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Keeping Balance on Ice & Snow – January Newsletter

New Year New Deductible

John Fiore, PT

For many Missoulians, the calendar year represents the start of a new health insurance deductible. Until a health insurance deductible is met, out-of-pocket costs for health care place a strain on our monthly budgets. While the use of flex plans and health savings accounts are a effective way to cover deductible costs, the value of each health care dollar remains considerable.

The current $2,500 to $6,500 health insurance plans of today were referred to as “major medical” plans when I became a physical therapist twenty-five years ago. The staff at Sapphire PT recognizes the importance of providing value consistent with the out-of-pocket cost of a physical therapy visit. We offer a discounted (calculated as the average reimbursement rate for a PT visit) cash payment option for PT services if customers pay for treatment at the time of service. If you choose the discounted time-of-service payment option, your PT visit will not be billed to your insurance payer by Sapphire PT, but you will be rewarded financially for timely payment. We also offer individualized payment plans as we are sympathetic with the strain of health care costs. If you anticipate meeting your deductible during the 2018 calendar year, we recommend allowing us to apply your PT visit to your deductible by billing your insurance company.

Physical therapy is a cost-effective medical treatment which effectively reduces pain and restores function. A one-hour treatment one-on-one with a physical therapist is one of the most cost-effective treatment options in the health care industry. So do not wait until an injury sidelines your 2018 plans and goals. Contact Jennifer, our patient accounts and billing specialist, to learn more about your insurance plan coverage and payment options. Physical therapy is a practical way to maximize your out of pocket health care dollars.

Reducing Injury in 2018

John Fiore, PT

January is the time to evaluate health and fitness goals for the new year. Will 2018 be the year you challenge yourself and succeed injury-free? Will 2018 be the year you achieve your training and racing goals? How can you reduce your injury risk when injuries impact nearly 80% of all runners (Br J Sports Med 2007)? While having a training plan is a good first step, four additional components will increase your running health and fitness success in 2018. The four Ps (plan, perspective, preparation, persistence) will collectively reduce your injury risk.

John Fiore running in the mountainsPlan: Training plans can be found in abundance on line. A plan for the calendar year, however, must center around a few key target racing goals. Fitness is composed of peaks and valleys. It is physiologically impossible to maintain peak fitness year-round. Divide your racing schedule into training races and peak races. Limit your peak races to a few per year, using training races to build fitness, experiment with nutrition, and identify areas of weakness. Allow yourself adequate time to recover from both training and target races to reduce over-training and injury risk.

Perspective: Missoula is full of experts in medical and training advice. Seek out those experts with experience in your sport. Utilize technology, but ask the question: “how will this technology improve my function?” At Sapphire Physical Therapy we utilize state of the art 2D video running analysis and accelerometers to objectively and visually measure your running stride. Interpreting your running data relative to proper and compensatory running biomechanics results in recommendations for improving running efficiency. Remember, the strongest predictors of of future running injury include a prior history of running injury, running throughout the year without a break, and a rapid increase in running mileage of >10% per week (Br J Sports Med 2007). The key to effectively treating and preventing running injuries lies in effectively determining the cause of injury rather than treating the effect or symptoms alone.

Prepare: Do the work, period. Train hard, recover well is a good mantra to follow. Recovery is as important as training and includes rest, nutrition, and sleep. If your performance is sub-par, re-evaluate your training plan and your goals. Failures are often more memorable than successes. Savor your training and racing failures as the life lessons they are rather than wallowing in disappointment. Preparation is a step-by-step process and January represents a fresh start.

Persistence: Unless you are a professional athlete, I personally do not condone focusing on a single sport year-round. Maintaining fitness throughout the year, however, is beneficial to all athletes regardless of age or ability. The “off season” is an opportunity to challenge and push your body in new and different ways to promote healing, strengthening, and mental freshness for the competitive season. Do not underestimate the importance of a strong mental game. A clear and focused mind will allow you to be honest in your training and racing goals.

Patience: Every body responds differently to physical training and recovers at different rates. Understanding your body and how you recover will reduce injury and over-training. Group training programs are great for comradery, but the group dynamic has potential consequences. Group intervals are an excellent way to maximize a high intensity workout. Group training runs when fatigued or recovering, however, may result in a workout which exceeds your body’s ability. Our body’s musculoskeletal system responds to physical demands (training, racing) by increasing tensile and muscular strength. If the body is not allowed adequate recovery between workouts, tissue failure will result. Building up mileage or intensity too rapidly has the same net effect. Be patient in your training to decrease injury risk. Here’s to an adventurous, challenging, enjoyable, and healthy 2018!
diagram of stress-strain (graph)


Reference:
Stress-strain graph:
https://www.kinetic-revolution.com/wp-content/uploads/2013/11/Load-Deformation-Curve.png


Keep Your Balance on Snow & Ice

Holly Warner, DPT, Jesse Dupre, DPT and Rachael Herynk, DPT

-Sharing a relevant article originally printed in our January 2017 newsletter -John Fiore, PT-

Getting around on snow and ice can be quite the challenge in the winter. Having good balance and taking precautions can reduce your risk of falls. Please read below about balance, how physical therapy is important for improving balance, and tips for reducing fall risk in slippery conditions. We write extensively on using good body mechanics while shoveling snow-we promise that is for good reason! Each year, we see many people with back pain, attributed to shoveling. Therefore, we have included tips for clearing your snow as well.

Balance
Balance is the body’s ability to maintain equilibrium and stability in the presence of adversity and unpredictable surfaces. Balance reactions protect us from falling, stabilize us during dynamic activities, and help us react to external perturbations such as slipping on the ice or running on uneven ground.

Several systems work together to sense changes and help us keep our balance. These sensory systems include vision, proprioception, which is our body’s perception of body position and changes at muscles and joints, and our vestibular system within our inner ear. Having full joint range of motion and muscular strength is also important in order for us to react to effectively react to conditions and make adjustments to maintain balance. When these body systems don’t work together, it becomes more difficult for us to stay upright. We can improve safety by modifying conditions, when possible, and training body systems that help keep our balance. In order for vision to be effective, consider using a headlamp or walking near street lights when in dark environments, such as in the evening. Vestibular rehabilitation can be particularly helpful for people who experience dizziness, vertigo, or have had concussions. Physical therapy offers techniques for improving strength, range of motion, and proprioception, especially after injuries.

Walking on Snow and Ice
Use appropriate equipment and footwear to help keep you from slipping. Wear shoes/boots with grip soles or deeper traction made from rubber or neoprene. Avoid flat soles. In a study completed by the American Geriatric Society, ice and snow cleats and shoe chains, such as YakTrax, reduce falls when worn over your shoes; however, you must take them off when indoors. You can purchase spikes to put on the legs of your walker or cane to increase stability. Trekking poles are also helpful in maintaining balance. Avoid wearing dark colors that make it hard for motorists to see you in case you fall.
Don’t jump or hurry across snowy or icy surfaces. Walk slowly and take small, shuffling steps. When walking quickly, the body has more momentum, which means it will take more effort to slow down, safely turn, or stop. Taking smaller steps keeps your center of gravity more securely above your feet. Avoid uneven surfaces, like icy curbs. Keep your hands free and out of your pockets to help you balance. Avoid carrying heavy loads if possible and keep items you are carrying still. Swinging items adds another source of momentum that you must control, and they are more likely to cause you to lose your balance. Hold onto railings if they are available. Avoid distractions such as digging through your purse or pockets, and limit your discussions with a friend until you are out of the snow to help you focus on safely negotiating any difficult terrain.

Getting in and out of your car can be tricky. Avoid parking near icy patches. Both feet should be either in or out of your car-You are at increased risk of slipping if you enter or exit your car standing on one leg. Hold the door frame to reduce risk of slipping! To safely get into your car, start by opening the door and placing one hand on the seat and the other on the car frame. Sit on the seat with your back to the inside of the car, feet on the ground (outside of the vehicle). Bring your feet into the car by pivoting on the buttocks so your entire body moves together. When getting back out your car, reverse the steps above. Once you have pivoted and both feet are on the ground (outside of the vehicle), scoot to the edge of the seat, then pull or push yourself to standing.

Snow Shoveling
Stay warm while you shovel by dressing in loose-fitting layers that you can peel off as you heat up, keeping your muscles warm. Wear shoes that are waterproof, slip resistant soled, and warm. Check your feet frequently if you have decreased sensation or diabetes.
Warm up your muscles by walking or marching in place or doing a light workout for ten minutes prior to shoveling. Stretch afterwards to decrease risk of injury. Stay hydrated and rest often. Keep a water bottle close and rest as needed. As our muscles tire, good posture starts to break down and increases our risk of injury.
Select the shovel that is right for you and comfortable to hold with proper posture. Try to work with a shovel that is long enough to allow you to pick up snow without bending forward too far. However, if the shovel is too long, it will put you at a mechanical disadvantage and require more force to move. One with a smaller blade will cause you to pick up less snow, putting less strain on your back. A plastic blade is lighter than a metal one which ultimately lightens the load when shoveling.

Try to maintain good body mechanics while shoveling. Keep things close to your body. Instead of reaching forward or twisting your trunk, it’s always better to move your feet. By moving your feet to turn your body and get close to where you’re working, you can lessen rotation and shearing forces through your trunk. Place one hand close to the shovel blade and keep space between your hands for better leverage when lifting snow. Hold the shovel close to your upper body, standing with feet hip width apart, keeping your back straight and bending at the knees when moving snow. Squat using your legs to pick it up, knees bent with your back straight. Squatting positions encourage your body to use the quadriceps and gluteal musculature rather than placing all demand on the spine Try to keep your spine in roughly the same position as it would be if you were standing quietly. In middle ranges of motion, your low back structures are under the least amount of tension or compression. This means less stress and lower risk of injury. Maintain abdominal contraction to protect your back while shoveling. When you can, use the shovel like a plow to push the snow, rather than lifting. Pushing motions do not stress the intervertebral discs in the same way as bending, and are less likely to result in disc herniation. Push the snow using your legs to reduce strain on your back. If you change direction, reposition your feet to face the direction you are pushing the snow. If you must lift the snow, only pick up small amounts. It’s easier to move snow in thin layers rather than waiting for it to all fall. Try to remove 1-2 inch layers at a time to prevent overloading your shovel. Carry it to the location you are dumping it, rather than twisting or throwing it, and keep your core engaged. Winter work can be daunting. If possible, work with a partner to remove the snow.
If you find your balance compromised or develop back pain, don’t hesitate to let us help you! Your physical therapist can help you develop an exercise program that addresses your specific impairments, pain problems, and help you train the above systems to improve balance and reduce risk of falls.

Exercises
When working on balance exercises try to make the exercises progressively more challenging in a safe environment depending on your skill level, comfort, and overall stability. If you are unsure at where you should begin, consult with a physical therapist to see what exercises are most appropriate for you.
Here are some ideas to try at home or at the gym. Make sure that you are near a counter, chair, or performing exercises in a corner to be sure you don’t fall.

    1. Initially, try balancing exercises on level ground/on the floor either in tandem stance or single leg stance
      image of a stretch using chair to work on balance Image of exercise with chair for working on balance Image of using the back of a chair to work on balance
    1. Then, try standing on an uneven surface like a foam pad or on a pillow
      Image of exercise using a foam square pillow to work on balance Image of exercise balancing on a round foam tube for balance
    1. Then, you can progress to balancing on a BOSU ball if you have access to it at the gym or home. This is a more advanced balance exercise and should not be performed if one is unsteady at balance on one leg on a foam pad. Either end of the BOSU can be used for balance exercises. Be sure you are near something to hold on to when initially trying to step up on the black side of the BOSU ball.
      Image of exercise balancing on top a BOSU ball for balance work Image of exercise balancing on top a BOSU ball for balance work Image of exercise balancing on top a BOSU ball for balance work
  1. Then progress to dynamic balance on uneven ground
      1. Try side-stepping on/off a foam pad/pillow
      2. Try heel raises on a foam pad/pillow
        Image of exercise balancing on top square foam pad for balance work
    1. Try squatting on a foam pad/pillow
    2. Try side-stepping on/off blue side of a BOSU ball
    3. Try squatting on the blue or black side of a BOSU ball

References
www.ag.ndsu.edu/pubs/yf/fitness/fn1518.pdf;
www.cbsnews.com/stories/2004/01/05/earlyshow/living/main591514.shtml;
www.popularmechanics.com/home/improvement/outdoor-projects/4345389;
orthoinfo.aaos.org/topic.cfm?topic=A00060;
www.coloradospineinstitute.com/subject.php?pn=wellness-snow-shoveling
www.belvoir.army.mil/safety/doc/Winter%20Safety%20Tips%20for%20Walking%20.pdf;
www.guardian.co.uk/lifeandstyle/2010/dec/21/luisa-dillner-walking-snow-ice
Brody, Lori T and Hall, Carrie H. Therapeutic Exercise: Moving toward function. 3rd ed. Philadelphia, PA: Wolters Kluwer; 2011.