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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 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.
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.

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.

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

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

Science Meets Design: The Rollga® Foam Roller

As a company that sells foam rollers as one of its primary products, we get asked the question quite often: “What’s the science behind a foam roller?” Or, as some put it, “Really…how can there be technology in a piece of foam?”

The Rollga® Dynasty, OPTP’s newest addition to its extensive lineup of foam rollers, offers answers to some of these questions. Shaped to fit the body, the Rollga has a unique contour design that allows for targeted, invigorating massage for tension relief and muscle recovery.

As Rollga co-founder Tim Schmidt has noted, Rollga is also the only foam roller to pioneer cross-directional forces; its rounded edges produce multiple angles that stretch and separate the fascia, resulting in fascial shearing.

The roller’s rounded edges also offer protection for the ankle, thoracic spine, and hip while rolling. The less direct application of force means that we can spend more time rolling out fascia and less time hitting bones.

While it might not be the stuff of NASA engineering, it certainly shows how therapy and fitness products such as foam rollers are incorporating scientific smarts into their design.

Watch as Tim explains in more detail how the anatomy of the Rollga affects the anatomy of the body.

READ MORE Josh Crane, OPTP Staff Writer - September 27, 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.

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

3 Foam Roller Exercises You Need to Try

Sure, the word on the street is out that foam rollers are great for self-massage, myofascial release, reducing muscle soreness, and increasing flexibility. But how many times have you thought about using a foam roller during exercise, as opposed to preparation for it or recovery from it afterward?

Magical Versatility
The foam roller can actually be used to perform a wide variety of exercise movements. Who knew? Turns out that a lot of folks in the Pilates and yoga scene did. In these disciplines, the roller is often used to create an instability that challenges the core, promoting strength and balance. Other movements use the roller in ways that increase flexibility and range of motion, such as stretching exercises. Like many fitness products, foam rollers hold possibilities for movement that are nearly endless, limited only by the imagination. But if you’re not feeling terribly creative, don’t worry…we have three great exercises demonstrated below, just waiting for you to try.    

Exercise #1: Toe Taps
This classic Pilates mat exercise is a great way to integrate the core and lower body. Adding the foam roller provides an extra balance and stability challenge, providing even further core engagement. When done slowly with precision, you can really feel the deep core muscles being worked.

How to Perform:
  • Lie vertically along the length of the roller as pictured
  • Rest your hands along the ground for stabilization
  • Keeping both feet together, pull your knees toward your chest as shown
  • Slowly, with focused control, lower one leg at a time until you tap your toes on the floor
  • Return to starting position, then continue to alternate lowering each leg
Description: Foam Roller Toe Tap Demo 1Description: Foam Roller Toe Tap Demo 2

Exercise #2: Push-Up Combo

Push-ups have been long regarded as one of the best exercises you can do for building upper body strength. This spin on the classic takes it to the next level. A great training and conditioning or general fitness exercise, it adds a “pike” component to challenge your core as well as your upper body.

How to Perform:
  • Begin with your hands placed on the roller in push-up position, feet close together
  • Perform a standard push-up
  • Roll the roller in toward you and perform a pike
  • Roll the roller back out away from you, extending into the top position of a push-up
  • Slowly lower yourself back down into starting position, then repeat 
Description: Foam Roller Push Up Demo 1

Exercise #3: Abdominal Crunch
The basic crunch is not an extremely difficult move. But performing crunches while balanced lengthwise along the roller makes for a much different experience. The instability of the roller requires more balance, making it an effective move that promotes a broader range of core activation.

How to Perform:
  • Lie vertically along the length of the roller as pictured
  • Place your hands behind your head
  • Slowly curl upward using your abdominal muscles
  • Don’t go too far forward; keep tension on the abs and avoid straining the neck

Looking for more?
Ask your fitness instructor if he/she is aware of more ways to use the foam roller in your exercise routines. Pilates instructor and integrative health coach Angela Kneale also has some great exercises for the foam roller in her books PRO-ROLLER Pilates Essentials and PRO-ROLLER Pilates Challenge. And don’t forget the plethora of foam roller exercise videos out there that can help you put that roller to good use. With so many ways to use the foam roller, you’re sure to enjoy all the creative challenges that it offers.

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

Goop Summit: Food, Foam Rolling & Everything Wellness

You might have heard about goop, Gwyneth Paltrow’s ambitious project that encompasses all things trending in the healthy lifestyle space. From content to products, the goop website and its various forms of outreach embrace topics such as clean-eating recipes, fashion, mindfulness, travel, and fitness. Here’s more about goop and their upcoming wellness summit scheduled for June 10, 2017 in Los Angeles, California.

The Scoop on goop
Actress Gwyneth Paltrow started goop as a weekly newsletter in 2008. According to the goop website (goop.com), she wanted “A place to organize her unbiased travel recommendations, health-centric recipes, and shopping discoveries for friends, and she also wanted to get her own questions—about health, fitness, and the psyche—answered.” The endeavor grew and has now become, as the website says, “A fully formed lifestyle site, offering a tight curation of products and content.”
Going All-In on Wellness
In goop Health, goop’s upcoming wellness summit, is being held on June 10 in Los Angeles. The event will share an array of healthy living content in the form of guest speakers and breakout sessions. Although just one day, the in-depth event promises to be packed with valuable information in the form of “…panels, keynotes, and restorative interactive sessions from the health-defining doctors and experts we rely on at goop.” Attendees will also get exclusive access to a market set to include beauty products, food companies, wellness products, and more. As the site says, “In goop Health brings our most requested and shared wellness content to life.”
Foam Rolling: Art & Science
The event will feature a number of wellness sessions led by health professionals. Topics include Crystal Therapy, Mani Time, I.V. Drip, Aura Photography, Flower Remedy Station, Sound Bath, and The Foam Rolling Physique. The Foam Rolling Physique session will be led by fascia and alignment expert Lauren Roxburgh, dubbed “the body whisperer” by goop. According to the website, Lauren will take participants “Through a revitalizing roller routine designed to flush toxins from the lymphatic system, reduce pain, and diminish cellulite — while lengthening and toning the body.”
While it might sound like a foreign concept, it’s one that Lauren Roxburgh has perfected. The certified Structural Integration practitioner and celebrity trainer released her first exercise book just a little over a year ago; Taller, Slimmer, Younger: 21 Days to a Foam Roller Physique. All of the book’s movements utilize the foam roller, and are part of a system based on the Rolfing “10 Series” combined with elements of Pilates. The program guides the reader through a series of foam rolling techniques for a balanced, aligned and more youthful body, as well as a calmer state of being — all in just 15 minutes a day over the course of 21 days.
Lauren, who was named by Shape Magazine as one of their "50 Hottest Trainers in America," developed her signature technique as a way to help busy clients with body transforming, muscular sculpting, stress releasing, and fascial remodeling. Her quest for the ideal foam roller eventually led her to OPTP, where she collaborated to develop the LoRox Aligned Roller™. The unique foam roller features raised, circular bumps that aid in lymphatic drainage and decreasing inflammation. Not only will the LoRox Aligned Roller be used in Lauren’s session at the event, but attendees will receive complimentary goodie bags that include a portable version; the LoRox Aligned Travel Roller™.

The Who’s Who of Health
Anyone attending In goop Health will have an amazing opportunity to see and hear from some of the biggest names in the industry. Wellness experts and celebrities that will be in attendance include:
  • Tracy Anderson, fitness trainer
  • Dr. Robin Berman, psychiatrist
  • Tory Burch, CEO & designer, Tory Burch LLC
  • Cameron Diaz, actress, author, advocate
  • Dr. Steven Gundry, surgeon & author of the Plant Paradox
  • Dr. Alejandro Junger, founder, The Clean Program
  • Jenni Konner, writer & Lenny Letter cofounder
  • Elise Loehnen, Head of Content, goop
  • Seamus Mullen, chef, restaurateur, author
  • Dr. Amy Myers, functional medicine practitioner
  • Gwyneth Paltrow, CEO & founder, goop
  • Esther Perel, psychotherapist
  • Nicole Richie, entrepreneur, philanthropist, actress
  • Dr. Habib Sadeghi, integrative practitioner & Be Hive of Healing cofounder
  • Dr. Sherry Sami, integrative orthodontist & Be Hive of Healing cofounder
  • Dr. Oscar Serrallach, family practitioner
  • Dr. Phil Stutz & Barry Michels, psychotherapists & authors 
Being There 
Although the trendiest, health-forward folks in LA will be attending In goop Health, most of us won’t be so lucky. The summit has three ticket price levels offering a range of experiences, but all three packages recently sold out according to a check of the event’s webpage. We’ll just have to live vicariously through the photos and event summary sure to come on social media and the goop website.

READ MORE Josh Crane, OPTP Staff Writer - May 25, 2017

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