind me. I felt pretty darn good, surprisingly, on the cooldown through the west Pre trail loop and back.
I'm overall pleased; not ecstatic, but satisfied, knowing that a strong effort and tough mindset established today is a crucial foundation upon which strong training and racing is built.
Congrats again to all finishers! And thanks especially to Team Eugene PT for their strong efforts today! Can't say I've ever run a 1oK with 4 other co-workers before! Very cool.
Monday, June 29, 2009
It was a terrific experience that afforded a myriad of opportunities, ranging from the usual training room fare -- heat, ice, stretching, massage, "the magic wand" -- to bonafide injury assessment. It was also a great opportunity to work along side many of the talented sports med professionals at the U of O, and the Eugene area, who did a top-notch job at delivering the highest quality care.
Midday Saturday I was approached by a senior shot putter with lateral elbow pain. He described his pain as "above and below the outside elbow", and "it hurts to lift a glass". The dreaded "L-Word" -- Lateral Epicondylitis -- was suspected.
Lateral epicondylitis -- also known as "Tennis Elbow" -- is the inflammation of the muscle originating or crossing over the bony prominences of the lateral elbow, muscles used to extend the wrist and aid in gripping tasks. It is a common sports injury (guess which one?), but it affects far more non-athletes, namely those who engage in repetitive grip and lifting tasks.
Common treatment for tennis elbow includes inflammation control (RICE), stretching and strengthening of the wrist extensor muscles, and activity modification. It also may involve addressing muscles and joints farther up the chain -- the shoulder and shoulder blade, which can dictate the position and stress on the elbow.
However, with this gentlemen, we did none of those things. Instead, we mobilized his elbow joint, focusing on the head of the radius, the bony formation most closely adjacent the lateral epicondyle. While working up a sweat pushing, pulling and rotating his brauny forearm, I explained to him my rationale:
Soft Tisse Injury: Rules of the Game
With a muscle-tendon injury (e.g. tendonitis, muscle strain or tear, etc.), the following "Rules" usually apply:
- Stretching the tissue is painful.
- Contracting the tissue is painful.
- Resisting contraction is most painful.
- Point tenderness -- the ability to point to a single area and say, "It hurts HERE!"
In this gentlemen's case, neither stretching the wrist extensors (flexing the wrist), active wrist extension, or resisted extension were painful in the slightest.
Not Tennis Elbow.
Likewise, if you have what you believe is a soft tissue injury, but it neither hurts to use or stretch that tissue, it's likely not a true soft tissue injury.
So what do you do if you've ruled out soft tissue? Most common possibilities:
- Joint dysfunction -- one of the joints in the area isn't moving the way it should (either too much, not enough, or out of sync)
- Neurogenic pain -- a nerve (either nearby or near the spine) is aggravated, causing pain in that area.
- Something More Sinister
After several minutes of mobilization -- during which time I recommended a must-visit in Portland for some terrific post-competition donuts -- the gentle giant reported a significant decrease in pain and increase in elbow motion.
I wish I could say that the thrower notched Hayward's next 70-footer, but it's not all miracles in Track Town USA. He returned the next day to report lingering pain in the elbow -- a common finding in a chronic joint dysfunction -- that limited his best throwing.
We felt badly, but he was thankful to have competed, and for our help. I really hope he got his donut.
Thursday, June 25, 2009
Sunday, June 21, 2009
By the time I crawl up the hill and hammer back down, I'm usually rolling pretty good. Today was no exception, and with a couple miles to go, I was definitely in the "Bring It Home" gear when I approached a trio of guys ahead on the Pre's trail. They looked fit but were clearly taking it easy.
As I passed, I turned and said "Hi" (my new habit with everyone I pass on the trail), to see that I recognized one of the guys that I knew from the Midwest. Turns out I had inadvertently rolled up on some of the local talent, clearly on an easy run leading up to The Big Meet.
We chatted a bit and I mentioned the new gig and what we're up to; specifically how Eugene PT is one of few practices to provide free public outreach -- be it through free injury screenings, phone calls, or e-mails -- to provide initial or on-going consultation, regardless of whether or not they're "paying customers". I'm very passionate about this, which is one of many reasons why I'm here.
I was happy to hear that these gentlemen -- unlike many people our age (elite athletes and non-, alike) -- actually have good health insurance. As we jogged along I was told they have access to diagnostic testing for various injuries that is (gasp!) actually reimbursed by insurance!
He then added, "Yeah, I've had several MRIs in the past year, which has helped save me from more serious injury".
About this time I'd reached my turn; I bid the guys farewell and good luck for next week.
An MRI may indicate which structure is injured and causing pain, but no scan -- nor magic wand, pill or elixir -- will tell you why it is injured.
As Physical Therapists, that's our job: to find out why it's injured, and to fix the cause.
For example, shin pain might be due to a training error or old shoes. Or, could it be:
- abnormal foot mobility
- insufficient hip internal rotation
- a functional leg length difference
- referred pain from the low back (neurological), or
- hitting it repeatedly with a hammer*
And the sad fact is, if you don't figure out the cause, the pain is doomed to continue or return, no matter how many scans, pills, or rests you take. This has become painfully obvious with my own injuries...and it is what drew me to this profession.
That diagnostic sleuthing and conquering those roadblocks is what makes going to work each day so fun and rewarding. And, in my humble opinion, that quality of work is what separates Eugene PT from the rest.
(*PTs can also provide therapeutic massage, when indicated!)
Saturday, June 20, 2009
Welcome to the official Eugene Physical Therapy weblog! The purpose of this site is two-fold:
First, to provide an additional resource of information and insight for past, present and perspective patients. Treatment sessions can be busy, and as much as we'd like to, therapists can't use up your time (and visits and copays) "educating" to the depth and detail as we'd perhaps like. This is an opportunity to provide a bit more information...and for you to comment and ask questions, as well.
I originally developed this idea after discovering another PT-related blog several years ago, while groping for help with yet another running injury. And it was a huge help!
Second, it's a fun way to keep you up to date on what we're up to; one of the great things about Eugene PT is that we've always got "many irons in the fire" around the community (or, "fingers in many pies"?). Moreover, we're constantly trying to learn more -- through coursework or certification -- which means we've got a lot to offer!