Michelle’s mission is to help you optimize your performance and maximize satisfaction, in sport and life, and to encourage the adoption and maintenance of healthy lifestyle behaviors for total health and well-being.

If you’re interested in setting up an appointment with Michelle, please contact her directly at (919)990-1006. She will be seeing clients in Carrboro on Fridays.

For more information, visit www.balanced-movement.com/sports-psychology

No whining

If you love endurance training, an injury this early in your training can be deflating. Forced down time can be a major pain. Keep things in perspective. The world isn’t going to end tomorrow. There are many people that you and I both know who aren’t or maybe will never be able to enjoy endurance sports. They may have severe illnesses or diseases. You get to go back and do something you really love. Yes, you will get better, and your love of what you do will bring you back. So, keep a positive attitude and stay positive. This will help speed your recovery.

Be patient

Injuries get better; it is their natural progression. Most of the pains and injuries you might experience because of endurance training heal when the environment for healing the tissue is optimized and sufficient time passes. Most of the time there are no magic pills to fix the problem. You will heal, so be patient and give the healing process the time it needs.

If you have a routine, stick to it

If you normally run at lunchtime, continue to get some sort of exercise at lunchtime. If you’re an early morning runner, go for a walk early in the morning. Continue your ritual stretching after your exercise time. There is more to your routine then just the exercise. The time you set aside for yourself is also important. Maybe, this is when you do your best thinking, or maybe it is your shut down time. Either way, it is YOUR time and there are probably a ton of things waiting to take that time. Don’t give that up. It will make it harder to start again and you will reap your mood boosting benefits from the routine itself.

Do it outdoors

This time of year it is tough enough to handle the short days. Many of us, benefit greatly from the exposure we have to daylight. There are physiologic benefits to endurance exercise that positively effect mood and happiness. Fresh air and increased sunlight can also help. Take advantage of it. It will help you maintain a positive attitude.

Sweat

If you normally work out for 45 minutes, then do another activity that doesn’t aggravate your injury for the same amount of time. You might need to do the activity a little more vigorously in order to produce as much sweat as you usually produce, but you will begin to satisfy your ego and need to work hard and feel good about yourself. You will also maintain your aerobic base, which you have been working so hard to develop. Not to mention burning those calories.

Lift weights

I don’t know about you, but when I’m gearing up for a long endurance event, the last thing I want to do is throw lead around in the gym. I barely have enough time to do all of the running and stretching I need, much less mix in weightlifting.

When you are hurt, weights can be a godsend. Since you are often at the gym anyway, riding a stationary bike or the elliptical trainer, it’s not a big deal to spend another 20 minutes with weights. And, because you’re not running, doing more legwork than usual, along with some abdominal and upper body stuff is not a big inconvenience. You might even gain strength and better prepare yourself for your future events.

Stay connected

One of the most difficult aspects of being injured is not being able to train with your friends. The only time you might see some of them is when you run or ride together. So when out of action, make an effort to stay in touch and at least feel like you’re a part of the scene. A good way to do this is to volunteer to help out at events.

You also get to spend more time with your family. They normally make all sorts of concessions to your training, so while your injured, do the activities they want to do. You might have a newfound respect for and from your community.

Do something every day to get your health back

While injuries can be markedly different, most of them respond extremely well to rest and treatment. If there are things you can do (see a Physical Therapist or other health care provider) that can help you, do them. Very often, there are simple things you can do that will get you back to the activity that you love. Most injuries occur for a reason, fixing the cause will stop you from re-injury and possibly improve your performance. By taking action, you’ll speed recovery, achieve peace of mind, and possibly achieve self-improvement along the way.

Focus on today

As we get older, injuries may take longer to heal. Don’t set yourself up to fail. Just because you had a similar injury in the past and it only took 2 weeks to go away, doesn’t mean it will be the same story again. Arbitrary deadlines for healing can be very disappointing. You may have to forget about that upcoming race you were planning on. Just because you sent in that entry form, doesn’t mean you will be healed by then. Even if you are, lower your expectations and be happy you made it to the starting line. Celebrate the day. You are fortunate. Happiness lives in the journey and your still traveling.

The event raised $5,000 for the park, to contribute to maintaining the trails, forest, and river.

Many thanks to the TrailHeads for putting on such a great event! If you haven’t run at Little River before, make sure to check it out!

Catherine worked in outpatient orthopedics for five years in Washington State before making a recent move to North Carolina. She is excited to be joining Balanced Physical Therapy in both the Carrboro and Durham locations. Her areas of interest include orthopedics, sports, and manual therapy.

Michelle is one of only 300 Dietitians in the United States Board Certified as a Specialist in Sports Dietetics. Through experience working with many high level athletes and personally competing as a Division I track & field athlete, Michelle has expertise in all aspects of Sports Nutrition. Michelle is passionate about helping all individuals with exercise, medical, and wellness nutrition issues. Her passion is helping all types of people maximize their athletic, psychological, and daily performance through realistic and sustainable nutrition strategies.

To learn more about Michelle and how she can help you, visit www.balanced-movement.com/nutrition

Tight, sore and sometimes chronically strained hamstrings are a common issue with running. Triathletes are particularly susceptible to these issues. The aero bike position forces the hip flexors (in the front of the hip) and hamstrings (the back of the thigh) to work in shortened positions. Anyone that has transitioned from bike to run has experienced the (hopefully) temporary effect of this as the muscles adjust from the unique demands of each activity.

If you have attempted hamstring stretching but not been able to change your issue, you may want to evaluate your flexibility in the front of the hip on the opposite side from the sore hamstring (or both sides if they both complain). Research on running gait shows an interesting relationship between the hamstrings and hip flexors on opposite sides.

In running gait the hamstring reaches it’s maximal length just prior to the forward moving foot striking the ground. The hip flexor reaches its maximal length just as the rear leg begins to leave the ground. Interestingly, these two actions occur simultaneously. If you think about this, it makes sense, so what? Well, the interesting part of the research is that if the hip flexor is tighter on one side than the other, it will automatically cause you to contract the hamstring excessively on the other side during your running gait. Meaning if one leg gets tight as it moves back, the hamstring must be excessively active to stop the other side from moving forward.

At best, this creates imbalances and inefficiencies in running. At worst, it causes injuries or perpetuates them so that full healing never occurs. Here are a couple of movements that one can use to assess symmetry. In an ideal world, both of these will feel the same on each side. If you notice a difference, then you know where you need work.

Low Lunge: Start the low lunge with the back knee directly under the pelvis and the thigh vertical. Bring the pelvis forward as far as you can without changing the curve of the spine.

Forward Bend on Wall: Place the feet equal distance from a wall and then lean the pelvis back so that both sides make equal contact with the wall. From this position, forward bend so that any differences or shifts can be clearly detected.

This clinic focused on the biomechanics of running, where common injuries stem from, and how to properly train your “core.”

[Download Flyer]

Free Educational Workshops for Breast Cancer Survivors
Please join us for a FREE four part lecture series with accompanying movement awareness via the Feldenkrais Method®

Sunday Afternoons 3-4 pm @ our Carrboro office
January 18th: What is Lymphedema? / Skin Care
January 25th: Exercise
February 1st: Compression
February 8th: Manual Lymph Drainage

About Feldenkrais®: Oftentimes, one’s arm becomes stiff and painful after surgery or radiation. Using the Feldenkrais Method is an opportunity for self-learning to examine habits of movement and facilitate more freedom through the neck, arm, shoulder, ribs, and breath. Come with a spirit of inquiry and adventure!

Valerie Collins PT, CLT-LANA Val Collins is a 1983 UConn graduate and is a national certified lymphedema therapist after attending the Academy of Lymphatic Studies. She works with breast cancer, lymphedema, and swelling disorder patients to help them achieve their goals.

Diana Griffin PT, CHT, CFP Diana studied the Feldenkrais Method and became a certified practitioner in 2003. Since that time, she has worked with people who have persistent pain that has been resistant to other interventions, helping them find ways to move with greater ease and integrity.

To register, call (919) 942-0240

Eleven percent of the population aged 64 years or older have symptomatic osteoarthritis of the knee.¹Â  The condition causes seniors to live with reduced mobility, daily pain, and the emotional consequences of pain & impairment.  Many seniors do not ask for help.  A study conducted by the Arthritis Foundation in San Mateo, CA showed that more than 50% of people suffering from arthritis did not believe or were not sure that doctors knew of anything that could improve their condition.²Â  A referral to Balanced Physical Therapy is one of the very effective things you can do to help your patients with osteoarthritis.  Research has shown that a short program of progressive strengthening, stretching, home exercise training, and possibly taping can produce long lasting results for your patients.

PT Proven Effective: Deyle et al conducted a randomized, placebo controlled study of eighty-three patients with confirmed osteoarthritis of the knee.³Â  Physical therapists treated both groups twice weekly for four weeks.  The treatment group received a combination of manual therapies and supervised exercises.  Exercises involved progressive strengthening, stretching, and conditioning of calves, hamstrings, and quadriceps.  The placebo group received ultrasound therapy at subtherapeutic intensity.  The treatment group demonstrated improved symptoms and greater six-minute walking distances.  The improvements were maintained after one year.  After one year, the treatment group had significantly fewer knee surgeries than the placebo group.

Home Exercise Shown Advantageous: Thomas et al randomized people suffering from osteoarthritis of the knee into four groups: home exercise plan, monthly telephone contact, monthly telephone plus exercise, and no exercise.⁴  Six hundred participants completed the study.  Researchers met with each home exercise participant four times over two months to supervise the home exercise program.  They developed a home exercise program to maintain and improve muscle strength around the knee, knee range of motion, and locomotor function.  The program used elastic bands to progressively increase the intensity of the exercises.  At two-year follow-up, the home exercise groups showed significant improvements in stiffness, muscle strength, and physical function.  There was a 12% reduction in knee pain.  Those who adhered best to the exercise regimen achieved the best results, but even moderate adherence produced significant results. 

Taping Shown Advantageous: Hinman et al randomized 87 participants with osteoarthritic knees into three groups: therapeutic taping, control taping that provided only sensory input, or no taping.⁵  The mean duration of symptoms was nine years.  After three weeks of taping by a physical therapist, the therapeutic taping group was seven times more likely than the untreated group to report reduction in pain.  The therapeutic group also reported significant improvements in disability and other secondary measures.  The improvements were sustained over three weeks.  The authors speculate that changes in the distribution of patellofemoral joint pressures may improve proprioceptive acuity, qaudricep strength, and neuromotor control of the knee.

At Balanced Physical Therapy, the therapeutic approach for osteoarthritis of the knee corresponds with the research published in the Annals of Internal Medicine^3,4 and the British Medical Journal.⁵  By combining efficient physical therapy programs, home exercise programs, and other proven effective approaches, Balanced Physical Therapy provides a proven option for improving the lives of your patients with arthritis.

REFERENCES

1. Felson DT, Zhang Y. An update on the epidemiology of the knee and hip osteoarthritis with a view to prevention. Arthritis Rhuem 1998; 41: 1343-55.
2. Communication Technologies. A study of help-seeking among individuals with musculoskeletal conditions in San Mateo County. National Arthritis Foundation. San Francisco, CA 1993.
3. Deyle GD, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med February 1, 200: 132: 173-81.
4. Deyle GD, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med February 1, 2000; 132: 173-81.
5. Hinman RS, et al. Efficacy of knee taping in the management of osteoarthritis of the knee: blinded randomized controlled trial. BMJ July 19, 2003; 327: 135-8.

©BMA 2008

For years, Balanced Physical Therapy has managed cases of swelling and lymphedema reliably and effectively.  Balanced Physical Therapy has served this community for almost a decade.  We put at your disposal more than a century of combined physical therapy experience, and our team includes a physical therapist certified by the Lymphology Association of North America (LANA).  Balanced Physical Therapy stands ready to help your patients manage swelling to prevent lymphedema and to help patients manage lymphedema when it does occur. 

Recommended Frequency, Duration, and Therapist Training:
A simple course of two visits plus education and home exercise may be all that is necessary to prevent simple swelling from becoming lymphedema.  For management of existing lymphedema, the research based position statement of the National Lymphedema Network states, “Optimally, CDT is performed until the reduction of fluid volume has plateaued, often after 3 to 8 weeks. . . At present, it is unclear to what degree deviation from the intensive and integrated approach that is the hallmark of CDT (Complete Decongestive Therapy), will compromise lymphedema treatment outcomes.”  The National Lymphedema Network position statement also states: “Therapists providing CDT should have completed at least 135 hours of training as recommended by the Lymphology Association of North America.”  If lymphatic management treatment plans have reduced frequency, fewer elements, or lesser-credentialed professionals compared to that called for by the nationally recognized recommendations, both the patient and the treating physician should fully understand the rationale for delivering lesser care.  The Lymphatic Management Program at Balanced Physical Therapy fully complies with current, research-based recommendations for intensive frequency, program elements, and therapist training.  A licensed physical therapist certified by LANA designs all treatment plans and delivers all the hands-on lymphatic treatments.  Our Lymphatic Management Program includes manual lymphatic drainage, compression therapy, compression garments, remedial exercises, home exercise training, and lifestyle fitness training.

Research:
Large case series on complete decongestive therapy demonstrate limb volume reductions of 50-70%, enhanced cosmesis, and reduced incidence of cellulitis.^1-4  Research involving lymphoscintigraphies has demonstrated that manual lymphatic drainage stimulates accessory routes useful for resorption of lymph.⁵  Numerous studies have demonstrated the safe efficacy of complete decongestive therapy^1-4 (which involves compression garments) and of manual lymphatic drainage alone^6-10 (without compression garments). 

Delivering Personal and Professional Experience:
Val Collins earned her physical therapy degree at the University of Connecticut in 1983.  Soon after moving to Chapel Hill in 1995, she began experiencing swelling and pain in her foot and leg.  While the problem proved life limiting in many ways, the inability to get a clear diagnosis or an effective treatment proved frustrating.  It seems that the combination of a bug bite and a transatlantic flight triggered lymphedema in her leg.  After ten years of not giving up, Val finally received Manual Lymphatic Drainage.  Val was so impressed by the therapy’s ability to resolve her symptoms and by the growing body of research on lymphatic drainage that she completed formal training to become LANA certified.  Now, Val Collins, PT works as part of the Balanced Physical Therapy team to improve the lives of your patients.

Please let your patients know that Balanced Physical Therapy serves as a reliable and effective choice for Lymphatic Management Programs.

REFERENCES

1. Cheville A, McGarvey C, Petrek J. et al. “Lymphedema management.” Semin Radiat Oncol. 2003; 12 (3): 290-301.
2. Fiaschi E, Francesconi G, Fiumicelli S. “Manual lymphatic drainage for chronic post-mastectomy lymphodema treatment.” Panminerva Med. 1998; 40 (1): 48-50.
3. Liao S, Huang M, Chou Y. “Successful complex decongestive physiotherapy for lymphedema and lymphocutaneous reflux of the female external genitalia after radiation therapy.” J Formos Med Assoc. 2003; 102(6): 404-6.
4. Leduc O, Leduc A, Bourgeois P. “ The physical treatment of upper limb edema.” Cancer. 1998; 83 (12 Suppl American): 2835-9.
5. Ferrandez J, Laroche J, Serin D, et al. “Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.” J Mal Vasc. 1996; 21 (5): 283-9.
6. Kafejian-Haddad A, Perez J, Castiglioni M, et al. “Lymphscintigraphic evaluation of manual lymphatic drainage for lower extremity lymphedema.” Lymphology. 2006; 39 (1): 41-8.
7. Williams A, Vadgama A, Franks P. “A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema.” Eur J Cancer Care (Engl). 2002; 11 (4): 254-61.
8. Kligman L, Wong R, Johnston M, et al. “The treatment of lymphedema related to breast cancer: a systematic review and evidence summary.” Support Care Cancer. 2004; 12 (6): 421-31.
9. de Godoy J, Batigalia F, Godoy F. “Preliminary evaluation of a new, more simplified physiotherapy technique for lymphatic drainage.” Lymphology. 2002; 35(2): 91-3.
10. Herpertz U. “Outcome of various inpatient lymph drainage procedures.” Z Lymphol. 1996; 20 (1): 27-30.

©BMA 2008