Ski Injury Prevention

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

It’s always refreshing to wake up to inches of snow on the ground and know that winter is approaching! For those of us Durangoans who love to ski, it’s even more exciting to hear about the 2+ feet of snow that fell in the last 24 hours at the resort. If you’re like me, this news got me looking around for my skis and gear this morning to make sure everything is ready to go to hit the slopes this weekend. As I prepare to get on my skis for the first time in many months, as a PT I also think about whether my body is ready to go in order to set my self up for success for injury prevention this winter. Cue the literature search…

Unfortunately, when digging into the research, there is little information on ski injury prevention for the recreational skier like me. However, I found an interesting review study discussion ski injury prevention specific to alpine racers, so- while not perfect- I’m taking some of the information from this review to extrapolate into my own skiing and the ability of my patients to think of certain methods to reduce their ski injury risk this upcoming season.1

In this review of the existing data, the researchers found that the majority of alpine ski racing injuries occurred while turning (80%) or landing (19%).The researchers also found that there were four athlete-related risk factors that have been identify with statistical evidence, including:1

  1. Insufficient core strength/core strength imbalance– something we can work on!
  2. Female/male sex– in this study, males were found to be at higher risk of injury than females
  3. High skill level– higher ranking athletes were found to be at higher risk of injury than lower ranking athletes, which could be related to many factors such as increased on-snow time
  4. Unfavorable genetic predisposition– one recent study showed that ACL injury risk of alpine skiers may be related to their parent’s history of injury

In addition to athlete-related risk factors, the researchers outlined their findings on equipment, course, and snow-related injury risk factors as well.1

Ellen’s husband, Brad, enjoying fresh powder in the Canadian backcountry

When assessing the findings of this article, my next question becomes: “Is there anything I can do or change for myself or my patients given this information?”. Given the information above, the one thing we can address in the physical therapy realm is core strength and muscle imbalance. Something that we are offering at Tomsic PT is our Winter Readiness Program, which gives you the opportunity to work with a PT one-on-one for an hour for an individualized assessment and program development to help you be successful in having an injury-free season. Although we can’t modify all of the factors related to ski, and other snow sport, injuries, we can focus on the modifiable risk factors and help you to reduce the impact of those those in a sound manner. If you’re like me and itching to get out on the snow while making sure you are as ready as you can be, make sure to call our office to schedule a Winter Readiness assessment soon. And, keep doing your snow dances!

One of my days out on skis enjoying our beautiful San Juan mountains
  1. Spo¨rri J, Kro¨ll J, Gilgien M, Mu¨ller E. How to prevent injuries in alpine ski racing: what do we know and where do we go from here?  Sports Med. 2017;47:599-614.

 

Introducing Dr. Daven Valdez, PT

Back in August, we welcomed a new member to our team- Dr. Daven Valdez, PT! Well, he wasn’t completely new, as Daven was a student here from January to March 2020 when he was undergoing his Doctorate education, so we were happy to welcome him back. Here is some information about Daven:

  • How did you end up in Durango and where did you live previously?
    I was born in Durango and grew up in Durango and Dolores. Southwest Colorado has been my home for most of my life and I always knew I wanted to end up back here after pursuing my professional degree. After graduating high school from Dolores I went to Grand Junction to obtain my Bachelors at Colorado Mesa University and then moved to Denver where I obtained my Doctorate of Physical Therapy degree from University of Colorado.

  • What do you love about working in Durango/at Tomsic?
    What I love most about working in Durango is being able to give back to the community that raised me. Once I decided to pursue Physical Therapy as my profession, I always knew I wanted to make my way back to Durango to provide high quality care for the active community members that call this amazing town home. What I love most about working at Tomsic is being able to learn from and work alongside some of the best and most knowledgeable therapists around. I was a student at Tomsic my second year of PT school and the PT’s here left such a great impression on me that I knew I had to work in that environment to help me grow as a clinician and person.

 

  • What are your special interests in PT and how do you incorporate them into your clinical time at Tomsic?
    A special interest I have in PT and one that I try to incorporate into my practice is resistance training. Utilizing the principles of progressive overload to build strength and stability for my patients is a big part of my treatment style when indicated. Being creative with my exercise prescription to replicate and build to my patient’s hobby or activity of choice is something I strive to implement and improve on each day in the clinic.

  • What’s one fun fact about yourself that you’d like to share?
    One fun fact about me is that I try to learn to the best of my ability all the activities that my patient’s enjoy. Being a great clinician in health care to me means being able to connect with each patient on a professional as well as a personal level. If I am seeing a patient that enjoys pilates or yoga for example, I will take classes to learn how to incorporate elements of that activity into their plan of care to better connect with them. It is something that also keeps me busy and ensures that I am always learning.

Make sure to say hi to Daven the next time you see him in the clinic!

Returning to Sports after an ACL-Reconstruction

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

When I was completing my initial doctorate degree at the University of Utah, I focused the efforts of my doctoral project on identifying risk factors for individuals to sustain a repeat or opposite-leg knee anterior cruciate ligament (ACL) injury after undergoing an ACL-reconstruction surgery. Nearly 10 years later, researchers are still working to identify risk factors for a second ACL injury and to either validate or invalidate previously identified factors. One such recent research article by Beischer et al.(1) sought to further understand the factors that may impact the likelihood of somebody sustaining a second ACL injury after going through surgery and returning back to sport.

The main reason why this topic is so heavily investigated is because the rate of reinjury has been shown to be concerning for young athletes. According to the literature review in the Beischer et al. study, “approximately 1 in 4 patients who are 25 years of age or younger and return to high-risk sport after primary ACL reconstruction sustain a second ACL injury.”(1) For the amount of time and energy it takes to have and recover from this surgery, I don’t like the sounds of those odds and I certainly try to prepare my patients as much as possible to have success when returning to their sport.

This research study focused on three specific factors: 1- the amount of time to return to a knee-strenuous sport after ACL-reconstruction, 2- symmetrical muscle function as assessed by a variety of strength and hopping tests to compare the injured leg to the non-injured leg, and 3- symmetrical quadriceps muscle strength at the time of return to sport.(1) After analyzing data from 159 athletes, this research group found that athletes who returned to knee-strenuous sport earlier than 9 months had an approximately 7-fold higher rate of new ACL injury- of either the same leg or the opposite leg- compared with those who returned at 9 months or later after surgery.(1) They did not find associations with muscle function or symmetry of quadriceps strength in relation to new ACL injury.(1)

The results of this study reinforce the results of many prior studies showing that returning to strenuous sport “too soon” after an ACL-reconstruction is risky. Ultimately, time is on your side when it comes to properly rehabilitating after an ACL-reconstruction surgery, and getting back into play is not to be taken lightly. For those patients of ours who are recovering from an ACL-reconstruction, we will continue to be diligent in educating them about the importance of time throughout the rehab process.

1. Beischer S, Gustavsson L, et al. Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. J Orthop Sports Phys Ther. 2020 Jul;50(7):411.

Return to Work Clinical Practice Guidelines

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

In conducting evidence-based practice, there are three main things that physical therapists rely on to help make the best decisions for how to treat their patient: the patient’s preference, the experience of the practitioner, and the research that is available. Focusing on the research aspect, we rely heavily on high-quality peer-reviewed resources and journals to gather our information. This information gathering is a continual process that is going on behind-the-scenes when we are not working face to face with our patients. One such resource that we use is the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), which provides us with monthly access to new research on a variety of topics within the orthopaedic and sports world of PT. This journal also publishes Clinical Practice Guidelines, which provide an evidence-based overview of specific topics.

Dr. Christine Richards, PT, OCS

Over the past few years, one of our very own PTs, Dr. Christine Richards, PT, OCS, has been working diligently with a group of PTs to author a Clinical Practice Guideline that was just published this summer in JOSPT, titled “Clinical Guidance to Optimize Work Participation after Injury or Illness: The Role of Physical Therapists.”(1) This guideline provides a summary of recommendations for best practice when it comes to physical therapists’ treatment of patients who have been involved in work-related injuries or illness, which is something we see often in the clinic. These recommendations covered all aspects of patient care, including timing and duration of care, evaluation, treatment involving multiple factors, ergonomic assessment and recommendations, and psychologically informed practice.(1) As with every patient that walks in our clinic, we want to use the most well-rounded approach to help workers either stay in their job or return to work after any illness or injury, and this guideline provides an excellent synopsis of the research on this topic over the past 20 years.(1) We are so proud of Christine for her hard work on this valuable project!

1. Daley D, Payne LP, Galper J, et al. Clinical Guidance to Optimize Work Participation after Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther. 2021; 51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303.

Strength Training for Low Back Pain in Older Adults

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

To follow up on my blog post from June regarding the importance of strength training, I’ve got another recent research review coming ‘atcha! A group of physical therapists in Spain performed a systematic review- a high quality approach to review multiple research studies- specifically looking at the effectiveness of resistance training programs to help treat older adults (60+) with chronic low back pain.1 Their search results yielded eight high quality research studies that were analyzed to describe the main characteristics of the strength programs used, so that us clinicians can glean the information in order to help us design more effective resistance exercise programs to help our patients over the age of 60 with low back pain that may be affecting their quality of life.1

Ellen taking her shot at perfecting bench press technique

 

Nathan laying down the knowledge on tips and tricks for the bench press

 

Me, working on perfecting my form with Nathan’s guidance

Ultimately, the researchers found that there were a variety of methods used in the strength programs across each of these research studies, but that they all had a positive impact on the patients’ pain, disability, and quality of life.1 The researchers also discuss the reasons why progressive strength programs work: by improving your brain’s ability to connect to the muscles in your body, bone mineral density, muscle function, physical strength, and functional capacity.1 Furthermore, research indicates that strength training programs also help older adults with chronic low back pain see improvements in coordination, balance, and flexibility.1

The three fundamental aspects of strength training programs that was found during this research review include:1

  • Global training of the whole body with emphasis on the large muscle groups
  • Using a traditional periodized program which utilizes the concept of alternating load plans in successive workouts (such as performing 8-10 rep maxes during one workout and 12-15 rep maxes on the next)
  • A gradual increase in volume and intensity initially and further increases in intensity later on in the program

Ultimately, this systematic review provided a big vote for the inclusion of resistance training to help with the treatment of chronic low back pain in adults aged 60 and over.1 A physical therapist will help not only create a program for you but more importantly guide you through proper technique and progression within the context of your individual body’s needs in order to move toward the end result of decreased pain, improved function, and improved quality of life. If you’ve been dealing with chronic back pain and are ready to do something about it, don’t hesitate to reach out to our clinic to schedule an initial evaluation so we can guide you through an individualized plan to help you achieve your goals.

1. Fritz N, Gene-Morales J, Saez-Berlanga A, et al. Resistance training for chronic low back pain in the elderly: a systematic review. J Human Sport and Exercise. 2021;16(3proc):S1492-S1506.

Strength Training in Physical Therapy

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

With the addition of Dr. Nathan Dailey, PT, OCS, CSCS to our team last fall came his strong drive to utilize more strength training within our physical therapy treatment due to his specific background and knowledge as a Certified Strength and Conditioning Specialist. Lucky for Nathan (and all of us!), the remodel that was completed last year provided the perfect space to install a strength training area so that we can meet the needs of our patients. Since the installation of this equipment a few months ago, Nathan has been educating the rest of our team on technique and utilization of strength training within the context of physical therapy.

As it turns out in my investigations of literature, so many of the common issues we see can benefit from the addition of strength training in order to maximize rehabilitation effect. While we have always utilized strength training in other forms in our exercise prescription up to this point- using body weight, bands, and lighter weights- we are now able to further maximize these positive effects using the new strength equipment. For example, take a peek at this recent infographic from the British Journal of Sports Medicine outlining the research that supports strength training for improving running performance.

Infographic from British Journal of Sports Medicine

Regardless of the issue that’s bringing you to physical therapy, make sure to ask your physical therapist about how strength training can be an adjunct to your treatment in helping you move better, feel better, and be stronger and healthier in your life.

Resilience

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

Resilience: The capacity to recover quickly from difficulties; toughness.

With the whirlwind of the past year during a worldwide pandemic, resilience is a word that comes to my mind often. I’ve witnessed resilience on so many levels in this past year: in our families, our community, our nation, the world, and within our clinic. The challenges of this past year have brought stress and difficulties to all of our lives, but our ability to maintain consistent relationships with our patients and help you all move better, feel better, and live better has been a bright light and source of inspiration to keep going strong.

Recently, our entire team had the opportunity to celebrate our resilience through the pandemic by participating in a guided three day mountain biking trip on the White Rim in Canyonlands National Park. Not only did we get to reflect on our ability to maintain and build our team in the past year, but we also had new opportunities to demonstrate our resilience through the activities of the trip itself. While some of us are seasoned mountain bikers, others of us are not, and there were good mental and physical challenges abound while navigating the gorgeous desert terrain. Whether it was staring up at the inclined road as it wound up from a low point, knowing we would need to make it to the top to eat our well-deserved lunch, or jumping over a two foot crack in the rim rock knowing that there was an 80 foot drop below, only to be able to stare in awe at the majestic view of the Green River bending and weaving through the canyon floor below us when you made it to the ledge, the challenges we faced led us to more strength and resolve knowing that we could do hard things and yet keep going to wherever we needed to next.

Looking up at the steep climb, knowing lunch is at the top!

The views making it worthwhile!

And, really, this is the greatest metaphor for physical therapy and life in general: facing challenges head on, whether they are mental or physical (or, more often than not, both), and doing what needs to be done to get to the next phase of the journey of recovery. The members of our team feel so lucky to be your guides along the way. Sometimes there is a delicious meal, or the comfort of camp, at the end of the challenge. Sometimes there is the excitement of meeting a milestone or goal that you have set for yourself. But, there is always power in the knowledge that you can do hard things, and that you have support along the way.

COVID-19 Recovery and Return to Physical Activity

COVID-19 Recovery and Return to Physical Activity By: Dr. Laura Wenger, PT, OCS, FAAOMPT

As we move into spring of this year, I can’t help but feel a heavy wave of anxiety and stress when thinking about this past year and the realm of emotions it has brought into my life and the lives of most everyone in the world: uncertainty, fear, and worry to name a few. After speaking with family, friends, and patients, I know that I am not alone. Even with the efficacy of vaccinations and increasing percentages of adults in our community, nation, and world becoming able and willing to have the vaccine, I am still very nervously and hesitantly looking toward days where I don’t have to hyper-analyze nearly every decision made in daily life. Although we are moving slowly and carefully back toward some semblance of “normal”, COVID-19 continues to exist in our community and nation and is still affecting people we know with both new infections as well as some cases of long-term COVID effects, or “Long COVID”.

As more information is gathered about the exact effects of COVID-19 on our bodies, the profession of physical therapy has also been given more guidance on how to help our patients safely return to activity after they have been diagnosed and recovered from the disease. One thing that is evident is that COVID-19 affects surviving individuals in a large variety of ways, from a range of people that don’t have any symptoms present at all to some who feel effects from the disease for months following their active infection. Even for those individuals who have only mild to moderate symptoms and recover quickly with no long-term effects, research currently recommends waiting at least seven days after their symptoms are gone before starting a slow, progressive process of returning to exercise that should take approximately four to five weeks to return to their pre-COVID baseline.(1) Furthermore, for those individuals who experience a more severe case or have any prior history of cardiovascular diseases, specific testing by a cardiologist is recommended in order to return to exercise due to the higher risk of cardiac complications or blood clotting events after COVID.(1) These recommendations are based on the fact that this novel disease is demonstrated to affect all systems in your body, but especially the lungs and heart.(1)

I’m dreaming of summer hikes like this one that I took up to Columbine Lake last year for a socially-distanced exercise adventure!


Ultimately, physical therapists and all other health professionals are becoming more equipped to guide patients through post-COVID recovery as more information and data becomes available. As exercise specialists, physical therapists can successfully guide individuals through a progressive program to return back toward their baseline level of fitness after they have recovered from a COVID-19 infection, as long as they have been cleared by their physician. As our community continues to navigate this new world within the existence of COVID-19, I know I’m not the only one who looks forward to seeing more of you out on the trails that we all love to have in our backyard, and I’m looking forward to helping more people get out there safely.

1. Salman D, Vishnubala D, et al. Returning to physical activity after covid-19. BMJ. 2021;372:m4721

Integrating Pilates Exercises into Physical Therapy

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

During this tumultuous past year, our clinic was fortunate enough to be able to go through with a planned remodel that included opening up our gym space (perfect timing in a world of physical distancing!) and updating our flooring. Along with updating our physical space, we have been able to update some of our equipment, as well! For those of you who have been patients of Tomsic PT in the past, you may have fond memories of the Shuttle machine. Now, in its place, we have a versatile clinical model of the Balanced Body Pilates Reformer, which has given us more ability to integrate Pilates exercises in our rehabilitation programs for many of our patients.

First, I’d like to explain a bit about what Pilates is. Names after its founder, Joseph Pilates, the exercise system created in the early 1900s is based on principles of core stability and strength through movement.(1) These exercises are performed on a spring-loaded machine, called a reformer, and there are also mat exercises that can be performed with no equipment necessary. Over the years, Pilates has evolved with many experts across the country teaching in Pilates studios, such as at one of the many esteemed studios that we have in our small town, as well as physical therapists and other health professionals integrating these exercises into the treatment of musculoskeletal problems from head to toe.

Christine teaching Jake the “Cleopatra” move for spine mobility

Nathan working on his spine mobility with guidance by Christine

We are lucky here to have the guidance of one of our PTs, Christine, to share her knowledge of a wide variety of reformer exercises that she has learned through her previous training. We were able to take some time in early January to have a few intensive skills sessions within our group to learn and practice these exercises. As we’ve been integrating various exercises on the reformer into our patient care, our patients have been seeing great results with more mobility, more strength, more function, and less pain. These results are in line with research articles that demonstrate the positive effect of using Pilates exercises as a rehabilitation tool for reducing pain and disability, such as the 2018 systematic review by Byrnes et al.(2)

Nathan cuing me on trunk stability during resisted arm exercises

Ellen giving Nathan feedback on his form during resisted leg exercises for core stability

We are excited to continue to learn more about the use of the reformer as an effective part of a rehabilitation program as we continue to explore its use on ourselves and our patients. If you are curious about how Pilates exercises can be integrated into physical therapy for a musculoskeletal injury or post-operative care, make sure to contact our office to discuss this with one of our therapists!

1. Balanced Body. Origins. https://www.pilates.com/pilates/origins. 2018. Accessed Feb 9, 2021.
2. Byrnes K, We PJ, Whillier S. Is Pilates an effective rehabilitation tool? A systematic review. J Bodywork & Movement Therapies. 2018;22(1):192-202.

Staff Spotlight: Dr. Nathan Dailey, PT, OCS, CSCS

We have another relatively new staff member that we would love to have you know better here at Tomsic PT! In October of 2020, we welcomed Dr. Nathan Dailey onto our staff just days after he finished his service with the US Army.

– How did you end up in Durango and where did you live previously?
My wife was fortunate enough to get a tenure-track professor position in Marketing at FLC early in FEB 2020 before this COVID craziness began. I was nearing the end of my contract w/ the Army and was excited to move out here with her and our 4-year-old son. My wife was coming from a professor position at the University of Texas at San Antonio (UTSA) and I was finishing an assignment at Fort Sill, OK (one of 4 basic training posts for the Army in the US). We are so happy to now call Durango home and to have our son grow up where there’s snow!

Nathan and his son at Mount Scott outside of Lawton, Oklahoma

– What do you love about working in Durango/at Tomsic?
One of the first things I noticed after only a few days of working here is how incredibly fit so many of the Durango residents are into their later years. So often we see the poor health outcomes associated with inactivity and Durango is an incredible little microcosm, a testament to how powerful remaining active is. I love treating patients who tell me that they ABSOLUTELY MUST return to skiing, hiking 14’ers, mountain biking and playing 2+ hour games of pickle ball.

Regarding the staff, I have been overjoyed to find that not one of them is unkind, mean-spirited or attempts to undermine me or the other members of the team; this was definitely not the case with some of my previous jobs and it makes going to work every day a pleasure.

– What are your special interests in PT and how do you incorporate them into your clinical time at Tomsic?
Anyone who talks to me for more than five seconds will realize that I am incredibly passionate about incorporating traditional elements of strength training into my clinical practice. I love not just incorporating the loaded movements themselves, but geeking out about such minutiae as load progression, volume manipulation and periodization. As most of the patients who come to see me have athletic goals (return to hiking every week for at least 9 miles per hike, be able to run across Zion National Monument in a single day, return to swing dancing), marrying these patients’ rehab w/ sport performance makes sense to me. This is something I did nearly every day while in the military and I am incredibly excited to bring this treatment style to the Durango community.

Nathan deadlifting 500lb at Fort Sill, Oklahoma in 2020

– What’s one fun fact about yourself that you’d like to share?
I am incredibly afraid of heights, but that didn’t stop me from jumping out of a perfectly good airplane (skydiving) in the spring of 2014 w/ my wife or sitting in the hurricane seat (near the window facing the wind) on several Black Hawk flights in Iraq. I continue to try to face my fears.

– Anything else that you’d like to highlight, feel free to share!
I am passionate about reducing the risk of injury to athletes (tactical or civilian) through careful manipulation of training load and slow introduction of resistance training. I have a white board and plenty of dry erase markers and am all too happy to share the insights I’ve learned!

Nathan, we are so happy to have you on our team!