Exercise for Health During Pregnancy

By: Dr. Laura Wenger, PT, OCS

I found it fitting to write a blog about health and exercise during pregnancy given that I’m 39 weeks pregnant and getting ready to welcome baby girl any day now! The good news is that there is a lot of content to pull from out there, as researchers continue to find more and more benefits of exercise whether or not you are growing another human inside of you. One of the latest research studies, a randomized controlled trial out of Brazil, confirms some of these benefits.(1)

The researchers split up 456 pregnant women into two groups: one was the “control group” that received standardized obstetrics care, and general nutrition and physical activity counseling, while the other was the “exercise group” that participated in a structured and supervised hour-long exercise program three days per week from weeks 8-10 of pregnancy until the the end of their third trimester right before having their babies.(1) This supervised exercise program consisted of a gradual warm-up, aerobic exercises, light muscle strengthening, coordination and balance exercises, stretching exercises, pelvic floor strengthening, and relaxation at the end.(1)

Sneaking in a little exercise between patients on my second to last day before maternity leave!

The research looked at two main outcomes, maternal weight gain and gestational diabetes diagnosis, to try to compare the two groups and to see if there were any positive effects of the structured and supervised exercise, and here is what they found(1):

  • The women in the exercise group had significantly lower weight gain, within normal amounts
  • The amount of women diagnosed with gestational diabetes was lower in the exercise group

Given all that is known about the positive effects of exercise in general, those results should not be surprising to anyone. However, it’s nice to see that just three hours of low- to moderate- exercise per week- which can feel tough for some women to accomplish during pregnancy depending on how they are feeling on any given day- can make such a positive difference in health. I feel fortunate that I’ve been able to use the daily movements and tasks of my job as my main exercise program throughout this pregnancy, and I definitely credit a lot of my ability to maintain good health throughout these past 39 weeks to my sustained activity levels even if I haven’t felt up to my usual exercise regimen of hiking, running, and biking during this time. If you are pregnant, make sure you talk with your care provider to ensure that exercise is safe for you and make sure to reach out to physical therapist if you need help establishing a well-rounded and safe exercise program to help as your body changes.

  1. Barakat R, Refoyo I, et al. Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial. Braz J Phys Ther. 2019;23(2):148-155.

Running Distance Changes and Running-Related Injury

By: Dr. Laura Wenger, PT, OCS

Spring is kicking into full gear with warmer temperatures, drier trails, and increased outdoor activity! With many Durango folks trading their ski boots for running shoes these days, it’s important to talk about safe increases in running distance in order to set up for an injury-free season.

A recent article in one of my favorite sources for quality research reports, the Journal of Orthopaedic and Sports Physical Therapy, touched on this topic by specifically looking to find out if there is an association between change in weekly running distance and running-related injury.(1) The researchers studies over 250 non-injured runners of a period of 14 weeks as they followed a running schedule that was either focused on distance increases or pace increases.(1) The main finding of this research article was that significantly more runners were injured if they increased their weekly running distance by greater than 20%, with this association more commonly occurring in the first few weeks of the training program.(1) This falls in line with a previous articles on this topic, where activity increases greater than 10-30% were associated with higher risks of injury.

A nice preview of what running on the trails will look like when all of that snow melts up high!

This current article does make a point to mention that there are many other variables besides schedule and weekly increases that can lead to injury in runners.(1) As physical therapists, we are uniquely qualified to assess you, whether or not you have a current injury, and help with ensuring that you have as good of a running season as you can with guidance on specific exercises and training plans to work with as you increase hit the roads, paths, or trails around town this year. Don’t hesitate to contact us if you want to do everything you can to minimize your risk of injury or reduce the effects of a current injury if you have one!

1. Damsted C, Parner ET, et al. The association between changes in weekly running distance and running-related injury: preparing for a half marathon. J Orthop Sports Phys Ther. 2019;49(4):230-238.

Second ACL Injury Risks

By: Dr. Laura Wenger, PT, OCS

Back when I was doing my Doctorate training at the University of Utah, I performed an extensive review of risk factors for repeat injuries or injuries on the opposite side after having an ACL-reconstruction surgery for my final doctorate project. Since then, researchers have continued seeking for answers to the question of why people who have had an ACL injury and surgery have a risk of re-injuring the same knee or injuring the opposite knee, which occurs in anywhere from 3 to 37% of people depending on their activity level, type of sport, and other factors such as age.(1)

In an attempt to reduce the risk of further injury, especially with people who are returning to sports that might put their ACL at risk (such as soccer, football, and any other running/cutting sports), researchers and clinicians have created many “Return to Sport” tests to try to prepare their patients to getting back to their usual activities as safely as possible. These tests are typically looking to see how symmetrical the legs of the patient are with comparing the surgical side with the non-surgical side, as well as with trying to gauge how confident the patient is during the tests as there is more and more information coming out about how confidence in movement can affect quality of movement and, potentially, their risk of further injury. A recent systematic review, which is a grouped analysis of multiple studies, sought to find out whether passing these return to sport tests are associated with actual decreases in the chance of a second ACL injury.(1)

Within the four studies that the researchers were able to look at in this review, approximately 42% of the patients were able to pass the return to sport testing performed.(1) Of those patients that passed their tests, 14% of them went on to have either a re-injury of the originally injuried knee or a new injury of the opposite knee.(1) Unfortunately, the researchers found that experiencing a “passing” grade of the return to sports tests only led to a 3% reduction in risk of injury- which is not a significant amount.(1) The results of this study show that there is still much work to be done in terms of trying to better identify what might place someone at a higher risk of a second ACL injury as well as trying to create tests that are more sensitive so that we can more confidently send patients back to their sport and activities of choice with reduced risk of a further injury. Here at Tomsic PT, we create a very individualized program for each patient to work toward the goal of getting them back to their activities as strong and safe as possible. If you have experienced an ACL injury, either just recently or further in the past, don’t hesitate to see one of our physical therapists for further evaluation on how to best decrease your risk of a second ACL injury.

Brad, Ellen’s husband, skiing some deep and steep snow in Canada this January! Skiing is a sport many folks like to return to after ACL injuries.

1. Losciale JM, Zdeb RM, et al. The Association Between Passing Return-to-Sport Criteria and Second Anterior Cruciate Ligament Injury Risk: A Systematic Review with Meta-Analysis. J Orthop Sports Phys Ther. 2019;49(2):43-54.

Cross Country Skiing and Strength Training

By: Laura Wenger, PT, DPT, OCS

Some of our snow dances must have worked in this past month with a decent start to 2019 including some plentiful snow storms! When the snow started coming down on January 1st, I’m fairly certain that I could feel the warmth of Durango’s large, collective smile as we all were anxious to see some of the white stuff fall after experiencing the negative effects of a dry year in 2018. One of the best parts about seeing all of the snowfall was the added potential for outdoor opportunities like downhill skiing, snowshoeing, and cross country skiing.

Living in Durango, you’re bound to either have some experience cross-country skiing or know someone who has experiences cross-country skiing. I’ve only tried skate skiing a handful of times, but I could tell from my short experience with it that it’s a great workout and way to enjoy the beautiful outdoors! For those of you who enjoy cross-country skiing, I wanted to share some info on how to maximize your ability to utilize your upper body strength for exercise and competitiveness based on a research article that came out of Norway last year.(1)

https://www.popularmechanics.com/adventure/outdoors/a14416161/how-to-cross-country-skiing/

The researchers set out to find how 8 weeks of added strength training helped cross-country skiers’ strength adaptations and double poling performance.(1) Double poling requires greater upper body demands and allows you to assist your legs in the workload of cross-country skiing, which is helpful whether you are a novice or competitive racer. The strength training used in the study included three days per week of three exercises- a standing “double poling”, seated pull-down, and triceps press- with progressive increase in weights and decrease in reps throughout the 8 weeks.(1) When comparing the groups that added strength training to their regimen to the group that did not, the strength training group had improved double poling performance as well as longer “time to exhaustion”.(1) This was a smaller study with some limitations, so you have to take the information with a grain of salt, but the results found reinforced the importance of added upper body strength training for improving athletic performance, especially with endurance activities.(1) So, whether or not you are a competitive cross country skier or just like to do it as a fun way to exercise outdoors in our beautiful backyard, you might consider performing specific upper body strengthening exercises a few days per week to improve the time you spend out on the snow. If you have specific questions about exercises you should or shouldn’t do based on your specific needs and current or past injuries, make sure to contact us to work with one of our specialized PTs to ensure an individualized program that works for you!

1. Øfsteng S, Sandbakk Ø, et al. Strength training improves double-poling performance after prolonged submaximal exercise in cross-country skiers. Scand J Med Sci Sports. 2018;28:893-904.

Let it Snow- and how to Stay Safe with Snow Shoveling

By: Dr. Laura Wenger, PT, OCS

Maybe I’m just trying to be optimistic, or am desperately hoping to avoid a repeat of this past summer’s fire, but I have been busy doing some snow dancing for the past month! In hopes of more snow coming down in and around the Durango area, I wanted to share some tips on snow shoveling that I recently came across in an article from the American Physical Therapy Association’s (APTA) website, Move Forward PT1:

-Lift smaller loads of snow, rather than heavy shovelfuls.
-Be sure to take care to bend your knees and lift with your legs rather than your back.
-Use a shovel with a shaft that lets you keep your back straight while lifting.
-A short shaft will cause you to bend more to lift the load. Using a shovel that’s too long makes the weight at the end heavier.
-Step in the direction in which you are throwing the snow to prevent the low back from twisting. This will help prevent “next-day back fatigue.”
-Avoid excessive twisting because the spine cannot tolerate twisting as well as it can tolerate other movements. -Bend your knees and keep your back as straight as possible so that you are lifting with your legs.
-Take frequent breaks when shoveling. Stand up straight and walk around periodically to extend the lower back. Backward bending exercises while standing will help reverse the excessive forward bending of shoveling: stand straight and tall, place your hands toward the back of your hips, and bend backwards slightly for several seconds.

Another tip that I would add is to make sure that you have shoes on that have good traction so that you are not slipping and sliding around on any packed snow or ice. You might even invest in a pair of traction “cleats” that you can slip over your current shoes to make sure you feel extra steady on the snow and ice while you are pushing snow around.

With fresh snow comes lots of playing and… snow shoveling!

If you do have any issues or concerns related to shoveling, any of our specialized PTs can assist you with any pain you are currently experiencing or to learn prevention techniques if you are not currently injured!

1. American Physical Therapy Association. (2018). 6 Tips to Shovel Snow Safely. [online] Available at: https://www.moveforwardpt.com/Resources/Detail/snow-shoveling [Accessed 21 Dec. 2018].

Update on Physical Activity Guidelines

By: Dr. Laura Wenger, PT, OCS

Are you sitting right now while you read this? Well, according to the federal government’s updated recommendations for physical activity, the next thing you should do is… Stand Up! The take-away message from this 10-year update of Physical Activity Guidelines for Americans is that any movement- anytime, anywhere, anyhow- offers health benefits.(1) The previous guidelines, originally published in 2008, recommended that physical activity of adults needed to occur in at least 10 minute bouts.(1) With this new update, the authors of these guidelines found that some physical activity is better than none, regardless of the time-frame of the activity.(1)

What does this guideline update translate to in real life? Easy changes, such as taking the stairs instead of the elevator, parking at the end of the parking lot to walk into work or while running errands, substituting your daily commute in your car with walking or biking alternatives if able, and taking that two minute lap around the office every hour if you have to sit at work, can all add up during your day to provide health benefits. These health benefits include improved sleep, improved blood sugar control, reduced anxiety, long-term cognitive benefits, and significantly lower risks of heart disease and certain cancers.

John and Josh bike commuting to and from work to get some daily dose of activity!

Here are the other specific key guidelines that were recommended for adults and older adults:

“Adults:
-Some physical activity is better than no activity (as discussed above).
-For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, OR 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.
-Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week.
-Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.

Older Adults:
The key guidelines for adults also apply to older adults. In addition, the following key guidelines are just for older adults:
-As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.
-Older adults should determine their level of effort for physical activity relative to their level of fitness.
-Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely.
-When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow.”(1)

150 minutes of moderate-intensity aerobic physical activity is just 22 minutes a week! Ideas to meet moderate-intensity activity that increases your resting heart rate include: walking, cycling, Nordic skiing, elliptical machine, high-intensity interval-training, and running. If you’re currently experiencing an injury and need help figuring out what you can do to get you on track with these guidelines for improved health benefits, call our office to schedule an appointment with one of our PTs!

Physical Activity Guidelines for Americans. President’s Council on Sports, Fitness, & Nutrition. U.S. Department of Health & Human Services. https://www.hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.html. Accessed on November 15, 2018.

Q&A with Dr. Josh MacNaughton, PT

By: Dr. Laura Wenger, PT, OCS

We have had an exciting past summer and fall welcoming our most recent PT additions, Dr. Stacey Woodward (see blog with a Q&A with Stacey here) and Dr. Josh MacNaughton. Some of you may recognize Josh as someone who has been at Tomsic for a long time, as he spent the months of January through April with us here at Tomsic PT as a student intern completing his final internship through Tennessee State University before he graduated with his Doctorate in Physical Therapy in May. We were lucky enough to be able to hire Josh as a full-time clinician with us right after his graduation, and he has transitioned seamlessly into our clinic given his experience in Durango and the clinic itself. I recently got to sit down and pick Josh’s brain about his background and interests:

What brought you to Durango?
Cycling. I was a competitive road cyclist most of my youth and when it came time to decide on what college I wanted to attend the choice was easy. One quick google search on highest ranked collegiate cycling team put Fort Lewis College at the top of my list, and since I had visited Durango before the choice was easy. After graduating from Fort Lewis I knew that I had to come back at some point. After returning to my home state of Tennessee to finish my Doctorate of Physical Therapy I made the move back to Durango.

How long have you been a PT and what areas have you worked in?
I have only been a PT since graduating May of 2018, however I have been involved in the profession since 2010 working as technicians and office coordinators for up to a dozen clinics total between Tennessee and Colorado. My primary experience has been in outpatient ortho but I did internships in inpatient hospital rehabilitation as well as skilled nursing facilities.

What do you feel you bring to the practice?
I love working with people who have active hobbies regardless of whether they are athletes or avid outdoors people. I have a lot of personal experience with endurance sports such as running and cycling that I feel will benefit the active people of Durango continue to be active after sustaining an injury.

What do you hope to gain from working at Tomsic PT?
The Physical Therapists at Tomsic are all very highly trained and I hope to gain as much knowledge as I can from them.

When not at work, where are folks most likely to run into you around town?
I enjoy riding my bike all around Durango, walking my dog Pepper on the river trail, and hiking up Hogsback to get a good view of town.

What is one fun fact about you that nobody would know?
During college I worked as a candy delivery driver for Fuzziwig’s Candy Factory in Durango.

Josh getting ready to hop on his bike during the Tri the Rim triathalon in September

We are happy to have Josh here rounding out our great team of therapists!

Treating Pain Takes Teamwork

By now, most people have heard that there is a healthcare crisis in our country related to the use and abuse of opioids. I just read an interesting fact that the Center for Disease Control (CDC) states that, “although sales of opioids have quadrupled in the United States, there has not been an overall change in the amount of pain that Americans report”.(1) Although there is certainly a time and place for opioid medication, the chronic overuse of opioid prescription medications can lead to other health issues, the worst of which being death related to abuse or dependence of the medication which is certainly getting the most press these days.

Because of this epidemic, the CDC and other health task forces are working to find alternatives to opioids for the treatment of chronic pain (pain lasting greater than 2-3 months). Of course, physical therapy is included in this list of alternatives, as our main job is helping people improve their quality of life and function while reducing pain. In the CDC’s main review and guidelines on the prescription of opioids, they highlight that physical therapy- specifically exercise therapy- is an effective tool for reducing pain and improving function in patients with low back pain, knee pain, hip pain, and fibromyalgia.(2) Furthermore, therapy that combines exercise with psychologically-informed approaches is even more effective in the treatment of chronic pain than one approach alone.(2) These approaches are integral in physical therapy training, and we are able to refer out to other psychological providers in our community if your specific treatment plan would benefit from this addition to maximize the benefits you can see.

With physical therapists that are specially trained to help you understand why you hurt and what you can do about it- including helping you find ways to minimize stress and make action plans for changing behaviors that may be feeding into your pain- you can see great benefit in your life when you team up with a physical therapist. All of our PTs at Tomsic Physical Therapy have been trained to help individuals in all walks of life to move better, feel better, and live better using the power of knowledge, exercise, and movement. If you have been dealing with pain and aren’t sure what to do about it beyond taking medication, don’t hesitate to contact us to set up an appointment for an initial evaluation to discover what physical therapy can do for your life.

1. American Physical Therapy Association. Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management. https://www.moveforwardpt.com/Resources/Detail/physical-therapy-vs-opioids-when-to-choose-physica. Accessed August 10, 2018.

2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: https://dx.doi.org/10.15585/mmwr.rr6501e1

The “Fourth Trimester” and Physical Therapy

By: Dr. Laura Wenger, PT, OCS

The old adage, “Happy Mom equals Happy Baby”, is one stated often to new moms but, frankly, can be difficult to implement. With the physical and emotional changes that occur after giving birth, moms can often have a hard time being “happy” in their sleep-deprived, uncomfortable state that they often find themselves in after the blissful oxytocin hormones of birth wear off. Plus, now you’ve got a tiny human to learn how to care for which can provide its own emotions and anxieties and ultimately ends up putting the needs of the mom to maintain physical and mental wellness to the side for many women. These effects are all related to someone who had a healthy pregnancy and delivery, so they can often be compounded for women who had high-risk pregnancies, traumatic deliveries, or are dealing with clinical postpartum depression or anxiety. Recently, the American College of Obstetricians and Gynecologists released a Committee Opinion to stress the importance of caring for new mothers during the “Fourth Trimester” in the first few months after birth (you can find the press release with more information at https://www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Stress-the-Importance-of-Postpartum-Care-The-Fourth-Trimester).

Laura getting back to physical activity with hiking during her “Fourth Trimester”

In this opinion statement, the group stresses the importance of coming up with a plan for postpartum care for the woman and her infant during pregnancy, with identification of the health care professionals to make up the woman’s postpartum health “team”. This team can include the obstetrician, pediatrician, nurses, mental health providers, the woman’s family and friends, community support groups, and… physical therapists! With one of the key aspects of fourth trimester care including facilitating the return to physical activity coupled with the fact that more than a third of women who have back pain during pregnancy continue to have back pain one year after giving birth, physical therapists are primed to play an integral role in getting women feeling better so that they can take care of not only themselves, but their families, in a more healthy and happy way.(1) I can speak from personal experience in that it’s easy for moms to just “deal with” aches and pains in their back, but there are actually simple exercises and muscle retraining exercises that can be done to address this prevalent condition. A skilled physical therapist can help you create an individualized exercise program that is easy to work into your busy days with baby to optimize how you feel. With physical therapy being one piece of the “Fourth Trimester” puzzle, don’t hesitate to contact us if you are planning for or are already in this stage, to learn how we can help you out during this very important time in your life. Also, don’t forget to plug into important resources such as https://www.postpartum.net for addressing mental health and wellness in the postpartum phase. For all you moms out there- remember that the best way to take care of others is to make sure you are taking care of yourself!

JOSPT Perspectives for Patients: Pregnancy and Low Back Pain- Physical Therapy Can Reduce Back And Pelvic Pain During and After Pregnancy. J Orthop Sports Phys Ther. 2014;44(7):474.

The Benefits of Dry Needling

By: Dr. Laura Wenger, PT, OCS

It’s very likely that, if you’ve been to physical therapy recently (or know anybody who has), you have heard of dry needling. For those of you who don’t know, dry needling is defined as a “skilled intervention using a thin filiform needle to penetrate the skin that stimulates trigger points, muscles, and connective tissue for the management of musculoskeletal disorders.”(1) Though not necessary for treatment of every patient that walks through our door, dry needling is a tool that we may decide on using based on our professional judgement of your condition and how helpful we think it will be in getting you to feel better, faster. There are many factors that help us make these decisions, but more and more research is being published regarding dry needling in order to find out just how effective it can be in addition to other physical therapy treatments.

Jeff performing dry needling on an upper trapezius muscle

One recent study was published in February 2018 by many renowned physical therapy researchers.(2) These researchers decided to hone in on a problem that is near and dear to many people- subacromial pain syndrome, more commonly known as “shoulder impingement”. As this is a very common problem for people, studies are often undertaken to figure out how best to treat this problem as well as how to cut healthcare costs by offering the most efficient and effective treatments. Specifically, this study looked at patients that had at least three months of shoulder pain that was at least a 4/10 level of pain.(2) The patients either received treatment of exercise combined with dry needling or exercise alone, with the exercises targeting the key rotator cuff and shoulder blade muscles that help to improved shoulder function.(2) The treatments were once per week for a five-week period and the dry needling was only performed in the first two sessions for the group receiving that treatment.(2) What the researchers found was that the addition of two sessions of dry needling to a quality, supervised exercise program for the shoulder led to the patients utilizing significantly fewer health care resources than those who had exercise alone: they had less visits to additional providers and less use of additional treatments such as more PT.(2) On top of that, the dry needling plus exercise group had significantly less cost related to missing work as well as had better quality of life ratings than the exercise alone group.(2) All in all, the addition of dry needling to the physical-therapist directed exercise program was a real “win” for getting the patients better faster and spending less overall money in the process.

Currently, we have four physical therapists who are certified in dry needling. If you are a current or upcoming patient, make sure to ask your PT if dry needling might be a worthy addition to your treatment plan!

1. APTA. Description of Dry Needling in Clinical Practice: An Education Resource Paper. Alexandria, VA: APTA Public Policy, Practice, and Professional Affairs Unit; 2013.

2. Arias-Buria JL, Martin-Saborido C, Cleland J, Koppenhaver SL, Plaza-Manzano G, Fernandez-de-las-Penas C. Cost-effectiveness Evaluation of the Inclusion of Dry Needling into an Exercise Program for Subacromial Pain Syndrome: en e from a Randomized Clinical Trial. Pain Medicine. 2018;1-12. Doi:10.1093/pm/pny021