Running injuries

What Sets MVPT Apart? Mechanotherapy.

Mechanotherapy is what you are looking for, you just don't know it yet!

You have water in your row boat. What’s the best solution: find the hole and fix it or bail the water out? This is the classic question of treating the symptom versus treating the source of the problem.

What causes pain?

If you have pain, is it chemical or mechanical? Mechanical pain is overwhelmingly more frequent than chemical pain. Something stiff or something weak will cause pain. The chemical reaction or some say “inflammation” is the consequence of the mechanical problem failing. Ultrasound, dry needles, electricity, lasers, are some of the examples of what we might use to treat a mechanical problem with chemical means.  There are no double blinded, good studies to show any of those things are any better than a placebo.  Clinical experience shows they don’t help.  

Mechanical fixes (mechanotherapy) are joint “mobilization” and muscle and tendon “progressive loading.” (both described below)  What is unfortunate is the American Physical Therapy Association doesn't even recognize mechanotherapy as a possible treatment option.  We as a profession cannot agree on what is best for patients so we end up losing patients to other professions because we don’t address the real problem.  Managed care doesn't want LESS things to bill for they want MORE.  The equipment used to treat chemical problems cost lots of money.  Expensive buckets to remove the water spilling into the boat.

Mechanotransduction (The scientific word for mechanotherapy) is defined by Khan and Scott as “the physiological process where cells sense and respond to mechanical loads.” These mechanical loads induce stress on the tissues to which they are applied, and this stress induces a response in the tissue to create a stronger structure in order to withstand that stress in the future. One of the most common examples of this concept being applied is through Wolff’s Law. Wolff’s Law states that “bone grows and remodels in response to the forces placed on it.” In other words, weight-bearing bones, such as femurs and tibias, are made stronger in loaded, weight-bearing positions--think squatting with a barbell. Not only are you squatting your body weight, but you are also squatting the additional weight of a heavy bar. Your bones thrive on this type of stress and they thank you.

Wolff’s Law is often only associated with loading bones to prevent conditions such as osteoporosis. However, it can be applied to other tissues as well, such as tendon, muscle, and cartilage. Therefore, another way of looking at this concept is that the application of Wolff’s Law to the entire musculoskeletal system is mechanotransduction. By utilizing a great enough stress to drive cells to respond in order to build and develop stronger tissues, we can create a progressive loading program through which the body trains to adapt to increased forces.

Mobilization is a form of stretching that changes the amount of range of motion of the joint as opposed to the flexibility of the soft tissue around the joint.  Allowing for flexibility through stretching and not stabilizing the joint causes a temporary change in pain that requires more attention.  

Stabilizing the joint through progressive loading then, once the joint is working better, loading the joint with heavy loads is how the hole in the row boat is patched.  Low load-high rep exercises will cause the connective tissue to grow.  Low rep-high load exercises require sound connective tissue integrity. This will improve the body’s ability to tolerate activities of daily living  as well as the ground reaction force of running, lifting, or sports.  

Restoring high level activities cannot be performed by chemical means, it must be done using mechanical means like loading.  Squatting, deadlifting, and push press are key to a body that can tolerate some force.  Here at MVPT, we do not use any modalities to treat your mechanical problem.  We do a thorough evaluation, find the stiffnesses or weaknesses and then put a plan together to help you correct the abnormalities in joint position or weakness.  Call 702-998-2900 to make an appointment today!

Want to read up?

Khan, K. M., & Scott, A. (2009). Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 43(4), 247–252. https://doi.org/10.1136/bjsm.2008.054239

How Wolff's Law Is Used During Fracture Rehab in PT. (2018). Retrieved from https://www.verywellhealth.com/wolffs-law-in-physical-therapy-2696151
 

Understanding the STRESS-->Recover-->ADAPTATION Phenomenon

Understanding the STRESS-->Recover-->ADAPTATION Phenomenon

MVPT brings a skilled balance of knowledge and experience to the rehabilitation and training of athletes of all ages and performance levels.

MAXIMUM VELOCITY PHYSICAL THERAPY: A FRESH APPROACH TO HEALTH CARE

What if the person you met during your next health care visit taught you that you didn’t need their services?  Wouldn’t it be nice if you booked an appointment with a health care provider and you knew exactly what he or she were going to do?  How much it would cost?  Wouldn’t it be nice to know there were no huge bills coming down the pipe after the care?  What if you knew up front that the goal of the health practitioner was to get you discharged as soon as possible? Are you worried about the health care provider telling you that what you are doing is bad for you?  Barbells are bad for you right?  Running is hard on your knees, correct?  Squats are the enemy, right?  NO.  After 15 years of experience, reading volumes of research, attending continuing education classes with the brightest and most accomplished practitioners of a wide variety of disciplines, a primary theme surrounding health care is: Quality care is hard to come by.  You will not find quality care in the corner health care facility.  The average health care provider is inundated with managed care hoops to jump through.  If you are an athlete, the “sports doctor or PT” who spends a quarter of their time with Medicare patients is not skilled in sports care.  If they spend ¼ of their time on total knees and hips, they don’t have the experience to help you.  You need someone who spends 100% of their time with active people.
At MVPT we spend our time with all kinds of active people of all walks of life.  Kids in team sports to “elderly” who run or hike(by the way, I would put these “elderly” up against any of our kids - so impressive).  Here is a list of athletes (but not limited to) that we at MVPT have had the pleasure of assisting:
    •    Obstacle Course Racers (OCRs)
    •    Triathletes
    •    Runners
    •    Crossfitters
    •    Gymnasts
    •    Cyclists
    •    Track runners
    •    Hikers
    •    Power lifters
    •    Swimmers
    •    Rock Climbers
    •    Team sports-Lacrosse, football, soccer, basketball, baseball, etc


“I am a rock climber. Three and a half years ago, my hand went numb. I have been to countless doctors and physical therapists since then without relief. Ron is the first PT/medical professional to really examine me from head to toe, as opposed to jumping to conclusions based on limited information or judgements on my athletic pursuits (like “You’re a climber? Tendonitis.” or ”Your hand is numb? Carpal tunnel.”). He made connections between what I thought were unrelated aches and pains, and all of the pieces are finally coming together. Ron gives each client a personalized training program, which he constantly tweaks based on your physical response and changing body. Even with multiple patients training simultaneously, Ron always manages to give personal supervision to each of us. Ron is also honest about your progress, and he is not one of those PTs who prescribes ongoing sessions; instead, he evaluates the benefit of continuing therapy on a daily or weekly basis. Because of the training provided by Ron, my strength and endurance are returning, people are noticing my muscles again (woohoo!), and yesterday I had my best rock climbing day in over 2 years!”  –JEN

What does MVPT do that other related health care professionals don’t do?  We listen and inspire, first of all.  We spend time with you.  We use 15 years of clinical experience to treat the origin of the problem, not mask the problem.  We use active treatments for active problems.  Passive treatments feel good, but they do not get the source of the symptoms as fast as progressive loading does.  Your sport or activity is very rarely bad for you.  The problem is you don’t have the range of motion (ROM), strength, or mechanics to do the job you are trying to do.  Rest will not give you the skills to return to activity quickly.   If you are here for a running problem then you need your run evaluated.  Walking mechanics are not running mechanics; rolling or sit-to-stand mechanics are not running mechanics.  You have to run to understand the biomechanical errors you are making during running.  After hundreds of hours of continuing education in running and gait training alone, we have the book knowledge/science background in all things running. We back up that knowledge with over 8 years of treating runners daily through rehab, strength training, and coaching.  We recognize the difference between “feeling good” and resolving the problem.  There are many interventions that feel good.  There are a select few that can that get you back to performing at a high level quickly. Most athletes agree, performing your best without pain or injury is what really feels good.

As an Athletic Trainer, it is difficult for me to admit something is an injury, let alone seek out another professional for my own rehabilitation. After a grueling attempt at World’s Toughest Mudder in November of 2015 – and I use the word “attempt” loosely, as I was an official finisher – I was left with nagging tibialis posterior (i.e. the inside of my ankle) pain that just was not resolving. I had heard about Ron through a friend, and figured it couldn’t hurt, especially as I refused to allow my MD to immobilize the ankle in a boot. Admittedly, I was a bit nervous, as I have a particular approach to dealing with injuries, and was afraid he might be another run-of-the-mill, protocol-rooted PT; fortunately, I was wrong, and his knowledge of the anatomy as it related to running (and vice-versa) was impressive to say the least. Within six weeks, not only was I pain-free, but I placed sixth at BattleFrog’s inaugural BFX24, another 24-hour Obstacle Course Race (OCR), with 55 official miles. Not only had Ron gotten me back to 100%, but he completely changed my running mechanics for the better, and, dare I say it, made me stop hating to run!

In September, with less than a month before OCR World Championships, he helped to quickly resolve a groin injury that threatened to end my season early. Whenever a friend or fellow athlete has asked for a recommendation, or mentioned a nagging injury, I never hesitate to recommend Ron – he has a phenomenal understanding of the capabilities of the human body, and will have you leaving better than you were pre-injury. -STEPHANIE, professional OCR


What is progressive loading?  Progressive loading is a progressive approach to loading the tissue in trouble and creating an environment in which the structure can learn to handle the stress of the activity. Or simply put: training/treating your body gradually and increasingly. No visit is the same.  We use 15 years of clinical experience to identify the tissue in trouble, examine the biomechanics of the activity in question compare it to the movement of the body in trouble, and build an individualized plan to restore the activity as soon as possible.  There is no evidence a cookie cutter movement screen or plan will identify an injury or aid in performance.  The needs of the individual patient cannot be generalized.  Let’s simplify things.  Our medical system has so many specialists that the entire body system is rarely taken into consideration.  Medical education has no contact with barbells whatsoever.  A barbell is not your enemy.  All athletes require strength.  All humans require strength.  There is no situation whatsoever where too much strength is a problem.  Crossfitters are not performing a dangerous sport.  They are mishandling loads.  They are moving the bar too fast, too soon, or with too much weight.  We team up with their coaches to ensure the athlete progresses well enough to get back to full activity as soon as possible.  Chances are the athlete does not possess enough ROM, strength, or biomechanics.  If you have a problem with your over head squat, for example, will a traditional PT have a barbell around so you can show them how you are doing it?  If they tell you that is a bad motion for you, they are misinformed.  

“When I walked into Max Velocity I had been struggling with pain for over a month that disrupted simple daily activities. Tying my shoes became a near impossible task. On my first visit, Ron was not only able to diagnose the cause of the pain, but he also took the time to explain why it was not an assortment of other issues. His demonstrated knowledge gave me confidence that I would soon be feeling healthy again. I continued to do the exercises he recommended and within days the pain began to subside. It’s just a few weeks later, and I am now pain free and back into my full training (and also hitting some new prs). Thank you Ron!”
- Lauren, Crossfit Regional Qualifier


Coaching
Wait, you coach too?  Yes.  Coaching is not our primary objective.  We coach out of necessity.  We decided that if we are going to be training experts then coaching credentials are necessary to ensure the knowledge base of what it takes to complete certain tasks is obtained.  Has your current PT asked you what the distances are for an Olympic triathlon?  Do they know what is required of you from a training point of view if you are trying to qualify for Boston in the marathon?  If you are 12 weeks from a marathon wouldn’t that load be different than if you are 2 weeks away?  Wouldn’t you want your PT to know the difference? A Physical Therapist who has finished a full ironman, 5 half irons, 4 full marathons, 20ish half marathons, and a lifetime of sport participation knows what it’s like to be an athlete.  2 years of Division 1 coaching in cross country and track, while developing friendships with NCAA champions, national championships, and Olympic caliber coaching experience makes us an ideal resource to help you return to full activity.  Wouldn’t you want your health professional to program your treatment to help you attain that goal rather than unnecessarily shut you down?  HYPERSPEED LV is in place to help the young athletes of the valley cross train intelligently.  Remove the one-sport over-specialization that is plaguing our youth.  The primary swimmers of the group have decreased times by the minute by removing 2 days a week of swimming and adding progressive loading.  If we gripe to parents about how their kids train then we should offer a solution.  WE DO NOT INTEND TO POACH athletes. We intend to make the patient the center of the situation and use a team approach to the athletes success.  Our goal is to teach you to not need physical therapy.  We would rather see you and 2 of your friends for 3-4 visits than 1 person for 12 visits.  WE understand athletes, we want to take care of our own.  Traditional medicine is set up for treating the sick and NOT to treat the near healthy.  Help us create a paradigm shift in health care.  Please feel free to interact, ask questions, and get informed.  If you are interested in making an appointment please call the clinic 702-998-2900 or go to maxvelocityPT.com to “request an appointment,” and I will call you back.   

 

How Young is Too Young to Lift Weights?

Generations ago kids played outside.  They ran, jumped, climbed trees, and rode bikes.  They played baseball in the spring and football in the fall.  And they played many other sports in between.  Neighborhood kids would gather after school, find a ball and some open area, and they would play a game. The kids these days have incredible technology and dangers that were not around 20 years ago.   A pick up game nowadays is an old thought.  They simply cannot play without supervision.  So what is a parent to do so their kids will exercise?  Many turn to organized sports - some to an extreme.  Kids are more competitive at younger ages than 5 years ago, 10 years ago, 20 years ago.  Club coaches mistakenly educate parents the kid must play year round to be competitive when the scholarships are handed out or big competitions come up.  That is simply not true.  Athletes, especially young ones need a diversity of physical activities.  81% of D1 college athletes were multisport athletes in high school.  The trend in collage recruiting is to PASS on one-sport athletes.  They are a risk to the investment the school makes in that athlete due to injury.  Single sport athletes typically get injured when they are sophomores or juniors in college.  Because kids don’t know any better (and don’t read blog posts), it falls on the parents to seek out the information that will maximize their kid’s chances of success.

They say that life is 90% how you react to the 10% of the things that happen to you.  I can say that over my lifetime, that is very true.  Today’s blog post is using that metaphor in a business sense.  While MVPT is still the community leader in running medicine and the Las Vegas valley’s only running specialty clinic, something interesting happened when MVPT opened its doors in 2014.  Kids came.  A lot of kids came.  The more kids who came, the more their parents talked to other parents.  The valley is full of kids who are training for sports.  Since the weather of Las Vegas is tolerable for the majority of the year, kids train year round.  That could be a problem.  Kids over-train the one sport they play.  Over specialization is a huge nationwide problem and Las Vegas is no different.

Injury “prevention” is almost an impossible goal.  Accidents and injuries happen.  “Minimization,” is a better goal.  While the spirit of prevention is alive and well, educating an athlete to do this or that to eliminate any chance of injury is simply incorrect.  I have been guilty of doing this.  Every day, I read research and study, and now I realize that is false hope.  Your young athlete will be injured.  That is a fact.  Can we make it a sprain instead of a fracture?  YES.  Can we get tenonosis instead of an ACL tear?  YES.  How?  Strength.  There is no situation ever where an athlete is ‘TOO STRONG” and therefore a detriment to his or her performance.  However, there are limits.  If the kid just picks up a barbell and loads it up he may be doing more harm than good.  The key is in the details.  Originally, the idea for MVPT was formed when a lot of the so called “sports trainers” were hurting kids left and right.  Not just asking them to lift, but asking them to lift too much too soon, or choosing inappropriate exercises. 

You see, the demands of the sport shouldn’t be replicated in training, it adds to the over use.  Understanding the movement patterns of the skills of that sport is the skill of training athletes.  Anatomy, physiology, and proper periodization are the key.  The skills have to have a progression.  The load of weight lifting is a major component health AND performance.  Weakness hurts.  Since the motor development of kids is hampered by NOT going outside, they are left to figure it out on the field.  Then that demand is specific to the sport.  The athletes flounder.   

Then comes the cross training.  The cross training should be movement specific, loaded when it is appropriate, and must compliment the sport.  The feather in the cap at MVPT is a physical Therapist who is trained in barbells and human movement.  A life-long multi-sport athlete himself, the program can be tailored to athlete specifically. The movement for an individual will depend on many factors.  The experience to deal with these factors comes from 15 years of clinical experience.  There are no short cuts - no models that can predict with certainty whether or not an injury will or will not occur.  There is simply no evidence with any predictive power that short cuts help.  They cannot prevent an injury nor do they help with performance.  The athlete’s nervous system has to learn and adapt to a new method.  Hard work, dedication, adaptation to loads, and movement correction are the keys to sports performance.  So the question is at what age can a young athlete begin a strength program?  The answer is, as soon as he or she has the movement maturation to tolerate such a load.  Some kids are ready at 8 while others need more time.  Age is not as important as movement when it comes to making this decision. 

We at MVPT pride ourselves in “evidence based” care.  Which means the interventions that actually help are the interventions we delegate.  We offer a “functional” evaluation to screen a healthy athlete and make recommendations on minimizing trouble.  We would love an opportunity to use our vast knowledge and experience to help your child perform better.  Discounts apply to teams.  Please go to the website at maxvelocity.com for more information or you may call the clinic at 702-998-2900 to make an appointment.  Please feel free to share, comment, or like!  Help us spread our message! 

Gait Training is the Key to Running Performance and Injury Minimization

Gait Training is the Key to Running Performance and Injury Minimization

Runners are miseducated everyday.  Running is healthy for your skeleton.  Rest will not help your ability to return to running.  Come to MVPT and learn how to apply the skill of running to your injuries or performance.  We would love to HELP!!

The TRUTH About Foot Pain

The TRUTH About Foot Pain

Foot pain does not have to be such a mystery.  Find the movement error and apply a change to that movement error to eliminate the pain.  We can help!

Top 6 Reasons MVPT is For You…..Even If You Didn't Know It

Top 6 Reasons MVPT is For You…..Even If You Didn't Know It

Lisa Leonard has summarized a very compelling list of things that make MVPT special.  What do you want from your health and fitness?  We can help.

MVPT Year 1: The Year in Review – From Nothing into Something

MVPT Year 1:  The Year in Review – From Nothing into Something

1 year later and the mission is the same.  Education and performance is the key to inspiring for full potential.

What Runners Need to Know About Running Injuries: Part III Limb Alignment

First, a quick review of the previous posts.  Running injuries are directly related to LOADING RATE or how your body handles the force and speed that the ground inflicts on our body.  Jay Dichary is the pioneer of this concept and I encourage you to read his book “Runners Anatomy.”  He states:

Running Injuries are directly related loading rate (Part 1). Loading rate is directly related to Contact or how your body adapts to force of running (Part 4).

Contact style from part II is how the body is interacting with the ground.  Limb Alignment is the focus of today’s discussion and limb stiffness will be discussed in part 4.  Limb alignment has the most variability of the aspects that influence loading rate.  Limb alignment is synonymous with running mechanics or even running biomechanics.  Running mechanics can be described as the position your body is in when contact with the ground occurs.  That position is key.  Remember running is a skill.  The skill of landing in a way that the big and powerful muscles do the work while minimizing ground reaction force.  Running is painful when we are doing it wrong.  Joint motion of the spine, hip, knee, ankle, and foot, as well as, stability of the same joints will have a huge impact on how we run.  In order to handle landing force we must be able to slow down 3-5 times our body weight and we must be able to propel 1-2 times our body weight.  Therefore, strength is the cornerstone for efficient running.  Postural muscles hold our body in positions while big strong prime movers handle the work of running.  Soft tissue injuries while running like IT Band, patellar tendon, plantar fasciaitis, and shin splints are related to the wrong tissues taking on force while the correct tissues are not working hard enough.  With proper identification of the problem, proper cueing during running, and a strength program that supports efficient running, pain-free running can be restored.

 

At Maximum Velocity Physical Therapy we are the ONLY running specialists in Las Vegas or Henderson, NV.  We offer gait analysis, that is, gait evaluation with video analysis, and can help runners return to running with no pain or assist a runner who would like to take their running to a new level.  At MVPT we believe that strength training is a runner’s best friend.  We offer running performance enhancement strength classes to assist an oft injured runner or help the runner reach new goals.  For a limited time, we will allow you come on by and experience a class to see if it is something you can benefit from (I will casually pitch you my program though, just be aware, lol!).  Please go to maxvelocityPT.com to read more about us or request an appointment for physical therapy, gait evaluation, or functional evaluation today!   

What Runners Need to Know About Running Injuries: Part II-Contact Style

In Part 1 we discussed that all running injuries are related to LOADING RATE.  To review, loading rate is how quickly the body (bone, tendon, muscle) absorbs the ground reaction forces with each step.  That is how our body handles speed and force.  Jay Dicharry PT, has done some awesome work in this area.  He has a book "Anatomy for Runners" and should be required reading in PT school and can be a great gift for any runner.  He says:

 

Running Injuries are directly related loading rate (Part 1). Loading rate is directly related to Contact style or how you land (Part 2), Limb Alignment or what your body is doing (Part 3), and Limb Stiffness or how your body adapts to force of running (Part 4).

 

Contact style is the focus of todays discussion.  Contact style is the interaction of the body and the surface you are touching.  It is the foot versus the ground.  Contact style is; are you landing forefoot, mid foot, hind foot or heel striking, landing hard, landing soft, over striding, under striding, what type of footwear do you use, asphalt, concrete, trail, etc.  Runners say "Heel striking is bad, right?  I should be a "forefoot striker?"  The truth is it doesn't matter.  WHOA!  It only matters where that contact occurs.  There are efficient heel strikers and there are inefficient fore footers.  Actually, the bare footers have it right.  What they learn (of course they learn the hard way, lol) is that soft landing is the key.  There are many studies that show the best possible cue for runners is "landing soft."  We see large changes in ground reaction force with soft landing.  Before you throw your shoes out, you must know that the bare footers traded old injuries for new ones.  The fact is that efficient running can occur with shoes on.  Did you realize footwear doesn't matter?  Wait, whhhhaaat?  The running industry makes millions of dollars brain washing you that you need new shoes when the pain comes back.  If your contact style is dependent on footwear then you will require footwear.  If your contact style depends on your bodies ability to move with stability (limb alignment, Part III) and control then the footwear does not matter.  Shoes cannot effectively correct movement errors.  

The best way to manage contact style is to work on landing soft.

At MVPT, a gait evaluation is key to healthy and effective running.  The gait evaluation is $135 one time fee and will be the baseline.  One hour, one on one, injury past, physical exam, "functional" exam, and video analysis on the treadmill.  Education comes next.  From there we can give you specific running homework (follow-up appointments are $1 a minute) and your progression from there depends on you.  You will be educated on what you need to do reach your goals and treatment will be YOUR decision.  We can be there once or twice a week to ensure effective inclusion of your exercises and running cues or we can meet less often, if that fits your lifestyle.  If you get injured down the road your videos and baseline data will be available to you.  We can be here the whole way close or from afar.  After all, the goal is life long runners who are setting the bar higher and higher and getting more and more efficient.  Go to our website maxvelocityPT.com to request an appointment today!