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



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,

  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 with your suggestion.

MyFitnessPal — calorie and exercise tracker

The Habit Factor — great for creating new habits around exercise, activity or anything

Chronic Pain Tracker

My Pain Diary: Chronic Pain Management

Fit Bit – Fitness meter for the whole family, including kids!

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 »

In my years as a physical therapist I’ve seen all kinds of injuries and heard all kinds of body-related complaints—some from accidents, some from surgery, and some resulting from extreme athletics. But there’s no athletic endeavor that is guaranteed to lead to injury quite like the Desk Jockey. It doesn’t matter the city or the type of therapy practice, the poor, weary Desk Jockey finds me over and over again.

The wear and tear on the body of a Desk Jockey is highly underestimated except, of course, by a physical therapist. We receive reports of neck pain, back pain, leg pain, tingling, and it confirms what we believe most: humans are just not meant to sit in the same position for 8 or 9 or 10-plus hours per day. Nor are they designed to wake up and repeat this pattern day after day. So what’s a Desk Jockey to do? Read the rest of this entry »

Do you have difficulty falling asleep? Do you wake up during the night tossing and turning? Feel tired, achy or sore in the morning? Check out the tips below to get a better night’s rest.

1. Invest in a good mattress.

The lifespan of most quality mattresses is about 8-10 years. But keep in mind that your body changes over time. So what may have worked for you even 5 years ago may no longer be a good fit now.

If you are a side-sleeper you will probably prefer a plush-firm to plush mattress. This allows the bonier and wider hip and shoulder areas to sink in a bit, while giving support to the low back and legs. *Quick Fix: If your mattress is too soft, side-sleepers support your low back pain by putting a folded towel under your waist.

Back and stomach sleepers usually do better with a firm to plush-firm mattress that will support the spine in neutral better. *Quick Fix: If your mattress is too soft, back sleepers support your low back by placing a folded towel under the small of your low back or under your stomach for stomach sleepers. Read the rest of this entry »

Back pain is very common. The daily demands on your body can cause muscle weakness in the lower back. Sitting continuously all day, improper posture, and limited physical activities are some of the contributing factors. Here are some tips to help you overcome and prevent lower back pain.

1) Maintain good flexibility.  Regular stretching helps keep muscles flexible. They can also reduce stress on joints and improve the flow of blood and nutrients throughout the body. Without it, stiffness, limitation in movement, and pain can occur. For specific low back pain, stretch your hamstrings  and hip flexors, which have direct attachments to your low back.

Stretching is also an important way to prepare the muscles for vigorous activities such as aerobics or playing a sport. Stretching
exercises should also be done before and after a workout to prevent muscle strain and soreness and to help avoid injuries. Read the rest of this entry »

In my work as a physical therapist, runners come to me all the time with questions about which running techniques are best. Usually they are struggling with injuries and they’ve heard about the latest, greatest technique on the Web or from their running buddy. They’re hoping that if they change their shoes or the way their foot strikes the ground they’ll get rid of that aching hip or knee or ankle—and they’ll run faster, too.

They want to bottom line answers to help them sort through all of strong—and often conflicting—opinions they’ve heard: Should a runner land on the heel, midfoot, or forefoot? What’s the deal with “overstriding?” And what is all the fuss about barefoot running?

Unfortunately I have to break it to them that there are no easy answers. There’s no silver bullet when it comes to running—a technique that has been the answer to your running buddy’s prayers might not be best suited for your body. If you really want to know which running techniques will suit you best, I recommend a full biomechanical assessment of your running and training patterns. (Full disclosure: In addition to my work as a physical therapist, I also work at a running clinic where we do these types of assessments.)

But since the Web is rife with opinions about this stuff, I’d like to share thoughts about the current running buzz based on what I’ve seen in my practice. I hope all of you runners out there will find it a useful reference as you continue to learn more about running. Read the rest of this entry »