All posts by CPMC Physical Therapist

CPMC Outpatient Physical Therapist working with orthopedic, surgical, and sports medicine caseload. Always interested in collaborative discussions.

Sports Wellness Center

by Natalie Wong, PT, OCS

 

CPMC Physical Therapy and Sports Wellness Center

 

In 2007, California Pacific Medical Center (CPMC) Physical Therapy Department started the Sports Wellness Program to bridge the gap between medically necessary therapy services and community based wellness and fitness programs.   With the growing number of active individuals in the Bay Area, life spans expanding, and the desire to make a more lasting change with our patients, the PT department began offering a range of wellness programs taught by therapists that are available to employees and the public.  With the medical and fitness expertise of the physical therapy team, we keep you fit in the safest way possible.

 

Below are brief descriptions of what we have to offer.

  • Total Body Fitness – An effective 60-minute cardio and strength workout for those trying to prevent injuries and stay healthy.  We provide a Level I and II class.

 

  • Fit for Life – A class designed for people 60 years or older to help them increase strength and flexibility, improving their balance and reducing their risk of falls. This overwhelmingly successful class helps keep participants healthy and independent.

 

  • Pilates – Our Pilates Mat Class and Private Pilates Reformer sessions are taught by Physical Therapists with Pilates certifications.

 

  • Bike Fit –Are you fit to ride?  Our Fit to Ride Program offers two bike-fit options.
  1. Option 1: A musculoskeletal assessment with a bike-fit evaluation with you seated on your bike that is secured to the bike-fit trainer.
  2. Option 2: In addition to the bike-fit evaluation and musculoskeletal assessment, this option includes an interactive cycling video analysis to optimize your comfort, efficiency, speed and overall cycling performance.

 

  • Running – CPMC’s Running Clinic will help you improve running mechanics to optimize biomechanical efficiency and endurance; improve posture, flexibility, strength, and balance; minimize repetitive joint stress and prevent injury; identify common running training errors; and provide skilled exercise program instruction and feedback.

 

  • Alter G Treadmill – Do you want to return to running or start a running or walking program but afraid you are too overweight or injury prone? The anti-gravity treadmill is a technology that unloads you so you can walk/run with an adjusted body weight.

 

  • Golf Conditioning – Are you ready to get back on the golf course or improve your game? Private sessions are with physical therapists who are (Titleist) TPI certified.

 

  • Fitness Training – What are your fitness goals? To prevent injury? Stay healthy? Lost weight? Exercise during pregnancy? Our private sessions with a Physical Therapist will tailor an exercise program to meet your needs. CPMC employee discount available.

 

For more information about the Wellness staff or see a list of our programs, please check out our website at www.cpmc.org/sportswellness.

 

We are located at:

Outpatient Physical Therapy – Pacific Campus

2360 Clay Street

San Francisco, CA 94115

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CADENCE: HOW YOUR RHYTHM CAN AFFECT YOUR RUNNING

by Jonathan Ide-Don, PT, DPT, OCS

WHAT IS CADENCE?

Cadence is the number of steps (or strides) a runner takes in a set amount of time.  It is often expressed in steps per minute (each foot hitting the ground counts as one step) or strides per minute (one cycle of right foot then left foot hitting the ground counts as one stride).  Other names for cadence include step rate, step frequency, and turnover.  Cadence is also one component that determines running speed:

Cadence  X  Step Length  =  Speed

WHY IS IT IMPORTANT?

Cadence is one of the key factors affecting running mechanics.  If a runner maintains a constant speed, but increases their cadence, their step length will shorten as well.  A shorter step length and faster cadence can have effects on muscle activation patterns, joint loading, and the overall movement patterns.

Cadence is one factor that is under conscious control of the runner, and short-term changes can be seen immediately with easily accessible tools or cues.  Making long-term changes stick will require practice over a period of weeks to months.

WHAT DOES THE RESEARCH SAY ABOUT CADENCE?

Key points from the research:

Running with a quicker cadence results in the following:

  1. Shorter step length (Fletcher 2010)
  2. Less vertical displacement
  3. Shorter stance time
  4. Better shock attenuation (Hamill 1995)
  5. Less energy absorption at knee (Heiderscheit 2011)
  6. Less energy absorption at hip
  7. Less braking as the foot hits the ground
  8. Increased gluteal activation (Chumanov 2012)

WHAT DO THE COACHES SAY?

There appears to be a general consensus that a minimum of 170 to 180 steps per minute is a good cadence to shoot for.  Pose running teaches at least 180 steps per minute, but faster if the athlete is able to perform the proper technique.  Chi running also teaches an ideal cadence of 180 steps per minute.  Blaise Dubois, a physiotherapist based in Quebec City, also advocates a cadence of at least 170 steps per minute.  He recommends increasing the cadence to 180-185+ steps per minute for faster workouts.

WHAT DOES THIS ALL MEAN?

  1. Increasing cadence lessens forces at the knee and hip joints
  2. Increasing  cadence lessens risk of stress fractures associated with repeated, excessive loading of the bone
  3. Increasing  cadence increases gluteal activation, which may positively affect alignment of your knees, ankles, and feet during running

If you are looking to prevent future injuries, or to return to running following an overuse injury, increasing your cadence 10% over your preferred cadence may be beneficial.

A specific target for your cadence is largely dependent upon the individual.  However, shooting for at least 170-180 steps per minute may be a good place to start.

HOW DO YOU DO IT?

1. Running intervals with a metronome

If you have a smartphone, you can download free or really cheap metronome apps onto your phone.  As part of your warm up, run for 30 to 60 seconds with the metronome matching your footsteps to the metronome beat, rest for 1 minute, and repeat 3 to 5 times.  Then shut off the metronome, and go out for your run and try to maintain your goal cadence.  My personal favorite is the Steinway & Sons free app for the iPhone:

https://itunes.apple.com/us/app/steinway-metronome/id393021343

2.      Running with music with specific beats per minute

Build a playlist!  Running with music can make some runners feel like they are working less hard to maintain a certain speed (Bood 2013).  Even better, the music can serve as your metronome.  Check out the websites below to search and find songs to build a playlist at different cadences:

http://www.cs.ubc.ca/~davet/music/bpm/

http://www.bpmdatabase.com/search.php

http://runningplaylist.net/category/bpm-2/page/2/

3.      Running drills with a metronome

These drills are excellent technique drills as part of your warm up.  Using a metronome while practicing the drills is a great way to practice the rhythm of running at a faster cadence.  Try each drill 3 times each for 30 seconds, matching your footsteps to the metronome beat.

https://ptsportswellness.wordpress.com/2013/12/04/running-drills-the-quick-switch/

https://ptsportswellness.wordpress.com/2013/12/04/running-drills-modified-butt-kicks/

https://ptsportswellness.wordpress.com/2013/12/04/running-drills-modified-butt-kicks-moving-forward/

4.      Jump rope

Practice jumping rope with both feet hitting the ground with a quick, light hop.  Jump rope is a great way to teach your body how to quickly get your feet on and off the ground.  Progress from 2 feet jumps to alternating right foot / left foot jumps.  Focus on quickly picking the heel straight up toward your sit bone, hopping just high enough off the ground to clear the rope.   30-60 seconds of jumping with 30-60 seconds of rest for 5-10 rounds is a great way to start.

5.      Use mental imagery

For those runners who work best with a mental image, some of my favorite cues I have heard are “run like you are running on hot coals,” “Hot feet,” or “run like you are running on thin ice.”  Try different mental cues, and find the one that works for you the best.

SOME CAVEATS

1.      Keep your speed constant.

Some runners who have tried to increase their cadence told me that their tendency is to just want to run faster.  This point is valid, because as running speed increases, running cadence tends to increase as well.  The challenge is can you run at a constant speed, but increase your cadence?  Running on a track, treadmill, or straight flat pathway with distances marked can help you control your pace while learning the faster cadence.

2.      Practice, practice, practice… and be patient!

A running course I recently attended recommended 6 weeks of running homework with drills 3 days per week, which included a lot of metronome drills.  It takes a long time to make permanent changes in your running cadence, as your body likely has “overlearned” its preferred cadence.

REFERENCES

Fletcher et al.  Biomechanical performance factors in pose running and heel-toe running.  International quarterly of sport science 2010/2012.

Chumanov et al.  Changes in muscle activation patterns when running step rate is increased.  Gait and posture.   (36): 231-235, 2011.

Bood et al.  The power of auditory-motor synchronization in sports:  enhancing running performance by coupling cadence with the right beats.  PLOS ONE.   8(8): 1-8, 2013.

Heiderscheit et al.  Effects of step rate manipulation on joint mechanics during running.  Medicine and science in sports and exercise.  43(2): 296-302, 2011.

Hamill et al.  Shock attenuation and stride frequency during running.  Human Movement Science.  14(1): 45-60, 1995.

Romanov, N. (2004).  Pose Method of Running.  USA: Pose Tech Press.

Tom House Shoulder Exercises

No more excuses!

Now you won’t need equipment to do shoulder exercises.

In fact, these exercises are better than lifting weights at the gym.  Tom House has developed a series of stability exercises for the shoulder that have been used by hundreds of successful athletes including Drew Brees and Nolan Ryan.  Whether you are recovering from injury, working to prevent injury, or trying to improve performance in an overhead sport, these exercises are for you.

Check them out!

Bracing for action: Are ankle braces effective for volleyball players?

Ankle sprains are the most common recreational sports injury, with ankle injuries making up about 25% of all adult sports injuries. To combat ankle sprains, ankle braces have become popular in sports that require jumping and cutting. In volleyball, ankles account for about 40% of all injuries. Volleyball players in particular have embraced the use of prophylactic ankle braces, with some coaches making ankle bracing mandatory for their players. With rates that high, who wouldn’t want to protect their ankles? But are braces really effective in reducing the risk of ankle sprains? We’re going to answer some frequently asked questions about ankle braces, based on the most current literature available.

Do ankle braces prevent injury?

In healthy, active people without a history of ankle sprains, studies have not shown a benefit to wearing prophylactic braces (those intended to prevent injury). Most studies do not report injury severity, so it is certainly possible that braces affect the severity of sprains—unfortunately there just isn’t good data out there to support it.

Do ankle braces prevent re-injury?

It does appear that braces are effective for ankles that have been sprained before, especially within the first year after injury. Ankle sprain rates double in the 1-2 years following a sprain. Furthermore, 30-50% of people who sprain their ankle develop chronic instability. Prevention of reinjury following a sprain is therefore vital, and several studies have shown that bracing does reduce the risk of reinjury. It is less clear if long-term use of bracing is necessary for injury prevention. A combination of bracing with specific ankle exercises is likely the best course of action in preventing re-injury. Read on for further information.

Does the type of brace matter?

Probably not. However, braces may vary in the type of support they offer. For example, lace-up braces add stability both on the sides and in the front and back, while stirrup type braces (such as Active Ankle) only support the ankle on the sides. This won’t make a difference in most people– as the majority of ankle sprains are inversion/lateral sprains– but if you have anterior/posterior instability it may make a difference. The second way braces work is by increasing proprioception and feedback to your sensory and musculoskeletal systems. Proprioception is your brain/body’s unconscious awareness of a joint’s location in space. Increased proprioception helps your muscles react faster and stronger when they are needed to support your ankle against a potentially injuring force. All types of braces will help give proprioceptive input. To date, studies looking at type of brace haven’t agreed upon the superiority of one brace type over another in injury prevention.

Will ankle bracing hurt my ankles?

There is currently no evidence supportive of ankle weakness or loss of function stemming from the use of ankle bracing. Contrary to the beliefs of some avid non-bracers, braces won’t weaken your lateral ankle muscles or cause them to ‘get lazy’ and stop working.

Will ankle bracing hurt my knees?

Probably not.  There is evidence to show that ankle injury rates increase with knee bracing, however no similar conclusions have been made linking knee injury rates to ankle bracing. Some lab studies have shown slight increases in knee rotation with ankle bracing versus without. It makes sense that if you restrict movement enough at one joint, other joints may compensate with extra movement. However, current studies are not substantial enough for this to factor into recommendations about ankle bracing.

Will ankle bracing hurt my vertical jump?

It shouldn’t. Several studies have shown that ankle bracing does not impair physical performance in activities like jumping, running, or agility. In other words, no looking down at your ankle brace in disbelief after burying that perfect set into the net during your company’s picnic volleyball game.

What are some other options to prevent ankle sprains?

Training: Training is a key component of staying healthy as an athlete, but often athletes forget to train their ankles. Incorporating ankle exercises can be as easy as trying to stand on one leg and balance. Once that’s easy, try balancing while doing arm exercises, standing on an unstable surface, or closing your eyes. You can also try leg exercises like squats, lunges, or side leg lifts on a BOSU or balance board. Agility and jump training programs, including training yourself to land from jumps with good body mechanics, may also improve your ankle strength and stability. Keep in mind that even the best training programs take 8-12 weeks to show benefits. If you’re coming off of a recent ankle sprain, you may benefit from the advice of a physical therapist to progress your exercises at a reasonable pace while your ankle heals.

Footwear: There has not been evidence that high tops or other shoe designs prevent ankle sprains. However, supportive shoes without too much wear and tear are important. Some minimalist footwear and shoes like shape-ups may promote increased movement in your foot and ankle. This may help strengthen your foot muscles during regular activities or running, but may also increase your risk of injury during jumping and landing, so keep those off the court.

Taping: Taping may provide a similar effect to bracing in the proprioception department, and has been proven to be about as effective to bracing to prevent re-injury. However, the mechanical stability of taping has been shown to decrease quickly: within 10 minutes of activity after taping, it is already 40% less effective mechanically, and may provide negligible support within an hour. Taping is also time consuming and requires a trained professional for optimal results. However, if you leave your brace at home, taping may be an alternative to bracing that is helpful in preventing reinjury.

Here are a few other things to consider when deciding whether or not to use an ankle brace:

-Most volleyball players have a ‘dominant ankle’, the ankle opposite their hitting arm. This ankle is more likely to be injured because they land on it more often. Setters may be at risk for more ankle sprains on the right because that is the ankle closest to the net, increasing risk for under the net contact after jump sets.

-If you play indoor and outdoor volleyball, consider that you may not be able to use bracing on the beach or grass, but should definitely be working on ankle strengthening and stability exercises to prevent injury outdoors.

-In almost all cases, bracing is not going to provide enough support to prevent a sprain when one player lands in a bad position on another player’s foot after jumping high off of the ground. The forces are just too high for the brace to control.

Recommended Reading

Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010 Dec;44(15):1082-8.

Dizon JM, Reyes JJ. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport. 2010;13(3):309-17.

Study Designs (publishing date TBD)

Janssen KW, van Mechelen W, Verhagen EA. Ankles back in randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomised controlled trial. BMC Musculoskelet Disord. 2011; 27;12:210.

Janssen KW, van der Wees PJ, Rowe BH, de Bie R, van Mechelen W, Verhagen E. Interventions for preventing ankle ligament injuries. Cochrane Database of Systematic Reviews. 2011; Issue 12.

Additional References

Frey C, Feder KS, Sleight J. Prophylactic ankle brace use in high school volleyball players: a prospective study. Foot Ankle Int. 2010;31(4):296-300.

Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc. 2010;42(3):413-21.

SantosMJ, McIntire K, Foecking J, Liu W. The effects of ankle bracing on motion of the knee and the hip joint during trunk rotation tasks. Clin Biomech. 2004;19(9):964-71.

Venesky K, Docherty CL, Dapena J, Schrader J. J Prophylactic ankle braces and knee varus-valgus and internal-external rotation torque. Athl Train. 2006;41(3):239-44.

Verhagen EA, Van der Beek AJ, Bouter LM, Bahr RM, Van Mechelen W. A one season prospective cohort study of volleyball injuries. Br J Sports Med. 2004;38(4):477-81.

How to get fit…faster and safer…and no excuses

What is your goal?  Lose weight? Get toned?  Prevent injury?  Perform better in your sport?  For many people they want the whole package.   The good news is that you can achieve all of these with the same kind of training.  Total Body Fitness  (TBF).

CPMC Sports Wellness team offers two levels of TBF three times per week.  The class is one hour and consists of a variety of High Intensity Interval Training (HIIT), Tabata Training and contrast training.  See the links above for descriptions on interval training.  Contrast training incorporates strength and power exercises for faster results.  See the video of sample exercises utilized in the more advanced TBF II class.  

Not ready for running, jumping, or heavy weights?  Build your strength with a Personal Fitness Trainer or Pilates classes.  Just starting to exercise and want to make sure you stay injury free?  Try TBF 1 classes which incorporates less bounding and less aggressive weight training.  Fit For Life classes are geared for the first time exercisers or older exercisers looking to improve bone strength, balance, and functional endurance.

There is an option for everyone to start achieving your fitness goals today.  Check out the schedule for CPMC Sports Wellness classes.  For more questions contact the wellness team below.

wellness@sutterhealth.org                                                                                                    415-600-5860

Attention SuperMoms (and Dads)! Playground Bootcamp…

Feeling like your super status is depriving you of time for exercise?  Well, do we have good news for you!  Next time you’re at the park with the kids, let them help inspire you to be more active.  Instead of sitting on the bench watching from afar, jump right in there with them!  Playing in the playground can burn calories, but there are also ways you can use the playground to gain that extra muscle tone.

With the kids:

Swing:

Challenge your kids to see who can go higher on the swing.  The harder you pump your legs, the more calories you’ll burn, and you may even feel those abs tightening up too!

Monkey Bars:

Challenge yourself to get all the way across the monkey bars without letting your feet touch the ground.  You’ll be amazed at how strong your child’s arms are after giving this a try!

Climb up the ladder:

Follow your child up/down the ladder and in and around the playground.  You’ll be surprised at how much upper and lower body strength this requires.  Don’t be afraid to get down and dirty when crawling through tunnels or over barrels.

On your own while the kids are busy having fun:

Bench squats (works the quads, glutes):

Stand in front of the park bench, as you would if you were about to sit down.  Begin to sit, but as soon as your bottom touches the bench, stand right back up.  Repeat for 1 minute and time yourself to see how many squats you can complete.  Next time, see if you can squeeze one more in. 

Pushups (works arms, core):

Pushups can be intimidating, but the good news is this: you can do a pushup anywhere, and anyone can do it.  If you’re new to pushups, start by placing your hands on the back of the bench, or on a picnic table.  Be sure to keep your body in a straight line (from head to heels) and keep your abs tight.  Work at this level until it starts to feel easy.  Over time, work your way down to the bench level, and ultimately to the ground.  Repeat for 1 minute. 

Heel raises (works calf muscles):

Standing in place, raise heels up, then lower back down.  Repeat for 1 minute.  You can add a little challenge by standing on the edge of a curb or step just with the ball of the foot, but allowing the heels to hang off the edge. 

Plank (works core, arms):

Get into pushup position, and hold.  As with the pushup, you can make this easier by placing your hands on an elevated surface, or harder by having hands and feet on the ground. For a little variety and extra challenge, alternate between 2 surface heights (ex: start with hands on the table, then walk hands down to bench and back up).   Try to hold this position for up to 1 minute.  If you can only hold the position for 10 seconds, try to repeat 6 times so you have a cumulative minute.  If you hold for 30 seconds, you only need to repeat twice! 

If you repeat the 5 exercises above for 1 minute each, and repeat that two times, in just 10 minutes you’ll have completed a total body workout!  Now if only we could help you decide what to make for dinner…

What Kind of Massage Should I Get?

As Physical Therapists, we utilize various forms of massage for rehabilitation purposes, however sometimes a full session of massage is helpful to prevent injuries or help recouperate from an injury.  Finding the right massage can be an intimidating task.  Is deep tissue massage better than soft tissue massage? Is massage about no pain no gain?  These are some of the many questions one may encounter prior to scheduling an appointment.   Essentially, what classifies a good massage is truly variable from person to person.  It is appropriate to feel pain at 6-7/10 on ones personal pain scale for therapeutic effects.  Anything over 7/10 pain will be counterproductive as you may resist the massage.  Furthermore, one Massage Therapist may be just as trained and competent as the next, but the comfort level you feel between one over another could make the difference in regards to your body’s reaction to their touch.  Just like there are many ways different restaurants prepare the same meal, there is one that makes it just the way you like it.  Please note that it may take awhile for you to find the right Massage Therapist.  Test a few out.  It’s a comfort thing.  So, below is a list of popular massage techniques that you may find helpful. 

 Swedish Massage

This is the basic massage that focuses on relaxation.  Long strokes are used to ease the body targeting the superficial muscles.  This type of massage can vary in pressure, so it is important to discuss the type of pressure with your massage therapist before and during the massage to get what you really want.

 Deep Tissue Massage

Most confuse strong pressure Swedish Massage and Deep Tissue Massage.  Deep Tissue may use some of the same strokes as Swedish, but this type of massage is intended to reach deeper soft tissue slowly.  It’s slow because if too much pressure is applied too fast the muscles have an automatic response to protect themselves, and tenses up, which defeats the purpose because now the deeper structures cannot be reached.  A mild discomfort might occur with this type of technique, but nothing too painful.  Again, muscles will fight back to protect.

Cross Friction is also utilized here.  Muscle fibers travel in a specific direction, and so the therapist/practitioner will move perpendicular to the muscle fibers.  This allows for scar tissue to be broken up due to the chaotic remodeling of micro-damage to soft tissues caused by repetitive overuse.  This type of massage technique is usually a focused treatment of a specific body part and not necessarily a full body experience.

 Sports Massage

This is not just for athletes.  A Sports Massage session is not likely to have wind chimes and soft music with flickering candles, but can.  A good Sports Massage is a mixture of techniques to increase flexibility, to ease tight muscles, to prep muscles to do work (you’ll often see runners beating their legs with their fists), to reduce swelling that have recently been working, to relieve “knots” or contractures, address cramping, and helps reorganize soft tissue.

Trigger Point Therapy

A trigger point is a specific “knot” of the body that produces referred pain around or near the site.  Janet Travell, MD has pioneered treatment for myofascial pain. She has mapped out the specific trigger points and its referred pain pattern.  This type of therapy takes a knowledgeable Massage Therapist, as there are hundreds of trigger points and referred pain patterns.  Pressure is applied to the “knot” or attachment sites of the “knotted” muscle to release the tight muscle band. 

This is a very brief introduction to what can be encountered.  There are a whole host of other types of massage techniques out there that are not so mainstream such as: Rolfing, Shiatsu, Reiki, Lymphatic Drainage, Acupressure, etc.  Explore and enjoy the experience and find which technique benefits you the most.  Do not hesitate to call or do the research and inquire upon the qualifications of your massage therapist.  It’s a good idea to find a Massage Therapist who can assess your needs before and during a session so that any number of techniques can be used. 

Check out this website to learn more about the different types of massage: http://www.massagetherapy.com/glossary/index.php