Excel Physical Therapy is excited to offer an electronic version of our January Newsletter
This month’s issue, “Is Your Lower Back Ready For Winter” is filled with great information and tips for maintaining a healthy back.
All posts by Excel Physical Therapy
Balance & Dizziness: How You Can Prevent Falls
Falls are not a normal part of aging. In the vast
majority of cases falls are easily preventable.
Learn some tips to help prevent falls and
keep yourself safe at home.
Read the full article in our digital flipbook, Excel PT: Balance & Dizziness
Foot Focused: The Importance of a Strong Foot Core System
Whether you are a school-aged child with chronic ankle injuries, a competitive athlete wanting to improve your skills, a “stand all day” hard worker with lingering back pain, or a retired grandparent concerned about changes in your balance, there is potentially a shared quality among you: a weak foot core system. Too often, the strength of the foot is completely neglected in exercise training programs. Recent research has pushed to bring attention and understanding to the importance of foot strength in treating musculoskeletal injuries and balance impairments.
The foot is a complex structure that serves many diverse functions. It is rigid, dynamic, and flexible in adapting to the frequently changing demands.1-3 Researchers equate the foot core to the well-known lumbopelvic core, proposing that the concept of core stability can be extended to the arch of the foot.1 Of the foot’s 29 muscles, 20 are categorized as intrinsic muscles that control movements in the foot.2 These intrinsic muscles are the local stabilizers that run along the foot’s bottom or plantar surface, making up four core layers. Without proper functioning of these muscles to provide stability, the foundation becomes unstable and misaligned, resulting in abnormal movement of the foot, ultimately leading to foot-related1 and lower extremity-related problems.2
Foot core training has been found to have positive benefits for reducing the risk of injury and improving performance. Variations in foot posture correlate with pelvic alignment, lumbopelvic muscle activation during walking, and transmission of force during running, all of which can lead to low back pain.4 Foot core training has resulted in increased performance in 1-legged jump distance, greater vertical jump height, and shorter 50-meter dash time.5 Furthermore, foot strengthening can alter running performance by increases in quadriceps activation6, muscle volume, and vertical impulse.2
Another essential role of the foot core is the system of sensory receptors located in the plantar fascia, ligaments, joint capsules, muscles, and tendons. The sensory system of the foot is critical to gait and balance. The alignments of the intrinsic muscles along the plantar surface provide immediate sensory information via a stretch response about changes in the foot’s posture.1 Specific training of these muscles via a short foot training program over the course of 4 weeks has resulted in reduced arch collapse or flattened arch and improved dynamic balance.7 Research suggests that foot and ankle strength exercise training may improve balance and functional ability and reduce the risk of falls in older adults.8 In younger populations, 4-week training of intrinsic strength during balance exercise demonstrated improved function in those with chronic ankle instability.9
Continued research introduces promising interventions for foot core training, offering substantial benefits to several populations with various conditions and goals. Excel Physical therapy can help you begin to stand strong on your feet by providing an individualized program based on your specific needs using research-proven evidence.
Jessica Hoerr, PT, DPT
- McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015; 49:290. Doi: 10.1136/bjsports-2013-092690.
- Taddei UT, Matias AB, Ribeiro FIA, Bus SA. Effects of a foot strengthening program on foot muscle morphology and running mechanics: a proof-of-concept, single-blind randomized controlled trial. Phys Ther Sport. 2020;42:107-115.
- Tas S, Unluer NO, Korkusuz F. Morphological and mechanical properties of plantar fascia and intrinsic foot muscles in individuals with and without flat feet. J Ortho Surg. 2018;26(1):1-6. Doi: 10.1177/2309499018802482.
- Mentz HB, Dufour AB, Riskowski JL, et al. Foot posture, foot function and low back pain: the Farmingham foot study. Rheumatology. 2013;52:2275-2282.
- Hashimoto T, Sakuraba K. Strength training for the intrinsic flexor muscles of the foot: effects on muscle strength, the foot arch, and dynamic parameters before and after the training. J Physc Ther Sci. 2014;26:373-376.
- Kean CO, Behm DG, Young WB. Fixed foot balance training increases rectus femoris activation during landing and jump height in recreationally active women. J Sports Sci Med. 2006;5:138-148.
- Lynn SK, Padilla RA, Tsang KK. Differences in static- and dynamic-balance task performance after 4 weeks of intrinisic-foot-muscle training: the short-foot exercise versus the towel-curl exercise. J Sport Rehabil. 2012; 21:327-33.
- Spink, MJ, Fotoohabadi MR, Wee E, Hill, KD, et al. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Arch Phys Med Rehabil. 2011;92:68-75.
- Sauer LD, Saliba SA, Ingersoll CD, et al. Effects of rehabilitation incorporating short foot exercises on self-reported function, static and dynamic balance in chronic ankle instability patients. J Athl Train. 2010;45:S67.
View our flipbook for the full article, Excel PT: Foot & Ankle Pain
Tips for Picking the Right Shoe for Walking or Running
A lot of people are interested in improving their fitness by adopting a walking program, but sometimes don’t know how to start. For many of us, it can be really scary and a bit intense to think about moving more and making changes to improve our health and fitness. But, where do you start? How long do you walk? How fast? How often? There can be a lot to think about, which can be quite intimidating.
Everyone Starts Somewhere
First, talk with your PT about starting this program!
Research shows total steps are what matters most, not speed. What’s the recommended amount of steps? 8,000 steps per day! More movement equals better health. If you are active, stay active. If you need to get more active, here are some tips:
- Start slow! Gradually increase your activity weekly
- Walk with a partner or in a group
- Go at your own pace
- Wear good shoes
Check out this video for tips for choosing the best shoe featuring Dr. Nicholas Romansky, DPM from Healthmark Foot & Ankle Associates. Running shoes are for walking as well. Running shoes are designed to help manage the stress of running, making them perfect for walking.
In Good Health
Is Your Back Pain Really Coming from Your Back?
Have you ever had pain in the base of your spine, going into your buttock, pelvis, or leg? Everyone says it’s your back, but is it? How do you find out?
The key to resolving your symptoms is an accurate diagnosis. Let me walk you through the in-depth evaluation that you will receive at our office. We start with the McKenzie Method of Mechanical Diagnosis and Treatment by taking a thorough history of your pain and any other issues such as numbness, tingling, unsteadiness, and falls or trauma. We then look at your sitting, standing, walking, and sleeping posture to see if your upper body, legs, or pelvis are shifted or tilted. We next check your sensation and your reflexes. While standing, we assess your ability to bend forward, backward, rotate and side bending to each side, once and up to 10 repetitions while carefully assessing the effects on the location and level of your symptoms. Then, while lying down, we check your spine flexion and extension motion, strength, and joint mobility. We may perform a prone instability test if we suspect you have weak core muscles that are not properly stabilizing your spine.
Next, we move on to check the flexibility and strength of your hip in all 6 directions as well as your hamstring flexibility and dural tension. If your symptoms are in the sacrum, we may add sacroiliac joint testing. We also fully assess your motion and strength in your knees, ankles and even your toes. We will check for any tenderness in the regions where you have symptoms to determine the status of the back and hip muscles and tendons. If you have X-rays or MRI results, we do integrate those tests into our assessment; however, our full evaluation is the key to knowing what motions cause and what motions will improve your symptoms.
We then combine your personal history with your full evaluation results, to arrive at your specific PT diagnosis and custom treatment plan. We start on the first day with hands-on treatment for soft tissue and joint mobilization, education in proper posture, and instruction in a home exercise program. Often, we find that patients that have back symptoms that peripheralize or move into the leg with the repeated motions have symptoms caused by lumbar or lumbosacral discs protruding on the nerves.
Sometimes we find that patients have a large imbalance in the strength and flexibility of hip rotator muscles, such as the piriformis muscle. A tight piriformis muscle can cause piriformis syndrome where the sciatic nerve gets compressed under a tight piriformis muscle. Other times, we see the pelvis tilted forward making it difficult to stand straight, and find that the patient has a tight iliopsoas muscle. The iliopsoas muscle is a hip muscle that originates on all the lumbar vertebrae and a tight iliopsoas can create a lot of back pain! You may have weak core muscles that are not properly stabilizing your spine and your PT might work on your transverse abdominal muscles and other core muscles to stabilize your spine. Bottom line, you may have pain originating from your lumbar spine, sacrum AND/OR your back or hip muscles.
Your personalized one-on-one evaluation at Excel will let you know what is causing YOUR pain and get you the most effective treatments such as the McKenzie method, stabilization, Graston Technique or Active Release Therapy. Our mission is to get you BACK to doing what you want to do pain-free!
Jean Scott, PT, DPT, OCS, Cred MDT, Graston Cert, ART cert
2019 Medicare MIPS Program Exceptional Performers
We are pleased to announce that Excel Physical Therapy has achieved Exceptional Performance in the 2019 Medicare MIPS program. The MIPS program tracks the clinical success of medical providers in improving patient function. As ‘Exceptional Performers’, our therapists have successfully proven that we are one of the top providers for getting patients better.
A Message from Excel CEO Kristin Mullen
“There is nothing healthy about racism. It’s a disease of the heart and mind that has infected not just people but customs, systems, and laws. There is no vaccine. We must be the cure.”
—-APTA President Sharon Dunn, Pt, PhD, Board-Certified Orthopaedic Clinical Specialist
Excel acknowledges that our nation and each one of us, is experiencing an extremely difficult time right now following the most recent death of George Floyd at the hands of law enforcement. This is but one recent incident in a long line of individuals who faced unjust deaths that include, Breonna Taylor, Botham Jean, Atatiana Jefferson, and the list goes on.
Please allow me to be clear, Excel does not tolerate racism or discrimination in any form.
As our community raises its voice to draw attention to this issue and start a catalyst to mitigate the unequitable treatment that exists in our society, there have been many that have used the platform to thwart these efforts through violent activity. Excel has placed the safety of its patients and team members as a priority, by closing clinics when it was not deemed safe, adjusting schedules to abide by curfews and adding protective measures to clinic facilities where needed.
We are all experiencing the anguish in many different ways, yet there is so much that binds us together, even as we see division amongst our nation’s people.
Healing comes to us through various avenues and there are many outlets to contribute to our community’s healing in a way that will bring about transformation.
The services in which each of our physical therapists deliver to anyone in need of our care, will always continue to be provided in a way that is inclusive, compassionate, individualized and expert. That is unwavering. We take pride in the values we uphold each day and our Excel leaders are here to listen, and to provide support, now and always.
Yours in Hope, Joy and Health,
Kris Mullen, CEO Excel Physical Therapy
Learn About the Impact of Being Sedentary in our June 2020 Newsletter!
Learn about the impact of being sedentary and how to relieve aches and pains with physical therapy in our June 2020 patient newsletter!
Learn How to Manage Pain, Inflammation & Your Immune System in our May 2020 Newsletter!
In this time of pandemic with COVID-19, learn how to manage pain, inflammation and your immune system with physical therapy in our May 2020 newsletter!
Learn the Benefits of Natural Pain Relief in our April 2020 Newsletter
Learn more about Physical Therapy as a Natural Pain Relief Solution in our April 2020 Newsletter