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Balance Training: How to Achieve the Greatest Benefits

Balance is one of the most commonly overlooked aspects of a fitness or exercise program. That is, until an injury, health condition or general aging forces us to pay more attention to it.

In the context of fitness and health, balance is the ability to remain upright, stable, steady, and controlled while standing, walking, jogging, running, or engaging in any dynamic maneuver (like hiking over uneven terrain).

Just like speed, strength, power, endurance and flexibility, balance can be trained and enhanced through proper exercise. In any balance training program, it’s important to consider the type of balance training you’re doing and the surface you’re doing it on.

Static and dynamic balance training

Balance training can be organized into two types: static and dynamic.

Static balance training involves holding a single position (for example, standing on one leg) for a set amount of time. This type of balance training is usually the starting point in any balance program, as it involves little movement and is generally safer.

As balance exercises progress in intensity, dynamic balance training is implemented. Dynamic balance training involves training balance while moving. Because how we move in life and sport is most often not static, dynamic balance training more accurately simulates the challenges and variability we experience in everyday life.

An example of dynamic balance training would be lunging to pick up a weighted ball off the floor, standing back up on a single leg, and quickly turning to toss the ball to a partner.

Balance training surfaces

Static and/or dynamic balance training can be done on different surfaces to achieve different benefits. The three main categories of surfaces are:

  • Even Surfaces (wood flooring, carpet, rubber gym flooring, sidewalks)


  • Uneven Surfaces (hiking trails, hills)


  • Unstable Surfaces (balance pads, balance balls, a wobble board)


Static and dynamic balance training on an even surface

Since even surfaces offer the lowest amount of challenge, this is where most individuals will begin with their balance exercises. Starting here with static, non-weighted exercises such as single leg balance holds and hip hinge single leg balance holds will help build a foundation.

Progressing to dynamic balance exercises like walking and lunging variations on even surfaces will add a greater, more functional challenge. Here, resistance in the form of dumbbells, medicine balls and other weighted tools can be added for increased strength and balance demands.

Dynamic balance training on an uneven surface

Throughout life, most people spend a fair amount of time standing, walking, hiking, jogging, or running on even and uneven surfaces, so from a “functional” standpoint it makes sense to focus balance training efforts here.

To train on any uneven surface, people would normally have to venture outside to the nearest park, hill, or mountain; until now. OPTP recently released an innovative new balance training product called CobbleFoam.

Each CobbleFoam board is 16” x 16” and features foam blocks of varying heights that create uneven terrain to stand on or traverse across. The CobbleFoam board/s simulate the uneven surfaces we encounter in everyday life and can be used safely and comfortably in your own home. Many health professionals also use CobbleFoam in their clinics, gyms and studios.

Conducting any static or dynamic balance exercise on an uneven surface like Cobble Foam immediately increases the benefits of the movement. Due to the variability of the uneven surface, the brain and muscles will be engaged at a deeper level to keep the body upright and balanced. In addition, the deep intrinsic stability system of the foot-ankle-knee complex will be activated to a much greater degree, building strength and joint integrity.

Last, unstable surfaces like balance pads and balance balls are also effective options for building better balance. Because most of these tools are light in weight, pliable and filled with air, they create an ever-changing surface to stand on. In theory, this instability builds communication between the brain and feet, thus improving balance. Unstable surfaces should always be used in conjunction with a static object that can be grasped and used for support, to avoid a potential fall.

CobbleFoam: A highly effective approach to improving balance

To make balance exercises even more functional and life-like, combining an uneven surface like the CobbleFoam board/s with other fitness tools like weights, steps, balance pads and hurdles to develop an “obstacle course” is a highly effective approach to developing and improving balance.

Incorporate static and dynamic balance exercise for the greatest benefit

In summary, people can engage in static and/or dynamic balance exercises on an even surface, uneven surface, or unstable surface to improve their body’s ability to remain upright, stable, steady, and controlled. While even surfaces and uneven surfaces like CobbleFoam are most functional, the greatest benefits will be had by engaging in both static and dynamic balance exercises across all three surface types. What is your favorite type of balance training, and why?

READ MORE Derek Mikulski, BS, CSCS, CPT - May 17, 2021


Uneven Surface vs. Unstable Surface Balance Training

Functional Balance Training: Uneven and Unstable Surfaces

Whether you are a physical therapist, chiropractor, athletic trainer, Pilates instructor, or other type of fitness professional, it is likely that you work with clients and/or patients who need to improve their balance.

The evolution of balance training

Over the last three decades, balance training has evolved dramatically. Through the 90s and into the early 2000s, health and fitness professionals began to look more closely at the “functionality” of the exercises they were prescribing; that is, how exercises translate to movement outside of the clinic, studio or gym.

It was realized that balance training in a predictable, static environment would yield sub-par results. Because most individuals need to have sound balance while moving, people need to combine traditional static balance exercises with mobile, multiplanar and unpredictable dynamic exercises across variable surfaces.

This realization caused health and fitness professionals to do two things differently:

1.) They began incorporating more dynamic, functional movement into their programming.
2.) They began utilizing functional new forms of equipment to help their patients and clients achieve their goals.

Balance tools for functional training

Since the shift towards more functional forms of balance training, innovators have created an abundance of balance training tools. Most of these tools offer some sort of variable surface to conduct exercises on and/or across. The basic logic behind these products is simple: exercising on a variable surface will introduce unpredictable balance demands to the patient or client, helping them build a stronger neurological connection between the brain, feet, and everything in between.

Most balance training tools fall into one of two main categories: unstable surfaces and uneven surfaces.

Unstable surface balance tools

Unstable surfaces can be thought of as any surface that moves as the patient or client is standing on top of it. With this variability in movement, the body’s main sensory systems that govern balance (the vestibular and proprioceptive systems) are turned on to a greater degree. Over time, this enhanced sensory and muscle activation can build better balance, helping the individual develop a better intuitive understanding of their body’s position in space.

While a vast number of exercises can be conducted on top of a balance tool that offers an unstable surface, mobile exercises (such as walking or lunging) can be challenging since the surface area of these tools can be quite small.

Examples of balance tools that offer an unstable surface include wobble boards, balance pads, balance discs, and instability platforms. These tools each offer their own unique form of instability.

Wobble Boards

Wobble boards come in many shapes and sizes, but the concept is similar across all variations. The tools feature a solid surface on top of a curved base that moves in either one plane of motion (easier) or in all directions (harder). Wobble boards are great for all patient and client types. If you are in the market for a wobble board, the Wobblesmart by OPTP is a great option. It can be adjusted across 6 degrees of difficulty to accommodate a range of balance abilities, making it very versatile.

Balance Pads

Balance pads also come in many shapes and sizes. These balance tools are commonly made from pliable air-filled foam, which collapses as a user stands on top. Balance pads are most commonly used with older adults, since they offer a lesser degree of instability and are low to the ground, minimizing the risk of a fall. For a great balance pad option, check out the OPTP Pro Balance Pad.

Balance Discs

Balance discs are similar to both wobble boards and balance pads in that they can be made of collapsible foam or offer a solid platform on top of a curved base. They can also be completely air-filled. These tools are circular in shape and are commonly used in unilateral (single leg) exercises. For an exciting and unique balance disc option, check out the OPTP Dynamic Duo™ Balance & Stability Trainers.

Instability Platforms

Instability platforms include a broad range of dome-shaped balance tools. These products are most commonly made from a durable rubber material that is balloon-like, being filled with air. This rubber air filled “balloon” can serve as the balance tool itself or can be affixed to a solid platform that the user stands on top of. For one of the newest innovations in instability platforms, check out the OPTP PRO-PODS™.

Uneven surface balance tools

As mentioned, one major consideration in today’s balance training program development is the functionality of exercises. That is, how does, “balance exercise x” help prepare the patient or client for doing, “activity x” in their day-to-day life?

Because most people spend a fair amount of time standing, walking, hiking, jogging, or running on surfaces that are not unstable, innovators recently began creating products that offer uneven surfaces. Balance tools with an uneven surface offer variability that is more similar to what people might encounter in their daily lives including hills, uneven grass or playing fields, rocky walkways, old sidewalks, and hiking trails.

These surfaces have fixed and unfixed obstacles that people must navigate on, over and across safely. Moving on and across an uneven surface offers the same benefits that unstable surfaces offer, with the added benefit of increased functionality. To train on any uneven surface, people would normally have to venture outside to the nearest park, trail, hill, field, or mountain; until now.

CobbleFoam: A highly effective approach to improving balance

OPTP recently released an innovative new balance training product called CobbleFoam. Each CobbleFoam board is 16” x 16” and features foam blocks of varying heights that create uneven terrain to stand on or traverse across. The CobbleFoam board/s simulate the uneven surfaces we encounter in everyday life and can be used safely and comfortably in the clinic, studio, gym or home.

Conducting any balance exercise on an uneven surface like CobbleFoam immediately increases the benefits of the movement. Due to the variability of the uneven surface, the brain and muscles will be engaged at a deeper level to keep the body upright and balanced. In addition, the deep intrinsic stability system of the foot-ankle-knee complex will be activated to a much greater degree, building strength and joint integrity.

To make balance exercises even more functional and life-like, combining an uneven surface like the CobbleFoam board/s with other fitness tools like weights, steps, balance pads and hurdles to develop an “obstacle course” is a highly effective approach to developing and improving functional balance.

The key to the most profound overall benefits

The use of both unstable and uneven balance training products offers incredibly beneficial outcomes for patients and clients. When combined with functional movement that is most similar to activities of daily life, patients and clients will realize the most profound overall benefits.

To explore all of OPTP’s 40+ balance training products, visit optp.com.

READ MORE Derek Mikulski, BS, CSCS, CPT - February 9, 2021


How to Choose a Foam Roller: 3 Features to Consider

So you’re going to get a foam roller? Seems like an easy enough decision to make. I mean, it’s a simple piece of foam, it can’t be that hard to figure out. But then you start looking at all the options out there, seeing the many different varieties. Pretty soon, it can become overwhelming.

Trying to decide which foam roller is best for you isn’t as easy as you might think, but it’s important. Choosing the right roller will help ensure effectiveness, usability and compliance. After all, if it doesn’t feel right you won’t be motivated to use it…and a roller that goes unused doesn’t provide much benefit!

In this article, we’ll look at three keys to consider when picking a roller, helping you break down the options. As follows, we’ve identified what we feel are the three most important factors; density, size/shape and construction.

  1. Density
Arguably the most important choice to make regarding your new foam roller is the density. You might also hear this referred to as the compression, firmness, cushion or “give,” which all mean the same thing. Generally, rollers can be broken down into three density categories; soft, medium or firm.


Soft
Soft density rollers have more “give” or cushion to them. They’re designed for those who are looking for more comfort as opposed to the deeper massage of firm and standard rollers. The soft density produces a massage that is gentler on the muscles, making it ideal for users with sensitive muscles or those who simply prefer a less intensive massage.
Standard
These rollers have a medium firmness. Their universal quality makes them ideal for both self-massage and exercise. They provide just enough firmness for deep massage while still having moderate cushion. Their medium density also serves nicely as stable props for use in core strengthening exercises such as those performed in Pilates and yoga.

Firm
For those seeking a deeper, more intense massage, firm density foam rollers are the answer. Athletes and highly active individuals often have tight muscles that can benefit from the penetrating nature of these rollers. Firm rollers are great at breaking up even the most constricted fascia (the interconnected web surrounding the muscles), a process known as myofascial release.  

  1. Size and Shape
There are also many different sizes of foam rollers on the market. While the majority are the traditional full-size round cylinders, many other sizes and even different shapes exist. Let’s take a look at some of the more common sizes to see how each lends itself to certain uses.

Standard Full-size
When most people think of a foam roller, this is usually what comes to mind. The typical full-size roller measures approximately 36” length x 6” diameter. This size is versatile for a variety of uses, including massage (ideally larger muscles groups like hamstrings, quads and the back), physical therapy and general exercise. Due to their three-foot length, these rollers are perfect for any type of exercise where you lie on the roller with it positioned vertically along the spine, such as Pilates or related core strength and balance movements.
Shorter Length
If you’re looking for a more portable roller, perhaps one that is travel size and you can take with you to the gym, physical therapy clinic or Pilates studio, consider a shorter length. Most shorter rollers have the same diameter as a traditional full-size (6” or thereabouts) but feature a shorter length; typically either 18” or 12”. In addition to the benefit of portability, they also make it easier to target certain muscle groups. The shorter rollers are ideal for targeting more precise areas such as calves, IT Bands or glutes.

Smaller Diameter
A smaller diameter roller — typically 4” — means that it will be lower to the floor and more stable. This is often important for physical therapy patients, aging users or those with a compromised sense of balance. Being lower to the floor means that it provides a safer, more stable feeling. It’s also easier to control while using for massage.
Ridges or Bumps
Need a little something extra? Some uniquely designed foam rollers offer protrusions for those that like a more invigorating massage or simply want the ability to target precise areas. Rollers with ridges, bumps or points can provide a deeper penetrating massage that breaks up fascia in even the most tight, compact areas.
Flat Half-size
There are a variety of foam rollers that lend themselves nicely to balance and core strength exercise. Although they come in a range of shapes, a typical size is a 36” length x 3” height that is cut in half the long way, making it rounded on one side and flat on the other. This shape is useful for physical therapy, Pilates, yoga, Feldenkrais® and general core strength exercise.

  1. Construction
Not all foam is created equal. Believe it or not, there is a fair amount of engineering that goes into the development of a foam roller. The way it is constructed helps determine its longevity — and primary location of use — important considerations to make before purchase.

Open-Cell
Rollers built with an open-cell construction, while suitable for massage and exercise, tend to break down much faster than closed-cell rollers. You’ll typically find open-cell rollers at your local big-box store and, while inexpensive, there are higher-quality closed-cell options available at affordable prices. Closed-cell foam rollers offer the durability you expect from a foam roller and are available in two types of foam; EPP and EVA.

EPP Foam
Rollers made from EPP foam beads are high quality but still relatively inexpensive. They’re versatile and suited for users of all levels. Because they offer a nice combination of durability and affordability, they make a great starting point for the average person while still being effective for the more advanced user. EPP rollers are designed to last much longer than open-cell rollers, though they do not offer the supreme durability of EVA foam.

EVA Foam
Rollers made from EVA foam deliver unmatched durability. These “professional strength” foam rollers are built to withstand the type of heavy, repeated use often found in gyms, clinics or Pilates studios where many people are using them throughout the day. The at-home user can also benefit from the longevity of these rollers, having confidence in knowing they will hold up for a longer time than any of the other foam types.

As you can see, there’s a bit of thought required before making your foam roller purchase. But put the time in up front and you’ll be rewarded with a roller that suits your comfort level and intended usage, motivating you to use it with consistency. Start with the big three features — density, size/shape and construction — and you’re well on your way to making the perfect selection.


Ready to browse all the options? View OPTP’s extensive selection of foam rollers, including the densities, sizes and foam types mentioned in this article.

READ MORE Josh Crane, OPTP Staff Writer - June 12, 2018


Thrust Joint Manipulation Skills for the Spine: A New Manual Therapy Textbook Delivering Clinical Pearls

Over the course of their combined 80 years of practicing and teaching manipulative therapy, Emilio Puentedura, PT, DPT, PhD, OCS, GDMT, CSMT, FAAOMPT, and William O’Grady, PT, DPT, OCS, COMT, DAAPM, FAAOMPT have developed a deep understanding of the why, when and how behind administering thrust joint manipulation.
 
Like anyone who devotes themselves wholeheartedly to a craft, they have acquired specific knowledge of the practice and honed their skills with laser precision. But for these two, simply becoming experts in their field was not enough. Their passion for helping others led to a desire to share their expertise, and so they authored a new manual therapy textbook published exclusively by OPTP.
 
Thrust Joint Manipulation Skills for the Spine, which includes access to videos demonstrating 45 manipulation techniques, is designed for both clinicians and students. The book demonstrates when and how to perform thrust joint manipulation techniques for patients with musculoskeletal dysfunction in the spine, providing numerous “clinical pearls” along the way.  
 
The book has already been well received and continues to garner recognition from the manual therapy world. We recently sat down with the authors to get their take on the unique value of its content, and here’s what they had to say.
 
 

Discover how these clinical pearls can enhance your practice and understanding of spine manipulation. Learn more about Thrust Joint Manipulation Skills for the Spine.

READ MORE Josh Crane, OPTP Staff Writer - May 10, 2018


From the Authors | Deborah Riczo: Sacroiliac Pain

In the second installment of our “From the Authors” series, Deborah Riczo tells us a little bit about herself, as well as her motivation for writing Sacroiliac Pain, an exclusive new educational and exercise book for those affected by sacroiliac dysfunction.

Shortly after graduating with my physical therapy license in the early ‘80s, I became an advocate for women’s health. While working full-time at MetroHealth Medical Center in Cleveland, Ohio, I started my first entrepreneur business along with my colleagues. Long before it became an accepted practice, we dedicated ourselves to providing healthy, safe exercise for women during pregnancy and in the postpartum period. We were recognized for our work and presented at the American Physical Therapy Association (APTA) national conference on the topic.

During this time, I was working part-time in the hospital clinic, working on my master’s in education and having two children. I became acutely aware of the problems of sacroiliac pain/pelvic girdle pain in this population. As we know, it often starts during pregnancy or postpartum and can continue thereafter.

I went back to school for my doctorate in physical therapy in 2007. As my “capstone” project, I chose to further investigate the exercise approaches I was using successfully in the clinic and compare them to the literature. My reputation with the physicians and my colleagues for treating sacroiliac pain continued to grow.

In 2011, I founded Riczo Health Education. My goals were, and still are, to:
  • Provide consumer health education, especially in the areas of:
    • Sacroiliac pain
    • Pregnancy and postpartum
    • Breast cancer
    • Health and wellness
  • Provide high-quality continuing education courses to health professionals
  • Provide dynamic presentations on a variety of healthcare topics to consumer groups
  • Provide experienced consulting to healthcare organizations and consumers
After more than 30 years as a practicing physical therapist at MetroHealth Medical Center, I retired in 2016 and am now focused exclusively on Riczo Health Education. It has been a wonderful journey, and I’m excited to continue branching out to create the largest ripple effect that I can!

In writing my first book, I sought to capture APTA’s vision; “The physical therapy profession will transform society by optimizing movement for all people of all ages to improve the human experience.” Sacroiliac Pain: Understanding the Pelvic Girdle Musculoskeletal MethodSM is a book based on a method that I developed and have been teaching to therapists since 2011. I partnered with the APTA Section on Women’s Health in 2016 to teach a two-day continuing education course to physical therapists, “Simplifying Sacroiliac Dysfunction,” also based on the method.

Ultimately, I wrote the book to reach out to those who are dealing with sacroiliac pain for either of two reasons; they have not sought medical help due to insurance reasons, or they have sought help but are still dealing with pain. The book is especially written for those being treated for sacroiliac pain with opioids or for those who are contemplating surgery. Of course, the book will not help everyone, as medical, psychological, spiritual, social, occupational and environmental situations all vary from person to person. However, in my experience as a practicing physical therapist, the Pelvic Girdle Musculoskeletal MethodSM is a very successful, cost-effective approach. I believe that the average person can pick up this book and benefit from it in some way, as it is holistic in its approach. Hope, belief and mindfulness are key, as well as movement and exercise. And of course, adherence!

Sacroiliac Pain is designed to help improve muscle imbalances and weakness by providing a simple approach. It begins with a background on recognizing sacroiliac pain; its common causes as well as muscles, joints and ligaments that are often involved. Additionally, the reader is made aware of how pain and fear of movement can result in decreased function and increased pain.

The section dedicated to the Pelvic Girdle Musculoskeletal Method provides step-by-step instructions for the exercises with supporting video links. We added the online videos as a convenient, visual way to help the reader understand the correct way to execute the movements.

In addition to the main exercises, we also included stretching exercises as well as instruction on breathing, which plays an important role in relaxation and pain management, along with mindfulness. Tips on beginning a walking program and progression to other forms of exercise are also included.

In the final section, the reader will find information regarding use of a sacroiliac belt and other frequently asked questions. An exercise planner is also included for logging workouts.

I hope that readers of this book who are struggling with sacroiliac pain find the tools they need for improving function, fitness and wellness. I’m optimistic that its approach will help to “optimize movement” and “improve the human experience” for many who read it.


Deborah B. Riczo, PT, DPT, MEd
Dr. Riczo has been a practicing physical therapist for over 37 years, the majority of it being in clinical practice at MetroHealth Medical Center in Cleveland, Ohio. She developed a continuing education course for physical and occupational therapists called “Simplifying Sacroiliac Dysfunction,” and has been teaching it since 2011. Deborah is the owner of Riczo Health Education and speaks nationally on sacroiliac dysfunction in addition to teaching physical therapy students who are at the doctoral level.

Discover a simple yet effective approach to addressing sacroiliac pain symptoms in Deborah’s book; Sacroiliac Pain: Understanding the Pelvic Girdle Musculoskeletal MethodSM.

For more info on sacroiliac pain, see Deborah’s blog at RiczoHealthEducation.com.

READ MORE Deborah B. Riczo, PT, DPT, MEd - April 13, 2018


Close to Home: Minnesota Physical Therapy Association Annual Conference

On Saturday, April 21st, the Minnesota Physical Therapy Association will be holding their annual conference. The event, named “Minnesota in Motion,” will be held at the Minneapolis Park Place DoubleTree by Hilton Hotel.

The one-day format will include the annual membership meeting, lunch, awards, exhibits and three separate sessions of educational courses, capped off with a “Celebration of Physical Therapy.” In addition, students from local PT programs will have a chance to share some of the research they’ve been conducting. Overall, the event promises to provide a great opportunity to learn, network and enjoy all things physical therapy.

As a Minnesota-based company, OPTP is looking forward to exhibiting at the local event and being part of the “hometown crowd.” Attendees who stop by our booth will get to see a variety of new and exclusive physical therapy products, including the following recently published books.

Pain Neuroscience Education: Teaching People About Pain
This clinician book provides an evidence-based perspective on how the body and brain work together to create pain, teaches how to convey this new view of pain to patients in a way that’s easily understood and demonstrates how to integrate pain neuroscience education into a practice. The revised second edition of Pain Neuroscience Education, which contains significant updates and new content, is written by physical therapists Adriaan LouwEmilio Puentedura, Steve Schmidt and Kory Zimney.

Thrust Joint Manipulation Skills for the Spine
This new manual therapy textbook explains when and how to effectively perform thrust techniques for patients with musculoskeletal dysfunctions in the spine. Thrust Joint Manipulation Skills for the Spine is designed to familiarize the reader with the concept of focusing to engage the barrier as it relates to patient comfort, and provides clinical pearls to enhance skill acquisition and technique. Perhaps most unique to the book is its access to videos demonstrating 45 techniques, allowing viewers to watch and learn from the authors and master clinicians; Emilio Puentedura and William O’Grady

Additional Physical Therapy Products
In addition to these books, OPTP will have an assortment of posture and back pain products such as lumbar rolls and other McKenzie Method® products, as well as hand therapy products like our Handii™ Healthy Hands. The versatile new Performance Wedges™ and Performance Block™, which offer endless exercise possibilities for increasing strength and range of motion, will also be on display. And of course, we’ll have products for myofascial release and massage therapy on hand as well, such as foam rollers and the new PRO Soft Release Ball, a soft density 5” diameter foam massage ball.

In Our Own Backyard
While our staff are accustomed to traveling far and wide for conferences and tradeshows — even internationally on occasion — it will be nice to stay close to home this time around. We’re looking forward to supporting the Minnesota Physical Therapy Association and encourage all those interested in attending to learn more and register at the annual conference website. We hope to see you there!

READ MORE Josh Crane, OPTP Staff Writer - April 13, 2018


From the Authors | William O’Grady: Thrust Joint Manipulation Skills for the Spine

In the first installment of our “From the Authors” series, Bill O’Grady tells us about his inspiration and intentions for writing Thrust Joint Manipulation Skills for the Spine, an exclusive new manual therapy textbook he co-authored with Emilio (Louie) Puentedura.

Louie and I had been teaching together for 10 years when we set out to write this book. Between the two of us, we brought almost 90 years of clinical experience and teaching to the table.

We both gravitated toward this field because we found that skillful application of these techniques provided such obvious successful outcomes. Its natural appeal was that we could witness immediate improvement in both the symptoms and quality of life for our patients.

We were fortunate to have great mentors and influences like Freddy Kaltenborn, Olaf Evjenth, James Cyriax, Stanley Paris, Geoff Maitland, Robin McKenzie, Dick Erhard, Peter Gibbons, Phil Tehan, David Lamb, Cliff Fowler, Erl Pettman and Laurie Hartman. Many of these renowned gentlemen authored their own textbooks on mobilization and thrust manipulation, and several of them were groundbreaking for our field. Needless to say, there are many books that provide descriptions of thrust techniques.

When Louie and I decided to write this book, we wanted to incorporate our education, clinical experience and teaching. Our goal was to publish a book that is simple to read and geared not only toward the entry-level and residency/fellowship student, but also the educator.  

The book includes a history of thrust joint manipulation (TJM) as well as research on the effectiveness, safety and clinical reasoning of using TJM. But we feel what makes our book most unique is the content in chapters five and seven.

Chapter five provides drills that both the student and educator can use to hone their thrust manipulation skills. There are drills in perfecting patient handling/palpation, stance, appreciating end feel as well as use of the core and larger muscle groups for control and speed development.

Chapter seven provides the “meat and potatoes” of the book. Each technique is briefly described, followed by the key recommendations of when to use it, which tests to perform after “red” and “yellow” flags are ruled out and the primary muscle groups that need to be activated to cue the operator and successfully perform the thrust. It is our belief that the larger muscle groups are responsible for speed and control while the hands are simply extensions of these muscles.  

Each technique is divided into five bulleted parts; “patient position,” “therapist position,” “points of contact,” “position for the thrust” and “application of the thrust.” Below each technique the reader will find tips for fine tuning and keys to success. These “clinical pearls” are provided to help the clinician/student perfect their TJM skills. The techniques and fine-tuning pearls are described in significant detail, providing the building blocks for effective and safe TJM to the spine.

Finally, the online videos provide both a “real time” thrust manipulation and a second step-by-step instruction of each technique. Easy online access allows the clinician to view techniques on their mobile phone or tablet from anywhere, at any time.


William H. O’Grady, PT, DPT, OCS, FAPTA, FAAOMPT, DAAPM
Dr. O’ Grady is a nationally recognized expert in the management of spinal disorders and has taught manipulative techniques for over 40 years. He has served as chair of the Board of Examiners for the American Academy of Orthopedic Manual Physical Therapists (AAOMPT), and as an instructor in advanced manipulation technique for the University of Southern California spine fellowship program as well as an adjunct professor at the University of Nevada, Las Vegas.


Discover how the clinical pearls from Bill and Louie’s book can enhance your practice and understanding of spine manipulation. Learn more about Thrust Joint Manipulation Skills for the Spine.

READ MORE William H. O’Grady, PT, DPT - March 21, 2018


Resistance Bands: The Ultimate in Exercise Versatility (Plus, 3 Must-Do Moves)

There’s no shortage of great exercise equipment out there. From stability balls to balance boards to various Pilates props to traditional free weights like dumbbells, most people will have no problem finding something to help them reach their fitness goals. In fact, it might be a bit overwhelming trying to figure out which items to make a part of your routine.

An All-around Champion
One type of exercise tool that almost anyone can use, enjoy, and benefit from is the versatile resistance band. Thanks to its simplicity, there’s not much of a learning curve required. And, because it can be used to perform so many different types of exercises, it can help people of all ages and ability levels achieve many different goals in physical therapy, general fitness, Pilates, and even more elite training.
Sanctband Exercise Tubing with Handles
One of the traits that makes the resistance band so adaptable is its varying degree of challenge. Products like Sanctband® Resistive Tubing with Handles, for example, are available in four color-coded levels of resistance, from light to extra heavy. This allows for progression as your strength increases. Or, if you prefer to work on muscle endurance, you have the option of performing a higher number of repetitions with the lighter bands.

Other products, like the Sanctband Loop Band and Sanctband Super Loop Band, also offer multiple resistance levels but allow for more niche training due to their unique design. Their continuous loop makes them ideal for hip abduction exercise, lateral band walks, sports-specific movements, and more.
Sanctband Loop Band
The “Take it with You” Tool
Another benefit of the admirable resistance band is its portability. Unlike larger, heavier, and more awkward exercise equipment, resistance bands generally fold up easily and can be taken with you wherever you go. This includes the gym, Pilates studio, rehabilitation clinic, or even hotel room while on travels. Some products, such as the Sport Cord® Kit, come with a convenient carrying bag for even easier transport.
Sport Cord Kit
All Muscles, Great or Small
Perhaps the greatest advantage of resistance bands, however, is their ability to provide a total-body workout from head to toe. Whether you want to focus on the larger muscle groups or isolate smaller ones, the exercise possibilities are endless. In the upper body, you can work the chest, back, shoulders, biceps, and triceps. Looking to target the lower body? Hit the quadriceps, hamstrings, hips, glutes, and calves. And don’t forget about your core; resistance bands make it easy to target both upper and lower abdominals, as well as the obliques and low back.  
 
One of the easiest ways to hit all these muscles effectively with your resistance bands is with the Resistance Band Wall Anchor by Bob and Brad. This set of three clips attaches firmly into a wall stud using the provided screws, securing your resistance bands during even the most intense exercise. In fact, each clip can accommodate a pull force of 800 pounds!
Resistance Band Wall Anchor
You can attach the three clips to lower, middle, and upper attachment positions on the wall. Installing at these multiple heights produces a variety of different angles for hundreds of movements. Additionally, each clip features three individual attachment points for your bands or tubes, allowing for even more options.

Created by physical therapists Robert Schrupp and Bradley Heineck, each wall anchor kit also contains a Sanctband resistive band, exercise poster, and access to online exercise videos to get you started. Below are three of the exercises featured on the poster; just a few of the hundreds that can be performed with the wall anchor kit. Get your resistance band setup ready and try them out!*

Resistance Band Lat Pulldown

Lat Pulls (Back, Shoulders)
  1. Attach the resistance band to a wall anchor clip positioned above your head. (Assembly instructions say the clip should be positioned at a height even with your wrist as you reach above your head.)
  2. Stand facing the wall clip. Grab each handle or end of the band and pull toward you, bending at the elbows and using your mid and upper back muscles to perform the pull. You should retract your shoulder blades toward each other and squeeze at the end of the movement.
  3. Hold for a second at the end of the movement, then gradually allow the band to release with control.
Resistance Band Core Twist
 
Core Twist (Abdominals, Obliques)
  1. Attach the resistance band to a wall anchor clip positioned at about shoulder height. (You can also perform this exercise starting from a lower or upper clip position.)
  2. Stand perpendicular to the wall clip. Grab each handle or end of the band with hands together.  
  3. From the waist, using your abdominals and obliques, turn your upper body out away from the wall clip as far as you can, making sure to keep your lower body still and planted.
  4. Hold for a second at the end of the movement, then gradually allow the band to release with control.
Wall Anchor Hip and Glute Extension
 
Hip & Glute Extension (Hips, Glutes, Hamstrings)
  1. Attach the resistance band to a wall anchor clip positioned just a few inches above the floor.
  2. Attach an ankle strap to each end of the band. Tighten the straps firmly around your ankles.
  3. Stand facing the wall clip and learn forward. Place both hands on the wall or solid object for support and balance.
  4. From the hip, using your glutes and hamstrings, pull the band back away from the wall clip. Keep your leg straight and do not bend at the knee.
  5. Go back as far as you can and hold for a second at the end of the movement. Then gradually allow the band to release with control.
The key to successfully performing these and other resistance band exercises is the ability to maintain smooth and controlled tension throughout the entire movement. If you’re used to working with free weights, machines, or pulleys, it’s a different feel and might take some getting used to, but you’ll quickly be able to develop the right tempo.

King of Versatility
Whether you’re ready to take your advanced training to the next level or just looking to increase mobility, endurance, and strength, resistance bands are a great option. They can also function as a warmup tool before your regular routine, or as part of a stretching regimen at the end of a workout to aid in recovery. With all this versatility, they might just become your favorite new exercise partner.


*Always consult with your healthcare provider before starting any new exercise program.   

READ MORE Josh Crane, OPTP Staff Writer - February 27, 2018


Shoulder Health: Exercises for Throwing Athletes

The crisp air descends upon us, and the leaves continue to fall earthward. It’s a beautiful time of year, and also an exciting one for many sports fans. From the MLB World Series to the football season revving into high gear, there’s no shortage of action.

The Golden Shoulder
Whether it’s baseball, football, or other sports that involve a throwing motion, athletes playing at any level know the importance of shoulder health and the risk of injury. In recent years, a strong push has been made in baseball to keep a close eye on the pitch count of players; a big step in the right direction. However, issues from repetitive arm movements can still occur for athletes, especially if proper precautions are not taken.

One of the more common shoulder conditions we hear about is the rotator cuff tear, which occurs when injuries to the muscles or tendons cause tissue damage in this area. The American Physical Therapy Association (APTA) has some good information on the anatomy and symptoms of a rotator cuff tear for those who want to learn more. Additional arm injuries include those to the elbow area, such as a tear in the Ulnar Collateral Ligament (UCL) that can result in the need for Tommy John surgery.

Warmup & Injury Prevention
While there are no guarantees when it comes to preventing injuries, there are a variety of healthy habits that we can practice to help reduce our risks. Proper warmup is certainly essential before playing any type of sport or starting an exercise workout. According to the Mayo Clinic, it can not only help reduce injury risk, but also improve athletic performance.

The warmup helps increase blood flow, raise body temperature, and generally prepare your body for the upcoming activity. The Mayo Clinic suggests that an effective warmup can involve doing the same type of activity you’re about to engage in, simply at a slower pace and reduced intensity. For throwing motion athletes, this might mean functional exercises that mimic the arm’s movement.
  1. Arm Circles. Arm circles are one simple way to increase blood flow and warm up the rotator cuff area. They can be done easily, both arms at once, by just creating small circular patterns. Perform the circles for 20-30 seconds, then reverse direction and perform for another 20-30 seconds.
  2. Arm Swings. Another simple method to ready the shoulder for activity is a basic pendulum movement. Start by holding on to a solid object such as a pole with one hand. Then, swing the other arm slowly out in front of the body, then behind the body, going back and forth. Try to gradually progress the range of motion.
Internal & External Rotation
Perhaps one of the best ways to warm and loosen up the shoulder is internal and external rotation. These movements are excellent for increasing flexibility and range of motion, and can also be key for aiding in injury prevention. Although these exercises can easily be done with resistance bands or resistance tubes, using a pulley system can provide constant, reproducible resistance and a smoother, more functional movement.

The TheraPulley® is a basic but versatile pulley system that can be used at home, while traveling, and on the field warming up before play. Unlike more elaborate systems, it packs up into a bag and can easily be taken with you anywhere you go; a portable “gym in a bag.”

The pulley has two anchors; one is stationary and attaches on top of the door, while the adjustable anchor attaches into the hinged side of the door. This allows for movement in different positions with resistance ranges from 1-20 pounds. Watch the video below to see how it works.

 

TheraPulley is an excellent functional mobility tool helping to improve joint range of motion, mobilize the joints, and increase blood flow to the muscles. The following shoulder internal and external rotation moves are just two of many exercises that can be performed with the TheraPulley.    

1. External Rotation - Elbow at Side
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your elbow and close the door shut.
  • Place the desired weight in the bag. You can use cuff weights and/or household items. The external rotators are sensitive and can get strained if you use heavy weights. Start with light weights (one pound) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing sideways with the targeted shoulder away from the door, grab the pulley handle at waist height and move away from your body. Keep your elbow bent at 90 degrees (forearm parallel to the floor).


2. External Rotation - Overhead
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your shoulder and shut the door.
  • Place desired weight in the bag. You can use cuff weights and/or household items. The external rotators are sensitive and can get strained if you use heavy weights. Start with light weights (one pound) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing facing the door, lift your arm and keep the elbow level with the shoulder. Keep your shoulder elevated and your elbow bent at 90 degrees. Grab the pulley handle and rotate the fist from horizontal level toward the ceiling (vertical position).


3. Internal Rotation - Elbow at Side
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your elbow and shut the door.
  • Place desired weight in the bag. You can use cuff weights and/or household items. Start with light weights (one to two pounds) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing sideways with the targeted shoulder close to the door, grab the pulley handle at waist height and move it to your stomach. Keep your elbow bent at 90 degrees (forearm parallel to the floor).


4. Internal Rotation - Overhead 90/90
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your shoulder and shut the door.
  • Place desired weight in the bag. You can use cuff weights and/or household items. Start with light weights (one to two pounds) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing facing away from the door, lift your arm and keep the elbow level with the shoulder. Keep your shoulder elevated and your elbow bent at 90 degrees. Grab the pulley handle and rotate the fist from vertical position to a horizontal level.


The TheraPulley is adaptable for anyone from professional athletes to rehabilitation patients. It has received support from throwing athletes for its role in promoting shoulder health, including high praise from MLB players such as Seattle Mariners hall of fame pitcher Jamie Moyer. As the oldest pitcher to ever start and win a game in the major leagues at the age of 49, Moyer credits much of his extended career and arm health to the TheraPulley.

Prevention is Protection
Preventive exercise can be extremely beneficial when it comes to shoulder health, regardless of your sport, activity, or level of intensity. Not only does a committed warmup aid in athletic performance (increased range of motion, flexibility, and strength), it can help reduce injury risk and ensure the longevity of the shoulder, one of the most mobile yet least stable joint regions in the body.

READ MORE Yousef Ghandour, PT, MOMT, FAAOMPT - October 24, 2017


Aging Well: Stay Active to Stay Young

One of the biggest challenges with growing older is that we begin to lose our overall body awareness. This unfortunate (and unstoppable) fact is one of the reasons why there is a direct correlation between falling injuries and age.

Let’s try a simple test. Reach both arms straight over your head and point your index fingers toward one another. Now, without looking up, try to touch the tips of your index fingers together directly overhead. Can’t quite get it? It’s okay, most people can’t do it on their first try, but they can get close.

How do you know where your arms, hands, and fingers are, even when you can’t see them? Body awareness. In this case, the sensory receptors (also known as proprioceptors) in your skin, muscles, and joint capsules were communicating with your brain to tell you where your limbs were, even though you couldn’t see them.

This crucial sense is necessary for many of the basic activities and tasks that each of us performs on a daily basis. And while our body awareness is slowly diminishing as we age, all hope is not lost.

That’s because there’s a second contributor to our body awareness ability — and this one’s actually under our control.   

Move It or Lose It
Lack of movement throughout your life is just as bad as, if not worse than, the physical aging process on your body’s internal balance and health systems. Living a life without exercise or physical activity can, simply put, speed up the aging process.

Aging Chart

Look at the chart above. Notice how from birth (the big red dot) as we age, our body awareness abilities are actually increasing (think going from crawling to walking to running as a child). This happens all the way until the age of around 16-18, when we are done growing through puberty and enter adulthood. Then, things start to go downhill, first slowly and then faster as we age.
 
But here’s the good news. Notice the people who follow the path on the red line. They have exercised their entire lives, ate well, and have generally taken good care of themselves. Those on the yellow line decided to ignore exercise and eat poorly. The result? Even though these two groups of people are the same age, one of them is living a fulfilling life while the other has limited functionality.  
 
We can choose to exercise, or we can choose to surrender our body’s mobility.  
 
Movement is Medicine
So we know that movement keeps your body awareness systems activated, your muscles strong, and your mind sound. It can also keep you free from disease, disability, and ailments, and allows you to do what you love. It truly is a medicine.

But what types of movement should we be doing? Are there certain exercises that are better than others when it comes to turning back the hands of time in regard to our balance and body awareness?

The ActivMotion Bar® was a training tool developed to address these exact needs. ActivMotion Bars are hollow and partially filled with ball bearings that shift during movement. This shifting weight allows you to feel and hear your imbalances as you try to keep the bar stable, training your senses and body awareness.



The 4.5lb ActivMotion Bar, the shortest and lightest weight of all ActivMotion Bars, is the easiest to control but still provides a great workout that builds balance, core strength and stability, and body awareness. It’s an ideal tool for active aging exercise and for anyone looking to focus on their proprioception abilities.

Most importantly, the shifting weight more closely imitates the tasks we are faced with in our daily lives. Its dynamic, constant state of motion means that we are always trying to maintain stability; unlike the static, repetitive movements performed with traditional exercise equipment. The ActivMotion Bar is more representative of real life activities such as gardening, tennis, and playing with children, and helps us prepare our body for doing what we love.

The video below features four exercises performed with the ActivMotion Bar. The moves are specifically focused on the development of proprioception and body awareness. Each can be adapted in different ways to allow for varying degrees of challenge.   



Age is But a Number
While there’s probably no such thing as a fountain of youth, that doesn’t mean we can’t do our best to fight Father Time. As they say, age is merely a number. Stay young by staying active; focus on your proprioception abilities with exercises that challenge your body awareness, core strength, and balance. It’s never too late to start, and your future self will thank you.     


About the Author
Derek Mikulski, BS, CSCS, CPT, is the creator of the ActivMotion Bar. He holds degrees in exercise physiology and health promotion, and also has fitness certifications from NASM, NSCA and NPTI. He launched ActivMotion in 2013, aspiring to build a stronger world through innovation grounded in sound fitness and training theory.


READ MORE Derek Mikulski, BS, CSCS, CPT - September 15, 2017


The 3 Most Common Running Injuries & How to Treat Them

Whether you run to reduce stress, beat the clock, or attain a leaner figure, it’s a lifestyle that’s hard to give up…even in the face of injury.

Over one-third of runners sustain at least one soft tissue injury over the course of a year.1,2 The following three types of injuries are some of the most common, and ones that you’ll likely experience at some point if you haven’t already. But don’t fear, we’ve identified therapy products for each condition to help expedite the recovery process.

Iliotibial Band Syndrome (ITBS)
ITBS is an overuse injury that presents itself in up to 12 percent of runners each year, and it is the most common cause of lateral knee pain in running athletes.4 Significant risk factors include downhill running and an abrupt increase in running distance, pace, or frequency.

One of the best ways to tackle Iliotibial Band Syndrome is through myofascial release with a foam roller. Foam roller therapy is an essential aide for several running injuries, including ITBS.3 If you’re new to foam rolling, it can be a bit overwhelming as foam rollers come in all shapes, sizes, and densities. This page provides a brief introduction to foam rollers to help you get started.

Once you’ve found your roller, take advantage of the many educational resources out there that will help you use it. Foam Roller Techniques by Michael Fredericson, MD features color illustrations and clear, step-by-step instructions to effectively massage and stretch a runner’s most important muscle groups, including the IT Band. Check out the video below and see how to massage the IT Band and other sensitive areas with your roller.



Shin Splints & Ankle Sprains
About 10-20 percent of all runners experience a bout of medial tibial stress syndrome (MTSS), or shin splints, at some point during their career.8 For inflammatory conditions like shin splints or ankle sprains, ice, rest, and orthotic shoe inserts are commonly prescribed.

Kinesiology taping, however, offers additional options for pain modulation and return to function. Unlike conventional tapes, SpiderTech® kinesiology tape has the same weight, thickness, and elasticity as human skin, allowing it to work naturally with the body’s own sensory system to reduce pain and provide natural stability. It’s available in more than a dozen pre-cut applications, including designs for the ankle as well as a foot arch and calf combo.  

Another way to address shin splints, ankle sprains, and calf strains is with the OPTP SlantTM. This pair of lightweight foam wedges allows for simple stretching exercises. Their 18-degree incline is ideal for stretching the hamstrings and calves to help with tight fascia and strengthening of the tissues in this region.

Plantar Fasciitis
Plantar fasciitis is the third most frequent injury among runners.5 It is characterized by inflammation in the long tendon at the bottom of the foot, which stretches from the heel to the toes. Although the etiology of this condition is controversial, several risk factors, including high body weight and reduced ankle dorsiflexion, have been associated with increased incidence rates.6 Research suggests that conducting tissue-specific plantar fascia stretching several times a day helps alleviate and prevent pain due to chronic plantar fasciitis.7

With a cradle design that encompasses the foot, the Stretch-EZ™ is a unique stretching aide that assists with plantar fasciitis, as well as calf, thigh, hip and low back strains and injuries. By inserting the foot into the cradle and pulling back, it produces superior dorsiflexion of the toes that stretches the plantar fascia. Since the Stretch-EZ features multiple strap loops, it allows you to safely and easily control each stretch.Half Balls

A lot of runners are told to use a tennis ball or lacrosse ball for their plantar fasciitis. While this can be a viable option, there are plenty of products out there designed specifically for massage of the foot. These Half Balls are the ideal texture and firmness for that purpose. The flat bottom ensures they won’t roll away during use, making it easier to target specific areas for a better massage and stretch of the plantar fascia.

Back Up and Running
Perhaps you’ll be one of the fortunate ones who’s able to steer clear of these running injuries. But if not, you now have some basic knowledge to guide you on the path to recovery. Hopefully, with consistent use of the right therapy tools and a mental approach grounded in patience, you’ll be back out on the pavement and trails before you know it.

* For your safety, always consult with your healthcare professional before starting any type of exercise or stretching program, especially if you have any health concerns. Products mentioned in this article are intended to provide therapeutic relief but do not guarantee cure of condition.


References
1 Buist I, Bredeweg SW, Lemmink K, et al. Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study.
Am J Sports Med. 2010; 38(2):273-280.
2 Rauh MJ, Koepsell TD, Rivara FP, et al. Epidemiology of musculoskeletal injuries among high school cross-country runners. Am J Epidemiol. 2006; 163(2):151–159.
3 Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006; 16(3):261-268.
4 Fredericson M, Wolf C. Iliotibial band syndrome in runners. Sports Med. 2005; 35(5):451-459.
5 Ribeiro AP, Trombini-Souza FT, Tessutti VD, et al. The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners. Clinical Biomechanics.
2011; 26:194-199.
6 Riddle DL, Pulisic M, Pidcoe P, et al. Risk factors for plantar fasciitis: a matched case-control study. Journal of Bone & Joint Surgery. 2003; 85A (5):872-877.
7 DiGiovanni BF, Nawoczenski DA, Malay DP, et al. Plantar fascia–specific stretching improves outcomes in patients with chronic plantar fasciitis: a prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2008; 88:1775–81.
8 Hubbard TJ, Carpenter EM, & Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exercise. 2009; 41(3): 490-496.

READ MORE Josh Crane, OPTP Staff Writer - July 31, 2017


Tools to Improve the Practice: ActivMotion Bar®

The Bar and its Activating Functional Mobility book provide a host of effective exercises for physical therapy patients


When I first picked up an ActivMotion Bar®, I was instantly intrigued. So many ideas came into my head, I spent a few hours testing it out and I was instantly hooked. I brought it to work the next day and started integrating the Bar into the exercise programs of many of my patients – those dealing with balance issues, those with trouble correcting scapular dyskinesia, post-ACL reconstruction patients learning to use full knee extension and maintain their stability in standing, and patients learning to stabilize their entire bodies by connecting their scapula, trunk, and pelvis with dynamic movements.
 
Incredible Sensory Feedback
I use a wide variety of techniques and tools to facilitate and correct functional movement patterns, and I was surprised how the Bar not only fit into each patient’s exercise program but how much better it was than other tools. ActivMotion Bars provide the feedback that our patients need to be aware of and self-correct dysfunctional movement patterns. As we all know, self-awareness plus quality feedback provide the best environment for learning. The sensory feedback provided by the Bar is almost more accurate than we as PTs can be with our own eyes and movement assessment skills. It is more sensitive and more tactile, as a slight hike of the shoulder or a dip of the hip into Trendelenburg can cause the rolling steel weights to shift and let the user know that they’ve lost their stable position. In addition, it gives them feedback when they’re doing the exercise correctly, as they can feel the weights become stable, but not static, inside the Bar. I enjoyed seeing my patients respond quicker, become more motivated, and enjoy their exercise programs more when using the Bar. I soon saw many of my patients carrying the Bar around the clinic and asking to use it even for exercises that had not previously involved the Bar.
 
Creating a Comprehensive Program
When I was approached by ActivMotion and OPTP to come up with a manual for how to apply the Bar to the field of outpatient physical therapy, I felt challenged in creating something that would accurately represent the Bar and all of its capabilities. How do I build a systematic functional exercise program for something that is so dynamic? We collaborated, and eventually came up with a system of three different ways to use the Bar; the first two using the Bar for facilitation and the third using the Bar for eccentric resistance. I brainstormed daily in the clinic and compiled a list of exercises, then categorized them in to the three cardinal planes of motion (sagittal, frontal, and transverse) to provide a comprehensive program of corrective functional movements. The result is Activating Functional Mobility: A Guide to Rehabilitation Training with the ActivMotion Bar.
 
Breaking Down the Exercises
The exercises are divided into sections that each address a common area of instability: Scapular instability, trunk instability, and hip/pelvic instability. Having to hold and stabilize the Bar actually makes every exercise a scapular stability exercise. We commonly refer to the “core” as simply trunk and lower body stability, but it is important to include the scapula as it is the proximal attachment of the upper extremities to the trunk. As there is no inherent joint space or ligamentous stability in the scapulothoracic joint – only muscle attachments – nearly all stability here relies on muscular control. Within each section (scapular, trunk, and hip/pelvic) there are 9 different exercises: three levels of exercises in each of the cardinal planes of motion. From here we can start our patients with a beginner level exercise in any of the planes of motion and progress them from using the Bar to provide tactile feedback to assist with stabilization, to using the Bar for dynamic resistance and eccentric loading of the joint stabilizers.
 
Beginning Level Exercises: Introducing Balance & Proprioception
The beauty of the ActivMotion Bar lies in its versatility. The beginner level of exercises in each section of stability involves using the Bar pressed against the body to physically create a closed-chain connection between the body and the Bar. The tactile feedback of the Bar’s connection to the body as well as the tactile and auditory sensations of the rolling steel weights shifting as the patient strives to find equilibrium help to stimulate the patient’s proprioceptive systems and facilitate a correction of that movement through increased self-awareness. The beginner level of exercises involve keeping the Bar parallel to the floor and are more isolated movements focused on gaining static stability through tactile sensation. A hook-lying bridge while pressing the Bar into the hips is an example of a beginner level sagittal plane exercise. Using the Bar to anchor the upper extremities to the trunk and facilitating symmetry in the hips and pelvis is great for correcting common deviations of lumbar extension, asymmetrical hip extension, and muscle imbalances between sides.



Intermediate Level Exercises: Increasing the Core Stability Challenge
The intermediate level of exercises in each section of stability involves moving the Bar with the body, while also maintaining a parallel position of the Bar to create balance. Exercises in this section require more stability than the beginner section as the patient now has to work to control their body and the Bar together in more active, dynamic movement patterns. The intermediate level progression of the hook-lying bridge is the side plank hip swing, in which the patient maintains a stable forearm side plank with the Bar balanced on the top leg and flexes and extends the top hip. Maintaining a balanced position of the body while moving the top leg and Bar together dynamically improves hip and pelvic stability in individuals with gait deviations. The patient can hear and feel the weights in the Bar shifting if they don’t maintain neutral hip abduction, and they are simultaneously working on trunk and scapular stability to keep their balance.


Advanced Level Exercises: Dynamic Moves, Full Range of Motion
The advanced level of exercises in each section of stability involves tipping, tilting, or swinging the ActivMotion Bar to create dynamic resistance throughout the full range of motion and provide eccentric core muscle activation at the end ranges of the movement pattern. Patients can feel and hear the active resistance shift within the Bar, and use this as feedback to create a rhythm and sequence the movement correctly. As patients tip, tilt, and swing the Bar, the resistance shifts to the end of the Bar and creates an eccentric force resulting in even greater contraction of the major core muscles as they work to control the increased weight. In Activating Functional Mobility, the advanced level sagittal plane hip/pelvic stability exercise is the static lunge with overhead sidebend. The sagittal plane muscles are working to maintain a stable position of the lower extremities, while the trunk and scapular muscles activate dynamically to tip and tilt the Bar and create a sense of dynamic instability for the lower extremities. This exercise could also be considered an advanced frontal plane stability exercise for the trunk and scapular stabilizers.


An Excellent Method of Corrective Exercise
In nearly every exercise performed with the ActivMotion Bar, users are truly required to stabilize their entire body, making the Bar a very effective and efficient tool for facilitating functional movement patterns in corrective exercise. Capturing the benefit of these traits, Activating Functional Mobility contains an overview on the science behind facilitating stability and proprioception in the human body. It also contains information regarding the unique aspects of the ActivMotion Bar, and instruction on cueing fundamentals to assist you in helping your patients use the Bar to its fullest potential.

READ MORE Nicole R. Bushong, PT, DPT, RYT-200 - June 1, 2017


Fight Back: 3 (Inexpensive) Ways to Lessen Back Pain

Low back pain. Millions of Americans have had it or will have it at some point. It’s estimated that it affects nearly 80% of us at one point in our lives (Adriaan Louw, Everyone Has Back Pain, 2015). And then there’s the expense. Billions of dollars go toward medications and surgeries to combat the common condition, though these costly solutions may be temporary or ineffective.

So how do back pain sufferers, or those who might be forced to deal with the formidable beast somewhere down the road, rise to the challenge? Here are three simple and affordable (compared to the alternatives) actions we can take to help prevent or alleviate pain.

1.    Increase Movement
Sitting has actually been called the new smoking. While this may be a bit of a stretch, it goes to show that many experts agree on the dangers of prolonged sitting. The fact is, we’ve become a sitting society (sit in the car on the way to work, sit at work for eight hours, sit in the car on the way home, sit on the couch), and our spines — not designed for this — are feeling the effects.

Due to this stagnant behavior, we tend to suffer from a lack of blood flow and oxygen to the discs of the spine. As physical therapist and research specialist Adriaan Louw says, “Motion is lotion.” When we don’t move enough, we don’t hydrate the discs, leading to more stiffness and less flexibility (think Tin Man from Wizard of Oz).

So what’s the best way to increase movement? Most experts recommend 30-40 minutes of moderate exercise four days per week. But even those of us who are achieving that outside of work might still struggle with back problems if we spend numerous hours plastered to an office chair. To be aware of how long you’ve been sitting at work, set a reminder on your phone, watch, or computer that tells you to get up and move. Take periodic breaks to get water or just get up and walk around.

A great way to increase movement and provide the back with therapeutic exercise is to use a foam roller. Foam rollers provide rejuvenating massage and tension release, helping to hydrate fascia (the body’s connective tissue). These foam roller videos demonstrate how to foam roll to relieve lower back pain.

Can’t foam roll at work? Incorporate some basic stretching into your day as your job allows. Occupational therapist Angela Kneale provides some ideas on how to do this without even leaving your desk in her exercise book, Desk Pilates. Another excellent way to reduce sitting time is to use a raise-lower workstation that allows you to stand while at your computer; many companies are now implementing them.


2.    Improve Posture
Sure, we’ve all heard this one before. But the way we carry ourselves while walking, lifting heavy objects, sitting and sleeping has a direct impact on our spine. And as we know from point #1, many people spend a good portion of the day sitting, so proper posture and alignment is crucial.

The spine’s natural ‘S-shaped’ curve provides the key. Many people tend to slouch forward while at a desk or computer, eliminating their natural curve and proper alignment. It’s so easy to do, it usually happens without realizing it.

Spine Illustration

To counteract slouching, try a posture awareness device that keeps the head from moving too far forward. The OPTP Posture Supporter™ can be worn discreetly underneath clothes to help reduce poor postural habits. It promotes awareness of spinal posture and assists in retraction of the shoulders.

OPTP Posture Supporter
OPTP Posture Supporter™

Another product that helps promote proper sitting position is a lumbar roll. Placed behind your lower back (lumbar region of the spine) on a chair or vehicle seat, it encourages good alignment while providing a comfortable support. One the most popular pain relief products of all time is the Original McKenzie® Lumbar Roll™, a foam cushion that has helped thousands achieve freedom from low back pain. Its simple design is the brainchild of the late Robin McKenzie, a world-renowned therapist who was also responsible for the famous McKenzie Method® of self-treatment.
McKenzie Lumbar Roll
Original McKenzie® Lumbar Roll™

Recent advancements in technology also offer promise for posture improvement. Everything from wearable devices to computer screen sensors have been designed to detect your positioning, providing reminders and feedback for adjustment. Although prices are still fairly high for these new smart gadgets, the market will surely be seeing more of them in the near future.  


3.    Get Stronger
Our muscles can also be a culprit. Because the lower back is not an area of the body that is often worked in most exercise programs, the muscles in this region can become underutilized and weak. It’s important to include forms of exercise that directly address the low back, hips, pelvis, and abdominals, helping to make these core muscles stronger. Stronger back muscles will not only alleviate pain, but also help prevent injury, especially in the case of lifting heavy objects.

Training core muscles can be done in many ways. Simple, classic moves such as sit-ups, squats and planks can be easily performed using just your own body weight. Practices that endorse controlled, focused movement such as Pilates and yoga are also excellent for enhancing core strength. Consider signing up for a class with a local instructor or practicing basic moves at home. Many exercises can be done without the aid of equipment, though these core strength and stability products make excellent props for use during Pilates and general fitness routines. As always, make sure to consult with your physician before starting any exercise program.
io-ball
io-ball

Looking to give your conventional chair an upgrade? All those hours spent sitting at work can be put to better use by simply replacing a regular desk chair with a stability ball. Actively balancing on a stability ball requires the subtle use of core muscles, strengthening them while you’re responding to emails. It’s like a workout while you work!

Ultimately, it’s up to us to take control of our own back pain. It requires effort, but making small lifestyle changes can lead to big benefits down the road. Not everyone will be able to avoid injury, surgical procedures, or hospital stays. But for many of us, a little self-help can go a long way toward achieving an active, pain-free life. As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.” 

READ MORE Josh Crane, OPTP Staff Writer - May 31, 2017


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