Dr. Jessica Robinson, PT, DPT

Yay, you’re having a baby! While this time will come with many changes, your exercise routine doesn’t have to be one of them. The days of doctors telling you to sit back, relax, and avoid exercise during pregnancy are a thing of the past (unless under certain conditions, i.e. being placed on bed rest). These days exercise is encouraged for women who are going through an uncomplicated pregnancy as it has been shown to have many benefits. These include helping to reduce common pregnancy complaints such as back pain, boosting energy level/reducing fatigue, reducing the risk of gestational diabetes and pregnancy-related high blood pressure, and it may even help reduce the risk of postpartum depression. Regular exercise can also help prepare you for the labor and birthing process by increasing muscle strength and stamina.
 
            It is always important to listen to your body while exercising. Things you may have been able to do prior to pregnancy and in the first trimester may be very different from what you are able to do and feel comfortable doing in the second and third trimesters. Safety and comfort are always key, and you should err on the side of caution if ever questioning whether to keep doing an exercise or activity. You should also avoid activities that may result in a fall or traumatic injury. Asking yourself the question “should I?” rather than “can I?” can set you on the right path when choosing exercise activities or considering modifications to ensure a safe and efficient pregnancy and postpartum recovery. Every person and every pregnancy is different, and you should always consult your healthcare provider regarding your exercise routine during pregnancy.
 
            As you progress through your pregnancy, you may find certain moves or exercises become more challenging or just don’t feel good. For the rest of this blog, we will talk about ways to modify general exercises and common CrossFit moves. It is important to maintain good communication with your coaches to let them know how you’re feeling on a day to day basis. They are also great advocates and can help with appropriate modifications as needed.
 
When making modifications to a CrossFit or general exercise routine, keep in mid these suggestions. Change the reps and/or weight: avoid overdoing it and creating excessive fatigue as well as lowering reps/weight with more of a focus on form and safety. Change the intensity: again, avoid creating excessive fatigue and go for quality over quantity to ensure proper breathing and muscle control. Change the exercise: substitute for a different exercise that is safe and more comfortable. Below are some examples of common exercises and modifications that can be made.
 

• Pushups: pushups to a box

• Deadlifts: swap barbell for dumbbells or a kettlebell or try a sumo stance if your belly starts to interfere with your thighs

 

• Burpees: up downs or step backs to a box

 

• Cardio: swap running for rowing or biking if comfortable

 
With barbell movements, you may need to modify the bar path starting in the second trimester. However, if this starts to compromise for or safety, opt for making it a two-handed movement instead by using kettlebells or dumbbells. Other modifications for barbell movements can include starting in the hang position and ending in the power position if you experience pain, pressure, or discomfort with full squatting. The Valsalva maneuver (holding your breath during heavy lifting) should also be avoided to prevent excessive pressure on the abdomen and pelvic floor as well as the risk of elevating blood pressure. Instead, use the “blow as you go” technique: inhale during the descent of a lift, and exhale as you rise.
 
Exercising and CrossFit during pregnancy can be completely safe with the appropriate pacing, progressions, and modifications. Remember to stay hydrated and replace fluids lost during exercise. Modifications are not something to be looked down on or discouraged, and not every workout will feel great or perfect. That’s okay! Always remember to give yourself lots of grace during this time. You’ve got this, momma!

Performance Coach Amy Nguyen, CF- L2, USAW L1
B.S. Foods & Nutrition, M.S. Exercise Physiology & Nutritional Sciences ​

Regular physical activity has been shown to help prevent and manage diseases such as heart disease, stroke, diabetes and several cancers. Also aiding in prevention of  hypertension, maintenance of healthy body weight and improving mental health, quality of life and well-being.
​

Annemarie Alf, PT, DPT, CSCS 
Owner/ Founder/ Doctor of Physical Therapy Olympus Movement Performance

​I wrote/ shared a blog on this topic about 4 years ago. 
The question has come up time and time again recently – why don’t you accept my ‘health’ insurance?
 
This is WHY?
Have you ever been to ‘traditional’ Physical Therapy and felt like you’re just a number, and NOT a person OR like it didn't really work, this post is for you.
There IS a better way!
I would say that the majority of new clients that we’ve seen, tried the typical PT office and have not gotten any or minimal results.
 
We want to educate you as much as possible on why you should consider paying out of pocket next time you need Physical Therapy.
 
Like most Physical Therapists, I began my career working in a traditional clinic and quickly realized that healthcare in this country is very broken.  Therapists are tied down by the rigid rules of insurance companies, poor reimbursements, and unable to use their knowledge and skills they have to truly help every patient that comes through the door the way they want to.

​WHAT IS CASH BASED PT?
This means that your physical therapists do not accept insurance (in- network) and they work solely on a private pay basis.
And guess what-- it's not as expensive as you think, and it's important that you know why it's worth every penny!
Yes, you are paying out of pocket, but you are getting a high quality, personalized one- one experience in return.
In many cases cash-based PT can and does cost even less that using your insurance.
 
Most of us usually don't think twice about going out to buy nice workout clothes, healthy food, or other self- care treatments, BUT when it comes to paying out of pocket for better healthcare, we suddenly question it.
Remember-- your health is worth it and is the best investment you can make.
It's time to change the conversation around cash-based PT, because the reality is that it is a very affordable and effective way to get you back to doing all the things
you love.

​So here are my top 10 reasons why cash based Physical Therapy might be for you:
 
1. More one-on-one time with your therapist.
This is 100%, without a doubt, the most important piece to me (and most of my patients as well)!  When you are not worried about billing insurance companies and being reimbursed for your time, you suddenly have much more of it to give to your patients. There are typically no aides or trainers involved in your session, it is all time spent with your Doctor of Physical Therapy. Most DPT's went into this business because they love working with and helping people. This therapy approach really allows us to get back to the reason we became DPT's in the first place- and you reap the benefits!
 
2. More personalized attention.
When you are working one-on-one with your Doctor of Physical Therapy, I can assure you the care you are getting is far more personalized than it would be otherwise. Your therapist won't be running back and forth between patients, the focus is 100% on you. This allows us to really assess each of your movements and adjust based on what is happening during each exercise. The result is a completely individualized treatment plan to correct your specific muscle imbalances and help you get better faster!
 
3. Builds a strong patient-provider relationship.
Now, I know this one may sound a bit redundant but it sure is important. When you are being treated in a cash-based PT setting you build a strong relationship with your therapist. You are probably going to be spending a lot of quality time together and end up feeling more like friends in the end. Trusting your therapist has a huge impact on your healing and having the opportunity to get to know each other one-on-one really allows for a deeper sense of trust to develop. All of our patients have my cell phone number and know I am always "on call" and they reach out whenever they need me. Most cash-based PT's I know do exactly the same for their clients/ athletes too .
 
4. Yes, It may actually save you money in the long run.
Quality over quantity is an important concept here. More one-on-one time with your DPT means we don't need to see you as often. On average, we only see our patients 1x/wk but it is for a full hour. Sometimes we need 4 visits, sometimes its more. Either way, it gives you plenty of time between sessions to work on your home/ gym program and start to see some results. More importantly, it empowers you to put in the work which = getting better, FASTER. With a less frequent PT schedule, this often works out to be much less than using your insurance.

Take this scenario for instance: a patient with a high copay of $60 per visit who needs to go to PT 2-3x/wk for 8 weeks will spend close to $1000 over the course of their care. During their visits, they are likely only spending ~20 minutes of actual one-on-one time with their DPT. That's a lot of money and time for little reward.
If that patient instead chooses a cash-based PT practice that charges $150/visit and needs only 6 visits, you are looking at $900. The math is a no-brainer!!
 
5. More freedom to address multiple issues at the same time.
While it is extremely unfair, insurance companies strongly dictate if you get better or not based on what they will approve. Did you know that under insurance DPT's can only bill for treating one body part at a time? That means that you would need 2 separate evals and visits each week to be able to bill your insurance for your knee and your shoulder problem. In some cases, your DPT may be able to justify it. They just better be prepared for a lot of extra paperwork, which really means less time for personalized patient care. Crazy right!? In the case of cash-based PT-- not an issue! We can treat whatever issues you are having without you needing to worry about it being denied by your insurance. Again, the outcome is you getting better faster because you are getting the care your DPT knows you need.
 
6. More freedom to explore the root cause of the problem.
With longer one-on-one appointments and not worrying about insurance approvals, your DPT can perform a thorough assessment of strengths, weaknesses, imbalances and how you move. This means we have a full picture of what is going on. It may be your hip that is pinching, but WHY!? Maybe you don't have a strong core or your upper back mobility is limited. So we work on all of these areas and make sure to address the reason it happened in the first place. This results in you living pain free and preventing issues from returning in the future. No trying to explain this to an insurance company just to get denied.
 
7. Many insurance companies reimburse for out-of-network PT.
Depending on your out-of-network benefits, your insurance company may actually reimburse you for your visits! Just make sure you get a superbill from your DPT that you can submit to your insurance company.
At Olympus Movement, we always provide my patients with a superbill on request.
In addition, you also always have the option of using your HSA/ FSA cards as well.
 
8. More flexible scheduling means getting more of your time back.
It is no secret that time is our most precious commodity, and we can’t get it back. Only needing to see your DPT once a week gives you more time back to do whatever you love!
At Olympus Movement, we try to give you back even more of your time by getting you back to the field, gym, or activities that you love.
 
The last 2 are my favorite...
 
9. Empowering you to help heal yourself.
A good Doctor of Physical Therapy will not "heal you" they will teach you to help heal yourself. Physical Therapists do not want you to use us as a crutch, we want you to take your health and wellness into your own hands. You have the power to help heal yourself, we just give you the guidance you need to get there. By choosing cash based PT, you have already taken a huge step towards empowering yourself, because you have made the commitment to invest in your health. The truth is, patients who pay out of pocket are far more committed to their treatment plan because they have paid their hard earned money for it.
 
10. Your health is worth any amount and is the BEST investment you could ever make.
It is simple, you only get one body and one chance-- take care of it!!
All of this really comes back to one main point.
Cash based Physical Therapy has the ability to provide you with the highest quality of care. Aren't we all looking for a better experience with health care these days? I can promise you that high quality, affordable care still exists and your insurance company does not have to be the barrier.
For me, 10 years later, I could not be happier with the choice that I made to leave traditional clinic life behind. As with most DPT's who switch to a cash based model, my intentions have always been to put our patients first and give them the care they deserve. I can now say with certainty that we are able to provide them with a better patient experience than they would get anywhere else.
If you are considering cash based Physical Therapy for yourself, start with a simple Google search for DPT's who may provide this in your area. I highly suggest taking advantage of a phone or in-person consultation so you can get a better feel for if this is the right way to go. In the end, its all about fulfilling your individual needs. Stay informed, do your homework and know that there are still so many health care providers out there who truly care about helping you live your best life!

THE ANSWER IS YES...
BUT KEEP READING !!! 

Coach Jamie

This is a question I have been asked by parents many times over the years and my answer is always the same: YES!. Weight training has not been shown to stunt the growth of children, and actually promotes the growth of healthy and strong bones in addition to many other benefits. 

In my experience, parents' main concern for their children when it comes to weight training in a gym is the potential to break a bone or growth plate. While the concern is valid, if a child is in a controlled environment, with a good coach who has experience working with kids, and the child is coachable, then the risk is extremely minimal. In fact, kids are more susceptible for injury while playing their sport without proper strength training. This is largely in part because of the many benefits strength training has to offer such as: 

• Increased bone density
• Improved Flexibility 
• Improved stability
• Improved body control
• Improved speed and power
• Improved balance
• Improved coordination
• Improved strength

In addition, when comparing sports and number of injuries sustained in those sports, weight lifting does not make the top list of sport related injuries according to Stanford Children's Health. According to Stanford, the sports that have children sustain the most injuries are:

• Basketball- in 2009 more than 170,000 kids were treated for basketball related injuries
• Baseball/softball- 110,000 children ages 5 to 14 were treated in hospital emergency rooms for baseball-related injuries.  Baseball also has the highest fatality rate among sports for children.
• Bicycling- More than 200,000 children ages 5 to 14 were treated in hospital emergency rooms for bicycle-related injuries.
• Football- Almost 215,000 children ages 5 to 14 were treated in hospital emergency rooms for football-related injuries.
• Ice Hockey
• Roller Skating
• Skateboarding
• Sledding
• Snow skiing or snow boarding
• Soccer
• Trampolines

While most of the sports in this list are organized, there is still risk of injury in even unorganized sport as indicated by the list above. So if the risk is so minimal for weight training and kids, why are parents so concerned?

Again, in my experience, when parents approach me about weight training for their children they are quick to mention, “but just not crossfit.” It is very common now for parents to think of or maybe even expect a crossfit style environment when they walk into some gyms. As I mentioned earlier, children should be training in a controlled environment, with an experienced coach and in a private or semi-private setting. The coach needs to have a plan and be able to explain and demonstrate to children how to perform various movements. Typically this is done first under no weight or very little weight. As the child progresses over time, the difficulty and intensity of the exercises can increase should the child demonstrate proper form with little deviation. 

After looking at the risks of children playing in both organized and unorganized sport vs weight training, it is easy to see that in the proper setting, weight training offers very minimal risk to children and is safe. In fact, the benefits of weight training can even decrease the risk of injury associated with most sports by creating better, stronger, healthier athletes in children. 

Dr. Jessica Robinson, PT, DPT 

​The short answer: yes! Weight training can have a multitude of benefits for dancers and gymnasts alike. Weight training is not a new concept for these two groups and has been slowly gaining traction over recent years; however, it does still come with some uncertainty and occasional controversy.
 
Traditionally, conditioning and cross training for dancers and gymnasts has consisted of Pilates, yoga, band work, and mainly body weight and/or sport specific exercises. While these forms of conditioning are still good options and have their place, it has been shown that they are not sufficient enough to reproduce the forces placed on the body during training and competition activities. For example, in gymnastics, forces being applied to the body when doing skills or landings can reach upwards of 15x that of body weight.

​The reason weight training can produce greater increases in muscular strength and endurance than body weight exercises alone is the fact that weight training results in a larger recruitment of muscle fibers. Tailored programming can also help to develop the neuromuscular systems in the body to increase both the activation and efficiency of muscle groups. Other specific benefits can include:

• Increased endurance
• Increased jump height
• Increased cardiovascular capacity
• Improved speed and power
• Improved bone density (helps prevent osteoporosis)
• Reduced risk for injury

Consistent strength training also creates a stronger foundation from which dancers and gymnasts can work. When dancers/gymnasts are well-prepared for the demands of their sport, they are better able to focus on the artistry and enhancing technique rather than on the ability to merely complete the movements.
 
With so many benefits, the real question is why aren’t dancers and gymnasts weight training more often like we see in other types of athletics?? There are some common myths associated with weight training amongst both these groups that we’ll go ahead and address.

• “I will get bulky”

One of the most common misconceptions about weight training is that it will make you look “bulky”. Sports that historically have a larger emphasis on aesthetics tend to shy away from weight training due to this (although, this is also changing, thankfully). However, the reality is that putting on enough muscle mass to “bulk up” is actually a lot harder than you would think. It requires detailed attention to a training and nutrition program with the appropriate number of sets/reps and progressions. Lifting weights a few times a week will make you stronger but is not going to create huge changes in muscle size.

​

• “I will lose flexibility”

Another misconception is that athletes will lose their flexibility by lifting weights. This can be seen as a concern in sports such as these where greater than normal flexibility is required and desired. However, contrary to popular thought, lifting weights when executed properly and through the full range of motion will not only maintain but can actually improve mobility/flexibility. By general rule of thumb, our bodies will not allow us to increase motion until we can control what we already have.

• “I will get injured”

In reality dancers and gymnasts are more likely to be injured in their sport than they are while cross training or conditioning. Most injuries occur from overuse. Studies show that dancing for 5 hours a day or more can lead to an increased risk for stress fractures and other injuries. So when our only conditioning consists of sport-specific activities, we are just adding to that repetition. The reality is that yes, if you lift weights the wrong way without attention to proper programming or technique, then you are susceptible to injury. However, with the appropriate guidance/coaching, the risk for injury is actually quite low.

• “I won’t be targeting the correct muscles needed for my sport”

There is a common fear that with any sort of weight training or conditioning, dancers and gymnasts will over train muscles that aren’t the primary ones needed to carry out the movements they perform. The problem with this, however, is that we need a balance in strength between all of our muscles. When there is an imbalance, we tend to end up with less than ideal movement patterns which can ultimately lead to injury.
 
            As we can see, weight training is definitely an effective way to enhance performance in both of these sports. While it is effective for building strength, it is important to note that it is only one aspect of cross training/conditioning. It should not be seen as a replacement for other forms of conditioning or dance/gymnastics specific training but rather as a compliment to bring about greater results, creating a well-rounded and more resilient athlete/individual.

​If you are interested in learning more about how weight training can enhance your sport performance, feel free to contact us!
           
 
 
Sources:
1.     Lauersen JB;Bertelsen DM;Andersen. “The Effectiveness of Exercise Interventions to Prevent Sports Injuries: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” British Journal of Sports Medicine, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/24100287/.
2.     Brown, Andrea C., et al. “Effects of Plyometric Training versus Traditional Weight Training on Strength, Power, and Aesthetic Jumping Ability in Female Collegiate Dancers.” Latest TOC RSS, J. Michael Ryan Publishing Inc., 1 June 2007.
3.     Iversen VM;Mork PJ;Vasseljen O;Bergquist R;Fimland MS; “Multiple-Joint Exercises Using Elastic Resistance Bands vs. Conventional Resistance-Training Equipment: A Cross-over Study.” European Journal of Sport Science, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/28628370/.
4.     Koutedakis, Yiannis, et al. “(PDF) Muscular Strength: Applications for Dancers.” ResearchGate, https://www.researchgate.net/publication/44392574_Muscular_Strength_Applications_for_Dancers.
5.     Shift Movement Science. Ultimate Gymnastics Strength Guide.

Mikaela Isa, Performance Coach 
​
Stress is a fact of life, unfortunately our body doesn’t differentiate between emotional and physical stress. It’s important to understand what is happening inside the body when stress occurs to support our health in the best way possible and optimize recovery! We must learn how to stop and listen to the cues our bodies are giving us before it takes over our most essential functions. When you get stressed your body produces a hormone called “cortisol”. Cortisol is a steroid hormone that is produced by the adrenal glands which sit on top of each kidney. When released into the bloodstream, cortisol can act on many different parts of the body and can help your body respond to stress or danger.
 
Most bodily cells have cortisol receptors, it affects many different functions in the body. Cortisol can help control blood sugar levels, regulate metabolism, help reduce inflammation, and assist with memory formulation. It has a controlling effect on salt and water balance and helps control blood pressure. After the pressure or danger has passed, your cortisol level should calm down. Your heart, blood pressure, and other body systems will get back to normal. But what if you’re under constant stress and the alarm button stays on?
 
It can derail your body’s most important functions. It can also lead to a number of health problems, including:
●    Anxiety and depression
●    Headaches
●    Heart disease
●    Memory and concentration problems
●    Problems with digestion
●    Trouble sleeping
●    Weight gain
 
In order to combat stress and get back to our relaxed state we need to activate the parasympathetic nervous system (rest and digest). Stress has the sympathetic nervous system (fight or flight) activated and as we’ve seen above, being in that state for too long can cause lasting health issues.
 
How can we activate the parasympathetic nervous system?
 
●      Deep Breathing
           Set a timer for 5 minutes, put your feet up on the wall and focus on deep breathing in through your nose to fill                your belly with air for 5 seconds and then slowly exhale out your mouth for 5-7 seconds.
●Touch your lips gently with your eyes closed, pay attention to how it makes your belly feel. Your lips have parasympathetic fibers spread throughout them, so touching them activates the parasympathetic nervous system.
●      Take a bath!
●      Light aerobic exercise
         ○.     Yoga & Stretching
         ○.     Talk a walk
 
What else can I do to help de-stress?
 
●      Organize your thoughts and tasks, make a list of what you need to do and prioritize it by  giving each task a         
         deadline or goal of when you want to accomplish the task. This tells your subconscious a few things.
         ○      You will get what you need to get done.
         ○      You won’t forget what you need to do.
         ○      This gives you something to work toward and achieve, it will not only be rewarding but it will bring a sense of
                  purpose to your day/week.
●      Get the right amount of sleep. 7 hours+ to help your body recover from the stress you face mentally, emotionally
         and physically.
●      Recognize stressful thinking - “stinkin thinkin”
Some are naturally more negative than others, some are more positive. Each way of thinking has its place and the right balance can have your mental state singing harmonies. Too much one way or the other and it causes an imbalance. Particularly dwelling on negative thoughts, emotions or making up scenarios in your head (no you’re not the only one who does that)
            ○      Journal - writing out your thoughts can be an escape. This is especially helpful for emotional stressors, it
                     can be just as helpful as talking to an old friend.
             ○      Write a bible verse or an affirmation for yourself and put it where you can see it.
●      Learn to say no to things you don’t have time for,  you do not need to do it all.
●      Take a break when you are overwhelmed. This could be 5 minutes or this could be a season of life where you take a break from added responsibilities.
 

BUILDING THE FOUNDATION: THE DEEP CORE STABILIZING SYSTEM
​Annemarie Alf, PT, DPT, CSCS, SFMA

Back problems are slightly more common in adult women than men; nearly 55% of the adult population suffers from LBP.

​What are the symptoms of lower back pain?
Symptoms of lower back pain can come on suddenly or appear gradually. Sometimes, pain occurs after a specific event, such as bending to pick something up. Other times, you may not know what caused the pain.