In addition to a full locker room, Active Care offers showers, shampoo, soap and towels to those patients that need these amenities.
How do I book an appointment?
Appointments can be booked with a member of our front desk staff by calling 415-387-6564.
Do I need a doctor’s referral to see you?
The State of California does not require a doctor’s referral to receive physical therapy services. However, health insurance does require a physician’s referral to provide coverage of physical therapy treatment.
Do you accept health insurance?
Active Care accepts most major health insurance providers and does verify benefits as a courtesy to our patients. For ‘out of network’ patients or for those whose benefits do not cover physical therapy services, a self-pay rate is available. More information about insurance plans can be found here (link to insurance page).
What should I bring to my first appointment?
Please bring your health insurance card, the physical therapy prescription from your referring physician and any recent X-Ray, MRI or other diagnostic studies that pertain to your injury. During the initial evaluation, the physical therapist will perform a full review of pertinent orthopedic history and will combine this with any information about range of motion restrictions or muscle strength impairments that are apparent during the physical exam.
What should I wear?
Since Active Care uses an exercise based approach, your first appointment will likely include physical activity. For patients with lower body injuries, shorts or sweat pants are preferred. T-shirts or tank tops are best for upper body or shoulder conditions.
What should I expect from an appointment at Active Care?
The words “typical visit” imply that we have already pre-arranged your program before we learn about your specific goals and needs. As our treatment philosophy is founded in the belief that a successful recovery involves a restoration of correct mechanics, strength, ROM and mobility every appointment at Active Care involves exercise. Depending on the patient’s diagnosis, we will include soft-tissue massage, manual exercise, manual mobilization and/or exercise program modifications as indicated. A visit will usually last 1-1 ½ hours.
How often will I have to keep coming back to Active Care?
The referring physician will often specify both frequency and total number of visits when prescribing treatment. Within this framework, your Active Care physical therapist will develop a plan that addresses each patient’s specific needs and one that will integrate with other work, family and travel constraints. Since we commonly see patients that come from a long distance, home exercise programs are also part of each patient’s program.
Foot Discrimination
Have you been a subject of foot discrimination? Relegated to the “supportive” section of the shoe store? Those who over-pronate or have “flat feet” have suffered from an injury prejudice that has stemmed from the belief that this foot type predisposes one to a variety of orthopedic problems. It has been deemed such a structural defect that flat feet can disqualify one from military service.
Of course, pronation is a natural part of every running stride. When the foot hits the ground it flattens and rolls inward or pronates as a means to partially absorb the force of the foot striking the ground. In the past, scientists and medical professionals have been concerned with over or under-pronation during the running stride and have long believed that those groups are at higher risk of injury.
Taking the lead from this firmly held belief, the athletic shoe industry has been built on the premise that every shape of foot needs a specific shoe. Generally these three types of shoe are the “cushioned” shoe for the high arched or under-pronated, “stability” for the neutral foot and the “motion-control” shoe for the more severely flat-footed or over-pronated.
But despite this conventional wisdom, and best efforts of the salesperson at the running shoe store, new science may liberate your shoe choices.
In a recent study published in the British Journal of Sports Medicine, novice runners with flat feet or high arched feet didn’t suffer from any greater rate of injury when they ran in a neutral shoe rather than a motion-control or cushioned shoe matched to their foot type.
In the study, researchers followed nearly a thousand novice runners with different foot types for a year. Every participant in the study received the same neutral shoe, regardless of foot type, and a GPS monitor to track mileage. The volunteers were able to run as much as they wanted and at whatever speed they wished.
The group of runners ended up covering over 200,000 miles over the one-year study period and suffered from 300 injuries. While nearly a third of the runners in the study suffered from an injury during the year, the study concluded that, “foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe.” Contrary to widely held belief, the over or under pronators didn’t didn’t suffer from an increased rate of injury. Notably, for those participants that amassed more than 600 miles of running, the neutral footed runners actually experienced more injuries than those with flat or highly arched feet.
This well designed out study supports earlier evidence reported in the same journal in which female runners were randomly assigned a neutral, cushioned or motion control shoe before commencing a 13-week half-marathon training program. Surprisingly, those that wore the motion control shoe experienced the greatest number of injuries and runners of all foot types reported the greatest level of discomfort with the ultra-supportive shoe.
Additionally, a recent review study in the journal Gait and Posture concluded that flat feet were not associated with any increase in injury rate other than a mild association with flat feet and shin splints. In fact, several studies in the review suggested that flat feet might be protective against the development of lower-leg stress fractures.
Now while those with a history of leg or hip injury may need more support, those that don’t have any problems shouldn’t rush to buy a heavily supportive shoe based solely on foot type. Comfort and fit are important factors and given the above research findings, should perhaps be given greater emphasis when choosing a running shoe.
Researchers now suggest that beginning runners put greater focus on those factors that seem to have a greater association with running injury, such as body mass, training volume and any history of previous injury.
The Athlete’s Body
The Olympics give us a fascinating look at the physical and athletic qualities of individuals who have achieved the top level of sport. But how did these athletes reach that level of athletic performance? One popular book has advocated the theory that excellence in any sport or activity requires 10,000 hours of practice. But how much does genetics matter? Does an athlete’s body adapt to years of repetition in the same sport or did the athlete find success because their body was suited for that particular sport? For example, would Michael Phelps have been so successful if he trained as a runner from an early age?
The evidence would seem to point to the contrary; Michael Phelps’ physical and athletic make-up optimized his chances for swimming achievement. Michael Phelps might have been a successful runner but chances are he would not have won 14 gold medals in two Olympic Games if he ran track. Add 10,000 hours in the pool to extremely long arms, huge hands and flipper-like feet and you have the makings of an athlete that has reached the pinnacle of his sport. Those same attributes wouldn’t be as valuable to a runner, with or without 10,000 hours of running. Watching Charles Barkley play golf is evidence enough that greatness in one sport does not necessarily translate to excellence in all.
One physical quality that should be added to the list of attributes that will allow an individual to swim more successfully is the mobility of the shoulder joint. Confirming this observation, a study in the Clinical Journal of Sports Medicine found that elite swimmers possessed a greater degree of shoulder mobility than recreational swimmers. The authors concluded that this mobility was both acquired through years of swimming and was an inherent trait in those that competed at the elite level.
Similar results are found in other athletes that compete in sports that place a high demand on the shoulder like baseball, tennis or volleyball. These athletes benefit from a greater degree of mobility of the shoulder and years of repetition in these sports enhances this mobility. However, the pendulum can swing the other way as this mobility comes with the price of the increased risk of excessive motion, meaning instability.
Countless sports medicine journal articles have been devoted to examining the incidence of shoulder injuries in swimmers and in one such article, a review article examining the causes of shoulder pain in swimmers, researcher Dr. Casey O’Donnell states, “controversy surrounds whether swimmers acquire shoulder laxity as a result of repetitive motion, or whether swimmers with inherent shoulder laxity are more efficient in the water, which leads them to stay in the sport longer and compete at a higher level.”
But like many attributes, too much of a good thing can become a problem. Too much shoulder motion can become instability after years of repetitive use. For swimmers, excess mobility in the front of the shoulder can lead to pain and sometimes structural damage. As swimming enhances the looseness of the front of the shoulder, additional stretching of the shoulder can contribute to the development of shoulder pain and laxity. Because of this, care should be taken to minimize stretching the front of the shoulder as with a doorway or partner stretch. When the front of the shoulder is inflamed or sore from the repeated stress of swimming, the shoulder can feel “tight”. Responding to this feeling with more stretching can further irritate structures that are already “overstretched”.
While there is conflicting research on the topic, researchers at the University of California, Irvine found that the swimmers whose shoulders displayed a greater degree of laxity or looseness were more likely to experience shoulder pain.
Rather than more stretching, the emphasis should be placed on increasing the stability of the shoulder to balance the inherent mobility. The rotator cuff muscles of the shoulder act to maintain the stability of the shoulder and strengthening of these important muscles should be a high priority. In his article Dr. O’Donnell recommends that all young swimmers be instructed in a shoulder-strengthening program, specifically one focusing on the shoulder blade and rotator cuff muscles.
High volume of any sport or activity, even a non-impact activity like swimming, can lead to an overuse injury. It is important to follow the same principles that guide runners, cyclists and dancers in the prevention of swimming injury.
Key Points
- Swimming naturally develops the mobility of the shoulder. Be careful with “extra” stretching of the front of the shoulder as this may contribute to the development of shoulder pain
- Strengthen the stabilizer muscles of the shoulder; the rotator cuff and the scapular muscles
- A frequent cause of shoulder “tightness” is inflammation of the front of the shoulder from too much stretching. Avoid further stretching.
- Include cross training and rest days into swimming program
- Avoid large abrupt increases in swimming volume
