Injury Prevention

Morning Mindful Mobility YouTube Playlist

Hello beloveds!

I want you living your healthiest life (LYHL), and of course, that involves you moving your healthiest and most capable. Daily mobility is a wonderful contemplative practice that puts you in tune with your body, while helping you actually become stronger, more mobile, more coordinated, have better endurance, experience better posture and endurance.

It’s hard to know what to do. I’ve seen this in my 17 years as a PT. You have been failed by your sports teams, and health class, and physical education classes. I’m here to fill in the gap. Subscribe to the Artisan Physical Therapy channel and to the “Morning Mindful Mobility” Playlist to follow along during your morning routines to get a full body workout and different options for each day to help you reach your potential.

Click here —> APT Morning Mindful Mobility Playlist

Bonus if you do your mobility in the morning and double bonus if you do it outside. Interested in joining live? Join the Morning Mindful Mobility mailing list by emailing me the subject line: Mobility Mailing List

Here to help you live your healthiest life. Let’s LYHL!

May you always see the blessing.

Dr. LYHL (Dr. Elle)

Morning Mindful Mobility

It’s been a long time coming, but I’m pleased to launch a view into my personal healthcare routine. My goal is to help you live your healthiest life (to LYHL). To do this, movement is key and doing it with presence and awareness. Our body is part of us and not to be used nor abused.

Have you wanted to know how to have a regular whole-body stretching routine? A whole-body active mobility? Have you been wanting a quick, helpful routine to start your day and incorporate your mind, body and spirit? Do you sense you have muscle imbalances and weakness, but aren’t sure how to identify them? Then this series is for you!

On the APT YouTube channel, you can now find episode 1 of “Morning Mindful Mobility.” You can follow along as Dr. Elle Bottrell uses her 25 years of study of the human body and applies her physical therapy knowledge to guide through helpful body movement to ensure you aren’t unnecessarily getting stiff and developing poor posture, weaknesses, and limitation from your daily life. Our body is very adaptable so we need to be conscious about these adaptations and put in thoughtful challenges.

Dr. Elle (aka Dr. LYHL) has found that many of her patients, clients, and people she meets don’t know how to do basic things like stretching and mobility work AND it’s not their fault. They were not properly taught in gym class or on their sports teams or in their movement groups.

Seeing people needlessly in pain or moving poorly is frustrating, so Dr. Elle is turning the camera on herself to show you what she does (hint - it’s different every day, but with common threads). She responds to what her body tells her and she wants to teach you to do the same - some days are more gentle and laying down, some are bigger movements and require more muscle activation and lead to strength gains.

Let her know what you think and send to someone you know who may benefit from this:

May you always see the blessing.

Dr. Elle (Dr. LYHL)

Healthy Living

What is healthy living? Someone asked me recently if I’m the healthiest I’ve ever been.

My reply was "no." I said no because I used to trail run long distances previously and now I can’t/don’t. I'm not in shape to run 21 miles through mountains at high elevation. I'm not able to do an olympic distance triathlon at this time. So no, I’m not the healthiest since I used to be able to do those previously.

Pause.

With some reflection, I realized how narrow my response was. I only addressed musculoskeletal fitness and conditioning in my answer. And even within that answer I'm not sure I answered it fully. What about the mobility work and physical therapy I am doing to address long-standing mobility issues and imbalance in my neck, upper back, and shoulder? What about the work I am doing on my core and deep stabilizing muscles? What about the work I am doing on my hamstrings and glutes to strengthen them and address front to back thigh and hip imbalances and thus reduce the likelihood of injury to my knees and back?

Often moving forward feels initially like taking steps backwards.

I don't believe that health is simply our physical bodies. What about my mental, emotional and spiritual health? What about my diet, my digestion, my mood, my relationships, my interactions with work, my sleep, ability to communicate, my generosity? In these areas, I am healthier than ever, and significantly so. That is not insignificant. I am living a very satisfying, rewarding, and peaceful life. And it took work to get to this healthy place.

It was striking to me how limited my view was when initially considering my response to: “Am I the healthiest I’ve even been?”. I believe so much in integrated health. I know that there is complex and little understood interplay between these areas. I preach this to my patients, clients, students, friends and anyone listening. I believe that anything I want to impart to others, I need to first inhabit. “Do as I say, not as I do”, doesn't deliver.

But wow, not only did I not think about my full physical body - sleep, strength imbalances, stiffnesses, muscle activation issues. I considered performance in my answer. I have long known that performance and health are different things. Often doing the healthy thing means doing less. And this is remarkably hard to do in our culture. Our society screams - DO MORE, ACHIEVE, ACQUIRE! But deep, deep health comes from knowing our body and this requires sufficient slowing down to learn to hear and understand the voice of your body. I have long served as an interpreter and guide for physical therapy patients to know what their body is speaking to them. Teaching them - “motion is lotion.” Helping them release - “pain is weakness leaving the body.” Our body is us, so we need to not separate ourselves from it, but our body is also not the only thing we are.

When I partner with patients and clients, I frequently suggest that their path to greater health might be doing less of a certain thing so they can focus on underlying problems and direct space, time, and energy to address them. We struggle frequently to do the behaviors that are most helpful for us.

What do you think it means to live your healthiest life?

What healthy habits do you struggle to incorporate into your routine?

What resources are you accessing to help you LYHL?

How would a coach benefit you with this goal?

Dr. Elle

Coaching? Coaching!

Yes, coaching is available for you via phone call or video, making it globally accessible. How can you take part?

Visit www.theellebottrell.com/coaching and request a session or buy a 6-pack for a discount.

What kind of coaching is this? It’s LYHL Coaching. It’s purpose is to help you Live Your Healthiest Life (LYHL). Health is integrated. Our musculoskeletal health is important - so places such as Artisan PT are important. But our health is not just physical. It’s also behavioral, mental, emotional, spiritual.

LYHL Coaching offers a place where you can explore all these domains by identifying your desires and goals, barriers and beliefs that are limiting you, and next steps you can take to bridge the divide between these two, by forging a path. Yes, you have to forge your own path. Fully optimized health takes you listening deeply to yourself. No one else can do that for you. But a guide to partner with you in the process can be invaluable.

Are you ready to take the next step to integrated health? Are you ready to LYHL?

Preventing Rock Climbing Hand & Tendon Injuries: Part 3 - Dynamic Hang Boarding - Bottom Up

How do you hangboard? Are you a long-time rock climber who wants to climb for a lifetime? A beginner climber who wants to train right and train smart to prevent injury? Are you currently side-lined due to a tendon or pulley injury in your hand and want to know how to rehabilitate it? Are you scared by witnessing your friends get sidelined from finger injuries for months or years and you want to do what you can so this doesn’t happen to you?

https://youtu.be/NuPYYDr0MB8


This is a long-awaited Part 3 to our video series about preventing rock climbing finger, pulley, and tendon injuries in the hand. Make sure to watch videos Part 1 & Part 2, if you haven't already, in which Dr. Elle explains why injuries commonly occur in the hand and tendons/pulleys of the hand, how your technique may be contributing to this, and why strengthening your hand, not just your forearm is important for preventing this and rehabilitating injuries here.

In this climbing training video, Dr. Elle addresses a common training error in hang board training - when climbers only hang statically. Climbing is not static and the abrupt movements in climbing are associated with injury, especially when projecting a route or problem, when fatigued, and when under-trained - all of which are common. You need to bridge that gap in your training. Here is a bottom up way to improve your hangboard training to include more dynamic load to your fingers and make them more resilient to injury.

Comment below with any questions and let Dr. Elle know what questions you have. This shelter-in-place is a great opportunity to train weaknesses and correct imbalances in your body to get you climbing healthy for a lifetime.

Make sure to subscribe to our YouTube channel to not miss any of our educational videos.

TELEHEALTH for You!

Let’s get right to the point. The world is changing. Our health and the people around us are the most important thing. Even with social distancing and shelter in place or even quarantining if you are having mild COVID-19 symptoms, you can advance your health.

At Artisan Physical Therapy & Wellness, we offer both physical therapy and injury prevention programs. For physical therapy we help athletes and regular folks get back to their favorite sports and fitness routines, but can also help you if your goal is to get through the day sitting with back pain or you want to get rid of that heel and arch pain during those first few steps of the day or that shoulder pain in those certain positions reaching overhead and behind you. We have the expertise for all this and can work on multiple areas within one session.

While our physical therapy is limited to California and Oregon residents only, we offer wellness and injury prevention education and services for folks throughout the US and even globally.

Yes, we can help you live a healthier life even if you live in the Midwest, Pacific Northwest, New Zealand, Brazil, or Ireland. We offer wellness consultation worldwide! We do this specifically for rockclimbers and runners, but we can make sure you are healthy to get in a lifetime’s worth of laps at the pool, chasing your kids or grandkids, hiking the El Camino, or playing competitive ultimate frisbee. We are movement analysis experts and exercise prescription and can do this over video remotely. A good portion of the injuries we see come from good intentions, but lack of knowledge. We can give you the knowledge to prevent injuries before they even occur! Healthy for a lifetime. As our seasons of life change and physical goals and demands change, our self-care and fitness routines need to change too in order to optimize our health. Bring us your questions and let us help you answer them!

Honored to partner with you to keep you healthy for a lifetime.

Elle

Tuesday Tune-up: Non-weightbearing Gluteus Medius Conditioning superset

Really want to get your hips strong for walking, hiking, running and any sports that require you to be on one leg? These exercises are for you! Injured and limited in your running abilities? Do these to be ready to hit the ground running? Want to fatigue less easily and be less likely to get injured while running? This superset of gluteus medium non-weightbearing endurance and motor control exercises will get you well on your way. Bonus it will also work on your back stability, strength, conditioning, control, and endurance! Yes!

Be aware, this is not a beginner exercise, but helpful for those looking to take their health to the next level of endurance and more thorough strength. Reach out to Artisan PT for a remote wellness consultation via video or schedule a wellness or physical therapy visit at our Los Angeles office to see what exercises are best for you, at this moment of time.

We are currently doing Tuesday Tune-ups on our Instagram feed and IGTV. Follow us at @artisanphysical to make sure you don’t miss out. As appropriate, we will do our best to also upload to our Artisan Physical Therapy YouTube channel as well. Make sure to subscribe to our YouTube channel to get notifications about new videos on how to live your healthiest life. Don’t miss out.

That’s our goal at Artisan PT: to partner with you to optimize your health for a lifetime.

Thank for reading and watching,

Elle

(owner, doctor of physical therapy, fellow in orthopedic manual PT)


(PS: These hip abduction/abductor exercises are helpful for preventing pain and improving tolerance to running, walking, hiking, skateboarding, soccer, ultimate frisbee, basketball, volleyball, triathlon, mountain biking, yoga, dancing, and anything else you spend time on one leg!)

Don't Be An Ageist!

Being an ageist, it's not cool, right? The first step to not being an ageist is to examine how you view yourself. I think ageism is quite common in US society. People are often self-limiting in what they pursue and what they routinely do simply because of the number of years under their belts. It's likely that if it's not something you actively think about or have noted in society, that it is present in your life.

Our society gives us this imprint and expectation of behavior that we tend to fall in line with and don't question. Questioning, by the way, is something we can do in our minds or with our actions. I've observed that in the US getting older means that hanging out with friends no longer means going to the park, or running around the block, or going on a bike or skateboard adventure, climbing a tree, or building a fort like it did during our youth. It means things like getting coffee, going out to eat, and watching TV or a movie, or sitting at a concert. Our communal time becomes less active and increasingly sedentary.

Also the types of movements we do become less and less playful, more rigid and predictable, less demanding of balance and coordination, and overall slower and slower.  Physically it means that our body is less adaptable to face the challenges of the world whether that's moving quickly to catch something that's dropping or falling, running across the street to get out of the way of a car or get a child out of the way of a car, catching ourselves from a slip and trying to prevent a fall, impaired balance and coordination, and later in life as a senior reaching for high objects off the shelf, lifting something overhead, getting out of bed or off the floor. Yes! I’m not exaggerating - a lot of the problems I see in older patients comes from this ageist attitude and habits. Our body responds to what we do, so less and less activity means more and more limitation. I see this behavior in younger patients, even though the habits often haven’t yet caught up with them, but sometimes it has, well before they are a senior. It makes me sad. But it’s also something we can change!

Our body thrives with variety. These good bits of stress, allow our body to make adaptations - adaptations such as quicker reflexes, better movement patterns, better proprioception which is knowing where your body is in space. As a result, our tendons and muscles are stronger in more varied positions and speeds. This is important because, injuries in daily life usually occur at higher rates of speed, so integrating faster movements into our regular life and training (once we have good movement patterns established at lower speeds), decreases this likelihood of injury in our everyday lives.

Ageism has negative consequences for us not only physically, but also emotionally and mentally. Mentally it's limiting because we've decided certain things aren't for us because of our age. We've decided that's for young people, we're too old for that, we'd be too silly or look too silly, we wouldn't do well at it. So we do less. How we live part of our life is how we live our whole life. If we limit ourselves physically, we are doing it mentally, and emotionally. We are not challenging ourselves.

Emotionally we miss out as well when we don't have playful movement such as dancing, or roller skating, or playing tag, games, or wrestling with children or grandkids. Brene Brown, a social worker and vulnerability/shamre researcher, can tell you more about this in her book, "The Gifts of Imperfection." In her 10 Guideposts to living whole-heartedly, a.k.a happily, (based on her research), you will find play as one of the required components to living this better life. You can also learn more about her research in her TED talks and now on her Netflix special.

Are you an ageist? Are you limiting yourself simply because of your age and what folks around you are doing? I don't want to be an ageist, not of my patients and my clients, nor of myself. This starts with how I view myself. In order to do this, I need to not view myself through an ageist perspective. What are some things that I do to combat this? I skateboard from my car to my classes as a graduate school instructor at USC. This alone makes me feel ~20 years younger. I snowboard. I adventure and play in the mountains doing things that get me dirty, require me to adapt to the environment, expose me to weather and natural elements, and make me work different every time. I climb, run, and mountain bike in the mountains.

One of the most recent areas of growth for me in this area has been incorporating a discipline of regular dance in my life. This is not choreographed, group movement. I throw myself regular dance parties, often in my living room, or the living rooms of friends. The music goes on and I let my body be creative and explore in response to the beat, the melody, the lyrics. It's been so fun, freeing, and even healing for me. I feel the change in my body, my mind, my emotions, and even my spirit. Every know and then if you follow me on social media, I share some of this dancing, because I want to break down these ageist walls we've built up or allowed to be built up around us, that keep us imprisoned in this limited mindset and perpetuates this negative belief in society.

I started this simply. It didn’t require any additional equipment. Just a little bit of space, my phone, and a song that I can move to. Early on it was simply one song after a work day. Often times I’d find myself feeling better and playing more songs. Now I have a “Daily Dance Party” playlist I’ve created on my phone. I’ll put it on shuffle and have built up to 20 minutes that I incorporate into my 20 minute of daily cardio. This has been so good for my mood and outlook and incorporates unpredictable, varied movements, balance, coordination to balance out things that are more predictable - running, swimming, biking for cardio.

What steps can you take to be less of an ageist? Remember it starts in your own life and how you're limiting yourself. As you try more activity, be wise - start slowly, give your body time to adapt, and get help (perhaps PT) if you need to get some basic, foundational movement - strength, coordination, mobility - down.

Together, Let’s Get Moving!

Liz

PT Better Than Surgery for Shoulder Impingement and Subacromial Pain

New guidelines for management of shoulder impingement are strongly in favor of physical therapy and away from surgery! These recent guidelines were posted in the BMJ (British Medical Journal) and you can read more here. This is exciting news supporting conservative treatment that physical therapy provides versus more invasive techniques such as surgery.

As the research was examined, the findings revealed: decompression surgery resulted in no significant differences from other approaches—including PLACEBO surgery! The lack of difference was long-term, remaining at 6-month, 2-year, and 5-year follow ups.

Shoulder impingement occurs when structure that pass through your shoulder get pinched between the humerus and acromion that compose part of your shoulder joint. This can lead to irritation, pain, and wear and tear to structures such as the bursa (bursitis), supraspinatus (rotator cuff strain, tears, tendonitis, and tendinopathy), biceps (long head of biceps strain, tears, tendonitis, and tendinopathy).

The following helpful schematic visuals presents the findings for how to management shoulder pain from rotator cuff disease/dysfunction (RCD) and subacrominal pain syndrome (SAPS).

PT better than SAD.jpg

The fact that physical therapy is the ideal way to treat these pain syndromes is not surprising given that the shoulder joint is a complex joint comprising of 4 separate joints and myriad muscles that must coordinate well. Tightness, weakness, poor endurance, control, or posture at any of these points including at the shoulder blade (scapula) can lead to narrowing at the subacromial space and thus impingement. Reversing these problems can then increase the space and reduce the strain, pain, and irritation.

Bottom line?

Having shoulder pain? Come to PT before a surgeon! Please note that these findings are for overuse and non-traumatic shoulder injuries present for more than 3 months.

Thanks for following along as we journey to: Get to the Source, and TOGETHER, get moving.

Liz

Daily Dose of PT (#dailydoseofpt)

Yep, I made a hashtag #dailydoseofpt. Why? Because everyday for 2019 I’ve committed to myself, for my own personal health to do at least one physical therapy exercise. I’m not going to limit myself to one, but I will do at least one.

After some thought, I thought": “why not bring others along?” 365 exercises is a lot and sharing them is a lot, so the daily dose of PT will be shared just on one platform. For ease of use, I’ve chosen Instagram and the live story. It’s not that you won’t find any excerpts or references anywhere else - blog, Facebook, Youtube, Google+, or newsletter, but the journey will be unfolding and evolving on Instagram live and then kept up on the story for 24 hours.

Daily dose of PT - climbing gym edition

Daily dose of PT - climbing gym edition

My hope is that my quest for personal health and well-being will be educational and motivational for you and those that stumble across it. At the time of the writing of this blogpost, I am 9 days into the challenge, with 356 to go. There are lots of opportunities to participate. To not miss out, make sure you follow @artisanpt on Instagram and even allow notifications for live posts from me.

The focus to-date of the #dailydoseofpt has been primarily shoulder, neck, shoulder blades (scapula), and postural stability. Over the course of the year, the whole body will get covered, as needed by my own personal PT intervention needs. If there are regions or parts of the body, that you would like me to focus on, let me know and I’ll do my best to incorporate them sooner rather than later.

Thanks for joining on this journey to optimize health and wellness.

Together, let’s get moving!

Liz

Finding the Perfect Pillow

Neck pain is a real problem for many people. Unfortunately for many people, their pillow is a main contributing factor. Also unfortunate is the fact that pillows are confusing. In desperation, many people will pay ridiculous amounts for a “perfect” pillow that promises to miraculously reduce their neck pain, improve sleep, and allow them to move their neck better throughout the day. All you need to do is spend $80-$200. However, many of the designs behind these pillows are flawed.

What should you look for in a pillow? You want a pillow that helps to keep your neck in neutral position. What is neutral position? Neutral position is a position that reduces the stress on your joints, muscles, ligaments, and tendons. Each joint has this ideal position. For your neck this means that when you lie on your pillow you shouldn't feel like your head is dropping down, or rotating, or getting forced up.

Find Neutral Position

This woman pictured has too much pillow & is straining her neck as she sleeps. The midline of your head should be straight with the midline of your torso to reduce stress on your body and prevent neck pain or arm numbness/pins & needles.

I suggest getting an inexpensive, soft, yet supportive pillow. Soft, yet supportive, is tricky. You want soft, but sufficiently full so that it gives support. Get a pillow too fully packed and it's no longer soft and adaptable to your head and your body position. Get a pillow that's too flat and it will not be appropriate for lying on your side. To get your neck and corresponding joints into their neutral position, you need the pillow to be just right, so do not be surprised if it takes time to find the right pillow for the size and weight of your head and the proportion of your body. For example, when lying on your side, you need the pillow to be the right size to take up the space between your head and the bed, created by your shoulder and torso. Too big relative to your body and your head will get pushed up, compressing the top side of your neck and pulling the lower side. Too small and your head will dip down, similarly causing strain to your neck but in the opposite pattern of too big a pillow.

I have a little trick for how to take any garden variety pillow from your favorite inexpensive store and make a winner, comfortable, soft, yet supportive pillow and look forward to sharing that with you in a future post and possibly even in video format. In the meantime, please save your money and don't buy that expensive pillow promising to save the world, starting with curing your neck pain and insomnia.

Questions? Comments? I'd love to hear them.

Liz

Headstands & Handstands - April Daily Fitness Challenge

Routines are good for our life, and are healthy. But our body and our mind also thrives with some variety. Neuroplasticity is a concept in phenomenon increasingly studied the demonstrates how the brain is always changing. It changes for the Better or For Worse depending on the inputs that we put in.

The daily fitness challenge that I have been taking part in since October is a mix of both these. There has been the daily routine of consistently challenging the body, but also variety as how the body is challenged each day varies and also there has been a different theme each month - running, abdominal and core strengthening, hip and shoulder stability, pull-ups, and this month is something else.

So trying new things is good for the muscles and the joints, ligaments and tendons, but also for the mind and the spirit. At the beginning of this year I set out an overall theme for the year. This year I'm focusing on theme of produce, which basically means working on moving forward and creating, without too much of the limiting mindset that can stop you from creating and participating and sharing. So I brainstormed what are some things that I might like to learn this year and some challenges I'd like to take on. Enter headstands and handstands. I haven't given them much thought before and I've never tried to do them. But I thought why not try and learn this new skill and just see how I do.

Liz's baseline attempts at headstand with her watchful assistant and spotter.

Liz's baseline attempts at headstand with her watchful assistant and spotter.

Trying a new physical skill might mean some preparation is needed in order to do this healthily. Thankfully as a physical therapist, I have good insight into the strength needed and the flexibility needed to be able to put weight through my shoulders.

In trying this new skill I'm excited for the new opportunities that this presents for my body to grow, and strengthen, and learn new balance and ways to control itself. Some of my Approach will involve trying the overall skill, but I will also break it down into small parts to allow my body to have the best chance for success. I look forward to learning from others who are skilled in the area of handstands and headstands and learning some techniques. I plan to try some of the techniques described in this well done instructional video from the UK.

This month a focus on headstands and handstands I hope to be fun as I learn a new skill that I'm not good at. But I also know this will be a good compliment two activities that I like to do that strengthen my body in the other direction, namely, climbing and swimming. Both climbing and swimming are pulling motions and really activate muscles such as the latissimus dorsi and teres major which pull your arm down into more of a handcuff position. Pressing away in pressing overhead will be new challenges for me that have been overlooked and are often overlooked in rock climbers and swimmers, including triathletes, and lead to muscle imbalances, which put increasing strain on joints, tendons, ligaments, and muscles. The strain overtime can lead to pain and dysfunction and difficulty doing the activities we love.

I'll be posting videos primarily on Instagram so follow us there @artisanphysical, but also intermittently on Facebook and here on the blog.

Want to join in on this challenge? I'd love to have you join in and share your successes and challenges. Arr you going to try a different daily fitness challenge? I'd love to hear about that too. Have ideas and suggestions for Liz's next daily fitness challenge? I'd love to hear that too.

Let's get to the source, AND TOGETHER, let's get moving!

Liz

Awesome, Effective Advanced Shoulder Stability Exercise

Looking for an excellent, if not awesome, way to strengthen your shoulder.? We've got an exercise for you including a video demo! Here is one of Liz's favorite exercises that she is incorporating into her March daily fitness challenge - which is alternating between the hip and shoulder stability and strength.

The shoulder joint is a "ball and socket" joint. It has a lot of freedom to move in a variety of directions, which is means it needs stability and strength in multiple directions. This exercise is a constant isometric force into external rotation pushing out with the wrists which strengthens and challenges two of the rotator cuff muscles, in particular, the teres minor and the infraspinatus. As you push constantly out through the band you will simultaneously raise your arms overhead which works additional shoulder muscles including shoulder blade (scapular) muscles responsible for upwardly rotating it. These muscles include the serratus anterior and the lower trapezius, which when weak can lead to shoulder impingement, bursitis, and rotator cuff tears and injury. 

This is not an exercise to perform when your shoulder is very weak. For that you want to exercises that place less demand on your shoulder. If you missed it, a video we created for that is this:

Mixing things up with "easy" and "hard" exercises is good for a healthy shoulder. I've been doing exercises from each of these videos as I seek to have an even stronger and healthier shoulder than I already have.

Have you started a daily fitness challenge? If so, what are you trying?

Not started yet, but thinking about it? What are you considering? Even the considering, is a step forward and progress! The planning stages count for fitness and health.

Stay tuned for next month's daily fitness challenge which will be headstands and handstands! April is almost here. Would you like to join me? At this time, May is scheduled to be ankle and foot stability, so reach out with any questions or suggestions for that if that provokes some interest from you. This is particularly meaningful for those of you with "weak" ankles, foot and ankle pain, history of ankle sprains or foot/ankle fractures (broken bones). 

Let's Get to the Source, and TOGETHER, Let's Get Moving

Liz

March Daily Fitness Challenge - Hip & Shoulder Stability

I'm pleased to say that the daily fitness challenge that began in October of last year has continued, with a different theme every month. So far we have attempted daily running, seven minute workout, pull-Ups, 8 minute abs, and now.... drum roll please...

BOSU overhead ball toss.jpg

This challenge this month, as the title of the blog post indicates, is hip and shoulder stability. I'm excited about this month because they are very important and foundational to so many activities and preventing injury as well as rehabilitating injuries. I've had my fair share of injuries over the years and they have left they're mark. Now if I had been better about doing all my rehabilitation exercises for these various injuries, I don't think I'd be in the same place. I'm excited of the possibility that the asymmetries I have from side-to-side could diminish, and even, completely resolve!

 Doing all the exercises that your body needs is a lot of work. Can I get an amen? It takes a lot of time, a lot of motivation, and a lot of knowledge. I have the knowledge and a good bit of motivation, but not always enough time in the day. Anyone else have a hard time finding enough time in the day? These monthly-themed daily exercises that I'm exploring are an avenue for me to rotate throughout the body and pay attention to each area and hopefully be better off than the intermittent and sporadic exercise provided otherwise.

Unstable hips or, in other words, hips that lack the strength, endurance, and coordination to control themselves in space, can lead to problems from the low back all the way down to the big toe. Yes, even the big toe! You think you inherited that bunion from your family? Where you born with it? Is it rather from how you've moved and used your body over time? Let's take a look at your hip stability and then let's talk about it.

Knee injuries ranging from patellofemoral pain, runner's knee, ACL tears, meniscal injuries can all arise from a lack of hip stability. Lack of hip strength and control or endurance can also lead to ankle injuries such a sprained ankles and fractures and down the chain into the foot with overpronation, plantar fasciitis, shin splints, or achilles or posterior tibialis tendonitis or tendinopathy.

Shoulder stability is also really important and isn't straightforward. Think of all the motions that your shoulder can do and that is a sign that keeping it healthy will similarly take a lot of work. The shoulder joint or complex is actually made up of four joints: 

  • Glenohumeral joint
  • Scapulothoracic joint
  • Acromioclavicular joint
  • Sternoclavicular joint

All of these are controlled by muscle. So once again the strength, the endurance, and the coordination of these muscles results in the control surrounding those joints. In terms of stability, the most important muscles are the rotator cuff and scapular muscles. You can think of your shoulder blade, or scapula, as the foundation of your shoulder. If the foundation is crooked or unstable, this has consequences for the areas attached to it.

As I work on shoulder stability this month, I am emphasizing the rotator cuff - all four of the rotator cuff muscles - and the scapula thoracic muscles - think rhomboids, trapezius, serratus anterior - as well as the scapulohumeral muscles. If these muscles are strong, can work for long periods of time, and can turn on and off at the right time, there should not be clicking in my shoulder with movement, nor am I very likely to injure myself. Bear in mind that as I strengthen these muscles, I will also need to stretch them because strengthening increases the tone of the muscles and often the stiffness of the muscles and sometimes shortens the length of the muscles. And tight muscles can lead to injury and dysfunction.

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Because it is unwise to strengthen the exact same area day after day, I will alternate between hip stability and shoulder stability, doing one one day and the next the other day. Want to learn a great routine to do for these areas, reach out and we can schedule either a visit or a remote consultation for you fitness, wellness and health goals.

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Stay tuned for April's daily fitness challenge of headstands and handstands...

Let's Get to the Source - and TOGETHER - Let's Get Moving

-Liz

Arm Strengthening for Climbers: Hand Sloper Strengthening with Rotator Cuff and Scapular Stability

Are you a long-time rock climber who wants to climb for a lifetime? Do you want to train right and train smart to prevent injury? Do you wish your hand strength was better for slopers and other open-handed grips while rock climbing?
In this video, Dr. Bottrell introduces a quick series of exercises that strengthens your hand and forearm in open hand positioning for slopers while simultaneously strengthening and increasing the stability of the rotator cuff and scapular (shoulder blade) muscles and joints. Incorporating exercises such as these present the opportunity for better performance & longevity of climbing of a lifetime, decreased likelihood of injury.


Bear in mind these are general recommendations, and a certain amount of strength and fitness are needed.
Interested in what weighted ball uses in this video? It's the Gymnic Heavymed 2 kg weighted ball for resistance.

8 Minute Abs

Last month I did a daily physical challenge of running every day - with the goal of being healthy. Success! This month the physical challenge is "8 min abs". I've spent everyday of November (one day to go) targeting abdominal strength, endurance and control for 8 minutes. Now this isn't about aesthetic or beach body abs. Being able to do crunches and sit-ups are important but have been over-emphasized in the fitness industry for years. Having healthy appearing abdominal muscles - a 6 pack - doesn't mean you are in fact healthy. More specifically, it doesn't mean you are preventing injury. Abdominal strength and stability in combination with low back and hip strength and control make up what we physical therapists call "lumbopelvic stability" or "lumbopelvic control." This is something we emphasize in helping and rehabilitating persons with low back pain, sciatica, SI joint (sacro-iliac joint) pain, lumbar radiculopathy, herniated discs, DJD (degenerative disc disease), arthritis in the joints of the back, and stenosis. The back is connected to the pelvis, which is connected to the hips/thigh/femur. I often sing  to my patients and clients about the wisdom of the children's song: "the back bone's connected to the hip bone. the hip bone's connected to the thigh bone" (They love it, as you can imagine).

So me spending on this focused time on this region wasn't just sit-ups and crunches. In fact, it was much more perform leg and arm motions without letting my back move. I spent 8 minutes each day this month emphasizing a variety of challenges to lumbopelvic stability to promote and preserve a healthy back. I brainstormed a list of exercises and invited a friend to join me with this month's challenge. My list is long and varied. I challenged my abdominal muscles - all of them (rectus abdominus, internal and external obliques, and very importantly the transverse abdominus). I rotated through 48 different exercises these 30 days! There's no reason to get bored. And as we strongly recommend here at Artisan PT - variety is good and very healthy for us. 

Want an example of how to train the transverse abdominus? The transverse abdominus is the most important abdominal muscle to prevent back injury and recover from a back injury or back pain. Learn more in our video on a starter transverse abdominus exercise. PS - Side effects of this exercise include flatter stomachs! PPS - I won't be posting pre- and post- 8 min ab challenge photos, but will be enjoying the results.

 

Watch should the next challenge be? December is right around the corner!

Let's Get to the Source, and TOGETHER, Let's Get Moving!

Liz

3 Simple Strengthening Exercises to Prevent Climbing Shoulder Injuries

Today we have a guest post from a friend and fellow colleague on preventing shoulder climbing injuries. Dr. Jared Vagy - The Climbing Doctor - out of Los Angeles, California works with high level climbers and teaches at USC. The following is an excerpt from his blog post

"It is the end of the day. You are tired and beat, but you decide to give it one last go on your project. You get to the crux move and give it everything you’ve got. Suddenly you feel a sharp pain in your shoulder. You know that you likely injured your shoulder. What happened and what could you have done to prevent this?

The tendons in the shoulder slide through a very narrow passageway and attach to the shoulder bone. Impingement occurs when the space between the bones in this passageway is reduced. This can occur from repetitively moving the shoulder into a stressful or suboptimal position. When this occurs, the bones in the shoulder pinch down on the tendons and cause shoulder impingement. You should be aware of the dangerous movements that can lead to shoulder impingement. These movements include hanging on your arms during rest stances, climbing with a hunched posture and strenuous overhead reaching."

Bent over T's, Y's, and L's:

Dirtbag tip - use items you have around: cans, bottles to provide the weight.

Dirtbag tip - use items you have around: cans, bottles to provide the weight.

These should not cause any shoulder pain! 

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Climb INJURY-FREE

Dr. Vagy just released another book! 

You can find it on Amazon now.

Thanks, Dr. Vagy for the helpful content.

Any questions? Comment below. 

Give Swimming a Try!

I was never a "water baby" - that is - I was never a kid that jumped into water whenever I saw it. I only wanted to get wet if I was dirty, sweaty, or super hot. This followed me into adulthood, so choosing swimming as a workout was not something that happened for me. That is until I was forced to. By age twenty I had injured my knee significantly twice. These ACL knee injuries (anterior cruciate ligament) had ended my soccer career prematurely. I had to wait a few months for ACL surgery, but wanted to stay active, so I did early morning walks with arm motions to get a whole body workout and I started swimming. 

I hated swimming. I hated it as I packed my swimsuit & towel, traveled to the pool, dressed, walked onto the pool deck, jumped in, and swam the first lap.  Do you see the trend? I hated it. But by the second lap it wasn't so bad. It was a quick and very intense workout for me. 20 minutes and I felt like jelly afterwards. All without any impact or pain to my knees! The workout was, in fact, so difficult for me that my cheeks tingled afterwards. Anyone else? Probably not. 

Flash forward to over a decade later and swimming is high up there on the things that I really miss about LA. Swimming laps outside midday on a sunny day is one of the most meditative and mind clearing experience I have. I get a whole body, no impact workout to balance out my running, hiking, biking leg workouts with inclusion of arm and abdominal conditioning and my mind gets to wonder through future ideas and possibilities as well as reflecting back on experiences and relationships. Oh and my cheeks don't tingle anymore.

So give swimming a try! 

Want to make sure you're healthy while swimming? Wonder what swim strokes are right for you? Wonder if you're stroke technique could lead to an injury? Wonder how much to do? Necessary stretches and strengthening? Let's chat. (Also possible future blog post topic - what do you think?)

Already swim? Where is your favorite place to swim?

Together - Let's Get Moving.

Liz

Why Does My Foot Hurt in the Morning?

"Why does my arch hurt?" 

"I get a sharp pain in my heel every morning I get out of bed.

"When I've been on my feet too long, the bottom of my foot hurts so bad."

Do you say these things? You may have plantar fasciitis.

The plantar fascia is a ligament that helps support the arch of your foot and gets stretched when you put weight on it and every step you take.

"Itis" is Latin for inflammation, so plantar fasciitis is a diagnosis of inflammation of the plantar fascia. Inflammation takes place when you have an injury and the body is trying to heal. Research is showing that most cases of plantar fasciitis is not an "itis" but is instead an "-osis" which reflects degeneration. This is why rolling on a frozen bottle might not make your symptoms go away.

At Artisan Physical Therapy, your PT will try to figure out a few distinct things in your evaluation - what tissue is injured or irritated and then the why it is injured/irritated/painful. Often both need to be treated the sore tissue needs to be calmed down and then that factors that led to the injury need to be changed and/or alleviated otherwise it will be perpetually irritated.

Common factors that lead to plantar fasciitis or fasciosis include:

  • Insufficient arch support - going barefoot, wearing flip flops, or shoes without arch support or very flexible soles
  • Tight ankles and calve muscles
  • Weak hip (gluteal muscles)
  • Excessive body weight
  • Increasing activity too quickly (deciding to train for a marathon or get in shape drastically from prior level of activity)
  • Weak foot muscles or inappropriate muscle use/activation

Just because you have arch or heel pain, it doesn't mean you have plantar fasciitis. It could be a tendinitis or tendinopathy of a foot or ankle muscle or an issue in the joints of your foot. A quality physical therapy exam will clarify this for you.  As mentioned above knowing which tissue is irritated allows for specific, targeted treatment to get rid of your pain and get you back to pain free walking, running and whatever else you love and need to do.

Think you might have plantar fasciitis? Take the first step towards health and get a PT evaluation to get quality manual therapy to temporarily decrease the pain in your foot and learn exercises to keep it away by learning how to reduce the stress to the plantar fascia and learn what activities to avoid a do instead to allow it to begin healing today.

Let's Get to the Source - and TOGETHER - Let's Get Moving!