Patients are Successfully Filing with Insurance and Receiving Payments
Many CoachAmyPT patients are having success self-filing and receiving reimbursement for services. In April, CoachAmyPT began using Therabill which is an industry standard software program that creates invoices from patients' electronic medical records. Invoices include all the dates, charges, codes etc. that patient's need to submit successfully. Insurance plans vary widely; patients should check with their insurance company to see how they will reimburse for out-of-network services.
Hammy Strain from Running Sprints Interferes with Gymnast's Mobility
Meet Sid...she is a level six gymnast who strained her hammy in gym class doing sprints for Presidential testing. In two treatments of A.R.T. and some functional exercises (my favorite PT treatment combo) - this chick was back to full, pain free mobility with splits. Go Sid!
Red's Door County Special: Pre-performance A.R.T. with Coach Amy
We are so excited for all the Red's participating in the Door County Triathlon!
Coach Amy is certified in full body and long tract nerve A.R.T.
Tuesday, July 11th CoachAmyPT is offering extended hours 6:00-8:30 PM for the Red's Tri Team. Pre-performance session includes a 30 minute race ready A.R.T. to focus on tight tissues, areas with hx of injury and worrisome spots. This is NOT a PT evaluation. If you need that, please schedule a PT Evaluation and Treatment at coachamypt.com > appointments.
$60/session
Steps to secure your spot:
email amy@coachamypt.com with name, date of birth, address and phone number to schedule. First come first serve. 6:00, 6:30, 7:00, 7:30, and 8:00 PM.
go to coachamypt.com > appointments and scroll down to required forms. Print, fill out and email or bring along to appointment. You do NOT need to fill out paperwork if you are past or present CoachAmyPT patient.
Arrive 5 min early, dressed in clothing you can move in!
Current injured Reds patients of CoachAmyPT are encouraged to keep their regularly scheduled 40 min. appointment that week if possible.
Water Running during Injury
Photo from http://www.sanctuaryequinerehab.com/pool_treatment.html
If Gavin, a race horse slated to race in today's Kentucky Derby can do it, so can YOU! Water running is one of the best cross training exercises you can do if running is contraindicated. Water provides buoyancy, decreasing load on joints while at the same time providing added resistance.
Most injuries that require rest from loading of joints will benefit from water running. Those with ligamentous tears of the knee should not water run until cleared by physical therapist or doctor to do so. Those with incisions post surgery should ask their doctor first before entering a pool.
Ask your PT for specifics on how to water run!
Coach Amy Presents Running from Head to Toe
This Sunday, Coach Amy is leading an interactive running technique clinic for beginner and advanced runners at Roe Park. Area runners will learn when and how to safely tweak run form to improve run economy and performance, and prevent injury. This event is hosted by Liz Weidling of the Red's Tri Team. To learn more go to Roadrunners of Kansas City. To register for Running from Head to Toe, go HERE.
Steps to Address Foot Pain
"Do as I say, not as I do!" - Coach Amy.
Oh, the dreaded “plantar"! It has stopped many athletes in their tracks and certainly affects non-athletes as well, interfering with activities of daily living such as walking and standing for long periods of time.
Not all foot pain is "plantar fasciitis". Sometimes foot pain is the result of a trapped nerve, tendonosis, stress fracture, referred pain, joint sprain, arthritis, bone spur…there are number of different diagnoses.
Plantar fasciitis is a misnomer. Rarely ever is the fascia of the foot at fault. Say that three times fast! Not only is the fascia rarely involved but “itis” indicates inflammation and researchers have found that there is not a lot of evidence to support an inflammatory process with this condition.
A better name for this may be plantarmyalgia - pain in the muscles at the bottom of foot! This condition involves one or more of the tiny muscles on the bottom of the foot and/or the aponeurosis - a strong thick band of connective tissue that acts like a tendon at the bottom of the foot. These tissues act together as the “foot core”. Like the core of your trunk aids in stabilization of your spine, the foot core aids in stabilization of your lower extremity.
Pain is usually located in arch of foot and/or heel with weight bearing or push off especially in the morning, beginning of a run or after sitting for a long period and then standing up to walk. Symptoms usually improve as the day, walk or run goes on, only to worsen if up on feet all day or after running. In severe or chronic cases, pain can be constant but usually varies in intensity.
There are many different causes of "plantar fasciitis". Most often it is a combination of factors that may include but are not limited to:
tight calves
poor footwear
training error/over use
longterm use of rigid insoles/orthotics creating weak foot muscles
poor joint mobility in the middle of the foot and or “big toe”
If foot pain from plantar fasciitis is interfering with your function, it is important to determine and address what is causing the condition in the first place. Simply treating the symptoms rarely results in successful long term recovery.
What should I do about my foot pain?
Rest from or modify activities that increase pain.
Avoid barefoot, wearing flip flops and high heels until inflammation subsides and strengthening of these muscles can occur.
Use ice cup massage 5 min or less for pain control. See How To: Ice Cup Massage.
Apply moist heat such as Epsom salt soak 1-2x daily for 20 min. to improve blood flow and assist in recovery of connective tissue.
Use a Strasburg Sock or foot splint at night.
If symptoms worsen or do not improve in a few weeks with these initial measures, schedule an evaluation and treatment with an experienced physical therapist.
What Color is Your Pee? Signs, Symptoms and Causes of Acute Exercise-induced Rhabdomyolysis.
The infamous 2007 Chicago Marathon and Coach Amy's first.
Really, Amy? Are you asking me the color of my pee? I'm not suggesting you report the color to me. However, urine color can indicate a condition afflicts endurance athletes called acute exercise-induced rhabdomyolysis (AER). The media has once again brought this condition to the forefront with the recent hospitalization of several Oregon Ducks football team members.
What is AER?
AER is an acute, serious, and potentially life-threatening condition for which the hallmark symptom is cola-colored urine. AER occurs in the case of severe skeletal muscle damage sustained through injury or profound overexertion.
AER can cause damage to the kidneys, liver, and long-term nerve and muscle damage. The incidence of this condition in endurance athletes is still being determined [1].
Acute kidney failure may be less likely in AER than in other rhabdomyolysis causes [2]. Therefore, it is conceivable that some endurance athletes go undiagnosed and treated yet suffer from other long-term complications, such as damage to nerves and muscles.
Signs and Symptoms
I listed the signs and symptoms of AER below [1], but not all athletes with AER exhibit these symptoms. Other conditions may cause these symptoms as well.
Dark brown urine (cola colored)
Confusion
Vomiting
Muscle pain (not normal delayed onset muscle soreness)
Generalized weakness
Causes of AER
As with many issues afflicting the endurance athlete, the cause of AER is a combination of "the 'perfect storm' where there are several [contributing] factors (heat stress, dehydration, [muscle exertion], non-steroidal anti-inflammatory [e.g., Alleve, Ibuprofen] or other drug/analgesic use, and viral/bacterial infection)." [3]
The most common cause of AER is "too much."
Too much too soon (e.g., returning to sport or starting a new form of exercise without a gradual introduction).
Too much eccentric contraction of the same muscle group (e.g., high reps of heavy-weight jump squats).
Excessive heat (running long distances or racing in high temperatures without acclimatization).
Other significant contributors to AER include high exertion in concert with the following:
Dehydration
Certain medications, namely statins and NSAIDs (Aleve, Ibuprofen)
Hyponatremia (overhydration - too little sodium)
When you look at the list of causes, it is sobering, right? How many triathlons and marathons have you raced under the "perfect storm" of extreme heat before being acclimated, dehydrated, taking painkillers (even though your coach told you not to), and coming off an injury or illness?
One case study tested four ultra-distance runners (two different years) after they ran the 95-mile off-road West Highland Way Race [4]. All tested positive for severe cases of AER. Each raced in at least half of the "perfect storm" conditions.
Takeaway
The takeaway from all this? Train smart with a solid training plan, do not take NSAIDs before or during a race, avoid racing when sick or after a recent illness, and acclimate to hot weather running or modify if you find yourself in those conditions unprepared.
As always, listen to your body. Be aware of contributors to AER and its symptoms. If you have cola-colored urine after extreme exertion and one more of the other signs, seek immediate medical attention; If treated early, we can reverse AER. When not appropriately treated, the long-term consequences could be severe; once an athlete has suffered from AER, they are more susceptible to recurrence.
Sources
[1] Brudvig T, Fitzgerald P. Identification of Signs and Symptoms of Acute Exertional Rhabdomyolysis in Athletes: A Guide for the Practitioner. Strength and Conditioning Journal. 2007 Feb;29 (1):10-14
[2] Sinert S, Kohl L, Rainone T, Scalea T. Exercise-Induced Rhabdomyolysis. Annals of Emergency Medicine. 1994 June;23(6):1301–1306.
[3] Clarkson P. Exertional Rhabdomyolysis and Acute Renal Failure in Marathon Runners. Sports Medicine. 2007 April;37(4):361-363.
[4] Ellis C, Cuthill J, Hew-Butler T, George S, Mitchell R. Exercise-Associated Hyponatremia with Rhabdomyolysis During Endurance Exercise. The Physician and Sportsmedicine Volume. 2009 April;7(1):126-131.
What the BOSU?
The BOSU isn’t an expletive, although some of my patients do swear when they use it. It is a funny looking piece of equipment: half ball, half platform. You can use one or two at a time, you can use them dome side up or bottom side up, you can put your feet on them, forearms, hands, knees, glutes…
It carries a warning on the bottom: "fall hazard." It’s goal is to stimulate the proprioceptors. What the heck are those? Proprioceptors are found in muscles, tendons and joints. They relay to your brain where you are in space. Yes, you are on planet earth in the Milky Way galaxy but what plane are you in? Is your body up or down, side to side, rotated right or left or a combination of these? The brain responds to this input by telling your body what to do to remain stable so ya don’t fall down!
The proprioceptors can become confused after an illness, injury, or post surgery for example. They then behave a little like your drunk uncle...responding sluggishly. In the therapy world we don’t start with the BOSU right away; it is used in a gradual progression of balance and stability training particularly with athletes.
The BOSU is not just useful for treatment of injury. It is a great tool for injury prevention and performance enhancement as well, especially when used in sport specific ways and always with guidance and instruction from a therapist or personal trainer.
PT Adventure Part I: Down and Out on the Slopes to Pre-surgery Rehab
Coach Amy of Coach Amy PT and Jennifer at her pre-surgery physical therapy appointment.
RRKC runner, Jennifer W. texted Coach Amy of coachamypt.com from a ski patrol hut, "Um. I think I'll be needing an experienced PT in the near future..." Accompanying this text was a picture of her lying on a cot with ice on her knee.
Jennifer fell skiing on the powdery slopes of Colorado and heard a pop in her knee. She was escorted off the mountain by ski patrol. Her main complaint, "...I can't put a lot of weight on it and it feels very unstable."
Suspecting an ACL (anterior cruciate ligament) tear, Coach Amy created a plan to expedite Jennifer's care. Before she left Colorado, she had an appointment with an orthopedic surgeon the day of her return to KC with strict PT orders: no weight bearing, ice, elevation and compression.
Within one week Jennifer had confirmation of an ACL and possible MCL (medial collateral ligament) tear, surgery scheduled and a prehab physical therapy appointment scheduled with Coach Amy PT.
For pre-surgery rehab, Coach Amy instructed Jennifer in a series of exercises to help restore stability of the knee and maintain her cardiovascular fitness. This will aid in a quicker and successful recovery post surgery.
JJ remains in good humor, "...do you have any tips on healing a bruised ego?" Her dedication to and positive attitude will do wonders in her recovery.
To follow Jennifer's adventure and to recieve all Coach Amy Says posts via e-mail, subscribe here: https://www.coachamypt.com/subscribe/
How to: Ice Cup Massage
Contrary to popular belief, icing an injury after the first 24-48 hours isn't the best way to decrease inflammation as it slows blood flow to the area. Blood flow brings nutrients and takes away waste and this is best achieved with moist heat after the first 24-48 hours. Ice can be useful in management of pain with chronic injury by numbing the area. One of the most effective ways to do this is with an ice cup massage.
Fill a 3-4 oz paper bathroom cup 3/4 of the way up with water and put it in your freezer.
Tear away 3/4 of the paper cup (after ice is frozen) leaving the bottom of the cup for you to hold onto, and the ice exposed to rub onto your injury.
rub the ice over the areas of pain or discomfort for 5 minutes or until numb whichever occurs first.
Do not apply ice for more than 5 minutes as this can lead to frostbite. Let's not create another injury! As always, seek medical attention for proper evaluation, diagnosis and treatment of your pain.