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At GSM we are known to chant “Strong people are harder to kill!”, but how do we measure strength?  It is quantified with a term called one repetition maximum (1RM), which is the most amount of weight that you can move one time.  If this makes you think of high-level CrossFit athletes and Olympians, think again!  1RM can be applied to several different movement patterns that we do all day long such as squatting to a toilet, deadlifting a laundry basket, or overhead pressing our kayak onto the roof rack.  But what happens when getting off the toilet is so taxing that it is a max effort just to do it once?  That indicates a person is maxing out throughout their daily routine or operating at 1RM Living. 1RM Living is dangerous in many ways.  It puts us at a high injury risk by putting excess strain on tissues and creating tremendous fatigue which can increase our fall risk. It creates a big spike in blood pressure which challenges our cardiovascular system in a less than ideal way, and it slows recovery which keeps our tissue sore all the time.  Even Olympic powerlifters only train to hit their 1 RM a few times a year, certainly not every day!

The good news is that our tissues are highly adaptable, and we can improve strength at any point in our lifespan if we challenge ourselves appropriately.  Strength training increases our 1RM capacity so getting out of the chair becomes easy and allows us to get through our day without crossing that 1RM threshold.  This leads to better tissue resilience, better activity tolerance, and lower risk of injury.

Unfortunately, “strength training” is often a misunderstood term and is often incorrectly thought to be high repetitions of unweighted exercises. To be hitting the intended strengthening stimulus, we need to be fatigued by the end of short bursts such as 5 repetitions 5 times.  In a nutshell, this means load, load, load!  If getting out of a low chair is a 1 RM max for you, scale (adjust) back to using your arms so you can do 5.   As you build capacity and progress, you will no longer need to use your arms and then you’ll begin loading your squat by holding a gallon of water.  Next thing you know, you’ll be confident holding that adorable grandbaby while you pop out of your recliner!  Strength can and SHOULD be built from any level, whether it’s working on standing from a chair without using your hands or loading plates onto the bar.  Increase your strength to fend off 1RM Living; your body will thank you!

Co authored by Lexi Klawitter, DPT and Darcy Cook, MSPT

Summer hits full stride in July, when the sun supervises us with long days filled with family, friends, and the great outdoors. The July calendar comes ready-made with opportunities to improve our sleep, movement, nutrition, and overall mental well-being. Warning: Nerdy brain science ahead! Our bodies and brains can release many feel-good chemicals if we choose to tap into them. A few of our favorites are serotonin, dopamine, endorphins, and oxytocin. Serotonin is great for improving mood and sleep, while dopamine offers pain relief, happiness, and focus. Endorphins also offer pain relief and an overall calming effect, while oxytocin, the love hormone, is associated with feeling connected to and trusting others.

Events like the weekly Farmer’s Market not only provide fresh, local produce to fuel our fire, but also furnish a venue for socializing and walking outside which increases serotonin levels therefore boosting our mood! In addition, interacting with our awesome community and catching up with old friends releases oxytocin making us feel connected.

Have you ever wondered why you sleep so well under the stars? Camping just two nights improves your sleep cycle by providing a break from artificial light.  Additionally, enjoying some awe-inspiring mountain views raises oxytocin levels.  Maybe you are brave enough to undergo a cold-water blast from taking a dip in a cool lake or river.  This can cause a 2–4-hour release of dopamine into your system.  There are so many opportunities for wellness in the mountains!

From a 10-minute walk at lunch to working out at the city pool to bagging peaks and logging miles, intentional movement is a great way to release serotonin.  There are numerous ways for all of us in Park County to increase our feel-good chemicals this summer.  Dip your toe into wellness this July and start building momentum towards year-round wellness, one activity at a time!

                                                                                                            -Lexi Klawitter, DPT

Did you know that injury reduction is connected to how well we move, how strong we are and how good our cardio capacity is?   Starting to do some squats now can have a big impact on your hiking this summer.   Not only can you reduce the likelihood of an overuse injury (looking at you IT band!), but you are also less likely to tweak something if you do have a slip or trip.   Now is the time to start getting your tissues ready for an active summer!

Let’s discuss how to improve squat strength first.  If you can’t do a full depth squat, which is getting your bottom just below your knees, it might be appropriate to come see us and see what the limiting factor might be.   If you can do a full squat, start by doing higher volume and reps, for example 4 sets of 15 or 21-15-9 repetitions.   If that feels relatively easy, then add some weight which is referred to as a goblet squat.  That might be holding a full milk jug, a 15-pound dumbbell or maybe a 25# kettle bell.   Once that feels accessible, progress to doing step ups.  Start again with no weight and perform the higher reps and sets cycles.  As that becomes easier, add weights.   Keep in mind that if you are going to hike up to Pine Creek Lake with a 15# day pack you will be doing high step ups and step downs all day long!

Lastly, we need to build cardio capacity.  Although longer distance aerobic activity has its place, you can get more bang for your buck if you focus on your anaerobic system.  This involves performing short “sprint cycles” that last for 30-120 seconds followed by a short period of active rest (keep moving but catch your breath).  The “sprint” portion can be your cardio of choice:  brisk walking, biking, elliptical, running, etc.   For example, maybe you ride your bike hard to the end of the block, then recover for a block.  Or you can crank on your elliptical for 30 sec followed by an active rest of 30 sec.   The total time is under 10 min so it’s a great way to do a short, sweet (ish), super effective work out!

Head over to our YouTube Channel and check out the squat playlist with the progression lined out via videos.  If you have any questions or concerns or want more coaching on form and workouts, come see us! 

Hope to see you on the trails this summer!

                                                                                                                                -Written by Darcy Cook, MSPT

This is frequently the question I get when I tell people what I do. They are first confused by pelvic health PT, then by pelvic dysfunction, and finally that a physical therapist could even help with any of this. Let’s start with defining pelvic health PT so we are all on the same page.

Pelvic health PT is treatment of the pelvic girdle which contains both core and movement muscles. We look at your posture, your breath patterns, your level of tension within your body and how this affects your pelvic floor (PF). Pelvic health PTs have extensive education on the group of muscles inside your pelvic bowl and how they affect your bowel, bladder, sexual function, and core stability.

Dysfunction can be a scary word for people. In a nutshell, it means that an organ or system is not working properly. When this is in conjunction with the pelvic floor muscles, it can lead to pain in the pelvis, hip, or low back with or without movement, pain with bowel and bladder emptying, or pain with sexual activity. Poor bladder or bowel control may result in symptoms like incontinence or constipation. It can also contribute to difficulty with sexual activities such as erectile dysfunction or difficulty climaxing during sexual activity. Because we are all individuals, we all experience these symptoms differently and therefore PF dysfunction can have varying impacts to our quality of life.

If any of these symptoms ring true to you or if you have been dealing with chronic low back or pelvic girdle pain without finding answers, seeing a pelvic floor specialist may bring a whole new set of tools to the table to improve your daily quality of life. Pelvic dysfunction can present in many ways but sharing your story with a pelvic health specialist and trying a new approach can be beneficial to get you back out doing the things you love with the people you love.

-Written by Dr. Alison Shannon-Lier

One of my favorite comments from patients is “Don’t take this wrong, but this is not what I expected!” typically said enthusiastically with a tinge of hope in their voice.  I love this comment because it demonstrates that we do things differently at GSM.  Our team is always evolving and keeping things fresh to offer novel solutions to acute injuries and long-standing issues.

At GSM we are myth busters and offer data to help you understand our progressive style and recommendations. We push back when you are told an x-ray, that is describing age related findings, is explaining why your knee hurts and we offer an alternative explanation with a solution.  We are contagious hope dealers that know our bodies don’t have an expiration date and with appropriate physical therapy, we can feel and perform better at work and play.  This is what gets me fired up to continue working with patients into my 20^th year as a PT!

Over the past few years, data strongly support that most of our aches and pains are more connected to how strong we are and less connected to what the underlying tissue looks like.   That means that even if your x-ray showed “bone on bone arthritis”, maybe a knee replacement isn’t the best solution.  Or if you’ve been told you have degenerative disc changes in your back, it’s unlikely that these changes are contributing to your back pain.   This is not to imply you aren’t experiencing pain and dysfunction, but that there’s a solution that doesn’t involve aggressive surgeries.

I embrace this new information because it allows us to offer our patients alternatives and hope.  Instead of signing up for a knee replacement with a long and painful rehab, we can often resolve your issues by easing into some squatting and encouraging your tissues to be more resilient.  Even if your back x-ray showed degenerative changes, often the ticket to resolving chronic back pain is to improve your ability to hip hinge and pick up weight.  I personally appreciate this because I experienced decades of ongoing back flare ups.   I started strength training in my early 40’s, and now 6 years later, I feel strong and no longer experience chronic low back issues.   I can pick up a bag of dog food and swing it up to my shoulder easy peasy.  And perhaps best of all, I don’t feel like a stiff and sore old lady every morning when I’m getting out of bed!

Our team knows what it takes to be active Montanans and we practice what we preach. We have fun, active families that hike high, harvest their own meat, lift heavy, and embrace awe-inspiring views year-round.  The GSM team puts positive energy into everything we do, and we love to crush goals in and out of the clinic. 

So, after 10 years of business, I can say GSM has grown into more then what I expected and hoped for.  Thank you all for your continued loyalty and enthusiasm.  Let’s stay active together!

-Written by Darcy Cook, MSPT

Heads up!

Concussions are the most common form of brain injury in the United States with roughly 25% of individuals in the US having experienced one at some point in their lives.  This is a growing problem and knowledge on the effects concussions have on the developing brain continues to evolve.  Children ages 0-14 account for nearly half a million Emergency room visits a year due to this type of injury.  Concussions in high school students can lead to difficulty in school due to decreased attendance, struggles with concentration, and mood swings.  These factors can induce depression, anxiety, and have a negative effect on mental health.

What can be done to reduce the high level of stress a concussion places on a student?  Vestibular therapy proves to be a useful tool in aiding patients in their recovery by helping with symptom management, developing appropriate healing time frames, and building resilience to future injury.  Every concussion is a unique experience and even multiple injuries in the same individual may act differently.  A therapist trained in concussion management can help guide a patient’s healing, allowing their body time to heal to keep their brain safe from further injury or long-term effects.  Symptoms are often exacerbated with increased heart rate, eye strain, and excessive external stimulus.  It is important to listen to the body since reshowing of symptoms is one of the greatest causes of reduced healing post-concussion, and adds to the risk of post concussive syndrome.

Speaking with a healthcare professional can help navigate these murky waters.  Timeliness of proper care and procedures for safely returning to school and sport allow for the greatest successful outcome.  Brain injuries are scary, but we are here to help with symptom management, answer questions, and develop a plan to bring about the best outcome for our patients.  Heads up!  We got you!

Written by Jeffrey Smith, DPT, Vestibular certified therapist

I came across this graph several years ago and immediately embraced it!  Why do I love this you might ask?  Because it gives us hope.  We often incorrectly assume that being “healthy” is an all or nothing commitment and that until we hit certain self-imposed goals, we aren’t making the mark.  Rather than having a black and white mindset such as “I will only be healthy when_____”, think of it as a continuum.  I visualize this graph as an old school speedometer and encourage folks to make small changes to push that needle up!  Regardless of where you start, small changes can have a big impact on your health and your resiliency. Aging isn’t the absence of disease or injury; it is how well we weather these incidences.  The more you push the “Wellness” needle up, the better prepared you will be to heal and recover for whatever life throws at you!  

There are quite a few metrics that help us determine where we fall on this curve and therefore a lot of different pathways to improve our health.  Our culture often overemphasizes our body weight, BMI (Body Mass Index) or body fat, and although it is a reliable metric, it is one of many.  Rather than wait until you lose those 20 pounds, why not start weight training now and work on muscle mass?  Or start meditating for several minutes a day to decrease blood pressure?   Or maybe, do 20 pushups off the counter while you wait for your coffee to brew to maintain or improve bone density?  Or if you have tried to quite smoking unsuccessfully for years, implement a daily brisk walk to improve your cardiovascular system and be a more healthy smoker.  Sound like an oxymoron?  I say, sounds hopeful.

It is so empowering to have choices on our path to wellness.  Health is not a scripted flow chart but rather an individual journey.  With the new year coming up, perhaps self-reflect on where you might fall on this continuum and identify a small, reasonable metric you would like to address.  Check out our Facebook page or Instagram for more ideas on how to successfully implement behavioral change in the New Year!!!   

                                                                                                                                 Written by Darcy Cook, MSPT

As you blast through the chaos of a holiday week, keep in mind how awesome your exhale breath is for stress management (who doesn’t love to spend time with their extended family?!) and for bracing your spine (hello 20# turkey!) The next level in our series is spine stacking, formerly known as neutral spine. The idea is that you maintain your natural curves and then support them through bracing, not flattening your back (posterior tilting) as we used to teach people.

So, let’s keep it simple: keep your ribs stacked over your pelvis. Place your thumb on your lower ribs with your index finger pointing down and touching the top of your hip. We like to call these your suspenders (shout out to Vanessa at Livingston Pilates for that great idea) or measuring sticks if you go to Foundation Training at LivWell. Round forward and notice that your suspenders became shorter, no good. Next reach overhead and notice that your suspenders may have gotten longer. The goal is to keep your suspenders the same length all day long. 

Here is a great video by another science nerd discussing different way of thinking about it: the Two-Hand Rule. 

In summary, stack your spine, brace it and breathe into your diaphragm, and tackle this holiday week with style!

Written by Darcy Cook, MSPT

NPR featured a newscast this week that ties into our recent conversations about breathing and meditation. 

"There's new evidence that mind-body interventions can help reduce pain in people who have been taking prescription opioids — and lead to reductions in the drug's dose."  Read or listen to the newscast by clicking here.