Multiple Sclerosis and Exercise– How Much Exercise is Safe?

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (i.e. the central nervous system). MS is a condition that causes the immune system to attack its protective sheath (called myelin) that surrounds every nerve. This protective sheath is very important when it comes to the health and efficiency of your nervous system as it is the communication between your brain and the rest of your body. MS can be a stable or progressive disease and can lead to permanent damage or deterioration of nerves.

Similar to my other blog posts, I like to emphasize that every neurologic condition is different for each individual. This is even more true for a condition such as MS! Multiple Sclerosis can present more as a brain injury, spinal cord injury, or a mixture of both depending on which part of nervous system is affected. Here are some common deficits that people with MS experience: numbness, weakness, changes in sensation, change in coordination or balance, vision problems, pain, dizziness, heat intolerance, and fatigue.

Fatigue is the most common symptom of MS, impacting 75-95% of patients. There is “neurologic fatigue” as well as “secondary fatigue”. Secondary fatigue is due to deconditioning and an overall a decrease in activity. Regular exercise is one of the main treatments to either improve and/or prevent this secondary fatigue. Heat intolerance is another very common symptom of MS. Exercise naturally increases your body temperature, however, with people with MS this can cause an increase in symptoms temporarily and leaves some people “scared” to exercise.

According to current research and clinical practice, exercise does not cause MS episodes or exacerbations. However, many report an increase in symptoms approximately 30 minutes after exercise. This change in symptoms is not permanent and is not causing any damage. The tough part is there are no recommendations for exercise for the MS population based on research. So, the following recommendations are just that – what I recommend based on my experience and knowledge of the diagnosis.

Benefits of Exercise With MS

One of the most important benefits of exercise is to reduce and prevent secondary deficits and fatigue! Sometimes these secondary deficits can be equally as debilitating and add to your MS symptoms. These are some of the benefits of regular, daily exercise for the MS population:

1) Improve cardiovascular fitness – prevent deconditioning and heart disease
2) Improve bowel and bladder function
3) Reduce secondary fatigue, as it adds to fatigue from MS
4) Prevention of bone density loss (osteopenia and osteoporosis)
5) Mood enhancement and decrease depression
6) Pain management – exercise releases endorphins in your body that reduces pain
7) Increase participation in social activities
8) Improvement in cognitive function
9) Weight management to maintain an ideal body weight for moving around

Exercise Recommendations

The following recommendations come from the American Heart Association. Again I want to emphasize that these are just recommendations, therefore, I often have many patients exercise more or less than these recommendations. It is strongly encouraged to consult your doctor and physical therapist before starting a regular exercise routine.

table of exercise recommendations for ms

In my practice of physical therapy, I often use the term “Rate of Perceived Exertion” or RPE to monitor the intensity of exercise. Therefore, you should feel like you are working “light to somewhat hard” when you complete any aerobic exercise. Exercising harder is not necessarily better for you! Later in this blog, we will go over more about what can be considered aerobic exercise as it is not just standard exercise.

borg's RPE scale

Types of Exercise

Give yourself credit for activities you do everyday that can be considered exercise! As well as remember, some may be able to perform lower or higher levels of intensity depending on their function and individual symptoms. Before you start or change your routine, I would challenge you to do the following:

  1. Have a mixture and variety of exercise. If you are able, try to mix up your routine to include at least two of the categories. That way you are continuing to challenge your body and you will see better results.
  2. Use the list below to help manage fatigue. You may want to prioritize, delegate, or pace/spread out certain activities that may be moderate-vigorous for you.

BLUE EXERCISES – light exercise (RPE 6-9)

  • Light household chores like dusting, making the bed, emptying the trash, etc.
  • Cooking simple meal in standing or complex meal in sitting
  • Relaxing Yoga
  • Tai Chi

GREEN EXERCISES – moderate exercise (RPE 10-13)

  • Gardening
  • Heavy household chores, like laundry, vacuuming, deep cleaning, putting away groceries, etc.
  • Strength training with light to moderate weights (<15#)
  • Aquatic Exercise
  • Walking Program – continuous >10min or faster speeds
  • Stairs when complete more than x1 flight
  • Pilates

YELLOW EXERCISES – vigorous exercise (RPE 14-17)

  • Biking with light to moderate resistance
  • Errands like grocery shopping
  • Yard work like raking leaves, push lawn mower, etc.
  • Dancing
  • Swimming
  • Jogging/Running 

Specific MS Considerations For Exercise

Here is some common evidence I provide my patients with MS to help improve tolerance to exercise as well as considerations for safety.

  • Stay hydrated!
  • Best to do exercises in AM when your body temperature is lowest and the environment around you is cooler
  • Wear light exercise clothes, recommend fabrics that wick moisture or are a lightweight material (not cotton clothes)
  • Don’t follow the “no pain-no gain” rule. You can over exercise as there is a neurologic fatigue factor which is not something to push through
  • Interval training (with rest breaks in between) is often more tolerable than continuous exercise
  • Perform both a warm-up and cool-down – approx. x5 minutes each at low effort
  • Cooling garments or fans for those who are heat sensitive with exercising (The National MS Society can help provide garments so visit the following website for more details https://www.nationalmssociety.org/Resources-Support/Find-Support)

8 Moves To Prevent Ski Injuries This Season

prevent ski injuries

Ski season is nearly here and it’s time to begin preparing for your first ride down the mountain. Making sure that your hip, knee, and core stabilizer muscles are strong and working well is a great way to aid in avoiding skiing injuries and ensuring a long and fun season.

Ski injury prevention starts with getting your quads and glutes into shape which will also help with your form and performance. Here are a few exercises to add to your training program to help prevent ski injuries-

Move 1: Sustained squat on bosu ball with side-to-side rocks

bosu ball squat

Place band around knees to improve lateral glute medius activation. Rock side-to-side sustaining a squat position.

Perform 3 sets for 1 minute each, 3 times a week. Progress holding medicine ball out in front of your body.

Move 2: Static skaters

Stand on one leg with a theraband around your ankles. Pull your opposite leg back at a 45 degree angle, keeping toes pointed forwards.
Make sure hips stay level and squeeze your glutes as you pull your leg out. You should be activating the stance leg glute as well to stabilize and will likely feel this leg working more during the exercise.

Perform 3 sets of 15 reps, 3 times a week. Progress ascend into a deeper squat on stance leg.

Move 3: Skater hops

Alternate hopping laterally. Descend into a controlled squat on weight bearing leg while reaching opposite arm towards floor and letting non stance leg bend behind your body.

Perform 3 sets of 15 reps, 3 times a week. Progress to landing on airex balance pad.

Move 4: Single leg squat

single leg squat

Begin with keeping weight in heel. Shift hips posteriorly, making sure your knee doesn’t travel too far forward. You can use a TRX band or a small board under your heel to increase range of motion.

Perform 3 sets of 15 reps, 3 times a week

Move 5: Paloff press single leg

Use a theraband anchored on a door or use a cable machine set up at shoulder height.
Obtain a single leg stance position on your outside leg farthest from anchor point.
Engage your core and glutes, ensuring to keep your pelvis level.
Hold your arms centered in front of you. Press out, up, down, and in, returning to starting position. Repeat.

Perform 3 sets of 10 reps, 3 times a week. Progress by standing on airex balance pad or unstable surface.

Move 6: Stir the pot

stir the pot

Begin in a plank position with elbows on a stability ball stacked beneath your shoulders.

While engaging your deep core muscles, move arms into small circles first clockwise and then counterclockwise.

Perform 2 sets of 10 in each direction, 3 times a week. Progress by increasing reps/time.

Move 7: Deadbug

Begin by lying on your back with a stability ball wedged between your arms and legs, with legs elevated into the air and knees bent at 90 degrees.

While opposite arm and leg squeeze into the airex pad, engage your deep core muscles and extended the other arm and leg out away from the ball.

Return to start position and switch to the other side.

Perform 3 sets of 10 reps, 3 times a week. Progress by taking away stability ball.

Move 8: Lunges with sliders

Begin with standing with one foot on the slider (May substitute Swiffer pad/paper plate).

Place your weight on the leg without the slider. Bending this knee, slide the other leg posteriorly into a squat position. Return to start position.

Perform 3 sets of 15 reps, 3 times a week. Progress holding weight at side or overhead.

Why Are These Moves Important To Do?

Adequate core, glute, and quad strength is very important to help ensure an injury free season.The sustained squat ski position demands a lot out of strength and endurance out of our legs. If glute weakness is present, it’s easy to allow our knees to fall medially towards each other. This throws off our hip, knee, and ankle mechanics leaving us prone to falls and injury. Having effective gluteal activation will allow you to maintain proper alignment through your joints allowing for pressure to be displaced equally and keeping you out of the “pizza” position to avoid possible injury.

A thorough glute program targets not only the glute maximus, but the glute medius as well. The above program is a great starting point to target the necessary muscles.

Now don’t be fooled into thinking only the legs need to be strong. Our cores have a big responsibility to drive our bodies into each and every turn and assisting to keep us upright. So give your core some love with our prescribed exercises above.

If you find you have questions about ski injury prevention, schedule an evaluation with one of our skilled physical therapists.

What You Should Know Before Returning To Running Postpartum

Running Postpartum

By Erin Mumby, PTA

There are multiple roadblocks mothers may encounter when returning to running postpartum. Prolapse, incontinence, diastasis recti, C-section symptoms, weakness and/or pain may be present and interfere with attempts to return to or beginning a running program. Seeking professional guidance from a pelvic floor specialized physical therapist for help returning to running post delivery can help reduce the impact of the above symptoms and get you back to running with confidence.

Before you run, you must walk (or rest!)

Mentally you may be ready to get back to your pre partum running routine, but your body may not be. Though you may feel like you are ready to return to running soon after delivery, the typical recommended return to running begins 3-6 months postpartum. However, you are encouraged to start off with gentle walks before you progress to running.

Be sure to check in with your doctor prior to returning to any physical activities.

Waiting the appropriate amount of time prior to attempting a return to high impact exercises is necessary for healing post-delivery especially when pelvic floor dysfunction symptoms are present including:

  • Urinary/fecal incontinence
  • Urinary/fecal urgency
  • Pelvic organ prolapse (typically accompanied by pressure/bulge in pelvic floor region)
  • Pain with intercourse
  • Diastasis Recti (separation of abdominal muscles)
  • Muscular pain

While on the topic of pelvic floor dysfunction, it is important to be aware of the potential risk factors and complications that may affect your return to running and can increase your present symptoms include:

  • Premature return to high impact exercises
  • Pre-existing conditions/complications
  • Breastfeeding
  • Obesity
  • Cesarean Section
  • Perineal scarring
  • Current pelvic floor dysfunction
  • Running with buggy/stroller (which alters normal running mechanics/form)
  • Level of fitness
  • Psychological status
  • Diastasis Recti
  • Sleep

If the above symptoms are present, you may need to wait a longer period of time before making a return to running. A visit with a physical therapist can give you helpful insight into your current situation and the best way to manage the symptoms you may be experiencing.  Your physical therapist can also recommend exercises you can perform that can help to prepare you for your return to running. 

Prior to beginning a running program, a new mom should be able to complete the following without pelvic floor symptoms including pain, urinary/fecal incontinence, or a feeling of heaviness:

  • Walking 30 min
  • Single leg balance 10 seconds
  • Single leg squat 10 reps each side
  • Jog on the spot 1 min
  • Forward bounds 10 reps
  • Hip in place 10 reps each leg
  • Single leg running man 10 reps each side

A Final Takeaway About Returning To Running Postpartum

It is recommended to have a thorough screening by a pelvic floor specialized physical therapist to ensure that you have adequate hip strength, core stabilization, and pelvic floor function. Your physical therapist will provide guidance for returning to running or other high impact sport/activities postpartum. Your physical therapist will also provide you a personalized program of specific exercises to ensure success with return to running postpartum, along with a structured plan for increasing distance and time.                                                                                                                                                                                                                                                                                 

The Effects Of A Stroke: Tonicity and Spasticity In The Extremities

The Effects of Stroke on Tonicity & Spasticity in the Extremities

Written by Jessica Dietz, PT, DPT, NCS

According to the American Heart Association, someone in the United States has a stroke every 40 seconds. The effects of stroke continues to be the leading cause of serious long-term disability in the United States. However, up to 80% of strokes can be prevented by lifestyle changes (especially exercise!) and management of atrial fibrillation, diabetes, high blood pressure and cholesterol.

There are two different types of stroke– ischemic and hemorrhagic.

Ischemic strokes: are the most common type of stroke and also the most preventable. Ischemic strokes occur due to disruption of blood flow to the brain, such as narrowing/blocked arteries or blood clots.
Hemorrhagic strokes: are less common and due to a blood vessel break or bleed in the brain like an aneurysm. For more information about types of strokes, visit the American Stroke Association.

Depending on the location, severity, and several other risk factors, every person with a stroke is different! There are many possible changes someone may experience as an effect of stroke such as:

  • Weakness
  • Difficulty speaking or swallowing,
  • Numbness
  • Altered cognition
  • Vision changes
  • Difficulties with balance

Only about 10% of patients experience a full recovery after having a stroke. That means almost 90% have some type of mild to severe impairment as an effect of a stroke that may continue to require rehabilitation or medical management.

One common as well as frustrating and potentially debilitating effect after a stroke is “TONE and/or SPASTICITY”. Throughout this blog, we will discuss more about tone/spasticity and its management and treatment.

What Is Tone/Spasticity?

Your doctors may have used the terms “tone” or “spasticity” to describe the stiffness in your extremities. Although tone and/or spasticity can be found in the neck and trunk it more commonly occurs in the extremities after a stroke. Often times these two terms are used interchangeable, however, they are different so it is important to know the difference as they are managed differently. To make it even more complicated, sometimes you can have both!

Everyone has some degree of TONE, which is the body’s underlying resting resistance to movement or stretch. Think, if you have low tone (i.e. hypotonicity) your limbs would be very easy to move almost like an overcooked noodle. More commonly, we see too much tone (i.e. hypertonicity) which causes a stiffness and resistance to movement.

SPASTICITY, however, is the body’s resistance to quick movements caused by a quick stretch to the muscle. For example, a quick stretch to your calf muscle when you are sitting can create clonus (which is a type of spasticity) that causes a fast beating motion of your leg. Spasticity is different than just muscle spasms as spasms often occur randomly and without a stretch of the muscle.

Why Does Tone/Spasticity Matter?

Normally with movement or stretch to the muscle, there would be a normal resistance in contrast to that movement or stretch. However, after a stroke there is often a loss of normal inhibition from the brain which can lead to over-excited neurons and nerve tracts. Hypertonicity and spasticity can further lead to postural changes, contractures (i.e. permanent loss of a joint’s range of motion), balance difficulties, and pain.
Here are two examples of condition presentations and how they impact function.

Example #1 – Hypertonicity in arm/hand
One of the most common presentations is hypertonicity in the affected arm and hand. This can cause the arm to remain stiff and difficult to move for getting dressed or performing other daily activities. Hypertonicity in the hand can cause the hand to remain in more of a clenched, fisted position which makes fine motor tasks difficult, such as grabbing a utensil to eat. This is also a common example of how an affected limb can be stiff (due to tone), weak, and potentially painful.

Example #2 – Spasticity in leg
Another presentation can be spasticity in the quadriceps muscle. The quad muscle is one of the most important muscles for standing and walking. If this muscle becomes spastic after a stroke it can lead to hyperextension of the knee or “stiff leg” when trying to take a step or go upstairs. This is a good example of also the phenomenon that spastic muscles are often WEAK muscles and sometimes you can use your spasticity for function. But if you take too much medication that decreases your spasticity you may find it more difficult to stand or walk.

How To Manage Tone/Spasticity?

Often the first treatment for both tone and spasticity include medication. Some common medications include: Baclofen (lioresal), Clonazepam (klonopin), Dantrolene (dantrium), Iazepam (valium), and Tizanidine (Zanaflex).

Other treatments for higher levels of tone/spasticity are botox injections, phenol/alcohol injections, and intrathecal baclofen pump. These medications should be managed and monitored by your doctor for the appropriate dose to minimize side effects of high doses.

Physical therapy and exercise provide conservative and non-medical management of either tone and/or spasticity. Physical therapy can help the most in the following ways:

Optimize the “window of opportunity” that exists with any of the above medications or injections that are used. For example, botox injections are most effective within 3-90 days after the procedure. This means we may have more range of motion, less resistance to movement, or less pain that our therapeutic interventions may be more effective.
Optimize function despite having tone or spasticity. Despite medication and other management, there usually is some level of abnormal tone or spasticity present which means you have to learn how to move and safely function with this new tone/spasticity. There are many “tricks of the trade” and techniques that a physical therapist can recommend to help maintain independence and function.
Skilled observer of function and movement. Often times, physical therapists and doctors work together in order to find the appropriate dosage of medication as well as muscle groups for injections that will allow someone to be the most mobile and independent.

Some other non-medical treatment ideas that can be performed in therapy include vibration, electrical stimulation (e-stim), taping, orthotics or bracing, and other adaptive devices.

The most successful treatment although continues to be specific stretching and strengthening, so see your local physical therapist for specific stretches and strengthening exercises to make it individualized to you!

How To Prevent A Stroke

We could not have a blog about stroke without highlighting the importance of stroke prevention! Once again, 80% of strokes can be prevented. Some of the most important prevention recommendations include some of the following:

  • Exercising/moving more
  • Eating healthy
  • Maintaining a healthy body weight
  • Quitting smoking
  • Decreasing alcohol consumption
  • Having regular doctor visits

To read more information about more prevention tips, visit the following websites:
National Stroke Association
American Stroke Association

Concussion Treatment: More Than Just Getting “Your Bell Rung”

concussion-management-treatment

According to the CDC, 2.87 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States in 2014. Concussions are considered a type of mild Traumatic Brain Injury (TBI); while there is no structural damage, there is a temporary chemical imbalance/flux . The CDC further describes concussions as “any bump, blow, or jolt to the brain or body that causes the head and brain to move rapidly back and forth”. Common causes of concussions include the following: sports and recreation, falls especially with elderly population, car accidents, and military blasts/blunt trauma.

Breaking the Concussion Myth

The common misconception with concussions is that they are not a “big deal” and someone can return-to-game, work, or combat/service without taking the necessary steps to help relieve post-concussion symptoms. During the first 24 hours, it is most important to eliminate the potential risk of a second concussion. The brain is at a highly vulnerable for what we call “Second Impact Syndrome” which can cause further – and more[JD3]  severe – brain injury and potentially even life threatening. Multiple concussions can also cause more and more symptoms and prolong recovery.

Concussions are not just “your bell got rung”! We need to encourage athletes, military, and the community to listen to their bodies, and if they suspect a concussion speak up and take action. Managing your concussion symptoms may be able to return[JD4]  to activity sooner and drastically reduce their time needed to recover as well as reduce the likelihood of having chronic symptoms.

What to Do Immediately After a Concussion

Immediately after a concussion, your brain goes through a flux of chemical imbalances that are at its peak for the first 24 hours and can last up to 7-10 days post-concussion. During this time, someone may experience any of the following symptoms:

Physical/Postural Cognitive
Emotional Sleep
-Headache
-Nausea/vomiting
-Light sensitivity
-Eye problems
-Dizziness
-General unsteadiness
-Fatigue
-Feeling dazed
-Mentally “foggy”
-Feeling slowed down
-Answer questions slowly
-Difficulty concentrating
-Forgetful
-Repeats self
-Drop in academic performance
-Irritability
-Sad/Depressed
-Personality changes
-Anxiety
-More/less emotional
-Drowsy
-Sleeping more/less
-Difficulty falling asleep or staying asleep

 

With current research, complete mental and physical rest is recommended for the first 24-48 hours after a concussion. During this time, it is very important that an athlete not return to play until cleared by a medical provider! After 48 hours, someone can gradually re-engage back into their normal daily activities. It is recommended to schedule half days when returning to work or school as well as allowing breaks as needed throughout the day. In order to manage symptoms and avoid the snowball effect, use the “Rule of 3’s”. This means stopping any activity that is increasing symptoms >3 points from your “baseline” (on healthcare’s 0-10 scale).

When to Seek Further Concussion Treatment

Someone should seek emergency medical care if they suspect skull fractures, potential spinal cord injury, significant loss of consciousness, worsening mental status, seizures, or persistent vomiting. Even have a family member or friend help monitor things! Medical doctors should be the primary team member to manage and follow-up regarding “return to play”, “return to work”, and “return to learn/school” considerations.

Typically, we recommend pursuing Physical Therapy, specifically concussion-based rehabilitation, after  ~1 month of persistent symptoms. Physical Therapy can help with headache management, dizziness/unsteadiness, light/noise sensitivity, eye problems, visual over-stimulation, and coordination/processing speed. It is recommended to find a Physical Therapist in the area that is knowledgeable and has experience with concussion rehabilitation. These types of experienced therapists will be able to make an individualized concussion treatment plan that are specific and directed toward the patient’s goals. Post-concussion rehab can last anywhere from 1 month to > 6 months.

Other team members may include neuro-psychologists who perform neuro-cognitive screening and assessment, ophthalmologist for continued eye problems, speech therapy for continued cognitive deficits, athletic trainers to help assist return to play, and teachers/coaches/employers  to construct appropriately paced return to activity.

 

 

Get To Know Your Physical Therapist Assistant – Erin Mumby, PTA

Therapydia Denver physical therapist assistant Erin Mumby, PTA, takes some time to talk about her own experience with injury, why she loves Colorado, and her continuing education focus on pelvic floor for male and female patients.

When did you know that you wanted to be a physical therapist assistant?

I was always active and knew I wanted a profession which would nurture this part of me. I injured my knee and hip during varsity cross country and received PT which started me down this path.

What’s your favorite song to get you motivated?

Morning Sun. It’s very repetitive but I love it.

What is the biggest challenge involved in being a PTA?

Being a PTA has a few unique challenges. PTA’s have to be able to form their own personalized treatment style while at the same time, learn each PT’s treatment style to maintain congruency with pt treatment plans. We also face the issue of patients thinking we have no formal education. So patient education is important for us to gain trust.

How do you like to stay active?

I love the activities that Colorado has to offer. I rock climb, backpack, hike, and ski. I’d much rather be outside than in a gym.

What surprised you the most about the physical therapist profession?

The most surprising aspect of PT to me is the fact that I still run into people, physicians, surgeons who don’t utilize PT or are unsure of how we can help as a profession.

Are you currently pursuing any further education/Certifications?

I’ve spent my continuing education with pelvic floor focus for male and female patient’s along with becoming certified in the Selective Functional Movement Assessment and Functional Movement Screen. I am a certified clinical instructor. I am currently searching for a gait/running analysis course.

What’s your go-to breakfast?

Bagels, breakfast tacos, oat meal…I love breakfast!

What do you wish everyone knew about physical therapy? / What is the biggest misconception you hear from new patients?

I just wish the general pubic as a whole knew more about how PT can help so that people didn’t suffer with pain for so long prior to seeking treatment.

What is the most important personality trait that a therapist must have?

Simply just caring about the profession. This is what drives us to continue with our education and put in the effort to spend time researching to find more effective treatment plans.

What do you do to de-stress/unwind?

Working out and reading both help me to de-stress in the evenings.

Finish this sentence: On Saturday mornings, you can usually find me…in the mountains!

What is your favorite piece of wellness advice to offer?

I think the medical profession as a whole needs to give more focus on nutrition and how poor/good nutrition has affects on our system globally.

Get to Know Your PT – Jessica Dietz, PT, DPT

Jessica Dietz Physical Therapist Denver

Therapydia Denver physical therapist Jessica Dietz, PT, DPT, takes some time to talk about her own experience with a torn ACL, the importance of regular physical activity, and sriracha.

When did you know that you wanted to be a physical therapist?

Since freshman year of high school after I tore my ACL. I had wonderful rehab/therapists, enjoyed the activeness of the job, and overall interacting with patients. It wasn’t until a personal experience in college when I helped my dad rehab after an unexpected stroke that I became more interested in neurorehab.

What surprised you the most about the physical therapy profession?

The reality of holistic care. I strongly believe that in order to be a great therapist you need to understand, treat, and respect all aspects of your patient.

How do you like to stay active?

Anything outdoors! I love trail running, hiking, skiing, playing tennis, gardening, etc.

What is the biggest challenge involved in being a PT?

Changes in healthcare that are primarily dictated by insurance companies. Especially the limitations towards shorter plans of care and fewer numbers of visits.

What’s your favorite song to get you motivated?

“Feel Good” by Neon Trees. It’s a song and band with an 80s vibe. You can’t help but dance when you hear it!

Are you currently pursuing any further education or certifications?

I just recently took my certification exam for becoming a neurologic specialist. Next up, I am hoping to pursue further training in NDT (a specific manual facilitation technique) and LSVT BIG/PWRI for Parkinson’s Disease.

What’s your go-to breakfast?

Open-face egg sandwich with sriracha. Sriracha is a condiment that goes on anything! 🙂

What do you wish everyone knew about PT?

To be successful with physical therapy, it is a collaboration between both the therapist and the patient. There will be skills, techniques, and education that will learn during therapy sessions but doing things like your home exercise program and performing regular physical activity is equally as important. Also, the power of regular bouts of therapy throughout a lifetime is best for prevention and identifying things before they become a problem.

In your opinion, what is the most important personality trait that a PT must have?

Good communication and being compassionate.

What do you do to de-stress/unwind?

Running, doing art projects, and cuddling with my three dogs (lab, rescue mutt, and English bulldog).

Finish this sentence: On Saturday mornings, you can usually find me…

Trail running, hiking with my dogs, or sleeping in.

What is your favorite piece of wellness advice?

Wellness is a life-long commitment where physical activity is an important piece of the puzzle. Staying active is linked to improved mood, mental health, cognition, and overall quality of life as well as reducing risk factors for serious conditions such as heart disease and stroke.

Physical Therapy at the Burton US Open

snowboarding physical therapy denver

By Aaron Page, DPT
Therapydia Denver Physical Therapist

Earlier this year, I was fortunate enough to be selected as one of the medical providers for the Burton US Open Snowboarding Championships in Vail, CO, just up the hill from our Denver clinic. Needless to say, this event brought many of its own unique and exciting challenges for a PT, but overall, it was another incredible way that we at Therapydia are able to relate to our patients and provide high-quality care in a variety of settings.

If you’re not familiar with the US Open, it is one of the largest snowboarding competitions in the country. In its 37th year overall (and 7th year in Vail), the event continues to grow and draw the top snowboarders from all around the world. Burton and the staff involved do an incredible job putting the event together—constructing a world class course in both Slopestyle and Halfpipe, as well as (more directly related to my realm) a remarkable medical support system for the riders.

Situated at the bottom of the Slopestyle course and steps away from the corral where the athletes land on the final jump, is the medical tent. In the tent is what can be described as a “Treatment and Recovery Zone” for the athletes—complete with all of the features you would expect from a small clinic. Treatment tables, compression recovery boots, foam rollers, exercise bikes, etc. all available for athletes throughout the entire event. Behind all of the equipment though, are those practitioners that help facilitate care and are what really shine through when it comes to protecting the pro athlete. The interesting thing to me was that familiarity and environment allowed the treating practitioners, physicians, and physical therapists alike, to jump right in to a quality treatment approach. Interactions with riders still began with an evaluation (though it may look slightly different than from one you see in our clinic) and focused on identifying specific needs and issues the rider may have. Ultimately for a PT in that setting, the foundation was the same: Pinpoint areas of concern (ie. limited mobility, limited flexibility, limited stability) and implement an intervention that addresses those concerns. Though the timeline and plan of care may be different for the snowboarder considering that they have to compete in the next few days, the framework is similar to any patient that we see in the clinic. Our goal was to educate the rider on what we can address together to improve their mobility, stability, and possibly strength, to get them where they needed to be for competition.

physical therapy snowboarding

Headed by Dr. Bryan Huber, Medical Director for Burton Global Snowboard Team/Team Physician for US Snowbaording and Dr. Tom Hackett, Steadman Hawkins Orthopedic Surgeon/Team Physician for the US Snowboard Team, they have developed a system and orchestrated a team that covers all aspects of care for the riders. For orthopedic surgeons, massage therapists, surgical fellows, paramedics, certified athletic trainers and physical therapists, the riders are supervised and cared for in each aspect of the event, something unique to this type of competition.

From a physical therapy perspective, unfortunately this high level of care is sometimes a rare occurrence at an event like this. More often than not, these competitions are not covered with the same detail due to the chaotic nature of trying to manage 40+ riders each day. Though some of the top riders/teams may have a PT on staff and receive quality care, being responsible for the entire team can make personalized treatment difficult following an injury when you also have to ensure the safety and care of the rest of the team. That’s where we came in that week.

physical therapy denver

With the first practice of the day at 9am, the medical tent was open and ready to assist the riders with any pain or concerns that they had. I heard from numerous riders during the first few days that they had been nursing an injury over the last few weeks but didn’t have an opportunity to follow up with a trusted medical practitioner. Some even waited intentionally because they knew they could trust the team at the Burton US Open. Engineered by Mike Giunta, owner and physical therapist at Evolution Physical Therapy in Los Angeles, this system of evaluation and collaboration with the other medical providers allowed for comprehensive, individualized care throughout the whole week. It wasn’t uncommon that a rider would come in shortly after practice, feeling the effects of being 20 feet above the deck of the halfpipe, and leave the medical tent more comfortable and confident that their issue was going to be addressed.

My time at the Burton US Open was extremely valuable. Not only was I fortunate enough to work with some of the best surgeons, ATCs, PTs, and snowboard athletes in the world, it also provided me with a renewed sense of understanding and circumstances of any patient. Now, not all of us are landing the first ever double crippler as a female in competition (shout out Maddie Mastro), but we can all relate to the challenges, on any scale, of dealing with pain and injury. The stakes are high for everyone and it is our responsibility as physical therapists to meet any patient where they are so we can fight for them to overcome their own adversity. Not just on the professional level but on any playing field: in the clinic, in the insurance industry, in the research lab, and with healthcare as a whole. I look forward to taking that back to Therapydia and continuing the high level of care for the field of physical therapy and those who need it.

Hip Labral Tear Recovery Timeline: Treatment Breakdown

hip labral tear hip pain torn labrum hip

A hip labral tear involves damage to the labrum, the ring of cartilage located on the outside rim of the socket of your hip joint. This is precisely where the thigh bone (femur) meets the pelvis (ilium). Tearing can be a result of repetitive twisting, cutting and pivoting movements, common among athletes who participate in sports like hockey, soccer, football, ballet or any other activities that require a lot of sudden movements and directional changes. A hip labral tear could also occur as a result of structural abnormalities that you’re born with, made worse by excessive wear and tear or a trauma that causes an injury or dislocation to the hip. However it occurs, if you’re experiencing a deep ache in the front of your hip or groin, pain that increases with prolonged sitting or walking, stiffness in the hip or symptoms such as clicking and locking, it’s possible that a hip labral tear is to blame.

Although the timeline for hip labral tear recovery varies depending on your specific injury, if you require surgery, you should expect about 4 months of one-on-one treatment with your physical therapist and roughly 6-9 months before you feel 100% again. It’s important to note that not all hip labral tears require surgery. Often times, physical therapy and exercises to stabilize the joint can help patients avoid surgery all together, even with the presence of a tear. If your condition does require surgery, the following timeline will give you some insight into what to expect during your physical therapy treatment process.

*Please note, the recovery times included in this timeline are general estimations and may not correlate with your specific situation.

hip labral tear torn labrum hip hip bursitis

0 Weeks: Prehab Prior to Surgery

So you’ve suffered a hip labral tear and you know that you need surgery. Did you know there are steps you can take prior to surgery to help expedite recovery? The amount of time you spend in prehab depends on a few different factors and is sometimes, unfortunately, dependent on your insurance plan. If you’re limited to 20 visits per year for instance, your physical therapist may have to save some of your PT sessions for post-op but if you have more visits available to you, prehab can take a bit longer. If you have comorbidities, or other limitations or disorders that could complicate the recovery process, this could also delay things.

When you begin prehab, your physical therapist will conduct a full body assessment to check for limitations in range of motion and strength to get an idea of what sort of plan of care your condition requires. If weakness is the main issue, you may be OK with just a few sessions to educate yourself on the post-op rehab process and to get a good idea of what lies ahead. You and your physical therapist will work together to create a prehab program to make sure that you’re entering surgery as strong as possible. Pain management strategies will be discussed as well as methods to strengthen weakened muscles, especially in the glutes, core and legs. This will help you maintain better strength with functional activities.

Torn Labrum Hip Bursitis Hip Stretches Surgery

0-4 Weeks: Post-Surgery Baby Steps

The amount of time after your surgery that you must wait before beginning any sort of physical therapy treatment is dependent on your surgeon’s specific protocol. Once your physical therapist and surgeon have come up with a good time to begin rehabbing your hip labral tear, your PT will ease you into an initial treatment plan that aims to reduce any swelling and pain, improve mobility with precautions/limitations and restore normal gait patterns. The progress you make during this period is dependent on your overall comfort level during mobility exercises and stretches. Because you’re still recovering from surgery, most activities should be avoided during this stage. To protect the repair limitations that are put on the hip, it’s important that certain movements are abstained from. Some physicians may ask you to use crutches with partial weight-bearing to reduce stress and load on the hip / repaired structures.

Your physical therapist will work on your soft tissue and muscles to improve tone and reduce pain. They’ll also prescribe range of motion exercises to help with mobility. It’s common to ease into exercising by riding an upright stationary bike to assist with range of motion. Your PT will guide you through initial exercises to ensure that you’re performing them correctly and with the right precautions. They’ll talk you through the best way to go about staying within range of motion restrictions as you go about daily activities as well. Manual therapy techniques will be utilized to help with passive range of motion through various movements. This helps to promote blood flow to the hip, decreasing swelling and inflammation within and around the joint.

The initial rehabilitation phase may be scary at first but your PT is there to help minimize your pain. It’s their responsibility to make your recovery as efficient as possible while working within your pain tolerance and not pushing you to the point of discomfort.

Physical Therapy Labral Hip Tear Hip Pain Surgery Upright Bike

4-8 Weeks: Keeping it Moving

As you begin moving more comfortably, your physical therapist will work even more to restore full range of motion, improve your strength and stability, normalize your gait and begin focusing more on increasing leg strength. In this phase of rehab, you should see decreased pain and improvements in range of motion, strength and stability. You should also notice the ability to walk further without pain and see progress with the ease of going up and down the stairs. It may be common to experience fatigue when performing weight-bearing activities so any high impact movements should be avoided.

Appropriate activities during this phase of recovery include walking short distances (gradually building up to 1 mile). You can also continue with the upright bike and begin to add resistance about six weeks post-op. Swimming and elliptical training can usually begin around week 8 as long as there is not a lot of pain. Your PT will help you through exercises that focus on hip strength and stability and continue to work on strengthening your glutes, legs and core muscles. There will be more focus on balance and stability as well. If you’re still experiencing a significant amount of pain at the 8 week mark or recovery, your PT will help you modify your activities outside of physical therapy to get a hold on your current threshold to activity. Pain may be the result of weak musculature which would explain why if you’re too active, fatigue sets in and muscles and joints can start to compensate which may cause discomfort.

8-12 Weeks: Beginning Lower Extremity Workouts

2-3 months after your surgery, your goal is to continue building strength and endurance and to train your stability. You’ll know that you’re progressing well if you see an improved tolerance to weight-bearing activities and a decrease in your level of pain. High-impact activities, such as jumping, should still be avoided but walking and stationary biking should continue. Your physical therapy treatment will begin to introduce body weight squats and various other strengthening exercises. Double and single leg closed-chain exercises may be included such as step ups, step downs, lunges, and single leg balance training. Depending on your progress and pain level, your PT may include manual therapy techniques to stretch your muscles and mobilize your joints.

Torn Labrum Hip Physical Therapy Surgery Hip Pain Post op

12-16 Weeks: Back to Jumping

If all is going well around 4 months post-op, you should begin dynamic drills to introduce jumping, agility and running into your plan of care. You’ll continue working on strength, endurance and balance training with the idea that your endurance shows improvement with all activities. It’s important to continue discussing with your physical therapist and surgeon the activities that you should avoid, as it will vary person to person. At this point in your physical therapy treatment, there should be less reliance on manual therapy techniques and more of an emphasis on exercises and self management of your recovery. Exercises included may focus on single limb strength and balance, non-loaded / loaded jumping, agility drills and a return to running program. As a patient, the best thing you can do is to stay compliant with your home exercise program so that you can maintain the gains you’ve achieved during your PT treatment.

4 Months+: Getting Back to Regular Life

Depending on your condition and unique body, it could take anywhere from 6-9 months before you feel 100% again. As mentioned above, staying compliant with the home exercises provided by your physical therapist is the best way to ensure the strength and mobility you’ve achieved continues. Consult your physical therapist if there is any doubt about returning to a certain activity or if you have questions with your home exercises.

Get to Know Your PT: Cami Hatch, DPT

Denver Physical Therapy Cami Hatch

Therapydia Denver physical therapist Cami Hatch takes some time to talk pelvic health PT, the importance of being a good listener and changing up her workout routine.

“It’s important to challenge the body in different ways. Try new things and be adventurous!”

When did you know that you wanted to be a physical therapist?

I took some time off after I graduated from undergraduate and got a job working as a PT aide. I really enjoyed the environment and working with people and I liked that I could stay active throughout the day while still challenging my mind.

What is the biggest challenge involved in being a PT?

I would probably say dealing with the healthcare system. It’s challenging to have to consider how the patient’s insurance will affect their treatment.

How do you like to stay active?

A little bit of everything; running, yoga, hiking, weights. I recently started biking a little more too. I like snow sports in the winter. I snowboard mostly but I am trying to get into cross country skiing.

What’s your favorite song to get you motivated?

I could never pick just one, it varies monthly. Right now I have a lot of 90s hip hop on my running playlists. I’m also a big fan of the 60s and 70s.

What surprised you the most about the physical therapy profession?

The plethora of different theories and beliefs that PTs have. There are so many different treatment options and programs that sometimes it can get a little overwhelming. I try to learn from all the different approaches and take what I can from each one.

Are you currently pursuing any further education/certifications?

I try to take continuing education courses as often as I can. I think eventually I will consider getting a women’s health certification.

What do you wish everyone knew about PT?

From a women’s health/pelvic floor perspective, I wish people knew more about what Pelvic Floor PT is in general. People are often told that medication or surgery is the only option when in fact there are other things we can try. I also wish more women would come in after childbirth. I think people assume that since the female body is designed to give birth, everything will be fine but in reality it is a trauma and it’s important to make sure the muscles and tissues recover fully to regain strength and function.

What is the most important personality trait that a PT must have?

I think it’s really important to be a good listener. Listening to how a patient feels and what their thoughts are about their pain/recovery helps to determine how to approach treatment. I think this is especially important with my women’s health/pelvic floor patients because their pain/issues may have more of an impact on their psychosocial health and personal relationships. It’s important to consider the patient as a whole person rather than just an injury/diagnosis.

What’s your go-to breakfast?

Sprouted wheat bagel with peanut butter and coffee.

What do you do to de-stress/unwind?

It depends on the day. Sometimes I like to go for a run, it helps to organize my thoughts and get out my energy. Other times I enjoy reading, yoga and meditation.

Finish this sentence: On Saturday mornings, you can usually find me…

Well every other Saturday I am working. Otherwise probably sleeping in and trying to convince my boyfriend to go trail running with me.

What is your favorite piece of wellness advice?

Change it up. I think it’s easy to get into a specific routine and to do the same things all the time but it’s important to challenge the body in different ways. Try new things and be adventurous!

Click here to learn more about Cami and the other physical therapists at Therapydia Denver.