Bringing Physical Therapy to Guatemala


"The joy is in giving. The joy is in helping lessen someone's pain. The joy is in making a difference in the life of someone who really needs the help." - Melissa Rudolph

It often takes a life-changing experience to remind us that the skills we possess mean the world to someone in need.

This summer two of our employees traveled to Guatemala to provide crucial physical therapy treatments to a number of people in remote villages. Joe Hanisko and Melissa Rudolph are physical therapy students at Grand Valley State University (GVSU) and have been getting hands-on experience at our Wayland and Cedar Springs clinics over the last 2 years. Through GVSU and a faith-based program called Hearts in Motion (HIM) they were able to share their skills and talents with underprivileged people in the area.

This was the 8th year GVSU made the trip down and each time people eagerly await the group's arrival. People would often stand in line for hours at makeshift clinics or churches to receive medical information or treatment. But it's not just the people of Guatemala who are benefitting from the trip. 

The group went to different towns and provided service in whatever space they had, often a big concrete room with small chairs or benches.

"Working in Guatemala made me eager to help. I gained a humble confidence," explains Joe. "Undoubtedly, Guatemala allowed me to be comfortable with who I am and taught me to live life more generously and optimistically as many people aren't granted the comparably stress-free life I live."

Similarly, Melissa came away with humbled perspective as well. She explains, "I learned the value of working as a member of a team to get different perspectives on the same issue. I also learned how much I rely on tools that just aren't available to people of different means, which was a humbling experience."

"I believe there's a higher power, someone with a plan that instills special talents and characteristics that allow us to be special. This trip offered me the opportunity to share who I was with others and ultimately make a difference in someone’s life. This is why we're here, it's a commitment but definitely worth the time." - Joe Hanisko

Visits with patients typically lasted between 60 and 90 minutes, and they were seen multiple times by the same group of students. Because the trip only lasts two weeks, education was vital to make sure the patient understood how to continue the healing process once the group had left. Melissa noted that it takes effort and a caring person to guide progress. You can see a difference in the patients and their families, even after just a few visits.

Aside from fixing the major aches and pains, both Joe and Melissa discovered that the little things matter just as much, if not more. "This trip showed me that PT is more than just anatomy or muscles. People of all ages, sizes, and races can benefit from the skilled hands of a therapist in so many different and unique ways," explains Joe. "Guatemala showed me the importance of focusing on the small details of one’s life because those details can make or break the perceived quality of life people are going through on a daily basis."

And while it may not have been on the agenda, Melissa found that listening was sometimes the best treatment of all. "Sometimes we found that the only thing a person really needed was someone to listen. And it was incredibly rewarding to be able to provide any relief we could."

"Always be grateful for what you have, and share whatever you can spare with people in need - whether that's money, knowledge, a listening ear, or just a hand to hold." - Melissa Rudolph

At the end of the day, both students found themselves using the same words to describe the trip that had been used by so many before them. The terms life-changing, gratifying, eye-opening, rewarding, and unforgettable topped the list.

We go into this field because we have a passion for helping others. We often see people when they're at their worst, feeling vulnerable and in pain. There's nothing more rewarding than seeing the smiles on their faces as treatment begins to take shape. Helping someone feel good is a powerful thing and that process knows no boundaries. We're proud of Joe and Melissa for the skills, compassion, and time they spent in Guatemala. Their generosity and desire to give back are contagious and we're proud to call them members of our team.

75% of Guatemala's population lives below the poverty level. The treatment they receive from generous volunteers like Joe and Melissa make a huge impact in their lives.

Mother-Daughter Duos Running For Each Other


Mothers and daughters often share a special bond that allows them to connect like no other. Sometimes it's a day of shopping, sharing an afternoon coffee, or evening chat sessions where 5 minutes turns into an hour before you know it. In this case, we witnessed two sets of mother-daughter duos who were connecting through running. It didn't necessarily start out as a love for the sport, but rather the idea of not letting the other one down, keeping each other accountable, and sharing a common fitness goal.

Let's run!
Lisa Otterbein-Bolek hung up her running shoes after giving birth to her daughter in the summer of 2013. Having previously ran several 5 and 10k races plus a half marathon, she knew she had it in her but with a toddler at home it was easy to let life get in the way. While talking with her mom Cindy, Lisa expressed her desire to get back into the running game and brought up the idea of our RunFit 5k training program. Lisa has been a long-time physical therapist with Northern so she was very familiar with our program, but it wasn't something she had ever participated in. To her surprise Cindy offered to sign up for RunFit too, "I'll do it if you do it!" she exclaimed, even though she had never run a 5k in her life. The ladies made a commitment to each other and knew if they did this together they would keep each other accountable.

"It was fun to see my mom push herself and work toward a goal that she had never accomplished in her life." Lisa Otterbein-Bolek said of her mother, Cindy Otterbein.

"What did we get ourselves in to?"
In the very same RunFit group we welcomed a second mother-daughter duo in Robin Fynewever and Katelyn Greiner. Katelyn had been quite the runner in high school, but just like Lisa, children and life took over and running got the back seat. After the duo participated in a Mackinaw Island run with finish times not as fast as they had hoped for, they decided something needed to give. Katelyn admits that after the first RunFit session she and Robin looked at each other and asked, "What have we gotten ourselves in to?" 

Katelyn Greiner and her mom, Robin Fynewever, getting ready for the big race.

But, the women carried on because they had made a commitment to each and neither was willing to let the other one down. They even began running together a few times per week, outside of RunFit, which meant enduring early morning runs, hot evening runs, and sore muscles. But they always came through because they made a promise to each other. 

"We Enjoy Running"
While each of the women faced challenges throughout the program, all four could see the progress they were making each week and after a few sessions the finish line didn't seem so far away. More important than the fitness goals they were achieving, Lisa and Katelyn both really enjoyed the time they spent with their mothers. 

"My mom has always been a huge motivator for me," explains Katelyn. "Whether cheering me on during track meets or cross country races in high school, she always took an interest in what I was doing and pushed me to reach my goals. RunFit was a way for us to set a goal, and achieve that goal... together. I'm so proud of our accomplishment! Having my two little girls see my mom and I run a few times a week gives me hope that I will instill that same motivation in them."

"Hills and speed work... BRING IT ON!" Katelyn Greiner

So What's Next?
All four women successfully completed the 5k at the end of our 8 week program. Held at Robinette's in Grand Rapids, the trail race brought on 80+ degree temps, high humidity levels, and a lot of hills and uneven terrain. Because of progress they were making and the bond they were sharing, each has committed to continue running together, for themselves, and for their families. They've even decided to kick things up a notch by joining our RunFit 2 program which is designed to help increase speed, add to overall distance, and become more proficient with hill running. Our goal is to help you take that next step towards possibly training for a 10k or just increasing your 5k speed, all while staying injury free.

"Onward and upward to RunFit 2 and maybe a 10K sometime soon!" Lisa Otterbein-Bolek is pictured with one of our RunFit instructors, Alex Hoffman

Barefoot running, what's it all about?


Barefoot running has been a hot topic for a few years. Research has shown both benefits and risks to "losing your shoes" and there's still a lot to be decided. If you've been thinking about trying to run barefoot (also called natural or minimal running), it takes some getting used to. Here's what you should know before hitting the road.

Getting started
Don't think you can just take your shoes off and head out for a quick 2 mile jaunt. You use different muscles and run differently when you run barefoot. Your feet aren't used to the rocks, sticks, and other hard debris on the road. You want to make sure you start out slowly.

Three easy tests:
Because ditching your sneakers requires more from your foot, we recommend testing your feet to see if you're ready to make the transition to bare feet.
1. Mobility – Sit on a chair with your knee and ankle bent at 90 degrees. Keep your foot planted on the ground and slide your hips forward so the front of your knee is just past your toes. If you can't keep your heel planted on the ground, your Achilles is too tight. Without flexibility in this area, a minimal or barefoot run will add stress and change your form, leading to an ineffective push-off.
2. Foot control – Sit on a chair with your knee and ankle bent at 90 degrees. Keep your foot flat on the ground throughout the entire process. Reach down, grab your big toe, gently pull it up to a 30 degree angle. If you can't raise it to 30 degrees, or if the ball of your foot comes off the ground, your plantar fascia (the tissue that connects your heel to your toes) is too tight. Proper flexibility in this area can lead to injuries farther up your leg.
3. Stability – Standing in front of a full length mirror, place your hands on your hips and put all your weight on one foot. Hold for 30 seconds. See if you can keep all your toes on the ground without raising the inside of your foot. Test the other leg, then and do it again with your eyes closed. If the inside of your foot and/or your big toe come off the ground, you don’t have optimal control of the muscles in your feet and you need to do some strengthening before you run barefoot.

If you lack mobility, control or stability as noted above, work toward those goals before taking your shoes off. If you have any questions, talk with Gina, one of our sports rehab and running specialists, to go through this quick assessment. Click here to email Gina.

You passed the tests, now what?
You want to start out slowly and for short periods of time. Run on a sports field or soft surface free of debris, then build your way up to running on firmer surfaces like a track. For example, once a week after an easy run, head to a soccer field, kick off your shoes and run for 2-3 minutes. If this works for you and feels good, add a minute or two each week. You may like the training effects of running barefoot but need some coverage on your foot. In this case a barefoot shoe or a minimal shoe may be something consider. The folks at The Runnery can assist in finding the right minimal shoe for you.

Potential Benefits of Barefoot Running
- Promotes a forefoot running pattern with less heel striking, potentially leading to less chances for injury
- Allows you to spread your toes while your foot becomes a stronger and steadier base
- Preserves your joints by landing softer
- Barefoot training may improve your running pattern, even if you only train barefoot periodically 

Potential Risks of Barefoot Running
- Your feet will be tender. Be cautious of rocks, broken glass and other debris in the road, as well as cold or freezing temperatures
-You are just slightly less efficient running barefoot at the same pace
- You may experience pain or blistering initially, especially if you don't start out slowly because your muscles and skin aren't used to the change in padding and foot strike

Benefits vs Risk
So, should you give barefoot running a try, or stick with your padded running shoes? Well, the answer isn't so black and white. Harvard recently did an extensive study that showed barefoot runners are typically less prone to foot and ankle injuries, but the real reason for less injury may be how we run, as opposed to what we're running in. Runners in shoes tend to strike the ground with their heels, sending a spike through the ankles, knees, and up through the spine. Heel strikers are nearly two times more likely to injure themselves over people who strike with the middle or front of their foot. 

Barefoot runners tend to land on the middle or front of their foot, utilizing the body's muscles, tendons, and ligaments, which create natural shock absorbers, eliminating that spike of force.

So, it's all about form?
Injury prevention strongly relies on proper form, whether you're in shoes or not. In fact, incorrect running form can lead to all sorts of issues like knee pain and low back pain. We offer a series of options for runners who would like to have their form and gait checked out. Our Precision Running Workshops are held every few months and every attendee has their run patterns videotaped, plus these workshops are free! In addition, our RunFit 5k training programs have weekly educational topics worked in, including lessons on form and run patterns. If you'd like a more in-depth look, we offer a running gait analysis which is a one-on-one consultation with one of our physical therapists that specializes in sport rehab. They'll conduct a video gait analysis and look at your run patterns closely to determine potential weaknesses. We also have custom orthotics and foot and ankle specialists in each location.

With better form you can run faster, more efficiently, and with less chance for injury. When it comes to running, Northern has you covered. 

Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management


No one wants to live in pain. But no one should put their health at risk in an effort to be pain free. Since 1999, Americans have increasingly been prescribed opioids—painkillers like Vicodin, OxyContin, Opana, methodone, and combination drugs like Percocet. According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though there has not been an overall change in the amount of pain that Americans report.

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March, 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed. But for other pain management, the CDC recommends non-opioid approaches including physical therapy.

When to choose physical therapy over opioids:
  • The risks of opioid use outweigh the rewards. Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, "experts agreed that opioids should not be considered firstline or routine therapy for chronic pain," the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, "risks are much lower" with non-opioid treatment plans.
  • Patients want to do more than mask the pain. Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
  • Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia. The CDC cites "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
  • Opioids are prescribed for pain. Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with non-opioid therapies, such as physical therapy.
  • Pain lasts 90 days. At this point, the pain is considered chronic, and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that non-opioid therapies are preferred for chronic pain and that clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.

As always, before you make a medication change, consult with your prescribing healthcare provider and educate yourself on all your options. Patients are also encouraged to consult with a physical therapist to discuss options for non-opioid treatment.

According to the CDC, as many as 1 in 4 people who receive prescription opioids long-term for non-cancer pain in primary care settings struggle with addiction.

 Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

Swim Personal Training :: Now Offered in Grand Rapids


Have you been wishing your triathlon swim times were faster? Looking to take the competition to the next level? Swim Personal Training is just the thing to get you there, and we're thrilled to offer it at the Northview Fitness Center Pool.

Ideal for triathletes who want to improve their stroke technique and race strategy, competitive swimmers trying to improve their performance or recover from an injury, any athlete wanting an intense workout in a change of scenery, or the person looking for a low impact general fitness program.

Swim Personal Training services can include:
- Detailed stroke technique analysis and revision
- Over and underwater high-def video recording and slow motion analysis
- Triathlon and competitive swimming race strategy counseling
- Deep water lap lane conditioning and stroke drills
- Shallow or deep water strength building exercises

Meet the instructor, Kelsey Wilterink

Kelsey grew up in Rockford, Michigan where she began swimming competitively and playing water polo in 7th grade. By the time she graduated six years later, she had won two state championships on the water polo team, set three swimming school records and earned over a dozen All-American honors for race times in the top 100 across the country. She was also given the Female Athlete of the Year award for Rockford High School. She continued her swimming career at Grand Valley State University on a full ride scholarship, and in three years she set three school records and placed in the top-16 at nationals 12 times. Having battled shoulder injuries throughout her aquatics career, she understands how crucial perfect technique is, as well developing the emotional and mental strength required to overcome obstacles and achieve top performance potential. Since graduating with honors and a B.S. In Clinical Exercise Science and a Spanish minor, she has worked in swim coaching, youth residential rehabilitation, lifeguarding, teaching water safety and swim lessons, physical therapy tech, and personal training. In her free time she enjoys doing triathlons, traveling, cooking, and helping her husband restore their 150 year old farmhouse. 

Program Details
Swim Personal Training sessions are available in 3 packs for $135, or 10 packs for $350. Discounts are available for groups of two. Sessions are available by appointment during fitness center hours. Please note, clients must be able to swim 25 yards and tread water for 30 seconds to participate. Call 616.365.6140 or stop by the Northerview Fitness Center to get signed up.

Red, White, and Blue Fruit Smoothie


Looking for a refreshing, but healthy, treat for the holiday weekend? This smoothie tastes great and it's packed full of fresh fruits. Enjoy!

Ingredients
1/2 banana, cut into pieces and freeze ahead of time
2 large strawberries, sliced
1/4 cup blueberries
1/2 cup milk
1 teaspoon vanilla extract
2 tablespoons vanilla yogurt
2 ice cubes

Directions
Place all ingredients in the blender, blend until smooth

The Perfect Smoothie Combination


Smoothies are the perfect alternative to breakfast, they make a great snack, or a light lunch. You can really alter the flavor by adding lots of fruits, and you'll consume your share of veggies in one sitting. Plus, take advantage of in-season fruits and fresh greens by pureeing them with a little bit of water, then freeze the mixture in ice cube trays. Each time you want to make a smoothie, grab a few ice cubes and you'll always have ingredients on hand. The image below shows a great combo to make the perfect smoothie.


Seated Core Exercises


If you think the only benefit of a strong core is a set of 6-pack abs, think again. A strong core can improve your posture, reduce back pain, improve athletic performance, help with balance, and allow you to breathe easier. 

If you're not used to working your core, it's a good idea to start slowly. We've put together a few exercises that don't even involve getting out of your chair.


The seated arm raise is going to strengthen your core and shoulders. Try 3 sets of 20, 3 times per week. Start by sitting tall in a chair with your arms in front, elbows straight, palms facing each other. Raise your arms overhead, then lower and repeat. Remember, don't arch your back or lean forward while doing this exercise. If you want to feel a little extra burn, use light hand weights for added intensity.


The seated march is great for strengthening your core and abs. Perform 3 sets of 20, 3 times per week. Start by sitting in a chair with your hips and knees at 90 degrees. Lift one leg up, lower back down, and repeat with the other leg. If you want a little more intensity try this instead: lift one leg, then straighten it out in front of you, bend and lower back down. Repeat with the other leg.


The side bend is a great way to strengthen your core and abs, as well as increase abdominal flexibility. Try 3 sets of 10 and perform this exercise 3 times per week. Start in a seated position, bend to the right then return to start. Repeat this on the left side and continue going back and forth.

If you want more exercises like these, our personal trainers are here to help. Contact the location nearest you for more information.

It's a Family Affair at Northern


Ron's Story
After years of pain in my left knee, it finally gave out in 2008 and I had a total knee replacement. That post surgical rehab was my first experience with Northern Physical Therapy and so began a relationship that would grow over the next 8 years. I later returned with a total right knee replacement, left and right shoulder rotator cuff surgeries which required therapy, and help with severe low back pain. 

When injuries happen you look for a good surgeon to be on your team of experts - someone who can help you get back on the road of recovery. The surgeon is just as important as who you choose to help with your recovery. Northern Physical Therapy is a GREAT choice to add to your support group. I've come to trust Northern and rely on their knowledge and expertise when I need help to get well from an injury, get back in shape, and return to work at my physically demanding job.

Northern Physical Therapy has also gone above and beyond in assisting me with referrals to another doctor, they've helped with billing through insurance companies, and even assisted in working through the governmental bureaucracy of Federal Workmen’s Comp issues.

Ronald and Nancy Zeerip are pictured with Nancy's therapist, Terri

Nancy's Story
My wife Nancy was having ongoing problems with bowel obstructions which ultimately resulted in a perforated bowel with peritonitis that required surgery. In one of my visits to Northern, my therapist Lisa, asked how everything was going and I relayed my wife’s issues to her and asked if physical therapy could help with abdominal surgery. Lisa suggested we see her colleague Terri, who specialized in women's issues. That advice would change Nancy’s life.

Recovery from surgery and learning to live with a colostomy was not easy. Eventually Nancy got well and a reversal of the colostomy was advised, leading to another abdominal surgery with major incisions.  The surgery and recovery process didn't go well. The incisions were painful and hard on her mentally.

At Nancy’s follow-up visit for staple removal we asked if she could get physical therapy. We hardly got the words out and we were told, “NO, there is no physical therapy needed for abdominal surgery.” Our efforts for additional discussion were met with negativity. Nancy discussed physical therapy with her Diabetic Physician and Primary Care Physician after problems arose with her left foot and leg. The diagnosis was ‘foot drop syndrome’ from nerve damage during surgery. And again after requesting therapy the reply always was that physical therapy would be of no benefit and that insurance wouldn't cover it. Nancy and I discussed it at home and even if insurance wouldn't cover it, I wanted her to try it. We thought it would be helpful and we would find a way to pay for it ourselves.

Terri works with Nancy on her physical therapy treatment

At the end of the day we asked Northern to write a request for treatment and submit it to our Primary Care Physician. The request was approved and the road back to health and physical well being began. Words like – helpful – dedicated – highly skilled – caring – just don’t seem sufficient to describe all the people at Northern and the services they've provided to Nancy and I over the years.

Northern Physical Therapy has truly changed our lives - you're a class act and we can't thank you enough for all you've done for our family.
Sincerely,
Ronald & Nancy Zeerip, Coopersville patients

Alternative Ways to Exercise on a Treadmill


Who said a treadmill was just for running? We've got some great ways to work your calves and legs, and build strength. Next time you're just not feeling up for a run, give these a try.


Tone Your Thighs with Side Shuffles
In addition to working your inner and outer thighs, side shuffles tone your calves and make for a great cardio exercise. Stand sideways on the treadmill with your knees slightly bent. Set the speed somewhere between 3 and 5 miles per hour. You can use a Theraband strap for a little extra resistance. Quickly shuffle, landing on the balls of your feet. Do this for 5 minutes and switch sides.


Work Your Glutes with Lunges
Walking lunges on a treadmill is an ideal way to tone your behind. Set the treadmill at a very low speed and on a slight incline, about 1-2 miles per hour with a 10% incline. Practice a few times while holding on. Once you get the hang of it do 1-3 minutes of lunges followed by 2 minutes of walking. Repeat this sequence for 20-30 minutes.



Tone Your Back Side with Reverse Mountain Climbers
This variation of the traditional mountain climber emphasizes kicking your legs back, as opposed to bringing your knees in. Set the treadmill at a very slow speed, around 1 or 2 mph. Get into a plank position and begin by placing your feet on the sides of the treadmill, putting your hands on the floor. Then, put your feet on the treadmill and bring one knee into your chest while extending the other leg back. Switch legs and repeat in 30 second intervals.


Build Leg and Core Strength with Jump Squats
Set the treadmill to roughly half the speed of your average walking pace. Start by bringing your feet together at the front of the treadmill and lower into a squat position. As you reach the back of the treadmill, take a long lunge/jump forward, returning to the front of the treadmill in your starting squat position. Repeat in 30 second intervals.