True of False? No pain - No gain

While our kids are growing rapidly in their pre-teens and teens, their bodies change in many ways. They grow taller, their hips widen, their feet change, and they gain significant weight. All of these changes place new stresses on their musculoskeletal system which takes time to adapt.

For those who are active and sports oriented, these changes may cause “growing pains” making participation in their activities painful. More stress is added through increased intensity of activity as they begin to compete at higher levels of competition, leading to repetitive stress and overuse injuries. These injuries may include tendonitis, stress fractures, sprains and strains throughout the body. If not addressed, these problems can derail a sports season or become lifelong problems.

What To Look For…

As a parent, the best sign to look for is pain. Some muscle soreness is to be expected, especially at the beginning of a season. Soreness should subside quickly as the body gets used to the new workload. Pain in a specific joint is rare in healthy adolescents therefore, if their soreness increases or becomes painful, your child may have an injury. Local pain in a joint is frequently the sign of an injury. Common injuries in teens are chondromalacia patella (pain under the knee cap), Osgood Schlatters (pain just below the knee on the tibia), shin splints, stress fractures, and ankle sprains.

As a parent it is important to listen to the concerns of your child. “No pain, No gain” is not always true, and can be harmful. It is important to monitor training schedules and have breaks to recover between seasons and large tournaments. If problems do arise, have your child evaluated by a physician or physical therapist. Once a problem is identified solutions such as exercise training, stretching, or bracing can usually solve the problem and get your child back on the field safely.

TOPIC OF THE MONTH - Selective Functional Movement Assessment

Do you ever wonder why you suffer from repetitive or chronic injuries that seem to be unrelated to any injury? Or do you ever wonder why you don’t perform as well athletically as other people? Do you feel like you work out and you don’t progress as well as you feel you should. Then the SFMA could be for you.

SFMA stands for Selective Functional Movement Assessment .This is a test designed to look at movement throughout your entire body to determine any limitations in mobility and stability you may have. These limitations may be underlying factors in any chronic problems or reduced performance you may be experiencing in your life. Frequently a restriction or weakness in one joint or area of your body can lead to limitations in a movement pattern that affects your whole body. The SFMA can help you pinpoint these limitations.

Once the SMFA identifies specific restrictions, your physical therapist can design a program to specifically address them. With a more individualized program you can be sure that you are doing the most effective work out routine and not wasting time and energy exercising areas that don’t need it. This will also allow you to address an area that may be leading to chronic pain and dysfunction and eliminate some unneeded aches and pains.

The SMFA is now available at Ascent Physical Therapy. Call 970.949.9966 to schedule an appointment and get your-self fit for summer.

New PT to the team!

Ashley Dentler received her Doctorate of Physical Therapy from Northeastern University in Boston, Massachusetts. She is certified as a Strength and Conditioning Specialist through the National Strength and Conditioning Association. She has had training in the areas of outpatient orthopedics, neuromuscular rehabilitation and functional movement therapy.

While at Northeastern, she succeeded in enhancing the learning and teaching environments for Physical Therapy curriculum as well as serving as a Teaching Assistant in multiple courses.

A Rhode Island native, Ashley is an avid runner, skier and swimmer and is looking to continue her love of the outdoors in Colorado. “I am thrilled to be a part of a community of people who share my passion and love of an active life style. It is an honor and privilege to join this team of professionals as we work to better the lives of our community.”

Ashley will be working at our Avon office Tuesdays and Fridays and the new Eagle office on Monday and Thursdays. To schedule appointments with her call 970.949.9966

TOPIC OF THE MONTH - Exercise for a Better Golf Game

The golf season is here and many of us are ready to hit the links and start golfing. We all want to stay healthy and play the best that we can. Five areas determine how well a golfer can play:

1. Natural talent - the athletic ability and talent we are born with
2. Skill - which can be improved through working with a pro and practicing
3. Equipment - which can add accuracy and distance
4. Mental game - such as course management and maintaining composure while playing
5. Physical preparation - addressing your body’s physical characteristics through exercise and stretching to improve your game

Many golfers spend considerable time and effort on practicing, taking lessons, and buying the best equipment. But, many golfers never address their most important piece of equipment, their body. Golf requires specific physical conditioning like any other sport.

The ideal golf swing requires flexibility, strength, balance and endurance. Many golfers neglect some of these critical components when attempting to improve their game. If a golfer has weaknesses in any of these areas they may make compensations in their swing, causing inconsistency or increased physical stresses on their body. These stresses can lead to pain and injury if they continue.

A regular exercise routine can address most of these strength, balance, and flexibility issues. Strength is important to control the club, maintain proper postures, and generate power. The key areas of strength to work on are core strength including lower abdominals and back muscles, scapular muscle strength, rotator cuff strength, and wrist and grip strength. Flexibility is important to allow proper set up posture and to maximize your ability to turn. Areas that frequently cause problems are hip rotation, thoracic spine extension and rotation, neck rotation, and shoulder flexibility. Balance is important to allow a full transition of weight throughout the swing. With poor balance power is lost or severe swing compensations are made. Endurance is important to allow a golfer to play a full round. Golfers with poor endurance will notice their play deteriorating toward the end of their round.

A physical therapist trained in proper golf technique can evaluate your body for the physical components of a proper golf swing. From this evaluation an individualized program can be developed to improve your game and keep you healthier.

Do you have pain?

Take the first step in dealing with your pain, by calling for a FREE physical therapy evaluation!

Ascent Physical Therapy can help RELIEVE your pain, RETRAIN your movement, and RESTORE your function!

A FREE evaluation includes:
• One-on-one consultation with one of our experienced Physical Therapists.
• Evaluation of the problem, which involves testing your movement, strength and function.
• Discussion of the problem, evaluation findings and your treatment options.
• An opportunity to ask questions regarding your pain and learn about the benefits of Physical Therapy.

Call us today on 970.949.9966 to set up your free evaluation.

TOPIC OF THE MONTH - Common Biking Injuries and Causes

It’s almost that time of year again. People are starting to dust off their bikes, the snow down valley is melting away, and trips to Moab are being organized. Bike season is upon us. Hopefully we’ll all make it through the Spring and Summer injury free. However you could be one of the unlucky one’s that end up with a bike related injury. Here are some of the most common injuries, and their causes:

• Knee pain (ITB syndrome, patellofemoral pain syndrome) is usually associated with a seat position that is too high or low or forward or back. Improper bike shoe or cleat position can also lead to this, along with muscle imbalances or even poor ankle mobility.
• Neck pain is a common cycling complaint. Often the result of riding a bike that is too long or having handlebars that are too low. Body mechanics that could also contribute to neck pain include poor thoracic mobility or tight hamstrings and hip flexor muscles – these postures all lead to the neck being placed in a hyper-extended posture.
• Foot pain or numbness (sesamoiditis, Achilles tendonitis) is often a result of wearing soft-soled shoes, or using too high a gear, which results in more pressure where the foot meets the pedal. Custom orthotics, can often resolve such problems.
• Hand pain or numbness (ulnar nerve compression, carpal tunnel syndrome, blisters) can be prevented by wearing padded cycling gloves that provide cushioning. Riding with your elbows slightly bent, not straight or locked will help act as shock absorbers and help absorb the bumps in the road. Having poor scapular stability could also lead to upper extremity and hand symptoms.

If you are unfortunate enough to experience any of these problems, the experienced Physical Therapists at Ascent Physical Therapy would love to help. We can analyze your bike posture and bike set-up, identify any muscle imbalances which could be contributing to your symptoms, and provide a custom treatment plan to get you back on your bike as quickly as possible. For more information on bike injuries and solutions, or questions about custom orthotics, please call Ascent Physical Therapy at 970.949.9966.

TOPIC OF THE MONTH - Reduce the risk of a Snowshoeing Injury

Snowshoeing is an excellent way to exercise and enjoy the outdoors at the same time during the winter months. At intense levels, snowshoe training can improve your fitness even more than running. Even snowshoeing slowly, at about 2 miles per hour, caloric expenditure will be about 480 calories per hour. Pick up the pace to 3 miles per hour and you can burn up to 1000 calories in an hour.

In general, snowshoeing is a relatively safe sport with regard to repetitive overuse injuries. It is a low-impact activity so there is much less potential for muscle/tendon damage. Still, there are steps to make snowshoeing even safer.

• Start your workout with a gentle cardiovascular warm-up and take time to stretch
• Focus on the large muscle groups in the legs and hips
• Worn out, ill-fitting or deformed snowshoe boots can be the culprit of various soft-tissue and joint injuries
• Check the shape and fit of your shoes before the season starts.
  
• Beginners should start slow and build up ability, strength and endurance gradually.

TOPIC OF THE MONTH - How to avoid snowboard injuries

Snowboarding carries a slightly higher risk of injury than alpine skiing - between 3-6 injuries per thousand boarder days (compared to 2-3 injuries per thousand days for alpine skiing). The risk varies with experience as well - the highest risk group being beginner snowboarders (especially those on their very first day). The risk becomes lower for those intermediate riders but then climbs again amongst experienced boarders - presumably because they are boarding faster and attempting jumps and tricks. The most common type of injuries seen with snowboarders are upper extremity injuries, specifically, wrist fractures, shoulder dislocations and AC joint separations. Here are some practical tips to help reduce the risk of an upper extremity snowboarding injury:

· Take a lesson: Most snowboarders don't take professional lessons, but learn from friends or are self- taught. Poor technique and bad habits increase your chances of falls and injury. Play it safe and pay for a few lessons before hitting the slope.

· Wear protective gear: It is a natural response to put out your hand to break a fall and as a result the wrist can be broken. Wearing wrist guards can help reduce possible wrist injuries in a fall.

· Take a break: The vast majority of injuries happen at specific times of day; just before lunch or the last run of the day when fatigue kicks in. When you are tired, mistakes happen – edges get caught and injuries occur. Pacing your-self, taking a break and not attempting the hardest run at the end of the day all help reduce the risk of injury.

· Get the right equipment: Damaged or inappropriate equipment may contribute directly to an injury or to the severity of one. Make sure the board is the right size and ability level for you. A beginner using an advanced level board which they are not yet competent to control could lead to trouble!

· Learn how to fall: When you are a beginner, falling is an unfortunate part of the learning process. Forward falls commonly result in shoulder-girdle injuries; falls backward more commonly produce wrist fractures, spinal injuries and head injuries. Common guidelines which may help minimize injury risk are to make a fist - this prevents fingers splaying and wrists hyperextending; roll onto your forearms and knees if you fall forwards, and roll onto your bottom – not your hands if you fall backwards.

· Pre-hab: It is a good idea to make sure you are physically fit before you hit the slopes. One of the main reasons people get injured while snowboarding is that they don't have the physical ability for the sport. Focusing on endurance, core strength and flexibility are all important aspects of prehabilitation. Strengthening the forearm and shoulder muscles may allow these joints to within greater force, preventing injuries from occurring.

· Ride Goofy: One study looking at almost 2000 injured riders discovered over 90% of those injured were in a regular stance when they injured themselves.

TOPIC OF THE MONTH - Avoid Injury this Winter

Winter has descended on the Vail Valley and many people have been hitting the slopes, lacing up skates, strapping on snowshoes and otherwise enjoying winter. It is important to take the following steps to avoid injury:

• Move outside cautiously: Just as you drive a car with greater caution when roads are icy, take extra care when walking outside on icy and snowed packed surfaces. Take an extra pair of shoes to work or to the mountain so you can wear shoes with good traction in parking lots. Remember to walk slowly and pay attention so you can adjust to a slippery surface.
• Ensure a proper warm up: Spend about 10 minutes at the start of any activity at a lower than normal exertion level. Your warm up should mimic the activity in which you are about to engage: if you are snowshoeing, start of at a slower pace; if your are skiing, hit easier trails for your first few runs.
  
• Avoid 'too much, too soon': Many months have passed between the end of last winter and now. Take steps to properly condition your body before engaging in a physical activity you have not done in a while. This can mean doing off season conditioning and cross-training as well as seeing a physical therapist to learn about any weaknesses or instability you may have, that can put you at risk of injury.
• Remember to cool down: Take some time at the end of physical activity to cool your body down. Return to a lower exertion level so you can signal to your body that you are ending activity.

TOPIC OF THE MONTH - How to avoid snow shoveling injuries

The snow has finally arrived, and for some of us this means dusting of the skis or snowboard and heading to the hill. However for others it means dusting of the snow shovel and removing the mounds of snow in the driveway!! While this seasonal activity may seem mundane, it can also be dangerous.

According to the U.S. Consumer Products Safety Commission:

• In 2007, more than 118,000 people were treated in hospital emergency rooms, doctors' offices, clinics and other medical settings for injuries that happened while shoveling or removing ice and snow manually.
• Types of injuries can include sprains and strains, particularly in the back and shoulders, as well as lacerations and finger amputations.

Snow shoveling can be compared to weight lifting, and in some cases, the aerobic aspect of this activity is similar to a workout on a treadmill! So to help your body function on demand, consider the following tips:

• Fresh snow is lighter - so clear snow as soon as it has fallen. Snow becomes dense as it compacts on the ground. Wet snow is very heavy. One shovelful can weigh 20 pounds or more!
• If the ground is icy or slick, spread sand or salt over the area to help create foot traction. Be aware that some areas may be uneven and could cause you to slip, trip, or fall.
• Warm-up your muscles. Shoveling can be a vigorous activity. Before you begin this physical workout, warm-up your muscles for 10 minutes with light exercise.
• Pace yourself. Snow shoveling and blowing are aerobic activities. Take frequent breaks and prevent dehydration by drinking plenty of fluids. If you experience chest pain, shortness of breath or other signs of a heart attack, stop shoveling/blowing and seek emergency care.
• Use a shovel that is comfortable for your height and strength. Do not use a shovel that is too heavy or too long for you. Space your hands on the tool grip to increase your leverage.
• Try to push the snow instead of lifting it. If you must lift, do it properly. Squat with your legs apart, knees bent, and back straight. Lift with your legs. Do not bend at the waist. Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovelful of snow with your arms outstretched puts too much weight on your spine. Never remove deep snow all at once. Do it in pieces.
• Do not throw the snow over your shoulder or to the side. This requires a twisting motion that stresses your back.

If you do experience a snow shoveling injury contact Ascent Physical Therapy on 970.949.9966 to learn about your treatment options.

Achilles Tendinosis

The Achilles tendon is the largest tendon in the human body and is very vulnerable to injury, probably because of its limited blood supply and the variety of forces to which it is subjected during activity. If treatment and rest is not implemented in the early stages of tendon injury and pain, known as Achilles Tendonitis, and chronic overload of the tendon continues, the tendon eventually develops microscopic tears in it. This is known as Achilles tendinosis and because of the poor blood supply to the tendon, the ability to heal these microscopic tears is limited and tearing of the tendon continues. Enlargement of the tendon, weakness and scar tissue formation results, which causes further pain and potential for tendon rupture

Undue strain to the Achilles tendon results in over 230,000 Achilles tendon injuries per year in the U.S. alone. The undue strain could be caused by a variety of factors, including:

• tightness or weakness of the leg, knee, hip, or back muscles
• high or low arches, poor foot biomechanics
• uneven leg lengths
• alternating between high (2”) heels and exercise shoes
• sudden (rather than gradual) increases in training, such as running faster, further, or up steeper hills.

Treatment focuses on addressing any factors which could be contributing to undue strain, such as providing customized orthotics to correct poor foot biomechanics, a very carefully designed program of stretching and strengthening, and modalities to encourage increased blood supply to the tendon, such as laser therapy and soft tissue mobilization.

For more information on Achilles tendinosis or treatment options for Achilles tendon pain, please contact Ascent Physical Therapy at 970.949.9988

FREE LASER CLINIC

Its that time of month again to take advantage of our free laser clinic. Here at Ascent Physical Therapy we use low level laser therapy (LLLT), also known as cold laser to help treat a variety of conditions including carpal tunnel, arthritis, muscle and joint pain, plantar fasciitis, tendonitis, heel spurs and swelling. It works by stimulating and energizing the cells in the injured area, to repair and strengthen at a remarkably fast rate.
The benefits include:

- It can relieve acute and chronic pain
- Increases the speed, quality and tensile strength of tissue repair
- Increases blood supply
- Stimulates the immune system
- Stimulates nerve function
- Helps generate new and healthy cells and tissue
- Promotes faster wound healing
- Reduces inflammation

This month the clinic is being tonight, 30th November 2010, from 4pm-7pm. Call (970) 949-9966 to schedule a free ML830 laser treatment.

We Moved....

Its been a busy summer at Ascent Physical Therapy. After 5 years at The Lodge at Avon, we packed up our plinths, and have moved to the Avon Recreation Center. We are offering the same great services along with some exciting new ones, such as aquatic therapy, a lecture series and access to extensive gym equipment.

TOPIC OF THE MONTH - Carpal Tunnel

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome or CTS is an increasingly common problem affecting the wrists and hands. This problem results in 2 million physician visits and 260,000 surgeries per year, affecting women 3 times more often than men. CTS is frequently caused by repetitive activities such as computer and tool work, but can be aggravated by sleep postures and daily household activities. If not properly treated, CTS can lead to nerve damage and permanent disability.

What Are the Symptoms of CTS?
CTS results in pain, numbness, and tingling in the hand and fingers, particularly the index and middle fingers. It is caused by decreased space in the carpal tunnel in the wrist, where the median nerve runs into the hand. This decreased space can result from inflammation or scar tissue formation in the tunnel. The nerve then becomes compressed and results in pain and abnormal sensation. Common activities which can aggravate CTS are use of vibrating tools, computer work, bicycling, knitting, and house cleaning. CTS can become severe enough to awaken people from sleep because of poor wrist postures.



Treatment of CTS
The most severe cases of CTS may require surgical intervention. Prior to surgery, however many options are available. Reducing the stress on the wrist is important. This can be done by maintaining the wrist in neutral posture while using your hands. That is keeping, your hands in line with your forearms and not bent up or down. Splinting can help with this, especially if you are having problems at night. Ergonomic evaluation of a work site can also be beneficial to put your body in the most optimum position. Decreasing repetitive hand movements that are forceful, awkward, or involve grasping and pinching will significantly decrease stresses on the wrist.

Cold Laser
One of the most fascinating and recent developments in treating CTS is the ML830 laser. In 2002 the FDA approved the ML830 laser for treatment of CTS because of its success in research trials. Cold laser is a non-operative pain free treatment which can be combined with other traditional forms of physical therapy.

Featured Associate of the Month - Tammy Rodell, MSPT

Tammy Rodell, MSPT
Specialty: Pediatric Physical Therapy


Tammy received her Masters in Physical Therapy from Texas Woman's University in 1998. She has 10 years experience and has provided physical therapy services to the children of Eagle County for the past 5 years.

Tammy has experience with torticollis, plagiocephaly, cerebral palsy, prematurity, toe walkers, developmental delays and a variety of other pediatric diagnoses. Tammy works with newborns to school-age kids, helping them to achieve their full potential, and provides assistance to parents to help their child become as independent as they are able.


In addition to working independently, Tammy works with Child Find, a free resource for parents that evaluates children, age birth to 5, to determine if early intervention is warranted. Tammy is also contracted with Mountain Valley Developmental Services, which provides assistance to qualifying children, age birth to three, who are demonstrating a developmental delay, have an established condition, or who have developmental disabilities.

Tammy states, 'In my free time, I enjoy all that Colorado has to offer, and I especially enjoy spending time with my two sons'.

TOPIC OF THE MONTH - Cross-Training

BENEFITS OF CROSS-TRAINING

Now the mountain has closed and spring is upon us, we are beginning to think about training for those fast approaching bike races, trail running events and 14er attempts! But before you don the cycling shoes – and start spending hours and many miles on the bike, think about incorporating cross-training into your training schedule. Cross training refers to training in different ways to improve overall performance.

The proven benefits of cross-training are:

• Greater aerobic fitness: Participating in a variety of exercise activities allows the body to recover from one beneficial stress, while being exposed to another. For example there is only so much running an individual can do in a week before they are at risk of an overuse injury, and as a result only so much aerobic fitness can be achieved. By adding a different exercise, such as swimming to the schedule, extra aerobic fitness can be gained, without increasing injury risk!

• Fewer injuries: Being involved in one sport alone can cause tightness or weakness in certain muscles – this can contribute to an array of injuries. Furthermore high impact activities such as running can lead to overuse injuries, such as stress fractures and shin splints. Cross training involving a non-weight bearing exercise can reduce the risk of injury occurrence.

• Reduces boredom and mental fatigue: Variety is the spice of life after all!! Boredom can potentially derail your exercise regimen. Mixing it up with a different activity once or twice a week can keep workouts from getting stale.

• Faster rehabilitation: Following an injury, you may not have to stop exercising. Instead, another type of exercise may be used that won’t aggravate the injury, but will still allow for maintenance of an appropriate training volume.

• Greater efficiency and power: By incorporating strength training, plyometric exercises, Pilates or Yoga into your schedule this will help build core strength and stability which in turn leads to more power for the athlete, and enhances efficiency of movements. This could potentially improve race times and also decrease the chance of developing an over-use injury.


If you would like more information about cross-training, an assessment to screen for muscle imbalances and potential injury risk factors prior to the start of your training schedule, and a specific exercise regimen to combat any deficits – please contact 970.949.9966

EXERCISE OF THE WEEK - Scapular Isometric

This is a great scapular exercise.

- Take an elastic band of sufficient strength and hold it in both hands palm up.
- Keep the elbows pinned to the side of the body.
- While keeping the shoulders depressed, contract the scapula and externally rotate both arms away.
- Hold the position for 5-10 seconds. Slowly return hands back to starting position.
- Repeat 10-15 times

Featured Physician of the Month - Dr. Greg Poulter

At Ascent Physical Therapy, we know how lucky we are to have such talented medical professionals in the Vail Valley. We welcome and encourage collaboration and would like to recognize this month's featured physician, Dr. Greg Poulter. Take a moment to read about Dr. Poulter's contribution to the Valley's healthcare system and his commitment to your health...

GREG POULTER, MD

Specialty: Comprehensive Spine Care & Surgery

Greg Poulter, M.D. joined Vail • Summit Orthopaedics in the summer of 2008. Dr. Poulter completed his orthopaedic surgery residency at the University of Michigan and more recently, a fellowship in adult and pediatric spine surgery at the University of California San Francisco. He provides complete spine care for both children and adults, offering the most current minimally-invasive and fusion-sparing techniques.

Dr. Poulter says the active lifestyle of people living in the Colorado Mountains is part of what attracted him to the job. "People who love the outdoors are the best patients to take care of; they are truly vested in getting better so they can get right back out there doing whatever it is they like to do," Poulter said.

Dr. Poulter takes pride in building rapport with his patients, allowing them the time and opportunity to feel comfortable with their diagnosis and treatment plan. He provides individualized care based on the patient’s needs and lifestyle. At VSO, you are truly not just another number.

Dr. Poulter is an avid hiker and skier (formerly a ski instructor) and is excited that he can now call Colorado home. He enjoys spending time with his wife and son and looks forward to continuing to build upon his success with Vail • Summit Orthopaedics.

EXERCISE OF THE WEEK - Shoulder Blade Squeeze

Any abnormality of the shoulder blade (scapula) position can result in secondary effects on the function of the shoulder joint. For instance, if the shoulder blade tilts anteriorly and laterally, the space available for the rotator cuff may be narrowed, resulting in tendon abrasion and injury, known as shoulder impingement syndrome.

Scapular stabilization refers to a set of exercises that strengthen the shoulder girdle muscles to restore normal shoulder blade motion and position. A great exercise to perform would be the Shoulder Blade Squeeze.

(PhysioAdvisor.com)
- Stand or sit with your back straight. Chin tucked in slightly and shoulder should be back
- Slowly move your shoulder blades back and down, so they squeeze together
- Hold for 5 seconds and repeat 10 times.

EXERCISE OF THE WEEK - Chest stretch

There are many reasons why people develop shoulder impingement syndrome, but a major factor is poor posture. When individuals have poor posture, the shoulders tend to roll forward, the chest (pectoral) muscles get tight, and the Shoulder blade (scapular) muscles posteriorly become lengthened and weak. This stretch, using the foam roller is marvelous for stretching out the chest muscles!

(Terre's Photo)

- Sit on one end of the roller and then lay back. Your head should be resting on the roller and your knees should be bent with your feet flat on the floor, shoulder width apart to provide balance.
- Drop arms out to the side. Let gravity stretch the muscles of the chest and shoulders. Hold for 1 minute.
- Bend both elbows to 90 degrees, forearms parallel to the ground. Hold this stretch for 1 minute.
- Move arms up, so they are becoming level with your ears, and hands are above the head (horizontally, not vertically). Hold this stretch for 1 minute.

Check out this video for more information and visual instruction: