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Arbor Center in Dripping Springs (512) 858-5191 | Medical Towers at Sawyer Ranch (512) 894-2194

Author: Jeremy Kethley

Keeping Dripping Springs Moving

What keeps Dripping Springs moving?  Is it the kids, families, schools, churches, gyms, athletics, or a combination of all?  Well, we all know that it takes a combination of these to keep a community moving.  The focus of this article is how and why we should keep our own body moving.

The human body has been blessed with 206 bones, 360 joints, and between 656 – 850 muscles (depending on which expert you ask).  All of those make up our wonderful musculoskeletal system.  I want focus on the makeup of those 360 joints.  Wherever you see a bend or crevice on your body, there is a joint.  Every joint has two bones that articulate with each other and a small capsule filled with synovial fluid surrounding that joint.  The ends of each bone have cartilage that makes movement easier.  The cartilage gets it nourishment from the synovial fluid.  If you do not have adequate cartilage health, then movement begins to become difficult and painful.  This is called osteoarthritis.  The number one way to combat OA is to keep moving!

What are the best ways to move?  If your joints are tight and painful, I would recommend swimming, then biking, then elliptical trainers.  You want to make sure that the movements you perform are non-jarring.  Dripping Springs is lucky to have multiple gyms with various types of equipment to help make your choice easier.  If you continue to have problems and pain moving, you should have a consultation with a physical therapist.  PT’s know how each of those 360 joints should move and how all those muscles should move each joint.  There are many different types of manual therapy techniques, exercises, procedures, and modalities that a physical therapist can use to help keep you moving.

Coming this June, Kethley Physical Therapy will be doing a little moving of our own.  We are moving down the street to the Arbor Center at 800 West Hwy. 290, Bldg. B. After all of the community support from the last 11 years, we are growing and moving to a much larger facility. We are all very excited about our move and would like to invite all of our past, present, and future patients to an open house in late June.  Please stop by, say hi, and see how Kethley Physical Therapy is “Keeping Dripping Springs Moving”!

IT Band Syndrome

In the past few articles, we have focused on the Big 5 conditions associated with running.  We have discussed plantar’s fasciitis and achilles tendonitis down in the foot.  This article is going to move up the leg and focus on a common ailment that affects the oustide of the knee.  It is iliotibial band friction syndrome (IT band syndrome).

The iliotibial band is a thick fibrous tissue that runs along the outside of your leg from the ilium (pelvic bone) down across the knee and attaches to the outside of the tibia (shin bone).  It is where the IT band crosses the knee that the symptoms and pain usually start.  The IT band gets rubbed back and forth over the outside of the leg bone and causes an irritation that leads to swelling, increased tightness and burning as you continue to run.  Once inflammed, you may experience popping and snapping when you bend your knee back and forth while running, walking, or cycling.

Some of the causes that lead to IT band syndrome is an abrupt increase of distance, inexperience running, descending stairs, poor foot support, pelvic and core weakness, tight muscles, leg length discrepancy, and running the same direction on a pitched surface.  Here are a few steps that you can take on your own to keep the pain under control.  Rest, ice before and after running, NSAIDs, avoid downhill running, make sure to change the direction that you run on pitched roads, stretch warm muscles, and purchase good, supportive running shoes.  Rolling back and forth on a foam roller along your lateral leg will help stretch your IT band.

If you are experiencing this lateral knee pain, it is important to find out exactly what the cause is, so you can return to running/playing as soon as possible.  That is where your doctor and physical therapist come in.  Physical therapists are trained to evaluate for all musculoskeletal conditions.  We can look at your foot posture and footwear, measure your leg length, check your pelvic and hip strength, and evaluate the biomechanics of your running stride.  After your evaluation, a physical therapist will give you a comprehensive plan for getting you back on your feet!

Stay tuned for Runner’s Knee next month!

Article written by Jeremy Kethley, PT

Is Your Computer the Cause of your Pain?

With the dropping temperatures, we find ourselves spending more and more time indoors. This inevitably means more time in front of the computer screen, the television, or reading a book/magazine.  And, unfortunately, most jobs today require people to spend a majority of time on the computer.  The human body was not designed to sit extended periods of time.  Improper posture can lead to or exacerbate back pain.  Therefore, proper posture is a valuable component of preventing or managing back and neck pain.

In this month’s article, we will address sitting posture.  Since most of us spend hours/day at a desk or computer, it is important that we minimize the stresses we place on our spine during this time.

There are 3 easy steps to find a good sitting posture – 1) sit at the end of your chair and slouch completely, 2) then draw yourself up and accentuate the curve in your low back, and 3) then release this position slightly (about 10 degrees).

Here’s how to achieve this position while sitting at your desk/computer:

  • Adjust the height of your chair so that your feet are flat on the floor, your thighs are parallel to the ground, and your hips & knees are bent at right angles.
  • You should sit back in your chair so that your buttocks touch the back of the chair with a lumbar support in the small of your back to help maintain the normal curve

in your low back.  Your weight should be evenly distributed between your hips.

  • The computer screen should be adjusted so that the screen is eye level in order to

prevent straining your neck.

  • The keyboard tray should be level with the height of your elbows and your shoulders should be relaxed.
  • When using the mouse, move from your shoulder rather than your wrist and keep your wrist flat.  Do not use a wrist pad that puts a bend in your wrist.

Most importantly, take frequent breaks.  Get up every 20-30 minutes and walk around.  If you are experiencing back or neck pain, try simply following the techniques outlined above.  If your pain easily resolves, then the cause of your discomfort was postural in nature.  If not, we recommend addressing your symptoms with your health care provider.

*** Please note:  Article written by  Erin Kethley, MPT

How Effective is Your Training? By Michelle Olson PT

Many of us start the New Year off by revisiting a “good routine”, wanting to lose weight or getting ready for spring season of sports, and so soon fall off that path.  Setting realistic objectives and understanding how to get to your goal can help you stay on task.  Are you training for a marathon, starting your pre-season training for baseball, or attempting to lose that holiday weight? This will help you get started.

Are you training for an aerobic or anaerobic goal, endurance or sprinting training?  If you are a sprinter, training for your track season, running long distances to train may be less effective than working on your speed and short distance training. The same can be said for marathon training, sprinting routines are not recommended to ready your muscles to perform at that level.  Training for the nature of the sport produces better results.  Now with that said there are always exceptions to that rule.  Pitchers are trained in distance or endurance, due to the length of the game and the repetitive nature of their position.

Muscle confusion, such as P90x, Insanity, Crossfit, and other cross training routines have shown good results in combination with a well balanced diet to be effective in losing weight.   Performing the same exercise routine every day is less effective than having variety in your workouts, which includes exercises, repetitions, and weights used. In addition, changing the specific exercise routine every 4 weeks is recommended.

Muscles, aerobic capacity, and our body’s intake needs can adapt to routines that stay the same.   When this happens the effect of your diet and exercise is lessened.   Changing our routines by mixing both intake and workouts will confuse your body so that it does not have a chance to acclimate. This is true with weight loss as well as pre-season training.  Proper nutrition and rest are also components in a healthy routine to ensure your energy needs are met during all phases of training.

Prevention has been talked about frequently in these articles.  Learning the proper and most effective way to train, begin new routines, or return to a healthy lifestyle is important prior to the start of your adventure.  This includes talking with your physician if you have health concerns.  Your physical therapist is a great resource to discuss proper technique, variation, and injury prevention.

Science of supplementation (3 of 3): Glucosamine: To Take or Not To Take?

For the past three months, I have discussed the latest scientific research in fish oil benefits, the need for protein for muscle growth, and now whether or not to take glucosamine.  In the United States, glucosamine is the most common non-vitamin, non-mineral, dietary supplements used by adults.  That is because America is too fat, and we have lots of achy, painful joints.  But first a quick anatomy lesson on our joints.  We have 206 bones in the human body with about 320 to 360 joints depending on your definition of a joint.  The definition we are going to work with is where two bones come together in the body and have movement/motion.  Each joint will be wrapped in a capsule around the end of the bones where they come in contact.  The end of each bone is covered in a slippery surface known as cartilage and inside the capsule is synovial fluid.  It is this synovial fluid and cartilage where the glucosamine may be beneficial.  Glucosamine is the precursor for glycosaminoglycans (a major component of joint cartilage), so in theory taking glucosamine should help to prevent cartilage degeneration and treat osteoarthritis. But does it work?

After reviewing numerous articles and studies on the efficacy and treatment uses for glucosamine, it still comes down to a 50/50 tie.  Studies at the Mayo Clinic show that available evidence from randomized controlled trials supports the use of glucosamine sulfate in the treatment of osteoarthritis, particulary of the knee.  The study goes on to say that glucosamine sulfate only benefitted those with mild to moderate knee osteoarthritis, but did not do much for the severe cases of OA.  The benefit was usually seen in decreased pain relief, an anti-inflammatory effect, and improved joint function.  Currently the Osteoarthritis Research Society International is recommending glucosamine as the second most effective treatment for moderate OA.

Since glucosamine is a dietary supplement and not a pharmaceutical drug, the US government does not have influence on different combinations, dosages, or forms.  One thing the studies did confirm was that the suggested dose is 1500 mg a day.  Manufacturers have combined glucosamine with hydrochloride, methylsulfonylmethane (MSN), and/or chondroitin to make it more effective or better.  All the studies state that the only beneficial combination is glucosamine sulfate!  The other combinations were no better than a placebo!  Another point was to take it in the capsule or powder form because the liquid form begins to breakdown, and the molecules start changing after the first 24 hours.  So when you buy it at the store, there is no telling what you are getting.

It is in my professional opinion, that glucosamine sulfate has shown to benefit many of my patients in the past 12 years who have had stiff or tight joints.  It has seemed to help them get moving and allow them to strengthen their muscles around the joints.  Pain relief has been noted and many patients swear by it.  My take is that as long as they are moving they will continue to improve overall.

Written by Jeremy Kethley, PT

Science of Supplementation (1 of 3): Fish Oil Health Benefits

Over the next 3 months we will be providing scientific information on the science of supplementation.  We will breakdown the latest research on fish oils for overall health, protein for muscle growth, and glucosamine for joint health.  This month we will focus on omega-3 fish oils and the top 5 reasons to take fish oils.

Reason 1:  Fish oils can make you smarter.  Research from Tufts University and the University of Pittsburgh show that DHA (docosahexaenoic acid) has led to cognitive improvements in both older women and children.  The DHA is found in oil rich fatty parts of fish and other marine life.

Reason2: Fish oils can decrease inflammation.  Many exercisers, especially those just starting an exercise program, will experience joint discomfort from inflammation.  The EPA (eicosapentaenoic acid) fish oils have anti-inflammatory properties to help reduce the production of factors that increase inflammation. Dr. Rob Wildman reports long-term consumption of fish oil is critical to lessening exercise induced inflammation.

Reason 3: Fish oil makes you stronger.  Researchers from the University of Nottingham and Washington University report that fish oil omega-3 fats seem to be important in optimizing muscle protein synthesis.  The studies also show that there is a potential benefit of fish oil by people building or maintaining muscle mass in both younger and older adults.

Reason 4: Fish oil is a heart saver! Consumption of fish oil has long been recognized as one of the most beneficial supplements for a healthy heart and cardiovascular system. Information and research shows that fish oils improve our cardiovascular health by lowering triglycerides, reducing inflammation in blood vessel walls, reducing platelet activity, and supporting healthier blood pressure levels.

Reason 5: Fish oils support your lean machine.   Some data suggests that taking a gram or more of fish oil can help keep children leaner during development and/or support weight loss efforts by adults.  A recent study showed that taking fish oils and walking led to a decrease in body fat over walking by itself.  According to Dr. Rob Wildman, author of The Nutrutionist: Food, Nutrition & Optimal Health and creator of, “regular, long-term consumption of liquid fish oil is critical to optimize brain levels and to lessen exercise induced inflammation as it can take several weeks for the fish oil to concentrate in the proper tissue to provide benefit”.

You can get fish oils in many different forms from pills to liquid oil.  After researching for this article, I believe that the best option to achieve the most benefits is to use the liquid version.  You can find them at www.original  Next month, we will discuss protein supplementation.

Written by: Jeremy Kethley, PT


Recently there has been a large increase in the amount of interest in cross-training workouts and fitness. Crossfit, Camp Gladiator, P90X, Insanity, and many other high intensity workouts have become the top fitness choices among many athletes and non-athletes alike. Cross-training is defined as a training program to improve competitive performance in a specific sport by training in a variety of sports. There are many advantages to these alternative workout regimes.  Cross-training effects do not exceed those of sport specific training, however for the general population, it can be extremely beneficial for overall fitness and weight loss.

Cross-training by the general population should be performed slowly and carefully.  Everyone should listen to their body and no their limits.  When performed correctly, cross-training can be used to help eliminate injury caused by overtraining for a specific sport. With sport specific training, it is important to monitor increases in intensity and frequency to avoid overuse injuries, such as stress fractures and different types of tendinitis or inflammation of the tendons. Overuse injuries are often caused by an attempt to improve rapidly. Cross-training can allow continued improvement in fitness, while giving the tendons, bones, and joints used most during sport specific training a break. Cross-training can also be a realistic supplement post injury, during the rehabilitation phase.

Unfortunately, if you are looking to improve in a specific sport, cross-training does not provide the most effective workout. There is a principle of training called specificity. This principle states that sports training should be relevant and appropriate to the sport for which the individual is training in order to produce a training effect. In other words, running does not make you a better swimmer, and swimming does not make you a better soccer player. However, different forms of training may help to improve endurance and fitness level.

Many exercises in the different workouts mentioned above are full body movements. It is important to refrain from using momentum, which increases the opportunity for injuries. With all types of cross-training, it is important to remember to learn and practice correct form while integrating core stabilization. When starting any kind of exercise, it is normal to feel muscle soreness. However, soreness is different from pain.  Soreness will peak in intensity about 24 hours after training and is expected to diminish within 2-3 days.  If you sustain an injury while exercising, be sure to see your doctor to discuss treatment. Physical therapists are able to use different modalities and other forms of physical activies to treat many kinds of injuries to muscles, ligaments, joints, and bones.  Have fun and get moving!

Choose the Right Shoe to Avoid Injuries

Are you an avid runner or do you just want to start walking for exercise?  If so, finding the right shoe is important in order to prevent problems such as tendonitis, plantar fasciitis, foot/ankle pain, stress fractures, and knee/hip/low back pain.  Many people can end up developing overuse injuries simply by wearing the wrong type of shoe.

Running and walking shoes are divided into 3 categories:  stability (neutral), cushioned, and motion-control.  The shape of your foot and the amount of mobility it has will determine which type you need.  You can determine your foot type by checking your arch height.  An easy way to do this is to wet the bottom of your feet and stand normally on a paper bag.  After a minute or so, step off and observe the imprint that your foot made.

If you have a normal arch, a stability (neutral) shoe is best suited for you.  These shoes provide a combination of cushioning and motion control.  This is the most common foot type, so most people should be fitted with this type of shoe.

If you have a high arched (supinated) foot, then a cushioned shoe is the best choice for you.

If you have a flat (pronated) foot, then you should chose a motion-control shoe.  People with low arches need extra support to prevent excessive foot motion during walking or running.

There is no one particular brand of shoe that is best.  So, in order to ensure that you find the right type of shoe, you should visit a specialty running store.  The people who work in these stores are trained to identify your foot type and will help guide you to the appropriate type of shoe.

Once you start your running or walking program, if you begin experiencing aches or pains, ask your doctor for a referral for physical therapy.  A physical therapist will evaluate your gait, treat any injuries you have, and make recommendations about proper footwear and/or orthotics.

Article written by:  Erin Kethley, MPT

Bed Rest for Back Pain?

Article written by:  Erin Kethley, MPT

Many people who experience an acute onset of back pain might consider a couple of days of bed rest to be the first thing to try.  In fact, in the past, bed rest and medications were indeed considered to be the primary treatment for low back pain.  Actually, it wasn’t until the 1980’s that it’s efficacy in the treatment of back pain came into question.  The truth is that current research shows that it will not fix the problem and can actually make it worse.  Studies have shown that people who stay active during episodes of back pain do better than those that are sedentary.

Evidence not only shows that prolonged bed rest does not improve outcomes, but that it is strongly associated with negative outcomes such as more days off work, intensity of pain, and disability.  So, not only can bed rest make the pain worse, but it can also lead to other problems such as decreased strength/muscle atrophy, cardiovascular deconditioning, loss of bone density, depression, and blood clots.  Prolonged resting in bed means limited mobility.  Our spines need motion in order to move nutrients to the vertebral discs.  A lack of motion can cause a loss of strength and impair the spine’s ability to recover after injury.  Studies show that people lose 2-5% of their strength per day of complete bed rest.

Additionally, research has shown that light activities, such as walking, reduce the need for medications.

Although some people may need to temporarily modify their activities during an acute phase of back pain, most people should be encouraged to avoid bed rest and resume their normal activities as soon as possible.  In extreme cases, bed rest may be necessary, but it should be minimized to the shortest time possible. Also, a tailored exercise program appears to speed recovery and decrease future episodes of low back pain.  Active patients experience less pain and will avoid the side effects of immobility.  It is also important to note that you should always seek medical attention from your physician for severe pain or pain that lasts greater than one week.

Back to School

The children are getting ready to go back to school and amongst all the excitement may come complaints of pain. Has your child mentioned headaches, neck/backaches, low back pain, muscle tightness or spasms, or tingling in the hands?   A recent study by the American Physical Therapy Association reported that over 50% of children are carrying backpacks that are too heavy.


If the backpacks are too heavy or incorrectly positioned, it can force the child backward or to the side. Two reasons for this are carrying the backpack on one shoulder, or having the straps too loose so that the backpack is hanging too low. Uneven distribution can lead to children compensating for the weight by leaning to one side. Shoulder pain may occur when the nerve that supplies the muscles to the shoulder region becomes pinched. This can cause the shoulder blade to wing.  Backpacks that are too heavy and/or hanging to low on the back can force the child to bend forward at the hips or arch their back.  This can lead to compression of the spine in an un-natural way, distorting the natural curvature of the middle and lower back. This distortion can lead to muscle strain. Both of these scenarios can be a cause of tingling and numbness in the arms and hands, and may also lead to headaches.


A few ways to help limit and prevent problems are limiting backpacks to the essentials, making sure the backpack has even distribution of weight, recognizing the backpack is too heavy, proper sizing of the backpack in proportion to your child’s age and weight, and teaching your children how to pick up the backpack properly by using good body mechanics.  Most physicians and physical therapists recommend a backpack weigh no more than 10-15% of the child’s weight.


Consulting your physician or physical therapist can start your child on the right track to a healthy back.  Your physical therapist can assess the asymmetry of the musculature and evaluate the source of pain.  Treatment can include pain-reducing modalities, correcting the biomechanics of the movements, and exercises to help strengthen, eliminating the asymmetry.  Education of the child and parent is always a key to our treatment plans to prevent re-injury.


Article written by Michelle Olson, PT