Toning shoes, good exercise? Or a pain in the back?

Skechers Shape-Ups™, MBT™ (Masai Barefoot Technology) and Reebok EasyTone™ are the latest rage in exercise shoes. The shoemakers all tout health claims for these shoes ranging from increasing calorie burn to helping relieve knee and back pain.


Your physical therapist can tell you if toning shoes like these Skechers Shape-Ups™ will help you, or not.



The common feature of all of them is an essentially unstable sole design using a curved, heavily cushioned sole. The theory is that by forcing wearers to continually adjust the foot and ankle to maintain balance, you work calve and quadriceps muscles causing you to burn more calories and strengthen the muscles.

At prices ranging from $100 to $245 you naturally want to know, do they work? Rick Jusko, PT, OCS, owner/director of Seattle Hill Physical Therapy says that a scan of popular blogs, and Google searches yield mixed results. Some people swear by them, while other complain of back pain and ankle and other injuries resulting from falling.

“Unfortunately, there are no credible studies that prove or disprove the shoemakers’ claims,” Jusko says. “However the American Council on Exercise conducted a small study that may shed some unbiased light on at least the exercise claims.”

Led by exercise experts John Porcari, Ph.D., John Greany, Ph.D., Stephanie Tepper, M.S., Brian Edmonson, Carl Foster, Ph.D., Meghan Sandve With Mark Anders the researchers designed a small exercise test comparing the toner brands to a pair of generic conventional running shoes.

The study involved 12 young women ages 21-27 who wore the shoes in random order in a series of five-minute treadmill tests. Researchers used electromyography (EMG) to record muscle activity in six muscle areas: the calf, quads, hamstrings, buttocks, back, and abs, as subjects walked in each of the four pairs of shoes. The result: None of the shoes produced a statistically significant increase in either exercise response or muscle activation.

“We tested Rate Perceived Exertion (RPE), which is basically how hard one is working, and oxygen consumption,” says researcher Stephanie Tepper, “how much oxygen you take in versus being at rest, and caloric expenditure and we found no significant difference between any of the shoes. So the toning shoes definitely don’t do more than the regular running shoe.”

As for increasing back pain and ankle injuries, Jusko says it is likely that changing the wearer’s gait causes the use of formerly unused muscles, which can result in aching. Such pain will usually go away as the muscles are strengthened with continued use. The balance issue, however, can cause people to twist ankles and sometimes fall.

“More studies will be needed to determine the benefits and risks of these toner shoes,” Jusko says. “Until then, if you are young and want to increase daily exercise, and these shoes motivate you to get out and walk, then that is probably a good thing. For older people, the balance issues and the risk of falling might outweigh any benefits you could gain. You probably are better off with conventional walking shoes,” said Jusko.

If you think that you would like to try these new shoe types, make an appointment with Rick Jusko at Seattle Hill Physical Therapy to determine if they are right for you.

SOURCE: American Council on Exercise,

© 2010 eClinic Solutions

If you have a pain in the back, you may need some backup

If you experience recurring low back pain and your doctor has ruled out underlying conditions, such as arthritis, it might be time to see a physical therapist.

A 2006 study in the journal Spine, found that, at any given time, approximately one quarter of Americans report experiencing low-back pain within the past three months. The causes can be as varied as the people experiencing the pain. But before you do a Google search to find some therapeutic exercises, and start on a resolution to heal yourself, you might want to consult a physical therapist. Without knowing the cause of the pain, you could end up making it worse.

Rick Jusko, PT, OCS, owner/director of Seattle Hill Physical Therapy, says that because there is so much variation in the causes of low-back pain a physical therapist can be the key to ending the cycle of pain, recovery and recurrent pain.

“Unfortunately, back pain is such a common problem stemming from such a wide variety of musculoskeletal issues and medical conditions, it is important to identify the factors contributing to your specific pain,” Jusko says. “Whether your pain is caused by over exertion, or by lack of strength, or poor posture, your individual status will dictate a personalized treatment approach. Each individual’s case is unique, requiring diagnosis and treatment with a plan of care that is suited to your particular condition.”

Jusko says he will carefully evaluate your physical condition, your activity level, your posture, flexibility, strength, body mechanics for the work, or sports you do and assess a number of other lifestyle factors, and then tailor a therapy program suited to your individual needs and most importantly will fit your lifestyle.

© 2010 eClinic Solutions

Get to know your back

If low back pain is keeping you from enjoying your favorite activities, sports, or work, learning a bit about the back can help you find relief.

(Illustration courtesy of the National Institute of Arthritis and Musculoskeletal and Skin Diseases)

While nearly everyone will experience low back pain sometime during their lifetime, it occurs most often in both women and men between ages 30 and 50. The causes are many including: normal aging, couch-potato lifestyles with too little exercise, sometimes too much exercise, or unusual exertion, such as shoveling snow.

The risk of experiencing low back pain from disc disease or spinal degeneration increases with age. If your low-back pain continues with no improvement for more than 72 hours call for a doctor’s examination.


The back is a complex structure of bones, muscles, and other tissues that supports the body’s trunk from the neck to the pelvis. The spinal column supports the upper body’s weight and houses and protects the spinal cord which is the main nervous system structure that carries the signals that control the body’s movements and convey its sensations.

The spinal column is composed of more than 30 bones, called vertebrae, stacked on top of one another. Each of these bones forms a circular casing that surrounds and protects the spinal cord. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage. Small nerves enter and exit from the spinal cord through spaces between the vertebrae carrying signals from organs, muscles and other tissues to and from the brain.

The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue called ligaments and tendons hold the vertebrae in place and attach the back muscles to the spinal column.

Starting at the base of the neck, the spine has four regions:
• Seven cervical or neck vertebrae are labeled C1–C7
• The next 12 thoracic or upper back vertebrae are labeled T1–T12
• Five lumbar vertebrae named L1–L5 make up the lower back
• Sacrum and coccyx, a group of bones fused together at the base of the spine.

The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.

Exercise can help prevent low-back pain

Regular exercise strengthens muscles that help stabilize your lower back and prevent common occasional back pain. The U.S. Department of Health and Human Services recommends 150 minutes (2 hours and 30 minutes) of exercise per week. Almost any regular exercise such as walking, jogging or swimming will greatly enhance your chances of maintaining a pain-free back. The American Academy of Orthopaedic Surgeons also recommends some back-specific exercises that target the back and abdominal muscles needed to maintain a healthy spine.

Note: If you are currently experiencing back pain, consult your doctor before beginning any back pain exercise program. Not all back pain results from weak muscles. If you are NOT experiencing pain, Rick Jusko, PT, OCS, owner/director of Seattle Hill Physical Therapy says the exercises below can help you keep it that way.

Abdominal contractions

• Lie on your back with knees bent and hands on your stomach below ribs

• Tighten abdominal muscles to squeeze ribs down

• Be sure not to hold your breath

• Hold for 5 seconds

• Relax

• Repeat 10 times

Knee to chest stretch.

This stretch can help strengthen muscles that help stabilize the spine. (click of image to view YouTube video)

Wall Squats

• Stand with your back against wall

• Walk feet 12 inches in front of body

• Keep abdominal muscles tight while slowly bending both knees 45 degrees

• Hold 5 seconds

• Slowly return to upright position

• Repeat 10 times

Knee to chest stretch

• Lie on your back with both knees bent

• Hold the thigh behind your knee and bring one knee up to chest

• Hold 20 seconds

• Relax

• Repeat 5 times on each side

SOURCE: American Academy of Orthopaedic Surgeons

© 2010 eClinic Solutions

You don’t have to live with shoulder pain

Rick Jusko, PT,, will design a program of exercises and activity modification tailored to your injury and your personal lifestyle. (Illustration used under license © Can Stock Photo Inc., 2011

You probably know someone who has had a rotator cuff injury. It is one of the most common causes of shoulder pain, according to the American Academy of Orthopaedic Surgeons. How do you know if you have a rotator cuff injury? Here are some signs to watch for:

  • Shoulder pain
  • Difficulty raising the arms above the shoulders
  • A dull ache in the upper arm that increases with movement

The rotator cuff consists of the muscles and tendons of the shoulders. It includes four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis, and the tendons that connect these muscles  along with three bones. These include the shoulder blade, or scapula, the upper arm bone or humerus, and the collarbone or clavicle.

Rick Jusko, PT, OCS, owner/director of Seattle Hill Physical Therapy says rotator cuff injuries can result from age-related wear and tear, a single injury event, such as a fall. Overuse injuries can occur with sports such as golf, basketball, baseball, tennis, weightlifting, or from work activities that involve raising the arms above the head.

Treatment may require surgery for serious injuries involving a complete or severe tear, or non-surgical treatment. In either case, Jusko, can work with you to design a program of exercises and activity modification tailored both to your injury and your personal lifestyle. The goal is to increase the range of pain-free motion, and to strengthen the uninjured muscles to compensate for injured tendons.

Following the rehabilitation plan Jusko recommends will help you return to full function sooner. And a maintenance regimen that fits your lifestyle will help prevent further injury in the future.

For more information about rotator cuff injuries visit American Academy of Orthopaedic Surgeons: Rotator Cuff Tears.

© 2010 eClinic Solutions

Sports and common shoulder injuries

Many winter and spring sports can take a toll on shoulders. According to the American Academy of Orthopaedic Surgeons most shoulder problems involve the muscles, ligaments and tendons rather than the shoulder bones. Rick Jusko, PT, owner/director of Seattle Hill Physical Therapy, says knowing the type of injury most common to your sport and strengthening shoulder muscles can help better prepare you for season-long enjoyment as well as prevent many shoulder injuries.


Most shoulder problems involve the muscles, ligaments and tendons rather than the shoulder bones. (Illustration courtesy of the National Institute of Arthritis and Musculoskeletal and Skin Diseases)

  • AC Joint Sprain
    This injury can often occur when you fall or land on the top of the shoulder. This is common for skiers and snowboarders who do not have time to protect themselves with their hands and land downhill, shoulder first.  This is also a common hockey injury because the hands are holding the stick and shoulder takes the brunt of the fall. The AC joint is where the Acromion, or shoulder blade, is joined to the tip of the Clavicle, or collarbone. Landing hard, headfirst, on the shoulder can strain or tear the ligaments that connect the two bones or even result in a fracture. Maintaining an appropriate program of stretching and warm-ups before activity, together with muscle strengthening can guard against such injuries. Learning suitable falling techniques can also help reduce the damaging impact of landing on the shoulder.
  • Impingement injuries Rubbing shoulder muscles against the acromion can cause swelling and is a common source of pain for swimmers, basketball and volleyball players. Golfers can experience pain during the height of the backswing. In each of these sports correct technique can both improve your stroke or shot, and reduce the friction-causing pain.
  • Rotator cuff strains Injuries to the muscles and tendons that make up the rotator cuff often occur with throwing or racket sports. Throwing, hitting or racket sports (overhead athletics) often cause injury to the supraspinatus, one of the muscles that make up the rotator cuff. It helps stabilize the shoulder and undergoes tremendous strain during the final phase of the throwing motion as the arm decelerates after releasing the ball. Similarly, tennis players stress rotator cuff components during the serve, overhead, backhand or forehand.  Exercises that emphasize both internal and external rotation of the arm and shoulder blade stability should be a regular part of your warm-up routine. Special emphasis should be on the stability of the shoulder blade as this is the base that the rotator cuff must work from.

© 2010 eClinic Solutions

Regular shoulder exercises can reduce injury

Here are some easy shoulder exercises that you can do to strengthen your shoulder muscles and prevent injuries.

These tubing exercises can strengthen internal and external shoulder rotation. (click photo to view video. Used with permission of

Basic Shoulder Strengthening

Attach elastic tubing to a doorknob or other stationary structure. Facing the tubing, stand far enough away to begin stretching the tubing. Now gently pull the elastic tubing toward your body, keeping the elbows relatively straight. Hold for a count of five. Repeat five times with each arm. Perform twice a day.

To strengthen internal and external shoulder rotation stand with your feet perpendicular to the tubing. Clutch a rolled up towel to your torso with your left elbow while grabbing the tubing with left hand with your left forearm across your abdomen. Pull the tubing tight by moving your left hand in an arc until your left hand is directly in front of the body. Repeat 10-12 times, then turn around and repeat with your right arm. Then reverse the starting position so that your hand starts slightly rotated toward the tubing anchor point, towel still between elbow and torso, then pull the tubing taut while maintaining significant control of the shoulder blade behind the shoulder.

Wall Push-Ups

Stand far enough away from a wall that your arms are outstretched and palms flat against the wall shoulder high. Now bend the elbows to bring your nose to the wall, then push back to the outstretched arm position. Add a “plus” of pushing your chest away from the wall with hands remaining on wall. Repeat 10-20 times.

Shoulder Dips

Sit upright in a chair with armrests, with your feet touching the floor. Use your arms to slowly rise off the chair. Keep neck elongated. Hold for a count of five. Repeat five times. Perform twice a day.

© 2010 eClinic Solutions

How to enjoy injury-free skiing all season long

The weather service is predicting a better than average snowfall with the La Nina weather pattern, and skiers are eager to hit the slopes. Nothing is worse,  however, than having your season cut short by injury. To avoid twisted knees and other pains, Rick Jusko, PT, owner/director of Seattle Hill Physical Therapy, says preseason conditioning (see accompanying articles, right) and following some common sense techniques can help you enjoy injury-free skiing well into April.

Jusko directs all patient skiers to the website of Vermont Safety Research (VSR), the research arm of Vermont Ski Safety. “They have great tips to help skiers prevent a skiing-related ACL (anterior cruciate ligament)  injury.  An ACL injury is a tear in one of the knee ligaments that joins the upper and lower leg bones.  The reason it’s so important is that it is the ligament that keeps the knee stable.

Jusko says a classic set-up for an ACL injury occurs when the feet are pointing one direction and the body is twisted in another.   Vermont Safety Research defines six elements that are dangerous to skiers:

● Uphill arm back

● Skier off balance to the rear

● Hips below the knees

● Uphill ski unweighted

● Weight on the inside edge of the downhill ski tail.

● Upper body generally facing the downhill ski

These six elements are a “perfect storm” for an ACL injury.  Once you find yourself already at risk there are measures you can take to prevent the injury. Keep your arms forward, your feet together and your hands over the skis. To read more about how to prevent an ACL injury go to

© 2010 eClinic Solutions

Tips to prevent snowboard injuries

Snowboarding is one of the 10 sport and recreational activities causing children injuries severe enough to merit emergency medical attention, according to the American College of Emergency Physicians (ACEP).

“Ski injury experts agree that snowboarding carries a slightly higher risk of injury than traditional downhill skiing,” said Dr. Bruce Bonanno, an emergency physician and member of the ACEP. “Research indicates that a snowboarder is likely to injure some area of the body every 250 days they spend snowboarding.”

Try these tips from ACEP to prevent common snowboarding injuries:

Wrist Fractures and/or Sprains: Falls are the most common cause of wrist fractures and sprains. These injuries are caused when snowboarders lose their balance or catch an edge and attempt to break the fall with their hands.
Tip: Wear wrist guards.

Ankle Sprains and Fractures: Both ankle sprains and ankle fractures are more common in snowboarders than in skiers, mainly due to equipment differences.
Tip: Hard-shell, rather than soft-shell boots, may be more likely to protect against ankle sprains.

Spinal Cord Injuries: Snowboarding is considered an “extreme sport” and enthusiasts often push the limits of their ability doing tricks on half pipes and jumps. Although still relatively rare, the incidence of serious spinal injuries is on the increase.
Tip: Wear a helmet and take lessons from a qualified instructor. Avoid attempting stunts without proper instruction, practice and protection.

Head Injuries: While head injuries account for only a small number of total injuries among skiers and snowboarders, they are the number one cause of death and serious injury for people engaged in these sports.

As a former ski bum at Alta, Utah and now a Board Certified Orthopedic Clinical Specialist and knowledgeable and experienced Physical Therapist, Rick Jusko can help you get ready for the winter recreation that lies ahead this season.

© 2010 eClinic Solutions

Get ski-ready now to avoid injuries

Maybe it’s been a few years since you hit the slopes and you’ve decided to dust off your skis. Wait! Preparing for ski season properly will almost certainly prevent problems. Have Rick evaluate your joint integrity. Any lingering pain along a joint line or the front of the knee can signal trouble. “Pain inhibits strength,” says Rick Jusko, PT, owner/director of Seattle Hill Physical Therapy. “Weakness causes most injuries.”

In addition to screening joints Rick will give you the strength activities that mimic slope demands. While doing squats is an activity most of us know to strengthen thighs it’s also very important to do exercises that prepare for the hopping, turning and side-to-side motion of skiing.

“One of the most overlooked components of skiing is the lumbar flexibility and strength, keeping the chest perpendicular to the fall line requires tremendous low back and hip flexibility and strength,” he says. “Skiers are flying down the hills at 40 miles per hour. Skiers need dynamic balance training.”

© 2010 eClinic Solutions