Low Back Pain and Pregnancy

It is assumed that low back pain and pregnancy go hand and hand. Many women believe that they are destined to have low back pain because they are pregnant. Although it is very common for women to have low back pain at some time during their pregnancy it is not “normal”. Studies show that nearly 70% of women have low back pain during their pregnancy but most do not report it to their doctors.
There are many reasons why women experience low back pain during their pregnancy. Women experience many hormonal changes during this time. One hormone, Relaxin, becomes elevated. It is responsible for relaxing the connective tissue throughout the body in preparation for delivery. It can also increase joint laxity which can increase joint instability. There are also many posture changes that occur as your pregnancy progresses and your baby grows. The woman’s center of gravity shifts forward which increases the curve of the lower back. This can contribute to nerve irritation in the hips or joint pain in the hips and low back. Weight changes can also contribute to low back pain.
You don’t have to just “deal” with this pain. Women should speak with their obstetricians about their symptoms. You may benefit from seeing a physical therapist who can evaluate you and guide you through exercises, recommend equipment or support garments, and educate you on posture and body mechanics that can help reduce your symptoms.
At Excel, we have a physical therapist who specializes in diagnoses as they relate to women during their pregnancy and after their baby is born. Contact Jennifer Rutkowski at our St. Peters office (636-939-9540) with any questions.

Submitted by Jennifer Rutkowski, PT

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Exercise During Pregnancy

No one will deny that delivering a baby is hard work. Pregnancy and delivering a baby are physically demanding, and exercising can help make them easier. For those who already have good exercise habits, there is no need to stop exercising because you are pregnant. For those who do not already have established exercise habits, it can be a good time to start. The American College of Obstetricians and Gynecologists recommends thirty minutes or more of moderate exercise a day on most days of the week as long as there are no medical or obstetric complications.

Some of the benefits of exercise for the mother include increased energy levels, improved sleep, controlled weight gain, maintained fitness level, and decreased pregnancy-related pain/discomfort. Exercise can also reduce the risk of developing pre-eclampsia and gestational diabetes.

This is not the time to start high impact aerobics, learn to ski, or any other activity that has a high risk of falling. However, starting a walking program or aquatic exercise can be beneficial. Resistance and flexibility exercises are important, and good for you as well.

There are a couple of things to keep in mind while exercising:
• Avoid getting overheated
• Stay well hydrated
• Avoid lying on your back after your first trimester
• Don’t hold your breath

Stop exercising and contact your doctor if you experience:
• Vaginal bleeding
• Shortness of breath
• Dizziness
• Headache
• Chest pain

No matter what exercise you participate in, it is important to talk to your healthcare provider to make sure the exercise program is right for you. A physical therapist can assist you in maintaining or achieving your fitness goals during your pregnancy. Contact Jennifer Rutkowski at the Excel in St. Peters at 636-939-9540 if you have any questions regarding your current exercise program or one that might be right for you.

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NUTRITION AND HYDRATION GUIDELINES

Hydration

-One of the most important keys to your success as an athlete.
-Just a 2% loss of weight (due to sweating during a sport) can have a negative effect on your athletic performance.
-You have to drink throughout the day, not just during activity
-As an athlete you should be drinking 6-8 bottles of fluids throughout the day (approx. 90-120 oz.).
-Water, sports drinks, juices, skim milk
-Water with flavoring added to it (i.e. Crystal Light)
-Cucumbers, lettuce, watermelon, tomatoes, honeydew melon, onions, peaches, pears, oranges, mandarin oranges (foods that are at least 80% water)
-Before Practice/Game:
-16 oz 2 hours before + 8 oz 10-20 min prior to exercise
-During Practice/Game:
-Water: 6-8 oz every 15-20 minutes
-Sports Drinks: with 6-8% carbohydrates; more than that could have a negative effect
*Alternate between the two
-After Practice/Game:
-16-20 oz per pound lost during exercise within 2 hours

Nutrition-Routine, Routine, Routine and foods from all food groups
-Breakfast (The most important meal of the day!!!)- gives your body and brain energy to start the day
-Snack
-Lunch
-Snack (before practice)
-Workout
-Post-workout snack (if not going straight home and eating dinner; away competitions)
-Dinner

Breakfast Ideas-Getting several different food groups involved
1) -Two slices whole grain toast with two tablespoons peanut butter
-1/2 grapefruit
-1/2 cup low-fat cottage cheese
-1-2 cups water
2) -1 cup cooked (1/2 cup dry) oatmeal with 1/4 cup raisins
-1 cup milk
-3/4 cup orange juice
-1-2 cups water
3) -2-egg omelet with vegetables
-1whole wheat English muffin with 2 tsp. margarine and jam
-1 cup melon
-1-2 cups water
4) -1 bagel with 2 tablespoons low-fat cream cheese
-3/4 vegetable juice
-1-2 cups water

5) -2 cups cereal, 1 cup skim or 1% milk
-1 bagel, low-fat cream cheese
-1 banana
-2 cups orange juice (100%)
Other good breakfast ideas:
-Yogurt, fruit, cereal (hot or cold), low-fat muffins, fruit smoothie (with fresh or frozen fruit), waffles or pancakes with jam and fresh fruits, etc., etc.
***Be creative, get a variety of different things so you are not always eating the same foods.

Snack Ideas
-Granola bars or energy bars
-Fresh fruit
-Dried fruit (ex. Raisins, apples, berries, bananas, etc.)
-Trail Mix
-Dry cereal (Cheerios, granola, oat squares)
-Graham crackers or animal crackers
-Juice boxes (100% Juice)
-Peanut butter sandwich-good for afternoon snack before practice
-Rice cakes

Lunch Ideas (be sure to add, veggies, fruit, drink)
PBJ Sandwich
Sandwich (Turkey, lettuce, tomato, cheese)
Spaghetti and red sauce
Vegetable soup
Baked potatoes or sweet potatoes
Rice
Grilled Chicken
Fish
Salad (vegetables, dressing, chicken)

Pre-Game
-What you eat 3 days before competition effects an athlete the day of competition.
-Stick with foods that your body is familiar with.
-Pre-Game Meals (Ideally eaten 3-4 hours before game)
Pre-Game-10 am soccer game
-Plan: Wake up at 6am, eat breakfast, go back to bed
-Cereal
-Whole wheat toast with peanut butter
-Fruit
-Fruit juice, milk, or Gatorade
Pre-Game- Afternoon or evening game 3-4 hours before game
1) -Spaghetti and tomato sauce (a little lean meat in the sauce is fine)
-Potatoes or rice
-Vegetable
-Dinner rolls
-Small serving (3 oz) of chicken or other protein-rich food
2) -Pasta and meat sauce
-Salad with low-fat dressing
-Bread/roll
-Orange juice
-Water

Post-Game/Recovery
-Within 15-30 minutes after practice/game, take in a high carbohydrate snack:
-Fluid or Solid Snacks
-Carbohydrate Fluids:
- 6-8% carbohydrate (example: sports drink)
-A drink with a 3-4 carbs to 1 protein ratio
-Solid snacks with fluids:
-1 cup orange juice and 1 cup fruit yogurt
-1 cup apple juice and 1 PB sandwich
-1 cup grape juice and 1 banana
-1 cup cranapple juice and 1 granola bar
-1 small fast food milkshake
-Energy bar
-Chocolate milk
-One 8 oz fruit yogurt and cereal bar or banana
-8oz milk and cereal bar

Dinner
-Within 2 hours, take in a high carbohydrate dinner
-Dinner Ideas
-2 cups pasta, red sauce
-4 oz. grilled chicken breast
-1 cup salad, veggies, dressing
-2 cups skim or 1% milk

Not Getting Enough Sleep Can Lead To:
-Less energy the next day
-Troubles concentrating
-Irritability
-Muscle fatigue; can lead to injury
-Weakened immune system

References/Resources
Clark, Nancy MS, RD. Eating Before Competing. The Physician and Sports Medicine. Vol 26:9,Sept 98.
Clark, Nancy MS, RD. Sports Nutrition Guidebook, 4th ed, 2008.
Kundrat , Susan MS, RD, LD. Presentation 6/05.
Kundrat, Susan MS, RD, LD. 101 Sports Nutrition Tips, 2005.
Ray, Tracy R., MD and Fowler, Rachel, MS, RD. Sports Nutrition in Athletes. Southern Medical Journal. Vol 97:9, Sept 04.
Sinton, Meghan M. Ph.D. Presentation 3/10.

Submitted by Ruth Young, ATC

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The Building Blocks of Nutrition for Athletes Part 1: The Macronutrients

 There are two groups of nutrients that make up what we eat and drink:  Macro- and micro-nutrients.  Macronutrients include carbohydrates, lipids, and proteins.  These nutrients provide the energy necessary to maintain body functions during rest and physical activity.  Micronutrients are vitamins and minerals that play highly specific roles in facilitating energy transfer and tissue synthesis.

Macronutrients

Carbohydrates

Carbohydrate-rich foods are the best fuel sources for athletes.  Athletes need 55 to 65 percent of their calories to come from carbohydrates.  Carbohydrates are classified as “simple” or “complex”.  Simple carbohydrates are typically associated with sweet foods and ripe fruits.  Complex carbohydrates such as starches should make up the majority of carbohydrate fuel.  Complex carbohydrates usually carry with them other nutrients, such as the B vitamins.  Examples of starchy foods are breads, cereals, pastas, and starchy vegetables such as corn, potatoes, dried beans and peas.  Fruits are also excellent sources of carbohydrates.  Obtaining carbohydrates from a variety of sources is very important.

Carbohydrates are the initial fuel source and are the primary fuel source in short-burst, high-intensity events.  Activities such as sprinting, jumping, hitting a ball, and pole vaulting are fueled 100 percent by carbohydrates.

The body is able to store carbohydrates in limited amounts as glycogen.  Athletes are able to store more glycogen and use its limited supply sparingly if their diet is rich in complex carbohydrates and through proper training.  The amount of glycogen storage is about 1800-2000 calories.  When glycogen stores are exhausted, then athletic performance suffers.  Glycogen requirements for endurance athletes are slightly higher than the typical athlete.

 Lipids

Lipids, or fats are another important source of fuel.  Fats also carry fat soluble vitamins (vitamins A, D, E, and K).  They have over twice as many calories as an equal weight of carbohydrates.  Aerobic training increases the body’s ability to use fat as an energy source, so glycogen can be spared.  Fats cannot be used as an exclusive fuel.  The body’s fat storage is more than adequate to supply the energy needed for activity, so it is not necessary to supplement fat into your diet.  In fact, a diet that is moderately low in fat (no more than 30 percent of total calories from fat) will not hinder the athlete’s performance and will promote a healthy eating style that will be beneficial to the athlete in the future.  Since fats are such a concentrated source of energy, reducing fat intake makes it possible for an athlete to eat much more food to provide other nutrients to your body.

Some simple steps for reducing fat intake include:  consume little or no fried foods, avoid prepared meats (bologna, salami, bacon, sausage, etc), and limit the consumption of visible fats (butter, margarine, fat surrounding steak, chicken skin, etc.).  Instead, select lean meats and low-fat dairy products to avoid saturated fats.  Excess dietary fat is very efficiently and easily converted to stored body fat.  Fats are metabolized during exercise, but it takes time and aerobic training to become an efficient fat “burner”.  Again, don’t eliminate fat from the diet; rather take some simple steps to reduce it.

Saturated fats occur in animal products like beef, pork, chicken, egg yolk, and in dairy fats of cream, milk, butter, and cheese.  These are looked at as unhealthy forms of fat.  Unsaturated fats are those that occur in canola oil, olive oil, peanut oil, and the oil in almonds, pecans, and avocados.  These are generally looked at as healthier forms of fat.

Protein

Protein is essential to the human body for growth and repair of tissue.  Protein also helps athletes regulate metabolism and is used as an energy source when calories from fat or carbohydrates are deficient.  Protein is made up of chains of amino acids, some of which the body cannot manufacture.  Amino acid supplements are unproven and expensive.  Adequate amounts of protein can be obtained through a healthy diet.  Unlike carbohydrates, protein cannot be stored in the body and any excess will be burned for energy or stored as body fat.

In general, 0.8 grams of protein per kilogram of body weight per day is the recommended amount for protein intake.  (Divide your weight in pounds by 2.2 to get your weight in kilograms.)  Athletes have an increased requirement for protein that is determined by duration and intensity of exercise, degree of training and the amount of energy and protein intake of the current diet.  Athletes who train hard need additional protein in their diet.  This can usually be achieved as easily as eating a can of tuna, proving that spending money on expensive supplements is unnecessary.  Adequate carbohydrate intake is essential for proper utilization of protein in the body.

Strength athletes need 1.4 to 1.8 grams of protein per kilogram of body weight per day.  This extra protein is needed to increase muscle weight.  Runners and other endurance athletes also need more protein because during long workouts their muscles will use protein as an energy source.  These athletes need 1.2 to 1.4 grams of protein per kilogram of body weight per day.  In general, endurance athletes weigh less than strength athletes, so the actual amount of protein needed is less.  For example, a 200-pound linebacker needs 127 to 163 grams of protein per day; where as a 160-pound cross-country runner may need 87 to 101grams of protein per day.  Children and adolescents who are growing have a slightly higher need for protein than adults.  It is recommended that moderate exercisers take in an additional 10 percent of protein above their RDA.

Too much protein can be a problem.  Extra calories, no matter what the source, can be converted to stored body fat.  If protein intake exceeds the recommendations then the liver and kidneys must work harder to rid the body of unwanted byproducts.  This increased stress can lead to health problems including dehydration, loss of calcium, and liver and kidney problems in the future.

Protein powders and liquids are very popular in athletes and body builders.  Athletes should know their protein goals and exactly how much they actually get in their diets.  Athletes should only try supplementing protein into their diet only after they have had problems obtaining the correct amount of protein through modifications in their current diet.  Shakes and protein bars are convenient methods of protein intake for athletes, but long-term studies have not been performed and the expense of them is not always worth the trade off.  For example, most protein supplements contain 20 to 50 grams of protein and cost between $20.00 and $50.00 a canister. A can of tuna provides 37 grams of protein and costs less than $1.00.  As stated earlier, a balanced diet that is modified for protein requirements is the most effective method of getting protein into the body.

Adequate carbohydrate intake is necessary to provide energy, so the protein consumed will be used for all valuable functions instead of being “burned” as a fuel source.  Burning protein as a fuel causes increased water loss that can increase the risk of dehydration.

Most of the attention in a nutritional plan must be paid to the macronutrients.  Athletes have an increased need for adequate calorie intake, but special attention must be paid to ensure that these calories come from the proper nutrients.

MiniPoster

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**NEW RUNNING PROGRAM AT EXCEL**

Injuries related to distance running have three main causes. The first is training errors. This can mean attempting to train faster than the body is capable of or increasing mileage too quickly. The second factor is the structural makeup of the runner, primarily focusing on flexibility and strength. The final factor contributing to running injuries is faulty form. A problem in one of these areas places excessive stress on the body and if not corrected leads to injury.
Anyone currently experiencing pain with running can benefit from a running evaluation, novice runners and experienced competitors alike. Also, if you have stopped running entirely due to injuries and pain, this program may be just what you’re looking for. On your first visit, our therapists will discuss your running and injury history and perform a thorough evaluation of your strength and flexibility. We will also analyze your running form and review the video with you. From there, your therapist will provide you with exercises to maximize your strength and flexibility to prepare your body for running. We will then work with you on modifying your running form to lessen the stress on your muscles and joints. Finally, we will discuss how to progress your mileage and speed safely to avoid further injuries.

Rehab for Running Brochure

Submitted by Chris Dollenmeyer, MPT

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The Role of a Physical Therapy Assistant

Physical therapist assistants (PTA’s) provide physical therapy services under the direction and supervision of a licensed physical therapist. PTA’s help people of all ages who have medical problems, or other health related conditions that limit their ability to move and perform functional activities in their daily lives. PTA’s can work in a variety of settings including hospitals, private practices, outpatient clinics, home health, nursing homes, schools, and sports facilities.
To work as a PTA, an individual must graduate with an associate degree from an accredited PTA program at a technical or community college, or university. Graduates must then pass the national examination for licensing/certification/regulation in most states to be eligible to work.
Physical therapist assistants are involved in the direct care of patients. Their duties may include observing patients before and during therapy, noting their status and documenting it. Helping patients through their exercise programs and progressing as needed. Using a variety of techniques, such as massage and stretching. They should be familiar with the use of devices such as walkers, canes, wheel chairs, electrical and Russian stimulation, and ultrasound. And they should be comfortable with educating the patient and family members about what to do after treatment for a home program.

References ; American Physical Therapy Association – APTA.org and Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook 2012-13 Edition – bls.gov./ooh/healthcare/physical-therapist-assistants

Submitted by Shannon Schuette, PTA

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Excel in the Community

On Tuesday March 19th, Shawn Heck PT/CHT director of the Warrenton clinic spoke at the March meeting of the Inspirations, a Warren County Self-help Support Group sponsored by the American Cancer Society. The Inspirations meet monthly at the Fellowship Baptist Church in Warrenton. Individuals dealing with cancer, family members, and care givers are invited to attend. March’s meeting was focused on physical problems related to cancer and the treatment of cancer. March is also colon cancer awareness month. On May 31st Warren County supports the American Cancer Society with the Relay for Life at Black Hawk Middle School.

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Syndesmosis Sprains In Soccer Players

At the 6th Annual St. Louis Soccer Conference hosted by Washington University Orthopedics, Dr. Matthew Matava presented the topic of syndesmosis, or high ankle, sprains in soccer players.
The syndesmosis complex consists of the posterior-inferior tibiofibular ligament and the inferior transverse tibiofibular ligament. These ligaments are located between the two lower leg bones, the tibia and fibula, and help hold these two bones in a stable position.
Although these sprains are very painful and generally take a significant amount of time to return to sports, they luckily account for only 10% of all ankle sprains. Risk factors for high ankle sprains in soccer include prior ankle sprains, playing in the first two months of the season, and playing a defensive position. In a 2005-2007 survey of 100 U.S. high schools, the ankle was the most commonly injured body part, accounting for 23% of all injuries, more frequent in females than males (25% vs. 22%). The three most common mechanisms of syndesmosis injury are external rotation forces of the lower leg (planting and turning), abduction of the lower leg (leg slides away from the body), and hyper-dorsiflexion (which the foot is pushed too far upward). This type of sprain is often found in combination with other ankle sprains, fibular fractures, and tendon strains.
When evaluating syndesmosis sprains, most pain is above the ankle joint on the front-outer lower leg. Often, athletes are unable to pinpoint a specific area of pain, but more of a generalized area of pain. Treatment of syndesmosis sprains includes R.I.C.E, NSAIDs, and a semi-aggressive rehabilitation plan. Surgical treatment is sometimes needed in severe cases, although all treatment will be determined by your orthopedic physician.

Written by Maggie Richardson, ATC/LAT

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“Shin Splints”

What are “shin splints”? This term is a non-medical term used to describe pain in the front of the lower leg, usually medial tibial stress syndrome. They are commonly seen in athletes who do a lot of running and can occur at the beginning of a sport season. “Shin splints” are treatable and preventable, but could turn into a stress fracture if ignored.

What causes shin pain? Several factors can lead to this condition, including: flat feet or fallen arches, tight lower leg musculature, inadequate strengthening, improper stretching, improper footwear, poor mechanics, poorly maintained running surfaces, or increasing mileage or intensity too quickly.

What should I do to prevent “shin splints”?

  • Check running shoes to be sure they provide enough support
  • Allow time for a proper warm-up and cool-down
  • Stretch lower leg muscles sufficiently
  • Get arch supports to wear in your shoes if you have flat feet or fallen arches
  • Avoid running in the street or other uneven surfaces
  • If running on a track, change directions periodically
  • Avoid hard surfaces, such as concrete or asphalt, when doing plyometrics or other jumping activities

How can I treat “shin splints”?

  • Rest from running
  • Ice the area for 20 minutes 2-3 times a day
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen) or Aleve (naproxen) will help reduce and prevent inflammation when taken according to the directions on the box or as ordered by your physician
  • Use arch supports for flat feet/arches
  • Perform appropriate rehabilitation exercises/stretches

Submitted by:  Emily R. Grozdanic, ATC, LAT

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Golf Season Is Here!

The weather will be breaking soon, so it’s time to break out the clubs! Along with resuming the game, the golfer can develop injuries or exacerbate old injuries from the previous year. Golf injuries are not traumatic; they are the result of overuse. Some of these injuries will resolve as muscles adapt to being used more frequently. Some injuries do not resolve, and may even carry on from season to season. Others are not due to overuse alone, but are the result of muscles and joints being overused in an improper manner.

Faulty swing mechanics will cause one muscle group or joint to be stressed beyond its capacity because another part of the body is not being used properly. For instance, you can develop shoulder pain because the hips are not moving properly. This can cause the shoulder to compensate for the lack of hip motion by moving further than it needs to. The wrist, hand, shoulder, elbow and spine are common sites of pain in golfers. The pain may be at a specific joint, but the root cause may be at another part of the body.

Some health care practioners will try to focus on the site of pain. They may treat symptoms, but do not get to the cause of the problem. A physical therapist experienced on swing analysis can help solve the problem, not just treat symptoms. Nick Weber, Paul Halleman, and Steve Thro are Excel physical therapists who have experience in treating the type of injuries that golfers develop. Give us a call and we can start guiding you on the road to recovery!

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