Omega 3/omega 6 ratio may not be a term familiar to everyone, but with all the hype today on taking fish oil to prevent heart diseases, it is not a topic one should be unaware of.  In case you didn’t know already, fish oil contains high levels of omega 3 fatty acids that can benefit the human body in more ways than one can imagine.  The DHA supplement that is often prescribed for expecting mothers is one type of omega 3 fatty acids, as well as EPA.

So just how do omega 3 fatty acids help with pain management?  To put it simply, they decrease productions of pain-increasing chemicals.  The typical north american diet (lots of red meat, chicken and refined grain products) is rich in omega 6 fatty acids, which when taken in through the digestive system become the building blocks for arachidonic acid (AA).  When an injury occurs and cell membranes get disrupted, phospholipase A2 gets released and breaks down AA to produce high levels of prostaglandin E2, thromboxane A2 and leukotrienes SRS-A, which are inflammatory mediators.  EPA and DHA are believed to compete with AA for binding sites in the cell membrane and are therefore able to modulate the cyclooxygenase (COX) pathway, and in a lesser degree the lipooxygenase (LOX) pathway, in the same way NSAIDs do minus the adverse effects.  The end result, less production of proinflammatory chemicals and therefore less pain.

Regular intake of cold water fish fat and marine algae can increase the omega 3/omega 6 ratio in your body, which can dramatically reduce the overall production of proinflammatory chemicals.  Because marine algae aren’t part of my regular diet, I choose to take salmon oil supplements instead.  This antiinflammatory property is also the basis on which regular fish oil supplement appears to have a cardio-protective effect.  As for pain management, omega 3 fatty acids work even better when taken with fruits and vegetables high in bioflavonoids, especially when in conjunction with botanicals such as ginger, turmeric (a common ingredient in curry) and boswellia.  While omega 3 fatty acids is relatively safe to consume as compared to NSAIDS, there are documented cases of allergic reactions that suggest one should always consult a physician or nutritionist before supplementing.

Chung Lee, DC. 

Think there’s nothing you can do about arthritis? Great news! You can act right now. Some of the ideas here are simple, one-time actions. Others are first steps toward longer-term goals. All can directly or indirectly improve your health, outlook or pain level, and can generally make life with arthritis a little easier.
• Pay attention to symptoms, see your doctor and get an accurate diagnosis
• Start early -- The earlier an accurate diagnosis is made and treatment started, the better.
Protect your joints -- Avoid excess stress on your joints.
• Get moving -- Exercise helps lessen pain, increases range of movement, reduces fatigue
and helps you feel better overall. A well-rounded workout routine for people with arthritis includes flexibility exercises to increase range of motion, aerobic exercises to improve endurance and decrease fatigue, and strengthening exercises to improve muscle fitness. Your doctor, a physical therapist, or other specially trained health professionals can show you range-of-motion exercises and strengthening exercises that are good for arthritis.
• Pick, pour or peel – Recent research has shown the importance of vitamin C and other antioxidants in reducing the risk of osteoarthritis and its progression.
• Play it safe in the sun – Protect yourself when you go out into the sun — wear sunglasses, a hat and sun screen.
• Resolve to reduce – Lose weight. You won’t just look better, you’ll feel better, too.
• Bone up – Stock up on your favorite source of calcium.
• Begin with breakfast – Like you’ve always heard, a healthful breakfast is a great way to start the day.
• Try this on for size -- A well padded, well-fitting shoe with plenty of room for your toes can make a world of difference in the way your feet feel.
• Take a hike -- Choose your favorite spots (indoors and out) and make plans to walk them at least once a week.
• Sit, soak and soothe – A warm bath before bed can relieve muscle tension, ease aching joints and help you get a good night’s sleep.
• Treat your muscles – Find a certified massage therapist and treat yourself to a good rub down.
• Stretch your legs, arms, body -- Stretching is a simple way to keep joints and muscles flexible. It relieves stress and can help enable you to maintain your daily activities.
• Take the plunge – Exercising in the water can build strength and increase range of motion, while the water’s buoyancy reduces wear and tear on sore joints.
• Make an ice pack -- When joints are hot and inflamed, applying something cold can decrease pain and swelling by constricting blood vessels and preventing fluids from leaking into surrounding tissues.
• Enjoy Your Exercise -- Take the work out of working out. Sign up for a class that makes exercise fun

For more information about treating arthritis, please visit the arthritis.org website. Excerpts from arthritis.org collected by licensed Physical Therapist David E. Larson, MSPT

“Wait, what?  How many did you say?”

Usually, this comment is accompanied by a raised brow and a surprised look.  “Yup.  That’s right.  You’re going to be doing a x reps...but over y-z number of sets.”  

That’s the answer that usually follows.  The reason this is so surprising for some people is that x is usually somewhere in the range of 75-100 and y-z is anywhere from 3-5.  That’s a lot you say?  Well, after reading this, it may make a little more sense.

Coming to physical therapy usually means there is some sort of injury, movement, or posture that needs to be addressed or corrected.  For the most part, this is concurrent with having a strength deficit, a muscular imbalance, a decrease in endurance, or even compensation for pain with a certain movement pattern.  To address these issues, we, as physical therapists, have to develop treatments for 1) increasing endurance, 2) pumping up strength and building muscle, and 3) reteaching proper neuromuscular movement patterns.

Each therapist has his or her own bag of tricks to cater to each and every one of these needs, because there are hundreds of different exercises/activities to reach these goals.  However, there are only a handful of parameters that are the most efficient to achieve them.

For the most part, research has shown that performing high repetitions with low weights is a great way to increase endurance.  It helps to increase circulation for healing purposes and also begins to push away the inflammatory chemicals produced by recently injured tissues.  Repetitions range from 15-25 reps, with the amount of weight dependent on the body part being exercised.  The amount of repetitions should be set so that one is pain free and able to complete them without being totally spent after a set. The number of sets ranges from 3-5 sets, depending on endurance and intensity.  Rest breaks are on the shorter end, around 15-30 seconds.

Building strength moves towards the other end of the spectrum - lower reps, higher weights.  With great strength comes great responsibility...wait...that's Spider-Man.  What I meant to say was that building strength comes a with greater exercise intensity.  Here, weight and load are increased, and repetition ranges from 8-15.  To build more strength and muscle, more load has to be moved.  Since the weight is higher, the number of sets are lower, around 3-4.  It also comes with a longer recovery period between sets, around 30-45 seconds.  

Reeducation of a compensated movement pattern runs a similar gauntlet as endurance training - just beat it up with high repetition.  A compensation happens if a certain motion is painful.  The body is very efficient in moving itself in the most pain free way, even if it is not the most efficient way.  The way to overcome this is to teach the body that it has to move back into its normal movement pattern.  This can only occur if we are able to work a client in a pain free/decreased pain range of that certain motion.  Once that is achieved, just getting the body to perform that movement over and over, repetition upon repetition, is the way to go.  It is essentially telling the body, “Hey, this is a better and more efficient way to do this.”  When this is figured out, the body will automatically adopt that pattern.

So that’s why you have to do 100.  There is a pretty good foundation of for doing all of those repetitions.  I’m not just trying to be mean...usually
 ;-)

Let me know what you guys think!  This is a pretty generalized overview of these topics.  To really get a good individualized plan for you, give us a shout.  You can email me at sancho@jointventurespt.com or if you live out of town, you can contact your doctor or local therapist!

Daily Human Dilemma
The vast majority of humans are struggling from sore necks. One favorite area of disgruntled discontent is just between the shoulder blade and the spine, the "Rhomboids." When the rhomboids are in working order, they assist with retraction of the scapulae (shoulder blades). Hence, they give the shoulder girdle stability. When they are weak, the other muscles of the shoulder suffer, leading to complaints of neck pain.

The issue at hand (and shoulder)
They come to me. As a massage therapist, I see them often. The issue is the same, over and over, and over again. These same muscles, the same pattern of tension and the same pattern of strain. Why?

Hint: Shoulder bag. 8 ounce mouse.

Primary Causes
The gravitational pull downwards upon the top of the shoulder affects not only that area at the top, but also affects further downwards, causing strain to these Rhomboids. 8 hours of slouching ever so slightly forward using using the muscles in front of your shoulder to move that 8 ounce mouse - creates weakness to the muscles opposite, these muscles in between the shoulder blades.

The Martial Struggle
And you thought you were alone? Martial Artists struggle in a similar manner, though typically not from shoulder bags, but forward thrusts and fists extended outwards, towards their opponent. The same result: weakness to the opposing muscle groups - commonly the rhomboids.

You do not need to suffer.

Strength Training
Often people are training in the gym and are drawing the arm back, though the elbow is outward, away from the body (right.) This works beautifully for White Crane Shaolin Kung Fu, though it does not train the Rhomboid muscles. The proper form for training and strengthening weakened Rhomboids is demonstrated in the photo at the left.

Jim Knoble, above, instructor from Yang's Martial Arts Association www.ymaa.boston.com demonstrating Shaoling White Crane Kung Fu and Rhomboid training using a theraband. (Information taken from John Bondlow our massage therapists blog @  http://integratedtherapy.blogspot.com/

Return to prior level of function is one of the most common goals a physical therapist will have for his/her patient.  But what does prior level of function mean?  Prior level of function is the condition you were in before you were injured.  For some of you, this may be playing a competitive college sport, running 5 miles a day, rock climbing, or competing in triathlons.  For others, this may be playing golf on the weekends, walking the dog, climbing a flight of stairs, or driving a car.  Prior level of function is an umbrella term including anything that you could do before the injury that you are unable to do now, even things as simple as getting dressed, sleeping, and performing household chores.  It may be something you could do a few weeks ago or something you haven’t done in years.  If you haven’t skied in years because you have been living with chronic back pain, then that is considered part of your prior level of function and your physical therapist will work with you to get you back to that level of function.

My favorite part of being a physical therapist is sharing the experience of a successful rehab experience with my patients.  Some of my favorite rehab experiences are post-operative rehab, specifically ACL reconstruction.  When someone undergoes surgery to repair a torn ACL (ligament in the knee) they literally need to learn to walk again without the use of crutches.  Often times, after an ACL injury, the surgery will not be scheduled until up to a month later. 

It is important to start physical therapy during that time, for what we call pre-hab.  A physical therapist can work with the patient to gain ROM and build strength prior to the operation in order to promote faster healing after the surgery.  Once the surgery is performed, it is usually 6-9 months before you can return to full sport activity.  The reason I enjoy working with people who have undergone an ACL reconstruction is because I get to see day one when the patient is barely walking with the use of crutches and a brace to the final day when the patient is running, jumping, and dancing around the clinic.  It is a very rewarding experience to be a part of each step along the way back to prior level of function.

I worked with a patient who had torn his/her ACL this past winter.  He/she came into the clinic 2 weeks after the surgery and I described what the rehab experience would be like.  When I asked the patient what his/her goals were for physical therapy, he/she told me he/she wanted to get back to cage fighting.  I knew this was going to be a fun rehab experience, because at the time, he/she couldn’t even go up and down stairs without a railing, crutches, and knee brace, but several months later they would be back to getting into the cage to fight.  We started with simple exercises to engage the quadriceps muscle, practiced putting weight on the leg, increased range of motion, and practiced walking without the use of crutches.  Weeks later the patient had full range of motion and we worked on more aggressive strengthening, normal walking, and balance exercises.  After 4 months, he/she was able to start running and at 5 months we began working on agility, speed, and change of direction while running.  After 6-7 months he/she was able to get back in the cage and fight again…until he/she needed surgery to fix an old shoulder injury.

No matter the type of injury you have, how long you have had it, or what your goals are, a physical therapist can work with you to help get you back to doing the things you love to do.  The best part of what I do is seeing someone on their final visit for physical therapy and seeing him/her smile knowing he/she is ready to get back to doing the things he/she loves.  If you have an injury that is preventing you from doing something you were once able to do, speak to a physical therapist and see what they can do to help you achieve your goal!

When people think of physical therapy, they often think of treatments for muscle and joint injuries; however, PTs treat nerve pathologies as well.  Common nerve injuries include nerve root impingement from a herniated disc in the spine, nerve entrapment in the extremities, such as carpal tunnel syndrome and sciatica, and rapid stretch to a nerve that can occur in athletics or automobile accidents (“stinger”).  These injuries to nerves can occur from repetitive overuse of joints and muscles, poor postural habits, or direct trauma. 

Peripheral nerves are complex structures that originate just outside the spinal column and then extend to all the muscles and organs throughout the body.  The nerves often wind around bones or go through tunnels made by muscles and connective tissue.   When a nerve is compressed by another structure in the body, or if a nerve is inflamed; it can produce numbness, tingling, or even sharp/shooting pain along the path of the nerve.   This can be extremely debilitating and interfere with one’s daily function with even simple tasks.  When a nerve is irritated in the above mentioned ways, the normal motion of the nerve is affected and the nerve can have increased tension placed upon it.  Nerves are made of less elastic-type materials than muscles and cannot be stretched in the same way.  When a nerve is tensioned from both ends at once (as with muscle stretching), one can actually damage or irritate the nerve further.   Instead, the nerve can be mobilized in such a way that one end has tension while the other end has slack.  Moving a nerve in this way is often referred to as “gliding” or “flossing,”  and this method can greatly reduce nerve irritation and return a person to daily and recreational activities with reduced symptoms.   Everyone has a pre-determined amount of tension throughout their nervous system, just as we all have a certain amount of muscle flexibility.  However, this tension can be improved with manual physical therapy treatments and proper instruction in neural mobilization techniques.  If you improve your neural tension, your overall flexibility can also improve, and this is an important component of overall fitness and health.

Here are a couple of ways you can feel your own neural tension:

Hamstring flexibility vs. sciatic nerve tension: while standing, place one heel on a chair with your knee straight.  Stand up tall with a straight back and then gently lean your chest forward by hinging at the hips (don’t curve your spine).  You should feel a stretch in the back of your thigh.  If you feel the stretch extend down to the back of the knee or the calf, that is sciatic nerve tension.  If you slightly bend your knee and you now only feel stretch in the thigh, that is your hamstring flexibility.

Bicep flexibility vs. median nerve tension: stand next to a wall or open doorway.  With your thumb up, and your palm facing away from your body, place your hand behind you on the wall just below shoulder height.  Keeping your hand on the wall, slowly rotate your trunk away from the wall and lean your head away from the wall.  If you feel a stretch in the front of your elbow,  forearm or wrist, you feel median nerve tension;  if the stretch is only in your upper arm and chest, you feel your bicep and pectoral flexibility. 

Through my years of practice in physical therapy, I have come to terms with the mentality of the “Weekend Warrior.”  Whether it’s a less active individual inspired to get off the couch in late fall and rake leaves for 8 hours, or the former college athlete, who hasn’t been out on the court in a few months and thinks her body is invincible, returning to the sport she grew up playing, weekend warriors are everywhere.  A great number of my patients feel participating in a sporting activity once a week is enough exercise, and they don’t think about preparing their body for the return to activity after a period of time off.

Tennis is just one example of a lifelong sport that people often revisit through life.  It has been the sport that’s always played a role in my life.  My participation started as a child, playing recreational tennis in my hometown growing up, then playing for my high school (boys!) tennis team, and, surprisingly, making my college team.  After college, I continued to play regularly, and not until this past year did I stop. I moved to a new city, was starting a new life, and finding a new outlet to play tennis wasn’t high on the priority list.  Recently, I started back up, dusting off the racquets, getting back out there, and enjoying the game.  I forgot how much I loved playing. BUT….my first time out, after a long 90 min session with an instructor, I realized: I had turned into a Weekend Warrior!

I do exercise regularly, stretch, strengthen, and find different cardio activities to keep me feeling good, but I did not prepare enough for the return to tennis. Nothing to prepare me for the critical components of playing (serves, strokes, and quick accelerations to the ball) you take granted when you’re doing it 4-5 times a week.  After about 10 months off, my mechanics of all those components changed, and I was putting myself at risk for injury.  To compete at any level includes preparing motor skills such as power, strength, agility, speed, explosiveness, and coordination. Another important area of returning to participation in sports is flexibility.

Over the years of my participation in the sport, warming up for tennis has changed.  Coaches have different philosophies, team captains lead warm ups differently, and recreational teams sometimes don’t warm up at all. New studies have shown the importance of dynamic stretching and sport specific warm ups. Tennis players of all levels should consider the following steps for proper warm up:

1. Cardiovascular warm up: A general warm up lasting between 3-5 minutes such as jumping rope, jogging, or jumping jacks.
2. Dynamic stretching including: Walking knee to chest with a heel raise, Grapevine or Carioca, Forward walking lunge with trunk rotation, Gradual small to large arm circles, Jogging “butt kick,” Lateral gallop, and Serving Circles.
3. Agility foot drills: Running the lines forward, back, and laterally, and Spider Drill from the base line.
4. The above basic warm up is a good way to get started before full participation on the court with a hitting warm up:
5. Mini-tennis from the service line. Mini-tennis cross court.
6. Pop-up volleys.
7. Baseline rally. Cross court rally.
8. Volley feed.
9. Overheads.
10. Serves.

    Knee pain is a very common complaint of people in the United States.  The Center for Disease Control and Prevention (February 2010) found that lifetime risk of knee osteoarthritis may be nearly one in two, or 46%. Nearly half of Americans may develop arthritis in one knee by age 85.
As a licensed physical therapist, I have found knee pain to be one of the most common diagnoses that I evaluate and treat. Common diagnoses that I see in the knee, are osteoarthritis, patellofemoral syndrome (also categorized as “runner’s knee”), chondromalacia, knee ligament sprains, meniscal injuries, total knee replacements and surgically repaired ligaments.

    When I evaluate a patient with knee pathology, one of the major problems and biomechanical issues I see is the deactivation/inhibition of the vastus medialis obliques muscle (VMO). The VMO muscle is one of the components that make up the four muscles of the quadriceps and is found on the medial aspect of the knee.

    The VMO muscle is important because it is the main dynamic stabilizer of the patella (knee cap). It controls the tracking of the patella when you bend and straighten your knee, especially in activities like stair climbing, running, jumping, and walking. If the VMO does not activate properly, and/or is weak, the patella may track poorly causing pain under/around the patella. This is common in diagnoses like patellofemoral syndrome or chondromalcia. Improved stability and strength of the VMO will return the knee to ideal biomechanics, decrease pain, and prevent future injury. 

    There are various ways to strengthen the VMO. In my experience I have found that biofeedback is one of the best ways for patients to strengthen and re-educate the VMO. Biofeedback can be performed by visual, auditory, and tactile cueing. I have had great success with the rehab process of knee injuries using a biofeedback machine that I call the “purple box”.  The idea of the biofeedback machine is to re-educate the VMO by reconnecting it to the brain. The biofeedback machine has an attached wire with a sensor at one end. When used on a patient, a sensor is placed on the skin at the site of the VMO. When the patient contracts the VMO, the sensor will pick up conduction of the contracted muscle. A baseline number is then set on the machine. The idea is to have the patient contract the VMO above the set baseline number. With practice, re-education, and strength gains, the patient will see the number on the machine increase, improving the activation and control of the VMO by the patient.

    There are many ways to re-train and strengthen the VMO in order to return the knee to ideal biomechanics. The biofeedback machine is one form of treatment that allows patients to have control and understanding of their body through the rehab process. I have had good success with the “purple box” to help patients improve strength, stability, and function of the knee.
If you have any questions or comments, please contact Jaime Herrmann, MPT, CSCS at jaime@jointventurespt.com

        The golf season has been in full swing for quite a while now.  If you are a golfer, it is not uncommon to start feeling some aches and pains this time of year.  In the physical therapy clinic, we see numerous golf related injuries, ranging from low back pain to shoulder problems to elbow pain, just to name a few. 

            Golf injuries occur when we rapidly or repeatedly strain tissues (muscle, tendon, or ligament).  If a certain tissue or multiple tissues can not tolerate the load being applied, we start to develop an inflammatory response, perhaps scar tissue formation, and eventually we feel pain as a result of this.  This may prevent the golfer from being able to swing a club.  Or, perhaps even worse, result in the golfer changing his or her swing mechanics and thus beginning to stress other tissues that may not be prepared to handle the new demand placed on them.

            It is important to realize that the golf swing is one of the most difficult movements in all of sports. It demands complex movement of the body and a high degree of coordination to integrate the movements in a precise sequence.  If a golfer lacks flexibility or mobility in one region, or is too weak somewhere else, then it becomes nearly impossible to swing the club as it is designed to be swung.  Not only will this result in hitting bad shots, but it significantly predisposes the golfer to becoming injured.  To put it simply, the swing plane of the club can be altered by tight tissues.  Once the club is off plane, it is nearly impossible to recover.   

            Here are some common deficits amateur golfers have that may result in injury, as well as those pesky slices, blocks, and hooks!

• Weak hips:  A good golf swing starts with good posture.  If posture is bad at address, the swing is destined to become off plane.  The hips, or more specifically the Gluteal muscles (buttock muscles), are vital in maintaining posture and keeping our low back in a strong and safe position.  They also play a huge role in the weight transfer as we shift our weight from the backswing to the down swing. 
• Tight hips:  Just like a Gluteal deficit, tightness around the hips is extremely common, especially in males.  If we lack hip flexibility (or mobility at the hip joint), then we can not internally rotate sufficiently over our back leg on the backswing, or over the front leg to produce a high finish or follow through.  This also places increased demand on the spine, and makes for a far less efficient golf swing. 
• Stiff thoracic spine:  This is our “mid back,” an area that tends to become stiff and slightly rounded forward from poor postural habits.  If we lose mobility here, we can not rotate our upper body properly on the take away, and usually we compensate by over-rotating the lumbar spine, or by putting an increased demand on the shoulders and arms.
• Tight shoulders:  Tightness at our pectorals, rotator cuffs or latissimus dorsae muscles can severely limit the range of motion required at our shoulders to keep the club on plane and reach our full backswing, as well as to follow through correctly. 

Those are just a few areas where many amateur golfers may need help.  If you are a golfer and have been “playing through the pain”, now is the time to see one of our physical therapists or personal trainers for a one-on-one evaluation.  Or, maybe your game has “lost some distance”.  Our staff can work on these areas with you to develop a more efficient and powerful swing.  If you have any questions please feel free to email me; brad@jointventurespt.com.   

Due to the fact that I’m relatively new to the Joint Ventures team (within the last few months), I’ve been asked time and time again by patients, “Whatmade you come to Joint Ventures?” I’ve answered the question a variety of different ways, but the general concept is always the same.

Joint Ventures has a very unique model, where each PT is able to spend an entire 30 minutes with each patient during a treatment session, and 60 minutes for an initial evaluation. This is something that I have not found anywhere else, thus far. Every other PT clinic that I’ve worked at has booked many more patients per hour, therefore the PT was only able to see each patient for about 5 minutes, with the rest of the time being spent with a student or aide. At Joint Ventures, the entire 30 minutes is devoted to one on one time between the PT and the patient.

The 30 minutes that I have with each patient is used differently, depending on the needs of the patient. I tend to use the time to perform manual techniques that the patient would not be able to perform on his/er own, however there is always some time allotted to go over exercises and other educational aspects of the treatment. As patients get to a point where they need less of the manual treatment, more of the time may be spent with exercises in the gym, in order to make the transition between PT and going back to the gym easier and without injury.

Coming from clinics where I did not have the time to spend with each patient, I have really noticed how necessary it is for good patient care and accurate progression of PT programs. Having that time allows for constant re-evaluation of patient’s status, questions about form with exercises and treatment, injuries and activities.

Patients who have gone to other PT clinics in the past occasionally ask how we are able to fit treatments into 30 minutes as opposed to the 90 minutes they may have spent at other clinics. The answer is that the 30 minutes at Joint Ventures is spent 100% on treatment with a PT, whereas the 90 minutes at another clinic is spent mostly doing exercises under the supervision of a student or aide, with minimal time actually spent with the physical therapist. The 30 minute treatments are also much easier to fit into a day, 2-3 times per week. Most people are able to squeeze the treatment in during their lunch hour, or before/after work, without making it an inconvenience.

Overall, when I am asked what made me make the change to Joint Ventures, the answer is simple. Joint Ventures is focused on patients, and allows 30 minutes of one on one treatment with a physical therapist, which I have not had the ability to do anywhere else!

I’d be happy to answer any other questions at Erica@jointventurespt.com