Accelerate Physical Therapy offers our services at two Denver Metro locations. In our twentieth year, we are grateful for the opportunity to serve our community. We provide the best effort and expertise anywhere.

Every Saturday we will present a speed and conditioning camp with Tigers Rugby Football Club, beginning at 8:00 am through February 7th. All are welcome. There is no cost to attend, other than the appropriate admission fee to Paul Derda Recreation Center.

Healthful self-hydration is very important to a fit lifestyle. Many
times our patients suffer from muscular and spinal and joint pain, leg
cramps and general malaise that could be an imbalance of fluids and
electrolytes. We suggest drinking 2 glasses of water as soon as the
discomfort begins.

People taking medications or even vitamins may have a unique need
to add water to their diet. Exercise and forced-air heat like furnaces
and car heaters dry you out as well. Many bottled drinks are in fact,
less effective than plain old water. If your urine is yellow, or your feet
are dry, add 2 glasses of water to your normal routine. Drink extra
water on days you exercise, have massage, or require the heater in
your house or car. Stop the pain. Don’t get dehydrated!

Eight a day

The body loses, on average, about two to three quarts of fluid daily through perspiration, exhaled moisture, and excretion. You must replace this fluid—hence the rule of thumb about consuming the equivalent of at least eight 8-ounce glasses of water daily. Some of the water you need comes from solid foods, especially fruits and vegetables. You get the balance from liquids you consume (juices, milk, soups), which are just as good as water.

Any change in diet—particularly an increase in protein or salt consumption—or an increase in exercise or outdoor temperature may raise your fluid needs. Certain drugs, notably diuretics, will increase water loss, as will alcohol or caffeine. Dehydration is a particular problem among the elderly, in part because the thirst mechanism becomes less efficient as we age.

Normally thirst is the best sign that you need more fluids. But if you’re exercising or working strenuously in the heat, you can lose a quart of water an hour. Don’t wait until you’re thirsty: drink before, during and after your workout. If you fail to do this and need to replenish the water you’ve lost, weigh yourself after your workout, and drink a pint of fluid for each pound you’ve lost.

One glass of water shuts down midnight hunger pangs for almost 100% of the dieters studied in a University study.

Lack of water is the #1 trigger of daytime fatigue.

Preliminary research indicates that 8-10 glasses of water a day could significantly ease back and joint pain for up to 80% of sufferers.

A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on the computer screen or

Drinking 5 glasses of water daily decreases the risk of colon cancer by 45%, plus it can slash the risk of breast cancer by 79%, and one is 50% less likely to develop bladder cancer.

Are you drinking the amount of water you should every day?

What is Shoulder Impingement?

Impingement refers to mechanical compression and/or wear of the rotator cuff tendons. The rotator cuff is actually a series of four muscles connecting the scapula (shoulder blade) to the humeral head (upper part of the shoulder joint.) The rotator cuff is important in maintaining the humeral head within the glenoid (socket) during normal shoulder function and also contributes to shoulder strength during activity. Normally, the rotator cuff glides smoothly between the undersurface of the acromion and the humeral head.

How is Shoulder Impingement Treated?

The first step in treating shoulder impingement is eliminating any identifiable cause or contributing factor. This may mean temporarily avoiding activities like tennis, pitching or swimming. A The mainstay of treatment involves exercises to restore normal flexibility and strength to the shoulder girdle, including strengthening both the rotator cuff muscles and the muscles responsible for normal movement of the shoulder blade. This program of instruction and exercise demonstration may be initiated and carried out either by the doctor or a skilled physical therapist.

Source: American Orthopaedic Society for Sports Medicine

Patients can often compensate for loose ligaments by increasing the strength and control of the rotator cuff and shoulder blade muscles. These muscle groups help pull the humeral head into the glenoid and will pull more tightly if they are strong.

Typical rehabilitation programs start with a short period of immobilization with a sling and then progress to exercises like closed grip pulldowns, rowing on a machine and shrugs, for shoulder blade strength.

Strengthening programs for the rotator cuff include rotation exercises with the arm down at the side. Resistant rubber tubing or cables may be used.

Exercises that increase coordination of the shoulder are also important and these include exercises with a medicine ball, and bouncing balls against the wall and the floor.

Source: American Orthopaedic Society for Sports Medicine

My most common instruction as a rehabilitation specialist is to fix shoes that simply hurt us. This should be one for conspiracy theorists. Most shoes are not made well enough, and it seems to create a lot of business for Accelerate Physical Therapy, PC.

Recently a high school football coach asked me what to do about a rash of shin splints among players training through the summer. My first suggestion was that all players should wear supplemental arch supports in their training shoes and cleats. Arch supports reduce the degree of pes planus (flat feet or falling arches), dynamic foot pronation, ankle eversion, the Q angle at the knee, pelvic obliquity, lumbar scoliosis, and each of these region’s most common complaints of pain and dysfunction.

“What was that?” you say. Well, really it’s all physics, but still mechanically it’s simple. Adding height to the navicular bone at the medial arch changes the foot’s mechanical function and reduces most problems. Residual pain can take a while to go away, but simply won’t if left uncorrected. The vast majority of the clients referred to me with leg pain, and an appreciable number of back pain sufferers treated over my first 26 years as a Physical Therapist, have benefited from a simple $10 - $30 investment in arch supports. Personally, I consider it a health crisis that shoes, especially athletic footwear, are sold with flat insoles, or at best, insufficient support. Pricing cannot explain away this negligence. Even if you only stand all day, arch supports are critical to avoiding pain and many more progressive problems that we commonly treat.

My second suggestion was that athletes need to play, or at least run on the front of the foot and avoid heel striking, especially in football, baseball and softball. In more enduring athletic efforts like soccer, rugby and distance running, landing on the flat foot, minimizing the intensity of heel contact protects the leg from destructive and compressive ankle joint impact. Recent discussion suggests the need for firmer soles, based on the premise that running shoes offer too much cushion. Players who don’t learn to run off of their heels are victims of their own over striding and this angle of heel strike may be the physics problem we must solve.

When you land on your heels, you are decelerating, or braking. Stay off your heels, and avoid slapping your feet. Lean forward, leading with your chin, holding your spine straight with core muscles. This puts the center of gravity in front of the planted, or stance leg. The more you lean, the faster you MUST move.

Learning to run is well managed by speed coaches who help teach athletes to recognize inefficient running in others and to take responsibility for their own peculiarities. Some people say you can’t coach speed, but athletes with talent and horrible techniques are prime arguments to the contrary. Becoming stronger while the season progresses (with speed training and progressive weight training) are the key elements of our most famous success stories.

These two suggestions continue to address this team’s needs. What could be your problem? Call us and PLEASE, go get arch supports.

Paul O’Brian, PT, CSCS, Director
Accelerate Physical Therapy, PC
(303) 421-2210
http://acceleratept.com

About the Author:
Paul O’Brian, PT, CSCS, has been actively involved in Colorado physical therapy for over 25 years.
You can contact him at his Arvada, Colorado office.

• Cardiovascular changes including elevated heart rate, decreased cardiac output, orthostatic and autonomic dysfunction, venous stasis and thrombosis.
• Respiratory changes include reduced lung capacity.
• Musculoskeletal problems of reduced strength, endurance, lactose tolerance, risks of contractures and heterotrophic ossification of individuals with CNS or spinal damage.
• Metabolic risks including negative nitrogen or calcium imbalances, carbohydrate intolerance and insulin resistance.
• Urinary stasis, incontinence and stones.
• Gastrointestinal effects include decreased appetite, reduced peristalsis/constipation, malnutrition and hypoprteinemia.
• Integument systems risks of pressure ulcers (hygiene, shear, edema, reduced capillary flow to the compressed area).
• Nervous system changes such as sensory deprivation, anxiety and depression.

• Increases size and strength in musculotendinous tissue and tensile strength
• Improves coordination and timing of muscular groups
• Reduces atrophy
• Improves reaction, recruitment and endurance
• Supervision and instruction by your therapist for safe use and progressions
• Instructed techniques which promote accelerated muscle development
• Improve cardiovascular fitness
• Reduces edema
• Improves connective tissue strength and integrity
• Promotes circulation to enhance soft tissue healing/metabolism
• Increases bone density
• Increases endurance, reduces fatigue
• Improve range of motion of the spine and extremities
• Improves agonist/antagonist balance.

BY: Ross Hutchinson, PT, CSCS, Clinic Director

When a therapist considers a patient’s rehab program several factors must be addressed. Beyond looking at individual strength levels and activity levels desired we must consider the severity of injury. We specify our programs to appropriately stress the injured tissue.

Tendons and ligaments should be treated in the same manner by considering the mechanics of injury, adaptation to activity, and healing response during rehabilitation. Mechanical loading of a tendon/ligament can create injury with a single high load strain or repetitive loading or misuse injuries. The single high load strain can result in sprains, partial tears or ruptures which are more prevalent in ligaments, as muscle will rarely contract hard enough to tear a tendon. Achilles and patellar tendon ruptures are usually a result of muscle forces in combination with external forces. In repetitive strain situations the tissue injury begins with micro damage, which if created too quickly cannot be repaired fast enough. This results in pain, swelling and degradation of the tendon/ligaments mechanical properties. When this cycle continues, it can create a progressive degradation and make the tissue more susceptible to traumatic overload injuries. Tensile load is dictated by increased length of tissue stretched by percentage. A 1.5%-3.0% tensile load is common in normal activities, however without this stimulation the tissue will weaken, and with increasing the tensile load tendon strength will improve. Injury is created usually with over 10% tensile loads.

After a soft tissue injury the tendon/ligament will go through a typical soft tissue healing process. Inflammation 3-7 days, proliferation 2-3 weeks followed by remodeling after 2-3 weeks and up to more than one year, all in overlapping stages. Through the remodeling phase, the tissue fibers increase cross-links and align in the direction of tensile load. It is critical that the rehabilitation program provide adequate stress in a program of progressive loading that avoids inflammation. We must avoid over stress that can impede the healing process and cause scar tissue to form. The paradox of functional tissue training comes in balancing between sufficient loading to guide the healing process and overzealous loading that continues inflammation and tissue degradation. We minimize inflammation with early mobilization and PROM-AAROM program. This may be increased as the tissue progresses into the remodeling phase by progressive AROM, isometric and eccentric exercises followed by high repetition progressive exercises including CKC with proprioceptive and perturbation activities assisting in return to normal upper level activities.

Careful management of exercise type and intensity relative to the particular tendon or ligament injury, as well as awareness of the phase of recovery the tissue has reached is the key in progressing the patient. Optimal management will produce minimal pain and increased speed of healing, providing improved patient satisfaction.

About the Author:
Ross Hutchinson, PT, CSCS, has been actively involved in Colorado physical therapy since 1991.
You can contact Ross at his Arvada, Colorado office.

By: Bill Steinberger, MS, PT, CSCS

Most functional movements in the lower extremity take place when the foot is on the ground. The hip, knee and ankle joints, when taken together, comprise the lower extremity kinetic chain. When the distal segment is fixed and proximal segments move, the motion is called closed kinetic chain motion. Muscle contractions in closed kinetic chain motion are different from those in open kinetic chain motion at the same joint, and they also recruit all 3 joints in unison. Joint motion in the lower extremity is caused by many controlled muscle contractions that are the opposite of those in the open kinetic chain. For example, in the open kinetic chain, knee flexion is caused by concentric contraction of the hamstring muscles, which moves the tibia towards the femur. During closed kinetic chain motion, knee flexion is caused by controlled eccentric contraction of the quadriceps muscles, which moves the femur towards the tibia.

Closed kinetic chain exercise has become highly popular in rehabilitation, partly due to the belief that it is more closely related to function than open kinetic chain exercise. It is also believed that closed kinetic chain exercises are safer, particularly with regard to a healing anterior cruciate ligament (ACL) graft. Research has shown that ACL strain is reduced during closed kinetic chain exercise by virtue of the axial orientation of the applied load and muscular co-contraction of the quadriceps and hamstrings. In addition, closed kinetic chain exercise, through recruitment of all hip, knee and ankle extensors in synchrony takes advantage of specificity of training principles.

Research has also shown that closed kinetic chain exercise is more effective than joint isolation exercise in restoring function in patients with patellofemoral dysfunction, improving reflex stabilization and proprioception, reducing pain and promoting a return to normal daily activities and sports. For athletes in particular, closed kinetic chain exercise has been shown to more greatly improve strength and jumping ability in comparison to open kinetic chain exercise.

While open kinetic chain exercise certainly has its benefits and its own place in rehabilitation and strength training of the lower extremities, it is important to incorporate (and quite possibly emphasize) closed kinetic chain exercises for the greatest functional gains.

Active exercise has become better understood over the past ten years as a valuable tool in soft tissue pain and injuries. Improved circulation of blood and other body fluids and controlled reactivation of the joints and muscles are achieved with exercise.

Eccentric Exercise
Widely publicized in the early and mid 1970’s for its value in body building and fitness training, eccentric exercise has proven to be an effective component of the rehabilitation in tendinitis and epicondylitis conditions like tennis elbow.

Unloading Techniques
When exercise is applied while the effects of gravity are minimized, several conditions see benefits that otherwise might have been aggravated by exercise. The spine, shoulder and knee joints are commonly approached at Accelerate PT with exercise setups, which eliminate the use of secondary muscles that substitute for the weakened primary movers of the effected joints. A gradual progression in the loading of the joints facilitates progress in functional tasks including weight-bearing activities.

Aquatic Exercises
Another transitional form of exercise is submersion in water for both loading the muscles with resistance and/or to unload gravity from the body. Stimulation of proprioceptors and assisting the body to withstand longer duration exercise training are possible using public and private swimming pools and hot tubs.

Stretching Exercises
In addition to restoring range of motion for joint and muscle conditions, nerve tissue benefits from stretching techniques for the extremities and the trunk. Specific techniques carried out daily are important in the management of postoperative joint conditions and postural maladies including thoracic outlet and carpal tunnel syndromes.