Dallmeyer Difference Newsletters

Dallmeyer Difference: Sitting Posture (Sternal Syndrome)

July 15th, 2011


Sternal Syndrome:  

Sternal Syndrome is a condition in which the sternum becomes the weight bearing surface for your thoracic and cervical spine. To test this, sit in your chair and observe how you feel with regards to your weight bearing. Sit up nice and straight and encourage the weight to transfer into your spine. Hold your spine in this position by tucking your chin and bringing your shoulder blades gently back just a couple inches. This is the correct sitting position. Slowly let yourself slump forward and feel the body weight change from your spine to your sternum. This is incorrect sitting posture, and often becomes the position we find ourselves slumping to when we are not paying attention. This is not a good thing. It encourages overuse syndrome in hands and arms, tightness in pectoral muscles, biceps and forearms- especially the wrist extensors, and tightening and shortening of the wrist flexors. The dropping of the sternum and the weight bearing through the sternum further limits ROM of the rectus abdominus and increases the dynamics throughout the pelvis causing for increased low back extension.

Standing up straight is the name of the game. Exercises that promote full extension are recommended. Stretching of the rectus abdominus and the psoas musculature, along with the abductors, the chest muscles and the lower neck and anterior throat, are recommended and can be achieved through a variety of exercises. You can consult your physical therapist, talk to your pilates or personal trainer, or come by our office for a free assessment.


Exercise May Prevent Bone Marrow Cells from Becoming Fat Cells:

In a recent article written by Gretchen Reynolds in The New York Times, exercise may keep your bone marrow cells from becoming fat cells. In the article, Gretchen discusses how Dr.  Janet Rubin, a professor of medicine at the University of North Carolina, along with other researchers, removed bone marrow cells from mice and cultured them. These mesenchymal cells, found in animals and people, wait for other certain molecular signals to tell them to transform into either bone cells, fat cells, or less commonly something else.

Once a cell differentiates, it can no longer be anything else: once a fat cell always a fat cell, etc. When Janet worked directly with these stem cells, she was trying to get them to become fat cells. She bathed the cells in what she called a “sweet soup,” a medium infused with extra insulin and other elements that normally would encourage the stem cells to differentiate into fat. “They love to become fat cells,” Dr. Rubin said. “It’s discouragingly easy to nudge them into that direction.”

When the stem cells were stimulated with mechanical vibrations, or as they were exercised, did not all become fat cells. “There was a really striking difference in outcomes,“ Dr. Rubin said.

Many questions still remain, however one lesson is indisputable. Don’t sit still more than you need to, Dr. Rubin said, and don’t let you children loll about either. “One of the concerns raised” by these experiments,” she said, “is that if you make fat cells when you’re young, then you’ve lost any opportunity to have that particular cell be bone, “and the fat cell will remain just that, for life.


Bone Marrow

Dallmeyer Difference: Runner’s Knee (Patellofemoral Pain)

November 9th, 2010

A Runner's Stride

As you can see, within a runner’s stride there is a period of a time when both feet are off the ground and the runner is in mid air. Running is a single leg ballistic activity that is one of the higher levels of activity that a human being can participate in. It requires strength throughout the entire extremity, but specifically in the pelvis.

The highest frequency of pain problems for runners is patellofemoral pain as well as ankle and foot pain. Both of these issues can be avoided by educating the runner on the high level of strength needed in the gluteal and buttocks muscles.

One of the worst things a runner can do is increase in quad strengthening and focus on hamstring stretching. These two misguided focuses will allow the runner to keep his glutes and low back weak, his adductors tight and his kneecap compressed. This encourages a distorted foot placement during the running cycle and encourages foot problems. Runners need to learn and understand the progressive steps of dynamic strengthening for the gluteal musculature.

Enclosed is a test called the step down test. This allows a person to see how weak or strong their glutes are. Stand on a 4-6 inch step (or one slightly less than that) and then step forward with the right leg so that you are lowering yourself with your left leg. Keep your foot dorisflexed so that your heel touches the ground and then come right back up and put your right foot back on the step. If this is an easy exercise for you to do, you have a good start on glute strength. If you find yourself wobbling, your pelvis dropping or your balance being compromised and is difficult for you to do; you likely have a significant weakness in your glutes and are not ready for single leg ballistic activity. You will need to consult our therapy group for strengthening advice regarding a return to running.

Correct Step Down Test Posture

Example of Incorrect Posture

*(These pictures demonstrate what occurs with weak glute strength (left) and what occurs with strong glute strength (right) while performing the step down test.)

Health News:

Childhood Gymnastics Have Positive Long-Term Effects

Gymnastics, a high impact physical activity, has proven to have positive long-term skeletal effects when practiced during childhood and early adolescence.
A recent study observed girls who participated in gymnastics more than 6 hours of gymnastics training per week, for at least 2 years, pre menarche and found significantly greater bone mineral density (BMD) and bone mineral content (BMC) at the radius than non-gymnasts. These benefits persisted for at least 4 years post menarche.

This study, conducted by Jodi Downthwaite (SUNY Upstate Medical University, Syracuse, New York) and colleagues observed 14 non-gymnasts and six gymnasts who stopped training 6 months pre-menarche and one year post menarche (ex-gymnasts).

The data consisted of the collection of height, weight, calcium intake, physical activity, and maturation every 6 months after 4 years pre-menarche to 9 years post-menarche. The study participants also underwent annual dual energy X-ray absorptiometry scans to measure real BMD and BMC at the skull and radius.

Childhood Gymnastics

The researchers reported that the BMC was significantly higher in ex-gymnasts that in non-gymnasts.

Dallmeyer Difference: Low Back Pain (Illiopsoas Trigger Points)

September 3rd, 2010

Symptomatic Psoas

Above is a picture of a pain pattern of active trigger points of symptomatically tight illiopsoas.
The illiopsoas can be an absolute source of low back pain. People with tight hip flexors and who have the above described pain pattern probably have low back pain due to the illiopsoas trigger points.

Patients with symptomatic psoas will have pain lying supine with legs and hips flat. They will have pain coming from lying to sitting and sitting to standing. They have difficulty standing fully erect, but moving about afterwards will slowly influence correct posture and sharpness of the low back pain will decrease.

Weakness of the rectus abdominis and obliques recruit the psoas to over work and substitute. This will cause a sharp low back pain when coming from lying to sitting.

The function of the illiopsoas is that it initiates the swing phase for walking and running. In stance phase it is a low back stabilizer and maintains the proper lumbar curve. It also works with the multifidus to stabilize and prevent shearing and rotating movement of each vertebra. Because the illiopsoas connects the trunk to the leg, and is part of the illiacus; which is opposite the gluteus maximus, it must work in concert as a trunk- pelvic-leg stabilizer.

Health Tip of the Month:

Ginger May Reduce Muscle Soreness

According to a recent article, written by Jennifer Warner, on WebMD, ginger may be effective as a pain reliever with sore muscles.

The Journal of Pain revealed that a daily dose of ginger eased muscle pain caused by exercise-induced injuries. An experiment was conducted to take a look at the effects of two grams of raw or heat-treated ginger, in supplement form, on muscle pain caused by exercise in 74 healthy adults. The participants performed a variety of exercises designed to induce muscle pain over an 11 day period. The participants were divided into two groups; one which took the supplement and the other who took a placebo.

The results showed a 25% and 23% reduction in muscle pain for those who took the supplement.

Dallmeyer Difference: Home Exercise Programs

July 8th, 2010
4th of Julyu

Happy 4th of July!

In order to restore function and produce true stability and dynamic strengthening, the following exercise progression must be executed. Our staff is trained in this unique advanced method.
• Exercise Progression
• Non-Weight Bearing
• Uni-Planar Motion
• Sidelying abduction
• Bi-Planar Motion
• Clam Shell
• Tri-Planner
• Fire Hydrant

Weight Bearing
1. Double Limb Support (Includes 9 Exercises)
2. Single Limb Support (Static)- STAND ON SYMPTOMATIC LEG (14 Exercises)
3. Double Limb Support (Dynamic)- Therex should be around 45 minutes, utilizing mirrors/video; Pt. may be utilizing cllipitical and TM at 6-7% grade for cardio, walk with chains fwd-back, crab with band (10 Exercises)
4. Single Limb Support (Dynamic) – GOAL AFTER THIS PHASE IS 10 PROPER STEP-DOWNS (10 Exercises)
5. Double Limb Support (Ballistic)- MONITOR FORM (chest above knees, shoulders behind chest, cycs up), OBJECTIVE TESTING (measure jump height/distance) (4 Exercises)
6. Single Limb Support (Ballistic): Sports Specific Training (10 Exercises)

Home Exercise Programs

Do people do them? Do they work?

For many years, it was apparent that most patients were not performing their home exercise programs due to complexity or because of sheer boredom. We have devised a series of home exercise programs, for every patient, based on a limited number of movements directed towards the patient’s weakest area or area of concern. By educating the patient on the importance of these movements, they see results almost immediately, and become optimistic and motivated as their home exercise programs become more dynamic.

Many exercise programs have an array of therapy bands with which the patient performs the same exercises over and over again. Home exercise programs work if the exercises are done more for postural restructuring and creating some tension in the tissue, which gets them to a point where they become more active and able to pursue more dynamic exercises. The goal of a home exercise program should be a functional change and not the exercise. Once a patient can tune into the fact that the exercise makes them feel better, or maintain their flexibility so they are capable of more activity and exercise, they are much more willing to practice their exercises.

In conclusion, home exercise programs do work and patients practice them consistently if their programs are very specific to their problems and the results of their exercises restore function.

The Dallmeyer Difference: Knee Control

June 8th, 2010
Arthritis Walk 2010

Arthritis Walk 2010

Thank you for your Support!

With your help, Team Dallmeyer Physical Therapy was able to exceed our fundraising goal of $500 to $900 for the 2010 Santa Barbara Arthritis Walk!

Knee control comes from the butt…

It has been a common thought in physical therapy that if we wanted to gain control of the knee, we needed to strengthen the quadriceps. Dr. Chris Powers at the USC Biomechanical Lab has proven this false.

Not only does over strengthening the quadriceps not gain control of the knee, but it also encourages patellofemoral pain.

Control of the knee comes from the gluteus maximus and the rest of the smaller buttock muscles working collectively to provide appropriate control during the swing phase and heel strike of our gait
pattern. By having strong butts, we can control the placement of our foot as it hits the ground, as well as the forces that this produces, into an appropriate biomechanical plane as it travels from the foot past the knee and pelvis.

There is a specific series of exercises that go from mild non weight bearing to dynamic to single leg ballistic. These are meant to be done in a very progressive and careful fashion.