Category Archives: Exercise

Exercise is a Cure!

Accelerate PTExercise is prescribed to assist healing from surgeries, injuries and chronic pain. At every stage, exercise activities aid in your recovery.

Here are some exercise benefits:

· Improve strength and restore range of motion.
· Stimulate soft tissue healing.
· Reduce inflammatory conditions.
· Improve body awareness.
· Reduce pain in joints because muscle balance improves the ability to move correctly. Reduce joint friction, stress and instability in dynamic activities.
· Stimulate bone strength in less active individuals.
· Bowel and bladder functions are enhanced by exercise.
· Improve circulation, reduce swelling in extremities.
· Prevent and reverse atrophy of the muscles.
· Decrease muscle spasms and back pain.
· Improve posture and associated soft tissue pain.
· Heal tendonitis and epicondylitis.
· Adapt support for longer, unloaded training.
· Aquatic exercise allows higher repetitions for accelerated return to athletics.
· Achieve wellness milestones with exercise.

Conditioning programs help physical therapists accomplish faster and more complete recovery with our clients. Evaluation and treatment by a licensed physical therapist can identify muscle imbalance and tightness that, with treatment can resolve problems and prevent a re-injury. A therapist will create a personalized treatment plan for the restoration of your active lifestyle.

Relieve Your Back Pain – at Home!

back pain wordle
Manual therapy enhances results for almost all back problems, as well other joints.

Back pain is a frustrating problem, but there are a number of techniques that extend the positive effect achieved in clinical physical therapy sessions. As with so many other problems, the body has the ability to heal. The role of the back pain sufferer and the physical therapist is to:

  • Eliminate aggravating circumstances
  • Engage pelvic, abdominal, buttocks and leg muscles to improve their performance.
  • Relieve mechanical pressure, and restrictions to movement.

Each time an aggravation of spinal tissue occurs, inflammation, tissue pressure and heightened sensitivity of nerve endings slows, or reverses the healing process. Sit up straight. Your mother was right. Stand, and walk with supplemental arch supports in almost all shoes. Don’t lift or pull with straight knees or a rounded trunk.

Pelvic floor exercise, and hip strength combined with improved effort of the muscles in front (abdominals) and behind (extensors of) the spine stabilize the position of its parts to control aggravation while the body resolves the inflammation and heals the injured tissue. Stretching the muscles in your legs and back is an important activity.

The effects of treatment are often remarkable. Manual therapy enhances results for almost all back problems, as well other joints. Decompression can be achieved clinically, but is also effective at home with a swiss ball. Some techniques are available on Accelerate Physical Therapy’s website as videos. Look for the Exercise Videos at  http://acceleratept.com/resources/exercise-videos/

Our summer intern, Jimmy DeAndrea demonstrates decompression and strengthening techniques in these videos. Jimmy has returned to The University of Wyoming for his final year. A graduate of neighboring Arvada West High School , he will pursue a career in physical therapy after graduation.

If you have questions about more specific issues, call a physical therapist. Exercise programs have traditionally provided astoundingly successful results. A number of specific causes, including combinations of joint and nerve irritations are distinguishable, and confirmation by your physician is always advisable. If you have questions about more specific issues, call a physical therapist.

Physical Therapy: Treatment and Training

All of the following describe generally accepted, well established and widely used physical therapy procedures and modalities provided at Accelerate Physical Therapy. These procedures are used as primary or adjunctive techniques in soft tissue treatment for the progressive development of strength, mobility and to improve functional outcomes.

Physical Therapy Procedures

The level of complexity can characterize the following physical therapy procedures and the expertise required to perform the task. These procedures involve training exercises or modalities requiring more specific skill than those characterized as modalities, but may be provided by assistants under the direct supervision of a licensed physical therapist.

Soft Tissue Mobilization is the skilled manual application of techniques designed to normalize movement patterns through the reduction of soft tissue pain and restrictions for the following reasons:
Muscle spasm around a joint
Trigger points
Adhesions
Neural compression

Joint Mobilization is the passive movement performed in such a manner (particularly in relation to the speed oft he movement) that it is, at all times, within the ability of the patient to prevent the movement if they so choose. Skilled manual joint tissue stretching is used to improve, and as possible, normalize joint movement of the spine and extremities and is performed for the following reasons:
To improve joint play/mobility
Improve intrascapular arthrokinematics
Reduce pain associated with tissue impingement or friction
Functional Activities involve the instruction, active-assisted training and/or adaptation of activities or equipment and has the following results:
Improves a person’s capacity for homemaking, including meal preparation
Improves a person’s capacity form communication, utilizing equipment
Facilitates return to work at previous level of function in lifting, driving, climbing, pushing, pulling, etc.
Job site modification to decrease postural dysfunction/pain

Therapeutic Exercise with or without mechanical assist or resistance has the following indications:
Improve cardiovascular fitness
Reduces edema
Improves muscle strength and coordination
Improves connective tissue strength and integrity
Promotes circulation to enhance soft tissue healing/metabolism
Increases bone density
Increases endurance, reduces fatigue

Massage – Manual or mechanical manipulation of soft tissue to achieve:
Reduced swelling
Reduced muscle spasms
Improved outlying circulation
Increased muscle tone prior to exercise
Reduced adhesions
Increased muscle length

Neuromuscular Re-education is the skilled application of exercise with manual, mechanical or electrical facilitation and through its use enhances motor response, strength and recruitment rate with independent control.

Neurodevelopmental Activities/Reflex and Sensory Integration/Proprioceptive Neuromuscular Facilitation (PNF) involves the skilled use of activities and exercises that promote neuromuscular responses through carefully timed proprioceptive stimuli to normal neurologically developed sequences. It also improves neuromotor response and reduces risk of impromptu muscle failure. It improves tolerance and enhances strength, normalizes movement patterns and improves cell waste and bacteria removal, and increases the muscular sense and perception of movement, stabilization and reaction time. These techniques achieve sensitization, or if required, desensitization of joint movement.

Gait Training – Crutch walking or walker instruction to a person with lower extremity injury or surgery:
Promotes normal gait pattern with assistive device
Promotes safety in proper use of assistive device
Instructs in progressive use of more independent devices (platform walker, walker, crutches, an cane)
Instructs in gait on uneven surfaces and steps (with and without railings) to reduce risk of fall or loss of balance
Instruction in the use of equipment to limit weight bearing for the protection of a healing injury or surgery

Straight Plane Exercises with or without mechanical assistance or resistance has the following effects:
Improves strength and coordination
Reduces atrophy
Improves reaction, recruitment and endurance
Supervises safe progression of resistance
Teaches techniques which promote accelerated muscle development
Increases size and strength in musculotendinous tissue and tensile strength

Activities of Daily Living involves the instruction, active-assisted training and/or adaptation of activities for personal care or equipment for mobility and self-care. This includes:
A person’s capacity in mobility and self-care to move from floor or sitting levels to standing, fluently and without pain.
Aids in sleeping without pain, grooming and self care including hygiene.

P.T. Physical Agents (Modalities)

The primary use of thermal modalities is for pain, swelling and to improve the rate of healing soft tissue injuries. Extended use is supported by consistently measured changes. Certain diagnoses and post surgical conditions may require periods of treatment beyond the normal ranges of 3-6 weeks.

Additional procedures are occasionally necessary to help control swelling, pain or inflammation during the rehabilitation process. They may be used intermittently as a therapist believes appropriate, or regularly if there is specific measured improvement during the treatment.

If our patient is not responding within 3-4 weeks, alternative treatment, further diagnostic studies, or further consultations with their physician or another physical therapist should be considered.

Ultrasound is the use of sonic generators to deliver acoustic energy for thermal and/or non-thermal soft tissue treatment. There may be a concurrent delivery of electrical energy. Ultrasound can be used to obtain the following results:
Softening scar tissue and reduce pain associated with scar tissue and adhesions
To soften collagen fiber
Accelerate soft tissue healing process
Increase flexibility of muscles and tendons
Reduce muscle spasms and reduce pain associated with muscle spasms

Hot Packs
Reduce pain or raise the pain threshold before exercise, postural training and gait training
Reduce muscle spasm to promote increased movement
Increases circulation to aid healing

Cold Packs
Lowers body tissue temperature for reduction of inflammation
Lessens pain resulting from injury or exercise by increasing the pain threshold
Reduces swelling and hemorrhage. Used in combination with compression and elevation
Lessens pain and inflammation from tendinitis and bursitis
Diminishes muscle spasm to promote stretching and decreases exercise induced muscle soreness
Increases circulation to aid healing

Electrical Stimulation
Applies electrical current (AC or DC) over skin to muscles, joints or other soft tissue for the following reasons:
Relaxes muscle spasms (including TENS)
Reduces pain (including TENS)

Iontophoresis – The transfer of medication (including but not limited to steroidal anti-inflammatories and pain relievers) through the use of electric stimulation. This procedures has the following results:
Pain reduction
Inflammation reduction
Reduction in swelling
Aids circulatory problems in the extremities
Decreases muscle spasms
Breaks down calcium deposits and softens scars

Phonophoresis – The application of ultrasound using a medicated lubricant that introduces molecules into the tissue similar to those used in iontophoresis.

Contrast Baths – Involves alternating immersion of the extremities; promotes circulation and has the following results:
Reduces swelling in the subacute stage of healing
Improves outlying circulation
Decreases joint pain and stiffness

Paraffin Baths
A form of heat application that uses paraffin wax/mineral oil mixture applied safely at 126 degrees Fahrenheit.
Symptomatic resolution of pain
Elevates pain threshold
Prepares for exercise, mobilization of the distal extremities and gait training

Exercise/Jog/Run Off Your Heels

Nearly 75%  of runners land on their heels. Joggers, runners, even walkers should not to land on their heels with great impact.  To prevent shin splints, ankle, knee, hip and back pain, all field athletes should try to land on the midfoot 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 joint impact.  Players are victims of over striding. The angle of heel strike may be the physics problem we must solve.

Recent discussion suggests the need for firmer soles, based on the premise that running shoes offer too much cushion.  Changing your running style to foot flat or forward on the foot may take concentration, but improves the whole leg’s ability to absorb shock.  If you exercise on a treadmill, elevate the incline 5% to easily learn this technique, and perhaps instantly reduce your pain.

When you land on your heels, you are decelerating, or braking. Stay off your heels, and avoid slapping your feet. To run faster, 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.run off your heels

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.

Mastering the Art of Walking

man walking street sign

We should be grateful for the instincts and development we have enjoyed since birth. Most of us are fortunate to have taken that crucial first step between 11 and 14 months old. Yes, crawling came first, but accomplishing the skill to walk is one of our immeasurable gifts in life. It is second nature for the most of us. With such simplicity, walking takes us from one destination to another and can be an adventure in itself. Walking requires no special skills, and no extra equipment. The experience can be as varied as the weather conditions.

People are almost dumb-founded to hear the actual benefits of walking daily, for a short 40 minute period. We’ve all heard that time is money, but where does our own health factor into our busy lives and budgets?

  • Walking is Exercise! Just Simple Exercise!
  • Walking, a painless activity burns more calories than you think.
  • Reduces Cholesterol! Walking can slowly reduce your cholesterol levels.Walking is good exercise
  • Walking can lower your risk of high blood pressure and reduce your chance of a heart attack.
  • While calories burn, your waist will begin to slim and your body muscles will gradually tone.
  • Surprisingly, walking will relieve your appetite.
  • A 40-minute morning walk, almost daily, can elevate your daily energy levels and stamina.
  • For those who suffer from osteoporosis (a disease where bones lose density), walking can slow down the disease process.
  • We all live stressful lives. Walking can help relieve mental stress and physical tension.
  • Walking on dirt trails, school tracks, or asphalt is softer than concrete or sidewalks.
  • Walking can be shared. Of course it is great to have your daily walk by yourself. It is gratifying and calming. However, taking your dog(s), spouse and kids on a walk through the neighborhood, or around a local lake can be as diverse as the direction, weather and season.

We never suggest walking in poor conditions, when the temperature is bitter cold, when pavement is icy, or when the sun beats down on you making it uncomfortable or unsafe for you to walk. The time that is spent walking provides time for thought, while exercising. In the end, it’s a win-win for all who develop the Art of Walking.

Activating Muscles

By definition, strengthening of muscles takes 6 weeks or longer. Strength is defined by the extent to which muscles can exert force by contracting against resistance. Quick changes in strength can often be attributed to changes in neurological activation. Few physical therapist and patients have 6 weeks or more to reach strength goals. We have to reach functional goals quickly to be reimbursed by the insurance companies and serve our patient needs.

Patients are like children and water. They always take the path of least resistance. In many cases our body will create compensatory movement patterns due to imbalances or injury. For our body to move efficiently we need all muscles to be active and work with appropriate force. You can’t strengthen a muscle that isn’t activated. The compensatory muscles are happy to kick in and perform the task, but perhaps with pain or decreased range of motion. A muscle that is inactive needs to be neurologically activated before it can become physiologically stronger.

Activation is neuromuscular education and movement training. Physical therapists are not personal trainers, we are neuromuscular experts. Finding imbalances or muscles that have become lazy and correcting muscles timing and coordination will improve specific joint function and often eliminate pain and improve function.

A common situation for muscle activation is following knee trauma. Our body protects our joint from injury by filling the knee with synovial fluid which in turn shuts down our medial thigh muscles to limit activity. We use exercise, as well as neuromuscular educational stimulation to reactivate the muscle group and restore function to the knee.

Following proper muscle activation exercises can be performed and over longer periods strength and power gains as well as muscle growth can be achieved.

Osteoarthritis? Exercise in Water!

Relieve pain with Aquatic Exercise

The prevalence of knee and hip osteoarthritis (OA) has increased in recent years as the average age of our population advances.  Increased patient cost reduces clinical time treating symptoms.  Yet, increasing incidence of OA challenges therapists to use the most effective ways to treat the pain and functional deterioration, which often accompany OA.

There has-been much research into bodyweight supported treadmill walking as an treatment.  A reasonable and similar alternative is aquatic therapy. The buoyant nature of water is similar to bodyweight supported treadmill therapy in that it reduces the amount of force transmitted through the joints of the lower body. When a person is standing in water, which is neck deep, 90% of their body weight is eliminated and at waist deep, 50% is eliminated.

Aquatic therapy encompasses any therapeutic activities, which occur in a pool. Often times these activities will include walking, balance exercises, stepping, etc. Using exercises such as these it is possible to target the hip and knee muscles which are often weak and in need of strengthening.

It is also possible to break functional activities into smaller parts and practice these with proper form in a non-painful environment thereby increasing the patient’s ability to perform the selected activity on dry land. By targeting these exercises to a patient’s specific needs and deficits in an environment of decreased weight bearing, we can make an impact on a patient’s functional ability.

Closed Kinetic Chain Exercises

Most functional movements in the lower extremity take place when the foot is on the ground. The hip, knee and ankle joints, together, comprise the lower extremity kinetic chain. Muscle contractions in closed kinetic chain motion are different from open kinetic chain motion. Joint motion is caused by many controlled muscle contractions. Closed kinetic chain rehabilitation is more closely related to function than open kinetic chain exercise.

Closed kinetic chain exercises are safer for the healing anterior cruciate ligament (ACL) graft. Research has shown that ACL strain is reduced during closed kinetic chain exercise.  Through recruitment of all hip, knee and ankle muscles in synergy, specific training and strengthening are functional and effective.

Research has also shown that closed kinetic chain exercise is more effective in patellofemoral dysfunction, improving reflex stabilization and proprioception, reducing pain and promoting a return to normal daily activities and sports. For athletes, closed kinetic chain exercise improves strength and jumping ability more than 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.

Spinal Stabilization Exercise

spinal stabilization exerciseSpinal stabilization is an important aspect of recovery from spinal pain, whether the problem is newly acquired or chronic. Exercise and proper body mechanics are well matched in this approach. Injuries and poor posture cause pain resulting in weakness that will not resolve completely without personal effort on the part of the person seeking assistance.  The symptomatic spinal segment may be held in a comfortable mid-range position by muscle force rather than a back brace.  Joint or disc pain will cause muscle spasm to protect itself, triggering additional pain.  By practicing “muscular fusion” during movement and static postures,  the pain is most often controlled and the muscles supporting the painful segment begin to overcome inhibition.  During movement, stability may also be maintained.  Proper muscle development and volitional control can be difficult to teach.  Spinal stabilization is a well-structured and meaningful application of tasks that result in balanced strength and reaction skills sufficient to control spinal pain.

The muscles responsible for the support of spinal segments are compromised by direct injury, and indirect factors including postural faults, gait deviations, hypermobile ligaments, muscle weakness, substitution or imbalances, and post-surgical or post-partum conditions.  Identifying and addressing problems in leg length discrepancies, foot position and support, knee and hip function, and whether they are symptomatic or simply inefficient are critical clinical decisions.  The most significant factor in clinical success with back pain is the consistency with which the back pain sufferer can be motivated, inspired, prodded, schmoozed, compelled, tricked, or simply asked to perform specific tasks (exercises and proper body mechanical movement) every single day.  Success is likely within 3 weeks if compliance is achieved.  Additional exercise training in aquatic,
unloaded and remedial situations bring the spinal pain sufferer back to the level of activities desired.

Osteopathic and chiropractic physicians and physical therapists attempt to restore normal joint mobility and position.  The only substantive support following these procedures is the normal muscle function of the region.  As in other joint issues, the ability to discontinue passive treatment of the spine is ultimately linked to the restoration of normal muscle strength, balance and reaction time.

Golf: Dynamic Stretches

A pro golfer typically might warm up 90 minutes to 2 hours before walking out to the tee.  His routine would consist of stretching, putting hitting, practicing short game and then back to any special shots and out to the green.  A typical routine for a recreational golfer would be different.  Get out of the car, find your friend and get whatever you forgot at the pro shop, swing a couple practice shots, and go to the tee.  Typically we don’t warm up until half way through the front nine.  The question is what is a quick time efficient way to warm up before golf with our busy lives.

The answer is dynamic stretches. Dynamic stretches Dynamic stretching is useful before competition and has been shown to reduce muscle tightness. Muscle tightness is one factor associated with an increase occurrence of musculotendinous tears. More recent scientific studies seem to suggest that dynamic stretches before competition are preferably to static stretches. This may be particularly true for strength and power athletes.

All exercises should have 5 second holds and be done 5-10 times.
Standing Cat n Camel/ Pelvic Rotation
Begin in your address position, arms across chest. Tuck the pelvis under then arch the back, creating a rocking of the pelvis into anterior and posterior position and return to a neutral spine.

Trunk Rotation/ Vertical and Horizontal Axis
Standing in your address position, bring the palms together. Inhale as you rotate from the core and bring the both arms back. Mimic backswing then follow through with a stop at the address position.

Try the same exercise at chest to shoulder height twisting trunk and keeping arms in the parallel to the ground.

Standing Hip Stretch
Use a golf club for assistance with balance. Place one ankle on the outside of the opposite knee. Inhale as you bend your stance knee, sitting back as if you are sitting on a chair. Bring the chest toward the shin, rolling the shoulder blades together.  Reverse legs.

Shoulder Rotation Stretch
Place the club or towel in your right hand, palm facing the ceiling. Bring the right arm over your head and the right palm behind your back. Bring your left arm behind your back and clasp the club or towel.  Move the club up and down your back stopping when you feel a stretch and squeezing the club together.

Upper Trapezius Stretch
Bring the right ear toward the right shoulder. Inhale as you press your left arm toward the floor, exhale and relax the left arm.

Standing Shoulder Blade Stretch
Bring the club to shoulder height, bend your knees and tuck your pelvis under. Inhale as you press your arms away from you, tucking your chin into your chest. Exhale, lift the head and squeeze the shoulder blades together.

1) National Strength & Conditioning Association. Essentials of strength training & conditioning. Champaign, IL: Human Kinetics. 2000
2) Yamaguchi, T., Ishii, K. Effects of static stretching for 30 seconds and dynamic stretching on leg extension power. J. Strength Cond. Res. Aug;19(3):677-83. 2005
3) Shrier, I. Stretching before exercise does not reduce the risk of local muscle injury: A critical review of the clinical and basic science literature. Clinical J. Sports Med. 9: 221-7. 1999