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.

Featured Physician of the Month - Dr. John E Gottlieb

Meet an associate of Ascent Physical Therapy, and this month's featured physician:

Vail-Summit Orthopaedics
Dr. John E Gottlieb, MD - Specialty: Knee injuries, Sports Medicine

Dr. Gottlieb graduated from Temple University in 1974 and then completed his Orthopaedic Residency in 1979 at the same institution.

Dr. Gottlieb was the first Orthopaedic surgeon in Vail and Summit counties, and has been serving an athletic sports population since 1979, the year he founded Vail-Summit Orthopaedics. He is one of the most active and innovative knee surgeons in the country, recently contributing to a national study.

Dr. Gottlieb and his wife Lynn, a local psychologist, raised three children in the Vail Valley. In his free time, he enjoys playing golf, hiking and trekking in the woods with his two golden retrievers.

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.

Featured Physician of the Month - Dr. Jonathan Feeney

Meet an associate of Ascent Physical Therapy, and this month's featured Physician:
Dr. Jonathan Feeney, MD
Specialty: Family Medicine
Colorado Mountain Medical

After graduating from the Case Western Reserve University School of Medicine, Dr. Feeney completed his residency at the St. Paul Ramsey Hospital in Minnesota. In 1980 he joined Colorado Mountain Medical and has worked there ever since.

Dr. Feeney has extensive experience in a constellation of health issues, from the very young to the mature adult, including Women's Health issues and sports related injuries. He is dedicated to wellness and comprehensive health care for the whole family. He has a special interest in multiple sclerosis and served as the Medical Director of the Heuga Center for the Physically Challenged now named 'Can Do M.S'. He has a further interest and experience in concussions in athletes.

During his free time, Dr. Feeney, his wife, and their two children enjoy scuba diving, skiing and travel.

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.

Gluteus Medius Strengthening - Bridge II