You’ve Got Questions about Physical Therapy, We’ve Got Answers…
Dynamic Braces
What is the difference between the Fab Tech brace and the Exo Sym?
FAB TECH
- 3 separate pieces.
- Easier paid through insurance.
- Multiple locations for fabrication with multiple different orthotists.
EXO SYM
- 1 piece construction
- Much more expensive: roughly $9,000 before any add ons.
- 1 place for fabrication.
- Precise fitting by an expert that has years of seeing multiple injuries and conditions.
- Cuff unloads better.
- Unload with minimal to no pain to improve overall function and quality of life.
What are the Pros/Cons to the Fab Tech and Exosym?
FAB TECH Pros
- Easier paid through insurance
- Multiple locations for fabrication with multiple different orthotist
- Cheaper
- 3 pieces- allows adjustments to be made easier (this modular system allows for you to modify a piece instead of casting a whole new device)
FAB TECH Cons
- No orthotist are the same, multiple different variations
- Has been said by many that the foot plate breaks 50% of the time
- Difficult time truly unloading the foot/ankle
- 3 pieces – more moving parts can lead to increase chance of breaking
EXO SYM Pros
- 1 Piece – no extra moving parts causing a decrease chances of breaking
- Precise fitting by an expert that has years of seeing multiple injuries and conditions.
- Cuff unloads better
- Unload with minimal to no pain to improve overall function and quality of life.
EXO SYM Cons
- $$$$$$$
- 1 place for fabrication
- Difficult to make adjustments without losing time and money
- 1 Piece- Difficult to make adjustments
What is a PDE?
Posterior dynamic element (PDE) is an advanced below-knee composite orthosis utilizing the PDE modular composite spring system for a range of orthotic applications including ankle and calf weakness. The orthosis facilitates postfitting adjustment and tuning to improve fluency and stability during gait and higher-level activities. Users may change the strut stiffness or ankle alignment for different activities; they can also adjust the device relative to the heel height of their shoe. Nine spring options are available for patients of various weights and activity levels.
One of the issues we have seen with the PDE is that the orthotist will often choose too weak of a strut and the patient will start to develop pain from having too much ankle Range of Motion during dynamic activities. This is why it is key to have a Physical Therapist and Orthotist work together to ensure the right fit is found.
More information about the PDE Orthosis From Fabtech Systems.
How does the strut work?
The strut is there to store energy like the Achilles tendon in your ankle would.
Comparable to the leaf spring in a truck, the strut will absorb impact as well as assist in push off with the stored energy.
Where can I find information on Dynamic Orthotics?
At TherapyNexus.com we will be providing free tutorials, education, research articles, and any other resources we have available. Please let us know if you know of any excellent recourses that we can share with others.
Watch our Video to learn more:
What the heck is an ExoSym and IDEO? Is it the best design for a dynamic orthosis?
Here are a few resources we’ve come across:
Dynamic Brace Accessories & Equipment
What kind of shoes are recommended for orthotics?
Leather Boots:
Tennis Shoes:
- Propét Men’s Propet One Lt Sneaker
- New Balance wide
- Altra’s Men’s high top
- Brooks Ghost 13 Running Shoes(free from the clinic)
- Salomon Men’s Speedcross 4 GORE-TEX Trail Running Shoes
Wide Shoes Only*
Do I need to get two separate shoe sizes?
Most likely when you have one Exo Sym, but if you have them on both legs, you would only need one shoe size.
What do you wear in the shower?
Shower chair and/or swim shoes. The brace should not emerge in water. We’ve had patients that wore their brace swimming but the padding may need to be changed after and could cost you money and time out of the brace.
What pants/jeans fits over the brace?
Most jeans will work, you just need to try them on first.
The only jeans that will probably not work are skinny jeans.
What brand of knee sleeve do I use with my brace?
Using a sleeve is so important while utilizing the dynamic orthosis. You will get rubbed raw if you aren’t careful. Zensa is the most common knee sleeve and holds up well. Just remember that some people will have to use a thicker sleeve after losing weight and needing to fill the space between the cuff and their knee.
And another if you need a thicker sleeve:
Can you customize the ExoSym?
You can put all the stickers you want too on it. I know the patients at the Center For the Intrepid would bring fabric that would be put on as the last layer of laminate to make it more customized. Here’s a picture of mine with a pretty sweet eagle and US Flag. But go ahead and B’Dazzle away!
Wayne Strube, former U.S. Air Force Security Forces patrolman, wears a customized Ideo brace that helps with military members rehab during his Return to Run at the Center for the Intrepid at Fort Sam Houston, Texas. Strube currently serves military service members as the Center for the Intrepid physical therapist in charge of the Return to Run program at San Antonio Medical Center, Texas. The CFI Return to Run program is currently servicing active duty service members and some civilians that have been injured in accidents. (U.S. Air Force photo by/Tech Sgt. Vernon Young Jr.)
Brace Cost
Cost of ExoSym?
The ExoSym currently costs $9,000 for one brace. And an additional $1,500 for a knee brace attachment.
More information: Hangar Clinic in Gig Harbor, WA.
Will Insurance pay for the brace?
Insurance will not pay for the Exosym. We have seen people comment that it is considered experimental and insurance is denied.
Most people have to start a GoFundMe to get one. This is a reason why it’s so hard for growing children to invest in a brace.
However, I have had one prospective patient tell me that their insurance was going to cover 80% – so you should certainly ask your insurer.
How can I afford an ExoSym or FabTech brace?
- Fundraising – Go Fund Me
- Grants
- Care Credit- 0% interest when you pay in a certain amount of time
- Monthly payments
- Sponsorship
ExoSym
Where can I get an ExoSym?
Only at Hanger Clinic in Gig Harbor from Ryan Blanck, CPO. They are the Specialty Provider of the Hanger Clinic ExoSym™.
Their Gig Harbor facility was specifically designed around the ExoSym Care Program to ensure the best possible outcomes for each person. The ExoSym is a hybrid prosthetic-orthotic device that is custom-made to your individual needs and goals with optimal alignment, positioning, off‐loading, and control for your needs. The ExoSym has helped restore mobility for individuals with a variety of diagnoses, including limb salvage injuries as well as ankle fusions, partial-foot amputations, fractures, tarsal coalitions, and other lower extremity dysfunctions.
What is the process to get an EXO Sym?
Kris Mill wears an ExoSym and made an excellent Video on YouTube explaining the process to get an ExoSym:
ExoSym Q&A Session: What you need to know!
You will need to email the Hanger clinic in Gig Harbor, WA for forms to fill out. Then return the forms with videos of you walking. They will want forward and side view videos. You will also need a Physician Referral.
IF APPROVED – you’ll have to go to the Hangar Clinic in Gig Harbor to get fitted. It can be either two small trips or one long trip.
Cost of ExoSym?
The ExoSym currently costs $9,000 for one brace. And an additional $1,500 for a knee brace attachment.
More information: Hangar Clinic in Gig Harbor, WA.
Who makes a good candidate for a brace?
ExoSym/IDEO user Kris Mill says of the brace, “You can’t be soft”. You have to be a motivated individual to get this device and be willing to put in the time. The time to raise the funds to buy the device, and the time to put the training in. This is something you must want, not just need.
We have seen the ExoSym/IDEO help people with: foot drop, Charcot-Marie-Tooth, Spasticity from Spinal Cord/Brain injury, multiple other types of nerve damage, Ankle Arthritis, Ankle Fusions, conditions resulting from Blunt Force Trauma, and ext. We recently have seen that someone with Muscular Dystrophy get approved to go to Gig Harbor for a fitting.
We have also seen people with significant arthritis stop wearing the device after a year or two because of the off-load effect. The body has a chance to heal itself without having to deal with the pain.
Insurance
Will insurance pay for PT?
We are what’s called an out-of-network clinic (direct care physical therapy). That means we don’t have any direct contracts with insurance, which is a really good thing for you. Hilary and Wayne make decisions based on what’s best for YOU. They spend a full hour with you every time you come in, and they have complete transparency about what you pay. You won’t get one of those frustrating bills from us three months later for $500 like you will from most doctors.
Now a good percentage of our patients do get reimbursed by their insurance companies for visits with us. It really depends on if you’ve met your deductible and what your benefits are. Many people can pay down their astronomical deductible by choosing us as their Direct Care Physical Therapist.
Will my insurance pay for the Dynamic Orthosis Training?
We are what’s called an out-of-network clinic (direct care physical therapy). That means we don’t have any direct contracts with insurance, which is a really good thing for you. Hilary and Wayne make decisions based on what’s best for YOU. They will spend hours with you during the time you are with them, and they have complete transparency about what you pay. You won’t get one of those frustrating bills from us three months later for $500 like you will from most doctors.
Now a good percentage of our patients do get reimbursed by their insurance companies for visits with us. It really depends on if you’ve met your deductible and what your benefits are. Many people can pay down their astronomical deductible by choosing us as their Direct Care Physical Therapist.
Will Insurance pay for the brace?
Insurance will not pay for the Exosym. We have seen people comment that it is considered experimental and insurance is denied.
Most people have to start a GoFundMe to get one. This is a reason why it’s so hard for growing children to invest in a brace.
However, I have had one prospective patient tell me that their insurance was going to cover 80% – so you should certainly ask your insurer.
Miscellaneous
Why didn’t my doctor recommend the ExoSym/dynamic brace?
Most general doctors have no idea what anything other than an off the shelf ankle foot orthosis (AFO) is. They are too busy trying to see enough patients to pay bills than to research something for just one patient.
Also, the saying “a hammer only sees nails” comes into play. If you’re being seen by a surgeon and they do not know about the amazing prognosis these devices have for patients, they will most likely recommend surgery.
Does my doctor need to refer me to an orthotist?
A referral from your primary care physician, referring physician and/or prescription is required at your first visit as most insurance companies consider prosthetists and orthotists to be specialists.
Are there support teams or social media groups for living with a brace?
There are many different social media groups. Here are a few of the most popular to try:
How do you drive with an ExoSym?
Need to use your hip flexors, hamstrings and quads to pick up your foot.
Practice before attempting on the roads. Can practice in the Hanger clinic parking lot.
What is it like going to an airport with an ExoSym?
Things will not be easy. It’s a device that is very foreign to the average public and with the airports having the highest of security, YOU WILL BE SEARCHED. You will probably have to take your braces off, will be swabbed and the whole nine yards.
Pain, Limited ROM & Spasticity
What conditions can an ExoSym improve?
We have seen the ExoSym/IDEO help people with: foot drop, Charcot-Marie-Tooth, Spasticity from Spinal Cord/Brain injury, multiple other types of nerve damage, Ankle Arthritis, Ankle Fusions, conditions resulting from Blunt Force Trauma, and ext.
We have also seen people with significant arthritis stop wearing the device after a year or two because of the off-load effect. The body has a chance to heal itself without having to deal with the pain.
Do I need to get an ExoSym?
We have seen the ExoSym/IDEO help people with foot drop, Charcot-Marie-Tooth, Spasticity from Spinal Cord/Brain injury, multiple other types of nerve damage, Ankle Arthritis, Ankle Fusions, conditions resulting from Blunt Force Trauma, and ext.
In our experience these dynamic orthotics have been life changing for most individuals. If you have a significant amount of ankle pain the ExoSym would be your best bet as in our research, we have read that the FabTech/PRE does not unload the ankle as well as the ExoSym.
But if you have pain and it is minor, the FabTech may be able to relieve your pain without having to invest so much in the ExoSym.
How do I unload a scar underneath the cuff?
The best way to apply cushion to the side or along the sides of the scar.
Will wearing Exosym/Fabtech (dynamic AFOs) over 5 years make your symptoms worse or better?
Wearing a correctly fitted brace that allows the proper unloading, decreases continuous inflammation, decreases pain, and allows you to stay active.
All this along with proper training of the utilization of the device should improve symptoms throughout time.
If one of these categories are not accomplished, it could make symptoms worse throughout time.
What do you use for wounds and rubbing areas?
Second Skin or Cica-Care
Be careful adding more padding, it will cause more pressure and sometime more break down of the skin.
The most important thing is to offload/unload the area that is being affected. The best way to unload a scar/wound or rub is to apply cushion to the side or along the sides of the scar.
The device may need adjustment by the orthotist if the friction is caused by the carbon fiber and you’re unable to unload it with padding.
Spenco 2nd Skin products or Cica-Care Self-Adhesive Silicone Gel Sheets.
How to place Padding around the wound.
What do I do if I have had previous hip trauma?
Need to focus on decreasing inflammation through diet, focus on “proper” hip and core strengthening prior to higher level activities, and continue the strengthening throughout your journey. Many people perform core and hip strengthening exercises poorly. Perfect practice promotes proper performance!! Therefore you need to have a great PT to help with the form. It always comes down to fundamentals.
As for diet, there are many foods that people do not even realize they are getting inflammation from. We’ve seen many patients improve their function by simple going through an elimination diet and finding out what is causing the problem. For instance, we had a patient who had been dealing with hip pain and limping quite a bit. Then one day he could not bear weight through his hip and was contemplating a hip replacement. Well, lucky for him we wanted to go through all noninvasive approaches first. He was walking within a week by simply reducing his carbohydrate intake.
Diet and inflammation videos:
Dr Ken Berry | The BEST Ways to Reduce Inflammation In Your Body
Would the Exosym work if I have no ankle ROM?
Most likely. A lot of your function will depend on what plantar flexion/dorsiflexion your ankle is stuck in. If the patient is fused or stuck in too much Dorsiflexion the rollover of the footplate with be significantly compromised.
Can I use the brace if I have spasticity?
Yes, the brace will assist you in walking and in normal activities of daily living. However, high impact activities may be a different issue. If you have a significant amount of clonus, it could significantly affect the ability of your lower extremities to absorb you landing.
Will I still have pain with an ExoSym?
It depends on level of injury or medical involvement, but if you are able to decrease the pain and decrease the inflammation it can improve over time or be completely pain free
Pain & Inflammation
How do I know if I have Chronic Inflammation vs True Injury?
Dr. Berry is amazing at explaining this. Please listen with an open mind and know that we have seen many people stop pain in it tracks by following the Proper Human Diet.
Dr Berry – ARTHRITIS: Is Your Diet Causing It? [Or Making It Worse?]
Dr Berry – The BEST Ways to Reduce Inflammation In Your Body
Why does my knee hurt?
Unless there was a direct impact on your knee, there might be more to look at than just your knee. Your knee is the joint in between your ankle and hip that gets the brunt of the forces when you have muscle imbalance, movement dysfunction, or joint impairments. If attending therapy, your therapist should examine your back, hip, knee, and ankle. Looking at the whole body as one and not getting tunnel vision on only one single part of the body. (Remember this when your surgeon says you need knee surgery and has only looked at your knee.)
Here is a video on foundational core and hip strengthening:
Low Back Pain Relief – 5 key muscles to target with these Easy Exercises even Knee Pain Will Improve
Why does my shoulder hurt?
Without a specific injury to the shoulder, Muscle imbalance, scapular stabilizers and deep neck flexor weakness, poor posture, repetitive movement, work environment, and/or poor lifting could be the cause of your shoulder pain.
Here is a video of scapular stabilization exercises than can assist with improving posture.
Upper Back, Neck, & Shoulder Pain Relief using 5 specific excises – Prevent Future Pain and Injury
Why does my back hurt?
Core weakness, muscle imbalances, poor posture, lack of activity, prolong sitting, and/or repetitive poor lifting technique
Low Back Pain Relief – 5 key muscles to target with these Easy Exercises even Knee Pain Will Improve
Contrary to what most people believe, just because imaging shows a “degenerative disk, bone on bone, or any other injury”, you’re not subject to a life of pain, pain meds and surgeries. Research has found that there is very little correlation in imaging and pain. In other words, many people with pain have imaging that doesn’t show any abnormalities and many people without pain have had imaging that shows a ridiculous number of (and sometimes quite disturbing) abnormalities.
What is my prognosis?
It depends if your injury is acute or chronic, if you have any comorbidities, diet, prior activity level, your determination and motivation to improve as an individual.
Do I need surgery?
We definitely hope not. I would mostly only recommend surgery to avoid death. A life over limb kind of look at things. Of course there are times when someone needs to have surgery like trying to avoid advancing deformity (broken femur). But we always, always, always want to take the least invasive approach.
ITB? Sciatica?
These are terms that describe some of the symptoms you may be having. We like to call them “umbrella terms” because they are definitely not a diagnosis. Your PT needs to dig down and find out why your having these symptoms and get to the route cause.
Low Back Pain Relief – 5 key muscles to target with these Easy Exercises even Knee Pain Will Improve
Do I need pain medication?
This is a touchy subject for many people. Sometimes it is important to reduce inflammation so you can perform some exercises to get you to where your body is healing itself and not having to fight against the pain and inflammation.
If you’re taking pain meds constantly and on a daily basis you need to take another look at what’s going on. You need to look at what else could be causing this inflammation in your body… A lot of the time it is food that is causing inflammation.
It may be time to check your diet, there are many foods that people do not even realize they are getting inflammation from. We’ve seen many patients improve their function and almost magically decrease their pain by simply going through an elimination diet and finding out what is causing the problem. For instance, we had a patient who had been dealing with hip pain and limping quite a bit. Then one day he could not bear weight through his hip and was contemplating a hip replacement. Well, lucky for him we wanted to go through all noninvasive approaches first. He was walking within a week by simply reducing his carbohydrate intake.
Diet and inflammation videos:
ARTHRITIS: Is Your Diet Causing It? [Or Making It Worse?]
Dr Ken Berry | The BEST Ways to Reduce Inflammation In Your Body
When do I need to take pain meds after surgery when attending PT?
Well, that depends. Some people like to take the prescribed pain meds 45 min to 1 hour prior to their PT session. They feel this allows them to tolerate completing their exercises without as much pain as they would if they had taken nothing. Others like to wait till after the PT session, almost like the proverbial carrot in front of the donkey to help motivate them through their treatment. The overall goal is for you to taper off of the medications to where you are able to tolerate the treatment sessions without any pain medications.
Can diet affect my prognosis?
YES, there are so many foods that cause inflammation to the body. Inflammation is a normal process to healing but can be amplified by the foods you eat. Everybody reacts differently to food. This is why we recommend an elimination diet to see what is causing your inflammation.
Physical Therapy
How do I know my therapist is a good therapist?
Questions to ask yourself when attending physical therapy:
- What experience or credentials does your therapist have?
- Who is treating you regularly? (PT tech, PTA, or PT)
- Are your symptoms being resolved?
- Is your exercise program changing appropriately or are you doing the same exercises every single visit?
- How long are you in physical therapy, 8 weeks or 5 months?
- Is your PT listening to you?
- Do you have a good rapport with your therapist?
- Are you receiving hands-on treatment, especially in the first few weeks?
How do you rate your therapist?
Questions to ask yourself when attending physical therapy.
Questions to ask yourself when attending physical therapy:
1. What experience or credentials does your therapist have?
You do need a therapist with expertise in your area of treatment. If you have a student or new PT treating you there should be an experienced physical therapist overseeing your treatment.
2. Who is treating you regularly? (PT tech, PTA, or PT) Are your symptoms being resolved?
This also pertains to the experience of your therapist. There’s some amazing PTA’s (assistants) out there. Also, remember a PT Tech should not be conducting your treatment. (It is illegal)
3. Is your exercise program changing appropriately or are you doing the same exercises every single visit?
Some therapists who are part of the PT Mills out there are getting so burned out from the job that they forget why they became a therapist. They are just holding on by a thread and trying to pay off their ridiculous school loan with their low paying doctorate. If your progress is stagnant and your exercises have not changed in 2 weeks, it’s time to have a discussion with the PT.
4. How long are you in physical therapy, 8 weeks or 5 months?
All diagnoses and prognoses are dependent on multiple factors. For example: simple low back pain should be resolved and on its way to healing after just a couple weeks. However if you had a SLAP repair to your shoulder you could be there for about 3 months. You should not be going to the same clinic doing the same exercises for low back, knee, and hip pain.
For an acute injury it should be about 2-3 weeks, chronic injuries 6-8 weeks (if you’re not seeing significant improvement), post-operative ~8-12 weeks. A maintenance program will be ongoing and everybody needs one.
5. Is your PT listening to you?
It’s great to debate with your therapist. Go ahead and educate yourself and keep the PT on their toes. The PT should be happy you’re wanting to be part of the answer to you pain and not someone malingering or just wanting some attention. If ANY doctor gets upset that you are researching ways to improve yourself, you need to get another doctor. You are part of the decision making process and need to have a say in all your health decisions!
6. Do you have a good rapport with your therapist?
Some folks just don’t click. A good PT will be able to empathize/sympathize and get along with even the most ornery of patients. You should feel comfortable and have fun with your PT.
7. Are you receiving hands-on treatment, especially in the first few weeks?
It is not always necessary for the PT to touch you to mobilize or stretch you out. However, it is very difficult to treat/teach proper movement without hands on or do a proper evaluation.
I’m doing the same exercises every time I attend PT? Is that a good thing?
NO, your therapist should be progressing you by adding new exercises, increasing resistance, taking away some exercises, providing a home exercise program, and challenging you appropriately. The only reason why you should be doing the same exercises every treatment is if you are not compliant with your home exercises or are not able to perform some of the core exercises appropriately.
Your PT may come back and reiterate some of your previous exercises to ensure you are keeping the core down and are compliant with your Home Exercise Program. If it’s been over two weeks and you are not seeing progression of your condition and/or exercise you need to be asking, “why?”.
What is a HEP?
HEP stands for Home Exercise Program. It should be given to you by your physical therapist and changed throughout your time at physical therapy.
What if I plateau in PT?
The definition of plateau is reaching a state of little or no change after a time of activity or progress. Once this happens you need to change the course, find something different, another challenge, change up your training. Your body can continue to improve, it just needs to be challenged. Your balance and strength must be challenged if you want them to improve.
No matter what they say about old dogs and new tricks there’s something called “Neuroplasticity”, which is the ability of neural networks in the brain to change through growth and reorganizations. Just like your muscles the brain can be improved and change itself to function in a better way by simply challenging it.
POSE Running
What is POSE Running?
The Pose Method was developed by Dr. Nicholas S. Romanov in 1977. POSE Method is about key body positions “Poses” that go through movement in time. Gravity plays a key role when achieving all movement. Redirecting the force of gravity from the initial position to achieve the final position. There are three poses in the Pose Method of Running and they are Pose, Fall, and Pull. In running the “Pose” position is happening during the stance phase and then gravity is interacting with our body “Fall “for supposed though action reposition on our body “Pull” to achieve the final position back to “Pose”.
What is good running form?
Good running form should have these components:
- Effortless
- Light
- Smooth
- Without muscle tension
- With quick legs turnover
- With short support time
- With almost silent landing
- With landing on a forefoot or flat foot
- With landing close to the vertical line going through the GCM
- With small vertical oscillation of the body
- With small upper body movement
- With slight forward lean or erect trunk position
If you ever say “I hate running” due to a lack of these components you might consider to get specific training to improve your like for running.
What are the best running shoes?
You want to achieve as close to zero drop shoe to avoid any compensations when running and maintain the flexibility of your foot and ankle. When changing shoes keep in mind the amount of training you are performing, just like everything else it takes time and perfect practice to achieve ultimate goals. One can cause severe injury if not adapted slowly into a zero drop shoe. When wearing more cushion shoes for a long period of time, you start to rely on the shoe instead of the muscles in your foot/ankle which causes muscle imbalance and leads to prolonged injuries.
Why does my knee hip, and/or back hurt when running?
Remember when you were a kid and your coach always told you “stride it out” to go faster… but when you stride it out, you reach in front of your center of gravity causing heel or flat foot strike (the ground reaction force is 3x your body weight that begins in you heel, goes through ankle, jars up the knee, and finally hits the hip and spine), it also decreases your cadence due to spending more time to transfer weight from one foot to the other. You want to maintain your feet underneath your center of gravity to avoid the unwanted force.
Why is the Pose method more sustainable than any other method?
The Pose method focuses on biomechanics, neuromuscular control, proprioception, and how to move your body efficiently against gravitational forces to prevent injury. By using the Pose Method you avoid the excess weight on ligaments, joints, and muscles. The Pose Method looks at the whole body working together as one unit and attempts to avoid compensations.
Why is my calf sore when running?
When starting the Pose Method calf soreness can occur around 2 weeks while you are adapting to a new technique as well as the neuromuscular re-education of loading the calf muscle.
How to keep good running form for long distance?
With distance comes training, endurance, and maintaining proper form throughout the run. The problem is fatigue, when fatigue hits your form goes to trash. So it’s important to work on short distances and work up to longer distances. Once you feel your form has changed or you start to have aches and pains, stop, reset, and start again.
How to recover faster after a marathon?
The worst thing to do after a marathon is nothing. You want to bring your muscles back to a normal contract-relax cycle. Perform a concentric regime with 2-3 sets of 20-30 reps in one set to receive burning sensation in your muscles. Another thing is to go back to the basics and work on form technique drills. It is also recommended to take a hot/warm bath with apple cider vinegar and have some miso soup.
How do I increase running speed?
To increase speed you need to increase your cadence and the more you increase your fall angle the faster you are. For sprinting, your cadence should be 220+.
Where should my head be positioned when running?
Postural alignment is crucial when performing any physical activity. When your head deviates from the proper position it causes muscles to activate incorrectly followed by muscle imbalances, the movement becomes less efficient, and fatigue can kick in quicker. It is so important to master the basics of movement.
What should my cadence be when running?
Jogging 180+ spm
Sprinting 220+ spm
What is the remedy for fatigue when running?
What is overstriding in running?
When you were a kid, your coach always told you “stride it out” to go faster… but bad things happen when you stride it out. You reach in front of your center of gravity causing heel or flat foot strike (the ground reaction force is 3x your body weight that begins in you heel, goes through ankle, jars up the knee, and finally hits the hip and spine), it also decreases your cadence causing you to spend more time transferring weight from one foot to the other. You goal is to maintain your feet underneath your center of gravity to avoid the unwanted force and therefore prevent future injury.
Does my form change when running up hill, down hill, or uneven surfaces?
Yes, when running uphill or on uneven surfaces you decrease your fall angle and increase your cadence. When running downhill your fall angle will naturally increase causing you to increase your cadence to avoid falling. This is when you allow gravity to assist you going down hill, but know your strength and capabilities. You can lean back to decrease your speed and have more control when going downhill.
What are signs of overtraining?
- Loss of coordination
- Heart rate deviates from average
- Loss of muscles ability to relax
- Onset of irritability, dissatisfaction and constant fatigue
- Radical drop in training and racing performance.
Preventative Care
How do I prevent injury?
Stay active, strive to perform proper movement (have a physical therapy/movement specialist evaluate your performance/activity to ensure proper form and stick with the good ones), core strengthening, and eat healthy non processed food.
Videos for foundational core and scapular stabilization exercises:
Low Back Pain Relief – 5 key muscles to target with these Easy Exercises even Knee Pain Will Improve
Upper Back, Neck, & Shoulder Pain Relief using 5 specific excises – Prevent Future Pain and Injury
How do I prevent reinjuries?
You have to stay mobile and stable. The best way to do that is to continue with the core and mobility exercises taught to you and progress accordingly. We will have a maintenance program available for everyone. We are also going to be developing a virtual maintenance program to assist those who live too far away to be seen regularly.
How do I improve activity performance?
It always comes down to fundamentals. You need to become an expert on the foundation of exercise or hire/recruit an awesome Physical Therapist. Never cheat on core/stabilization exercises, then add distance, speed and or power to your programming. Then watch your performance soar.
Do I need a maintenance program?
Everyone does. Even if you are following your core and mobility exercise regimen you want to have that trained eye that can see your form and tweak what needs to be to keep you at you physical peak as well as injury & pain free. One of the keys is your need for continuous development of proprioception exercises so your body’s awareness of where it is in space improves as you progress.
PT Careers
How do I start a career in Physical Therapy?
Contact us at info@therapynexus.com for any specific questions.
Surgeries
Amputation vs. ExoSym brace
First I’d like to say that we are usually anti-amputation. I have seen many amputations after attempted limb salvage and it isn’t always what you want. Many of the patients have phantom limb pain (so they continue to feel the pain they felt prior to amputation, a lot of time even worse pain), most have to undergo more surgeries which may result in having an above the knee amputation and that is a whole different ball game.
I have seen a few cases where life is great for the time being. Just remember it’s a lot easier to limp to the bathroom when you 80+ years old then it is to hop. With amputation you may be stuck in a wheelchair the rest of your life. I would say to try EVERY avenue of limb salvage before amputating.
There was one specific situation when I was discussing the need for one of my patients to have an amputation with the surgeon at BAMC. He would not amputate unless all other alternatives were taken. This patient had tried everything and had gone through multiple surgeries, but he was still in so much pain that he was contemplating taking his own life. After I told the surgeon this, he set up the surgery for the next day. The patient was doing great the last time I checked.
You never know what technology will be like in the future and [not amputating] this leaves you open for those possibilities.
Why get a dynamic AFO instead of an ankle fusion or ankle replacements?
Surgery is trauma. You always want to go with the least invasive approach first. Getting a fusion or replacement is permanent and irreversible. A dynamic orthosis will give you time to reduce inflammation and possibly allow injury to heal as well.
Medical science is advancing everyday and a better option may come along in the future that would not be possible if you had taken the more invasive route.
Time Frame
How long will I be going to PT?
For an acute injury it should be about 2-3 weeks, chronic injuries 6-8 weeks (if you’re not seeing significant improvement), post-operative will be about 8-12 weeks. Maintenance program will be ongoing.
How long is each treatment session?
Each treatment session should be ~1 hour.
When can I return back to activity?
It is best to ensure you have NO PAIN, you’re able to facilitate PROPER MOVEMENT, you’ve become a boss at CORE STABILIZATION, and you are being true to your MAINTENANCE PROGRAM. I personally would not continue with hard training before I ensure I have this foundation down so as to not reinjure myself.
Also, If you had a significant surgery it is in your best interest to follow the protocol recommended by the surgeon while being followed by an awesome Physical Therapist.
Remember there’s a difference between muscle soreness and true pain from injury. You’ll need to differentiate between these to safely move on.
Training
What if I have plateaued in my brace?
The definition of plateau is reaching a state of little or no change after a time of activity or progress. Once this happens you need to change the course, find something different, another challenge, change up your training. Your body wants to continue to improve, it just needs to be challenged. Neuroplasticity is the ability of neural networks in the brain to change through growth and reorganizations. The brain can be rewired to function in some way that differs from how it previously functioned.
Why do I need more training after devoting time and money at Gig Harbor?
Developing the muscle memory needed in order to acquire the biomechanics to sustain proper habitual movement takes more than a few days. Physical therapist are movements specialist and with our knowledge and experience with the device we can fine tune and improve your movement drastically.
We’re the best because we have 7 years combined experience in training people in the utility of the IDEO. While working with the elite military population we have been able to treat just about every injury imaginable. Also, with this experience comes contacts who we can call on to consult with about any condition.
Many civilian Dynamic Orthotic patients we’ve spoken with have gone to see a PT and have received subpar care or even been turned away because their PT did not understand or know how the dynamic orthosis works.
As physical therapists, we are movement specialists. This along with our experience in the IDEO population make us the best there is to train anyone in the use of a dynamic orthotic. It is crucial to develop your biomechanics under the specialized eye of an experienced physical therapist. Developing the muscle memory needed in order to acquire the biomechanics to sustain proper habitual movement takes more than a few days. The 4 week program is imperative to learn how to use the dynamic orthosis to its fullest capacity.
Why train with Therapy Nexus with my Dynamic Orthosis?
Both of us – Wayne and Hilary Strube – at Therapy Nexus have 7 years combined experience in training people in the utility of the IDEO. While working with the elite military population we have been able to treat just about every injury imaginable. Also, with this experience comes our extensive network of contacts who we can call on to consult with about any condition.
Many civilian Dynamic Orthotic patients we’ve spoken with have gone to see a PT and have received subpar care or even been turned away because their PT did not understand or know how the dynamic orthosis works.
As physical therapists, we are movement specialists. This along with our experience in the IDEO population make us the best there is to train anyone in the use of a dynamic orthotic. It is crucial to develop your biomechanics under the specialized eye of an experienced physical therapist. Developing the muscle memory needed in order to acquire the biomechanics to sustain proper habitual movement takes more than a few days. The 4 week program is imperative to learn how to use the dynamic orthosis to its fullest capacity.