Learn More About Your Body

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

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.

Halloween has come and gone, so you should probably put that mask and cape away.  The GSM team thinks YOU can be your own superhero any time of year and we want to replace your cape with our new wristband!

It turns out we breathe a lot, all day long, and if we aren’t doing it correctly we may feel the results of poor spine stability, poor oxygen exchange and poor stress tolerance. The hardest part of intentional breathing is incorporating it into our daily lives and making it our new normal. But how do we remember to do it all day long? 

First, you could use pain as a catalyst for change. Do you have neck tension? Use that as a reminder to exhale longer. Or maybe your low back gets sore? Use that as a cue to maintain abdominal tension and breathe into your lower back ribs.  

Do you perform certain activities regularly? Identify an activity that you can use as a cue to focus on breathing and bracing. Washing dishes, commuting to work, picking up your grandchild, moving hay bales, or lifting weights are all actions that would be enhanced with bracing through breath.  

Or even better, stop by the clinic and pick up a GSM wristband that has the words right on it: Brace! Breathe! Not only will it remind you to focus on the techniques, you will feel like a GSM superhero. 

Our next topics will include stacking your spine and hip hinging, so stayed tuned over the next few weeks to build on this knowledge. In the meantime, build your foundation!

Go superhero! Go!

In case you didn’t pick up on it, I've been on a kick to spread the word on how beneficial bracing and breathing is for our wellbeing. Why am I so fired up? Because it has helped me tremendously with my back issues! I can say with a few small changes in the past couple years, I feel stronger and have less pain at 45 years old than I did at 35, and I want to share this information with everyone!

Our recent blogs on breathing and bracing may seem like information overload, but the primary message is simple.

- Focus on your exhale breath to create abdominal tension, which will calm down your nervous system.

- Then inhale into your lower back ribs.   

Now of course, this is much easier said than done and is a motor skill that needs to be learned, practiced and integrated into your daily activities. I always use the analogy that intentional breathing is no different than learning to play an instrument. You need to practice your chords before you can strum with John Mayer.  Know what I mean?

Start in the position that is most comfortable for you: on your hands and knees, lying on your back, or standing with your back against the wall. Use the trick we talked about last week and place a belt around your lower ribs for tactile input to inhale into your lower back ribs.  Practice this often throughout your day to create the new motor pattern. Once it becomes easier and more accessible, integrate it into a static activity such as standing at the kitchen sink or while driving on your commute. (Remember exhale breath is great for stress and neck tension!) After some time you can incorporate it into higher level activities such as hiking or lifting hay bales. Then all of a sudden, you may notice that you feel stronger with less spine pain, have more tolerance of cardio activities and have less stress. Eureka!  See why I’m fired up?  

Written by Darcy Cook, MSPT

Last week we introduced intentional breathing and today we are going to continue to expand on how proper bracing and breathing can make significant impacts on your health. If you’ve been practicing your exhale breath this week, you may have noticed less neck tension, improved posture and hopefully a sense of calmness! Another awesome benefit is the recruitment of your abdominal muscles or what we refer to as “bracing”.  Recruitment simply means connecting to your muscles, or turning them on. Did you happen to notice that you were engaging your abdominal muscles while breathing intentionally? It was happening, even if you didn't tune into it.

I’ve been practicing for more than 17 years and I’ve seen the label “core exercises” applied to all sorts of activities (from sit ups to back extension machines to sitting on a therapy ball).  I have great news for you: bracing is much simpler than all those crazy core exercises. Recruiting our core muscles is more about sequencing than it is about doing some complicated exercise, and the exhale breath is the first step of the sequence. So instead of doing 100 sit ups every day (which makes your six pack look amazing, but offers your spine zero, let me say that again, zero stability), let’s just focus on the muscles that turn on at the bottom of the exhale breath and keep them recruited while you inhale. 

You might think that this would be easy, but it can be a difficult motor skill to master because the majority of us are not using our diaphragm to inhale. Think about how you’re breathing right now. Are your shoulders moving up and down or is your chest rising? The diaphragm is a horizontal disk-shaped muscle at the bottom of our rib cage that contracts when you inhale creating a vacuum effect to pull air into your lungs. Your spine needs to be in an ideal or stacked position for the diaphragm to function and there must be some abdominal tension for the diaphragm to contract. We’ll talk more about “stacking” later. 

Stick with me on this because I know it’s a difficult concept to get your head around, but when you do it can be life changing. Picture sitting on a stool and pushing off the ground with your feet to spin. Your feet represent your diaphragm and the floor is your abdominal tension. Now try to spin without pushing off the ground. Hmmm, not an option right?  If you don’t have some light tension in your abdominals, your diaphragm has nothing to push off from and thus, throws its proverbial hands up in the air and turns off. 

For years I taught my patients to belly breathe, or let your stomach rise or pooch out when you inhale. However, the new research shows us that the diaphragmatic breath involves us inhaling into our lower ribs, especially towards the sides and back. We will continue to discuss breath in more detail over the next few Thursdays, so stay tuned!

For now, exhale completely, feel that tension in your abdominals, and try to maintain about 20% of that tension as you inhale into your lower side ribs. For the tactile learners in the group, put a belt around your lower ribs and cinch it down at the bottom of your exhale. When you inhale, push your lower ribs into the belt throughout the entire circumference. The inhale movement should be in your lower ribs, and if you're maintaining tension in your abdominals, your chest and your belly should not lift. 

Not only does abdominal bracing and diaphragmatic breathing increase spine stability and decrease spine pain, this action sharpens balance, enhances digestion, and boosts your ability to completely fill your lungs. This improves the oxygen exchange throughout your body, which is especially good for you in high altitude areas, and can help to enhance your mood, decrease anxiety and even boost your immune system.  Awesome, right?

Written by Darcy Cook, MSPT

On average, we take about 20,000 breaths per day. Yet how often do we really consider how we’re doing it? Breathing has a profound impact on neck pain, spine stability, digestive health, and stress response, just to name a few. 

Let’s start with the basics. Breathe normally for a few moments. Notice the sensations as air enters through your mouth or nose, fills your lungs and leaves your body. This “intentional breathing” is very calming for your nervous system and counts as meditation.  

Now let’s take it to the next level by focusing on making your exhales longer than your inhales. Exhale completely and pause before you inhale through the nose. Then slowly exhale through the mouth again pausing before the inhale. Try practicing this for a few minutes when you can throughout your day. Breathe intentionally while you are driving, walking the dog, or doing house chores and appreciate how favorably your body responds.  

Next week, we will discuss creating abdominal tension and correct diaphragmatic breath as you inhale. You’ll be amazed at how beneficial breathing can be!

Healthcare is constantly changing, which can be daunting to most people. The GSM team is made up of self-proclaimed super nerds and we find the majority of the changes really exciting. Common phrases heard around our clinic are “Do you know what I just read?” and “I can’t wait to share this podcast with you.” We read peer-reviewed journals, attend outstanding continuing education classes, and work closely with our colleagues to improve our skills. We’d love to share relevant information with our family of patients to help you live your best life!

So, let’s make a deal. We do the research and you get the short version written in a language you can understand. We have a lot to talk about and we want to make sure you don’t miss anything. Visit http://www.granitesportsmedicine.com/blog/ to sign up for specific topics you may be interested in or have them all sent to your email inbox.

Look for Email Notifications on the right side of the page near the bottom. You get to choose your level of nerdiness, but you know at GSM, we're all in. If you’re into social media, you can also follow us on Facebook or Instagram.  Follow us, we have lots of cool things to share!

2017 was a whirlwind of activity, benchmarks, and growth at Granite Sports Medicine (GSM). We celebrated our 5 Year Anniversary and this year’s activities reflect the growth and breadth of our services and community involvement. We’ve really hit our stride with an amazing team of dedicated professionals who work together like champs to provide personalized and specialized physical therapy to our clients. We’ve upgraded our front desk process and restructured our administration to provide even better service and efficiency. Thanks to everyone who’s been part of this year’s celebrations, support, wellness, and learning. 

Highlights from 2017 include:

- At the 2017 Prospera Business Network’s annual Business Excellence Awards we were honored to receive Montana Women’s Business Center’s Start-Up of the Year. 

- GSM sponsored various teams and activities throughout the year, including the Western Sustainability Exchange’s Farmer’s Market, Livingston Parks and Recreation youth basketball team and Ultimate Frisbee with GSM’s Alison Shannon-Lier. You’ll recognize Alison and her family participating in nearly every public athletic activity in the community!

- Darcy Cook, in her ninth year of giving injury prevention workshops to fire and trail crews, worked with crews at Grand Teton Park, Yellowstone Park, Gallatin Forest service, and Zion National Park employees.

- For our 5^th Anniversary, we celebrated for a full month with giveaways and contests and capped it off with a fun Cinco de Mayo party. Thanks to all of you who showed up to celebrate!  

Building on this year's successes, we look forward to continuing our momentum. After hosting our first continuing education class 2017, we will offer more classes in 2018 including the popular new Mobility|WOD; a guide to resolving pain, preventing injury, and optimizing athletic performance and a Level 2 KinetaCore Dry Needling. We will create an online registration and payment system on our website in the coming year further streamlining the registration and payment process, and continue to offer a Prompt Pay Discount, increasingly necessary for the uninsured and underinsured with high deductibles.

GSM’s Darcy Cook is a popular annual presenter at Park High’s Trades Day and will go to Bozeman High in January this year and share some physical therapy inspiration with students interested in the medical field. Physical therapist Max Bartlett is working with Cross Fit coaches to help their athletes prevent injury, and Pelvic Floor specialist Alison Shannon-Lier is furthering her education with male-specific pelvic floor classes and is seeing more people of all genders and ages benefit from her services.

Remind your friends, family, and coworkers that physical therapy is your first line of defense for muscular/skeletal health care needs - no referral needed - as the American Medical Association recommends: choose physical therapy first. Learn more and make your appointment online at granitesportsmedicine.com.

Thanks to all the wonderful people we have had the honor of helping on their healing journey, our active community, and inspiring peers. Cheers to a fantastic 2018!

Can you believe Granite Sports Medicine (GSM) is 5 years old? GSM is proud to the celebrate benchmarks, achievements, growth and success stories from the active community we’ve served in our first 5 years over the next month. Thank you Park County! Follow us on Facebook or stop by the clinic to see how you can participate in our anniversary month and win cool stuff!

To celebrate GSM’s 5 years of Success Stories from our active community, we are having lots of drawings for fun stuff. To enter, stop by GSM to fill out our quick “Say Something Nice” form, and we’ll enter you into a drawing for stainless steel GSM water bottles. We have a bunch so increase your odds by filling out a bunch!

If you aren’t able to stop by, share your testimonial online at http://www.granitesportsmedicine.com/livingston-physical-therapy-testimonials/ or post a phots of you and a GSM logo doing something cool on our facebook page to be included in drawings for deluxe GSM soft-side coolers!  

At the end of the month, we will pick our 5 favorite “Say Something Nice” testimonials and each will win a cooler. The end of our 5-year anniversary month will culminate with a Cinco Tailgate party in GSM parking lot, 5/5/17 from 4 – 6 pm. We’ll have a full taco bar and more swag giveaways, so stop by and help us celebrate.  

GSM’s 5 Pillars: 
As part of a Prospera workshop on business startup many years ago, we created 5 Pillars that we felt were integral to the success of our business. It is interesting how these have summarized our culture at GSM and continue to be relevant.

1. Strong community presence
2. Client retention
3. Positive work environment
4. Efficient systems
5. Fiscal responsibility

These pillars lead to a customer experience that makes a lasting impression, “The clinic, including the reception, is efficient, very professional and makes the patient more knowledgeable. The clinic is the most dedicated that has ever treated me. The patient is made to feel comfortable and cared for,” says a client and another adds, “Entering Granite Sports Medicine is a happy experience! There is an infectious enthusiasm that helps patients want to get better.”

GSM’s 5 Year Benchmarks:

1. Remember the Main St Carwash?  We sure do, and we remember all the pigeons. Yuck. It was important to us to repurpose an old structure and contribute to cleaning up Livingston’s Main Street. Amazing that Randy Cook had the vision and the skills to remodel the old car wash into the extensive physical therapy hub GSM is today.  
2. Client Retention/Customer Service: you made suggestions and we implemented them. No unnecessary paperwork at check-in, virtually paperless clinic, clear explanations of client’s insurance benefits, and making sure our customers understand the process. Quote: “The front office staff is always welcoming, fun and positive. They are great with patients, explaining costs and insurance thoroughly, and juggling appointments around work schedules.”  
3. Winning the 2016 Montana Women’s Business Center’s Start-Up of the Year at Prospera Business Network’s annual Business Excellence Awards for exceptional contributions to the region's business community. “Prospera’s support has been a huge part of our success since opening our doors in 2012. Six years ago, I went into the Prospera office thinking, ‘Maybe I should open a physical therapy clinic,’ and here we are now with a beautiful 4,500 square foot facility and 9 employees. It’s been an incredible growth process and Prospera held my hand throughout; from developing a business plan, to formulating financial projections, securing gap financing, to building Human Resource manuals, and how to use social media. Prospera has been integral to GSM's success and I am so honored by this recognition. I feel like I went in as a pupil and recently graduated from their fantastic ‘Business Start-up School’,” says Darcy Cook.
4. Hosting a sold-out first continuing education class in Level 1 KinetaCore Dry Needling. Part of our big vision was to be able to bring quality continuing education classes to Montana. Not only does it keep our PTs up to date but it elevates our entire profession. Our first class was a huge success and there will be more to come. 
5. Incredible growth. We can’t thank our community enough for the support over the past 5 years. We are fortunate to have experienced incredible grow and recruit amazing staff members, for that we thank you, our supportive and active community.

GSM’s 5 Physical Therapists

GSM’s mission is to enhance health and wellness through innovative, evidence-based Physical Therapy interventions. It has been our goal to be the most current, progression clinic in Southwest Montana. Our physical therapists are passionate about the profession and pursue the highest level of evidence-based continuing education and certifications, offering clinical excellence.
We are proud to have all of our staff certified in Dry Needling as well as the following specialties:

1. Founder Darcy Cook, MSPT; headaches and facial pain, and bonus: the physical therapist for the U.S. Snowboarding Team.
2. Gary Miller, MS, PT, CPed; Orthotic Fabrication.
3. Jennifer Gauthier, DPT; Vestibular Rehabilitation.
4. Alison Shannon-Lier, DPT; Pelvic Floor Rehab.
5. Max Bartlett, DPT; Certified Strength and Conditioning Specialist and Sports Physical Therapy.

A client says of GSM founder Darcy Cook, “It is evident she stays informed with the latest in physical therapy news and advances in technology regarding the profession. Darcy is organized and thoughtful about her individualized treatment protocols. Thanks to her and to the staff at Granite Sports Medicine, I left each visit feeling positive about my recovery. We are lucky to be able to receive such care in the state of Montana.”

GSM’s 5 Community Actions:

1. GSM sponsors various teams throughout the years, including Livingston Parks and Recreation youth basketball team (photo) with GSM’s Alison Shannon-Lier as one of the coaches.
2. GSM sponsors and joins Western Sustainability Exchange’s Farmer’s Market.  You may remember the awesome beer cozies we give away....
3. GSM’s Gary Miller does free foot screens for the Park High track team.
4. GSM’s Darcy Cook does physical therapy presentations at Park High’s Trades Day (back by popular demand!)
5. GSM offers free 20-minute sports injury assessment to Park High athletes performed by Jennifer Gauthier and Max Bartlett

Thanks for all the support, enthusiasm and for inspiring us with your recovery GSM clients and community! Here’s to many more years of healing and actively enjoying our wonderful region.

Granite Sports Medicine is located at 315 S Main Street in Livingston, phone (406) 222-4682. Sign up for our informative newsletter at http://www.granitesportsmedicine.com/livingston-physical-therapy-newsletter/, share your testimonial online at http://www.granitesportsmedicine.com/livingston-physical-therapy-testimonials/  and follow us on social media at https://www.facebook.com/granitesportsmedicine.