#choosept

For the past year, I had been running injury free. I was training consistently and had run many miles at least five times a week, every week, for at least a year. Then a friend who I hadn't run with before asked me to go on a run with him. I don't normally run with other people, but I took him up on the invitation. We had 20 miles planned that day. While we were running on that ill-fated day, I realized his goal pace for that run was much slower than what I was used to running. At the time, I didn't think this would be a problem. The run went fine, but at the end of it I noticed a strange pain in my ankle. The next day, it was difficult to walk without a searing ache snaking through the inside of my ankle like some kind of dark convoy being led straight into a pain cave. All I could think was, "What happened?!"

As a physical therapist, I started analyzing the run to figure out what went wrong. I needed to figure out why walking was difficult when just a few weeks prior I had run my fastest marathon time ever. 

In the end, it all came down to cadence. 

Thinking about how I was running with my friend and looking at my run data from my watch, I realized I had changed the way I was running to better match his speed. Instead of just putting less power through my legs, I had slowed my cadence and was actively braking my speed with every step. This meant more force going through my legs. Over the course of 20 miles, this equated to a drastic increase in impact on my bones, and an injury that lasted for months. This is all something that I knew could happen. I often coach patients who are returning to running on the benefit of increasing their cadence rate. So here I am now - finally healed and offering you this article to help prevent the pain that I got to enjoy for a few months.  

Studies show that increasing your cadence decreases the ground reaction force (think, impact) going through your legs. A great deal of elite-level runners run with a cadence of at least 180 steps per minute or more. In addition to lowering the impact on your knees and the rest of your legs, increasing cadence has other benefits as well. Often when working with runners in our clinic, I find that simply increasing their cadence can help correct a lot of other problems with their running form. Over-striding, or reaching too far forward with your legs while running, is one of the big problems increasing cadence helps to correct. Ideally, your feet should be landing more or less underneath your hips. By having quicker steps, you have less time to reach out with your legs, and so your footfall becomes more optimal in most cases. This can especially be of benefit when running on trails. In Hawaii, many of the trails are covered in roots, rocks and any number of fun things to trip over. By quickening your steps, you will become lighter on your feet and more adept at being able to change your angle or quickly step over a possible toe-smasher. 

With all good things comes a caveat, however. It's also important to consider this point: if it ain’t broke, don't fix it. If you have been running for years without injury and have a somewhat slower cadence - you keep doing you. There are professional runners out there who run below the "holy grail" number of 180. It is not a cure-all, and shouldn't be considered as such. Every athlete is different and this should be just one more tool in your toolbox to aid in injury prevention. I am not a big proponent of changing things just to change them. Altering cadence may be most beneficial for the runner who is perpetually injured (most studies show that well over half of all runners eventually sustain an injury.) By trying out a quicker cadence, you may be able to help yourself step off the injury train and start gliding down the road of pain-free running. 

So how to get started? The easiest way is to use something you probably take with you on most runs: your phone. There are plenty of free metronome apps out there you can download. Get one of those, set the beat to 180, and start running. As you run, try to match your foot-fall with the sound of the metronome beat. At first it may seem like you are running like a cartoon character. Your feet will probably feel like they're going much faster than they want to. Also, be prepared to be a little more winded than usual - that's OK. After a few runs like this, your body will start to adapt and you will be able to settle into your new cadence. After a week or two of regular running with a faster cadence, you most likely will no longer need the metronome to keep your feet moving quickly. 

We hope this guide helps lower your chances of getting injured while you are out there running. But if an injury does occur, you can see your physician for a physical therapy referral to Jaco Rehab. 

Stay happy, healthy and strong!

Article by: August Kryger, PT, DPT

#1 - You don’t have to live with the pain

If you’ve had physical therapy in the past and your injury or condition has started to bother you again, don’t get discouraged, but DO seize the day. Here’s a helpful perspective from my colleague Jerod Carter:

If symptoms return after treatment has concluded, it doesn’t mean that you have had a big setback. Moreover, it doesn’t mean that PT wasn’t the full answer to the problem. If you achieved pain-free status in PT before, it can be done again!

Please give my office a call if your injury has started to hurt again. I can get you back to doing the things you love.

#2 - Put exercise to work for you

I know our lives and the times we live in aren’t getting any less stressful, and this time of year can be especially difficult. But physical activity DOES help and is far from being just one more “to-do.” According to the Mayo Clinic, getting moving has immediate physiological benefits:

It bumps up your endorphins (your brain produces more feel-good neurotransmitters).

It lets your body systems safely practice working together through the effects of stress, providing protection for your cardiovascular, digestive, and immune systems.

It reduces anxiety and mimics the benefits of meditation. Focusing on your body’s movements can generate energy and help you feel more calm, clear, and focused.

Perhaps you know you need to exercise but have trouble making that happen either due to physical limitations or a lack of motivation. A physical therapist can provide excellent support in both of those areas. If you’re just starting out, I can address any pain you’re experiencing and design a gentle yet effective workout. If you already exercise, a consultation with me can change up your routine and provide accountability. I specialize in helping clients set and attain goals and I’d love to help you create a plan to manage stress and enhance your day to day life.

#3 - Get guidance on getting healthy

If you have a health-related “reset” in mind for after the holidays, you’re probably considering the many diet and exercise options out there – and there are too many to count! Why not make it more simple for yourself and talk it over with an expert? My practice has the tools you need to lose weight and improve your nutrition. 

For years, I’ve partnered with IDLife to offer my clients realistic, effective solutions that work because, like personalized PT treatment plans for my patients, this wellness approach is not cookie-cutter. IDLife is about as customized as you can get. A thorough assessment for every client ensures the regimen is completely suited to your needs and lifestyle, and we even offer DNA testing to analyze your body’s unique makeup and zero in on the fitness and weight loss strategies that will be most successful for you. No need to wait until the new year – come in today to understand your options and be ready to hit the ground running in January!

I’m thrilled to be embarking on this next chapter in a new facility, and I commit to maintaining the 100% personal, flexible, targeted, and efficient care that my valued patients expect and deserve. I truly look forward to seeing you soon!

Address: 3000 Cabot Blvd West, Suite 200, Langhorne PA 19047 

Hours: Monday through Friday, 8:30am to 5:00pm

Phone: (215) 968-0156

Be well,

As you’d imagine, I get to know my patients really well over the course of treatment. I hear about their families and their interests, their joys and their challenges -- it’s a great part of my day and my job. But physical therapy isn’t usually a permanent intervention, and so for most patients, the time comes to say goodbye. When a client feels better and overcomes his issues, it’s time for him to be discharged from therapy and continue on his own to maintain his progress. As their treatment winds up, I ask myself, do they have all the tools they need? Will they continue to follow my instructions? Are they in a good place to be done and moving on? Just like my patients move on when it’s time, I’ve had to come to the realization as a parent that the same is true for our kids. 

My oldest son recently left our home after two years of community college to transfer to college in Virginia. That was a very difficult time as a dad -- knowing that my son who is now a young man is suddenly six hours away from home in a new place, not knowing anyone, and off to start a whole new chapter in his life and engage in new and exciting experiences all on his own. Only two weeks later, my other son, a recent high school grad, departed for Army Basic Training in South Carolina. Like his brother, he’s leaving home for the first time and entering a whole new world not knowing anyone and hardly knowing what to expect. 

I’m so proud of both of my sons and the boldness with which they step into these new chapters. I’m proud of my daughters too, and I know they’ll be taking their own new paths in the not so distant future. For now, the impact of both sons leaving our home and our family within two weeks of each other has drastically impacted the four of us remaining at home.  Simply put, we miss them terribly.

But as a dad, it’s more than that. I’ve been asking myself over and over, “Did I do enough? Did I teach them all I wanted to and what they need to know now that they’re on their own out in the world? Did I give them enough advice to help them handle themselves in all situations?” That and many other questions and thoughts that have run through my mind since they both left. I’ve always tried to instruct my kids and teach them to have good morals and values and valuing others more than themselves. We share a great faith and I tried to instill in them the importance of persistence, working hard and reaching for goals no matter how big or small. They are great kids and I’m sure they will be fine, but the idea that a new phase of life has begun for them and for me as their parent is a strange place to be in. I don't know if I’ll ever feel that I’ve done enough in teaching them and instructing them, but I know I did my best in guiding them to be the people they will continue to grow into, and I’m thankful that God will lead them wherever they go and will always watch over them. They’re always my kids and I’ll never stop being a dad, no matter how old they become. Being a father is a blessing and thrill that I wouldn’t trade for anything. 

Step 1 - Assess risk

During a balance and gait assessment at my practice, I discuss the patient’s history (past falls, especially in the last year, and any recent hospitalizations or other causes of weakness or lost muscle mass) and any diagnoses like osteoporosis or arthritis. I assess their strength and stride and conduct a range of tests to check their balance. 

I typically ask about the patient’s medications, too. If you take multiple medicines (prescribed or over the counter), your risk for falling is higher. Many drugs can cause you to be dizzy, lose your balance or have blurry vision. Once identified, these side effects and medications can be discussed with your doctor or pharmacist. Additionally, it helps to be aware that fall risk increases significantly in the days following a medication change (start, stop, or dose change), according to some studies.

Step 2 - Implement a personalized treatment plan

The best treatment plans combine exercises to address four key areas: strength, balance, coordination and posture. Flexibility matters too, since range of motion in the legs or spine impacts your walking and gait pattern. I utilize various tools to get baseline scores and track improvement throughout the treatment plan and sessions.

In many cases, the best way to improve balance is to challenge it. We accomplish this by combining upper body and lower body movements, working on steps and curbs, practicing standing on one leg, and navigating unsteady surfaces. All of these potentially risky actions can be practiced safely and beneficially with the help of a trained therapist.

I can also help a client prepare for how to minimize injury if a fall can’t be avoided. We practice getting up from the floor, and we evaluate safety measures like life alerts or smartphone/smartwatch apps for fall detection. 

Importantly, my patients’ treatment course extends outside the clinic to touch their daily lives. We talk about the importance of staying active to maintain strength, flexibility, coordination and balance. Staying active has the added benefit of typically reducing your fear of falling. I help my patients select activities that they can do safely - yoga, swimming, walking, or other pursuits they enjoy.

Overall, physical therapy can be extremely effective in preventing falls and building confidence, and that leads to other benefits. Recently I worked with a client who was reluctant to walk on the grass for fear of falling, and as a result he’d missed out on many backyard picnics and his grandkids’ sporting events. When I help a patient like that achieve new goals and do things they thought they couldn’t, it improves so much more than their physical function, it improves their quality of life. It’s a privilege for me to play a role in that. 

If you or a loved one needs a falls screening and guidance about reducing risk, please contact me today.

Be well,

Brian