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Winter 2020 Newsletter

Sapphire PT is Expanding

John Fiore, PT
Sapphire PT expansion photoWe are pleased to announce the expansion of our Bow Street clinic to include 3,000 additional square feet. The new space includes additional gym space, private treatment rooms, exercise equipment, and room for classes. On-site massage therapy (Amy Price), music therapy (Ascend Music Therapy), and training services are also available. Watch for our open house in February.

Periodization and Recovery to Enhance Training

Sara Boughner, DPT, CPH

Winter can be a challenging time of year for those in Missoula who cannot fully embrace the joys of skiing and snow sports. Feelings of depression, anxiety, and lack of motivation to keep getting out can arise, especially as trails become less accessible. Some in our mountain town take a break from intense activity, while others feel that they must stay in peak shape year-round.

One of the benefits of living in a place with true seasons, however, is the natural encouragement to properly follow periodization within one’s training. Periodization is defined broadly as the organization of activity into periods of “progressively-loaded training stress followed by a period of rest.”1 This embraces the principle that for athletic gains to be observed, rest and recovery are an important part of the plan.

Different approaches to periodization exist, and the organization of a training plan can be adapted to the individual’s background, goals, and personal needs. Pyramidal periodization entails spending most of one’s training time in a lower-intensity range, with gradually decreasing proportions of time spent with higher-intensity training. Polarized training involves spending significant proportions of time performing both high- and low-intensity exercise, with minimal moderate-intensity training. Threshold training focuses on spending much of one’s time at a moderate-intensity or near the lactate threshold.2 A 2018 systematic review comparing these different types of periodization found pyramidal and polarized periodization to be more effective than threshold training, providing another reason to make sure easy days are truly easy.3

Regardless of how one decides to organize their yearly training, whether they are a runner, cyclist, skier, swimmer, or other endurance athlete, there is common consensus that utilization of a “transition phase” is an important element of one’s plan. The transition phase is a period, usually lasting two to four weeks, spent significantly cutting one’s training volume or using lower-intensity cross training to recover from periods of higher-stress activity levels. This might be after a long race, or a condensed series of larger efforts. Active rest may be utilized during this time, but repetitive higher-intensity efforts should be avoided. Importantly, this time may serve as a psychological reboot to prepare for another season or year of training. It may also allow time for micro-injuries to heal, and hormone fluctuations from hard efforts to balance out.4

Use of a transition phase will look different from person to person based on how many different athletic activities they engage in, the number of years they have been training, their age, and whether they engage in sport competitively. Utilization of a transition phase doesn’t mean that recovery during hard training should be neglected, nor should one try to “compensate” for designated time off as they return to higher activity levels. Regardless of where one is in a training cycle, factors of sleep, nutrition, and stress management are key elements of the recovery and rest needed to replenish the body’s metabolic systems.4

If you are considering designating a structured transition phase into your training plan, don’t worry too much about losing fitness. Research shows that changes in VDOT, a metric used for determining fitness, declines just 2.7% after 14 days completely off, and only drops 6.9% after 28 days off.5 If Winter is not your main competition season, it can be the perfect time incorporate a transition phase into your training. It will certainly be much harder to take a break and avoid the trails once the snow and mud clears come Spring.

1. Kaufmann, Sarah. “What Is Training Periodization?” TrainingPeaks, TrainingPeaks, 20 Aug. 2019, https://www.trainingpeaks.com/blog/what-is-training-periodization/.
2. Stöggl, Thomas L, and Billy Sperlich. “The Training Intensity Distribution among Well-Trained and Elite Endurance Athletes.” Frontiers in Physiology, Frontiers Media S.A., 27 Oct. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621419/.
3. Kenneally, M., Casado, A., & Santos-Concejero, J. (2017). The Effect of Periodisation and Training Intensity Distribution on Middle- and Long-Distance Running Performance: A Systematic Review. International Journal of Sports Physiology and Performance, 1–26. doi:10.1123/ijspp.2017-0327
4 Bompa, Tudor O., and Carlo Buzzichelli. Periodization: Theory and Methodology of Training. Human Kinetics, 2019.
5 Roache, David. “Why It’s OK to Take Time Off from Running.” Trail Runner Magazine, 19 Mar. 2018, https://trailrunnermag.com/training/why-its-ok-to-take-time-off.html

10+ Uses for a Tennis Ball to Decrease Muscle Soreness and Tension

Sarah Menhennett, PT, DPT, SCS

Most people have a tennis ball or two lying around the house. If not, a set of three can arrive on your doorstep in a few days for less than $4. Although using the balls for the actual sport of tennis can be enjoyable for many, I’d like to talk about some of the amazing uses of the tennis ball to address tight and sore muscles.

Your set of three tennis balls can be easily made into two useful tools. First, take two of the tennis balls and tape them together with plain white athletic tape (found at your local drug store) so they look like a peanut. The third ball will be used on its own.

Now that you have your tools, you’re ready to start working on those sore muscles using a technique called self myofascial release (SMFR). What is that? Myofascial release is described as “an umbrella term to for a wide variety of manual therapy techniques in which pressure is applied to muscle and fascia”. (Beardsley & Skarabot, 2015) Fascia is a thin, but strong layer of connective tissue that surrounds each muscle in the body. In this case, you will be using the tennis ball(s) as a tool to provide pressure to your muscles and fascia with the goal of decreasing soreness, pain, and tension. Another commonly used tool for self myofascial release that you may be familiar with is the foam roller. The great thing about the tennis ball versus a foam roller is that they are very cheap, readily available, and portable—meaning you could stick one in your backpack or purse and take it just about anywhere!

What is the benefit? While this technique is unlikely to permanently “fix” your muscles, it has been demonstrated to (in the short term) promote improved flexibility, range of motion, and reduce muscle soreness. It may also improve blood flow which can be an important component of recovery.1,2 Because this is likely to only offer temporary relief, if you have recurring muscle pain and soreness, it’s a good idea to consult with a physical therapist to determine why the muscle are getting tight, sore, and painful in the first place. This technique will treat the symptoms, not the cause.

Why does it work? There has been a lot of research looking at why this technique seems to help, and truthfully, although there are several theories, we haven’t completely figured it out yet. One theory suggests that the nervous system is stimulated by the pressure applied to receptors in muscles called mechanoreceptors and this stimulation results in a decrease in muscular tension. Another theory suggests that muscles and fascia tighten because of increased inflammation. Improved blood flow resulting from SMFR decreases inflammation of the targeted muscle tissue which results in the loosening of muscles and fascia.1,2

Should I do it before or after a workout? Studies have shown that it does not seem to have a negative effect on athletic performance, so feel free to do it before a workout if flexibility is an issue and then again after to address any post-workout soreness.1,2

How do I do it? The technique itself is easy to do and the same principal applies to each of the body regions illustrated below. Using the tennis ball(s), find the sore spot in the muscle of your choosing by applying pressure through the ball. This can be achieved by pushing the tennis ball into the muscle either with the pressure of your hand, or between your body and another surface such as the wall, floor, or stool. Once you find the tender point, apply enough pressure to cause slight discomfort, but not significant pain. Move the position of the ball if you start to feel any numbness or tingling. You can maintain the pressure, or move the ball just slightly in up/down or circular motions around the tender area. It is possible to overdo it, so start off with 30 seconds and work up to 1-2 minutes (per desired muscle group). See pictures and set-up instructions below:

Upper trapezius/levator scapula ball positionUpper trapezius/levator scapula
Place the ball between your neck and the top of your shoulder. Lunge into the corner of a wall (as shown) with the ball between the wall and your body.

Shoulder blade ball placementShoulder blade (periscapular muscles)
Place the ball between your back (on the inside border of your shoulder blade) and the wall.

Chest ball placementChest (pectoralis)
Place the ball between your chest (a few inches below your collar bone) and the wall as shown.

Subscapularis ball placementSubscapularis
Place the ball at the point between your shoulder blade and ribs. Keeping your elbow at 90 degrees, move your palm towards the floor and then away from the floor.

Forearm ball placementForearm ball placement position 2Forearm
This works well sitting at a desk or table. To address the underside of your forearm, apply pressure with the ball between the table and your forearm. To address the top of your forearm, use your other hand to press down on the ball.

Calf, tibialis posterior ball placement

Calf, tibialis posterior ball placement 2Calf, tibialis posterior
This can be done on the floor, but works best if you prop up your leg on a yoga block (as shown), stool, or stack of books. Use your leg to apply downward pressure. Angle your body slightly towards the inside of your calf to get the tibialis posterior muscle.

Shin ball placementShin (tibialis anterior)
This also works well with the leg propped up as shown. Apply downward pressure between the yoga block (or other prop) and the fleshy part of the outside of your shin.

Foot ball placementFoot
This can be done seated or standing. Apply downward pressure with your foot onto the ball.

Back of thigh ball placementBack of thigh (hamstrings)
This can be done on the floor, but works best if you prop up your leg on a yoga block (as shown), stool, or stack of books. Use your leg to apply downward pressure.

Front of thigh ball placementFront of thigh (quadriceps)
Lie on your stomach with the ball between the floor and the front of your thigh, moving the ball to find the tender points.

Glutes ball placementGlutes/piriformis
Sit on the floor with one leg crossed over the other (as shown). Place the ball in the fleshy part of the outside portion of your hip. Lean towards the ball to increase the pressure.

Double tennis ball suboccipital release ball placement

Double tennis ball suboccipital release ball placementDouble tennis ball suboccipital release
Place the double ball just below the base of your skull. Hold in place with your hands. To intensify the technique, rock your body towards your feet while keeping the balls in place. This technique can be helpful with addressing tension in muscle that often contribute to headaches.

Back muscles ball placementBack muscles ball placement

Back muscles ball placement

Ball position

Back muscles (paraspinals)
Place the double ball on your back, with your spine resting in the space between the ball. Apply pressure by leaning against a wall. For more pressure, you can lie on the floor.

If it doesn’t feel like the tennis ball gives you enough pressure, you can graduate up to a lacrosse ball which is firmer. A softball also works well for the gluts and hamstrings due to its larger size as there is often more flesh to go through to get to the muscle. Again, these are great techniques for providing temporary relief, but the effects will not likely be permanent. Feel free to give us a call and consult a PT with any questions!

1. Beardsley, C., & Škarabot, J. (2015). Effects of self-myofascial release: A systematic review. Journal of bodywork and movement therapies, 19(4), 747-758.
2. Schroeder, A. N., & Best, T. M. (2015). Is self myofascial release an effective preexercise and recovery strategy? A literature review. Current sports medicine reports, 14(3), 200-208.

Gluteal Strengthening for Sacroiliac Joint Pain

Jesse Dupre, DPT

Sacroiliac (SI) joint dysfunction can be a painful condition and associated with pain primarily at the region of the joint itself, which is located at the back of the pelvis. It is also thought that pain associated with SI joint dysfunction it can radiate or refer to the groin or low back. Some research studies estimate that 10-25% of cases of chronic low back pain may be associated with the SI joint. SI joint pain usually worsens during prolonged sitting. SI joint dysfunction can be associated with falls or direct trauma. Non-traumatic factors including malalignment or leg length discrepancies can also be contributing factors. SI joint pain is also more common during/after pregnancy, when there tends to be more laxity in ligaments due to hormonal changes.

The SI joints are located at the back of the pelvis, one on each side. They are the joints where the sacrum articulates with the ilium (winged bone of the pelvis) and the points where the trunk and spine meet the pelvis and lower extremity. The SI joint is a large joint with relatively small range of motion. While it does have some degree of mobility, its primary function is stability and transmitting forces from the spine, through the pelvis and lower extremity. Because of this, the joint is subject to high force and is surrounded by numerous and large ligaments to resist these forces and assist with joint stability.

SI pain can be difficult to address. Manual therapy can be used to help restore alignment changes due to muscle tension imbalances. However, in the case of instability problems, research studies have suggested that focused strengthening exercises can be a useful treatment. The gluteus maximus and gluteus medius are two large, powerful muscles at the posterior and lateral aspects of the pelvis and are important for maintaining stability at the hip and pelvis, which also provides a more stable base of support for the low back, and can decrease rotational and lateral forces at the knee. Weakness in these muscles can have an opposite effect, subjecting the low back and knee to increased and unnecessary accessory motion.

SI joint strengthening exerciseWith regard to SI joint stability the gluteus maximus may have specific importance due to its position as it has attachments at the ilium, sacrum, and femur, putting it in a good position to provide stability to the region including the SI joint. Exercises to strengthen the gluteals can help improve stability at the pelvis and may help to reduce pain if the SI joint is hypermobile. Various modifications on supine bridging, and hip extension are examples of straightforward exercises that can be used to isolate the gluteus maximus.

SI Joint strengthening exerciseAlthough the SI joint can be a source of pain, there are a number of structures in the area that can cause localized or referred pain in the low back, buttock and groin, including the lumbar spine and hip joint. For those with pain in these regions, it is important to assess and diagnose the primary contributing factor in order to be most successful in treating it. A physical therapist can help differentiate between these structures, and assist with creating a plan to address those impairments.

Added MAN, de Freitas DG, Kasawara KT, Martin RL, Fukuda TY. Strengthening the gluteus maximus in subjects with sacroiliac dysfunction. Int J Sports Phys Ther. 2018 Feb;13(1):114-120.