Prevention

Awesome, Effective Advanced Shoulder Stability Exercise

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

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

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

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

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

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

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

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

Liz

March Daily Fitness Challenge - Hip & Shoulder Stability

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

BOSU overhead ball toss.jpg

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

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

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

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

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

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

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

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

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

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

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

-Liz

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

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


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

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. 

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!

Quick Yoga Sequence for Runners: Stretching with Some Core

New video out!

In this video, Doctor Elizabeth (Liz) Bottrell PT, DPT, FAAOMPT of Artisan Physical Therapy in Portland, Oregon demonstrates a quick and effective yoga sequence for runners. Whether running your first 5k, training for a marathon, triathlon, or an ultra, you need to stretch. Stretching takes time and knowledge. In this video, you'll learn a quick vinyasana or flow yoga sequence that efficiently stretches your hamstrings, calves (gastrocnemius & soles), and hip flexors (Iliotibial band and iliopsoas) to maximize your time, as well as incorporating abdominal strengthening and control and cross training strengthening for the pectoral muscles and triceps. This fast routine, also trains balance, breathing, and improves motion in your back and abdominal muscles!

You can repeat and hold longer as needed. Do not hold your breath!

Pay attention in the video because you need to make sure you know which muscles to stretch. Follow-up videos will show specifics for a few other essential muscle groups for runners to stretch.

Try it and let us know what you think.

Contact our Portland office to schedule your personalized evaluation or join in one of our LA PT Pop-ups while they last (next PT pop-up is January 23rd).

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!

6 Effective Tips to Less Back Pain with Sitting

Do you have difficulty completing work due to back pain with sitting?

Does your low back pain limit your social life with things like sitting at a restaurant, driving, and sitting through a movie.

Low back pain with sitting is common with disc and muscle injury.

To get yourself feeling better, try these 6 simple tips:

  1. Use the back rest on your chair
    • Sitting up is hard! 
    • Give those muscles a rest by allowing your back to use the support of the backrest.
    • Don't sit at the front of your chair
    • Keep your chair close to what you are working on, so you can stay all the way back in the chair.
  2. Use an extra and portable back support
    • Chairs are often not designed ergonomically for ideal posture.
    • Chairs are not one size fits all! Our bodies differ wildly in shapes and sizes from one person to the next.
    • You should maintain the same amount of curve in your back while sitting that you have while standing.
    • To assist with this, I recommend some thing like the Wonder Roll, which you can find online at www.wonderroll.com. It changes support quickly and easily while being portable, yet can stays in place on your chair with a simple strap.
  3. Take frequent breaks
    • Let your body heal and get stronger, by planning and not sitting longer  that your back can tolerate. 
    • If it starts every 30 min, get up every 25 minute, etc.
  4. Make sure your hips are flexible
    • Remember the song you sang about the human body? "The back bone's connected to the hip bone, the hip bone's connected to the thigh bone..." (You get the point).
    • Stretch the back side of your hips both the muscle and joint, so your back isn't being strained.
  5. Increase the strength and endurance of your low back muscles
    • If your back muscles are tired, they will do one of two things.
      1. They will start to complain and be your source of pain.
      2. They will stop working and let you go into poor posture thus putting bad stress onto the passive structures in your back: discs, ligaments, and joints.
  6. Watch your posture
    • If you saw your posture from an outside perspective, you might be horrified!
    • Set regular reminders in your calendar and alarms on computer and phone to remind you even when caught up in tasks and projects requiring your full mental attention.
    • Give permission to those around you to remind you when you are sitting with poor posture, so you spend less time there and thus strain your disc, ligaments, and muscles less.

Thanks for reading. If we get enough interest, we will make some videos about how to sit with less back pain. Leave a comment about how it works for you and what tips you use.

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

 

 

5 Best Neck Posture Exercises

Have you noticed a prominence or lump developing in your upper back and wondered what it was, and if you can do anything about it?

A friend of mine last week asked a question. What is this lump on the back of my neck? When I heard the word "lump," I was not hopeful that this was something a physical therapist could help with. A quick examination revealed that his spine was changing shape over time and he was developing a bony prominence where his neck and upper back meet. Why? This often takes place from repeated stress on the area over time. The forward slouched sitting posture so many of us find ourselves throughout the day while we are doing activities such as studying, working on the computer, driving, and reading.

Think about the elderly person with the stooped posture and rounded upper back. This didn't happen over night but was from poor sustained postures that resulted in progressive stiffness and weakness that eventually prevented them from sitting and standing with a straight back and neck. I like to say the body adapts to what we do to it and the spine is like wet cement that is hardening - what position do you want it to stiffen into?

(Disclaimer: Some people with stooped postures (aka excessive kyphosis) have pathological conditions in their spines that lead to these deformities, not simply due to impaired posture).

What can be done about it? My friend wanted answers! He might not be able to change his "lump" that is already there due to bony changes that have already occurred but maybe we can help it from increasing by working on some posture exercises to improve the flexibility of the thoracic and cervical spine and improve the strength of the muscles that hold these positions. Fortunately for him, His condition isn't painful yet. Doing some simple posture exercises can prevent painful conditions from forming in his neck and shoulders and even reduce headaches.

Subscribe to the blog and get access to the to 5 Best Neck Posture Exercises delivered to your inbox! Who doesn't love free professional advice?

Comment below for any questions you have for a physical therapist and Liz may answer your question in a future blog post!

 

Chasing Your Goals

How 'bout them New Year's Goals?

It's been a busy summer transition into fall here at Artisan PT and in life in general. The seasons are changing even though here in Southern California it doesn't always feel like it. We have (hopefully!) made it to fall (finally!).  The Weather Channel app is telling me just a high of 74 deg, so I'm going to risk it and say: "we made it!" Here's to wearing layers, enjoying hot beverages, having comfortable workouts, and eventually enjoying falling leaves.

It's been 6 months since the last post about one of my goals: To do a race this year. September 19th, 2015, it happened. I competed in the Nautica Malibu International Distance Triathlon. 1.5 km swim, 40km bike, and 10 km run in the books!

 As a special bonus, I got to race with good friends. Nothing makes it more fun than to create memories together!

As a special bonus, I got to race with good friends. Nothing makes it more fun than to create memories together!

It's been 9 months since I started training for the race. I was even training for the race 4 months before I signed up! Someone might ask - isn't 9 months a bit excessive for training for an Olympic distance triathlon? After all, it's nowhere near the length of an Ironman! My answer would be that it depends how you think about it. Starting in January of this year, I joined a local gym, which was my first traditional gym membership in the past 5 years. I hadn't lifted weights, for at least that many years, and I hadn't been running for at least 2 years. As a physical therapist, I wanted to be healthy and decided to practice what I preach.

One of my PT mantras is that: Your body WILL change, but change takes time!

Body composition takes time to change, as does developing muscle strength and hypertrophying (i.e. increasing the size of your muscles), so does endurance, and cardiovascular adaptations. I don't want you to think that in those 2-5 years I was inactive, I wasn't. I'm a firm believer in activity and varied activity; I was simply doing other exercise. The first few years of those 5 years I climbed a lot and hiked. Then I got back into biking and would do that whenever I could with some swimming sprinkled in there. My enjoyment of swimming while in LA has taken birth. Prior to living here, I worked it into my routine simply because I new it was good for me or 10 years ago because I needed to in order to perform reasonably well in my triathlon races, not because I enjoyed it. Here, I've grown to love it, particularly during the sustained Indian Summer months that we just survived through, yet again.

Having not run in so long, I knew that my hip strength, in particular, would be limited and this would in turn affect my running and my mechanics during running. If not addressed, I would run a much higher chance of becoming injured. If I wanted a healthy race, I needed a healthy base. I think it's noteworthy that at that time I didn't even know what race I was going to do yet alone what distance, sports, or time of year I'd be competing. I simply knew that I needed to start with the basics. So I worked on leg, core, and upper body strength, I stretched, and worked on all the imbalances that I knew I have. I worked on exercises that combine single leg balance and strength. 

We all have our issues and we all need to do our best to stay on top of them! I spent 3 months focusing on weight-training, stretching, and doing my "PT" exercises. Any runs I did were very short and focused on good form. Any leg pain? I would immediately stop. Any break down in form? I would stop.

I followed up that 3 month phase with cardio that built up all the way to my race. My goal was to do cardiovascular exercise - working in biking, swimming, and running - for one hour per day. As I got closer to race day, I started combining workouts (bricks) and doing 2 workout days to get the endurance for the multiple hours required for the race.

I had an almost unspoken goal of 3 hours for my race. I calculated this by simply combining my individual time from workouts for each portion of the triathlon. It was mostly "unspoken" because it was a dream time. I didn't know if I could do it all back to back that fast.

Well, I raced and I'm happy to report that I did it in 3 hours and 6 minutes. So close to my unspoken dream goal!

Most importantly, I was healthy the whole time and, in fact, my muscles and joints felt better than they had prior to my commencing training. I finished the race motivated to compete again, knowing that with the knowledge I gained from my training, I could reach my goal. Goals are important. Setting high goals are important. It helps you expand yourself and growth, whether you obtain the goal or not! Part of my purpose with the race, was not just the physical. I wanted to train my mental fortitude, too, in a way that I wasn't able to when I competed in triathlons previously in my 20's. I focused and learned from leaning into the discomfort that accompanies continued on when things get hard.

Don't wait until the pain comes, schedule a physical therapy visit with Liz at Artisan Physical Therapy to learn how to reach your goals healthily!

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

Stayed tuned for future blogs to read about how to tweak my training from what I learned from the experience. Let me know any questions you might have.

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

New Years Goals

Do you have any new years goals? Some call them resolutions, but others of us are put off by that term. Goals, however! Those are worth having! Still others, including myself, select a theme for the year.

My theme for the year is: whole-hearted.

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