It’s Genetic… NO, It’s Mechanics!

By: Dr Dawn DPT

If I had a nickle for every time a client tried to convince me their foot problems were genetic, I’d be rolling in the deep money! I won’t dispute the possibility of some genetic predisposition due to collagen fibers, bone structure, and other genetic markers. However, I take issue with the statement “It’s genetic, I have my mother’s (or father’s or uncle’s or grandmother’s) feet being used to avoid owning their bad habits and correcting biomechanical faults that can change the course of their foot health for a lifetime. A genome can not be altered (well, for the sake of this discussion it can’t!) but a mechanome can definitely be modified for the greater good.

“We are how we move” according to Katy Bowman, biomechanist extraordinaire. Read her timely blog on this topic here: Mechanome vs Genome. The moral of the story is you can do something, many things in fact, to address the issues with the tissues in your feet (or anywhere else in the body for that matter but today it’s the feet).

The most common malalignment of the foot attributed to genetics is the bunion. In reality, gait pattern, tissue tension, and poor shoe choices are the biggest contributors to bunion formation. Tight calves and hamstrings as well as walking like a duck (or ballerina) are the quickest way to achieving a beautiful (not) bony protrusion on the side of your big toe. Add wearing a shoe with a small toe box and a heel to push your entire body weight onto the ball of the foot and pow!

If we were meant to wear heels, our foot structure would look more like this:

So… what can I do? you may ask. I will tell you.

First: Wean down your heel height as much as possible and wear heels for special occasions instead of daily.

Second: Choose shoes with wide toe boxes to give your toes plenty of room to spread out. And help your toes find a new spread position by encouraging them with your fingers, spreading with toe muscle control, and wearing my new favorite toe aligment tool:

 I wear these in the evening for about an hour or so before going to bed. WOW! What a stretch!

Third: Use a myofascial release tool to loosen up the tissues in the foot and create space for blood flow, nerve communication, and mechanical efficiency. My favorites are the Yoga Tune Up® therapy balls. They come in several sizes but the classics are best for the feet. 

Fourth: Stretch your calf muscles

Fifth: Stretch your hamstrings/posterior chain

Sixth: Fix your standing and walking foot pattern. If you are not a duck or a ballerina on the stage, please work on paralleling your feet one to the other.

Your feet should line up similar to the middle set, feet in parallel to each other. Practice this in both standing and walking. The more you practice this preferred posture, the more comfortable and less foreign it will feel.

Seventh: Make an effort to do something for your foot health daily. Your feet and toes will thank you immensely for your efforts! You can create change! Your foot structure is malleable based on the mechanical stresses placed on it.

Proprio”de”ception

By: Dr Dawn DPT

It’s 3pm on Tuesday. Do you know where your body is in space?

Proprioception is our body’s sense of its own position, balance and movement. It informs our brain about our physical environment and how we are interacting with it.

But often times the body lies about its whereabouts… not on purpose mind you… but because it’s been led to believe a certain set of spacial information is true just because it occurs most frequently. So, oft held postures or movement strategies become your body’s default way of interacting with the world because they are most familiar to the brain. And then aberrant postures or movement patterns become the new normal no matter how unnormal or unnatural they may appear to others or even ourselves if we look in a mirror!

How does this happen you may ask? Neuromyofascial imbalances occur over time due to injuries, handedness, unilateral sports (tennis, golf, baseball, etc), habit (carrying a baby while doing 3 other things, always standing like a duck, always crossing the same leg over the other). We have an amazing array of movement patterns available to us that diminsih over time when we ignore half of them! Move it or lose it is definitely a truism! The movements and postures we habitually practice are strongly embodied, but ignoring huge chunks of our evolutionary movement strategies creates a proprioceptive embodymap akin to the incredible shrinking continent. And the repetitive over-use of limited patterns of movement leads to degenerative changes and injuries.

SO… how do we stop deceiving ourselves?

1. Seek out a mirror and/or a movement professional to assist you in developing better postural habits and designing biomechanically appealing movement strategies.

2. Spice up your movement with liberal doses of variety and integration . Adding them to your daily life movement recipe ensures a creative concoction of proprioceptive potpourri. EXPLORE! PLAY! Use your non-dominant hand and/foot in an activity. Trying juggling while standing on 1 leg. You are only limited by your creativity!

3. Watch and learn from this amazing man:

Now that’s some proprioceptive magic right there folks!!!

GET OUT AND PLAY!!!

The Importance of a “Plan” ~ Coach Kimmie

The Importance of a “Plan”

Do you go into your week with a plan regarding your exercise and movement?  Just like our “work” week has a fairly specified amount of time allotted for it, so should our “movement” week.  If I didn’t plan my weekly workouts just like I schedule each client or class, TRUST ME – they’d never get done!

“So Coach Kimmie, how do I plan my week?”

Write down all the types of movement you really like to do first. LOVE that TRX class on Monday? Write it down!  Prefer the Yoga Tune Up class at Kinesis on Tuesday or Wednesday? Write it down!! Commitment to what you love (or really like) will undoubtedly help create success. Once you have these in place, build the week from there.

We all know that there must be components of each of these in our general fitness scheme:

**strength**

**cardiovascular**

**flexibility/mobility**

We also know that there should be at least 1 day of no exercise or very light non-impact activity per week depending on our body’s needs.  And finally, we know that our body sometimes needs a little down time.

“So Coach Kimmie, what does a sample week look like?”

Monday:  off

Tuesday:  20-30 minutes of medium intensity cardio plus stretching.

Wednesday:  30-50 minutes of *strength training followed by 10-20 minutes of cardio.

Thursday:  Lower intensity strength & self-care day. **Pilates, maybe get a bodywork session, spend more time stretching or try a Yoga Tune Up class.

Friday:  20-30 minutes of interval cardio with stretching and Yoga Tune Up® therapy ball rolling for your specific “hot spots” afterwards.

Saturday:  low intensity cardio for 60 minutes and maybe a Pilates class or core series as well.

Sunday:  30-50 minutes of combined strength and cardio. Do a 1:1 ratio of strength and cardio movements.

Daily: spend 10-15 minutes stretching major muscle groups and using your self-care tools. Foam roller, Yoga Tune Up balls, foot wakers, etc.

Your week can obviously be different from what I’ve listed, but it has to make sense in your life.  If you know there’s NO WAY you can exercise on Wednesdays, then that’s your definite day off or you can focus on your flexibility/mobility program. If Sunday is always your family/relaxing day, then keep it that way.

The main things to keep in mind are:

1) When performing full body strength sessions, spread them out so you have at least 1 day between for adequate muscle recovery.

2) Be smart and work up to aiming your sessions just slightly out of your comfort zone.

3) Listen to your body.

4) Be aware of and use all the tools available to you! Physical therapy consults with Dr. Dawn, acupuncture/alternative options with Laura, bodywork with our fabulous therapists, etc….

Injury-free is the way to be!!

Ultimately, aim for 2-3 days of strength, 4-5 days of cardio, and 1 day off.  Mix these up into your life and you’ll be set up for success.  Remember, if our bodies are learning something new, there could be some crankiness coming from some muscles. If you’re really sore from the previous day’s workout, keep moving but maybe slow yourself down a bit and be good to your body!

Need help? We’ve got you covered!  One-on-one sessions can be spent figuring out your needs and customizing a plan THAT WORKS FOR YOU. FaceTime sessions are also available.

Notes:

*Strength training can be done with your bodyweight movements or with the use of free weights, TRX, dumbbells, or other weighted non-machine based equipment. If you’re newer to strength training, take a private session with our amazing trainers at Kinesis. We offer a 3/$150 Personal Training special if you’ve never had personal training at Kinesis.

**Pilates is considered strength training in my book.

You have the power to make it happen. ~Coach Kimmie 

Hell on Heels!

By: Dr Dawn DPT

Are you a slave to fashion? A real fashionista? Can’t give up your Choos? And yes, wedges are still heels!

Fashion Heels

There is a growing body of evidence, not to mention your own body you have probably been trying to ignore, that wearing heeled shoes is detrimental to your posture and biomechanics. The soft tissue imbalances created from faulty posture and biomechanics when the heel is in a raised position frequently lead to musculoskeletal pain. The World Health Organization (WHO) states “these debilitating conditions are painful for the individual, lead to the inability to work and to enjoy life fully, and are a cost to societies and countries.” According to WHO, millions of people are affected globally by musculoskeletal diseases/injuries.

Everything matters because everything is connected! What do you think happens to your knees when your heels are lifted throwing your delicate balance with gravity in a tail spin? And then your hips? Your spine? Your shoulders? Your head? Compensatory changes occur all the way up the chain to your brain.

So why do so many women (and some men) continue to punish their feet, knees, hips, backs, necks? Why haven’t more women just said NO! and demand a fashionable flat? We have to demand it and they will supply it! Right?!? Here’s hoping your heels find their way to the dumpster while you’re in search of an answer to your nagging body aches and pains. Throw on a pair of nice flats on your way out the door!

Fascianistas unite! Fashionistas watch out!!

Posturing

By: Dr Dawn DPT™

Your posture follows you like a shadow wherever you go… Stand up for yourself… Stand with integrity… Sitting is the new smoking… Death by sitting… Take standing breaks…

There is lots of posturing going on lately… thank goodness!!! We are finally talking about the elephant in the room, the problem at the core of many injuries. Basically, posture is as posture does. In other words, it’s the posture you practice ALL DAY LONG that makes a real difference in your default posture… your go-to stance, sit, and exercise position when no one is looking, not even you!

Here are some examples of good and bad standing, sitting, and exercise postures. Which side of the fence does your posture fall… um…er… stand?

Side view of standing posture: Align your hips over ankles, rib cage over hip cage, shoulders overs hips, and ears over shoulders.

Front view: Stand evenly on both feet with your feet facing forward and parallel with each other approximately front hip bone (ASIS) distance apart.

Here’s a great benchmark test: Wall standing… where do you stand?

And now for your sitting (dis)pleasure: Are you more likely to find yourself looking like the left (poor) side or right side?

Ever been in this position waiting for someone or something?

And what about your posture as you go about your daily activities:

 Does this look like good posture to you?

Or this?

Practice makes permenance. If you practice poor posture throughout your day, that is your default positioning no matter how many times you do a “posture” exercise. We MUST continually remind ourselves to remind ourselves about our posture ALL DAY LONG especially when we’re not exercising!

And don’t forget to remind your kids! They’ll thank you for it later… much much later…

Confessions of a movement specialist

By: Dr Dawn DPT

OK… I admit it… I have an injury. I am done hiding it… hiding is mentally and physically exhausting… and it hasn’t made the injury go away!

I did “something” to my knee almost a year ago. I say “something” because there was no clear injury moment that can be pin pointed. However, I know I foolishly engaged in catch up training last September. I went through a grueling teacher training for Yoga Tune Up® and then suffered a nasty upper respiratory virus. These two things set my Ironman training back a few weeks. SO… as soon as I felt well enough, I came back to my training with a vengeance! I put myself through my hardest run workout for my welcome back… and fools suffer! It all felt great during the run although winded. About 1-2 hours after the run, my left knee swelled to twice its size and I have been struggling ever since.

Initially, I ignored the pain and swelling (I know… stupid… and so not the advice I would give any client) believing it would go away. How could it not?!? I did nothing. Really. Except overwork an already compromised knee joint from 2 previous surgeries that I worked really hard to heal to the point of doing half ironman triathlons without any problems. Really.

Soooooo after months of ignoring the issue, pretending I was fine, running through the pain, cycling under my performance level, gingerly pushing off the pool wall with every turn, and deflecting all questions about my knee (are you limping? is something wrong? etc) I decided to start treating THE KNEE. Bodywork, ball rolling, LASER, kinesiotaping, and directed strengthening took the place of swimming, cycling, and running. I stopped socializing with my tri friends so I wouldn’t have to deal with their requests for a training run, ride, or swim.

Everything helped a little bit for short periods of time but the pain marched on. And the knee began to pop and stick and click with every move. I couldn’t sit on the toilet (or anywhere for that matter) without deweighting my left leg and using my arms to assist. I was frustrated and depressed over my inability to heal myself. I was “this close” to seeing my knee surgeon for another clean up of an already minimal lateral meniscus and joint surface stemming from a nasty lateral tibial plateau fracture in 1995.

And then a miracle happened! Well, not really a miracle. But it feels like one!! The pain is slowly diminishing! So why now you may ask? Well… I finally began devoting 100% of my attention to my movement patterns. And I mean every movement. I began analyzing the way I stand, sit, walk, pick up a dropped item from the floor, etc all day long. It begins with my first movement of the morning upon awakening and my hypervigilance extends until I am lying in my bed and drifting off to sleep… only to begin again upon awakening. Yes… it is mentally and physically exhausting, but so was hiding it. At least now I am reaping the benefits of my hard work. The healing is in motion now that the motion is biomechanically in line with my joint’s best interest with every movement, not just during strengthening work.

I can’t say yet if I can really avoid the surgeon’s scalpel, but I am hopeful. I ran 200 meters twice last week without pain. I ran 400 meters once this week without pain. I can bend and straighten my knee (weighted and deweighted) without clicking, popping, and sticking. The stiffness that comes from joint effusion is gone. I can do a near full air squat without pain. I can swim and push off the pool wall easily with both feet. I cycle to work without pain. But I study and analyze every footfall, pedal stroke, knee alignment during motion, muscle activation sequence, etc. Healing is a full time commitment.  But I’m worth it! Aren’t you?!?

I am excited at the prospect of training again, in due time. Until then, every move I make, every step I take, I’ll be watching me…

My smile at the end of a 6 mile run!

FasciaNation with Movement

By: Dr Dawn DPT

I know I have talked about fascia previously, but really you can’t talk too much about long overlooked tissues that just happen to be uber important for body maintenance of mobility and strength. And it just so happens that two of the most common complaints as people age are loss of mobility and strength. Fear of falling is a common consequence of these critical system losses. In fact, recent literature shows that just the fear of falling predisposes one to falling.

So how do we combat loss of mobility and strength? Well… start mobilizing your tissues now! Here’s a great little sequence for fascial mobilization from Jill Miller, creator of Yoga Tune Up®.

Fascia Focused Fitness

And practice your “get ups”!

It’s never too early or too late in life to begin a body maintenance/self care program. Mobilize and strengthen those tissues!

R.E.S.P.E.C.T. Yourself

By: Dr Dawn DPT

How we do anything is how we do everything.

Everything is attached to everything and anything can cause anything.

An hour in the gym x 2-3/week does not offset the hours spent dishonoring your biomechanical structure. As my dear friend and mentor Jill Miller says: Your posture follows you like a shadow wherever you go, whatever you do! Take a good look in the mirror or your reflection in a store window as you walk by. Is your postural shadow creepy or classy?

Bow to the temple of your familiar:

Reveal your body blind spots through frequent introversion of attention during your daily movement rituals. The next time you are working out, focus completely on form detail vs your friend’s run down of last night’s or today’s or the weekend’s festivities!

Examine your body’s posture and movement strategies. A mirror is quite helpful but seeing and feeling from the inside through proprioceptive awareness is just as important.

Self-explore your tissues with regular use of myofascial release tools. My favorite tools are Yoga Tune Up® therapy balls!

Posturize yourself! Stand on your 2 feet equally, feet under lungs and parallel to each other, rib cage over hip cage, head over shoulders. Lift your cell phone to eye level vs stooping your head and neck to your lap!

Excel at being a good posture example in your world.

Cultivate conscious breath control during times of added stress whether it be physical or emotional.

Thank yourself for showing up to life and fully focusing and refining your unique movement patterns.

And no, no one else can do it for you Homer! 

Cash is King… but what about my insurance?

By: Dr Dawn

I am often asked why I do not accept insurance payments at my practice. “Don’t you want more business?” “Is anyone willing to pay cash for physical therapy services?” “Why would I want to come to you instead of someone who accepts my insurance?”

The restrictions placed on my services by third-party payers interfere with my ability to help patients reach their goals. Additionally, the cost of collecting payment from third-party payers and the difficulties in negotiating rates with insurance companies undermine the financial viability of an insurance-based practice. For these reasons, I choose a cash-based model for my practice. It frees me to treat my patients as I deem necessary for full return to living their best life whether that be walks in the park or an Ironman triathlon. Every person deserves more than a perfunctory “return to functional status”. This is insurance speak for the ability to walk, drive, return to work, etc. It does not include return to sport and many claims are denied past the dreaded “return to functional status” determination.

And cash-based practice is often similarly affordable for the consumer as an insurance-based practice. Let’s take a quick look at the numbers!

Modality	Appt Time	Ave # of visits	Ave Cost
Cash	Full hour w/PT	1-2/wk x 4-6 wks	$75-$150 x 6 = $450-$900
Insurance	15-30 minutes w/PT	2-3/wk x 6-8 wks	$50-$75 x 8 = $400-$600

Please note that more quality time is being spent at each physical therapy visit in a cash-based practice which often results in quicker healing times for clients. More quality time with less overall frequency and duration… time as well as money is money my friends!

Also, many insurance companies do reimburse their beneficiaries for services rendered outside their plans. I freely offer super bills with all the necessary coding for self-submission to insurance companies. Most of my clients who opt to self-submit are reimbursed reasonably well depending on their actual policy guidelines. At the very least, many insurance companies will allow the out of pocket costs of cash physical therapy to assist in meeting the beneficiary’s deductible and/or out of pocket expenses for the year. Every person’s insurance policy is unique, and I advise everyone to know your policy guidelines especially for out of network providers. Many physicians and some physical therapists are opting for out of network status and trending towards cash-based practices, so most of us will encounter this new wave in healthcare.

I highly recommend adopting a healthy lifestyle where self-care is performed daily. This may include healthy nutrient dense food intake, exercise (strengthening/stretching/cardio of your choice), myofascial release, and practicing good postural alignment in all daily activities. This will limit your injury exposure. Use movement and food as medicine and    you’ll keep the doctor at bay!

Feeling Fuzzy?

By: Dr Dawn

Do you ever wonder what happens inside your tissues when you stop moving? For a day because you’re sick, for a week because you’re too busy with work, for a month because you’re injured, for a year or more because you have a chronic health condition? Don’t you feel stiff, sore, or tight when you don’t move your body regularly? Many wake up feeling this way just from not moving during sleep! There are multiple reasons and/or excuses people have for not moving regularly – it hurts, I’m tired, too busy, have an injury, etc. But NOT moving in some way – stretching, walking, massage, self myofascial release with Yoga Tune Up® therapy balls, etc – is damaging to your entire neurobiological system.

We are connected from our heads to our toes by a continuous webbed framework of fascia that thrives on movement. Our tissues were constructed to slide and glide one upon the other. Motion is lotion! When there is loss of movement, the system puts into effect minor chain reactions that eventually lead to major body break downs if left unchecked. Gil Hedley, anatomist extraordinaire, describes it best in his now infamous Fuzz Speech. Please be warned, there are cadaver images in the following video. Do not watch it if you have issues with cadaver visuals. But you can definitely still gain knowledge from just listening to the video! Gil speaks rather eloquently on the topic.

After viewing… get up get moving!!