My experience with custom orthotics, and will they work for you?


A while back I wrote a blog about how even physical therapists need treatment sometimes. I went over my experiences with a foot problem that I developed over a few summers ago. I wanted to do a follow up post on my current situation and how it has taught me something that I teach my patients on a daily basis.

To summarize my experience I started to get some foot discomfort in the fall of 2015 after a long season of tournament baseball. I used to wear spikes when I coached because it made it easier to do things with the players. That Thanksgiving I played in a Turkey bowl and wore those same spikes and the next day I could barely walk. It took about 2-3 months of self treatment and taping methods to finally get some significant relief. It would still bother me from time to time, but I could deal with it. Well, summer came in 2016 and I decided to get a new pair of spikes thinking that it was just the brand the they were a few years old. At first it felt fine, but as the season wore on I could feel my foot slowly hurting again. I finally just started wearing regular running shoes and that seemed to help, but never completely. I finally bit the bullet and went to see a foot specialist. I was diagnosed with nothing more than over pronation of my forefoot and in turn my arch was collapsing causing significant pain. This is honestly nothing that I already didn’t know. I just wanted to make sure I didn’t have a stress fracture. To my relief I was recommended to get custom orthotics done so I obliged. I didn’t receive a call for a few months and by that time my pain was gone so I never called back.

Fast forward to April 2017 and baseball season had been in full swing since Thanksgiving indoors of course here in Western PA. We were just getting outside and I started wearing my spikes again…bad move. They hurt so bad that I decided to get some turf shoes most coaches wear. I also decided to call the foot specialist again to pick up my orthotics. I made an appointment and within 10 minutes of being there I was walking out with orthotics in my shoes. The initial feeling was a little different. I wasn’t sure what to think really. I just knew that I needed to give them a shot. I always tell my patients with any type of change in footwear whether it’s new shoes or orthotics do it in steps. So I wore them for an hour for the first week. Just one hour a day, then bumped it up to 3 hours and so on. I now wear them all day when I’m at work because I am on my feet most of the day. I have to say that since wearing them I have not experienced foot pain at all!! It’s amazing what a difference they do make and I’m very happy I made the decision to get them.

My advice to my patients with foot problems is always try orthotics, especially if they have a flat foot. I usually tell them to try an over the counter version to see. Some insurances don’t cover them and it can be expensive. So before they go full out I tell them to go the cheaper route first. Now that I have had such a positive experience with orthotics it will drive me to be more aware of patients that will benefit from this.

If you have any questions about your foot problem or any musculoskeletal issue that you may be experiencing please don’t hesitate to contact me! 

nicksivrichpt@gmail.com

Putting in the work and staying consistent always pays off!

I am one of the coaches of my son’s travel baseball team. My son is almost 9 and it’s his first full year of kid pitch travel baseball. He has played with most of the kids on his team since he was 4. They all started out on a rec team together. Year to year you can see the improvement. Constant practice and playing for most of the year is our life right now. It’s so much different than when I was a kid. I played a lot of baseball, but only from April till August. These kids started in November and will play until the end of summer. Constant practice and games keep these kids consistent. They stay focused by doing things on a regular basis and it shows. Most of the things that we succeed at in life are done on a regular basis. We make a habit of them and they become a constant.

This past weekend we had another tournament for baseball. We played very well in pool play to earn the second seed to start the playoff/championship round. Sunday afternoon we were set to play the same team we beat the day before 5-4. It was a close game, but we played flat that game. The kids seemed pretty upbeat at the beginning of this game, but it didn’t start out the way we wanted it to. My son started the game pitching and was a little off with his location. He ended up giving up a 2 run home run in the 1st inning. Luckily we got out of it without going down by any more runs. He was down, but his teammates encouraged him as well as all of the coaches after getting out of the inning. The kids were off and losing most of the game. We entered the second to last inning down 7-3. The kids battled this inning getting timely hits and staying disciplined at the plate scoring 4 runs to tie it up! We would have scored 1 more if it wasn’t for me running my son into an out at third after a nice 2 run double. The last inning comes and the other team scored 2 runs to make it 9-7. Things just were not going our way. The rain came off and on and it was just a miserable feeling. The kids did not seem defeated though. They have been in this situation before! This is what they practice for each and every week. We ended up with bases loaded and 2 outs, a situation every athlete wants to be in! As a kid we always played and yelled out 2 outs bottom of the 9th bases loaded down by 1!. So who steps up to the plate? My son steps into the box ready and focused. First pitch is thrown and he swings out of his shoes! He was pumped up for this! I yell down from 3rd where I was coaching and tell him to relax, because a hit scores two! Next pitch comes and boom! He smokes this ball high in the air towards left center field. I knew it was gonna at least score two right? Then it keeps going and going and I yell “GET OUT OF HERE!” And the ball sailed over the fence! You would have thought I hit the ball because I was jumping up and down like a little kid screaming! As my son rounded 3rd he had the biggest smile on his face and it’s a moment I will never forget and cherish forever! I’m getting chills right now just typing this! The kids went crazy and it was just a great moment to be a part of! They won the game!


These kids never cease to amaze me! They showed me something that day that will always stick with me. Putting in the work and staying consistent will always pay off in the end. They never gave up on each other and they never quit. Even when my son gave up a home run in the first inning he kept his composure and stayed focused. Every single one of them contributed to that great victory!

I always like to bring things back to a situation related to physical therapy or situations in life in general. If we stay consistent with anything in life we are going to make our situation better. If we practice at something or make a habit of doing something on the regular it’s proven that you have a better chance of success. If you are trying to be more healthy then make a commitment to stick with a new way of eating and doing some sort of physical activity weekly. Do these things at the same time and same day to make a habit and stay consistent. When you make an appointment to come to physical therapy stick to it and commit to the full length of treatment sessions. Do your program at home and stay consistent. It’s proven to work because I saw it first hand this past weekend.

The benefits of warming up before exercise

I see it all the time at the gym. People come in, check in at the front desk, hang their keys on the board and go right to the bench press. Are they going to warm up at all? How many of you reading this right now have done that? I know I used to be one of those people in the past. I would just get in there and start full throttle not having a clue as to what I was doing to myself and the potential injuries I could have caused myself. Warming up is very important for a few reasons. It absolutely can aid in preventing injuries during your workout. It can also help enhance your performance during your workout. In fact the more intense your workout is going to be the more important a proper warmup is.

When you start a new workout routine or you are starting a new program your body is just getting used to those specific exercises. Nobody ever tries to run a marathon without first warming up. So why would we just jump right into something without really getting our body in a state of warmth? Working out is one of many elements involved in losing weight and leading a healthy life style. If you are not used to working out, a warm up is crucial to help your body ease into it.

Warming up before exercise slowly loosens your muscles at a better pace than just jumping right into a routine. Studies have suggested that warming up before a exercise regimen can prevent injury. Here are some of the specific benefits of a proper warm up:

Increased muscle temperature: A warmer muscle tends to contract more forcefully and relax a lot faster. This decreases the probability of overstretching and causing injury.

Blood vessel dilation: This can reduce the resistance to blood flow and have a little less stress on the heart.

Increased body temperature: This increases muscle elasticity and reduces the risk of strains and muscle pulls.

Increased blood temperature: Temperature of blood increases when it travels through your muscles. As that rises the binding of oxygen to hemoglobin decreases so oxygen is more readily available to your muscles. This can improve endurance.

Improved range of motion (ROM): As your muscles increase in temperature so do your joints. In turn this helps increase the available ROM that you have and this helps improve performance.

A typical warm up should start out slow with a gradual increase to what you are trying to accomplish. If you are a runner you should be jogging a bit mixing in a few sprints to engage fast and slow twitch muscle fibers. For those of us that like to strength train you should be starting out with light weight for a few sets gradually working your way into the exercise you are trying to accomplish. I personally like to run about 2 miles before I strength train. By the time I’m done. I’m very warm, loose and ready to start my workout. Another point I would like to make is that the best time to stretch is after a workout or after your warmup. This way your muscles are loose and more pliable and at less risk for injury.
Keep in mind that each person’s warmup is different. It can be very individualized and only comes with experience, practice and experimentation. I recommend trying various ways at a slow pace to find what works best for you.

REFERENCES:

https://www.verywell.com/how-to-warm-up-before-exercise-3119266

How much does weight really impact my joint health?


If you have the occasional twinge of pain in your knees, hips or even your back, it is your body’s way of warning you of a potential problem. Pain is your body’s way to tell you that something is wrong and you need to do something about it. Similar to an engine light coming on in your car, pain is indicating a possible problem. Now, what is the cause? There are multiple reasons why your body sends off pain signals. First, if you injure tissue your brain tells you that you are in pain. If you have bad posture, eventually you will feel pain. Our joints are designed to take a lot of pressure during different activities. But when that pressure is increased just the slightest it can cause an enormous chain reaction and your function can be lost. So how does increased body weight really impact our joints health?

Studies have shown that for every pound of excess weight exerts 4 pounds of pressure on your joints, your knees in particular. Let’s just think about that for a minute…if you are 10 pounds overweight you have 40 pounds of extra pressure on your knees. If you are 100 pounds overweight now you have 400 pounds of pressure on your knees!!! That’s a crazy statistic! Now, walking on a level surface puts a force equivalent to 1 ½ times your body weight normally with everyone. So if you weigh 200 pounds you are putting 300 pounds of pressure on your knees. If you add an incline, the pressure goes up. Going up and down a step increases this pressure 2 to 3 times. And squatting, a very functional activity that we all do on a day to day basis, can add up to 5 times your body weight of pressure. This is why it is so important to know what we are doing to our bodies and the affect a few extra pounds can have.  

What does this mean? Well, with increased pressure on joints this can lead to joint break down, in turn causing osteoarthritis. Obesity and being overweight is one of the leading risk factors of osteoarthritis. Osteoarthritis is caused from wear and tear of joints. Once the cartilage is worn away this causes a bone on bone atmosphere which causes inflammation in the joint. Increased weight causes this breakdown to occur quicker than normal. And, pain levels can be even worse with those that already have osteoarthritis. Now you have an inflamed joint that is bearing 3-5 times the amount of pressure that it should.  

What can be done to avoid this? The simple answer is to lose some weight. Most people can afford to lose a few extra pounds. It’s easier said than done, I know. It all comes down to 2 questions. Is it important to you? And what are my goals? You really have to decide what is important to you. If not having pain is important to you, then this should be a priority. If being able to do any activity you want without pain, then this should be a priority. What are your goals? I would suggest setting small goals at first so that they can be easily reached. Seek out another partner to hold you accountable during your journey. In the long run it’s a life style change and it needs to be done in steps. Nobody ever said that getting to a healthy lifestyle is easy, but once you get there it is very easy to maintain that environment.  
So to sum it up, weight has a huge impact on your joint health. Your joints already have a great deal of pressure put on them when doing a specific activity. Adding any additional weight, just increases that pressure even more. This, in turn, can cause other issues such as osteoarthritis. Having a healthier lifestyle can and will prevent such things from happening and should be a priority.  

Which running shoe is best for me?


With so many shoe choices out there, in can be tough to find the right one. You ask yourself questions like: “What color will go with most of my clothes?”, “Do I want a high top or low cut?”, “What brand do I want?”, “Which shoe is the best value?” While all of these questions are valued points, they are not the questions you should be asking yourself. Even the most advanced runner needs help from time to time in the decision making process of choosing a running shoe. Here are a few tips and questions to ask yourself. These will help steer you in the right direction of picking that perfect shoe leather express footwear!

What type of arch do I have?

Normal arch: A normal arch has a half of an arch in a foot print

Low or flat arch: A low arch shows a print of the whole foot

High arch: A high arch only shows a print of the heel and ball of foot. Sometimes it shows a very thin line on the outside.

Once you determine what type of arch that you have then you can search for shoes in that criteria.

How much running do I plan on doing?

This will vary tremendously so I always tend to round up a bit for this question. If you intend on running 10-15 miles per week I would round that up to 15-20. Certain shoes wear more rapidly than others. Similar to tires on a car. If you plan on doing a lot more running you will go through shoes a lot faster and in turn will cost a lot more money in the long run. Cost as well as distance play a big part so choose wisely.

Once I find a shoe is this the only type I should ever run in again?

Some people think that since this shoe works now it will be the only one they can use forever. Many factors go into what works for certain people. Speed of running, stride length, body weight, arch type etc…these same things change over time with everybody. Finding the right shoe for you is a challenge. Sometimes you need to just experiment to see what is best for you. As your fitness levels and ways that you run change, so should your shoes. Bottom line is as you change, your shoes should also follow suit.

Should I only wear my running shoes for running?  

The quick answer is yes! All shoes wear at different rates, but if you use them for everything chances are they will wear out a lot faster. Wearing shoes specifically for running will help with the way the tread wears and will also help with injury prevention. Activities that involve side to side movement like basketball will start to wear the shoe in directions that it should not. Running shoes are meant to wear while running. They have a balance for forward motion. And the cost of a good shoe is not cheap so why wear them out quicker than you have to.

Should I wear in new shoes before I go for my run?

Most shoes now a days have nice movement in the material and do not need to be broken in. Some people will disagree and that is okay. I suggest that if you feel the need to break them in with a few short runs before your long ones than go for it.

When is it time to retire my running shoes?

About 300-500 miles is the suggested time to replace your running shoes. This varies because of different style runners. Some people have a very long stride length so the miles will be higher due to less strides per mile. Shorter people have a shorter length so they will have more strides per mile. This is just a general rule of thumb. In my opinion, if your shoes feel like they need replaced before the recommended mileage then replace them.

Choosing the right running shoe takes time. Sometimes it’s more trial and error. My suggestion is to find a Physical Therapist or a Podiatrist that can evaluate your feet and help you make the right decision.

My running shoe:

http://amzn.to/2lU4vhV

http://amzn.to/2memu3x 
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