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.
Category Archives: Health
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.
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!
Latest Update on COVID-19 from Excel CEO Kristin Mullen
To Our Patients,
As part of our ongoing efforts to communicate with our patients during this critical time period, we wanted to share several updates since our last correspondence and hope that you and your families continue to remain healthy and safe.
The past several weeks have marked a challenging time for each of us, as we deal with unprecedented actions and new ways to go about our daily activities. During this time, our focus is on our patients and we remain committed to servicing the needs of our patient population during this time of crisis. While we do not know how long these conditions will last, we have taken multiple steps to ensure that we continue to remain available for all of our patients, and do so in the safest way possible.
Our goal is to continue to balance the need to assist all of our patient population, including those who suffer in pain and require manual therapy or stimulation which can only be performed in a clinic setting, while also offering TeleHealth services to assist patients as a temporary means to deliver care and also relieve any added burden to the health system. We continue to monitor directives from Governor Tom Wolf and Secretary of Health Dr. Rachel Levine, who detail in their most recent update dated March 30th that individuals are allowed to perform tasks essential to maintain health and safety, which includes visiting a healthcare professional, as well as travel to a life-sustaining business such as Excel Physical Therapy.
As of Monday, March 30, 2020, all of our Excel clinics have reopened under new safety protocols, in which our physical therapists are available to perform in-clinic treatment and we are currently accepting calls and scheduling appointments for patient visits. These protocols include new precautionary safety measures and implementation of patient screening areas that meet and exceed the recommended guidelines from OSHA (Occupational Safety and Health Administration) and the CDC (Centers for Disease Control). A list of our specific measures is included in this email and can be found on our website in our COVID-19 information section. Our website also includes a short video which details the new process a patient will experience upon visiting our clinics.
We have also introduced a new TeleHealth service as of Monday, March 30, 2020, to accommodate patients who may be unable to visit a clinic setting, or for higher-risk patients, such as those over age 65, or those who are immunocompromised, to obtain treatment until such time that they are able to obtain in-clinic therapy. Many insurance providers have recently relaxed their requirements to allow for payment and wider use of TeleHealth Services. The Services area of our website provides additional details about TeleHealth, its ease of use, as well as insurance coverages, length of treatment sessions and the differences between TeleHealth and In-Clinic visits. Please contact any of our clinics directly to learn more and see if TeleHealth is the right choice to achieve your recovery goals.
Our website is a valuable tool to obtain the latest updates regarding COVID-19 Information, TeleHealth, Excel Physical Therapy News, Videos and resources to locate and contact any of our 33 area clinics, or to submit a request for an Appointment or Online Inquiry via our Contact Us page. We also invite you to visit and Like our Excel Physical Therapy Facebook Page which is updated daily with important resources and information.
Effective March 30, 2020, Excel Physical Therapy has implemented the following Clinic Precautions to ensure patient safety:
- All staff will be screened prior to entering the clinic daily (temperature and symptom screening)
- All patients will be screened prior to each clinic visit. A patient screening station will be established at each of our clinics to assess for risk of contact exposure or symptoms prior to entry. Should we identify any risk, the appointment will be rescheduled.
- We strongly recommend all patients wear a mask or face covering to their appointment, in accordance with CDC guidelines
- Each physical therapist will only schedule 1 in clinic patient per hour.
- Only half of our staff will be in the clinic at one time, with no overlap in schedules
- Each physical therapist will be required to utilize Personal Protective Equipment (PPE) while treating patients
- All equipment, common areas, entry and exit doors and access areas will be sanitized hourly
- All highly touched items (coffee, food, magazines) will be removed from the waiting area
- Community water stations will be closed and considered off limits
- Any patient over the age of 65, or those with a compromised immune system or other high risk ailment, will be encouraged to speak with their physician and physical therapist for proper guidance as to whether it is recommended to attend in-clinic therapy, utilize TeleHealth, or postpone treatment to a later date.
- Patient waiting areas will have chairs separated, as will the gym area, so as to continue to maintain the practice of physical distance
- All therapeutic areas will continue to be sanitized before, during and after each patient
We look forward to continuing to serve you and will share additional updates as we progress in this unprecedented time period. Please do not hesitate to contact us at 866-883-9235 if we can be of further assistance and thank you for your continued trust.
Sincerely,
Kristin Mullen, CEO
Excel Physical Therapy
Updated Clinic Protocols and Safety video
Click to view a video overview of our new safety protocols at our clinics which are now effective March 30, 2020 to ensure patient safety.
https://www.facebook.com/EandATherapy/videos/886312305151450/