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

Sleep Hygiene? Part 2 of 2

Not sleeping well is a detriment to healthy living and healing. Now that you have considered the concept of sleep hygiene from Part 1 of this 2-Part series, consider the following list of habits to develop in order to improve your quality of sleep, allowing you body to heal, recover, and reenergize:

1. Exercise daily - but not too close too bedtime. It varies, but exercising too late at night can disrupt sleep, if performed 1-2 hours before trying to sleep.

2. Limit screen use (TV and social media) before bed - Neither allows you to focus and declutter your mind nor control the imagery and messages you let in. Being on the screen is also often about productivity and on social media easily brings us to envy and comparison, both of which do not promote rest. The blue light from the screen is not good for you. You can have your phone dim and switch to orange or black/white light later in the evening to assist you in this regard.

3. Prepare things for the next day ahead of time, so that your mind does not need to focus on them - e.g. set a reminder in your calendar so you remember to email that person and don't have to worry about keeping it in your mind. As you do this, move more slowly, so your body gets the cue to slow down.

4. Meditate or contemplate 10-20 minutes - in contemplation you have an affirming mantra/phrase that you keep repeating bringing your mind towards as it wanders.

5. Limit talking - decreasing your motor output will help you slow down and unwind both physically and mentally.

6. Read with low light:

   • Something engaging, but not upsetting

   • Consider something about positive human potential

   • Try not to read something so light that your mind doesn't have to focus

7. Stop being productive - don't work or study right up until sleeping, instead create a buffer zone. 

8. Practice being in the present moment - pay attention to your body, your breath, enjoy physical being with your family/partner/roommate. This is a perfect time for cuddles and getting cozy with pillows and blankets!

9. Breathe - work on slow breaths from your abdomen to ensure your diaphragm is properly facilitating your breathing and thus promoting the parasympathetic system to be active (which is your "rest and digest" system).

10. Turn lights low as you prepare for sleep and then fully dark to optimize deeper sleep states

11. Rest in bed before attempting to sleep

12. Sleep in a cool room. Too much heat can be disruptive to sleep.

13. Create quiet environment: Use ear plugs or head phones to limit outside distractions & silence your phone

14. Listen to calming, quiet music; podcasts, talks, or books that are quiet as well as affirming and positive about the human potential. Use a timer to have this turn off after 15, 30, 45, or 60 minutes, depending how long it typically takes you to drift into a dream state. I bookmark my starting point in books so that I can easily come back to where I started from - some days it takes a whole 30 minutes for me to fall asleep, sometimes I am no longer listening within 5 minutes!

15. Journal to process thoughts and concerns from the day to limit them from looping in your mind

Do you have other things you practice and find helpful? Comment below.

Oh! FYI - You shouldn't have pain with waking up from sleep. This may indicate you need help from a physical therapist, but it may also mean that you need to sleep with different pillows or mattress to obtain more healthy and restful sleep.

Happy sleeping!

Elle

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).

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

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

Is Your World Spinning?

Are you having the unfortunate experience of vertigo caused by BPPV (benign paroxysmal positional vertigo)? We can help! It’s a mouthful to say, but we can treat it quickly and efficiently. With our extremely short wait times to be seen for your evaluation, you can been evaluated and treated within just a few days. We can’t promise, but you’ll likely feel markedly better that same day, which is great news! The effective of the treatment is typical dramatic and fast, usually within one visit. We wish we could say that for all diagnoses. Don’t hesitate to schedule, if you have this problem!

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...

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

Is What You Are Eating Keeping You Hurting?

What you eat has a big influence in how you feel. Not too many people will disagree with this statement, however many are not aware the extent that this is true.

Your diet could be perpetuating your back pain, our contributing to your achy knees, or be prolonging that car accident our recent injury pain.

What do we know?

AVOID eating refined carbohydrates, french fries and other fried foods, soda and other sugar-sweetened beverages, red meat (burgers, steaks) and processed meat (hot dogs, sausage), and margarine/lard.

EAT MORE tomatoes; olive oil; green leafy vegetables - spinach, kale, and collards; nuts like almonds and walnuts; fatty fish like salmon, mackerel, tuna, and sardines; fruits such as strawberries, blueberries, cherries, and oranges.

Eating this way helps reduce diseases associated with inflammation: e.g. heart disease and cancer. You can read more about this at http://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation.

But eating this way will also contribute time reduce your musculoskeletal and orthopedic pain. (Read -  less pain in your muscles, discs, joints, fascia, and ligaments). Sounds great, right?

If you're not seeing the consistent pain reduction you want from changes in posture, strength, stiffness, and flexibility, consider taking that next step to reduce what my be stagnant inflammation in your body and change your diet to tips towards anti-inflammatory in addition to all the good work your doing with exercise, position, rest, icing, etc.

Every little step towards healthier living counts!

Car accident blues

Were you in a auto accident? Rear-ended? T-boned? Don't relinquish control of your health!

One of the biggest mistakes we see people make after automobile accidents is not taking responsibility for their health. Waiting on payment from insurance and settlements before receiving professional medical care to rehabilitate from whip lash, pulled, strained, and sore, achy muscles, joints, and ligaments is common and results in prolonged injuries, negative outcomes, side effects, and chronic pain.

The best thing to do is to receive professional care as soon as possible, and what better, than a physical therapist? Physical therapists are EXPERTS in musculoskeletal movement dysfunction and rehabilitation.

Make sure to rest, limit extremes of body range of motion and speed, let your body recover, and take steps to reduce inflammation in your body. Don't put off take care of your health. It is your livelihood. It is your life. First get the quality, personal, and focused care you need to deal with your motor vehicle accident (MVA).

At Artisan Physical Therapy, you don't get generic treatments such as lying on hot packs, getting electrical stimulation, and ultrasound. Instead you get quality and focused manual therapy specifically suited to your needs to reduce swelling, inflammation, pain, stiffness and tightness so that you can get back to doing what you love and when you want to do it. We give you things to put you in control of how you feel - education on the specifics of what to do and what not to do in your daily activities and active body movements and therapeutic exercises.

It's not uncommon that people through care with Artisan Physical Therapy can learn more than they even knew about their bodies and live healthier lives than they did even BEFORE their car accident.

A Physical Therapist's Back Pain Confessional

Dang it, even therapist's have injuries, so let's talk about it. In our latest video, Dr. Liz Bottrell shares her personal experience with an acute occurrence of low back pain (aka - lumbar spine pain). Learn what happened and what she's doing about it and what you can do when you experience unexpected pain that lingers.

Back pain can come on suddenly and unexpectedly as it did for our physical therapist, limiting the ability to sit and lift and do normal daily activities. Learn how to recover as quickly and as optimally as possible. Note - you may have to change your behavior!

What is Manual Therapy & Why is it so Effective for Pain?

Liz Bottrell, PT, DPT, FAAOMPT, manual physical therapist and owner of Artisan Physical Therapy in the Echo Park neighborhood of Los Angeles, CA explains what manual therapy is.

Manual therapy, or "hands on," evaluation and treatment improves motion, mobility, decreases stiffness, tightness and pain, as well as improving circulation and speeding healing. The healing hands lead to areas of injury and work them out. It is a place where science and art meet.

Do you want to get better as soon as possible? Do you want to see an expert? Have you not seen the results that you hoped for with prior physical therapy. Maybe your therapist wasn't highly skilled in manual therapy. Liz is a fellow of the American Academy of Orthopedic Manual Physical Therapist (FAAOMPT) - her specialized manual therapy training and skills set her apart from other physical therapists.

See a manual therapy specialist and experience the difference in your day to day - the ease of movement, the reduced pain and stiffness, and improved muscle activation (read strength, coordination, and balance). All of this helps you sleep, walk, run, stand, reach overhead, and so on more easily and with less pain.

Combine quality and focused physical therapy with your needed exercises and necessary modifications and get ready for amazing results beyond what you though possible!

2 Simple Exercises for a Healthy Rotator Cuff

Want to have healthy shoulders and rotator cuff? Want to prevent injury when swimming, doing yoga, while weightlifting or crossfit? Want to rockclimb better? Want to play tennis and volleyball for years? Then take a couple minutes and learn a few strengthening exercises for the rotator cuff using an exercise band. The exercises are simple and easy to do wherever you are! No fancy or expensive equipment needed!

Have lingering shoulder pain, a prior rotator cuff tear, aching or weakness? Try these as some basic strengthening.

The rotator cuff is extremely important for basically all arm movement and certainly all shoulder motions. Make sure your rotator cuff is strong and has a lot of endurance to prevent injury!

For recommendations specific to your situation and body, contact Liz in Los Angeles or your neighborhood physical therapist. We are the movement specialist.

Let's get to the source, and TOGETHER, get moving!

Until next time,

Liz

Exercise recommendations for Minimizing IT (iliotibial) Band Tightness

Did you watch the first video in my 2-part series about IT (iliotibial) band tightness and have been waiting ever since for video 2? Well, wait no longer, for that moment has finally arrived! In part 1, I explained the anatomy of the IT Band and how it can become tight and problematic. It is often muscle imbalances that lead to this or sometimes just shear volume of activity and training.

In this video, I detail some of the practical, basic stretching and strengthening exercises that I recommend for people's whose IT Band and tensor fasciae latae (TFL) are tight, particularly due to the TFL/ITB serving as an "overachiever" muscle in the hip.

Enjoy the video.  Contact me with any questions and/or suggestions for future video topics.

Let's get to the source, and together, get moving!

Liz

Iliotibial (IT) Band Tightness/Syndrome - Anatomy, the Why, & the What

Iliotibial band or IT band tightness effects a large segment of the population and can manifest itself in many negative ways. It can get tight in the sedentary (aka non-active) population but is a common problem with runners, bikers, and cross fit participants or those regularly lifting weights.

Liz created a 2-part video series to help you understand the issue and what to do about IT band tightness and IT band syndrome. In this first segment, Liz talks about what the IT band is and why it becomes problematic. Then discusses some general ways to manage or prevent it. The follow-up to this video will go through specific stretching and strengthening exercises that are beneficial for minimizing IT band tightness.

Subscribe to the blog and the Artisan Physical Therapy YouTube channel to benefit from free advice and education from a movement specialist including part 2 of the IT band tightness series to get the exercise recommendations and demonstration.

Together, Let's Get Moving!

Liz

Injury Prevention for Cycling - Giving Back

A couple week ago, I spent some time teaching some injury prevention exercises for Team in Training coaches/mentors as they prepare to train others to ride 100 miles in "Americas Most Beautiful Bike Ride" to raise funds for lymphoma and leukemia ‬ research. I am so grateful and had so much fun giving to folks who are also giving. Definite paying it forward! Not only are they making their own life better by taking on the physical challenge to properly train for an 100 mile bike ride this June, they are doing it for a fantastic cause.

What I did was give them an overview of stretching and common areas such as the hip flexors, iliotibial band, and neck muscles that become tight due to use and position while on the road bike. We also discussed common alignment or positioning problems that people have when on the biking or pedaling.

Interested in what I suggested? Leave a comment and join the RSS feed for the blog and I'll send you the pdf of the exercises.

‪Thank you Team in Training - Los Angeles for the opportunity to help with this great cause.

To learn more about Team in Training visit the Team in Training website. To learn more about the Leukemia & Lymphoma Society visit the Leukemia & Lymphoma society website.