How does wearing heels affect your feet and the rest of your body?

Are you having difficulty wearing your favorite heels because of foot and knee pain?  Having low back pain when wearing heels?  Well, below is a picture of how wearing heels affects the feet and the rest of the body maybe predisposing you to getting your pain.  

We can help address some of the problems that can present with wearing high heels.  We can correct the problems, address any impairments, to help get you back to wearing the shoes you love.  Call us at 407-494-8835 or visit us at PursuitTherapy.com to schedule an appointment today!  Get back to being pain free in your favorite heels!

Bad Medicine!.......... for low back pain

Maybe Bon Jovi was right with Bad Medicine!  Does your clinician follow the established guidelines to treat low back pain (LBP) or are you receiving "bad medicine"?  A recent study from the Journal of American Medial Association - Internal Medicine, stated that " Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care."  The results of this 2013 showed:

No change in physical therapy referrals

Increase in narcotic usage

Decrease in NSAIDS and tylenol usage

Increase in diagnostic imaging (such as CT scans and MRI)

Increase in physician referrals

Physical therapy and the usage of NSAIDS were considered as GOOD coordination with the LBP guidelines and evidenced based.  Physician referrals, diagnostic imaging, and narcotic usage were considered BAD coordination with the guidelines.  This looks like the health care system is doing everything along the BAD track doesn't it?   So,is your clinician following the guidelines, that have been set by proven and established research, and may lead to better outcome for our patients with LBP or are they following Bad Medicine!   Here is another link to physician guidelines in the clinic regarding the treatment of LBP from the American College of Physician.  At Pursuit Physical Therapy, you never have to question your quality of care.  Your treatment is always what is best for you!  If you have LBP, call Pursuit Physical Therapy at 407-494-8835 or visit our website at www.PursuitTherapy.com for more information about how we can help your LBP.  

Fit Body Boot Camp Orlando and Injury Prevention

Are you a member of Fit Body Boot Camp Orlando?  Fit Body Boot Camp is a new fitness and weight loss training method that is sweeping the nation.  I had the opportunity to attend a training session at the Orlando location, and I love the training style!  This is the perfect workout: high intensity, total body involvement, functional movements, cardiovascular, and overall a short duration (30-45 minutes).  This is the perfect workout to help you lose weight, decrease body fat, and maintain muscle, and you don't have to plan anything!  Just show up and the trainers will take care of the workout.  I thoroughly enjoyed the workout even though my legs were sore for days!  Great job to Kerry and Andrea for opening a great gym, for their community involvement, and for spreading health and fitness throughout Orlando.

Proper biomechanics and flexibility is going to be essential to help prevent injuries from occurring with this type of training.  Just for example when squatting or even with a deep squat, you must have the proper flexibility and strength to complete the task with proper form.  When form and biomechanics become poor, this may increase the risk for injury.






Below is an example of a functional deep squat that you should be able to perform without any compensation.  How many of you can perform this?

This training may also predispose people to getting many overuse injuries such as knee pain, foot pain, and other tendinitis injuries.  Proper stretching, warm-up, and again flexibility will all be essential to help also decrease injury rates.

So what can you do to help prevent injury when training hard to reach your personal goals?  Here are 5 strategies you can do to decrease your chance of injury:

1)  Warm-up prior to high intensity workouts.  A simple 5-10 minute light warm-up should be fine.

2)  Stretch involved muscles.  Such as calves, hamstring, and quad muscle.  Stretching should be done for a 30-90 second hold!  If you do not like to stretch foam rolling is also a great way to reduce trigger points in muscle, increase flexibility, and decrease pain.

3)  Avoid Over Training.  Especially, if you have just started working out.  Slowly progress yourself to 3x a week and continue until you can perform training 4-5x a week.  Weight loss from decreased body fat does not occur over 1-2 sessions.  If it does, it is probably just water weight.  It takes a long time(> weeks) and your are changing your lifestyle so there is no rush to over train.

4)  Be aware of joint pain vs muscle pain.  Muscle pain is OK and this is just something that comes with exercise and training.  FUN FACT:  The muscle soreness the day after the workout is not lactic acid build up.  Lactic acid is removed within hours after your exercise.  The soreness the day after is called DOMS (delayed muscle soreness) and it is caused from muscle damage from exercise with is necessary for your to get stronger.  If you experience joint pain consult your local medical professional, example Pursuit Physical Therapy!, sooner rather than later.  The sooner the better and the more chronic the pain is the longer it takes to get back pain free!

5)  Follow a healthy diet with plenty of sleep.  It is amazing to see how the body feels and heals as you continue to train hard, when you eat healthy vs bad.  Has anyone ever done the same workout multiple times but when you happen to drink alcohol and eat bad after, how much worse and sore you feel the next day?  There is a difference.  Eat as a function of attaining your goals!

I hope these can help you decrease your injury risk and allows you to keep training at Orlando Fit Body Boot Camp!  For more information about Fit Body Boot Camp Orlando visit their website at http://www.fitbodybootcamp.com/fl/orlando-fitness-boot-camp/ and check out their client appreciation night on August 2nd here.  Pursuit Physical Therapy and Dr. Ron Miller will be there to answer any questions regarding proper training techniques, current pain and symptoms, and to perform free functional assessments.

Early Physical Therapy Treatment for Low Back Pain: Better Outcome and Cheaper?

When you have low back pain (LBP) who should you go see to receive great patient care, to resolve your LBP, and how much will it cost you?  Well, a recent research study showed when experiencing LBP, early physical therapy treatment shows a good outcome and it is more cost effective thus reducing medical costs.  It also showed a decrease in surgery rates, injections, number of physician visits, and a decrease in opioid medication usage.

This sounds good to me!  If you have LBP, consult your physical therapist to see what is the best treatment option and to help get you out of pain now!  Pursuit Physical Therapy will get you in to see a specialist as soon as possible and you will see a board certified specialist.  Call us at 407-494-8835 or visit www.PursuitTherapy.com for more information.

Looking for Treatment for a Golf Injury around Orlando, FL? Look at my new TPI Profile!

The Titleist Performance Institute (TPI) recently upgraded their website and many links.  Click here to view my new TPI profile and get my contact information, credentials, and level of training.  This makes it very easy for those who golf around the Central Florida and local Orlando area to find any TPI certified expert.  Do you have pain with your golf swing?  Low back pain after golfing 18 holes?  Research shows that you can decrease your injury rate by > 50% by just warming up for 10 min prior to golfing!   Visit www.pursuittherapy.com to find out more information about our golf specialty program and golf swing assessments.  Get back to golf pain free and schedule your consultation now.

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.

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!

We are on Pinterest!

Pursuit Physical Therapy is on Pinterest now!  This will be a great way to share pictures of exercises, treatments, and to help with home exercise programs.  Follow us on Pinterest or visit the Pursuit Physical Therapy website for more information.  Starting a new standard of health care!

How Much is it Costing You Out of Pocket For Your Physical Therapy?

So we have reviewed why Pursuit Physical Therapy is cash-based, what evidenced based practice is and why it is important for you as a patient, and what is wrong with healthcare.  This post will show you the difference between a cash based practice vs and insurance based practice and how much it will cost you out of pocket.  Below is a table that shows the difference between a standard physical therapy practice and what it entails vs what Pursuit Physical Therapy offers.

Normal Standard Practice	Pursuit Physical Therapy Evidenced-Based Practice
3x  week for 4 weeks 12 sessions	2x a week for 2 weeks 4-6 sessions
No manual therapy	Manual Therapy
10+ exercises	4-6 exercises
60+ minute session	30-60 minutes session
Guided by health insurance	Guided by what the patient needs
Average out of pocket cost $500-1000	Average out of pocket cost $400-500
No incentive to get you better quicker	Incentive based

Many patients feel that they have insurance to cover their physical therapy and they do not want to pay out of pocket for physical therapy services.  So now we will review the difference in cost and an example of how much you pay out of pocket for each physical therapy service.  You think that since you have insurance that it will not cost you much out of pocket, but lets look at an example.   Now, every insurance policy is different, but we will use an example from what the average is that I have seen.  So we will factor in deductible, co-pay, and the miscellaneous bill that is sent to you house 3 months after you have received treatment.  Yes for some reason, with the standard insurance, sometimes they do not cover 100% of physical therapy services and I find more and more patients calling in 3 months after treatment saying that they received a bill from the hospital saying that they owe another couple hundred dollars for their treatment?? I know!

Normal Standard Practice Cost	Pursuit Physical Therapy Cost
3x a week for 4 weeks	4-6 treatment sessions
Average Deductable = $1000-5000	No deductible needed to be met
Co-pay = $20	No co-pay
Miscellaneous bill = $300	Each session =$75-100
12 visits x $20 = $240	6 visits x $100
+ 300
+ deductible ($500)
TOTAL = $1040	TOTAL = $600

So a cash based model turns out to be a cheaper out of pocket expense for the patient after all!  You also receive a much better quality of one-on-one care with a faster outcome.  Is it worth it to pay that much out of pocket at a standard insurance clinic, getting double booked with other patients and need to be seen for 3x a week for 4 weeks???  To me, I would rather pay less and get better faster.   What do you think about a cash based physical therapy service and how much you have to pay out of pocket?

Do I need to warm up before golfing?

A recent review of golf injuries reported that 50% of golfers do not warm-up prior to playing golf.   They went on to report a significant decrease in injury rates by 60% in golfers who stretched and warmed up for at least 10 minutes before playing.    Don't forget to warm up for 10 min prior to golfing to help prevent injuries.  If you need any ideas for warm-up look at the Pursuit Physical Therapy YouTube Channel and click on the golf playlist for warm-up exercises.