Taping to help pull up the inside of the arch and decrease flat foot / pronation.

In our company, Probility Physical Therapy, we commonly do hands-on techniques called “joint mobilizations”.  These are used for when a patient has a joint that is not moving correctly due to being “stuck”, hypomobile, or out of position (subluxed).  There are also physical therapists who call these techniques manipulations and there is some ambiguity in this.  A Manipulation can be any therapeutic technique that increases the range of motion of a joint or it can be a very specific kind of mobilization – referred to as a high-velocity, low amplitude thrust (sorry for the technical terms, here).  A “thrust” technique is similar to what many chiropractors call an “adjustment”.  In the end, as far as Physical Therapists are concerned, all of these techniques are just trying to get a joint moving more normally so that a person can move their body without restriction or pain.

Joint mobilizations can be done to any joint in the body.  They can be done in multiple directions and with varying degrees of force or speed.  A mobilization can be done where a therapist takes a joint to its end-range barrier and stretches it at that point or where a therapist takes it to the end range barrier and oscillates it (gentle glides the joint back and forth).  It is important to note that joint mobilizations are DISTINCTLY different from stretching a part of the body.  A therapist who takes a part of the body and just moves it through its range as far as it can go and stretches the muscles around the joint is not mobilizing the joint – and often times this type of technique (aggressive stretching of a dysfunctional joint) simply causes compression of the joint structures and pain.

Our belief is that it is best to mobilize the joint to make sure it moves correctly, release / relax the muscles in the areas and then do stretching and muscle retraining to those same muscles.  This is basically a concept that, when a person has a dysfunction that is creating pain, you need to fix/correct the problem before you should stretch or strengthen the area.  After you correct the underlying issues that are creating the pain, then it is perfect to strengthen the heck out of the muscles to make sure it doesn’t come back!

Pilates is an exercise style that has grown significantly in the last 5-10 years and there are many good reasons for this.  It incorporates strength and stretching into almost all of the movements and is different than most other types of exercises in that it builds significant stability into your body – especially in your core – along with strength.

Exercises in Pilates can be slow and controlled or fast but they are all focused on quality of movement.  Any class that you go to should have an instructor who is watching all of the time and giving feedback on where your body is compensating around a weakness that you might have.

Common classes are mat-based but some of the fun of Pilates is the very cool/funky equipment that you may get on to stress your system and finds it’s weaknesses.  The name of some of the pieces is part of what adds to its “coolness”.  Things like the Reformer, the Trapeze, the Barrel, and the Cadillac!  Very cool!

Back to the serious stuff, some specific benefits of Pilates include:

• Improved posture
• Increased muscle tone
• Increased strength
• Increased Flexibility
• Improved overall mobility
• Increased focus on your breathing
• Improved circulation and decreased stress

As far as an adjunct to Physical Therapy, there are few better exercise styles.  Once your therapist has fixed specific dysfunctions in your system that were causing pain and gone through a progression of strength, stabilization and stretching exercises, Pilates is a natural next step.  It is a great way to stay strong or further progress your stability so that the chance of your pain coming back is very, very small.

Yoga is a practice that focuses on stretching, breathing and meditation.  Many people are drawn to it because they want to work on relieving stress, get in shape, become more flexible, decrease pain and increase core strength.

There are different kinds of yoga:

• Hatha: One of the most popular types of yoga, hatha yoga is meant to achieve balance between the mind and body. It includes traditional yoga postures for all levels, and is often a general term used to describe a collection of yoga styles.
• Ashtanga and Power Yoga: This involves a fast-paced, flowing sequence of postures that gradually increase in difficulty.
• Forrest: A more contemporary type of yoga that makes you work up a sweat. It involves deep breathing, core strengtheners and holding postures for a longer time period. It is meant to purify and strengthen the body, along with promote the release of negative emotions and pain.
• Vinyasa: A gentle yoga practice in which breathing is synchronized with the poses.
• Bikram: A series of 26 poses are performed in a heated room (the temperature can be anywhere from 90-100 degrees F) to make your body sweat. The heat in the room is meant to increase your body’s flexibility, reduce the risk of injury and help you to detoxify.
• Kundalini: Kundalini yoga is meant to awaken a powerful energy that is located at the base of the spine. The energy, once released, is said to bring a great sense of well-being and awareness.
• Bharata: Bharata yoga helps to align the spine to increase mobility and improve posture.
• Ananda: Includes a series of gentle hatha yoga poses designed to send energy toward the brain to prepare the body for meditation. This type of yoga is meant to promote spiritual growth and self-awareness.
• Anusara: Meaning literally “to step into the current of divine will,” anusara is meant to promote awareness and well-being along with body alignment.
• Iyengar: This is a practice geared strongly toward bodily alignment. Poses are held for longer periods (as opposed to “flowing” from one into the other).
• Jivamukti: A physically intense yoga series that also involves chanting, meditation, and spiritual teachings.

I will typically refer people to yoga when I feel that flexibility, posture and stress are significant causes of their pain.  We have a number of staff members who do yoga regularly for both the flexibility and the strength aspects.  It is something that some people go to simply to have a time of peace in their day or week and that is a rare and precious thing these days!

No matter what the reason is that a person may go to yoga, my personal thought is that it is a wonderful practice and that it has many positive benefits for a person’s physical and psychological health.

Let’s start off with the answer to that question – it is both a small “Yes” and a big “No”.  Read on t0 learn more. . . .

Recently there was a story written about a research study done that showed that running shoes increase the torque on your knee joints even more than high heels do – wow!

The article was written by Rachel Rettner, with LiveScience.com, and was a good article – www.livescience.com/health/running-shoes-joint-strain-injury-100112.html.  The article it references is:

The effect of running shoes on lower extremity joint torques.  Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. PM R. 2009 Dec;1(12):1058-63.

In its conclusion, the article states:

“The findings at the knee suggest relatively greater pressures at anatomical sites that are typically more prone to knee osteoarthritis, the medial and patellofemoral compartments. It is important to note the limitations of these findings and of current 3-dimensional gait analysis in general, that only resultant joint torques were assessed. It is unknown to what extent actual joint contact forces could be affected by compliance that a shoe might provide, a potentially valuable design characteristic that may offset the observed increases in joint torques.”

The study had 37 women and 31 men who ran at least 15 miles/ week, recreationally.  The comparison was of barefoot running versus running with a typical modern running shoe and measured the torque at the knee, hip and ankle joints.  It also measured the amount of bodyweight force created, using a foreplate under the treadmill (basically a scale under the treadmill).

The author, Rettner, states:  “The researchers found an increase in the torque for the knees, hips and ankles when the participants were wearing running shoes as compared with when they were running barefoot.”

Specifically, they saw a 38 percent increase in torque in areas of the knee where osteoarthritis develops.  This was greater than what is created while wearing high heeled shoes, which showed a 20-26 percent increase.

Even though the increased force can lead to damage in the joint, it is not recommended that you stop wearing your running shoes.  Today’s running shoes absorb shock very well from the hard running surfaces that people run on today and that is a significant issue.  They also support the foot and help to prevent things like shin splints.

A key question at this point, obviously, is whether running and running shoes are “good” for you or not.  There are significant benefits from running, specifically – cardiovascular, weight, emotion, balance, bone strength, and on and on.  It should be recognized that there is increased stress on your joints with running – and now apparently specifically from running shoes and I think it is interesting that the higher heel of a running shoe impacts your joints negatively.  Having said this, you shouldn’t stop running and, as the article says, you shouldn’t ditch those shoes – like most things in life, they some positive effects as well as some potential negatives. . . .

There was a recent article written in the NY Times about Physical Therapy which I thought brought up some very interesting issues and I thought I would share my view on it with everyone.  The article spoke of the worthiness of therapy, how much of it is evidence-based and how some parts of it are “Voo Doo”.  The title of the article is “Treat Me, But No Tricks Please” and was written by Gina Kolata.  The link is: http://www.nytimes.com/2010/01/07/health/nutrition/07best.html.

One of the most significant points that it speaks about is how classic (what I would call low-level and old fashioned Physical Therapy)  is not very beneficial.  Therapy such as this is primarily focused on modalities such as Ultrasound, Heat, Electrical Stimulation and Ice and is considered “Voo Doo” by many physicians.  It does not focus on what is causing the symptoms and  how to decrease these symptoms.  Most pain, muscle spasms (“knots” in a muscle) and limitations of motion are due to limitations in the mobility of a joint or overworking of specific muscles.  If you fix the underlying “drivers” of a person’s pain, the inflammation, pain, muscle spasms, etc all go away.

The author of the article makes some interesting comments on the use of modalities.  A quote from the article:

When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.

My doctor at the Hospital for Special Surgery in New York, Joseph Feinberg, seems to share my opinion. “Very often, I think the hot packs, cold packs, ultrasound and electrostimulation are unnecessary,” he said, adding, “For sure, in many cases these modalities are a waste of time.”

I agree thoroughly with most parts of this article, including where we need to have more evidence to back up what we do in therapy.  Unfortunately, there is a definite side of therapy that is difficult to measure and “prove” in a research study.  This side  is significant, however, in why patients get long-term improvement with treatment.  The American Physical Therapy Association wrote a response to the article listed above (link is:  http://www.apta.org/AM/Template.cfm?Section=Letters1&CONTENTID=67938&TEMPLATE=/CM/ContentDisplay.cfm) and they make a fantastic statement in the response that I’d like to share:

But evidence alone cannot heal a patient. With the best available evidence at hand, a health care provider must use their evaluative skills, clinical judgment and assessment of a patient’s needs to develop a plan of care.

Evidence is essential, but it must be combined with a health care provider’s unique knowledge and understanding of an individual patient.

Physical Therapy, just like much of medicine including Orthopedic Surgery, is a combination of science and art.  A good therapist will treat their patient keeping these two things in mind.  Therapists who simply focus all of their treatment on exercise are basically glorified Personal Trainers and clinics that recommend every patient be treated with heat, cold, electrical stimulation and ultrasound are places that give Therapy a bad name.  A great PT clinic finds the source of a person’s pain and treats the source. Taking it one step further, a great PT will teach the patient how to treat themselves with specific exercises for strength and flexibility which will address postural issues that a person may have.  And, only if needed, the use of modalities to settle inflammation down along with everything else.