Monday, March 30, 2020

Telehealth for Patients






In the Rehabilitation World, the Coronavirus or Covid-19 has created a situation where many clinic owners have opted to close their clinics for outpatient Physical Therapy.  One of the results of this is the "Gold Rush" toward telehealth. Telehealth is a way for a client to have a 1:1 virtual treatment between a Physical Therapist and a client.  The first question or concern that comes up, is that it is not hands on, can a virtual appointment really help?  My experience lies in directly treating clients with a hands on approach, whether it be soft tissue work, joint mobilization, or trigger point dry needling to name a few. The hands on work goal is to decrease the nervous system output or simply calm things down, so we can build them back up. The nervous system can be calmed down through exercise.
As a PT, I have provided telehealth visits, and have had good success designing, and in real time taking a client through an exercise program. Recently one client started her telehealth session with 5/10 back pain and by the end had a "trace" of back pain.  

Due to the rapid changes of the pandemic, many insurers are now covering telehealth.

If you are in Colorado, I am presently offering free telehealth visits. Call 720-352-0678 for more information, or email to mkohmpt@neuromuscularstrategies.com


If you are outside of Colorado Google Physical Therapy Telehealth near me.

Sincerely,
Mike Kohm PT

Tuesday, March 24, 2020

The Sickness-Wellness-Fitness Continuum

This whole current epidemic with covid19 can be a scary thing, but how can you/us help to prevent sickness-death if we were to catch a virus that could possibly kill us?
The Sickness-Wellness-Fitness Continuum.
From the numbers I have seen thus far, the vast majority of deaths that have occurred are in those who had some type of chronic disease, which once catching covid19, pushed their immune system to not be able to handle fighting off the virus.

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“Medicine has no effective treatment for chronic disease: It is symptomatic only. The doctor gives you a drug to bring your cholesterol down, a different drug to raise your bone density. You might need bariatric surgery if you have morbid obesity. If you have paved-over coronary arteries, they can do bypass surgery. If you become glucose intolerant, the doctor can put you on insulin. But all of these are not fixes. They are masking the problem. If you have persistent malignant hypertension, you should take an antihypertensive if you cannot get your blood pressure down otherwise. But how would you get it down otherwise?”
@crossfit holds a uniquely elegant solution to the greatest problem facing the world today. It is not global warming or climate change. It is not the worst two choices imaginable for president. It is chronic disease. The CrossFit stimulus—which is constantly varied high-intensity functional movement coupled with meat and vegetables, nuts and seeds, some fruit, little starch and no sugar—can give you a pass on chronic disease. It is elegant in the mathematical sense of being marked by simplicity and efficacy. It is so simple.”
Mitigate the risk of sickness-death by doing everything in your power to decrease chronic disease and keep your ticker to the right side of the fitness continuum. 👍🏻💪🏻

Wednesday, March 18, 2020

Why Should I Take CBD?


How CBD Functions in Your Body
When we take CBD, it interacts with a regulatory system within our bodies called the “Endocannabinoid System”. This system is pivotal in regulating all sorts of processes that affect our day-to-day experience from boosting the immune system, regulating everything from mood to blood pressure to even how we experience pain or hunger! While we can’t always control the variables that cause us stress in our bodies, we can use CBD daily to make the most of our endocannabinoid system. Give this amazing regulatory body the best chance to succeed!


“So... What does it feel like?”
We get asked this all the time. Simply put, CBD feels different to everyone because everyone is unique. The day-to-day needs of each person’s body are unique. This is one reason why you’ll see one person swearing by CBD to help them sleep while another is praising it as an anti-inflammatory. Because their individual endocannabinoid systems are working to help them with their own unique issues, they’ll each “feel” CBD in their own way!


Using CBD Daily
In our many years of working with CBD and our customers, we’ve seen a pattern emerge. While folks often come to us with a specific need in the beginning that they want CBD to address, many find themselves eventually taking it each day and become very used to the routine. When the product runs out and that daily routine is no longer happening, people tell us they really get an idea for how CBD was helping them. It might seem subtle at first, but the continual effect of CBD in our lives can really make a difference!


Find the Method that’s Right for You!
We make a wide variety of products to keep up with the wide variety of people that use them. Do you prefer the tried and true method of a dropper-full of CBD oil? Our Full Spectrum Daily line of oils should fit you perfectly. Do you like to take your CBD on the go in your vitamin caddy? Check out both of our lines of softgels! Maybe you would prefer to add CBD to your beverage of choice instead of taking it straight? We formulated our Water-Soluble Rapid Delivery 150 just for you. No matter the person, we can find the CBD product that’s right for you!


Post courtesy of Ambary Gardens

Sunday, March 15, 2020

Anxiety and fear during the Coronavirus or a Hockey player trying to be a Buddhist!

As someone who has delved into meditation, and someone who has equally "fallen off the pillow". I find myself in this time returning to meditation. Often, I joke that I am a hockey player trying to be a Buddhist, am by no means any kind of expert.




I have a "beginner's mind"after several years of meditating and my mind jumps from thought to thought as I focus on the breath. The present news is at times overwhelming and changing on an hourly basis. These are truly uncharted waters for our planet. My mind wants to go to that to the anxiety and fear and I feel it attempting to drive my emotions. The amazing aspect about meditation or contemplative prayer is at times you can step back and witness the thoughts and separate from the thoughts and their attempts to drive emotion. The next aspect as this observation is going on is an amazing quietness inside that may last for two-three breath cycles. At times it expands and then contracts and then the thoughts resume.

A question might be is sitting for 30 minutes worth a sense of quietness for a few seconds? I can resoundingly Yes! Sometimes if I am really lucky it is 8-10 breaths for a few times during the sit. The sense of quietness feels like a reboot and the volume on the anxiety drops. At a meditation retreat last weekend the presenter asked us to share, how mediation helps us. As the title implies, the hockey player aspect of my mind, wants to grind and get in the corner an muck it up. Meditation at least that Saturday, provided a witness to the reaction of my mind, and I humbly can say I felt that I was sitting in my own sitcom! The witness aspect allowed a sense of humor regarding reactions that occur! felt like I was in my own Seinfeld episode.

A friend introduced me to a Zen meditator Paul Reps who wrote the book Zen Flesh Zen Bones. Paul Reps was simply known as Reps and he spent summers at the meditation center where I lived. Reps has two favorite sayings that I like "Slow Motion Cures Commotion" and "You Are Your Own Fortune Cookie" Lately I have been thinking of Reps in this challenging time and am trying to slow down and witness the thoughts of my mind, to create a bit of separation. Hopefully by returning to sitting, this is creating the foundation for sense of quiet, even if it is transitory in nature. If nothing else try sitting in a chair for 10 minutes and simply observe your breath. watch the inhale and the exhale, if the mind jumps around return to the breath. In the beginning its not all rose petals falling from the sky, but with a little practice, you will derive great benefit! If you are interested in Zen this is the link to Zen Flesh Zen Bones.

https://amzn.to/2UcvZiw


Another great book, I found to be insightful and funny as well as scientific is "Why Buddhism is True" by Robert Wright


https://amzn.to/2WhemRw

Tuesday, March 10, 2020

If You Have any of These 5 Symptoms, You May Need Physical Therapy.

Physical therapy is a highly beneficial form of treatment that can address many of the most common sources of pain. However, there are many people who don’t realize that the pain they are experiencing is something that can be easily addressed with physical therapy.
If you are experiencing any of the five common symptoms listed here, then it may be time to consult with a physical therapist as far as the best ways to address your pain and discomfort.

1.Back pain.

Back pain is one of the biggest causes of pain among American adults, and there are far too many who struggle with back pain who are not doing anything about it. The reason for the increase in back pain can be blamed on all sorts of different environmental factors, from rising obesity rates to a dependence on computer-based office work that leaves adults in uncomfortable chairs for hours on end, day after day. Physical therapy can help to address the cause of your back pain, and help to alleviate tension in the back, thereby actually reducing the experience of pain.

2.Neck pain.

Neck pain can develop for a series of reasons, including following an injury or car accident, but also as a result of poor posture—and that includes your posture while you are asleep, as well as awake. Neck pain can be difficult to cope with and treat, and attempting to treat neck pain on your own isn’t always safe. An experienced physical therapist can identify the cause of your neck pain and create a treatment program that will alleviate your experience of pain.

3.Headaches.

Regular, recurring headaches are another complaint that can be addressed with physical therapy. In many situations, chronic headaches are a sign of tension in the neck and back, and therefore working with a physical therapist through targeted stretching and massage can in many cases actually reducing the occurrence and severity of these headaches.

4.Joint pain.

Joint pain can develop as a result of arthritis, or as a lasting effect of an injury. The best way to deal with joint pain is to seek support through physical therapy. Your joints are something that you can’t really work around, and in more cases than not, attempting to rely on another part of your body to reduce pain in your joints will only lead you to experience multiple areas of pain.

5.Difficulty with Movement.

There is a long list of reasons as to why someone may be unable to move as effectively or efficiently as they could in the past. In many cases, stroke victims will find themselves unable to take regular steps and walk as they once were able to do, and even after the pain subsides, the difficulty moving may remain.
Likewise, those who struggle with an athletic related injury are often prone to having limited range of motion—and this is especially true following surgical repair of muscle tissue and tendons. Physical therapy can help you to retrain your body for traditional movement.
These are just five of the most common symptoms that can be addressed with physical therapy, but the list goes on and on. Whether you are experiencing pain following a car accident or a sports injury, or have realized that the pain in your back or neck has become more constant than you first expected it to be, it may be time to consult with a physical therapist as to the best way to deal with your pain.

Monday, February 24, 2020

Say Goodbye to Your Stress-Related Headaches

If stress-related headaches are happening so frequently that they are impacting your daily life, it’s time to start thinking about physical therapy for relief. Stress-related headaches, also called tension headaches, are the most common type of headache that impacts people. While they are not as serious as migraines, tension headaches are a sign that something in your body is “off.” A physical therapist can work with you to determine the cause and eliminate stress-related headaches for good.

Causes of Stress-Related Headaches

One of the main causes of stress-related headaches is right there in the name: stress. The headache generally happens when the muscles in the neck or scalp become tense and contract. Depression and anxiety are similar emotions to stress that can also lead to headaches. In addition, there may be a physical cause behind your stress-related headaches. An accident or injury to the neck or back can contribute to headaches. Poor posture and arthritis are two other potential causes.

Diagnosing Your Headaches with a Physical Therapist

Before your physical therapy treatments begin, your therapist will work with you to diagnose your headaches. You’ll need to discuss your medical history with the therapist. If you sustained an injury to your neck, back or jaw years ago, it could still be contributing to headaches to this day. The location where you experience pain, such as in the face, back of the neck or forehead, can also help to diagnose the source.
Your physical therapist will likely run you through some tests as part of the diagnosis phase. For example, your posture will be checked as you engage in several activities. The strength of your muscles and the range of motion in your neck and shoulders will be tested. Your therapist might do some manual therapy to see how mobile your neck joints are. Once the cause of your stress-related headaches is determined, a customized course of physical therapy can be prescribed to treat them.

Physical Therapy for Stress-Related Headaches

The treatment of your stress-related headaches will depend in part on the diagnosis. For example, one course of treatment that would work for correcting your posture and strengthening the neck muscles might not be appropriate if your headaches are the result of a past injury. In general, you can expect stretching and strength training to be part of your treatment. Other options that your physical therapist might employ can include:
  • Soft tissue mobilization
  • Hot and cold compressions
  • Body mobilization
  • Cervical traction
  • McKenzie therapies
Aside from your physical therapy sessions at the clinic, your therapist will also recommend exercises, stretches and lifestyle changes that you can make at home, which will all contribute to eliminating your headaches.

Benefits of Physical Therapy for Headaches

The ultimate goal of your physical therapy regimen will be to eliminate your stress-related headaches. However, in addition to relief, you will gain additional benefits that will likely improve your overall quality of life:
  • Improved Strength: Your therapist will teach you exercises to strengthen your neck and upper back, which will lead to improved posture. With better posture, you will be able to stand and sit longer without experiencing discomfort.
  • Reduced Neck Tension: You will have better range of motion in your neck and reduced tension, thanks to manual physical therapy techniques applied to the muscles there.
  • Better Posture: Bad posture is really one of the leading causes of stress-related headaches. If you don’t enjoy good posture throughout the day, it is likely to lead to more generalized aches and pains, as well as the muscle tension that contributes to stress-related headaches.

Wednesday, February 19, 2020

Review of Rocktapes FMT BLADES & BLADES ADVANCED IASTM COURSES

As a PT, I have been performing Instrument Assisted Soft Tissue Mobilization (IASTM) with a tool for a few years now. Rocktape offered the course in denver a couple of weekends ago and I jumped in. The course instructor Stuart Wilson PT was excellent. The science behind the course was refreshing and dispelled what I call medical myths that persist today in the rehabilitation world. One of the first slides he put up was that as therapists we are not changing fascial length! Fascia takes 2,000 pounds per square inch to stretch! That is something to think about when someone tells you they are "stretching your fascia". The course focuses upon making changes through the nervous system input. The IASTM tools that Rock Tape provides are excellent and offer a wide variety of applications. The tools can be utilized to target sensory receptors in the skin, fascia and muscles. As a practitioner is using the tools to work on your muscles, IT Bands, etc the tool is providing a lot of feedback to the nervous system, and can help change the input back to the brain. In PT school and in anatomy in general we are taught systems, nervous, joint, muscle, digestive etc, and as a result we have a tendency to think of these systems as separate entities. The systems all interface with the nervous system and that is ultimately the brain, which is where pain is perceived. The IASTM tools appear to help down regulate an overactive system and are a great way to help an injured area reduce muscle guarding or heightened tone. The tool can also enhance fascia's ability to glide in its respective layers. The course demonstrated this through ultrasound videos. I highly recommend the course and the link for this course can be found at

https://www.rocktape.com/medical/education/fmt-blades/


Mike Kohm PT

Tuesday, February 18, 2020

Tired of Your Hip and Knee Pain?

Is it difficult for you to engage in your regular activities due to hip or knee pain? Whether your hip or knee pain occurs when you’re moving or sitting, physical therapy can help get you back to your regular routine. Be sure to call our office for a consult to find out how we can help alleviate your pain. No one should have to live in pain.

What is Hip and Knee Pain?
The hips and knees are the body’s largest joints. They work in close coordination with each for mobility and support the body’s weight. The hips and knees have a demanding task.

The knee is made of several ligaments and muscles and is a complicated joint. Knee pain can wreak havoc on your quality of life. As a matter of fact, knee pain is the second most common cause of chronic pain. The hip joint consists of two main parts: the femoral head and the acetabulum. The femoral head of a ball-shaped piece of bone, and the acetabulum is the socket into which the femoral head fits. Ligaments connect the ball to the socket. Like the knee, the hip is a complex structure. Hip pain can also affect younger people.

Causes and Symptoms of Hip and Knee Pain
Knee pain can be caused by a wide variety of injuries and diseases. It can be the result of auto accidents, recreational activities, sports or a slip and fall. The most common causes of knee pain include:

  • Osteoarthritis
  • Anterior injuries
  • Ligament strains and sprains
  • Overuse
  • Gout
  • Fractures around the knee


In addition to causing pain, knee pain can affect mobility, reduce strength and affect muscle control.

Problems with the hip joint can result in pain in the groin or inside the hip. When the pain is on the outside of the hip, it’s typically due to issues with tendons, muscles and ligaments that surround the hip joint. Hip pain can also be due to:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Hip fracture
  • Sciatica
  • Sprains
  • Bursitis

With hip pain, you may experience intense pain or the inability to stand.

How Physical Therapy Helps Hip Pain and Knee Pain
A physical therapist will do a gait evaluation, palpate, range of motion measurements, function mobility tests to determine a treatment plan for your hip pain or knee pain.

Different modalities may be incorporated into your treatment plan, such as heat and ice therapy, ultrasound and specific exercises. Research has shown that joint mobilization techniques used by a physical therapist can help with long and short-term pain involving the hip. There is typically an improvement in mobility also.

Monday, February 10, 2020

Product Review: Barbell Apparel

Product and Company Preview:
Your clothing deserves to be better. Hand-crafted from premium materials, our Athletic Chino Pants are built to perform like high-tech athletic gear.

With our omnistretch fabric, these pants will keep your quads comfortable and give you complete freedom of movement with the fashion conscious fit that's made our pants best sellers.

FEATURES: 




  • Technologically Advanced Flexible Fabric 
  • Sits just below the waist 
  • Generous through hips, thighs, & glutes 
  • Straight from knee to ankle 

Barbell Apparel was founded with a simple vision: clothing should be better.

Founded by a team of friends and athletes, we started our story by launching our Athletic Fit Jeans on Kickstarter.

That campaign grew past our wildest expectations, becoming the 2nd most funded fashion project of all time, and sparking a change across the fashion industry to bring "Athletic Fit" mainstream. Since then, we've launched three more successful Kickstarter campaigns, been featured on ABC's Shark Tank, and sold out of our Athletic Fit Havok Polo over 3 times.

Our mission is to inspire you to reach your full potential. Your fitness isn’t about what you do today. It’s the result of what you are willing to do every day. We apply the same relentless dedication to developing our flawless athletic fits and cutting-edge technical fabrics, culminating in high performance, ultra comfortable clothing that is far greater than the sum of it’s parts.

You train hard in the gym. Our clothing works even harder to show it off.  Because when it’s all said and done, the fiercest competitor is rarely the most talented, but always the most disciplined.

My Review:
I had pretty much given up on wearing jeans/khakis due to large glute, quads from baseball causing them to not fit properly in any one pair, relative to my height and waist size . I saw Barbell Apparel on shark tank awhile back and then again at the Arnold Sports festival and finally getting a chance to try them out.  Barbell Apparel was one of the first companies to bring ‘athletic fit’ into vogue with their stretch jeans. They were the second most funded fashion project on Kickstarter and went on to present on ABC’s Shark Tank where they crushed it with their Athletic Fit Havok Polo.

I have been wearing my barbell apparel khaki pants for an extended period of time to test its fit and durability from what is promised during my physical therapy internship as an assistant. I won't be lifting/working out in them by any means but in any case, so far the fit is much better than any other pairs of pants I've ever owned. Mobility increase is huge as well. While I may not workout in them, the flexibility of material allows me to better demonstrate exercises and technique to clients and patients in the clinic with no restrictions. I can run, jump, kick, etc with no restriction of movement. It feels like I'm wearing sweatpants at work.Image result for barbell apparel"

The pants itself are pretty standard as far as design go. They look like regular jeans or khakis, which is exactly the point. The real star of the show is the fabric. A combination of 95% Cotton, 4% polyester and 1% spandex makes the fabric very soft, but more crucially; VERY flexible. Normal jeans/pants have no give what so ever, resulting in the above mentioned constricted legs. But the Barbell Apparel products stretch in all the right places while staying in check in places where no stretching is required like calves or ankles for example.

This means complete freedom of movement, which is almost a liberation for someone like me who always had to watch out with movements. No more worries though, these khakis allow you to squat, bend, lunge, twist and swing any way you want to, without ripping open. Demonstrating how to pick something up from the floor is no longer an issue as the pants move with you and allow full ROM.

All pairs come in a 34” length inseam which is common for luxury brands but note, men’s legs do not come in increments of 2”.
They will set you back $135 (after using my promo code "jones19" for 10% OFF!) plus shipping, which is certainly not cheap. But if you look at jeans from other established brands that are not fitness friendly you could easily be spending that kinda money, so while not cheap the value is certainly there. Since I will be wearing the same khaki pants every day during my next 8 week clinical rotation, I will have to wait to comment on durability, which is the biggest question mark, but I see no reasons, after wearing them several times the past month, to be alarmed.


My Rating: 9.2/10
The jeans from Barbell Apparel are exactly as advertised and provide all the benefits of wearing jeans without any of the drawbacks in a, in my opinion, stylish package. These pants fit perfect, look great and also feel so comfortable. The second you try them on you will never want to wear any other pants. My rating is based on the wait to gauge durability and the slight price barrier that may prevent some consumers to be able to afford such awesome pants!

Be sure to check them out at http://barbellapparel.com?rfsn=540907.db481

Monday, January 27, 2020

Surprise! Physical Therapy cant "fix you"

If you are a person who has had a long standing injury, or can't quite recover from an injury, maybe ask yourself how dedicated have you been to your PT homework? Or if you are a person who has moved from practitioner to practitioner in search of "the answer" and the treatments you have received are mostly passive, keep reading!

What do I mean by passive?, something that someone does to you, cupping, massage, needling, "stretching you out" are just a few examples of passive treatments. Muscles, tendons, ligaments, joints upon injury, need to be built back up to be able to accept the demands placed upon them. If you sprained your ankle, you strengthen it and perform balance work, etc to get your previously injured ankle, game ready.

I often find the missing link in treatments is strength training and nerve mobility work.

To read more go to the link below.

Physical Therapy "Cant Fix you!"


 Thanks

 Mike Kohm PT

Thursday, January 23, 2020

PT Pathologies: Osteoporosis

Osteoporosis is a disease characterized by decreased bone density due to insufficient calcium and decreased osteoblast activity.  This condition results in porous bones that are more vulnerable to breaking; often it is asymptomatic until fractures begin to occur in the affected individual.  The bones of the hip, spine, shoulder and arms are most vulnerable to fractures.  Compression fractures of the vertebrae result in the characteristic kyphosis frequently associated with people suffering from osteoporosis.  According to the American Physical Therapy Association, there are 1.5 million fractures per year due to thinning bones; 55% of Americans over the age of fifty will fracture a bone.  Women are more likely to suffer these fractures, since the decrease of estrogen after menopause contributes to less osteoblast activity; since osteoclast activity does not decrease, there is a greater proportion of bone being broken down than being formed.

        There are various affecting factors that contribute to the formation of osteoporosis, and some of these are controllable.  The predisposing factors that are not controllable include: advanced age, gender, a slight skeletal frame, and genetics.  However, there are controllable factors as well, including: cigarette smoking, excess intake of alcohol and/or caffiene, a calcium poor diet, low vitamin D levels prolonged steroid use, lack of weight bearing exercise and an overall inactive lifestyle.  Although a greater proportion of sufferers are women, there are men who develop osteoporosis as well; men who have Celiac disease, inflammatory bowel disease, spin bifida, cystic fibrosis, rheumatoid arthritis, and/or kidney disease have a greater likelihood of developing porous bones and the resulting fractures.

        Individuals suffering from osteoporosis can benefit from physical therapy.  Although complications of this disease cannot be reversed, its progression can be decelerated.  In addition to the increased intake of dietary calcium, weight bearing and resistance exercises can help to increase osteoblast activity and result in stronger bones.  Examples of weight bearing activity that are of benefit including dancing, jogging, and racquet sports.  Activities such as weight lifting, exercise with resistance bands, water aerobics, push ups and yoga are examples of light resistance exercises that can benefit individuals with osteoporosis.  Additionally, a physical therapist can help patients develop better posture and balance; along with educating patients bout ways in which to increase the safety of their environment, these skills can help to lessen the chances of a fracture occurring.

Monday, January 20, 2020

Product Review: State and Liberty Dress Shirts

Product Details:
Crafted from our Athletic Performance Fabric; this shirt is as light, soft and stretchy as it gets. "The Kopitar" is the perfect dress shirt for business or casual wear.

Hidden collar button ensures your collar will be standing tall and crisp all day long

Comes equipped with two "State and Liberty" silver collar stays and monogrammed "S&L" on the button side placket

SIZING
Our shirts are designed for a "V" shaped body type with an extremely tailored waist. Therefore, the fit of this shirt is an athletic slim cut shirt - if you prefer a looser fitting shirt, size up from the recommended sizing.

All body types are different; therefore, we always recommend ordering two sizes and then returning one.

CARE
Unlike traditional dress shirts, we do NOT recommend dry cleaning our dress shirts...
Instead, please follow our recommended instructions:
  • Wash shirt on a cold, delicate cycle alone or with other State and Liberty Dress Shirts (or other similar style fabrics)
  • Hang to Dry

My Review:
A common issue for a lot of guys who are in shape is finding button up shirts that fit well. The problem is that our proportions are unlike that of the average male as we typically have chests and shoulders that are much wider than our waists (i.e. a classic v-taper shape).

This means that most off the rack button up shirts don’t fit us particularly well. They are either fit too tight through the chest and arms or too baggy through the midsection.

Is there a solution?
A quality dress shirt that looks good, feels great and doesn’t cripple your wallet? This used to be impossible to find! Until I found State and Liberty shirts. I threw the shirt in the dryer for 15 minutes to freshen it up.  Once I pulled the shirt out of the dryer, wrinkle free and feeling as though it had been pressed, I noticed it had a feel to it like no other dress shirt I’ve encountered. It felt stretchy, yet supple. Relaxed, yet ample and up to the task.

I pulled the shirt over my torso and was befuddled at how the shirt fit me so well, as I had casually requested a “large” sample. There were no previously exchanged measurements, or painstaking trips to the Men’s Warehouse to act like I was buying a dress shirt in order to acquire my exact dimensions. And yet, the shirt fit my torso perfectly, with perfect sleeve length to match. It even made my biceps look outstanding thanks to the superior fit.

Here are the main summary points to purchase this shirt over a tailored or off the rack shirt:
They were pretty accurate with the description of the fit! Also, this tag was a nice touch and really gave it a high-quality feel to the whole transaction.  I love that the white and blue are not solid; they have the other colors woven in. I'm not a clothing connoisseur, but I love the way the material looks as well as feels. It is surprisingly soft.  These look great and the buttoned down collar is a nice touch to keep the collar in shape and in place all day.  Stiff cuffs, stiff collar, tight on the arms, up tight into the pit.  The shirt hugs the forearms and arms. Not baggy in the front, back or side. No wasted material anywhere.

Order your shirt here:
https://stateandliberty.com/collections/all-shirts

Thursday, January 16, 2020

PT Pathologies - Cystic Fibrosis


         The pathology of cystic fibrosis is a defect in a gene that affects the production of mucus.  The defect in this gene varies in severity.    Defective CFTR impedes release of chloride and increases reabsorption of sodium and water across epithelial cells.  This results in reduced fluid lining the cells leading to dry mucus that is thick and hard to clear, because the viscosity of the mucus inhibits the cilia.  The mucus traps bacteria and leads to infection and inflammation.  The inflammation causes damage to the lung tissue over time.  The lungs become less elastic and have impaired gas exchange causing end-stage lung disease and early death.  Many other organs are affected by this disease such as, pancreas and other digestive organs.  The mucus in these organs also becomes thick due to this disease and decreases their function as well.
           
            Cystic Fibrosis is a genetic disordered, which means that it is inherited trait.  A child must receive two copies of the gene in order to inherit the trait.  This means that both parents must carrier at least one gene of the disease.  The parents might not even know their child is at risk for the disease.  If a parent is a carrier they will not show any symptoms of the disease.  The mutation of this gene affects the protein that regulates the movement of salt in and out of cells.  The result is thick mucus in the digestive, respiratory and reproductive system.

            Cystic fibrosis is just one of many diseases that a newborn is screened for.  A blood sample is taken to assess for high levels of immunoreactive trypsinogen, which is released by the pancreas. Other tests are needed to confirm the diagnosis.  A sweat test is conducted to assess for high salt content.  DNA can also be assessed for gene defects that cause cystic fibrosis.  Older adults and children may also be tested.  They would receive a sweat test as well as being assessed for symptoms of cystic fibrosis such as nasal polyps, chronic sinus or lung infections, bronchiectasis or male infertility.  Early identification of the disease is important in treatment. It is important to know if this disease has ever affected anyone in your family history due to its genetic origin.  Environmental factors that can affect this disease are things such as secondhand smoke and lack of meeting the diet needs of someone with CF.

            It is imperative to be able to recognize multiple symptoms of cystic fibrosis.  It’s a progressive disease so the severity varies patient to patient.  This means that the symptoms may not be as obvious in some patients as others.  Distinctive symptoms in the respiratory system are wheezing, thick mucus producing cough, as well as a history of recurring respiratory infections.  The patient may have difficulty on exertion or fatigue, especially if the disease is in the later stages of progression. The changes in gastrointestinal function may lead some patients to have difficulty gaining weight even with a proper appetite.  GI symptoms include greasy stools, constipation, inflammation of the pancreas, salty skin. 

            The main treatment performed by a physical therapist is chest physical therapy or postural drainage.  This includes percussing the back, vibration, deep breathing, and coughing to promote airway clearance.  This technique loosens mucus and allows it to be moved to larger airways to be coughed up.  Doing this on a regular basis will enable the patient to breathe easier and will decrease the risk of infection by decreasing the buildup of bacteria trapping mucus in the lungs. They often receive antibiotics to treat and prevent infections.  Mucus thinning drugs are used to help the patient cough it up.  Bronchodilators are used to keep the airway open by relaxing bronchial tubes.   Other management techniques include a diet with extra vitamins and minerals, supplemental digestive enzymes, and high in calories and fats.  Fitness is also an important aspect because activity improves lung function.

Monday, January 13, 2020

Running Injuries, How to prevent, restore and return to running

Have you heard the rumors that running or squatting is bad for your knees? Do you have Achilles Tendonitis, Plantar Fasciitis, Shin Splints, Knee or Hip Pain? Has your rehab or Physical Therapy only focused on the area of pain and not how your entire body is reacting to the ground?
Try this simple test, an inline kneel. Line up your front foot, directly "inline" with your back knee, your back foot should be down. Try to hold this for 30 seconds. Can you hold it? Are you wobbling all over? If you are not steady in the position, you are running on that instability! Runners legs afford them so much stability, your legs may be overcompensating for a lack of stability or strength in your hips, lumbar or thoracic spine. Your issue may be the opposite a lack of stability in your hips, in concert with your lumbar spine. You may lack mobility in your thoracic spine. Tightness in your shoulders can affect your lumbar spine through your latissimus dorsi! The fascia from your lats crosses the same and the opposite side posterior hips. Practice this position until you get steady in it, then add challenges such as chops and lifts with a ball or a small weight. A movement screen (FMS, SFMA) can be very effective way to discern where the issue is occurring. Call 720-352-0678 for a free phone consult, or schedule online at http://www.neuromuscularstrategies.com

Physical Therapy, Boulder, CO

Thursday, January 9, 2020

PT Techniques: Transverse Friction Massage

Friction massage is indicated for chronic conditions of soft tissues - usually tendons, ligaments, or muscles - arising from abnormal modeling of fibrous elements in response to fatigue stresses or accompanying resolution of an acute inflammatory disorder.  The intent is to restore or maintain the mobility of the structure with respect to adjacent tissues and to increase the extensibility of the structure under normal loading conditions.  The goal is to allow for increased energy-attenuating capacity of the part with reduced strain to individual structural elements.  Typical conditions in which friction massage is often indicated include:

TENDINITIS:
  • Suprasinatus or infraspinatus at the shoulder
  • Tennis elbow
  • deQuervain tendinitis at the wrist
  • Peroneal tendinitis at the ankle or foot

SUBACUTE OR CHRONIC LIGAMENTOUS SPRAINS:
  • Intercarpal ligament sprains at the wrist
  • Coronary ligament sprain at the knee
  • Minor medial collateral ligament sprains
  • Minor anterior talofibular sprains

Acute signs and symptoms should be resolved at the time at which friction massage is used.

Technique of Application:
The part should be well exposed and supported so as to reduce postural muscle tone.  The structure to be treated is usually put in a position of neutral tension.  It should be positioned so that the site of the lesion is easily accessible to the fingertips.  If adherence between a tendon and its sheath is suspected, then the tendon should be kept taut to stabilize it while the sheath is mobilized during the massage.          The therapist should be seated if possible.  His elbow should be supported to reduce muscle tension of more proximal parts.  The pad of the index finger, middle finger, or thumb is placed directly over the site of the pathology.  Fingers that are not being used at the time should be used to provide further stabilization of the therapist's hand and arm.  No lubricant is used; the patient's skin must move along with the therapist's fingers.
     Beginning with light pressure, the therapist moves the skin over the site of the lesion back and forth, in a direction perpendicular to the normal orientation of the fibers.  The amplitude of the movement is such that tension against the skin at the extremes of each stroke is minimal.  This is necessary in order to avoid friction between the massaging fingers and the skin, which might well produce a blister.
     At the beginning of the massage, the patient may feel mild to moderate tenderness.  This should not be a deterrent.  However, after 1 or 2 minutes of treatment with light pressure, the tenderness should have subsided considerably.  During the first treatment, the massage should be stopped after 5 or 6 minutes and the key signs reassessed.  If it is a muscular or tendinous lesion, the painful resisted movement is checked; if it is a ligamentous lesion, the painful joint play movement is retested.  The patient should feel some immediate improvement.  If they have not, the therapist should consider whether the technique of treatment was appropriate, assuming that the disorder is one for which friction massage is indicated.
     With successive treatments, the dept massage is always gradually increased, as described above and the length of treatment is gradually increased working up to 12 minutes each session  However, treatment should not be continued if, at anytime, symptoms increase.  It is not unusual for a patient to feel some increased soreness following the first or second session, but it must be distinguished from exacerbation of symptoms.
    A common mistake during treatment is the development of skin blisters or abrasions.  These result either from fingernails that are too long, or from poor technique that causes friction between the finger and skin.  Another common mistake is for the therapist to apply the massage to the area of pain rather that to the site of the lesion, they may not be the same location.  Friction massage should be avoided when the nutritional status of the skin is compromised and in cases with impaired vascular response.

Monday, January 6, 2020

Reebok Nano 9 Testimonial


Product Details:
The Nano 9 Men’s CrossFit Shoe is truly a “Nano for All,” incorporating the most popular elements of past models with several new features developed through direct feedback from the CrossFit community.

Reebok’s industry-defining cross-training shoe includes updated figure-8 “Flexweave” technology to create a more durable, flexible and breathable upper. New cushioning in the forefoot makes for more comfortable sprints and distance running, while a soft rubber midsole wrap adds another level of reliable protection. As a carryover, the Nano 9 still includes a wide bootie construction, low-cut design, minimal drop outsole, and RopePro tech; ensuring a strong foundation for explosive lifts and ample grip for rope climbs, quick pivots, box jumps, etc.


Testimonial:
"For me personally this has been the most versatile shoe that reebok has come out with so far. The new additions to the nano 9 have increased the durability and comfort of the shoe. The improved flexweave design, midsole, and split outsole are the highlights of this shoe.

The flexweave and wrapped midsole hold up well against all wods even ones including rope climbs. One downside I personally found is that the forefoot will slightly bunch if you have narrow feet and enjoy wearing your shoes tied tightly. This has had no affect on the performance or feel of the shoe and is a minimal complaint when compared with the overall improved performance.

The split outsole and additional cushioning allow you transfer from deadlifts to running with ease. This shoe feels sturdy and solid enough for all lifts while maintaining comfort and flexibility for box jumps, buprees, and running. In conclusion, it is my favorite cross training shoe thus far."   - Taylor

Wednesday, January 1, 2020

THERAPISTS!

"We are experienced licensed physical therapy assistants and certified occupational therapy assistants. We made it through intense college programs. We spent hundreds of dollars and studied hundreds of hours to sit for hours and pass a state boards exam to get our license. We are drowning in student loan debt. We bi-annually pay hundreds of dollars out of pocket to continue our education and maintain our license. We care for every patient we see.

We will hold a basin while you vomit. We help you to the bathroom. We team up with nursing staff so that you can get the care you need quickly when you are so debilitated you need 2 people to roll you over in bed. We give out high fives and hugs when you are finally able to sit up at the edge of the bed by yourself or when you are able to move an arm or leg you thought would be paralyzed forever. We pay attention to every little detail - how can we position you so your pressure wound on your back heals? What adjustments can we make to your wheelchair to keep you comfortable and independent? We brainstorm with our PTs and OTs and research ways to reduce your Parkinson's tremor or relieve your chronic pain or set you up so you are able to feed yourself. We will try anything.

We work as a team to find ways to incorporate activities into our session so that you are able to enjoy the holidays when you are staying with us. We will push you out into the sunshine to do your exercises and take walks to help you relax and refresh.

We will step into your world of aphasia and speak to you as if everything makes perfect sense. Your impulsivity doesn't scare us, we are trained to help you redirect and find a sense of calm. We celebrate with you when your hard work pays off and you're finally ready to leave us and return home. We retrieve tissues to wipe away tears and encourage you to do the things you think you can not do. We see your potential and we advocate for you. We fight with insurance companies to pay for the care you need. We listen to your stories, meet your families and are invested in your success. And if you spend enough time with us and we get to know you well enough, we will sit by your bedside and hold your hand while you're dying and your family can't get there in time.

Our commitment to and care for you runs deep. But right now we are struggling to keep jobs. Struggling for hours. Sacrificing more and more weekends and holidays and time away from our families. Struggling to find jobs. Taking $20k paycuts annually to work under increasingly demanding and unrealistic expectations. Struggling to pay back student loans. Many of us are talking about leaving our profession or have no choice but to find a new profession. I hope in 5 years you still have these kind of therapists. I hope you are getting the care you need. I hope that everyone who sees this knows how much we love what we do and our patients that we care for. Our profession is in a scary place right now. I hope things change. Medicare sets the standard for the reimbursement and longevity of our profession. I hope they listen."