The Benefits of A Bike Fit

the benefits of a bike fit

Spring seems to be coming early in the Pacific Northwest with trees budding and flowers starting to bloom. This may get people inspired to pull their bikes out and start riding again. Whether you are a casual rider or a high-level racer, you can benefit from a bike fit. Bike fits help you ride as comfortable and efficient as possible, therefore making the ride more enjoyable!

Common areas of pain while biking include, but are not limited to: knee pain, low back pain, neck pain, foot pain, and/or numbness in the hands. If you have cycling goals for the summer, it is best to start getting out on your bike as early as possible to start building endurance and getting a feel for if your bike needs some adjustments.

Our bodies are always evolving and changing. If you have not been on your bike for several months or even years the bike may feel different as the flexibility, strength, and mobility of your body may be different than the last time you rode. Your bike fit should match your current abilities with flexibility, strength, endurance, and mobility. As you get back in “bike shape” the bike may gradually feel different again.

If you are experiencing pain or discomfort on the bike, many parts of the bike can be adjusted to improve optimal fit and performance. If you bike with pedals that have cleats locking your shoe in, this is the first and most important thing that can be adjusted. Our feet are the only part that are in constant contact with the bike while working to propel us forward. If your feet are in a poor position, this can lead to foot pain, calf pain, knee pain all the way up through the rest of the body and limit efficiency of pedaling. If you have standard pedals, we can give you tips on foot placement on the pedal to improve efficiency and comfort.

Other bike components that may be adjusted include the saddle. The saddle height, position forward/back, and angle have a huge effect on the knees, low back, and pedaling efficiency. After adjusting the saddle, if it is still uncomfortable some riders will consider trying a different saddle that may have a different amount of padding, different size, or shape to improve comfort.

The next area that we look at with a bike fit is the stem angle and handle bars. The stem angle can be a game changer for some cyclists. Bikes with a more aggressive and aerodynamic fit may have a stem with a very small or no angle. The smaller the stem angle, the more flexibility in the hamstrings, mobility in the spine and hips, and strength throughout the gluteals and core one will need to ride comfortably in a more aerodynamic position. Increasing the stem angle can also take stress off the neck, shoulders, and hands. At Therapydia, we have a fully adjustable stem we can put on your bike to find the best angle and length for you. Other adjustments can be made with the handle bars and hoods, which can make minor changes without having to get a different stem.

Last, but not least, we can make recommendations for posture on the bike. This may include spine and pelvic posture. With a neutral spine and pelvic posture, the gluteal and core muscles can engage better for more power and pedaling efficiency. Head, neck, and shoulder position is also an important area to look at for comfort of those areas. Lastly, hand and wrist position can make a difference with pressure on the hands as well as nerve irritation and symptoms.

If you are interested in a bike fit, please give us a call or shoot us an email. We can talk about options with insurance paying for the fit. Happy riding!

Get To Know Your PT: Steven Jew PT, DPT

therapydia pearl clinic director steven jew

Get to know Therapydia Pearl’s newest Clinic Director, Steven Jew PT, DPT as he shares what surprises him the most about physical therapy, his favorite pump up song and how he likes to spend his weekends.

Start the day by making your bed and the rest of the day will come a lot easier.

When did you know that you wanted to be a physical therapist?

I knew I wanted to be a physical therapist when I first did a high school project on the profession. I vividly remember, while shadowing a therapist, witnessing a patient take his first steps since sustaining a gunshot wound to the spine. I continued to follow this patient for a few months and got to experience his journey from being bed bound, to running and biking again. I knew then that I had found my passion and profession.

What’s your favorite song to get you motivated?

Best Friend – Sofi Tukker

What is the biggest challenge involved in being a PT?

I think the biggest challenge is my habit of continuously performing movement analysis on pedestrians when I’m in waiting rooms, airports, or just walking down the street. It’s especially difficult when I go to the gym.

How do you like to stay active?

I enjoy running with my dog, Luna. But I also love to hike, rock climb, and play volleyball.

What surprised you the most about the physical therapist profession?

I was really surprised at how quickly the effects of therapy can begin after initiating treatment. When I was still in school, I was under the impression that therapy would take weeks or even months to make notable changes. But I quickly learned that we more commonly have same day significant changes. That, to me, is powerful.

Are you currently pursuing any further education/certifications?

My goals this year is to pursue additional certifications in endurance training,

What’s your go-to breakfast?

I am always happy with eggs benedict and a good pour over coffee.

What do you wish everyone knew about physical therapy? / What is the biggest misconception you hear from new patients?

A lot of new patients I meet think that physical therapy is “just exercise”. But it is so much more than that. Physical therapy is about manually changing joint positions, correcting movement patterns, specific tissue training, and making huge changes with minimal intervention. I think a lot of people miss out on just how specialized physical therapy is.

What is the most important personality trait that a therapist must have?

The most important trait is definitely having a compassionate heart. If you don’t care about your patient and all that goes into their life it’s really easy to perform a haphazard exam or treatment. It’s even easier to miss out on identifying their barriers to achieving their goals. To do our best, we must care about each of our patients.

What do you do to de-stress/unwind?

I like to turn my brain off for a while so I walk my dog while listening to music every morning and every evening.

Finish this sentence: On Saturday mornings, you can usually find me…

…walking the dog with a cup of coffee.

What is the best piece of wellness advice you’ve ever received?

Start the day by making your bed and the rest of the day will come a lot easier.

Learn more about Steven and the other Therapydia Pearl physical therapists.

 

Creating a Window of Opportunity: How Myofascial Mobilization Makes Way For Strengthening

Creating-a-Window-of-Opportunity--How-Myofascial-Mobilization-Makes-Way-For-Strengthening

By Tyler Baca, PT, DPT

Both in the clinic and at the gym, I will get asked: what is the best “mobility tool”? 

There are endless options that range from foam rollers and lacrosse balls to scrapers, massage guns, and car buffers. While each tool may create a different sensation of stretching or relaxation, they are all producing a similar neurophysiological effect. To start this conversation, let’s discuss what is meant by “neurophysiological” and how these changes are fleeting.

“Neurophysiological” changes: How are we going to take a physical pressure applied muscle and create a change in the nervous system to allow the muscle to chill out?

The lacrosse ball is a common staple in my physical therapy practice. I explain to patients that the lacrosse ball is a powerful tool that can help reduce symptoms that may be produced by tightness or restrictions in specific muscles. Pressure, whether it be from a manual therapist’s hands or a mobility tool, stimulates mechanoreceptors in the myofascia (think muscles and the white stringy stuff you see surrounding it). Imagine little sensors in the myofascia that are designed to specifically respond to applied pressure. Once these sensors have been adequately stimulated, they transmit a signal through the spinal cord to the brain. This process leads to stimulation of our sympathetic nervous system to decrease the tone to the “tight” muscle in question. You can think of your “tight” muscle as an overcooked steak: firm and rigid. Your muscle, in a state of decreased tone, should feel more like the consistency of a raw steak: pliable and soft. This decrease in tone may lead to pain relief or decreased pull on structures that are causing pain. The big caveat to this complex mechanism is that these results are TEMPORARY. 

Now this is not to say that I expect the patient to live with a lacrosse ball on hand all day. Instead, I explain how this quieting of the myofascial system creates a “window of opportunity” to create a long term change in the tissue…. This means strengthening!!

For example, for a patient that has shoulder pain, we may have found that the lacrosse ball to the back of the shoulder provides a window of 2-3 hours where he or she can move the arm with a lot less pain. During that window, I would expect the patient to have completed the rest of the home exercise program that I had prescribed. This home exercise program likely includes strengthening exercises to address the source of the patient’s symptoms. If prescribed and completed correctly, I would expect the strengthening exercises to start contributing to a lasting relief in that shoulder pain. We are able to address the source of the symptoms while minimizing discomfort while doing so.

Bonus: Completing exercises with decreased discomfort will create a positive association with the strengthening program when compared to trying to complete the exercises while in pain.

It is important to get proper guidance in myofascial mobilization and strengthening of the specific muscle tissues. Our PT’s at Therapydia can help you identify the underlying source of your symptoms, provide mobility exercises through the use of many different mobility tools, and prescribe strengthening exercises to ultimately create lasting change.

Take A Hike: 4 Necessities You Need For Your Next Hike

hiking accessories for injury prevention

“The mountains are calling and I must go.”

– John Muir

Ah, hiking! There’s nothing like exploring the wilderness and getting in touch with mother earth. Whatever your experience is, hiking can be intense. To prevent pain and enjoy your trek, preparation is important. You’ll want to protect your back, knees, and ankles from any predictable or unpredictable terrain. Here are four important things to keep in mind when planning your next hike to keep injuries at bay: 

Trekking Poles

Many people have misconceptions about hiking poles. Most people think that you have to be old to use these! Trekking poles are actually beneficial in many ways: 

  • Reduce the load to the knee by offsetting force through the upper body and core.
  • Improve balance and stability particularly when going downhill or over unstable terrain
  • Improve forward lean when going uphill which helps recruit the back extensors, glutes

There are many options available; a pair of poles can be fixed or collapsible. For proper height, your elbow should be close to a 90-degree angle at your side while you hold the poles, which may vary slightly if you’re going uphills or downhills. Lastly, keep your grip light. 

Backpacks

There are many backpacks out there- don’t try to find the “perfect” pack. The ideal pack will vary depending on the length and difficulty of your hike. Here are a few things to consider when deciding what pack will best suit your needs:

Capacity:

The size of the backpack will look different for a day hike versus a 5-day overnight hike and how much additional weight you’ll want/need to carry. 

  • Weekend trip: 1-3 nights requires a 30-50 liter backpack. Aim to keep it light, it’s harder than you think!
  • Multi-day: 3-5 nights requires a 50-80 liter pack
  • Extended-trips: 5+ nights requires a pack of 70 liters or larger.

Frame types

  • Internal frames are a common pack design because the load-support technologies can help transfer load to the hips
  • External-frame backpacks are recommended if you plan on carrying heavy gear like an inflatable kayak. 
  • Frameless backpacks are for the fast and light hiker. You’ll be able to carry a small bottle, a handful of snacks and a jacket (trading weight for lack of support)

Fit:

The fit should take into account your torso length and waist, not height! Test out multiple packs with load to give you a realistic feel. A store should let you try on the packs, put some weight in them, and walk around the store for a bit. 

Features:

Different brands will offer different features – waist belts, chest straps, attachment points, rain cover, additional zipper access, etc. Depending on the duration and amount of supplies you will be bringing, these additional features may be helpful. 

Boots

Foot wear is incredibly important regardless of a short day-trip or a multi day trip. A durable shoe can be a game changer, but you have to make sure they fit well. No one wants to deal with blisters and cramped toes at the start of the trip. 

Wear appropriate socks and spend some time in the boots before taking them on a trail. Walk up and down stairs, ramps, uneven surfaces. If you wear orthotics, try your boots with them in prior to taking them out on the mountain. 

Hydration Equipment

Regardless of the distance you’re planning on going during your hike, DO NOT forget water! The quantity of water you should consume will depend on the type of activity, intensity, duration, sweat rate, etc. A good general recommendation is about a one-half liter of water per hour of moderate activity in moderate temperatures. A wearable hydration pack is a great option or you can fill up a water bottle and stash it in your backpack as well.

What if I Have Pain?

Whether you are currently experiencing pain or have previous injuries, a physical therapist can assess your joint mobility, strength, and mechanics. Your PT can also provide strengthening exercises to help reduce the risk of injury!


Hiking Trails in Oregon to Try This Spring

Bull of The Woods

Bull of The Woods

Bull of the Woods Wilderness (easy to Pansy Lake, varying lengths) in Mt. Hood National Forest

Cape Falcon

Cape Falcon - Oregon Coast

Cape Falcon hike (rated easy, 5 miles) on the Oregon coast

Broken Top

Broken Top Hike

Broken Top hike (moderate/difficult, multiple routes) near Bend, Oregon

Visceral Mobilization Benefits

visceral mobilization benefits

What is Visceral Mobilization?

Visceral mobilization involves identifying and mobilizing the organs. Like muscles, organs need to have a certain amount of mobility such as sliding and gliding to function properly. Physical therapists’ main focus is the organs of the digestive system, but other organs may also need mobilization.  

Who Would Benefit From Visceral Mobilization?

Patients who have low back or pelvic pain often have visceral restrictions as well as restrictions in the joints of the spine and sacroiliac (SI) joint. As joints and muscles tighten or stiffen, this can also limit the mobility in the viscera. Like a tight muscle, the intestines for example can become “bound down” on one side or possibly even the same side as spinal stiffness. With visceral mobilization, the intestines can be released, similar to muscle release or massage to restore the mobility of the gut.  Improved visceral mobility will also take stress off of fascia, bones, and joints. Additionally, patients who have taken pain medications and have become constipated may also benefit from visceral mobilization to improve gut motility. 

Patients experiencing irritable bowel syndrome (IBS), reflux, or digestive issues would benefit from visceral mobilization. There is a correlation between restrictions in viscera and IBS. If any portion of the digestive system is restricted anywhere between the esophagus all the way to the rectum, can limit or impede proper digestion and may lead to constipation, bloating, reflux, and diarrhea.

Additionally, female patients who have difficult or painful menstrual cycles often have visceral restrictions. For example, if the uterus is bound down or restricted on one side can result in increased cramping, bloating, and bleeding. Ovaries can also become restricted, contributing to discomfort or other problems. Visceral mobilization has also been found to help patients with fertility issues. Another example is with the uterus; if it is restricted or bound down it may impede proper implantation. 

Patients who have had nearly any kind of abdominal surgery, whether it’s through a laparoscope or an open surgery can also benefit from visceral mobilization. As there is often scar tissue present even with a less invasive laparoscopy that can bind down the viscera, limiting digestion or contribute to loss of mobility throughout the spine, pelvis, and musculature.  Patients may have compensations present due to the surgery that lead to restrictions in the viscera as well. Mobilization can help restore the proper sliding and gliding of the viscera resulting in reduced pain and an increase in movement. 

Not all physical therapists are trained in visceral mobilization and manipulation. Evaluation for visceral mobility will include a careful review of symptoms and history, evaluation of mobility and strength throughout the trunk and spine, and palpation of viscera to determine if and where restrictions are present. Please contact Therapydia Beaverton with further questions or to schedule an evaluation with one of our physical therapists who is trained in visceral mobilization. 

Heal Your Heel Pain: Physical Therapy for Achilles Tendon Pain

achilles tendon pain

By Annika Piros, PT DPT

Do you ever experience pain in the back of your heel? Does this pain limit your ability to walk, run, and carry out daily tasks? You may be experiencing a condition called Achilles tendinopathy. Achilles tendinopathy is a common and painful condition, often endured by runners and endurance athletes, that results in functional limitations due to pain.

As part of my doctorate studies at George Fox University, I conducted research on individuals with achilles tendinopathy. As you may be experiencing, this condition makes it difficult to resume regular activity and exercise.

What Causes Achilles Tendon Pain?

Many tendon injuries fall under the umbrella term of tendinopathy: this term covers tendonitis (inflammation of the tendon) and tendinosis (degeneration of the tendon). Achilles tendon pain is The mechanism of injury for this condition falls into a cycle of acute-on-chronic injury where the tendon can never fully heal prior to being re-injured again.

This continuous re-injury leads to the eventual degeneration of the tendon (tendinosis), meaning it can no longer effectively tolerate and transfer load to your muscles for optimal force production. This decreased load capacity can often result in heel pain and muscle weakness (tendon connects muscle to bone) making it difficult to operate at former levels of physical activity.

Treatment for Achilles Tendon Pain

The good news is that physical therapy can help with this condition! A specific type of Achilles tendinopathy known as mid-portion Achilles tendinopathy, responds very well to a progressive loading program.

A revision to the physical therapy clinical practice guideline for this condition was released in 2018 and outlines the efficiency of current interventions for this condition. Exercise (specifically a heavy-load, slow-speed concentric-eccentric program) was deemed the most beneficial, receiving a “Grade A” recommendation – the highest level of recommendation.

To put this into perspective: no other type of intervention received a Grade A recommendation! This is very exciting for physical therapists as we are licensed healthcare professionals and movement experts that prescribe exercise in the rehabilitation of injuries.

Exercise Recommendations for Achilles Tendon Pain

The most effective exercise for relieving Achilles tendinopathy pain is an eccentric calf raise. The key to this move is to progressively load the tendon to induce adaptation. In a pathological tendon, collagen cross-bridging (the elastic materials that make up your tendon) are disorganized which results in poor load tolerance. In order to promote healing of the tendon, a progressive loading program is necessary.

A physical therapist can help you recover from this condition. Physical therapists have extensive training – all physical therapy programs now award a Doctor of Physical Therapy degree – and are the most well-equipped in the treatment of this condition. A physical therapist can help you restore mobility, strength, and function that is often lost when suffering from tendinopathy.

Your physical therapist will perform a thorough evaluation of your condition and any mobility issues you may be having, educate you on modifiable risk factors, and perform interventions such as corrective exercise.

Other Interventions to Reduce Heel Pain

Other interventions such as manual therapy may be used to help modulate pain. A physical therapist will evaluate neighboring body regions – i.e. the hip and knee that may be contributing to physical dysfunction and restriction at the achilles. It is important that a physical therapist prescribe the appropriate dose of exercise to help you recover from this condition and get you back to enjoying the activities you love!

If you are suffering from Achilles tendon pain and are looking for relief, contact your nearest Therapydia physical therapy clinic.

3 Common Physical Therapy After Car Accident Myths

3 common physical therapy after car accident myths

It’s Myth Busters time!

Did you know that more than three million people each year are involved in a car accident? Of that number, 27% of people involved in a car accident suffer from injury. That is nearly a million people who could benefit from physical therapy after a car accident.

Today, we are debunking the 3 most common myths about physical therapy following a car accident.

MYTH 1: I need to wait to start physical therapy after I’ve been in a car accident

TRUTH: Research shows that starting physical therapy sooner rather than later after a car accident results in a quicker recovery.

We hear it all the time. “I’m in too much pain for PT right now,” or “I can’t do exercises right now because I just got in a car accident.” Physical therapists prescribe more than just exercises and we won’t provide treatment that is not appropriate for you at that time. We do hands-on treatment (manual therapy) to help with pain, mobility, and muscle guarding. We will also recommend safe and effective movements and gentle stretches/exercises to reduce any potential fear of movement and/or tightness restricting your mobility.

MYTH 2: I need to finish chiropractic and/or massage therapy before coming to physical therapy to treat my injuries after a car accident.

TRUTH: You can see a physical therapist before, during, or after treatment with other providers. You do not need to wait.

We work closely with doctors, chiropractors, massage therapists, acupuncturists (and more!) when we’re treating mutual patients. We want to make sure that everyone providing treatment to our patients are on the same page and working towards the same goals- to get you back to feeling pain free! We understand that each profession has their specialty and physical therapy will always provide a unique approach to treating your pain and/or injury that your other providers are not doing.

MYTH 3: You aren’t “ready” for physical therapy.

TRUTH: Everyone is ready for physical therapy.

We approach each patient differently and take special care to individualize your treatment to your specific pain level, abilities, and goals. Although we will be challenging your body in order to make the necessary changes, we will not do anything that you are not ready for. If something hurts, we regress. If something is to easy, we progress. As you improve each week, we may do less hands-on treatments so that you gain confidence and learn how to continue to heal yourself without the use of someone else’s hands. We want to enable you to heal yourself; we’re here to guide you through that process.

Seeking physical therapy after a car accident is an important step to getting you moving and feeling better. Our physical therapists are highly skilled in treating patients in all stages of healing post car accident with individualized treatment programs to help you reach your goals.

3 Ways To Make Exercise a Daily Habit

3 ways to make exercise a daily habit

By Annika Piros, DPT Therapydia Tanasbourne

The health benefits of exercise have been well studied. The American College of Sports Medicine outlines the inverse relationship between physical activity and premature mortality, as well as many other negative health conditions. We all understand that exercise is beneficial to our health, however, finding time for regular exercise can be a challenge on top of an already busy schedule. How can we make exercise a daily habit?

I recently read the book Atomic Habits by James Clear who outlines many useful strategies for habit change. As someone who values daily exercise but admittedly struggles to establish routines in the face of change, I have found his strategies very helpful. Without a routine, I find myself expending additional energy on decision-making which becomes exhausting! We make so many decisions all day long: at our jobs, in our personal lives, even with simple tasks like what clothes to wear or what to make for dinner. Personally, the more I can get out of my own head and automate my behavior, the more successful I find myself to be with executing a desired behavior. Below, I have outlined three of James Clear’s strategies with applications for making exercise a daily habit:

Setting up an environment conducive to forming habits

This rule outlines the importance of your environment in dictating behavior, i.e. if you keep a plate of cookies on your kitchen countertop, you are likely to eat a cookie every time you walk through the kitchen. I think case-in-point for me is Halloween. My husband and I keep the candy next to the front door on Halloween night. However, this year, we left the bag of candy there for the next few days instead of diligently getting rid of it or hiding it. As you may have guessed, the temptation of taking a piece of candy every time I walk by the front door got the best of me and resulted in an excess of candy-eating by me.

Bottom line: Shape your environment to facilitate desirable behavior.

Application: Place important workout items in an obvious place that will act as a reminder for you to perform daily exercise. For me, putting a yoga mat or my workout clothes and shoes at the foot of my bed act as a facilitator. For those early morning movement sessions, I have also found knowing ahead of time what workout I am going to perform, as well as laying out my work clothes the night before, take the decision-making out of the picture and help automate my next steps.

The 2-minute rule to make or break your habit

This rule outlines the importance of starting small. “When you start a new habit, it should take less than two minutes to do.” – James Clear. By starting small, you are using this rule as a “gateway” habit that will eventually lead to the habit you want to instill.

Application: Maybe your goal is to run a 5K or do 30 minutes of yoga. Start by putting on your workout shoes or taking out your yoga mat for the first week. That’s it. Maybe you get one pose in or a walk around the block…or maybe you don’t even get to the exercise part. However, by starting small and making it easy, you can gradually progress towards the goal over time.

Habit stacking

Identify a habit that you already do on a daily basis and then “stack” the new desired habit before or after the existing one. This will facilitate the automaticity of making exercise a daily habit.

Application: Current Habit >> followed by or preceded by >> New Habit.

For me, I love enjoying a warm cup of coffee in the morning. My current habit is that I go downstairs and drink a cup of coffee right after waking. By stacking this habit with a new one – putting on my workout clothes right before – I find it that much easier to do at least some sort of movement or exercise. That is…once the caffeine has kicked in.

And of course, if there are aches, pains, or physical disabilities that are keeping you from engaging in daily activity, making an appointment with your local physical therapist or medical provider is a great starting point. A physical therapist will help you restore physical function to get you back to your active lifestyle and help you reach your goals.

Get To Know Your PT: Jordon Whitaker, PT, DPT

Jordon Whitaker, Therapydia Lake Oswego Physical Therapist

Lake Oswego physical therapist Jordon Whitaker, PT, DPT takes some time to share how she became interested in the physical therapy profession and what she wishes everyone knew about physical therapy and that physical therapists can also be a part of the preventative care process.

Always move. The activity that you are going to do is the best activity for you.

When did you know that you wanted to be a physical therapist?

I went to physical therapy in high school for my shoulder pain. I heard a pop in my shoulder when I threw the ball, which ended up being a mass that broke off of my growth plate. My PT helped me get back to playing softball pain free and helped me to realize how much continued strengthening I needed to maintain for my shoulders.

What’s your favorite song to get you motivated?

This changes frequently but a good go to song for me is Everyday by Logic. Or songs by Post Malone or Maroon 5.

What is the biggest challenge involved in being a PT?

Understanding how natural history plays a role in the rehab process and knowing when there is something immediate that can be done to improve someone’s experienced pain. Everyone is different and pain is complex, and incorporating that into care can be difficult but also very powerful when using to improve people’s conditions. Understanding that we don’t always have the answer is difficult but knowing we can be there to assist people through the process is important.

How do you like to stay active?

I enjoy spending time at the gym. Running or lifting. I also love to hike or go to the river or lake.

What surprised you the most about the physical therapist profession?

There are so many treatment styles and so many ways to help somebody. I realized that there are multiple ways which can result in the outcome of the client improving.

Are you currently pursuing any further education/certifications?

I take part in the virtual institute of clinical excellence to stay up to date on research and clinical advice. I love listening to podcasts pretty much daily. I am still figuring out what I want to specialize in as I have had experience in a lot of settings at this point in my career with being a traveling PT.

What’s your go-to breakfast?

On the go: Protein bar. Meal prep: Yogurt, oats and fruit. When I have more time: eggs and toast.

What do you wish everyone knew about physical therapy?

I wish everyone knew exactly what physical therapists can treat. A lot of people are still learning what a physical therapist is. The more people we can reach and educate will help to improve the general wellness of the population. I believe it is just as important that PT’s take part in preventative care in addition to rehabilitative care.

What is the most important personality trait that a therapist must have?

Being a great communicator is important. We need to be able to clearly communicate the patient’s options for moving forward through the plan of care. The client realizing they have a choice and that they play an equal part in the process is crucial. We need to be able to instill confidence and reassurance. People are often more resilient than they think.

What do you do to de-stress/unwind?

Work out. Hike. Be outside. Try a delicious craft beer at a brewery with my husband.

Finish this sentence: On Saturday mornings, you can usually find me…

Hanging out with my husband either relaxing or on a planned weekend getaway. We love to travel.

What is the best piece of wellness advice you’ve ever received?

Always move. The activity that you are going to do is the best activity for you.

Learn more about Jordon and the other Therapydia Lake Oswego physical therapists.

Perfect Your Pull Up: A Step By Step Manual

Perfect Your Pull Up

It’s time to get that first pull-up! Mastering the pull up movement can be a difficult and frustrating process if you don’t know where to start. When I first learned this movement, I remember going through about 10 or so reps with my buddy giving me assistance through my legs. I collapsed off the bar and immediately felt like I was going to throw up. Since then, I have found that there are many ways to scale and progress towards a full pull up. As a physical therapist and a CrossFit coach, I have found the exercises and progressions described below to be very useful in helping individuals achieve their first pull up.

Warm-up:

Scap pull up: This is an important step to make sure that you initiate the pull up with muscles that will stabilize the shoulder joint.
Start with a dead-hang on the bar.
Depress your shoulder blades to elevate your body slightly. The elbows will stay extended!
Slowly lower yourself back to the dead-hang.
Cue: think about putting your shoulder blades into your back pocket.
Regression: start with this exercise on a lat pull-down machine so that you can control the amount of weight being pulled.

 

Ring or TRX Row: This exercise will engage the latissimus dorsi and trapezius, the prime movers in the pull up.
Pick an appropriate starting position: the closer your torso is to the horizontal plane, the more challenging the exercise will be.
Squeeze the shoulder blades together to initiate the movement.
Pull towards the handles until they are just about at your chest.
Reverse the motion slowly.

Strength Building:

Negative pull up: This exercise will help build eccentric strength through the pull up movement.
Start by standing on a surface that allows your chin to pass the pull up bar.
Assume the top of the pull up position and slowly lower yourself down until your elbows reach full extension.
Continue to assess if you can INCREASE the amount of time it takes you to lower yourself down.
Stand back up to start the next rep.
Regression: use a long elastic band for support throughout the lowering portion of the movement.

 

Assisted Pull Ups:

Banded pull up: This modification is good for individuals having trouble initiating the pulling motion.
Attach band to pull up bar appropriately and place one foot in the bottom of the band.
Complete the pull up while being conscious of cues such as “put your shoulder blades in your back pocket” to start building appropriate motor patterns for the movement.
Note: More resistance on the band will decrease the amount of strength required to complete the motion.

 

Box assisted pull up: This motion allows you to directly choose how much assistance is needed to complete the rep.
Start by standing on a surface that allows your chin to pass the pull up bar.
Come to full elbow extension while standing on the box; your knees will be bent and you may even find it beneficial to be on your toes (see visual below).
Begin the pull up motion and use your legs to raise you up as much or as little as needed.
Once your chin has crossed the bar you can either control the descent with your legs as well OR take your feet off the box and practice the eccentric movement as described above in the Negative Pull Up.
CUES: Make sure throughout the rep, regardless of how much assistance is coming from the legs, that you are squeezing you are thinking about “shoulder blades to the back pocket” or “getting your elbows to your hips” to keep your upper extremity muscles active.
PROGRESSION: Take one foot completely off the box to further increase the demand on the upper extremity muscles.

 

 

THE PULL UP:
From the dead hang, engage the shoulder blades as described in the scap pull up.
Adduct the arms and bend at the elbows to complete the rep with your chin over the bar.
Control the descent until you come to full elbow extension.
CUES: Throughout the rep think about “shoulder blades to the back pocket” or “getting your elbows to your hips” to keep your upper extremity muscles active.

 

Pull Up Progressions:

Weighted pull up: Once an athlete is comfortable with a pull up, I like to recommend trying a weighted pull up. Just like other movements we train (i.e. squats, lunges), once we have the inherent strength to complete reps with bodyweight, adding weight to the movement will continue to help us develop strength. This may mean just starting by putting a 5 pound weight in your pocket to start! In addition, once you remove the added weight, the body weight pull up should feel even easier and translate into an increase in consecutive reps!

Below are some ideas for weighted pull-ups:

  • Weight vest
  • Weight belt with dumbbell or kettlebell attached
  • Dumbbell or medicine ball between your feet