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TheraPlus Saint Louis Physical Therapy and Personal Training in Brentwood


2001 South Hanley Road
Suite 190
Saint Louis, MO 63144
phone: 314-821-8304
fax: 800-327-1957
frontdesk@theraplus.org

Understanding the Functional Movement Screen (FMS): A Tool To Avoid Injuries.

FMS Shoulder Mobility Test

The Functional Movement Screen (FMS) is a screening tool used to evaluate a person’s movement patterns and identify asymmetries, weaknesses, muscular and joint stiffness that contribute to injury.  It is a screen not an in-depth evaluation.  A blood pressure test is a screen that helps identify problems in your cardiovascular system that should be further investigated.  The FMS is a movement screen to help identify areas that can become a problem resulting in pain or injury. 

The FMS is seven exercise tests plus three clearing tests.  A clearing test is a test used to rule out problems at a joint.  In a clearing test, you move a joint through a full range and into positions that would provoke problems if one existed.  The exercise tests are a deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, and rotary stability.  The client receives a score of 0-4 on each test.  The scores are totaled and left and right sides are compared.

What gets screened in the Functional Movement Screen?  The deep squat screens ankle mobility, knee mobility, hip mobility, shoulder mobility, trunk strength among other things.  The hurdle step screens hip abductor, extensor, flexor, and adductor strength, hip rotational control, trunk strength among other things.  The inline lunge test screens ankle, knee, and hip mobility stressing one side at a time. The shoulder mobility test and impingement clearing test screens for shoulder internal and external range of motion, shoulder mobility, acromioclavicular injury, and rotator cuff impingement.  The active straight leg raise screens hamstring and hip flexibility, trunk stability, and hip flexor strength among other things.  The trunk stability push up screens upper body strength and trunk strength among other things.  The spinal extension clearing test screens for lumbar spine dysfunction.  The rotary stability test screens hip, spine, and shoulder rotational strength and control among other things.

So what? How would this benefit me?  Research with groups of people has shown that there are crucial thresholds for scores to avoid injury.  The threshold varies from activity to activity but the quick message is that you need a score of at least 14 to 16 to avoid getting hurt in most sports and activities.  This has shown to be true in NFL athletes, runners training for the marathon, soldiers entering boot camp, and those beginning officer candidate school.

The clearing tests and screening tests are quick screens.  If you have pain with these movements you should be examined further by a medical professional.  Not every injury will be uncovered by these screens but many will.  Research has shown the sooner you seek treatment for a musculoskeletal injury, the shorter the treatment, and the better the outcome.  Ignoring the warning signs your body is giving you and ramping up your training and workload usually does not end up with great performances.

The FMS quantifies areas of stiffness and weakness.  Tight calves and ankle stiffness with impact numerous tests dropping your score.  Tight calves and ankles can contribute to Achilles tendonitis, knee pain, plantar fasciitis, and other issues.  You know you have tight calves and stiff ankles but you haven’t done enough about the problem.  Facing a failing score can be motivating to address the problem, improve, retest, and face the challenge of your sport knowing you are better prepared for the challenges ahead.

The FMS can be used with any fitness level and instantly provides the practitioner with information to customize exercise plans, set realistic and achievable goals, and guide corrective exercise selection.   Call 314-821-8304 today and schedule an appointment to be screened with the FMS at TheraPlus Physical Therapy and Personal Training.

Training journal? I don’t need no stinking journal!!!

Years of workout journals - TheraPlus Physical Therapy

Why should I keep a training journal?

The genius of most people in the gym amazes me. For years I have kept a training journal.  When you look around the gym, you hardly see one. Other people must have total recall for the weights, reps, distances, and times they did in their last workout much less two years, three months, and six days ago. If you don’t know or cannot remember what you did, how do you know where you are? Have you improved or fallen back? Take a few minutes and keep a record and have all this information to gauge your training and progress or lack thereof.

Why should I write it down?

We keep records in physical therapy to document status and measure improvement. Flexibility, strength, and function are measured and documented. Exercise, weight, and number of repetitions are recorded so the client can be challenged. Never adding any more challenge does not force the body to adapt. keep personal workout records so I can avoid any drift in memory.  Was it 310 or 320?  Was it a 3.2 or 3.25?  Like you, I have other things to think about and remember.  I am amazed I can function remembering all the passwords I have today.  While I might remember my weights and times correctly, journaling them relieves me of the burden.

I revisit my journal to check progress and status.  How much could I back squat when I snatched 90?  What could I snatch when I cleaned 125?  Am I stronger or more explosive?  Has a change in technique improved efficiency and allowed me to put up higher numbers?  A coach in high school once said “The older I get, the better I was.”  A workout journal keeps that inflation in check.

My training journal inspires confidence.  Am I ready for the competition in three weeks or next week?  Referencing the training before my last competition tells me I am stronger, more explosive and putting up better numbers.  The records in my journal give me more confidence and drive and less guesswork.

Am I not getting better?  The training journal allows you to examine and critique your training structure.  You have no sprint endurance?  If your journal shows you that you have not touched that energy system in weeks, you have an easily correctable problem.  If you have worked it regularly and are still struggling, you can ask yourself if you have hit it hard enough, long enough, or too often. Your memory might be a little harder to audit.

Paper or electronic?

There are electronic options and apps but I stick with a pen and paper.  Sitting down to scribble gives me a breather with a purpose.  A peek back to a previous workout gives me motivation for the next part of the workout.  I currently use a moleskine notebook and fashioned a pen holder out of scrap vinyl.  It doesn’t get lost in my workout bag.  It withstands drops, bumps, and crushing by lifting shoes, lifting belts and etc.  The moleskine notebook will last for years.  I should fill it a year or so of workouts.  Or I will move on to a new one when it is time to start anew.

T's workout journal - TheraPlus Physical Therapy

Can you read kindergartner?

My six year old has noticed my scribbles and how the outlines of workouts for her mother and sisters.  Last time she joined her mom and sister for a workout she recorded her workout.  I am impressed by her circuit structure and variation between movements alternating push and pull, legs, and trunk.  In a few more years I might have her write my workouts.

What should I record in my training journal?

Record what you want in your training journal.  Record what you need to keep the workouts going and the improvement happening.  I have a section for daily workout records.  I write down the exercise, weight, reps, distances, etc.  What is going on in life?  Why has there been a gap in workouts?  Did I tweak something and how?

I have a section for training personal records.  I record my best lift in twenty or so key exercises.  I have a section for meets and competitions: What were my warm ups and what weight did I attempt in competition?  Was it a make or a miss?

At one time I tracked bodyweight.  I have tracked heart rate on waking up in the morning.  I have tracked number of hours of sleep.  What I track has changed through the years but I keep tracking to see where I was and help me keep going.

Try a training journal and see if it impacts your workouts and your progress.  A little time invested might pay off great dividends.

 

Evaluate your training: Training max? Competitive Max? How Hard to Push? How Much to Fail?

Evaluate your training: How hard to push and how much to fail?

Mark Felix mentally prepares for tire deadlift

Not thinking about his training, Mark Felix mentally prepares for a big tire deadlift at the 2011 Arnold Strongman Classic.

Work out. Break down. Rest. Recover. Repeat. Training is often simplified to these five steps with improvement implied in the recovery. Unfortunately many people simplify their training in another way. Train. Compete. Get Injured. Rehab. Repeat. Training with steady improvement and avoidance of injury involves planning, execution, and luck. Let’s start by discussing planning.

Are You Biased?

Training programs, methodologies, and periodization are evaluated with a great deal of bias. People exhibit choice-supportive bias and post-purchase rationalization; because I did it, it was the best choice. I am asking you to step back, examine your training, and analyze what has worked and not worked. You might be thinking this is a weight training article and you are correct.  If the focus of your sport is more endurance than strength, I ask you to extrapolate to your athletic experience.

Training Max

Currently I am training with a training max system: Jim Wendler’s 5-3-1. Training maximum is the best performance you are capable of today; right now without adrenaline or stimulants or anything driving you to maximal performance. What can you lift, run, swim, jump, throw at this very moment? 5-3-1 has lower expectations for energy, adrenaline, and drive.  Going hard is draining.  Pushing your limits is fatiguing and if you are already fatigued, you will not do well under many training systems. With my current schedule and lifestyle, this system has been successful in developing strength.

Competitive Max

Mark Felix sets up for tire deadlift at 2011 Arnold Strongman Classic

Setting up for a heavy lift.

I also learned information critical to any Olympic lifting competition I enter: how my training max relates to my competitive max. Competitive maximum is the best performance you are capable of under ideal conditions with optimal motivation, weather, and competitive environment. If I can clean and jerk 105 kilos on any given Tuesday, with the adrenaline of competition flowing in a meet I can clean and jerk 115-120 kilos.   Adrenaline and some taper from a reasonable training load gives me 10-15 kilos on each lift.

90% of Training Max

Jim Wendler’s 5-3-1 Program recommends you base your training percentages on 90% of your current training max. I believe he does this because he knows his audience.  With hope, prayer, and the help of two spotters, Meathead A bench presses 350 pounds. He figures this is his maximum. (We could generously call it his competitive max.).  So he figures his training percentages from 360 and fails miserably.  If he based his training percentages off 315, he would progress and have a great deal of success.

Limited Amounts of Failure and Compound Interest

Mark Lewis pulls a massive tire deadlift at the 2011 Arnold Strongman Classic

Pull. Pull. Pull.

My second thought is that Wendler’s system allows you to push the last set (and only the last set) for maximal repetitions to challenge your limits.   Jim is extremely knowledgable, experienced, and well read.   Talking to him years ago he referred to a system of training that limited your failure.  When performance declined more than 8-10 percent, you called it a day.  No need to pound yourself into the ground.  No finisher sets. You were done. The idea was how long does it take to recover from a small amount of fatigue and what is your return on investment.  If you can gain 1% improvement on 5% fatigue and workout again two days later and repeat the process, why would you break down 15-20% for 1.2% improvement if you were unable to workout for 3-6 days afterwards.  Small improvements compounded more often over time would lead to greater performance than a system with less frequent compounding.  That is one of beautiful elements of his program, it limits the fatigue and failure setting the stage for greater success.

5-3-1 and The Half Marathon?

What do you base your training on: your competitive max, your training max, or your what-if competitive max? My question for the swimmers, runners, and cyclists is who is going to develop the 5-3-1 program for your discipline? Are there already similar programs out there?  Is there a program with regular small bites of training with consistent but limited opportunity for failure and fatigue allowing for adequate recovery and improvement?  Jim Wendler left his job based on the success and sales of 5-3-1. What would publishing a similar program for your sport do for you?

Good luck in your training.
Tom Nuzum
TheraPlus Physical Therapy and Personal Training

Physical Therapy After A Total Knee Replacement (TKR)

Physical therapy After A Total Knee Replacement Has A Varied Course

The path, location, and amount of physical therapy you will receive after a total knee replacement depends on your activity level, goals, surgeon expectations, and surgeon’s treatment plan. If you feel you need more physical therapy to reach your goals, be assertive and direct with your surgeon. TheraPlus Physical Therapy and Personal Training treats clients in the outpatient phase of physical therapy.

Initial Physical Therapy After a Total Knee Replacement

Physical therapy after a total knee replacement begins on the same day of surgery or the next day. Initial physical therapy should work on range of motion, reducing swelling, controlling pain, and walking and moving around the house. They will teach you to use an assistive device (crutch, cane, walker) to help you walk easier, with less pain, and with higher quality. Most people start with a walker. They will coach you in getting in and out of bed and standing up and sitting down under control. The main goal of the initial phase of physical therapy is your safety when you get home.

The Second Phase of Physical Therapy

Many patients go straight home and begin home health. Home health services include physical therapy and nursing. Other people might go to a sub-acute or rehabilitation facility. People go to a sub-acute or rehabilitation facility when they need more help than there is available at home, when there are issues that need more intensive care, or your having a great deal of difficulty walking and getting out of a chair. During this phase of physical therapy you will continue work on range of motion, walking, standing up from a chair, and begin strengthening. Your physical therapist will assign you exercises to do several times a day. The goal of this phase of physical therapy is preparing you to safely get around the community and restore normal knee range of motion, strength, and mobility.

CPM

You might go home with a CPM (continuous passive motion) machine. You will use this several hours per day, in addition to your physical therapy session. The goal of the CPM machine is improve motion and prevent scar tissue. Use of the CPM depends on the surgeon’s experience with and without it and the medical literature.

Patients sent to subacute or rehabilitation facilities might go to outpatient physical therapy when discharged or they might go home and receive home health services.

Outpatient Physical Therapy After A Total Knee Replacement

When you are safely and easily able to leave the house, you might go to outpatient physical therapy. This is when we hope to see you at TheraPlus Physical Therapy and Personal Training. In this phase of physical therapy we continue to work on strength, balance, gait, mobility, and range of motion. Our goal is to get you better than you have felt in the past five years. We want to eliminate the need for an assistive device if possible restoring strength, balance, and coordination. Restoration of strength and motion is more than just bending and straightening your knee. How is your ankle strength and hip strength? How is your rotational control? How well do you balance on uneven surfaces? Can you walk up and down on uneven ground? Do you want to play golf and tennis? These are all skills and activities we want to help you master at TheraPlus. Patients go to outpatient physical therapy a few times a week for four to twelve weeks. Please keep in mind that each person’s rate of progress is different with different goals, history, and expectations.

Graduating from Physical Therapy

When you graduate from physical therapy you should continue doing your home exercise program. Since healing and remodeling will continue for up to a year it may take a while to return to 100%. We want you to return to 110-120% of how you were before surgery. Healing, strengthening, and re-learning balance and coordination takes time, effort, and practice.

We look forward to working with you at TheraPlus. Call us at 314-821-8304.
Tom Nuzum, PT, MS, OCS, CSCS
TheraPlus Physical Therapy and Personal Training

What to do when you are sore and achy? The answer might surprise you. Learn how to do a restoration workout.

What should you do when you are sore and achy? The answer might surprise you.  Do a restoration workout.

What should you do when you are sore and achy? Workout. “I worked out yesterday. Muscle needs time to recover. You can’t go hard every day.” Nobody asked you to workout hard. I said to workout. You need to learn how to do a restoration workout.

What is a restoration workout?

Think through your exercise history. No matter your sport and activity, you have probably done a restoration workout. You just did it wrong. Whether your sport is lifting, strongman, CrossFit, running, biking, or swimming, you have walked into a workout hurting and flat. Twenty to thirty minutes into a workout you felt better. That is where you went wrong. You should have stopped. Instead, you transitioned your workout at that point. You went hard. You begin to push again. You need to learn to stop. Every workout should have a purpose in meeting your long-term training goal. The purpose of the restoration workout is to make you more successful in the next workout. It is difficult to do well in an interval workout if your calves, quads, and glutes are sore from the last run. It is challenging to squat, clean, or snatch heavy on a maximum effort day if your shoulders, back, and hips are sore when you start. Performing a restoration workout will help in your training volume, general physical preparation (overall condition and work capacity), and set you up for greater success with your specific physical preparation work (qualities important to sport performance such as maximal strength, explosive power, endurance).

The basic how of a restoration workout

Go easy to moderate for 15-20 minutes. If you are training with weights, use warm up weights and do several sets. Think pump. Endurance athletes should start out easy. Do not aggravate what is hurting. Find success going at an easier pace and speed up as you feel better. Fifteen to twenty minutes in you will be feeling better. Stop. That is the workout. Think flush with blood, oxygen, and nutrients. Use the muscle pumps to clear your lymphatic system and promote venous return. Throw in some corrective exercise/preventative exercise that you failed to fit in last workout or for the last month. And stop. Stop when you feel good. Stop when you feel like you could go harder. Walk away, go shower, and move on with the day. Congratulations, you just did a restoration workout.

Think long term investment return

In your personal financial portfolio do you chase an overnight 50% return or a steady rate of return over years. While we all dream of the jackpot investment and the breakthrough workout, most of us would be happy with steady improvement in our financial and physical/athletic well being. An extra hour of exercise spread over three days you would have rested through before will make every other workout session better. You will need less warm up, have less aches, and be able to push your limits sooner, further, longer.
Instead of arguing with me, try it for two weeks and let me know how the restoration workouts worked or didn’t work for you.

I look forward to your feedback.
Tom Nuzum, PT, MS, OCS, CSCS
TheraPlus Physical Therapy and Personal Training
314-821-8304

What Is A Frozen Shoulder or Adhesive Capsulitis And Why Do I Need Physical Therapy For It?

What is adhesive capsulitis or a frozen shoulder?

A frozen shoulder is technically known as Adhesive Capsulitis. It is a frequent cause for referral to physical therapy services at TheraPlus Physical Therapy in Saint Louis. Adhesive capsulitis can be spontaneous in nature with no known cause or it can begin with a chronic inflammatory process. In either case, pain usually occurs first, followed by restriction of motion. If left untreated, muscle imbalances occur around the shoulder, scapula, and neck. These imbalances occur because your body tries to compensate for the lack of motion, pain, and inflammation. Physical therapy targets all three of these limitations.

A frozen shoulder has three phases: a painful phase, a freezing phase, and a thawing phase. The duration of each phase varies. It is believed that the sooner the condition is recognized, diagnosed and treated, the shorter the treatment process and recovery will be. The condition can take as long as 24-30 months to run its course.

What movements are limited with a frozen shoulder or Adhesive Capsulitis?

The restriction of motion typically presents in a pattern. Most often clients lose the ability to reach out in front of the body, out to the side of the body, and up and out like waving to somebody. In physical therapy terms we describe this as a loss of flexion, abduction, and external rotation. Common complaints that arise from these limitations are inability to reach up to overhead shelves, difficulty washing or styling hair, and problems putting on clothes. This pattern of movement loss can be different for clients who have diabetes.

What causes a loss of shoulder motion?

The cause of the loss of movement and restrictions is the adhesion of the actual shoulder capsule onto the head of the humerus. The shoulder joint capsule normally has some space to allow rolling, gliding, and sliding of the humeral head (the ball of the shoulder joint). When this space is lost, movement of the ball is limited and movement of the shoulder becomes restricted with compensatory movement patterns developed.

What does physical therapy do with a frozen shoulder?

In physical therapy at TheraPlus Physical Therapy in Saint Louis, we work on the mobility of the shoulder joint with manual therapy and joint mobilization. Manual therapy techniques might include deep tissue work, cross-friction massage, and mobilization of the joint to restore the roll, slide, and glide of the humeral head (ball of the shoulder joint). Exercises to stretch, strengthen, and correct compensations are done in the clinic and at home. Modalities such as ultrasound, heat, and ice are used to prepare your body for the treatment to get the most motion each session and to help make the treatment less uncomfortable.

What happens if physical therapy doesn’t help me?

Sometimes physical therapy is ineffective or the patientis unable to tolerate treatment. In this case a manipulation under anesthesia (MUA) may be performed. When this option is chosen, the client is put under anesthesia and the physician manipulates the arm and tears the adhesions and scar tissue loose. Generally after this procedure a patient is sent directly to physical therapy to begin range of motion exercises to maintain the range and prevent scar tissue from re-occurring.

Suggestions for a successful treatment

Adhesive capsulitis can be very challenging for the client and the therapist. It is best when early intervention is received. Look for small successes in treatment and at home. Discovering you can soap up in the shower without pain or shampoo your hair are little successes to be celebrated. Do your home program! Restoring normal movement patterns and joint mechanics is helpful in speeding recovery. Take your pain medication before physical therapy. Talk with your therapist. When you are especially painful or tender, tell your therapist and ask for a gentler day. Your therapist wants you to improve and succeed. They realize not every day is a charge ahead day.

We look forward to working with you at TheraPlus Physical Therapy and Personal Training in Saint Louis. Call us at 314-821-8304.

How fluent are you in insurance-ese? Understanding the language and terms of insurance.

At TheraPlus Physical Therapy, we understand the challenge of learning and understanding your insurance benefits. We have put together this list of terms to help our patients understand the language of insurance.

In-Network

Providers (Doctors, hospitals, clinics, physical therapists and other licensed health care providers and facilities) who have a signed a contract with your insurance plan to provide services or equipment at the insurance company’s rate.

Out-of-Network

Providers (Doctors, hospitals, clinics, physical therapists and other licensed health care providers and facilities) who don’t have a contract with your insurance company but will still provide services or equipment. How much your insurance company will cover of the out-of-network rate can be determined by checking your benefits.

Deductible

The amount you pay for eligible healthcare services and equipment during a defined insurance benefit period before your insurance plan begins to pay. For example, if your deductible is $1000, your insurance plan won’t pay anything until you have paid $1000 for covered health care services and equipment. However, not all services and equipment apply to your deductible. Copayments and coinsurance are not always applied against your deductible amount and may be an additional expense.

Coinsurance

Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if your plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. Your plan pays the rest of the allowed amount.

Coinsurance maximum

The limit on the amount of money you will pay for coinsurance after which your insurance plan will pay 100% for covered services and equipment for the rest of the insurance benefit period.

Copayment

The fixed dollar amount (for example, $15) you will pay each visit to a health care provider for a covered service or piece of equipment. Copayment amounts can vary depending on the service, the type of health care provider, and whether the provider is in or out of network. Copayments might not count toward your deductible.

Maximum Out of Pocket

This is the limit on what you will pay for health care services or equipment.

Pre-Certification and Pre-Authorization

Authorization that needs to be obtained from the insurance company before the provider or facility can perform a service or provide treatment or equipment.

This information is provided for educational purposes. Every insurance plan has it’s own definition of each of these terms and interpretation is made at the time of payment. At TheraPlus Physical Therapy and Personal Training, we check benefits before beginning services whenever possible. We do this to help you determine the best and most affordable plan for your course of physical therapy treatment and recovery.  We look forward to working with you.  Call us at 314-821-8304.

What happens in physical therapy after a knee arthroscopy for meniscus problems?

Physical therapy after knee surgery for a meniscal tear is prescribed to improve knee and leg strength, increase range of motion, improve flexibility, decrease swelling, decrease pain, decrease muscular guarding, improve movement habits, and increase function.

The meniscus can be thought of as a gasket. It improves the congruence between your thigh bone (femur) and shin (tibia) in your knee. It helps one bone slide easier on the other during movement. It also aids with shock absorption. There are two pieces of meniscus: the inside or medial meniscus and the outside or lateral meniscus.  When there is a tear, the resulting flap can fold over or get stuck impeding motion and creating locking sensations.

Unfortunately, only the outside of the meniscus has sufficient blood supply to heal when damaged or surgically repaired. The bulk of the meniscus does not have enough blood supply to heal and is shaved down in surgery when injured. With less meniscal tissue after surgery, there is also less shock absorption, less congruence between bony surfaces, and less assistance in sliding and gliding with movement.

During arthroscopic knee surgery the surgeon will shave back a meniscus tear (meniscotomy) or repair the tear if it has enough blood supply (meniscus repair).  During the surgery, cartilage defects can be discovered and smoothed out (chondroplasty), joint lining of the knee can be removed (synovectomy), and other emerging techniques such as cartilage transplants might be performed.

The course of therapy is dependent on factors including the surgeon and their protocols and instructions, what was done in surgery, how extensive the damage was in the knee, other health issues that can impact healing, and the length of time the patient has been dealing with these issues.  Extensive damage and resulting surgery might mean a limitation to activity afterwards. Our goal is to maximize function and assist you in returning to everything you want to accomplish while maximizing the lifespan of your knee.

Physical therapy can include modalities to help with swelling and pain, modalities to help you recruit and strengthen muscles especially your quadriceps or quads, gentle stretching and range of motion exercises to get your knees equal again, strengthening of weak muscles, and movement retraining to eliminate limping, guarding, and unconscious movements that you developed to help work around the injury.

At TheraPlus, some clients are seen for a handful of visits. Some clients with longstanding issues and problems are seen for numerous visits to help restore strength, motion, balance, flexibility and function. One of our favorite things to hear from clients recovering from this surgery is “I haven’t been able to do that for two years.”

All of us at TheraPlus Physical Therapy and Personal Training look forward to meeting you and working with you. Call us at 314-821-8304.