If the Shoe Fits: What Your Running Shoes Would Tell You If They Could Talk

At T.O.P.S. Physical Therapy and Osteopractics, we pride ourselves in our “shoe game” as we strive to put together the best outfits in the business. HOWEVER, there is so much more to a running shoe than the visual aesthetics, and we are reminded all too often of the implications from wearing the coolest looking kicks day in and day out instead of opting for comfort. We have come up with some helpful advice and tips about choosing the appropriate shoe to fit your training needs.

Take them out on a test run:
The right running shoes offer more than just comfort. Stores that specialize in running often have treadmills, so ask a salesperson to watch you run and recommend sneakers based on your running form and foot posture.

One shoe is not fit for every workout:
Running shoes are designed for forward motion. They lack the ankle support provided by cross-trainers, which are better suited for activities with lateral movement, like tennis and boot camp classes at the gym. To help avoid injury, save running kicks for the road or the treadmill.

Make sure the shoe fits:
Generally, your running shoes shoulder be a half size larger than your normal size to give your feet room to shift without jamming your toes. While standing, you should have half a thumb’s width of space between your longest toe and the shoe’s tip.

Hand-wash those bad boys:
For dirty sneakers, remove the insoles and spot-clean the outsides with warm water, soap, and an old toothbrush. Stuff newspaper inside the shoes and let them air-dry. Avoid putting your shoes in the dryer at all costs: direct heat can ruin the shape and adhesive on the shoes.

Do not exceed the ‘expiration’ date:
The best indicator of when to retire a pair of running shoes is mileage – between 300 and 500 – which you can track manually or with apps like MapMyRun or the Nike Running Club. Creases in the midsole (the squishy part of the shoe between the shoe’s bottom and the sneaker itself) are a better clue of overuse than worn treads are.

For more tips and tricks to keep you on T.O.P.S. of your competitors AND your shoe game, visit us at T.O.P.S. Physical Therapy and Osteopractics! Be sure to check out a few of these local retailers when you are looking to buy your next pair of running shoes.

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!

2017

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.

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.

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.!

FOOT STRENGTHING FOR RUNNING

Running season in Arizona is upon on us with training for the P.F. Chang’s marathon. With the increased training and mileage comes potential for foot pain/injuries. During the running gait each foot must be able to stabilize and provide dynamic stability individually. Therefore, it is important to perform supplementary single leg stance loading in all three planes of motion. The three planes of motion are the sagittal plane (forward and backward movement), frontal plane (side to side movement), and transverse plane (rotational movement).

We have come up with four different exercises to perform 2-3 x per week to supplement your running that will encompass all three planes of motion:

  1. Nose to Wall: Stand on one leg with other leg in the air out front. Shift your body weight forward to the point where you almost feel your heel come off the ground on your stance leg and then shift your body weight back. Try to avoid the woodpecker type motion. Repeat for 3 sets of 10-12 reps alternating legs.
  2. Lateral bandwalk: Put a band around both ankles and start with your knees and hips slightly bent. Keep your feet pointed straight forward the entire time take 12 steps sideways. Stay facing the same direction and take 12 steps back, repeat the movement 2 more times down and back.
  3. Posterior medial step down: Stand on one leg with most of your weight on the heel, but still keeping big toe in contact with step. Sit back like performing a single leg squat focusing on more of a hip bend as opposed to a knee bend. Pay attention to your knee on the side you are loading to ensure that it is stable, not diving in too much and touch the floor with your opposite heel. Return to a fully extended position with the knee and hip completely straight focusing on squeezing your glutes and quads at the top.
  4. Doorway touches: Stand and balance on one leg with a soft slightly bent knee and touch the Left doorjam with Right hand and Right doorjam with Left hand. Perform this alternately for 10 on each side for 20 total touches. Repeat this for 3 sets.

This group of exercises can be best performed prior to running as a movement prep to engage your foot intrinsics and to get the posterior chain acitvated.

If there are any activities you are having difficulty with come in and see us at TOPS Physical Therapy and Osteopractics.

LET’S TALK FOOT PAIN AND SHOES!

Ever have foot pain or discomfort and cannot find the right shoe for your foot? Feel like all of the cool name brand shoes just don’t quite cut it? If so, there have been many patients who have the solution to your problem! There are a variety of shoes that help to minimize many of the “foot-pain” issues. These include a wider toe box, zero-drop sole, and flexible sole. What do these things mean??

Toe box: the area where the toes reside. In general, the widest part of the shoe should be at the end of the shoe and not at the ball of the foot.

Zero-drop sole: The sole of the shoe does not have a build-up or larger heel as compared to the toe of the shoe. In many traditional shoes, the heel has a larger sole, which can sometimes be the cause of foot pain. This also contributes to a tighter calf muscle, which when wearing sandals, as we often do in Arizona, would cause increased pain. **Warning: if you are have not transitioned to a zero-drop sole yet, please talk to us or a trained professional prior to quickly transitioning out of an elevated heel. This will prevent pain from starting!

Flexible sole: The bottom of the shoe should not be rigid when bending the toe towards the heel, which allows for a more natural motion of your foot. There should also not be a crease that occurs in the toe box when bending the toe towards the heel. This also goes for orthotics that are placed in the shoe. If you experience increased toe pain after inserting orthotics, please inform the medical professional who suggested them, or bring them in and let us check them out!

There are a couple of brands that have withstood test of time: Altra and Lems. These two have been created for the active person while allowing the foot to remain in a natural, relaxed position across every terrain!

If you have any further questions or are curious if you could benefit from these shoes, please contact us and we will help you figure out what is best for you! Happy Shoe Shopping 🙂