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Photo from the Roosevelt library collection.

“We must fear a resurgence of this dreaded disease.”~ Peggy Bowditch

Read Peggy’s story here.

Join Gloucester Point Virginia Rotary Club as we raise awareness and funds to help eradicate polio as it lurks in just two nations: Afghanistan and Pakistan.   Plants to End Polio is a project where we partnered with Brent & Becky’s Bulbs Bloomin’ Bucks program so that when you select Gloucester Point Rotary Charitable Foundation, 25% of your sale is donated to End Polio Now.  Unfortunately, the “shop” is closed for the season but will re-open in January.  In the meantime, please help us spread the word.  The Bill and Melinda Gates Foundation will match every dollar donated to End Polio Now 2:1.

Check out this post for hints on growing beautiful bulbs during the dreary winter months.

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polio amaryllis

Click here to read Susan Camp’s hints for growing indoor bulbs.

Our Gloucester Point Virginia Rotary Club wants to raise awareness and funds to help End Polio Now.  Through a partnership with Brent & Becky’s Bulbs Bloomin’ Bucks program, when Gloucester Point Rotary Charitable Foundation is selected, 25% of your sale is donated to Rotary International’s effort to eradicate polio.  The store is closed for the season but will re-open in January.  But until then, you can find out more about Plants to End Polio here.

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Photo by Amber Case

Click here to read A Child’s Memory by Susan Camp

Our Gloucester Point Virginia Rotary Club is working to raise awareness and funds to help eradicate polio, once and for all.  The virus persists in two nations: Afghanistan and Pakistan.  Plants to End Polio links to an online store that is closed for the season but will re-open in January.  In the meantime, we want to build an on-line community of supporters.

Cycling pace lineIf the rest of the world is allowing drafting during the bike portion of triathlon, why is it such a big deal in the U.S.? From all that I have read, the biggest grievance is that up until now, triathlon has been considered an individual, not a team sport. USA Triathlon, the national governing body, held its first draft legal sprint age group championship this year in Florida.

Triathlon’s history lies in the crowning of the world champion at the Ironman distance event in legendary Kona. It is not about working together; it is about which individual can cover the distance the fastest without any help out on the course.

Triathlon is historically about digging deep to find personal strength and not being able to rely on the work or effort done by anyone else. For now, let’s overlook the fact that it is completely legal and advantageous to swim on the heels of a competitor during the first leg of the event.

Another concern has to do with safety when a large group of people not used to cycling together is now riding in a pack or pace line. It is not a question of “will someone crash?” but “when will someone crash?” and wondering how many others will literally be brought down.

Riding in a pace line requires extreme focus and excellent bike handling skills, unfortunately not a prerequisite for entering a triathlon. This likely has an impact on the medical teams and coverage necessary to provide adequate emergency help at a triathlon. Will race directors and event sponsors be taking on more liability?

Aero bars, known to give individual riders an advantage, are not allowed in draft-legal racing. They are too dangerous when cyclists are riding that close to each other. What about the athlete who has financially invested in a time trial type bike? This may actually put cyclists on a more even level, at least from an equipment perspective.

Pace line riding will certainly make for faster events and likely even more exciting races as the cyclists work together and take turns pulling at the front. The strong riders who are not such good runners will lose their advantage as individuals come into the second transition closer together.

Both non-drafting and draft-legal events will continue for now. Participants wary of pace lines and the sport of triathlon losing its identity as an individual contest will find that most races in the U.S. will look and feel like they always have, at least for now. Athletes looking to compete at a different level will be provided with yet another challege in the new format.

If you want to learn more about the new draft-legal triathlon format, plan to attend the panel discussion at the 3rd annual Richmond Endurance Athlete Symposium & Expo, January 23, 2016 at the Richmond Westin. Karen Kovacs, PT is a Clinical Director at Tidewater Physical Therapy, Inc.’s Gloucester Point location. She is board certified in orthopedics and a USA Triathlon certified coach.  Photo by Ethan Lofton.

brain mediumPain is not just a physical reality. It is impacted and affected by how someone behaves, thinks and feels, which makes it truly in the person’s head, not just in damaged tissue.

Dr. Cal Robinson, Psy.D, Medical Psychologist at Orthopaedic and Spine Center spoke to our audience of physical therapists about the challenges that patients living with chronic pain face. Acceptance and Commitment Therapy, his approach, embraces a behavior modification method that can help this population take control of their lives.

Dr. Robinson describes the cycle that begins with an acute injury or surgical trauma causing pain. As the pain persists, it elicits an emotional response to the thoughts associated with the discomfort. Wondering when the bad feeling will go away can turn into annoyance, sadness, fear, anger, and giving up. This transforms into patterns of suffering that are recognized as pain behaviors. Those may include avoiding activity, depression, over-eating, and reluctance to go to work.

Mindfulness, a contemporary strategy for helping people cope with chronic pain, contrasts with our culture’s current approach that attempts to suppress pain with medications. In mindfulness, the chronic pain patient is taught to non-judgmentally acknowledge what he or she is experiencing in that moment.  Pause. And then consciously choose to act in a way that demonstrates a behavior destined to improve quality of life, not wallow in self-pity.

The patient is encouraged to actually pay attention to the pain. But rather than respond immediately with the conditioned reaction to take another pill, lie down, give the pain level a number, not go to work, or complain to a loved one, the person is trained to practice allowing some time before responding. Dr. Robinson describes this as an action plan to help let go of the notion that “my life is on hold until my pain goes away.”

Patients are taught to respond with a behavior that reflects energy directed in a more positive manner. This could be anything from getting up and dressed, going for a walk, completing a chore, going to work or not complaining. These are obviously unique to each individual. And, like any new skill, it takes practice to respond to the pain in this “new” way.

Viktor Frankl, as Dr. Robinson explained, summarized why this practice works. “Between stimulus and response, there is space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

Dr. Robinson reminded us that humans have the capacity to develop and change our attitudes. This means that with training and practice, people who live in chronic pain can be taught to choose how they will respond to the sensation of pain. The decision to pause and consciously choose a practiced, more desired behavior offers a tool for living a more satisfying and fulfilling life.

But you have to want that.

Image courtesy Creative Commons Allan Ajifo http://www.aboutmodafinil.com

Volleyball Dr. Eric Hegedus, DPT, MHSc, OCS acquainted twenty-five clinicians with the term “rotary collapse” at a recent continuing education course focused on lower extremity dysfunction and exercise prescription for Physical Therapists and PT Assistants hosted by Tidewater Physical Therapy, Inc.

It’s been at least 10 years since PTs have delved into how knee pain can often be caused by hip muscle weakness and poor motor control. Until recently, I have always used the term “dynamic valgus” to describe the movement pattern where the femur collapses in (adducts) as the hip internally rotates instead of staying neutral like it should. This is accompanied by a relative lateral glide of the patella, which in turn often results in pain isolated to the knee. It is also many times the underlying mechanism of injury in the dreaded anterior cruciate ligament (ACL) tear.

This phenomenon is typically coupled with excessive foot pronation as that body part follows what is happening up the leg chain, or does what is happening at the foot drive everything higher? Until this weekend, I would say I have ignored, or at least not paid close attention to what was happening above the belly button of the patients I have been observing do single leg squats as I determined why they had pain or guided their rehabilitation from ACL reconstruction.

As we increased the challenge of doing a single leg squat during the course by observing each other perform it with hands over head, it was interesting to see the compensatory trunk rotation either away from or toward the test leg that either causes the hip to rotate “in” to maintain balance or is the consequence of that action. Fascinating, if you consider yourself an expert in recognizing deviations from normal movement patterns, because it adds a dimension to exercise correction that I may have neglected that is more complicated than simply “core strength.” Welcome to the term rotary collapse.

Keep in mind that the context of this course revolved around whether we as PTs are returning injured athletes to sports when they are “good enough,” only to have them get reinjured because of the increased intensity of game-day play compared to practice and rehab. Hegedus challenged us to develop exercise progressions that address not just local and regional deficits, but global ones as well (trunk control with arms over head or against resistance, contact with other players) before returning patients to high-level activity to decrease the athletes’ likelihood of getting re-injured.

Picture a basketball player going up for a lay-up (hand overhead while landing); a volleyball player jumping and landing after a block at the net; or a lacrosse athlete with stick overhead throwing forcefully for a goal. The trunk adds another dimension to the stress at the knee. And if that knee has already been injured or surgically repaired, we really do need to make sure we include testing and challenging that sport specific trunk control before we send our athletes back out on the field.

So my relationship with the term “rotary collapse” (hip adduction, femoral IR, knee valgus, tibial ER, rearfoot eversion, midfoot pronation) has moved to the next level: examining the role of trunk rotation and stability, in addition to what we have already been looking at: strength, flexibility, pain inhibition, body structure and fatigue. Rehab will include more speed drills and more simulated fast paced play and effort to reproduce many of the demands my athletes’ bodies will experience when they resume unrestricted play. No more basing decisions on the leg, or knee being “good enough,” (90% on a physical performance test comparing the involved to the uninvolved leg).

Here’s to physical therapists and a deeper understanding of #rotary collapse so that we may all better prepare our athletes for play and life after injury. And ideally, to helping prevent their injury in the first place. Photo: Creative Commons: Texas A & M Volleyball 2014

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The Selective Functional Movement Assessment (SFMA): Consider an annual musculoskeletal exam by a physical therapist.

I was among 50 clinicians from Tidewater Physical Therapy who recently attended the Selective Functional Movement Assessment (SFMA) certification course. The SFMA provides a systematic, movement based strategy for identifying the underlying cause of a patient’s pain. It is one component of the traditional musculoskeletal examination or initial evaluation.

The structured, algorithmic approach utilizes a physical therapist’s (PT) expertise in recognizing deviations from normal human movement patterns. The examiner looks at patients from top to bottom, including neck motion, how the patient bends forward, reaches overhead and squats. When there is a deviation from normal, the PT assesses further to determine the cause of the pain.

The source of the problem, often not even in the same part of the body as where the patient complains of pain, is likely due to a restriction in soft tissue, like a muscle, or a stiff joint. The other significant reason a patient may experience pain is because she or he does not have sufficient motor control to promote normal biomechanical motion. The stability for proper, pain-free movement is lacking.

The PT treats the restriction with manual skills, including assisted stretching, myofascial release, trigger point dry needling, and joint tissue mobilization. The stability and motor control deficits are corrected with specific exercises and muscle re-education.

The SFMA is particularly useful for athletes, actively aging adults, and as a baseline for an annual musculoskeletal exam. Much like an annual tune up of your car, a physical by a primary care doctor, or teeth cleaning by the dentist, your physical therapist keeps a watchful eye on how you are moving over a period of years.

Ideally this would mean the PT identifies faulty and compensatory movement patterns that if untreated will cause tissue to break down. Those muscle and joint changes result in arthritis, fixed bony changes that cannot be reversed. The source of the pain becomes that much harder to treat. Next thing you know, you are setting up surgery for a total knee replacement.

The biggest difference between the SFMA and a traditional physical therapy evaluation involves looking at how the entire body moves and not just the affected area. This can help unravel chronic underlying causes of pain that are not caused by a specific pathology (like bursitis or tendonitis) but because of tissue stress due to faulty movement related to mobility and/or stability.

Consider making an appointment today with a physical therapist for your annual musculoskeletal exam.

Photo: Creative Commons by DBCLS By DBCLS [CC BY-SA 2.1 jp (http://creativecommons.org/licenses/by-sa/2.1/jp/deed.en)%5D, via Wikimedia Commons