Benefits of Vestibular and Balance Training for Sports

When we think of training for our sport of choice we often think that strength and conditioning combined with proper nutrition provides us with the best opportunity to succeed. What is it that goes into strength, power, and speed? How are some able to skate on a couple thin blades while tracking a small puck, all while knowing where their opponents are? It has to do with a few systems working in sync with each other to maintain a correct posture or produce an efficient movement.

Visual System

The most dominant system is the visual system (our eyes) and it tells us what the environment around us is like and what obstacles we may encounter. Often taken for granted, the eyes provide a large amount of information and take into account what we are focused on as well as what is in our peripheral field (ambient vision). Training our visual system has gone to a whole new level as more and more athletes attempt to separate themselves from the rest of the group.

Proprioception/Somatosensory System

Another system includes the proprioceptive/somatosensory system that tells us where our body is in space. The proprioceptive system uses sensory information that comes from within the body. For example, if we hold our right arm above our head and close our eyes, we still know that the right arm is raised due to information sent to our brains from sensory nerves. So if you think about walking or standing, we don’t really look at our legs when we’re walking, but rely on the proprioceptive information from our legs to tell us where they are.

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Vestibular System

The third one is the vestibular system, which has a lot to do with the balance portion of our movements or stance. This system resides within our inner ear and as our head moves (along with our body) we receive information as to what direction and how fast or slow we’re moving. It doesn’t just help us with posture or stance but tells our eyes what they should be looking at and where to look next. Can you imagine how this might affect our balance if it were somehow “off” or not working right?

Typically these three systems are healthy as we’re young and can diminish in acuity as we grow old. Injuries to the head that we might sustain during sporting events or car accidents can also have an impact on these systems. These injuries are known as traumatic brain injuries (TBI) and sometimes can be tough to diagnose as they may not present themselves right away.

Training these systems, including the vestibular system, will vary from athlete to athlete. If you’re doing most of your strength training on machines or benches that support your body weight, it would be as simple as doing more exercises where you have to support yourself. For example, if you’ve been doing the shoulder press seated on a bench with your back supported, you could either take the back rest away or do the shoulder press standing. Including equipment, such as the BOSU, will also train these systems that work together to help us produce efficient movement patterns.

Most sports have a strong element of balance, coordination, and awareness of position. Specialized vestibular and balance training takes the skills you’ve already learned to a whole new level and can also help you recover from injury more quickly. It can help you recover from concussion-related dizziness and headaches or significantly reduce ankle, knee, and hip strain during dynamic activities, lowering the risk of ACL tears and ankle sprains. You can easily fine-tune eye, hand, and foot coordination to be the first to quickly identify the path of a flying ball while looking over your shoulder running across an uneven field. You can make cutting motions and change direction quicker while being more efficient in outmaneuvering an opponent. Set yourself apart, a stride ahead of the competition!

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Makovicka Physical Therapy Contest Update

Our contest is up and running and we already have a number of participants showing us how physical therapy has gotten them back to doing what they love most. As we designed this contest we wanted to focus on how our patients viewed the benefits of physical therapy. Is it something as simple as being more mobile so they are able to navigate their home with confidence, getting to spend more time with friends and family doing the things they’re used to doing, or competing at a higher level than before.

As we asked everyone to send us their pictures using #MakovickaPT we began to realize that this contest could have bigger implications to the world of physical therapy than just our clinic! This is why we are introducing #GotPT to the contest. We want this concept of “what physical therapy can allow us to do” to outlast the contest.

To win prizes through our contest still include #MakovickaPT in any of your Facebook, Twitter, or Instagram posts, but help us spread the word and throw in #GotPT so we can keep this concept going after the winners have been announced!

Good luck to everyone and we’re excited to see what physical therapy has allowed everyone to do, from walking and golfing to Division I scholarships and more.

A special shout out to WebPT (@WebPT)  and Dr. Ben Fung (@DrBenFung) for continually challenging the physical therapy community and helping to push this campaign!

Monthly Newsletter / September2013

Has physical therapy gotten you back to doing the things you love? Have you been able to compete at a higher level? Physical therapy doesn’t just help prevent injury but it gets you back and feeling better than before. Through the month of September, we’re holding a contest to allow people the chance to share what physical therapy has given them the chance to do. Whether thats getting back to the golf course, throwing the ball around with the kids, or spending more time outside. You can even win a $100 Scheels gift card or a pair of Husker football tickets!

Take a picture, win Prizes!

Makovicka Physical Therapy in the community

September 13th (4-7pm) – There will be food and games for the whole family at our Millard location on 157th and Harrison as we take part in the Millard Park Plaza open house. Come chat with Josh and the rest of our staff through out the night!

September 15th – The 2013 Corporate Cup will be taking place at the Aksarben Village this year. Each year this event raises money for the American Lung Association and they’ve already surpassed their $100,000 goal.

Take a second and Like us on Facebook and Follow us on Twitter

What has Physical Therapy allowed you to do?

Now that you’re back in the game, we want to see what physical therapy has allowed you to do!

Makovicka Mountain

Has physical therapy given you the ability to do something you weren’t able to do before? Did it get you back to work, the golf course, or competing at a higher level? Whatever that may be, we want you to show us for a chance to win a pair of Husker football tickets, $100 Scheels gift card, and more!

Anyone can win!

To participate, all you need to do is take a picture of what it is that physical therapy has allowed you to do and post it to Facebook, Twitter, or Instagram using the #MakovickaPT hashtag. Get as creative as you want with the pictures you post. If you’re currently going through physical therapy, this is not an excuse to go beyond your doctor or physical therapist’s orders. Rather get creative within your limits.

Use #MakovickaPT (don’t misspell it) to win big!

Anyone can win, but how you say?!

  1. Like us on Facebook
  2. Follow us on Twitter
  3. Post pictures on Facebook (message us the pictures) or Twitter throughout the month of September with #MakovickaPT in the post. Thats it!

The most important thing is to do #3!


–          A pair of 2013 Husker Football tickets

–          $100 Scheels gift card

–          iPod Shuffle (2x)

–          Swiss workout balls

–          Makovicka Physical Therapy t-shirts

*The contest will run from Sept. 1st – Sept. 30th with the winners being announced on October 2nd. Any pictures posted using the #MakovickaPT hashtag might be shared on our Facebook, Twitter, and Instagram pages.

Preventing Injuries for Football – Knee Injuries

If you’re getting injured, you’re not on the field. If you’re not on the field playing, you’re not getting better. If you’re not getting better, Nick Saban and Bo Pelini aren’t sending you letters asking you to have dinner with them and their family, their football family that is. Make sure your doing everything you can to prevent those football injuries. They can happen after a huge hit or from making a cut. Although either one can knock you out of the game or season, non-contact injuries are some of the most frustrating injuries. These occur due to poor mechanics or weakness in a muscle group that stabilizes a joint. We’ll touch on a couple ways to help prevent these injuries from happening.

Preventing Knee Injuries

Take a look at a running back taking a cut as he’s changing direction. Is he using his outside or inside leg to push off with? In most cases its his outside leg that he’s using to make the initial cut with. If its the inside leg, chances are he’s not running anymore. Many non-contact knee injuries occur this was as the knee is put under more force and torque than it could handle when its under the body.

As you go through drills, focus on pushing with your outside leg. This puts your knee in its strongest and most powerful position, protecting it from possible ligament damage.

EP-706079875There are several prehab exercises that will help prevent injury by activating the muscles that support the knee. One exercise is the terminal knee extension (TKE), which targets the vastus medialis oblique (VMO). Other exercises such as a single leg hop and hold the landing will help target the quadriceps and increase stabilization. While performing any of the knee exercises, keep your knee tracking in the direction of your foot and don’t allow it to fall inward or outward. This facilitates proper mechanics trains the muscles to perform this movement when needed most, in the game.

Injuries that occur from contact are hard to prevent from the prehab exercises above but the severity of the injury can be decreased.

What Supports the Knee

The ligaments that support the knee include two (medial and lateral) collateral ligaments and two (anterior and posterior) cruciate ligaments. The medial and lateral collateral ligaments prevent the knee from buckling inward and outwards and is often injured from being hit from the outside of the knee. As for the anterior and posterior cruciate ligaments, they prevent rotation and front to back movement of the tibia under the femur and are located with in the joint.

The knee joint moves over two menisci that act as a cushion for your upper leg (or femur) on top of the shin (tibia). Injuries and complications to the meniscus often occur with rotation of the tibia under the femur as with ACL and PCL injuries and often at the same time. Some symptoms might include the feeling of instability, swelling and stiffness.

Decreasing Recovery Time

Recovery from injuries to these ligaments often take 6-12 months. Going through physical therapy prior to surgery greatly decreases the length of therapy after surgery. It increases range of motion and prepares your quad for post-surgery strengthening. Through out the process, rest, ice, and elevation will help decrease the swelling that will also help decrease the recovery time, getting you back to the playing field faster.

Don’t assume the time you put in at physical therapy is all you need. Be sure to follow the home exercise program your physical therapist has prescribed to stay on track.

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Benefits of the Graston Technique

For those of you who have never heard of or experienced the Graston Technique, it is used to help with the breakdown of scar tissue and fascial restrictions. The tools are made for specific parts of the body and help detect and treat chronic inflammation and soft tissue fibrosis.

Stop putting it off. Get in today!

By combining this technique with corrective exercise, stretching, and modalities clinicians can help the healing process to rebuild the appropriate tissue. We also see many patients who come in solely for Graston as it has many benefits on its own.

The treatment time for each restriction is approximately 30-60 seconds per spot, while bruising and pain are avoided to provide comfort for the patient.

Graston may be incorporated in the treatment of:

Achilles Tendonitis

Carpal Tunnel Syndrome

Tennis Elbow

Golfer’s Elbow

Lumbar Strain/Sprain

Patellofemoral Dysfunction

Plantar Fasciitis

Want to know how you can benefit from Graston? Visit a Makovicka Physical Therapy clinic Today!

An easy transition from traditional to minimalist shoes.

The first thing you want to do after you purchase your first pair of minimalist shoes is to use them as you would if you bought a normal pair. Throw them on and go for the same run or walk you did the day before. That is where most people go wrong. The transition from traditional shoes to minimalist shoes is a long process but can


A pair of Vibram Five Finger minimalist shoes.

The debate of using shoes for any mode of transportation, whether its walking or running, has been going on for decades if not longer. Barefoot (minimalist) shoes, such as the vibram’s, have been popular in the fitness community as a replacement to the highly supportive traditional running shoes. Being barefoot is natural and strengthens the muscles that support or feet. The benefits are numerous but takes time to achieve.



A pair of ASICS stability running shoes, model...

A pair of ASICS stability running shoes, model GEL-Kinsei (Photo credit: Wikipedia)

What many people do as they switch from traditional running shoes to minimalist shoes is they don’t ease into them. As we come from the traditional shoes, our muscles and joints have not been used to absorbing the force that comes with minimalist running. The amount of time it takes to adjust to the barefoot or minimalist shoes varies from person to person. Start by using them to walk around the house a little each day and slowly increase the time you use them to walk in. As you start to run in them, try softer surfaces such as a track or grass.

Jeff Gaudette, from, gives a great tip on how you should transition into your minimalist shoes. “Begin with some short 20 to 30-second accelerations in your minimalist shoes after an easy run in traditional trainers. Once you’re comfortable in your new kicks, progress to 3 to 5 minutes of minimalist running every other day and slowly add 3-5 minutes each week, focusing on landing softly with an efficient midfoot strike.”

Another thing that may change as you switch from traditional shoes to barefoot or minimalist shoes is your gate pattern or landing style. This typically occurs without you thinking about it to help absorb much of the increased force that the cushioned shoes took for you. Those who use traditional shoes usually run with a heel strike compared to minimalist runners who are usually mid- to fore-foot strikers. Although the point at which your foot contacts the ground changes from heel to mid- or fore-foot, there isn’t any research confirming the estimated increase in injury when running with a heel strike.

Minimalist shoes aren’t for everyone. Different gate patterns or biomechanical characteristics may need the support of a traditional shoe. These supports and shoe styles are dependent on the need of the person and a physical therapist or foot specialist can point you in the right direction.

Monthly Newsletter / August 2013

August is going to be a busy month for Makovicka Physical Therapy. Everything from The Best of Omaha contest to a contest of our own. We also had to say good-bye to one of our residents, Ryan Vincent, as he took a new position in his home state of Wyoming. Ryan, thank you so much for imparting your knowledge among the rest of us and we wish you the best of luck! We’d like to welcome Zach Kramper, and Michelle Ripperger to the Makovicka family as we continue to grow.

Social media seems to be the hot marketing tactic, and we are taking advantage of it! Along with Facebook, we just added Twitter and Pinterest accounts to the mix. These accounts are what we will be using for our contest in September for a chance to win Husker football tickets, gift cards, and more!

Football Season is right around the corn stalk and training camps have been underway for a few weeks. Brain injuries are a popular topic among coaches and staff and there is little information we have on what exactly causes them (in terms of force and direction from which it comes). If you or your son have any questions as the season nears, don’t hesitate to stop by one of our clinics or give us a call.

What to look for when backpack shopping.

Here is a link to our BACKPACK SAFETY tips. Take a look at them before you go shopping for a new backpack or before the first day of school. These things are often overlooked and can have long lasting effects on our kids.

If you’re having a hard time viewing the pdf above here are some of the tips.


•           Two wide padded shoulder straps

•           Lightweight fabric

•           Padded back

•           Multiple compartments

•           Waist belt

These features not only make it more comfortable to wear a backpack,

but helps evenly distribute the weight



•           Wear both straps. Backpack should sit evenly on the middle of the back,

two inches above the waist.

•           Weight of the backpack should not exceed 10-15% of child’s body weight.

•           Be aware of your posture when standing or walking with book bag.

•           Pick the backpack up by bending at the knee, instead of throwing it over

the shoulders.



•           Use desk or locker more frequently

•           Do not carry around unnecessary items

•           Lighten the load! Bring home only the books needed for homework/ studying each night. Organize the heaviest contents so they are placed near the back.



•           Child struggles to get the pack on and off

•           Complaints of back pain arise

•      Child’s standing posture is altered due to the weigh and fit of pack

Traumatic Brain Injuries in football

Summer is almost over and high school football teams are starting camps all over the country. Whether the players have been training to make the varsity team, preparing for a state championship, or trying to impress college scouts, it now comes down to how they perform. Their training may help prevent non-contact injuries to the knee or ankle, but what about the head? Injuries to the head can cause far worse damage then one might think. Anything from experiencing no symptoms at all to life-altering traumatic brain injuries (TBI).

What used to be the most overlooked part of the body (in terms of training) until recent NFL lawsuits is starting to become a focus point of companies around the country. Companies are claiming that their products might help reduce the chances of sustaining a head injury or speeding up the diagnosis process. Are these products worth the money? It’s hard to say but something that might help player safety that doesn’t cost a penny is awareness.

The more we know about traumatic brain injuries the better we can prepare our athletes and the faster we can diagnose an injury to ensure that they aren’t playing through it. According to the CDC, older adolescents (15-19 yrs.) are some of the most at risk age group to sustain a TBI. What does this all mean in terms of football?

What kind of hits can cause a TBI? It can be anything from major hits that cause unconsciousness to a normal tackle or block to the helmet. It is still difficult to determine the amount of force and direction from which the blow comes from that causes these brain injuries. When these injuries occur, specifically in football, they may cause symptoms that players can often point out but don’t want to admit to the coaching staff in fear of being benched. Besides those symptoms that appear right away, other symptoms might not arise for days to weeks after the initial injury. This makes it difficult to pinpoint the cause.

Sustaining a traumatic brain injury during football, specifically youth football, can have long-lasting effects. We’re hearing more and more that kids are hiding their symptoms to be able to keep playing either out of fear or competition. Doing this can have life-long effects on their health, and it’s not just a knee that can be repaired, it’s their brain. This can be enhanced by the fact that football players are continuing to hit harder at younger and younger ages while the brain and skull are continuing to develop.


Nothing. After being diagnosed with a concussion or TBI the best thing to do is nothing. The obvious things to refrain from include physical contact and activity but some of the other not so obvious are limiting the amount of time that your brain is being used. That may include time home from school, studying, etc. Continue to stay in contact with your doctor or physician as every person is different in how they recover and are effected by a brain injury.


Trying to find ways to reduce the risk of your son sustaining a brain injury while playing football besides abstinence? Be sure that their helmet they are using fits correctly and continue to check the fit after games as it may loosen.

If you have further questions as training camps continue and the season nears, please contact us at or give us a call at 402.934.0045. Do everything you can to prevent a traumatic brain injury.