Rotator Cuff Strengthening

Many of us have experienced shoulder pain and weakness which ultimately affects the ability to perform activities we once thought were simple.  The rotator cuff is one group of muscles that may be a culprit of these issues.  The prevalence of rotator cuff dysfunction increases with age, with 20% of those in their 60s and 31% of those in their 70s having a rotator cuff tear.Additionally, many people with rotator cuff tears may have no pain or weakness at the moment, however if left untreated that tear may progress into a symptomatic tear.

There are exercises that research has shown to be useful in strengthening the rotator cuff, therefore reducing the risk of future injury. The exercises outlined below are based on EMG studies which look at the degree of activation in a specific muscle during the exercise.  These exercises have demonstrated high levels of rotator cuff activation and were found to be tolerated well by patients with both rotator cuff and scapular (shoulder blade) dysfunction and pain. Incorporation of these exercises into a training program has been shown to improve strength, muscular endurance and athletic performance in overhead athletes.2

If you want to prevent shoulder issues and improve your strength, try a few of these out and let us know what you think! There are full videos of the exercises on both our facebook & instagram accounts!



  1. Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001;10:199–203. doi: 10.1067/mse.2001.113086.
  2. American Physical Therapy Association, Orthopedic Section. Current concepts of orthopedics. 2006. La Crosse, WI.

Is Your Tibialis Posterior Causing Heel Pain?

Heel pain is one of the most common complaints we hear about in the clinic. Whether it is a runner, gymnast or someone who’s always on their feet, heel pain is notorious for interfering with every day activities that once seemed simple. More often than, not people self-diagnose or determine after googling that they have plantar fasciitis. While plantar fascia irritation is definitely a possibility, there are a ton of other structures in the foot that can mimic plantar fascia pain. One of those is the posterior tibialis muscle & tendon. Check out the picture below to get an idea of where this muscle is located…1

The posterior tibialis is a dynamic stabilizer of the arch and has many attachments at the foot which make it susceptible to irritation. The actions of this muscle are to plantarflex (point your toes down) and invert (turn your foot in) your ankle & foot. A dysfunction of this tendon can lead to a collapse of the arch which research has found to be linked to knee dysfunction as well as running injuries.2

Last week, University of St. Augustine DPT students invited a few Orthopedic Manual Fellowship trained PTs to present various manual therapy and exercise techniques and Steve was one of them. Check out his original posterior tibialis exercise that targets both concentric and eccentric strength throughout the full range of motion. Note that before doing this exercise it is best to address foot/ankle mobility & muscle length deficits as these are required for optimal muscle function & strengthening.3

If you are interested in learning more about running related injuries or refining your running mechanics, contact us today at Be sure to let us know if you try this exercise out!



  1. Kendall, F. P., McCreary, E. K., Provance, P. G., Crosby, R. W., Andrews, P. J., & Krause, C. (1993).Muscles, testing and function: With Posture and pain.
  2. Hughes C. The foot and ankle: physical therapy patient management using current evidence. Current Concepts of Orthopaedic Physical Therapy. LaCrosse, Wis: Orthopaedic Section, APTA, 2011. Print.
  3. Patla, C, Chaconas E, et al. Cuboid manipulation and exercise in the management of posterior tibialis tendinopathy: a case report. Int J Sports Phys Ther, 2015; 10(3):363-370

Foam Rolling 101

It seems like every gym & athlete owns a foam roller…. Even the target dollar section sells foam rollers! But what does foam rolling really do and will it really improve your flexibility and decrease soreness after a workout?

Recent research has shown that foam rolling can be helpful in multiple ways if performed appropriately.

Benefits include:1

  • Reduced pain associated with delayed onset muscle soreness (DOMS)
  • Acutely increases range of motion when performed for a longer duration of time (30-60 seconds)
  • Reduces muscle tender spots
  • Improves neuromuscular efficiency after foam rolling which can improve athletic performance
  • Foam rolling after static stretching seems to improve flexibility to a greater degree than stretching alone

To summarize, recent evidence seems to point to the idea that longer durations of foam rolling (30-60 seconds, 2-3x per muscle group) performed after static stretching (2 sets of 30 seconds per day per muscle group) performed 5-6 days a week may be the best way to improve flexibility.Let us know if you try this out!



  1. Behm, D. ECSS 2017
  2. Thomas et al 2018

Are You Getting Enough Exercise?

Recently, an updated version of the Physical Activity Guidelines for Americans was released by the US Department of Health and Human Services. Although we often hear of the benefits of exercise from various sources, here is what the most recent research recommends:

For adults:1

  • To see significant health benefits, engage in at least 150 minutes – 300 minutes per week of moderate intensity exercise or 75 min – 150 min  of vigorous intensity aerobic exercise. This should preferably be spread throughout your week
  • Exercising beyond 300 minutes (5 hours) per week provided additional health benefits!
  • Strength training that involving major muscle groups should be performed 2 times per week

For Children (ages 6-17):1

  • 1 hour or more of moderate-to-vigorous physical activity daily is recommended
    • Most of the 60 minutes should be aerobic exercises on at least 3 days per week
    • Muscle strengthening as part of the 60 minutes, 3 days per week
    • Bone strengthening (or weight bearing) exercises as part of the 60 minutes, 3 days per week

Some of the numerous overall health benefits to adhering to these guidelines include:

  • Lower risk of mortality overall
  • Lower risk of cardiovascular disease, hypertension, type II diabetes, dementia & multiple forms of cancer
  • Improved cognition, quality of life, sleep, bone health
  • Lower risk of falls in older adults
  • Decreased anxiety & reduced risk of depression
  • Weight loss
  • Maintain strength & range of motion in joints2
  • Provide pain relief & improvement in function in those with orthopedic conditions2

If you are interested in reading the 2018 Physical Activity Guidelines, check out the link below & feel free to reach out to us with any questions!

  2. Current Concepts of Orthopedic Physical Therapy, 4th

Injury Prevention for Dancers

Over the years, we have been lucky enough to work with multiple sports teams & organizations in the area. Most recently, Megan Dickerson, PT, DPT  had the opportunity to work with Abella’s School of Dance and provide information regarding common dance-related injuries, as well as preventative and corrective exercises to combat common musculoskeletal deficits often seen in dancers. Dance is a sport that varies greatly from dancer to dancer regarding intensity of training, and thus is often misunderstood by many healthcare professionals.

Research has shown that young competitive dancers, ages 5-17, are especially susceptible to injuries due to the imbalances in strength, flexibility and endurance of their musculoskeletal system.1    One common strength deficit found in dancers is muscle weakness in external rotators which are the muscles that help dancers turn their feet outwards. Weakness of these hip muscles has been shown to be a predictive indicator for development of low back injuries.2

During the injury prevention clinic at Abella’s School of dance, Megan instructed dancers on foam rolling techniques, specific stretches and strength exercises to target these imbalances. All the dancers asked fantastic questions about & we are so happy to get to work with such talented athletes!

If you are interested in learning more about the injury prevention & physical therapy services VASPT offers for dancers & gymnasts contact Megan Dickerson at!



1.Steinberg N, Siev-Ner I, Peleg S, et al. Injuries in female dancers aged 8 to 16 years. J Athl Train. 2013;48(1):118-123. doi:10.4085/1062-6050-48.1.06

2. Gildea JE, Hides JA, Hodges PW. Size and Symmetry of Trunk Muscles in Ballet Dancers With and Without Low Back Pain. J Orthop Sport Phys Ther. 2013;43(8):525-533. doi:10.2519/jospt.2013.4523

SPEED for Female Athletes

Speed for Female Athletes Program begins Monday June 11th.  It runs for 5 weeks until July 12th, at 2x/week on Mondays and Thursday at 7:30 am.  Cost is $200 for the whole program and space is limited. 

Led by Megann Schooley, Board Certified Sports Physical Therapist, Strength and Conditioning Specialist and Pedro Menendez Women’s Varsity Soccer Coach.

Participants are asked to bring:

  • Running shoes
  • Water
  • Towel

Prior to participating participants will be required to:

  • Have a release signed
  • Fill out a medial history form
  • Have a physical performed within the last year (for those under 18 years old, must provide physical copy as well)
  • Arrange for payment.

To sign up or if you have any questions please email or call us at 904-516-8121 today!

Exact dates noted below:

Runners and Back Pain

Steve Vighetti, creator and instructor of Running Rehabilitation course from the University of St. Augustine

Resident expert and owner of Vighetti & Associates Sports Physical Therapy, Steve Vighetti is now renowned in print through Furthermore with Equinox regarding the topic of Runners and Low Back Pain.  With multiple quotes on the topic in this national publication, if you had any questions as a local St. Augustine runner who to contact when experiencing low back, look no further than Steve Vighetti!

Runners and Back Pain

Read the quick article with some good tips and exercises at the link above. And if you have any questions, please feel free to reach out to Steve personally at!

Steve Vighetti running in the 2017 New York Marathon, finishing in the top 2%




Female Athletes Class

Calling all female athletes interested in moving with Strength, Power, Speed AND Agility!  This 10 week session will be taught by Megann Schooley, well known in the St Augustine, FL community as a board certified sports physical therapist, certified strength and conditioning specialist, previous elite college soccer player and soccer coach at Pedro Menendez High School.  The session will be June 1st to August 3rd, 2017 and will take place once a week on Thursdays*.

With the goal of this class to create better athletes and prevent injury, this session was developed specifically to cater to female athletes.  Be aware limited spots are available to provide the best attention and care to participants.

Contact us by email at or or by phone/text at 904-516-8121 if you have any comments, questions and/or concerns or to sign up today!

Foam Rolling Workshop

Due to popular demand, we repeated the topic of Foam Rolling this spring.  In this workshop we started off with discussing how foam rolling works and why we should be doing it, aka the logistics to convince you how important this is to make it a part of your regular routine!  So see below, to learn more.

When is the best time to foam roll?  Before, during, or after exercise and why?  Or does it not matter?  Click on the video below to learn more.

Next up: how long should you foam roll for? Research doesn’t say, but we give our clinical decision on the length of time to foam roll.  We do discuss that when you find a sensitive spot, a possible trigger point to hold that position for 60-90 seconds until the areas becomes less sensitive/relaxes.  We also explain how many times a week or how often you should foam roll as well.

Ok, now everyone’s favorite part…How do you foam roll?  And where should you foam roll?  The following videos will discuss numerous different areas of the body and how to foam toll, what to avoid and how to make the foam rolling more or less intense.

Butt (Gluts, Piriformis, Hip Rotators), Hamstrings & Calves

IT Band?  Quadriceps and Hip Adductors

Upper Back, Latissimus Dorsi (Lats) and Quadratus Lumborum (QL or the sides of your low back)

Bonus!  Due to an audience question, we also discussed when to static stretch and why in the following video.

Hopefully you have learned much from the numerous videos shared with you all today from our latest workshop on Foam Rolling.  You should now know why you should foam roll, the benefits of doing so, when you should foam roll, for how  and for how often, and last but not least, how and where.  If you all have any comments, questions or concerns please feel free to comment below, contact your local area physical therapist or if you are in the St Augustine, FL area contact us at or 904-516-8121.  We hope you to see you at upcoming workshop!

Why You Should See Dr. Heath (Kirsten)

Recently, a letter was received from a past patient of Dr. Kirsten Heath’s, one of our physical therapists.  Without prompting or even a conversation with this patient, “Patient X” took it upon herself to write a letter regarding her interaction with Kirsten and wanted it to be known by all, despite the fact that Kirsten had moved to being full time practicing in St. Augustine, and was no longer Patient X’s physical therapist.  So with her wishes in mine, below is the letter:

RE:  Kirsten Heath, DPT Letter of Commendation

 To Whom It May Concern: 

 In 1990, I learned from my favorite boss, Frank Voehl, (total quality management guru) recognition of outstanding service is an important part of successful leadership.  My favorite job was writing letters of commendation on behalf of various bosses.  Mitigating circumstances caused a delay in the part of business I enjoy the most.  Christmastime is when I generally send personal commendation letters.  However, “better late than never” has to be my motto today…So, without further delay:

I had the extreme pleasure to meet Kirsten Heath, DPT, when she worked at In Motion Physical Therapy in Jacksonville, FL.  I had asked my doctor to refer me to a physical therapist who specialized in aqua therapy after discovering In Motion Physical Therapy utilized a pool where I go for water aerobics, (although I have not been able to do the workout in full due to chronic musculoskeletal issues).  Thanks to Dr. Heath I am gaining physical strength and beginning to do activities of daily living again.  I was sick in the bed almost six months last year.  I believe Dr. Heath’s medical expertise and guidance has been the main reason why I have been able to achieve better quality of life. 

In fact, I feel Dr. Heath is the best medical professional I have had the honor of learning from over the course of many years in this chronic musculoskeletal pain syndrome journey.  My humble opinion is based upon a lifetime of experience and having worked in the medical profession.  A couple examples of why I feel Dr. Heath is “the best of the best” is because the first time I went to a doctor for a back sprain was when I was 10 years old after falling off a galloping horse.  I worked for both orthopedic surgeons and a chiropractor way back in the late 70s.  I also worked in the medical profession for many years in other capacities to include medical transcription at Martin Memorial Medical Centers in the late 90’s early 2000s. 

The first time I had physical therapy was in 2000 at Martin Memorial Wellness Center with an exercise physiologist.  My former water aerobics teacher also was an exercise physiologist.  I’ve also been to physical therapists at Shands/University of Florida, Brooks, and a private doctor of physical therapy who specialized in ART pursuant to a car accident in 2014.

I also feel Dr. Heath has some of the best listening skills of any medical practitioner I have ever met.  Dr. Heath demonstrates the ultimate professionalism in all realms and definition of the word.  Her direction exceeds patient satisfaction. 

If the student Dr. Heath had under her direction (when I was her patient) had not been the new physical therapist to take Dr. Heath’s place I would not have continued with physical therapy.  I Thank God that I am able to continue because my sole desire is to get better.

Accordingly, please place a copy of this letter in Dr. Heath’s personnel file for future reference.


Patient X

Sports Physical Therapy