• Back sleepers: Use a thin pillow that does not throw your head forward. Find a pillow with extra loft in the bottom third of the pillow to cradle your neck.
• Side sleepers: Use a larger pillow that supports the space between your ear and your shoulder.
• Stomach sleepers: Just get over it. You’ll crank on your neck no matter what pillow you use.

Pillows are made of many different materials: Lots of people like memory foam, but it may be too hot for some people. Latex stays firm, so may not contour to your neck well. Down can be great, if you are not allergic to it.

A product called “PT Pillow” makes a fabulous down pillow with variable loft. One side is bigger than the other, so it could work for either a side or a back sleeper. Check it out:

http://www.mybetterspine.com/product/sample-pillow-1038.cfm.

Your PT can also help you problem solve the pillow dilemma. Send us your questions. A solution is waiting for you.

I am fortunate to have been mentored by strong visionaries who encouraged me to stray outside the box a bit as I searched for new knowledge. What a fun journey I am on! Since being a part of the ALTA team, my horizons have soared. I’ve been exposed to a variety of more subtle energy- based practices such as Integrative Manual Therapy, Body Talk and visceral mobilization. And, they resonate with me.

But how will they help you?

The treatments are gentle, but produce amazing results. I have learned that less can really be more. That intent can really create change.

So what is IMT? Integrative Manual Therapy was developed by a physical therapist /neuroscientist named Sharon Weiselfish. It comprises a multitude of different evaluation and treatment techniques that gently correct organ, soft tissue or joint dysfunction. With IMT, we can find restrictions in blood vessels, ligaments, nerves, organs and cartilage that affect normal movement. Using very specific directional forces, we target tissues in dysfunction and set up an environment for the tissues to self correct so they move in a healthy way. These releases often correct dysfunction on their own and surely help to prepare a joint or muscle for other types of treatment, like direct joint mobilization or exercise.

Injuries often have underlying tissue damage that affects your ability to move with ease, decrease pain or increase strength. My wonderful colleagues at ALTA are keen to share patients if it helps accelerate healing. If your therapist says you could benefit from a few sessions of IMT, I would have to agree. It is a fabulous system and a wonderful adjunct to mobilization, TDN, and exercise.

If the clam is “the” exercise, why isn’t it workworking?

Chris Powers, Professor at USC, says Barb and her friend’s problems are all about hip strength. Chris has devoted years of research to finding the right exercise in the right sequence to make hips strong enough to eliminate common lower extremity problems. Using fine-wire EMG, Powers evaluated a number of exercises to determine which ones specifically activate the posterior hip muscles (gluteal muscles) while not firing anterior hip muscles (the pesky tensor fascia lata/ITB and psoas). Weak glutes lead to poor control of hip motion, which can cause a host of problems: knee, hip, ankle and back pain. Here is how that happens:

Strong glutes keep the hip from falling in and the knee from collapsing. Because the gluteus maximus and medius are endurance muslces, they need to be able to fire for a long time. Minimum requirements:

• Fire for at least a minute under sizeable resistance
• Fire strongly in isolation (i.e. no help from the TFL or psoas)

So start with the basics:

• Begin lying down, because if you can’t activate the glutes lying down, how can you expect them to work when you need them in the bumps or on the trails?
• Start with isometrics. These muscles need to hold a contraction for a sustained      period of time – a minute is what Powers recommends.
• Once you know what you need to recruit, you can quickly get off the ground and start    doing more functional exercise so that running, riding, hiking, or just managing a flight of stairs can happen without pain. What a concept.
  

  Clam Shell Video

If you have had a poor firing pattern for a while, you may need some help learning the exercises. How do you keep the TFL and psoas relatively quiet? That’s the key–doing the clam and getting the burn in exactly the right place makes all the difference. You can feel for the right muscle and you can also look at the front of your hip and see if you are firing there. If you activate the TFL, you tighten the ITB, the hip rolls in, and stress shows up in multiple joints.

Having the right muscle fire might take some fine-tuning. Maybe you’ll need a trained eye to see those little compensations. If so, make an appointment. Firing the right muscle while the other muscles are quiet is when magical changes start to happen.

A solution is waiting for you.

The GOOD News: T’ai Chi is a fantastic way to improve balance and core stability, reduce the fear of falling and generally decrease anxiety. T’ai Chi classes develop a more confident, steadier, sturdier you.

I had the great pleasure to sample Deb’s Tai Chi class at ALTA. I was amazed by how the flowing and gentle movements relaxed my body and allowed me to feel centered and engaged. No grocery lists, no to do lists running through my brain. I was completely in tune with the movements and with my body. Debbie’s cadence and tone of voice lent to the restorative nature of the exercises. Each new move was challenging but not in that heart pounding/anxiety provoking way. It just challenged me enough to keep me in the moment.

This class is unlike Tai Chi classes elsewhere. The individual postures and sequences you learn will be chosen and tailored to the specific needs of the group. The focus will be on comfort with each posture before adding new movements. Proper breathing and weight-shifting are a part of each class, as well as emphasis on balance. Try this class, you’ll be hooked!

Taught by Debbie Steinman, LPTA, GCFP

Classes Thursday 12-1 p.m. starting April 4th

Class size will be limited to five. 

NO, actually there are some great ways to give your feet a little TLC at the end of the day and just maybe avoid pain, and hopefully bunion surgery.

We know that barefoot cultures have fewer foot problems per capita than any other population. Hmmm…maybe our feet want to be freer, more out in the open, toes more separated from one another. Vibram Five Finger shoes allow toes to stretch, feel the ground, separate, do what toes are supposed to do. Maybe I should make the leap – if I could just get over how ridiculous they look!

Then there is Yogatoes. Yogatoes are toe stretchers that claim to do a lot of things, including decreasing bunions and hammer toes. Our feet have little muscles deep inside called the foot intrinsic muscles. These muscles work hard! They support our feet and thus, our entire bodies. Yogatoes stretch and relieve these muscles so they can do their job and we can do ours! As I sit at my desk writing, Yogatoes sound pretty good to my sock and shoe clad feet. I stretch other parts of my body, other parts that don’t support me through thousands of steps. Why not my feet?

Have you heard of Yogatoes? Tried them? Do you wear Vibram Five Finger shoes? Do you give your feet any TLC

“I really want to get in shape this year – that’s my New Year’s resolution.”

“Isn’t that the same resolution you had last year?”

“Yeah, but this year, I am really going to do it.”

How will you do it? Learn to use pessimism and 5 other surprising tips to increase your willpower.

The most popular New Year’s resolutions involve health:  losing weight and getting in shape. And most of those resolutions are forgotten within the first month or two of the year.  So why bother?  Well, because you want to live a more vital, healthier life, right? You want to feel good about yourself and your future. And that requires willpower.

According to researcher Kelly McGonigal*, we have one brain but two minds.  We have a mind that acts on impulse and seeks immediate gratification, and we have another mind that controls impulses and looks out for our future best interest. How do you capitalize on your forward thinking mind to reach your long-term goals? The research will surprise you…

6 ways to improve your willpower:

1. Move.   Even 20 minutes of walking 5 times per week will strengthen the part of your brain that controls impulses. With regular exercise, the prefrontal cortex gets bigger and stronger and creates better connections to other parts of the brain. In as little as 2 months, exercise improves willpower.
2. Take a nap.   A study of people with a significant willpower challenge (drug addiction) had one half the incidence of relapse when they were able to sleep an extra hour per night when compared with those who slept less. Fewer than 6 hours of sleep per night causes sleep deprivation and lowers resolve.
3. Go easy on yourself.  The harder you are on yourself, the more likely you are to continue to repeat an unwanted behavior. Shame and guilt drive people back to the very comforting behavior that they want to end. If you instead are able to acknowledge that everyone is imperfect and makes mistakes, and that what you are doing is hard, you are more likely to stick to your plan. Belly breathing, meditation, BodyTalk and Tai Chi help decrease anxiety, and thereby increase willpower.
4. Be pessimistic.  Imagine yourself failing to meet your exercise (or other) goals. Get specific. When are you not going to exercise? What will you say to yourself that allows you not to exercise – “I’m too tired”? or “I forgot my shoes”?In studies, those who became clear about how they would fail, exercised twice as much as those not in the failure awareness group.  AND, optimism about future success correlates with poor achievement. “I’ll feel more like doing it tomorrow” is a recipe for failure.
5. Hold Your Breath.  Distress tolerance, or the ability to stay put, to hang in there when things get uncomfortable, is a great predictor of future success with willpower challenges. So hold your breath: you might start with 15 to 60 seconds- whatever time feels challenging. The practice, which has nothing to do with your particular willpower challenge, will prepare your body physiologically to stay true to your long-term goals.
6. Make a small change.  Something as simple as promising yourself to use the word “yes” instead of “yeah” for two weeks trains your brain to be disciplined. Discipline practices – those that are relatively easy and not tied to your willpower challenge – carry over to making more meaningful changes in all aspects of your life. Trying to change your world in one day can mean defeat. “Go big or go home” is the wrong way to think about willpower.

So start small – do one of your PT exercises every day for a week. Increase movement by taking the stairs instead of the elevator. Breathe deeply. If you get stuck, BodyTalk or T’ai Chi can decrease stress – and before you know it, you’re off to a great start.

* Kelly McGonigal, PhD, Stanford Researcher and author of the book The Willpower Instinct.

Here’s why I was wondering: One week in December, I did six evaluations on patients with recent ACL reconstructions. They all tore their ACLs – a primary stabilizer of the knee. They tore them early in the ski season  and had the surgery over Christmas break. I saw them for PT before the New Year.   PTs see this all the time. We joke about when the post-operative ACL’s will start rolling in and it is predictably in late December and early January.

As much as we love our patients and love the business that ski season generates, we would rather you didn’t have to go through the pain and hassle of a major surgery. So how can ACL tears, as well as other ski injuries, be prevented?

Most ACL tears result from what we call a valgus collapse. This means that when you land from a jump, or ski the bumps or simply hit an uneven patch of snow, your knees come together in a “knock-kneed” posture. This bent and slightly twisted form wreaks havoc on the ACL and can cause it to snap. In an instant, you are facing major reconstructive surgery and months of rehabilitation.

You can avoid this, but it starts now.

Now, before you strap on your skis and hit the slopes. Avoiding the knee injury has very little to do with your knee and a whole lot to do with your glutes and core. Your glutes are powerful external rotators and are extremely effective in avoiding the dreaded valgus collapse.

Are Ya Skiin’ or Peein’

If your glutes are strong and prepared for an unexpected or awkward landing, your ACL will be protected. So how do you strengthen your glutes? The ever-popular clam exercise is a good start. But there’s more . . .

Beyond the Clam

Any weight-bearing exercise where you focus on proper knee alignment will help you avoid valgus collapse.

• do squats
• do squats on a Bosu ball
• do squat jumps
• do single leg squats
• balance with one leg on a stack of pillows

The list goes on. But when you do these exercises, keep your knees aligned over your toes. Do not let them fall in. Tie a band around your knees to prevent them from pointing inward.

Do all these things, every day, before you put on your skis. Early in the season, your glutes are not strong the way they will be by March (if your ACLs make it that long…). Your ACLs will be vulnerable. Do the work before the season starts so you can ski the whole season injury-free.

ALTA can help. In fact, we just might be the best place to start. In one session, we can give you an exercise program with exercise progression that you can work on to prevent skiing injuries. We can evaluate your susceptibility to an ACL tear and give you individualized exercises to keep you healthy. We can get you into a Pilates class that will kick your butt (pun intended!), prevent injury, and be fun. Doing ski season “pre-hab” is a no-brainer. Doing it at ALTA is the best decision you will make all winter.

We are what we think.  All that we are arises with our thoughts.  With our thoughts, we make the world. The Buddha (c.563-483 B.C.)

“I am done with cyclocross racing.  I’ll just have to stick with road I guess.”

“Why?”  I ask.

“My knee.”

“What about your knee?”

“I have arthritis.”

Did you know that just the word – arthritis – could limit your ability to heal?

Arthritis – you’ve got arthritis. The word alone conjures up crippling pain and disability that can influence how you heal. You may remember your grandmother’s swollen, gnarled hands or the grimace on her face when she climbed the porch steps. You may have visions of her constantly rubbing her sore knees. You knew Gram had arthritis. So when the doctor looks at your x-ray and says you have arthritis, the very word makes you hurt more. And the mention of it may alter your ability to recover.

The same is true for a host of maladies. Culture dictates to a great extent how our bodies are affected by an illness. Neuroscientist Mario Martinez looked at the very powerful influence of culture and words on our health. Peruvian women were studied during menopause. They had, as a group, more complaints and symptoms than did women in other cultures. Their inflammatory markers were elevated, indicating immune systems that were working overtime. The Peruvian word for hot flash  -  “the shame”.

Contrast this with Japanese women who generally transition through menopause without symptoms, and without increased inflammatory markers. The Japanese words for menopause are “a second spring”. Menopause is viewed positively; it’s a time to join the revered elders in the community. This positive outlook in the culture is reflected in a healthier physical response to menopause.

Back to arthritis. Even if the story is not a personal one, arthritis has it’s own ethos in our society. The general feeling is that 1) it will get worse over time and 2) there is nothing you can do about it. When an x-ray shows abnormalities, it can give substance to your pain and decrease your self-perception of health. Then if, out of fear, you avoid moving, you predispose yourself to continued pain.

Among a large group of subjects 60 years and older, MRIs showed that 30% had herniated discs, 21% had spinal stenosis and 90% had degenerated or bulging discs. Yet none on them had back pain. The association between MRI findings and symptoms is tenuous at best. Because an MRI or X-ray looks bad does not mean you are destined to keep hurting. If you look closely enough at almost any joint in the body, you will find something wrong with it. Don’t assume that whatever shows up on the MRI is the source of your pain.

Perceptions, both cultural and personal, influence how our bodies work. The influence is often under the radar of conscious thought, but can set off alarms that derail physical improvement. Yes, pay attention to pain and seek out diagnostic tests, if recommended. But remember, you are not your X-ray or MRI. You have a host of wonderful options to help you get better, and knowing it’s possible to be pain free is a huge step towards recovery.

A solution is waiting for you…

With the diaphragm, as with any muscle in the body, if you don’t use it, you lose it. Tightness and/or weakness in any muscle leads to poor efficiency and a cascade of compensations throughout the body. Imbalances that are extreme enough eventually cause pain.

What does that have to do with the diaphragm? Well, in addition to respiration, the diaphragm is a trunk stabilizer. And those suffering from chronic low back pain often have instability in the lower spine. Part of the instability comes from weakness of the diaphragm.  

Strengthening the diaphragm gives you two for one. Not only will you perform your sport better, but strengthening your diaphragm may also help stabilize your lower back and chase that pain away. 

16 years later…

I rode my bike 300 miles last week and climbed over 16,000 feet. We climbed Independence Pass, Cottonwood Pass, Ute Pass and more passes whose names I can’t remember. Yowza.  I felt tired and exhilarated, but strong.  No sciatica, no IT band pain, no stress fractures – nothing. Nothing hurt – NADA. ZIP. ZILCH. At 57, I can still run up Sanitas, bike to Ward and sit in a low chair.  Even more importantly, I can get out of that chair without a twinge. And my secret? PILATES.    

It was 1999 when I took my first Pilates class, and I haven’t looked back. Sure, I had done lots of weights, aerobics classes, hot Yoga — I tried it all.  But until I landed in Pilates, I never really knew what I was missing. My injury rate has dropped to “too little to mention” and when I have an occasional problem, my colleagues are quick to treat it. I get better faster than ever before, even as I get older.  

I honestly can’t think of a better insurance plan against any injury – and it’s fun. I end up tired and relaxed at the same time. The breathing focus can eliminate a headache in no time. One hour a week is what I do now to keep my body happy – and I’d like to do more. But then, where would I find the time to bike and run and ski, and do all the things I couldn’t do 16 years ago?

If you have never tried Pilates, do it. Beware though, you might get hooked. In October, we are offering The Discovery Series. For clients new to Pilates, we have an amazing deal. Take a 5 class series for just $99. It’s the cheapest insurance you’ll ever buy.