physical therapy

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
 

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! 

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!   

Why a "Running" Physical Therapist is Best for Your Skeleton

First and foremost you must hear every chance you can that RUNNING IS NOT BAD FOR US.  Simply put there is no evidence to say that running is harmful for the human skeleton.  That is right none.  There is a monster wives tale that running is pounding and that pounding is bad for us.  Truth is the pounding is GOOD for us.  Our skeletons are hardwired biologically to respond to force.  Wolfe's Law states that human tissue will respond to the force that is placed on it.  Bones need pounding, tendons need tension, and cartilage needs sheer force or rubbing.  The specialized forces make these tissues grow and get stronger.   It is not uncommon to have a tendon problem that "feels better" with a brace.  Sure the pain is less but by removing force from the tendon the problem stays there longer.  The brace makes the problem stay there longer.  

 

Running research is compounding weekly.  There are very smart people world wide adding to the pile of evidence that all of us can benefit from the force of running.  The area of biomechanics is exploding as technology get more advanced.  High speed cameras, better force plates attached to treadmills, and better wiring for studying muscle firing are just a few.    Based on this information we have baselines for rules of running.  These rules are guidelines that successful runners are handling well and injured runners are struggling to learn.  These guidelines are broad enough to catch non runners as well as very good runners.  Running is fundamental to the human experience.  Not only is the running the basis for every sport (except may be swimming or a few others) but it is built into our genes.  We walk up right because we run.  We have specialized musculature because we run.  Out ancestors ran up to 20 miles a day.  What happened to us?  We got lazy.  Convenience is a way of life, especially in America.

 

 

After over 100 continuing education hours in running and learning from the world wide leaders in medicine of running and elite training of runners, running literature has tremendously affected my practice of physical therapy.  Every human has the same anatomy, they just use that anatomy differently.  Running literature expresses the science of human performance at a very high level.  When our skeleton is handling those types of forces than lesser forces are easy to handle.  The answer is to do more.  Unfortunately American medicine has a reputation for instructing us to do less.  "Oh you shouldn't do that."  Oh you should rest.  Uh oh, thats not good for you.  Simply not true.  Usually an injury is a lifestyle check.  The answer is to do more.  Our skeletons need time to react appropriately to force but adding force is the idea, just dose it in smart.  Interventions from the outside in like electricity, ultrasound, massage, ice/heat, and any other palliative treatment do not change how the inside of you handles force.  Force is the problem.  Running is not the problem, how you are doing the running (or not doing it), is the problem.  If this post brings up questions chances are you are not the only one, share them.  Feel free to start a comment thread and help me educate the Las Vegas running community.  Feel free to stop by the clinic and ask questions I love the interaction.  MVPT is open anytime for that.  Happy Training!

 

 

 

 

 

There are 2 Types of Patients: DO MEs and SHOW MEs

Physical Therapy (PT) is a very dynamic profession.  When compared to the rest of the professions in the medial field PT is very young.  Very young professions are trying to prove they belong.  PT has an initiative in place to build more and more evidence that we belong.  When I hear about my colleagues rushing over 50 patients a day through a clinic, my heart breaks.  When I hear people complain about the type of care they received and I see "hot pack, ultrasound, massage," I cringe.  Physical Therapy is fighting for legitimacy and greed or money takes precedence over quality care.  

When Physical Therapy puts out a watered down, factory-like product people think thats what Physical Therapy is.  This style of treatment breeds a patient expectation that I call "DO ME."  DO ME's believe that when they arrive at PT someone is going to DO something to them to make their impairments go away.  When the patient return to the doctor with no change in impairments the doctor proceeds to the next level of care.  Usually something more invasive.  PT has let the patient and the medical community down by not fulfilling our role.  DO MEs dont realize this is happening as they are relying on the experts.  DO Me's dont read research.  They dont realize that hot packs, ultrasound, electricity, dry needling, and massage are not proven to be beneficial.  There is a lot more to the treatment of medical problems especially musculoskeletal problems.  Sure those treatments feel nice but changing impairments sometimes doesn't feel nice.  Thats where the SHOW ME's come into play.  You cannot replace the work.

SHOW ME's do not crave short term benefit.  SHOW ME's can be educated on why they feel, what they feel, what they need to do to change it, and be given a plan for the future.  PTs are experts in biomechanics, movement, and the treatment of such injuries.  If the problem is climbing stairs then the PT should evaluate the task of climbing stairs for you. The PT should identify a movement error and apply a plan to help this person move better.  Show them how to move better.  Movement disorders are governed by daily habits that causes anatomical reactions that can lead to performing well or limiting performance.  For everyone how we feel is a result of how we are trained.  By sitting on the couch or not training, anatomical problems find you.  Arthritis is a result of inactivity not overactivity.  For those who are exercising but not controlling all variables may be contributing to symptoms without knowledge.  

If you are not getting what you want out of your body or the treatment you have received ask yourself "how much responsibility have I taken during this process?"  Am I a SHOW ME or am I expecting someone else to do this for me.  DO ME's can become SHOW ME's.  If your network of health professional are not educating you and are supplying "things" (modalities such as heat, ice, ultrasound, elctro, massage, braces, orthotics, etc) for you, take control and change your network.  I am challenging the health care system, health care professionals, patients, and anyone who will listen to take responsibility for your role in this situation.  In this era of fast food type health care voice your opinion with where you spend your money.  Don't let big business rob you of your functional life especially your happiness.  Every human according to our biology is hard wired to move.  Thats right, our happiness is directly related to how much we move.  When was the last time someone regretted a workout or a run?