Bike Because Queen Said So!

“I want to ride my bicycle, I want to ride my bike “ - Queen

With World Bicycle Day being June 3rd, it only seems right.

The weather is getting warm, the smell of burgers and brats fill the air, and you’re ready to bust out your bicycle.  New or old, tandem or unicycle, red or green, Trek or Schwinn, you’re ready to hit road for another summer – determined to finally complete that triathlon you’ve put off for the last 3 years. Hold on cowboy - before you mount your horse let’s get a few things straight regarding proper bike fitting. Bike fit varies a lot based on your primary goal: recreational riding vs leisure riding. See below for a great graphic illustrating this from article recently published by the Wisconsin State Journal (2018). In general, seat height should be set with the goal of achieving a 25-30 degree knee bend; specifically avoid your knee going past your toes. This reduces risk of knee pain and makes for optimally efficient riding (Bini et al., 2011). On the contrary, setting your seat too low will result in greater overall fatigue and higher risk for anterior thigh/knee pain. While research has shown upright trunk positions are most comfortable for riders, it obviously results in less advantageous aerodynamics (Priego Quesada et al., 2017); again, your goals should drive your bike fit – no pun intended. If you have further questions, please stop in your local APSTM for a FREE 15-minute screen and pick our providers’ brains in order to optimize your summer biking experience.

Also, please be sure to look into our Tour de Ripon bike even going all summer in the Ripon area; sign up, bike to a restaurant, and get incentivized with free food & drinks!  The event runs from June 1, 2018 – August 31st, 2018 – sign up anytime! More info available on our website and Facebook page.


With World Bicycle Day being June 3rd, it only seems right.

Safe riding,



Bini, R.,Hume, P., Croft, J. (2011). Effects of bicycle saddle height on knee injury risk and cycling performance. Sports Medicine: 41(6), 463-476.

Kittner, G. (2018). Time to Tune Up. Wisconsin State Journal.

Priego Quesada, J., Perez-Soriano P., Lucas-Cuevas A., Salvador Palmar R., Cibrian Ortiz de Anda, R. (2017). Effect of bike-fit in the perception of comfort, fatigue and pain. Journal of Sports Sciences: 35(14).


The Green, but "Injured" Thumb

Most of us don’t think of overuse injuries when starting a new hobby.  Especially those hobbies that involve what we perceive as less strenuous activities.  But, did you know that planting and tending to your garden can predispose you to some of the same injuries of as athletes such as golfers and rowers?  We always advise you to start a new activity at a gradual pace, increasing duration and intensity slowly. The same is true for gardeners anxious to get digging into the fresh spring soil. Don’t attempt to clear all the winter debris in a single day, or plant the flats of annuals brought home from the nursery all at one time.  This is why they have the yard pickup team arrive at your curb over a 6-week timeframe instead of 1x/season.  Instead, undertake these new hobbies at moderate intervals and take a few minutes to stretch prior.

Typically, the pain of sprains, tendinitis and even arthritis is mild at first and often ignored. However, these ailments can develop into serious conditions if left untreated. Here are a few common gardening-related problems that would require medical attention:


The repetitive motion of opening and closing shears or other hand tools can lead to a painful triggering or locking of the fingers or thumb. The condition is caused when the “eyelet” that holds the flexor tendons in place along the finger or thumb interferes with the smooth gliding of the tendons through it. Patients may feel a pain in the palm or the finger and, in severe cases, the finger is stuck downward and requires “unlocking” with the help of the other hand.  In addition, using vibrating tools and blowers excessively can cause significant vibration concerns. This adds pressure on the median nerve, which could potentially lead to pre-carpal tunnel like symptoms.


Persistent pain in the wrist could develop from repeated motion of the wrist. In De Quervain’s tendinitis, the tendons that attach at the base of the thumb become irritated or constricted, causing painful swelling along the wrist. Heavy raking can cause pain in the forearm about three inches above the wrist, a condition called Intersection Syndrome. It results from the overuse of the wrist extensor tendons, which rub against one another as the wrist repeatedly bends backward. The friction caused by the rubbing tendons leads to irritation, inflammation and painful swelling.


Tennis and golfer’s elbow (medial and lateral epicondylitis) are painful conditions involving the tendons that attach to the humerus bone at the elbow. With tennis elbow, repeated bending of the wrist while gripping something like a rake weakens tendons attached to the outer, or lateral, side of the elbow. Similarly, weakened tendons attached to the inner, or medial, side of the elbow and can lead one to suffer from Golfer’s Elbow.

In most cases the overuse-related conditions described above can be resolved with activity modification, ice and over-the-counter anti-inflammatory medication. If the pain persists more than five days or so, however, it would be wise to consult with a physician who can assess whether bracing, physical therapy or other treatments are needed.


One other gardening-related risk to mention is Sporotrichosis. Also known as Rose Thorn Disease, Sporotrichosis is caused by fungus found in soil, rose thorns, hay, moss and twigs and usually enters the body through a thorn prick. The fungus is more closely related to mold found in stale bread or yeast used to brew beer than to bacteria. Once the mold spores enter the skin, the disease can take days or months to develop. The first symptom is usually a painless bump or lesion that is pink or purple in color. In most cases, the mold spreads to the lymph nodes. Over time, new nodules can develop from your fingers all the way up the arm, becoming open sores or ulcers that are susceptible to infection. The disease is rarely life threatening, but it is important to seek medical attention. Left untreated, the ulcerative lesions can develop into a chronic condition that can persist for several years. All the more reason to wear garden gloves.

(Some content borrowed from WAG, May 2, 2o17)


Have you hugged your OT today?

Have you hugged YOUR OT today?

             April is Occupational Therapy Month!  Um, excuse me, but what the heck is OT anyway?  Is that kinda like physical therapy?  Do occupational therapists help you find a job, or what?  Not exactly... 

            Occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability.

            Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include:

•       an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,

•       customized intervention to improve the person’s ability to perform daily activities and reach the goals, and

•       an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.

                      Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment and/or task to fit the person, and the person is an integral part of the therapy team. It is an evidence-based practice deeply rooted in science.

            There are a handful of highly skilled occupational therapists who are an integral part of the Advanced Physical Therapy and Sports Medicine clinical team .  The OT's at APTSM work in a variety of settings: 

•         Outpatient clinics.  Several OT staff members specialize in hands and upper extremity, treating patients with pain and dysfunction associated with injury or the wear and tear of daily living and aging. 

•         Industrial sites across Northeast Wisconsin.  OT provides on-site work-hardening, job-site analysis, education for body mechanics, and pre-injury screenings.

•         Recovery Inn in partnership with the Orthopedic & Sports Institute of the Fox Valley. Occupational therapists provide therapy for acute care, post-surgical patients, helping them return to maximum independence before returning home.

April is Occupational Therapy Month!  Have you hugged YOUR OT today? 

Allison M. Salm, OTR, CLT



A Day in the Life!

Last week we introduced you to what exactly is Athletic Training, and where do you find these mysterious healthcare figures.  We want to dive a little further into this today, and see one of their most sacred rituals: game day. 

It's game day, you're standing in the tunnel, the crowd is cheering....whoa, whoa, whoa, wait, we should back up 6 days to when the preparation for game day really began. It's Sunday, treatments are occurring. Treatments range from contusions, ankle sprains, overuse injuries, and ongoing rehab from previous injuries.

It's Monday, typical practice preparation, rehab during the day and emails out to the visiting team. Throughout the remainder of the week, it's decisions regarding if an athlete can play on Saturday, nutritional advice so the athlete can fuel for the big game, more rehab, and too many other things to list. 

Now, it's game day. Arrive earlier than anyone else, make last minute decisions and time to prep. 10 gallons ICE, water bottles, AED, crutches, splints, emergency airway equipment, treatment tables, and all of the tape that fits in the sideline kit. Pregame treatments begin followed by pregame taping and a last minute glance to make sure everything is ready. Warm ups begin, last minute stretching while organizing the sideline. EMS arrive on scene along with the team physician; introductions are made and review of the emergency action plan is discussed. Finally, the national anthem. The game begins. 

Ready to do start this all again tomorrow?  

Thanks for reading.

Ashley Rottier, MSAT, LAT


At Your Own Risk

Given that March is National Athletic Training Month, I would like to open up to the world of Athletic Training to you! What is an Athletic Trainer?  Athletic Trainers (AT’s) are health care professionals who work under the direction of physicians as prescribed by state licensure statutes. What services can an AT provide? The services provided by AT’s comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.

The statutory title of “athletic trainer” is actually a misnomer, but is derived from the profession’s historical roots. Athletic trainers provide medical services to all types of people – not just athletes participating in sports – and do not “train” people as personal or fitness trainers do. However, the profession continues to embrace its proud culture and history by retaining the title. In other countries, the profession bears the label of athletic therapist or physiotherapist.

Here in the U.S., the National Athletic Trainers’ Association (NATA) represents more than 44,000 members domestically and internationally, there are about 50,000 ATs practicing nationally. The athletic training profession began early in the 20th century, and NATA was established in 1950. At Your Own Risk is a public awareness campaign sponsored by the National Athletic Trainers’ Association designed to educate, provide resources and equip the public to act and advocate for safety in work, life and sport. In an effort to provide comprehensive information, the association has launched a website, that provides recommendations on keeping student athletes and communities active and employees safe on the job.

Did you know that Advanced Physical Therapy and Sports Medicine provides Athletic Trainers for the Appleton Area School District, St. Mary Catholic High School, Lawrence University and numerous industrial sites in the area? Well, they do! Advanced Physical Therapy and Sports Medicine can provide the care for you, your student-athlete, or your event!

Please explore more about athletic training at the following pages:

Wisconsin Athletic Trainers' Association: Homepage


Profile of Athletic Trainers.

trainers.pdf.Published July 2016.Accessed March 1,2018.


Falling For You!

Falling for You #PunnyValentinejokes

You hear about it every winter in Wisconsin: someone you know – a family member, a friend, a neighbor - has fallen and gotten severely injured. Often times a broken bone is the result of these tragedies. Based on an earlier blog post, we already know that physical therapy (PT) can help prevent falls; let’s say you weren’t convinced PT could help prevent your fall. What if I told you that physical therapy (PT) could be the difference between your fall resulting in a broken bone or simply a superficial flesh wound? Physical therapists are movement experts, and research has shown that exercise, the foundation of PT, increases bone mineral content & density across the lifespan – from childhood to older adults (Behringer, et al., 2014 & McMillian, et al., 2017). More bone mineral density means stronger bones, and stronger bones could be the difference between a bruise and a fractured hip. According to McMillian and company, “a seemingly small 1–3% improvement in bone mineral density may be sufficient to avoid a fracture” (2017). Although many various types of exercise are beneficial for bone health, it is hypothesized that higher impact activities (running, jumping, lifting heavier weights, etc.) result in higher bone densities (Behringer, et al., 2014). A famous Wolff once created a law stating “bones will remodel based on the stresses placed upon them”. In summary, sitting on the couch = weak bones; physical activity = strong bones.

Another large variable playing a role in bone health is nutrition. Making sure you have enough calcium and Vitamin D in your diet also ensures stronger bones; calcium makes our bones strong, and vitamin D assists in our bodies’ absorption of calcium (Behringer, et al., 2014). Combine physical activity with these nutrition tips and your long bones will be grinning from epiphysis to epiphysis.

Last, but not least, it is very important that when you are planning to increase your physical activity level you consult a medical profession who can create and individualize program that fits all your needs. As mentioned before, physical therapists are movement experts, and this is where we at Advanced Physical Therapy & Sports Medicine come in.

Happy Bone Building,

Dr. PJ


Behringer M, Gruetzner S, McCourt M, Mester J (2014) Effects of weight-bearing activities on bone mineral content and density in children and adolescents: A meta-analysis. J Bone Miner Res 29: 467–478. 

McMillian L., Zengin A., Ebeling P., Scott D. (2017) Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults. Healthcare 5(4): 85.