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There are 3 main shoe types for running, with any number of hybrids. The type that is best for you depends on how your feet and how they move when you run. All 3 types come in many different brands. Brand is usually not nearly as important as fit and type. The team at the Run Clinic can help guide you in your future shoe selection.

A motion control shoe helps to control excessive medial (toward the middle) motion, often referred to as pronation with dual density midsoles, roll bars or foot bridges. This medial (inside support) support slows the rate of over pronation.

Stability shoes combine cushioning features and support features into its design to provide support and shock absorption.

Cushioned shoes emphasize enhanced shock absorption and can assist in motion for a foot that moves less.  Materials are often incorporated into the soles to enhance the cushioning properties of the shoe such as air cushions, gel, and HydroFlow.

No matter what type of shoe is recommended, or what brand & style you prefer, make sure to try the shoes on and jog & run at least a short distance to ensure fit, comfort and that they don’t create or contribute to any pain or discomfort. 

For more shoe information and some cool suggestions on where to run in San Francisco, go to http://www.fleetfeetsanfrancisco.com/about/visiting-sf

Consumer Direct Access to Physical Therapists in California was signed into law by Governor Jerry Brown, on October 7, 2013. Being able to directly access a physical therapist will save people time and money.

Lindsay Haas, DPT at our Castro Clinic is also an amateur knitter, passionate about sharing her expertise in human mobility and movement with other knitters. Interviewed here by Knit and Tonic blogger, Wendy Bernard:
http://www.knitandtonic.net/knitandtonic/2013/02/and-to-think-i-thought-knitting-yoga-was-a-joke-.html

An east coast transplant to California, I’ve fallen in love with the mountains.  In the winter, for me that means strapping on a snowboard to play in the snow in Tahoe.  As those of you who ski and snowboard know, this requires a certain level of fitness.  Aside from the endurance and general strength it takes to have fun out there, there comes risk.  Having the perspective of being on orthopedic physical therapist, I see first hand the injuries that can happen out there, to all different degrees.  I’ve also been injured myself, and was reminded how important it is to take care of my body properly so I can keep snowboarding…until I’m 80 or older!

Having started snowboarding later in life, having more awareness of the risks associated because of what I do, and just some of my personality, I definitely ride more conservatively out there; my main goal being having fun.  I know the consequences of taking more risks with my riding, especially when the conditions are firm or icy.  Now that being said, I still like to get out there, make smart decisions, like calling it a day when I feel that fatigue set in.  Most importantly, I train my body for the hill.  Sure it’s important to work on endurance and cardio, and cross train, but more importantly is balance and core stabilization training.  I make it happen, every day during the week…I pick 4 or 5 quick exercises to keep challenging my stability to increase my response out there, so my body knows how to respond to the variable conditions that present themselves.

Everyone out there should have a program to prepare themselves for the season, and upkeep during the season.  That should include a flexibility program (my foam roller lives up at my ski house during the season), a strength and core stability program (including things that challenge your balance on uneven surfaces), and a dynamic warm up program to start off before the first turns of the day.  With doing those things, you will significantly decrease your risk of injury, your body will be more stable on the hill absorbing those bumps, and you will even perform better.   And when you do have an injury, even a minor one, it’s important to consult with a PT (the movement experts) to minimize your time off the slope and get your body back to functioning quicker.  I didn’t do this when I should have last year, and ended up limited in my summer activities because of it…lesson learned!

Jessica Monaloy, PT CIMT
San Francisco Sport and Spine Physical Therapy
Jessica@sfsspt.com

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Low back pain (LBP) accounts for 2.5% to 3% of all physician visits in the United States.1-3 Annual direct health care costs were estimated at more than 85 billion dollars nationally in 2005, up 65% from 1997.4 The prevalence of chronic, disabling LBP is increasing, despite increasing spending on the problem.4, 5

Most patients with LBP initially access health care through their primary care provider.6, 7 Decisions in this setting are likely to have a substantial impact on outcomes and costs.8 Only 7% of people who consult their primary care provider for low back pain (LBP) are referred by their provider to physical therapy in the first 90 days of an episode.9 Practice guidelines generally recommend delaying referral to physical therapy for several weeks following initial consultation.10,11 The rationale for this recommendation is that most patients recover rapidly, and not intervening quickly wastes resources and might impede recovery for some patients by excessively “medicalizing” the condition.12,13

According to Fritz’s study in SPINE, early physical therapy intervention was associated with decreased risk of advanced imaging, fewer additional physician visits, fewer injections, and less opioid medications compared with delayed physical therapy. Early intervention was defined in this study as commencing within 14 days of initial onset. Total medical costs for LBP were $2736.23 lower for patients receiving early physical therapy.9 That is a cost savings of over $2700 per case, on average.

Dr. Gellhorn concluded in a separate study in SPINE that “There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times. Medical specialty variations exist regarding early use of PT, with potential underutilization among generalist specialties.”7 If the patient is not consuming more healthcare resources in this scenario it is likely because they do not require them. They got better.
Please call us or email if you’d like a referral pad for your patients. We’re here to help you and them return to activity and get out of pain as quickly as possible. 415.593.2532, David@sfsspt.com

  1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine 2006; 31:2724-7.
  2. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain: frequency, clinical evaluation, and treatment patterns from a national survey. Spine 1995; 20:1-9.
  3. Licciardone JC. The epidemiology and medical management of lowback pain during ambulatory medical visits in the United States. Osteopath Med Primary Care 2008; 2:11.
  4. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299:656-64.
  5. Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169:251-8 .
  6. Deyo RA, Phillips WR. Low back pain: a primary care challenge. Spine 1996; 21:2826-32.
  7. Gellhorn AC, Chan L, Martin B, et al. Management patterns in acute low back pain: the role of physical therapy. Spine (Phila Pa 1976) 2012; 37:775-82.
  8. Feuerstein M, Hartzell M, Rogers HL, et al. Evidence-based practice for acute low back pain in primary care: Patient outcomes and cost of care. Pain 2006; 124:140-9.
  9. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: Impact on future health care utilization and costs, 2012. Spine 2012; 25:2114-21.
  10. Koes BW, van Tulder MW, Lin CC, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19:2075-94 .
  11. Murphy AY, van Teijlingen ER, Gobbi MO. Inconsistent grading of evidence across countries: a review of low back pain guidelines. J Manipulative Physiol Ther 2006; 29:576-81.
  12. Moffett J, McLean S. The role of physiotherapy in the management of non-specific back pain and neck pain. Rheumatology 2006; 45:371-8.
  13. Von Korff M, Moore JC. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001; 134:911-7.

Below is a compilation of apps we, at San Francisco Sport and Spine Physical Therapy have used or had recommended that work well and align with what we do to get people better and help them stay that way!
If you have a particular favorite, please email sturdy@sfsspt.com with your suggestion.

MyFitnessPal — calorie and exercise tracker
http://www.myfitnesspal.com/

The Habit Factor — great for creating new habits around exercise, activity or anything
http://www.thehabitfactor.com/welcome/

Chronic Pain Tracker
http://www.medhelp.org/land/pain-tracker

My Pain Diary: Chronic Pain Management
http://itunes.apple.com/us/app/my-pain-diary-chronic-pain/id338627856?mt=8

Fit Bit
http://www.fitbit.com/

ZamZee.com – Fitness meter for the whole family, including kids!
http://www.zamzee.com/

Ski through the entire season by avoiding injury.

New jacket. Check. Snowboard waxed. Check. Chains on the tires. Check. You’re ready, and there is finally fresh powder on the hill. The anticipation built up over the sunny, summer months is finally about to be unleashed down the hill. And then it happens. All your preparation lost to the jump you landed wrong and your newly torn ACL. It happens. And there is nothing that you could have done, right? WRONG.

We see it in our clinic every season. Knee pain, tears, sprains, wrist and shoulder injuries…many that could have been prevented with the proper preparation. Yes falls will happen, especially with inexperienced athletes, but you can reduce your number of falls and how your body responds to falls with the appropriate training. Read the rest of this entry »

Do you think you know what ‘good’ physical therapy is? Is there a difference in the quality of physical therapy from clinic to clinic or is it all basically the same? Do you just go with the first place listed from a Google search? How can you tell what truly good physical therapy consists of?  Would you be able to tell the difference between the two?

There is a lot of difference in physical therapy clinics and we want you to know what that difference is. Getting to a physical therapist is easy, getting rid of your problem and truly moving better is much more difficult. The first step is know what a physical therapist is and does. Read the rest of this entry »