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Longmont Physical Therapy

New Parents

     Those of you out there with newborns be sure to get them screened regularly for neurological developmental stages. It's important to monitor their progress physically to confirm the proper neurological progress. It's important you stay on top of this aspect of development so you can catch flaws early and correct them. No one wants to think their child is anything but perfect but the truth is that you have to acknowledge when something isn't right and the sooner you do so the better off the child is. If caught early you can find the proper care and help to decrease the deficit while the child is still moldable, if you wait too long their ability to rehab the deficit is substantially hindered. They are absolute sponges and much like Play Dough in the first 5 years of life, after that they have a foundation of mental and physical competence that is significantly harder to un-train. At the end of the day a birth defect isn't a reflection of your parenting it's just a fact and the sooner you acknowledge its presence the sooner you can seek treatment and provide the child with the life tools needed to be successful in life. We can't be there to take care of them forever so do them a favor and give them the skills they'll need when you're not around to do it for them anymore.

Heres a few things to look for an approximate time you should notice it:

- at 4-6 weeks: optical fixation, primitive reflexes diminish, Co-activation of muscles, Postural activation of phasic muscles, the fencer's stance.

-3 months: when face down they are head up with weight on the elbows and pelvis, Galant reflex and grasp reflex diminish, lateral grasp, foot to foot touching when on their back.

-4.5 months: tripod support (elbow, hip and opposite knee) in prone and grasping object, asymmetrical trunk lengthening.

-5-6 months: rolling (back to front only), grasping across the midline, they push up onto their hands and thighs, hand to foot coordination, most primitive reflexes should be gone at the end of 6 months.

7-9 months: rolling (front to back), quadruped position (hands and knees, 7 months), grasping a toy in quadruped in month 8, crawling by month 9, pincer grip (thumb and forefinger opposition) 9 months.

Hope this helps. For any clarification please don't hesitate to make an appointment and clarify. --Cheers

See the Forest for the trees........

See the Forest for the trees........

   When rehabbing an injury it's important not to lose sight of your goals.  Many time in traditional, old-school thought of rehab, the clinician and patient get so focused on individual muscles to be activated they fail to recognize the dysfunctional system, hence the "forest for the trees" comment.

   Rehabbing individual muscles does not make a dysfunctional system functional.  that sort of thinking would be no different than thinking a replacing the engine of a rundown old junker suddenly makes it a hot rod! There can be some muscular rehab for some injuries but to apply that to all scenarios and limit rehab to isolated muscle activation would be ineffective.

    The emerging trend in rehab is to train the system.  The muscles you would normally rehab have to function appropriately within the system they are a part of in order for the system to be efficient.  Therefore it only makes sense to train the system as a whole.  

   In order to do so, you have to remove the stress of being upright, weight bearing.  If/when the system fails in weight bearing you take it down to non-weight bearing, like kneeling or sitting.  If that is still too much for the system take it down further to a suspended spine (hands and knees).  And if this is still unstable then you take it back to the most basic of positions, on you your back.  From here you are in the simplest of position and have removed all postural stability requirements.  In this position you can perform any exercise without a need for postural stabilization, allowing the brain to focus on the unimpeded motion in the joint.  Once you can perform proper ranges of motion without pain with stability, you start climbing the ladder back to standing.

   For some people even laying on their back is unstable.  For those folks, we focus on breathing, because when the diaphragm isn't being utilized as designed, nothing can be stabilized.  It may not seem like much but relearning to breathe with the right muscles is the foundation of spinal stability which is necessary to achieve extremity stability.

   Anybody can get by without stability for a period of time but eventually, the compensations will fail and the system fails.  This is where you start noticing pain, some worse than others.  At the point of pain you know has dysfunction, to postpone rehabbing said dysfunction means you move in pain regularly which also means you move differently in an attempt to reduce painful movements.  These compensation further destabilize the system and only prolong the road to recovery.

 

Dynamic Neuro Stabilization

Dynamic Neuro Stabilization

Postioning of the diaphragm relative to the pelvic floor are key to trunk stabilization, resulting in more efficient movement. 

Postioning of the diaphragm relative to the pelvic floor are key to trunk stabilization, resulting in more efficient movement. 

Effective vs. Efficient:
    Although they can be synonymous they are not always the same.  When using the two terms while describing human movement they are rarely the same.  Many times we get things done without thinking about how efficient we are in the process.  Efficiency can also be somewhat subjective.  for example when on a road trip is it can be more efficient to be faster by using more gas to go faster or more gas efficient to go slower requiring less gas.  With human movement its pretty straight-forward, effort!  Not every movement is the same therefore you can train everyone to be efficient for everything.  A shorter person, regardless of training, will never be quite as fast as a taller person in the pool, all else being equal, its just physics.  We can, however, train efficiency on a person to person basis to more efficient in general.  The side effect of this efficiency is improved function and health.  Whether you're an athlete or a "weekend warrior" efficient movement patterns allow you to enjoy your chosen activities more.  Less time catching your breath and more time enjoying the scenery.  

The Prague School's approach to Trunk stability is based on 60+ years of clinical application.  They have worked with numerous international weightlifting programs producing dozens of medalists in that time.

The Prague School's approach to Trunk stability is based on 60+ years of clinical application.  They have worked with numerous international weightlifting programs producing dozens of medalists in that time.

    Like any other system, efficiency starts with a good foundation.  A good foundation for quality, efficient human movement is a stable trunk or core.  Although this may seem cliche, in this case its a new take on an old concept.  This is because of the starting point.  Most people think core stability starts with sit-ups or planking.  These are nice but they aren't the foundation.  The foundation is in the breath or the diaphragm to be exact!  Without proper breathing patterns, by that I mean expansion of the diaphragm into the abdomen, you cannot properly stabilize the lumbar spine or the trunk.  Second to that is a loss of stability in the extremities.  When you lose stability you become inefficient in your movement.  Peripheral stabilization is then required, recruitment of other muscles.  In other words, when unstable you use 2x the energy to accomplish the same action as someone with proper stabilization.  Do you think these world champion weight lifters squat 1200 pounds without stability and efficiency?  HECK NO!! 

movement rehabilitation is based on human developmental stages.  

movement rehabilitation is based on human developmental stages.  

    So if you are one of the thousands of folks out there that can't seem to get rid of that nagging low back, upper back, neck pain, etc.; perhaps its time to stop the insanity (def. insane: repeating the same action and expecting different results) and get properly assessed and learn how to be more efficient.  Pain shouldn't be a part of your every day routine.  If it feels like you aren't as energetic as you used to be, maybe its not "low T" or old age, maybe its inefficiency?  You're wasting half your mental and physical resources just trying to stabilize!?  I'm here to help, make an appointment and lets talk about what you want to improve!

 

Hot vs. Cold

Hot vs. Cold

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   People are regularly asking me what to use, heat or ice?  So I thought I'd take this time to give a little feedback, for the record.  Before I do, I need to explain a thing or two.  First, There is no research that has definitively linked heat or ice to any significant change in recovery.  Considering that most research design has an inherent flaw, some more flawed than others, there is just as much research supporting hot/cold therapy as there is refuting it.  Most research suggest neither manage to effect tissue more than 1/8-1/2" deep, the skin is normally about 1 sheet of paper thick.  There will be body parts it can be more effective than others, ankle v. gluteals, but overall the research is inconclusive.  Secondly, considering that half the game is in the athletes head, if you think it helps..... IT HELPS!! haha!  Seriously though, this isn't the only treatment out there that science has failed to confirm or deny that is still widely used.  So with that said if you like to take contrast baths after a big game to prep for the next game, be my guest.  One thing science hasn't done is prove it hurts to ice or contrast!  So if it provides you a mental edge, then don't hesitate!  I know I used to do it all the time when playing, I'll be the last person to tell you "stop".   So with that said, on to the point of this article.

There are numerous forms of heat that can be useful.  Just make sure to be aware of too much heat.  Too much can cause burns that can complicate your achy muscles.

There are numerous forms of heat that can be useful.  Just make sure to be aware of too much heat.  Too much can cause burns that can complicate your achy muscles.

     Heat should only be used on a subacute injury (old or chronic injuries) before activity.  Heat is something you would use to start the day or before your workout.  The body responds to heat by sending more blood to the area, through vascular dilation, increasing blood flow to the area.   The additional blood to the area helps increase the core temperature of the muscles of the area of application.  The increased muscle temperature helps to prevent muscle damage like strains and/or tears.  Its the same principle behind dynamic stretching.  They both are used to increase blood flow to the area.  With increased blood flow comes increased temperature and increased elasticity.  To get a nice visual, try taking 2 rubber bands, freeze one and put the other in a warm water bath then try stretching them and see which one snaps first.  Although a little exaggerated, this is very similar to how your muscles work.  cold muscles are fragile and warm ones are responsive and adaptive, which is key in injury prevention.

Old school bags of ice cubes or frozen veggies are out of style these days with all the different colds packs made these days but they can be expensive and don't work any better than your "old reliable"!

Old school bags of ice cubes or frozen veggies are out of style these days with all the different colds packs made these days but they can be expensive and don't work any better than your "old reliable"!

     Ice should be applied at the end of the day when all activity is completed.  Ice will aid in lower the core temperature of the muscles/joint over the area applied.  Cold causes vascular constriction in the area of application, this reduces the amount of blood that makes it to the area.  This is the bodies response to cold in an effort to maintain core body temperature, much like when you are outside in the winter and you feel fine but your fingers and toes go numb.  Its the bodies natural response for staying alive.  The use of ice helps decrease inflammation in the area.  Its especially helpful in the event of an acute injury (new), like an ankle sprain, to prevent/limit secondary injury due to excessive swelling.  With a new injury tissues are torn, including capillaries, causing blood to flood into the muscle compartments.  If the swelling is left unchecked it can overfill these compartments resulting in rupture of the fascial dividers and further injury.  It can also cause compression of other structure restricting blood flow and sensation, which can lead to necrosis (death) of compressed tissue (muscle and nerves alike) if left long enough.  It's imperative to make sure the PRICE (Protect, Rest, Ice, Compress, Elevate) guidelines are implemented immediately following injury.  Here's a general rule of thumb for ice usage is 20/40 (20-minutes on followed by 40-minutes off) with compression till bedtime.  Some people like to use contrast baths for recovery.  As mentioned above, the research is inconclusive but if that's part of your routine and you feel it helps, by all means, keep it up!

    I hope this was useful.  Please don't hesitate to reach out with any questions or concerns.  Hope to see you soon on the field or in the office.  Until then take care and best of luck!  Cheers!

About Your First Visit to Our Longmont Chiropractic Facility

About Your First Visit to Our Longmont Chiropractic Facility

     First, Observation!   It's important to understand movement is a big key to your function or dysfunction.  When in pain movement is altered to reduce the pain.  These altered movement patterns can contribute to further dysfunction.  I want to see how you walk, stand, sit, lay down and breath.  Ever think about breathing?  I find dysfunctional breathing in most patients with pain.  proper breathing is key to trunk and core stability, so if your breathing pattern is off, makes sense you'd be in pain! 

    Secondly, we'll have a lovely little chat.   This is where we get to know each other while I get a little history.  I want to know what you do every day, what you used to do and what you want to do going forward.  Are you an accountant trying to make it through tax season, are you a high-level athlete trying to recover from a nagging hamstring that won't stay healthy or are you somewhere in between.  I'm happy to help wherever I can but I'm not trying to make you something you aren't.  I am not for everyone and I cannot fix everything.  There is a limit to what I can do.  One of the best indicators for care is your patient history.  While we talk we will get to know one another and whether or not you are in the right office.   This is important so we can be as efficient as possible while in the office.  We all got things to get to so I'm not interested in keeping you here any more than necessary.  Let's get you patched up and on your way again!

    Third, I'll conduct a thorough physical exam that will include vitals, neurological exam, orthopedic exam, muscle testing, a movement screen, and reflexes.  Before treatment is rendered it is imperative to make sure you are physically fit enough to do so.  These exams are designed to ensure there isn't something more sinister going on that would necessitate a referral to your PCP.  Without a physical exam, I could miss something that could cause me to hurt you even more.  At the same time, they provide clarity to a foggy picture of dysfunction.  Every step of the process provides more insight to the root of your problem.  Although we do not perform imaging here (X-ray or MRI) we do have referral privileges at Health Images, located just south of town, and can have you seen, imaged and results in our office in the same day.

     Fourth, appropriate treatment will be rendered.  Depending on the primary complaint it may include some or all of the following: Chiropractic adjustment, palliative care (e-stim, heat, ice etc.), Soft tissue work, taping (k-tape or the like) and home exercises.  I am a chiropractor and will always adjust when indicated and safe but its not adjusting for the sake of adjusting.  I try to adjust with specificity, to make a change in the nervous system.  Hearing a "pop" is good but if it doesn't improve function then what was really done?  The first visit won't involve much adjusting of the spine.  The focus will be making sure a few key areas are aligned.  When addressing a problem you start with a narrow focus and get broader as you eliminate variables.  Treatment on the first visit will be more soft tissue, extremities, breathing and exercises than adjusting.  

     Lastly, care plan.  I like to see my new patients 2x/week for 2 weeks to make sure you're responding appropriately to care followed by 1x/week for 1 month to reinforce care and modify home exercises as needed.  Home exercises are imperative to improvement.  Dysfunction involves faulty motor patterns.  In order to change them the patient MUST do the work, this is called active rehab.  The treatment I perform (adjustments, e-stim etc.) are all passive.  Passive therapies are helpful in reducing inflammation and correcting misalignments but they do not create new motor stabilization patterns for the joint.  Therefore, if you want a change, you'll have to make it!  Nothing new there, just thought I'd remind you.  

    At the end of the day, we were designed to move, pain-free.  If pain causes you pain something is wrong and the sooner you have it looked at, the easier it is to fix.  Pain shouldn't be a part of your day and I look forward to making sure it isn't but I can't do it by myself.  So call for your appointment and let's see what we can do together to get you moving pain-free.

Are you getting the most out of the gym?

Are you getting the most out of the gym?

Let us help you understand your best approach to accomplishing your goals in the gym. We blend a sports medicine, physical therapy, chiropractic, manual medicine principles in solving your health issues.

The Sports Medicine Approach

The Sports Medicine Approach

Dr. Ray writes about the modern day sports medicine approach and how a more tailored treatment plan is far more effective.