“What are minimalist shoes and what do they hope to accomplish?” is a question that I ask myself every time I see someone using them. Well here’s a simple gist of what this specific type of shoe hopes to achieve: reduce the amount of stress on legs and lower the incidence of running injuries by mimicking running mechanics of a barefoot runner. With the frequency of injuries in runners ranging from 19.4%-79.3%, this concept is definitely appealing.

The theory behind the minimalist shoe is that barefoot runners, or users of the minimalist footwear, land with a fore-foot or mid-foot strike which generates less impact force. Therefore, this concept decreases the risk the runner would sustain a stress fracture, plantar fascia involvement, and obtain other running-related injuries…but does it work? A case-series1 that was done here in Boston shows interesting results.

This study looked at ten experienced (25.9 miles/week for an average of 18.9 years) runners, aged 21-57, who transitioned from using traditional running shoes to minimalist running shoes. Here’s a look at a set of data table obtained from the article:

Now you can see a couple things going on with this data table. 1) There is no control group for this study so you can’t compare the effectiveness of the experimental group, which is the minimalist group, successfully against traditional running shoes. 2) Not all patients were the same. As you can see, 2 of the 10 patients did have injuries prior to the minimalist transition which skews results. 3) The transition length from which they either immediately switched to a minimalist shoe to a traditional shoe (which is signified as a 0) or gradually worked themselves into a minimalist shoe varied.

So is there an explanation as to why injuries still occurred? One theory is that although the amount of impact generated with a minimalist shoe is lower than a traditional shoe, the impact force may be directed at a different location: the metatarsals rather than the heel, which may explain the amount of metatarsal stress fractures. Another theory is that minimalist runners’ connective tissues are conditioned differently. Therefore, a safer and more effective way to transition from wearing traditional running shoes to minimalist running shoes must be found so that runners can adapt safely. Again, these two points are only theories at this given time.

Overall, with the 3 facts/issues about the article in consideration, these results can be seen as speculation as to what the minimalist really does. Is it really effective in decreasing the amount of injuries that could occur in runners in comparison to traditional running shoes? Perhaps, and perhaps not! There is still room for a more controlled study (specifically, a randomly controlled trial) which could provide more concrete results. But, interpret from what you will from the data table as above: you can still sustain an injury using minimalist shoes!

Dr. Wu is a Physical Therapist at Boston Sports Medicine

Spring has finally sprung in New England.  The nice weather has arrived and people are shaking cobwebs off of their equipment and venturing outside for their exercise.  As you are beginning to enjoy the outdoors, there are a few important points to remember for safe and injury free return to outside activity.

Running shoes:  How old are they?  How many miles have been run in them?  Now is a good time to ask your self these questions in order to avoid unnecessary injury.   You should think about replacing running shoes every 400-500 miles as they tend do break down.  If your shoes are over a year old, you should also buy some new ones as materials degrade over time.  You should also dedicate your running shoes to just running.  Daily use for walking, etc will increase wear.

Walking shoes:  The experts usually talk about replacing running shoes.  It is equally as important to replace your walking shoes after 500 miles if you are a walker.  Same rules apply.  Shoes break down over time and mileage walked.

Cycling:  As you are digging that bicycle out of the garage after the winter season, it is important to make sure it is in good working order.  If it isn’t, your safety can be compromised.  It is always a great idea to take it into your local bike shop for a tune up.  You want to make sure the brakes are working properly, and the gears are fluidly shifting up and down.  Another important consideration is the tires.  Make sure they aren’t worn as they are your contact point to the ground.  They also need to be pumped to the adequate pressure. 

In summary, we tend to focus on keeping our body stretched, strengthened and in good working order.  We must also not forget to do the same for our equipment.  The beginning of the spring season is a good time to remember to give your exercise equipment some thought and attention.  Abiding by these simple guidelines can help maintain an injury free spring, summer, and beyond

Sara Bresnick is a Physical Therapist at Boston Sports Medicine

With sports medicine, it is often more effective to treat alignment deficiencies as well as localized areas of injury.   The human body requires optimal flexibility, optimal strength, and symmetry to function in the most efficient manner.  It is apparent that patients develop tendonitis, muscle sprain, or muscle spasm injuries due to their own body mechanics and alignment abnormalities.   I take a biomechanical approach with many of my patients.

My treatment approach often includes the following items:

• Postural Assessment:  For example, do your shoulders curve forward?  Is your neck in a straight line with the rest of your body?
• Functional Activity Assessment:  Walking, running, and/or just getting on and off the treatment table.
• Leg Length Difference Assessment:  Are your leg lengths equal?  Does your body present with changes that would have caused a leg length discrepancy?

All of these assessment are performed in addition to finding areas of tenderness, measuring flexibility, checking range of motion, testing strength, etc.

By taking more of a global treatment approach in addition to the localized region of complaints, we will be able to treat the cause of the injury –therefore, stopping the cause right in its’ track.   We will also be able to address the secondary factors – the body’s way of creating compensatory patterns.

Patients may ask, will it take a long time to perform this type of comprehensive assessment?  The answer is, NO.  Often by assessing your walk to the treatment table, observing how you sit in a chair, and performing 2-3 assessment techniques while on the table I can begin to understand the biomechanical influences.

Patients will be given postural cues and feedback to address the biomechanical influences.  However, other times a more strategic approach will need to be created.

Functional, alignment, and postural assessment strategies are key elements in the creation of a comprehensive sports medicine treatment plan.  Treat the cause – not just the effect.

Dr. Merson is a Physical Therapist at Boston Sports Medicine

I want to spend a little bit of time talking about 3 essential areas of physical wellness – MOBILITY, STRENGTH, and STABILITY. All too often one or two of these is overlooked. This is what makes the human body more susceptible to injury, leading to compensation, overuse, and ultimate breakdown. Part of my job as a physical therapist is to guide my patients toward restoring the BALANCE of all 3 of these elements – key word being balance. This conversation has risen to the forefront of my thoughts over the last 2 months, both personally and professionally.

After several encouraging “nudges” from students, patients, and friends, I have finally jumped head first into the world of CrossFit. And believe me when I tell you, it has been awesome! I’m not sure why it has taken me this long to come around and give it a try, but I’m happy to say I’m finally there. One of the things I love about CrossFit is their understanding, and more importantly implementation, of these 3 essential areas of wellness. We spend a good portion of each class on each of these areas. My friends at Rugged CrossFit (ruggedcrossfit.com) truly get it! I have had to work mostly on my joint mobility in my hips and overall strength, but for some of my fellow Ruggedeers it might be shoulder mobility or that all-too-forgotten-about thoracic spine. Does it really affect the way your shoulders work? WHOA NELLY, it sure does! It’s been 7 weeks and I feel great! I have seen changes each week, which are largely due to my coaches’ implementation of these 3 essential areas of physical wellness.  Refreshing to say the least!

So, let’s break it down, starting with mobility. Mobility refers to the body’s ability to move. That means that both joint mobility and flexibility are important. This is one area that dancers excel in. While, I don’t envision all my patients being able to hold their foot over their head, I do think there is a lot we can learn from dancers. They spend a lot of time working on their flexibility and joint range of motion. They truly have a great balance of  mobility, strength and stability. While stretching (dynamic and static) is a large part of mobility, it’s not the only way to improve. Addressing soft tissue restrictions (“knots”) through self maintenance practices is also important. Foam rolls, massage sticks, lacrosse balls, and the SOMA system are all great tools to help us accomplish this. I  use acupressure and Graston techniques with many of my patients which also address mobility restrictions.  Allowing the body to move into greater ranges of motion will enable you to begin to make strength gains in these  newly gained ranges.

Would you rather have difficulty getting in and out of a chair, or have the mobility to easily get up and down off the floor whenever you want. I mean that’s a no brainer!

Next, let’s talk about strength. I think most of us have a pretty good idea of what strength is. Keeping your muscles healthy and strong is important. However, one of the areas I see lacking in most of my patients’ routines is the lack of strength variation. Doing the same routine each week is not healthy, nor does the body make gains as quickly. Variation is key. Cross training (yes, all my runner friends) is key. Adding this concept to your workout will allow you to progress more quickly. The sky is the limit!

And lastly, stability. This seems to be an area of confusion for many. Stability has to do with the timing and firing of the musculoskeletal tissues. For example, when you lift and hold your arm overhead, it’s not just the muscles that lift it up there that are working, it’s also the rest of the muscles that hug the joint . Does the rotator cuff ring a bell? The rotator cuff is largely involved in stabilization and therefore involved in almost all arm movements. Don’t only work the big muscles at the expense of the little guys! When everything is firing at the same time the joint is well supported. Would you rather have your joints cracking and popping through movement, or have a nice smooth motion? This is where balance and proprioceptive exercises come in to play. Using free weights, kettle bells, and lower body balance equipment can help you step up your game.

In my world of PT, restoring a healthy balance of these 3 is what I spend most of my time doing. For those of you not in PT, working on a healthy balance is the key to preventing injury.  So next time someone talks to you about the importance of foam rolling, stretching, and stabilization (most overlooked), try not to think of it as nagging conversation, but as a step in the right direction. In order to change the way you feel and look, you have to change the way you train and think!

Until next time,

Dr. Looney is a Physical Therapist at Boston Sports Medicine

Most of us have heard at one point in our lives that you need to stretch before or after a workout or activity, but how many of us actually do this?  Maybe you have a morning stretching regime or attend a yoga class a couple times a week, however, do you know WHY stretching keeps us healthy?

Muscle flexibility is a large part of keeping a healthy body.  While strengthening and working on cardio endurance is also very good for us, flexibility is critical in an active lifestyle.  No matter how much strength your muscles have or how many days a week you commit to activity, if you lack flexibility you leave yourself at a much higher risk for injury.  Strengthening your muscles without incorporating a stretching program into your routine leaves your muscles strong but in a shortened state.  Your muscle becomes powerful but in a very small arc of motion.  This means your muscles will be very effective but only in small movements.  When you need to push your muscle beyond its flexibility, like lunging quickly for a ball, your muscle will only stretch so far then the fibers will begin to tear.  This leaves you with what is called a muscle strain.  Depending on the force of the movement and how far beyond the muscles flexibility you reach the strain can be mild to severe in nature. 

Keeping a daily stretching regime will greatly help prevent these tears from happening.  Along with strengthening, if you can lengthen your muscles through stretching, when sudden quick movements happen your muscle will be able to perform accordingly without injury.  Think about slipping on ice in the winter.  You’re not expecting this to happen but if your muscles are more flexible they may be able to stretch and react in time to stop you from falling and tearing muscle fibers.  Flexibility also helps with balance and ease of movement in daily life.  Desired flexibility will allow your body to move as it should instead of compensating due to loss of balance or lack of range of motion.  This becomes increasingly important as we age.  You can check with your doctor or physical therapist for what normal flexibility should be and what is appropriate for you and your lifestyle. 

Stacy Choquette is a Physical Therapy Assistant at Boston Sports Medicine

A review of the literature on the treatment of meniscal tears and knee OA.

A recent research study in the New England Journal of Medicine (NEJM) showed that physical therapy is as effective as arthroscopic surgery for treating patients with meniscal tears and osteoarthritis of the knee. This study validated the idea that therapy could be used as a conservative alternative to surgery. The study looked at 351 patients aged 45 years or older who had a meniscus tear and moderate osteoarthritis of the knee. The study participants were randomly assigned to either surgery with post-operative physical therapy or physical therapy only. At 6 months, both groups showed similar improvements in their functional status and pain. The results also showed that 70% of patients who underwent just physical therapy were able to avoid surgery all together.

Meniscal tears have been observed via imaging in 35% of people older than 50 years of age, with 2/3 of those being asymptomatic. This high prevalence of meniscal tears and osteoarthritis can make it difficult to pinpoint the exact symptomatic cause of pain in the knee.

The level and progression of symptoms for patients with osteoarthritis can vary considerably ranging from very minor symptoms in early stages to very severe in later stages. It should be noted that treating patients with osteoarthritis with or without a meniscus tear is easier to manage when the patient is the in the earlier stages of symptoms. Treating knee symptoms early, at any stage of life, can make the difference between simple lifestyle changes and more complicated symptoms later in life.

Source:

Katz. 2013. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis.  http://www.nejm.org/doi/full/10.1056/NEJMoa1301408

Andrew Provost is a Physical Therapist at Boston Sports Medicine

WE HAVE A NEED FOR A PART-TIME PTA IN OUR WATERTOWN AND SOMERVILLE OFFICES.  PLEASE SEE OUR PAGE FOR THE DAVIS SQUARE SOMERVILLE OFFICE AND THE WATERTOWN OFFICE.  PLEASE SUBMIT YOUR RESUME BY EMAIL TO info@bostonsportsmed.com.  DO NOT CALL.

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In the last few years, PRP injections have been in the headlines as a new injection used by professional athletes and weekend warriors alike to improve healing after injury. What are these injections and do they really work?

PRP injections have been around since the mid 1990’s when surgeons began to use this injection for bone healing following spine surgery and tissue healing following plastic surgery. Now many athletes and orthopedic patients are inquiring about these injections to assist in healing following surgery to many joints such as the ankle and knee as well as conditions such as Achilles tendonitis and patellar tendonitis. Tiger Woods and Hines Ward have made headlines for utilizing such injections before winning important matches and games.

PRP stands for platelet rich plasma. It is obtained from the patient by drawing about 30 milliliters of blood and putting it through a centrifuge to separate out the different components of blood. The plasma is then injected back into the patient directly to the area of injury.

How does this help heal the injury? Many types of conditions where a PRP injection would be used are a chronic overuse injury such as Achilles tendonitis or patellar tendonitis. With these types of injuries there are often microscopic tears in the tendon, but these tissues don’t have a great blood supply making it difficult for oxygen and nutrients to reach the tendon. The PRP injection will stimulate growth and healing to the tendon/tissue injured. The platelet rich plasma naturally contains the body’s own growth factors and nutrients to give a “healing boost” to the area.

What is the dose and how often are the injections given? Right now there is no rubric for how much PRP to inject or how often. Some patients are injected once while others are given two to three injections over the span of several weeks. This can depend on area of injury as well as nature of injury. The 30 milliliters of blood drawn gives the centrifuge enough to work with to separate out the plasma, only the plasma is injected back into the body.

Do studies prove this works? I feel this question is the trickiest question in terms of “evidence based practice”. It is very difficult to perform random, blind, placebo effect compared trials. In trials performed so far the model has been to take a sample of people with a certain injury such as Achilles tendonitis and provide them with PRP injection to assess for progress. These studies have shown good evidence to support the injections. Personally, I believe healing in the human body is never due to just one factor. If something like PRP can be added to other treatments in assisting a patient to heal, and the patient does heal more efficiently and effectively then it is a valid treatment option.

One downside to these injections is that almost no insurance company is going to pay for these injections. This is due in part to the lack of “random clinical trials with placebo comparison”.

To sum it all up, these injections are safe when administered appropriately with very few side effects. If the injection doesn’t help, it won’t hurt either. It may be a good topic for discussion with your doctor to see if these injections would be a viable treatment option for you.

Dr. Fox is a Physical Therapist at Boston Sports Medicine

We are proud to announce that Boston Sports Medicine is now the official physical therapy provider for the Boston Derby Dames Women’s Roller Derby League! What is roller derby and why should you check out the next bout? Roller derby is a competitive team sport played on a flat track, and the Boston Derby Dames are an all-female player-operated league that includes three (and a new one coming soon) home teams and two travel teams. A bout consists of two 30-minute halves and includes 5 players from each team on the track at once. Each team has a player called the jammer (with a star on her helmet to identify her), who each try to score by breaking through the pack, skating all the way around the track, and passing each of the four players on the other team as many times as she can.

It’s a physical contact sport with many potential penalties and potential injuries throughout training and competition. The most common injuries include scrapes and bruises from coming into contact with other players or with the track while skating. Beyond that, there can be more serious injuries from chronic overuse to trauma. The teams compete by skating counter-clockwise and the body can become asymmetrical from training to skate in one direction only. This can contribute to foot, shin, knee, or hip injury from muscle imbalance and subsequent tightness or weakness of the legs. These women are also spending a significant time on roller skates, where you roll your ankle inward or outward to steer and there is little support in the skate itself. If a person does not maintain good foot strength, the arches may collapse when not supported in the skates, leading to potential problems in the foot and further up the leg. Another source of pain can be the low back, from the prolonged leaning forward and twisting of the spine during play and from potentially tight hamstrings. If a person rounds the back while skating, this could result in low back muscle spasms or disc herniation if left unchecked for too long. During the competition, there is also risk of traumatic injury, including ligament sprains, meniscus tears, fractures, muscle strain, concussions, and bone contusions.

Despite (or maybe a little because of!) the high risk, roller derby has had a big resurgence in popularity in the past 5-8 years. Boston Sports Medicine is now doing what we can to keep the Boston Derby Dames doing what they love to do and staying injury-free too. If you are interested in seeing a bout, please visit http://www.bostonderbydames.com to find out more. If you participate in a sport that is equally brutal to your body, come visit Boston Sports Medicine for an evaluation to rehabilitate your injury.

Dr. Lingerfelt is a Physical Therapist at Boston Sports Medicine

Tennis elbow is not just for tennis players. It can affect anyone who plays racket sports or has a job requiring a lot of gripping and grasping, especially for those who repetitively use hand-held tools throughout their workday.

The muscles that extend the wrist and fingers meet at the elbow forming a tendon known as the common extensor tendon. The specific area of bone that the tendon attaches to is called the lateral epicondyle, hence the name “lateral epicondylitis.” When these extensor muscles are overused, the result is a repetitive stress injury in the common extensor tendon. There can be a tremendous amount of pain and inflammation. It can be so painful that it wakes you up at night and makes you wince when you pick up a cup of coffee after that night of bad sleep!

If left untreated while continuing to engage in the activities that aggravate it, tennis elbow will only get worse, leading to degradation and tearing of the common extensor tendon. In advanced cases, surgery may be indicated. Cortisone injections are not an effective treatment for tennis elbow. They do provide short term relief, but many people will have a cortisone injection and immediately go back to performing the very same activities that caused the injury without any rehabilitation. It is an absolute guarantee that the tennis elbow will come back, and it will likely come back with a vengeance.

If you have tennis elbow, you need to STOP the activities that make it worse and allow the tendon to rest. If it is impossible to stop entirely, your PT can help you figure out ways to modify the activity. A tennis elbow brace can also help, as it takes some mechanical stress off the common extensor tendon.

Modalities such as ultrasound, ice and cold laser applied by your PT will help with pain and inflammation. Friction massage performed by the PT will also help remodel the tendon and desensitize it, easing the pain. Since tennis elbow is a tendon injury, eccentric exercises will help immensely, as they remodel the tendon and build tensile strength. I give my patients this exercise known as the Tyler Twist, which is performed with a Therabar:

http://www.youtube.com/watch?v=gsKGbqA9aNo

We have the Therabar in our clinic, but it is worth purchasing your own Therabar if you have suffered from tennis elbow more than once in your life and you frequently engage in activities that place you at risk.

Dr. Ullman is a Physical Therapist at Boston Sports Medicine