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

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

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!

LA 2.0

LA we are coming back to you!

We are so excited to be serving the Los Angeles Community, once again. You can book appointments as early as August 20th. We will be based in the Silverlake neighborhood just down the road from our previous office in Echo Park. We are just down the road from Hollywood, Los Feliz, DTLA, Frogtown, Atwater Village, Highland Park, Lincoln Heights, Glendale and Burbank.

Drop us a line to say "hello" and let us know what you've been up to.

Do You Have Weak Ankles?

Ankle sprains are incredibly under treated. 

"Just walk it off."

"Time will heal it."

"Just ice and rest it."

Over the course of my career, the number of times I've heard "I have weak ankles" is noteworthy. It is typically said with a matter of fact complacent "this is the way it is" tone. 

But it doesn't have to be this way. Ankles can't be weak, but the muscles around them, which are myriad, can be. What do you do with weak muscles? You strengthen them. Muscles don't get stronger just because time goes on. If they naturally got stronger with time, wouldn't our abs all be "beach body"-esque. How are your abs? If they look amazing, Congratulations!, you worked for them.

After ankle sprains people typically end up with poor balance, ankle stiffness into dorsiflexion (think the action your foot does when you do a squat), and weak muscles. Surprisingly, research shoes that after ankle sprains, not only are the ankles chronically weak, but so are the gluteal muscles!

If you have a history of chronic ankle sprains, go see a physical therapist to have an evaluation to determine what impairments might be persisting and consequently leading to foot pain, ankle pain, knee pain, hip pain, and back pain. These impairments can contribute to things down the line like bunions, plantar fasciitis and fasciosis, meniscus tears, arthritis, and ACL tears. If you're an athlete of any sort involving running, squatting, jumping, cutting, these problems will lead to worse performance, not just injury.

Any questions? Comment below or reach our to our office via email.

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

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.

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...

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

Pull-ups!! - January Daily Fitness Challenge

Pull-ups. Pull-ups can be an arch nemesis for some, yet pull-ups are essential to advancing rock climbing potential. 

This January I've been continuing my daily fitness challenge, that I began in October of 2017. The first month I ran, the next month I did abdominal exercises everyday, and December I did and 7 minute body weight exercise routine, and in January, right now, everyday I'm doing pull-ups.

I've been able to do pull ups for a long time. Meaning I have had the strength to do pull ups for a long time. But strength is different than endurance. If I want to climb long or hard I need to have the endurance to sustain myself. So my pull-up challenge this month is important for my performance while climbing. 

But first and foremost I'm using it as a transition from not climbing for almost a year back into climbing. The progressive loading through my finger flexor tendons my joints, my finger pulleys, my lats, my shoulders, and my rotator cuff will be essential to the health of those tissues as I transition back into climbing. (Let's be honest: gripping to the edge of a cliff for dear life is not the most normal thing for the human body, but it sure is fun!) The body does the best with slow sequential loading, with time for recovery, and time for the body to rebuild and remodel. While I have the strength and ability to climb brief bursts of climbing at the level I did when I stopped a year ago, my tissues haven't been repeatedly loaded over that time and are vulnerable. This is a common mistake that people make that leads to injury. People often want to start off where they left off, regardless of the time that has transpired since their last participation in the activity. What I encourage my patients and clients to think of when they're deciding their activity level is not - what did they do the last time they did it - but rather - how much of those movements and activity and similar loading of the joints and muscles and tendons have you done in the past few days, weeks, and months. This should be your guide. Increase slow from what you've  done recently. In this way you're building your body to be healthy for a lifetime.

So'm getting back to climbing, but not before I begin with some progressive loading off the wall. Because of my baseline strength, pull-ups are sufficiently safe, but for others starting with partial weight gripping and pulling would be much more appropriate. I started with 10 pull-ups per day and added 10 pull-ups per week until the end of the month. Always mixed in with in my workouts is common sense and listening to my body. I'm always having a conversation with my body to determine whether I should do something or not and I modify as needed to stay healthy. No fitness challenge should lead you to unhealth. 

P.S. Going now to stretch these lats that are getting overloaded through pull-ups, and soon, climbing!

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

Liz

Snowboard (& Ski) Strength and Conditioning Training Plan

Are you a snowboarder or skier who wants to get the most out of your time on the mountain? Are you a snowboard newbie who wants to train your muscles for some of the movements of snowboarding? Are you tired of getting injured on the slopes at the end of the day or being too tired to get your full day' worth of money? Do you want to fall less while snowboarding?

This video introduces a pyramid series of exercises that strengthens and conditions your leg muscles for the demands of snowboarding back to back days, in powder, on groomers, as well as long traverses across the mountain.
These exercises are designed to improve your fitness, prevent injury, and improve your fun while snowboarding and skiing, primarily if begun 1 month prior to your trip of back to back days on the mountain. 
Bear in mind these are general recommendations, and a certain amount of strength and fitness are needed to perform.

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.

These should not cause any shoulder pain! 

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!

Performance Does Not Equal Health!

Performance = health, right? Running faster means you're healthier, right? Lifting more weight is healthier too, right? You have to be healthy to finish a marathon, right? Climbing harder routes means your more fit and therefore healthier, right?

The way many health and wellness professionals and physical therapy clinics, even doctors offices, promote performance you would think it was the same thing as health. But is that true?

Just considering this question should lead to better outcomes for you.

Think about how early professional athletes or Olympians have to retire. They performed at a very high level, but was it healthy for them?

At Artisan Physical Therapy, our goal is always health and how to help with performance long-term. Our emphasis is not about short-term results at the expense of long-term health. We are not interested in helping you do that next race or obstacle competition, if it will damage your body.

There are good stresses and bad stresses for your body. We are only about good stresses and we can help you know the difference.

Are you focused on health or performance? Choose the long road. Choose health over performance, because health will lead to long-term increased performance. 

Follow along with future posts as we discussed some of the key principles for healthy living. Comment or ask questions below.

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

What Stretches are Right for After Running?

We frequently get the question of: What stretches should I do before versus after a run? No one solution is right for everyone and every situation, but a dynamic cool down is very appropriate for after a run when your muscles are very warmed up, but have shortened from repetitive use.

This quick one to two minute routine should reduce the soreness, stiffness, and tightness you feel after a run. Muscles only know how to shorten and this happens over and over with running, we have to make them lengthen through their full range.

In this video, demonstrates a quick 1 minute stretch routine to be done to stretch the thighs and hips - that is - glutes, quads, hamstrings, and hip flexors after a run. (Note: you will need to stretch the calves/gastroc/soleus separately).

Happy trails and happy stretching!

As always, comment with any questions and any suggestions for future videos. Subscribe to the YouTube channel to not miss out on any videos. 

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

Preventing Rock Climbing Hand & Tendon Injuries: Part 2 - Techniques For Open Grip Strengthening

People are often injured by trying to progress too quickly and this is very prevalent in rock climbing. People fall hard for the sport and enjoy the challenge of pushing their limits, but lack the knowledge needed to stay healthy, prevent injury, and thus climb for a lifetime and not have to take months and month off due to tendon or pulley injuries in their hands or forearms.

In this video you'll learn the how-to principles of hand strengthening to cross train to improve open grip strength and reduce hand pulley and tendon injuries for rock climbers. Climb better, climb harder, climb longer. Climb for a lifetime.

For a personalized assessment, contact us at our Portland office.

If you have injured this area, make sure to give sufficient rest and see your local PT who specializes in manual therapy & treating climbers to learn how to get back to your prior level and incorporate this open hand strengthening to improve your grip and reduce compensatory strategies that overload your pulleys. Also find out how shoulder weakness, for example, can influence which grip you choose. 

This is Part 2 of a 2 Part series, with the possibility of a Part 3 adapted to interest, questions, and feedback from the first 2 Parts. Watch Part 1 to learn why hand strengthening matters to prevent injury and the important of incorporating into your climbing routine. Questions? Should we do a Part 3?

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