In the past 2 weeks, I have received calls or had conversations that were about 8 different girls who tore their ACL’s and will be having surgery in the next few weeks to reconstruct their knees.  Obviously because I specialize in treating athletes with ACL injuries I hear about it more frequently than the average person.  The problem is  7/8 of injuries were non-contact and believe it or not, preventable.

All Sports and orthopedic injuries and most causes of osteoarthritis (OA), fall into two categories; non-contact and contact.  Contact means that it was a car accident, they got kicked, hit with something etc.  A non-contact injury means that they were moving their bodies in such a way that they were not able to tolerate the demands or forces put on their body either in a specific movement such as cutting while running or with repetition of certain movements such as long distance running.  A non-contact injury could be classified as traumatic which leads to injuries such as ACL tears and acute or repetitive, chronic overuse injuries such as patella tendinitis or a stress fracture.   During my research and time spent at the University of Cincinnati and Cincinnati Children’s Hospital, I learned that non-contact injuries are nearly entirely preventable if the athletes are screened appropriately and put into the appropriate training program.

The problem is this screening never occurs.  We as a society, are not proactive enough.  Most of the injuries occur to female athletes.  Female athletes tear their ACL’s 10 x more than boys.  A total of 17,000 per year.  1/10 college female athletes had torn their ACL prior to their freshman year.  These numbers are crazy, especially when the research has been done to show a significant decrease in these injuries simply by taking the time to do and appropriate screening.  Most people, coaches and health care practitioners are not aware of the research that exists which shows the effectiveness of screening to prevent injuries, let alone how to do it.  The screening is only the first step.  Once someone is identified as being at risk they need to be entered into a prevention and performance enhancement program like we utilize at Revolution to address their deficits.

I have an entire series of videos explaining non-contact injuries, primarily ACL injuries in females, the surgeries, the rehab, etc on my youtube channel –search drlyneil46.  Here is one of the videos.  http://www.youtube.com/watch?v=QuQ1C0rT0TA

Hopefully this helps.  One of the missions of this Revolution is to have a significant reduction in non-contact injuries in all people and athletes.  I hope you will join us in this effort.  As an athlete, and now a PT, it baffles me that we are not implementing these programs in all sports.  I had many non-contact injuries.   I was a hard worker.  I trained.  I participated in strength and conditioning.  I was willing and so are many other athletes out there.  I felt a disservice when I became a PT and decided  I would try to do something about it.  People just need to be aware and exposed to the truth.  There is no reason an athlete or anyone has to experience the pain and dysfunction associated with these injuries.  We are here to help.  Please contact me if you have any interest in learning more.

Thanks

Lyneil Mitchell, DPT

Currently, 47 states and the District of Columbia allow direct access to physical therapy without a physician referral.  This means if you are having aches and pains you can come to a place like Revolution who has PT’s with a special license to treat patients without a referral from a physician.  Early intervention is the key!  Waiting to get a referral to get treated by the person who knows what treatment is best doesn’t make sense and only costs us more time, more pain ,more dysfunction and ultimately more money! $$$$$

According to a study by Mitchell and DeLissovoy published in the Journal of the American Physical Therapy Association in 1997, when Physical Therapy is accessed without a referral there is an average cost savings of $1200 per patient care episode .   This also resulted in 67% less time spent in physical therapy as well.

Right now currently in the U.S., < 5% of all PT visits are without a referral.  That means 95% of these episodes of care are 67% longer and $1200 more expensive.  Direct access to Physical therapy is the obvious choice and is the greenest choice for musculoskeletal conditions.  Revolution is one of the few Physical Therapy companies that bases their philosophy around this principle.  Save money, get treated sooner, get better faster and spend less time on the bench or couch!

This obviously needs to change and starts with you.  When you have pain, if it is not an emergency, go see a physical therapist first.  “It just makes sense, right?”

Thanks

Lyneil Mitchell, DPT

#1.  I often get a lot of inquiries as to why we are called Revolution and what our symbol (the delta and infinity) means.  After about a 15 minute conversation explaining the story and the reasons behind it, most of the people I talk to say, “Yeah, that just makes sense.”  Well if it makes sense then why doesn’t there seem to be a Revolution going on?   The main reason is there is a huge information gap between the policy makers and healthcare practitioners and the public.  There is a large information gap between those who are providing medical, fitness and wellness services and the average consumer.  It has been kept that way so those in power, stay in power.

Power to the People!  One by one, the power in industries is shifting towards customization and catering towards the consumer and users of products and services.  We control our own banking, we pick our own wireless plan, we can comparison shop online, we buy songs instead of albums, and we can print our own photos.  “Power to the people”, everywhere except healthcare, especially physical therapy.

In a society where the consumer is the most important and can select their own Primary Care Physician, Dentist, Chiropractor or Pharmacist, they should be allowed to choose their own physical therapist.  The government and insurance companies would agree.  47 states and the district of Columbia allow direct access to physical therapy without a physician referral. Physical therapy is a consumer product and one of the most intimate relationships with a healthcare provider.  If you want to get the best physical therapy, shouldn’t you try to go to the best physical therapy practice?  Beware,  not all healthcare practitioners are created equal.

Physical therapists have their Doctorates now because we are the experts in physical therapy.  There is no one that knows what we do, better than us.  Private practices which are direct access(No referrals necessary!) have to look at each individual as a unique situation and attempt address the causes of their problem.  Hospitals and Physician owned PT practices(POPTS) are physician centered, which many of them, know very little about physical therapy, other than to refer when they can’t fix the problem without medicine or surgeries.  (POPTS are those PT practices right next to the orthopedic surgeons office.)  I often feel bad for these PT’s because although some have their doctorates, they do not get to practice like a Doctor.  They barely have to think because they don’t have to figure out the cause of the problem.  They rely on the referring physician to do this for them.  This creates poor practice patterns in which the Physical Therapist is more of a technician following a protocol, instead of a practitioner who thinks and formulates a diagnosis to addresses all of the needs of the patients.

I often wonder how many of these PT practices stay open.  I truly believe many of them will be shutting their doors in the decades to come.  Most of these referral based practices have patients who do not choose but end up there by referral.  If they would take the time to make a choice, I am sure it would be much different.

The number one reason why we opened Revolution is because we believe that each and every individual deserves to make a choice to have access to the best Physical Therapy to get back to the highest potential possible.  85% is not good enough.  Would it be good enough for a professional athlete? Our owners and physical therapists have worked and interned at some of these other types of practices and felt that their standards were sub par.  We wanted to actualize the potential of our profession to help people realize a new standard of living and return to a level better than they were before they came to see us.  We wanted to provide a practice that would also actualize the potential of our clients and patients, as well as the PT’s who work there.  We opened Revolution to one day leave the world better than what it was and to provide people with what they deserve.  A place to go for Physical Therapy that people will want to choose!  “It just makes sense, right?”

As children develop into adolescents, their bodies change dramatically.  Most often, they never learn how to appropriately use these newly developed vessels.  Enhanced coordination is the number one competitive advantage in sports.  When watching an athletic competition of any kind, all of us can agree that the best athlete on the field is the one who demonstrates the most coordination.  Speed, power, explosiveness, and precision are all important aspects of sports performance but are the results of coordinated movement.  Many of our youth fail to excel in sports, especially as they grow and develop, because many other aspects of training are improperly placed ahead of training coordination.  These aspects usually fall under the “necessary to win” category.

In the “necessary to win” scenario, player and athletic development is placed behind strategies to win.  Unfortunately, training with this philosophy, the athletes are not better at the end of their time with the coach.  The team’s record is placed at the forefront while individual progression of each athlete’s performance and athletic development takes a backseat.

Just as in any successful plan in business, government or sports, we need to look at the long term goals.  These goals are often never even considered when approaching the development of a young athlete.  Most want to win now, but they also want to be successful at the next level in sports whether high school, college, amateur or professional.

In many other countries outside of the U.S., athletic talent is scarce.  The coaches and trainers of these countries have to be much more systematic while approaching athletic development.  In the U.S., we get away with being sloppy and inefficient because we have an immense supply of talent.  Most countries outside of the U.S. believe that children who wish to excel in a sport should be training to peak at an age possibly greater than a decade or more from their starting point.  They also design their training programs with this as the basic premise.  They don’t really care if an athlete can win at age 14, they want the athlete to win at the Olympic level.  In fact, the techniques and strategies used to win at a young age are nearly useless as the athlete moves up the levels.  Many coaches will focus on using trick moves and plays to win but none of them will work as the competition increases with age.

Athletes should be training towards the elite levels as the standard.  Progression towards this elite level should be the starting point of program design.  Elite level competitors have developed a strong base way before you ever see them on television.  Every elite athlete has superior physical attributes such as body control, coordinated movement and power.  If an athlete fails to develop the basics, over time, they will get left in the dust by their competition.

Many people believe the next advancement in sports will not be through fancy shoes, equipment or any other gimicks.  The next advancement in sports performance will come through enhancing an athlete’s biomechanics and muscle firing patterns and capacity.  Many have been in search for a program that will do just this.

Programs which focused on enhancing the components for long term athletic development never existed in the U.S. prior to the Sport Science Lab’s Neuromuscular Intensification Training(NIT).  Fortunately, we now have a training system which takes long term athletic development and places it on the forefront.  And Revolution has it!  NIT uses movements, techniques, exercises and routines which solely focus on improving athletic ability.

At Revolution, our clients and patients can be assured they will be assessed with a proprietary evaluation system.  They will then receive a customized nutrition and exercise program, tailor fit to their needs.  This program is guaranteed to deliver you or your child with the results you want.  Better athletic performance.   

Sport Science Lab clients will reap the benefits of the proven results of the program, while enjoying access to the most efficient, science based performance enhancement programs.

Best of all, at Revolution Physical Therapy, you can get a free consultation to discuss how the Neuromuscular Intensification Training System would be of benefit.

For more information, please visit www.revolutionphysicaltherapy.com, www.sportsciencelab.com or contact us:

Lyneil Mitchell, DPT

Owner Revolution Physical Therapy

drlyneil@revolutionphysicaltherapy.com

Office: 724.591.8005

Fax: 724-591-8205

There are approximately 22,000 ACL injuries in female athletes each year from high school to collegiate sports.  1/10 girls that compete collegiately in any sport(not just jumping, cutting and pivoting sports) will tear their ACL prior to graduation.  That is crazy especially when it is largely preventable.

The Cause:  Different biomechanics.  Females demonstrate different landing and decelerating patterns than males.   Females have a tendency to land with their feet flat and heels hitting the ground.  This also occurs with less bending of the hips which causes excessive force through the knees.

As a female hits puberty, the long bones of the leg the femur (thigh bone) and tibia (shin bone) grow as they begin to ascend to their adult height and skeleton.  However, this occurs with an increase in estrogen and a decrease in testosterone.  A boy typically sees a significant spike in testosterone as their limbs begin to grow.  This in turn creates an increase in the ability to develop more muscle tissue and control the movement of the now increasing long levers of the tibia and femur which are producing increased torque at the knee.

The knee is a hinge joint primarily but has 6 degrees of freedom.  It can move forward and back, side to side and rotate each direction however most of the motion is front to back.  The joints in which most of the rotatory motion occurs are at the ball and socket joint of the hip and the pseudo ball and socket joint of the ankle.

When the hip and knee joint are not controlled during dynamic movements, the excessive rotational torque is distributed to the knee tearing the ACL.  There are 2 and sometimes 3 bundles to the ACL which is actually twisted and runs at an angle. It is designed to resist some rotational and angular forces but easily tears in the position of dynamic knee valgus, which you see above with opposite side hip drop, thigh bone and knee medially deviating and rotating internally.  This is often seen with pronating of the foot and ankle or collapsing of the medial arch of the foot.

Females also demonstrate less of an ability to fire their hamstrings at high speeds.  During slow speeds they are equal to boys but at faster speeds they are deficient.  This makes sense.  The ACL is a restraint to anterior(forward) tibial movement and tears with excessive anterior tibial translation.  The Lachman test, pictured below, is the gold standard for testing the ACL in which anterior force is exerted manually on the tibia by an examiner to assess integrity of the ACL.

When the hamstrings contract, they exert a posterior pull on the tibia which allows the knee to flex or bend as pictured above.  Females typically tear their ACL during high velocity movements such as decelerating, cutting and landing from a jump.  This suggests that the nervous system is not sending the appropriate message to fire the muscles to stabilize the knee quickly enough.   This means it is not necessarily strength alone but speed of contraction and appropriate coordination of muscle firing patterns.

The best part about this is that bioemechanics and nervous system responses are easily trainable.  Most ACL injury prevention programs have a greater than 90% success with participants not experiencing these devastating injuries.

Females are not built like males and they need specialized training.  They at least need to be screened to determine if they have high risk biomechanics.  I often say that female athletes are the most neglected population in the country.  How can we allow 22,000 of our sisters, daughters, cousins, nieces and friends to experience this nearly preventable injury each year.

In conjunction with the Sport Science Lab, Revolution Physical Therapy has an answer for our young ladies.  I am now offering a free screening for any female who would like to know if they are at risk.  I feel  so strongly about this that I am willing to help people for free.  If you don’t know if you or your loved one is at risk, then how can you know how to prevent it.  It’s like smoking cigarettes, at some point a smoker will get health problems.  Undeniable.  If you are a female athlete playing sports involving cutting, pivoting and jumping  without the appropriate training, you are eventually going to have a knee problem.  This could be season or career ending.  Thousands of college bound females lose their scholarships every year from indifference, denial and neglect..  Time to make a change.  Join the Revolution!

Lyneil Mitchell, DPT

drlyneil@revolutionphysicaltherapy.com

724 591 8005

A sound mind in a sound body is a short but full description of a happy state in this world – John Locke

The Truth About Sports Performance!  Just What the Doctor Ordered…

An innovative sports performance training philosophy with astounding results has invaded the medical profession, leaving physical therapists, physicians, patients and athletes raving about its ease of use and impressive outcomes.

Athletes are returning to sports better than they ever were before their injuries.   Most athletic injuries occur from improper training which leads to poor biomechanics and uncoordinated muscle firing patterns.  The Sport Science Lab provides the best option for correcting biomechanical impairments and improving coordination which will lead to reduced injuries.

Sports Science Lab is not just a training system. It is a lifestyle and a philosophy. 

Much like Bruce Lee, Sport Science Lab founder Gavin McMillan infuses movement and exercise science, nutrition, psychology and philosophy into improving human performance.  Gavin was a former professional athlete in Canada and realized that he could not find the best methods to train an athlete.  He realized there was no comprehensive answer or resource for the question, “How do we train appropriately to create the perfect athlete?”   

Over the years Gavin has fought great opposition to his philosophy of training.   One of Gavin’s main training principles revolves around the fact that the best athletes are the most coordinated.  This coordination of their bodies allow for more precise control over power movements in sports.

Checkout http://www.sportsciencelab.com/methodology/what-makes-an-elite-athlete to learn more.

Gavin is the exclusive trainer for Pittsburgh Steeler standout and future Hall of Famer Troy Polamalu as well as recent Super Bowl Champion Will Blackmon and many other elite athletes.   

Revolution Physical Therapy is proud to offer the Sport Science Lab in Cranberry Township, PA.   Sport Science Lab is now represented in only several states across the nation.  Lyneil Mitchell, DPT of Revolution Physical Therapy is the exclusive Sport Science Lab certified trainer for the Pittsburgh Area.

Sport Science Lab and the Neuromuscular Intensification System was uniquely designed to systematically take any athlete to their highest levels of performance in any sport.

Revolution Physical Therapy bridges the gap between athletic performance and rehabilitation.  Thanks to this inspiring program, Revolution is now able to offer a comprehensive program that both reduces chances of injuries and enhances.

The Sport Science Lab Neuromuscular Intensification Training System focuses on performance enhancement, primarily teaching coordinated movement with progressions that improve body awareness and control, agility, jumping and landing, speed, power and eating habits.   These are the aspects which lead to long term success and will always be a competitive advantage.  They should be at the foundation of every program not just the Sport Science Lab.  

Sport Science Lab clients and patients can be assured they will be assessed with a proprietary evaluation system.  They will then receive a customized nutrition and exercise program, tailor fit to their needs.  This program is guaranteed to deliver you or your child with the results you want.

                                        Better athletic performance.   

Sport Science Lab clients will reap the benefits of the proven results of the program, while enjoying access to the most efficient, science based performance enhancement programs.

Best of all, at Revolution Physical Therapy, you can get a free consultation to discuss how the Neuromuscular Intensification Training System would be of  benefit.

For more information, please visit www.revolutionphysicaltherapy.com , http://www.sportsciencelab.com/ , or contact us:

Lyneil Mitchelll

Owner Revolution Physical Therapy

drlyneil@revolutionphysicaltherapy.com

Office: 724.591.8005

Fax: 724-591-8205

http://www.youtube.com/watch?v=5gmYwYxU-DQ - Dynamic exercises

http://www.youtube.com/watch?v=YM4LspF6Mhc - Balance and Coordination

http://www.youtube.com/watch?v=l5c6uwXctTc - Supercat jumping exercises

http://www.youtube.com/watch?v=GAYUmBCEzyo - Baby video

Video of Revolution Physical Therapy – therapeutic treatments

http://www.youtube.com/watch?v=3Sw5L-_7j9Q - ACL prevention and post-op training

http://www.youtube.com/watch?v=GsFrplhlQBY - New way to stretch hamstrings

http://www.youtube.com/watch?v=Fyn4VdMux2U - Revolutionary Stretching

More Workout videos

http://www.youtube.com/watch?v=4J7XmJcd20Q = Dynamic exercises

http://www.youtube.com/watch?v=N6wjHTWifm8 - Upper Body

http://www.youtube.com/watch?v=bpLNPAgLcgw - Balance and Coordination

http://www.youtube.com/watch?v=U_unoaMaB_E Dynamic Explosion

This just means that a person is more likely to convert nutrients such as carbohydrates and fats, into body fat. Why does this happen? How can one person eat the same things and they gain body fay but another does not? The answer revolves around insulin and I will explain later. Promise!

Yes some people will have to fight a lot harder prevent the conversion of nutrients into body fat. These people just have to understand the process that allows fat to be converted into muscle. They may have to work harder at this but so does anyone who isn’t born with the perfect genes. Not sure the perfect person exists, Hollywood and E! wouldn’t let you think that. Having excessive body fat is more than aesthetics. It leads to decreased energy, chronic diseases such as Diabetes and metabolic syndrome and possible disability. Once we all understand how to fight fat gain, we can possibly cure obesity.

We can also be our leanest and healthiest. Maybe better than we ever have been. The answer is really easy if you ask me. Changing isn’t the hard part. Convincing ourselves that we need to change is. Once we have convinced ourselves or allowed ourselves to change, we can easily have anything we want.

There is more to it than just genetics. Gestational diabetes may also play a role. Altered sugar metabolism and excessive fat gain during pregnancy causes children to be pre-disposed to fat gain. Cultural practices are passed down to our children as well. Who teaches a child what to eat? The parents! In this era, our schools also play a great role in providing meals for our children and educating them on food selection. None the less, children tend to eat a similar diet as their parents. If their parents eat cookies, cakes, soda, and chips all day long, the kid has no reason not to think this is normal behavior.

Many of the chemicals and concentrations of macronutrients in foods today do not exist in nature. Corn has fructose in it. High fructose corn syrup doesn’t really have any corn it. It is a concentrated carbohydrate. There are many other concentrated forms of natural food substances we are fed which do not exist in the nature. Sugar and other carbohydrates however are the largest and most widespread natural foods found in the American diet that are concentrated to toxic levels. Other toxic chemicals found in our diets that should be avoided are but not limited to MSG, aspartame and trans fats.

The human mouth would never encounter these in nature and they would not encounter levels of carbohydrates in nature which we find in candy bars, soft drinks, and any type of fructose or sucrose syrup.

A young child experiences pain at lower thresholds because their nervous system receptors are still really sensitive. This is the same for all of the child’s senses including taste. Soda tastes sweet to an adult. A soda to a child is like cocaine. Just go to Chucky Cheese. What do you see? A bunch of cracked out kids going nuts! Watch the car ride home. A bunch of cranky kids going through withdrawal, passed out, coming down from their high.

I look back and think that maybe I was drugged at a young age. It wasn’t fair. I didn’t have a choice and my parents didn’t know they were giving us poison. Now, I am forever ruined. Once you cross the line there is no going back. You have been exposed. I will always know how good a, “insert favorite junk food” tastes.

The only way to eliminate body fat is to eliminate the cause for fat storage in the first place.  Any diet which focuses on anything but our hormones and physiology first, will be destined to fail.

thanks

Lyneil Mitchell, DPT

A sound mind in a sound body is a short but ful description of a happy state in this world – John Locke

Creeping of the wood or any tissue of the human body occurs when low levels of stress are applied over an extended period of time.  Deformation of the tissue will occur.  We need to take our joints and muscles slowly and repetitively to their end ranges and spend a considerable amount of time in that end rage to experience a change in the length of the tissue.  We have an enhanced ability to do this after a training session because the nervous system is taxed, the muscles are warm and very extensible, and we need to perform some light physical activity while our heart rate begins to return to normal.

Static stretching should be minimal prior to engaging in the main part of the training session.  Many studies have demonstrated a decreased capacity to generate muscle tension after static stretching. 

Movement occurs because of the nervous system.   The best movement also occurs because of the nervous system and our adaptations start with the nervous system as well.  When a muscle is lengthened and held for long static periods of time, it alters the neurological feedback loops and reflexes of the muscles.  There are small sensory organs inside of the muscle called spindles and golgi tendon organs.  These receptors sense the length and tension of the muscle providing feedback to the brain.   When these receptors are over stimulated, they will cause the muscle to relax and will not allow it to develop its maximal amount of tension.  This is the phenomenon behind contract relax stretching which can be very beneficial at the end of a training session during the cool down phase.   Static stretching uses this phenomenon as well which when a muscle is held under tension at its rend range for long periods of time, it will relax and begin to lengthen.

All stretching and ROM activities should be light in intensity but repetitive.  Whether holding at end ranges or repetitively placing the limb in end rage, creep will set in and the body will respond appropriately.  The intensity felt when stretching a muscle or ranging a joint should never be greater than a 5/10. 10/10 being a high feeling of intensity and potential tearing sensations.  We need to be relaxed to allow the muscle to accommodate.  If done too quickly, our muscle will spasm and will not allow end ranges to be met.  If done too quickly and too forcefully tissue damage may occur. Static stretches should be held for at least 20 seconds for several sets daily for optimal tissue changes.

Static stretching is not a simple as it one seemed either.  End range movements cause lengthening of more tissues than just the muscle.  Our capsules and ligaments of our joints, blood vessels and nerves are all made from connective tissue and are stretched and shortened during movement.   This means that these tissues can also be the limiting factor in attempts to achieve end ROM.  I caution people on this for two reasons

1. Some muscles. if at their normal length for your activity. do not need to be statically stretched.  In fact being too flexible can cause performance decline for certain activities.  Many of us do not know whether we have normal or limited ROM for our activities.  This is where professionals come in.  I believe everyone should be assessed to get the best out of their programs.  A professional can let you know what you need to do specifically to enhance any component of your physical performance especially with stretching.                                2. Stretching the wrong way may cause damage and declined performance.  If we are stretching a muscle but it is really the ligaments, nerves or joint capsules limiting movement, we could cause tissue damage.   Each tissue has a certain type of stretching or mobility that goes with it.  For most young athletes this is not a problem but it could be especially if they have been attempting to stretch and never see results.  Actions usually deliver results unless they are the wrong actions.

Simply static stretching over taxes the neurological system and alters the ability of the muscle to generate tension and should be saved for the cool down phase.  Static stretching prior to exercise or training sessions is not likely to cause injuries if the appropriate warm up is utilized to prime the nervous system and increase blood flow however it may decrease performance during the training session and that is simply undesirable and leads to inefficiency.

To see an example of a dynamic warm up check out this link

http://www.youtube.com/watch?v=t2t09AM9QmE&list=UUZAgq41aww9crlmJhoL0mtw&index=2&feature=plcp

Thanks

Lyneil Mitchell, DPT

a sound mind in a sound body is a short but full description of a happy state in this world – John Locke

I wanted to write this in response to a New Year’s Resolution post my cousin made the other day.  It was kind of a jab at me for a comment I made to her at our family’s Christmas party.  I noticed that she had absolutely zero pressure on her toes while she was standing around talking in her bare feet.  Her toes were actually slightly elevated off of the ground.  When I pointed it out, she was shocked to realize that she was doing it.

As many know, I have had foot problems since my senior year of high school when I sprained my big toe in a football game.  I could still run after I taped it, so I just kept playing.  I re-injured it again badly my sophomore year of college and subsequently developed a serious case of turf toe which plagued me throughout my college career.  I never did any therapy.  I put it in the ice bucket, taped it and wrestled when I could.  I had 9 cortisone injections over an 18 month period. I couldn’t push off on that side at all and frequently re-injured it even walking up the stairs.  The cortisone took the pain away but my function never improved because I didn’t do anything to try to improve.  I just kept managing the symptoms.  This was the common way to approach a problem like this less than 8 years ago.  My toe will never be the same but I have now seriously improved my function and virtually have no pain.

This is a current picture of my feet.  It was taken after I sprained my right ankle in May.  As you can see my left big toe is now structurally altered forever. This happened because I couldn’t push off my big toe so, I started pushing off the inside of it.  There was little to no muscle controlling it and I developed hallux valgus, meaning my big toe pushes out towards my pinky toe.  I also developed a larger bunion (I was also blessed with a bunion on my right foot as well) which is basically a bone spur. Bone spurs occur from repetitive trauma, instability and stress to a joint because the body is trying to strengthen the area by laying down calcium deposits.  Unfortunately the body’s response only makes the problem worse!

Since I have become a physical therapist, it would be obvious that I would seek methods to fix my problems.  In the past few years I have taken a new approach to training my feet.  During that time, I have noticed that people with problems of the low back and legs often have impairments in their feet. Most of our movements, especially in athletics are performed on our feet.  Our feet create a base of support for our postural stability, alignment and locomotion.  Impairments in the feet will cause many different types of compensations in which some practitioners believe can be seen the whole way up to the neck (cervical spine).  If the impairments in the feet are not addressed, the whole movement system will be flawed.

The Sport Science Lab Neuromuscular Intensification Training Program (NIT) focuses on strengthening and stabilizing the feet.  For years, many people have told me that the big toe is one of the most important parts of the body.  However, there are no other programs focus on strengthening the feet and very few physical therapy approaches actually improve funtion of the feet.  When I evaluate my athletes and PT patients, I thoroughly examine their feet.  I look for difference in shapes and structures such as fallen or high arches which are associated with many lower extremity issues.  However, the main thing I look at is balance, muscular control, strength, and plantar pressure (how pressure is distributed on the bottom of the feet).

I have really begun to recognize two things.
1. The best athletes I have trained will press their toes, especially their big toe, into the ground while standing, doing heel raises, balancing and jumping.

2. People with common overuse foot injuries, especially plantar fasciitis, do not press their toes into the ground while standing, let alone the other movements. These people also have a poor ability to curl their toes.  They have very weak muscles that help them to curl their toes, about 50% or less of what my athletes demonstrate.

The bottom of the arch of the foot is supported by the plantar fascia.  The plantar fascia is attached to the muscles that cause the toes to curl.  In standing, walking and other forms of locomotion the plantar fascia becomes taut in order to help support the arch.  The muscles that curl the toes run along the bottom of the foot and also help to support the arch.

Many people believe that simply having abnormal structure (versus function) of the foot is the cause of injury and poor performance in activities such as running.  I used to believe this too.  I still think it plays a role but it fails to recognize that our bodies are not just a bag of bones.  The nervous system and our muscles control our movements and ultimately the forces we can create and absorb.  I believe poor postural control, dynamic biomechanics (body positions during movement), force creation and force absorption are more of the culprit.

Why do I believe this?  I have trained many athletes with many different shapes and sizes that have structural abnormalities with minimal movement dysfunction nor pain.  I worked with a football player from the University of Cincinnati, which made it to the NFL, that ran a 4.3 second forty yard dash and had the flattest feet I had ever seen.

The arch of the foot is formed by many tiny bones and ligaments. It is truly a marvelous biologically engineered structure which allows humans to effectively transmit forces through the foot to the ground to push us forward during walking and running and upward during jumping.

The ends of the arch are in contact with the ground.  The back end is formed by the heel or calcaneus.  The front of the arch is formed by the metatarsal heads and toes.  As you can see in the picture below(D), the person with the lowest arches also tends to place more pressure, during weight bearing, behind their toes on the metatarsals and the arch of the foot.

This creates several problems.  First it causes a change in our center of gravity and therefore places extra stress to our joints, ligaments and tendons as they try to compensate.  It also causes the arch of our foot to be less supported by the muscles of the foot, placing extra force on the plantar fascia, muscles and other tendons of the foot and ankle such as the achilles tendon.  Poor strength and control of the toe flexors also causes us to place more pressure on the metatarsal heads during the push of phase of gait and jumping instead of pushing off the toes.  Most people actually lift their foot off of the ground early, which limits the push off or propuslion forward and upward.  Walking, running and jumping effectively incorporates full utilization of the toes for push off(see the youtube link below to see the feet in action).  Also, as the toes bend(extend) during push off the plantar fascia is taut to support the arch but will have less support if there is weakness or poor control of the toe flexors which counteract the force of the extension of the toes eccentrically.  This creates instability of our base of support and therefore a less rigid lever to push off.

http://www.youtube.com/watch?v=Pc-Hfz459zw&feature=mfu_in_order&list=UL

The arch needs to be stable to limit excessive forces to the rest of the foot and ankle.  The arch has to be stable at both, the front and the back; the toes and the heel.  If the toes do not exert a downward pressure into weight bearing surface, the arch will be more mobile, less stable and poorly controlled.  This can be associated with but not limited to plantar fasciitis, achilles tendonitis, metatarsalgia, and poor athletic performance in running and jumping sports.

You can check this yourself.  Stand in your bare feet on a firm surface.  Where is most of the pressure?  Are you pushing your toes into the floor?  If so, raise your heels off of the ground.  Are your toes still firmly pressing into the ground.  If not, you could be at risk for foot and ankle injuries.

For starters you can perform towels scrunches.  I do these for 1 minute on each foot after I get out of the shower.  Also stand on one foot in your bare feet.  Do 10 sets of 10 seconds. 1 x per day.  Finally, do 3 sets of 10 heel or calf raises(some people call these toe raises although the toes never raise) barefoot.  Slowly lower yourself down each time for 2 seconds and concentrate on keeping your toes pressed into the ground.

Hope this helps.  If you are experiencing pain, have any balance issues or have any other reason to not perform these exercises at this time, please consult your doctor or physical therapist about this prior to attempting.

Hope this helps and thank you for your time,

Lyneil Mitchell, DPT