Category Archives for The Training Room

Physical Therapists’ Foundations Back Health Series was a Success!

Physical Therapists' Foundations: Back Health Series was a Success!

written by: Lindsay Kizinkewich, PT, DPT, OCS of Precision Physical Therapy

The first run of Foundations Back Series was a great success over the month of September!

Doctors of Physical Therapy, David Bond and Lindsay Kizinkewich, spent Tuesday evenings leading an exercise and education based class about management and prevention of back pain. Through nutrition, hydration, sleep, relaxation techniques, and movement pattern training with progressive loading, the participants gained an understanding of the importance of a holistic approach to back health. 

Our passion for back health is rooted in the staggering number of people that live with back pain everyday. Worldwide, back pain is the single leading cause of disability, preventing people from engaging in work and everyday activities. Although, many people with low back pain recover, reoccurrence is common, even without a serious underlying condition.

Current research suggests, that MRIs findings do not correlate with current symptoms or future prediction of back pain or injury, and variations of normal or normal aging process occur in the spine without symptoms of pain.

Back pain is most often mechanical, due to movement pattern dysfunctions, muscle imbalances or weakness, or mobility deficits, and can be treated effectively with a conservative approach.

We would like to share some of the course highlights to help you feel your best and function at your greatest potential.

One of the greatest pieces of advice to share is how to manage an acute episode of low back pain. It is important to remember early intervention is key for a quicker and more complete recovery process.

Some Recovery Golden Nuggets to hasten the healing process include:
 Avoiding prolonged rest; especially bed rest
 Utilize “active rest”; meaning to get up and move intermittently throughout the day.
 “Your best position is your NEXT position”. Changing positions frequently will help reduce stiffness and pain.
 Keep “neutral spine” in mind and use a lumbar roll/ pillow to support your low back when sitting. Firm sitting surfaces, rather than cushy couches or recliners will typically feel better.

In addition to walking, our favorite acute low back pain exercise are:

Hands and Knees Rocking

This position lightly engages the core muscles, while offloading the spine and structures around the spine. Gently rock your body weight over your hands, and back to decrease muscle guarding, improve mobility, and decrease pain.

Cat / Camel

From the hands and knees position, draw your bellybutton up toward your spine, and allow your pelvis and tail bone to tilt inward, slightly rounding up your low and mid back. Hold for 5 counts, and reverse directions to allowing the low back to arch downward. Hold for 5 counts. Important to only move through a painfree range of motion.

For those people with recurrent episodes or chronic back pain a program consisting of 150 hours per week of moderate- to high-intensity exercise is a best treatment. During Foundations Back Series, we taught aerobic, body weight, resistance/ loading exercises and movement patterns that are essential are a well- structured, self-care back program.

One of these movement patterns is hip hinge and loaded deadlift.

Hip Hinge

Using a dowel to cues a straight back, maintaining three points of contact on the back of your head, between the shoulder blades, and tailbone. Slightly bend the knees and hinge the hips back until you feel pulling/ loading through the gluts and hamstrings. Be sure to keep the three points of contact with the dowel, and not let the spine flex or round.


Once you have mastered the hip hinge with the dowel, to ensure proper form and position, you can begin to load the movement with weight bar, trap bar, dumb bells, or kettle bell.

As always, maintaining a positive mindset that you pain will improve is important in
recovery. Keep in the front of your mind that the human body is resilient, and the spine has inherent anatomical/structural strength and is difficult to cause actual structural damage with everyday movement and motions. Intensity of pain does not correlate with pathology, therefore resuming normal activities, even when experiencing some pain, as early as possible is encouraged. Recognize the improvement in activity levels, not just pain relief as an important marker as you begin to return to previous activities.

Low back pain has a favorable prognosis if treated with Physical Therapy within the first 14 days of onset.

We look forward to sharing more self-care information! Please let us know if Physical Therapy can help you get you back to doing the things you love without pain.

‘Go To’ Exercises for Runners

'Go To' Exercises for Runners

with Lindsay Kizinkewich, PT, DPT, OCS of Precision Physical Therapy

As you approach the final weeks till the Bellingham Bay Marathon, Half Marathon and 10k, it is important to keep your body in optimal condition. As the training miles get longer, the load increases on our tissues and joints, and this is when injury can occur.

It's never too late to incorporate strengthening into your training program. Running is essentially a series of single hops. Your body structures need to withstand enough loading to avoid strain.

These are my "go to" exercises for functional strengthening for runners. They work the body in the same way the body has to control movement while running, especially with longer distances, as the body starts to fatigue. Controlling force into the ground with an eccentric focus builds resiliency to loading and can help prevent running injuries.

Bulgarian Split Squat Hops
Start in a lunge position with your back foot elevated on a step. Slowly lunge down to the floor, keeping your knee from falling inward or in front of your toes. Focus on a quick hop upward, and land back into the lunge position with a quiet landing. Absorb shock through the knee and don't let your front knee collapse inward. Increase the challenge by elevating the back foot on a higher step or bench.

Single Limb Deadlift
Start by balancing on one leg. Slowing hinge forward from your hip, keeping the back straight and hips level. Lean forward from the hip, until you feel the back of the thigh and glutes engage. The knee on the stance leg should maintain a slight bend. Use a weight in the opposite hand than the stance limb to challenge hip stability. This is a balance and stability exercise, as well as eccentric loading for the hamstrings. This movement is about control, not repetitions.

Curtsey Lunge
Start by standing on one leg in level ground, or increase the challenge by using a step. Slowly reach your foot diagonally behind you allowing your hip/pelvis to drop into the lunge slowly. When you return to standing, squeeze your glute and hike the opposite hip to achieve maximal work through full available range of motion. The key is to maintain balance throughout the reps. Use a weight in the opposite hand than your stance limb, on an elevated surface for greater challenge.

​Please schedule an appointment with Precision Physical Therapy, if you would like individualized treatment for a running injury or screening for exercise recommendations to maximize your running performance. Precision would love to help you maximize Movement with Purpose.

Prime Sports Institute: The Training Room

written by Kerry Gustafson

If you played a sport in high school or college then you're probably already familiar with athletic training facilities from school.

Or maybe you've watched your favorite professional athlete in an athletic training facility before or after a game.


An athletic training facility is where you'd go before practice or competition to get yourself ready to be at your best. You could count on everything you needed - from taping and stretching to a dynamic warm-up to get the right muscles activated and firing.

You'd check-in with your athletic trainer and get to work on your pre-hab to prevent injuries, rehab for any current or chronic injury, and figure out what you'd be able to do that day in terms of participation in your sport.


An athletic training facility is also the place where you'd go after practice to use specific techniques, modalities, and protocols to help you maximize your recovery for the next day of practice or competition.

Sit in a cold tub, utilize compressive modalities, or just make sure you're actually taking time to roll out those tired muscles using foam rollers or self-massage tools before you go back home and crash.


This is exactly what we're creating for you here in athletic training facility where you can come before or after your workout, race, or you can be at your best.

  • Maybe you have a new injury...come in and begin treatment right away
  • Maybe you've just had surgery...find out how to speed your healing
  • Maybe you're getting ready for a big race or competition...there are definitely things you can be doing to be better prepared

So stay tuned!

Over the next few weeks, I'll be letting you know more about what our facility will look like.

I'll teach you more about each modality we'll have and specificy the ways it will benefit you.

I'll also let you know how you can get access to the training room and when you can come in.

Something that's this beneficial shouldn't be saved for college and professional athletes. If your goal is to stay healthy and active then you can benefit from an athletic training facility, too!

Stress Fractures

Here's are some excerpts from a great article on stress fractures from the American Orthopedic Society of Sports Medicine.

What is a stress fracture?

Each day, the body produces new bone to replace the bone that is broken down by the stress of everyday living. Usually, this process is balanced, with the body replacing the amount of bone lost. However, this balance may become upset with excessive physical training. The body, due to several factors, may not produce sufficient bone. As a result, microcracks, called “stress fractures,” can occur in the bone.

Learn more about diagnosis, treatment, & prevention by downloading the complete publication.

Muscle Cramps

written by Kerry Gustafson

It's summer.  It's getting hot.  Whether you are training, racing, or recreating, everyone is going to succumb to muscle cramping at some point.  

The question is:

Are all leg muscle cramps the same?  Should we treat them all the same?

The answer is, No

There are two different types of leg muscle cramps.

Type 1, or single muscle cramping, is due to electrolyte imbalance, dehydration, and depletion.

Type 2, is skeletal muscle overload and fatigue.  It can also could be a deficit in strength or flexibility from a prior injury.

​Cramping is often reported following calf or hamstring strains.

What You Can Do About It

​Prevent Type II race-associated cramping by: protecting any recent muscle-tendon injury (due to strain or cramps) and allowing time for full regeneration.

Then use stretches and strengthening exercises to improve imbalances in strength, flexibility, and activation of surrounding muscles.

If leg muscle cramping continues to plague your training and races, it's time to seek outside expertise and consult a sports medicine clinician.

Additional strategies to preventing cramps:

  • 1
    Take a longer and more gentle warm-up.
  • 2
    Shorten your exercise segment, rest for 3-5 mintues between segments, and gradually increase the number of segments.
  • 3
    Slow down the pace of your workout--especially from the beginning.
  • 4
    Shorten the length of the workout on a hot/humid day.
  • 5
    Break your workout into two segments.
  • 6
    Look at any other exercise that could be causing the cramps.
  • 7
    Take a buffered salt tablet at the beginning of your exercise.
  • 8
    Runners: Shorten your stride-especially on hills, and take more frequent walk breaks.

Aqua Jogging

written by Kerry Gustafson

In the beginning, the AquaJogger® was conceived in Eugene, Oregon USA as a way to take the impact out of running for world class runners like Mary Decker. Mary’s coach, Dick Brown, in addition to training elite runners, was also working with Dr. Bruce Becker (Washington State University) in designing water rehabilitation programs for pre and post surgery patients. Unhappy with the various flotation vests and water ski belts available, Dick began to search for something better.

In 1987 a collaboration between Dick Brown, Dianne Bedortha, a water exercise specialist and Lew Thorne, the president of Excel Sports Science, resulted in a flotation belt design now known as the AquaJogger® Classic. This unique and affordable flotation device soon captured the attention of athletes, fitness instructors and medical professionals around the world and "AquaJogging" was born.

The AquaJogger® is a tool that provides access to the many benefits of deep water exercise. Gravity loads the body causing stress through impact and compression on the joints, bones and muscles. Running and exercise in deep water eliminates the affects of gravity and frees the body to cross train in an effective and safe way.

Aqua running offers benefits to both healthy and injured individuals. In both untrained and post-operative individuals, aqua running offers:

  • Increased strength
  • Increased VO2 Max
  • A non or partial-weight bearing component
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    Improved neuromuscular control and proprioception
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    Decreased heart rate (10-12 beats per minute) and increased RPE due to resistance of upper extremities and lower extremities against water Increased venous return resulting in decreased edema

The benefits of aqua running in trained individuals and athletes include:

  • VO2 Max values similar to land-based training (within 3.8 ml/kg/min) 
  • with improved running economy, core strength, and proprioception
  • Improved strength, respiratory function, and endurance 
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    Decreased compressive loading of the spine
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    Active rest from running without effects of detraining

Further evidence of the value of aqua running include:

Bushman et al demonstrated that distance runners on a 4-week program of aquatic only training maintained running performance, VO2 Max, maximum heart rate, and lactate threshold. Bushman et al noted no difference in 5K time after 4 weeks of deep water running only w Wilber et al report that 32 recreational distance runners maintained a 2-mile run performance after only 6 weeks of deep water running only.

Recommendations for aqua running in trained individuals:

Tartaruga et al report that distance runners replacing 30% of their training with deep water running demonstrated no change in maximal O2 uptake, ventilatory threshold, maximal expiratory volume, running economy, maximal heart rate, stride frequency, length, and time. Martel et al demonstrated an increase in vertical jump of volleyball players with aquatic plyometric training, and an 11% improvement in jumping performance on land.  Robinson et all demonstrated that aquatic plyometrics resulted in the same benefits as land-based plyometrics with less muscle soreness.

  • Intensity must be similar to land-based training 2-3 days per week
  • Durations of 50-90 minutes (90-100% VO2 for 30 minutes, 70-75% for 60 minutes) with deep water running for distance running training
  • Shallow water training for vertical jump training
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    Water shoes/socks are recommended for shallow water running and jumping


  • Increased enjoyment of running 
  • Faster running times
  • Decreased injury risk 
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    Achievement of goals



  • 10 minutes easy pool running
  • 10×1’ at hard effort with 1’ active recovery
  • 10×30” at sprint effort with 30” active recovery 
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    5-10 minutes easy warm-down


  • 10-15 minutes easy pool running
  • 1’, 2’, 3’, 4’, 5’, 4’ 3’, 2’, 1’ at hard effort except the 5’ session which is at tempo effort 
  • Each interval has 1’ of active recovery
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    5-10’ easy warm-down


  • Warm up 10-15 minutes
  • 1’, 2’, 3’, 4’, 5’, 4’ 3’, 2’, 1’ at hard effort except the 5’ session which is at tempo effort 
  • Cool Down 10-20 minutes


  • Warm up 20-30 minutes.
  • 3 minutes hard, 2 minutes recovery
  • Repeat this 5-minute interval 6 times.
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    5 minutes recovery “jog”
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    3 minutes hard, 2 minutes recovery. Repeat this 5-minute interval 6 times. 
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    Cool down 15-20 minutes.

Shin Splints

written by Kerry Gustafson

As cooler autumn weather arrives, it seems to be the perfect time to head out on the trails for a long run. Whether you are running to simply run or you are preparing your legs for turns down Baker in just a few months, nothing puts a damper on those plans like the striking pain of shin splints.

Posteromedial tibia stress syndrome, known to most as ‘shin splints,’ is caused by repeated stress and inflammation of the muscles, tendons and bone tissue around the tibia – where the muscle attaches to the bone. It is very common in runners and jumpers and dancers with a 13-17% occurrence rate. 

KEY POINT: It is important to know the difference from a stress fracture

  • stress fractures are usually a specific point of pain over the bone and can keep you up/awaken you at night,
  • shin splints are more of a stretched pain lingering down the entire shin. In the beginning symptoms may subside after activity has stopped. Over time the pain can become continuous.

The most common factors leading to this over-use injury are:  

  • 1
    improper shoe wear
  • 2
    muscle imbalance
  • 3
    lack of stretching 
  • 4
    non-gradual training  

There are times when the pain does not subside from basic treatment and rest. We may want to make sure you do not have a stress fracture – this can be caused by stress and overuse of the area. An MRI may be suggested to help diagnose a more consistent pain.

Although treatment for both shin splints and stress fractures can heal with a combination of rest, non-steroidal anti-inflammatory drugs, ice, stretching, physical therapy, and modifications in training; it is always best to avoid this painful diagnosis all-together. For runners, shoes need to be switched out every 300-500 miles, or every 4-8 months.

With simple modifications such as properly fitting footwear, cross training and slowly building your fitness level, you may avoid this pain creeping into your legs.