The Most Important Part of a Workout

Warm up exercises are crucial to any sport or fitness program and should precede every exercise session. This component of the work out is the most important part and, if done correctly, will reduce risk of injury and improve overall movement quality. A proactive approach should be used in the warm up to improve strength, mobility and flexibility in areas where the athlete is weak. There are major factors influencing the extent of improvement elicited from a warm-up, such as structure and specificity of warm-up to the task.

Warm-ups are beneficial for many reasons. First, it serves to prepare the athlete mentally and physically for exercise or competition. Second, a thorough warm up will result in physiologic responses to improve subsequent performance. Temperature-related responses will increase muscle tissue temperature, enhance neural function, and disrupt transient connective tissue bonds. Non-temperature-related effects are related to a rise in heart rate and respiratory rate and lead to increased blood flow to muscle, elevation of baseline oxygen consumption, and post-activation potentiation. Post-activation potentiation is the phenomenon by which the contractile history of a muscle directly affects its subsequent ability to generate force in a rapid manner. In other words, post-activationpotentiation results in short-term improvement in performance (i.e. jumping) due to use of a conditioning exercise before hand (i.e. back squats).

Among these positive effects of a warm up are faster muscle contraction and relaxation of both agonist and antagonist muscles, improvements in the rate of force development and reaction time, increases in muscle strength and power, lowered viscous resistance in muscle and joints, enhanced metabolic reactions, and increased psychological preparedness for performance. Furthermore, increased muscle tissue temperature has been shown to increase resistance to tears.

There are several key elements to a proper warm up. The warm up should progress gradually and provide sufficient intensity to increase muscle and core temperatures without causing fatigue or reducing energy stores. Warm-ups should last 10-20 min and end no more than 15 minutes before the start of the next activity, as positive effects of warm-up start to dissipate after this time.

There are two main phases of a proper warm up. The first phase, the general warm-up, should consist of five minutes of slow aerobic activity, such as jogging, skipping, cycling, rowing, or jump rope. The goal of the general warm up phase is to increase key physiological parameters—heart rate and respiratory rate—to improve blood flow to muscles, increase deep muscle temperature and decrease viscosity of joint fluids. The second phase, the specific warm up, incorporates movements similar to those to be performed in the upcoming sport or exercise with a goal of activating key muscle groups. This phase is analogous to stretching with addition of movement patterns required for the workout and in the athlete’s overall development by actively moving through the range of motion. For example, a person warming up for squats with a barbell may perform body weight lunges and squats in the specific warm up phase. The athlete will perform specific movements in this phase that progress in intensity until they are performing at the intensity required for the subsequent competition or training session. This phase presents the opportunity to address particular movement issues the athlete demonstrates and also work on other aspects of performance such as speed and agility.

Beneficial warm up effects are best elicited with active movements rather than passive. Dynamic stretching in a warm up is time efficient and will target activation of key muscle groups, maintain the increased temperature of the general warm up phase and incorporate many joints. Examples of dynamic stretching are toy soldiers for the hamstrings and low back muscles, spiderman lunges for the hips, and inchworms for the pectoral muscles and triceps. Static stretching prior to exercise has shown negative effects on performance in force production, power development, running speed, reaction time, and strength endurance. However, studies have shown that static stretching performed after exercise compared to pre-exercise facilitates greater range of motion improvements. The elevated body temperature post-exercise increases the elastic properties of collagen within muscles and tendons, which allows for a greater stretch magnitude.

The range of motion required for the exercise should be considered in a warm up. Those in sports that require greater range of motion, such as golf, volleyball or gymnastics, may need to spend more time with dynamic stretching than those with a lower range of motion required for exercise.

The more power necessary for the sport or activity, the more important the warm-up becomes. A warm up routine for plyometrics, such as box jumps, broad jumps and sprinting, deserves its own discussion. In short, a warm up for plyometric exercises should consist of low-intensity, dynamic movements. For example, butt kicks and straight-leg jogging prepare the body for the impact of plyometrics and emphasize quick take off and landing to mimic plyometric activities.

Article written by Dr. Jessica Khani, PT, DPT, CSCS


The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.



Fletcher, I.M., and B. Jones. The effect of different warm-up stretch protocols on 20 meter sprint performance in trained rugby union players. J Strength Cond Res 18(4):885-888. 2004.

Knudson, D.V., P. Magnusson, and M. McHugh. Current issues in flexibility fitness. Pres Council Phys Fitness Sports 3:1-6. 2000.

Funk, D.C., A.M. Swank, B.M. Mikla, T.A. Fagan, and B.K. Farr. Impact of prior exercise on hamstring flexibility: A comparison of proprioceptive neuromuscular facilitation and static stretching. J Strength Cond Res 17(3):489-492. 2003.

Haff, Greg. Triplett, Travis. Essentials of Strength and Conditioning. Fourth edition. Champaign, IL: Human Kinetics, 2016. Print.

Are you Drinking Enough Water?

Drinking water is crucial to staying healthy and maintaining the function of every system in your body, including your heart, brain, digestion and muscles. Water acts a lubricant, shock absorber, building material and solvent. Water is essential for body temperature regulation through sweat, nutrient transport, waste product removal, and maintaining fluid balance. In the summer when it is hot and people sweat more, they often don’t get enough fluids. Air travel also negatively effects hydration status due to low humidity levels in the airplane cabin.

Elderly populations are at a higher risk of dehydration as a result of physiological changes and age-related decline in fluid intake. Children are also at a higher risk of dehydration as they have increased heat gain from the environment. This is due to greater surface area-body mass ratio compared to adults, increased heat production during exercise, decreased ability to dissipate heat via sweat, and decreased sensation of thirst compared to adults. Pregnant and lactating women require additional fluid intakes to avoid dehydration, as well.

Clothing, equipment and larger body size can increase sweat rate and thus dehydration risk, along with environmental conditions such as hot, humid environments and altitude. Furthermore, athletes may be more prone to dehydration during the beginning of training season. However, repeated exercise in hot environments helps the body adapt to heat stress and will result in greater sweat volume, lower electrolyte concentration of sweat, and lower temperature for onset of sweat.

Thirst may not be a reliable indicator for fluid needs and those with great sweat losses may not voluntarily drink enough fluid to adequately rehydrate. Therefore, a systematic approach to fluid replacement is necessary. For every pound of weight lost with exercise, a pint of fluid is required for replenishment (Essentials of Strength and Conditioning). Fluid guidelines differ for children and adults. The recommended water Adequate Intake is 3.7 L (125.1 oz) for men and 2.7L (91.3 oz) for women per day (Food and Nutrition Board, Institute of Medicine, National Academies). During activity, children weighing ~88 pounds should drink 5 oz cold water or flavored salted drink every 20 min during the event whether they are thirsty or not (American Academy of Pediatrics). All sources of fluid (coffee, tea, juice, soda, food fluid, etc) contribute to meeting a person’s water needs.

During exercise, sweat output can’t keep up with increases in core body temperature unless fluids are consumed. Sweat losses that exceed fluid intake can quickly lead to a hypohydrated state with subsequent increase in body temperature, decrease in blood plasma volume, and increase in heart rate and perceived exertion. Mild dehydration can greatly affect performance, resulting in increased fatigue, decreased motivation, neuromuscular control, accuracy, power, strength, muscular endurance, and overall function.

All electrolytes, including sodium chloride, potassium, magnesium and calcium, are essential to muscle contraction and nerve conduction. Increased loss of electrolytes with significant sweat production could alter performance. When large quantities of hypotonic fluid are consumed, lots of urine is produced long before the person is hydrated. Likewise, athletes who exercise intensely or for many hours and hydrate with only water or a no- or low-sodium drink may dilute their blood sodium levels to dangerously low levels, called hyponatremia. Hyponatremia leads to intracellular swelling and the athlete may present with HA, nausea, vomiting, muscle cramps, swollen hands and feet, restlessness, and disorientation. Some athletes need to replace sodium losses with higher-sodium foods and add electrolytes to drinks. Fluid intake shouldn’t exceed sweat losses to avoid hyponatremia (for example, athletes should not weigh more after workout).


Article written by Dr. Jessica Khani, PT, DPT, CSCS


The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.



Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005) and Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005). National Academies.

American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Sports Medicine: Health Care for Young Athletes. 2nd ed. Elk Grove Village, IL. American Academy of Pediatrics; 1991:98.

Haff, Greg. Triplett, Travis. Essentials of Strength and Conditioning. Fourth edition. Champaign, IL: Human Kinetics, 2016. Print.

Mobile Devices Aging the Spine, Causing Headaches

Your Smart Phone Could Be Rapidly Aging Your Spine

Chances are that you probably haven’t given much thought to how your neck and back are faring in the era of the smart phone, but studies show that you most certainly should. It’s practically a reflex these days to pull out our smart phones when we’re standing in line, sitting at the airport or riding the subway. And while it’s great that we rarely need to venture beyond our pockets for entertainment, our bodies are beginning to retaliate—and mourn the pre-texting days.

Feeling headache after Texting?

So, what exactly are these contemporary conveniences doing to our bodies? A surgeon-led study that published in Surgical Technology International assessed what impact surgeons’ head and neck posture during surgery—a posture similar to that of smart-phone texters—has on their cervical spines. With each degree that our heads flex forward (as we stare at a screen below eye level), the strain on our spines dramatically increases. When an adult head (that weighs 10 to 12 pounds in the neutral position) tilts forward at 30 degrees, the weight seen by the spine climbs to a staggering 40 pounds, according to the study. How pervasive of a problem is this? According to the study, the average person spends 14 to 28 hours each week with their heads tilted over a laptop, smart phone or similar device. Over the course of a year, that adds up to 700 to 1400 hours of strain and stress on our spines.

As a result, the number of people dealing with headaches, achy necks and shoulders and other associated pain has skyrocketed. Trained to address postural changes and functional declines, physical therapists are well-versed in treating this modern-day phenomenon, widely known as “text neck.” Over time, this type of poor posture can have a cumulative effect, leading to spine degeneration, pinched nerves and muscle strains. Scheduling an appointment with a physical therapist can help people learn how to interact with their devices without harming their spines. The PT will prescribe an at-home program that includes strategies and exercises that focus on preserving the spine and preventing longterm damage. Exercise is an important part of taking care of our spines as we age, but what we do when we’re not in motion matters, too. So next time you pick up your smart phone or curl up with your e-reader, do a quick check of your head and neck posture. Your body will thank you for years to come

Dr. Marci Catallo-Madruga is Trained to help you relieve headaches and improve posture.

Call to schedule (303)773-0771

Request an appointment at

The Season of Giving

This time of year we look for ways to give back. Some do that locally and some try a more global approach. When I look at charities to donate time or money to, I  look for a few factors

  1. How much of my donation goes directly toward what I am supporting
  2. How much goes to overhead or the Operating expenses including salaries of the charity
  3. How much does the CEO, COO, CFO make for that chairty
  4. What is the gain provided by the charity.

Personally, I only want 10-20% of my donation to go to overhead. I don’t believe that most of my money should go to salaries and overhead. I look at what the C-Suite or executives make because I want to see how much my money is eaten up by their salary.

The Charities I choose to support have really good causes, provide education and have other ways to cover overhead.

Here is The Charities I choose to support and a little information about them:

  1. St Jude: From 2000 to 2005, 83.7% of every dollar received by St. Jude went to the current or future needsIn 2002 to 2004, 47% of program expenses went to patient care and 41% to research.

    2012, 81 cents of every dollar donated goes directly to research and treatment.

    Operating costs are covered through fundraising efforts and events like The FedEx St. Jude Classic, a PGA Tour event, and things like the St. Jude Math-A-Thon, Up ’til Dawn, direct mailings, radiothons and television marketing. St. Jude also has a merchandise catalog called the Hope Catalog. The catalog contains everything from shirts to office items, and from patient art to "Give Thanks" wristbands. *wikipedia

  2. Charity Water: Founded in 2006, It provides clean drinking water to areas that don’t have access by building wells. 100% of public donations go to fund projects and it costs about $500 to build a well for drinking water. GPS coordinates and pics are provided for each well Built. The Overhead and operating expenses are provided by private donors, Foundations and Sponsors. IF you could get 20 friends to donate $25 each you could help get clean drinking water to people in need
  3. The Heifer Project: Founded it 1944 it is a Global non-profit looking to eradicate poverty and hunger in the world. The encourage persons who have received a gift to then become donors themselves. The educate persons receiving a gift how to best care for their livestock to get the best yield. 23.4% of all donations go to overhead and operating expenses.
  4. Angels Unaware: This non-profit seeks to help and guide children affected by HIV/Aids. It runs 100% on volunteers and offers a camp for children called camp Ray-Ray. All donations go to help with camp Ray-Ray.

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Physical Therapy’s Scope of Practice Extends Beyond Aches and Pains

Physical therapy is an obvious choice when you’ve sprained an ankle or developed tennis elbow, but what about when you need to boost your mood? Though highly skilled in methods that improve mobility and reduce pain following an injury, physical therapists can also play a key role in improving a patient’s mental health.

Exercise, a core component of any physical therapy regimen, is known to benefit patients with mild to moderate mood disorders such as depression. Depression is an underlying condition often associated with chronic illnesses and orthopedic injuries that limit mobility and participation in daily activities. With depression affecting one in 10 Americans at some point in their lives, physical therapy is another avenue to diagnose and treat the associated symptoms. Physical activity reduces feelings of anxiety, depression and stress by improving the patient’s cognitive function and self-esteem. Moreover, studies have shown that aerobic exercise decreases overall tension levels, elevates and stabilizes mood and improves sleep. Because exercise’s mind-altering effects are temporary, however, patients should work with a physical therapist to develop a regular exercise routine to ensure continued benefits.

Patients can expect to work closely with a physical therapist to develop a custom treatment plan based on a thorough assessment and detailed patient history. PTs are trained to recognize the signs and symptoms of depression and identify the ways in which mental health disorders interfere with a person’s ability to enjoy life. Each individual care plan includes some combination of flexibility, strength, coordination and balance exercises designed to achieve optimal physical function.

Physical therapists may be trained to identify and treat a wide range of movement disorders including sprains and strains but they’re also adept at identifying and reducing symptoms of depression. Developing behaviors that maintain good mental health is an important part of overall health and wellness, and it’s never too late to get started.

Vertigo is Not Always Just Crystal Related

What's wrong with self treating?

This video gives some great information in regards to Crystal related BBPV only. This means that if crystals have been Knocked loose and travel into the Canal from the Utricle, It can help Immensely. When we as healthcare providers start isolated a disease process to one option only, We can certainly do harm. The question you should ask is, “Is the room spinning or am I?” Vertigo is the room spinning, not you. What I would like to also add is this, “Is it worse if I move my head when both lying down and sitting up and does that last for 1min or less?” If it happens other than that, or it takes longer, It might be something other than BPPV and it may need more care.

Notice in this video that the ENT ask specific questions regarding Face droop, Speech trouble, Fall and hit head, Etc. The reason he is asking this is because there could be signs of stroke, Bells Palsy, Migraine, Tumors, etc. You really need to have Vertigo that is persistent checked out properly.

After any episode of Vertigo, You might want to see a Physical Therapist who specializes in Vestibular and concussion rehab or at a minimum balance and fall prevention.

The American Healthcare Act Failed, Now What?

Many people are discouraged by what has happened since the Affordable Care Act was passed in 2010. Most don't know enough about what was going on in healthcare prior to that to really have fact based opinions. What we all know is that change is needed, but how do we get there?

How do we fix the ever failing healthcare system in this country?

If you look up stats on other countries healthcare systems you'll see a disturbing trend. The US uses more care, but is sicker, dies earlier, and have more diseases and medications than all other developed nations. We even have the Highest Infant Mortality Rate in all OECD countries. With all of the advancements we have made, how can we justify the increased expense of care? How can we justify that no Cure for any disease has been found since the Polio Vaccine? Why are we settling for more drugs and less car?

There is a serious growing concern in this era of rising deductibles, co-payments and Co-insurances, especially as those costs don't seem to offset the raise in Premiums the Insurance companies are charging as well. The Health Care and education Reconciliation Act from 2010 that lead to the Affordable care Act (Obamacare) was supposed to make health insurance more affordable for all, But what it did was create more loopholes to increase premiums and cause more payments for care to be made by insured than by the insurance company.

The General history of what has occurred is that the overall rate of uninsured went from 14% to 8.6% as a country. Costs of Premiums went from an average of $12,680/year to $18,142/year. This rise in cost is said to be 11% less than the cost increase from 2006-2011, and 43% less than the cost jump in premiums from 2001-2006. High deductible plans ($2500/person insured in a family plan) have become the gold standard, But that's with the increased premium, so what is the insurance company paying for exactly? Unless you have a surgery or two, you likely won't hit the deductible. Even if you do, the out of pocket maximums have jumped from an average of $6,000 to $12,500.

So what happened in the decade before the affordable care act? Total jump in premiums was 131%, even though inflation was only at 28%.

What does this mean? If you look at the rising cost of healthcare, the first place that we should be looking is the payroll for the C-Suite executives at the healthcare Insurance companies. In 2013, there was such a windfall for CEOs that they saw an additional $125 million in bonus's paid to them. Just incase your unsure what that means, 11 CEO's maid $125million extra, above there $11-$17million salaries for that year. That Nearly Doubled the Salary for EACH CEO of the 11 Major Insurance Companies. Why is there a need to pay anyone that much money to stop covering the basics and charge the public more? If you're looking in Colorado here are some figurative stats. At $11million, that CEO brings home about $366,000 per month after taxes are taken out at 40%. As you can see by the Data provided below from the Colorado Census for Wages by Occupation, The CEO makes more in a month than most providers actually giving care in Colorado in a year.

Type of Provider AVG. Monthly Take Home Avg. Yearly Salary
Orthopedic Surgeon $22,500 $450,000
Family Physician $9,594.30 $191,886
Physical Therapist $3,850 $77,000

Why should the pay for non-medical business managers be so much higher than those of the providers who are scraping by to see you, care for you and get you at least somewhat better? I think we can all agree that the rise in Medication first, address the problem later may be driven by this startling trend.

Another thing we might consider is looking at programs run in other countries like Germany, Austria, New Zealand where the actual Consumer (patients) are involved every step of the way. In those countries, the consumer can call, talk to an office representative and get and estimate of costs that are actually fairly accurate. They can compare those costs to a quote from another provider and make a best choice as to how much they want to pay for services. They pay upfront for the care they receive to the provider. Then, at then end of the month or the quarter, they gather all of their healthcare receipts and take them to the national system and the National system then process them and deposits, directly to their bank account, the money due back to them. Imagine the possibilities of actually having doctors compete for your business. They would need to price things so that they can sustain their business and lifestyle appropriate to fit the needs and costs of education; however, they would be able to tell you exactly what costs would be with no surprises later. They would have to prove why they are the best person to earn your business.

This model could cause the insurance companies to actually need to lower premiums and deductibles for the fact that if you have the option and are more aware of how to be a true Consumer of Healthcare, you could form a reasonable argument as to why your premiums should not go up and why they may actually need to go down.

Let us know if you'd like more information on the truth about what your Insurance company does for you versus what you can do for yourself as a consumer of Healthcare.

Think of Food as Medicine

Food as Medicine

"Let Food be thy medicine and medicine thy food."


Before we had a medication to treat every condition, we had food. When is the last time you went to the doctor's office and were prescribed food to treat an ailment? Don't get me wrong, we have made many incredible advancements in the medical field and some medications can be extremely effective, however, I believe we can still learn a lot from Hippocrates' wisdom.

Modern medications are not always aimed at treating the root of the problem, sometimes they focus on alleviating the symptoms. Some also come with a variety of unpleasant side effects. The best part about using food as medicine is usually there are not side effects and often they are able to better address the root of the problem rather than the symptoms. Have you ever heard of someone taking a drug for one condition, but develop side effects so bad that they had to start taking another medication to help? That just does not seem logical or right to me. It's like putting a band aid over another band aid and thinking the wound will heal faster.

If only we knew of foods that decreased inflammation, lowered cholesterol and blood pressure. Food is more accessible, more affordable and easier on our body as a whole. What if I told you there are foods that do all of these things and more. Studies have shown that common foods can do many incredible things for our body.

So why don't our Doctors tell us about these foods prior to prescribing drugs? There are a variety of factors that go into this, but money is the biggest of them all.

The pharmaceutical industry in the US is a billion dollar industry. The top companies are bringing in up to 70 billion dollars a year in revenue and the industry as a whole is spending over 2 billion dollars in research and development annually. When an industry is spending 2 billion dollars in research and development, you better believe they are not going to want people talking about a food that is $3.99 per pound that can work better or as well as their billion dollar drugs. Simply put, there is no money to be made from food. Even the most expensive and exotic health foods cannot come close to the cost of some medications.


Another setback for doctors is the lack of evidence supporting the use of common food items for medicinal purposes. This again, can be tied to financial gain. To complete a large randomized control study, which is considered the highest level of evidence, you need money to support your work. Remember, the pharmaceutical industry spends over 2 billion dollars to fund that research to prove their medications are effective. Do you think the food industry has that much money allocated for research and development? Not at all. Most research completed on food is completed on a small scale and with a limited budget.

For example, one study that was completed on 10 people showed that eating 4 brazil nuts during a single meal resulted in a decrease in LDL or “bad” cholesterol levels by 20 points within 9 hours of consumption. It takes the commonly prescribed statin drugs 4 days to begin showing a decrease in LDL levels. After 30 days, cholesterol levels were tested again on each of the participants and their LDL levels maintained the improvement. Again, this study involved a single serving of 4 brazil nuts without any other diet modifications and cholesterol levels were improved for one month! The most common side effects from statin drugs are listed as headache, difficulty sleeping, muscle aches and weakness, dizziness and nausea and vomiting. The most common side effects of eating 4 brazil nuts…a little extra protein in your day?

Usually a study with incredible results like this would be repeated on a larger population to determine if it was a fluke or if in fact, 4 nuts can make such an impact on cholesterol levels. However, due to lack of financial incentive, this study was not reproduced. But when comparing the side effects of statins vs brazil nuts, do you think it would be worth a shot to start with 4 brazil nuts a month instead of a few pills a day? My thought is even though the research is not rock solid to support this claim, as long as there are not any ill side effects, you might as well try 4 brazil nuts a month first. It's inexpensive, easy and requires less effort than taking a prescription drug every day.

A larger study completed in 2015 in Australia followed 2,500 people over a span of 15 years. Their diets were tracked throughout this period and a surprising connection was made between the amount of nuts a person was consuming and the risk of death from chronic inflammatory diseases such as heart disease and stroke. People who ate more nuts had anywhere from a 25% to 50% reduction in risk of dying from these types of diseases over the 15 year study. A handful of other studies have also found the heart protective properties of nuts, especially walnuts. The best part about these studies is that they are not talking about an exorbitant amount of nuts. Most studies showed about a handful or two of nuts a day could do the trick. One study even stated 1/2 a walnut a day could be beneficial! Is there space in your diet for less than a single walnut a day if it could cut your risk of having a heart attack in the future?

Another under the radar food that could make a huge impact on how you feel is the spice turmeric. Turmeric has been used in Eastern Medicine for hundreds of years for its anti inflammatory and antioxidant properties. More recent research is showing that turmeric, along with many other common spices used such as ginger, rosemary and clove have the potential to decrease inflammation and pain as well as some over the counter medications. Studies completed on rats have shown doses of curcumin, the active ingredient in turmeric, were nearly as effective as cortisone in decreasing edema. Other studies have found that curcumin was as beneficial than pain medications in patients after hernia surgery.

Here's one more study to sink your teeth into. A study performed in 2013 on 110 people looked at the effect of ground flax seed on blood pressure in hypertensive patients. The study demonstrated a potent effect of flax seed consumption on patients blood pressures. Over 6 months of eating 30 grams of ground flax seed daily, participants decreased their systolic pressure (the top number) by 10 points and diastolic pressure (the bottom number) by 7 points. The decrease in pressure over the 6 months correlates to a 46% decrease in the risk of having a stroke and a 29% decrease in the risk of developing heart disease. Even more interesting, if a participate had a starting systolic pressure greater than 140, they dropped that number by 15 points.

Now that is a lot of information to chew on! By no measure does this information mean that you should go home and empty your medicine cabinet and start eating only flax seeds, walnuts, brazil nuts and turmeric. Before making any changes to your currently prescribed medications please discuss it with your doctor or pharmacist. What I hope you gain is some insight and knowledge and potentially peak your interest into a hidden world of food as medicine. Most of these foods have been found to be more effective as preventative medication. So if you don't have high cholesterol or elevated blood pressure, maybe adding a few brazil nuts and flax seeds to your diet will help you keep it that way. Next time you snack on some walnuts think about the impact your making on your health.

Preventative Rehabilitation for Hiking

Prehab for hiking
It's getting warmer, the snow is melting, and the days are getting longer. Winter is coming to an end (hopefully) and spring and summer are upon us. For some Coloradans, that means heading to the mountains to hike and explore the endless miles of beautiful trails this state has to offer. Some may be enjoying a easy day hike with friends and family, others may be attempting to bag a few 14er's this year.

Whatever you choose, are you ready to tackle those trails all summer without those pesky knees, hips and ankles acting up? What about that back? Are you going to suffer through those aches and pains that pop up after your first few tough hikes? What if there were a few exercises that you could start doing now to get your body ready?

Hiking can be a lot more strenuous than your day to day walking, especially in Colorado. You will have to deal with uneven terrain, elevation gains, and possibly carrying a heavy pack. All of these things can wreck havoc on your joints and can potentially end in injury. Good ankle stability can be the difference between recovering from stepping awkwardly on that root and a nasty ankle sprain. Strong hips can make all the difference in the forces your knees have to put up with while descending that mountain you just conquered. And good core stability can allow you to rest pain-free after a long day in the mountains and be ready to do it all over again the next day.

By focusing on specific strength exercises and addressing any movement dysfunctions, a physical therapist can help you put your best foot forward this summer. I want to share with you a few of my favorite prehab exercises that focus on what hikers need most. These exercises are also great for those trail runners out there.

Calf Raises

We will start at the bottom and work our way up. Balance starts at your feet. If you don't have good foot and ankle strength, flexibility and stability, you may have trouble adjusting to uneven terrain. My favorite exercise for foot and ankle strength is single leg balance. The twist is, you lift your heel off the ground so you are balance on the ball of your foot. In this position all the muscles in your foot and ankle have to work together to keep you stable. First try this while holding onto two hiking or ski poles. This will give you a little more stability at first. Try to balance for up to 2 minutes at a time. To progress, make small circles or a marching motion with your non-stance leg. You can also get rid of the poles to challenge yourself more.

Hip Flexor Stretch

Next, lets move up to the hips and knees. The biggest complaint I hear about hiking is knee pain. More often than not, it really has to do with hip strength. Your hip abductor muscles help to keep your knees in proper alignment, this can significantly reduce the risk of anterior knee pain. Hip abductors, the muscles on the lateral side of your pelvis, are often ignored in exercise routines. There are a few exercises you can do in your home to improve the strength of your hips. Half kneel balance is my favorite stability exercise. Line your front foot up with your knee as if you were on a balance beam and attempt to hold this position for 2 minutes. If this is easy, close your eyes. Keep your front knee bent to 90 degrees and focus on keeping good posture throughout.

Doorway Squat

Doorway squats are another great way to improve hip strength and stability. Being in a doorway limits your ability to 'cheat'. Focus on keeping the knee of your front leg in good alignment with the door, but do not let it touch the door frame. You want to keep your weight through the heel of your front leg and try to sit straight down. Only use the door frame for balance, do not pull on it. Do 10-20 repetitions each leg.


And last but not least, core stability. Core stability is the building block of all movement. If our arms and legs have a solid foundation, they are able to move correctly and efficiently. There are hundreds of different exercises you can do to maintain good core strength and stability. If you are lost in a sea of YouTube videos about which one is the best, fear not; just plank. There are a few plank variations I like more than others. As always, start on elbows and knees, focus on maintaining alignment of shoulders, hips and knees throughout, and do not perform any exercise that causes you pain. Side planks with a leg lift are a great two for one exercise. Core stability and hip stability in one! Shoot for 10-20 repetitions on each side. Front planks with alternating leg extensions are great too. They focus on keeping your trunk still with alternating leg movement, mimicking the demands of walking with a heavy pack. Do 10-20 repetitions at a time.

All of these exercises can be completed in your home without any special equipment in about 15 minutes. Everyone can make time for 15 minutes of stability and strength training. The standing balance exercise can even be done while waiting in line at Cost-co, just don't try the other ones there…people may question your sanity!

This is not a comprehensive list and by no means will address every impairment that you may have or guarantee an injury free hiking season. The only way to address your specific deficits is to see your PT and let them customize a program for you. Currently our healthcare system is pushing for more preventative health care. Let's translate this to physical therapy. PT's are movement experts and we love nothing more than to help people move better. If we can keep you moving well, hopefully, we can keep you pain and injury free. Wouldn't you rather see your PT a time or two now so you can avoid having to see them down the road after an injury or surgery? Prehab is typically not covered by insurance, however, if you compare the cost and benefit of a personal training session or two versus a couple sessions of PT, there is more value in seeing a PT. Physical therapists are highly trained individuals who typically have a clinical doctorate degree. You will gain insight into how and why your body moves and functions the way it does and what you can do to reduce your risk of injury. Our goal is to not have to see you again unless it is to enjoy a hike together. So call a physical therapist today and ask about a prehab program customized to your needs.

Agility Physical Therapy and Sports Medicine

(303) 773-0771

Preventative Rehabilitation for Orthopedic Surgeries

Prehab: It's not a typo for rehab.

You may have heard the term being tossed around by orthopedic doctors and rehab professionals. Prehab, an abbreviation for preventative rehabilitation, is the use of rehabilitation principles and strength training prior to any actual injury. Prehab can also be used to improve strength and endurance prior to a surgery with the idea that the stronger you are prior to surgery, the quicker you will recover.

Today, I want to discuss how prehab can help prior to surgery. In upcoming blogs, I will discuss the benefits of prehab for athletes of all types and the active, injury-free population.

Studies have found that prehab prior to abdominal or cardiac surgery results in fewer postoperative complications, shorter hospital stay and improved quality of life. Unfortunately, research has shown prehab and pre surgical education is not necessarily beneficial for orthopedic surgeries including total joint replacements. So those six PT visits your orthopedic surgeon suggests you complete prior to surgery are not always necessary.


So why am I talking about prehab if it is not beneficial with orthopedic surgeries? Often times, when surgery is imminent, a person will feel as though there is nothing they can do but wait. Control is lost over the situation, which can be scary. Having a concrete role in your health by having specific exercises to do, can give you some control back. PT's are also helpful with answering questions, decreasing anxiety and providing a support system during a stressful time. Being proactive about your physical strength and endurance will also give you a daily exercise routine. This will make it easier to be compliant with your exercise routine after surgery.

So is just going to the gym sufficient? Probably not. The most important part of a prehab program is to strengthening the key muscles in recover while minimizing pain. Your best bet is to get in and see your physical therapist.

What will Prehab look like? First, your physical therapists will complete a full evaluation and assessment. This will include gait and posture analysis, strength and flexibility testing, as well as balance and movement screens. After, a PT will be able to customize an exercise routine that is specifically tailored to address the weakness they uncover. Expect to have a 30-45 minute routine that you can complete 3-5 times a week. These can be exercises that you can complete in your home if you do not have access to a gym.

Don't wait until the week before a scheduled surgery to meet with your PT about setting up an exercise routine.The best time to start a prehab program is as early as possible. Two to three months prior to a planned surgery is ideal. This will allow for true strength and endurance gains and develop a strong habit of exercises. If you don't do this before a joint replacement, you will still have to do it after…it's your call.

Agility Physical Therapy and Sports Medicine

(303) 773-0771