Tony has been training for the Pittsburgh marathon and someone asked him how he chooses a goal race. He broke it down into five easy steps... 

1. Decide how far you want to race:

You can choose any distance race from a 5K to an ultra-marathon.
5K - 3 miles
10K - 6 miles
Half Marathon - 13 miles
Marathon - 26 miles
Ultra Marathon - 50 to 100 miles
Triathlons - vary between 16 - 140 miles

2.  When do you want to race? AND when do you want to train?
 
When considering what season you want the race to take place (Spring, Summer, fall, Winter) you also need to consider when you want to train. For instance, if you want to do a fall race, your training will take place during the summer. 
 
 How much training time you’ll need will be discussed in an upcoming step. 
 
3. Where do you want to race?
 
Do you want to race locally or are you looking for a destination race? There are a lot of factors that go into making this decision that should be considered (fees, accommodations, terrain, etc.). To locate races you can use these two resources: 
runningintheusa.com 
trifind.com
 
4.  What terrain / conditions do you want the race to be in?
 
This will help determine where you want your race to be held. Think about the terrain that you’re looking for - do you prefer flat runs or do you love running up hills. 
Flat race, hilly race. Also take into consideration the climate / weather of the place you’re considering - is it typically humid around the time of the race? What will the temperature be? 

5.  Assess your current fitness level:

Your current fitness level will not only determine the length and type of race you’re ready for but it will also help you determine how much training you need to prepare for the race. If you’re a beginner you’re going to need an optimal amount of time to train and prepare. Typically you need:  

4-6 months to prepare for a marathon
3-4 months for a Half marathon
8-12 weeks for a 10k
4-8 weeks for a 5

We received a question from one of our patients about running cadence. He’s preparing for his first marathon and so he asked Tony if his running cadence could improve his running speed.

Running cadence, or stride rate, is a measure of how many strides per minute (SPM) are made while running.  You can find your cadence by counting how many times your right or left foot hits the ground within sixty seconds, then multiply that by two. It’s important to note that cadence changes with different runs. 

You can’t discuss cadence without considering stride length. The two of these factors come together to determine how fast you’re running. One runner could have a fast cadence with a short stride and another with a slow cadence and long stride and yet they both could be running together. 

What is a good running cadence?

It was widely thought that a rate of 180 SPMs per minute was optimal but that theory has been debunked. 
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Recent studies show that everyone has their own natural running cadence and there is no such thing as a ‘one size fits all’ approach. As you’re running you will naturally find a pace you feel comfortable with but that’s not to say that you can’t improve your cadence (more on that further into this blog).

So which is better - a fast or slow cadence?

From a Physical therapy stand point, taking shorter and faster steps will make you a more efficient runner and will reduce the impact on your joints. When you take large strides, you’re stretching your legs out further and landing heavily onto your heels (heel strikes). Heel striking vs. midfoot striking is another debate that we will discuss in the future. 

Shortening your strides can reduce injury risk because you’re not over activating leg muscles and putting too much force through your knees. 

Is cadence the most important factor for running?

As a physical therapist and a running coach, Tony says no. Experts have taken a look at the different cadences of marathon runners and the numbers are all over the place. There have been runners that win with 155 SPM and others that have won with 205 SPM - so a very large range and there isn’t a clear cut number to strive for. 

In terms of trying to improve overall performance, Tony suggests focusing on the follow metrics: 

• RPE - Rate of Perceived Exertion 
• Heart Rate/Zone training
• Speed or Minutes per mile 

These metrics will gauge how hard you’re working on your runs. So in terms of improving performance, cadence is not the most important thing and in terms of injury, cadence is something to focus on.

Working on your cadence:

You can use a metronome, some higher end watches have one built in.  
Run to music - find songs that have a faster or slower BPM (beats per minute), depending on what you’re looking for. 

Tips to improve cadence:

•     Tony recommends improving in small increments. Don’t try to go from 150 SPM to 180 SPM, instead steadily increase by 5% increments on each run.
•     Start with a few sessions on a treadmill. Tracking your cadence is easier when you don’t have to worry about a bump in the road or a hill/incline. It makes for a more controlled environment. 

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A patient slipped and fell while taking out the trash. The fall resulted in a dislocated shoulder. The injury left her unable to move her shoulder for a prolonged period of time - eventually causing frozen shoulder, also known as adhesive capsulitis.

Frozen shoulder is a condition where you experience pain and stiffness in your shoulder joint capsule, eventually losing mobility - hence the name frozen shoulder.

Signs and symptoms can occur gradually or within a short period of time. For some people it may happen overnight, for others it will gradually get worse over the course of weeks or even months. 

Symptoms - you will start experiencing pain in the shoulder and then your range of motion will steadily decrease. You may start to notice that you can’t lift your arm past your shoulder, then eventually not at all. 

How does it happen?

Your bones, ligaments, and tendons that make up your shoulders are encased in what’s called a capsule. Frozen shoulder happens when this capsule thickens and as a result, tightens, causing your shoulder to become immobile. 

Things that put you at more at risk -

• Surgeries or medical conditions that prevent you from moving your arm for long periods of time (strokes, rotator cuff surgery, labral repair, breaking your arm).

 

• Systemic diseases - the main one being diabetes as well as having an over or under active thyroid 

The most common cause of frozen shoulder is shoulder surgery. Most shoulder surgeries cause you to be in a sling for a prolonged period of time. This immobility of your shoulder makes you more susceptible to frozen shoulder.

How is frozen shoulder diagnosed?

A physical therapy can diagnose frozen shoulder by moving the arm around and documenting the patient's range of motion.

Your doctor can use imaging tools such as X-Rays, MRIs, or an ultrasound to rule out other possible causes of the pain and stiffness such as shoulder dislocation, torn rotator cuff or arthritis. 

Frozen shoulder treatment - 

Some treatment options include…

• Physical therapy focusing on joint mobilization and strength training exercises
• Steroid Injections 
• Shoulder manipulation (surgical intervention) - a surgeon manipulates the joint to release scar tissue. 
• Arthroscopy (surgical intervention) - a surgeon cuts or releases the tissue​

​Thanks for reading!

Did you watch the super bowl? Did you hear the announcers say “ACL”?

Joe Burrow, the starting quarterback for the Cincinnati Bengals tore his ACL two years ago, and during the game, former New York Giants wide receiver (currently on the LA Rams) Odell Beckham Jr. tore his!
ACL stands for Anterior Cruciate Ligament. 

What is it?

It’s one of the primary ligaments in the knee, along with the Posterior Cruciate Ligament (PCL) Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL)
So how does an ACL tear?

The majority of ACL tears come from non-contact injuries - when a person themselves places great force or movement on their knee to cause injury. They can also tear with contact injuries which is when there is a valgus force (force from the side) on the knee from the force of another person. 

In field sports a big culprit of non-contact ACL tears is from what we call the “turf monster”. This is when the turf catches the person’s foot while they’re running or trying to come to a stop on the field. Which is how Odell Beckham Jr. tore his ACL.

There is also an increase in ACL tears among women, most likely due to the Q Angle  (The angle between the hip and knee) - something that we will touch on in more depth on another Five Minute Friday episode.
Rehab for an ACL tear typically involves surgery as there is poor blood supply to this ligament. Therefore, it’s unlikely to re-heal itself. ACL tears are generally replaced by a graft of another tendon, such as:
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• Patellar tendon (most common)
• Hamstring tendon
• Allograft - tendons from a cadaver 
• Gracilis tendon (least common)

Generally a return to sports is a 9 month timeline, obviously there are always outliers (Adrian Peterson) but 9 months is a framework that most protocols revolve around. 

We will go more in depth of return to sport on another episode of 5 Minute Friday. Stay tuned!

Thanks for reading!


By: Dr. Tony Tanzi, PT, DPT, CSCS and Dr. Kyle Ioos, PT, DPT

You're fresh out of surgery and you arrive to physical therapy in your sling. You're not allowed to move your arm but your physical therapist is... 

This is what we call manual therapy.

It's when a physical therapist is doing any skilled intervention (treatment) with their hands.

There are 3 main reasons to do manual therapy:

Reduce Pain
Improve tissue tension
Improve mobility / range of motion

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These are all great to do at the early stages of treatment, meaning in your first few visits due to the higher level of pain you are experiencing. As your pain decreased we will transition you off of manual therapy and onto more functional based exercises. We broke down manual therapy into six different types:

1. Passive Range of Motion:
This is when a Physical Therapist is moving your limb through a motion and you are
totally relaxed, letting the therapist do all the work.

2. Joint Mobilization
This is when the Therapist will try to loosen a specific joint capsule, again with you the
patient being totally relaxed

3. STM or MFR
Soft tissue massage or Myofacial release are two types of “massages” to relieve tissue
tension.

4. Transverse friction massage
This is usually performed across a healed scar or over scar tissue in a “transverse”
direction to aid in breaking up scar tissue.

5. Strapping
A massage is done on a muscle while there is movement.

6. Effleurage
Primarily used to decrease swelling of the limbs in post surgical patients. This type of
manual therapy gently attempts to circulate the swelling back into the system.

Manual therapy is NOT what we would call instrument assisted therapy (IASTM). This type of therapy is when a Therapist uses tools (graston tools, cupping tools etc) to assist with the manual techniques.
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It is important to note that manual therapy is best used at the early stages of your treatment. As you progress it is vital to transition to more functional based activities and exercises. This helps you the patient regain independence and get back to living an active lifestyle!

By: Dr. Kyle Ioos, PT, DPT and Dr. Tony Tanzi, PT, DPT, CSCS

“I have pain that starts in my low back and goes down my leg, what is it?

Ah, yes, good old - SCIATICA!

What is sciatica you ask?

Sciatica is nerve pain in your lower back that radiates down your leg and is caused by an
irritation, inflammation or pinching of a nerve in the lower back. The most common cause is a herniated disc or slipped disc.

Did you know?

The sciatic nerve is the longest and thickest nerve in the body.

What does Sciatic pain feel like?

Sharp, shooting, jolt, burning, electric or even jabbing pain that travels anywhere from your buttock down to your toes.

But I have pain in both legs, is that Sciatica?

Although it is unlikely to be affecting both legs, it CAN happen.

Does sciatica happen suddenly or slowly over time?

Both - Sciatica can come on suddenly or gradually. It all depends on the cause. A disk
herniation will cause sudden pain where arthritis in the spine will develop slowly.

Who is at risk for sciatica?

- Anyone with a previous back injury - any injury to your lower back puts you at risk.
Overweight - Increased weight or load on your spine can lead to back strains and pains
Lack of core muscles - the core is what protects your spine and gives you support.
Manual labor or active jobs - heavy lifting / bending puts you at high risk
Have osteoarthritis - any damage to your spine will compromise the nerves
Inactive lifestyle - prolonged sitting or not being active can make your muscles stiff can increase your risk
Pregnant women - certain hormones of pregnancy cause loosening of ligaments making the spine less stable

What are the common causes of Sciatica?

Herniated or slipped disc
Degenerative disk disease (natural wear down of the discs between the vertebrae of the spine)
Spinal stenosis (narrowing of the spinal canal)

How do you diagnose Sciatica?

PTs use what's called a Straight Leg Raise Test

MDs can use:
X-rays
MRIs
Nerve Conduction Velocity test
​
How is Sciatica Treated?

Various manual techniques, stretches and exercises all go into a proper sciatica plan of care.

If you or someone you know are suffering from Sciatica pain or discomfort, text
BACKPAIN to (845) 225-2000 and I will send you a video with 3 simple exercises to help
alleviate or reduce your pain!

Don’t wait, text BACKPAIN to our number (8452252000) and you can get started in
reducing your discomfort!

We get this all the time:

“On my script it has ultrasound checked off. I just want to know what is ultrasound and what is it used for?”

There are two types of ultrasound: Diagnostic and Therapeutic.

Diagnostic: Sound waves are used to create a real time image
Therapeutic: (What we use) To put it simply, the ultrasound machine produces an electrical current that is converted into acoustic energy through the transducer.

In order for this acoustic energy to be absorbed into the body, we use a coupling agent. This is where the blue gel comes into play. This gel decreases acoustical impedance by eliminating as much air as possible. This allows us to more effectively direct this energy to our target area

Why do we use it?

Therapeutic ultrasound is considered a deep heating agent, so unlike moist heat and hot pads, ultrasound can increase tissue temperature at a depth of 5 cm. This allows us to more effectively treat deep structures like muscle. Ultrasound has the potential to decrease pain, muscle spasms and joint stiffness as well as help facilitate tissue repair.
We personally like to use ultrasound early on in a patient's rehabilitation when movement and exercise is contraindicated or not well tolerated. 

​With that said, ultrasound is not indicated for everyone and their are contraindications that your therapist must screen for prior to providing treatment
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