physical therapy

Secrets To Downhill Running

The thrill of bombing down a fast section of single track is part of why I crave the thrill of mountain running. For me, it is the closest thing I can get to flying.

But let’s face it...not ALL of us love downhill running. For those of us that don’t fancy the quad thrashing, knee aching, fear of falling, good time- there are a few secrets I am about to let you in on, that will take your descending from pounding to flying.

What The Heck Is Manual Therapy?

So you arrive to your first physical therapy appointment expecting to receive hot packs, ultrasound and instructions on how to complete a series of exercises. You think to yourself, "Dude, I have heating pads and ice at home. Is this really how I have to spend my next 6 weeks?"

From Defined To Refined

At the time, I was competing at the highest level of success ever experienced within my running career. The season had just started and I had kicked it off with 5 podium victories, a VO2 engine that was stronger than ever and the exciting anticipation that I had just began to scratch the surface of what I was capable of.  And then, like any great tragic irony (or so I thought at the time) I was struck with an injury that would alter the course of every single one of my goals. What I didn't know at the time was how it would also alter the course of my life.

Understanding Aging and Its Effect on Tissue Composition

In discussing wound care and tissue healing after injury, it only makes sense to add a note on the way soft tissue composition changes as the body ages.

The connective tissue of the skin is composed of collagen and elastin. Collagen offers tensile strength which provides a degree of stiffness and maintains structural integrity. Elastin is exactly that, an elastic tissue that allows for stretch and recoil without deformation.

Skin strength gradually increases by about 25% until the age of 30 and then remains at its strongest from 30-40 years of age. After 40, skin strength gradually decreases due largely to a decrease in blood supply to the skin as well as a slower rate of healing (regeneration).

Myofascial release, massage and skin rolling are all beneficial to promote blood flow to the skin and subsequently maintain optimal skin health. This also prevents adhesions from forming which cause dreaded cellulite. Supplemental collagen can be beneficial in order to maintain the nutrients necessary for the skin to regenerate. The purest form of collagen is powder because it is most rapidly absorbed by the digestive tract and contains none of the additives necessary to make it into a gel capsule or a “gummy”. (We recommend: Great Lakes Gelatin Collagen Hydrolysate)


While on the topic of aging, let’s talk about arthritis.


“Arthritis” is inflammation of a joint. There are two types of arthritis: Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis (OA) is a degenerative disease - meaning that it occurs gradually over time. OA is usually associated with mechanical wear and tear. Overuse or improper use of a joint (such as the knee for example) results in wearing down of the cartilage. There is debate over how much is too much (i.e. “running will give you arthritis” etc). There is no direct correlation between running and knee OA. However, it is known that the body responds to stress in different ways. Running, strength training (exercise in general) promotes stronger, healthier cartilage as the cartilage gains strength from being loaded and joint movement promotes synovial fluid movement for lubrication. No exercise results in soft, weak joints. Too much exercise (overload) creates too much stress to the point where the body cannot adapt fast enough and instead of an anabolic response (positive building) and catabolic response occurs (breaking down). Equally important is awareness of proper joint alignment - whether it be shoulder, hip, knee, ankle or foot! If a joint is not properly aligned due to weakness or tightness of the supporting musculature, stiffness of the joint capsule, faulty positioning of the joint below (think improper footwear)...the joint will not be able to dissipate force and will wear unevenly and much more rapidly.


  • “Early Exercise and Protection of the Growth Plates”

  • Body Alignment and Posture”


Rheumatoid Arthritis (RA) is a chronic, systemic inflammatory disease. The cause of RA is not definite but it is related to immune system dysfunction. RA does not affect the joint surfaces as much as it affects the joint capsules (the synovium). Inflammation of the synovium leads to the formation of  a “granular layer” and migration of “pannus” between the articular surfaces. This “pannus” turns into a tough, fibrous layer of tissue which can eventually ossify. The reason for the pain associated with the process is pretty obvious. SImilar to OA, maintaining strength of the surrounding muscles in order to maintain proper joint alignment will help prevent and/or minimize deformity.

Bone continues to remodel throughout life reaching its maximum strength in men and women between ages 20-29. From here, it is a gradual decline as bone is lost both in strength and amount - it becomes more brittle and less dense. The goal is to truly maximize the strength at its peak so that when the decline starts there is a long way to go before you hit the danger zone. This is especially important for women whose bone density is more dramatically affected by age (largely due to decrease in estrogen).

Ultimately, there is no “magic” pill. As much as we all want quick results and lasting change, it is truly the cumulative effect of exercise (or no exercise), of good nutrition (or bad nutrition), of caring for our bodies (or not caring) that ultimately determines our future health and well-being. Yes there are extraneous circumstances, but even so, everything we do for the better will only offer to benefit.

Create habits. Find balance.  

Growing Pains

Ocean Photography For Veer

Ocean Photography For Veer

The idea of “growing pains” is real! Many parents say that their kid seems to have grown over-night. That they literally wake up taller. And they do.

Growth hormone is an anabolic hormone (“building” hormone). It is produced in the pituitary gland and increases collagen synthesis, protein synthesis and cell proliferation. It is therefore responsible for increasing muscle mass and increasing linear growth. Growth hormone typically spikes during the night so the majority of growth (collagen synthesis, protein synthesis and cell proliferation) does occur at this time. This is also why kids wake up starving! They burn through all their energy stores while they sleep and need a good breakfast to replace the calories burned during the night otherwise they start their day completed depleted.

The process by which long bone growth occurs was discussed in our blog about “Early Exercise and Weight-Lifting”. Due to the spike in Growth Hormone and subsequent rapid linear growth in the long bones, extra stretch is placed on the muscles and tendons. The result is several painful disorders associated with growing pains. They all fall under the category of “juvenile osteochondritis” which translates “inflammation of the cartilage and/or bone”.

The most common is Oshgood Schlatter’s (OS). Most adults who had this as a kid remember it. Pain with running or jumping is pretty typical. There is a telltale bump on the bone below the kneecap. This is where the patellar tendon is being pulled away from its insertion because the long bones (tibia and femur) are growing faster than the patellar tendon and quadriceps muscle can stretch.

Sever’s is the next most common. The same thing is occurring at the Achilles tendon insertion on the back of the heel causing painful pulling and inflammation.

Osteochondritis is not something can you can just play through. Besides the pain, if the inflammation becomes severe and chronic enough, there is risk for an avulsion fracture. This is where the bone and cartilage becomes soft from ongoing inflammation and the tendon can actually pull off.

Most physicians will recommend rest from sports and activity which is the first step. Rest removes the aggravating factor, however, when sports are resumed, the problem will return. I have worked with many of these young athletes both OS and Sever’s are VERY manageable when treated properly. A skilled manual therapist can accelerate the recovery process by incorporating myofascial release techniques as well as kinesio taping to off-load the strained tendons. Stretching immediately will not help as it is already a problem of too much stretch. Once the tension has been taken off the muscles and tendons the inflammation will go down and pain will be relieved.

By definition, juvenile osteochondritis is a “growing pain” and will therefore be a present threat for as long as the athlete is growing and remains active. However, it is very treatable with good physical therapy and consistent foam rolling.

Did Your Insurance Provider Go To Medical School? Then Why Are They Dictating Your Health Care?

You, the patient, need to take control of your health and wellness as insurance companies will continue to manipulate the system and the providers within it. Ultimately this causes you, the patient, to be the one who suffers as access to quality care will quickly diminish.