Research Corner - AB ALERT!!

So many people with back pain have been taught to artificially hold, grip, or tighten their abdominal muscles during exercise or daily movements, for the purpose of "stabilizing" the lumbar spine. New research shows why this approach not only doesn't work, but actually might reduce shock absorption, jeopardizing the spine and other joints like hips, knees and ankles:

http://www.jospt.org/doi/abs/10.2519/jospt.2016.5774

Revolutions in Fitness physiotherapists, trained in the Functional Manual Therapy approach, train clients to achieve stability through appropriate movement strategies, not just by sheer strength. Core strength is important, but our approach to achieving a happy spine is to encourage an automatic, integrated, well-timed core response during functional movement patterns, so it becomes a way of life. Movement should be a joy, not a chore!

Mark McMahon, DPT, OMT, CFMT

Revolutions’ PT, Mark McMahon authors an interesting article about hip health and the practice of yoga to lessen the pain and tension of certain yoga poses.

Solving the hip yoga puzzle the FMT way

by  Mark McMahon, DPT, OMT

Yoga Instructor in the Iyengar tradition

This NY Times article by William Broad puts the spotlight on the potential risks of yoga practice, especially regarding  women’s hip health. The author uses primarily anecdotal evidence from respected orthopedists and yoga teachers to show an apparent recent trend of hip injury among women yoga practitioners. The doctors theorize that some yoga poses which emphasize fully folding or twisting the hip joint, along with women’s natural flexibility toward these poses, contribute to pinching and unnecessary degeneration of the tissues around the hip. After describing the problem, the experts make some common sense suggestions: practice gently, avoid poses where the hip is fully folded, and don’t push through pain. This is sound advice, given that a primary principle of yoga practice is to cultivate nonviolence.

I would point out modern American life has wreaked havoc on hips, it’s been proven: the US has the highest per capita rate of hip replacement in the world. Sitting, driving, and other sedentary lifestyle issues are probably much worrisome factors in the epidemic than the few overaggressive yoga practitioners! In general, even Mr. Broad acknowledges, yoga probably helps more people maintain joint and body health than get injured doing yoga. So it’s likely that the problem with yoga injuries lies not with the poses themselves, but in how they are (or not!) being instructed.

The primary safeguard from developing an injury in yoga is to find a good teacher and attend classes regularly. A good teacher should be able to give verbal and/or touch cues to guide a student to a proper alignment in a pose. If that’s not possible then they should be able to give a modification which allows the student to experience the essence of the pose with less strain. Classes in which poses move very quickly from one to another, or in which few alignment cues are given, should be considered for advanced practitioners. Instructors who encourage competitive straining or “pushing through the pain” are to be avoided. Finding the right class and intensity level for you is key. Those with significant injuries or other concerns about their musculoskeletal health might do best with private instruction at first from a qualified teacher, before getting into general yoga classes, OR entering into a course of physical therapy with yoga goals in mind.

Here at Revolutions in Fitness we commonly work with all kinds athletes of all levels, with all kinds of goals. Our physical therapists work with the the principles of Functional Manual Therapy (FMT), as taught by the Institute of Physical Art (Gregg and Vicki Johnson, co-founders), in which treatment is guided by the overriding goal of enhancing function through the entire system, not just the injured body part.  Given its central location in the body and how it transmits force from leg to torso and vice versa, a strong, stable hip is key to any athletic pursuit. The hip is just like the shoulder, it has its own "rotator cuff" system which often needs to be strengthened to ensure the health of the joint. Whether you’re walking, running, cycling, or holding a yoga pose, an efficient hip helps. What does efficient mean? According to FMT, an efficient joint has a) good mechanical alignment and mobility, b) sufficient strength, endurance and power for the desired activity and c) good control of movement and position throughout the range of motion of the activity. So in yoga for instance, a very flexible woman may need to be trained to NOT fold the hip all the way during a forward bending pose! This takes strength, control, and awareness. All of these qualities can be assessed, trained and enhanced with the FMT approach in a physical therapy setting.

So if you’re a yogi or yogini and your hip is bugging you, don’t ignore it. Consider a consult with one of our expert PTs to help sort things out. Or if you’re happy with your yoga and just want to keep it that way, we can help you identify and improve weaker areas that can lead to problems in the future. Yoga practice can be a wonderful laboratory for self improvement and integration of body and mind. Wishing you safe movement and happy hips.

NY Times article referenced above: http://www.nytimes.com/2013/11/03/sunday-review/womens-flexibility-is-a-liability-in-yoga.html?_r=0

My Aching Body

By Curtis Cramblett, P.T., CSCS, Expert Level Cycling Coach

If you sat at your computer in a poor ergonomic position for six hours straight, bending and straightening your elbows 300,000 times or more, you’d expect a repetitive strain injury, right? 

Cycling is similar in that it too is a poor ergonomic position with repetitive motions. In a six-hour ride your knees, hips and ankles will bend and straightening approximately 300,000 times. Your neck and back will be in a constant forward position. So if you want to prevent or get rid of aches follow Coach Curtis’s “5 F’s of Training”

1. Bike Fit: Andy Pruitt once said changing the seat height by a mere inch changes the mechanics and muscle actions of every joint in the lower extremity. I find that changing it by 1/16th of an inch can cause or alive pain! For example, if you decrease the seat height you increase the forces on the front of the knee, but if your saddle is too high, forces increase in your hamstrings, low back and hands.

WHAT TO DO: 

Educate yourself on bike fits and make the appropriate changes. If you are doing rides longer than 2 hours or multiple days then I recommend getting a professional bike fit. 

2./3. Fatigue ability (endurance/strength) and Flexibility 

Think Yin and Yang of muscles and joints

Muscles need to be both strong and flexible to allow proper movement and support of the joints in your body. As mentioned above, this is especially important for cyclists because our joints are either stuck in a static position as with the upper extremity or in repetitive motion as in the lower extremity. 

If joints are not flexible AND strong then you’re asking for trouble. What’s more, muscles on either side of the joint need to be balanced. For example, many cyclists have very strong quadriceps muscles (front of the thigh) and relatively weaker hamstring muscles (back of the thigh). This is similar to the unequal guide wires on a tent causing the tent to tip. 

WHAT TO DO:

- Static positions need to be reversed. This means occasionally backward bending when you get off your bike.

- Strengthening and stretching both sides of the body joints. Incorporate pulling and pushing exercises to strengthen the upper body, and hamstring and quadriceps exercises for the lower body. --Use proper pedal mechanics (discussed below).

4. Fitness Progression - Proper progressive training

You might expect an injury if, in one week, you increased weights in the gym by 60%. However, many people think nothing of increasing their longest ride from a 40 mile ride to a 65 mile in one week, the same 60 percent increase. Once our bodies have reached their fitness limits they can only tolerate gradual increases of no greater than 5-10 percent per week of mileage or time increases. Frequent high-intensity rides or long rides with greater than moderate intensity will also lead to injury. 

WHAT TO DO:

- Intense rides (greater than 75 percent of max heart rate) should be limited to one to 2-3 days a week. 

- Gradually progress time spent on the bike and/or mileage in 5 to 10 percent increments per week.

- Every 3-6 weeks decrease your training time by 40-60% to allow your body to regenerate and adapt to training. 

5. Cycling Form - How you pedal counts

Pushing hard gears is analogous to walking up a flight of stairs two or three steps at a time, when you only need to take them one at a time. By selecting easier gears you break up the same amount of work over more pedal strokes, taking a great deal of stress off of your knees. 

WHAT TO DO: 

- You should aim for a cadence (pedal revolutions per minute) of 85 to 95 on a flat road and no less than 70 on a hill. You can achieve this by selecting the proper gear for your ability. However, on a significant hill, this can present a challenge without a triple chain ring on your front gears. 

- Improper pedal form will also cause pain: not pushing and pulling on the pedal. Or if knees are not staying in a straight line when you pedal then your form needs some work. If you notice your knees bowing out or in relative to the top tube of your bike, ouch, this is you. 

- Use all your muscles to propel yourself forward. With proper pedal strokes, both your quadriceps and hamstrings play a part. Imagine your pedal going through a full circle; as your foot moves to the bottom position of the stroke, imagine scraping bubble gum off the bottom of your shoe. Then, pull your knees toward your handlebars as you bring your foot to the top of the stroke. This will take pressure off of the front of your knee and give those tired quadriceps a rest.

- Focus on keeping your knees going straight up and down. This problem is frequently a bike fit issue however. 

6. Fuel and Hydration - Nutrition

Proper fuel, water, and electrolytes will fuel those muscular engines. With out it they will seize up, cramp and sputter. Imagine trying to run an unleaded car on leaded gas. This is what happens when we do not fill a body with what it needs to carry out those long rides.

WHAT TO DO:

- Research suggests 55 to 65 percent of our fuels should be in the form of carbohydrates, mostly complex. Fifteen to thirty percent of our foods should be fats and 10 to 20 percent protein.

- Drink between two and four liters of water a day depending upon your workout intensities. Watch your urine; it should be a light yellow color. Check your weight before and after a ride, it should not change by more than 1 pound if it does replace it with the water you have lost!

For recommended readings and more in depth articles on the subjects mentioned in this article, please visit my website at RevolutionsinFitness.com

Curtis@RevolutionsInFitness.com

www.RevolutionsInFitness.com

w:(408)676-7430 

Licensed Physical Therapist

Personal Trainer

Certified Strength and Conditioning Specialist

USCF, USA Expert Level Cycling Coach

Certified Spinning Instructor

Introduction to Revolutionizing your Bike Fit

As most avid cyclists already know, riding a bicycle represents fun, fitness, companionship with fellow riders. Unfortunately, most cyclists at some point in their lives have learned their bicycles can also be a source of aches, pains and overuse injuries. There is hope, however. Ongoing developments in bike fit technology, greater biomechanical understanding relative to cyclists’ needs and sophisticated bike fitting techniques have resulted in a comprehensive bike fit solution capable of addressing the underlying causes of physical complaints, and returning the affected rider to comfort on the bike.

What Should A Comprehensive Bike Fit Include?

Since the above suggests the prospect of a bike fit as a source of ‘pain relief,’ it is important to note that not all bike fit providers are created equal. Instead, the achy rider would do well to ensure his bike fit solution of choice marries physical therapy/biomechanics evaluation and treatment, and appropriate technology with traditional evaluation and adjustments to the bike itself. Only then is a bike fit solution truly comprehensive and able to:

• Accurately evaluate the patient’s physical dysfunction/source of pain on the bike, rather than simply guessing at the problem
• Effectively translate on-table evaluation and treatment, into on-bike changes in patient biomechanics
• Determine a short-term bike position that accommodates and facilitates healing by reducing stress on injured/recovering tissues.

Lucas Euser of Garmin Slipstream 

As a minimum the following bike fit-related contact point dimensions should be checked (and adjusted, if appropriate):

• Cleat position – Fore/aft, rotation and medial/lateral
• Seat height – Fore/aft, seat angle (this dimension is best determined via motion capture technology such as Retül, a goniometer can be substituted not available)
• Handlebar position – Determined by handlebar stem length/angle
• Handlebar dimensions – Width, reach and drop (road bike)/brake lever position

The above dimensions have ‘neutral/efficient positions’ for the average healthy cyclist; however, they can also be altered to reduce tissue stress if disorders such as hamstring tendonitis, cervical disc injury, and Achilles tendon injuries are present. The bike fitter must know which dimension must be adjusted in light of the patient’s biomechanics. In addition, the fitter must understand which components might need to be replaced or added to the patient’s bike as part of the bike fit process, e.g., addition of forefoot or rear foot shims to patient’s clipless pedal system to address foot tilt, or changing out improperly sized handlebars to achieve appropriate width. 

At Revolutions In Fitness, a long-time provider of physical therapy comprehensive bike fits, such adjustments, along with physical therapy evaluation/treatment and advanced biomechanical tools such as Retül (motion capture) and Spin Scan (pedal mechanics), have often eliminated patient pain with a single bike fitting session! 

For an in-depth article on comprehensive bike fitting, visit  www.revolutionsinfitness.com/articles.html.

Revolutions In Fitness – Who We Are:

Revolutions In Fitness Inc. is a physical therapist-owned outpatient orthopedic cash practice providing a range of services and products to enhance human performance including comprehensive bike fitting, physical therapy, cycling coaching, personal training, cycling efficiency analysis, power/heart rate zone testing and custom orthotics. Founded by Curtis Cramblett, LPT, CFMT, CSCS in 2003, the Revolutions In Fitness team has since helped people from all walks of life, from mainstream patients seeking recovery from aches, pains and injuries, to the pro-level athlete vying for a podium position at the season’s A-level races. Recent successes include:

• Designated physical therapy/bike fit provider, Garmin Transition Pro Cycling Team (Gerona, Spain) – Provide of on-site team member evaluation on/off bike, implement related bicycle adjustments, and summarize for Garmin Transitions medical staff biomechanical dysfunctions associated with each team member requiring treatment in order to improve rider efficiency.
• Bike fit provider of choice – Chris Lieto (2nd place finisher, Ironman Kona 2009) and 2004/2008 Olympians

A number of aspects make Revolutions In Fitness different from other comprehensive bike fit providers:

• Comprehensive bike fits incorporating physical therapy evaluation/treatment and use of advanced biomechanical tools such as Retül (motion capture) and Spin Scan (pedal mechanics)
• Highly qualified and educated staff with advanced Manual Therapy Certifications
• In-depth knowledge of athletes and their performance needs and goals
• Revolutions In Fitness has two locations in San Jose and Menlo Park, and employs two licensed physical therapists and one ATC, a recent finisher of Revolutions In Fitness’ bike fit fellowship program.

Soreness and pain with running

I have soreness and pain with running, is massage therapy the solution?

Answer: Manual Physical Therapy combined with exercise for flexibility, and movement re-education can get you running healthier and faster again!

Treating soreness with soft tissue work is a great idea to get rid of the achiness and tightness short term. Usually ‘structural integration / deep tissue’ work helps loosen up some of the underlying tightness.


Longer term think about your training routine especially around appropriate rest (sleeping enough?) and rest between runs, intensity of runs, ‘cross training’ outside of running including stretching, core or possibly some running specific strength work.


We frequently find that when this kind of soreness continues there are some running form issues along with some tight areas muscles and joints that are root causes. Frequently poor movement at one's ankles, hips and trunk along with core strength are present. Massage therapists can work on some of the tight muscle stuff but start to think about the other pieces as well.

We are big fans of some of Danny Dreyer’s Chi Running exercises and form videos to help. www.chirunning.com. You might also consider a professional evaluation at some time. Most bodies have some old injuries that healed well enough not to hurt anymore but have lagging stiffnesses that can arise when we work to accomplish new goals.  These stiffnesses or inefficiencies mentioned above are quite changeable at any age and allow us to start growing younger by getting healthier in these weak links.

--- Revolutions in Fitness Staff

BIKE FIT - answers for an aching neck!

by Dan McDonough | Revolutions In Fitness Retül Certified Bike Fitter

('07 Tour of California pro's starting Sierra climb - by Beverly Garrity)

My aching neck, why is flexibility important? 

Neck pain and many times hand numbness that comes from a pinched neck / nerve on the bike is usually a combination of:

1) The interrelationship between a person's flexibility and their bike fit.
2) The interrelationship between a person's strength in their bike fit.
3) Any existing or pre-existing problems such as: disc bulge is, nerve root encroachment, facet misalignment (neck joints).

When we are on the bike, assuming a forward bend position (usually around 45 degrees to the horizon) we must somehow get our head facing forward so that we can see the road. This can be accomplished in one of three ways.
The first is to by solely extending the neck
The second is to extend our lumbar spine and/or thoracic spine
The third is a combination of the two above.

So here's a demonstration sight unseen, to help explain these relationships.  Follow each of these directions and progressively.
1) Bend forward slowly sliding your fingers down the front of your thighs when you reach your kneecaps stop.
2) Slowly look up by just moving your neck. Do not move your back.
This is an example of the first method.  It puts great of stress all of the neck and low back. It increases pressure on the facet joints (joints in your back), nerve roots, and adds stress to the muscles that support the neck.

The second option:
1) As above, bend forward slowly sliding your fingers down the front of your thighs when you reach your kneecaps stop.
2) Slowly pull your belly button down toward the floor letting your lumbar spine extend (arch down, dip / sag toward the floor).
3) Slowly pull your shoulder blades together causing extension or arching of your mid back (thoracic spine).
4) Lastly, as needed, looked up to see the road.

Notice that most of your movement looking up needed in order to see the road can be gained from your low back and mid back. However, this takes flexibility of your hamstrings, whole spine (lumbar spine, thoracic spine and cervical), chest (pectoralis) muscles, and neck muscles. It also takes strength and ENDURANCE of these muscles: abdominals, back extensor group (multifidus erector spinae, illiocostalis, multifitis), shoulder blade muscles (mid traps, lower trapezius, serratus anterior) and the neck muscles.

If you look at your pelvis (hips) to your spine as a chain, if several of these links are still (back upper / lower or hamstrings) then the other links (in your neck) have to make up for the stiffness.

The biggest factor relative to the neck regarding bike fit is the relationship between seat height and handle bar height. The lower your handle bars are as compared to your saddle, the more you must bend forward and thus the more flexibility in strength is needed.


Thus think about stretching next time you feel that nagging ache.

Meet RIF Physical Therapist - Belinda Ting

Belinda Ting, Doctorate PT, FAAOMPT, Certified Pilates instructor  

Belinda is one of only 462 fellows belonging to the American Academy of Orthopedic Manual Therapy committed to advance orthopedic manual therapy worldwide. She graduated in 2003 with a Doctorate degree in Physical Therapy from Columbia University and has been an Orthopedic Certified Specialist since 2006. Belinda’s interest in sports began at an early age with her participation in competitive tennis and gymnastics. With 13 years of movement science experience, Belinda began her journey of promoting health through fitness as a Personal Trainer in Singapore. Belinda worked for almost 4 years at a Sports/Orthopedic Physical Therapy Clinic in Palo Alto Medical Foundation.

In addition to working as a Physical Therapist, Belinda has also been teaching Pilates in a studio for the past 4 years. She combines fitness and rehabilitation through core strengthening and dynamic stretching from Pilates. Her background in gymnastics combined with her recent research in this field gives her a very well rounded understanding towards these athletes.

Belinda’s Philosophy

Belinda believes strongly that ‘Our body’s dysfunction is an accumulation of our lifetime of sports and daily activities. It is movement that brought us to this dysfunction and I believe that movement through rehabilitation can bring back function but only through manual therapy can we expedite this process’.

Credentials:

• Doctorate / Licensed in Physical Therapy

• Fellow of the American Academy of Orthopedic Manual Physical Therapy

• Board Certified Orthopedic Certified Specialist

• National Strength and Conditioning Association-Certified Strength and Conditioning Specialist

• American College of Sports Medicine-Health Fitness Instructor

• Certified Pilates Instructor from Power Pilates (Classical)