The answer to "two truths and a lie" is number 3! Gabriella's favorite yoga pose is actually supta baddha konasana aka bound angle pose!
We're excited to introduce the newest member of APH. Gabriella is joining us as a yoga therapist and at APH she will be working one-on-one with patients to teach them flows for warm-up, pain in targeted areas, balance, and strength.
Gabriella is a 200hr certified yoga instructor, intuitive Reiki master, and energy expert. She is currently attending Philadelphia College of Osteopathic Medicine to obtain a Master's Degree in acupuncture
Her strong connection to the energy of the Universe and the energy of others makes her a supportive and compassionate yoga instructor as well as a thoughtful and effective healer.
In her own practice, she works to achieve balance with the yin and yang in her own life, and she is excited and passionate about sharing that with her students. She enjoys life most when outdoors in the woods reconnecting with nature. Her passions include hiking, camping, swimming, yoga, and attending music festivals. Her mantra in life is, Be Here Now.
#DrToddSays: Integrate multiple therapies into your treatment plan for optimal results!
Make an appointment for a one-on-one yoga session here!
Dr. Todd recently saw a 13-year-old patient for treatment of patellofemoral tracking disorder. Her pediatric orthopedist said he sees this disorder 2-3 times per day!
What exactly is this common condition and what can we do to help treat it at APH?
In simplest terms, patellofemoral tracking disorder is when your kneecap moves out of place when you bend or straighten your leg. Your kneecap is kind of a “floating” bone that is held out in front of your knee joint by muscles, tendons, and ligaments. When you bend or straighten your leg, the patella glides along a groove in the femur. In tracking disorder, the patella moves either too far to the outside or inside of your leg, causing pain usually at the front of the knee.
So what can we do to help?!
The good news about patellofemoral tracking disorder is that it’s treatable with non-invasive techniques. At APH, we take a multifaceted approach:
Heat -- to increase blood flow to the area
Active Release Techniques (ART) to the muscles, Graston (IASTM) for myofascial release and Therapeutic Exercises (TE) to hold the correct alignment.
Pelvic manipulation -- to correct sacroiliac joint dysfunction, when stretching and TE cannot correct alignment. We work with the hips, because poor range of motion leads to problems down the kinetic chain (i.e. knee problems)
Therapeutic exercise -- IS CRUCIAL to correct muscle imbalances. For tracking disorder, we work directly with the quads of course, but also with the hip flexors and glutes to help balance and mobility in all muscles and joints. It may feel silly spending time working on your hips and glutes when you have pain all the way down in your knee, but dysfunctional movements caused by muscle imbalances in your hips and glutes are directly related to your knee joints (and even further down), as illustrated here:
If you are suffering from knee pain that you think could be attributed to Patellofemoral Tracking Disorder, we can help! Schedule your appointment here and we'll get you back on the right track. Pun intended, as always :)
#DrToddSays: Let me help you get your knees back on track!
Why is Dr. Todd so passionate about the Functional Movement Screen for young athletes that he's offering complimentary screenings for two whole months?
Two words: Personal. Experience.
Here's Dr. Todd in his own words:
"I personally have permanent injuries to my back that were sustained from poor technique and guidance as a student athlete. This led to multiple disc herniations in my lumbar spine in my late 30s. If FMS was introduced to me as a young athlete, I would have been a much more efficient athlete and may have never experienced the debilitating injury to my back.
In 2010, I hired a Physical Therapist who introduced me to FMS. I was tested and failed miserably, barely getting through the test because of pain and weakness. That was when I realized that traditional rehabilitation treatment was missing something. It was only treating patient symptoms and not the cause of their actual problem. At APH, as we started to take a more global approach to treatment plans, things began to change and patients were getting better more quickly and permanently instead of just feeling better for a brief period. After seeing these results, our patients began to bring in their family members and children. What stood out to us the most is that the KIDS HAD THE SAME ISSUES AS THEIR PARENTS! We began working with kids as young as 6, teaching them how to move correctly. The postural issues were unbelievable! We saw dysfunctional movement patterns in almost every child we saw. These issues are basic and simple to correct before the abnormal movement becomes a significant injury that could impact and limit them from performing their sport.
I truly believe if I knew my risks for injuries at an early age, how to prevent them, and how to maintain my body, I would have been a better athlete as a child as well as an adult with less permanent injuries now."
Dr. Todd Schragen
D.C., C.C.S.P., ART
To book your complimentary FMS, please make an appointment here.
How many hours a day do you spend on a computer or wireless device? Be honest! Do you ever have unexplained neck or shoulder pain? If so, you could be suffering from Text Neck!
Text Neck is a newly coined term for a uniquely modern problem that refers to neck and shoulder pain, repeated stress injury, and severe damage to the spine from using phones, iPads, laptops, or any wireless device with poor posture.
With proper posture, we have about 10-12 lbs. of force on our cervical spines. Every degree we tilt our heads forward to get closer to our screens, we add more force and unnecessary (and unnatural) pressure to our spines. As most adults these days spend most of their time with some kind of wireless device in hand or working on laptops or desktop computers, Text Neck is becoming increasingly common.
Take a look at this (embarrassing) picture of Julie, APH patient and content creator, that Dr. Todd secretly snapped while she was researching content about (guess what!) proper posture and spine care. *facepalm*
Not only is this an incredibly unflattering posture, but she's also close to the 60 degree downward angle, putting up to 60 pounds of extra pressure on her cervical spine!
Luckily, with awareness and proper posture, you can keep yourself out of this new epidemic. A few things you can do to keep your head on straight:
- Bring your wireless device to you instead of bringing yourself to your wireless device. Hold it as close to eye level as possible at all times to avoid that downward tilt.
- Put your wireless device away completely. Obviously this is a lofty goal but try to at least take breaks. Set timers to remind yourself to go device-free for periods of time. This is good for sanity and preserving actual human relations as well as Text Neck prevention :)
- Make sure your work set-up is ergonomically friendly. There are a lot of opinions about how to do this, but for Text Neck purposes make sure your chair (or desk if you have a standing workstation) is at a comfortable height so the monitor is at eye level.
- If you're already suffering from Text Neck, make an appointment at APH for an individualized treatment plan.
For Julie, all it took was one look at that embarrassing candid picture compared to this much more flattering picture to take a more mindful approach toward her wireless device posture.
#DrToddSays: Keep your head on straight!
( #JulieSays: Be mindful of your posture to take more flattering photos! )
Last week we talked about healthy hip joints and this week we’ll help you “get... that... dirt off ya shoulder” (and also keep it off ya shoulder) like Jay-Z. Side note: After this, we at APH hereby pledge that we won’t make any more corny song references. Maybe. At least not for a while.
We have two sets of ball and socket joints in our bodies -- our hips and our shoulders. Ball and socket joints can be unstable which is why it’s important to make sure all the surrounding muscles are warmed up and mobile. The shoulder is made up of your glenohumeral joint, humerus (arm bone), clavicle, and scapula. It’s surrounded by the rotator cuff, which consists of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles, and an extensive network of other larger muscles that hold everything together.
This extensive musculature connecting the upper extremities, shoulders, and cervical spine directly and indirectly affects the motion of your entire body -- from throwing a ball, to balancing your body in space, to high-fiving your new Physical Therapist!
Here’s a great shoulder warm-up and mobility drill adapted from Lance Ito and passed on to Dr. Todd by his personal PT and good friend Russel Ditchfield. All of these moves are meant to warm up the rotator cuff muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) and surrounding muscles that support the shoulder joint.
Videos 1 and 2: External rotation and abduction with bands.
3 sets x 15 reps each on each side
External rotation and abduction with bands.
Video 3: 3x15x3 reps plus 10 second stretch in each position.
#DrToddSays: Don’t let your shoulders get “dirty”! Keep them warmed up and stretched.
#DrToddSays: Integrate multiple therapies into your treatment plan for optimal results. Meet our new PT!
If you’re coming from Instagram to find out which of the three “facts” is actually a lie, the answer is #2!
Dr. Joshi is a skilled massage therapist and a Bharatnatyam dance enthusiast but he’s never been a Pilates instructor.
And here’s a little more about APH’s newest member:
Dr. Joshi is a NJ licensed and Board Certified Physical Therapist.
He spent the early years of his career path as a teacher and a massage therapist and enjoyed the opportunities afforded to him by each to empower people in various settings.
He went on to earn his Doctor of Physical Therapy degree at New York Institute of Technology with the hope of continuing to have a positive impact on patients’ lives on a physical and emotional level. As a physical therapist, he believes in approaching conditions and situations holistically, restoring patients to their prior level of function and improving their quality of life.
Currently, he works in multiple outpatient physical therapy facilities in northern New Jersey providing quality health care for musculoskeletal, orthopedic, and neurological conditions.
With his training in Ayurveda, an ancient Indian science of healing, he provides a comprehensive and collaborative environment to promote overall health and wellness. Due to his eclectic approach, he provides utmost care in the process of rehabilitation by empowering, reviving, restoring, preventing, and educating his patients.
He is open and taking new patients for PT at our office in Livingston! Schedule your appointment today!
It's already March but that doesn't mean we're out of snow storm season in NJ! Shoveling snow can be a very hazardous activity for your back. Done correctly, though, it can also be a great opportunity for a workout!
Here are some tips to help you avoid throwing your back out while shoveling and cash in on a killer workout instead.
- Foam roll first. It’s important to warm up your muscles and joints before any strenuous activity. My personal favorite way to stretch and warm up is by foam rolling. See our video library for foam rolling demos.
- Engage your core. Pull your belly button in and your rib cage down to protect your low back.
- Bend at your knees. Instead of making your arms and shoulders do all the heavy lifting, engage your legs while moving snow to allow the stronger low body muscles to do some of the work.
- Keep your arms and shoulders as close to your body as possible. When engaging the shovel and lifting the snow keep your arms and shoulders as close to your body as possible. They are levers (your torso is the fulcrum) and keeping them close to your body will minimize the effect of the extra weight of the snow.
- Take frequent breaks. The cold weather may prevent you from working up a serious sweat but that doesn’t mean your muscles aren’t feeling the heat. Make sure you stay hydrated and if you need to take a break (or call someone with a snowblower), take one!
Below, Dr. Todd demonstrates safe shoveling technique:
DO THIS: NOT THAT:
Keep these tips in mind while shoveling and your arms, shoulders, and back will thank you tomorrow!
Enjoy your snow day!
Tri season is finally here in NJ. I've been eagerly awaiting the opening race of the season and watching results from warmer areas trickle in over thelast several weeks. Last Sunday finally marked the beginning of racing here in NJ with JerseyMan. The lead in to the race had it's ups and downs both mentally and physically. Although I had a solid run build and had been doing strength work throughout the winter months, some unexpected trips in the car made for an extremely tight hamstring and compromised the early season progress.
Dr. Todd came back into action just in time. I was having trouble bending down without pain in my lower back and upper thigh. My hamstring was so tight that you could actually feel the muscle as just a taut chord. It was not comfortable. I was losing power and it took a little while to get started on runs. Dr. Todd and I worked on it over the course of 3 weeks pretty religiously. We managed to get ahead with a couple double visits in a week. The ART and focused work on the hamstring and down into the compromised calf muscle was brilliant and in short time I was feeling stronger and better. By race day, the tightness that had plagued my workouts was gone. I could come off the bike without any worry of settling in and without any sign of a limp. This was huge.
Fast forward to race day and I came off the bike in 5/6 place with another strong athlete. Had I not been able to quickly settle into a run, I could have kissed the race goodbye at that point. Instead, we had a constant back and forth duel for the first 4.5 miles before I managed to pass and put away the other runner. In the end, I came about 0.5mi short of catching 4th place but finished with a strong showing of 5th.
Using techniques and exercises that Dr. Todd has suggested based on my own functional movement screening, I was able to recover quickly from the effort and move forward with the training. Cycling power is at a new all time high and the run pace is beginning to creep to an even lower level. The season looks promising and the hammy is happy.
I had a doctor's appointment last Thursday that prompted me to learn about myself and better articulate what it is that makes me against drugs. I thought I'd share this because I suspect a lot of people have the same view and that it might be helpful for anyone else debating whether to take a pharmaceutical or not.
When the topic comes up, I typically just say "I don't like to take drugs" and that I prefer natural solutions, however, that's an oversimplification of what I really mean, which is that I don't like the things drugs typically stand for. These three things in particular:
A Real Life Example
Ugh. It was all going so smoothly, but here I am facing some hefty bumps in the road. My bone density has barely moved, and I've given myself another stress reaction. What happened?!? Here's the scoop:
My health was returning, so I jumped, ran and lifted heavy weights. No problems! It had been 4 months since I had the initial stress reaction and I stopped training, my hormone levels are back to normal, and my hips were feeling fine. No evidence of any bone injury. I had come to believe that my bone density must be coming back nicely, but I wanted to check it out and make sure before ramping up my training more, so I scheduled a DEXA bone scan.
The result: low bone density!
My reaction: "What?!?!? I only gained 9.7% in my spine?!? And I lost 4.0% in my femur!?!? I thought I was on the right track!"
The problem: There are lots of them. First, my expectations weren't set properly. I was under the assumption that I could gain tens of percents in my bone density within a year. My fault. I should have known, by asking my doctors or doing some Googling, that bone density improves really really slowly...to the tune of 10% per year if you're doing well. Second, there is a margin of error of +/- 5% for these tests. Third, the two datapoints, 7 months apart, don't tell the whole story. I was very disappointed at first, but after giving it some thought, talking to my doctors, and looking at the evidence, this is actually a pretty good result. Yes, even the loss of 4% isn't so bad. My first DEXA was done in May 2016, but that probably wasn't my low point. I was injured and had low testosterone, both of which were further hurting my bone density. Further evidence comes from a bone resorption test that I did (it shows how much bone you're breaking down) in late June that showed I was breaking it down pretty quickly. I had another bone resorption test in November that showed a dramatic decrease in the amount of bone I was breaking down. Therefore, the story is likely that my bone density continued downward till a low around July, but then necessarily must have rebounded in order to arrive back at the "nearly unchanged" numbers we see in January 2017. This would suggest that I've actually been progressing since mid-summer, and that I need to just keep doing what I'm doing. Great. So my priorities are: 1.) I'm still susceptible, so don't get a stress fracture 2.) keep hormone levels normal, which is of utmost importance for healthy bones and 3.) keep lifting heavy weights to encourage bone growth
Fastforward three days. I go for a 9 mile run with a few short pickups. It's nothing out of the ordinary as I've been doing pickups recently and have run up to 10.5 miles at a time without issue. Two hours after the run, though, my hip starts aching ever so slightly. It's the same feeling as when I first had the stress reaction. My first thought..."this must just be in my head. I got the disappointing bone density result and bone stress injuries are fresh in my mind. Plus, I've been doing runs like this, and throwing heavy weights around, and jumping and I haven't had any problems, so why would this run-of-the-mill 9 mile run affect me? Are you becoming a hypochondriac? Matt!? Are you!?" Then I ran on Thursday morning, an easy 6 miles. The ever-so-slight achiness returned...hmmm...then I lifted heavy that same day and the achiness moved into the range of undeniability. It felt like soreness deep in my hip area, but only on my right side, the same exact feeling I had back in May 2016. I immediately contacted my doctor to set up an MRI, which I did the very next day. Well I got the result on Tuesday and WHAM! I've got a stress reaction. It's in the same exact spot as before and looks to be approximately the same intensity.
What does this mean? For the short term, it means I won't be running anytime soon, I won't be doing any heavy lifting, and I can't do any hard bike workouts. Chances are slim to none that I will be doing Puerto Rico 70.3 . I'm lucky to still be walking without crutches. I can, for now, still bike easy and swim, but if that aggravates it, then I won't be able to do those either. For the longer term, maybe this is God's way of telling me to put this mission aside. "Here, I'm giving you something more important to worry about, a daughter!"
My new priorities: 1.) get ready for the arrival of our little one 2.) heal my stress reaction 3.) maintain hormone levels 4.) restore bone density to levels where I can run without reinjuring myself
I write about this topic so that others will be aware of the health debacle that can occur if you overtrain. So many articles write about overtraining and how it's not good for you, but they don't get into the nitty gritty. What actually happens to your biology? Why does performance suffer? Why do you become more injury prone? Why do you feel tired and why don't you want to have sex?! It's much deeper than "I'm tired from training," and I feel I have a duty to spread that word. I'll be doing a speech on this topic in 2 weeks at a Sports Medicine conference in Greenville, SC, I'm working with a researcher named Dr. David Hooper on a study assessing overtraining in endurance athletes, and I offer consultations to those who are in a hole and need help. To be clear, my point isn't to diminish enthusiasm about training for endurance sports, but just that we need to be smart about it! There is a balance that can be found in each person's life situation that will allow them to fully enjoy triathlon and become better athletes, all while remaining healthy. I encourage you to find your balance!
Train happy, train healthy,
I learned some helpful tidbits the other day from my doc, Todd Schragen at All-Pro Health, because I asked for a warmup routine that I could do before workouts and races. I had two reasons to ask for it: 1.) Some of my injuries have come from not warming up properly and 2.) Sometimes I feel that my glutes aren't firing properly. Here's more:
1.) Injury Prevention - Most people don't warm up properly. This is especially true for any of us post-collegiate athletes who no longer have a coach and team enforcing warmup everyday. Ever hop out of bed, throw the sneakers on, and run out the door for a 5 mile jaunt around the neighborhood? I have. When we do that, our joints and connective tissue are stiff and haven't had a chance to loosen up, and it makes us prone to injury. A bunch of those little nagging injuries (that sometimes turn into full-blown catastrophes) can be avoided by doing a simple warmup before SBR'ing.
2.) Fire Up Those Glutes - Another thing a warmup can do is fix a stubborn butt. Most of us don't engage our glutes properly and it leads to less power on the bike, worse stability while running, and a slower push off the wall / less efficient kick in the pool. Just do a quick google search for glute activation and you'll see a smattering of articles talking about how big and strong the glutes are, and how they aren't used to their potential. In fact, it's the biggest muscle in the body, and is one of the most powerful engines to power a bike, yet we barely use them. Sitting as much as we humans do deactivates the glutes. Fortunately, it's possible to fire 'em up and get them working as hard as you do.
I told Dr. Todd that it's gotta be a quick routine or I won't do it before every workout, so here's Dr. Todd's 10 minute routine (with videos where Dr. T demonstrates) that I've adopted for pre-workouts that you can do too:
1.) Foam Rolling - Hop on that foam roller for 3 minutes and roll out your myofascia. I hit my calves, hammys, glutes, quads, back and shoulders (shoulders are a little tough to roll, but good to do if you've been swimming)
2.) Floor Exercises - These activate your core and encourage good posture
i.) Pelvic tilt
iii.) Prone press up
iv.) Modified plank
3.) Glute Activation - Get the big guns fired up for your next workout
i.) Bridge with march (7 each leg)
ii.) Lunges (7 each leg)
ii.) Single leg stance (15sec each leg. You can do it on the ground or anything unstable if you don't have an Airex balance pad)
All of these videos can be found on the All-Pro Health website in the video exercise library. New Year's Resolution to do these before your workouts? It can only help you as an athlete.
Quick update: I'm being formally coached again! I'm back in action with Earl Walton looking to take on Puerto Rico 70.3 on March 19th before Baby Bach arrives :-)
In other news, my first published article is online now - Triathlete Magazine!
Train happy, train healthy,
Dr. Todd and I have been through a lot together this year but always with the same aim – get to the start line of the next race in the best possible shape to focus on performing. Most of the time, my body has cooperated but setbacks are natural in training especially for long endurance events. Training blocks incorporate periods of high intensity and power as well as speed development and aerobic capacity gains.
One area that we really worked on was core training and a strength program. Core is not confined to attaining the much desired 6 pack abs. Core strength extends so much further than that and impacts your ability to engage muscles groups properly and efficiently. I have never felt as strong at the end of races as I did this year. Standing up tall, engaging leg muscles without tapping into other muscles groups for compensation, and staying relaxed all helped keep me focused on racing and not managing cramps or muscle fatigue.
Dr. Todd nailed it with a late season addition to the program. After IM Chattanooga, I was left unsatisfied and wanting more in terms of competition and race results. Working with my coach and a somewhat clear head, we decided on IM Arizona. This gave me 8 weeks to recover, rebuild the lost fitness, and get to the race ready to crank away. The only catch – I banged my ankle on a Starbucks door two days before IM Chatt and I couldn’t really put weight on it. In hindsight, the sore muscles and tired legs from the race probably prevented me from damaging the ankle more by running on it. After about 2 weeks, I finally went for me first couple runs again. The ankle hurt and the ligaments around it were sore from compensating. Dr. Todd worked on the whole area and just kept giving it the care and attention it needed while I did my best not to beat it up too much. Then one day, after graston and some ART, I worked out in the afternoon and didn’t pay any attention to it before realizing that night that the ankle didn’t hurt. Five weeks on and it was finally back together. Now, I had three weeks to work out the other muscle compensation issues that arose. Dr. Todd went after my calf and quad on each visit.Race day came and the body just did what it was supposed to do. No doubt about it, the upkeep and care is the only way I made it to the line and through the race.
What a year it’s been together. I can’t control the quality of the field that arrived at IM Arizona but I executed the race plan and crossed in 9:08 for 5th in my age group and 13th amateur. After some mental and physical recovery, I’m looking forward to another together, conquering new goals, and reaching now heights.