On any given day, the Colorado landscape is spotted with running enthusiasts of all ages and intensities. Running for health-related purposes is one of the best documented exercises to increase cardiovascular and general health as well as weight loss. Despite its health benefits, concern has been raised about whether impact exercise such as running can cause osteoarthritis, primarily in the hip and knee.

What is OA: Commonly referred to as the "wear and tear" arthritis, OA is a degenerative joint disease where the cartilage or cushion between the joint surfaces begins to break down and wear away. Cartilage covers the end of the bones and provides a smooth surface for the joint to glide and provides impact control. In OA, the cartilage breaks down, wears away, and can lead to pain, swelling, and difficulty with joint motion.  In some cases, motion can be restricted, and in other situations, may be increased… initially. For example, think of mortar between two bricks: if the mortar wears away and becomes uneven, motion may feel stiff or limited—conversely, if it wears and becomes too thin, motion my increase as the surfaces are not as congruent. In both instances, you may experience popping, crunching, clicking, with or without pain.

As OA worsens, the bones may develop growths called bone spurs, or parts of the bone or cartilage may chip off, float around in the joint, creating more inflammation, imitation, loss of function. Unfortunately, inflammation can facilitate more degeneration and damage to the cartilage. In the final stages, the cartilage is worn away such that the bone rubs on bone, leading to more dysfunction.

INSIGHT: So, the big question remains: Is running safe and healthy for weight bearing joints?

Let's be clear, in general, studies have demonstrated that previous injury, heavy occupational workload, obesity, and the level of sport participation may play a factor in developing or progressing OA. Contradictory data exists with respect to running, wherein, running was protective in nature to bone health, and others have observed a higher risk of OA. Why? most likely due to the presence of mentioned variables in those studied.

In a more recent study (JOSPT, 2017), along with others, the researchers found that in general, running was not associated with OA in a certain population, however led to an increased association compared with runners of other populations, and variables, and in non-runners.

QUESTION: To Run, or not to Run.

Running is still considered a favorable option for bone, joint, CV and mental health! However, recreational runners have a lower incidence of OA vs competitive/elite runners as well as sedentary people, whom have demonstrated an increased association with OA. The Good news is recreational running shows protective potential on the hip and knee, whereas increased mileage, intensity and years running are shown to aide in progression of OA, and is more present in long distance/elite runners. Of course, controlling all of the other risks involved in these studies related to running are limited.  Alas, recreational running appears to be safe and healthy and somewhat protective.
In summary, running is found to have a beneficial association with runners with less than 15 years of exposure and running at recreational levels. Sedentary people are more subject to OA due to lack of bone and cartilages stimulation.

Like most activity... MODERATION is Key!

PRACTICAL INTERVENTIONS: So, you want to continue running or take it up as a sport for all the health benefits described? Perhaps you are experiencing limitation or want to minimized progression? Wish to continue running long distances?
There are a number of interventions that can keep you in stride: From a functional PHYSICAL THERAPY perspective, our team at Revolution
identify muscular and functional imbalances in strength, flexibility, stabilization, and movement patterns. In addition, a discussion regarding shoe wear, supports, and running techniques is beneficial. Creating balance across the joints acts to unload and disperse forces.

ALTERNATIVE TECHNOLOGIES: Have wear and tear, but not quite ready to consider surgery or cease activity? Cortisone and Hylagan injections are an option to discuss with an Orthopedist. The combination of a good home program and running schedule with injections has proven to be very beneficial.

Of more recent interest and review is Regenerative Medicine, i.e.: Stem Cell implantation. While the research and results are still out there, Stem cell therapy in the appropriate population is gaining favorable outcomes and longevity of function. Dr. Michael Shell, a Regenerative Medicine Specialist quotes: "Stem cell therapy in its various iterations is cutting edge medicine that is transforming patients’ lives by improving quality of life, physical function and reducing pain. There is no question that stem cell therapy will be the standard of care for musculoskeletal pain and other medical conditions in the future.”

Visit Revolution Rehab to Repair, Restore, and Renew to keep you in stride!

Keep it Moving!
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Dr. Allie

Hand pain and conditions.
​The following is an overview of overuse and repetitive strain injuries, often grouped as Cumulative Trauma Disorders, of the forearm wrist and hand.

​TCTD Injuries to the muscle, nerve, tendon and ligaments that occur from work and overwork are very common. The majority of these injuries are not the result of an accident or mishap but develop gradually, as a result of repeated activity and overuse. In most cases the onset is slow and often innocuous in nature, and we ignore the symptoms until they become more chronic and permanent in nature. 

Cumulative trauma indicates that the injury developed gradually over a period of weeks and months or even years as a result of repeated stress in activity. Trauma indicates bodily injury from mechanical stress. Disorder refers to physical ailments or abnormal conditions as a result of such. While CTD belongs to a collection of health problems that are related to work, overuse conditions are not absent in populations that perform repetitive activities. Whether you are an athlete, partake in a fitness or competitive sport, caretaker, or simply performing activities around the home, overuse can occur.
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The cycle begins when motions are performed in the same frequency, range of motion, duration, and intensity over an extended period of time. This overuse and repetition taxes the muscles, tendons and nerves, caused by continuous use over an extended period of time, improper techniques in positions, persistent repetition or force. Basically, there’s not enough rest time between activities to allow for the tissues to recover and repair. 

​Activities such as typing, texting, gripping, squeezing, pinching, or Sistine positions can create irritation. Weight training, or overtraining, in the same plane of motion, with the same resistance can also bring on symptoms, without apparent reason. Cross training and variability with any activity is helpful. Prolonged impact, vibration, and repeated exposure to cold or he can precipitate symptoms as well. Symptoms often include tenderness, stiffness, or tingling in the affected area, soreness to touch, with associated weakness pain with use. Symptoms initially occur after the activity but as the tissues our place under greater demand, symptoms can occur before during and after they give an activity. 

Intervention may include anti-inflammatory medications and over the counter drugs, ice or heat, depending upon if there is inflammation can help to promote circulation and tissue repair. Physical therapy to address mechanical and functional deficits, including Manual therapy and dry needling techniques are very effective with tendinitis and nerve entrapment conditions such as carpal and cubital tunnel syndrome. Engaging in a program that includes flexibility/tendon glides, and functional retraining of the tissues is beneficial. On a daily basis, variety of motions in positions is recommended. Posture and ergonomic evaluations, aids or splints are helpful as well as addressing any deficiencies in technique and form.

Examples may include adjusting to size and width of your grip, such as racquet sports, golf, or if using a tool, such as with a hammer, or any activity that requires sustained power grip. Adjusting your desk, computer, or oh you use your iPad or technology can also be beneficial. Utilizing a supportive pillow at night for proper neck position and alignment also helps to mitigate pressure on the nerves in the neck that can also contribute to tingling in numbness in the arms and hands. And remember, motion is lotion so stretch frequently throughout the day, find alternatives positions to perform your activity, and remember to hydrate!

Whether your condition is simple or complex, our qualified orthopedic hand and upper extremity specialist at Revolution Rehabilitation offer effective and advanced options for treatment and rehabilitation. Thumbs Up! —Dr Allie

HOW TO ACE IT ON THE COURT

The rivalry of many top-notch elite tennis players has brought the sport to a new level.  Tennis is a complex physical sport requiring full body participation. Two-thirds of injuries are due to overuse, with the remaining one-third due to acutely or traumatic events. While some injuries may be random occurrences most can be minimized/prevented by proper conditioning, technique, & equipment.

​ Perhaps the most well known injury, “Tennis elbow “ or lateral epicondylitis occurs with repeated stress and strain to the outside area of the elbow or extensor muscles, and generally occurs as a result of repetitive and prolonged gripping, twisting or sustained contraction of forearm or wrist flexion / extension with the elbow extended. Most experts believe overloading is due to a faulty backhand technique, such as when the elbow leads the racquet, combined with late strokes and Increased wrist action to complete the hit. Treatment may involve over-the-counter anti-inflammatory agents, ice/heat, and physical therapy to address the Soft / Joint mechanics and Dry needling to decrease scar tissue and promote appropriate scar alignment and collagen. Proper strengthening of the extensor muscles and surrounding muscle groups of the wrist and shoulder is important. Paying attention to the technical aspects, such as modifying grip and stroke form aides to reduce recurrence. Racquets with larger heads that increase the surface area, and string tension at the manufactures lowest recommendation, are preferred.

Repeated overhead, backhand, and long lever arm strokes can result in overuse and subsequent tendinitis, or inflammation of the rotator cuff tendons. (RTC) and bursa. The RTC is composedof 4 muscles that surround the joint and act in concert along with the scapular muscles to elevate and rotate the shoulder complex in multiple planes . Dysfunction in any one of these components can lead to pain, swelling, and
weakness. RTC tendinitis in tennis players is usually the result from excessive overhead serving particularly if you hold your arm at a 90°
angle from your side. When fatigued or weak, increased “play” of the ball in the socket of the joint can irritate the tissues. Treatment generally consist of ice, OTC anti-inflammatory drugs and engaging in PT or a program to facilitate a balance between flexibility, stability and endurance of the shoulder girdle, core and rib cage. Changing serve technique and mechanics will assist in injury reduction.

A common underlying cause in both calf and Achilles tendon injuries is a tight calf muscle. The calf is composed of the gastroc and soleus
complex and the Achilles tendon. Where the GS meets the Achilles tendon is called the musculo-tendinous (MT) Junction, and is a transitional
zone of weakness. The majority of tears and ruptures occur at this area. An Achilles rupture is a snapping or tear of the tendon in 2 pieces.
Typically a forceful push off, eccentric loading, i.e. coming down from a jump or deep squat, lunge, or abrupt impact can cause damage. Tendinitis, or inflammation of the tendon, generally occurs over time. Tennis Leg is an incomplete rupture of the inside portion of the GS muscle, usually related to an abrupt push off such as a sprint, or when lugging , pushing off one leg to reach a wide ball. Common symptoms include a tight or achy feeling in the back of the care and difficulty raising up on the toes. Both Achilles ruptures / strains and other tendinitis conditions are commonly associated with over pronation of the foot, so consider orthotics/ shoe inserts and proper shoes. Treatment for calf and tendon injuries may include Physical Therapy to elongate and remodel the  scar tissue, and to promote a balance between flexibility and eccentric strength. A good warm up followed by proper stretching can help diminish injuries.

One of the most costly, yet overlooked / unattended injuries is the ankle sprain, regardless of the cause of injury. The abrupt side to side activities, variable speed and direction change, and stop and go maneuvers render the foot and ankle prone to injury. Fatigue often plays a part injury. Persons with tight gastrocnemius, over pronate or have increased joint mobility/laxity, and muscular imbalances are more susceptible. Lateral (outside) ankle sprains are prevalent in most sports, but particularly tennis. Rolling of the ankle in either condition can damage the tendons and ligaments, and create a stretching injury to the surrounding nerve bundles. Recurrent ankle sprains are more common in the lateral ankle , and can lead to chronic instability and early degenerative joint changes. Often times it would be better to fracture the bone then to sprain an ankle! The immediate treatment to the ankle is to provide compression ice and elevation while protecting it. Placing the foot and ankle in a walking boot or "CAM" is recommended for at least two weeks. 40% of people with an ankle sprain will have a recurring injury. Proper early immobilization can never do you any harm as it allows for the joint to be in a good position to promote proper scar tissue formation and healing. PT for joint protection, while addressing flexibility, functional retraining of the lower leg,
core, ankle is recommended to avoid recurrent injury. Promoting balance, coordination, proprioception and sequencing , such as on a
wobble board, bosu, balance discs, and agility training. Proper inserts/shoes are helpful.

Stress fractures are the result of increasing training too rapidly without adequate down time. With muscle fatigue, the bone takes the brunt, and cannot adjust rapidly enough to absorb the stress and starts to crack. Most common in the foot, fractures of the spine are commonly found due to the hyper extension, rotation, and lateral bending required during a serve. Decreased bdominal and core stability is associated with increased risk of fractures, and is more prevalent in the younger tennis players who experience growth spurts. Rest for approximately six weeks to allow for the bone to heal combined with flexibility exercises to lower extremities and muscular stabilization to the core and pelvis area should begin once clinical healing has occurred. Just a note, stress fractures may take 6–8 weeks to show on the x-ray. As with any new sport, consult a coach/rep to educate about form and function. Veterans of the sport can always benefit from a check up to fine tune as well. Put the Love back in your game and play like an Ace!

​                                      Dr. Allie


​Visit either of our 2 Revolution Rehabilitation locations for a complimentary analysis, address your injury needs and for helpful links,  exercises, and tips!

It’s summer time in the Rockies!   Are you ready for golf?  Breaking out the swim suit?  Tackling the yard cleanup and maintenance? It might be a good time to focus on improving your core, but what does that really mean? Core exercises are part of a well rounded fitness program but aside from sit ups and push-ups many core exercises are neglected.  The abdominal area has been marginalized to include just one muscle, the most superficial...rectus abdominis,  the coveted “Six-pack”,  but the anatomy and function go much deeper..
 
Function:
The majority of our recreational and daily activities depend on the stability of the core muscles, be it reaching overhead to grasp an object, swinging a golf club, pushing open a door, or simply getting out of bed. The core is capable of a multitude of actions, but  the primary function is in maintaining good posture and spinal alignment. Functions also include stabilizing the rib cage when you cough or sneeze, increasing pressure in the chest cavity such as when you hold your breath, stabilizing the pelvic floor for urinary and bowel function and to assist in labor/delivery. Essentially your core is the “foundation“ of your house.
Weak core muscles can leave you susceptible to poor posture, spine and muscle injuries, and can lead to long standing neck and back dysfunction. Research has shown a correlation between injury and altered core strength in professional athletes, and a higher incidence of back pain in those patients who typically had a sedentary job and lifestyle.
 
Anatomy: Go Deep!
Anatomically the  “core “ is a complex mass of tissue comprised of muscles,  ligaments , bones and organs. The core muscles can be divided into two groups: 
 
The first group are  the deep core and “local ” stabilizers of the spine, due to their proximity and closeness to the spinal column .These include the transversus abdominis and lumbar multifidus and generally coactivate to provide spinal segmental stabilization and maintain the spine in a neutral position. In addition these muscles provide fine-tuning motor control and proprioception to provide finite spinal stability. The second more shallow group of muscles provide “global” stabilization to the spine, pelvis, and thorax. These muscles include the rectus abdominis, internal and external obliques , erector spinae, quadratus lumborum, and hip musculature including the glutes and the hip flexors. These muscles produce high forces to counterbalance any resistance or action imposed on the spine, and are more of a secondary stabilizer. 
 
Core Strength vs Core Training? 
The terms core strength and core training have been something of a buzz....so is it core training or just a fancy way of saying tone and defining your abs?
In essence, Core-strength training is directed at training the deep trunk muscles, however independent or isolated  training in this area remains challenging.

Training is best focused on multiplanar, multijoint and combined  movements that emulate and activate the muscles in a more natural, functional manner, and are more effective and attainable. Research has shown that resistance training, which generally isolates individual muscle groups , can be more challenging for those who have a history of back pain because those muscles tend to shut down in the presence of disuse  or discomfort.

​Functional training helps you develop better posture by supporting your spine in helping with things like balance, coordination, functional movement patterns and when  working in multiple directions, various speeds, and against different levels of resistance. Movement patterns that work your core are going to work more than one muscle group and you benefit from the results much faster and can aid in injury recovery and reduction.
 
Go with your GUT! :
Building  core strength and control promotes a sturdy central link in the chain connecting your upper and lower body. Weak, tight, or unbalanced core muscles and surrounding tissue can undermine your ability to have a fun and productive life. Engaging in a program that includes core stabilization, flexibility, and cardiovascular training will build up your balance and stability , bring more power to your athletic and daily pursuits, and aid in injury prevention. While it’s important to build a strong core, keep in mind that overtraining abdominal muscles and ignoring muscles of the back, hip and pelvis can set you up for injury. If chiseled washboard abs are your holy Grail, it is still wise to embrace in a functional training program and trim body fat through diet and aerobic exercise.
 
Avoid getting stuck in the middle rut...visit one of our locations at Revolution Rehabilitation for a complementary consultation to assess your training and injury needs, and get back your groove!
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Visit our website for helpful tips and links for your core training regimen!

Motion is Lotion!!
Dr. Allie

These days, there’s a lot of discussion and investigation surrounding proper running form, and more people than ever are trying to fix their form in the 
such as Minimalism and Chi Running, each of which has its converts. BUT... how do you know if your form needs fixing? 

In most cases, if you are running comfortably, at the pace and distance you desire, and remain injury free, there may be no reason to fix what is not broken. There are a number of world-class runners that display what some would consider as improper form, however, go the time and distance without consequence. Despite all this chatter, one thing remains... there has not been any definitive answer nor one size fits all style to running form that proves 100% across the board. Despite, analytics abound, and a number of experts have identified mistakes in running form and how to address the flaws.  The following tips should help to prevent injury and keep you in stride. But... a word to the wise... Making a radical change to your form without giving your body a chance to just will render are you injured and off the pavement.

Insight: Most coaches and experts would agree, there are 4 key components to running: Posture, Alignment, Core/Pelvic Stability, Flexibility, and it is generally a deviation in one of these areas that could lead to mechanical issues and injury. Consider these components and how they relate to the following running techniques.

CADENCE: Most people, unless you're Carl Lewis, have a low cadence. Speed is a result of stride length multiplied by frequency. Most runners will attempt to increase their stride length which reduces frequency, and more time on foot per stride. Optimal stride frequency is around 180 strikes/min. so if you increase stride length, you spend more time on your foot per strike, requires more propulsion, and is less efficient. So, you want to spend the least amount of time on your legs. The less time the foot is on the ground the less you will decelerate or "hit the brakes" when your foot lands. Less = more in this case. Tip: Maintain a short quick stride.

PROPER LEG / HIP MOTION: Push up and off the ground behind you. Over-striding is a major cause of both hamstrings and lower leg injuries because you land with your feet in front of you instead of under you. There is a lot of controversy out there with respect to heel strike versus fore-foot contact. Minimalist runners engage contact on the front of the foot versus heel, simply because if you were barefooted it would certainly hurt! Tip: bend your knees at a 90° angle when you're warmed up and running at a good, medium grade pace to facilitate forward motion and contact.

POSTURE: Running technique and efficiency is dependent on the quality of your posture. Good posture means having a slight "S" curve from the side view, but not too much bend or straightness. The more you lean forward or slump, the more work needed to hold you upright, and puts your trunk ahead of your legs. In addition, maintain good alignment with your knee over your foot, rather than striking the foot too far forward. Work to keep your head up right and avoid bouncing.

FLEXIBILITY / MOBILITY: Maintaining good flexibility and balance around your joints trumps everything else when it comes to running and injury prevention. If you lack mobility anywhere in your lower body you are susceptible to injury. There's probably not any joint that doesn't benefit from some flexibility training in runners. As we age, flexibility decreases, so do your best to maintain and improve to facilitate better movement and prevent compensation and injury.

Chillax: Do you feel uptight or tense while running? If so, INHALE and breathe... Tension=wasted energy. Keeping your elbows at 90 degrees, by your side, with your hands relaxed, slightly below your chest is more efficient. Pumping your biceps, crossing midline and clenching fists expends, plus may throw off your gait. One activity that I utilize with runners to ensure efficiency and good alignment is the the "hands on head" drill. While interlocking your hands on your head, focus on stabilizing and maintaining your core tight and straight while keeping the hips and shoulders level. This will help to minimize any excessive deviation in movement through the hips and avoid crossing midline with the arms.

CORE WORK: Your core is the engine that drives you. Like a foundation of a house, if it's unstable or wobbly the remaining structures will have difficulty performing their function. Engaging in a good stabilization program of the trunk and pelvis promotes better posture, functional efficiency, and decreases the compression on your lower extremities.

*Gradual change: introduce change over time, and initially cut back time and distance to allow your system to adjust, and ramp up mileage slowly. *Adequate Recovery: Self explanatory, but avid runners struggle with this! Alternate days with some other form of exercise, cross train, yoga, bike, etc. *Shoewear: proper support, adequate toe box and heel counter are staples. Remember to change out your shoes regularly. Visit a specialty store to assess your shoes and needs.

In the end: No single running "school" or method of thought will completely render you exempt from injury. Creating a good balance across the board will ensure enjoyment and injury prevention. For a Biomechanical or Running Analysis, visit one of our clinics at REVOLUTION REHABILITATION to keep you in stride!
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Keep Moving! Dr. Allie