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Spring 2020 Newsletter

Sapphire PT is Here for You

John Fiore, PT

Sapphire PT inside expansion shotWe are open to evaluate and treat new and existing patients in the clinic. Our staff is following CDC Covid-19 precautions (taking temperatures, hand-washing, vigorous cleaning, social distancing in the clinic), and both staff and patients are required to wear a mask. Our clinic is 6,000 square feet which makes social distancing in the clinic a reality. We have two separate entrances, four separate waiting areas, and we are staggering our schedules to eliminate waiting and congestion. We also offer telehealth evaluations and visits for at risk populations. Call us with your questions and don’t spend your spring in pain!

Overuse Injuries During COVID-19

Holly Warner, DPT

The weather has been beautiful and spring is so energizing in Missoula. Many of us have seen a lull in our daily workload giving us more time to get out and enjoy the fresh air. This is great, but does make us more prone to overuse injuries.

Overuse injuries most often are caused by a training error, which is an easy mistake to make when the weather gets nicer and we suddenly have more time to spend exercising. A sudden increase in training volume or intensity can put one at risk of developing an overuse injury due to the repetitive strain placed on tissues without appropriate recovery time.1

Keeping track of weekly mileage is something runners use to prevent overuse injuries. Often the 10% rule is referenced in an attempt to avoid injury with progressions in running mileage. While the 10% rule is a good conservative approach to increasing mileage it 10% does not factor in the intensity of the run.2,3 Looking at the acute-to-chronic workload ratio may be a better way to keep us informed about whether we are putting ourselves at risk of developing an overuse injury.3 This ratio compares the current week’s mileage/intensity to the previous 4 weeks, giving us a better understanding of our true workload progression.

To figure out the ratio, take the total mileage of the current week and divide it by the average total weekly mileage over the last 4 weeks. If the ratio is >1.5 or <0.7, it increases the injury risk.3 You can use this equation with mileage as noted above, but also with total time multiplied by intensity/rate of perceived exertion (RPE) values to keep track of workload progression.4

It is important for runners to keep a running log. You can download an app on your phone, make an excel spreadsheet, or use a good old fashioned hand written log. In the log keep track of your daily mileage and how long it takes you to complete that mileage. Also, keep track of where you run, elevation gain/loss, and if you felt any nagging pain/injury. Make note of how that run felt on a scale of 1-10. This is called the rate of perceived exertion (RPE) scale (see image below).

If you do find your body feeling tired and fighting nagging pains/injuries don’t hesitate to reach out to a physical therapist. At Sapphire Physical Therapy we are seeing patients both virtually and in the clinic. Please reach out with questions and don’t let an overuse injury stop you from getting out and enjoying Missoula this spring and summer.

1. Kozinc Ž, Sarabon N. Common Running Overuse Injuries and Prevention. Montenegrin Journal of Sports Science and Medicine. http://www.mjssm.me/?sekcija=article&artid=144. Accessed May 6, 2020.

2. Nielsen RØ, Parner ET, Nohr EA, Sørensen H, Lind M, Rasmussen S. Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. The Journal of orthopaedic and sports physical therapy. https://www.ncbi.nlm.nih.gov/pubmed/25155475. Published October 2014. Accessed May 6, 2020.

3. Oconnor EJ. Rehabilitation Principles of the Injured Runner. Clinical Care of the Runner. 2020:101-112. doi:10.1016/b978-0-323-67949-7.00011-2

4. Hutchinson A. Acute-To-Chronic Training Ratio Calculator. Runner’s World. https://www.runnersworld.com/training/a20841513/acute-to-chronic-training-ratio-calculator/. Published June 18, 2019. Accessed May 6, 2020.

Environment Affects Risk of Falls

Jesse Dupre, DPT

Humans are capable of sustaining many postures and have a wide variety of movements that we can accomplish. The trade off for being able to stand, walk and run on two legs, is that maintaining balance becomes a more difficult task, because when we are standing, we have a relatively high center of gravity and a small base of support. This makes balance reactions incredibly important to our ability to stay upright. Unfortunately, as we age, balancing becomes more difficult and the incidence of falls and fall-related injuries over time increases, more so after the age of 65.

Ideally, we can improve standing balance and safety in the long term in all environments through exercise to address both strength deficits and and balance reaction impairments. However, it is also important to be attentive to your environment and make good decisions to avoid falls.

  • Use clear, well marked and non-slippery paths, both indoors and outdoors. It likely goes without saying that when navigating more difficult terrain, there is a greater chance to lose your balance. Keeping pathways clear and avoiding convoluted or unnecessary twists and turns or slippery surfaces will make it easier to navigate.
  • Support can be used in higher risk environments. Always use handrails on stairs. If needed, try trekking poles for outdoor walks.
  • Be aware of your potential risks in your surroundings. Tripping hazards can affect people of any age or balance proficiency, potentially causing falls. Watch for uneven surfaces, cracked sidewalks, or indoor items, including toys or throw rugs.
  • Light areas appropriately. Generally, we rely on three systems in order to stay upright and balanced: proprioception, the vestibular system and vision. Proprioception refers to the body’s ability to sense position, movement and orientation is provided by muscles, joints and other tissues. The vestibular system relies on structures in the inner ear to sense position and movement of the head and neck. Vision provides us with quite a bit of information related to movement and position, and we rely on it more as we age. It is more difficult to maintain balance in a dark environment, because we cannot see obstacles or hazards, and have effectively removed an important system used in maintaining balance.

If you know your balance is impaired, it is possible to to improve your physical abilities. Both balance and strength can be improved, but must be challenged in order to see improvement. Similar to moving additional weight to improve muscular strength, balance exercises including challenging positions and movement tasks can be used to train and improve balance. The most important thing while working on balance is to make sure you are safe. If you need guidance or assistance with balance retraining, a physical therapist can help.