Success Story: Sarah!

Congrats to Sarah on completing her first Spartan Race! Sarah has worked extremely hard to overcome both the physical and mental hurdles of battling running injuries. When they come at you one right after another, it takes a lot of patience and persistence to stick with the process of rehabilitation and cross training, even when it feels like there is no light at the end of the tunnel.

My motto for Sarah is:

"If you run to get fit, you are tempting injury. If you get fit to run, you feel better, run faster, and finish badass spartan races!"

Way to go Sarah! Your hard work has paid off!

What makes Endurance Physio unique?

By Jamie Terry, DPT, SCS, CSCS

I often get asked, “What makes Endurance Physio different from every other physical therapy clinic in Missoula?” I think a few wonderful things make us unique and set us apart in this amazing community full of great physical therapists. The first thing is size. The clinic is small. You will see Anya or myself for your care, and the entirety of your care. This is our quality control. We are strong believers in continuing education, evidence based practice and providing the best possible care to our patients. This is our passion. Being a small clinic, we are also able understand our patients’ insurance plans and educate them on their coverage to help keep their costs down. Anya and I know what it’s like to be injured and not able to do the things we love. We would never want cost to get in the way of getting you back to what you love. So we don’t let it.  

Our approach to patient care is unique. We teach our patients how to activate the right muscles, apply that activation to movement and load that movement to improve strength. All too often I see patients who have missed a piece of the puzzle. Sometimes the right muscle wasn't firing at the right time. Sometimes the correct way to move through the correct joint was misunderstood. Occasionally the tissue wasn't loaded enough to cause strength changes. My goal is for my patients is to feel changed when they finish their care here and have all the pieces to the puzzle-- stronger, more knowledgeable about why they had their pain, and how to avoid getting into the same situation again. Recovery from injury takes commitment and hard work with proper guidance. We are fortunate to help guide this process.

Another unique aspect of our clinic is that we refer-out when appropriate. If I think my patient would benefit from a 3D running analysis at the University Movement Science Lab, I’ll send him/her over. If my patient is suffering from vertigo, lymphedema, or another area I don’t specialize in, I will send them to a physical therapist with advanced training in that area of treatment. We keep our patients' best interest at the forefront of our care. Missoula has so many amazing services to offer, and we believe that helping our patients find these services to facilitate their plan of care is a big part of our job.

Anya is unique. Her resume in the running world is impressive to say the least. She was a collegiate pole vaulter and has evolved into one of Missoula’s best female trail runners. She is as passionate about her patients as she is about running and that’s why she is the only one I want to work beside. I have had the opportunity to work and learn from many amazing therapists over the years, but Anya has inspired me the most. Anya has applied herself to physical therapy for runners and gait mechanics at a level that supersedes any other therapist in this community. If running is your jam and you are hurting, this is your girl. Hands down.

The main thing that sets us apart from other clinics in Missoula is we are sports specialists. Many clinics are afraid to declare a specialty at the risk of turning away potential patients. I know through specializing we can provide better care. You wouldn’t go to a orthopedic surgeon if you had a stomach ulcer. You wouldn’t go to a dermatologist if you had a neurology problem. The medical field supports specialization to provide patients with the best possible care. Physical therapy is no different. I am one of 3 board certified sports specialist in Missoula and the only one that is residency trained. This means I went to an additional year of school to focus on sports physical therapy and specialize my care. I also am a certified strength and conditioning specialist.

I grew up competitively ski racing, playing volleyball, and playing basketball. I continue to bike race, run, practice yoga, practice pilates and lift weights. I practice what I preach. I understand your sport from personal experience and advanced education. I am also a mom. I know how hard it is to get back in the game after having a baby. I think that makes me unique and all the hard work helps me relate to my patients. Anya and I are both athletes and specialize in helping people return to their active lifestyle. This is the main thing that sets us apart from other clinics in this amazing community. We are so lucky to live and work here and proud to be specialists in helping athletes get back to the things they love.

Photo Credit: John Sieber Photography

Photo Credit: Tom Robertson Photography

Photo Credit: Vo von Schlen

Photo Credit: Owen Gue

How to Safely Increase Your Running Mileage

One of the primary causes of running injury is increasing mileage too quickly. Although it's not even February, some folks are beginning to think about ramping up mileage whether it's training for Boston Marathon or an early season 50k (anyone else signed up for Chuckanut 50k on March 19th?). I am sharing a useful, evidence-based guideline for safely increasing your running mileage. Feel free to email me with any questions regarding this article at endurancephysioanya@gmail.com.

Sorry about the small print. I have re-typed the smaller print below if you are having difficulty reading.

New insights

Although runners, coaches, and health care providers commonly use the 10% rule, more science is needed to understand its role in injury prevention. Researchers followed 873 new runners for 1 year; during this period, 202 runners had a running-related injury. The researchers compared runner injuries based on each participant’s weekly increase in running distance: less than 10%, 10% to 30%, and more than 30% in the

2 weeks prior to injury. Runners who increased their mileage by more than 30% had a higher injury rate than those who increased their mileage by less than 10%. Runners who ran farther faster were at higher risk for patellofemoral pain (runner’s knee), iliotibial band syndrome, medial tibial stress syndrome (shin splints), patellar tendinopathy (jumper’s knee), greater trochanteric bursitis, and injury to the gluteus medius or tensor fascia latae (see illustration). However, other types of injuries were not linked to the 10% rule, such as plantar fasciitis, Achilles tendinopathy, calf injuries, hamstring injuries, tibial stress fractures, and hip flexor strains. The authors suggest that these injuries may be related to other training errors. 

Practical advice

A sudden increase in weekly running distance by more than 30% over a 2-week period may put runners at increased risk for developing running-related injuries. The lowest injury rates were found in new runners who increased their weekly mileage by less than 10% over 2 weeks. However, other running injuries may be linked to running pace, increasing running speed, sprint training, or other training errors. If you are starting a running program, your physical therapist can help customize a safe running progression to meet your needs. For more information on a personalized running program, contact your physical therapist specializing in musculoskeletal disorders and running-related injuries. 

Running Injury Prevention Tip for the Weekend

You should not run to get fit, you have to be fit to run.

Ask yourself, is your body "fit" for the daily recreational tasks you ask it to perform? January-March is a great month to get yourself fit to tolerate the mileage and racing you may have planned for the warmer months. Here are two scenarios that I implore you to avoid:

1. Neglect to perform additional strengthening and cross training during the off-season and find yourself disappointed in your performance at your first race in May. You could tell that you lacked the power to get up those hills as quickly as your fellow racer and you decide you had better start doing some extra strengthening in order to "get your butt in gear" for your next race in June. So, you hit the high intensity strength workouts at your local fitness center. Your body's tissues can't take the additional loads from strength training in addition to continued increase your weekly mileage, and you end up with muscle strain or tendonitis, forcing you to take weeks off of running.

2. Decide that you want to "get fit" as a new years resolution and start running off-the-couch as your method to do so. After 3 weeks of running for 30 minutes every day on your lunch break, your knee starts to hurt, and you give up on running. I'm not saying you shouldn't start running, just make sure your progression is gradual (10-20% increase in weakly mileage) and assure you are performing some routine strengthening routine in addition to a gradual increase in your running mileage. Strengthening should focus on core and hip stability exercises as well as dynamic single leg balance and squatting.

Feel free to email me with questions at endurancephysioanya@gmail.com.

Thanks for reading! 

Christmas Vacation Recap from Endurance Physio - Missoula Physical Therapy

Endurance Physio took a few days off for the Holidays to celebrate family and play in the snow. We hope you all got to spend a few days celebrating with loved ones and doing whatever it is that makes you happy!

                     Hilary and her husband John took advantage of a powder day at Big Mountain Resort

Anya got to skate ski with her Dad and Sister. Blue sky, and good company made the 10 degree temps and 40 mph winds tolerable and fun! Photo credit: Owen Gue (who was keeping the pace up in order to keep our lungs burning and toes warm)

Anya and her Dad -  A wood chopping family affair. Photo credit: Owen Gue (who was the master wood-chopper when not taking photos)

                  Jamie skate skis with her husband Doug on the pristine Whitefish nordic trails.

                    Jamie hit the slopes with Sabine

Followed by enough hot chocolate to make anyone loopy!

Like mother-like-daughter. Sabine is quickly turning into a little ripper and is totally loving it!

Happy Holidays!!!

Missoula Injured Runner's Success Story!

After completing 11 Miles to Paradise trail race back in May, Chuck was sidelined from running due to nagging hip pain. Ample patience and dedication to 7am physical therapy appointments, as well as cross-training with Momentum trainers Rhea and Kiefer has allowed Chuck to successfully complete the Mt. Jumbo Elk Ramble and the Turkey Trot with no pain!

Congratulations Chuck!!! Endurance Physio wishes you continued success with your running endeavors for 2016!

How Anya's 3D running analysis helped her reduce her achilles and low back pain pain associated with running...

Endurance Physio is very excited to be partnering with the University of Montana Movement Science Lab in order to offer 3D running analysis services to aid in injury rehabilitation, prevention, and performance enhancement. Anya would like to share one pice of her personal 3D running analysis that has been beneficial in improving her running experience.  

                                         During the running analysis. Photo by Tom Robertson

As an avid trail runner and physical therapist, I am constantly evaluating my running mechanics, and any possible asymmetries that could be contributing to my aches/pains that surface during training. For the past 4 years, I had been able to feel my running gait change in symmetry, but I hadn't quite been able figure out what I'm doing. In the meantime, I had developed significant right achilles and right sided low back pain, which I believe is related to my faulty running mechanics. I had been able to manage this pain so that I could continue running, but the overall trend had been gradual increased pain, which was making me nervous. 

I had been working on functional hip and core stabilization, which had improved my low back pain to a degree. I had also been doing eccentric heel raises diligently for my achilles tendinopathy with some improvements, but I could tell I was missing something.

I have been fortunate enough to be working with Dr. Ryan Mizner, PT, PhD in the UM Movement Science Lab on  implementing the use of a 3D camera system as a tool for in-depth biomechanical movement analysis of athletes. In the process, I was able to collect data on my own running mechanics and analyze the results to see if I could gain some new insight and decrease my pain. 

My results revealed some abnormalities that I had already suspected (which I will not go into at this time), but one finding in particular has really helped me make a few slight alterations that I believe have improved my low back pain and achilles symptoms. 

The image below is one of the significant findings from my 3D running analysis. The graphs that we generate can be tricky to understand, but the point is, my right (the red line) is quite different than my left (gray line). The circled peak at the bottom of the curve indicates my peak hip extension, the angle between the pelvis and thigh, as the leg advices backwards during the gait cycle (see image to the left).

You can see that my left side is about 5 degrees whereas my right side does not actually pass neutral (the dark horizontal line). Ideally, they would both be at 10-20 degrees. If you watch me run, you would likely not notice this difference because I have been able to find compensatory movement patterns to get that right leg behind me. Because my thigh was not extending at the hip, I was likely tilting my pelvis forward and arching my back causing excessive compression and pain. 

This finding relates to another asymmetry that I discovered at my ankle. The graph below depicts my ankle motion. You can see that the red line, depicting my right ankle (red) is consistently below my left (gray). Therefor, I am constantly in a more plantar-flexed (toe pointed) position throughout the entire gait cycle, indicating excessive use of my calf and achilles for shock absorption and push-off. No wonder my achilles was sore! This may have resulted in or have been a product of my lack of hip extension. This makes more sense if you try the following activity: Stand in a staggered stance with your left foot about 2 feet in front of your right with your right heel on the ground. You will notice that your right ankle is relatively dorsi-flexed (opposite of plantar-flexed, so pointed back), and your right hip is relatively extended. If you lift your heel off the ground, you will notice 2 things: your ankle will be less dorsiflexed, and your hip will be less extended. Get it? 

As it turns out, these asymmetries were primarily due to faulty movement patterns that I had developed as opposed to mobility deficits. With this knowledge, all I had to do was consciously think about landing with less point in my right foot, keeping my right heel on the ground a little longer, and allowing my hip to extend with my glut while keeping my core engaged. It may sound like a lot to think about, but a few drills helped solidify this movement change. To my surprise and delight, I have significantly less achilles and back pain. 

If you have any interest in a 3D running assessment, call Endurance Physio to discuss you options. We might be able to help you discover some useful information...and you can even get in a glamorous sweat shot if you want;) 

                                    Anya, post-running analysis.  Photo by Tom Robertson

Feel free to email me at endurancephysioanya@gmail.com with any questions or comments.

Thanks for reading!

Meet Hilary, she's our engine

If you haven't been into the clinic and met Hilary, you should. Hilary has been with Endurance Physio since the beginning and is a total rockstar. Let me tell you why. When we opened Endurance Physio this past summer, one of our goals was to keep all aspects of running the clinic in house. We did this so we could fully understand the dynamic health care environment and how it directly affects our patients. To make that possible, Hilary manages our medical billing, patient care coordinating, scheduling, daily clinic operations and is always smiling. She will answer the phone and answer ALL of your questions and if she doesn't have the answer, she will find it. One of the benefits of receiving PT at a small sports and orthopedic clinic is all of your questions will all be answered by one person. This is your person. We are so very fortunate to have her. She keeps this clinic up running. 

Sucess Story!

Here's what one runner had to say about his experience resulting from a 3D running analysis at the University Movement Science Lab:

"I was thinking about it this morning on my run. It's really made a huge difference. I'm running faster.... But more importantly, more efficient. And without extra effort. All because of that small adjustment. It's kind of blown me away."

-Tom R.