Good Morning! Time to get up and get the day started!  Gotta warm up the body and the Bretzel is a great way to get that accomplished.

The next thing is to stretch the other side!

Hope you enjoy the Bretzel!

​Dominick

Many exercise routines and strength regimes tend to incorporate of some sort of pressing overhead.  Alternating arms, both arms, military press, even overhead triceps work, and the list can go on and on.  It is a GREAT way to target multiple muscles in the shoulder BUT (a BIG but) you MUST make sure you have enough shoulder range of motion (ROM) to complete the task.  If you cannot complete the motion withOUT weight, what makes you think you can do it WITH weight?  Here is the check:

Start by laying on your back, knees bent and hands by your sides.  Next, arch your arm overhead.

You should be able to have your hand and arm touch the ground overhead with 

• no pain
• no arching low back

If you can, GREAT.  You are all set.  If not, there are many things that you can do to improve that ROM.

If you have any questions, please let us know.
Dominick
dominick@sanramonvalleypt.com

Ab scissors are one of the best core and hip stabilizing exercises, but, like most exercises, it needs to be done correctly.  There are a few major errors that are commonly made which we will aim to fix today.

I like to perform 10-20 reps on one side, then repeat on the opposite side.  Some people like to alternate, which can be effective.

I hope this helps and gives you a few pointers the next time you try ab scissors.

Dominick
dominick@sanramonvalleypt.com

One of the most prescribed (and most favorite) exercises I give to patients is the single leg Romanian deadlift.  It is such a well rounded exercise that can be easily progressed and regressed, works on multiple muscle groups, challenges balance, and emphasizes proper lifting mechanics.  I give the SLRDL for most lower limb injuries and even low back pain when appropriate during the course of treatment.

Repeat 10x 3 sets.  ​Try to not let your swing leg touch the ground throughout the set.

Let me know if you have any questions!
dominick@sanramonvalleypt.com

Chris Bleakley wrote an editorial in the Journal of Sports Medicine about the most recent evidence on icing after an injury and here is a great infographic.

Running involves a motion with high impact and injuries are common. There are many things that you can do to prevent this, from wearing the right shoes to running on more gentle terrain. It’s important to understand common injuries, how to treat them, and prevent them.

Approximately 30% to 40% of runners will experience at least one of these five most common injuries.

Knee Injury
Knee injury affects 30% of runners and it can be caused by issues such as soft tissue mobility, lack of strength, and flexibility. What to do? Stretching and strengthening the muscles around the knees, even hips muscles and hamstrings are a crucial part of preparing yourself for a run.

Shin Splints

This injury is most likely to happen at the beginning of training. Shin splints are common among runners in high school and runners who had time off before going back to running. The injury is caused by overtraining, and appropriate rest is important to prevent further injuries. Improve flexibility of hips, calf and ankles to prevent the injury.

IT Band Syndrome
The IT band is the fibrous band that supports the outside of the knee. IT band syndrome is the second most common injury among runners. It’s important to strengthen the muscles which control stability, especially the hips and glutes. Also, it can be very beneficial to improve balance. Use a foam roller and do exercises such as lunges, leg raises and bridge exercises. On top of this, yoga and pilates can be helpful to increase flexibility and strength.

Achilles Tendinitis
This injury is common among hill runners and sprinters. The symptoms include pain around the tendon and swelling. Again, flexibility, balance and strength play an important role. If you have Achilles tendinitis rest and put some ice on it. Also stretching the calf area and heel can help. What type of exercise should you do? Try calf raises and toe-to-wall stretches.

Plantar Fasciitis
This injury is caused by the repetitive nature of running and it mostly happens to those who already injured their foot. Rest is crucial here. Also, foot and toe stretches can help you deal with the pain. You can wear compression socks, proper footwear to help you deal with the weight-bearing pressure of the injured foot.

Should You Run When Injured?
The answer to this question depends on how severely you are injured. Each one of us is different. However, it’s important to stress that you shouldn’t make this decision on your own. Go and see a doctor before running while injured. The answer to this question is: “Yes if your doctor says so.”

How to Prevent Injuries from Happening?
Many injuries can be self-inflicted if you are increasing intensity, changing running shoes or terrain, or using improper training and stretching. You should talk to your physical therapist about factors that can lead to injuries and help them treat these.
If you have a personal trainer, keep in mind that they are not equipped to diagnose an injury or treat one. Still, they can give you tips on proper terrain and factors that play a role in the injury.
​
Two also important things to do in order to prevent injuries are starting slowing and making sure you have enough rest between two runs. Avoid increasing your weekly mileage by more than 10%. Also, find some time to rest by switching to other physical activities such as yoga or swimming, riding a bike. If you are an avid runner, always keep in mind that you need one full day of rest every now and then.


https://www.gildshire.com/five-common-running-injuries-and-how-to-avoid-them/

You’ve been sent for an MRI and there you are with the scan results in your hand. The report is telling you that your knee has a range of abnormal findings including a meniscus tear. Uh oh! This must be why your knee hurts…well maybe not. The reality is that this tear may have been there long before the knee pain existed.

Often scan findings are linked to a person’s cause of pain however this relationship between knee pain and abnormal MRI results is not always precise. Not only meniscus tears but cartilage defects, bone marrow lesions, osteophytes and other features of osteoarthritis can be commonly found on knee scans. It’s never been more important that scans must be interpreted with caution. We now have unprecedented access to imaging services with over 27,000,000 medical imaging investigations occurring annually in Australia. This costs their medicare a whopping $4 billion yearly.

So what are the facts?

A large review study published in 2018 looked at 3761 knees in people who were pain free. From a collection of 44 studies this is what they found:

• On average, 10% of pain free knees had a meniscal tear
• 4% of people younger than 40 years old had a tear
• 19% of people 40 years or over had a meniscus tear (2)

Just recently another study looked at both knees of 115 uninjured, pain free volunteers (that’s 230 knees total). This study used an even stronger MRI machine than previous studies and what they found was:

• 30% of pain free knees had a meniscus tear
• A further 18% had meniscus degeneration
• Therefore 48% of asymptomatic volunteers had an abnormal meniscus

Should I get a scan?

The answer to this isn’t a straight forward yes or no but there should be a good reason to send someone for a scan. Guidelines were developed to prevent unnecessary knee radiographs following knee trauma, these are called the Ottawa Knee Rule.  . The indications for a x-ray are as follows:

• aged 55 years or over
• tenderness at the head of the fibula
• isolated tenderness of the patella
• inability to flex knee to 90 degrees
• inability to bear weight (defined as an inability to take four steps, ie. two steps on each leg, regardless of limping) immediately and at presentation to a health professional

If the knee pain is from a non-traumatic incident then imaging is likely not needed unless the health practitioner is concerned about other factors such as malignancy or infection. Often a diagnosis and management plans can be developed successfully without the need for any imaging.  MRI should only be considered when the knee injury diagnosis is doubtful, difficult and complex.

So what does this mean for you?

Just because you have abnormal findings on a scan does not mean it’s the cause of your knee pain. Again, we can’t determine someone’s pain source purely from a scan. This is where it is important to always match a person’s clinical history with their medical imaging – and this is what good health practitioners do! Chances are that some of those scan findings were probably there long before your pain existed. 

Summary

• The relationship between knee pain and MRI results is not always precise
• A large review found that in on average 10% of asymptomatic people had a meniscus tear. This grew to 19% in over 40’s
• In 2020, a new study found 30% of pain-free people had a meniscus tear
• 3 large reviews found that people will do just as well with physiotherapy than surgery
• Just because you have a torn meniscus on MRI, doesn’t mean you will always experience pain from it

This article was written by James Gardiner at POGO Physio in Australia.  They have a fantastic blog with tons of resources.  Check it out!

If you have any questions, please let us know!

Dominick
dominick@sanramonvalleypt.com

I started doing this exercise from an Orange Theory online class and really liked it.  I have implemented it in many of my workouts and given it to patients.  It is great for:

• shoulder stability
  
• core strength
  
• glut strength
  
• cardio 

Start in a nice tall plank.  Don't over arch your back in either direction

dominickRepeat the movement without your swing foot touching the ground.  Try 10-15 reps each side for 2-3 sets.  You can also mix it in with a sequence of other exercises you plan to do.  I have this inserted as a 60 sec exercise (30 sec each side) in many of my routines.

Please let me know if you have questions.

Stay active, stay safe!
​Dominick
dominick@sanramonvalleypt.com

​Sufficient shoulder mobility is important to minimize injury to the shoulder (obviously), but also the neck, spine, and entire arm.  We are constantly checking the 2 below motions on patients who come to with any issue from the waist up; anything ranging from headaches to carpal tunnel.  

If you notice one side is limited and/or painful compared to the other side, give us a call and see how we may be able to help.


Check out this great 5 minute video on various shoulder mobility exercises.  It was created by Dan Pope, a physical therapist who has many great posts (@ www.fitnesspainfree.com).  I figure a guy that looks like Aaron Rodgers and has a better body than me is better suited to make a YouTube video for this sort of thing.  Check it out!