DBS not to be confused with IBS (Although, you might develop DBS from sitting on the toilet too much)!

DBS not to be confused with IBS (Although, you might develop DBS from sitting on the toilet too much)!

Dormant Butt Syndrome (DBS). Sure, it’s a funny name, but it’s a condition that’s growing in our nation and causing people to experience much more than a ‘pain in the butt.’ While DBS stems from a patient’s gluteus (butt muscle) not working efficiently, it causes aches and pain in the knee, back, and hip areas.

When these muscles are weak, or inefficient, they aren’t able to sustain the shock that they should. With that, areas like the knee, back, and hip are forced into the responsibility of accepting additional stress – possibly causing pain.

The world we live includes a lot sitting – in our cars, at a desk, in front of our TV. This in turn, causes tightness in anterior chain, specifically the hipflexor in the front of the hip. Because these areas get so tight our hips never achieve adequate hip positioning allowing for efficient glute activation.

Seemingly, as our culture leans more and more on inactivity, incidents of this syndrome will only increase. In addition, beyond sitting and repetitive physical exercise, there are even certain sleeping positions – the fetal, for example – that can also contribute to DBS.

So how do you treat DBS? Get moving! TOPS Physical Therapy and Osteopractics can treat you with exercises that both stretch the hip flexor as well as strengthen the gluteal muscles. If you’re in pain from DBS, you can make it a habit to break your sitting habit – set an alarm to notify yourself to get up and walk around.


  1. Dan Fleury PT, DPT, OCS, Diploma Osteopractic, FAAOMPT, ‘Dormant Butt Syndrome – The Newest Threat to Humanity’. Daily Press; Woods, Shannon. https://www.dailypress.com/brandpublishing/healthy-body-healthy-mind/dp-bp-osc-butt-syndrome-story-110116-story.html.

  2. ‘Aches and Pain? You Could Have Dormant Butt Syndrome’. CBS News. https://www.cbsnews.com/news/dormant-butt-syndrome-a-cause-of-common-aches-and-pains/.

Why You Are Asked To Do The Painless And Timely Outcome Measure

Are you always bombarded with satisfaction surveys and questionnaires, yet you rarely get feedback or changes from the surveys?? At T.O.P.S. we’d like to break this cycle! We find great importance with having you fill out the surveys to better dictate your treatment. “Why?”, you may ask… Here’s a great read about a patient who is very well spoken about his injury and utilized the outcomes measures to demonstrate his great improvement from dry needling at T.O.P.S.

We would love to discuss the results from your data as well. And for us to do this, we need you to fill out at least two surveys as honestly as possible, so the data can be accurately calculated and assessed. And from that, we can help get you back to your activity as quickly as possible!


Over the past several years I have done what most former male athletes do when they begin to suffer musculoskeletal pain in their mid-thirties, they operate on the premise of denial and neglect. Although this worked a short while for me, the occasional icing after basketball became a constant icing after every physical activity. I eventually took it upon myself to develop and administer a treatment and rehabilitation plan. As a practicing athletic trainer for 20 years I had a couple of treatment options in my tool box and I was able to get enough relief to continue to participate in the recreational activities of choice. However, after years of self-treatment and no permanent relief, I began to suspect that something more serious may be wrong with my knee.

I discussed my case with Grand Canyon University’s team orthopedic physician, Dr. Maddox, and he recommended that I have an MRI done on my left knee. The results came back and he diagnosed me with left quadriceps tendinopathy. Essentially, I was suffer from a chronic degenerative connective tissue disorder of the tendon that inserts into the top of my left kneecap.

I began to utilize instrument assisted soft tissue massage, prolonged passive stretching and eccentric strengthening to my benefit. I also sought a colleague of mine to perform a functional movement screen with me, which identified a few muscle imbalances that I was able to correct. In spite of all of these efforts however, I was still suffering from chronic pain just above the left knee cap, particularly when I would mountain bike, hike down steep inclines, and sometimes after playing basketball.

So finally after years of denial, neglect and self-treatment I turned to a friend for help. I sought out the expertise of Amy Brannon, DPT at T.O.P.S. Physical Therapy. Upon Amy’s recommendation I begin receiving treatments of electro dry needling on my left knee. I was very interested in knowing how effective this treatment approach would be for me, therefore prior to our first treatment I assessed the overall function and pain in my knee using two reliable outcome measurement tools. I continued to assess the outcome of the 5 treatments received over a period of 4 weeks. The results of my assessments are below:

0 Tx’s 3 Tx’s 4 Tx’s 5 Tx’s 4 months post Tx
Aug 10th Aug 17th Aug 23rd Aug 30th 1/9/2017
Total Knee Injury and Osteoarthritis Outcome Score(KOOS) 88.7 92.3 92.9 97.6 93.5
Total IDKC Score 78.2 90.8 95.4 96.6 93.1

It is apparent from the data above, and my current physical activity level, that I benefited from a very significant improvement in the overall function and pain in my knee. I am grateful for the wisdom and care which Amy Brannon provided. I give her my highest recommendation for anyone looking to improve their quality of life through optimal treatment and advanced musculoskeletal care.

Thank you Amy.

How I Learned to Love My Body As A Female Athlete

As a topic that is near and dear to my heart, I could not help but to reflect on my experiences as a collegiate athlete and the body image issues that consume many young women on a daily basis. The article “How I learned to Love My Body As a Female Athlete” by Victoria Garrick highlights the stark reality that young, female athletes experience day in and day out, and the existing societal pressures for women to fit a certain “mold” oftentimes does not align with the responsibilities and physical demands required for sport performance. As a impressionable young woman, I felt like I was always fighting the battle between trying to look like the “skinny, sexy, delicate, gentle, soft” woman society wanted me to be and the “strong, confident, competitive, tenacious” woman athletics required me to be.

As an athlete, I needed to be able to squat more than 200 pounds, jump higher than 30 inches, and produce enough force with my volleyball swing to attack the ball hard enough to penetrate two blockers and hit the ground within the 30-foot court. As an athlete, I needed to be able to lift weights and practice anywhere from 3-4 hours per day (burning approximately 1600-2000 calories) and to fuel my body with the appropriate caloric intake to complete my workouts and to replenish my glycogen stores (requiring me to eat approximately 3500-4000 calories per day). But as a woman trying to fit the mold of society, consuming 3500-4000 calories per day was surely going to make me “fat,” and it was not “sexy” to lift over 200 pounds and to bulk up so much that my jeans would not fit over my thighs or my booty. Thus began my internal struggle between athleticism and feminism, a struggle that continues to haunt me more frequently than I wish to admit.

To conquer the body hate-fest that ensues with most collegiate athletes and young women alike, the best way to start is by shifting your focus from external to internal. The following steps have helped me quell my internal battles and have instilled in my mind that feminism and athleticism do not need to be mutually exclusive, but rather they can co-exist harmoniously if the right mentality is fostered.

  1. Focus on health and feeling well.
    Stop obsessing over external appearances and obtaining an ideal body, and instead focus on the way being healthy makes you feel and what it gives you. You will find a deeper sense of gratification and more motivation to stay on track with this shift in mentality, and you will also begin to lose tolerance for the way unhealthy choices make you feel.
    You can also reframe the way you look at diet and exercise as something wonderful you do for yourself rather than a way to punish your unhealthy choices. Feed your body nourishing food so you always feel your best, and remove the worries of disease and poor health. Exercise to relieve the daily stresses of life, to release endorphins, to fight anxiety, and to feel good. Meditate to get in touch with your emotions, to connect with the bigger picture, and to feel at peace with yourself and where you are at in life.
  2. Treat yourself the way you would treat someone you love.
    Stop talking to yourself that way you would not take to one of your loved ones. If is powerful to recognize that the self-hatred you harbor toward yourself is not only unproductive, but it also begins a spiral that takes you further and further away from the things you want. How motivated would you feel to perform well for a boss who constantly demeaned you? Now imagine a boss who supported, encouraged, and nurtured you: how motivated would you be now? Our subconscious mind hears the self-talk and responds to it in a similar way, so make sure your self-talk is loving, supportive, nurturing, and forgiving. I challenge you to repeat a positive affirmation to yourself every single morning when you are getting ready to begin your day. Although it may take some time to believe it, in a short period of time you will retrain your thought process to be more positive and optimistic. When a negative thought about yourself enters your head, take a deep breath, release it, and repeat your positive affirmation in its place. Treat yourself with the utmost respect, and you will want to give your body the healthy choices that it deserves and needs to function in the best possible way.
  3. Stay positive and be grateful.
    Do not waste time and emotions staring at pictures of perfect bodies and wishing to be one of them. If you need visual inspirations, find photos of yourself at your best, not someone else at their best. Learn to release negative thoughts about your body and to focus on the good that it brings you every single day. Rather than fixating on not having lost that 5 pounds yet, or not fitting into that dress yet, make a daily list of your accomplishments and your gratitude. Just like in the rest of life, when we focus on what we do not have or what we have not accomplished, we feel frustrated and ready to give up. Listing your achievements instead puts your focus on what is going right, which in turn motivates you to do more. No accomplishment is too small to be grateful for, because it has taken you one more step in the right direction. There is now no reason to give up because with this attitude, you cannot fail.
  4. Love yourself first and the rest will follow.
    Learn to love yourself by catching and releasing negative thoughts, acknowledging your efforts and achievements, making positive daily affirmations, and seeing perfection in your so-called ‘imperfections.’ Ironically enough, focusing on loving and caring for yourself first will most likely lead to the external transformation that you have always wanted. Once you begin to treat yourself with the respect and care that you deserve, the habits needed for physical transformation develop naturally. You will want to nourish your body because you are grateful for it, so healthy choices will come with ease. When an unhealthy choice makes you feel awful, you will not stand for it because you know you deserve better. Before you know it, you will see your body transform physically, mentally, and emotionally and you will experience a healthy glow from the inside out. You will finally be at peace with yourself, and that inner beauty and peacefulness will translate to all avenues of your life.

For more information about the article that inspired me to write this blog post, I have attached the link to the article, “How I learned to Love My Body As a Female Athlete” by Victoria Garrick. Stayed tuned for more blog posts including ways to improve one’s body image with our new business venture MuscleSound! Stop by T.O.P.S. Physical Therapy and Osteopractics for more information on this innovative technology.


Written by Jordan Schaffer

What Is Osteopractic?

With healthcare, patients are more informed and knowledgeable than ever before. As with everything else in today’s world, they want things performed a certain way, done as quickly as possible, and they will use the internet to find the best place where they can get that service. These individuals want results, and they will shop around until they can find the provider that can effectively provide that in a shorter length of time.

As healthcare evolves, manual therapy is becoming increasingly important as it (1) provides results in a shorter time than traditional methods, and (2) it does so in a more personal, one-on-one manner. A Physical Therapist may find him or herself readily compared to massage therapists, chiropractors, or even craniosacral therapists, as patients are looking for just the right person to get them pain free. We Physical Therapists are the most qualified to return patients to a healthy lifestyle as we offer a broad scope of practice ranging from therapeutic exercise to pain management to, yes, manual therapy.

Hands-on treatment of soft tissue mobilization, joint mobilization, and dry needling therapy, among others, are rising to prominence in the field. With this, the newest form of PT is that of an Osteopractor, and our own Amy Brannon holds a diploma in Osteopractic Physical Therapy. The word ‘Osteopractor’ translates to ‘bone practitioner’ and they are therapists trained in diagnosing and treating neuro-muscluo-skeletal disorders. This diploma is given to a doctor or physical therapist who has completed an intense course of study that includes Certificates in Spinal Manipulation and Dry Needling, as well as IASTM (Instrument Assisted Soft Tissue Mobilization) and Extremity Manipulative Therapy. These techniques are proven to heal tissue, reduce joint impairment, and lessen pain.

An Osteopractor is a highly skilled, hands-on manual therapist who graduated through the Spinal Manipulation Institute. Dr. Brannon is one of a select and minimal group in the world to earn this title. If you are struggling with joint or muscle pain, and you’re searching for a solution…look no further than T.O.P.S. Physical Therapy.

Why “Sitting” Is Evolving Into Yesterday’s “Smoking”

There has been a lot of talk recently about the dangers of too much sitting, prompting many to say, “sitting is the new smoking”. Now for the good news. A meta-analysis of trials recently published in Lancet concludes that an hour of moderate-intensity activity offsets the health risks of 8 hours of sitting.

According to the meta-analysis, high levels of moderate intensity physical activity (i.e., about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time. The activity could include brisk walking (at 3.5 mile per hour) or cycling for pleasure (at 10 miles per hour). However, even shorter periods of activity (about 20 to 25 minutes per day) could attenuate the mortality risks associated with prolonged sitting.

Companies are trying to implement new ways to avoid sitting for long periods of time. One alternative would be to have stand up operations or working tables that allow employees to have the ability to stand or sit! Although, a treadmill desk is the preferred method of beating the “sitting all day blues,” it’s not always practical. The next best thing is a standing desk. It’s also cheaper than a treadmill desk.

In the meantime until further change is implemented, there are things you can do right now to help this problem. If you can’t walk or stand at your desk, don’t worry. There are still lots of things you can do to minimize the health hazards of a desk job. For example, offset the effects of sitting by taking the stairs at your work place, instead of the elevator.

Planning on Tearin’ it up on the Slopes Snowboarding this Weekend?

Here are some helpful exercises to get you ready!

After a whopping 7+ feet of snow this week in Flagstaff, snowboarders are flocking to the slopes for the weekend. (We know this because our social media feeds are full of people going! And hurting from it! Haha). Unfortunately, not all snowboarders will be prepared for a weekend of rippin’ up the fresh snow. Many will come back sore and stiff, making returning to reality a little more difficult. So…we decided to come up with an exercise plan to help you prepare for the physical strains that will be placed on your body during your weekend of crushin’ the slopes. We have written out the exercises here, but you can check out our Facebook page to see the videos that go with the exercise names! If you have any questions, let us know. Or if you have another favorite exercise, post it for us so we can share!


  • Start and end the day with a good stretch!


  • Bandwalks on heels and toes
  • Ice Skaters
  • Sideways hip raises with universal weight machine (T,Y,I motion)
  • 1/2 Foam roll rocks


  • Supine Hamstring Curls (with towel)
  • Bosu Med-Ball pass throughs
  • Bosu ball rocks
  • Double Bosu toe stands (lean forward and rock back and forth)
  • Lateral Bounding – without a band
  • Buddy pulls


  • High knee tuck with Box Jumps
  • Lateral Bounding – with a band
  • Sandbag get ups with no hands
  • Bulgarian split squat (1 min hold)
  • Kneel on Swiss Ball – either hold, or do upper body workout while on the ball
  • Rock ups- rolling sit to stand

(If you don’t have the bands we show in these exercises, you can order them on Amazon or similar online store, or you can purchase them at a sporting good’s store.)

** Mark McMorris recommends “finding the balance” before a snowboarding run
** Jamie Anderson and Torah Bright recommend yoga to stay limber and start the day off right
** Silje Norendal recommends squats with added weight

Lesson About Health Insurance

This is a quick 5 minute read that is important for all consumers to understand when getting medical services from an office! This is a simple lesson on health insurance and medicine…

Now that it’s the New Year, PT offices, and many other medical offices have to reset all of their insurance information. With that said, Ron Pavkovich gave a great summary of this fiasco, from the point of view of a PT front office…great read, not only for PT offices, but ANY medical office!

For those who don’t know, you, the patient, is ultimately responsible for knowing and understanding your benefits for medical care. The patient has the responsibility of knowing their plan, what is, and is not covered. As a courtesy, physical therapy and medical offices verify your benefits and explain them to you in a “language” that you can better understand. This courtesy of checking benefits is a relatively COST CONSIMUING gesture on their part. It is also ALWAYS an estimate. With that said, it is your choice and responsibility to either check your own benefits or know your plan. If your insurance does not pay for the services or care you received, it is still your responsibility at the end of the day. This is why you sign you initial paperwork advising that you understand and agree to pay for the services provided, in the scenario that your insurance does not pay.

If you have had a service performed, it is not the PT or MD office’s fault that your insurance did not pay. Therefore, you cannot, and should not, expect that office to not collect for services rendered and treat you for free.

This is a simple education lesson on health insurance and medicine. Please do not blame your provider for you not knowing what your plan does and does not cover. Your provider’s office is simply the messenger and doing you a courtesy by trying to help you understand the type of coverage you have. At the end of the day, your provider does not make these insurance policies nor do they have a say in what is paid for. Also, please keep in mind that your provider is likely only getting reimbursed about 40% of what they bill your insurance carrier. Insurance carriers are killing medicine!

Another point made is that often the PT or MD offices are responsible for pre-certifications. If the office is “in-network”, the office is obligated to write off some procedures, which are oftentimes beneficial.
Furthermore, if you provide insurance information that has lapsed after the first of the month, that carrier isn’t liable for payment! Good luck collecting or getting backdated approval from whatever carrier, if any, succeeds the lapsed carrier. And TPA’s will not backdate authorizations until you can prove they were wrong with processing it the first time. So in other words, they can allow for their mistakes, but never yours.

This becomes particularly frustrating for small private practices. They bill everyone the same, yet they generally are not able to negotiate with insurance companies, as they have no leverage. Thus, they have to either take what they pay (usually around $0.40 of every $1 billed) or not participate as in-network. They then approve the full rate, but pass it to the patient as an out-of-network cost. Most small private practices will offer anyone who pays day of service, a discount (and if insurance paid day of service, they would get it too). So anyone is welcome to see the prices, but insurances can change what they pay on a whim, so that is more difficult to keep up with.

This is an issue in our health care system that tends to be heated and followed with a lot controversy. Some responses we have had about this topic are:

  • Insurance anymore is only catastrophic Insurance at best. The deductibles are crazy and your 100% right about it killing medicine.
  • The mouse print on our patient delivery confirmation is extensive and has expanded to include all these points. Most folks have no clue how their insurance works. I have to explain regularly that office visits to their doctor and prescriptions don’t generally apply to deductibles.
  • I agree and fully understand your point. When will I be able to pay my doctors the same price for a service that they accept from insurance companies?
  • I agree the patient is ultimately responsible to know their benefits but we all live in the real world and that usually never happens. Protect yourselves and document, document and document some more!

MRI… Friend Or Foe?

There is always a question as to whether or not an MRI is needed, desired or unnecessary… which is what we address with each of our patients individually. If you talk to the experienced health care provider, the answer is probably “no” more than “yes”. However, if you talk to the patient, they oftentimes swear they need one, or will gain more confidence in getting one.

Here is some insight on why experienced health care providers shy away from getting an MRI until it is absolutely necessary!

Thank you to Adam Meakins for eloquently stating this information:

Do you think an MRI for that patient with persistent back pain will give you the answer?

This is an interesting study that highlights one issue with medical imaging.

1 patient with persistent low back pain had 10 MRIs in 10 different settings interpreted by 10 different radiologists.

49 possible pathologies where identified on the reports in total, but none, that’s NONE were reported consistently by all 10 radiologists.

Just how confusing is that for you as a clinician and the patient?

When it comes to medical imaging remember the 2 golden rules…

  1. Is there a high risk/suspicion of sinister life threatening pathology?
  2. Will the information gained from a scan change my management plan?

If no to both then DO NOT scan!

It will only hinder not help you or your patient!

For more information, visit: https://www.thespinejournalonline.com/article/S1529-9430(16)31093-2/abstract.

After Your Physical Therapy Visit: Short-Term Soreness Equals Long-Term Health

If you’ve suffered an injury, you most certainly wish that you could just click your fingers and have the pain be gone the next day. Of course, the body’s healing process doesn’t function that way and it takes time and proper care to get you back to feeling 100%. Oftentimes, physical therapy is an element to your recovery, stretching and activating muscles and other parts of our body that potentially haven’t been used or fully functional in quite a while. This movement will come as a slight surprise to that area of your body, as it may have been used to it’s new habit. While activity is necessary to get you back to your old self. this movement will cause resistance, and with this resistance will come soreness. So how can you deal with soreness after a physical therapy session? These three tips can help alleviate some of your discomfort:

  1. Ice the area >> Soreness typically means that the tissue of the body part is inflammed. Ice will work to cool and soothe the area – just as inflammation is a typical part of the healing process, ice should be a typical response to that inflammation. Apply ice for 20 minutes at a time, applying as often as you feel necessary.
  2. Drink water >> Soreness after a physical therapy session may be related to local inflammation, which produces waste products the body needs to eliminate. Drinking water throughout the day after a session will enable your body to process any toxins that had released into your blood stream.
  3. Take notes >> It’s your body, and your soreness, so write down where you feel the discomfort, how (if at all) the feeling has changed, and even how you feel following a physical therapy session. Any feedback you provide your therapist can act as a guide for future sessions.

Healthy Tips and Tricks to Keep You on TOPS in 2017

With the beginning of a new year upon us, we all have one thing on our mind: WEIGHT LOSS. This is the time of the year when the gyms are packed and everyone is trying to find the next best weight loss scheme to help shed those extra holiday pounds. We have put together a few suggestions to help everyone stay on TOPS of their goals in 2017!

  1. Get Moving! – This is seemingly a no brainer, but we often forget that moving our body does not require a gym membership or several hours of our day. We can all add in extra cardio throughout the busy day by opting to take the stairs at work, to walk for 10-20 minutes during our lunch break, or to mix in some squats, lunges, or stretching every 1-2 hours at our desk or on our way to a meeting. Exercise is exercise regardless of whether it is performed in one chunk of time or if it is conducted in short bouts throughout the day, so stay consistent with working movement in some capacity or another into your regular day and you will notice an improvement in your mood, your productivity at work, and your waistline.
  2. Meal Preparation – As the old saying goes, you cannot out train a bad diet. We all try to find a quick fix to help stimulate weight loss, but instead of spending money on buying various weight loss products you should invest your time in good old fashion meal prepping at home. Plan on using one afternoon to shop and prep every meal for the week, which usually saves you time and money if you stick to eating your scheduled meals. By cooking meats in bulk and portioning vegetables, fruits, and healthy carbohydrates, you will be more apt to stick to the diet and less likely to overindulge. If you find yourself in a time crunch and you need a quick fix to avoid those ‘hanger’ pains, look for snacks that are high in protein with minimal ingredients. A good rule of thumb to follow is to opt for food choices with 5 ingredients or less (all of which you can pronounce), and be sure to look for snacks with no added sugars and no artificial colors or dyes.
  3. Relax – With the holiday hangover from all the hustle and bustle, it is important to remember to take some time for yourself and RELAX! All the stress from shopping, cooking, and hosting can really bog you down, so make sure you are allotting 7-8 hours per night for restful sleep. Not only is sleep important for mental clarity and total body rejuvenation, but it is also vital for hormone synthesis and hormonal balance. If you cannot find time to squeeze in 7-8 hours of sleep, make sure you are taking short bouts of time throughout the day to focus on performing mindful, diaphragmatic breaths to decrease your heart rate and return your body to homeostasis. Try it out: sit still and bring your attention to your breath. Deeply inhale through your nose for a count of 5 seconds, hold your breath for 3 seconds, and slowly exhale through your mouth for a count of 7 seconds. You should be able to perform approximately 3 diaphragmatic breaths per minute, and after 1-2 minutes you should notice a decrease in your resting heart rate.

For more tips and tricks on staying motivated and rejuvenated in 2017, come in and see us at T.O.P.S.!