The Park Press Release!

Don't forget to grab a The Park Press June 2013 issue and look at our local Winter Park, Baldwin Park, Maitland, and College Park Press Release!  You can also view it online here.  Visit our Testimonial Page to find out what our patients are saying about their experience at Pursuit Physical Therapy.  Feel free to call us at 407-494-8835 or visit www.pursuittherapy.com for more information.

How Long Should I Hold my Stretch For?

First, it actually took me longer to find a good picture of a calf stretch than I though it would.  Surprising!  But, second, a common question that many patients ask me is " How long do I need to hold my stretch for?"  Many people (and I will admit to doing this also) is recommending the usual 3 sets for a 30 second hold.  This may have been based on a old research article that showed no greater benefit after a 30 second on stretching the hamstring muscle. There are many reasons for stretching, ie: injury prevention, performance, and to increase flexibility.  For this blog, today, we will focus on flexibility.  But what does the research say about the optimal time to stretch a muscle?  This study showed the best long term results are from a passive static stretch when comparing four different stretching techniques.  Short term results were seen with active stretching, though.   Research shows that the greatest increase in flexibility to a muscle was experienced with 5 sets with a 90 second hold stretch.  Chris Johnson has a great video that reviews the proper technique to perform a calf and hamstring stretch.  So we promote a static passive stretch with a 90 second hold for our stretches.  For more information and more home exercise videos, visit the Pursuit Physical Therapy You Tube channel or visit www.pursuittherapy.com.  Pursuit Physical Therapy trying to set a new standard of care in the Central Florida and Orlando Area and we focus on what is best for the patient.  Don't be in pain any longer!  Call us to schedule a consultation today.

How to Use a Foam Roll!

Does using the foam roll really work for my pain?

I found this picture with different positions to use a foam roll.  Many people are using the foam roll for a "myofascial release" and to help with their muscle or tendon pain.  A recent blog post we reviewed the current research to understand the mechanism of how the foam roll works.  Strength and Conditioning Research also did a review to see if the research supports using a foam roll.   It might not be what you think? There is still much discussion among professionals regarding the foam roll and more research is needed to support its usage with certain pathologies.

Do you use a foam roll?  Does it work for you? 

 I use a foam roll in combination with strengthening to help prevent my anterior knee pain when running, and I know it works.  A patient of mine, starting a new training regime, began complaining of anterior knee pain.  I instructed him to perform the foam roll once a day and by the end of the week he was pain free with his exercise.  So it works and it is simple.

The research to support the use of the foam roll is very limited.  One study showed and increase in range of motion without any muscle strength loss.  Another study showed a change in vascular function after foam rolling.  Clinicians sometimes say that "research needs to catch up to clinical practice"?  This may be one of those examples.  Using a foam roll to help decrease you pain is simple, cost effective, and there are no side effects.  So if it works for you, use it!  Here is an example of what I teach patients to use for mid back pain at home.  This simple foam roll exercise can help decrease any mid back muscle pain that is associated with prolonged sitting and bad posture.  You can visit the Pursuit Physical Therapy YouTube Channel to view other techniques on using a foam roll.  Feel free to contact Pursuit Physical Therapy regarding any questions about your pain at 407-494-8835 or visit us at PursuitTherapy.com.

New You Tube Layout for Pursuit Physical Therapy!

Check out the new look of the Pursuit Physical Therapy You Tube Channel!  More videos to come and please contact Pursuit Physical Therapy at 407-494-8835 or visit www.pursuittherapy.com for more information.

Can Tart Cherry Juice Really Help Me With My Pain?

I must admit that I am fairly new to this tart cherry juice thing.  I usually don't believe the general press or the internet on certain claims or statements, but the affects of tart cherry juice is beginning to have more research to help support its claim of decreasing pain, decreasing the effects of exercise and DOMS (delayed onset muscle soreness), and decreasing inflammation.  Recently Life Extension just released an article, with attached references, regarding the Anti-Inflammatory Properties of Tart Cherry and reviewed it effects of decreasing exercise muscle soreness, decreasing inflammation, prevention of CV disease, and its anti-cancer properties. Imagine if a simple supplement could help decrease medication usage (and its known side effects) in patients with chronic pain and inflammation such as gout, osteoarthritis, RA, and atherosclerosis?  What is it could prevent or change the state of disease in pathologies such as atherosclerosis, cancer, or Alzhiemer's disease?

Chris Johnson, PT recently blogged about the performance effects of tart cherry juice with endurance training and states he is an avid user of tart cherry juice with his training.  One study in 2010, showed tart cherry juice supplementation aided in recovery after strenuous exercise when running.  Another study, showed a decrease in pain and muscle strength loss after exercise induced muscle damage.   Further research, showed an increase in antioxidant defense towards decreasing oxidative damage.  These three research articles are starting a body of literature that supports the use of supplementing tart cherry juice to help decrease pain, decrease inflammation, and decrease side effects of exercise.  As Chris Johnson said, are you on the juice?  Great stuff!

Pursuit Physical Therapy Testimonials!

Click on the link here to see what others are saying about Pursuit Physical Therapy!  We want to help those in the Orlando, Maitland, Winter Park, and Central Florida area with a new gold standard of physical therapy and patient care.  There is no need to be in pain and physical therapy is an efficient and cost effective service that show great outcomes.  Visit www.pursuittherapy.com or call us now at 407-494-8835 and get pain free today!

What Kind of Running Shoe is Best for Me? Or Does it Really Matter?

Many runners ask what is the best shoe for me?  To date, many clinicians promote matching a certain shoe to a person's certain foot type.  Is this the best for my running patients and does this prevent injury?  I promote that there is a difference between poor shoes vs good shoes, but is there truly a difference between good running shoes?   A recent research article showed that matching a foot type to a specific shoe is not evidenced based and may not be needed.  Another study showed there was no difference in injury rates when shoes and foot types are matched vs randomly matching shoes to a foot type.  Another study showed no change in injury prevention and no decrease in injury rates when matching shoes.  So current reaserch does not support matching a specific shoe to a certain foot type in regards to injury prevention.    Ian Griffith wrote and excellent review regarding the evidence behind choosing the proper shoewear.  When dealing with a running injury there is a definite need for the proper shoe and/or shoe modification.  Chris Johnson shows an example of this here and also posts the importance of how to safely return from a running injury.  Good general shoewear is important, but it may not be as important as we think.  For example, I can run in a stability shoe or a cushioned shoe without any pain or symptoms.   The current research regarding matching shoes to a specific foot type is poor and this matching may not be a necessary.  Future research is needed to show optimal clinical outcomes with running shoewear.  Some general recommendations are: 1) choose a light shoe, 2)  make sure it is a good feel and comfortable 3) I still recommend a running store (in Central Florida, either Fleet Feet or Track Shack) 4) once you find a shoe that works for you, don't change it.   If you have a running injury or have any questions regarding the proper shoewear for you, contact Pursuit Physical Therapy at 407-494-8835 or visit www.pursuittherapy.com.

Elevator speech on Pursuit Physical Therapy

I was asked to give my "elevator speech" today for Pursuit Physical Therapy.  It should roughly be 8-10 seconds so here it is:

Pursuit Physical Therapy is a new brand of therapy that is based on treatment outcomes and what is best for the patient, and not guided by insurance companies or strict guidelines.  Patients will receive One-on-One, high quality evidence-based care, by a board certified specialist, doctor of physical therapy, showing better outcomes than other standard health care.

What do you think?

Should I run with a Heel Strike or Midfoot Strike?

Many beginner and novice runners ask me how they should be running.   Running training should be focused on injury prevention or for performance.  So we will focus on injury prevention and treatment with this post.  Landing with a midfoot strike has been associated with decreases in peak impact loads and a decrease in knee pain (patellofemoral symptoms).  Below is a diagram from a breakthrough article in Nature from Lieberman et al.,  that shows landing forces with different striking patterns.

Notice the lack of the sharp increase spike with a mid foot strike.  One of the main points to take away from the article is the decrease in force and lack of transient impact with strike with a mid foot strike.  This difference and benefit of barefoot vs shod running is for another post, but these two articles show great evidence to help support a mid foot strike to help prevent injury and decrease impact forces to the legs.  I promote most long distance runners to land with a mid foot strike, with a shorten stride length, and increased step rate to help prevent injuries and to return to pain free running.  Feel free to contact Pursuit Physical Therapy at 407-494-8835 regarding any questions or visit www.pursuittherapy.com for more information.

Running with Knee Pain? Try this. Physical Therapy!

Do you get knee pain when running?  Tired of knee and foot pain?  The picture above shoes a great example of the difference in forces (yellow line) when running with a long stride with heel strike vs a shorter stride with mid foot strike.  Here is something very simple and easy to do to help you get out of pain and decrease the stress to your knees!  Current research shows an increase in step rate (with a decrease in stride length) can  reduce the loading to the hip and knee joints during running!  This may also prove beneficial in the prevention and treatment of common running-related injuries.  I tried it and I feel I can run much more efficiently now with less stress to my knees.  There is no need to run with pain so consult with Pursuit Physical Therapy for a biomechanical analysis or visit www.pursuittherapy.com for more information.  Visit the Pursuit Physical Therapy You Tube Channel for more running exercises and information with great videos by Chris Johnson, PT  regarding tips for runners.

Tennis Elbow, Try Physical Therapy! No Need for an Injection

Tennis elbow (or lateral epicondylitis)  is a common elbow injury experienced by tennis players and other tasks that involve repetitive motions of the wrist and elbow. Typical signs and symptoms include pain and tenderness over the lateral epicondyle ( lateral elbow), worsened by resisted wrist extension and passive wrist flexion, and decreased grip strength.  Many people rush to the physician and get an injection for their first line of treatment and go on playing or doing their activity.  Current research actually showed worse long term outcomes with patients with chronic lateral epicondylitis who received corticosteroid injections.   A recent physical therapy study actually showed great outcomes with patients with  lateral epicondylitis within 5-10 visits.  What is even more amazing is when physical therapy included a cervical spine (neck) intervention that outcomes were reached in fewer visits!   Physical therapy is associated with short-term relief, the fewest recurrences, the best rate of full recovery at one year, and the lowest rate of nonsteroidal antiinflammatory drug use.   There is no need to be in pain or to play tennis with elbow pain.   Contact Pursuit Physical Therapy at 407-494-8835 or visit www.pursuittherapy.com for more information regarding your elbow pain.  Get pain free in fewer visits than the standard treatment!

Pursuit Physical Therapy T-shirts are in!

The Pursuit Physical Therapy T-shirts are in!  If you want to help support Pursuit Physical Therapy and order a t-shirt please send an email to pursuittherapy@gmail.com. Sizes are S, M, L, and XL.  Shirts are $15.   I even convinced my beautiful wife, Mrs. Miller, to model the new shirts in the pictures below!

How Does the Foam Roll Work? Everyone is using It!

This is a great review by Better Movement about how the foam roll works and the theories behind it.  Enjoyed reading this.

Can You Tell Me Where Your Low Back Pain is Coming From?

Where is your low back pain (LBP) coming from?  This is an MRI of a 56 year old male with LBP.   Many patients come to me with spine pain and the first this that they tell me is ..... "well I have degenerative disc disease", " I have a herniated disc", "I have a bulging disc", etc.  Usually I come back and say " Well, I have a bulging disc at L5-S1 too and I don't have low back pain."  Their facial expression is usually disturbed and surprised!  This is what my lumbar spine looks like and what a normal spine should look like (as compared to the first picture).

For those that do not know what we are looking at this is an MRI image of a lumbar spine.  The last disc before the sacrum starts is L5-S1 and this is the most common area of LBP.  To the left is the front of the body and the right is the back.  You can see that my L5-S1 does not look the same as the other discs above it and it is not as bright.  So some degeneration is going on there, but it doesn't mean that you have to experience pain.  This may be normal degenertion that occurs from stress to the spine, weightllifting, and from playing sports.  I usually tell my patients that you can take 10 people with LBP, put them in an MRI machine, and their MRI will have positive findings, such as a herniated disc, degenerative disc disease, modic signs, osteoarthritis, etc.  You can then take 10 people WITHOUT LBP, put them in an MRI machine, and their MRI will have the same positive findings!  Research has shown ( from a highly respectable journal and from a high quality study) that these abnormalities seen in MRIs do not strongly correlate the underlying pathology and cause of your LBP.  This means that there are false positives with MRI and with most LBP, you may not need an MRI right away.  This is when you can get started with physical therapy and treatment right away!  Why do you need to see a physician with complaints of LBP and get diagnosed with LBP, and then get referred to a specialist?  Research has shown the cost effectiveness, improved outcomes, and more efficient treatment with the early treatment of LBP with physical therapy services.

In Florida, you have direct access to physical therapy so you can begin you treatment early and there is no need to wait for weeks to begin treatment.  If you do not respond to physical therapy or if you present with red flags, then you can be referred to a spine specialist for more diagnostic testing and possibly warranting an MRI.  Contact Pursuit Physical Therapy today for your LBP and start treatment now!  407-494-8835 or www.pursuittherapy.com.  We also have a Patient Perspective page for information for patients regarding LBP and physical therapy.  Feel free to consult with us regarding your LBP and what is the best treatment for you!  Remember just because you have a herniated disc or a positive MRI finding doesn't mean you have to have LBP.  Even this person was asymptomatic and did not have LBP!  Look how far the spine has slipped forward in the picture below!