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After decades of running without injury despite my weaknesses and poor mechanics, things finally caught up with me in the form of a hip problem and plantar fasciitis. That is when, providentially, my path crossed with Allison. Even though I live on the West side with many PT locations between there and East Rochester, I felt led to make the trek to Peak Performance and I am so thankful to have landed here! As Allison has shared her knowledge, skill, creativity and encouragement, I have learned so much, am way stronger and have the tools to stay that way. I am back to running and look forward to increasing the time and distance while continuing to implement all that I’ve been taught. A shoutout, also, to Mike, Karen, and Andrew, who were also sources of advice at certain times over the past year. It is a great team that Rochester is blessed to have working to help so many get relief from pain and regain function. Thank you! Lynn Eich Sept. 4, 2019

Surprisingly great experience! I walked into this facility with my left hip hurting with bursitis and my lower back in pain. On my first day, when the session was over, I walked out with no pain and had no need to continue taking pain medication. My ability to walk up and down stairs has improved considerably. Due to the leg exercise I am no longer breathless when I get to the top of the stairs. When I do experience any pain in my hips, I just do the stretches. I am happy to no longer take pain medication…no more chemicals for this body! Andrew is an exceptional therapist, displays considerable expertise, is very friendly and quickly builds rapport, and is very knowledgeable in his field. I am very fortunate to have met him. Theodore “Ted” Mozeleski October 31, 2018

This spring I developed bursitis in my knee. My clavicle also started to protrude. My orthopedist specializes in knees so didn’t address the clavicle but sent me to PT. I chose Peak because my daughter benefited so much from coming here. Andrew and Karen helped me so much! Karen is the first person who looked at all my “parts” together and found two curves in my spine. She worked with me on all these issues which helped my knee, back and hips. I love to garden, hike and work out at the gym, and I’ve learned how to move better and stay safe and healthy. These guys are awesome professionals! Annette B. October 1, 2018

View this email in your browser Peak Performance Physical Therapy & Sports Training EVIDENCE-BASED PRACTICE UPDATE August 2018 New insights into hip rotation and chronic back pain: When back pain isn't coming from the back CURRENT EVIDENCE Hoffman, S. Johnson, M. Zou, D. Van Dillen, L. Sex Differences in Lumbopelvic Movement Patterns During Hip Medial Rotation in People with Chronic Low Back Pain. Arch Phys Med Rehabil. 2011; 92: 1053-1059. by Allison Pulvino, PT, MSPT, CMP, CAFS Background: There have been numerous links between back pain and hip motion, but not many comparing the differences between the sexes with medial hip rotation and the possibility of low back pain. This study attempts to assess how medial hip rotation in males and females may differ with mobility as well as pain levels. Method: 62 subjects were selected from a larger randomized controlled clinical trial, and an equal numbers of males and females (n=31) were utilized. Subjects were required to have low back pain for a minimum of 12 months. Active hip medial rotation in prone was measured using a 6-camera, 3-dimensional motion capture system to collect and process kinematic data. The measurements were assessing hip and pelvic motions, with angular displacements calculated between the initial and final position of the pelvic and lower leg segments. Results: Men demonstrated significantly more total lumbopelvic rotation motion than women, as well as having decreased hip medial rotation before the start of the lumbopelvic rotation. Also, men were found to have less total hip medial rotation than women. A much greater proportion of men reported increased symptoms (60%) than women (34.5%) on one or both sides during active medial hip rotation. Hoffman et al do conclude that men and women average varying levels of medial hip rotation, and affects can be seen proximal to the assessed hip. Although this study does have limitations, it can lead to special considerations of appropriate lumbar and hip treatment interventions for males versus females due to the level of lumbopelvic mobility as it relates to lack of hip mobility. THE PEAK PERFORMANCE PERSPECTIVE So many people report being frustrated with back pain that just never seems to go away with stretching the sore structures, and/or performing the classic “core strength” exercises that they may have been taught. But what many still don’t know is that their back pain may not be coming from their actual spine limitations, but other adjacent or even distant regions of the body. Our hips, being able to move in three planes separately along with all the combined motions possible, provide the mobility necessary for ADL or sports/recreation tasks, but it is well known that current cultural habits include prolonged sitting or standing for the better part of the day, which mutually contributes to certain directions begin to develop other ROM deficits over time. Hoffman et al are wise to explore the relationship of hip internal rotation with chronic LBP and also any gender-based differences that might exist. It’s increasingly accepted that kinetic chain deficits are a contributing factor to the onset of low back pain. The activities we enjoy that involve bringing our hips past ranges that we have not been accustomed to with normal ADL (for example, kicking a soccer ball or swinging a golf club) can produce compensatory movements and eventually strain at the low back. Too often low back pain is treated locally and appreciation for underlying kinetic chain deficits is ignored. Men and women are now more than ever performing many of the same recreational activities such as weightlifting, rock climbing, golf, lacrosse, etc. This study sheds some light on the subject of why males may report more limitations with certain activities than females. Males had less hip IR than females and lumbopelvic compensatory motion. While Hoffman et al did not measure hip IR in a WB functional position, this motion limitation would be expected to potentially impact functional tasks. For example, from the proximal to distal (or “top-down” directed motion) aspect we can stress our hips with spinal/pelvic movements over the femur. If you are standing still and a sudden loid noise causes you to turn to the left to look and you lack adequate left hip IR, then the lumbar segments would likely experience excessive left rotational stress, potentially leading to back strain. Similar examples would be a right-handed thrower during release and follow-through phases or a mother reaching into the passenger side back seat to lift a child from her car seat. More classic distal on proximal (or “bottom up” directed motion) examples of similar kinetic chain examples would be when changing position and by stepping over something or cutting during athletics like soccer or football. Limited hip IR, as found by Hoffman, et al, causing earlier and larger lumbopelvic motion could then bring stresses more proximal to the spine. Some important limitations exist in this Hoffman, et al study. They studied only NWB internal rotation AROM done distal on proximal style. It must be remembered that we move differently actively versus passively, NWB vs WB, and directionally when proximal over distal. These are functional biomechanics differences that relate to normal human movements and demands that this study did not specifically examine. Motor control and tissue tensions will differ in WB and NWB environments. Concentric muscle actions (studied by Hoffman et al) may result in different forces and influences than when required to perform eccentrically, as is often the case with functional movements against gravity. Finally, this study did not examine cause-effect relationships, so care must be taken to avoid assuming the hip IR loss was contributing to the LBP since it also could have developed afterwards and be the result of and not a cause of the LBP. This is where a very thorough three-dimensional movement assessment is necessary to actually pinpoint one, two or even more structures that may be limiting this person’s eventual goal of swinging that golf club, or playing in a full tennis match without low back pain limiting this favorite activity. THE PEAK PERFORMANCE EXPERIENCE Richard stated recently: “I was able to golf three out of the last four days without any back pain, and only feeling stiffness in my back with prolonged sitting now for work. Golfing has been going much better! HX: Patient is 52 y/o male and reported having back pain after golf one day and when he woke up the next morning he felt “locked up.” He had right-sided lower back pain and right great toe numbness. His main goal was to be able to golf without pain as that’s what he loves in the summer. Patient Initial Subjective: Patient’s lower R side back pain can get up to 8/10 and was 5/10 at initial exam. The pain was much worse in the morning and felt somewhat better as the day would progress. Pain with golfing, any distance driving, sitting more than ten minutes, and standing more than ten minutes. His right side of his back feels constantly sore. ODI score was 38%. Objective Data: Patient demonstrates R thoracic convexity with forward flexion, R ischial tuberosity higher than L, decreased medial arches B feet, positive Thomas and Ely’s test B with negative Slump and SLR B. Tenderness reported R psoas, R iliacus and proximal ITB and QL. See table below. Treatment: Manual therapy: Muscle energy technique for SI jt correction prn, B anterior hip capsular mobilizations, R iliacus/TFL/ITB myofascial release, thoracic P-A mobilizations. Hip mobility: Functional dynamic multiplanar stretches/mobility drills for psoas, IR, ER done in WB. Thoracic and lumbar mobility: Elevated hip isolated thoracic R/L rotation with shoulder pullback, seated thoracic extensions over chair back prn daily with feet elevated, prone on elbows, prone press-ups, side-lying rotation with hip flexion, isolated R rotation for backswing loading R hip, isolated L rotation for follow-through loading L hip. Neural: Supine and seated sciatic nerve glides TID as able. Strength: Calf strength-Seated to standing progression single leg calf raises to allow for proper push-off at terminal stance. Trunk stability: Birddogs, incline planks with lateral taps, incline planks with alternating hip extension for sagittal control. Hip stability dynamic control: Hip IR and also extension stimulus via reaching and tubing resistance and balancing Golf swing progression: Half to full swing progression practicing loading each hip separately for each backswing and then follow through. Full swing performed only after single leg load with acceptable triplanar hip motion + trunk rotation noted You can trust the Physical Therapists at PEAK PERFORMANCE to do a thorough evaluation, to search for related but underlying contributing factors to kinetic chain dysfunction, and to design exercise progressions that both respect tissue healing and creatively use biomechanics principles to prevent symptoms and optimize carryover to your patients' functional goals. Call us at 218-0240 to discuss your patient's specific needs. Allison Pulvino, PT, MSPT, CMP, CAFS Peak Performance is just minutes away from your patients in Penfield, Fairport, Pittsford, Brighton, Rochester and, of course, East Rochester. We promise Individualized, hands-on and biomechanically appropriate Physical Therapy for your patients. No "one-size-fits-all" approaches. We WILL go the extra mile and "dig deeper" to discover underlying causes for injury risk and delayed recovery using the most advanced Evidence Based methods available and, we’re able to make unique adjustments to exercise prescriptions to speed the return to function and to minimize or prevent symptoms from interfering. No surprises. No hassles. Confident your patient is in the right place.  COME VISIT US AT 161 E Commercial St Just 1 mile off 490 exit (585) 218-0240 www.PeakPTRochester.com This email was sent to << Test Email Address >> why did I get this? unsubscribe from this list update subscription preferences Peak Performance Physical Therapy · 161 East Commercial Street · East Rochester, NY 14445 · USA

When I first started coming to Peak Performance, I could barely walk and severe back pain kept me awake at night. Karen was so kind and the gentle exercises helped me prepare for surgery. After my back surgery, Karen helped me recover and I got much stronger, which helped me prepare for my 2nd surgery…a full hip replacement. I felt so confident going in to the surgeries and recovered very quickly afterwards with minimal discomfort. I have virtually no restrictions now and I have Karen and Peak Performance to thank for that. Thank you for giving me my life back! P.S. I am also off all pain meds and anti-inflammatory meds! Marianne S. April 26, 2018

I have been a walker for years and began experiencing pain in my back and hip. I had x-rays, MRIs, PT and cortisone and was still in pain. My granddaughter told me about Peak Performance. She had ACL surgery and went there for rehab. I saw how quickly she healed and how much she praised Peak Performance. So I decided to give PT another try. When I met Andrew, he explained his plans for me and I knew I was in the right place. In less than two weeks, my back pain was gone and my hip was getting better. Graduation was both happy and sad for me. Happy because now I am pain free for the first time in 3 years! Sad because I will miss Andrew. I always learned something from him to make my body feel better and stronger. He was kind, caring and understanding. He always had a plan for me. My time was not wasted with icing, heating or handouts with pictures of exercises; everything was hands on and personalized. Today I feel better and fitter than ever. Andrew taught me exercises that I will use all my life, and I look forward to living as long as possible since Andrew and Peak Performance! Judy Y. March 5, 2018

I came to Peak Performance because of hip pain. It stopped me from doing all the movements required to play softball: running, pitching or fielding. I started with anti-inflammatory meds and then came to Peak for help. Andrew and Brittany were very helpful with showing me stretching and strengthening exercises. The medication helped some with the pain, but the exercises given to me have helped a great deal. Joseph M. February 20, 2018

I’m very glad to have chosen Peak Performance for my hip replacement therapy. I have been elsewhere for therapy and here I received in-depth training on the exercises. It helped me in doing the exercises correctly and getting the most benefit from them. I can easily pick up small items that fall on the floor. My increased strength allows me to stand up quickly. My walking stride is much stronger even on uneven ground. Before PT here, my legs would get tired and now I walk with more power and climb moderate slopes with little difficulty. When I play tennis I can run down a short-placed tennis ball. Doing housework is easy (it was tiring before PT) and I used to have to lie down often. I’m very pleased with the skill and presentation of the therapy. Judith W. December 14, 2017

Before PT, I was having problems on the soccer field because I strained my quad, hip flexor area. After weeks of stretching and sessions with Andrew and Karen, I was able to get back on the field. My experience at Peak Performance wasn’t just beneficial, it was also fun. I loved talking with the people there and getting a garbage plate on the way home. So, if you’re at Peak Performance be sure to ask Andrew if he watched “Stranger Things” and appreciate the amount of care you receive! Mark W. November 26, 2017

My experience at Peak Performance has been wonderful. I have been to four other PTs in my life but I feel Karen has been the best! She really listened to my problems and took my crazy lifestyle with two little ones into consideration. I came in with hip and back pain and was struggling to pick up my girls. Now I feel like I am functioning more freely and am able to complete all daily tasks with minimal pain. She taught me tricks when lifting and bending so that hopefully the pain does not come back. Peak Performance has been a welcoming experience and I appreciate all the help! Jennifer O. December 13, 2017

After I broke my hip in March 2016 I did 2 months of PT with another well-known clinic, but I still wasn’t walking steadily. From the moment I began working with Andrew, he tested my strength, explaining why each measurement was taken. Then he set up a cycle of exercises for me, making sure that I understood why each was necessary for strength or balance. As I keep up with the program Andrew designed just for me, I can feel the improvement in my day-to-day life. I am sure that I will continue to strengthen my hip following the exercises Andrew created for me. I appreciate that Andrew gave me his full attention, never sending me off to work independently for the rest of my time with him. I can tell that Andrew is a person who is striving for excellence in his profession. He encouraged me, yet he always made suggestions and corrections so that my experience would improve. I have high regard for Andrew and I would recommend him and Peak Performance to anyone! Bonnie K. November 21, 2017

I have had pain in my left hip for years. Within the past year, I had to stop walking for exercise. I couldn’t do yoga or Pilates workouts and greatly decreased my physical activity, including sitting on the floor. In May, I had a total hip replacement. I started seeing Karen 4 weeks after surgery. When I started at Peak Performance, I was using a cane full time. I could not get down on the floor, which is necessary for my job as a pediatric OT. Working with Karen has been wonderful…each week she changed up my routine based on what I reported back and now I am able to enjoy my walks for exercise again. My endurance is back to normal and I have resumed all of my household and work activities, including sitting on the floor! Martha M. October 12, 2017

Before I came to Peak PT I had severe pain in my left hip. I was walking with a cane and with great difficulty. Both of my knees hurt. I couldn’t go to the gym or even walk around the block. After the first week at Peak Performance, I gave up the cane. Over the next two months, with Mike increasing my exercises every visit, my hip pain stopped and my knees and hips became stronger. I can now walk easily, racking up 15,000 to 18,000 steps a day while on vacation. I can also do all of my housework and go back to the gym. My pain has lessened considerably and movement is so much easier for me now. Thanks, Mike, and all of the Peak Performance staff, for improving my life! Kathleen D. October 3, 2017

Competitive fencer training 3 days/week at Rochester Fencing Club. Trouble with right hip pain, especially on lunging. Had pain for about 1 month prior to PT. Thorough, sport-specific evaluation and treatment plan with individualized warm-up routine, treatment including ultrasound, and strengthening exercises. Returned slowly to fencing and was able to attend class/take lessons with little to no pain initially and no pain now. Mike is friendly, fun and very knowledgeable and professional . Highly, highly recommended! Timothy F.

As we Rochesterians recovered from the 2017 wind storm, I took a controlled fall in the snow storm that followed. That fall did not feel bad until the next day, when my right hip and neck hurt. I met up with Karen and Mike the following Sunday and they had me in the next day! In less than six sessions, Karen has cut my pain level from a 10 to a 2. Now in mid-April, I am pain free and knowledgeable of stretches and exercises to keep me pain free. Thank you, Karen and Mike! Sean F.

I came here three and a half months ago with very little ability to go through my day and couldn’t dance at all because of my hip. Mike helped me get to the point of “marking” my dance classes two months into therapy and Karen helped me to get fully back into motion for dance and everything else. I’ve never been to such a great and helpful PT place! Hannah W.

Peak Performance has given me back my confidence towards being physically fit and capable to achieve what I set out to do. I struggled with walking on the Canal for an extended period of time. Even the smallest incline was painful on my hip. Now it’s a breeze to walk a steep incline. As a woman, I can wear heels with comfort when it’s necessary! I am back and ready to push myself to be healthier and fitter than before my surgery. Kathy W. October 3, 2016

There is no greater gift than having the ability to assist someone in increasing or regaining their quality of life. Mike has done this, for me, three times in the past 6 years. I came to Peak Performance in 2010 for physical therapy after rotator cuff repair. I was referred to Peak Performance PT by my surgeon, after the initial physical therapy services from a different provider resulted in little to no progress in my healing process. I returned to PPPT again in 2011 after rotator cuff repair on my other shoulder, and most recently for physical therapy after a total hip replacement. I returned to Peak Performance time and time again because of my strong belief that I am in the most qualified hands in the Rochester area. This belief is founded in my own successes as a result of the physical therapy I received while in Mike’s care. The individualized treatment plan that was put in place for each of my recoveries was developed with a holistic approach, combining Mike’s expertise on functional movement, biomechanics and physical therapy techniques with my personal hopes and desires in regard to the activities I wanted to return to and participate in. Mike was able to listen, and continued to adjust the plan of care based on the visible and measurable strengths and needs as my rehab progressed, as well as always taking into consideration my continued input and feedback. My ability to regain strength, flexibility, and increased participation in the activities of life and leisure that I value was evident to me early on in the rehab process, and continued to grow throughout. I attribute my success to Mike’s expertise guidance, ability to listen, and genuine care. I know that if I find myself needing physical therapy again, I will request services from Peak Performance PT. I highly recommend Peak Performance to my family and friends, and to anyone else that may need Physical Therapy. Oh, and 9 months post surgery, not only am I greatly enjoying a summer filled with Pro Kadima, long bike rides on the canal and my basic and gentle yoga sessions…I flipped my dog!!! With a heart full of gratitude, Jennifer I.M. July 25, 2016

After left hip replacement, [i'm] back to biking, swimming, hiking and long walks! Mike is very patient and explains exercises thoroughly! Mary G. August 18, 2016

My experience at Peak Performance was much better than at any other physical therapy office. When I first started, I had recurring pain in my left hip. The pain moved to my right hip and then shifted to my left shin. My injuries made it difficult to participate in track and cross country; sometimes it was even difficult to walk. Now that I have completed my rehab, I am able to run, walk, lift weights, and cross train pain free! All of my success is because of the time and dedication showed by my physical therapist, Karen Napierala, and my parents! Alyssa L. August 3, 2016