Featured

How I Caught a Zebra… Part 6/6

It’s taken a while, but I’m finally getting to the point. This is post 6 out of 6, and I’m going to tell you about that zebra. Click here to get back to the beginning. Part 2, Part 3, Part 4, and Part 5.

In the last post, I talked about how my geneticist was concerned that I might have the vascular type of EDS. A few weeks after I saw Rheumatology in 10/2019, my genetics results came back. Thankfully, I am negative for the vascular type of EDS. I have a “defect of unknown significance” for the genetic marker for the most common (and most mild) type of EDS.

I talked with my rheumatologist who then helped me figure out what this meant. Basically, I have the hypermobile type of EDS. Researchers haven’t yet identified the genetic marker for this subtype, so it will not show up in genetic testing.

So, I finally had a diagnosis. I caught a zebra. Ehlers Danlos Syndrome is associated with a zebra because it’s a rare disease/condition. 
zebra
What does this mean for me? Since my joints are hypermobile, I’m at higher risk for developing nerve injuries and early osteoarthritis, the degenerative type of arthritis that is seen with aging. This means that I will “age” faster than my peers and that I’m more likely to have achy joint pain.
So, what should I do about it? The treatment of Hypermobile Ehlers Danlos syndrome depends on the signs and symptoms present in each person.
  • Physical therapy is the preferred management method for Hypermobile EDS. It helps to strengthen muscles and improve joint stability.
    • How convenient that I had already done the research for this! I had been applying some of these principles since early 1/2019.
      • The focus is more on low resistance exercise (like bodyweight exercises or yoga) to build stability than high resistance exercise (like heavy weight lifting)
      • People with this type of EDS are sometimes told to pretend that they are in a “box.” The idea is that you want to try and limit your extra range of motion to prevent further damage.
  • Activity modification
    •  High-impact activity increases the risk of acute subluxation/dislocation, chronic pain, and osteoarthritis
  • Assistive devices
    • Braces, wheelchairs, or scooters may be needed if joint instability becomes severe
  •  Treatment methods for osteoarthritis
    • Physical therapy is highly recommended; muscle strengthening helps to reduce the stress load on your body’s joints
    • Turmeric supplements can be tried to help with inflammation
    • Use NSAIDs like Ibuprofen and Advil as needed; excessive use can lead to toxic side effects on your liver and kidneys
  • Monitor for related conditions
    • Osteopenia (low bone density)
    • Aortic root dilation (enlargement of the blood vessel that distributes blood from the heart to the rest of the body)
References:

 


img_20191107_063201_7786263157454685867523.jpg

 

I’m a dedicated exercise physiologist with a passion for fitness, health and wellness, good food, and dancing. I work with clients online and face-to-face to help them reach their fitness goals. Feel free to check out more at my Facebook page, Rebekah James – Facts, Fitness, Fun

Featured

How I Caught a Zebra… Part 5/6

This is part of a series about my healthcare journey over the past ~10 years. Click here for the beginning! Part 2, Part 3, Part 4.

In the last post, I talked about how my geneticist was worried that I might have vascular type EDS. Why?

She was particularly concerned about this subtype because of my family history. My paternal grandmother had an abdominal aortic aneurysm that was “accidentally” found during surgery and repaired. And as you may know, my father passed away at 56 from a heart attack (aka myocardial infarction: this is where the heart muscle is damaged due to lack of blood supply to the heart.)

I learned that his autopsy report would only list myocardial infarction as the cause of death; it wouldn’t specify which type. There are two main subtypes of heart attacks: Type 1 and Type 2.heart attack

  1. Type 1: Caused by a blockage in one of the heart’s arteries. This is the most common type of heart attack. It’s usually caused when a cholesterol plaque lining an artery ruptures. This forms a clot, which blocks the vessels.
  2. Type 2: Caused by imbalance in blood supply and demand. Doctors are realizing that many heart attacks are actually caused by this instead. 
    1. Consider a person whose arteries are narrowed because of heart disease. If they develop internal bleeding or low blood pressure, their vessels will fail to bring enough blood to meet the heart’s oxygen demands. 
    2. If someone has a high heart rate or blood pressure, the demand for blood will be more than their vessels can supply.
    3. Sometimes, the heart’s arteries temporarily contract. This is known as a coronary spasm, and again, the blood demand and supply don’t match up.
    4. In rare cases, a heart attack can be caused by a tear in the wall of a heart artery. This is also known as a spontaneous coronary artery dissection. In this case, the vessels will fail to bring enough blood to the heart. 

My geneticist was concerned that my father had a heart attack from a coronary artery dissection since he passed away so quickly. He was dead before the ambulance reached the house (it was less than ~10 minutes from the hospital.)

bekah
One of my favorite pictures with my dad.

This brings a weird sense of comfort to me. Men don’t typically die from their first heart attack, but mine did.  My father was also the healthiest I had ever seen him in 2010. He had changed his diet, increased physical activity, and as a result, lost a significant amount of weight. I was so proud of him, especially as an exercise physiology major. It just didn’t seem fair, and it didn’t seem right.

I wouldn’t receive my test results for 6 months. During that waiting period, I followed up with pediatric cardiology and had an ECHO. An ECHO, or echocardiogram, is an ultrasound of the heart. It indicated the following: “mild mitral valve prolapse of the anterior leaflet with mild mitral valve insufficiency.” While this might sound scary, my prolapse was so small that the ECHO technologist didn’t find it. I have to return for annual monitoring, but I was told it isn’t anything to be concerned about. Interestingly, this type of defect can be seen with EDS.

lupus rash.jpg
Different types of rashes seen with lupus.

I also had an interesting event in 10/2019. You know those “return to rheumatology signs” I mentioned at the end of post three? Two days after I lost my insurance coverage (due to a raise at work; health insurance in the US is broken), I developed 5+ oral ulcers in a period of two hours, starting running a low fever, my joints felt like they were being crushed, my eczema was flaring, and felt like I had been hit by a truck. I finally understood what “fatigue” meant. Just walking up the stairs felt like a marathon. Luckily, I was able to be seen by rheumatology the next day. My symptoms were pretty consistent with a “lupus flare,” so I had even more blood work. I was also sent to dermatology for a skin biopsy to evaluate for discoid lupus (a type of lupus limited to the skin.)

It all came back normal.

My rheumatologist was shocked, and I was back to monitoring for other “weird symptoms.” The going theory is that I had some sort of virus. Luckily, I haven’t felt that bad since!

In the next post, I’ll discuss my genetics results, and I’ll finally explain how I caught a zebra. 

 

References:

https://rarediseases.info.nih.gov/diseases/6322/ehlers-danlos-syndromes

https://www.health.harvard.edu/heart-health/heart-attacks-clarifying-the-causes-and-consequences

https://www.healthline.com/health/autoimmune-disorders

 


img_20191107_063201_7786263157454685867523.jpg

I’m a dedicated exercise physiologist with a passion for fitness, health and wellness, good food, and dancing. I work with clients online and face-to-face to help them reach their fitness goals. Feel free to check out more at my Facebook page, Rebekah James – Facts, Fitness, Fun

 

Featured

How I Caught a Zebra… Part 4/6

This is the 4th part of series. Click here to go back to the beginning. Post 2! Post 3!

 

Not going to lie, I was a bit bummed not to have a diagnosis, but an autoimmune disease is not something that you want to have! My provider suspected that I might Ehlers Danlos Syndrome (EDS), so I was referred to genetics, pediatric cardiology, and pediatric orthopedics. EDS are a group of inherited connective tissue disorders caused by abnormalities in the structure, production, and/or processing of collagen.
So what’s collagen? Collagen is a type of protein, and it makes up about 25% of the protein in your body. It makes up tendons, bones, and teeth. Bones and teeth are actually made from adding mineral crystals to collagen. It’s a structural protein; it helps to protect and support softer tissues and connects these tissues to the skeleton. Interesting, people with EDS are more likely to have a chest wall deformity, like pectus carinatum.  (I was diagnosed with this in Fall 2018.
Interestingly enough, I actually treated a patient with EDS during my first physical therapy rotation. Her symptoms were eerily familiar. She had frequent subluxations (partial dislocations), ankle/foot pain, and was pretty “double-jointed.” Beighton’s score a test that is used to evaluate for hypermobility. I’m pretty sure she scored at 9/9. I found her case to be really interesting so I did a presentation on how to treat patients with EDS.
Beighton's score - EDS
I scored a 6/9. (I can’t bend my little fingers back, and only my R knee bends backwards)
I first learned about this test in my undergraduate, and I scored a 6/9. A positive test is considered anything 6/9 or above. I’d always been a flexible child, and I had my dad’s “floppy ankles.” I sprained my ankles a lot as a child (check here to learn more about ankle sprains.) There were times when I would walk, and my ankle would just give out on me. (Which is pretty embarrassing.) I just told people I was clumsy and had a “derp foot.” My favorite thing was my party tricks. I could sublux my thumb joints, my elbows bent backwards, and I could do a backbend and grab my ankles.
12556022_1684900255084386_2085694374_n
Back whenever I was doing stretching training for pole fitness in 2016.
screenshot_20191214-185748_instagram4548817268827295921.jpg
In the upper right photo (ignore my room mess – this was the middle of DPT school), you can see that my R foot is bent at a pretty severe angle.
When I went to my genetics appointment in 5/2019, I was actually worked up for both Marfan Syndrome and Ehlers Danlos Syndrome. This past week, I learned that my 1st cousin was actually tested for Marfan Syndrome, but they were fine.
Marfan's graphic
The scary thing about my genetics appointment is that she suspected that I might have had the vascular type of EDS. There are actually 13 different subtypes of EDS, and vascular EDS is one of the most dangerous subtypes. (There used to be 6 subtypes, but this was changed in 2017.)
I’m only going to talk about 3 subtypes: Hypermobile, Classical and Vascular. (Symptoms I have are in blue). Click here to learn about the other 10 subtypes!
  • Hypermobile EDS– main symptom is joint hypermobility affecting both large and small joints. This can lead to recurrent joint dislocations or subluxations. Other signs and symptoms include: soft, smooth, and velvety skin; easy bruising; and chronic pain of muscles and/or bones.

 

79281678_532189530841168_733783673484083200_n
This is known as a cigarette paper scarring. I thought everyone scarred like this.
  • Classical EDS– main symptoms include joint hypermobility and extremely stretchy, smooth, fragile skin. Other signs and symptoms include: easy bruising; wide, atrophic scars (flat or depressed scars); mulluscoid pseduotumors (calcified bruises over pressure points like the elbow); spheroids (fat containing cysts on forearms and shins); hypotonia (decreased muscle tone); and delayed motor development

 

  • Vascular EDS– main symptom is thin, translucent skin that is extremely fragile and bruises easily. It also effects the arteries and certain organs (intestines, uterus). Since they are more fragile, they are more like to rupture. People with this type have a higher risk for aneurysms (bulges in blood vessels) and rupture. Other signs and symptoms include: short stature, thin scalp hair, facial features of: large eyes, thin nose, lobeless ears; joint hypermobility (but more located to small joints like fingers); club foot (a deformity where the foot points down and inward); acrogeria (premature aging of skin on hands/feet); early onset varicose veins (enlarged, swollen, and twisting veins, often appearing blue or dark purple – usually caused by faulty blood vessel valves); pneumothorax (collapsed lung), gum recession; and decreased fat under the skin.
club foot
Club Foot

acrogeriavaricose veins

 

 

 

 

 

 

 

 

There’s a lot of cross over between types, so it can be hard to make a clinical diagnosis. Genetics testing is required to figure out what subtype of EDS you have.

 

Why did my geneticist think I had vascular EDS? I’ll go over that in tomorrow’s blog post!

References:

img_20191107_063201_7786263157454685867523.jpg

 

I’m a dedicated exercise physiologist with a passion for fitness, health and wellness, good food, and dancing. I work with clients online and face-to-face to help them reach their fitness goals. Feel free to check out more at my Facebook page, Rebekah James – Facts, Fitness, Fun

Featured

How I Caught a Zebra… Part 3/6

If you’ll recall, this is part of a 6 part series about my health care journey. Click here to get back to the beginning. In the second post, I left off talking about how my husband and I realized that the front of my chest was rotating. I was sent for a CT scan of my chest.

assyemtric ct
This isn’t my CT scan, but it looks very similar. This view is a cross section of the body. You can see the left side is rotating forward. The white bone at the top center is the sternum, or breastbone.

inside view pectus

 

 

 

 

 

 

We figured out that I had been born with a chest wall deformity: pectus carinatum or “pigeon chest.” It’s caused by an overgrowth of rib cartilage that pushes your sternum out at an angle. This is usually caught in adolescence, but I didn’t have any severe signs, other than getting bruised by underwire bras. It’s less common in females, and usually the treatment is breast augmentation to distract from the protruding bone. Genetics has blessed me in that department. Males are encouraged to strengthen pectoris/chest muscles for the same reason.

 

assymtric pectus
An example of asymmetric pectus carinatum. Left is before treatment. Right is after treatment.

Let me tell you, this was a revelation! My chest pain, rib pain, and stomach pain all made sense. Pectus carinatum is also associated with the following symptoms. I’ve bolded all symptoms. I’ve never been diagnosed with asthma, and I luckily don’t have respiratory infections.

  • Shortness of breath, which is more common during exercise
  • Tenderness or pain in the areas of abnormal cartilage growth
  • Frequent respiratory infections
  • Asthma
  • Tiredness
  • Chest pain
  • Rapid heart rate

The orthopedic started me on 500mg naproxen twice a day to calm down the inflammation. I also was referred to orthotics/prosthetics. They gave me a hard brace that I was told to wear 8-12 hrs a day. It encourages the left side of my chest (which is curving forward) to fall back in line; as a result, my midback spasms relax. I’ll be honest that I’m not the most compliant with bracing, but it has helped. I usually put it on after I get home from work, so I’m up to maybe 5 hours per day. These braces are more effective during puberty; they don’t expect my chest to go back to normal like the male’s above. Instead, we are trying to keep it from progressing, and it gives me some symptom relief. The most surprising thing is how much easier it is to breathe!!!

It's World Camera Day!
Quick look at my custom made brace!

I was also referred to rheumatology for a repeat visit in 4/2019 since my inflammation was so high in my joints.

Autoimmune stats

Several tubes of blood later, I had a positive ANA test at 1:160, centromere pattern. This is a non-specific marker of autoimmune activity; about 10% of people have it. Of that ten percent, 1% have autoimmune disease. (I currently work in a rheumatology clinic as a scribe, so I’ve learned a lot from the providers I work for!) Basically, this meant that there was some sort of autoimmune process and Autoimmune s:sinflammation going on, but not enough to be concerning. I was told to return to clinic if I developed any of the following symptoms:

  • Oral ulcers
  • Fevers of unknown origin
  • Chest pain
  • Pleuritis (inflammation around the lungs)
  • Pericarditis (inflammation around the heart)
  • A new rash
  • Increased/new joint pain
    • Warm, red, swollen joints
  • Hair loss
  • Numbness/tingling
  • Dry eyes
  • Dry mouth
  • Increased fatigue

Part 4 will be posted tomorrow, December 17th, 2019!

References: 

https://www.medicalnewstoday.com/articles/320836.php#treatment

What is Prosthetics and Orthotics?

https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Antinuclear-Antibodies-ANA

https://www.healthline.com/health/autoimmune-disorders


img_20191107_063201_7786263157454685867523.jpg

I’m a dedicated exercise physiologist with a passion for fitness, health and wellness, good food, and dancing. I work with clients online and face-to-face to help them reach their fitness goals. Feel free to check out more at my Facebook page, Rebekah James – Facts, Fitness, Fun

 

Featured

How I Caught a Zebra… Part 2/6

This is the second post in my series of six. Check out this part first!

I started my Doctorate in Physical Therapy at West Virginia University in 2013. Grad school was rough, and I’ll be honest, I didn’t take great care of myself. I pulled my first all-nighter (it didn’t help; I still failed my final), and I ended up gaining ~20# in 3 years.

screenshot_20191214-185640_instagram2724919837427197328.jpg
2013: Start DPT; 2016: 3rd year DPT; 2018: 30+lbs lighter thanks to lifestyle changes.

Overall, I was about as healthy as your average grad student: stressed and tired. Things started to go downhill again in the Fall of 2015. I was having dizzy spells, felt nauseous, my joints hurt, my eczema was flaring, and just felt awful overall. And the chest pain was back. It all came to head with me being diagnosed with shingles the morning of my final capstone presentation. (Shout out to my group mates who picked up my slack.)

My professors sent me home so I wouldn’t spread the joy of shingles, and I later received 6 insomnia cookies from my sister. I ate cookies, slept, and binged Netflix. It was a mild case, and I luckily didn’t find them painful. Things were stressful over the holidays, but I was thrilled to be finishing up my DPT in the Spring of 2016.

I started my rural rotation. 4 weeks later, I was diagnosed with shingles. AGAIN.

How does that happen? It’s not supposed to. Your immune system, if working properly, should have the antibodies to fight the virus. The doctor at urgent care told me that I might have cancer, and I needed to see a rheumatologist.

Sufficiently freaked out, I ended up seeing a rheumatologist. A rheumatologist is a medical doctor who completes a Fellowship in Rheumatology. Rheumatology is the study of autoimmune disorders. In lay terms, they study why people’s immune systems get too aggressive. With autoimmune disorders, it’s like your immune system has “roid rage.” It sees your body as the thing that needs destroyed. Not good.

He was a fantastic doctor, and it was so good to hear that a lot of what was happening could be connected together in what he thought was a connective tissue disease. He ordered $4,000 worth of blood work. I think it was either 8 or 12 vials of blood. (On a side note, working as a rheumatologist is a great cover for a vampire…)

Guess what? Normal. He couldn’t explain it. “There’s something wrong with your connective tissue, but I can’t find it.” Great…

Blog photo

Fast forward to 5/2017. I had changed my diet from sorta vegetarian to vegan, focused on mental health and self-care, reduced stress, started an exercise regimen, and had lost +30# through lifestyle changes by 12/2017. I felt pretty good. My eczema was still bad, but eh.

Fast forward to Fall 2018. My chest pain is back, and it is getting worse. I’m getting right upper quadrant pain again, and symptoms are worse after I eat greasy foods. My primary care physician is fairly certain it’s the gallbladder this time. Ultrasound and HIDA scan round 2!

NoRmAl? What the hell. She had no suggestions, and I just started to monitor my “grease” intake.

I also had midback and rib pain. Anytime I turned to the right, my L 5th rib will pop and shift. If anyone has ever broken a rib or had inflamed ribs, you know how bad that it. I had to stop my weight lifting program in 9/2018 because I was getting close to passing out. As you may know, exercise is a vital part of my mental health routine, so this was rough on two levels.

So what about that zebra?

I “started to hear hoofbeats” of a diagnosis around 11/2018. I followed up with an orthopedic doctor about my rib, midback, and chest pain. My husband and I had noticed that my sternum (the center bone to your rib cage) was ROTATING.


img_20191107_063201_7786263157454685867523.jpg

 

I’m a dedicated exercise physiologist with a passion for fitness, health and wellness, good food, and dancing. I work with clients online and face-to-face to help them reach their fitness goals. Feel free to check out more at my Facebook page, Rebekah James – Facts, Fitness, Fun

Featured

How I Caught a Zebra… Part 1/6

I apologize for the click-bait title, but hey, you’re here now! Might as well stay awhile.
If you’ve read some of my other posts, you might be familiar with my health journey. Essentially, everything was normal until my junior year of college, Fall 2011.
Then, things just got weird. I starting having chest pain. Since my dad passed away from a heart attack at 56 years old, and I used to have terrible cholesterol levels (even though my diet was good), I was freaked out.
I went to student health, and they thought I had pericarditis or pleuritis. It’s a fancy way of saying that they thought the lining around my heart or lungs was irritated. This usually can be seen with a virus. No big. So, they ordered a chest XR and EKG. Ideally, you should be able to see something on these tests.
There were normal. Their next theory was heartburn. I did love spicy food, and I was having some stomach pain, so I tried some over the counter heartburn medication for a month.
HIDA
HIDA Scan

Still having chest pain. Next, they decided to check out my gallbladder. This can refer to the chest, and since I was having pain after eating, maybe it was inflammed? I ended up having a HIDA scan; they inject you with a radioactive dye, and then you lay on your back for ~1 hour while the machine tracks the dye through your GI system. It gives doctors an idea of whether or not my gallbladder was behaving.

Guess what? Yeah, it was normal, too.
At this point, student health didn’t really know what to do. I was the typical straight A, Type A personality, so they thought maybe some of this could be related to anxiety. Well, about 1 month later, I was so fatigued walking to my mom’s work office that I ended up sitting on the floors in tears. I just felt horrid. Back to student health I went.

I was describing my symptoms of fatigue, just feeling like I had the flu, etc, and they tested me for mono, which is also known as the “kissing disease.” Ring-a-ding-ding. That was positive. So was my strep test. If I recall correctly, I was told I was so sick that mono wouldn’t even explain my symptoms; I had to have another virus on top of that.

graduation
Rebekah James, BS in Exercise Physiology

 

Well, the good news is that I rested up and felt much better. That was a rough year, and I was so happy that it was over. (And I still pulled off a 4.0, thank you very much.)
2012 was pretty uneventful, but I ended up having a horrible eczema flare in the Spring of 2013, during my senior year. Since eczema is triggered by stress, I wasn’t surprised. I was applying to my graduate program in Physical Therapy, finishing my Honors Thesis, finishing my Certificate in Disability Studies, swing dancing, and keeping up with my club commitments while working 20 hours per week as a transcriber. I was a tad busy to say the least.
If you’ve it this far, congrats! I swear I’ll get to the Zebra soon. I’ll be posting the second part of this series tomorrow.

 


img_20191107_063201_7786263157454685867523.jpg
I’m a dedicated exercise physiologist with a passion for fitness, health and wellness, good food, and dancing. I work with clients online and face-to-face to help them reach their fitness goals. Feel free to check out more at my Facebook page, Rebekah James – Facts, Fitness, Fun
Featured

Changes…

If you’ve been wondering why there has been a few months since my last post, I’ve been going through some life changes.

One of my colleagues, Will Butler, posted this quote he found earlier. I find it beautiful.

Thought

Over the past two years, I’ve felt my share of outside forces. My ‘5 year plan’ has been thrown to the side. I’m definitely not where I planned to be! It’s taken some time to process my choices and find a new direction.

I determined that instead of increasing my student debt load and finishing my doctoral degree in physical therapy that I would focus on working on my own passions: helping keep people active, especially dancers.

The growing pains are tough, but I know that they will be worth it.

To all who have helped me through this process, thank you. I appreciate it more than you’ll ever know.

——————————————————————————————————————————–

Headshot
March 2017
26655349_394153551005852_1794130314_o
January 2018

From April 2017 to a healthier January 2018

I’m a dedicated exercise physiologist with a passion for fitness, health and wellness, good food, and dancing. I work with clients online and face-to-face to help them reach their fitness goals.

Featured

6 Tips on Dancing Defensively – Part One

For anyone on the dance scene, especially the social dance scene, dancing defensively is key.  It’s not as aggressive as it sounds; dancing defensively describes how an individual dancer is aware of their body and possible ways that could either injury their partner or themselves.  Check out the tips below to learn more.

  • 1. Consent
    • When approaching a potential partner to ask for a dance, enthusiastic verbal consent is vital.  It’s important to not assume that every person present would like to dance.
    • When asked to dance, do not feel pressured to say yes.  You have a right to say no, and you don’t need an excuse or explanation!  Social dancing should be a fun and safe experience.  Declining a dance is not rude.
  • 2. Communicating With Your Partner
    • Let’s be honest.  Communication in general is difficult.  Communication with a stranger is harder.  And, talking to someone on the social dance floor can seem tricky.  It’s important to avoid personal attacks with discussing concerns or preferences during a dance.  As a general rule, using “I feel XXX when YYY” is a great way to express yourself without coming across as harsh.

For instance, “I feel uncomfortable when I’m led into a dip that I’m not expecting” is less threatening than “Don’t do that!”

However, safety ALWAYS comes first. Do not compromise your safety just to avoid a socially ‘awkward’ situation.

  • 3. Shoulder Protection
    • Your shoulder is a ball and socket joint which allows for more movement.  In fact, your shoulder joint has the most range of motion in your body.
    • However, this also means that it is less stable. The shoulder is the most commonly dislocated joint.
    • Most common type of dislocation is anterior; this means that the humerus moves forward out of the joint.
      • This usually occurs because when the arm is abducted and externally rotated, like when you are going for an epic high five. Or, when you’re trying to do turns like shown in this picture.possible dance injury
    • The best injury prevention is to keep your arm in front of your body.  Don’t have a ‘floppy arm.’ Instead, it should be actively engaged and ready to accept cues from your partner.
    • The shoulder joint relies on local musculature to maintain a healthy joint capsule and to prevent injury.  The 4 rotator cuff muscles are a main part of the joint capsule.  These muscles are tiny and tend to be weak.  It’s a good idea to strengthening the surround muscles as well.

While this is known as the “Thrower’s Ten,” these exercises are a comprehensive program to strengthen the shoulder.

throwers 10

  • 4. Lead Role Tips

Personally, I have limited experience in the “lead role.”  I consulted with a few friends to determine the most common defensive dancing tips for leads.

    • A big concern among leads is how to handle “self-dips” by a follow. 
      • A self-dip occurs when a follow has initiated a dip that the lead was not ready for. In a worst case scenario this can lead to either dancer (or both) falling.
      • The most important thing is to avoid a “top heavy” feeling by remaining upright.
        • It’s important to react to the change in partnership with the lower body; moving into a squat position is ideal.
          • In the ideal swing position, both dancers should be in a shallow squat position. It is harder to throw off someone’s balance if they are squatting.
        • Expand your base of support by moving your feet wider apart. This increases your stability.
    • As a lead, you should focus on slowing the descent instead of STOPPING the movement fully. If you try to completely stop a motion, it increases your risk of injury.
      • This might sound counterintuitive, but it was a skill emphasized in patient care. If a patient faints or falls, it is safer for both parties to slowly descend to the ground.
    • With any unexpected situation as a dancer, it is important to communicate with your partner. Refer to point 2 for suggestions on how to voice concerns without personally attacking your partner.
      • Examples:
        • “I felt unbalanced when you dipped. If you are interested in dips, please let me know beforehand”
        • “I’m not experienced enough at dips to support a self-dip.”
        • “I felt unsafe with the previous dip.”
  • 5. Follow Role Tips

My dance experience tends to be in the “follow role” where I interpret the energy I receive from a lead and add expression to the partnership.  These are a few of the concerns that I’ve have had myself or heard from others.

    • “Wrenching Turns”
      • During a “wrenching turn,” the follow experiences excessive energy from the lead during a turn that can cause injury.
        • Follows can prevent this by having a strong frame. It’s important that you don’t let your arm get away from your body.
      • During turns, make sure to follow your wrist – this is a great external cue on keeping your frame.
    • Unexpected Dips
      • This goes for both roles, but is very important as a follow. Do NOT expect anyone else to support your body weight.
        • You should be able to support your own weight if the partner breaks the connection.
      • If you feel an unwelcome dip/aerial coming, lower your weight to floor by squatting.
        • Your center of gravity is now lower.  You are harder to move and are more stable.
      • Increase Resistance to the Partnership – not enough to injure either partner
        • You don’t want to injury either partner. Instead, think about keeping your dancing ‘frame’ more rigid.
        • This resistance is usually enough to slow down your partner to prevent an unwanted dip.
    • Verbal Response 
      • Again, communication is key during a social dance. Here are some suggested ways to express your concerns.
        • “I don’t feel comfortable when you do XXX move.”
        • “I’m not familiar with your partnership, so I do not feel safe doing dips or aerials with you.”
  • 6. Crowded Dance Floor 
    • Communicate with Your Partner
      • If either partner notices that the dance floor is getting crowded or seems smaller, tell your partner. Communication is a great way to prevent collisions on a crowded floor.
    • Rules of Floor Space
      • In general, if there is a large and clear dance space, there is more freedom in how ‘large’ your moves can be. “Flashier” moves, like creating long lines with your arms, tend to take up more space.
      • On a smaller dance floor, you need to be respectful and aware of the other dancers on the floor.
        • A good way to do this is to use smaller footwork. Keep all movements within your partnership and avoid creating larger shapes.
    • Situational Awareness
      • It’s important to know where other dancers are to prevent run-ins. You can do this by:
        • Using your peripheral vision (what you can see out of the sides of your eyes when you face forward.)
        • Turn your head when changing directions.
    • Dance is a Partnership – Both Leads and Follows Have a Responsibility to Prevent collisions
      •  Lead
        • It’s important to know where you are sending your partner. For instance, if you plan on opening the connection, make sure the area where your partner will be heading is clear.
          • Be sure to keep an eye out for other partnerships that might potentially use that space.
      • Follow
        • Keep a firm connection and frame.
          • In a way, you a “back-leading.” If you see an obstacle that your partner seems to have missed, feel free to veto that movement.

Defensive dancing is a vital skill.  Applying these tips can prevent dangerous situations, improve partnerships, increase time on the dance floor, and lead to a happier experience.

Keep dancing my friends!

DO-xz2rXkAAb9X3
PittStop Lindy Hop 2017

Resources:

A special thanks to all the instructors and fellow dancers who have helped me along my own defensive dancing journey.

The talented WVU Swing Dance instructors have been a valuable resource in teaching defensive dancing and the importance of consent.  Check out our Facebook Page for more information!

Defensive Dancing: Handling Uncomfortable Situations

What to Do When You Are Uncomfortable

https://lindyfitness.wordpress.com/category/injury-prevention/

https://sagermeister.com/tag/rotator-cuff/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000468/

——————————————————————————————————————————–

Headshot

Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

Featured

6 Reasons Why Workout Music is Vital

 

maxresdefaultIt’s #WorkoutWednesday!

Cross training with cardio and weight lifting will boost your endurance and strength during dancing.  I’ve found that swing dancing at a higher BPM is much easier now that I’ve been working out consistently.  And all those squats are definitely helping with blues!

I’m a huge fan of listening to music when I workout.  If I’m doing cardio, it’s usually pop music of some sort. If it’s anything intense, like lifting or high intensity intervals, I always pick metal.  Metal helps me to push harder, and it honestly makes me feel badass.  

But, is there research to support the benefits of music while working out?  There is! 

Here’s 6 reasons why music can boost your next exercise session.

1. Music Provides a Good Distraction

You’re less aware of how tired you are. Some studies show that it can increase your performance by 15%.

2. It Increases Your Effort

Listening to music with a higher BPM (beats per minute) helps you to workout harder. The ideal range is 120-140 BPM; you don’t want it to be too fast.  According to Costas Karageorghis, an expert on the psychology of exercise music, music should be seen as “a type of legal performance enhancing drug.”

3. It Puts You in the Zone

Your go-to song can put you “in the zone.” This is because your memory associate to this song or the emotion of the music boosts your motivation.  But, it’s not as simple as having a playlist with fast music.  Each person needs to consider their memories, emotions and associations that different songs evoke as different people are motivated by different parts of music: the singer’s voice, lyrics, etc.

4. A Good Beat Keeps Your Pace

For self-paced exercises like running and lifting, a steady rhythm stimulates the motor area of the brain. This allows you to keep from fluctuating in intensity.  Most people naturally settle into a rhythm of 120 BPM when asked to keep time; this is a great tempo to consider. On the treadmill, most people prefer music around 160 BPM, but research has shown that motivation doesn’t significantly improve past 145 BPM.

5. Music Can Elevate Your Mood

Music helps you escape from “the moment” for awhile, and it usually reduces negative feelings.

6. It Makes You Want to Move

Music with good “groove” excites the brain and encourages movement. Think about Lady Gaga’s “Just Dance.” It’s hard to listen while sitting still.  In psychology, it’s referred to as the rhythm response.

26678496_1302518379882369_6862617149713678584_o
Feeling healthy and happy during my latest progress photo

These results are from cardio, high intensity interval training, and mainly body weight strengthening.  (Portion control played a big part as well.)  I’m 30+ pounds lighter in 2018 than I was in 2017.

I know I wouldn’t have stuck with the high intensity workouts without my favorite workout tunes.

If you’re interested in starting an exercise program, I’d love to hear from you.  Helping people to find a workout that they ENJOY is my passion.

Keep dancing, my friends!

Resources: 

Let’s Get Physical: The Psychology of Effective Workout Music

How Music Might Improve Your Workouts

Reasons You Should Listen to Music When You Work Out

——————————————————————————————————————————–

Headshot

Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

Featured

Dancing and CrossFit?

When I first heard about CrossFit, I wasn’t too impressed to be honest.  It seemed like it would be a whole environment similar to the ‘downstairs weight room’ in my university’s rec center: lots of grunting, dropped weights, and testosterone.  I was a fan of weightlifting, but I thought some of the WODs (workout of the day) were too much.  

In one of my clinical rotations, I treated a patient who was admitted to the hospital because of too many overhead presses from her WOD.   She wasn’t able to lift up her arms the next day, and they became very swollen.  After going to the ER, she was diagnosed with rhabdomyolysis, a condition where muscle starts breaking down and leaks a harmful protein into the kidney.  While rhabdomyolysis sounds scary, it is easily treated if noticed early on.  Rhabdomyolysis can occur whenever anyone works out too intensely, and it isn’t just seen in CrossFit.

While in physical therapy school, I met a few people who did do CrossFit; some of them were dancers as well.  Several of my friends also started working out at a local “Viking Fitness” program with an amazing personal trainer.  From talking with them, I realized that CrossFit can be a wonderful experience; IF the person running the gym knows proper form and stops people from sacrificing form for that new PR (personal record).  

cross fit
Infographic from Limitless Physio

I’m trying to learn more about CrossFit and its relation to physical therapy, and I came across this infographic while browsing InstagramDr. Seth King is a physiotherapist in Michigan who is a CrossFitter himself.  He gave me permission to reshare his blog post: 

For far too long I’ve heard people misrepresent CrossFit as a jocks-only club for crazy people that just throw around kettlebells, do muscle-ups, and half-assed versions of olympic lifting. I’ve had well-respected colleagues scoff at it as a patient(injury)-generating machine, and have had patients assume they’d never be able to do anything “as intense” as CrossFit. 

Honestly…I even had some of these misconceptions myself. 

But since when did it become OK to have literally zero experience with something and be so against it? My mom used to always tell me “try it, you’ll like it”. That was usually in reference to green vegetables, but the wisdom is still rooted in there:

Don’t trash something you don’t have any experience with.

With the gentle nudging of a few good colleagues (shout out to Mitch Babcock at FitnessTx.PhysioCrossFit Tuebor West), I decided to stop making judgments without first giving CrossFit a try. And so I tried. And my eyes have been opened. 

Instead of letting these myths and misconceptions go on, I thought I’d put together a list of 7 of the most common phrases I’ve heard and try to address each one appropriately.

It’s time to stop with the myths, and get on with the truth! Enjoy…

(1) YOU’LL GET HURT

If you’re “into” the sport of CrossFit, you’ll probably get injured a lot, right? After all, it’s easy to understand how dangerous throwing barbells up the air and swinging your chin all over the place by the pullup bar could be…

EXCEPT…when you really look at some evidence (like, information that objectively looks at injury data across different sports. See: this article in the Journal of Sport Rehabilitation or this blog post that outlines the injury rates between several kinds of sports), you will learn that participating in CrossFit probably poses no more injury risk than running or being a part of that pick-up basketball league at the local gym with your church buddies. Dr. Zach Long of The Barbell Physio does an incredible job laying out the research on CrossFit injuries in this article (which you should definitely check out and read).

And look, injuries happen when we move. But I’ll take my chances, considering that an inactive lifestyle leads to:

  • Depression
  • Obesity
  • Heart Disease
  • Osteoporosis
  • Type 2 Diabetes
  • the list goes on and on…

It’s quite clear these days that the the most dangerous thing you can do is:
to NOT be active

to live a sedentary lifestyle.

So let’s put that phrase to rest, shall we?


(2) IT’S TOO HARD FOR YOU

The amazing thing about CrossFit is that it is scalable.

That means that every single movement can be modified to fit your fitness level. And I really mean ANY FITNESS LEVEL. The beautify of CrossFit programming is that the founder’s definition of “constantly varied functional movements performed at a high intensity” is a completely relative statement that can fit anybody, anywhere. Here’s an example…  in the gym I go to (quick shoutout to the incredible team at CrossFit ReviveR in Rochester Hills, Michigan!), it’s not uncommon to have a prescribed movement be something like Power Snatch. The snatch is an olympic lift that requires the athlete to pull a loaded (or unloaded) bar from the floor into an overhead position (arms locked with bar overhead), and then stand up straight. It’s hard, and it’s something I suck at. Now that that’s out of the way…it’s extremely common to see this movement scaled all over the place during a workout kind of like this:

  1. 1 or 2 people in class may perform the Power Snatch.
  2. 1 o 2 other classmates may perform a snatch with very little weight, only the bar, or even just a PVC pipe to work on form.
  3. Another 4 or 5 may instead do a heavy or moderately heavy deadlift instead.
  4. Another 1 or 2 may opt to do a lighter kettlebell deadlift
  5. And finally 1 or 2 others may be too exerted by all of the above, and could opt to lay down on the ground and do some bridges/hip thrusts.

The cool thing? Each one of these options would be perfect.

What matters more is the competency of the individual with a particular movement, and that he or she is working at the appropriate/prescribed intensity.

Objectively, there is no movement that is “too hard” for anyone that comes to a class, because a good box is going to have an unlimited amount of scalable movements to meet you where you’re at.


(3) CROSSFIT “BOXES” ARE ONLY FOR MEATHEADS & YOUNG PEOPLE

This is an outdated and naive stance that a lot of individuals still take for some reason.

Well, it’s time for an update.

CrossFit facilities all over the world welcome & open their doors to any person that is looking to become better versions of themselves. While not all CrossFit affiliates are created equal, there’s probably not as much grunting, screaming, and bros gettin’ swole as you think. My class (admittedly we’re all a little crazy to hit a group WOD at 4:30 a.m.) is made up of a truly fantastic diversity of age and fitness level. Here’s a snapshot of the kind of people in the “bright & early” class: an electrician, a contractor, an engineer (or three), a math teacher, an insurance case manager, a few nurses, an attorney, and a bike shop owner. The age spread on this class is from teenager to 50+. People who still think that young age and high fitness level are required to hang with the CrossFit crowd are just…well…wrong!


(4) PEEING DURING A WOD IS “JUST NORMAL”

Is it common? Yeah – more than you probably know.

But normal? And should you just accept it?

There is such a huge plethora of misconceptions about “springing a leak” during intense portions of your workout. Chief among them that I have personally heard are that it is something to just deal with, that you should just suck it up and wear a pad, or that “a thousand kegels a day makes it all go away” (actually, studies have shown that only about 50% of women are able to properly contract the pelvic floor muscles in the “kegel way”).

If you’re feeling discouraged, embarrassed, or even complacent about leaking during a workout – please realize that you’re not alone, and that there are actually some FANTASTIC options to help you out. It’s time to take control and do something about it.

For help, find a physical therapist in your area who understands the demands of CrossFit and pelvic floor health. And please, for the love of God, read this great article by the Pelvic Guru herself, Tracy Sher, an absolutely fantastic physical therapist who runs this huge resource of a website.

www.PelvicGuru.com


(5) THE SOLUTION TO AN INJURY DURING CROSSFIT IS TO “JUST STOP” DOING CROSSFIT

Let’s face it. America is already full enough of healthcare professionals that prescribe “just stop doing that” as their solution to painful movements. That advice is a bandaid, and probably does more harm than good.

We know that participation in sport, exercise, fitness, etc has an incredibly far-reaching impact. And so “just stopping” removes us from an extremely positive social environment, from the metabolic and cardiovascular benefits of regularly elevating your heart rate, and from the psychological benefits of challenging yourself then overcoming, among other things.

I have worked with countless athletes and average Joes/Janes that benefit much more from scaling back a painful movement, working out the kinks, and then moving back into that same movement stronger and more resilient than before.

Complete avoidance of all painful activities is simply not always the answer.

There are certainly times where rest and stopping an activity is warranted (see: some fractures, illness, or the presence of serious pathology). But there are just too many important variables involved in sport participation to just issue a blanket cease and desist order when an athlete (recreational OR elite!) has pain.

Some suggestions I usually give to my patients to allow them to still participate:

  • Work with your local CrossFit Physio/Coach co-op to figure out which movements and lifts are just fine, how much pain is OK, and to learn which movements/lifts you should temporarily stay away from (cooperations DO exist out there like this, such as what we have going on at CrossFit ReviveR)
  • Do some cardio instead during class (a.k.a. go to class, spend some time on that assault bike, rowing, running, jumping rope, etc. if loaded movements are bothering you)
  • Ask your coach to help you appropriately scale each movement of that day to better fit your injury status. A basic regression/scaling example of what I mean if you were to have back pain with deadlifts:
    • Heavy deadlifts > Moderate/Light deadlifts > Kettlebell deadlifts > Weighted hip thrust/bridges > Bodyweight-only bridges

Pain and injury do not mean you have to stay away from the gym. In fact, it probably will be better for your overall health if you don’t entirely cut out that part of your life!


(6) IT’S CRAZY EXPENSIVE

This all depends on what you call “expensive” and what you call a “priority”. Membership to a CrossFit box is definitely more than Planet Fitness. No doubt about it. But if you do a budget audit, I’d imagine many of us (including me!) could find some things we’re paying for that are LESS important than our health & fitness (Starbucks addiction, anyone else?).

If you’ve read anything else of mine, you know that I generally push that you need to MAKE time for exercise and PRIORITIZE your health. It’s something we all struggle with, myself certainly included. So I’m not going to say more.

Instead, here’s this list of “average” monthly budget items in America:

  1. The average American car payment is $493/month.
  2. The average working American spends $80/month on coffee.
  3. The average American family spends over $230/month on restaurants and take-out meals.

So that $80-180/month on improving your health, losing weight, getting stronger, preventing injury, preventing or changing chronic disease, and potentially prolonging life…is it that unreasonable?


(7) CROSSFIT IS A GREAT SOURCE OF BUSINESS FOR PHYSICAL  THERAPISTS, PHYSICIANS, ETC.

I can’t tell you how many times I’ve heard, in some way/shape/form: “Oh CrossFit – you know what that is? It’s a great source of business for me!”

But guess what? Times they are a’changin’…

CrossFit has contributed in such a major way to public health, addressing a wide variety of things from the growing tolerance for sedentary lifestyle to chronic disease. And it’s time for healthcare professionals to understand that and give credit where credit is due.

Now, more than ever, patients are starting to call B.S. on the whole “just stop” prescription. They won’t settle for it anymore. And they shouldn’t! As good medical literature continues to grow in favor of conservative options for injuries and pain (physical therapy, exercise) and lean away from invasive and medicine-based options…

-FELLOW HEALTHCARE PROVIDERS-

Don’t be a hater. Try it out. Learn something about the movements in CrossFit and the language used, and stop dismissing it as a fad that causes injury and increases your paycheck. If you can’t keep up with those basics, then refer to someone who specializes in this kind of athlete.

-FELLOW CROSSFIT ENTHUSIASTS-

See a physical therapist or other healthcare pro that truly understands your sport and its’ demands. Work with a CrossFit Doc who knows his or her stuff…

I’m a big fan of Dr. Seth King’s work.  To see more of his work check out: 

Instagram: limitless.physio 

Facebook: Limitless Physio

Website: https://limitless.physio/

Muscle strengthening is important for dancers as it improves endurance, strength, and general health.  Dancing and CrossFit do mix; I think it is worth checking out.

Keep dancing my friends!

26655349_394153551005852_1794130314_o

——————————————————————————————————————————–

Headshot

Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

 

 

 

Featured

Why Exercising Should Be Your New Year’s Resolution – And I Can Help!

This is a fantastic infographic I saw on Twitter, and it covers one of the main reasons why I exercise.26194183_391644034590137_644384490_o

In January 2017, I weighed the most I ever had: 153lbs.  It was a real wakeup call when I saw the number on my visit summary.  2016 had been a rough year to say the least; there were many changes in my life.  For the most part, they were positive changes, but my “life plan” was turned upside down.  The stress was real, and my weight reflected that.

As an exercise physiologist and physical therapy student, I knew that I had to focus on my self care.  If I’m not healthy, how can I help others heal?  I began watching portion sizes, my diet, and I started an exercise program.

While there were a few false starts in getting my exercise routine figured out, I finally made it a habit.  When I started exercising regularly, I noticed a real change in my outlook. It really became another way to help with self care and mental health.  While I was being treated for depression and attending counseling, I needed something extra to get me back to “me.”  Exercise was the bridge I was looking for.  Like the infographic says, exercise can lower anxiety and improve tranquility.  Through consistent exercise, I felt healthier and more whole than I had in years.

Plus, I began online coaching because of my exercise routine.  I had previously helped friends get started in the gym, but I hadn’t done more than that.  I believe that there is some sort of exercise that can be ‘fun’ for every individual.  For me, it’s dancing, hiking, interval training, and weights.Blog photo  The hardest part of sticking to an exercise program is finding an exercise program you enjoy.  Through the courses I run, I’m able to do what I love – help others see how vital exercise is for overall health while encouraging a community of positivity and support.  Together, we work to identify what exercise routine works best for them.  Coaching has been one of the biggest blessings of my life.

There’s a new low impact program that I’m starting January 1st.  This is ideal for someone who hasn’t been working out for awhile, and those with back and/or joint pain.  I’m excited to partner up with Orion Metheny, a local doTERRA representative.  We’ll cover nutrition tips, ways essential oils can assist recovery, live video support, community events, and there are prizes, too!  Plus, we’ll follow a 4 week exercise program that can be done in the comfort and privacy of your own home.  No gym membership or equipment required!  A personal trainer and gym membership together would cost up to $289.99/month, but this course is only $75.  Plus, you’ll save $10 if you sign up with a friend.

It’s a great way to stay positive throughout the winter and keep your body agile and ready throughout 2018. I want to help you start off the New Year with a fresh step.  We can reach YOUR goals together.  

Interested?  Sign Up Here!

Keep exercising my friends!

23131912_372468876507653_4367433442245414886_n

——————————————————————————————————————————–

Headshot

Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

Featured

Bummed About Bunion Surgery? There Are Other Options (Part 3/3)

An estimated 64 million people in the US experience bunions (hallux valgus).  The number of corrective surgeries for this per year is more than 200,000! As a dancer and active individual, I didn’t want my bunions to limit me and began searching for alternatives to surgery.  So far, I’ve discussed what causes bunions and 4 non-surgical options for relieving bunion pain.  In this final post, I’ll cover current research about the efficacy of physical therapy treatment to manage bunions.

How Effective is Physical Therapy Treatment? 

1.  A recent systematic review discussed whether hallux valgus (bunion) should be treated by a surgeon or physical therapist.  7 different studies were analyzed and the method of physical therapy treatment among them included: exercise, manual therapy, gait training, taping, and orthosis.

  • In all 7 studies, patients had beneficial effects; reduced pain and improvements in function were the most common.  While physical therapy didn’t always fully correct the deformity, it seemed to improve quality of life.
  •  The review had some limitations. The studies all used small sample sizes; larger sample sizes allow researchers to be more confident about the outcomes.
    VAS
    Visual Analogue Scale

    The studies recorded pain with a visual analogue scale; specific questionnaires about pain with certain activities, like walking or dancing, would be more ideal.  Since the studies only looked at short term results – no more data was taken after the end of the therapy program – it’s unknown how long these benefits last.

  • Overall, the results of conservative physical therapy treatment were comparable to surgical outcomes.  This is great news as non-operative methods have fewer complications and lower cost.  Plus, the splints and braces are readily available.
  • Takeaways: Every foot is different and should be individually evaluated to determine treatment options.  Hallux valgus shouldn’t just be treated by surgery; physical therapy can improve foot function and can be used to prevent/slow down deformity if full correction isn’t possible with surgery.

2.  Another resource looked specifically at treatment options for hallux valgus in dancers.  They concluded that conservative treatment was ideal as surgery can lead to less motion at the big toe joint; this reduced motion can end professional careers.  Suggestions for management included: toe padding on the big toe joint, toe spacers between the first and second toe, and strengthening intrinsic muscles.  Most importantly, dance shoes need to be carefully fitted to avoid further stress on the big toe.

3.  This study look at the effects of a 2 month home exercise program (HEP) on correcting advanced hallux valgus.  When hallux valgus is severe, corrective surgery is often seen as the only option.

  • 7 women ~55 years old had a MTP (1st joint angle) of more than 20*; this is considered severe.  Foot pain was evaluated with a foot specific pain scale before and after the exercise program.  The passive range of motion of the big toe joint (MTP joint) in extension (up) and flexion (down) was also tracked.
  • The exercise program included 15 different exercises and was completed two times a day.  It usually took 20 minutes to complete.  9 exercises focused on improving mobility, 6 exercises focused on proprioception (knowing where the foot is in space), and 3 exercises focused on strengthening the foot muscles.  (Some exercises worked on two or more areas.)
    • Unfortunately, a description of the exercises used was not provided in the research article.
  • Significant differences were seen for passive extension of the big toe and foot pain score.  Passive flexion of the big toe improved, but it wasn’t statistically significant.
  • Takeaways: The two month HEP helped to improve big toe movement and reduce pain.

What Exercises Are Recommended?

 Screen Shot 2017-12-22 at 8.54.45 PMFoot-Abductor-Adductor-HallucisRight1

Screen Shot 2017-12-22 at 8.18.00 PMFive muscles are thought to be able to slow the progression of hallux valgus.  The muscles are illustrated above, and the table explains the movements of each muscle.  Intrinsic muscles are located within the foot.  Extrinsic muscles start in the leg and cross into the foot; they control the power and coordination of walking.  These muscles work together to stabilize the midfoot and arch and to limit pronation (whenever the foot looks ‘flat.’) With a bunion, the adductor hallucis is more active than the abductor hallucis, so the big toe (great toe) is pulled towards the outside of the foot. Improving the strength of the abductor hallucis has been shown to prevent/manage bunions in the early stages; the other muscles mentioned are believed to have a role as well.

There are three main exercises that are recommended throughout the articles: 

  • All exercises are done barefoot
  • Exercises are first done in sitting, but the goal is to progress to completing them standing on both feet and then only one foot if possible.  Standing on one foot helps activate the muscles the most.
  • Each exercise is repeated until the muscles are fatigued.  The time spent completing the exercises varies per person.  Each repetition is held at maximal effort for 5 seconds.
  • When holding the exercise position, focus on what activating the muscles feel like.  Try to reproduce this feeling at different times throughout the day while going through your normal activities to optimize your results.

While these exercises may appear too simple, they are harder than they appear!  7 people weren’t able to do them correctly out of 25.  So, it’s important that people watch their form when doing the exercises to make sure that they are preforming it properly.  Using a mirror or having a partner can help. When doing these exercises, it is important to not compensate with your legs.  Instead, keep your leg facing straight forward throughout the exercise.

 

 

Screen Shot 2017-12-22 at 8.17.27 PM

A) Short Foot Exercise (SF):

  • In this strengthening exercises, the idea is to bring the metatarsals towards the heels WITHOUT bending your toes.  It is done in either sitting or standing, and it specifically helps the arch of the foot. This is called the ‘short foot exercise’ because you are trying to make the foot shorter without bending your toes. However, some studies found this exercise is better for improving flat feet than bunions.  Since some people with bunions have flat feet as well, it is ideal for treatment.  

B) Toe-Spread-Out Exercise (TSO): Toe up and out

  • This new exercise is newer and activates the abductor hallicus 44.9% more than the above SF exercise.  The ratio of activation of the abductor hallicus and adductor hallicus is more ideal as it’s closer to 1:1. On average, the TSO exercise reduced the bunion angle by 9 degrees.  (The SF exercise didn’t help reduce this angle).
  • The picture on the left shows how to complete the TSO exercise.  Each position was held for 5 seconds before the whole cycle was repeated.

C) Heel-Raise Exercise

  • This exercise focuses on strengthening the muscles that support the ankle and foot.
  • During this exercises, bend your knees slightly because this reduces the activity of your calf muscle (gastrocnemius).
  • Then, stiffen and raise your arch while keeping your hindfoot turned inwards.  (Your heel should not swing towards your 5th toe.)  This helps to activate your tibialis posterior.
  • Next, lift your heel off the floor while keeping pressure inside the ball of your foot.  Only transfer enough weight forward onto your toes to keep your balance during this exercise.  You can also lean against a wall to help with balance.
  • In order to optimally activate the fibularis longus, place a flat object like a coin under the first metatarsal head as a target for loading.

In most studies, it took 8 weeks of this exercise program to see changes and reduce pain.

I hope that these posts have been helpful in explaining option in bunion management.  As always, feel free to contact me with any questions!  The resources I used are posted below.

Keep dancing, my friends!

——————————————————————————————————————————–

Headshot

Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

Resources: 

 

Mortka K, and Lisiński P . “Hallux Valgus-A Case for a Physiotherapist or Only for a Surgeon? Literature Review.” Journal of Physical Therapy Science, vol. 27, no. 10, 2015, pp. 3303–7., doi:10.1589/jpts.27.3303.

Kadel, Nancy. “Foot and Ankle Problems in Dancers.” Physical Medicine & Rehabilitation Clinics of North America, vol. 25, no. 4, 2014, pp. 829–844., doi:10.1016/j.pmr.2014.06.003

Arge, Aire, et al. “Range of Motion and Pain Intensity of the First Metatarsophalangeal Joint in Women with Hallux Valgus Deformation After Two-Month Home Exercise Programme.” Acta Kinesiologiae Universitatis Tartuensis, vol. 18, 2013, pp. 111–111., doi:10.12697/akut.2012.18.12.

Glasoe WM. “Treatment of Progressive First Metatarsophalangeal Hallux Valgus Deformity: A Biomechanically Based Muscle-Strengthening Approach.” The Journal of Orthopaedic and Sports Physical Therapy, vol. 46, no. 7, 2016, pp. 596–605., doi:10.2519/jospt.2016.6704.

Kim MH, et al. “Effect of Toe-Spread-Out Exercise on Hallux Valgus Angle and Cross-Sectional Area of Abductor Hallucis Muscle in Subjects with Hallux Valgus.” Journal of Physical Therapy Science, vol. 27, no. 4, 2015, pp. 1019–22., doi:10.1589/jpts.27.1019.

Kim MH, et al. “Comparison of Muscle Activities of Abductor Hallucis and Adductor Hallucis between the Short Foot and Toe-Spread-Out Exercises in Subjects with Mild Hallux Valgus.” Journal of Back and Musculoskeletal Rehabilitation, vol. 26, no. 2, 2013, pp. 163–8., doi:10.3233/BMR-2012-00363.

 

Featured

Bummed About Bunion Surgery? There Are Other Options (Part 2/3)

In my previous post, I covered what causes a bunion, and my personal experience with bunions (also known as hallux valgus).  Bunions are an issue with dance lovers like myself.  There’s conflicting research on whether dancers are at higher risk of bunions.  But, if you have a ‘flat foot’ like me, bunions are a common foot issue.  Bunions are also 3x more common in females.  After doing research and seeing a few bunion surgery patients during my clinical hours, I was afraid of surgery.  There are other options!  I’ll be covering four of them today.

1. Orthotics Outcomes

  • The first study compared orthotics devices of 3 different lengths: Orhtoticsfull foot length, 3/4 foot length, and sulcus-length versus wearing no orthotic at all. They measured the pressures of the bottom (plantar), top (dorsum), and outside (medial) of the first metatarsal head (big toe joint) while walking. The hallux valgus deformity usually occurs because of increased pressure on the outside of the toe joint.
    • None of the orthotics tested provided a significant decrease in the outside (medial) pressure.  In fact, the full and sulcus legnth orthoses caused a trend towards increased medial pressure.  The 3/4 length orthosis had a trend towards decreased pressure.
    • Takeaway:  This means that if you are prescribed a orthosis, a 3/4 length would be a best choice. However, the researchers didn’t find that orthoses can significantly reduce medial pressure.
  • The second study was a meta-analysis of information from 1950 – March 2011 that focused on rheumatoid arthritis and orthoses.  Image result for rheumatoid arthritisRheumatoid arthritis (RA) is a chronic inflammatory disorder affecting many joints, like those in the hands and feet.  People of any age can experience RA, but it is more common in the age ranges of 19-60+.  (A rheumatologist told me that I had early signs of RA in my big toes at the age of 24.)
  • The goal of the analysis was to evaluate evidence on whether orthoses would aid in the treatment/management of a bunion.  Meta-analyses also consider if the experiments conducted were of high standard.
    • After meeting the inclusion criteria, 17 studies were analyzed.
    • There was weak evidence for custom orthoses reducing pain and forefoot plantar pressures (which are usually increased with hallux valgus).
    • There was contradictory evidence on whether custom orthoses help to improve foot function, walking speed and other parameters, or reducing the hallux valgus angle progression.
    • Takeaway: Custom orthoses may help with reducing pain and forefoot plantar pressures in patients with rheumatoid arthritis.  However, more research needs to be done to have a clear conclusion.

2. Taping Outcomes

  • The researchers looked at the effects of 10 days of kinesiotaping on 21 females with hallux valgus.  Kinesiotape is the bright tape that you may have seen on Olympic athletes; it’s designed to aid the body’s natural healing and to provide support/stability to muscles/joints without limiting movement.  It can also be used to prolong the effects of manual therapy.  Kinesiotaping is learned by clinicans through a certification course.taping pic
  • The outcomes tested were: pain (on a scale of 0-10), hallux angle, and patients’ functional status as evaluated by standard questionnaires.  X-rays were taken pre/post the one long treatment.
    • The angle of the hallux valgus was signficantly reduced.
    • Pain level was significantly reduced.
    • The questionnaires showed significant improvement.
    • The x-rays showed significant results compared to the control group.
    • Takeaway: 10 days of kinesiotape can provide short-term decreased pain and disability in hallux valgus.results from tape

3.  Braces and Stretching Outcomes 

  • The researchers studied the effect of specially designed splints versus splints on the market on treating hallux valgus on 30 subjects.  The patients were followed every three months for a year; during this time, weight bearing x-rays of both feet were taken to measure the hallux valgus and inter-metatarsal angles.
    • The group with the specially designed splints decreased the hallux valgus angle more than the market splints.
    • Takeaway:  Despite controversies about nonoperative treatment of hallux valgus, mild and moderate bunions can be treated with splints.  This study was conducted in 2011; since splints are more available, it is possible that there may be a more effective splint on the market now.  The study did not describe the market splints tested.

4.  Botox Outcomes

  • This study analyzed the effects of using botox injections as a treatment to manage bunions on 16 patients.  These patients either received botox or a saline injection. uscles of the foot The injections focused on the oblique and transverse heads of the adductor hallucis, flexor hallucis brevis, and extensor hallucis longus muscles; tightness in these muscles are believed to contribute to bunion development.
  • The outcomes were a foot specific pain and disability questionnaire and the hallux valgus angle.  Measurements were taken at baseline and 1, 2, 3, and 6 months after treatment.
    • Both botox and saline injections reduced pain for one month after injection.  However, the botox injections reduced pain for at least 6 months.
    • The botox group had greater improvements on the foot and disability questionnaire.
    • Another study had found that the hallux valgus angle was reduced from ~20* to 7* 6 weeks after the injection.  This reduction lasted for up to 69 weeks.
      • This study only saw reductions in the angle that peaked around 2 months; it wore off 3 months after treatment.
    • Takeaway:  Botox injections could be used as a tool to manage bunions.

So what route should you go?  Personally, I’ve used a splint to help with bunions with positive results.  It has reduced my pain and slightly improved my bunion angle.  However, every foot is different, so there is no one-fix-all.  Physicians, podiatrists, and physical therapists can help determine your treatment plan.

My final post comes out December 22nd.  It will cover the effects of physical therapy on bunions as well as suggested physical treatments As always, feel free to ask me any questions.  I also posted my references below.

Keep dancing, my friends!

1915812_410607133782_5740354_n

——————————————————————————————————————————–

Headshot

Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.

Resources: 

Doty JF, et al. “Biomechanical Evaluation of Custom Foot Orthoses for Hallux Valgus Deformity.” The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 54, no. 5, 2015, pp. 852–5., doi:10.1053/j.jfas.2015.01.011.

Hennessy, Kym, et al. “Custom Foot Orthoses for Rheumatoid Arthritis: A Systematic Review.” Arthritis Care & Research, vol. 64, no. 3, 2012, pp. 311–320., doi:10.1002/acr.21559.

Karabicak GO, et al. “Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus.” Journal of Manipulative and Physiological Therapeutics, vol. 38, no. 8, 2015, pp. 564–71., doi:10.1016/j.jmpt.2015.09.001.

Mirzashahi B, et al. “Comparison of Designed Slippers Splints with the Splints Available on the Market in the Treatment of Hallux Valgus.” Acta Medica Iranica, vol. 50, no. 2, 2012, pp. 107–12.

Wu KP, et al. “Botulinum Toxin Type a Injections for Patients with Painful Hallux Valgus: A Double-Blind, Randomized Controlled Study.” Clinical Neurology and Neurosurgery, vol. 129, 2015, pp. 58–62., doi:10.1016/S0303-8467(15)30014-7.

Kadel, Nancy. “Foot and Ankle Problems in Dancers.” Physical Medicine & Rehabilitation Clinics of North America, vol. 25, no. 4, 2014, pp. 829–844., doi:10.1016/j.pmr.2014.06.003.

 

Welcome to Humble Hills Farm

This is such an in depth post! Great for anyone who wants to try making their own soap. I can vouch for how wonderful these smell, and they’ve been great for my sensitive skin.

Humble Hills Farm

Beautiful wildflower honey harvest from our honeybees.

Even in January, the homestead has a big to-do list!

Here we are at the beginning of 2020. I will be honest in saying I have been working on this blog for sometime, and it has been an ongoing learning curve. I think all of my farm hobbies have been easier than getting this blog together! If you want to know more about the farm, please visit the About section of my blog. I’ve finally got myself organized, and so I would like to begin with a summary of what the homestead has going on in January:

  • We discovered we lost our beehive over winter (it appears they swarmed) and so we mailed in the check to pick up two new nucs in May.
  • I ordered five new chickens to join the flock, including a Blue Copper Maran rooster and a Black Copper…

View original post 122 more words

New Look, Same Management. NEW BUSINESS GOING LIVE 11/18/19!

Continue reading “New Look, Same Management. NEW BUSINESS GOING LIVE 11/18/19!”

%d bloggers like this: