Back To The Basics #1: Proper Execution of the Squat & Variations


The squat uses most of the major muscle
groups in the legs including the glutes, hip flexors, quadriceps, hamstrings
and even the muscles in the lover leg like the tibialis and muscles in the calf.
It also activates the core, erector spinae and the abdominal muscles, for
stability.
Before getting into your workout always
remember to warm-up with some movements that increase the heartrate slowly and
get blood and oxygen out to the muscles preparing the body before executing the
exercises. After completing your workout, end with stretching the muscles used
in the workout. Warm-up and cool-down may take 5-15 minutes, depending on age
and fitness level. Make sure that you are mindful and present when executing
the movements. Never move into any new pain. Always start small and work into
larger range of motions building up to your full range in the motion to help
prevent injury. Once you are warmed up let’s get started!

Stationary
Squat


Start by standing with feet
parallel and hip to shoulder-width apart. Keep a straight line from the crown
of the head to the tailbone and from shoulder to shoulder. With core engaged move
hips back transferring weight into the heels. Keep knees behind the toes and
lower the hips. Arms may extend forward for balance. Press through the heels to
return to a standing position.

Too
Difficult?… add a chair.


Place a
sturdy chair behind you making sure that it is secure and will not slip. Start by
standing with feet parallel and hip to shoulder-width apart. Keep a straight
line from the crown of the head to the tailbone and from shoulder to shoulder.
With core engaged move hips back transferring weight into the heels. Keep knees
behind the toes and lower the hips to touch down as if going to have a seat in
the chair. Arms may extend forward for balance. Press through the heels and return
to standing a position.

Too
Easy? … add overloading one leg.


With arms overhead and palms facing
each other, raise one heel off the ground to the ball of the foot or extend one
leg straight with heel on the floor, overloading opposite leg as if a single
leg squat. With core engaged move hips
back transferring weight into the heel of the overloaded leg. Keep the knee
behind the toes and lower hips. Arms may extend forward for balance or remain
overhead. Press through the heel to return to a standing position.

Squat
Down & Reach Up Variation


Start
by standing with feet parallel and hip to shoulder-width apart. Keep a straight
line from the crown of the head to the tailbone and from shoulder to shoulder.
With core engaged move the hips back transferring weight into the heels. Keep
knees behind the toes and lower hips. Reach fingers down toward the ground.
Fingers may touch the ground for a deeper squat. Press through the heels to
return to standing position. After returning to standing position, raise up on
toes lifting heels off the ground and raising arms overhead for additional balance
challenge and range of motion.

  

Too
Easy? … add plyometrics


Start by
standing with feet parallel and hip to shoulder-width apart. Keep a straight
line from the crown of the head to the tailbone and from shoulder to shoulder.
With core engaged move the hips back transferring weight into the heels. Keep
knees behind the toes and lower hips. Reach fingers down toward the ground.
Fingers may touch the ground for a deeper squat. Press through the heels,
raising arms overhead accelerating up adding power to create a jump off the
ground then decelerate, controlling the
landing and easing back into the squat.

Blog
post by Ally Wilson.

Working from Home: Pandemic Edition Part 2


Many Americans recently saw a change in their daily work routine. With
the current stay-at-home advisory extended, many of us are working or attending
school from home. In a previous blog, we talked about how prolonged sitting can
have negative short-term and long-term effects on the body. We went over
sitting posture at a desk, muscle groups affected by sitting, and the American
College of Sports Medicine’s recommended activity levels. If you have not read
it, go check it out! 

In today’s blog post, we will go over a few stretches that
you can do to combat the short-term effects of sitting. Stretches should be
done every 1-2 hours.

Standing Back Extension


Stand with your feet about hip-width apart, place hands on your hips. Bend
backwards slightly. Return to starting position. Repeat this 10 times. This
exercise is not for you if you have spondylolisthesis, spondylosis, or nerve
pain/leg pain that worsens with each repetition.


Burdenko Sitting and Head Turning (Modified)


Begin sitting on stable chair. Place your hands behind your head,
elbows are up and turned out. Simultaneously stretch your arms out to the sides
as you turn and look to the right. Return to starting position. Repeat on the
left side. Repeat this 10 times on each side. Be careful if you have any
shoulder limitations/injuries, or neck limitations.


Burdenko Bench On/Off Stretch


Start sitting upright in a chair, facing a second chair. Lift one leg
up onto the chair in front of you and reach for it with the opposite hand.
Return to starting position. Repeat on the other leg. Return to starting
position. If you can, lift both legs up simultaneously (back should be
neutral), and reach for your feet with both hands. Repeat 5-10 times each side.
This will stretch your hamstrings. If you have a preferred hamstring stretch,
go ahead and do that instead.


  

Seated Hip Flexor Stretch


Sit with half your buttocks on the chair, support your self with your
arm. Stretch the leg that is “hanging” off the edge back until you feel a light
stretch along the front of your hip. Hold for 20 seconds. Repeat 3 times on
each side.



Interested in more exercises related to posture? Check out this blog
post: https://fitplancapecod.com/2015/03/10/5-quick-exercises-to-help-correct-poor-posture/
Blog
post by Damaris Marques PT DPT.

About Damaris
Marques PT DPT

Damaris
(“Dee”) joined Cape Cod Rehab in August 2017 after receiving both her
Doctor of Physical Therapy and Bachelor of Science from Springfield College.
She is certified in Part I and Part II of the Burdenko Method and believes in a
patient-therapist partnership where both are working together to meet the
patient’s functional goals. Dee is bilingual (English and Brazilian Portuguese)
and lists crocheting as a hobby along with singing and a little dancing when no
one is looking!

Working from Home: Pandemic Edition Part 1


Many Americans recently saw a change in their daily work routine.
With the current stay-at-home advisory extended, many of us are working, or attending
school, from home. We do not know when we will be able to go back to “normal.”
So, for now we find ourselves mostly at home, and if you are anything like me,
you are sitting for most of the day.
While sitting may seem like a harmless activity, it can cause both
short-term and long-term problems. A small research study1 looked at
the effects of prolonged sitting (2 hours) on the stiffness of the spine, and
found that in university-age men, stiffness of the spine increased after only 1
hour of sitting, whereas in women it varied in the 2 hour window. The reality
is that many of us are sitting for longer than 2 hours. Chronic prolonged
sitting can be detrimental to your long-term health. In a recent study2,
researchers found that sitting for long hours (usually 6+ hours) is associated
with all-cause and cardiovascular disease mortality risk in sedentary adults,
but this association is decreased or completely undone when the recommended
levels of weekly moderate/vigorous exercise are met.
What does this tell us? That prolonged sitting today can cause
problems both today and tomorrow. Here are 3 tips to combat the risks
associated with prolonged sitting.

1: Office Ergonomics




Some basics: Sit up with your back supported, use a lumbar roll or
a towel roll along the small of your back for support. Elbows should be
approximately 90 degrees, with wrists in a neutral position. Your neck should
be held in a neutral position (ears aligned with your shoulders; shoulders set
back). Ideally, have your monitor set up to eye level.






Knees should be approximately 90 degrees, and feet should rest
comfortably on the ground. Use a phone book (or your pathology book from
college) to adjust the “height” of the floor if you are short like me.








If you are using a laptop, try angling the laptop to help with the
eye level. This is not ideal.
  










2: Take Stretch Breaks


Sitting keeps the hamstrings, hip flexors, chest musculature, and neck
extensors short and tight, while it lengthens and weakens the quadriceps, neck flexors,
and upper back/shoulder blade musculature. Get out of that seated position
every 1-2 hours to stretch out and walk around the house. Some people have
standing desks. If that is you, use that to your advantage. Otherwise, stretch
the chest and squeeze your shoulders back, stretch your hamstrings and your hip
flexors, and do a lap around the house.

In our next blog post about working from home, we will go over
more specific stretches to do at home.

3: Hit the Recommended Activity Levels


Regardless of how long you sit for, regular moderate to vigorous
activity is still the best way to combat long term health issues associated
with chronic prolonged sitting.

For most adults, the America College of Sports Medicine recommends
150-300 minutes of moderate-intensity aerobic activity per week, or 75-150
minutes of vigorous-intensity aerobic activity per week, and 2 or more
days per week of strength training of all major muscle groups of the body.

Similarly, older adults should engage in 150-300 minutes of
moderate-intensity activity, and this should include a mix of aerobic
training, strength training, and balance training. Older adults should also
take special consideration of any co-occurring conditions. Remember to always
consult with your physician or physical therapist when starting a new exercise
program.

Here are some ideas of aerobic activities: walking around the
neighborhood, hiking along the beautiful trails of Cape Cod, walking on the
beach, a light jog or run outside, body-weight circuit training, bike riding, roller
blading, jumping rope, dancing/aerobic dance to name a few. If you need some
help getting started, or feel most motivated when working with others, check
out our offering of FitPlan Live VIRTUAL classes at Mashpee Fitness.
I hope you find these tips helpful. Keep an eye out for the next
blog!
Blog post by Damaris Marques
PT DPT.
About Damaris
Marques PT DPT
Damaris
(“Dee”) joined Cape Cod Rehab in August 2017 after receiving both her
Doctor of Physical Therapy and Bachelor of Science from Springfield College.
She is certified in Part I and Part II of the Burdenko Method and believes in a
patient-therapist partnership where both are working together to meet the
patient’s functional goals. Dee is bilingual (English and Brazilian Portuguese)
and lists crocheting as a hobby along with singing and a little dancing when no
one is looking!
References
1. Beach TA, Parkinson RJ, Stothart JP, Callaghan JP. Effects of
prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine.
Spine J. 2005 Mar-Apr;5(2):145-54.
2. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D.
Sitting Time, Physical Activity, and Risk of Mortality in Adults. J Am Coll
Cardiol. 2019 Apr 30;73(16):2062-2072. doi:
10.1016/j.jacc.2019.02.031.
Resources
2. Link to the Physical Activity Guidelines for Americans: https://health.gov/our-work/physical-activity/current-guidelines

Fighting Falls: Changing Risk Factors


Let’s talk about falls. The World Health Organization defines
falls as “an event which results in a person coming to rest inadvertently on
the ground or floor or other lower level.”1 With that definition in
mind, did you know that 1 in 4 adults in the United States will sustain a fall
in a given year?2 In 2010, the United States spent approximately 111
billion US dollars addressing fall-related deaths, treatments, or
hospitalizations in emergency departments.3 While falls can occur at
any age, certain factors can increase your risk of falling. Some of you reading
this may have never experienced a life-altering fall. Some of you have. But I
am sure that everyone reading this knows an adult who has fallen.
As I mentioned before, there are factors that will increase your
risk of falling. Some of those, like sex and age, cannot be changed. Other
factors, like the home environment and activity level, can be changed. So if
you are concerned about falling, or you are concerned of a loved one falling,
read on to learn 4 things that can be done today to reduce the risk of falling.

Change your Home Environment


The first and easiest thing you can do is “fall-proof” your home.
  • Have clear pathways to prevent tripping over loose items or
    electric cords on the ground.
  • Mark thresholds and steps with a contrasting color so you can see
    where the floor level changes.
  • Get rid of rugs or secure them.
  • Wear shoes in the house (instead of slippers/socks).
  • Put non-slip mats in the shower/bathroom.  
  • Make use of night lights, especially if you make trips to the
    bathroom at night and need to navigate a dark room or hallway.
  • If you can, install grab bars in the bathroom


Get Active


Enroll
in an exercise program that is right for you. Muscle weakness and poor posture
increase your fall risk. While changes to your muscles, bones, and joints are a
normal part of ageing, falling is NOT. Regular physical activity will
help combat these changes associated with ageing. If you do not know where to
start, start right here with Mashpee Fitness and Barnstable Fitness. We have plenty
of virtual classes that have been carefully catered by our excellent trainers.
Special mentions: Tai Chi with Ally, Chair Exercises with Erin, Burdenko
Balance with Eric, Chair Stretch with Craig, and Flexibility/Mobility with Jami.
Local senior centers also tend to offer balance and exercise classes.
  • Tai Chi classes are excellent for posture, balance, and joint
    mobility
  • Yoga or a stretching class can improve flexibility and balance
  • Strength/weight training will increase bone density and combat
    osteoporosis
  • Specific Balance classes and programs will lead you into balance
    exercises coupled with falls-related education and falls prevention tips.

Review your Medications


Polypharmacy is when you take multiple medications, usually 4 or more, and this
can increase your risk of falling. TAKE YOUR MEDICATION AS PRESCRIBED but go
over your medications, including over-the-counter and supplements, with your
pharmacist or your primary care doctor if you are experiencing side-effects
related to dizziness/light headedness. Ask your healthcare provider if all your
medications are necessary and up-to-date.

Schedule an Eye Exam


Get your eyes checked regularly. The older we get, the more our bodies rely on
its visual input to make balance-related decisions. Our bodies rely on
information from our eyes for visual acuity, peripheral vision, depth perception,
determine incoming/moving objects, and even perceiving changes to surface
textures.
Blog post by Damaris Marques PT DPT.

About Damaris Marques PT DPT
Damaris
(“Dee”) joined Cape Cod Rehab in August 2017 after receiving both her
Doctor of Physical Therapy and Bachelor of Science from Springfield College.
She is certified in Part I and Part II of the Burdenko Method and believes in a
patient-therapist partnership where both are working together to meet the
patient’s functional goals. Dee is bilingual (English and Brazilian Portuguese)
and lists crocheting as a hobby along with singing and a little dancing when no
one is looking!
References
3. Verma SK, Willetts
JL, Corns HL, Marucci-Wellman HR, Lombardi DA, Courtney TK. Falls and
Fall-Related Injuries among Community-Dwelling Adults in the United
States. PLoS One. 2016;11(3):e0150939. Published 2016 Mar 15.
doi:10.1371/journal.pone.0150939

Boston’s Postponed – Now What?!


The COVID-19 Pandemic has left many of us stuck in our tracks when
it comes to our spring marathon training. Being 1 month out from Boston,
several of you likely had long runs of close to 20-miles under your belt. I can
appreciate how disappointing this is for everyone, and wanted to give some
advice as to how you can make the best of the situation and go into your newly
(re)scheduled fall marathon with confidence and injury-free.
So how do you make this happen? Should you stop running for a
while because Boston postponed? Should you consider taking part in a new
fitness program? How do you avoid becoming injured in this process?
The new Boston Marathon date is September 14, 2020 and marathon
training programs typically being 12-20 weeks long depending on your “base”
mileage. This means that if you are planning running Boston at the new date,
your training could start as early as the end of April, or as late as the end
of June.
Regardless of your training start date, you’re going to want to
take a week or two off from running in order to give your body a proper break. In
a 2018 study, Wiewelhove
et al looked at various fatigue markers in individuals following a marathon.
What they found is that both massage and cold-water immersion (ice bath) helped
to reduce post-race fatigue markers quicker and more effectively than active
recovery (continuing training). This doesn’t mean that you have to stop
exercising completely. In fact, doing some light stretching and strengthening
is all OK, but I definitely recommend that you keep it light and use the time
to rest.
If you are a more experienced runner who is used to running
several races a year, you might not need to completely rest your legs, but
instead cut your mileage way back and add in more cross-training. If you are
more of a novice or intermediate running you are probably better off taking a
week or two (max) off completely and starting back at your base mileage for a
couple weeks prior to starting your formal training.
Here are some suggestions for some low-impact cross training that
you can do during your “rest” week:

You can also take this time to get really good at those exercises
that your Physical Therapist gave you way back when (hint hint).
If you have more specific questions pertaining to training and/or
injury prevention don’t hesitate to myself or another member of the CCR Run Team by emailing running@capecodrehab.com.
Blog
post by Tiffany Sadeck.
About
Tiffany Sadeck PT DPT OCS CSCS
Tiffany is a member of the Cape Cod Rehab
Running Team with a Doctor of Physical Therapy degree. She is also a Board
Certified Orthopedic Clinical Specialist and Certified Strength &
Conditioning Specialist with a long history of running which began her freshman
year of high school. A 3-season athlete, Tiffany was captain her junior
and senior year and went on to run Division 3 Cross Country and Track &
Field at Springfield College. She competed in events ranging from the
800-2 mile and high jump. Tiffany began running longer distances up to the
marathon and would like to help runners to help better times and meet goals
while preventing injuries and maintaining a fun, friendly training environment.
References
Wiewelhove T, Schneider
C, Döweling A, Hanakam F, Rasche C, Meyer T, et al. (2018) Effects of different
recovery strategies following a half-marathon on fatigue markers in
recreational runners. PLoS ONE 13(11): e0207313.
https://doi.org/10.1371/journal.pone.0207313

Running and Knee Health

When it comes to knee health, running often gets a bad reputation
as being a cause for many ailments, the primary one being osteoarthritis.  However, as more research becomes available,
these claims are found to be increasingly baseless, showing that running at
reasonable volumes and intensities leaves the joint no worse for wear.  And according to some studies, possibly better
than before!

What the research tells us:

There are many studies suggesting that running is not detrimental
to the knees.  In one such study, 504
former collegiate cross country runners were surveyed to assess their levels of
hip and knee osteoarthritis.  The follow
up period for individuals was between two and fifty-five years, averaging
twenty-five years.  Of those assessed,
only 2% reported severe pain, and only 0.8% had surgery for their
condition.  They compared these results
to former collegiate swimmers, which had 2.4% reporting severe pain along with
2.1% having surgery (1).  The evidence
from this study suggests that there is no association between moderate
long-distance running and the development of osteoarthritis.  Additionally, it suggests that heavy mileage
and the number of years running are not contributory to the future development
of osteoarthritis.
That is all well and good, but those are former elite
athletes!  How about when compared to
people who do not run regularly? 
In another study, a group of male runners (who averaged 28 miles
per week over 12 years) were compared to male nonrunners to assess a variety of
factors.  The groups were compared in
perceived pain and swelling in the knees as well as the hips, ankles and
feet.  Additionally, radiologic exams
were conducted to assess osteophytes (bony outgrowths in joints), cartilage
thickness, and overall grade of degradation. 
There was no statistically significant difference between either group
for all measures, further suggesting that long-distance running is not
associated with premature join degradation (2, 5).
A more recent systematic review conducted in Australia sought to
analyze the effects of physical activity on the individual structures of the
knee joint.  After analyzing 1,362
studies, the data suggested that there is an association between physical
activity and osteophytes in the knee joint. 
However, this is not necessarily a bad thing, and could possibly be an
adaptation to the stimuli associated with exercise.  Additionally, the review states there is no
strong evidence on physical activity narrowing the joint space from cartilage
degradation.  In fact, there is strong
evidence for an inverse relationship between physical activity and cartilage
defects (3).  In other words, people who
are active have stronger cartilage in the knees than those who do not.  This is further supported by a Swedish study,
in which researchers gave people at risk of osteoarthritis a running program,
and by the end showed improved biochemistry of the associated cartilages (5).
It is also worth noting that factors such as gender, education and
mean exercise time do not appear to increase the chances of developing
osteoarthritis in the knee.  Despite
these findings, running is not an activity that everyone should participate in
without the proper guidance.  Various
factors such as genetic predisposition, higher than average BMI, and previous
damage to the knee can all increase the chances of developing osteoarthritis
(4).

What you can do to prevent damage to your knees?

If you are a runner and have not had knee problems, great!  Keep doing what you are doing.  
If you have had problems, here are some suggestions:

Try maintaining a stable BMI
Since it has been shown that having a high BMI while performing
repetitive exercise can be a risk factor towards osteoarthritis (4), it is
important to try having a consistent, average BMI.  Doing so will reduce the impact that your
feet and knees take.  Did you know?  Depending on the intensity, running can
create an impact of three to ten times a person’s body weight! (6)
Watch your form
Improper biomechanics can place increased strain on the lower
extremities.  Research suggests that
running with a slightly forward-leaning trunk reduces stress on the
patellofemoral joint (7, 8), which is the part of the knee where the thigh bone
and knee cap meet.
Increase volume/intensity gradually
Among runners there is a training philosophy called the “10%
rule”, in which during a training cycle weekly mileage does not increase by more
than 10% from week to week.  The rule has
validity, with one 2014 study showing that runners who followed this rule were
less likely to become injured compared to a group that increased their mileage
by 30% (9).

In conclusion:

If you are an experienced runner or someone who would like to
start and have no underlying knee issues, do not fear that running will damage
your knees.  That being said, always talk
to a healthcare professional before making major lifestyle changes.  Train smart, and above all, enjoy running!




Sources:
1.
Sohn, Roger S., and Lyle J. Micheli. “The Effect of Running on the Pathogenesis
of Osteoarthritis of the Hips and Knees.” Clinical Orthopaedics and Related
Research, no. 198, 1985
2.
Panush, Richard S. “Is Running Associated With Degenerative Joint Disease?”
JAMA: The Journal of the American Medical Association, vol. 255, no. 9, 1986,
p. 1152.
3.
Urquhart, Donna M., et al. “What Is the Effect of Physical Activity on the Knee
Joint? A Systematic Review.” Medicine & Science in Sports & Exercise,
vol. 43, no. 3, 2011, pp. 432–442.
4.
Chakravarty, Eliza F., et al. “Long Distance Running and Knee Osteoarthritis.”
American Journal of Preventive Medicine, vol. 35, no. 2, 2008, pp. 133–138.
5.
Neighmond, Patti. “Put Those Shoes On: Running Won’t Kill Your Knees.” NPR,
NPR, 28 Mar. 2011
6.
Elert, Glenn. “Force on a Runner’s Foot.” E-World, 1999,
hypertextbook.com/facts/1999/SaraBirnbaum.shtml.
7.
Teng, Hsiang-Ling, and Christopher M. Powers. “Sagittal Plane Trunk Posture
Influences Patellofemoral Joint Stress During Running.” Journal of Orthopaedic
& Sports Physical Therapy, vol. 44, no. 10, 2014, pp. 785–792.
8.
Teng, Hsiang-Ling, and Christopher M. Powers. “Influence of Trunk Posture on
Lower Extremity Energetics during Running.” Medicine & Science in Sports
& Exercise, vol. 47, no. 3, 2015, pp. 625–630.
9.
Nielsen, Rasmus Østergaard, et al. “Excessive Progression in Weekly Running
Distance and Risk of Running-Related Injuries: An Association Which Varies
According to Type of Injury.” Journal of Orthopaedic & Sports Physical
Therapy, vol. 44, no. 10, 2014, pp. 739–747.
Blog
post by Robbie Papapietro.

Prevention & Treatment of Shin Splints

Shin splints are a painful condition caused by microtears of
connective tissue at attachment sites in the tibia (lower leg bone) from
overuse or mechanical stress.  Symptoms include
pain and tenderness along the front of the shin (tibia) and when chronic or
severe, may be accompanied by swelling and the presence of ridges or bumps
along the front of the bone. 
Muscle weakness, stiffness, and poor alignment of the lower
extremity joints (such as flat feet) and use of non-supportive shoes may predispose
you to developing shin splints particularly if training or activity is accelerated
too quickly, you walk/run on hard, ramped or uneven terrain, or you play a stop
and go high impact sport such as basketball. 
Shin splints can side line even the most seasoned athlete. 
To prevent and treat the condition try the following
exercises.  Stretches should be held for
a minimum of 30 seconds to allow time for tissue elongation and to avoid reflex
shortening. Repeat 2-3x, 3x/day. Strengthening should be done 10-20 repetitions
for 2-3 sets daily.  Icing, kinesiotaping,
and non-steroidal medications may be helpful in the management of pain.  Consult your physical therapist for
assessment and always speak to your doctor before taking any medication.

Stretching

Calf stretch
(gastrocnemius)
Stand upright holding chair or
hands on wall for support with one leg behind you, foot flat and pointed
straight ahead.  Keeping back heel down
and knee straight, bend front knee. 
Stretch will be felt in calf and Achilles. 

Tip: Tighten abdominals and don’t lean forward
with trunk.


Soleus stretch
Stand upright holding chair or with hands on wall for support with one leg
behind you, foot flat and pointed straight ahead.  Keeping back heel down, bend BACK knee.
Stretch will be felt in lower part of calf deep under Achilles tendon. 

Tip: If you cannot keep your heel down,
shorten your stride.


Toe stretch (toe
flexors and plantar fascia)
Place 2-3” book or small
platform/step against wall.  Place toes
against edge of step. Keeping knee straight, lean towards wall. Stretch will be
felt in arch of foot.


Dorsiflexor
stretch (tibialis anterior)
Sit on knees on cushioned surface
with ankles pointing down.  Sit back on
heels to stretch front of foot and ankle. 
Leaning back with upper body will intensify the stretch. 

If unable to
kneel, or if ankles are too tight, sit up with foot crossed in front of you and
use your hand to pull ankle and foot downward. 

Strengthening

Ankle
Dorsiflexion (anterior tibialis)
Long sit on
bench or floor. Anchor tubing away from you with loop around foot.  Keeping foot and ankle aligned with toes
facing up, flex ankle up towards you to the count of 2, and return down to the
count of 4.  

Tip: To maintain proper alignment, keep 2nd toe in line with your shin bone.


Wall Toe Raises
(toe extensors and anterior tibialis)
Stand with back
against wall, feet slightly away and facing forward.  Lift toes off ground keeping knees straight.
Hold 5 sec.  

Tip: If unable to raise, toes, bring feet a little
further from wall.




Calf Raises
(gastro-soleus)
Stand with feet
shoulder width apart. Go up on toes to count of 2, lower to count of 4. 
Challenge yourself by doing on one leg.  

Tip: To progress
strengthening through greater range of motion, do off edge of step.




Toe Curls (toe
flexors and plantar fascia)
Sit in chair. Place
towel on tile or wood floor.  Position
bare foot on towel.  Keeping heel down,
curl toes to “scrunch” towel. 


Single Leg Bridge
(gluteal muscles)
Lie on your back with knees bent and feet on floor.  Straighten one leg keeping thighs in line.
Tighten abdominals and lift hips off ground using bent leg. Keep pelvis
level.  Hold 5 sec.  

Tip: If too difficult, keep both feet on floor while lifting hips.


Heel to toe
walking
Start in standing position. Step out with
right foot flexing ankle toward you as your foot contacts the ground.  Transfer weight to ball of right foot, go up
on toes, then step forward with the left foot contacting heel first with ankle
up.  Repeat cycle.


Blog
post by Jody Coluccini PT DPT.

About Jody Coluccini PT DPT

Dr. Coluccini received her Doctorate with distinction from Arcadia
University and her BS in Physical Therapy from Boston University. She brings 39 years of continuous clinical orthopedic, sports and geriatric physical therapy
experience to patient care. Prior to relocating to Cape Cod, Dr. Coluccini
owned a successful private practice in NY and is currently licensed in both New
York and Massachusetts. Jody believes that successful rehabilitation is a
collaborative effort between the therapist and patient achieved by mutual trust
and respect, constant therapeutic reassessment, mutual goal setting and patient
compliance. She understands that being “fit” as one ages or returns
from injury or illness requires a constant modification of goals and activity.

Perform a Better Prone Plank

Do you remember your first plank you
were asked to hold? Did it feel like the seconds were minutes and that someone
had lit a fire under muscles in your stomach that you never knew you had? Well
if you dread the plank or are having a difficult time maintaining good form
here are a couple methods to use to improve your experience.

Do you ever get pain in your lower back?
Set up is key!

When preparing to plank it is important
to remember the focus of the exercise is preventing hyperextension of the lower
back.  That being said, engaging the
muscles of the lower abdomen and pelvis properly before even lifting off of the
table is crucial in preventing any excessive motion in the lower spine. One
strategy is utilizing the Posterior Pelvic Tilt. This exercise will teach you
how to build tension in your lower abdomen and create a “flat back” to help aid
in any drooping or arching of the lower back when in the prone position.
Supine
Posterior Pelvic Tilt with Ball Squeeze
Begin by lying on your back with your knees bent and
feet flat on the floor. Place a ball between your knees and squeeze. Slowly
bend your low back and tilt your pelvis towards the floor. Return to start
position.


Do you feel more pressure in your
shoulders than your stomach?

Improper alignment of the shoulders over
the elbows can cause abnormal strain on the individual’s tendons and ligaments
of the shoulder joint leading to possible injury. It is just as important to
ensure to keep the weight of your torso from sinking to the ground as well as
shifting forward during the plank. This can again place a shearing force across
the joint line of the shoulder and needs to be avoided. One exercise that can
help is the Scapular Push Up on a Table.
Plank on
Table with Scapular Protraction Retraction
Place both hands on the edge of a table and step your
feet back into a plank position. Slowly round your upper back, pulling your
shoulder blades apart. Next, lower your back down, squeezing your shoulder blades
apart.


Remember to breathe!

How often do we tend to hold our breath
when performing strenuous exercise? This sometimes can hurt you more than help
you. In our case with the plank, a deep exhale through pressed lips can help
tighten your core just before you lift up and continue to hold the ribs down to
prevent hyperextension at the back during the hold. Quadruped Diaphragmatic
Breathing drills can help you establish a good spinal position as well as core
contraction just from breathing!
Quadruped
Diaphragmatic Breathing
Begin on all fours. Breathe in, pushing your abdomen
down, then exhale and repeat. Make sure there is no movement in your chest or
shoulders as you breathe.

 Plank Progressions: 


Plank with Elbows on Table –> Plank on Knees –> Standard Plank

Plank with Elbows on Table


 Plank on Knees


Standard Plank

Blog post by Craig Moody.

Falls Prevention Awareness Day

There seems to be a day for everything on the calendar! National
Hot Dog Day was July 19th, October 4th is Random Acts of Poetry Day, October 9th is National Fire Prevention Day and September 22nd is Falls Prevention
Awareness Day!  

Some are more important
than others.  Preventing falls should be
high on the list.  There are some
alarming statistics related to falling:

  • One in four Americans 65 and older fall each year,
  • Annually 37.3 million
    falls require hospitalization,
  • And an estimated annual cost of $67.7 billion
    due to fall injuries by 2020.

Fortunately one of the best strategies for preventing falls is
exercise.  

A simple but highly effective
exercise to maintain or improve balance only requires a chair.  At the surface the sit to stand exercise
seems very basic and possibly easy for some (until you do multiple repetitions
in a set).

Begin sitting upright with your feet flat on the ground underneath
your knees. Move your shoulders and head over your toes, bring your knees
forward, and allow your hips to come of the chair, then push down equally into
both feet to stand up. Sit back down and repeat.

Tip: Make sure to keep your weight evenly distributed between both
legs, and try to keep your back straight throughout the exercise. Do not lock
out your knees once you are standing. 

What makes this exercise one of the top choices for improving
balance and preventing falls, to start it is functional.  Think about how many times you have to get up
and down from a chair throughout your day. 
Often standing up from a chair people feel unsteady and need to take a
moment to ready themselves before walking. 
Practicing this exercise will not only improve your leg strength which
will make the act of getting up and down easier but it will also give you
confidence that once you are standing you will be able to move.   The sit to stand exercise requires minimal
equipment, all you need is a chair! It can be executed in a safe manner and
modifications can be made to make it more or less challenging. The use of arm
rests on a chair to assist in standing is one modification that can be used to
make the exercise easier.  If you have
difficulty with your balance once you are standing try placing your chair near
a counter so you have support in front of you once you are on your feet.
Start with trying to build your repetitions gradually up to a set
of 10.  Once you are able to achieve this
goal you can add multiple sets throughout your day.  One simple way to sneak in some extra reps is
to stand up and sit down twice when getting out of a chair! 

Blog
post by Eric Chandler.

Osteoporosis: Lazy Isn’t for Bones

Osteoporosis
and Screening

Osteoporosis is a disease that reduces
the strength and mass of bones, making them fragile and susceptible to fractures.
Although it is most common in middle-aged and older women, osteoporosis can affect
both men and women of any age. According to the National Osteoporosis
Foundation, about nine million Americans have osteoporosis and an estimated 48
million have low bone density. This means that nearly 60 percent of adults age
50 and older are at risk. One in two women and up to one in four men age 50 and
older will break a bone due to osteoporosis. One measure of the health of bones
is “bone mineral density” or BMD for short. A bone scan to assess BMD is a
relatively simple procedure that is offered by medical practitioners. The U.S.
Preventive Services Task Force (USPSTF), an independent panel of experts
commissioned by the government to study the evidence behind routine health
screens, has issued guidelines for osteoporosis screening. They recommend that
women younger than 60 get bone density scans if they have risk factors that
increase the likelihood that they could experience a fracture within the next
10 years. That means women with parents who fractured bones, a broken bone
after age 50, post-menopausal, a history of smoking, alcohol abuse, or a
slender frame. The panel maintained its recommendation that women age 65 and
over and men 70 and over should get bone density testing, even if they have no
other risk factors. Plan for the future – Talk with your health care provider
to find out what is recommended for you.

Pressure
your bones into growing stronger

For bones to increase and maintain their
density, they require the application of weight-bearing force.

In fact, studies
suggest that the best exercise may not only be weight-bearing but also impact
exercise. This means imparting a jolt to muscle and bone such as you would when
placing a foot forcefully on the ground while running, or lifting or pushing a
weight suddenly. Naturally, you have to ensure you do such exercise safely.  Weight-bearing exercise, when preformed
correctly, causes the muscles and tendons to pull on the bones. This stimulates
them to produce new cells to replace old ones and absorb calcium, making them
harder. The load on the bones can be created by your own body weight or by
external weights like dumbbells or gym machines in a weight training program. 

Appropriate exercise as we age, not only help keep bones healthy, it protects
against falls and fractures as well improving balance and strength.

Suggested
Exercises to Help Build Bone Density

While all exercise benefits your general
fitness. Weight-bearing exercise is best for strengthening bones.

Some good examples are:

  • Running and jogging
  • Gymnastics
  • Aerobics class — step, dance, and floor
    aerobics
  • Weight lifting — dumbbells, barbells,
    machines, body weight exercises
  • Team sports involving running and
    throwing — basketball, football, baseball, softball, volleyball
  • Individual sports involving running —
    racket sports
  • Walking (but less effective than running
    or jogging)

Examples of least effective exercises:

  • Swimming
  • Water aerobics
  • Cycling

These exercises are not useful for building
bone density but are still effective in building cardiovascular fitness. Bear
in mind that running or leg-based exercise acts mainly on the lower body.

And
although much of the disabling effect of bone loss is felt in the hips and
spine, exercising the upper body with weight-bearing exercise is of equal
importance. Broken wrists and arms from falls, as we age, are not uncommon.

Without proper diet and exercise, bone
density deteriorates over time, leading to symptoms such as back pain, poor
posture and fractures. A well-rounded fitness plan, including cardiovascular
exercise, weight training and flexibility exercises, combined with a healthy
food plan, will help to prevent bone loss as we age.

Blog post by Ally Wilson.

Begin a Fitness Routine

Happy 2017!  Did you know that 66% of New Year’s
Resolutions involve fitness?
If you’ve been consistently working out
and running in 2016—then great!  Keep it
up!
But if you decided that today is the day
that you will get off the couch and begin a fitness routine then read below for
some tips to help you get going…


Set goals.

A lot of New Year’s Resolutions are very
vague: lose weight, eat healthy, start running, etc.  If your goal is to lose weight, as yourself
how much you want to lose, how long it will take me to get there and what do I need
to do to accomplish that goal?  Set SMART
goals.
  • Specific.
  • Measurable.
  • Achievable.
  • Realistic.
  • Timely.

Have a plan.

You know what they say, “A goal without
a plan is just a dream.”  Whether it’s a
running specific goal or you’re starting to strength train and eat better,
develop your plan.  Map our a few weeks
and refer back.  This will help you stay
on track.

Ease into it.

The worst thing you can do the first
week of January is go hard on your resolutions every single day.  Being too ambitious and diving right into a
new routine or high mileage running will only set you up for burnout and
injuries.  Your body needs to adapt to
the new stresses and recover.

Hire a coach.

Not sure what to do or how to get
started?  Hire a personal trainer or
certified coach for some guidance and expert knowledge.

Be patient.

Fitness doesn’t happen overnight.  Diet and exercise takes a lot of discipline
and self-motivation.  All you can do is
stay consistent and keep working towards your goals.

Have fun!

Enjoy the process.  Hard work is easy work.

Blog post by Jen Skiba.

Marathon Training Tip #13: Try Kinesiotaping


What is Kinesiotape and how can it help?

You’ve probably seen it in the Olympics,
the “magic tape”, but what does it really
do?
Kinesiotape is a multi-purpose tape that
physical therapists will sometimes use to aide in rehabilitation following an
injury. This tape can be used to assist muscle movements, inhibit other
muscles, reduce swelling, reduce scar tissue, and improve overall muscle function
and joint kinematics. Kinesiotape actually refers to a specific brand of tape,
but in reality there are several other brands that offer similar benefits-
Rocktape, and Bodytape for example. This type of tape offers much more mobility
than other kinds of more restrictive tape which can be used to stabilize
joints.
There are several different taping
techniques that we use as physical therapists. If you have an area that is
really swollen following an acute injury, we can actually basket weave the tape
to assist with lymphatic flow. For this technique, you can cut the tape as
shown- with strips, or “tentacles”. I recommend cutting 6-8 strips/strands if
you’re using the wider (4 inch) tape, or 4 strips if you’re using the narrow (2
inch) tape. Find the area that is most swollen, and apply the tape with zero
stretch over this area. Avoid applying the tape to sensitive areas (behind the
knees, inner elbow, or face).
Here’s another technique we will
commonly use if you are having knee pain. This technique works to more so
stabilize your knee. You will need 3 strips of 2 inch tape for this technique. Cut
one strip to about 2 inches in length, and the other two to 4 inches in length,
then round the edges. Starting at the body area directly below your knee cap,
anchor one piece of tape with no stretch on the ends, then apply 50% stretch as
you encircle your patella on the inside. Repeat this procedure with your other
4 inch strip of tape, on the outside of your knee. For the final strip, you’re
going to want to apply 50% stretch to the middle portion of the tape, and apply
it directly below your patella.
Another technique that we commonly use
in runners in this technique for plantar fasciitis/arch support. You will need
1 piece of 2 inch tape cut about 4 inches long, and 2-3 pieces cut 2-3 inches
long. With your foot flexed (toes pulled up towards your shin), tape from the
ball of your foot towards your heel. Then apply 2-3 strips at your arch. The
middle of the tape should be stretched to 50%, then no stretch on the ends. You
can also perform this taping technique (or have someone else help you) in a plank
position in order to get your toe involved.

What if you have sensitive skin?
Although skin irritation can happen, it is extremely rare. If you have
sensitive skin, it is possible for you to have some irritation from the tape,
but if this occurs gently take off the tape with soap and warm water.
Generally, we recommend that you take the tape off after 3-5 days of wear. If
you know you are usually sensitive to adhesives, you may want to actually take
the tape off sooner.

Here are some general guidelines that
you should follow if using this tape:

  1. Wear the tape for 3-5 days maximum at a
    time, if you have sensitive skin, you may want to wear for a shorter period of
    time.
  2. When removing the tape, do not just rip
    it off, this may damage the underlying skin. Instead, hold the skin, and roll
    of the tape. Soap and warm water, or baby oil can also be helpful in tape
    removal.
  3. You may wear the tape in the shower or
    in the water- but if it gets wet do NOT blow dry the tape- this will activate
    the tape and you could burn your skin.
  4. If itching or discomfort occurs with the
    tape, do not hesitate to take it off immediately.
  5. It is OK to exercise and perform all
    regular activities while you are wearing the tape.
  6. If the skin surrounding the tape is
    showing redness/irritation remove the tape immediately.
  7. If the skin under the tape starts to
    feel numb/tingly remove immediately.
  8. Do not tape over numb areas or areas
    with poor sensation.
  9. Shoes/socks/other clothing can be worn
    over the tape- never apply the tape over clothing.
  10. Do not use tape over areas where you’ve
    been treated with radiation, or if you have history of cancer without first
    checking with your doctor.
  11. Tape comes in different colors/patterns,
    feel free to choose based on your color preference. The color and/or pattern of
    the tape has no bearing on the strength or effectiveness of the tape.

As always, if you are unfamiliar with
taping, or are unsure if taping could benefit you, make sure you have a
physical therapist show you how to apply the tape properly. If you are taping
yourself, and you’re experiencing pain or itching- take it off!

How to Kinesiotape for Knee Pain




How to Kinesiotape for Foot Pain, Plantar Fasciitis & Arch Support




How to Kinesiotape for Swelling of the Foot



Blog post by Tiffany Sadeck.

About
Tiffany Sadeck PT DPT CSCS

Tiffany is a member of the Cape Cod
Rehab Running Team with a Doctor oh Physical Therapy degree.  She is also a Certified Strength &
Conditioning Specialist with a long history of running which began her freshman
year of high school.  A 3-season athlete,
Tiffany was captain her junior and senior year and went on to run Division 3
Cross Country and Track & Field at Springfield College.  She competed in events ranging from the 800-2
mile and high jump.  Tiffany began
running longer distances up to the marathon two years ago and would like to
help runners to help better times and meet goals while preventing injuries and
maintaining a fun, friendly training environment.

Marathon Training Tip #12: Recover from Shin Splints


Mention the term “shin splints” and almost every runner recalls
experiencing pain in the lower leg associated with running.  The term itself is non-specific and is what
we call a “waste basket” term.  Pain in
the lower leg usually can be identified as Medial Tibial Stress Syndrome
(MTSS), stress fractures and exertional compartment syndrome.
MTSS occurs on the inside edge of the lower leg bone (tibia).  It is usually tender to touch mid-way between
the knee and ankle or in the lower 1/3 of the leg.  This injury usually occurs with runners new
to the sport, running on hard surfaces, training errors—doing too much too soon
or increasing distances too rapidly, muscle imbalances or biomechanical faults
especially excessive pronation.   The
source of the pain is usually either inflammation of the tissue that lines the
bone called the periosteum, or the posterior tibialis tendon that runs along
the inside of the bone to the foot. 
Left untreated or pushing through this injury can lead to a stress
fracture of the tibia, a small crack in the bone.  X-rays are usually not necessary and the
stress fracture doesn’t usually show up for 2-3 weeks and either an MRI or bone
scan is needed to find it.  Women are 2-3
times more likely to experience this problem than men and should be certain
that their vitamin D and calcium intake is sufficient.  If stress fractures are recurrent, a full
medical work up is necessary to rule out other potential causes.
MTSS often develops when the Achilles tendon and Soleus muscle are
tight and or weak.  Performing stretching
and strengthening exercises to correct that problem often eliminates the
problem.  Most runners know how to
stretch the Achilles tendon but often are unfamiliar with stretching the
soleus.
If the lower leg pain is on the top or outside of the bone, the
anterior tibialis muscle may be the culprit. 
If the pain worsens during the run and the foot gets numb and the ankle
gets weak, so weak that it is difficult to lift the toes up with the heel on
the ground, exertional compartment syndrome may be the problem.  The muscles, nerves and blood vessels are
grouped in what is known as a compartment. 
If the pressure builds in the compartment the muscle can swell and the
nerves and blood vessels become compressed to the point the ankle loses
function.  Usually only present during
running and resolves shortly after stopping, but left unchecked may require
surgery to relieve the pressure.

Follow these tips at the first sign of lower leg problems:

  • Ice the area after running.
  • Stretch the Achilles and soleus.
  • Strengthen the lower leg muscles, core and hips.
  • Run on softer surfaces like a trail or track.
  • Correct excessive pronation with an arch support.
  • Replace shoes if worn excessively.
  • Cross train in pool or elliptical until pain lessens.
  • Still a problem after 2 weeks? 
    See a Physical Therapist or Sports MD.

Watch the video for a 3 exercises to
help you recover from shin splints…

Blog post by Joe Carroll.


About
Joe Carroll PT DPT SCS

Joe is a Doctor of Physical Therapy and
co-owns Cape Cod Rehab with his wife, Kathy. One of the first PT’s in the state
to be certified as a Sports Clinical Specialist (SCS), Joe is also a Master
Instructor in the Burdenko Method. He continues to run and support local road
races every year and knows what it takes to help athletes get to the level they
desire. Joe is a 5-time Boston Marathon finisher and ran his 7th marathon on
April 18, 2016 at the Boston Marathon raising money for Boston Children’s
Hospital.

Marathon Training Tip #11: Treat Plantar Fasciitis

What is Plantar Fasciitis?


The plantar fascia is described as a thick fibrous bands of
connective tissue that originates from the medial aspect of the heel through
the sole of the foot and inserts at the base of each toe. It is a shock
absorbing bowstring supporting the arch of the foot.  For
runners the plantar fascia can be a source of major discomfort causing stabbing pain at the
base of the heel and aching throughout the arch of the foot. It affects the
push off mechanism of the foot and produces pain during push off phase while
running.  It can also cause stabbing pain in the morning during the first
few steps getting out of bed.
Plantar fasciitis was originally thought to be an inflammatory
condition but recent research has found it is non-inflammatory breakdown of
tissue as a result of repetitive microtrauma and the name of the condition may
eventually be renamed to plantar fasciosis.  There
are also studies discussing the tension on the flexor digitorum brevis and its
resultant forces on the plantar fascia contributing to plantar fasciitis pain.
Diagnosis of plantar fasciitis would be tenderness to touch along
the medial aspect of the calcaneus (heel bone) on the soul of the foot.
Tenderness can also be present along the medial arch when palpating the edge of
the fascia. The condition is also accompanied with tightness in the calf or
Achilles causing a decrease in Dorsi flexion. Strength of the flexor digitorum
brevis can also be a factor. In one third of all plantar fasciitis patients,
the condition is bilateral.

While plantar fasciitis is thought to be caused by being flat
footed, and flat footed runners have higher occurrence rates, it is not
clinically proven that fallen arches are predisposing factor. Runners of all
arch height can be affected by this condition.

Treatment

Treatment of plantar fasciitis can come in many forms. There is
strong evidence supporting manual therapy including self-mobilization of the
ankle joint and toes as well as self-soft tissue mobilization of the plantar
fascia itself.
Stretching of the gastroc as well as Soleus components
of the lower extremity also have strong supporting evidence of improving
plantar fashion conditions. Stretching of the sole of the foot by
pulling the great toe back is another treatment technique that is supported by
strong evidence.
For those runners with significant morning pain, night splints
have also proven to be successful in reducing plantar fasciitis pain. Foot
orthoses with a supportive arch are also clinically proven and have strong
evidence of improving this condition.
Other external treatment alternatives which have good supporting
evidence are anti-pronation taping of the plantar aspect of the foot as
well as kinesiotaping of the arch of the foot. 
RockTape shows an example below:
Strengthening of the flexor digitorum brevis will also help in the
treatment of plantar fasciitis conditions. Different ways to perform
strengthening exercises for the flexor digitorum brevis include a simple
exercise such as picking up rocks or marbles with your toes or trying to
scrunch a towel or pick up a hand towel with your toes.

Prevention

While treatment of plantar fasciitis is a good thing to know,
knowing how to prevent it in runners is probably more important. Changes to
increase mileage to quickly as well as increase in hill training are common
flaws that can lead to plantar fasciitis conditions. Making sure you have good
ankle joint flexibility to perform Dorsi flexion as well as well stretched
lower extremities and a strong flexor digitorum brevis will also help prevent
this annoying condition.

Watch the video for some self-help treatment techniques…


Blog post by T.C. Cleary.

About
T.C. Cleary PT DPT SCS

T.C. is a member of the Cape Cod Rehab
Running Team not because she enjoys running herself, but because she is one of
the select few PTs in Massachusetts to be Bard Certified in Sports Physical
Therapy. An ice hockey player and coach, T.C. particularly enjoys working with
high school and college athletes. She believes in treating everyone the way you
would want your child or mother treated and employs many different
interventions to obtain maximum recovery. T.C. also has special interest in
Anterior Cruciate Ligament (ACL) Injury Prevention & Treatment along with
Concussion Management.

Marathon Training Tip #10: Reduce Knee Injuries


Pain is a language.  Ignore it and you will more often than not
pay the price.  Most running injuries are
not traumatic, but present over time beginning with pain during the activity of
running and progressing to pain during and after a run.  Acting at the first warning sign will shorten
the recovery time and reduce any down time that might be necessary.  If you ignore pain more likely than not
symptoms will worsen and more time will be lost from your training.  If pain worsens to the point that it is
painful with normal daily activities or keeping you awake at night, you should
seek a professional evaluation.
The knee is a complex joint and primary
shock absorber for running.  Approximately
12 times body weight is absorbed with each stride.  Patella-femoral
injuries, sometimes referred to as Runner’s
Knee occur if we land with our knees extended or do not have strong
quadriceps and hamstrings along with a flexible Achilles tendon to absorb
shock.  Landing toward the midfoot with a
slightly flexed knee and performing strength training exercises can help
minimize this injury.  Follow this link
to learn a series of strength training exercises for runners using a simple piece
of equipment: https://mashpeefitness.blogspot.com/2016/08/cape-cod-rehabs-ccm-training-tip-6.html

Training Errors

Increasing the number of times you run
per week and or number of miles per week is the biggest culprit.  When injury does occur it is best to modify
your schedule and remember the ultimate goal is to be healthy come race
day.  Missing a week of scheduled runs is
preferable to pushing through and worsening the injury.  If you can keep the pain level below a 4 on a
1-10 scale during a run, 10 being terrible pain, it is usually safe to continue
on a reduced frequency and duration schedule. 
Increase non-impact activities to either help recover following runs or
to substitute if pain is greater than 4 or present at rest.  Highly recommended is water running.  If a pool is not available then try the elliptical trainer or
spin bike for low impact cardiovascular conditioning.

Biomechanical Faults

“Stay in your hinges.” The late Dr. Rob Roy McGregor, sports
medicine pioneer coined that phrase and simply means to run with good
alignment.  When alignment is off, the
stress on the knee will be magnified with each stride.  If you have arches that collapse (excessive
pronation) the inside of your lower leg and inside of your knee is susceptible.  If you tend toward valgus (knock knee) or
varus (bow legged) you are susceptible for
Iliotibial band (IT band) issues.  

Strengthening
the outside of the hip is often overlooked, but is key in preventing and
recovering from many knee injuries.  Here
is a link with an exercise called Scooters used to strengthen the hip abductors: https://mashpeefitness.blogspot.com/2014/11/5-burdenko-strength-exercises-for.html

Proper shoes as well as arch
supports are important as well as correcting any muscle imbalances.
Use a common sense progression of 10%
per week in your training, correct and condition the muscles that cross your
knee joint, listen to your bodies signals and your knees will carry you many
miles without a problem.

Watch the video for a few simple self-help
techniques…


Blog post by Joe Carroll.

About
Joe Carroll PT DPT SCS 

Joe is a Doctor of Physical Therapy and
co-owns Cape Cod Rehab with his wife, Kathy. One of the first PT’s in the state
to be certified as a Sports Clinical Specialist (SCS), Joe is also a Master
Instructor in the Burdenko Method. He continues to run and support local road
races every year and knows what it takes to help athletes get to the level they
desire. Joe is a 5-time Boston Marathon finisher and ran his 7th marathon on
April 18, 2016 at the Boston Marathon raising money for Boston Children’s Hospital.

Marathon Training Tip #9: Other Recovery Techniques


Last year I
completed my first 2 half marathons.  I
was cruising through my first half back in June and I remember saying to myself
at mile 10, “Wow, I can’t believe how great I feel!”  Then I got to mile 11 and my left calf
started to cramp, shortly followed by my right calf.  No matter how much stretching I did on the
course, I could not stop the cramping. 
It wasn’t pretty but I finished the race, limping across the finish line.  I remember the pain being severe over the
next few days at work but this didn’t stop me from registering for another
half marathon in the fall. 
Moving forward
with my training, I decided to try wearing compression sleeves over my
calves.  There isn’t much evidence out
there supporting that they’ll improve performance, but there is some evidence
stating that they prevent muscle soreness post longer runs.  I wore these sleeves during my second half
marathon last year and I got through the entire race without cramping and
without excessive soreness afterwards either.  
When faced
with an injury you always want to remember the acronym P.R.I.C.E.
P stands for protection from further injury
R stands for rest
I stands for ice
C stands for compression
E stands for elevation
Paula Radcliffe sporting compression
as she sets the World Record at the
2003 London Marathon!
During
exercise muscles produce lactic acid. 
Too much lactic acid causes muscle soreness and also makes muscles
fatigue quicker leaving them susceptible to injury.   Wearing compression socks helps fight the
effect of gravity and can help return blood to the heart quicker.  This allows the body to eliminate lactic acid
more efficiently allowing our muscles to perform better over the course of a
long run. In theory this sounds great! 
My calves definitely felt the difference in a good way.  But do they actually work?  

There is a great article written by Andrea
Bachand, MSc PT, BSc Kin who does an excellent job summarizing the current
evidence on this topic.  Basically most
studies do not correlate wearing compression socks to improved running
performance or improvements in physiological performance such as HR, blood
lactate levels, or VO2 max profiles. 
However, one study from the International Journal of Sports Medicine by
Bringard et al back in 2006 showed that wearing compression tights decreased
running energy costs but only at very low speeds.[i]  So the compression socks/sleeves may provide
a benefit for those like me who run at 9-10 minutes/mile or slower paces.  You can check out Andrea’s article here: https://www.run3d.co.uk/announcements/compression_socks.
Ice is always
beneficial after an injury.  It is a
natural anti-inflammatory.  Sometimes the
body over compensates for an injury and swelling can become excessive.  Ice helps reduce swelling immediately after
an injury.  However, when swelling is
already present, that’s where combining ice with compression can help even
more.
Game Ready is
a company that provides Active Cold Compression Therapy.  A sleeve is wrapped around the injured body
part which circulates ice water and inflates to aid in the healing process.  Cold therapy is effective because it slows
the metabolic demand of cells, which limits the cells need for oxygen,
preventing secondary tissue damage.  The
unit then inflates adding compression to the desired body part.  This produces a pumping action, mimicking
what our muscles do. This muscle pumping-like action helps eliminate swelling
from the area, aiding in lymphatic drainage and improving blood flow. [ii]

Another
company that provides dynamic compression is NormaTec and has become very
popular among professional athletes. 
NormaTec makes dynamic compression devices that use a Pulse Massage
Pattern to help improve lymphatic drainage, thus improving blood flow.  There have been several studies published
demonstrating the benefits of dynamic compression.  There are 3 components to NormaTec’s patented
Pulse Massage Pattern. Pulsing is the first component.  This is more effective than static
compression because it mimics the muscle pumping action of our arms and legs,
“greatly enhancing the movement of fluid and metabolites out of the limbs after
an intense workout.”[iii]  NormaTec also utilizes gradients to mimic the
one way valves in our veins and lymph vessels. 
These valves prevent fluid backflow. 
NormaTec uses hold pressures in separate zones to keep fluids from being
forced in the wrong direction, allowing the device to deliver maximum pressure
in each zone.[iv]  NormaTec than utilizes a distal release
pattern, releasing the hold pressures in lower (or distal) zones once they are
no longer needed to prevent backflow.[v]  There are 7 levels of pressure.  I feel most comfortable at level 5.
Check out the
video below to listen to Celtics Head Athletic Trainer, Ed Lacerte, explain the
benefits of NormaTec![vi]  (I love Waltah!)
[vii]
I’ve been
using the NormaTec sleeves as part of my recovery from a recent hamstring/calf
injury.  It feels great after a 15-minute
treatment and really helps accelerate the recovery process.
These are a
just a few things that can help speed your recovery after a long run or help
accelerate the healing process after an injury. 
Let’s face it, us runners hate to take time off from running!
Blog post by Jon Carroll.

About
Jon Carroll PT DPT OCS

Jon joins the Cape Cod Rehab Running
Team with a few personal running accomplishments including finishing his first
2 half marathons in 2015.  A three sport
athlete in high school, Jon took up running after completing his first Falmouth
Road Race back in 2010 and hasn’t looked back. 
A Physical Therapist and Orthopedic Clinical Specialist (OCS), Jon
enjoys working with runners because he knows how good running feels and
understands the frustration when runners have to take a break when
injured.  Jon’s goal is to run a full
marathon in the near future.  His motto:
“Ultimate fitness is a marathon, not a sprint.”

——


[i] www.run3d.co.uk/announcements/compression_socks
[ii] https://www.gameready.com
[iii]
https://www.normatecrecovery.com/how-compression-works/how-and-science/default.aspx#sci
[iv]
https://www.normatecrecovery.com/how-compression-works/how-and-science/default.aspx#sci
[v] https://www.normatecrecovery.com/
[vi] https://www.youtube.com/watch?v=OuQRMkAf7mY
[vii] https://www.normatecrecovery.com/

Marathon Training Tip #7: Give It A Rest


I’m sure you’ve been
crushing your long runs, giving big efforts on your tempo runs and speed work,
but maybe you’re starting to feel some tightness and soreness creeping in at
times. What is the first step to preventing this from becoming an injury
situation that keeps you from finishing your training and reaching your goals
on race day? 

REST!
Why
do you want to do this you might ask? Well for one reason, resting is when you
get faster! All of your training is a stress to your body, this makes your
tired, sore and decreases your ability to hold efforts in training. When you
rest, the adaptations take place and you bounce back ready to go harder and
stronger than before. Another benefit is that all that soreness from the great
training you’re doing is going to decrease. You’re going to be more comfortable
and that will translate to more productive workouts.

So,
how do you incorporate rest into your training?

Professional
triathlete Jesse Thomas shared some tips with Competitor Group:
Go
way easier on your easy days.
Not
every workout needs to be a personal best, your hard workouts should be HARD
and your easy ones should be really, really, really easy. You’re training for a
big effort on a single day, not a multi-day event like a cycling stage race.
Change
the plan when your mind or body aren’t up to it.
If
you have a long run or intense track session planned but the kids are sick,
work went late and you skipped lunch, change the workout or push it to another
day when the workout can be more productive for you.
Sleep
More!
The
single biggest difference between professional endurance athletes and amateurs
is sleep. It’s hard to do; between family obligations, work, home maintenance
and watching the Olympics every night, but if your motivation is dropping and
the body is feeling sore, get some extra sleep. Even if it means skipping a
workout here or there, remember the workouts are the stimulus for improvement,
the actual improvement comes when we rest. Just a little bit adds up fast, one
of my cycling friends once pointed out to me that just an extra 15 minutes of
sleep a night is an extra hour and 45 minutes of sleep in a week.


When should you rest and how should you rest?


Blog post by Eric Wheeler.

About
Eric Wheeler MSPT MPE CSCS

Eric joins the Cape Cod Rehab Running
Team with an extensive list of athletic accomplishments including 2x Ironman finisher
with a PR of 10:09:05. He earned a Boston Qualifying time for 2016 with a
marathon PR of 3:06:27. A Physical Therapist and Certified Strength &
Conditioning Specialist (CSCS), Eric enjoys helping injured runners get back on
their feet.  It’s hard to believe Eric
only started running in 2010 because everyone at Cape Cod Rehab was excited
about the Falmouth Road Race! His motto: “Never judge your life because of one
bad day. Judge it because of the BEST DAY.”

Marathon Training Tip #6: Strength Train


What do most runners do
to train?  Run.
The majority of
distance runners started running because they love to run.  There are many health benefits to running and
it is also convenient to just walk out the door and run.  Often overlooked or ignored by runners is the
importance of strength training. Complimenting your running program with
strength training will improve your performance and also reduce your risk for
injury.  
Here is a TRX series of exercises that
will help strengthen your total body with exercises specifically selected to
address weaknesses typically seen in runners. 
They will help strengthen the core, upper body and lower body and should
be performed 2-3x per week, with a day of rest in between.
Note:
Do not perform any exercise that causes or increases pain.

Warm Up

Squat/Row to Heel Raise
Hold the TRX handles with arms bent and your feet shoulder width apart. Sit back
into a squat keeping your heels on the ground and extend arms. Stand back up
pushing through your heels and pulling with your arms. Once fully standing
raise up on to your toes. 
2×15

  


The Workout

Power Pull
Hold the TRX handle in single handle position with one hand.  Keep elbow bent at the start and feet shoulder
width apart.  Extend arm holding handle
and drop back into a squat.  Reach back
with your other arm towards the ground. 
Return to the start position by pulling with your arm and driving up
with your legs. 
2×10 each arm

Alternating Side Lunge
Hold the TRX handles and stand with your feet together.  Take a large step out the side keeping toes
pointed straight ahead. Bend the knee that you took a step with pushing hips
back and sitting into a side lunge position. Return to the start position and step
to the other side.
2×10

Balance Lunge with Knee Drive
Hold the TRX handles and stand with your
feet together.  Step back into a reverse lunge.  For a challenge: keep the back foot off the floor in a
balanced position!  Stand up on your
stance leg driving your knee forward into a march position.  Do all repetitions on one side then the
other.
2×10 each

Bridge with Hamstring Curl Series
Lay on the floor with your heels in the TRX cradles (handles should be about 12” off
the ground). Raise your hips into a bridge position.  Keeping hips level draw one knee in towards
your body.  Extend leg out and repeat
with the other leg. Repeat with both legs. Lower body back to the floor.
2×10

Watch Meaghan demonstrate all the TRX Strength Training for Runners exercises…

Bonus! Runner’s TRX Core Circuit

Complete the three exercises in a row
without rest.  Try the circuit 3 times.
Mountain Climbers
Start in a push up position with your feet in the straps. 
Maintain a flat back as you march knees towards your chest in an alternating
pattern.  As the knee comes in towards
your body your hips should rise slightly. 
10x
Three Position Crunch
Start in a push up position with your feet in the straps.  Maintain a flat back as pull both your
knees towards your chest. Return to the start position and pull both knees in
towards your right elbow, return to the start position and pull both knees
towards your left elbow. Repeat the series of 3 movements 5x.
Pike
Start in a push up position with your feet in the straps.  Keep your legs straight and drive your hips
towards the ceiling as you pull your feet towards your hands. 
10x
Blog post by Eric Chandler.

About
Eric Chandler

Eric joins the Cape Cod Rehab Running
Team with a background in Exercise Science. He is a Certified Strength &
Conditioning Specialist (CSCS), certified in Part I & Part II of the
Burdenko Method, a Certified Functional Movement Screen (FMS) Specialist, and
has also been training in the TRX Suspension Training Method. Eric looks for
his clients’ strengths and uses those strengths to help them get the most out
of each session. A recreational runner, Eric has served on many of the CCR
Flyers Cape Cod Marathon relay teams as has a goal of breaking 20 minutes in
the 5k.

Easy Exercises for Better Balance

It’s
that time of year where we start walking in a winter wonderland. This winter
wonderland is great for the holiday season, but with
winter also comes snow and ice. Losing your balance in these conditions can
lead to slipping and falling and possible injuries. Luckily, there are
exercises you can do to help train your balance and avoid sliding around! Here
are a few:

Stand
on One Foot

Stand
near the wall, a rail, or the back of a chair. Staying tall, stand on one leg.
Start with 20 second intervals and work your way up. You can start with holding
on, but try to use only fingertips and eventually using no hands once you are
ready. For an added challenge, try standing with your eyes closed.


Tandem
Walk

Walk
heel to toe. Try not to look down at your feet!


Half Roll Exercises

Step Forward and Backward

This
can also be done while doing the tandem walk. Stand on the half roll with one
foot in the middle. Step forward, shifting your weight. Then step backward. Try
not to look down. This can be done close to a wall, but try to work your way to
not using your hands. Make sure you are focusing on shifting your weight!
Switch which foot is in the middle as well.


Squat
and Touch

Stand
on the half roll with one foot in the middle. Step forward and slowly squat
down. Try to touch your knee first, then stand back up. Once you feel
comfortable, try squatting down and touching your shin or the insole of your
foot. This can also be done stepping backward on the half roll.


Leg
Swing

Stand
with one foot in the middle of the half roll. Simultaneously swing the other
leg forward with the opposite arm (I.e. swing left leg with right arm). Then
swing the leg back, again coordinated with the opposite arm. Stand tall, leg
the swing come from the hip not the knee. Make sure to switch the leg you stand
on.


Blog post by Nikki Courtney.

Alignment for Squats and Lunges

Now
who doesn’t do squats and lunges as a part of their workout routine?
Squats
and lunges are great multi joint exercises utilizing multiple muscle groups,
making them very effective and useful in a variety of exercise programs. Not
only do squats and lunges strengthen, but they help with balance, stability,
and can even improve your gait. Performing an improper squat or lunge, however,
can result in some pretty bad pain. Unfortunately, knee pain/injuries are
common, especially in women. Protecting your knees with proper alignment will
allow you to get the most out of your exercises. Maintaining good form will
also save your back, so pay attention!
1.    
Avoid driving the knee forward; keep your weight in
the heels!
·      
Many have heard
to “never let the knee over the toe.” This is a common phrase used by trainers
and therapist. What this is really getting at is to avoid forward movements
from the knee during the squat or lunge. Pressing the knee too far forward puts
an anterior shearing force on the ligaments that support the knee. Try to track
your knee over your little toe on the foot, this way you should still be able
to see your feet and avoid excessive forward movement.
·      
Do not go up on
your toes! The weight- especially in a squat- should be distributed into your
heels. Toes should be forward. When stepping forward into a lunge, keep the
weight in the heel of the leg you are actively stepping with and in the ball of
the foot on the trail leg.
2.    
Keep your shins over your ankle
·      
The goal is to
try and keep a somewhat vertical lower leg. While it may lean slightly forward,
you do not want the knee to move in a different direction than the ankle joint
(ex. knees collapsing inward). The stance can be wide, narrow, or hip width on
a squat so long as the knee ankle alignment is correct. For a lunge, look for a
right angle from the thigh to the knee to the ankle, keeping the knee in line
with the ankle.
3.    
Start with a pelvic tilt first then hinge at your
hips!
·      
The pelvic tilt
is critical to avoiding back pain and allowing activation of the powerful
gluteal muscles. A pelvic tilt sets a neutral lumbar spine (low back) and from
there you can hinge properly at the hips.
·      
To hinge at your
hips you must push your butt backward allowing the trunk to bend forward thus
loading your body weight in your heels. Without a good hip hinge, you put your
lower back and knees in jeopardy. The motion is almost like trying to sit in a
chair behind you for a squat. A general rule for forward lean is that the hips
should match the angle in your lower leg. It also facilitates equal weight
distribution between legs when performing a lunge. Make sure to clear your hips
once returning to the start position!

Forward Lunge


    Knee tracks over little toe, weight
evenly                          Right angles at knee
joints, toes forward 
distributed in front foot heel and ball of
trailing foot                     shins in line
with ankle joints

Squat with Counter Weight

                               Start position for most squats            Pelvic tilt and hip hinge

             Sit back on heels as if sitting in a chair              Full squat, thighs parallel to ground,
                                                                                              back and shin angles match

Follow
these basic form tips and you should see improvement in your squats and lunges
in no time! If you are unsure if correct form is being used, try performing the
exercise in front of a mirror or a friend who can help cue you.

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Blog post by
Nikki Courtney.