ACL Protocol, Assessment, and Training at Excel Sports and PT

ACL, three little letters that are notorious in the sports world. In the United States alone there are over 400,00 ACL repair procedures each year. Once you tear the anterior cruciate ligament in the knee your world will change forever. You will feel angry, upset, and nervous about what the future holds for you. Why did this happen to me? Why now? Will I ever play again? Will I hurt my knee again? All reasonable questions to ask. Your head is spinning. But it doesn’t have to be that way or stay that way. Not if you have the right physical therapist to guide you through this long and arduous process.

At the Excel North O’Fallon location we feel it is the responsibility of the physical therapist to provide a thorough and complete program for the patient in order to put them in the best position to succeed. We do this by using a progressive and systematic rehabilitation program that allows for some flexibility with each athlete. Included in this program are advanced strengthening exercises, neuromuscular reeducation, plyometrics, agility training, core strengthening, functional training and sport specific training.
Once the athlete approaches a return to sport, they are put through a battery of tests to ensure that the involved knee is close to the level of the uninjured knee. Research suggests that the surgically repaired knee perform to at least 90% of the uninjured knee during testing before returning to sport. We also do a complete and full biomechanical assessment that includes evaluating the athletes running form, jumping and landing form, and cutting/pivoting form. Studies have shown that neuromuscular deficits and functional limitations are common in athletes either due to preexisting abnormalities or because of subsequent surgery. All of this is done under video analysis so that we can slow down and break down the movements at trunk, hip, knee and ankle.

Again, we put a lot of time and effort into researching and developing new ways to treat our athletes and to get them back to where they want to be. When you choose us for your post-surgical rehabilitation, know that you are dealing with a group of experts you can trust. Call Brian Manning at the North O’Fallon clinic: (636)978-5255

Do you want to be an Athletic Trainer?

Excel Sports and Physical Therapy and Lindenwood University Athletic Training Program is hosting a FREE CLINIC on November 14, 2015 at Lindenwood University. Please see attached flyer!

Contact Anna Rozanski, MS, ATC/LAT

2015 Flyer

CampusMap (1)

‘Fall’ Prevention

The seasons are once again changing. Many people I talk with tell me this is their favorite season. Even if it is not, the cool weather, spectacle of changing leaves, and all the smells that accompany autumn have to make you smile. As the leaves begin to fall, everyone needs to take special precaution not to do the same. According to the National Council on Aging, falls are the leading cause of fatal and non-fatal injuries for older Americans. The U.S. Centers for Disease Control and Prevention have found that one-third of Americans aged 65+ falls each year and that falls result in more than 2.5 million injuries treated in emergency departments annually, including over 734,000 hospitalizations and more than 21,700 deaths. provides a check list for preventing falls in the home. Some easy steps include:

  • Making sure stairs have handrails and that the handrails are securely fastened preferably on both sides of the steps.
  • Make sure floor boards are even and secure all rugs, including area rugs with tacks or double sided tape.
  • Install grab bars at the toilet, in the shower, and in the bath tub.
  • Use and secure non-slip bath mats.
  • If you have to use a step stool, make sure that it has a bar at the top to hold on to.
  • Place nightlights in hallways, bedrooms, bathrooms and stairways.
  • Install light switches at the top and bottom of stairs.
  • Repair holes and uneven joints on walkways outside the home.
  • Wear shoes in the home as socks present a slipping risk.

By taking simple steps the risk of falls can be reduced significantly. If you feel a loved one is at risk for falls, help them to take the necessary steps to make their home as safe as possible. The following is a list of additional resources to aid in fall prevention:

References and additional information:



The Difference Between Manual Therapy and Chiropractic

Many neck and back patients can benefit from manual therapy to their spine. A common question that arises is “What is the difference between manual therapy and chiropractic care?” While the patient may perceive many similarities, they are rooted in very different philosophies. Most manual therapy is based on Osteopathic theories which focus on proper movement of the joints. Traditional chiropractic training is based off “The Law of the Nerve” which believes that the key to proper healing is through ensuring proper nerve flow. Traditional chiropractors look at perceived alignment problems of the vertebrae and manipulate to correct these positional faults. Manual therapy, on the other hand, assesses movement of each joint in the spine to see if it moves too little or too much. A joint that moves too little needs to be mobilized or manipulated whereas a joint that moves too much requires a stabilization program to strengthen the muscles around it. Physical therapy joint manipulation uses “locking techniques” to isolate a segment that moves too little without manipulating the adjacent segments. The goal of a successful manipulation is not a “pop,” but rather improved movement at the manipulated segment. If a cavitation or “pop” is brought on it should be a single level if the technique is performed correctly.

A great deal of research exists to support the specificity of skilled manual therapy and its use with an exercise program to correct improper movement patterns. If a manipulation is not accompanied by a stretching program the results tend to be temporary and require repeat manipulation. Performing a home exercise program designed by a physical therapist can minimize the chance of recurrence.


Joe Schmersahl, PT, MTC

Vestibular Rehabilitation Therapy and BPPV

Have you ever felt the space around you spin uncontrollably?  Have you had difficulty with balance and walking because of dizziness?  If so, vestibular therapy may be the right path for you.  As your physician will tell you, there are multiple causes of vertigo. It can be caused by something as simple as an ear infection or may be more complex.

One of the most common problems is benign paroxysmal positional vertigo (BPPV), which is caused by tiny calcium crystals, or otoconia, which may clump in the inner ear canals.  When these otoconia become displaced it can send a false sense of movement to our brain, resulting in vertigo.  Fortunately, there are a series of maneuvers which can help realign the particles in the proper place and provide relief from the vertigo.

Having recently experienced a bout of vertigo, I was especially thankful  I work for a physical therapist who specializes in vestibular therapy.  Stacey Batson, DPT, explained how BPPV impacts feelings of motion and was able to guide me through a series of exercises and head movements designed to help alleviate the symptoms of vertigo.

So if you are experiencing recurrent symptoms of vertigo, ask your doctor about the benefits of vestibular therapy.  You will be glad you did!

For more information on Vestibular disorders, check out this website:

Submitted by Linda Wallace

My Ankle Sprain Just Won’t Heal

At the 6th Annual St. Louis Soccer Conference hosted by Washington University Orthopedics, Dr. Jeffrey E. Johnson presented information on ankle sprains that won’t heal and referenced 18 other injuries that could be misdiagnosed as an ankle sprain.

Ankle injuries account for approximately 15% of all sports injuries. Ankle sprains are the most common ankle injury and are six times more common than all other ankle injuries combined. There are two locations for sprains, inversion (lateral) ankle sprains and eversion (medial) ankle sprains, with inversion ankle sprains representing about 95% of all ankle sprain injuries.
Inversion (lateral) ankle sprains occur when the foot is plantarflexed and inverted (toes pointed down and in), while eversion ankle sprains occur when the foot is dorsiflexed and everted (toes and foot are turned up and out). Regardless the location, 40% of patients diagnosed with an ankle sprain will have residual symptoms at six months post injury.

When you sprain your ankle, you may experience swelling and bruising over the lateral and/or medial malleolus (ankle bone) immediately after the injury or within 24 hours of the initial injury. You may also find that weight bearing may be difficult due to pain. So how do you know that this is “just an ankle sprain?”

A thorough examination of your ankle injury is essential. Your athletic trainer or orthopedic physician may also find it necessary to have x-rays taken of your ankle to rule out differential diagnoses. After being diagnosed with an ankle sprain, it is imperative that you follow through with the treatment plan created for you by your athletic trainer or orthopedist. If you find that you are not experiencing a significant improvement after 3-4 weeks from the initial injury and have been compliant with your treatment plan, consider a follow-up visit with your orthopedist.

Hamstring Injuries – Incidence and Treatment

Hamstring strains, or injury to the hamstring tendon, can be a challenge to both the athlete and clinician when attempting to rehabilitate, recover, and return to prior activity level. This is due in part to a number of factors including the high incidence rate of this type of injury, slow healing process, and persistent symptoms. It has been found that nearly 1/3 of hamstring strains recur within the first year following return to sport without a proper and comprehensive rehabilitation program.

Hamstring injuries can occur in a variety of sports. Hamstring injuries that result from high-speed running as in track and football generally occur during the end swing phase of the gait cycle. In this type of injury the lateral hamstring tendon, or biceps femoris is generally the most often injured. Hamstring strains can also occur during activities such as dancing, kicking, and water skiing. These injuries result from simultaneous hip flexion and knee extension, which places the hamstring in an extreme stretch position. This type of injury typically presents in the semimembranosus, or most medial tendon.

The primary goal of hamstring rehabilitation is to return the athlete to his/her prior level of performance with minimal risk of injury recurrence. Factors that must be considered during rehabilitation include hamstring weakness, fatigue, lack of flexibility, and muscle imbalances between the hamstring and quadriceps muscles. In addition, limited quadriceps flexibility and strength and pelvic, core and trunk strength deficits may contribute to hamstring injury risk and should be addressed.

Hamstring injuries are generally classified according to the amount of pain, weakness, and loss of motion present. They are categorized by the extent of muscle fiber or tendon damaged, resulting in grades of I (mild with minimal damage), II (moderate with minimal disruption of fibers without a tear), and III (severe with complete tear or rupture). Your physical therapist will perform a thorough evaluation during your initial visit. The evaluation will include a battery of tests that measure range of motion, strength, and pain. This will help to provide a reasonable estimate of rehabilitation duration and a basis for beginning treatment.

The physical therapist will develop an appropriate treatment regime for your return to prior level of function and sport participation. Initial exercises may include hamstring stretching and strengthening (with specific focus on eccentric hamstring strengthening and neuromuscular control), quadriceps flexibility and strength, and lumbopelvic control. The treatment program is specific to each individual and each injury, and should be tailored to promote the goals of the patient. Progression criteria is based on factors such as pain response, strength and flexibility improvements, and activity progression. Agility activities, plyometric exercises, and return to sport-related activities will be incorporated when deemed appropriate and based on progression criteria.

Proper rehabilitation is necessary following hamstring strains in order to return to prior activity level. Physical therapy can provide you with the proper treatment aspects to assist you in your return and prevent reinjury once return-to-sport is accomplished.


Heiderscheit B, Sherry M, Silder A, Chumavno E, Thelen D. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. Journal of Orthopaedic &Sports Physical Therapy. 2010; 40:67-81.


Grilled Asparagus with Caper Vinaigrette


1 1/2 pounds asparagus spears, trimmed

3 tablespoons extra-virgin olive oil, divided

1/2 teaspoon kosher salt, divided

Cooking spray

1 tablespoon red wine vinegar

1/2 teaspoon Dijon mustard

1/4 teaspoon freshly ground black pepper

1 garlic clove, minced

2 teaspoons capers, coarsely chopped

1/4 cup small basil leaves



  1. Preheat grill to medium-high heat.
  2. Place asparagus in a shallow dish. Add 1 tablespoon oil and 1/4 teaspoon salt, tossing well to coat. Place asparagus on grill rack coated with cooking spray; grill 4 minutes or until crisp-tender, turning after 2 minutes.
  3. Combine remaining 1/4 teaspoon salt, vinegar, and next 3 ingredients (through garlic); stir with a whisk. Slowly pour remaining 2 tablespoons oil into vinegar mixture, stirring constantly with a whisk. Stir in capers. Arrange asparagus on a serving platter; drizzle with vinaigrette, and sprinkle with basil.


Nutritional Information: Calories 91, Fat 7.2 g, Saturated fat 1.1g, Monofat 5 g, Polyfat 1.1g, Protein 2.6 g,

 Carb 4.8 g, Fiber 2.5 g, Cholesterol 0 mg, Iron 2.5 mg, Sodium198 mg, Calcium 32 mg

– submitted by Linda Wallace

Ham & Cheese Breakfast Casserole

This healthy update of a traditionally rich ham-and-cheese breakfast strata is made lighter primarily by losing a few egg yolks and using nonfat milk. Gruyère cheese has a delicious, nutty aroma and flavor, which means that with the relatively small amount in this recipe you still get a big impact. To finish the makeover use nutritious, fiber-rich, whole-grain bread instead of white. The results: plenty of flavor, half the calories and one-third the fat of the original.

Makes: 6 servings

Active Time: 30 minutes

Total Time: 1 3/4 hours


  • 4 large eggs
  • 4 large egg whites
  • 1 cup nonfat milk
  • 2 tablespoons Dijon mustard
  • 1 teaspoon minced fresh rosemary
  • 1/4 teaspoon freshly ground pepper
  • 5 cups chopped spinach, wilted (see Tip)
  • 4 cups whole-grain bread, crusts removed if desired, cut into 1-inch cubes (about 1/2 pound, 4-6 slices)
  • 1 cup diced ham steak, (5 ounces)
  • 1/2 cup chopped jarred roasted red peppers
  • 3/4 cup shredded Gruyère, or Swiss cheese


  1. Preheat oven to 375°F. Coat a 7-by-11-inch glass baking dish or a 2-quart casserole with cooking spray.
  2. Whisk eggs, egg whites and milk in a medium bowl. Add mustard, rosemary and pepper; whisk to combine. Toss spinach, bread, ham and roasted red peppers in a large bowl. Add the egg mixture and toss well to coat. Transfer to the prepared baking dish and push down to compact. Cover with foil.
  3. Bake until the custard has set, 40 to 45 minutes. Uncover, sprinkle with cheese and continue baking until the pudding is puffed and golden on top, 15 to 20 minutes more. Transfer to a wire rack and cool for 15 to 20 minutes before serving.


  • Make Ahead Tip: Prepare casserole through Step 2; refrigerate overnight. Let stand at room temperature while the oven preheats. Bake as directed in Step 3.
  • Tip:To wilt spinach, rinse thoroughly with cool water. Transfer to a large microwave-safe bowl. Cover with plastic wrap and punch several holes in it. Microwave on High until wilted, 2 to 3 minutes. Squeeze out excess moisture before adding the spinach to the recipe.


Per serving: 286 calories; 10 g fat (4 g sat, 3 g mono); 167 mg cholesterol; 23 g carbohydrates; 23 gprotein; 4 g fiber; 813 mg sodium; 509 mg potassium.

Nutrition Bonus: Vitamin A (70% daily value), Folate (37% dv), Calcium (30% dv), Vitamin C (20% dv).

Carbohydrate Servings: 1 1/2

Exchanges: 1 starch, 1 vegetable, 2 medium-fat meat


submitted by Linda Wallace – recipe found on

Diet Soda or Regular Soda?

Many people believe that drinking diet soda is better than drinking regular soda, but that is a very common misconception. A new study put out by the Journal of the American Geriatric Society found that people that drank diet soda gained almost triple the abdominal fat over a nine year time frame versus those that did not drink diet soda.

This study followed 749 people ages 65 and older who were asked every couple of years how many cans of soda they drank a day and how many of those sodas were diet or regular. The answers given by the test subjects ended up being predictive of abdominal-fat gain, even after the researchers adjusted for factors like diabetes, smoking, and levels of physical activity. People who did not drink diet soda gained about 0.8 inches around their waists over the study period, but people who drank diet soda daily gained 3.2 inches. The occasional drinkers of diet soda gained about 1.8 inches.

The sugar-free and diet sodas contain substances that sweetens soda 200-600 times the regular sweetness of sugar. Regular sugar triggers your body into thinking you are ingesting energy in form of calories, but if you don’t burn them then they are converted to fat. Artificial sweeteners that are in diet sodas confuse your body and weaken the link in your brain that leads your body to crave sweeter treats to get that same sensation of digesting sugars for energy.

As these calories turn to fat it causes an increase in waist circumference which is a bad place to gain fat. Fat gained in the waist is called visceral fat and is associated with a higher risk for cardiovascular disease and Type 2 diabetes.

Submitted by Rachel Steinlage, Physical Therapist