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Women’s Running Clinic – Winter 2019 Newsletter

Sapphire PT Announces Upcoming Women’s Running Clinic

Sara Boughner, SPT & Holly Warner, DPT

Sapphire Physical Therapy is excited to present its Spring Women’s Running Clinic, on April 6. In partnership with Runner’s Edge and other local organizations, this clinic will provide a well-rounded experience for female runners who are interested in learning how to stay healthy while running at all ages. The clinic is open to women all ages and abilities, and will entail a full morning of running, learning, and connecting.

The clinic will be held from 9am-1pm in the Runner’s Edge basement. Participants will go for a short run, then enjoy a light, healthy breakfast while learning about the latest women’s technical running apparel. Subsequent breakout sessions will then include a running gait analysis, female-specific nutrition information, strength training guidelines, and pelvic floor health. Keep an eye out for registration details coming soon. Mark your calendars and bring your favorite female running friends for this valuable opportunity to learn more about running healthy.
Picture of kids running on the shore
**Registration will open soon and there will be a 24 participant cap for this clinic.

Shoulder Impingement

Jesse Dupre, DPT

Joint pain in the shoulder is a common occurrence, and impingement syndrome is one of the most common diagnoses at the shoulder. Most of us have probably heard the term impingement used to describe shoulder pain. The term impingement doesn’t refer to a specific pathology, but to a clinical sign which could be caused by a number of reasons.
Front and Back view of shoulder

The shoulder is often described as a ball and socket joint, where the head of the humerus articulates with the glenoid fossa of the scapula as the ball and socket, respectively. However, because the shoulder has to accommodate a wide variety of motions during daily activities like reaching, lifting, and throwing, the joint is constructed with a very shallow socket to allow it to be more mobile. This means the shoulder requires significant assistance from ligaments, the joint capsule and muscles, in order to spin as it was designed to do without excessive translation of the head of the humerus or shifting during movement.

There are different types of impingement that can occur in the shoulder. In the more common variety, subacromial impingement, the structures between the head of the humerus and the acromion process become compressed when the humerus translates (slides) upward toward the acromion, putting pressure on the supraspinatus, long head biceps tendon and subacromial bursa, and causing pain. This most commonly occurs when raising the arm during reaching or overhead activities. This may be because of structural changes, including the shape of the acromion, degenerative changes in the tissues of the shoulder, or inflammation, all of which can cause structures to be more crowded. This is often referred to as primary impingement. Alternatively, impingement can occur because of abnormal alignment or movement patterns which result in poor tracking of the humerus as the joint moves. This is referred to as secondary impingement. Factors contributing to secondary impingement could include poor posture, abnormal resting position of the scapula or the humerus, muscle imbalances or poor functioning at the rotator cuff and possibly poor scapular mechanics, which put the joint in a less ideal position during arm movements.

Shoulder exerciseOne of the most important elements in restoring normal shoulder mechanics is the rotator cuff. The rotator cuff functions like a manager of the shoulder joint. It consists of 4 muscles (supraspinatus, infraspinatus, teres minor and subscapularis) that have to function together in order to produce precise movements and allow the joint surfaces to track properly. This effectively allows the head of the humerus to “spin” in the socket without excessive shifting. Strong and well coordinated rotator cuff muscles will help prevent the humerus from translating upward toward the acromion causing impingement. Strengthening exercises, such as resisted shoulder rotation can be used to strengthen the rotator cuff.

In addition to good rotator cuff function, scapular muscles need to function with sufficient strength and appropriate timing to produce normal movement patterns.Shoulder exerciseThe scapula houses the socket portion (glenoid fossa) of the glenohumeral, or shoulder joint and should serve as a strong foundation for the humerus to move on. This requires the trapezius, serratus anterior and rhomboids to stabilize the scapula and help orient the scapula with the correct timing to accommodate shoulder motion. Exercises, including rows and serratus push up plus, can help improve the function of scapular stabilizers.

Postural correction can also play a role in shoulder function. Poor posture, particularly at the thoracic and cervical regions can contribute to abnormal alignment at the scapula and arm, making it more difficult to achieve precise shoulder motions. This could be due to muscle tension imbalances, including pectoral stiffness or weakness in postural muscles.

While shoulder impingement is common, it can be treated with physical therapy. Targeted exercise to correct posture, muscle function and movement patterns can be effective in restoring normal, pain free joint mechanics.

Loading for Healthy Bone, Muscle, Tendon, and Disc Tissue

John Fiore, PT

While there is no single formula to achieve overall fitness, a necessary component to any fitness program is tissue loading. Tissue loading is crucial for elite athletes, amateur athletes, individuals who are beginning a fitness routine. Loading tissue is a concept used by physical therapists to selectively strengthen tissue in order to increase that tissue’s capacity to tolerate biomechanical loading. Tissue loading capacity is impacted by the intensity of an activity, the duration of the activity, and the frequency at which it is performed.

Wolff’s Law (German surgeon Julius Wolff 1892) explains that bone is deposited (strengthened) in response to the demand or load placed upon it, while bone is reabsorbed (weakened) if less demand decreases. A 2018 research article in the Journal of Bone and Joint Surgery compared hip and knee arthritis reported rates of 675 active marathon runners compared to non-runners. The study found lower arthritis prevalence in the subgroup of U.S marathoners (8.8%) compared to the matched group of U.S. non-runners (17.9%).1 Prior injury history, age, BMI (body mass index), and family history are better predictors of arthritis than activities such as marathon running.

Cook and Docking 2015

Photo: Cook and Docking (2015), courtesy of @BJSM_BMJ

While Wolff’s Law is widely accepted in regard to bone health, the role of loading on muscle, intervertebral discs, and tendons warrants further explanation. Our muscles let us know when they have been adequately loaded. The familiar soreness the day (or two, or three) after a workout tells us our muscles were stressed and will strengthen with adequate recovery. Tendons, however, remain quiet until the tendon’s loading capacity is exceeded. Tendon inflammation (tendinitis) occurs when a tendon is unable to keep up with the biomechanical demand placed on it. Strength training is important for all sports, including endurance sports, in order to adequately load tendons in a controlled manner to increase tendon tensile strength and durability.

Although muscles and tendons work together as a unit, they strengthen through different mechanisms. Muscles respond to higher loading rates and frequency exercises2 such as plyometric, whereas tendons respond to slow, heavy loading exercises which lengthen the tendon such as weighted knee flexion-extension exercises. Your physical therapist will understand how and when to load muscle and tendon tissue uniquely to optimize your recovery and function.

Understanding the importance of loading for spine health has huge health and financial implications. A 2006 review estimated the total cost associated with low back pain in the United States is over $100 billion per year, with two-thirds of the cost associated with lost wages and decreased worker productivity.3 It is widely accepted that flexion and compression of the spine and torsional forces are detrimental to the spine and discs. But what activities are good for the spine? Low back pain often leads to decreased physical activity, but prevention and treatment lies in increasing physical activity through spine-specific loading to increase intervertebral disc health. Most research looking at relationships between spinal loading and disc health were done with animals. A 2017 study, however, looked at disc health (measured via MRI scans) of 79 sedentary and active humans.4 A “no-sport” sedentary group was compared to a group of joggers (20-40 km per week) and a group of long-distance runners (50+ km per week). The joggers and runners had to have a >5-year history of similar mileage and activity level. The MRI scans of the joggers showed an average increase in intervertebral disc height of 9.2% and an increase of 11.4% in the distance runners when comparted to the no-sport group. Physical therapist have long believed in the “move it or lose it” approach to strengthening and rehabilitation. It is promising to see research is supporting the importance to move and selectively load tissue for both injury recovery and injury prevention.

Runners have more hydrated (left) and hypertrophied (right) lumbar Intervertebral Discs

Runners have more hydrated (left) and hypertrophied (right) lumbar Intervertebral Discs

Values are mean(SD) averaged across all lumbar discs. Left panel: Higher T2-times indicate 13 better IVD hydration and glycosaminoglycan content. Right panel: IVD height relative to vertebral body height. *p < 0.05; †p < 0.01 and indicate significance of difference to the non-sporting group.

Recreating in Winter: How to stay healthy and balanced

Holly Warner, DPT

The snow and ice change the way we are able to exercise and move outdoors. Often the footing can be bad, placing us at greater risk for foot and ankle injuries. It is important during the winter months to work on balance, ankle strength and stability, core and hip strength, and use traction devices when needed to give us confidence running/walking/hiking on suboptimal terrain.

Often overlooked and less emphasized in strength training routines is balance. Balance deficits become more obvious in the winter months walking/running on snow and ice. It is through repetition, practicing on varied surfaces, and working on both static and dynamic control that noticeable improvements are made. Balance drills can begin by simply practicing balancing on one leg throughout the day. It can be made more challenging by adding in a secondary task like tossing a ball side-to-side or multi-direction leg or arm reaches. Then, progress to balancing on any type of uneven surface. In the clinic we use foam pads, ½ foam rolls, BOSU balls, dyna discs, and rocker boards. At home a couch cushion or pillow can be used. By balancing on varied surfaces we are able to improve our proprioception. Proprioception is the sensory information we get from our muscles, tendons, and ligaments. Proprioception can become impaired when we injure these tissues. Common winter injuries include calf muscle strains, Achilles and posterior tibialis tendinopathy, and ankle sprains. It becomes even more important to work on improving our single limb stability after sustaining these types of injuries to decrease risk of recurrence and restore our balance and proprioception.

Balance exercise balance exercise on BOSU ball

Ankle strengthening
Winter footing requires good foot and ankle strength and stability. Multi-directional ankle resistance strengthening using a band or ankle weights is a great place to start to work on foot and ankle weaknesses. To perform these exercises, move the foot upward, inward, outward, and downward against resistance. Also adding in single leg calf raises is important to maintaining good ankle strength and power. These exercises seem simple, but are fundamental after ankle sprains or if you are experiencing ankle pain/fatigue after activity.

ankle stretches on board foot stretches with band

Core and hip strengthening
Trunk and hip strength and stability are also key to establishing a stable base to move from to avoid muscle fatigue and reduce the risk of lower extremity injury. When the ground is more uneven and unpredictable it is our trunk and hip muscles that work hard to keep us upright and stable. Here are some ideas of good core and hip strengthening exercises:

  1. Planking (forward and side)
  2. Bridging
  3. Side lying hip abduction
  4. Multi-direction hip with resistance band
  5. Lunge with weighted rotations
  6. Russian twists
  7. Single leg deadlift

leg raise exercises Beding leg exercise leg band exercises

1 Ponzio, et al. (2018). Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners. Bone Joint Surg Am. 100(2): 131-137.
2 Falk, et al. (2017). Imbalances in the Development of Muscle and Tendon as Risk Factor for Tendinopathies in Young Athletes: A Review of Current Evidence and Concepts of Prevention. Front Physiol. 8(987), 10.3389/fphys.2017.00987.
3 Katz JN. (2006) Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [review]. J Bone Joint Surg Am. 88(suppl 2): 21-24.
4 Belavy, et al. (2017) Running Exercise Strengthens the Intervertebral Disc. Scientific Reports. 7(45975).