Tendonitis and Athletes

This month, I want to touch on the topic of "tendonitis". Tendonitis is very common in all athletes, and is found amongst nordic skiers as well. Tendonitis is the inflammation of tendons around different joints. Depending on the activity you partake in, tendonitis flares up in specific areas. Some common places are the shoulder, knee, elbow, wrist, and ankle (specifically, the achilles). The inflammation and pain from tendonitis are a result of either overuse or overloading (too much weight or pressure on the tendon). This is why it is found most commonly in athletes. We tend to use the same motions over and over in practice or training, and certain sports require doing that motion under stress of weight or against the pull of gravity.

Some common forms of tendonitis found in nordic skiers are knee and elbow. The knee is common because we run a lot for training and that puts stress on the joint and in some people this flares up and turns into tendonitis. I have also seen cases of patellar tendonitis (the knee cap) due to rollerskiing. Rollerskiing is done almost daily 7 months out of the year. The skis are heavy and sometimes track differently depending on how worn the wheels are. This can cause tendonitis because the knee is forced to perform a motion that places it repeatedly in a funky direction, like out to the right or left, thus putting extra stress on the knee and knee cap.

Elbow tendonitis can also develop as a result of frequent rollerskiing. In a previous post, I described how I have developed tendonitis in my elbows and listed a few stretches that can help the pain. This type of tendonitis comes from repeated poling motion while hitting the cement or pavement with force for long periods of time. This is overuse and overloading on the tendons in the elbows, and in result causes inflammation and pain. The stretches I listed in the older blog helped, but here are some other ways to treat tendonitis that Therapeutic Associates suggests:





1. Ice! When you notice pain around certain joints and tendons, make sure to apply ice for at least 15 minutes after the activity that causes the pain. Being religious about icing is very important because it will immediately help the swelling go down.

2. Take ibuprofen or other anti-inflammatory over-the-counter drugs to combat the swelling.

3. Rest the area. Take a break from the activity that is causing the pain. The sooner you can do this after the onset of pain, the faster you can heal the area. How developed the tendonitis is will determine how long you need to take a break from the activity. In some cases you may have to take up to a month away from the activity, and in others a week will suffice.

4. Stretching in the early stages will help restore the tendons flexibility and lengthen them, releasing any knots. Check out my older blog about pain in the elbows due to excessive rollerskiing for some pictures of stretches for the elbows. But, be careful with stretching if your tendonitis is more advanced. Stretching as the tendonitis is in a more advanced stage will only traumatize the weak tissue and the symptoms might actually get worse. Be sure to check with your PT about what they think is best to do.

5. After light stretching, it is important to work with your physical therapist on eccentric exercises. These are decelerating movements where the muscle is lengthening and working at the same time. For example, with elbow tendonitis, you could do bicep curls but lower the curl slowly with light weight. Also, try triceps extensions with slow extension and release. For lower extremities (knee or ankle), try single-leg dead lift slowly lowering down to lengthen the hamstring. Do 3 x 15 reps of these exercises depending on where you are experiencing pain, and always with light weight! These eccentric exercises are the best way to strengthen chronic tendopathy.

6. Along with stretching and eccentrics, the PT's at Therapeutic Associates also may perform ASTYM on the affected area. This process is also described in a previous blog below and targets areas of built- up stress and tight tendons/tissues.

7. Use supportive braces or compression sleeves when doing the activity to provide extra support and keep some of the pressure off of the affected area.

Doing these several things will help your symptoms of tendonitis drastically, but make sure to always be on the same page with your PT in order to keep the pain under control. Tendonitis is not a fun injury and has the potential to develop into worse conditions, so address it and then...

Go out, have fun, and GET MOVING!!

Get MOVING!!

Therapeutic Associates Physical Therapy is ringing in 2014 with a focus on movement and getting active.  Being active and fit is central to my lifestyle and profession, so I wanted to share a little bit about my lifestyle as a professional ski racer, specifically, why I exercise, what motivates me to keep going day-in and day-out, how to get started on the right track, goal setting, and how exercising can benefit your health.

                                     Ski racing at Soldier Hollow, Utah at U.S. Nationals

Why Exercise?

I exercise because I love the way I feel during and after. Of course I feel the surge of energy from the endorphins and adrenaline, but I also get a sense of accomplishment and self-worth from having pushed myself beyond my comfort zone, or from completing my workout goal/s. When I exercise, I feel satisfied for the rest of the day because I know that I have done something good for my body. It encourages good health and in result boosts my confidence. When I am confident and comfortable in my own skin, the possibilities for happiness and success are endless!!

As a professional ski racer, exercising is my job, but it also takes me to wonderful places and brings a sense of adventure to my life. I love being able to get away from the distractions and my nagging "to-do" list for a few hours by simply running out my door and exploring a new part of town, a new trail, or a new park. Exercising has taken me to the summits of incredible mountains, through endless miles of unmarred wilderness, through breathtaking mountain meadows, across sandy beaches, and more! And, I feel like I have only just scratched the surface of the places it could take me.

                       High on the summit of Mt. Cobb with my friends and teammates. BEAUTIFUL!

What Motivates Me

It is pretty clear that I am motivated to exercise through the feelings of confidence and self-worth, as well as sense of adventure it provides, but doing it day-in and day-out can at some points seem tedious and overwhelming! And, sometimes I am just plain tired physically as well as mentally. This is when I look to my friends and teammates for motivation. They provide a release in the sense that they distract and then push me back on track, because believe me, training all year long can sometimes get old! So, if you find yourself in this type of mindset regarding exercising, call up some friends and have them join you. Going into the pain cave with company is much more bearable then going solo, and good friends make for a good time!

                            Speaking of pain cave... Parker and I in the aftermath together


Another way to motivate when feeling bored or burnt-out, is to find a new passion, or look for a new adventure. This could be as simple as trying a different class at your gym or finding a new trail, or could be as elaborate as planning a week-long backpacking trip in a new place. Mixing up your daily routine will surely get you back on track and motivated. And, bring those friends along to make it even better.

                                 My teammates and I skiing in Canmore, Alberta, Canada

Lastly, I am motivated day-in and day-out by my goals. As a professional athlete, I make goals every year. There are small goals that I work to daily, weekly, monthly, and then the BIG goals that I strive for as the ultimate payoff for reaching all of my small goals. When I am having a lapse in motivation and am not in my usual focused state, I remember my goals, and remind myself that all other athletes may be going through the same mental state, but those that succeed are the ones that are able to reset and re-motivate.

                                           My team motivates me, and we all aim high!

 How to Get Started

 I have been involved in sports and athletics since before I can remember, but getting started with exercising for someone who has never done it before can be compared to taking up a new sport for me. I think about how I feel when I start something new: nervous, doubtful, excited, intrigued, etc. A whole myriad of feelings accompany the beginning of something new in life. I think of when I first learned to whitewater kayak because it is something completely different than ski racing, and it was totally out of my comfort zone; like getting started with exercising could be to someone who has never been involved in sports. Kayaking is totally different because it is done in the water, requires being able to "read" a river, uses totally different muscles, etc. I was very nervous when I signed up for my first class to learn how to "roll" my kayak (an essential skill to have for staying upright and alive in the water). I did several things to help myself get over my nerves and fear. First, I invited my two close friends to join me because as said before, it is always better to suffer with friends. Secondly, I thought about all the fun people were having when they went kayaking and knew I wanted to be involved. Thirdly, I told myself "Rose, just do it!", and leaving all inhibitions behind, I went to the class and tried my best to have fun.

                                        Mali, Marta, and I in our kayak class!

When it was difficult at times, which new things usually are, I always reminded myself of the end result; think about the adrenaline and pure joy you will feel when you are on the river! This can be compared to going to that tough new body-pump class at your gym and hurting everywhere, but then reminding yourself how good your body will feel afterwards and how accomplished you will be! It makes it all worth it in the end.

Getting started with exercising or anything in life is always difficult, but think about these few things as you look for new classes to take, a new sport to learn, a league to join, etc:
1. Take some friends along
2. Think about the potential fun you could have with new people and the new experiences you will have
3. Think about the end result and the feelings of accomplishment and self-worth you will gain
4. JUST DO IT!!

Goals

After getting started with exercising or a new sport, making goals is important for continuing motivation and enjoyment. As a ski racer, I make both short-term and long-term goals. I make many short-term goals that will ultimately line up to help me complete my long-term goals. For example, every time I go out to train, I have a goal for the workout. If the workout is based on intensity and I am doing intervals (where you sustain a certain heart rate for a certain about of time), my goal might be to keep up my heart rate while at the same time, keep my ski technique relaxed and fluid. I also make monthly goals, where I decide that I am going to focus on a certain ski technique (like relaxing my shoulders when I double pole) that whole month to improve. These little goals all add up to helping me reach my long-term goals, which are generally involved with ski results during the season or on improving a certain aspect of my race strategy (example: this year I want to ski in the top 10 at U.S. Nationals). 

                              Working on some double pole technique with my teammates.

So, when you start exercising, think about what you want to focus on in each workout, what you want to get better at over the course of a few weeks or a month, and then what your ultimate goal is for the end of the year. 

Exercising is Healthy?!

YES. Exercising is great for your health, and over the course of this entire blog entry, I have mentioned how exercising makes you feel great through the adventure and sense of accomplishment it provides, but you may also be wondering why it makes you feel great physiologically? Exercising helps many of the systems in your body: your skin, your organs, your muscular system, your cardiovascular health, your skeletal system, and even your brain. It is important for the health of your heart, your main life-source, and brings balance to your body, promoting healthy connections to and from the brain. This effects your attitude and behavior, making you happier and more in-tune with your body. When exercising, you are using your muscles and bones, which need use in order to become stronger and work as they should. Without exercise, muscles deteriorate and bones become weak causing many problems later on down the road. Exercising leads to all systems working in unison together, cutting out problems. The body becomes a well-oiled machine with all systems a "go"! 

We could go on and on about how each system is affected by exercise and how they work together to perform better, but that would take a few more blogs. The bottomline is that exercising ultimately helps you live longer and in better shape. 
So let's GET MOVING in 2014!!

Foam Rolling: What it is, why to do it, and how to do it

This post is going to talk a bit about foam rolling, which is a fairly new recovery technique for athletes at every level and not excluding your Globo-Gym/Average Joe's regulars. Foam rolling is something I, along with a majority of other nordic skiers have adopted to help speed the recovery of our muscles after workouts and races. It is also utilized by about 50% of Therapeutic Associates Physical Therapy's patients. The physical therapists at Therapeutic Associates believe that it is an important way to maintain balance in tissues that may have localized tightness.

There is obviously more to know about foam rolling, so here is the lowdown on the what, the why, and the how...

What
Foam rolling is the act of releasing knots in muscles that are the result of sustained activity/extreme exertion with a cylindrical piece of foam that is manufactured in different densities (low to high). Using your body weight and pressing the affected muscle/body part into the top of the roller becomes a self deep-tissue massage and is often referred to as self-myofascial release (SMR). Some popular foam rollers are:

Trigger Point Performance's "The Grid" Revolutionary Foam Roller







 SPRI Super High Density Foam Roller












The PT's at Therapeutic Associates prescribe this recovery tool to their patients because, as stated above, it helps to maintain balance in the tissues and fibers of muscles. Foam rollers isolate the "knotted" muscle fibers that have been bothering you because they have been shortened due to overuse. When these muscle fibers lock up due to being shortened, they usually don't unlock easily, and it takes direct pressure to release them. The act of applying direct pressure is referred to by many PT's as "trigger point" therapy. When direct pressure is applied to the "trigger points" (knotted tissues and fibers), the knots unlock and the fibers are stretched out again. This is due to an increase in blood flow which flushes out any toxins or metabolites in the area, as well as the breakdown of scar tissue, which is often found in tight or injured muscles. The breakdown of the scar tissue increases the pliability and flexibility of the muscle.

Why
Foam rolling releases trigger points, allowing you full access to your muscles and all that they are capable of doing. Tight, shortened muscles restrict blood flow and may have built up scar tissue, but after rolling them out the fibers become elongated and blood rushes through them, cleaning out anything that could be detrimental to athletic performance. Scar tissue is broken down and muscles become more flexible, which aides in injury prevention.

How
I roll out every day for at least 15 minutes, usually right after I train, or if I haven't trained, I go for a jog to warm up my muscles beforehand. I usually focus on certain areas that are especially tight and sore. As a nordic skier, the most common areas of soreness are in the glutes, the upper/lower back, the hip-flexors, and the IT band. I concentrate on these areas at first, and if time allows, continue to other areas. Foam rolling does not have to be tedious and long. Hit the muscle groups that need attention and then if you have time, do more. Here are some ways to roll that I use almost every day:

Back

Lay directly over the roller with hands behind head and elbows up. Roll up and down the spine.

Glute

When massaging your glutes, focus on one cheek at a time. You can warm up by rolling up and down the glute (from the lower back to leg) and then do as this picture shows and do the "cross fiber" technique by wiggling the select cheek across the roller from left to right.

Hamstring

Move roller up and down the back of your leg, putting as much body weight on it as possible.

IT Band

Similar to hamstring, roll over onto the side of your leg to isolate the IT band and roll up and down the leg from hip to knee. 

Calves

Put the roller directly under calves and roll from knee down to ankle. 

These are just a few good ways to do it. 

Go roll it out!!

A Few Exercises for the Aching SI Joint

This month, I went into Therapeutic Associates Physical Therapy with pain in my lower back. This has been a common occurrence throughout the years that I have been skiing. I found that the pain is centered around my sacroiliac joint (SI joint). This joint is found in the pelvis, between the sacrum and the ilium.

When it is repeatedly in use, especially when force and pressure are applied to the ligaments surronding it for long periods of time, it often becomes sore and feels as if it is not aligned. For example, this last time my SI joint flared up, I had just done a 2 hour double pole followed by squats in the gym. This combination did not fare well for my SI joint, and it started aching and seized up. This video will show you the exercises I did that helped the pain dissolve and got me back to normal.

Check it out here: http://www.youtube.com/watch?v=sj4blt2PcCE&feature=youtu.be

How to Address Elbow Pain Due to Excessive Rollerskiing

Becoming a full-time nordic skier has led to many changes in not only my training, but also in my lifestyle, my diet, and my body! The increase in training now compared to what I had time to do in college has definitely created noticeable differences in my joints and limbs. The increase of time on rollerskis, specifically, has led to an onslaught of pain in my elbow joints.

I went to my PT- Therapeutic Associates Physical Therapy of Boise, concerned about this pain and explained that after a long double pole session or double pole intervals, they would ache all day. They have also started "popping" more when I move my arms suddenly from a bent to an extended position. My PT, Rob Barnes, was worried that two of my elbow bones (humerus and ulna) and the surrounding cartilage and ligaments were being compressed and put under too much pressure due to the pounding and vibration sent through the arms after hitting pavement while poling. He deduced that this movement and force applied for hours on end created the soreness and rubbing that was giving me pain.

Rob suggested that in order to help this situation, I should address it right away by doing the following stretches:

1. Hand/Finger/Wrist. Wrist Flexors.
Elbow straight, palm up. Grasp fingers with other hand and slowly bend wrist backward. Hold for 30 seconds. Repeat this 1 time/session and 3 sessions/day.

2. Shoulder. Posterior/Inferior Glide. Flexion Above 90 degrees.
With towel roll wedged in elbow, grasp wrist and gently pull arm back and slightly down. Hold for 5 seconds. Repeat 5 times/set. Do 1 set/session. Do 2 sessions/day.

3. Shoulder. Inferior Capsule Stretch. 
Gently pull on raised elbow with other hand until stretch is felt in shoulder. Hold 30 seconds. Repeat 1 time/session. Do 1 set/session. Do 3 sessions/day.

4. Hand/Finger/Wrist. Wrist Flexors. 
Kneel on all fours, palms flat on floor, fingers pointing backward. Slowly sit backward toward heels until stretch is felt in wrists. Hold 30 seconds. Repeat 1 time/session. Do 3 sessions/day.

5. Hand/Finger/Wrist. Wrist Extensors.
Elbow straight, palm down. Place other hand with thumb on underside of wrists and fingers on back of hand. Slowly bend wrist down until stretch is felt on top of forearm. Hold 30 seconds. Repeat 1 time/session. Do 3 sessions/day.

Rob also suggested wearing compression arm sleeves during rollerski sessions to help absorb some of the vibration and force from poling.

I bought these at Big 5 Sporting Goods for $12.99 so they were very affordable and definitely do the job, as well as make you look HUGE!

My elbows are feeling better now and I couldn't have done it without Therapeutic Associates Physical Therapy!

ASTYM as a Treatment for Symptoms of Chronic Compartment Syndrome

        ASTYM (pronounced A'-stim) is a treatment which regenerates soft tissue and eliminates/reduces scar tissue. I have used ASTYM as a treatment for the symptoms I had when I was first diagnosed with chronic compartment syndrome. Chronic compartment syndrome is a very common injury among Nordic skiers and is the build up of pressure between a compartment of muscles and its surronding fascia due to over-use and exertion of that compartment. Nordic skiers are constantly using the same muscles in their bodies as they are training regularly (especially while skating when their ankle and shin muscles are held at a constant angle), and thus may experience symptoms of chronic compartment syndrome. When the pressure builds enough, the circulation in the lower leg decreases and becomes numb or gives off a "tingling" sensation. This is dangerous for a nordic skier as they may lose control of their legs during a race or in training.

        I had these symptoms during several races and it was painful, as well as scary. I turned to my local physical therapist- Therapeutic Associates Physical Therapy of Boise, and we decided to take action by using ASTYM. Using small, hard plastic instruments, the ligaments and scar tissue in my tight calves and shins were worked out and regenerated. It did not hurt, but acted as an actual release for my tight leg muscles and felt like a massage, working out the knots. The therapist applies a fair amount of pressure when doing this procedure in order to stimulate the body's healing responses. A great amount of pressure and muscle tightness is relieved and bumpy scar tissue is straightened out. Receiving ASTYM treatment was a relief for me when my symptoms were bad, and was sufficient treatment until I went to college and wasn't consistent with my treatment and chose to have surgery. 

        I would highly recommend using ASTYM as a way to prevent and treat symptoms of compartment syndrome. But, if you are to undergo this treatment, be sure to follow your PT's instructions by doing the prescribed stretches and exercises on your own. This is essential to the success of ASTYM and takes only a few minutes. It is totally worth it because in only a few weeks you will feel amazing again and you can still train while doing the treatment. Consistency with ASTYM is the key to avoiding surgery (something I wish I had done)!

      

      If interested in this procedure you can check out Therapeutic Associates Physical Therapy's website: http://www.therapeuticassociates.com/treatment/services/astym/physicians/