Welcome

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Welcome to Health and Fitness 101, a blog for people who enjoy the Montana lifestyle.
The aim of our blog is to interpret, distill, and then deliver to you the threads that bind physical medicine with applicable health and fitness ideas and principles.
It's all about helping to connect the dots that foster optimal human function and, ultimately, superior performance. Feel better. Perform better.

Missoula Area Events

Getting to the Core Postpartum

Sam Schmidt, MPT,  returns to some basic reformer footwork while her new little guy gets in some tummy time! Its all about multitasking and doing what you can when you can, as any active parent will attest to!

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Taking Pain Treatment to the Next Level at Alpine PT

Last weekend, several of Alpine’s physical therapists attended an excellent course here in Missoula on helping patients with persistent pain issues by way of mobilizing their nervous system. 

Brent Dodge, Gary Gales, Dennis McCrea, and Brace Hayden took a two day continuing education class designed to help people with chronic pain and irritable back, neck, and extremity issues move and feel better.

Re-educating the body that ‘movement is good medicine’ is a helpful approach for those in pain that avoid healthy mobility. The course was a thorough approach to assessing and treating this patient population with a lot of dynamic interventions to optimize their return to a higher level of activity. 

Here Gary Gales mobilizes the radial nerve path in the arm of our co-worker Dennis McCrea. 

For more information about the approach Alpine Physical Therapy takes to help people with persistent pain, visit our webpage describing our Pain Clinic by clicking here.

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Last weekend, several of Alpine’s physical therapists attended an excellent course here in Missoula on helping patients with persistent pain issues by mobilizing their nervous system. 

Brent Dodge, Gary Gales, Dennis McCrea, and Brace Hayden took a two day continuing education class designed to help people with chronic pain and irritable back, neck, and extremity issues move and feel better.

Re-educating the body that ‘movement is good medicine’ is a helpful approach for those in pain that avoid healthy mobility. The course was a thorough approach to assessing and treating this patient population with a lot of dynamic interventions to optimize their return to a higher level of activity. 

Here Gary Gales mobilizes the radial nerve path in the arm of our co-worker Dennis McCrea. 

For more information about the approach Alpine Physical Therapy takes to help people with persistent pain, visit our webpage describing our Pain Clinic by clicking here.

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What Is Femoral Head Osteonecrosis and What Are the Treatment Options?

Special thanks to star physical therapist Antara Quiñones of Alpine Physical Therapy for providing this write up on a recent article from the Journal of American Academy of Orthopedic Surgery.

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Osteonecrosis of the femoral head most frequently affects 30 to 50 year olds, with 20,000-30,000 new cases diagnosed annually. Although the actual pathology behind femoral osteonecrosis is not yet understood, the disease typically follows a progression to eventual femoral collapse, which results in the need for a total hip replacement.

Osteonecrosis literally translates to bone death. There are several reasons why this can occur.  Ischemia, or lack of blood flow, is one.  This can happen from trauma, (like a hip dislocation or fracture), a blood clot blocking blood flow, or high blood pressure at the level of the bone tissue from excessive alcohol or corticosteroid use.  Some genetic  blood clot formation mutations have also been linked to femoral osteonecrosis.  Disruption to the bone cells themselves by irradiation, chemotherapy, or the presence of excessive free radicals, also causes osteonecrosis. Primary risk factors include corticosteroid use, alcoholism, trauma, and coagulation disorders.  They have found, however that a risk factor alone does not determine the onset of osteonecrosis, but that there must also be a genetic factor present.

The earlier the disease is diagnosed, the better the outcome.  The most frequent symptom is deep groin pain that can radiate to the buttock or knee on the same side.  The gold standard for femoral osteonecrosis detection is an MRI, which can give insight into the amount of bone death present, its location, and the amount of swelling in the bone.  All of this information can help physicians treat the problem and predict whether or not the femoral head will “collapse.” which then means a need for a total hip replacement.

Nonsurgical treatment of femoral osteonecrosis is limited to smaller, symptom free lesions for a period of no weight bearing to see if symptoms do occur.  Little evidence exists backing shockwaves and electromagnetic field treatment.  Pharmacologic agents are also not strongly backed in the literature for prevention and treatment of femoral osteonecrosis.

Surgical treatment is the primary treatment option for femoral head osteonecrosis and consists of femoral head preserving procedures or total hip replacement.  The type of femoral head preserving procedure is subject to debate and dependent on the extent and location of the bone death. Femoral head sparing procedures are also indicated for the younger patient.

Charalampos G. Zalavras, M.D. and Jay R. Lieberman, M.D. Osteonecrosis of the Femoral Head: Evaluation and Treatment. The Journal of American Academy of Orthopedic Surgery. July, 2014. Vol. 22, No. 7. Pp 455-464.

For more information, visit our topic module on this topic on our clinic website by clicking here.

Best Treatment Options for Lumbar Disc Herniation

Special thanks to star physical therapist Brace Hayden, DPT, CSCS  of Alpine Physical Therapy for providing this write up on a recent article from Spine.

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The incidence of “slipping a disc” in your low back or herniating an intervertebral lumbar disc, in the medical vernacular, while attempting to move that heavy filing cabinet is not uncommon. The ensuing low back pain and often accompanying radiating leg or buttock pain from a bulging disc putting pressure on your spinal nerves is also unfortunately, quite common. Dr. Jon Lurie and a collaborative team of researchers based out of Dartmouth’s Department of Medicine, Orthopedics, Health Policy and Clinical Practice set forth to assess the data of 8-years of outcome research from operative versus non-operative treatment for this debilitating back issue.

Decompression surgery to relieve disc-related spine pain is a well-researched and a highly-accepted indication for spine surgery. While in the throws of an episode of raging low back pain, the quick fix of going under the knife seems like a logical decision, but spine surgery comes with plenty of costs and risks. The questions Dr. Lurie’s team set to answer was: why does the rate of surgery vary so greatly geographically in the U.S, if the surgical option is more effective and faster to provide relief? They also aimed to add to the body of knowledge of high-quality, multiple-testing sites, with randomized controlled trials of prospective surgical (or conservatively managed) effects on patients over the long term.

This study was considered a ‘concurrent prospective randomized and observational cohort study’, as each of the 1,991 eligible participants chose either a route into randomized study (surgery vs nonsurgery) at one of 13 spine clinics participating in this Spine Patient Outcomes Research Trial (SPORT) or the observational group. The observational group got to choose their not-so-random, treatment route of surgery vs nonsurgery. There was plenty of lenience in the eight-year study for either group to opt in or crossover to the other group as their back issue and provider deemed necessary. The nonoperative group was tracked over the course of the study and received the “usual care” recommendations. These treatments were customized to the individual and included at least: physical therapy, back pain education and counseling, and medication management.

All of the enrolled participants received thorough screenings and imaging tests for eligibility (such as >6 weeks of radiating low back pain with a confirmatory MRI), outcome measures and assessments on a regular basis (6 weeks, 3 months, and 6 months, and annually thereafter). Most surgical participants had the standard bulge trimming or ‘open discectomy’ and exam of their pinched nerve root. The study gets highly complicated statistically, as the analyses were multifactorial and convoluted to best capture the longitudinal comparisons of the randomized and observational groups. Lurie et al. provided plentiful and excellent flow diagrams cited in the original paper for those that want to peruse the detailed statistical intricacies behind such analyses as “intent-to-treat” versus “as-treated” groupings.

The results reiterated the hypothesis that usually, effective and selective surgery relieves radiating low back pain. Over the course of this 8-year study, more measurable improvements were “clinically significant” in all of the main outcome measures (ie. bodily pain, physical function, perceived disability) for the surgical group than those who remained nonoperative. However, both groups experienced heavy amounts of statistically challenging “crossover”, as humans tend to change their mind on the question of: Should I Get My Sciatica Relieved Surgically, Or Should I Wait? The common exception for both groups was neither returned to prior work status. Or once you ‘blow a disc’ hoisting that filing cabinet up the stairwell, you’re less likely to return to moving heavy office equipment regardless of choosing surgery or conservative care for your back. The study goes on to throw the conclusive bone to those deliberating this costly surgery, that “even among patients with strong surgical indications, many (34%) remained in the nonoperative group out to 8 years”. Take comfort in conservative rehabilitative care and do your core stabilization exercises and spine stretches if surgery doesn’t sound like your calling, as improvements in “sciatica bothersomeness” happened in both groups.

Jon O. Lurie, MD, MS, et al. Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation – Eight-Year Results for the Spine Patient Outcomes Research Trial. In Spine. 2014, Volume 39, Number 1. Pp. 3-16.

For more information, visit our patient guide on this topic by clicking here.

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Balance Problems? Don’t Fall for Anything

Falls are a big deal to many older adults with over a third of the +65’ers falling annually. According to the Centers of Disease Control and Prevention, a fifth of these falls results in a traumatic injury, and many of them (like one every 29 seconds) leads to their demise.

We’re not only paying for these falls with our lives, but medical expenses from falls cost over $28 billion per year.

Alpine Physical Therapy makes an effort to be a part of the good news on this threatening topic by reaching out to reduce falls in our community. We participated in a multi-agency collaboration (MonTECH of the Rural Institute, UM’s School of Physical Therapy, and the National Council on Aging) again this year for National Falls Awareness and Prevention Week.

We offered free balance and falls-risk screens to all interested this year at the Peak Health and Wellness Center’s first annual health fair last Friday evening (9/19/14). The event was a success with over 10 older adults screened and subsequently educated on local falls prevention classes, physical therapy options, balance and strength exercises and their relative risk.

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Alpine PT is pleased to be a part of Missoula’s falls reduction network and reminds the community that we offer free balance/falls-risk screens year round at our three locations.

For more information on this important topic, visit our clinic website on the topic of our Vestibular and Balance Clinic by clicking here.

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Alpine’s Presence at the First Annual Health Fair at the Peak Health and Wellness Center

Most Friday nights are spent watching a movie as a family, perhaps going downtown for dinner and a night out, or enjoying time with friends and family. Several Alpine physical therapists and staff chose to spend their Friday night at the first annual Health Fair at the Peak Health and Wellness Center on Blue Mountain Road. Joining the fitness and training staff from the Peak, Alpine Physical Therapists helped spread the word of wellness to the Missoula community.

Brace Hayden was joined by several University of Montana PT students providing free balance testing at the event. Morgan York-Singer and Leah Versteegen educated participants of the importance of their core, and Matt Schweitzer was joined by Ana Soulia providing postural guidance for daily life and exercise. Participants ranged from young to old; some were current members at the Peak, while others were simply interested members of the Missoula community.

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Kayli Julius, the coordinator of the event and a Health Coach at the Peak envisioned a community gathering to promote the concept of Health and Wellness. Vendors included local businesses such as Great Harvest and Lolo Peak Brewery. Fitness instructors from the Peak provided free 10 minute classes, such as Oula , Spinning, Pilates, and Yoga. Staff members from the Spa at the Peak were present to give massages and free wax services.

The night was a success with participants finding new ideas and approaches to living a healthy lifestyle. Special thanks to Alpine physical therapists who led the way with their guidance on improving overall wellness. We at Alpine are already looking forward to next year’s Health Fair!

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Alpine’s Presence Runs High at this Year’s Mountain West Cross Country Classic

The Alpine tent was up and ready for action this past Saturday for Montana’s largest annual cross country meet, The Mountain West Cross Country Classic.  The event draws youth from all over the Northwest for a 3 mile run for High School athletes and a 1.3 mile run for Middle School athletes. The sun was out, the air was clear of smoke, making it a spectacular morning for such a great event.

Physical therapists Kristi Moore and Jamie Terry spent the morning taping, consulting on injuries, and triaging athletes to local Missoula Emergency Services. We were really fortunate to have support from Athletic Trainers Emily and Winter, Physician Assistant Kris Provo and Alpine Aide Maddie with the constant hustle in the medical tent. Trying to keep athletes doing what they do and injury free is a top priority here at Alpine, so it was an honor to spend the morning with these runners and see them excel.

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Highlights from the morning, a huge upset in the female varsity run with Freshmen Anne Hill of Glacier upsetting Senior and reigning champ Makena Morley of Big Fork with a time of 16:39:64. In the JV race, local 9th Grader of Hellgate, Isaac Smith, came out on top with a time of 16:27:99. It will be really exciting to see what these two do over the next 3 years.

A big thank you to Michele Chalmers and the Mountain West Track Club for having us again this year. We love being a part of this community event and are looking forward to it again next year!

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Alpine Feels the Beat of Fall in the Great Outdoors

It’s that time of year again where people get up in the wee hours of the morning and head out to hunt, which for many adds up to a big long hike. So many of these folks feel like super heroes with heightened senses for the task at hand in the great outdoors.

People so often take for granted what it takes to get out and make this happen.

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Experiences like these get everyone at Alpine Physical Therapy upbeat, for it’s our aim to ensure that everyone gets out and enjoys all that fall here in Montana has to offer, including healthy hunting days.

Best to our area hunters!

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Is My Neck Getting Stiffer Every Year?

Special thanks to star physical therapist Brace Hayden, DPT, CSCS of Alpine Physical Therapy for providing this write up on a recent article from Spine.

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Our neck mobility seems to gradually get worse as we celebrate birthdays and suffer our share of accidents and uncomfortable hotel pillows. The garden variety pain or achy stiffness in the neck, categorized in the healthcare world as ‘nonspecific neck pain’ sends a lot of people to their care providers for some sort of treatment and medical relief. In order to best assess neck complaints, providers perform an examination of the spine. The physical therapist (or other provider of choice) will measure their range of motion (ROM), as in many cases one of the goals for patients with nonspecific neck pain is to improve the neck’s mobility.

Normative values for the neck’s mobility are memorized by clinicians during their respective education, so relative stiffness measured in degrees, documented and treated for hopeful improvements. For example, we learned in PT school that the “normal” neck flexes and extends about 60 degrees, rotates 90 degrees and side bends 45 degrees. But, “normal range of motion” changes with age, and thus ‘normal’ for a 20 year old is quite a bit more generous than the age-reduced ‘normal’ for a 60 year old.

Enter the work of Dr. Swinkels and his team of researchers from the Zuyd University’s Department of Physiotherapy in the Netherlands. They recently published a paper on their investigation on the range of motion differences in the cervical spine as we age. They studied four hundred people without neck issues and quartered the data set with 100 for each decade of age from 20 years to 60 years and in each quarter subgroup. Each subgroup also had an even balance of genders with 50 males and 50 females. The mobility of the neck was measured with a special cervical range of motion device called the ‘CROM’ (see Figure 1). Swinkels’s team crunched the nitty-gritty analyses of variance, linear regressions and even further dredged the data with Scheffé post hoc tests to investigate the differences in neck mobility between the decades of age and any possible relationships of age and/or gender.

As one may expect, they found that age does have a significant effect on active ROM of the neck. Table 2 beautifully illustrates the diminishing trend of neck ROM in healthy adults without neck pain. Recall the “normal” ROM for neck flexion we committed to memory was 60 degrees. This normal mobility of 60 degrees in Swinkels’s study was assessed as typical for 20-somethings, but each decade men and women evenly lose a degree or two, until the 50-something decade. 50 years and older, active ROM declines greatly in all directions except neck extension and side bending. Neck flexion on average is reduced 12 percent (7 degrees) to 53 degrees.  Clinically this is relevant, as we in the physical therapy profession tend to council a lot of people on improving their stiff neck’s mobility. In all due fairness, the “new normal” should be on an age-adjusted sliding scale when goal setting for target neck mobility. ]

Raymond A. H. M. Swinkels, PhD et al. Normal Values for Cervical Range of Motion. In Spine. 2014, Volume 39 , Number 5 , pp 362 – 367.