Written by: Lindsay Simmons
Clinical Director, Purcellville Orthopedic Physical Therapy

Do you ever get the urge to dance when a song comes on the radio, or even find yourself dancing around the house while jamming out to music? If that is a yes, then you are not alone! I find myself thinking to "All I want to do is DANCE!!" Well ladies and gentlemen Zumba is where you can be free and dance like no one is watching.

Every night I go to the gym and I know that I have to keep switching things up so I don't get bored with the same old routine. I have learned that if I have the same routine my body becomes familiar with this and I hit a plateau, which is never fun when you are trying to either tone, maintain or even reach a new fitness goal. But when there is a will, there is a way!!

I have found that Zumba is just what I need to keep things fun and interesting. Zumba is a workout known as a dance fitness party. I originally tried Zumba with a friend by following a fitness DVD. While the DVD was fun and the hip-swiveling moves were a blast (and effective at working up a sweat!), the best part of the workout was dancing with my friend. We would giggle at each other as we tried to get our hips to salsa, merengue and cha-cha-cha like the girls in the video. Zumba Fitness is a Latin-inspired cardio-dance workout that uses music and choreographed steps to form a fitness party atmosphere. While many of the types of dance and music featured in the program are Latin American inspired, classes can also contain everything from jazz to African beats to country to hip-hop and pop.

Don't worry if you think you can't dance or that it's not your thing, because Zumba is just people dancing. Well, let me tell you that no one is watching and if you lose the step all you need to do is move to the sound of your own drum. Just have fun with it! No one is expecting you to be amazing but just enjoy a different way of working out. For those who feel that Zumba is just dancing, boy you have no idea what you are missing. Researchers determined that Zumba is an effective interval-style, total-body workout with built in variety because every class and every instructor is slightly different. The heart-rate during a Zumba session, looks like an interval workout, going back and forth between high intensity and low intensity therefore; with Zumba you burn a lot of extra calories compared to a steady-state exercise like jogging.
With that being said, enjoy switching things up and live a little on the wild side.

My Doctor Said I have Osteoarthritis in my Knee. What is it? and How can Physical Therapy Help Me?

What is Osteoarthritis of Knee?

Osteoarthritis of the knee (knee OA) is a progressive disease causing inflammation and degeneration of the knee joint that worsens over time. It affects the entire joint, including bone, cartilage, ligament, and muscle. Its progression is influenced by age, body mass index (BMI), bone structure, genetics, strength, and activity level. Knee OA also may develop as a secondary condition following a traumatic knee injury. Depending on the stage of the disease and whether there are associated injuries or conditions, knee OA can be managed with physical therapy. More severe or advanced cases may require surgery.

 

How Does it Feel?

Individuals who develop knee OA experience a wide range of symptoms based on the progression of the disease. Pain occurs when the cartilage covering the bones of the knee joint wears down. This narrows the space between the bones and causes friction. Because the knee is a weight-bearing joint, your activity level, and the type and duration of your activities usually have a direct impact on your symptoms.

Symptoms of knee OA may include:

• Worsening pain during or following activity, particularly with walking, climbing, or descending stairs, or moving from a sitting to standing position
  Pain or stiffness after sitting with the knee bent or straight for a prolonged period of time
• A feeling of popping, cracking, or grinding when moving the knee
• Swelling following activity
• Tenderness to touch along the knee joint

Typically these symptoms do not occur suddenly or all at once, but instead they develop gradually over time. Sometimes individuals do not recognize they have osteoarthritis because they cannot remember a specific time or injury that caused their symptoms. If you have had worsening knee pain for several months that is not responding to rest, it is best to seek the advice of a medical provider.

 
 

How Can a Physical Therapist Help?

Your physical therapist will design an individualized treatment program specific to the exact nature of your condition and your goals.

Range of Motion

Often, abnormal motion of the knee joint can lead to a progression of OA when there is more contact between, and wear on, the bones. Your therapist will assess your motion compared with expected normal motion and the motion of the knee on your uninvolved leg.

Muscle Strength

Strengthening the muscles around your knee will be an essential part of your rehabilitation program. Individuals with OA who adhere to strengthening programs have been shown to have less pain and an improved overall quality of life. There are several factors that influence the health of a joint: the quality of the cartilage that lines the bones, the tissue within and around the joints, and the associated muscles. Due to the wear and tear on cartilage associated with knee OA, maintaining strength in the muscles near the joint is crucial to preserve joint health. For example, as the muscles along the front and back of your thigh (quadriceps and hamstrings), cross the knee joint, they help control the motion and forces that are applied to the bones.

Strengthening the hip and core muscles also can help balance the amount of force on the knee joint, particularly during walking or running. The “core” refers to the muscles of the abdomen, low back, and pelvis. A strong core will increase stability through your body as you move your arms and legs. Your physical therapist will assess these different muscle groups, compare the strength in each limb, and prescribe specific exercises to target your areas of weakness.

Manual Therapy

Physical therapists are trained in manual (hands-on) therapy. Your physical therapist will gently move and mobilize your muscles and joints to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own. In patients with knee OA, the addition of manual therapy techniques to exercise has been shown to decrease pain and increase function.

Modalities

Your physical therapist may recommend therapeutic modalities, such as ice and heat, to aid in pain management.

*Information provided my MoveForwardPT website: Osteoarthritis.

Maybe you’ve seen the CrossFit Games on ESPN or possibly have a friend that has received positive results from joining CrossFit. You’re not alone as a lot of people around the world have been joining the CrossFit craze within the past few years. Maybe you’re even thinking about joining a CrossFit gym near your home in Frederick. Before you jump right into, you may want to read the rest of this blog in order to learn a little bit more about the methodology and potential injury risks of this high intensity workout routine.

CrossFit’s goal is to create a general fitness that focuses on functional exercises while incorporating a variety of workouts improving strength, speed and endurance. While focusing on functional activities that are actually used in sports, CrossFit workouts can include any combination of exercises from running to rowing to Olympic lifts to plyometrics. Generally speaking, most workout’s ultimate goal is to do the workout as fast as possible or as many repetitions as possible within a given time frame.This will encourage you to constantly improve upon previous workouts and never let you settle for anything less than your best. In addition, there are usually no designed rests between sets which can turn any regular workout into perhaps the most difficult workout you’ll ever try.

When performed properly, CrossFit can be a fun and motivating way to get into fantastic overall physical condition and prepare you for your sport. One of the great aspects of CrossFit is the constant variety of workouts which prevents boredom and will definitely keep you excited to continue towards your fitness goal. Another great aspect of CrossFit is the team atmosphere that reverberates throughout the gym. Support from the trainers and other CrossFitters will encourage you to keep going during a workout and encourage you to come back for more.

Just like any other workout regimen, it’s very important to take care of your body in order to limit the risk of injury. Proper technique is critical to limiting injury, especially in power lifts such as the dead lift and squat. Prior to doing an exercise during a CrossFit workout, be sure that you’ve mastered the technique and understand what it feels like when form is slipping due to fatigue. For example, a common compensation during the squat is rounding your back which can increase stresses on your back and can lead to injury. Be sure to take a break when you feel technique slipping in order to avoid these compensations. It’s better to do one correct repetition than 100 with poor technique.

Given the high demand of these workouts, make sure you take care of your body outside of the gym as well to decrease risk of injury. Proper nutrition and rest are key components to preparing your body both before and after workouts. Rest doesn’t just include getting proper sleep at night but also means proper rest between workouts. This means allowing 48-72 hours of rest before working out the same muscle group.

Whether you’ve already begun CrossFit training or you’re interested in doing so, be sure to exercise smart and never sacrifice quality for quantity. The compensations that follow will inevitably lead to imbalances, pain and eventual injury. Understand that high intensity training should only be utilized by those in top physical condition and have been training for an extended period of time. If you have any questions, our wellness team at Superior Physical Therapy & Sports Rehab can help prepare you to begin this high intensity workout program.

If you have watched any sporting events, you may have seen some athletes wearing that crazy sports tape on their shoulders, knees, ankles, or any other part of their body. You may have wondered what is that stuff and what does it do? Well wonder no more, the tape you see on Olympiad Kerri Walsh's shoulder is called Kinesio Tex tape (KT tape, for short).

The history of KT tape may surprise you. It began in Japan, Dr. Kenzo Kase first developed the Kinesio taping method in 1979 (over 35 years ago!). He is a chiropractor as well as a licensed acupuncturist. Dr. Kase realized that manual therapy (i.e., massage therapy, chiropractic care, and physical therapy) was extremely effective for the treatment of different ailments, but often the effects were short lived. He sought out for something his clients could use between appointments to increase the effectiveness of manual therapy for longer lasting results. The Kinesio taping method was introduced to the United States in 1995, and then Europe in 1996. However, it wasn't until 2008, when Kerri Walsh was seen with the tape did it become popular in the States.

So what does the KT tape method do? Kinesiology taping is based on the body's own natural healing process. Unlike conventional athletic tape, kinesiology tape has elastic properties and does not restrict movement. It is made of 100% elastic fibers that are latex free. You may notice a wave-like pattern, which is put on the tape to mimic fingerprints and allows the tape to breathe. The amount of stretch in this tape correlates with the elastic qualities of our skin and its special properties aid our proprioceptors and lymphatic system. When applied correctly, kinesiology tape can be used to treat:

• Acute and chronic pain
• Swelling/edema (Research | Kinesio Tape)
• Myofascial tightness (https://www.manualtherapyjournal.com/article/S1356-689X(09)00147-7/pdf)
• Provides joint alignment/stability (Motion tracking on elbow tissue from ultrasonic image sequence for patients with lateral epicondylitis.)
• Over-active muscles
• Bruising

Can anybody use the KT tape method? The success of this tape is dependent on proper examination and application. Therefore, it is best to see your favorite physical therapist for the assistance of proper application. Different techniques are used for each unique objective. Are you trying to relax a tight muscle, assist a weak muscle, decrease pain or swelling, or support a joint? To be truly effective, a practitioner needs to know exactly why the tape is being applied. Having this information determines joint/muscle positioning for taping and determines the amount of tension and in what direction it is applied. Here at Superior Physical Therapy and Sports Rehab (www.frederickpt.com), we are trained in using the KT tape method for orthopedic and neurological issues and would love to help you get back your function in a safe and supported manner.

It has been a long day at work at your computer, you have been sitting for hours and your head is “pounding” again, but why? Tension and migraines can typically be the culprit, but this time it could be coming from your neck. Cervicogenic Headache, or neck related headache, according to Zito in 2006 makes up 18% of all chronic headaches, and according to Hall in 2007 makes up 20% of all recurrent headaches.

When patients come in to the office for evaluation, I look for 3 items to determine if their headache is coming from the neck.

• Decreased Active Range of Motion for Neck extension: Looking up
• Pain with palpation to c1-c4 joints: Upper portion of the neck
• Weakness in the deep flexor muscles of the neck

These items are only present in a cervicogenic headache. Not a migraine, nor a tension headache.

These type of headaches are very treatable and typically involve, postural training, neck strengthening, joint mobilization to the upper portion of the neck, and ergonomic assessment.

So if you have a headache, and don’t quite know what is the cause. Make an appointment with your physical therapist, preferably Superior PT, and allow us to assess if it is coming from your neck.

After Christopher McDougall’s book “Born to Run” became a national bestseller in 2009, the running world was turned upside down by the notion that the current running shoe model may be one of the leading causes behind the high prevalence of injuries to runners. After reading the book, millions of runners around the world decided to ditch their expensive running shoes for the Vibram FiveFingers (the funny looking toe shoes) or something of the like. During their running shoe transition, many runners experienced lower leg injuries which eventually led to a class action lawsuit against the Vibram FiveFinger company in 2014 for making false health claims.

However, the question still remains: is barefoot or minimalist running beneficial to running athletes? The research published in some of the most respected physical therapy and sports journals in the world suggests that barefoot running may have significant advantages in improving running mechanics, performance, and decrease the risk of injury.

Barefoot running encourages a forefoot strike which has been shown to reduce the risk of injury compared to a rearfoot strike pattern. Have you ever tried going outside and running on your heel? I promise you won’t last long. That’s because a forefoot strike is more forgiving than the more common rearfoot strike pattern. Landing on the front of your foot allows for the small muscles in your feet, Achilles tendon, and calf muscles as well as the quadriceps to all work together to help dampen the impact during each stride. When you land on your heel, all of the force is immediately felt in the bony heel and transferred up the chain to the knees and hips. That might not be a big deal for one step, but when the process is repeated over an extended period of time, overuse injuries are inevitable. It’s probably not a coincidence that 95% of runners land on their heel and 80% of runners are injured in a given year.

In addition to the benefit of a forefoot strike, barefoot running increases sensory feedback when the foot hits the ground and increases the energy storage in the arch and Achilles tendon. This allows the Achilles to act similar to a spring, absorbing the shock and rebound, decrease the amount of effort required in the push off phase of the running cycle.

So if there are so many benefits to barefoot running, why was there an increase in the amount of injuries to the runners that tried it out? The answer likely lies in a flawed transition period. Making the transition to barefoot running takes a long time (conservatively, 1-2 years) for a number of reasons. Number 1, people have been living in a literal foot cast for most of their lives. When you put your leg in a cast after an injury, it doesn’t take long for the immobility to cause severe atrophy and weakening of the muscles in the leg. Likewise, the shoe acts as a cast for the small muscles in the bottom of the foot, not allowing them to work and causing them to become weak. It takes time to build up the strength of these muscles. Number 2, it also takes time to recreate the way you run. There is a significant biomechanical difference between rearfoot and forefoot striking. It takes time and effort to transition properly.

If you have a desire to run in a more efficient way and reduce your risk for injury, please contact one of our offices to get more information. Our physical therapists that we have on staff are well educated in the most up-to-date research regarding running rehabilitation. We will work with you in order to help you get over a current injury and even prevent a future injury.

Spring Cleaning:
I know all of you are hoping, just like I am, that spring is finally around the corner. For most of us, the change of season brings the "itch" for spring cleaning. With this in mind, I thought I would present everyone with some tips on lifting techniques to reduce the risk of serious injury.

1. Stand close to objects you are trying to lift.
   When you are trying to lift something whether it is from the floor or off a shelf get as close to the object as you can before picking it up. It is simple physics; the further away an object is from your body, the greater torque it will put on your shoulders, back, etc. Greater torque=Stronger muscle force needed to lift.



2. Bend your knees.
   Remember, when picking something off the floor, don't bend only at your back. You should have your back straight, head up, and knees bent. The muscles in your back are very small compared to your quadriceps and gluteal muscles in your legs. Smaller muscles are at greater risk of strain because they can't generate as much force, and they fatigue quicker.
3. Take breaks.
   All of your work doesn't have to be completed in one day. Just as Jules said last week, we are coming out of the "winter hibernation". Take some breaks. If you feel tired and try to push through, you are putting yourself at risk for injury. As you get tired, your lifting posture will deteriorate. The more it deteriorates, the higher your risk of injury.

If you follow these tips, you will have taken the steps needed to prevent back injury while performing your spring cleaning chores. Of course, we know that not everyone is perfect. If you tweak your back, or for that matter any part of your body, give us a call. As physical therapists, we are the experts at conservative management of musculo- skeletal issues.

The importance for dynamic warm-ups prior to exercise
Let's face it, we've had a long hard winter. Some of us fought those winter blues by remaining active; however, there are those of us who tend to go into hibernation and don't come out until the snow has melted. With spring coming, there are some of us who are getting ready to begin working on those New Year's resolutions and head outdoors for some running, jumping and playing.

Many times as the hibernators attempt to "jump" back into the swing of things full force without proper preparation; an injury may occur. Which brings us to today's topic: the Dynamic Warm-up. According to some research; performing a dynamic warm-up increases flexibility, improves core stabilization and balance in a safe manner.

• A TOTAL MOTION RELEASE WARM‐UP IMPROVES DOMINANT ARM SHOULDER INTERNAL AND EXTERNAL ROTATION IN BASEBALL PLAYERS
• COMPARISON OF THE IMMEDIATE EFFECT OF DIFFERENT TYPES OF TRUNK EXERCISE ON THE STAR EXCURSION BALANCE TEST IN MALE ADOLESCENT SOCCER PLAYERS/

Before any type of sporting event, whether it's a baseball game, volleyball practice or 5K race you've put on that resolution list, it is important to warm up your body and muscles properly to help avoid injury. The most efficient and effective way to do so is with a dynamic warm-up. A dynamic warm-up is comprised of a series of 8-15 movements that will increase your heart rate, improve muscle elasticity, open up your joints, and physically get your body warm in order to prepare for the demands of the activity you are about to participate in.

A good dynamic warm-up consists of movements that will incorporate your upper extremities, lower extremities, and core. The dynamic warm-up should incorporate all planes of the joints that will be used to help stretch and facilitate the muscles. Lastly, the dynamic warm-up should be done with focus and should not be "walked through" - think of this as preparing your body for the big game.

The following is an example of the flow and routine that athletes should perform:

• Walking Lunges
• Reverse Lunges With Torso Rotation
• Lateral Lunges
• Straight Leg March
• High Knees
• Butt Kicks
• A Skip
• Lateral Shuffle
• Inch Worms With Push-up (plank walk with straight legs to hands and back out)

Again, remember the purpose of these warm-ups is to prepare your body for activity to prevent injury and prepare the cardio-vascular system.

Should you need assistance wiping those proverbial "winter blues" away, contact Superior Physical Therapy and Sports Rehab (https://frederickpt.com/); we'd be happy to set a plan in motion to get you and your loved ones game ready for a lovely spring/summer season with injury prevention in mind!

We have either said this or heard this said. In fact, there is a 22 – 65% prevalence that individuals will experience low back pain this year. Wow! That is a significant population. So how do I avoid straining/spraining my back? Here are a few tips!

• First, never jump right out of bed! Actively pump you ankles, slowly move your knees and hips. Then when you are ready to get up, log roll onto your side (if not already there), bring your legs off of the bed as you push off your same side elbow and the opposite hand. When you go to stand make sure you are focus on something straight in front of you. This will keep you from bending your back.
• Second, a strong core and quadriceps muscles will help reduce your risk of back pain. Pilates and general exercise are good places to start.
• Next, one of your hamstring muscles tenses a ligament in the Sacroiliac region. So having strong flexible hamstrings may reduce your risk.
• Finally, know what your body mass index is (BMI). Every 5 extra pounds of additional mass increases the strain on your back by 100%.
• Again, these are just a few tips. As always eat right, exercise, stay hydrated and get enough sleep. Avoid heavy, repetitive lifting.
• If you do experience back (and/or leg) pain that does not subside in a week, consult your friendly neighborhood physical therapist.
• Good luck and stay tune for our weekly “health and fitness” blogs!