Vail Integrative Medical Group

The Effect of Kinesiotex Taping on Back Muscle Endurance Among Patients with Low Back Pain: A Randomized Controlled Crossover Trial

2012-01-04T10:03:00.000-08:00

Dear research participant,

We invite you to participate in a research studylooking at the effects of different therapeutic taping procedures on backmuscle endurance.

Nature and Purpose of theStudy

When treating patents with low back pain, it is commonpractice among physical therapists and chiropractors to improve back musclefunction and endurance. One way toaccomplish this is through the use of therapeutic taping procedures. However, littleis known about the effectiveness of different taping procedures.

Therefore the aim of this study is to compare fordifferences in back muscle endurance under three treatment conditions: when twodifferent types of tape are applied to the back and when no tape is applied.

If you consent to take part in this research study, itis important that you understand the purpose of the study and the tasks youwill be asked to complete. Please make sure that you ask any questions you mayhave, and that all your questions have been answered to your satisfactionbefore you agree to participate.

What the Study will Involve

Potential research participants will be considered forinclusion in this study if they are between the ages of 18 and 60 years of ageand are currently experiencing low back pain. You would be excluded from participating in this study if:

1) Yourback pain radiates into the leg and beyond the knee

2) Youexhibit signs or symptoms which may indicate a potentially serious condition

3) Youhave had surgery to your lower back

4) You arecurrently pregnant

5) Youhave a history of tape or adhesive allergy

6) You donot think that you could tolerate the muscle endurance test.

If you decide to participate in this study, you will beasked to complete the following tasks

· Complete4 questionnaires that ask about:

1) Yourdemographic information (e.g., age, height, weight), and details about yourhistory of back pain.

2) Theeffects of back pain on your daily activities.

3) Theintensity of your back pain.

4) Yourattitudes about the relationship between your back pain and your work relatedand physical activities.

Perform a back muscle enduranceassessment. This assessment will requireyou to lay prone (i.e., face down) with your upper body over the end of apadded examination table, and then extend your upper body against gravity untilyou reach a “neutral position” meaning that your back is straight. We will use three cloth straps to secure your hips and legs to thetable. These straps will be placed overyour hips, knees and ankles and towels will be placed at each level to ensurethat this set up is comfortable. Once this is accomplished, you will maintainthis position as long as possible while being timed by a research staff member.Before starting this assessment, the research staff member will demonstrate thetest for you. It is estimated that thequestionnaires will take approximately 30 minutes to complete and the backmuscle endurance assessment will take 5 minutes to complete in addition to yourtravel time to and from the clinic.

You will be asked to complete the back muscle enduranceassessment on three different occasions, each one to three days apart. Prior to the assessment, you will be treatedusing one of the previously described options (Kinesiotex tape, athletic tapeor no tape). The tape will be applied tospecific muscles on your back and will be removed upon completion of the backmuscle endurance assessment.

Voluntary Participation andWithdrawal from the Study

Your participation in this study is entirely voluntary.You may withdraw at any time without discrimination or prejudice. If you electnot to participate or to withdraw from the study, such actions will in no wayinfluence quality of healthcare you receive or the relationship with yourhealthcare provider(s). All information is treated as confidential and no namesor other details that might identify you will be used in any publicationarising from the research. If you withdraw, all information you have providedwill be destroyed.

Benefits of the Study

It is possible thatthere may be no direct benefit to you from participation in this study.

While there is no guarantee that you will personallybenefit, the knowledge gained from your participation may help others in thefuture. For example, if one of the taping procedures appears to be moreeffective, future patients with low back pain may benefit from thisunderstanding.

Possible Risks

We have identified two potential risks which could beassociated with your participation in this study. First, while this type of back muscleassessment is routinely used by clinicians caring for patients with low backpan, it is possible that you may experience some discomfort either during orfollowing the assessment. This type of response is rare, and the discomfort istypically mild and self limiting in nature. The second risk would be the result of a tape or adhesive allergy whichhad gone undetected. This wouldrepresent a very remote risk which will be minimized by only keeping the tapein contact with your skin for short durations of time. You will be monitoredclosely during the study and you are free to withdraw at anytime during thesessions. If you experience any unwelcome symptoms associated with yourparticipation in this study, we will assist you by helping to arrange anappointment with your primary medical provider.

If you have any questions about this project pleasefeel free to contact either myself, Dr. Jeffrey Hebert in Australia on +61 8 93602566 and J.Hebert@Murdoch.edu.au or, Dr Joel Dekanich in Colorado,on 970.479.6262 and Joel@vailhealth.com. We are happy to discuss with you any concerns you may have about thisstudy.

Once we have analysedthe information from this study we will put on our web site (http://vailhealth.com) a summary of our findings. You can expect to receive this feedback inapproximately six months.

If you are willing to consent to participation in thisstudy, please complete the Consent Form.

Thank you for your assistance with this researchproject.

Sincerely

Jeffrey Hebert, DC, PhD

This study has been approved by the Murdoch University Human Research Ethics Committee (Approval xxxx/xxx). If you have any reservation or complaint about the ethical conduct of this research, and wish to talk with an independent person, you may contact Murdoch University’s Research Ethics Office (Tel. 08 9360 6677 (for overseas studies, +61 8 9360 6677) or e-mail ethics@murdoch.edu.au). Any issues you raise will be treated in confidence and investigated fully, and you will be informed of the outcome.

Stay Strong and Injury Free all Ski Season Long

2011-12-23T14:05:00.000-08:00

When thinking about exercises to improve lower extremity strength for skiing, quadriceps (quads), and dominant movements such as lunges and plyometrics, typically come to mind. While quad strength is important, you need to look beyond this if you want to stay strong and injury free all season long.

Many athletes, especially skiers, are quad dominant. This means their knee extensors are much stronger than their knee flexors. Also, these athletes will often have imbalances, including weak glutes and overactive or tight hip flexors. A frequent mistake in strength training is to over-emphasize the exercises targeting the most commonly used muscles. To create more balance and stability, we need to strengthen the muscles and movements that oppose those primary muscles to keep from making an established imbalance worse.

Exercises that target the posterior chain (muscles that include the back extensors, glutes and hamstrings) can help offset some of the common imbalances. The hamstrings have a direct effect on stabilizing the knee by decelerating knee extension and reducing the shearing forces on the anterior cruciate ligament (ACL). This results in more stable knees and hips, stronger skiing and decreased injury potential.

There are many exercises that address the posterior chain. Squats and lunges are exercises used in most ski conditioning classes, however depending on how they are performed, they are exercises that can be very quad dominant. Simply keeping a more erect posture and maintaining balance through the mid foot to heel will help shift the emphasis to the glutes and back extensor muscles. When performed correctly, other exercises such as dead lifts, glute-hamstring raises, hamstring curls and bridging can effectively target the muscles of the posterior chain.
Some exercises, like hamstring curls, body weight side lunges (with attention to weight distribution) and bridging can be done with little or no equipment and still yield excellent results. Hamstring curls done on hardwood flooring while wearing socks or having a towel under your feet is a great way to increase resistance with your own body weight. Bridges, specifically single leg, can address both flexibility of the hip flexor and end range extension of the hip.

To view these exercises and to learn more about how to address the posterior chain for keeping you skiing strong all season, visit www.vailhealth.com and click on the “Spine & Sport Health Tip” link.

Mark Pitcher is a chiropractor, exercise physiologist and TRX instructor with Vail Integrative Medical Group at Vail Vitality Center located at Vail Mountain Lodge and Spa. He specializes in rehabilitative medicine.

http://www.vaildaily.com/article/20111219/AE/111219801/1078&ParentProfile=1062

The Benefits of Active Release Technique

2011-12-19T11:24:00.000-08:00

Active Release Techniques® (ART) is a techniquethat is utilized in our office on a daily basis. There are many frequentlyasked questions regarding ART. I will try to answer some of these commonquestions and give a more clear understanding of what ART is, what it is usedto treat and what kind of results you may expect.

ARTis a patented, state of the art, soft tissue movement based system. It caneffectively treat soft tissue injuries which do not respond to othertraditional treatment methods. Soft tissues include muscles, tendons,ligaments, fascia and nerves. Some of the common conditions we treat using ARTinclude headaches, low back pain, IT Band Syndrome, shin splints, plantarfasciitis, knee pain, and sciatica.

Thegoal of ART is to restore optimal texture, motion and function of the softtissue. This is accomplished through the removal of adhesions or fibrotictissue through specific protocols. These adhesions can occur as a result of aninjury, repetitive movements and constant pressure or tension. Through thespecific protocols our trained ART professionals have learned, we are able toeliminate the pain and dysfunction which is associated with these conditions.

Everytreatment with ART is patient specific. It will consist of examination andtreatment of the entire kinetic chain, not just the area of pain. Usually, itis also combined with various treatments of chiropractic and physical therapy.The ART provider will evaluate the tissue looking for any abnormalities intexture, tightness and movement. Any abnormal findings will be treated withvarying degrees of directed pressure and tension on the tissues, as the tissuesare taken through specific movement patterns. Often, patients will describe thetreatment as a “hurt so good” feeling. Every patient responds differently totreatment. However, utilizing ART has given our patients tremendous results.Typically, results are seen in a few treatments and may include decreased pain,improved tissue quality, improved range of motion and better functionalmovement capabilities.

For aninformational video on the benefits of this technique or how it is performed,please visit our website at www.vailhealth.com and click on the Spineand Sport Health Tip Link (on the left).

Dr. Joel at the Parapan American Games

2011-12-19T11:18:00.000-08:00

This past summer, I had the honor and privilegeof being selected by the United States Olympic Committee (USOC) to be part ofthe medical staff with Team USAfor the Parapan American Games in Guadalajara, Mexico whichconcluded last month. The Games (the 4^th) are aninternational multi sport event for Olympic-caliber athletes with variousphysical disabilities and is a qualifier for the Paralympic games this upcomingsummer, in London.

Atotal of 1300 athletes (200 athletes from the United States) from 24 different countriescompeted in 275 different events in 13 sports. The national governing body (NGB) I worked with was track and field. Oursports medicine “team” consisted of a multidisciplinary group including amedical physician, physical therapist, athletic trainer, massage therapist andmyself (sounds like VIMG!).

Atypical work day would average between 16-18 hours and include covering trackand field practices, clinic treatment time, Team USA and medical staff briefings andhopefully (but not always) a quick bite to eat. The days were long but incredibly rewarding. The opening and closingceremonies were remarkable and Mexicoput on a great show! One of thehighlights of my trip was meeting and speaking with Mexico’s first lady, MargaritaZavala.

Eachathlete (and their disability) is ‘classified’ early in their athletic careerwith a very specific process. This ensures the events and competitions are equallyfair. For example, you have similarathletes, with similar disabilities, competing against one another. While Brazilbeat us in the overall medal count, Team

USA

recorded 51 gold, 47 silver and34 bronze over the 8 days of competition.

If havingan opportunity to work on some of the best US athletes wasn’t enough, watchingthem compete with their physical disabilities was a very moving experience (tryto picture a blind athlete performing the long jump). There were Iraqi veterans who had lost limbs,spinal cord injuries, traumatic brain injuries, cerebral palsy, stroke and blind/visuallyimpaired athletes to name a few. Notonly have these individuals become world class athletes, they are the mostpositive and ‘can do’ people I have ever met.

Theonly draw back to the entire experience was being away from my wife and children. I learned how to Skype like a pro while I wasgone!

To seemore photos from my trip to Guadalajara,please visit our gallery

Dr.Joel Dekanich

Miki Blanchard Helping Children in Uganda this January

2011-12-19T08:57:00.000-08:00

“Being unwanted, unloved, uncared for,forgotten by everybody, I think that is a much greater hunger, a much greaterpoverty than the person who has nothing to eat”

~Mother Theresa

In January, I will be joining Visiting Orphansand Sixty Feet on a mission trip to Uganda. I cannot begin to tell you the impact this is making on my life. As a physical therapist, I will have theopportunity to work with some of the most severely disabled and handicapped childrenwho are imprisoned there. I will havethe privilege to teach the Sixty Feetstaff, who volunteer their time and gointo remand centers every day, how best to facilitate any recovery orrehabilitation in these children.

Thousands of children in Uganda livebehind bars, not knowing if someone will ever come for them. They are there because of petty theft, orthey were picked up off the street, or they were abused or unwanted by family,or simply abandoned at the Police Station. Sixty Feet is working towards moving the most vulnerable children out ofremand centers and into family style structure where they will have theopportunity to really live and maybe someday, lead.

Please visit the Sixty Feet website at www.SixtyFeet.org to read their story and the work they are doing for the imprisonedand forgotten children in Uganda. If youare willing, you may donate to Sixty Feet (they have a list of items candonate), to our trip (Uganda Jan 2012) or donate abottle of Gummy Vitamins at any of the VIMG offices. If youdonate money at one of our office locations, I will use it to purchase GummyVitamins, games, toys, pencils and other supplies the children need when I amthere in Uganda.

Thank you, and have a blessed HolidaySeason! Miki Blanchard, MPT

Free Golf Fitness Class at the Eagle Ranch Fitness Center this Thursday!

2011-08-03T11:21:00.001-07:00

Foam Rolling to Improve Tissue Quality

2011-07-02T11:22:00.000-07:00

Foam Rolling to Improve Tissue Quality

View more presentations from Mark Pitcher DC, MSc

Train Your Abs and Back the Right Way

2011-07-01T13:54:00.000-07:00

Are you sure you are training your abdominals and low back in the correct way? For years fitness professionals have been prescribing sit-ups and crunches as the means for building a strong core, but recent research shows that these exercises put unneeded stress on the lumbar spine (low back). Here are three exercises that spare the low back from unneeded stress and actually activate your abdominals more than a simple sit-up or crunch.

Before beginning these three exercises, one abdominal technique must be explained. This is called an abdominal brace and it involves activating the abdominal musculature before beginning the exercises listed below. Without drawing in or pushing out the abdomen, contract or stiffen all of the muscles around the abdomen. Many describe this motion as what you would do if someone were to punch you in the stomach. While maintaining the abdominal brace be sure to keep breathing throughout the exercises.

1) Curl up- The starting position is laying on your back with your hands placed on the small of your back. Next, flex one knee to 90 degrees while the other leg stays relaxed on the floor. While keeping your head, neck and upper back in a neutral position perform an abdominal brace and raise your shoulders off the floor approximately 1-2 inches. The head and neck should remain elongated in a straight line without poking or tucking the chin. Hold the position for 5 seconds.

2) Side Bridge- Start on your side with your legs extended and elbow directly under your shoulder. Place your opposite hand on the opposite shoulder, pulling down on the shoulder for added support. With legs straight on the floor, place the top leg in front of the bottom leg. Activate the abdominal brace while keeping the spine in a neutral position and raise the hip off the ground until the entire body is in a straight line. Hold the position for 5 seconds.

3) Bird Dog- Begin in a four point stance on your hands and knees with your hands placed directly under your shoulders and knees directly under the hips. Maintain a neutral spine, perform an abdominal brace and raise the right arm and left leg in a sweeping motion. Do not raise the arm or leg past horizontal. Hold the position for 5 seconds and repeat on the other side.

Depending on the level of fitness for the individual performing these exercises they can be performed in a wide variety of sets and repetitions. A beginner could start performing the exercises once a day for 5-10 repetitions and an advanced person could perform the exercises two to four times a week with multiple sets and reps. By performing these exercises with proper form and technique you should notice increased abdominal and spinal stability, while also decreasing the strain on your low back commonly associated with the sit-up and crunch exercises.

Jonathan Weimer DC, MS

TRIGGER POINT DRY NEEDLING

2011-06-27T08:20:00.000-07:00

What is trigger point dry needling? Trigger point dry needling or (TDN) is a treatment technique which uses small filament or acupuncture type needles to release tight muscles. The goal is to permanently reduce muscle pain and dysfunction. Physical therapists are now using this technique around the world to effectively treat acute and chronic orthopedic and musculoskeletal conditions. Dry needling uses a small needle for deactivation and desensitization of a myofascial trigger point. This technique should stimulate a healing response at the tissue and reduce the biomechanical stress of the muscle treated. TDN can help patients reduce muscle spasms and combined with other therapies, can eliminate mysofascial pain.

What is myofascial pain syndrome? Myofascial pain syndrome is a disease of the muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and a sensory abnormality (tenderness and referred pain). Myofascial pain syndrome is classified as a musculoskeletal pain syndrome that can be acute or chronic, regional or generalized. It can be a primary disorder causing local or regional pain syndromes or a secondary disorder that occurs as a consequence of some other condition. This is a treatable condition which can respond well to manual and injection techniques but requires attention to postural, ergonomic, and structural factors.

What is a trigger point? The term “trigger point” was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics:

Pain related to a discrete, irritable point in skeletal muscle or fascia not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
The painful point can be felt as a tumor or band in the muscle and a twitch response can be elicited on stimulation of the trigger point.
Palpation of the trigger point reproduces the patient’s complaint of pain and the pain radiates in a distribution typical of the specific muscle having the trigger point.
The pain cannot be explained by findings on neurological exam.

Overall, TDN is a treatment that addresses dysfunction of the neuromuscular system. Trigger points develop in the muscle secondary to various stresses (i.e. postural, repetitive motion, psychological, emotional etc.) and are more likely to develop in tissue that has neurological dysfunction. Most dysfunctions are caused by compression, disc dysfunction, facet joint dysfunction, vascular compression, metabolic stress, biomechanical stress, and postural abnormalities. When muscles develop trigger points, they neurologically remain tight causing local compression of vascular, neurological and joint/biomechanical structures hampering the normal function of that tissue. All tissues away from the involved nerve will likely be involved. If you adequately release the muscle, the tissues are then allowed to resume normal function with improved neurological conduction and vascularity.

Lastly, TDN is a treatment that uses acupuncture needles but that is where the similarity to acupuncture ends. Acupuncture tends to be a more superficial treatment that focuses on restoring energy or “Qi” to the body. It is thought there are blockages that can be restored by properly placing needles along energy channels called meridians. TDN directly treats the neuromuscular system affecting muscle tightness, joint mobility and symptoms of pain and irritation. Testing active trigger points with an EMG needle has shown there is increased spontaneous electrical activity causing the nerve muscle connection to trigger the muscle to be tight. This tightness can cause a decrease in joint movement and many times will restrict the joint enough to limit normal functional activities of the whole body. Relatively new research has reported that there are numerous inflammatory and pain producing chemicals at an active trigger point causing pain and dysfunction of the muscle, consequently affecting the local nerves and joints.

TDN has been shown, when causing a twitch response in the acute trigger point and muscle fiber, to decrease or completely reduce that spontaneous electrical activity and eliminate the irritating chemicals in that active trigger point. This release can immediately improve range of motion, decrease pain and improve function. Patients often feel a significant cramping sensation from the twitch response but then feel an immediate improvement of their symptoms.

Finally, utilizing TDN in physical therapy allows the patient a hastened return to strengthening and exercise, which in turn, results in an accelerated return to function and improved maintenance of that dysfunction.

Dave Blanchard MPT
www.vailhealth.com

Avoid Overuse Tendon Injuries:

2011-04-28T10:13:00.000-07:00

As the weather heats up, we head outside to test our athletic prowess. We hit the road and trails on bike or foot without questioning that we may have lost some of our endurance since last fall. Tendon issues may arise during repetitive activity without proper training. Tendons attach muscle to bone and “tendonitis” or “tendonosis” is a degenerative, inflamed tendon. With tendon injury, the tendon tissues become disorganized bundles of collagen, rather than in parallel orientation and no longer function properly. The most commonly injured tendons in the lower extremity are the patellar tendon, Achilles tendon, and the posterior tibial tendon.

The patellar tendon attaches the knee cap to the shin bone and can produce anterior knee pain with overuse. The Achilles tendon attaches the calf muscle to the heel and will cause pain along the tendon or at the heel. The posterior tibial tendon supports the foot arch and attaches the posterior tibial muscle to the bottom of the foot. Injury can weaken the foot arch causing collapse.

The best way to strengthen these areas, to prevent or recover from tendon pathology, is with ECCENTRIC strengthening. Eccentric means lengthening. By strengthening the tendon in a lengthened position the tendon properties are able to re-align in the parallel orientation making the tendon inherently stronger. The eccentric motion of these tendons is the functional position of where the tendons are at highest stress during repetitive motions. Strengthening in this position is most efficient.

Eccentric strengthening for tendon pathology has been proven is various studies to be effective. The protocol that has been used in research is performing 3 sets of 15 repetitions twice a day. The exercise varies based on which tendon you are attempting to load/strengthen in an eccentric position.

Patellar tendon = Perform single leg mini squats on an incline board. The heel should be raised, toe pointing towards the ground; keep the knee aligned over the first two toes. Only squat to 45 degrees of knee bend.

Achilles tendon = Perform single leg heel raises off a step, focusing on slow controlled lowering motion, getting the heel lower than the step.

Posterior tibial tendon = Perform seated with a resistance band over the ball of you foot and attached to a stable surface (band perpendicular to the outside of your leg).Resistance should be pulling your foot into an outward position. Pull the band so your foot/ankle turns inward. Again, focus on the slow controlled outward motion or back motion. Also, performing the Achilles exercise will help strengthen the tendon, since it functions in both actions.

Before you get on your bike or lace up your running shoes to enjoy the spring sunshine, make sure your tendons are ready to handle the load. ECCENTRICALLY strengthen! Happy trails.

Lindsey Fitch is a doctor of physical therapy and running specialist at Vail Integrative Medical Group. She is an Avid competitive runner, most recently winning the Salt Lake City Marathon

Vax-D Decompression Therapy for Low Back Pain

2011-04-26T16:04:00.000-07:00

Do you suffer from low back pain? Vail Integrative Medical Group may be able to help. Approximately 5.4 million Americans are disabled annually due to back pain and up to 85% of the U.S. population will have back pain at some time in their life. And did you know that spine surgery is the second leading surgical procedure in America, with the total number in the U.S. approaching 500,000 per year. Lastly, an estimated 93 million workdays are lost each year due to back pain. What, if anything, can be done about this growing epidemic?

Common conservative treatment for low back pain includes chiropractic, physical therapy, massage therapy and acupuncture. Another form of treatment is Vax-D or vertebral axial decompression. What is Vax-D you ask? It is a patented non-surgical therapy proven to be as much as 88% successful at treating chronic low back pain. This pain may be caused by bulging, herniated or degenerative discs leading to sciatica. Even post-surgical patients and those suffering from stenosis (a narrowing of the spinal canal) have reported significant pain relief from Vax-D treatments.

How does Vax-D work? Vax-D lengthens and decompresses the spine, reversing high intradiscal pressures through the application of negative pressure via a patented “slow ramp-up” process. This reversal of pressure creates a vacuum inside the discs, which takes pressure off of pinched nerves and helps to reposition bulging discs and pull extruded disc material back into place. Nutrients, oxygen and fluids are simultaneously drawn into the disc to create a revitalized environment conducive to healing.

Vax-D stimulates the body’s repair mechanism, providing the building blocks needed to actually mend injured and degenerated discs. Vax-D’s process is the only patented treatment clinically proven to decrease disc pressures to the negative levels needed to facilitate healing.

A recently completed 2 ½ year study has demonstrated that Vax-D achieved a remarkable 88% success rate in the 283 chronic back pain patients studied. The patients selected for the study had failed at least two previous non-surgical treatments. The study also used pre and post MRI’s to determine the extent of the damage to the discs and showed actual reduction in disc herniation, rehydration of disc heights and improved lordotic curve after 6 weeks of 30 minute Vax-D treatments as well as their own tailor-made exercise program.

A typical Vax-D treatment regimen consists of approximately 20 sessions (5 days a week for 4 weeks). Some conditions require fewer visits, some require more. Many patients report relief from their pain and other symptoms during the first few treatments sessions. Most experience dramatic pain relief after completion of their full treatment.

At VIMG, we specialize in treatment of chronic lower back pain and offer a comprehensive approach to treatment. Along with Vax-D, we offer chiropractic, physical therapy, massage therapy and medical neurology. During the month of May, we will be doing a 12 session trial of Vax-D for $900. This is a 50% discount! Give us a call today at (970) 926-4600 and reserve your appointment for Vax-D. Another day with back pain is another day you are not living life to the fullest.

Dave Blanchard MPT

Functional training focuses on the fundamentals

2011-03-30T09:31:00.000-07:00

From the Vail Daily March 29, 2011

The term functional training, once an obscure idea, has become a buzzword in the fitness industry. However, much like the term “core exercise,” its definition often depends on who you ask. Some people equate doing exercises, like bicep curls or squats, while standing on gym balls with functional fitness. Unless you are a circus bear, these types of exercises are not overly functional or well suited to develop purposeful strength.

Functional training is not about fancy gadgets or gimmicks but about a philosophy of training. It is based on strengthening fundamental movement patterns, which have carryover into everyday activity or athletic endeavors.

It is a common myth that machine exercises are safer than free weights. In reality, exercises performed with more freedom of movement better engage the core musculature. This means the intensity of the exercise is determined by the weakest link. When you strengthen the body, beginning with the weakest link, you reduce the risk of injury. To borrow a quote from physical therapist Gray Cook, “Having strong arms or legs without a stable foundation or core is like shooting a cannon from a canoe.” When the foundational movement improves, all other movements that follow are stronger.

Any workout program can be modified to become more functional. Simply replace seated or supported single plane exercise with more full body multi-planar exercises. Here are three simple effective substitutions to make your workout more functional.

• Trade your seated biceps curl for a chin up, pull up or TRX curl.

• Knee extension, hamstring curls and hip abductor/adductor machines are all isolation exercises. Replace with exercises such as squats, dead lifts, lunges and side lunges. These require more neuromuscular activation, are better for your joints, burn more calories and have excellent carryover to your activities of daily living.

• Again, gadgets are not necessary for functional training but some do offer significant benefit. For example, the TRX suspension trainer exemplifies functional training. Almost every exercise performed on it can be multi-planar, multi-joint with high neuromuscular demand.

Some of the best exercises for your body require proper technique to be performed safely. Movements like squats and dead lifts are exceptional foundational movements but often require some instruction to be performed properly and safely. If you wish to learn more about how to make your workout more functional or to reduce injury and improve performance, we would be happy to help.

Mark Pitcher DC, MSc
markjpitcher.com

2011-03-23T14:29:00.001-07:00

Vail health: Add running to your routine

From the Vail Daily March 14, 2011

March is here; the sun is shinning, the temperature is rising, and it's time to get outside and jump-start your heart rate with a run or jog.
Running is extremely beneficial to both physical and mental wellbeing. It can impact all bodily systems — from reducing your chances of catching the common cold, to lowering your risk of cancer, to strengthening your muscles and bones and reducing your chance of developing osteoporosis. Running is one of the most effective ways to improve the aerobic conditioning of your lungs and heart. As your cardiovascular health is enhanced, your blood pressure is reduced, the elasticity in your arteries increases, and your resting heart rate is lowered. All of which diminish your chance of heart attack and stroke, and improve circulation throughout your body.

Emotional benefits, though harder to prove with statistics, have been reported by runners time and again. The “runner's high” is a physiologic change in your endorphin levels, which lower the effects of depression and reduce stress. Running can literally be a mood changer as well as a life changer. Those who engage in daily exercise are more likely to make healthier food choices throughout the day. And consistent aerobic exercise, combined with a healthy diet, will result in weight loss and improved self-image, as well as reduced symptoms of depression.

But where do you start? Running is one of the easiest and least expensive hobbies/activities. All you need is a pair of shoes. And then it is just you and the road, wherever you are.

On the other hand, if you are a social person, joining a running group or signing up for local races are great ways to stay motivated and ensure you accomplish your goals. The Vail Recreation District offers a trail running series throughout the summer varying in distances from 3 to 14 miles.

A word of caution: Start slow and listen to your body. Build a running base gradually, one mile to one-half mile at a time. Never increase your total mileage by more than 10 to 15 percent per week. Your pace should be comfortable and you should be able to hold a conversation. As your endurance improves try increasing your speed so that the conversation is interrupted with heavy breathing, pushing your cardiovascular system. Lastly, get proper footwear based on your body-type, arch of foot, and type of running you plan on doing (road versus trail).

Typical running shoes are classified into four main categories: motion control shoes for heavier weight runners with flat arches who have a tendency to over-pronate ; stability shoes for medium to light-weight runners who have the tendency to over-pronate and need stiffness built into the arch of the shoe to help support their natural arch; cushion shoes for the medium to light-weight runner with high arches who stays in a neutral to supinated position as they run; and performance shoes for race day for runners who do not require additional arch support -—these shoes are lightweight and are not made for excessive mileage.

Looking for more information? The Vitality Center at Vail Mountain Lodge & Spa is hosting a running clinic in June (more information to come), including a video running analysis to provide participants with feedback on how to improve running efficiency and prevent overuse injuries.

Spring is a great time to add running to your exercise routine. So get outside and celebrate the sunshine and a healthier you.

Lindsey Fitch is a physical therapist and a doctor of physical therapy at Vail Integrative Medicine, located at The Vitality Center at Vail Mountain Lodge & Spa. She specializes in running injury prevention and running analysis.

Kinesiotape Seminar in October

2010-09-09T20:16:00.000-07:00

VIMG is hosting a K1, K2 & K3 approved accelerated format seminar on Oct8-10 that will allow attendees to get kinesiotape certified in ONE weekend as opposed to TWO!

Our instructor is Dr. Darren Hancock, one of Kinesiotapes top instructors that has taught kinesiotaping to USA's Olympic Training Centers

You can click on the photos to the right or download the full pdf brochure here.

Hope to see you there.

TRX Suspension Training

2010-09-02T21:42:00.001-07:00

I’ve been working out with fitness anywhere’s TRX system lately. I had read about it and heard rave reviews from some of my fellow fitness and sports med professionals. The TRX is a portable suspension exercise system that delivers as easy or intense as exercise session as you want. Because the design uses your own body weight, you can modify the exercises from easy to ridiculously hard…all while dialing in your core musculature. I already do metabolic and strength circuits, but was impressed at metabolic demands and intensity of workout that was available with this system. From my first use of this system I could see some good rehab application. Sure enough, they are launching their sports medicine & rehabilitation stream to their system. Click below to see a quick clip about how the TRX works.

http://markjpitcher.com/wordpress/?p=198

I’ll post some of my own workouts in the next few weeks. If you want to try it out, see how you can use it to enhance workout routine, or want to talk about working this into your rehab program, give me a call. All the best. Dr. Mark

The Running Clinic

2010-08-23T20:39:00.000-07:00

Injury Management, Rehabilitation

& Performance Enhancement

with

Lindsey Fitch, DPT
physical therapist, running specialist

Tuesday August 31, 2010 6:00pm
Eagle Ranch Fitness Center

Learn how to:

Improve running form
Increase running efficiency
Decrease Running Injuries
Increase strength and flexibility

Good luck Brian this weekend at the Leadville 100!

2010-08-20T14:32:00.001-07:00

5-time Leadville 100 runner, Brian Costilow getting K-taped by Lindsey Fitch, DPT prior to going for number 6!

Good luck Brian!

Long may you run

2010-08-19T15:55:00.000-07:00

The Leadville 100, America's highest 100 mile race is this weekend. Dr. Joel, Dave Blanchard, MPT and Andrew Reiff are all smiles before Andy’s Leadville 100 running race. Good luck Andy and long may you run!!

Adam Plummer in Trail Runner

2010-08-16T14:46:00.000-07:00

Own own Adam Plummer gets top spot and a great inside spread in Trail Runner magazine this Summer!

On that note, keep an eye out on our blog, facebook and twitter for our Running Clinic in late August. Our new physical therapist and resident running specialist, Lindsey Fitch will be holding a free seminar at our Eagle office and the Eagle Ranch Fitness Center center and show how we do video analysis of your running gate to identify deficits and faulty biomechanics.

Functional Movement Systems

2010-08-16T09:12:00.000-07:00

I was in Brighton, CO this past weekend for theFunctional Momvement Systems seminar withBehnad Honarbakhsh.

The background and rational for the Functional Movement Screen and associated corrective exercises are excellent. Despite being the only chiropractor there, the functional movement analysis created by physical therapist Gray Cook fits seamlessly into my problem solving approach to injury and dysfunction. In the few days back at the office since the seminar, I have already started looking at patients differently and changing how I address their problems.

The Functional Movement Screen (FMS) and Selective Functional Movement Analysis (SFMA) uses challenging movements that are meant to exaggerate deficits and asymmetry in the body. If the fundamental movement patterns in the body are altered, then any strength, power or sport specific training may be built upon a shaky foundation which at best will prevent optimal performance, and at worst reinforce imbalances leading to greater chance of injury.

Check out the video here:markjpitcher.com/wordpress/?p=125

Mark

VIMG Welcomes Lindsey Fitch, DPT

2010-07-27T14:32:00.000-07:00

A Big Welcome to Lindsey Fitch

We are very pleased to welcome Lindsey Fitch to our team! Lindsey completed her Master and Doctorate Degrees in Physical Therapy from San Francisco State University/University of California, San Francisco. She has worked in the outpatient orthopeadic setting focusing largely on sports injuries. Lindsey has completed specialized training in running analysis and routinely assesses and treats running related imbalances and injuries. Lindsey will be practicing in our Vail and Edwards locations.

Please call 970-926-4600 to schedule an appointment.
Learn more about Lindsey here

Dr. Joel at Larry Fitzgerald's pre-season training camp.

2010-07-12T10:43:00.000-07:00

Dr. Joel was invited to provide care for Arizona Cardinals and NFL great, Larry Fitzgerald's star-studded pre training camp in Minneapolis.

In conjunction with long time colleague, Dr. Josh Sandell, Dr. Joel assisted pre and post sports medicine treatment for the NFL veterans and rookies for the week. 8-time consecutive pro bowler and training camp coach, Chris Carter had not put on cleats in 5 years until several treatments with Dr.
Joel and the group which gave him the 'fountain of youth' to show the NFL rookies a thing or two about creating success in the NFL. Michael Irvin also stated he would have played longer in the NFL with the treatments he received over the week.

Dr. Joel worked with several dozen players from various teams as they prepare for their official training camps in a few weeks. Some of them include Dewayne Bowe (Kansas City Chiefs), Eric Decker (Denver Broncos), Matt Spaeth (Pittsburge Steelers), James Laurinaitis (St. Louis Rams), Golden Tate (Seattle Seahawks), John Carlson (Seattle Seahawks), Domineque Byrd (Arizona Cardinals) to name a few.

http://www.bostonherald.com/sports/football/other_nfl/view.bg?articleid=1266
295&srvc=rss

http://espn.go.com/blog/afcwest/post/_/id/14590/legends-try-to-help-bowe-get-his-groove-back

http://sports.espn.go.com/nfl/news/story?id=5359007

One Love, One Blog

2010-06-25T16:02:00.000-07:00

To make life easier for patients, contributors and me, I have merged our articles, patient resource and news blogs into one. I hope you find the compiled information more convenient. All the best - Mark

Turkish Get Up

2010-06-23T17:24:00.000-07:00

If you have been at the Eagle Ranch Fitness Center, you may have seen me doing these odd looking exercises and wondered what the heck is he doing? I certainly do seem to be breathing hard to just get off the floor a few times.

The Turkish get up (TGU) is an old school, whole body strong man exercise. You know what I am talking about - Big guys with handlebar mustaches wearing leopard print unitards and bending steel with their teeth. You may not have such fashion or fitness goals. That's ok. The Turkish get up also builds core strength and when used in a circuit with short rest periods between exercises, can be part of a great fat and weight loss program.

One of my friends once remarked " I have no idea what muscles its working, but it definitely kicks my butt". The truth is, it works all of your muscles to some extent. Have a look at the exercise below:

shoulders, lats and chest to hold and stabilize the weight above you.
abdominals to bring yourself to a seated position.
triceps and arms to hold your body as you swing your leg through.
legs as you go from lunge to standing.
core activation throughout the exercise.

There are a few variations of this exercise typically having to do with balance and how you move your leg behind you. It is most safely done with kettle-bells and dumb-bells. Start with lower weights get the form, rhythm and balance down. As always, it is good to talk to the resident trainer or therapist to help guide you your first time around.

Mark Pitcher DC, MSc

chiropractor, exercise physiologist

Dr. Pitcher works in the Vail, Edwards and Eagle offices. To make an appointment call, 926-4600. If you have questions for Dr. Pitcher, you can email him at drpitcher@vailhealth.com

Eating Healthy Food is a Human Right.

2010-06-23T15:25:00.000-07:00

This might seem like an odd rallying call in this day and age. After all, it seems like there is healthy and nutritious food available in every grocery store. However, if you've ever read a book by Michael Pollan, watched "Fresh", "Food, Inc.", or seen Jaime Oliver's Food Revolution on tv, you may be wondering if your food is really healthy beneath the surface. Over the years there have been product recalls ranging from spinach to frozen meat and peanut butter that have shaken our trust in the large agribusiness and food processing companies. Why are we so scared of our food? And what can we do to ensure that we don't have to be?

My grandmother used to tell me that food didn’t have flavor any more. I was 10, and I thought that my grandmother was just old and experiencing what happens when you get old. As I grew up I saw an explosion of processed foods, convenience foods and fast foods that seemed to be huge steps forward until I was out in an organic garden. I plucked a ripe tomato and bit into it; all of the sudden I understood what my grandmother had meant all those years ago. My grandmother was raised on a farm in Mississippi over 90 years ago where they grew a few cash crops to support the family’s finances along with their own vegetables and raised their own livestock. This was a prototypical small family farm that helped provide for the family and the wider community. As the world changed and industrialization started to become the norm these very small farms faded quickly. After World War Two industrialization spread like wildfire, making many farms impossible to sustain.

We live in a world that surrounds us with cheap food. My grandmother spent a full 25% of her income on food. The average modern family only spends 10%. Subsidies of commodity crops and the extensive use of chemical fertilizers, pesticides and herbicides allow us to grow a lot of cheap calories. Add convenience foods full of empty calories and fat to this equation, and you can see how our food culture has changed.

Thankfully we are experiencing a renaissance of food that has more flavor, nutrition and vitality than anything we have seen in decades. As people found organic foods and demanded more, the industry listened and organic products flourished. Even more importantly, we now understand that even organic food has high costs and risks associated with long distance shipping. As a result, we are seeing a resurgence in gardening, community gardens, farmers markets, farm stands and community supported agriculture.

The relocalization of our food system is a vibrant movement that can change the food landscape all over our state and the country. The challenge in the high country is that we have such a short growing season, ranging from 39 days in Summit County to 59 days in western Eagle county and Routt county. Colorado Mountain Communities are blessed to have growing regions on the Front Range and Western Slope that can feed us through their much longer growing season.

Community Supported Agriculture (CSA) is a way to connect you and your family to a local farm. In a CSA program people become members of the farm and purchase a full season of vegetables that are grown for you on the farm. This direct relationship allows you to know who is growing your food and dramatically reduces the miles your food travels to get to you. Unlike grocery store produce, your farmer grows food for you that is allowed to fully ripen in the field so that you can eat food that is full of flavor, nutrition and healthy for you. CSA’s will normally deliver your produce to your town once a week throughout the growing season. Even in the high country it’s easy to eat farm fresh produce.

To learn more about Community Supported Agriculture and how you can eat better this year call 970-328-1200 or 970-846-6233

http://www.grantfarms.com/home.php

VIMG at the Red Kettle Golf Tournament

2010-06-15T13:05:00.001-07:00

We were at the Red Kettle Golf Tournament, June 15, supporting the Salvation Army. We were offering complementary consultations to Red Kettle participants, as well as pre-game sports massage and facilitated stretching. Learn more about the Red Kettle here:http://www.salvationarmyvail.org/volopps.asp

PGA Medical Staff Treatments

2010-06-11T11:40:00.000-07:00

ESPN article explains PGA Tour medical staff treatments. Dr Joel has been part of the PGA Tour medical staff since 2009. Enjoy!!

http://sports.espn.go.com/golf/news/story?id=5256227

Interview with Stuart McGill

2010-06-10T15:50:00.000-07:00

This is a great interview with Dr. Stuart McGill about how his laboratory research propelled him (Albeit reluctantly at first) into clinical evaluation of patients. He talks about his approach and addresses many rehab myths surrounding lower back pain. Its a long, but extremely interesting interview. Click here and have a listen and you'll see why I am a big fan of Dr. McGill's no nonsense scientific approach to evaluating and treating low back pain.

Enjoy,

Mark

Learn more at backfitpro.com

A Balanced Approach to Core Stability

2010-05-22T15:58:00.000-07:00

If you have picked up a health, fitness or training magazine recently, you can not avoid reading about the importance of “core stability”. Core stability is touted as paramount to maintaining a healthy back, however the idea of what “core” actually means, what muscles are involved and what exercises are best vary greatly depending on who you talk to. When you think of the core, the abdominal muscles inevitably come to mind. But that is only part of the picture.

Many of today’s popular ideas of spinal stability originate from research out of the Australian physical therapy group back in the 1990s. The research showed that the transverse abdominis (TA), a deep abdominal wall muscle and the multifidus, a series of spinal muscles, thickest across the lowest part of the lumbar spine, had unique behavior when injured. The transverse abdominis was shown to have a feed forward ability, meaning it turned on before other muscles did during a task that required stability.^1,2. Further it was shown to have altered activity when there was a lower back injury, sometimes turning on late or not at all. The multifidus was shown to decrease in size and have increased fat content after injury local to the site of injury. ³ This deficit did not recover spontaneously, even if the pain went away and it was found specific exercise was needed to rehabilitate the area.⁴ Therapists began to use very focused rehabilitative exercises to activate the multifidus and deep abdominal musculature.

The research became popularized, spilling over beyond physical therapy and other health disciplines to personal training and popular fitness culture. The rehabilitative concepts, while useful for addressing specific muscular deficits, grew beyond its scope shaping personal training and core conditioning programs. This may have led to an overemphasis of the deep musculature.

Researchers such as world renowned biomechanist Stuart McGill found that exercises used to activate many abdominal exercises particularly those that repetitively flex and extend the back, offer unhealthy loading of the spine and only work very specific muscles. Further he argues that emphasis on deep musculature can actually destabilize the spine (More on this next time). McGill’’s live and biomechanical modeling also showed that there are not necessarily muscles that were more important than others. All the muscles in the trunk are important at different times, with different loads, under different circustances.⁵ Movements in the body are almost never a result of one specific muscle, but a result of coordination of many muscles, or muscle systems. Muscles that are further away from the center of rotation (the spine) offer better mechanical advantage than deeper muscles. McGill’s approach is to take a broader stroke, training the movement, not an individual muscle. He developed exercises to address the trunk musculature more comprehensively, focusing on exercises that create adequate muscular challenge across a number of muscle systems while putting the least compressive load on the back.

These exercises are often distilled down to what is often referred to as the “Big Three”. (See the related article on our blog) These basic exercises are commonly used initially in lumbar spine rehabilitation. These exercises are also becoming popularized beyond clinical practice as well. (See the NY Times video here: http://video.nytimes.com/video/2009/06/17/magazine/1194841000095/core-values.html?scp=1&sq=core%20values&st=cse)

All patients are different and what is appropriate for one person may not be appropriate for another. But generally McGill’s basic spine sparing core exercises can be used across many patient populations. Clinically I typically pull from more than one school of thought. If there problems with joint mechanics or muscle adhesions, they are addressed with manipulative and soft tissue techniques. I may also look to identify overt muscular deficits such as multifidus or transverse abdominis issues. If present, muscular deficits are addressed and some basic motor control exercises are taught. However, I will usually progress quickly to include a broader and more balanced approach using various spine sparing exercises based on McGill’s research and concepts.

In our next newsletter, we will continue exploring spinal stability

References:

1. Cresswell, A.G, Thorstensson A. (1994) “Changes in intraabdominal pressure, trunk muscle activation and force during isokinetic lifting and lower. Eur J Appl Physio Occup Physiol. 68: 315-21

2. Hodges, P. W., Richardson C. A. (1997) “Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement.” Experimental Brain Research 114 (2): 362-370

3. Hides, J.A., Stokes, M.J. et al. (1994) “Evidence of lumbar multifidus wasting ipsilatreal to symptoms in patients with acute/subacute low back pain.” Spine 19(2) 165-72

4. Hides, J.A. , Richardson, C.A. et al. (1996) “Multifidus recovery is not automatic after resolution of acute, first episode low back pain.” Spine 21(23): 2763-9

5. McGill 2. M, (2004) “Linking latest knowledge of injury mechanisms and spine function in the prevention of spine disorders.” J. Electromyogr Kinesiol 14(1):43-7

Mark Pitcher DC, Msc

chiropractor, exercise physiologist

Graston for Ligament Repair

2010-04-22T15:54:00.000-07:00

At the clinic, we've used Graston Technique for muscle and tendon injuries, but the recent research suggests that it may be useful for increasing the recovery time from ligament injuries as well. It is generally accepted that ligaments repair through repetitive scar formation rather than true regeneration. This can lead to mechanical weakness in the ligament and may be one reason that re-injury is so common in patients with previous ligament injury.

A study published this summer in the Journal of Orthopaedic & Sports Physical Therapy (1) examined instrument assisted cross friction massage (Graston) in an experimentally induced ligament injury in rats.

Four weeks after the injury, the treated ligaments were 43.1% stronger and 39.7%

Stiffer, able to absorb 57.1% more energy before they failed than the non-treated ligaments.

Twelve weeks after injury the differences between treated and untreated ligaments were minimal in terms of strength; however the treated ligaments were 15.4% stiffer.

Although an animal study, this study does support the theoretical basis of using early cross friction massage to speed repair after ligament injury. Although the differences in strength even out over time, lasting increases in stiffness could confer additional protection to the joint itself.

1. Lohgmani MT, Warden SJ. (2009)“Instrument-assisted cross-fiber massage accelerates knee ligament healing”. Journal of Orthopaedic & Sports Physical Therapy. 39(7): 506-514.

VIMG loves Lindsey Vonn

2010-04-12T08:05:00.001-07:00

Kate Dekanich was out to represent VIMG at Vonn's Vail homecoming.

Spinal Stabilization Exercises:

2010-03-22T16:01:00.000-07:00

New Study from Dr. Stuart McGill’s Biomechanics Laboratory at the University of Waterloo

As many of our patients know, we favor research based exercise and rehabilitation at our clinics. For many types of low back pain, spinal stabilization exercises are very commonly used. For patients with back trouble, the back’s load bearing capacity is often diminished so that many commonly prescribed exercises can excessively load the back and are usually inappropriate.

One of the exercise protocols we use for improving spinal stability while minimizing excessive loading is based upon research out of Dr. Stuart McGill’s laboratory at the University of Waterloo in Canada. I have had the opportunity to study with Dr. McGill and am always impressed by his ability to explain extremely complex physiology and biomechanics with clarity. The quality and sheer volume of his research has allowed him to construct an evidence based approach to lumbar spine rehabilitation.

Dr. McGill’s publishes exceptional papers more often than some people change underwear. But we found the recent article published this year in the Archives of Physical Rehabilitation titled “Exercises for spine stabilization: Motion/motor patterns, stability progressions, and clinical technique” especially relevant for patients and clinicians.

The article investigates three well researched and commonly used spine sparing exercises that are used in our clinics for spinal stabilization. Three exercises and their progressions were studied: (1) curl-up (2) side bridge, and (3) bird-dog (the “Big 3”). With these exercise, they studied muscle activation, 3D spinal mechanics and the effect of theclinician offering corrective input during exercise.

While I rarely see anybody doing the neutral crunch at the gym I do occasionally see the side bridge and bird dog. However when performed, they are usually done too fast and without the control, neutral spine posture, or attention to muscle co-contraction that is talked about in McGill’s methodology.

One of the co-contraction techniques widely used is an‘abdominal brace” where the patient contacts the abdominal muscles like they are bracing for a abdominal muscles like they are bracing for apunch. Not pushing the belly out or sucking the belly in. Dr. Mcgill’s research showed that raising the elbows off the floor during the neutral curl up increased rectus abdominis activity. Co-contraction with an abdominal brace during the neutral curl up increased the internal and external oblique to 30% of maximal voluntary contraction.

The studies involving the side plank exercise showed clear progression in muscle activation from ½ bridge to full bridge (with legs straight) with the most muscular challenge moving from side bridge to plank resulting in muscle challenge of 50% of maximal voluntary contraction in the rectus, abdominis internal and external obliques.

The bird dog progression was from the all fours position to just arm, then just leg and then both arm and leg, using abdominal bracing and then abducting the arm slightly. The study again showed a clear progression of muscle activation through the progression of the exercises.

When evaluating clinical guidance, factors such as addressing patient asymmetries and applying fascial raking (using firm fingers pressure on the abdominal musculature to add feedback and better activation) were assessed. The fascial raking resulted in increased oblique muscle activation and decreased rectus abdominis activation, therefore improving the neutral spine posture. It was also especially useful in decreasing the amount of twisting (or uncoupling) of the torso during the plank to side bridge.

Although we currently use employ feedback on abdominal bracing and clinical corrections for asymmetry during the exercises, strive for neutral posture and promote abdominal bracing, we have not used the abdominal fascial raking to any large extent. Given the findings of this study, I think patients should expect to start seeing our practitioners digging their fingers in some abdominal musculature during stability exercises.

Mark Pitcher DC, Msc

chiropractor, exercise physiologist

For additional information read Dr. McGill’s Books:

Low Back Disorders and Ultimate Back Fitness

Visit www.backfitpro.com for more information.

Back in the day with Shawn White

2010-02-18T21:13:00.000-08:00

Honda Sessions circa 2005

Martin Cupka to go to Paralympic Games!

2010-02-18T19:30:00.000-08:00

VIMG is proud to celebrate Martin’s 3^rd Paralympics! GO Martin!

http://www.vaildaily.com/article/20100217/NEWS/100219476/1078&parentprofile=1062

Dr. Joel and Dave Blanchard, MPT lecture at Olympic Traning Center

2010-02-18T15:14:00.000-08:00

Just four short weeks before the Vancouver Olympic Games, we had a great opportunity to lecture for the CCSP post graduate course on assessment and management of extremity disorders.
What an amazing venue to speak at considering the upcoming winter games. Go Team USA!

Integrated Model Of Stability

2010-02-02T15:53:00.000-08:00

There is often great confusion around the concepts of core and spinal stability. A simple but excellent model is the integrated model of stability described by physical therapist Diane Lee and clinical anatomist Andry Vleeming. Although initially developed to describe stability in the pelvis it is relevant for any mobile joint and certainly in the spine. They originally describe three factors that when operating together result in optimal stability in a joint:

1. Form closure

2. Force closure

3. Motor control

Form Closure describes the passive integrity of the joint system. “Form” refers to how the parts (joint surfaces) fit together. Ligament stiffness, disc health, joint alignment all contribute to this integrity.

Force Closure refers to active muscular component. Inherent muscle stiffness and appropriate muscle contraction applies tension to the joints in the spine like the guy wires of a tent. Tension creates joint compression maintaining integrity of the joint. Tension and compression in the spine must obey the “goldilocks effect”. Too little compression results in instability and too much compression results overloading the spinal structures; it needs to be just right.

Motor Control is achieved through coordination of the nervous system and muscle feedback to create appropriate amounts of tension. Tension needs to be applied through activating the right muscles at the right times. Unlike the tent pole, the spine has moving parts and changing demands requires near constant changes in muscle activation. Although mechanically the spine may act like a complex tent pole, muscle control is more like an orchestra. All the instruments have to work harmoniously to achieve the desired music. If one or more instruments are out of tune, or come in at the wrong time we don’t get the desired symphony, but noise. If the muscles don’t act harmoniously, then the forces exerted on the spine may not protect it when needed, or worse apply uncoordinated forces which may cause it to buckle under load.

These three systems must work together to achieve the conditions for optimal stability. They work in a continuum so if one system becomes compromised, the other systems can compensate. However certain methods of compensation are clearly less than desirable than others.

If the muscle activity or control are compromised and muscles are not activating when they should, or with inappropriate forces, then injury may occur causing damage to passive joint structures. Research has shown us that these deficits in muscle activation and control can also be caused by previous injury. Therefore motor control and muscle activation deficits can be both a cause and effect of pain. Over time, these deficits are compensated for by the damage and anatomical change to the passive structures. Degenerative changes in discs and joints typically results in instability, but the damage over time like drying out of discs and formation of bone spurs eventually increased joint stability. This stability typically comes only after years of pain and disability.

In the opposite situation where passive structures are compromised, muscle activity and good motor control able to compensate with far more favorable outcomes. For example, if there is disc degeneration and decreased disc height, then ligaments can no longer exert the same stiffness across the vertebrae and prevent undue movement. (You’d rather not rely on ligaments to do this anyways – but that’s another article.)The resulting instability can be countered by appropriately increasing the muscular tension across the involved joints. The only disadvantage with this strategy is that unlike anatomical decay, it is not automatic and requires exercise and practice. In people with previous injury, proper motor control often needs to be re-learned and repeated to become habit.

This integrative model is a very useful way to visualize how stability is achieved. Having good motor control, training multiple muscles and ensuring proper joint mobility and alignment are all important elements in maintaining and restoring spinal stability.

Mark J. Pitcher DC, Msc

chiropractor, exercise physiologist

If you have additional questions about core or spinal stability, or wish to make an appointment with Dr. Pitcher to address stability issues, please feel free to contact us at the clinic 970-479-6262, or by email at drpitcher@vailhealth.com

Adrian Fernandez

2010-01-13T20:50:00.001-08:00

International racing legend Adrian Fernandez gives Dr. Dekanich an autographed book during a recent treatment over the holidays.

Dr. Joel attends Chicago Active Release Technique (ART) seminar.

2009-12-31T12:57:00.000-08:00

Last week I spent 21 hours learning a soft tissue technique that has become one of the leading treatments for muscle and tendon injuries.

Active Release Techniques®

ART ® is a soft tissue management system that effectively treats soft tissue problems, which frequently do not respond to other traditional treatments.

The goal of ART® is to restore optimal texture, motion, and function of the soft tissue and release entrapped nerves. This is accomplished through the removal of adhesions or fibrosis in the soft tissues via the application of specific protocols. Adhesions can occur as a result of acute injury, repetitive motion, and constant pressure or tension. ART® eliminates the pain and dysfunction associated with these adhesions.

.
Some of the more common conditions are:

Carpal tunnel and other peripheral nerve entrapments
Spinal pain and dysfunction
Tendonitis and other soft tissue inflammatory disorders of the hand, wrist, elbow, shoulder, hip, knee, ankle, and foot
Sciatica, TMJ, recurrent sprains and strains

Only a credentialed ART® provider can ascertain whether ART® might prove beneficial for your condition. To become proficient in ART®, it takes approximately two years of working with patients once a provider has taken the courses and passed the required examinations. Providers must attend annual update seminars to maintain their credentialed status and keep current of any new protocols and research.

ART® is sought after by nearly every professional sports team, Olympic athletes, movie stars and insurance carriers. This technique has filled a void in the management of soft tissue conditions.

Learn more at http://www.activerelease.com/

Merry Christmas and Happy Holidays from VIMG

2009-12-23T13:30:00.000-08:00

VIMG celebrates the holiday spirit by giving to local families in need. Merry Christmas!

Ski and Snowboard Conditioning

2009-11-15T15:52:00.000-08:00

The ski/snowboard season is just a month away for us here in the Vail Valley. Some of you may have already taken advantage of Loveland or A-Basin and started your season early. For many individuals your summer has been filled with tackling the mountain on a bike or your good ole two feet. Kudos to you for being active, but skiing is a different animal altogether. And if you have not already started preparing for the winter season, now is the time. Prevention is the key to avoiding injury on the slopes. A well rounded conditioning program consisting of five key injury prevention workouts will help prepare you for the mountain and most importantly help to decrease your risk for injury. What are those 5 key injury prevention workouts?

1. Cardiovascular Endurance

2. Muscular Strength

3. Muscular Flexibility

4. Muscular Stability

5. Plyometric Strength

Each key prevention workout and their effect on decreasing the risk of injury are explained below:

Cardiovascular endurance is vital when lasting on the mountain run after run. The cardiovascular system delivers blood and oxygen to your working muscles. A conditioned cardiovascular system allows muscles to perform longer before fatigue occurs. Fatigue is one of the number one causes for injuries when skiing. The majority of injuries occur at the end of the ski day, when the muscles have lost their ability to use and produce energy efficiently. Start building up your cardiovascular endurance now by performing 3-5, 30-45 minute aerobic sessions per week. Some of the best choices for training the cardiovascular system are running, biking, rollerblading, stairmaster, elliptical, or arc trainer.

Muscular strength is also important when preparing for the ski season. The muscles and particularly the joints sustain a great deal of stress when skiing. Increasing strength increases the ability to endure the high stress demands of skiing. Even though skiing is a total body workout, specific major muscle groups are often used more including the quads, hamstrings, calves, low back, and core. During skiing the majority of your joints (knees, hips, ankles, and back) are kept in a flexed position, putting several muscle groups in an anti-gravity or eccentric loading position. Incorporating slow, controlled, eccentric training for the hamstrings, glutes, quads, and calves can help to improve your performance in turn decreasing your risk for injury. Some of the best ski conditioning exercises includes squats, split squats, ball hamstring curls, bridges, and calf raises.

Building strength in the legs is important for skiing, but so is building the strength of your core and low back. Remember, when skiing you are in a bent position which can place a lot of pressure on your low back. Improving your core and low back strength will help to offset low back discomfort. Core strength refers to not only strengthening the deeper, intrinsic muscles of the abdomen, but also the larger superficial muscles. The intrinsic muscles provide a “girdle” type of support between the rib cage and pelvis. The superficial muscles provide support for larger movements. Having a strong core improves your stability and decreases your risk for low back injury. Some great core exercises to incorporate into your ski conditioning program include plank, side plank, superman, birddog, and the dead bug series.

Muscular flexibility is another key factor when preparing for the upcoming ski season. Muscles need to be pliable when skiing. Tight muscles increase your risk for muscular sprains/strains or even more serious injuries including ACL tears, or avulsions. Since skiing is a predominately fixed, flexed sport attention needs to be given to hamstrings, hip flexors, calves, low back, and chest. Some light stretching of these areas should be performed before hitting the slopes and then more time spent stretching these areas again after skiing. Beneficial flexibility effects occur when the stretch is held for 30 seconds or greater. Try and stretch each muscle group 2-3 times.

When skiing, the terrain is always changing; therefore you must have excellent balance and full body stability. Increased balance and stability decreases your risk for falling due to enhanced proprioception along with an increased reactive ability to self-correct changes in your balance. Balance training can easily be added to you ski conditioning program by using equipment such as dyna discs, BOSU’s, and stability balls. Try those same exercises suggested earlier in the muscular strength section, but on a BOSU.

Plyometrics can be incorporated with stability training. Plyometrics are explosive movements such as jumping, power squats, and split lunges. Plyometrics are very stressful on the body and should only be performed after you have built a strong cardiovascular, strength, flexibility, and stability base. Adding plyometrics to your ski training regimen will help you prepare for the rigors of landing after bumps, jumps, and moguls, by training you how to absorb impact with a less rigid frame decreasing your risk for injury.

Preparation is prevention. This winter you’ll want to spend your time on the mountain not on the couch with an injury. You now have 5 key injury prevention type workouts to help prepare you for this season…..so get to work!

Casey Charlebois MS, MPT is a physical therapist and personal trainer with VIMG. If you have questions, you can reach her by email at casey@vailhealth.com. If you wish to jumpstart you ski conditioning program and get you season started right, call 926-4600 to schedule an appointment.

USA Taekwondo Rocky Mountain Open

2009-11-11T17:18:00.000-08:00

Dr. Joel Dekanich assisted with medical coverage for the USA Taekwondo Rocky Mountain Open at the US Olympic Training Center in Colorado Springs, CO November 7-8.

Chiropractic and Easing Back Pain For Soldiers

2009-11-02T17:20:00.000-08:00

Fox news Interview with Brigadier General Becky Halstead -Chiropractic and Easing Back Pain For Soldiers - http://bit.ly/2Hm22s

Evening with Phil Jackson

2009-09-16T07:34:00.000-07:00

The evening with Phil Jackson was a memorable one. A great night for a great cause gave us an opportunity to hear some life lessons from the “Zen Master.”

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Graston Technique for Olympians

2009-07-22T15:57:00.000-07:00

When at the Olympic Training Center last summer I was introduced to a technique that has great results for soft tissue injuries like tendonopathies, strains and myofascial adhesions. I set out to learn this technique and since implementing this technique into our practice this year, we have seen excellent results. Unlike massage, Graston® Technique Graston® Technique uses stainless steel instruments to break down fascia and help re-align the muscle fibers.

The Graston® Technique, originally developed by athletes, is changing the way clinicians view treatment of acute and chronic soft tissue injuries.

Graston® Technique is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. This technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.

The curvilinear edge of the patented Graston® Technique Instruments combined with their concave/convex shapes molds nicely to the various contours of the body. This design allows for ease of treatment, minimal stress to the clinician's hands and maximum tissue penetration.

The Graston® Technique protocol induces micro trauma to the area, which increases the amount of cells that are associated with wound healing. The damaged tissue is replaced with new tissue. Ice is then applied to reduce the pain and exercise is implemented to increase function and range of motion.

Dr. Joel Dekanich is Clinic Director at VIMG and practices out of the Edwards Location. You can contact the Edwards office at 970-926-4600

For more information on Graston® Technique research click here.
For frequently asked questions about Graston® Technique click here.

Dr. Mark's Applied Physiology article is now available in free full text version

2009-07-08T10:44:00.001-07:00

The Journal of Applied Physiology Nutrition and Metabolism has made the article "Reliability of electromyographic and force measures during prone isometric back extension in subjects with and without low back pain" available in a free full text format. Check it out here !

PGA Tour

2009-07-08T06:58:00.000-07:00

This past June I had the opportunity to work my first PGA Tour event in Milwaukee, WI. Formerly known as the GMO (Greater Milwaukee Open), the US Bank Championships have been a Tour stop for many years and just so happened to coincide with the British Open where Tom Watson had his ‘almost’ amazing finish. Many people want to know what the medical staff does at the PGA Tour and here is a quick answer. At each PGA event there are two double wide trailers available for players to have treatment, rehabilitation and therapy before and after a player’s round. Many players use the staff to get stretched out before a round and/or get an adjustment or therapy if needed on a particular issue they might be having. Some is based solely on prevention while others have true injuries that need attention. The staff is comprised of two excellent physical therapists and one chiropractor as each event and they work in concert to what the players needs may be. These ‘moving clinics and gym’ have all state of the art equipment for treatment and therapy. What is probably most unique is that players have such a wide range of athleticism, fitness and body types yet are all the best golfers in the world!

A typical day is from as early as 5:30 am to about 7:00 pm and about half the field (80 players) was treated for various needs and conditions throughout the week. All in all it was a great week (in my home state) and I look forward to working more events in the future with such talented staff and players.

Joel

Control Over Pain

2009-06-22T15:59:00.000-07:00

Pain is created and transmitted in the body. It is an unpleasant sensation, a signal to the body that it has been damaged. Pain is influenced by our beliefs, culture, stress level, and genetics. Pain may cause change in heart rate, blood pressure, breathing rate, emotions and behavior. When pain becomes chronic (lasting longer than 3-6 months) some people will stop doing things they once enjoyed. They may limit social activities, stop doing hobbies or sports because of the possible pain those activities may cause.

People in pain may loose a sense of control over their bodies, mind and spirit, becoming a hostage to their pain. There are many alternative ways of managing pain such as meditation and breathing techniques. These various techniques teach patients how to develop a locus or center of control over their pain. A gentle exercise or movement therapy that is used is QiGong. QiGong is one part of a multi-faceted system of Traditional Chinese Medicine. Most hospitals in China include QiGong as part of their health care program. It is one method of cultivating chi, a term used to describe the body’s vital energy system that promotes all activity of the human body. QiGong is included in physical therapy rehab programs at VIMG for patients suffering from headaches, stress related injuries, balance dysfunction and chronic pain management. It is part of the NorthBay Pain Management Essentials program which she co-founded in Fairfield, California and she uses it here at VIMG. Instruction is based on the DVD from the National Qigong Association. It gives patients an introduction to Qigong and Miki provides community resources if patients are interested in persuing their practice further.

The Healing Wave Project is sponsored by the National Qigong Association and an effort to expose all people to the benefits of Qigong. Their website www.nqa.org has information on how you can receive the Qigong DVD and more information about practioners in your area

Miki Blanchard is a physical therapist based out of our Eagle Office. She can be contacted at 970-328-1200
Click here to read more about Miki.

Eagle Boot Days

2009-05-28T10:17:00.000-07:00

On May 16th, VIMG sponsored a tent and ‘jumpy house’ for the Boot Days festival in Eagle. More than 1,500 participants took part in Eagle’s fun and sun along with the 10K Bone yard Boogie. Physical therapists’ Miki and Dave Blanchard along with Dr. Stanzel provided free injury assessments and consultations throughout the day. Most of these came from mid air collisions in the jumpy house!

And Miki rubbed her forearms and fingers raw while doing 5 (yes 5!) hours of free chair massage...which was as popular as the jumpy house...just older crowd!

Annual Chiropractic Sports Sciences Symposium

2009-04-25T06:46:00.000-07:00

Last weekend I attended the ACBSP (American Chiropractic Board of Sports Physicians) annual sports medicine symposium in San Diego. Besides leaving four feet of newly falling snow into warm, sunny ‘beach’ weather, the seminar was packed with great speakers and relevant sports science updates. Of interest to me were the medical directors of the USOC (United States Olympic Committee) Mike Reed, DC, DACBSP and John Reasoner, MD discussing the new model of sports care at the USOC and primary care issues during international competition at the Olympic level. Having recently returned from Beijing, several sports chiropractors also gave presentations regarding specific cases from last summer’s Olympic Games. Having been at the USOC training facility in Colorado Springs the two weeks before Beijing, it brought back great memories of that environment. Drs. Tim Brown and Doug Anderson also gave their consistent great lectures. The annual conference is also a great time to hook up with great friends and colleagues of mine from around the country.

Joel Dekanich, DC, DACBSP, EMT, CSCS
Diplomate American Chiropractic Board of Sports Physicians

Arnold Palmer Invitational at Bay Hill

2009-04-08T21:59:00.001-07:00

March 25, 2009

I had an opportunity to spend a morning with Scott Fonda, DC, DACBO in the medical trailer at this recent PGA Tour event. Scott has been on the staff for the PGA for the past 3 years. Days working as the staff chiropractor are long (5:30 am to as late as 7:00 pm) but he says that working with the PGA players is extremely rewarding. Many of the players are very interested in a higher level of fitness and health that focus on strength, agility and endurance. Golf (and travel) is very demanding on the spine so many players get worked on daily when at an event. The ‘team’ is comprised of two physical therapists, a chiropractor and the medical director.

Joel

Chiropractic Board of Sports Physicians in Vail

2009-03-28T08:10:00.000-07:00

In February, several DC's from around the country met at the Arabelle in Vail for the practical committee with the American Chiropractic Board of Sports Physicians. Pictured (left to right) are Jeff Hebert, DC, DACBSP, PhD (c), Park City Utah, Josh Sandell, DC, ATC, DACBSP, Minneapolis, myself, Darren Hancock, DC, CCSP, Chicago and Tim Schardein, DC, DACBSP, Denver.

We are responsible for scenarios and relevant current content for the diplomate practical examination for the ACSBP. It is always great to 'hang with my crew' and these guys are some of the best minds and clinicians in the country.

Dr. Joel

Pilot study finds chiropractic care and physical therapy may reduce costs and need for surgery

2009-03-22T15:56:00.000-07:00

After only one year, a pilot program designed to measure patient quality of care shows significant clinical outcomes and health care cost reductions. The Wellmark Blue Cross and Blue Shield 2008 pilot was a quality improvement program for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists, and occupational therapists participated in the pilot, submitting information on the care provided to 5,500 Wellmark members with musculoskeletal disorders.

"...89 percent of the Wellmark members treated in the pilot reported a greater than 30 percent improvement in 30 days. . . . The comparison showed that those who received chiropractic or physical therapy care were less likely to have surgery and experienced lower total health care costs."

Data from participating clinicians show that 89 percent of the Wellmark members treated in the pilot reported a greater than 30 percent improvement in 30 days.

In addition, Wellmark claims data for members who received care from chiropractors or physical therapists was compared with data for a member population with similar demographics (including health) who did not receive such services. The comparison showed that those who received chiropractic or physical therapy care were less likely to have surgery and experienced lower total health care costs.

Commenting on the value of the program's data collection and reporting, Dr. Shayan Sheybani, clinics operations administrator at Palmer College of Chiropractic, said the following: "The faculty, staff, and interns of the Palmer Clinics were able to objectively and consistently gather valuable information for services provided for our Wellmark patients that support the College's commitment to providing quality patient care. Overall, we have a positive impression of this program, and we are planning to continue our participation during the 2009 fiscal year. Continued participation in Wellmark's pilot satisfies our desire to contribute to new knowledge, continual improvements, and the development of quality-focused patient care."

Pamela A. Duffy, PT, PhD, OCS, Wellmark's physical medicine director, believes the results are reflective of the participants' commitment and dedication to providing quality care. "Participants in our first pilot on quality are dedicated to pursuing professional development, improving quality health care, and helping their patients live the most productive and pain-free lives possible. Wellmark is very pleased with the clinical outcomes demonstrated by these practitioners, and will continue working with providers to design programs that help evaluate the value of physical medicine services for members."

Triad Healthcare will continue to administer the 2009 program for Wellmark, which is open to participating Wellmark medical and osteopathic physicians, podiatrists, chiropractors, physical therapists, and occupational therapists in Iowa and South Dakota. To obtain additional information about the 2009 Physical Medicine Pilot on Quality, contact Wellmark at 800-799-0199, option 1.

Wellmark, Inc., does business as Wellmark Blue Cross and Blue Shield of Iowa. Wellmark and its subsidiaries and affiliated companies, including Wellmark Blue Cross and Blue Shield of South Dakota and Wellmark Health Plan of Iowa, Inc., insure or pay health benefit claims for more than 2 million members in Iowa and South Dakota. Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Blue Cross and Blue Shield of South Dakota, and Wellmark Health Plan of Iowa, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

Source: Wellmark