Do You Have Weak Ankles?

Ankle sprains are incredibly under treated. 

"Just walk it off."

"Time will heal it."

"Just ice and rest it."

PSX_20180514_153920.jpg

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.

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.

-----

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.

-----

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

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.

We Are On SE Belmont too! Why?

This post is long overdue to let you know about our relationship with Wholeself Wellness at 2121 SE Belmont Street. We have been working closely with the owner, Ian, since late spring and started treating patients and clients there in July. It has been a blast. At Wholeself Wellness, Artisan Physical Therapy clients have access to their private treatment room, as well as, their open concept gym for body weight, resistance band, and free weight exercise - it seems there is almost no shortage to the tools there.

For those of you looking for personal training that will move you towards increased wellness without injury - Wholeself Wellness is your place. The emphasis there is not the external and aesthetic that you find with some trainers, but with deeply rooted healthy habits - including balanced and symmetrical movement patterns and nutritious eating and living for the long-term.

Dieting is notorious for rebounding back to original weights and habits, so they are there to help with understanding your "food story" - the story you tell yourself and believe about food - and moving it to a healthier space and they also address body image and hang-ups that many of us have about our body shape. So you can see where their name comes from they want to treat - the whole self - not just part of it, and not just superficially.

 Liz working out at Wholeself Wellness

Liz working out at Wholeself Wellness

It's been a great relationship and pleasure to work with them. Personally, I've been participating weekly since July in the semi-private training sessions that they offer. It's provided insight into long-standing asymmetries I've acquired due to being right handed and playing things like softball, tennis, football and participating in things like snowboarding, skateboarding, and soccer. Over the months, the imbalances are disappearing I'm getting stronger and I have a clear path for how to continue to work on these primarily rotational imbalances I have. I felt strong enough that I even ran every day in October - something I had never tried before and an experience that I wrote about in a previous blog post.

For Artisan PT patients and clients, working out of Wholeself Wellness gives the convenience of a near SE location, more physical therapy appointment times, and a variety of strength and stability tools to use for those ready to take their health to the next level. It also gives our physical therapy patients a place to transition to, with confidence, for personal training.

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! 

Screen Shot 2017-09-25 at 12.53.07 PM.png

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!

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!

Preventing Rock Climbing Hand & Tendon Injuries: Part 1 - Why Hand Strengthening is Important

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?

In this video, Liz 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.
This is Part 1 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 2 to learn specific techniques, strategies, and exercises to incorporate into your climbing routine.

The weather is warming up and it's time to climb!

We can take it to the next level and help you with focused and personalized examinations in our downtown Portland location or with mobile therapy throughout the Portland, Oregon area. 

 

March LA PT Pop-UP announcement

We have it! Our next Artisan Physical Therapy LA PT Pop-up is on the schedule: THIS Sunday March 5th in Silverlake.

If you'd like to snag one of the limited remaining appointments, email us to inquire about how to reserve your spot. Come get some quality evaluation, manual therapy, movement analysis, and movement and exercise instruction and prescription. 

Here's to a healthier you, LA!

March LA PT PopUP