Welcome to Advance Physical Therapy, Inc. Newsletter

Imagine this scenario: 
You've finished working from home today and have had the itch to get outside to enjoy your favorite open space preserve. You quickly lace up your running shoes, happy that the days in July are long enough to enjoy the scenes and smells of the trail. Once out, the wind is blowing gently, your breathing begins to deepen, and it feels good to stretch out your legs, letting your memory of the trail guide your cadence..... Fast foward to the end of your run, your legs are feeling heavy and burning, but knowing that you only have a few minutes left, you decide to push on just a bit more.... thoughts of ice-cold water and a welcome rest beckon. Your breathing becomes very deep and rhythmical. Your legs are getting heavier and the sweat begins to sting your eyes and make your vision a little fuzzy.... You don't notice the rock sticking out from the middle of the trail and step on it awkwardly. You pull up your leg as quickly as you can, but it's too late and your legs are not as responsive as usual since they're tired. You feel your foot roll and then you land again, this time with a sharp pain on the outside of your ankle...and maybe a slow motion fall and roll onto your side, hugging your knee to your chest and clutching your ankle.  

Thankfully, this is fiction, but all too common! This month, we continue our discussion of ankle and foot problems, and discuss in detail how a manual physical therapist approaches evaluation and treatment of a inversion ankle sprain and plantar fasciitis, two prevalent injuries we see at Advance PT.

We're also highlighting the power of Pilates and sharing some stellar news about Advance PT.

To Your Health,
Advance Physical Therapy, Inc.

2015 Best Physical Therapy Practice

Advance Physical Therapy Inc has been selected for the 2015 Best of Redwood City Award in the Physical Therapists category by the Redwood City Award Program.

Each year the Redwood City Award Program honors the achievements and accomplishments of local businesses throughout the Redwood City area. Recognition is given to those companies that have shown the ability to use their best practices and implemented programs to generate competitive advantages and long-term value. We focus on companies that have demonstrated their ability to use various marketing methods to achieve exceptional success in their local community and business category. The companies chosen exemplify the best of small business. They enhance the positive image of small business through their leadership and service to their customers and their community.

For most companies, this recognition is a result of dedication and efforts as well as the work of others in the organization that have helped build the business. The team is now a part of an exclusive group of small businesses that have achieved this selection.

We are truly thankful and blessed to be able to touch the lives of so many wonderful people. Providing the best physical therapy care is our passion and we look forward to keeping you well.

Manual Therapy for Ankle Injuries - A Manual Therapy Approach

Last month, we began a lesson on the ankle and foot. We defined the important anatomical features of the hindfoot, including the leg bone (tibia), the heel (calcaneus), the leg (tibia and fibula), and the hindfoot “keystone” bone, called the talus. We described one common injury that involves the hindfoot - an inversion ankle sprain. We also described a particularly persistent midfoot problem, a painful condition called plantar fasciitis.
This month, we discuss how a manual physical therapist approaches treatment to these diagnoses.

Ankle Sprain/Strain:
When someone sprains their ankle, usually, the bottom of the foot rolls inward and causes an overstretch to the three short ligaments that attach the talus to the lateral leg bone, or the fibula. Generally, if one ligament is torn, it’s less traumatic than if two ligaments or all three are disrupted. (See diagram).  At this point, the patient is having throbbing pain and swelling around the outside of the ankle and often on top of the foot, too. Walking is painful, and the ankle feels stiff. 

Your physical therapist will perform a test to ascertain how much laxity is present between the talus and fibula. This is one piece of information that helps to determine how many ligaments were torn and to predict recovery time. A manual therapist will also begin gentle mobilization to the hind foot and midfoot .You may ask why mobilization is performed on an area that already has too much laxity. The answer is part of what distinguishes a manual physical therapist from other physical therapists. Gentle oscillatory movements performed passively, will help decrease the swelling, excessive muscular tension and restore movement between joint surfaces which are abnormal due to the swelling and limping. Your therapist will implement gentle soft tissue work to the disrupted ligament to speed healing, minimize scar tissue formation, and promote collagen growth in the ligament.

Your exercise program will include tolerable active movements around the ankle and midfoot  with the intent of decreasing swelling and pain. As your ankle becomes less painful to walk on, your ankle muscles will begin to tolerate more resistance for weight bearing and balance activities. A manual therapist may implement special techniques called proprioceptive neuromuscular facilitation (PNF) or muscle recruitment to speed up your ankle strengthening and stability. Challenging the muscles that turn the foot outward, inward and upward will support the healing ligament.

Run-of-the-mill ankle sprains can heal  without much intervention, and many people never pursue physical therapy because their pain gradually goes away as they resume activities.  Repeated ankle sprains, however, or persistent pain with use after an appropriate length of healing time (about 8 weeks) should be followed up by a physical therapist. A  chronic ankle instability can result from incompletely resolved weakness around the ankle. The long term consequence is difficulty and pain loading the leg for everyday walking or sports which then make it more susceptible to recurrent ankle sprains that can get worse over time.

Plantar Fasciitis:
When someone develops an excessive amount of connective tissue thickening on the bottom of the foot and it develops into a painful condition, it is termed “plantar fasciitis.” Most of the time, the condition is not noticed until the fascia develops microtears, which causes inflammation and pain on the bottom of the heel or arch of the foot.

The first steps out of bed in the morning can be excruciating, and often, the pain also worsens  as the day progresses.

During the physical therapy exam, the manual physical therapist will thoroughly examine all passive movements of the hindfoot and midfoot, since this tissue attaches  the calcaneus to the “ball” of the foot. During treatment, any joint restrictions should be mobilized strongly, if tolerable. The plantar fascia thickening develops slowly, often with shortening of the posterior leg muscles. The joints controlled by the short posterior leg muscles, like the talocrual or ankle joint, can get very, very restricted. This joint restriction exacerbates the thickening of the plantar fascia. In addition, the joints in the midfoot also need mobilizing. The plantar fascia and posterior leg muscles are massaged, often with the ankle-foot complex held in a position of tension.

Training exercises address weakness of the muscles that control the knee, ankle and foot. Stretching and self- mobilization to the plantar fascia is another critical component to recovery from plantar fasciitis. A thorough analysis of the lower extremity body mechanics and joint function is performed to ensure that there are no improper alignment issues that may be perpetuating a plantar fasciitis injury. 

Besides ankle sprains and plantar fasciitis, there are many more ankle and foot diagnoses that we treat at Advance Physical Therapy.  No matter the medical diagnosis, each condition is evaluated and treated not by “recipe,” but with a thorough examination, led by the individual’s unique presenting signs, symptoms, and history.
Pilates - Is It Right For You

Many have heard the name. Many have tried it. Countless others even believe it has “changed their life.” Pilates is a method of exercise developed out of Germany by Joseph Pilates back in the early 1900s. When performed correctly, Pilates can be a powerful form of strengthening that activates the core muscles and teaches our bodies how to move properly and efficiently. The practice connects the mind to the body, and can be therapeutic in many mental and physical ways. If you are already engaging in a Pilates exercise program, or are looking to start, here are some things to consider:

The Benefits of Pilates

Pilates exercises follow a set of principles developed by Joseph Pilates. One of the main principles of Pilates pertains to core control. When working on core control, we focus on activating the transversus abdominis, a deep abdominal muscle that, when drawn inwards, functions like a corset around our backs. We also try to activate the multifidi, which are little muscles attaching the spine (vertebrae). When these deep muscles are “turning on” correctly, and have adequate endurance to work properly while we go about our daily activities, they work to keep our spines stable.

Research shows that in the presence of back pain, the first muscles to become inhibited are the transversus abdominis and lumbar multifidi. Unless reactivated and strengthened, those muscles may continue to have difficulty stabilizing the spine. With poor stabilization, excessive and repetitive shearing and compressive forces across the spine can lead to further spinal injury and pain. Thus, those with spinal injuries and back weakness can benefit from Pilates. Improved posture is another great benefit of Pilates. Poor posture can be due to a combination of factors including core and scapular weakness, spinal stiffness, and/ or other structural imbalances such as an increased kyphosis or scoliosis. Besides working on core control, Pilates exercises work to improve segmental mobility of our spines – in other words, individual movement of one vertebra on another. This improved spinal mobility can sometimes alone allow us to stand straighter, and will allow for a more healthy way of moving for our spines. Our bodies will also function with better posture once core muscles are trained to hold the body more upright, and scapular muscles are strong enough to keep the shoulder girdles from falling forward. Individuals with shoulder problems can also benefit from Pilates strengthening since many problems that we see at the shoulder are related to muscular imbalance and poor shoulder positioning.

What Pilates Program Would be Best for Me?

Pilates training can come in many forms. Some individuals follow a DVD at home or take a mat class at a gym or Pilates studio. Others have  access to a facility offering group or individual training on Pilates equipment. One thing to note is that working on a mat alone can often be more difficult than working on an apparatus. With mat work, you need to be strong enough to control your body in space without support from a machine. And, although most exercises can be modified, some mat exercises can be difficult for those with neck problems.

Use of Pilates equipment, such as the Reformer or Trapeze table, can be incredibly versatile. Those just starting a Pilates program might need assistance for various movements, which springs on the equipment can provide. These springs can also challenge the strongest and most fit individuals with a total body workout. Most important to note is that not every Pilates exercise is good for every individual – and some can even be detrimental. As physical therapists in a rehabilitation setting, we are very selective with exercises prescribed and implemented by our clients. These selections are based on one’s diagnosis, physical problems at hand, and other medical conditions. If you have questions regarding whether your Pilates program is right for you, or would like to learn about exercise progression with a multidisciplinary approach give us a call and we can assess what types of integrated exercise program will work best for you.

If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
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2944 Broadway Street                         1208 E. Arques Avenue Suite #105
Redwood City, CA 94062                    Sunnyvale, CA 94085

(W) 650.261.0330                                 (W) 408.720.8225
(F) 650.261.0331                                   (F) 408.720.8755

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