Rolling Your Ankle

How many times have you sprained your ankle? Chances are if you’ve sprained it once, you may experience recurrent sprains as well. Inversion ankle sprains, commonly referred to as “rolling your ankle” are common among active people. In the United States, approximately 23,000 individuals sprain their ankle every day, with female athletes being the most susceptible to experience this injury.1

Often, these sprains go untreated which can lead to reinjury and functional deficits down the road. One result of untreated ankle sprains is chronic ankle instability which may lead to osteoarthritis of the ankle.3 When an injury like this occurs, it is especially important to ensure a fracture hasn’t occurred. Some indicators that you may have broken a bone include, inability to walk or put weight on your lower extremity and pain/tenderness at any of the bones in the ankle and/or foot. An x-ray is necessary if you suspect a fracture.

What many people don’t know is that physical therapy is an effective solution for ankle sprains and chronic ankle instability.One common thought is that crutches may be necessary for an ankle sprain, however current research has found that in most cases progressive weight bearing with external support (brace, wrap, etc.) is actually more effective and aids with healing during the acute phase.3  Another important factor in ankle sprain rehabilitation is strength and balance training. Physical therapy programs incorporating manual therapy, strength, range of motion and balance training have shown effectiveness at reducing pain, disability and reinjury.Below we have included two general exercises we commonly use with patients recovering from ankle sprains. (Please note these are just general recommendations and for individualized treatment it is best to see a PT.)

The first is balancing on one leg… simple enough right?

This can eventually be progressed to uneven surfaces such as foam pads, BOSU ball, etc. According to research, individuals 18-40 should be able to do this for approximately 40 seconds with their eyes open and ~10 seconds with eyes closed. Those who are 40-60 years old should aim for ~36 seconds with eyes open and ~6 seconds eyes closed. Individuals >60 should aim for ~25 seconds with eyes open and ~5 seconds with eyes closed.1

The second exercise is a stretch to improve ankle range of motion – specifically dorsiflexion. Limitations with this range of motion are important to address in order to avoid reinjury.3  Keeping the knee facing forward, bend and straighten your knee keeping your heel on the ground. This is recommended to be performed 30 times in an on/off manner for 3 sets.3

Please let us know if you have any questions about these exercises or ankle injuries you may be experiencing!

References:

  1. Whitman J.M. et al. Predicting short-term response to thrust and nonthrust manipulation and exercise in patients post inversion ankle sprain. 2009; 39(3): 188 – 200
  2. Martin RL, McPoil TG. Reliability of ankle goniometric measurements: a literature review. J Am Podiatr Med Assoc. 2005;95(6):564-572.
  3. American Physical Therapy Association, Orthopedic Section. Current concepts of orthopedics. 2006. La Crosse, WI.

Patellofemoral Pain Syndrome – What Is It & How To Prevent It!

Pain in the front of the knee (anterior knee pain) aka Patellofemoral Pain Sydndrome (PFPS) is one of the most common diagnoses among active individuals. This type of knee pain may be experienced during squatting, going up/down the stairs, sitting for long periods of time as well as repetitive activities such as running and jumping. This diagnosis can be confusing because not all individuals with anterior knee pain possess the same underlying cause or contributing factors.  There are criteria that put individuals at increased risk of PFPS which include female gender, tight quads, hyper/hypomobile (moves too much or not enough) patella, and decreased quad strength and/or neuromuscular control.Addressing known impairments such as weakness and tightness is key to treating and preventing PFPS.

Research has shown the following common impairments contributing to PFPS:1

  • hip abductor weakness,
  • quad weakness,
  • patellar hypomobility,
  • patella hypermobility,
  • pronated foot posture (decreased arch height)
  • lower extremity muscle tightness

These impairments can contribute to malalignment of the patella which means it will not sit and move in where it is supposed to. Below is a picture of the patella and surrounding musculature as well as a picture demonstrating how hip drop due to weak hip abductors, excessive pronation at the foot may cause dysfunction at the knee. 1

The good news is exercise can help address a lot of these contributing impairments! Here are a couple exercises that may help you prevent patellofemoral pain… If experiencing knee pain currently, contact us today and let us know if you have any questions about these exercises! (Please note these are just general exercise recommendations and to get an individualized plan it is best to see a PT)

  1. Clamshells – these are great for hip abductor strength, particularly glut med which helps prevent hip drop during walking & running.

2. Quad stretch – increase flexibility of the quads can help decrease compressive pain at the patella; it is important to tighten your abs while performing this to avoid excessive arching in the low back

3. Side plank with hip abduction – this is a bit more advanced of an exercise in that it requires core stability as well; it’s important to now lift the leg too high otherwise you will be utilizing other muscles and not the target muscle (glut med)

References:

  1. American Physical Therapy Association, Orthopedic Section. Current concepts of orthopedics. 2006. La Crosse, WI.

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!

 

References:

  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 info@vighettipt.com. Be sure to let us know if you try this exercise out!

 

References:

  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!

 

References:

  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!

  1. https://health.gov/paguidelines/second-edition/
  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 megan@vighettipt.com!

 

References:

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
  • MOTIVATION!

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 meg@vighettipt.com 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@vighettipt.com!

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 info@vighettipt.com or meg@vighettipt.com or by phone/text at 904-516-8121 if you have any comments, questions and/or concerns or to sign up today!

Sports Physical Therapy