Physical Therapy

Summer is finally here! Which means it is time to get outside and enjoy the sunny days. For you that may mean heading to the river, traveling across the mountains, or hopping on an airplane. If you are like me, that means heading to the back yard. Our family enjoys lounging around in hammocks and cooking on the Traeger.

Before you can enjoy that awesome yard you need to get it looking good. Which, in the Pacific Northwest, means you need to power wash. Here are the top tips to keep in mind to keep your back, neck, and hands pain free while sprucing up the house and yard.

1. Stand up straight – Keep your spine aligned while you are chasing after that dirt. Usually people start off with really good posture and great alignment in their spine. It is over time when people are most likely to lose that good control. You may notice yourself bending over to get the wand closer to the dirt. Or you may notice that your back is getting fatigued which is causing you to bend over. Either way, maintaining good alignment with you head over your shoulders, your shoulders over your hips, and your hips over your knees will decrease your risk of low back and neck pain when you are done.
2. Take breaks every 30 minutes – Power washing involves holding your body in a very specific position and taking small steps to move the wand. Your entire torso stays in basically the same position for the entire time you are power washing. You need to take a 2 minute break every 30 minutes to allow your body a break from that position. During the break you can do some different movements including gentle arm circles, roll your shoulders out, bend your spine forward, and mini squats to get your body moving in a different direction.
3. Stay hydrated – When your muscles are working hard to stabilize your body and control the wand while power washing they need proper nutrition to keep up the good work. Water is what delivers the nutrition to the muscles. Keep a water bottle close at hand for those break times so you can stay hydrated and avoid muscle cramping.
4. Take care of your hands – Holding the trigger on the wand down for even 30 minutes at a time can be challenging to our hands, as they aren’t used to working in that way. Add on top of that keeping the wand pointed at the location you want and you have got some hard working hands/arms. Take good care of your hands by giving the regular rest breaks every 30 minutes. Get them moving by making a fist and then spreading out your fingers as far as possible. Another tool that can help is what our family calls the “power washing rumba”. Seen on the right hand side of the picture above, this device at the bottom of the wand helps to focus the water to clean flat surfaces. It makes cleaning the pavement much quicker which decreases the time needed to power wash.
5. Get moving – Once you are done with power washing make sure you get your body moving. Take a walk around the house or better yet around the block. Get those arms swinging, those shoulders moving, and the hips stretching. Your body will appreciate the movement as it helps the water pump nutrition to the muscles and joints. Moving after power washing will also help to decrease soreness you may experience the next day. The movement does not have to be aggressive but it does need to encompass the entire body. So, grab your power washing pal and take a lap around the neighborhood.

If you find yourself waking up the next day very sore from power washing keep the above tips in mind. Make sure you drink plenty of water, stretch throughout the day, and do some cardiovascular exercise like walking or running. Soreness after an intense workout (which power washing is) is normal. However, if that soreness turns into pain or lasts more than 48 hours it’s time to get some help — before the pain becomes an issue that lingers around for months. Lingering pain can lead to abnormal movement patterns and decreased activity level. If you find yourself with soreness that lasts longer than 48 hours or pain after power washing feel free to give us a call. We can help get your body moving correctly which not only eliminates pain but prepares you for all of your summer activities.

Happy power washing and happy summer!

We are in the final countdown for the first ever “Be the Hope XOXO” walk for all cancers here in our very own Maple Valley. Created by the Valley Girls and Guys, this walk is raising money for cancer awareness, treatment, and research that stays in our local community. PT4EB is honored to be a part of the post-walk treatment team offering free calf, quad, and hamstring massages to all the walkers.

What does it take to train for an 18 mile walk?

The following are the top 5 tips to keep in mind before beginning a walking program.

1) Start with the right shoes – Many people believe that walking can be done in just any shoes but I guarantee bad shoes lead to foot, knee, hip, and low back problems in the future. Start yourself off on the right foot by heading out to find a pair of proper walking shoes for you. In general you are looking for a good level of support balanced with cushion to help absorb the shock. If you are planning on spending most of your time on trails, look into a trail shoe that has a better sole to handle the rougher roads.
2) Use a comfortable pace – When you are beginning a new program you may be very excited and ready to charge forward. This can lead to quick injuries that will end up sidelining you for so long that you lose your motivation. Start with a pace that gets your heart rate up but you can easily talk through.
3) Grab a friend – Having someone on this journey with you gives you someone to talk to during your walks to make sure that you are keeping your breathing steady. It will also help increase your accountability. Have you ever said you were going to start a walking program only to find that months later you still hadn’t started? Having a partner can help keep you accountable. You can even enlist your dog to help. Once they get used to daily walks they can be great motivators to keep you going!
4) Drink more water – The great thing about exercising is that it makes us thirsty, so we want to drink more water. Make sure you are drinking enough water to meet your increasing exercise demands. How much is enough? Well, there are several formulas but I prefer to keep it simple. Drink enough water that your pee is clear and then keep drinking water to keep it clear.
5) Keep going and progress regularly – If you are new to exercise, or it has been awhile since you have used a regular exercise program, start off with 1-2 miles a few times per week. As you build up your endurance, add ½-1 mile per week. When you increase your distance you might have some increased muscle soreness, but you should not have increased pain in your muscles or joints.

Muscle soreness is normal after starting an exercise routine but pain is another matter completely. Muscle soreness feels better after you are moving around and stretching out. Pain may increase the more you move. Painful muscles do not like to be stretched. Stretching them may actually make the pain even worse.

If you find yourself having increased pain with a new exercise program we can help with that. We will help locate what is causing the pain and get you on a personalized plan to get you back to your training program. At PT4EB we believe that movement is life. So, we design all of our treatments and exercise programs to get you back to the movements your life requires.

For all those who are joining this walk, we here at PT4EB give you a standing ovation. We hope you will come see us after your walk to help work out any muscle soreness in your calves and legs. Or just stop by so we can give you a high five and thank you for walking.

It was dark the first time I saw our house 12 years ago.  I couldn’t see the backyard very well.  We live on a pie shaped piece of a cul de sac so the backyard light only went so far that first night.  I remember asking Matt “How’s the yard?”

His reply – “The yard is fine”

You may or may not be surprised to hear – the yard was not fine!  The yard was a hot mess.  There were planter boxes that had not been put together well and were never maintained.  There was a spot where the playground used to sit that was covered in wood chips.  And the retaining wall was bowing outward.

Imagine my shock the first time I saw our new yard – on the same day we signed the paperwork to make it ours.  But we loved the house so we could figure out the yard.  Or so I thought.

We spent 10 years trying to figure out that yard.  We raked up all the wood chips and planted seeds to renew the grass.  We tore up the planter boxes and used the dirt to make flower beds.  And we completely rebuilt the retaining wall so it fit together correctly.

We weeded non-stop to try and stay on top of it.  And every year I bought different plants trying to get my yard to grow.  I had friends give me plants that they were sure would survive.  Most of them did but some of them, well, not so much.

I spent 10 years trying to make this yard into an enjoyable place to hang out.  I bought different patio furniture, planted, weeded, trimmed – in short, I spent a lot of money, time, and energy.  And no one wanted to hang out in my backyard.  Except the dog.  Who does not have very discriminating tastes.

I was so frustrated that when Wendee entered my life I sprung at the chance to get help with my yard.  Have you ever been to that point of frustration that you are willing to do whatever it takes to find an answer?  Well, Wendee had the answer and a magic touch with plants.

Wendee came out to my house for the first time a year ago and we spent the entire day playing in the yard.  She tasked me with rebuilding the “river stream” we have running around the yard.  She helped me build a pea gravel path to get to the air conditioner.  Wendee decided that the extra rock needed to be used to build a pathway to the little table in the corner of the yard and we should plant succulents along the side.  Along the way, she trimmed, pruned, weeded, and worked her magic on my yard.

Then she taught me about the difference between mulch and bark.  Let me just say, mulch is good and helps your yard.  Bark is just pretty and washes away.  Trust me, mulch!

After our first day together, the yard looked amazing and I finally found some peace in spending time in the backyard.  The mulch greatly reduced the number of weeds so the yard stayed weed free for the rest of the year.  Plus, the bushes weren’t going out of control so it made mowing way easier.  For the first time in 10 years we actually hung out in the backyard.

Wendee has been back twice since then and each time my yard looks better.  This spring I almost didn’t have Wendee come out because the yard was looking great.  But a few hours of her magic hands and my yard looks amazing! I am so glad that I had her over and so grateful for how she magically transforms my yard into an oasis that we enjoy hanging out in.

Why didn’t I hire Wendee sooner?  Well, you see, I thought I could do it on my own.  I mean, it’s yard work.  I grew up doing yard work.  I can pull a weed!  And it seems ridiculous to pay someone to do something so simple.  But I didn’t weight the cost of the stress I was carrying from having a yard that I didn’t enjoy.  The frustration from not being able to do yard work right.  I mean, who can’t do yard work right?

Three lessons from my DIY experience:

1. After 10 years it’s time to give up and hire a professional. How much time, energy, and money are you willing to spend before you solve this problem for good?
2. Professionals make their work look easy and the solutions appear out of thin air. We pay people good money not just for their skill but also the expert knowledge they carry in their heads.
3. Getting the problem taken care of clears up head space. What are you focusing on that could easily be taken care of by someone else?  What would clearing that space allow you to create?

Sometimes we are like a dog on a bone in our fierce independence to get something done by ourselves in our own way. What would it look like to allow someone to help us with that problem so we can put our brains to work on more interesting tasks?

Let me know if you need help solving any body aches, pains, or movement limitations.  Let’s free up your body so your mind can go and do great things.  And, if you need a landscaper, please let me know.  I am happy to give you Wendee’s contact information.

Have you ever been to see a Physical Therapist with complaints of low back pain and they are watching you walk or talking to you about your foot?  Have you ever questioned (to yourself or out loud!) why they are discussing your knee movement or hip strength when you came in because you can’t sleep because of back pain?  Have you ever wondered what is going through their minds?  I am here to tell you –

It’s all connected! There are two bones, the tibia and fibula, that run between the ankle and the knee.  As we age, all bones become stronger and less flexible.  By the time we are adults, the bones have very little “give” or movement in them.  So, any movement that occurs through the ankle is transferred through these bones up to the knee.

Helping to move the foot and knee through daily activity are several muscles.  Many of these muscles start just below the knee and cross the ankle joint to insert into the foot.  These are the muscles that help your foot move up, down, and side to side.  The big muscles in your calf even cross above the knee joint!

On top of all this you have fascia.

Have you ever tried to pull fat off a raw steak?  You know that silvery white stuff that firmly holds the fat onto the steak – THAT is fascia!

The fascia is what holds everything together under our skin. There is fascia throughout our body and there are thick sheets of fascia that help to keep the lower leg connected – to each other and to the rest of the body.

Moving on up the leg, we have the largest and strongest bone in our bodies – the femur!  The weird thing about the femur is that it has a ball at one end and a straight edge at the other end.  Also, it doesn’t run completely up and down.  Instead, it runs at an angle which makes the hips wider than the knees.  So, any force that is coming up through the ankles and into the knees has to take a turn before it heads into the hips.  This has the potential to be a turn for the worse!

Between the hip and the knee we find many big, strapping muscles – the quadriceps (in the front) and the hamstrings (in the back).  These big muscles help to get the hip and knee moving which allows the foot to be in the optimum position to walk, jump, run, or play.  If these muscles are having any problems then the foot has difficulty connecting to the ground.  The reverse is also true – if the foot has any restriction that limits motion then the knee/hip will not receive the required motion they need.  The problem that starts in one area can easily lead up (or down) the chain!

Remember that fascia?  Well, along the outside of our leg we have the largest single piece of fascia in our bodies – the iliotibial band (or ITB for short).  The ITB is a thick, fibrous band that starts from the gluteus medius on the side of the hip and inserts into the fibular head.  The ITB directly transfers force from the lateral hip into the knee joint – and vice versa!  This band can particularly be a problem for women as our hips are wider than our knees.  Pro tip – pain in the ITB may be due to weakness in the gluteus medius!

Moving up the chain and headed towards the low back, we cross the pelvis. The pelvis is made of 3 bones.  One ilium on each side and a sacrum in the middle.  The spinal column stacks up onto the sacrum.  So, the 5 lumbar vertebrae stack up onto the sacrum which is attached to an ilium on either side.

What holds all that together? There are muscles that help to connect the lumbar spine to the sacrum, the ilium, and the femur.  There are muscles to connect the ilium and the sacrum (this is often called your pelvic floor).  And, of course, the silvery/white fascia helps to hold all these bones, muscles, tendons, and ligaments together.

Now, I don’t mean to get controversial here but I am just going to say it – the ilium move on the sacrum!  If that makes sense to you – HOORAY!  This is a huge discussion among health care practitioners that has received endless debate.  You see, the ilium and sacrum are connected by very thick, fibrous ligaments that allow for very little movement in the pelvis.  This helps to provide stability for the pelvis while you are performing daily activities.  However, too much movement can be a big problem.

Back to our foot-low back connection.  If your foot doesn’t interact with the ground the way it should, this can cause an immediate pain (as in our example of stepping off the curb above) or cause a wearing of the joints over time in your low back.  If you challenge your muscles to work harder by walking in the sand, this can actually improve the muscle control through the foot that decreases the stress on the joints in your low back.

As you can see, the bio-mechanics through our legs are complicated. Each bone, muscle, and joint interacts with other bones, muscles, and joints to allow us to move through our environments.  This is why your body deserves a full, comprehensive evaluation of the pain or dysfunction you are experiencing.  And why Physical Therapists look at your foot, knee, hip, and pelvis while talking about your low back pain.

Physical Therapy utilizes art and science to create a specific program for restoration of each patient’s physical function. Later blog articles will focus on the ART while this article is focusing on the SCIENCE. Physical Therapists are passionate about finding, confirming, and using optimal treatment strategies for their patients. We are greatly indebted to the researchers who dedicate their lives to helping us in that pursuit.

The Journal of Orthopaedic and Sports Physical Therapy (JOSPT) is one of my “go to” journals for good, sound research. In June 2017 they published a new Clinical Practice Guideline for Hip Osteoarthritis. What does that mean for you, the person living with hip osteoarthritis? That means that a bunch of really smart people combed through all the research and made recommendations for people like me to use when helping the most important people involved – our patients! And, here is what they said…

How do we diagnose Hip Osteoarthritis? Adults over the age of 50 with moderate anterior or lateral hip pain during weight-bearing activities, morning stiffness less than 1 hour duration after waking, hip internal rotation (IR) range of motion less than 24 degrees or IR and flexion 15 degrees less than non-painful side, and/or increased hip pain associated with passive hip internal rotation. What is hip internal rotation? Lie on your back with one knee and same hip bent to 90 degrees. While maintaining this hip and knee position, try to bring your foot out to the side. Compare the motion to the other side.

What tests and measures should be included in the evaluation? You should be assessed for physical function measures, balance performance/risk of falls assessment, active range of motion for the hip, and muscle strength.

How should we treat Hip Osteoarthritis? Manual therapy should be used to improve hip mobility. This should be followed up with flexibility, strengthening, and endurance exercises to address impairments in hip range of motion, specific muscle weakness, and limited muscle flexibility. Patients should receive education on activity modification, exercise, weight reduction when overweight, and methods of unloading the arthritic joints. Bracing should be used as a last resort if these forms of treatment are not effective.

If you have any questions regarding these recommendations, please feel free to contact us here at Physical Therapy for Everybody – amykonvalinpt@gmail.com or (360)367-0970.

If you would like to read the complete article:
http://www.jospt.org/doi/full/10.2519/jospt.2017.0301