EXERCISING IN THE SUMMER HEAT

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EXERCISING IN THE SUMMER HEAT

It’s that time of year again. Summer has officially arrived. With rising temperatures it can become increasingly difficult to get out and enjoy outdoor exercise and to do without incidence.

Here are some general guidelines for enjoying some outdoor activities:

  • Hydrate, Hydrate, Hydrate. When exercising outdoors be sure to drink plenty of water. It has been recommended that you drink 24 oz of water for every hour you are exercising outdoor. Try to consume 4-6 oz every ten minutes. If you are thirsty your already dehydrated. Continue to hydrate throughout the day.
  • Exercise in the early hours of the day, get out before 10am. Allow yourself time to acclimate to the heat. Start out slowly 20-30 minutes of activity and increase time as your body gets used to exercising in the heat.
  • Limit sun exposure. Wear sunscreen, hat and sunglasses. Protect you skin from the sun’s harmful rays.
  • Wear performance fabrics, not cotton. These specially designed fabrics are created to wick perspiration. These fabrics help maintain your core body temperature.
  • Recovery. Be sure to stretch and continue to hydrate following activity.
  • Leave your pets at home in the air conditioning. Don’t forget that they are wearing fur coats and don’t have the ability to sweat.

These tips will permit you to continue to be active during these hot summer months and remain injury free!! So get out and enjoy our beautiful Valley of the Sun!!

WHAT TO DO WHEN STARTING A NEW PROGRAM

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WHAT TO DO WHEN STARTING A NEW PROGRAM

When starting a running program there is always an adjustment period.

Sometimes we make the mistake of too much, too soon, too fast. Before starting a new running program I would recommend starting off with a new pair of running shoes. When shopping for a new pair of running shoes be sure to go to a running specific store, there are a few in the Valley. Take your usual running socks and orthotics to get the real feel. It is best to purchase shoes later in the day as our feet tend to swell as the day progresses.

When starting a running program it is best to start with a run – walk technique so your body can adjust to the impact that running imparts. Start with a reasonable goal. Some people like to run by time and others like to log their mileage. Either way keep it reasonable. An every other day basis is best to allow the body to recover and rebuild. Never increase by more than 10% each week. Also consider the terrain. For example tracks are softer than trails/canals are softer than asphalt is softer than concrete. Mix up the terrain.

The next thing is to make sure you take time to stretch out post run. Stretching should be considered part of your daily workout regime. It is important to stretch out all the major muscle groups that are used during running. Here are just a few stretches that I recommend:

  • Quadricep stretch – In standing lift you foot up behind you (heel to butt) and grap it w/ your hand. Keep the knee pointing to the ground and tuck your tail bone under.
  • Hamstring stretch – Lie on your back and lift your leg up and reach behind the thigh, and grab on. Take the heel up towards the sky and keep your opposite leg flat down and be sure not to arch your back.
  • Hip Flexor stretch – get into a 1/2 kneel position(one knee down on the ground and the other up w/ the foot on the ground). Tuck your tailbone/pelvis under and lean forward into the leg that has the knee on the ground. Lean until you feel a stretch and hold.
  • Calf stretch – stand on a curb or step and drop one heel towards the ground. Do a couple with the knee straight and a couple with the knee bent.

Hold each stretch for 30 seconds and do 2 repetitions on each leg. Time permitting do some upper body stretches etc…

Lastly, a little ice post run can help decrease that achy feeling. Ice for 20-30 minutes at a time. If needed take a little Ibuprofen to take the edge off.

If after trying all of the aforementioned your friend is still experiencing knee pain have her/him seek medical attention. Don’t let injuries linger, if there’s no improvement in 2 weeks it’s time to get it checked out.

Happy Trails!

PATELLOFEMORAL PAIN INCYCLING

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PATELLOFEMORAL PAIN INCYCLING

Written by Nathan Koch

Endurance Rehabilitation

Patellofemoral pain (pain around the kneecap) is among the most common injuries that affect cycling performance. This is secondary to thousands of pedal revolutions in a fixed position. As a result, we speak in millimeters when evaluating the cyclist and bike position. Any slight deviation in the chain of movement and put undo stress on a joint. Ultimately causing the cyclist to lose efficiency and possibly create an overuse injury such as patellofemoral pain.

Patellofemoral pain is a global diagnosis that may include one or more of the following: patellofemoral syndrome, anterior knee pain, patellar tendinitis, patellar tendinosis, plica irritation, fat pad impingement, ITB friction syndrome, chondromalacia and subluxation. The specific diagnosis will describe the location of pain and the possible mechanism of pain. Typically, the cyclist will complain of vague knee pain or aches with minimal to no swelling and possibly popping or catching sensation around the kneecap. They will experience increased pain with squatting, ascending/descending steps (descending is typically worse) and getting up from prolonged sitting. On the bike, they will report generalized knee pain/stiffness that can be worse in cooler climates, worse with seated climbing, pushing big gears and often occurs after riding (particularly trying to get up from sitting on the days that they ride). Ultimately, it is important to determine what factors have caused dysfunction and subsequent pain.

A general understanding of patellofemoral anatomy and function is necessary in determining what factors can put you at risk for injury. The extensor mechanism of the knee (front of the thigh) consists of the quadriceps femoris, quadriceps tendon, patella, and patellar tendon. The hamstrings (the back of the thigh) provide dynamic control of flexion and extension of the knee as an opposite to the quadriceps. The VMO or vastus medialis obliques (inner portion) of the quadriceps is recognized as the primary medial stabilizer of the extensor mechanism and patellar alignment and is assisted by the hip adductors (groin muscles). The lateral (outer) dynamic forces acting on the patella are the iliotibial band (ITB), the lateral retinaculum, and the vastus lateralis (outer portion of the quad). The patella is the centerpiece of all the stabilizing forces. As these stabilizing forces act through the patella, a patellofemoral joint reactive force (PFJRF) is created by compression of the patella against the femur (thigh bone). The greater the tension generated by the quadriceps, the greater the resultant PFJRF. The PFJRF increased significantly with increased knee flexion (bending) such that at 15 degrees of flexion it is 1 x body weight; at 30 degrees, 2 x body weight; at 45 degrees, 3 x body weight; and at 75 degrees, 6 x body weight. From 20 degrees of flexion to full extension, little patellofemoral contact occurs. After 90 degrees of flexion, the center of the patella again does not articulate significantly with the trochlear groove. It is primarily in the mid ranges, from 30 to 90 degrees of flexion, where the patellofemoral contact areas are the greatest. During the pedal cycle, the knee goes through approximately 80 degrees of motion. The knee begins the power phase flexed about 110 degrees and extends to about 30 degrees of flexion. This is of great significance in cycling since most revolutions are performed when there is the greatest pressure on the patellofemoral joint. This can help explain why most cyclists have increased pain with seated climbing versus climbing out of the saddle. As a result we must keep this in mind when assessing bike fit and when designing a strength and flexibility program.

In order to further understand how the patellofemoral joint works on the bike you must understand how the hip and the foot and ankle influence function. Common hip/foot/ankle findings that can cause patellofemoral pain are: leg length discrepancy, wide pelvis, excessive or limited hip mobility, muscle weakness (particularly gluteals), excessive or limited ankle motion, foot pronation and/or flat feet and inflexibility. For example, while watching a cyclist ride you notice that he or she brushes the inside of their thigh or knee against the top tube. This abnormal hip and knee motion may be due to structural deformities, tight tensor fascia lata, imbalance in the strength and/or flexibility of the hip rotators, foot and ankle pronation or weakness of the gluteal and piriformis muscles. Clinically, measuring the quadriceps angle (Q angle) has been used by therapists and doctors to determine abnormal forces through the patella with respect to the hip. But there has been no consensus with respect to how this measurement should be taken. More importantly, this measurement is typically taken statically; therefore, the contribution of abnormal segmental motions and muscle activation to the Q angle during dynamic activities may not be appreciated. Therefore, in a cyclist, we must evaluate the patellofemoral joint along with the pelvis, hip, ankle and foot as they function together on the bike.

The patellofemoral joint functions on the bike based on the individual’s anatomical considerations described above, bicycle fit and pedaling/training techniques. Bike fit specifications that may cause patellofemoral pain are: low saddle, saddle to far forward, fore/aft cleat alignment, crank arm length, excessively rotated cleats and potentially even frame size and geometry. Look for signs of abnormal wear on the seat and cleats and re-evaluate any new additions to the bike that you have made recently. Remember that when making a change to the bike fit to reduce knee pain, you may cause a ripple effect and subsequent inefficiency or pain elsewhere. Always consult a trained professional if you are unsure. Training errors that may also contribute to pain are: low cadence/ pushing high gears, excessive duration, high intensity, excessive climbing, heavy weight training, plyometrics and an aggressive race schedule. There is significant research available demonstrating that heavy training loads and high mileage contribute substantially to knee injuries. Likewise, a rapid increase in training distance or intensity, seen in the early cycling season, also leads to overuse injuries.

In addition to changing your training program and bike fit there, are several other pain relieving techniques that can be instituted prior to seeking a medical specialist. Try the standard RICE protocol: rest or reduction in cycling (low resistance and high cadence), ice, compression and elevation. Avoid sitting with knee excessively bent, cross-leg sitting and prolonged squatting. In addition, perform a daily stretching routine that includes the entire lower extremity and use a foam roller or massage your legs. NSAIDS and analgesics (Biofreeze, Traumeel lotion and Arnica gel) can also be beneficial for reducing pain and inflammation. Core and lower extremity strengthening exercises are extremely important although if not designed and performed appropriately then further irritation may occur. If medical attention becomes necessary, the decision to treat the lower extremity needs to be based on a systematic biomechanical evaluation, in particular, a thorough analysis of bicycle fit and functional movements. This intensive evaluation should be performed by a sports medicine physical therapist or physician that traditionally works with cyclists. Cycling specific physical therapy for patellofemoral pain may include core/hip stability in all planes of movement, static and dynamic flexibility exercises, manual therapy techniques, lower extremity strengthening, neuromuscular re-education, patellar taping and cycling specific orthotics. Seek medical attention immediately if any one of the following occurs: moderate to severe swelling, persistent swelling, joint-locking, minimal to no change in pain with conservative treatment listed above, severe weakness, constant unrelenting pain or patella dislocating. If the pain starts during a critical period in your race season seek medical care immediately – fast results that allow us to endure is what we all strive for.

References
1. Asplund C, St.Pierre, P: Knee pain and bicycling. The Physician and Sportsmedicine 2004;32(4).
2. LaBotz M: Patellofemoral Syndrome. The Physician and Sportsmedicine 2004;32(7).
3. Powers C: The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33(11).
4. Child D, Doucette S: The effect of open and closed chain exercise and knee joint position on patellar tracking in lateral patellar compression syndrome. J Orthop Sports Phys Ther. 1996; 23(2).
5. Press J, Kibler B, Herring S: Functional Rehabilitation of Sports and Musculoskeletal Injuries. Maryland, Aspen Publishers, 1998, pp 254-264.

SHOULDER INJURY PREVENTION IN THE OVERHEAD ATHLETE

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SHOULDER INJURY PREVENTION IN THE OVERHEAD ATHLETE
By Brandon Penas, PT

Do you ever wonder how fast the human arm has to move in order to throw a baseball greater than 90 miles per hour? The answer: roughly 0.03 seconds from the cocking phase to ball release, thus making the overhead throwing motion one of the most violent, ballistic motions the human upper extremity undergoes. In the sport of baseball, the incidence of both elbow and shoulder injuries among professional and youth players is dramatically high due to the repetitive distraction, compression, and shear forces placed on the shoulder and elbow. In professional baseball, 50 percent of all injuries occur at the throwing shoulder (28%) and elbow (22%). Moreover, fifty percent of youth baseball players between the ages of 9-14 years old complain of shoulder or elbow pain with the number of severe, ligament-related injuries on the rise. In order to decrease the risk of injury, an overhead athlete’s body must be developed and consistently maintained year round.

This four-part series will examine and provide various solutions to the underlying factors that predispose athletes to injury associated with overhead throwing/pitching. The four areas that will be addressed include:

Part 1: Throwing Injury Prevention Guidelines for the Underdeveloped Pitcher

Part 2: Pitching Mechanics

Part 3: Shoulder strengthening for the Overhead Athlete

FIBROMYALGIA AND EXERCISE

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FIBROMYALGIA AND EXERCISE

By Nathan Snell, PT, CSCS

Fibromyalgia is a disorder that causes pain in your muscles, joints and overall fatigue. People diagnosed with fibromyalgia have specific tender points on the body. These tender points are painful with applied pressure and typically found on specific places on the neck, shoulder, back, hips, arms and legs. Individuals diagnosed with fibromyalgia may also suffer from poor sleep, headaches, morning stiffness, numbness/tingling, problems with concentration and memory. Fibromyalgia affects as many as 1 in 50 Amercians and occurs more commonly in women than in men. The causes of Fibromyalgia are unknown.

Managing Fibromyalgia becomes a lifestyle change. There are a number of things you can do to help yourself feel better. These things include; exercise proper sleep habits, healthy diet, taking prescribed medications, and activity modification (keep the stress to a minimum).

Literature suggests that light, regular exercise can be very beneficial. Regular exercise may improve sleep and provide an outlet for stress. When considering an exercise program you want start easy to allow the body to adapt to the new stressors of exercise – the key is to not overdue it!! Here are some ideas:

Stretching: Gently stretch all your major muscle groups. Hold each stretch for 20 – 30 seconds and repeat each 2 times.

Aerobic Activity: Walking is a great place to start. Start easy 5 minutes on flat terrain. Slowly add 2-5 minutes daily until you can walk comfortably for 60 minutes. Once you build up to 60 minutes walk 3-4 times a week.

Aquatic exercise is great too! Get in the pool and walk forwards, backwards, side-to-side. Do squats in the shallow end. Grab a noodle to do a skiing motion with your legs, scissor or bicycle with your legs. Hold onto a kick board and just kick. You can purchase aquatic dumbbells and an aqua jogger at your local sporting goods store. The options are endless!! Start slowly – the water acts as resistance and set a timer, it’s easy to get carried away in the pool. Start with ten minutes the first day and perform every other day for a week and then add 5 minutes the next week.

Indoor Cycling: Start with 10 minutes at low resistance, add 5 minutes each session. Slightly increase your resistance once you can do 30 minutes continuously on the bike.

Other activities:

Yoga: try a beginner yoga class or one that focuses on relaxation and meditation. Again, start slow, try one class (30 minutes or less) and slowly build by completing a full class or adding a class a week.

T’ai Chi or Qigong Both of these activities focus on energy and quality of movement. Performing these activities require complete concentration and focus.

A few words of caution:

Always start slowly!! It’s important to allow yourself a day or two recovery when first starting out. It will permit you to evaluate how you’re feeling and how your body responded to the activity. Listen to your body.

Another thing to keep in mind is the temperature of the environment you are exercising in. Extreme temperatures should be avoided. Extremes can cause an exacerbation of the fibromyalgia. In the summer stay indoors for exercise, use the pool at the gym – it’s typically heated between 89-90 degrees. In the winter, exercise in warmer part of the day and cover up from the sun. Avoid excessive sun exposure.

Diet and exercise go hand-in-hand. Eat well! Avoid a lot of processed foods. Become a label reader. A nutritional label is on almost everything in the grocery store. Try to have healthy snacks (fruits, vegetables, yogurt etc…) on hand. Eat 5 small/ well balanced meals a day. Kicking caffeine may help too.

Keep a journal. Keeping a journal may help you determine patterns and pin point what causes your fibromyalgia to flare up. This will help you and your physician determine what treatments are best for you. Write down the number of hours you slept, rate your stress level (use a 0 – 10 scale), how well you ate, your mood (smiley faces work here), how much exercise you tolerated and how you felt after.

Lastly, find a good physician!! If you’re not getting what you need from your physician, find another one. The best way is to ask around – word of mouth works best. A team approach may be beneficial (i.e. a rheumatologist and a natropath). Also, it’s a good idea for you to keep a copy of any tests or treatments performed. This will help when seeing a new physician. Be informed!

Find what works for you and stick with it!!!!!

COMMON ORTHOPEDIC ADOLESCENT INJURIES

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COMMON ORTHOPEDIC ADOLESCENT INJURIES

By Nathan Snell, PT, CSCS

When I was in school as a teenager, the changing of the season meant beginning a new sport. I would look forward to spring and the crack of the bat as baseball season kicked off. However, in today’s competitive club sports scene, this rotation of sports no longer exists. It is not uncommon for a 10 year old to play one sport all year round, and at an extremely high level. Each year, approximately 30 million children and teenagers participate in organized sports. Sports are the leading cause of injury in adolescents, and it is estimated that one half of all sports injuries are preventable with proper education and use of protective equipment. As a physical therapist, I have seen a growing number of adolescents, playing year-round sports, with injuries related to overuse and repetitive trauma. Adolescents may be particularly at risk for sports-related overuse injuries as a result of improper technique, training errors, and muscle weakness and imbalance. Most of these injuries can be managed conservatively with proper and timely diagnosis by a physical therapist.

Overuse syndromes in adolescents often involve stress to the growth plate region as it is unable to meet the demands placed on it. As overused muscles pull on this attachment site, repetitive microtrauma develops. In severe cases, it can progress to involve a fracture, called an avulsion fracture. Some common apophyseal (growth plate) injuries include little leaguer’s elbow, Osgood-Schlatter disease and Sever’s disease.

Little Leaguer’s Elbow

Little leaguer’s elbow has been described as an apophysitis of the medial epicondyle in athletes between nine and 12 years of age. Most patients experience pain in the medial aspect of the elbow during throwing, and they may have decreased pitch velocity or control. Symptoms may include swelling, loss of motion, and tenderness of the elbow or forearm. Our expertise as physical therapists allow us to identify causative factors related to the condition. A thorough assessment of posture, body mechanics, flexibility and strength can begin the road to recovery and successful return to the sport. Proper education is imperative; little leaguers who make more than 350 forceful throws per week are at a higher risk of trauma.

Treatment consists of complete rest from throwing or pitching for at least four to six weeks; ice packs and analgesic medications may be used for swelling and pain. General conditioning, stretching, and core strengthening should be encouraged. When we make the decision to return the athlete to baseball, a gradual and progressive (interval) throwing program may begin. Most athletes are able to return to competitive pitching and throwing at 12 weeks.

To help prevent little leaguer’s elbow and shoulder, the American Academy of Pediatrics recommends limiting the number of pitches to 200 per week or 90 pitches per outing. However, USA Baseball Medical and Safety Advisory Committee recommends more conservative pitch counts (i.e., 75 to 125 pitches per week or 50 to 75 pitches per outing, depending on age). Other preventive measures we use frequently with the athletes include a preseason conditioning program, instruction on proper pitching mechanics, and allowing time during the early part of the season to gradually increase the amount and intensity of throwing.

Osgood-Schlatter Disease

Osgood-Schlatter disease often is encountered in children 10 to 15 years of age who participate in cutting and jumping sports such as soccer, basketball, gymnastics, and volleyball. The exact cause of this condition is unknown, but histologic studies suggest that as bone growth outpaces soft tissue growth, muscle-tendon tightness across the joint and decreased flexibility develop. Also, the strong pull of the quadriceps musculature, through the patellar tendon, on the tibial tuberosity leads to microtrauma. As the quadriceps contracts, the patellar tendon can begin to pull away from the bone.

Patients often have anterior knee pain and swelling, and occasionally the symptoms involve both extremities. Examination reveals tenderness and swelling at the tibial tubercle, the bony outgrowth below the knee cap, and pain can be produced with contraction of the quadriceps.

Most patients respond to conservative treatment consisting of rest from painful activities, icing, and analgesic medications as needed for pain. Quadriceps stretching as part of a strengthening program encouraged once symptoms are controlled. As a PT, the primary focus of my treatment is to correct any muscular imbalances between muscle groups and work on proper sequencing of muscle firing. Most patients are able to return to full activity within two to three weeks.

Sever’s Disease

Calcaneal apophysitis (Sever’s disease) is the most common cause of heel pain in athletes five to 11 years of age due to repetitive microtrauma or overuse of the heel as the Achilles tendon pulls on its attachment site. In our clinic, we commonly see athletes with this condition who participate in basketball, soccer, track, dance, gymnastics and other running activities.

Patients with Sever’s disease may have activity-related pain in the back of the heel, and commonly patients report pain of both extremities. Our clinical evaluation often reveals tenderness with compression of the sides of the calcaneus and decreased flexibility of the calf musculature. Treatment consists of activity modification, icing, stretching of the gastrocnemius-soleus complex, analgesic medications, and heel lifts or cushions. Most patients are able to return to pain-free activity within three to six weeks.

RUNNING ON AIR

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RUNNING ON AIR

Written by Matt Kraemer PT, DPT, ATC, CSCS

The Alter-G, G-Trainer, has landed at Endurance Rehabilitation in Arcadia.

Gone are the days of long recoveries, runs missed due to injury, and unachieved time splits. With the usage of the G-Trainer, athletes form all backgrounds and levels can train and compete to their full potential. This gravity altering treadmill allows the user to reduce their effective body weight (amount of weight and force they have to absorb while running) and train to their full potential without symptoms.

Designed and produced by Alter G, in Menlo Park California, this futuristic treadmill uses air pressure to lift the user and therefore unweight them allowing for greater ease with walking and running. A surprisingly quiet airflow system continually adds and removes air in the see through bubble that surrounds the user from the waist down. This change in pressure is determined by a force plate in the treadmill platform that is constantly analyzing the forces produced. The Woodway treadmill sports a touch screen interface allowing for speeds up to 18 MPH forwards or backwards, 25% incline, and a reduction in body weight of up to 80%.

Patients and non-athletes agree, the G Trainer is a remarkable machine. By unloading a post-operative knee patient, they are able to begin gait training at a much earlier time, and therefore reduce the amount of compensation and strength loss. This allows for faster progressions in their rehab, and a quicker return to their sport. “The G-Trainer allowed me to walk normal without pain or crutches 4 weeks following ACL reconstruction”, said Jerame Powell.

Athletes are also benefiting from the lack of gravity in their training with or without injuries. “Before the G Trainer I could not run past 9 miles without pain, but since using the G Trainer, I was able to increase my training mileage to 14 miles without any symptoms, in addition to reducing my pace from 9:00 min/mile to an 8:00 min/mile,” said Darlene McClellan-Brosamer, recreational marathoner.

Other athletes from all walks of light are taking advantage of the unweighting properties to continue to train through injuries without symptoms and to improve their speed. By decreasing the amount of force the body has to absorb, the user is able to recruit his or her muscles faster and more rapidly, allowing for greater foot and step turnover. When utilizing this learned response by the body with normal outdoor running, speed is increased.

So whether you are recovering from an injury, trying to avoid one, or just trying to become a better athlete, the G Trainer may be your ticket to the next level.

ASTYM – GOOD FOR WHAT AILS YOU

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ASTYM – GOOD FOR WHAT AILS YOU

Written by Nathan Koch

In my work as a physical therapist, I encounter athletes of all stripes who are limited by soft-tissue injuries. Plantar fasciitis, hamstring strain, patellar tendinosis – these are just a few diagnoses of injuries that can stop an athlete cold, or at least limit their effectiveness in and enjoyment of their activity. Triathletes are particularly susceptible to overuse injuries dealing as they do with the high volume hours of training necessitated by their sport.

While I use many therapies in my practice to heal patients, there is one treatment system I have found to be excellent and effective in healing soft-tissue injuries. ASTYM treatment is a cutting-edge therapy system that really does work. It is evidence-based, with proven and reliable outcomes I trust.

I work with many coaches, personal trainers and doctors who also believe in the ASTYM system. Joe Friel, who has coached many elite-level athletes to personal records, often sends injured athletes in to receive ASYTM therapy. He says: “My injured athletes have responded very well to ASTYM treatment. I like how it gets them back into training more quickly than other methods I’ve seen used in the past.”

Soft-tissue injury typically goes something like this: An athlete increases her running miles and starts to notice that a hamstring becomes irritated. She stretches, maybe uses ice or ibuprofen, but the discomfort continues. Being an athlete, she continues to train through her discomfort. Some days are better than others, some days are worse, but the hamstring never really feels wonderful. After a while, the hamstring becomes the limiting factor in her training and her success as an athlete. In worst-case scenarios, the athlete tells herself that she is too old, or too injured to continue running, and gives up the sport she loves.

One age-grouper triathlete I worked with was in this exact painful physical and emotional state. Carlos Mendoza, 42, was considering retiring from the sport of triathlon because of his discomfort with IT band and hamstring issues. After receiving ASTYM treatment, he went on to a PR at the SOMA Half Ironman, placing second in his age group. He says, “ASTYM works. I recommend it to any athlete who is dealing with endurance training injuries.”

Physiologically, what happens when injury occurs is this: The athlete increases her training, and her hamstring – for one reason or another – gets irritated. The body first causes inflammation to happen around the muscle and, as she continues running, it starts to lay down scar tissue, trying to heal itself.

Scar tissue, if you look at it under a microscope, is disorganized and crazy – it looks like steel wool. Healthy tissue looks like dried spaghetti – it lines up together in tidy, parallel lines. Scar tissue is by nature contractile: it contracts down upon itself over time. In our hypothetical runner’s case, this would mean that her injured hamstring would get shorter and less flexible the longer she ran with her untreated injury.

Restricted motion is another by-product of soft-tissue scarring. The layers of skin, fascia and muscle adhere to one another, and develop a grainy, gritty texture easily felt by patients. These adhesions have poor blood flow, restrict movement, and can be precursors to injury.

What ASTYM therapy does is jump-start the healing process of the body. The system is a three-tiered process. After evaluating the patient, a certified ASTYM clinician performs a hands-on treatment of the injured area. We spread a heavy cream over the skin, and use specially-designed tools in firm strokes, working not just the injury, but also surrounding areas. The patient can feel the adhesions being mobilized underneath the skin, often identified as a “crunching” sound.

What happens on a cellular level is that the tools are causing microtrauma in the tissue. The body’s response to the microtrauma is to start the healing cascade: it sends in collagen and starts to lay down fresh tissue. The old scar tissue is resorbed into the body as part of this healing process.

A critical part of the ASTYM system rests in the hands of the patients themselves. The second and third parts of the treatment system are specific stretches and strengthening exercises that tell the body to lay down new tissue in an organized fashion. Also – and this is crucial to the athletes I treat – ASTYM therapy asks patients to do the activity that led to their injury. This may sound counter-intuitive, but staying active in their sport actually strengthens the body specifically for the activity.

I truly believe in ASTYM therapy and have used it with great effect in my clinics. I use it on over 75 percent of the patients I see. It works. It’s fast. It allows people to keep doing the sports they love. And finally – ASYTM makes a lot of sense.

Nathan Koch, PT, ATC, is a physical therapist and Director of Rehabilitation for Endurance Rehabilitation in Arizona, with offices in Phoenix and Scottsdale.

A Valuable Resource

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A Valuable Resource

January 3, 2006 – When an athlete is injured they usually have resources for recovery that most of us will never have access to, until now.

I’m a 46 year old who’s in reasonably good shape. Approximately four years ago I injured myself performing Yoga, of all things. The injury occured in my left hamstring/gluteal area. Unfortunately time was not on my side. Other symptoms appeared based on favoritism to the opposite side of my body. Subsequently I began having difficulty with my ankle/foot, and to top it all off a bulging disk in my mid/lower back appeared causing great discomfort.

In a nut shell over a four year period I sought help from a multitude of practioners. These include Orthopedist’s, Physical Therapist’s, Chiropractor’s, Acupuncturist, Rolpher, Myofacial, Massage therapist’s, and Podiatrist’s. Say that three times in a row quickly.

Some of these professionals gave it their best shot. Others laughed at the idea of having an injury to the glute area. A so called pain in the ass. And I was begining to live up to that moniker, only because my frustration level with incompetence was growing. I had reached a point where by each practioner I saw was handed a letter the moment they entered the room, giving them a preview of my past escapades. I no longer wished to waste my time or theirs.

Which brings me to the point. Matt Kraemer of Endurance Physical Therapy has been the only person besides my Orthopedist who finally said he could help me, and did. Matt, as well as the other employees of Endurance Rehabilitation, have been a God send. My four months of therapy were difficult and painful at times, but whoever said getting well was easy. I found no other level of professionalism anywhere like I found with Endurance Rehab. It was as if I was given access to those resources reserved only for elite athletes. Every step of the way someone was there to instruct me on proper form. I was impressed since no other facility had ever come close. Each and every person at Endurance Rehab, no matter the position, had enough knowledge and understanding to assist in reaching my goal of becoming injury free.

I wish to thank all the staff at Endurance Rehab, especially Mr. Kraemer who has faith.

Sincerly,
Paul C. Donner