St Luke's Physical Therapy is happy to announce that we are the proud sponsor of the 5k portion of the 2010 St. Luke's Lehigh Valley Half Marathon & 5K race on Sunday, April 25, 2010
Please check in weekly to find out important tips for all runners.!
Ask your Physical Therapist....
Heart Rate Monitoring
Rett Holmes MSPT, DPT, Cert MDT
St. Luke’s Physical Therapy-Palmer 610-438-8093
One of the more challenging tasks for runners is gauging appropriate workout intensity. Training at an optimal pace can significantly improve performance and enjoyment. There are numerous methods to determine the appropriate training intensity.
The most simplistic method is the talk test. For aerobic training, one should select a pace where talking is possible without significant breaks, discomfort or slowing. However, the pace should be quick enough that singing is not possible. Using the talk test to determine pacing is imprecise and likely best for use only by casual runners and joggers.
Many runners use a pace per mile approach to determining workout intensity. This is a more specific approach than the talk test since the pace selected can be based on a projected target time or prior performance level. To effectively implement this method one must be experienced and in tune with one’s body enough to accurately judge one’s speed. With experience, many runners can become quite skilled at judging their workout pace using this method. However, monitoring heart rate to determine appropriate training intensity provides an even more precise, accurate and scientific approach to training.
Using a heart monitor while exercising is very useful, but not everyone has access to one. It is still possible to exercise using the principles of heart rate monitoring without an actual monitor through use of Borg’s Rate of Perceived Exertion Scale, or RPE scale. This scale is used to self rate how hard one is working. The scale ranges from 6-20, with 6 representing resting and 20 representing maximal effort. Adding a zero to the RPE number approximates one’s heart rate in beats per minute. For example, while exercising if perceived exertion is rated at 12 on the scale this correlates approximately to a heart rate of 120 beats per minute. Therefore, by self monitoring effort through use of the RPE scale, heart rate can be approximated and effort can be adjusted accordingly. The RPE scale is more effective with training and practice but remains at best somewhat imprecise in gauging heart rate.
Use of a heart monitor to assess cardiovascular status is the most specific, accurate way to train. By using a heart rate monitor, training can be performed at a specific target heart rate or target heart rate range. Most heart rate monitors work through use of a chest strap in addition to a watch. These models are best for runners and joggers as they provide continuous monitoring with activity. Strapless models are available but are best used by walkers and casual exercisers since one needs to stop activity to obtain a reading.
When using a heart rate monitor, a few calculations are required to determine the proper target heart rate range for training, so a calculator will be helpful. First, maximum heart rate needs calculated, since workouts typically are based on a target heart rate which is a percentage of the maximum heart rate. Maximum heart rate varies from person to person and there are many methods of determining maximum heart rate. A recent study found the most accepted method to be Maximum Heart Rate = 205.8 – (.685 x age). Once the maximum heart rate is determined the target heart rate can be calculated. Again, there are various methods, but one of the most common and accepted is the Karvonen Method. The Karvonen Method is considered a more accurate method than others since it incorporates resting heart rate into determining the target heart rate so it is a bit more specific from individual to individual. With the Karvonen Method, target heart rate is calculated by subtracting the resting heart rate from the maximum heart rate. This number is multiplied by the target heart rate range % [for example if a desired target heart rate is 70% of maximum heart rate the number would be multiplied by 70% or 0.7] This number is added to the resting heart rate. This calculation may be a bit confusing or complex but its mathematical formula is:
Target Heart Rate = [(Max HR – Resting HR) x % Intensity] + Resting HR.
The target heart rate range is dependent upon the type of training desired. Most runners will include both aerobic and interval training methods. Typically for aerobic training the target heart rate range is between 70-80% of maximum heart rate while interval training is typically performed between 80-90% of maximum heart rate.
There are many different methods of determining the appropriate training pace ranging from simplistic to quite scientific and calculated. As a runner or jogger if you are looking to take your training to the next level, monitoring your heart rate and basing your training intensity on a specific target heart rate range can increase the precision, effectiveness and even enjoyment of your.
For More Information, please call 877-73-REHAB
Custom Foot Orthotics
Matt Babbitt, DPT, MPT, Cert. MDT
What is a custom foot orthotic?
Custom foot orthotics are insoles manufactured from a cast impression of your feet by your health care provider and worn inside your shoes. Custom foot orthotics help your feet function in their optimal neutral position. They reduce the need for your body to compensate for misalignment in your feet.
Who can benefit from custom foot orthotics?
Almost everyone will benefit from wearing custom made orthotics. The orthotics are manufactured to meet the specific needs of each individual. There are a variety of styles and materials to choose from, ranging from soft and flexible to a more rigid material. The material and style will be chosen by your health care provider based on a biomechanical evaluation.
How do custom made foot orthotics help reduce or eliminate pain?
A custom foot orthotic helps bring the ground up to the foot at predetermined angles so that the foot is supported in its optimal position. The orthotic helps to realign the foot with the rest of the body which may decrease strain and allow other joints in the body to work more efficiently. Special padding can also be used to accommodate painful areas.
How will a custom foot orthotic fit into my regular shoes?
There are different styles of orthotics available to fit into a wide variety of shoes. Orthotic styles vary to be able to fit in athletic shoes, men’s and women’s dress shoes, pediatric and diabetic shoes.
What is the difference between off the shelf store bought orthotic insoles and custom made orthotics?
Store bought orthotic insoles, while sometimes helpful, are generic in size and contour. Custom made orthotics are made specifically for your feet and are designed to meet you individual needs.
What are some common conditions that custom orthotics can help?
- Low back pain
- Leg fatigue
- Heel pain
- Arch pain
- Corns and calluses
- Bunions
- Knee pain
- Hip pain
STRESS FRACTURES: When can you run again?
Julie Spencer, DPT
Stress fractures make up about 10% of running injuries. They occur most often in the tibia (our shin bone), followed by our metatarsals (the bones of the foot) and then the fibula (the skinny bone on the outside of our shins). Risk factors that make one more prone to stress fractures include running greater than 20 mi per wk, menstrual disturbances (especially the absence of a period for more than 6 months), the angle of the femur in women and running in old running shoes. How long should you keep your sneakers? No longer than 350 miles. In fact, after about 250 miles, 50% of shock absorption in the shoe is lost, causing greater force to be placed through the bones of the shin and foot each time you run.
What are signs that you may have a stress fracture versus a shin splint? If you have pain during transitions in training (walk to run, speed changes), if there is no history of a sprain or strain to explain your pain, pain with hopping or point tenderness then you more than likely are suffering from a stress fracture. If you have pain at the end of the run or AFTER a run, then a stress fracture is more probable. In contrast, if you have pain when you first start the run, which decreases with a warm-up or as you run, then your pain is likely the result of a soft tissue problem (muscle, shin splints).
Stress fractures that are noncritical will heal without complications between 4-8 weeks-GIVEN ADEQUATE REST! Critical fractures will require prolonged period of immobilization because they may heal abnormally or incorrectly.
For noncritical stress fractures, it is recommended to weight bear through the leg as tolerated and to train in a cross-training nature (bike, elliptical, pool running). Use of a boot for about 3 weeks is also recommended. The guidelines to return to running are: 1) pain to palpation of the area is gone for 1 week, 2) you are able to walk without pain for 1 week. Once you return to running, activity must be modified if: 1). You run with more than mild pain (Mild pain:1/10 to 3/10, 4/10-6/10: back off, 7/10 to 9/10: no running), 2).Your does not go away with running, 3). You are limping.
How to return to running:
- Cross train or run/walk for your typical duration for 2-4 weeks until you are painfree, then start replacing runs.
- Walk, then walk-jog, then run
- Increase 10% per week
- For long runs, increase no more than 2 miles per week.
For more information or to schedule an appointment, please call Julie Spencer at 610-967-0770. www.stlukespt.com 877-73-REHAB
GRASTON TECHNIQUE
New Non-Surgical Physical Therapy Treatment
aids in the Treatment of Running Injuries
People who suffer from the often-debilitating symptoms of plantar fascitis, tennis or golf elbow, jumper’s knee, iliotibial band syndrome, shoulder tendonitis/impingement, ankle sprains, pulled muscles, neck or back pain, and carpal tunnel syndrome, will be pleased to know there is a non-surgical treatment called the Graston Technique®.
The Graston Technique® enables Physical Therapists to detect and treat areas of scar tissue or adhesions in muscles, tendons and ligaments that can lead to pain and dysfunction. This technique of soft tissue mobilization actually breaks down scar tissue, while stretching connective tissue and muscle fibers.
A Certified Physical Therapist uses a stainless steel instrument that glides along a patient’s muscle, tendons or ligaments and acts like a scar tissue “stethoscope.” When knots or bands of scar tissue are encountered, both the therapist and the patient sense a restriction or a granular feeling. The therapist uses the instrument to “break up” this restriction or adhesion.
The benefit of the Graston Technique® is not only in detection of restrictions or adhesions, but also in the amount of improvement that takes place in a short amount of time. Unfortunately, the unaided hand is hard pressed to detect and break up as much scar tissue as the stainless steel instruments can. When the Graston Technique® is coupled with the necessary strengthening and stretching exercises, it allows the patient to get better much quicker and more completely.
Patients typically experience significant relief in a few weeks and sometimes get relief after just two visits, compared to twice that time for conventional procedures.
Our therapists at St. Luke’s Physical Therapy have been certified in this new innovative procedure and are available at 16 locations in the greater Lehigh Valley and Quakertown. Please call 877-73-REHAB for more information or to schedule an appointment, or visit our website at www.stlukespt.com
For more information on The Graston Technique® and how it can help you, go to http://grastontechnique.com/ or to see case studies on the effect of using Graston on different types of patients, click on http://grastontechnique.com/users/78//The_Edge_-_Winter_2009.pdf
RUNNING – STRONG PELVIC FLOOR
Julie Spencer, DPT
St. Luke's Physical Therapy/Rehab Partners - Emmaus - 610-967-0770
A strong pelvic floor is an important component to core strength and improved postural alignment in runners. Although this seems specific to women, men benefit from strengthening of the pelvic floor as well.
The muscles of the pelvic floor (PF) are the muscles used to stop and start the flow of urine. A contraction of the PF is also known as a “Kegel” contraction. Although many have heard of performing “Kegel’s”, they are often performed incorrectly. When contracting these muscles, you should think of pulling the PF “up and in”, as if stopping the flow of urine. Never “squeeze”, “push out” or “bear down” with these muscles. Doing so can cause and increase in PF muscle tension and could result in urinary dysfunction, pain and spasm in muscles of the PF or inflammation of the sciatic nerve. This could also cause stress incontinence, or “leaking” while running.
There are two types of PF contractions: slow hold and quick flick contractions. To perform the “slow hold”, pull up the muscles of the PF and hold this for 5-10 seconds, then let the muscles relax (don’t push!) and stay relaxed for about 15-20 seconds. Repeat this 5-10 times. A “quick flick” is a pelvic floor contraction that you don’t hold; essentially you contract the muscles and immediately relax them, repeating this 10 times in a row. Slow hold contractions promote improved endurance of the pelvic floor, which is needed for core stability throughout the run. Quick flicks strengthen the pelvic floor, which helps to stop any urinary leaking many experience while running.
If you are in doubt whether you are properly contracting and/or relaxing these muscles, they can be evaluated by a physical therapist specifically trained in pelvic floor rehabilitation. To ask about this, or any other question regarding pelvic pain and/or incontinence as well as running during pregnancy, please contact Julie Spencer, DPT at our Emmaus facility at 610-967-0770.
Remember a strong pelvic floor = a strong core!
The CORE
Julie Spencer, DPT
St. Luke's Physical Therapy/Rehab Partners - Emmaus - 610-967-0770
The core muscles play an important role in injury prevention for runners.
In order to focus on core strength, we must first realize what muscles make up the core. The abdominals are the most well-known muscle group on the core, but doing crunches alone is definitely not enough! The core also consists of back (or lumbar) extensors, lateral flexors of the trunk, trunk stabilizers, the gluteals and the external rotators of the hip. Strengthening these muscles has proven to reduce injuries to the lower extremity, including hamstring and groin pulls, knee pain (including paterllar-femoral syndromes), shin splints, stress fractures and ankle sprains.
If you think of the body as a swing, the swing (your leg) will not swing in a nice, smooth motion if the base (your core) is not sturdy in the ground. An unstable base (poor core strength) will cause the swing to move in a wobbly motion. It is this inefficient motion of the swing (your leg) that leads to injury.
Exercises like planks, sidelying bridges, clamshells, single leg squats (focusing on keeping your knees aligned with your second toe) and double leg squats (focusing on pushing your knees outward during the entire squatting motion) are all excellent exercises that incorporate more than one core muscle group and are easy to do in your own home.
For a more detailed core exercise program or to evaluate your core strength, please contact your local St. Luke's physical therapist. See our locations page for the facility that is most convenient for you or call 877-73 REHAB.
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St. Luke's Physical Therapy News
New Locations:
St. Lukes Physical Therapy St. Luke's Physical Therapy
3760 Brookside Road 2793 Geryville Pike
MACUNGIE, PA 18062 PENNSBURG, PA 18073
Open 11/16/09 Open 9/14/2009
Please go to our locations page for additional information
We moved our Quakertown facility to the new St. Luke’s Bone & Joint Institute at 1534 Park Avenue in Quakertown (behind Pep Boys & Dairy Queen)
15 physician specialists will be at St. Luke's Bone & Joint Institute working collaboratively to provide personal care plans for the treatment of bone, muscle, joint and neurological conditions. The St. Luke’s Bone & Joint Institute is being designed in a way that truly puts the patient at the center of everything. Whether it is a quick visit or care for a chronic condition, people should be able to have access to the best physicians, get the answers they need quickly and make an appointment promptly.
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New Clinical Techniques
The Graston Technique – This is a relatively new physical therapy technique that was recently covered by ABC News. This technique is used to treat myofascial, tendonus and ligamentus conditions. Many of our therapists have attended one or two courses to become certified in this treatment method. If you are experiencing tendonitis, plantarfascitis or a painful adhered scar, please contact us for a free consultation to see if the Graston Technique can help you. For additional information on the Graston Technique, check our website under Physical Therapy-Advanced Treatment Techniques.
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Events
St. Luke's Physical Therapy staff join in the fun at last year's Lehigh Valley Half Marathon & 5K on Sunday, May 3, 2009
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