Tuesday, January 29, 2019

PT Pathologies: Cerebrovascular Accidents (CVA, Stroke)

Cerebrovascular Accidents (CVA)  also known as a stroke happen to 750,000 people a year in the US.  A CVA is when there is an interruption in the cerebral civulation that results in cerebral insufficiency, destruction of surrounding brain tissue, and subsequent neurological deficit.  It can either be very abrupt or evolve over 1 to 2 days.  CVA results from prolonged ischemia (inadequate blood supply) to a cerebral artery.  There are some modifiable and non modifiable factors for a CVA.  Modifiable includes hypertension, atherosclerosis, heart disease, diabetes, elevated cholesterol, smoking and obesity.  Non modifiable factors are age, race, family history, and sex.  A CVA can be diagnosed by CT scans which can confirm infarcted areas of the brain and an MRI can show where the ischemia happened within the brain almost immediately after onset.  FAST is an acronym that can help a person who is having a CVA.

F= Facial drooping
A= Arm Weakness
S= Speech difficulties
T = Time

If you are around someone and notice these signs, take them to a hospital immediately.

       The clinical presentation of CVA would be such things like hemiplegia, hemiparesis, sensory, visual and perceptual impairments, balance abnormalities, dysphagia, aphasia, cognitive deficits, incontinence and emotional labiality.  A CVA affects the opposite side of the body from where the ischemia occurred.  For example, if you had a right CVA the left side of your body would be affected.  Physical therapists would treat a stroke patient by doing therapy like pressure relief, sensory awareness, ROM, weight bearing, gait training, muscle reeducation, balance and postural control.  The outcome depends on the severity of the CVA and the patients overall health.  There has been research that indicates that a patient can continue to improve the control of movement and show progress for an average of 2 to 3 years post accident.  The first three months after a CVA is most critical because it is n indicator for long term outcome for measurable neurological recovery.

Thursday, January 17, 2019

Gait Deviations

Trendelenburg gait results from the loss of function of lesser gluteal muscles. Lesser gluteal muscles are hip abductors, and they keep the pelvis level during unilateral stance phase. Notice that in the trendelenburg gait, the hip is dropping to the unaffected side, while there is a slight lateral flexion of the trunk to the affected side. 

Hamstrings extend the hip and flex the knee, while the gluteus maximus acts as an accessory hip extensor. During walking, hamstrings prevent the trunk from bending forward following heel strike. To compensate for the loss of hip-extension when these muscles are paralyzed, notice that there is a backward lean or extension of the trunk immediately after the heel strike. 

Vasti are knee extensors. During walking, they arrest the collapse of the partially flexed knee under body weight. To compensate for the paralysis of the vasti muscles, notice that the knee on the unaffected side is completely extended just before heel strike. After the heel strike, the trunk is bent slightly forward to keep the center of gravity anterior to the knee.

These muscles slow down the extension of hip at the end of stance phase, and initiates flexion of hip at the beginning of the swing phase. When the adductors are paralyzed, flexion of the hip on the affected side is accompanied by hip and thigh abduction. 

Triceps surae muscles plantarflex the foot, and regulate tendency of ankles to collapse in dorsiflexion.  When these muscles are paralyzed, and the foot can no longer be plantarflexed, the patient tends to walk with very short steps to keep weight back on the heels. 

Anterior tibial compartment muscles dorsiflex the foot and extend toes. Paralyses of these muscles lead to "foot-drop". To compensate for this loss, the patient tends to walk with a high-stepping gait to clear the ground.  When the patient walks quickly, the foot on the affected side lands on heel, and the forefoot slaps down on the ground.  When the patient walks slowly, he tends to land on the forefoot.

Monday, January 14, 2019

Reduce Pain and Inflammation Through Nutrition

Internal inflammation can wreak havoc with your health. You may already be seeing a physical therapist for inflammation-related health issues, such as arthritis. Whether you have a specific diagnosis or generalized pain in your back and joints, MotusX can help. Your physical therapist may also suggest an anti-inflammatory diet for additional pain relief to reduce inflammation through nutrition

What to Avoid
One of the quickest way to reverse nutrition-based inflammation is to stop eating the foods most associated with it. Unfortunately, for many people, these foods tend to be convenience items. That means that you may need to readjust how you think about preparing meals and snacks in your quest for pain relief.

On the plus side? There are few surprises in the types of foods that make inflammation worse. You probably already know these nutritional “no-nos” – they’re also bad for your heart and your waistline. So whether your guilty pleasures are savory or sweet, begin to ease them out of your meal plans.

Packaged meals and junk food snacks are often full of trans fat, sugar and preservatives. In addition, avoid fatty and fried foods, red meat, pastries and donuts, white breads, white rice and semolina pasta. If you’re at all sensitive to inflammatory foods, these are among the worst when it comes to bringing on painful flare-ups.
How to Replace Inflammatory Foods
Many “bad guys” in the food world have easy alternatives. Substitute white bread with whole-grain bread, white rice with brown rice, and semolina pasta with wheat or garbanzo pasta. In place of hamburger, chops and meatloaf, focus on fish, chicken and veggie “steaks.”

Preparation is also an important component of an anti-inflammatory diet. Avoid frying foods or ordering fried foods when eating out. Instead, opt for the same ingredients that have been grilled, roasted or steamed. Rather than topping main courses and side dishes with creamy sauces and dressings, choose healthier alternatives. Topping options for various salads, side dishes and main courses include vinaigrette, Greek yogurt, tomato salsa, fruit salsa, lemon juice and herbal olive oil.

Anti-Inflammatory All-Stars
Along with healthy substitutions of inflammatory foods, look for nutritional choices you can make that directly address internal swelling, Make sure to add these to your meal plans each week, and assess whether your health issues seem to ease in response.

Certain anti-inflammatory herbs, spices and supplements may provide some pain relief. Multivitamins and fish oil pills are among the supplements noted for their anti-inflammatory properties. Good herbal supplement choices include boswellia, green tea, cat’s claw and devil’s claw. Other non-food items are turmeric and fresh or powdered ginger for seasoning and green tea as a soothing beverage. (Enjoy green tea hot or chilled.)

The “rainbow” of fruits and vegetables that you’ve heard of for heart health and boosted immunity may also fight inflammation. Eat more colorful fruits like berries and mangos. Vegetables that range from dark green (kale and spinach) to orange (carrots and sweet potatoes) to red/purple (beets and tomatoes) to yellow (sweet peppers and corn) are also great choices.

Along with fish oil pills for omega-3 inflammation protection, add more actual fish to your diet. The types highest in Omega-3 fats are, not surprisingly, fatty fish. Salmon, herring, sardines, trout, mackerel and tuna all may provide some pain relief when inflammation is the culprit.

Long-term pain relief can rarely be achieved with diet alone. As important as nutrition is, it’s also crucial to consult your doctor about other ways to gain flexibility and reduce pain. Physical therapy can help to work with your dietary changes. Together, these changes address the inflammation that’s causing stiffness and discomfort. Call our conveniently located physical therapy clinic in Cookeville TN, MotusX Physical Therapy and Performance at 615-933-1715 today to learn more about how physical therapy and nutritional coaching can make a difference.

Thursday, January 10, 2019

PT Pathologies: Spina Bifida - Myelomeningocele

Spina bifida is a congentital neural tube defect that generally occurs in the lumbar spine but can also occur at the sacral, cervical, and thoracic levels.  This pathology can be classified into three categories; spina bifida- occult, meningocele and myelomeningocele.  Occult is an incomplete fusion of the posterior vertebral arch with no neural tissue protruding.  Meningocele is an incomplete fusion of the posterior vertebral arch with neural tissue/meninges protruding outside the neural arch.  Myelomeningocele is an incomplete fusion of the posterior vertebral arch with both meninges and spinal cord protruding outside the neural arch.  Spina bifida - Myelomeningocele will affect as many as 1 out of 4,000 infants.

The cause of spina bifida is unknown but health professionals think low levels of folic acid during the pregnancy is a factor.  Folic acid or folate is important for brain and spinal cord development.  This can be detected before the infant is born.  Blood tests can be done and alpha-fetoprotein can show elevation in levels at week 16 of pregnancy.  These infants might have other disorders like syringomyelia, a fluid filled cyst within the spinal cord, and a hip dislocation.  Hydrocephalus, buildup of fluid inside the brain, affects about 90% of the mylomeningocele cases.  The caregivers will place a shunt in the child's brain that will drain the excess fluid down to the abdomen area.  Myelomeningocele patients will typically use a wheelchair for their life span and the primary reason of death is due to kidney complications.

In spina bifida myelomeningocele, immediate surgical intervention is needed to repair the protruding sac from the spinal area.  Physical therapy is an important component needed in the early years of an infants life.  This focuses on educating the family about proper handling, positioning, range of motion, and therapeutic play.  In the long term, physical therapy assists in maximizing functional capacity.  Also included are range of motion exercises, facilitation of developmental milestones, therapeutic exercise, skin care, strengthening balance and mobility training.  Upper extremity strengthening will make use of assistive devices easier such as wheel chairs and walkers.  A patient with spina bifida has a near normal life expectancy as long as the patient receives consistent and thorough healthcare.

Monday, January 7, 2019

Product Review: Titan Fitness Heavy Foam Plyo Box (30/24/20in)

Product Details
The Titan Fitness pro-duty Foam Plyometric Box is perfect to start doing box jumps, box push-ups, dips, step ups, and other creative exercises. Are your workouts too easy on the 20" side? Simply rotate the box to add 4"-10", forcing you to jump higher and burn more calories! These boxes are constructed from high density foam and built to last. With up to a 350 lb weight limit, you can be confident that when you land your jump, this box will support you. An added bonus is that the edges and sides won’t hurt your shins!

- Pro-duty firm foam construction
- Soft material helps prevent injury
- Slip free surface
- No assembly required
- Save money and space with 3 box sizes in 1
- Solid foam platform supports heavy weight athletes
- Rotate the box for more challenging heights

67lb Specifications:
- Material: Foam
- Height: 20"
- Width: 24"
- Length: 30"
- Weight: 67 LB

Product Review:
I am a huge crossfitter, doing 2-3 sessions a day. I wanted a foam plyo at home but did not want to spend a fortune on some of the other brands with less utility. I did a good amount of research and found this one to be very sturdy and high quality. Foam plyos are great, though can be deceiving. They are soft but they cannot be too soft or you do not get the right feel and landing on them can be difficult. This one seemed to have a good stiffness to it as well as it weighed enough to know that when I use it at 30" (which is most of the time) it will not tip or be unstable. It has performed well, seems like it will hold up for the long haul, just wish the foam was a hair stiffer. Great quality none the less for a very reasonable price. Perfect for a home garage box.

There are alot of wooden ones out there but this one is great, knowing that it is foam makes that jump easier for those that have never tried it before. The ladies I am working out with had never Attempted box jumps, it was great to see.  It came put together already (unlike my wood box) which was a plus. I've bit it and landed my shins on it, and only bruised my ego (versus splitting open my shin like on my wood plyo box).

This is HEAVY. I have to either sled push or tire flip it across my garage. I've had 0 issues with tipping, and there is plenty of surface area for box jumps/jump overs. Cover unzips, although I just wipe clean with a Lysol wipe. Colors are great to easily find the height I need.  Already had a couple members save their shins on this box.  The only down side is that and the fact it has to be flipped all the way to where you want to use it (no handles obviously).

Each jump box features an ultra dense foam core with softer foam on all six sides—making them firm and secure enough to perform plyometric movements, but soft enough that you won’t tear up your shins on the edges if you misstep. The box can be quickly positioned at three different height settings—20", 24", and 30"—and an 18 ounce vinyl is included with printed indications of which height you’re jumping at.  This plyo box is an absolute steal. It’s everything that the first offering was not. Heavy, sturdy and safe. The Black Friday sale price was insane for this piece of equipment.
In conclusion, by removing much of the fear factor and injury risks from high-intensity box jumps, and by allowing multiple athletes to set their own preferred height, the Titan Fitness Heavy Foam Box offers huge benefits for any size training facility.  The durable vinyl cover resists wear and tear while remaining firm even after heavy use. Never worry about footprints or dirt again, as the vinyl covering allows for easy cleanup.   This 3-in-1 Ballast Plyo Box is a staple item of any fitness studio or box. It allows you to design your workout & adjust on the fly. This unmatched versatility removes clutter from a workout space.

Wednesday, January 2, 2019

WOD Wednesday #95

For time:
100 squats
15-ft. rope climb, 4 ascents
75 squats
15-ft. rope climb, 3 ascents
50 squats
15-ft. rope climb, 2 ascents
25 squats
15-ft. rope climb, 1 ascent

Rope-Climbing Techniques

Reduce the reps on the squat so that each round can be completed in only a few sets with little rest. Reduce or modify the rope climbs to something that allows you to keep moving throughout.

Intermediate OptionFor time:
80 squats
15-ft. rope climb, 3 ascents
60 squats
15-ft. rope climb, 2 ascents
40 squats
15-ft. rope climb, 1 ascent
20 squats

Beginner OptionFor time:
60 squats
4 rope climbs, lying to standing
45 squats
3 rope climbs, lying to standing
30 squats
2 rope climbs, lying to standing
15 squats
1 rope climb, lying to standing