Alpine Physical Therapy hosted a hands-on physical therapy seminar addressing neck and back pain management techniques. Our presenter was Colette Seyman, an Australian-trained manual therapy specialist based in California. In total, 24 physical therapists from Alpine and from a total of three states were present for this three-day Maitland Australian PT course held at our south location within the Peak Health & Wellness Center on Blue Mountain Road. Courses like this are offered through Maitland-Australian Physiotherapy Seminars.
Our professional staff in attendance included Antara Quinones, Brace Hayden, Dennis McCrea, Gary Gales, Jess Kehoe, and Morgan York-Singer.
This intensive seminar is one of a group of core classes toward manual therapy certification. Specifically, this recent course covered approaches to improving spine mobility to reduce pain and improve the function of our patients. We were particularly interested in this course as we tend to work with a lot of Missoula’s population with persistent and challenging neck and back issues.
These manual techniques can be highly effective and specific to each region of a dysfunctional or irritable spine, but they require a lot of background and hands-on practice. For more information on our approach to helping patients with neck and back pain, click here to view our Spine Clinic at Alpine.
Alpine Physical Therapy connected this week with Ander’s Brooker, owner of Runner’s Edge in Missoula. Anders shared with us many new styles and methods of improving comfort and efficiency in runners. With so many new styles and shoes on the market, it was super helpful for our physical therapists to hear first-hand from Anders all the ins and outs of the new gear.
We’re looking forward to collaborating on a new idea together, a spring running expo, which we plan to launch and deliver within the Peak Health and Wellness Center. Keep your eyes open for this event, as it will be a tremendous outreach to our area runners. We plan to include talks by our running specialists at Alpine PT, along with a discussion of footwear by Anders. Other topics will also include training concepts and strategies. And we’ll have other guest speakers for topics on orthopedics, women’s health, and injury prevention.
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.
Toes are like teeth- you take them for granted until they hurt and then you realize how much you rely on them and are amazed at how much pain they can cause. Toe instability resulting in a rigid deformity is a common foot problem. A recent review article speaks to new knowledge of toe instability and a surgical technique that should be utilized—specifically, repairing the plantar plate.
In a healthy foot the tiny muscles of the feet and toes along with ligaments on the sides of your toe joints (collateral ligaments) and a thick piece of fibrous tissue on the pad of your feet and toes, called the plantar plate, help to resist the forces your toes undergo during walking and running. The second toe is most vulnerable to hyperextension because there is no muscle responsible for resisting your second toe moving towards your big toe. Authors of this review found that the plantar plate is primarily responsible for the stability at the 2nd toe joint. If this plantar plate is torn, due to abuse or trauma, and not repaired the toe instability becomes worse and typically results in a crossed toe.
Toe deformities go by various names depending on the direction the toe goes, but generally speaking a bent toe is called “hammer toe” which can turn into a toe stuck under or over the adjacent toe. Any deviation from a straight toe is an indication of joint instability and should be addressed to prevent future pain and walking difficulty.
Hammer toe is caused by outside pressure (like high heels), inflamed joints, and autoimmune diseases. Predisposing factors include genetics, a longer second toe, flat feet, and an already poorly aligned big toe. Curled toes, or hammer toes, most often happen to women older than 50 years old whose feet have been pressed into high heeled shoes with narrow toe boxes. Men and younger people can also develop hammer toe, however it is more rare. Often, these deformities are ignored until they become “fixed” or the bones have fused into place. Fused toes are problematic because as we push off with our back foot while walking the toes must bend and tolerate 40% of our body weight.
Symptoms of toe instability are pain on the bottom of your toe where it meets your foot, toe swelling and numbness, a feeling of “walking on marbles,” and a gradual change in the direction of your toe towards encroaching on its neighbor. It may be uncomfortable to walk barefoot or feel better to walk on the outsides of your feet. Imaging, such as x-rays or MRI, can diagnose hammer toe. However two simple tests combined show good diagnosis results: a “drawer test” to test the mobility of the joint, and trying to pull a piece of paper out from under the toe in standing.
Treatment of hammer toe depends on the extent of the instability of the toe joints. Often, people do not seek treatment until the toe has completely crossed under or over and has become rigid. Conservative treatment is moderately effective for early joint instability and includes shoe modification (lower high heels, wider toe box, more cushion), pads placed in the shoes or rocker bottom shoes to redirect the forces across the foot during walking, or steroid injections at the joint (keeping in mind that any steroid relieves pain but does disturb the already fraying tissues). Keeping your foot, ankle, and calf muscles strong can also help, as well as checking in with a physical therapist to help correct any faulty movement patterns further up the chain.
Surgery is a common option, especially for more advanced stages of hammer toe. Two main approaches are used–one accessing the area from the sole of the foot and the other from the top of the foot. Surgeons trim any unhealthy tissues and suture any obvious tears in the plantar plate and collateral ligaments.
In the past the collateral ligaments have been the primary tissue repaired. However, authors found better outcomes with surgery prioritizing plantar plate repair along with collateral ligament repair. They found that this helped significantly with lasting deformity correction and improvement in pain and a person’s ability to function.
Jesse Doty, M.D. Metatarsophalangeal Joint Instability of the Lesser Toes and Plantar Plate Deficiency. In Journal of American Academy of Orthopedic Surgery. April 2014. Vol. 22., No 4. Pp235-245.
For more information, visit this topic module on our clinic website by clicking here.
Alpine Physical Therapy is proud to be an ongoing sponsor for Missoula MMA fighter, Skye Folsom. He’s on a winning streak and has regained his title and belt. Thanks to Skye for this blog post, kind words on our behalf, and pictures.
Being a professional fighter, I get banged up a lot. Like “a lot a lot.” Seriously, every day I get get bruised, and my joints end up getting whacked out of place. My muscles often go into spasm and get knotted up in my back, making training hard at times.
I can’t stop though; I must keep pushing myself to be the best. It is my goal to soon be the featherweight champion of the world.
My special thanks to my physical therapist Brent Dodge at Alpine Physical Therapy. My pre-fight sessions ensure I train hard every day. Brent keeps my body inline and helps my muscles stay relaxed. With Brent Dodge and Alpine Physical Therapy on my team, I will without question take my fighting career all the way!
Keep watching the UFC, and you’ll see me soon!
Skye “Chiflow” Folsom
At Alpine, our physical therapists are dedicated to continually enhancing our skills. We meet monthly to share our clinical expertise in various areas.
This month we met to discuss retraining important muscles around the hip that provide stability in weight-bearing and promote pain-free range of motion when all is working correctly. The two muscles we targeted include the iliacus and the gluteus minimus. They are deep muscles, so retraining and strengthening them can often be difficult.
To overcome some of that difficulty we are using Ultrasound Imaging so we can see how these muscles are currently firing, and the client can see on the screen when they correctly or incorrectly activate these muscles. Using visual feedback can take your rehab from good to GREAT!
Just ask Leah Versteegen, PT who is recovering from an ACL injury and surgery. At first it was difficult for her to find these muscles, but with visual feedback, cueing, and practice she was able to get the right muscles firing. By the end of the demonstration, her hip felt tired but great!
Who might benefit this approach benefit? Almost anyone with hip, knee or low back pain or injury.
For more information visit our clinic webpage on the topic of rehabilitative ultrasound imaging by clicking here.
As October comes to an end, so does this years fall session of Fit to Fight. This session was quite special, as all the participants were females, and almost all had been diagnosed with breast cancer. Each participant showed improvement in physical ability as well as balance while participating in Fit to Fight.
Fit To Fight continues to reach out to the community, and today received a very special gift from Bitterroot Flower Shop. A very nice surprise from a local organization, also in support of celebration of October which is National Breast Cancer Awareness month. Thank you Bitterroot Flower Shop for your appreciated support and gift!
The next session of Fit to Fight is still accepting participants. Anyone who has been diagnosed with cancer is invited to join. Fit To Fight aims to empower cancer survivors to improve their quality of life through a program of fitness and health. Please contact Emily Melton at firstname.lastname@example.org or 406-750-0943.
Once again thank you Bitteroot Flower Shop, Fit To Fight, and all those who helped support Breast Cancer Awareness month!
As a physical therapist who works with runners, there is one consistent area I find weakness even in very fit & strong runners – lateral (side) motions.
Running involves muscles to move you in a forward direction on flat ground, up hills, and down hills. The majority of strengthening most people focus on in legs is quads, hamstrings and calf muscles, which is helpful for running but not the only muscles a runner should focus on. While running is not done sideways, the muscles that function in side motions are important stabilizers to help keep you balanced and decrease the stress that occurs in lower back, hip, knee, foot and ankle.
As many runner head into their slower race time of year, it is a great time to begin to work on strengthening for the demands that running requires.
So continue to work on the strength needed to move you forward, but add in strengthening in the lateral motions. Some exercises to address this area are: sidelying clamshell, side stepping with theraband tied around ankles (keep feet parallel), side planks (adding in arm and leg lifts as you gain strength), side step ups or hops, jumping side to side, grapevine/carioca.
Also as you work on balance exercises make sure you keep your pelvis level and challenge your balance by being on unstable surfaces (ie. BOSU balls, foam, cushions, or pillow). So make a change to work your body in new directions!
Kristi Moore, MSPT
Alpine Physical Therapy, North
2965 Stockyard Rd.
Missoula, MT 59808
Antara Quinones, Brace Hayden, Leah Versteegen and Jess Kehoe of Alpine Physical Therapy jumped (literally) into a collaboration with Missoula’s Freestyle Ski Team’s dry land preseason training the past 2 weeks at Bitterroot Gymnastics.
In an effort to reduce training and competition injuries that keep these young athletes off the slopes, Alpine PTs worked with Freestyle Ski Team coach Donovan Powers and Bitterroot Gymnastic’s coach and owner David Stark on a dynamic warm up, core stabilization exercises and proper jump landing drills.
It was a great experience to work with these talented athletes and their coaches to improve their sport performance and reduce potential injuries. Seeing these kids land amazing jumps like double back flips and 540 degree spins with good form was an awe-inspiring evening of PT community outreach. (Photo Credit of Antara, Brace, and Jess (L to R) thanks to Leah Versteegen, DPT)
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!
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.