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!"


 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

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.

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:

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

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:

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

  • 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.

"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


"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."