HEALTHLY LIFE Plus

Providing Care Beyond the Cast

According to the 2010 CDC report on national emergency department diagnoses, fractures are consistently listed in the top 20 diagnoses in nearly every age group, with a particularly high incidence in children under age 15 and adults over the age of 65 (1). A recent study indicates that around one third of children under the age of 17 sustain at least one fracture, with falls being the most common cause of fracture (2). While most fractures heal with casting, and occasionally with surgical intervention, the physiological effects of several weeks of immobilization can result in even longer lasting functional limitations. Studies have indicated that even 6 weeks of immobilization can negatively alter the contractile ability of muscle, as well as the strength and fiber size of muscle tissue. A study by Hortobagyi et al. (2000) demonstrated that both type I and II muscle fibers decreased in size, and that even with 2 weeks of spontaneous recovery, they continued to be 5% smaller than prior to immobilization. Additionally, immobilization reduced eccentric, concentric, and isometric strength by nearly 48%, with a continued strength deficit of 11% after 2 weeks of untrained recovery (3). In addition to muscle changes, Harwood and Amiel (1992) concluded that after 9 weeks of immobilization, physiological changes occurred in knee ligaments (MCL and ACL), with a progressive loss of collagen and tissue atrophy after 12 weeks of immobilization, as well as tissue loss in the patellar tendon. This study also identified that the ACL is the most susceptible to these changes following knee immobilization (4). As a result of these physiological changes, muscle groups become weaker, joint movement more restricted, and ligaments more susceptible to injury. In order to minimize the negative effects of immobilization, early movement and strengthening after
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Issue IV, Summer 2013

Hours: Monday 7:30am6pm Tuesday 8am5pm Wednesday 7:30am6pm Thursday 8am5pm Friday 7:30am6pm Saturday -In Home Physical
Therapy appointments only

Location: 1802 N. Woodbine Rd. St. Joseph, MO 64506 Contact Us: Phone: (816)232-5113 Fax: (816)232-0453
www.perfomanceplusrehab.com

Posture Check: Quick tips for a healthy back

By Mikaela Roe, PTA Good posture is an easy and important way to maintain a healthy mind and body. When you practice correct posture, your body is in alignment with itself this can alleviate common problems such as back or neck pain, headaches, and fatigue. Exercises that strengthen the muscles across your upper back and shoulders will help you to maintain good posture. You dont need to develop a body builder physique it is more important to build muscle memory so that you unconsciously and naturally maintain correct posture without fatigue. A healthy back has three natural curves: an inward curve at the neck (cervical curve), an outward or backward curve at the upper back (thoracic curve), and an inward curve at the low back (lumbar curve). When standing, keep the following tips in mind to maintain proper positioning of these three spinal curves. Hold your chest high, keep shoulders back and relaxed, pull in your abdomen and buttocks, keep your feet parallel, and balance your weight evenly on both feet. Try not to tilt your head forward, backward, or sideways, and make sure your knees are relaxed but not locked. To test your standing posture, take the wall test. Stand with your head, shoulder blades, and buttocks touching a wall, with your heels two to four inches away from the wall. Reach back and slide your hand behind the curve in your lower back, with your palm flat against the wall. Ideally you will feel about one hands thickness of space behind your back and the wall. If there is too much space, tighten your abdominal muscles to flatten the curve in your back. If there is too little space, arch your back slightly so that your hand fits comfortably behind you. Walk away from the wall while maintaining this posture. Try to keep up this posture throughout daily activities the key is to practice good pos-

Wall Test Stand with your head, shoulder blades, and buttocks touching a wall, with your heels two to four inches away from the wall. Reach back and slide your hand behind the curve in your lower back, with your palm flat

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Upcoming EventsSummer 2013

7am September 21st, 9:15am Performance Plus/Cameron 3rd Annual Southside Fall YMCA Sprint Triathlon and Festival 5k Run/Walk. FolDuathlon. This sprint triath- low the parade route, then lon is for both the beginner watch the parade! This and advanced triathlete. To family oriented 5k run is register or more information part of the historic go active.com or in person at Southside Fall Festival Performance Plus. weekend. Start your weekend with a run, then enjoy the food and festivities. Register at www.enter2run.com or at

Performance Plus now offers

July: Saturday, July 20th

September: Saturday,

in-home physical therapy!

No extra paperwork, no hassles. Let us come to you!
With just a prescription for physical therapy, we are able to perform physical therapy evaluations and treatment sessions in your home. Contact our office for more details. 232-5113

Meet Our Physical Therapy Assistants

Coupon good for one health assessment. Includes height, weight, BMI, blood pressure, and heart rate.
Limit one person per coupon. Services available by appointment only. Call our office for details and to set up an appointment.

Mikaela Roe, PTA

Beau Sigrist, PTA

Lanna Burnich, PTA

Importance of Exercise and Mobilization after Fracture Healing

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fracture healing is key. Range of motion availability is the foundation for efficient movement if a joint is unable to move through the full range, agonist and antagonist muscles are unable to act optimally to control the desired movement. Often patients are hesitant to immediately move a body part through full range of motion after removal of a cast or splint, which not only continues to limit their functional activities, but continues to contribute to muscle shortening and joint restriction. With specifically designed stretches and manual mobilization, full joint motion can usually be achieved, even after extended periods of immobilization. Additionally, identifying and correcting muscle imbalances is essential for regaining proper bio-

mechanical movement. While return to daily activity does contribute to rebuilding muscle strength, targeting the most affected muscle groups, and ensuring appropriate motor patterns and muscle recruitment greatly decreases the likelihood of developing secondary injuries due to poor movement mechanics or continued strength deficits. This is especially important in the pediatric population, as muscles pull on growing bones is a strong determinant for bone density and structure (5). Additionally by strengthening surrounding muscles and ligaments, the risk for a second injury to the body part is decreased. While many patients are familiar with standard fracture care, often including some form of immobilization, many are unaware of the risk of developing secondary impairments and functional limitations following the period of immobilization.
Targeting the most affected muscle groups and ensuring appropriate motor patterns decreases the likelihood of developing secondary

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Injury Prevention
With warm Summer weather, many are spending more time outside working, exercising, or participating in sports activities. While outdoor activity is healthy for both mind and body, there is also an increased risk for injury. Below are five keys to injury prevention to keep in mind during athletic training, sports practices, and any other strenuous outdoor activities.
1. Warm-up and cool down
Before beginning a strenuous activity, whether it is a sports event, distance running, or other type of exercise, spend 5-10 minutes performing light warm-up, such as walking or jogging, and light dynamic stretches such as lateral lunges to help warm up muscles and mildly increase heart rate. Likewise, after strenuous activity spend a few minutes cooling down with light walking or jogging, followed by prolonged stretches to major muscle groups. For example after a long run, walk for 2-3 minutes to bring the heart rate down, then perform stretches to the quadriceps, hamstrings, and calves. can help increase muscle strength. Just a few examples of body weight exercises include planks and crunches for abdominals, pushups and dips for upper body, and squats, lunges, and calf raises for lower body.

4. Hydration
With higher temperatures, and often high humidity, staying well-hydrated is essential for anyone spending time outdoors. While specific guidelines for water intake varies, preparing for workouts by drinking water prior to exercise and continuing to hydrate during prolonged activity is crucial for healthy exercise. Be sure to increase water intake with higher temperatures or high intensity workouts. One rule of thumb recommends 8 ounces of water for every 1520 minutes of activity.

factors when planning workouts, and allow ample time to acclimate to changes in terrain, playing surface, and temperature.

3. Strength training
Many people tend to get in a rut when it comes to exercise routines. Distance runners run, cyclists bike, and walkers walk. However when it comes to injury prevention, an essential component of any exercise program is strength training. Building and maintaining muscle strength not only increases overall fitness, but helps increase efficiency of movement, improves control of movement (especially during high intensity activities such as running, jumping, and cutting), decreases stress on joints, and increases overall body metabolism. In order to incorporate strength training into an exercise routine, you dont need a gym membership or full weight set while these do offer a greater variety of exercises, performing resistance training using just your body weight

2. Proper progression
One of the most common causes of injury in athletes, particularly endurance athletes, is overtraining. Avoid starting too quickly into an exercise program if you are new to an activity or have not exercised in a long time. Runners should follow the 10% Rule, which recommends increasing mileage by only 10% week to week. For example if you ran 10 miles total one week, only increase by 1 mile the following week for a total of 11 miles. It is also important to take into account the activity environment. A flat 3 mile run is far less strenuous than 3 miles of hills likewise running on rocky trails puts a different stress on the body than running on level roads. Be mindful of these

5. Rest
Finally, ensure proper training and recovery by spending ample time resting. Make sure you get 7-9 hours of quality sleep each night to allow the body to recharge. Those training in a specific activity should take 1-2 days of rest from that activity each week. For example, regular runners should have at least 1-2 non-running days each week to allow for body recovery, or to spend time strength training or cross-training by swimming or biking. Finally a key for anyone participating in regular activity is