My Mother Always Told Me to Sit Up Straight

I’m sure many of us had a parent or grandparent tell us to stop slouching.

I know I did! Why didn’t I listen when I was younger? It took me going to physical therapy school to start paying attention to why posture is important.

Let me give you the run down on posture.

You may ask, “why do so many of us slouch, lean on one elbow or hinge on our hip?”

The main reason is that it is really easy to do when we get tired.

When our postural muscles don’t have enough strength of endurance to hold us in good posture we start to rest on the passive structures in our bodies (aka non-muscular tissue) to hold us in one position.

What is the benefit of good posture?

The main benefit of good posture is to distribute forces evenly throughout our body and reduced pressure on areas that shouldn’t be stressed.

For example, the classic slouchy forward head posture can cause irritation of the joints in the neck, tightness of the muscles in the neck, and pinching of the nerves in your neck that can lead to pain, numbness/tingling, and dysfunction of your arm.

Good posture naturally encourages your core muscles to become more active.

Good posture aids with encouraging diaphragmatic breathing. Diaphragmatic breathing is so beneficial to our bodies in many ways, but to name a few:

• It helps activate our parasympathetic nervous system to help reduce stress and improve digestion

• It helps to improve our core strength

• It helps to improve our balance

If you want to know further about diaphragmatic breathing and how to do it, click here to see the blog post titled “One exercise to improve core strength, reduce stress, and improve muscle recovery.”

Why do I keep reverting back to my old postures?

The quick answer is because it is easy for our bodies to go back to where they habitually have been.

Our muscles, fascia, joints, and ligaments get used to a certain tension that is placed on them and accommodate to this.

Therefore, certain muscles may become tight with our habitually poor posture and then limit us from achieving good posture.

If my body has now conformed to my poor posture, how will my body ever adjust to good posture?

The same principles apply with good posture that applied to poor posture, meaning that our bodies will conform to what we ask it to do.

If you constantly practice good posture, the muscles, fascia, joints, and ligaments will begin to adjust themselves accordingly. It will be easier and easier to hold this posture as you practice.

Be patient though, this doesn’t happen over night! Think about how long it took your body to get used to poor posture!

Here’s a breakdown of some of the main components you should be looking at with your posture:

Ideally when you are standing, if someone were to look at you from the side, your ears should be in line with your shoulders which should be over your hips and ankle bones.

You should be able to draw one straight line from your ears to your shoulders to your hips and to your ankles.

The cues that I give my patients are:

• #1 Think about lifting your chest up and growing taller. The phrase “growing taller’ is key as this encourages you to avoid over-arching your back as you stand up taller.

• #2 Think about a string drawing you up from the back of your neck. This encourages you to tuck you chin slightly and avoid the forward head posture.

• #3 When standing, shift your pelvis back so that you feel the weight of your body more in the heels of your feet rather than the balls of your feet.

Other things to think about: Make sure to have a slight bend in the knees to avoid locking them into extension, place your pelvis in neutral so that it is not rocking forwards or backwards.

In sitting, the same principles apply except for your ankles will not be in line with the ears, shoulders and hips. Keeping your pelvis in neutral is a good starting point in order to stack the rest of your body above it.

Try to avoid sitting with your legs crossed all day, leaning to one side on your elbow, and sitting into your hip while standing mostly on one leg.

If you can work on these things, you are off to a great start!

I suggest setting a timer for various points throughout the day to help remind you to check in with your posture.

It’s easy to get wrapped up in something else and revert back to old habits.

Here’s a video to help you with your posture journey: Click here

Shoot us an email here to let us know how you do and if you have any questions!

Is My Shoulder Really That Complicated?

Who has shoulder pain? Who has poor posture? Who wants stronger arms?

I think many of us could answer “yes” to one of these questions.

If so, this post is for you!

A little background first:

The shoulder is a very complex system. Notice I didn’t say “the shoulder is a very complex joint.” You’re thinking “wait the shoulder is a joint, what are you talking about?”

Well, the shoulder is made up of four separate joints: the sternoclavicular joint (at our chest and collar bone), the acromioclavicular joint (at the collar bone and shoulder blade), the glenohumeral joint (at the ball and socket joint that we think of as the shoulder), and the scapulothoracic joint (at the shoulder blade and the thorax).

All three of these joints must be moving through the appropriate ranges with the appropriate muscular control in order to produce the motions that you want with your arm.

So it’s more of a system with all of the components working together.

You didn’t think it was that complicated, did you?

Bonus trivia: the only bony attachment from the shoulder to our body is through our sternoclavicular joint at the front of our chest. Crazy, I know!

Now you can see why the muscular control, strength and coordination needs to be on point when you reach your arm forwards to grab your cup of joe or when you push a heavy weight overhead.

There is something called force coupling that happens at the shoulder to produce overhead motions. One of the force couples that happens at the shoulder is between the serratus anterior (SA) and the trapezius. The other force couple at the shoulder blade is between, the subscapularis, there’s minor, and infraspinatus opposing the deltoid.

What is a force couple?

Essentially, it is opposing forces acting to stabilize or produce a movement.

Today we’re going to discuss the SA and why it’s so important.

The SA’s main function is protraction and upward rotation of the scapula (shoulder blade). It helps with external rotation and posterior tilting of the scapula as you raise your arm. All this is fancy lingo to say that they SA helps to rotate your scapula up so that you can reach your arm overhead easily without pain.

The SA also helps keep your shoulder blade securely attached to your thorax. Because remember, the shoulder is only connected to the rest of the body by bone at that teeny tiny point on the front of the chest.

This muscle needs to be strong enough that when we lift our arm, the deltoid doesn’t pull the scapula down in the opposite direction.

So what happens when this muscle isn’t strong enough?

Well, you can get pinching of your supraspinatus tendon (one of the rotator cuff muscles), shoulder pain, less efficient movement patterns, and adaptive shortening of your pec minor muscle.

How can you tell if your serratus anterior is firing properly?

The biggest sign is that your scapula is winging at rest or when you move your arm (ie. your shoulder blade is not sitting flat against your body). Another way to tell is if your scapula rotates down instead of up when you raise your arm out to the side.

I see that my scapula is winging, am I doomed?

Of course not!….

Here are two exercises to help get this muscle back in action:

1. Bear Hugs: (exactly as it sounds!) Start with your arms reaching out in front of you. You may wrap an exercise band around your back and arms and hold it in your hands. Reach your arms as if you are hugging a bear or very large tree, allowing the shoulder blades to come apart. Then slowly return to starting position. Shoot for 2-3 sets of 15 reps.

2. Serratus Push-ups: Start in a plank position on your hands and feet or hands and knees. Keep your core activated. Press your body backwards so that your spine is pushing towards the ceiling and your shoulder blades separate. Then slowly return to the starting position. Again shoot for 2-3 sets of 15 reps.

Test out these exercises and see how challenging or easy they are for you.

Working on scapular control will help you eliminate pain, improve the efficiency and ease of using your arm, improve your posture, and improve your overall shoulder strength.

Why Choose Physical Therapy?

With many options out there, why would you want to choose physical therapy, specifically GOfit Physical Therapy, over another discipline?

To answer this question, let’s first answer another question: What is physical therapy?

As a physical therapist I am now painfully aware that many people don’t really know what it is I do, or who exactly I work with.

When asked what physical therapy is, to those who have never experienced it, an image of an old lady working on her walking in parallel bars usually flashes in their head before they respond “don’t they work in nursing homes?'“

Yes, that is true, but working with geriatrics in a nursing home is only one specialty in the field of physical therapy.

Another common answer would be, “don’t they work with people after surgeries or injuries.”

Yes, again that is true, but it still is only a small part of the field of physical therapy.

There are a number of specialty areas in physical therapy including orthopedics, neurological, pediatrics, sports, geriatrics, and acute care. And there are specialties within specialties, like pediatric neurological physical therapy, spinal cord injury physical therapy, orthopedic manual physical therapy, acute care cardiac physical therapy, women’s health physical therapy, and lymphedema physical therapy just to name a few.

Much like the field of medicine, if there is a specialty patient population you can bet there are physical therapists devoted to the care of this group of people.

So, what do we specialize in?

The physical therapists at GOfit are fellowship-trained orthopedic manual physical therapists that specialize in treating active, athletic adults. That means we are a specialty within a specialty, within a specialty.

Most of the patient’s we see have specific activity goals in mind, whether that is running a 5k or marathon, participating in CrossFit, playing lacrosse, or hiking to name a few. However their goals are currently not being met as they are having pain or limitation with their activity. This could be for a variety of reasons from joint pain or muscle pain to possibly recovering from a surgery or serious injury.

As orthopedic manual physical therapists we are a bridge that serves to move a patient from their current state to their activity goals.

To accomplish this we identify and treat dysfunctions in the joints, muscles, and motor control system in order to allow a patient to progress towards their goals.

As fellowship-trained physical therapists we have a lot of tools in our treatment tool bags that range from joint mobilization and manipulation, dry needling, soft tissue mobilization, neuromuscular re-education, and scientific therapeutic exercise.

Why Choose GOfit Physical Therapy?

With so many treatment options that we can provide at GOfit, we are truly a holistic practice. Pain and limitation could be caused for a number of different reasons. We have the expertise to identify problem areas and then direct treatments to those specific areas. There is no one size fits all treatment approach to every patient we see.

We develop specific and targeted treatment plans that are individual to the unique needs and goals of a patient.

Two different patients with knee pain who want to run a 5k may have very different treatment plans because they may have very different causes of their pain and limitations.

Compared to other providers both in the physical therapy profession and in different disciplines, we afford the opportunity to look at a patient through a number of different lenses and provide unique and specific treatments to help patients achieve their goals.

"Healthy" Is A Lifestyle

These days healthy living is a lifestyle choice. Conscious effort has to be made to take care of your body, your mind, and your health.

Gone are the days when our environment and lifestyle naturally gave rise to healthy living.

These days most of us are inundated with stress, poor food choices, little time, lack of sleep, and little exercise.

When our environment pushes us towards the unhealthy what are we to do?…. Make a choice.

We don’t have to be passive participants in our health. Choose to take small steps towards health and wellbeing.

There is really no better time than today.

Our overall well-being and health is multifactorial. Health isn’t just about what we eat, or how we exercise, or how much we sleep, or how much stress is in our lives. Health is a result of all those things. Health is a maze of interconnected factors.

Sure, eating better just by itself will improve your health, just as getting more sleep will. All these factors by themselves would certainly improve your health. But you know what would really make the biggest difference? All of it. Change your lifestyle, prioritize well-being.

In this article we are going to talk about five actions you can take today to be a healthier you.

If you were to hydrate, sleep, meditate, ground, and get outside, you would be well on your way to improve your overall health.

Hydrate:

Drinking more water is one of the easiest ways to improve your overall well being. Did you know that drinking water can do the following?

• Improve athletic performance

• Help with waste removal

• Help access water soluble nutrients

• Help with production of hormones and neurotransmitters

• Improve joint lubrication

• Help with digestion

Drinking more water can have a profound effect on our daily nutrition, brain function, and muscular function and it’s an easy habit to get into.

How much water should you drink per day?

A general formula is to multiply your weight by 2/3 and drink that number in ounces.

Example: weight 150lbs x 2/3 = 100 ounces per day.

If you are more active and sweat a lot you may need more.

Can you drink too much water?

Yes! Drinking too much water can also have severe consequences so don’t go out and chug gallons! Follow the formula above.

Sleep:

Look we get it, sleep seems to be the first thing to go when you don’t have enough time. But maybe if you knew more about sleep you would think differently. Maybe you would prioritize sleep and be able to notice how much energy you have during the day to be more productive in the time given to you.

You can tell yourself that you will catch up over the weekend, but the truth is you can’t. You can never truly catch up on sleep. Once it’s lost, it’s lost and you will never get it back.

In fact, sleep, or the lack thereof is so destructive that the World Health Organization lists chronic sleep deprivation as a carcinogen.

Here are a few of the numerous benefits of getting high quality sleep:

• Improves mental acuity and cognition (literally makes you smarter)

• Improves athletic performance

• Improves muscle recovery and healing

• Improves immune function

• Reduces risk for cardiovascular disease and neurodegenerative disease

• Reduces risk for mental health disorders

So how much sleep should you get? This depends person to person but it usually lies somewhere in the range of 7 to 9 hours a night. The true answer is that you should be getting enough sleep that you wake up naturally without feeling like you need to go back to sleep.

Meditate

The benefits of mediation are numerous and this once niche practice is becoming more and more mainstream for obvious reasons.

Mindfulness meditation is another great way to improve overall well-being and health.

Just 15 minutes of mindfulness meditation a day can have the following affects:

• Improved focus

• Reduced stress

• Reduced anxiety

• Reduced pain

• Reduced depression

• Reduced blood pressure and risk for cardiovascular disease

• Improved sleep quality

One of the easiest ways to get started is to sit comfortably in a quiet space and focus on your breath (Tich Naht Hahn style).

Breathe in and out through the nose focusing only on the inhalation and exhalation. If your mind wanders (as it will) re-focus your attention back on your breath and continue.

Set an alarm for 10 or 15 minutes to start. Like anything, meditation will take practice to learn how to focus your mind and prevent it from wandering.

Grounding:

Grounding is simply making contact with the ground to create electrical contact between the human body and the earth.

The earth produces a subtle negative electrical charge. A conductive body (the human body) can absorb free electrons from the earth’s surface. These free electrons can stabilize our internal bioelectrical environment and fight free radicals.

Grounding has been shown to have many positive effects on the body including:

• Reduce inflammation

• Reduce stress

• Improve heart rate variability

• Improve wound healing

• Prevent and treat chronic autoimmune disease

• Reduce pain

• Reduce DOMS (delayed onset muscle soreness)

The recommendation is to do 30 minutes of grounding per day, but even a few minutes of grounding can make a difference.

There are two keys to grounding’s success. One is you have to stand barefoot. Rubber or plastic shoes are non-conductive and won’t give you any benefits. Two, you have to stand on the earth’s surface. That means no asphalt, no cement; just you, the dirt, grass, or sand.

Get Outdoors

Probably the easiest one on this list. This seems like a no-brainer. Let’s be honest we were made to be outside. We didn’t evolve for millions of years to sit inside on our butts all day. Spending more time outdoors can have a number of significant health benefits.

The benefits include:

• Improved cognitive performance

• Reduced stress

• Increased vitamin D levels (if your skin is showing) which helps with calcium and phosphorus absorption, leading to increased bone mineral density. Vitamin D levels are also important for our immune system functioning

• Reduced depression

• Reduced inflammation

During these times as many of you are working from home, you have to make a special effort to get outside the house.

Getting outside for just 15 minutes will have significant benefits to your health. Think about starting and ending your day with a walking “commute.” Walk for a short time before and after work to give yourself a reason to get outside again.

Conclusion:

There you have it: five actions you can take to improve your overall health and well-being. Each one of these actions addresses a number of factors in the interconnected maze of overall health and well-being. Many of these actions would take very little time to implement in your day.

Make a commitment to prioritizing your health through specific actions and the results will keep you coming back for more.

Enjoy your day!

Should you really be wearing shoes inside the house?

I was watching the TV the other day and saw a medical “expert” tell the viewers that EVERYONE should be wearing shoes at home around the house.

I must say my initial reaction was shock, followed by anger.

I was shocked because I couldn’t understand how this person was deemed an “expert.” I was also shocked that you could make such an outrageous generic claim on TV and get away with it (although I really shouldn’t be shocked at that).

I was angry because I got to thinking how damaging that comment could be to the viewing public. If even 10% of viewers listening to that advice actually followed it, that could be thousands of people who may be set up for future foot pain.

To comment that everyone should be wearing shoes at home is flat out wrong.

I’m not however going to make a comment and just leave it there to linger without providing rationale or reason. Read on as I break this down.

Evolution Of The Human Body:

It is believed that our human evolutionary process began some 55 million years ago. At this time our ancestors were more similar to primates, moving around on all four limbs. Arguably somewhere around 6 million years ago our predecessors transitioned from walking around on four limbs to just two.

So let’s put this into context: Our bodies have been adapted and fine-tuned to walking on two feet for somewhere around 6 million years! We have evolved and refined specific bones, muscles, ligaments, and joints entirely for that purpose of walking on two feet.

So according to this “expert” I’m to believe that over 6 million years of evolution the only places on our bodies that make regular contact with the ground haven’t evolved enough that they somehow need extra support and cushion to handle the load? What?

Evolution Of Footwear:

By contrast it is believed that humans started wearing some form of rigid shoes approximately 40,000 years ago. This very niche area of research has been pioneered by an anthropologist named Erik Trinkaus (https://anthropology.wustl.edu/people/erik-trinkaus?_ga=2.165310525.307364462.1604509443-1205021368.1604509443). According to Dr. Trinkaus’ research he believes that there is a noticeable correlation between the use of shoes and a reduction in bone density of the foot. He believes that anthropological findings of human feet from this time period show a decrease in bone density and bone size of the feet compared to previous periods where shoes were not believed to be used.

Wolff’s Law:

Wolff’s law states that a bone will respond to the load that is placed on it. So if you use your body and do a lot of weightbearing exercise (walking, running, sprinting) your bones will respond and get bigger. If you sit on the couch all day and don’t put any load through your bones, they will get smaller.

It’s pretty simple, muscles work the same way too. If you go to the gym and lift weights your muscles will respond by growing bigger. If you sit on a couch all day your muscles will atrophy. Use it or lose it.

Shoes Act Like A Cast:

Have you ever broken a bone and been in a cast? I have. I still remember what my leg looked like when the cast was removed, skinny and pale. That’s because my calf muscle had atrophied significantly while I was wearing the cast. The fracture in my tibia had also healed, but the density of the bone had decreased.

Shoes act like a cast. They restrict your feet, they give you an arch and they do all the work for you. Your muscles either can’t do as much work or don’t have to. In the same fashion shoes reduce the load that is placed through your feet and as a result the bone density decreases. So your feet become weak.

Practical Advice (Conclusion):

We should all be working towards wearing shoes as little as possible. We should be working towards wearing shoes only when we are outside the house.

If you have good arches and no history of foot problems, get out of your shoes immediately and never put them on inside your house ever again!

If you have been wearing shoes all day long for years or decades and your arches aren’t ready for it, then I would recommend a more calculated transition. You absolutely should work towards getting out of your shoes when you’re in the house but your approach needs to be gradual.

Remember your body will respond to the demands that you put on it.

I would recommend starting by taking off your shoes for 10 minutes longer than normal each day for one week. Then if your feet feel good and you don’t notice any soreness, move on to 20 minutes a day for the next week. Continue this weekly trend until you are spending your time at home completely shoeless.

As you spend more and more time out of your shoes the bones in your feet will become more dense, the muscles in your feet will become stronger and more flexible, and the joints in your feet will become more mobile.

Going shoeless is one of the easiest ways to improve your foot health!

Three things that every person with back pain should be working on.

If you have back pain there are three things that you should be working on right now to relieve your pain.

I know there are a number of causes for back pain. But there are general patterns that emerge with almost ever single person we see who is experiencing back pain, regardless of what is causing their pain.

The three most common contributing factors that almost all patients with back pain have are:

1.) Poor hip mobility

2.) Poor core muscle strength

3.) Altered breathing patterns

How poor hip mobility leads to back pain:

Hip mobility is key to the success or failure for a majority of the activities that you do. Good hip mobility will allow you to squat down to pick something up while maintaining good spinal posture.

Good hip mobility will also allow you to efficiently walk or run without overextending your spine to compensate.

There are three key directions that your hips need to be mobile into in order to effectively take stress off your low back.

Cara in Supta Badda Konasana pose

1.) Adduction: Being flexible into adduction will allow your pelvis to clear your hips when you squat down to pick something up. By clearing the pelvis through the hips you will be able to squat deeper while maintaining a nice neutral spine. This way you won’t have to round your back so much to when squatting down.

A great stretch to improve adduction is supta badda konasana (yes it’s a yoga pose, you could probably tell by the name) shown here.

Cara demonstrating the pigeon pose.

2.) Flexion: Being able to flex your hip higher will allow you to squat deeper while maintaining your back in a neutral alignment. In order to do this you need to have flexible glutes.

A great stretch to improve hip flexion and glute flexibility is the pigeon pose, shown here.

Cara demonstrating a kneeling hip extension stretch

3.) Extension: Having good hip extension is critical to maintaining a happy and healthy spine when you walk or run. Naturally you need your hips to extend to move through your full gait cycle. If your hips are tight into extension then the body will compensate by extending more into your low back. Over time this could cause irritation and pain in the low back.

A great stretch to improve hip extension is a kneeling hip extension stretch, shown here:

How poor core muscle strength leads to back pain:

Honestly this one is pretty self explanatory. If your core is weak you won’t be able to stabilize your spine when you perform daily tasks. This can easily lead to back pain through overuse. Traditionally this means that your paraspinals (the muscles that run along the length of your spine) will be overworked leading to fatigue and soreness.

Watch this video below to get a better idea of how to properly contract your core:

Now that you know how to properly contract your core there are a number of exercises you can do to strengthen.

How altered breathing patterns lead to back pain:

This one is not so obvious compared to the first two. But how you breathe is critical to stabilizing your back during activities throughout the day.

The diaphragm is one of your core muscles. Possibly one of the most important and least talked about core muscle.

Timing diaphragm breathing to specific movements like squatting and lifting can significantly improve your core stability and reduce strain to the low back.

For example: As you squat down to pick something off the floor you should be taking a nice deep breath in through the diaphragm. The contraction of the diaphragm will increase the intraabdominal pressure making your back more stiff and rigid to lift.

For more info on diaphragmatic breathing I wrote a great article recently that you can check out here: https://www.gofit-pt.com/blog/diaphragmatic-breathing.

In Conclusion:

Back pain can have a number of different causes. However there tends to be a trend among all patient’s with back pain regardless of the cause of the pain. These patient’s all seem to have three things in common. First, they have poor hip mobility. Second, they have poor core muscle strength. Lastly, they do not know how to breath properly and use their breath to stabilize their spine.

To learn how we can help, or to schedule an appointment, click here:

The one thing you should know about pain that no medical professional is telling you.

There are many misconceptions perpetuated by the medical community these days.

One of the most impactful misconceptions that we experience on a regular basis in our physical therapy practice is the misconception about pain.

after reading this article you will have a new understanding of pain.

If a medical professional has ever told you that because you have a bulging disc, or rotator cuff tear, or osteoarthritis, or any other diagnosis, that you will have pain for the rest of your life, this article is for you.

The standard way that pain is taught is that Pain = Tissue Damage and that Tissue Damage = Pain. This idea has been disproven time and time again by research but somehow this misconception lives on.

Ever find a bruise on your body and wonder how it got there? That bruise is a clear sign of tissue damage but somehow it didn’t hurt. How does that happen?

Did you know that there are a number of studies (referenced below) that show a high rate of “abnormalities” (that include disc bulges, herniations, labral tears, rotator cuff tears) in ASYMPTOMATIC (meaning they don’t have pain) individuals?

Did you know that there are likely a high number of people walking around with full blown rotator cuff tears that have no pain or limitation?

How does that happen?

Let me expand on this:

Did you know that there are no nerves in your body specifically designed to sense pain? There are nerves that sense touch, pressure, temperature, and chemicals to name a few. But it is entirely up to your brain on how to interpret those sensations.

Take this example:

Your eyes sense light, it’s your brain that interprets the light based on your experiences and the context of events and then produces an image that we call vision.

Another example is your ears:

The nerves in your ears sense vibration. It is once again your brain that interprets these vibrations based on experience and context and produces what we call sound.

So how does pain really work?

You experience pain when your body perceives a threat.

Let’s say your walking barefoot and you step on a piece of glass. The nerves in your foot sense something sharp and send a signal to your brain. Your brain then interprets that signal and sets off an alarm. That alarm is pain. The brain has decided that the piece of glass is a threat and it makes you experience pain so that you will stop and remove the piece of glass in your foot.

This makes sense right?

Now, lets make this example a little more complicated:

Let’s say you’re awakened in the middle of the night to a ragging fire in your room. What do you do? You run out of the room. But as your running you step on that same piece of glass. What happens now, do you think you feel pain? Definitely not! You stepping on a piece of glass is much less of a threat than the ragging fire in your room. So you run out of the house with the piece of glass in your foot and only until you have safely removed yourself from the threat of fire, do you start to notice that your foot hurts. This is because the bigger threat has been removed and your body can now worry about the smaller one.

So what does this have to do with physical therapy?

In the example above, the brain activates an alarm based on the brains perception of threat. That alarm makes you sense pain. The alarm can be turned on or off depending on the circumstance, seen in the second example.

Once the threat is removed (i.e. once you remove the piece of glass) the alarm starts to turn off and in few minutes the pain is relatively minor. In a few days the pain is gone.

However, what happens when the alarm stays on?

This can happen in about 25% of people that experience pain.

Remember pain is triggered by the body’s perception of threat. The real key here is that THREAT is multifactorial.

Let’s compare the following two examples:

Example 1: Lets say you’re a quarterback for a professional football team and you have injured your throwing shoulder. You’re midway through the season in the last year of your contract, the season hasn’t been going well and your worried that if you don’t perform this could be the end of your career. You’re married with two children who fully rely on the income that you make. You love playing football, you have worked incredibly hard to make it to the professional level and it’s the only thing that you have ever wanted to do in your life.

Example 2: Lets say you were convinced by a friend to play a game of pick up football and you sustain the same exact injury to your throwing arm. You don’t really love playing football, you barely ever play and you have a secure job that doesn’t require more out of your arm than typing on the computer.

Of these two examples who is threatened more by the same injury? Clearly it’s the professional quarterback. Because the repercussions of the injury have more of a potential impact on all aspects of the quarterback’s life. For this hypothetical quarterback this injury could mean that he gets replaced. If he gets replaced then maybe his contract won’t get picked up again. He could loose his job, his source of income, his identity, and even his opportunity to do the one thing that he loves to do, play football. Think his alarm is going off? Absolutely, there are a number of underlying factors that are making his alarm go off like crazy.

Because of these extra factors it is possible that the quarterback’s alarm will keep going off even as the tissues heal.

The quarterback wouldn’t be alone in this. Remember this happens in 25% of people who experience pain and most people don’t even know it’s happening because all they have ever been told is that pain = tissue injury.

Tissues heal, but sometimes the alarm stays on.

Part of a good physical therapy approach is to identify if someone’s alarm is still on.

Treating the sensitive alarm so that it calms down is just as important as treating the tissues.

If you have gone through failed treatment after failed treatment it’s almost a certainty that your alarm is way too sensitive.

There are plenty of ways to turn down the intensity of that alarm. The first and most important is through knowledge. Studies show that just by understanding how pain really works you can start to turn down that sensitive alarm.

Call/Text today To Book an Appointment.

we can help you turn off the alarm!

References:

1. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73. doi: 10.1056/NEJM199407143310201. PMID: 8208267.

2. Bastian SA, Rahmi H, Crues J, Bhanu S, Blout C, Rangarajan R, Lee B, Itamura J. Variations of magnetic resonance imaging findings in asymptomatic elbows. J Shoulder Elbow Surg. 2019 Jun;28(6S):S154-S160. doi: 10.1016/j.jse.2019.05.006. PMID: 31196510.

3. Gutierrez NM, Granville C, Kaplan L, Baraga M, Jose J. Elbow MRI Findings Do Not Correlate With Future Placement on the Disabled List in Asymptomatic Professional Baseball Pitchers. Sports Health. 2017 May/Jun;9(3):222-229. doi: 10.1177/1941738117701769. Epub 2017 Apr 10. PMID: 28394713; PMCID: PMC5435154.

4. Gill TK, Shanahan EM, Allison D, Alcorn D, Hill CL. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Int J Rheum Dis. 2014 Nov;17(8):863-71. doi: 10.1111/1756-185X.12476. Epub 2014 Oct 8. PMID: 25294682.

5. Hacken B, Onks C, Flemming D, Mosher T, Silvis M, Black K, Stuck D, Dhawan A. Prevalence of MRI Shoulder Abnormalities in Asymptomatic Professional and Collegiate Ice Hockey Athletes. Orthop J Sports Med. 2019 Oct 10;7(10):2325967119876865. doi: 10.1177/2325967119876865. PMID: 31637270; PMCID: PMC6787880.

6. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016 Jul;32(5):332-55. doi: 10.1080/09593985.2016.1194646. Epub 2016 Jun 28. PMID: 27351541.

Overuse injuries explained.

Learn what overuse injuries are, why they occur, and what you can do to fix them.

What is an overuse injury?

An overuse injury is pretty much exactly how it sounds. You ended up overloading an area of your body through a particular activity or combination of activities and this has resulted in injury.

This can happen for a number of reasons but often times the cause is more complex and possibly multifactorial.

Why did I develop an overuse injury in my leg?

To answer this question let’s dust off that old high school physics book (if you still have it and let’s face it, you don’t).  You may remember being taught that for every action there is an equal and opposite reaction.

This is absolutely true when we walk, jog, or sprint. When we take a step, we are exerting a force on the ground. The ground is also exerting a force back through us (equal and opposite). This is termed the ground reaction force.

A changing ground reaction force:

Whenever you take a step, or even stand still for that matter, the ground is exerting a force through your body.

The force is constantly changing. For instance, the ground rection force gets larger with more intense activity. Stand still and the force is relatively small, walk and it goes up a little bit, jog it goes up a little bit more, sprint and it goes up even further.

The type of surface we walk or run on makes a difference too. Harder surfaces will produce more ground reaction force while softer ones will produce less. Think about running on cement vs. running on a dirt trail.  I’m sure you noticed that the trail feels softer and easier.  

The type of shoe (or lack thereof) makes a difference.  Shoes with more cushion will reduce the ground reaction force just as running barefoot will increase it.

So why not just wear super cushiony shoes and run in mud?

There is always a catch and here it is: with all things being equal a softer surface will make you slower and a harder surface will make you faster.  A shoe with more cushion will make you slower than running barefoot. Think about sprinters, they don’t wear big cushiony trainers, they wear slim track spikes.  

So, what does all this have to do with injury?

Thanks for hanging in there with me. 

This could start to explain why you may have noticed pain after a particular run. Maybe you ran a different loop and the surface was harder. Maybe your shoes having been wearing out and they are no longer giving you that little bit of extra shock absorption that you needed.

These are a couple of the possible external variables that could have sparked an overuse injury. 

There are however some intrinsic reasons why this happened as well.

Your body must be able to control the ground reaction force

This is where a lot of problems begin.  Back to physics…

Remember your body needs to be able to meet the ground reaction force when you move. In a perfectly balanced, mobile, and strong body the force will be equally taken up and distributed throughout the joints, muscles, and tendons.

But what happens if, let’s say, your hip is a little weak?

Well in that case something else along the path will have to take up the slack. This could be around the knee or the ankle for starters.

Let’s just say for the sake of examples your quad is the muscle that makes up for your weak hip…. Do you see where this is going?  Can you say runner’s knee(chondromalacia patella) or patellar tendinopathy?

Or maybe it’s your foot or ankle. Hello plantarfascitis, Achilles tendinopathy, or tibialis posterior syndrome.

Typically, it tends to be the large muscles that aren’t pulling their fair share of the load and the poor little muscles get beat up as a result.

You can fix it.

Even though the problem likely started without you even knowing, there are ways that you can fix it.

Here are 3 tips to get you back on track:

1.)   Cut down the intensity of your activity to a level that is non-aggravating.  There isn’t necessarily a reason to stop altogether. You just have to bring it back down to a level that your body can handle. This likely means cutting the intensity and/or duration of your exercise.

2.)   Get stronger in your core, glutes, and quads.  Add two to three glute and quad strengthening activities 3 times a week to your routine.

3.)   Build back slowly. The safest return to activity is at an increase of 5-10% (either intensity or duration) every week. If you have time be conservative and progress slower at a 5% rate, do it, your body will thank you.

One exercise to improve core strength, reduce stress, and improve muscle recovery.

Is there really one exercise that can do it all?

Yes, there is. And, it won’t even make you sweat!

This blog post is a follow up to a recent Facebook and Insta post.

Diaphragmatic breathing can have a huge impact on many aspects related to our health.  

For instance, did you know that diaphragmatic breathing exercises can actually improve your balance?!? Whaaaaat?

I know, it sounds crazy, but it’s true. Let’s take a closer look at how the diaphragm can improve your core health:

How the diaphragm can improve your core stability:

We typically use the concept of a cylinder to explain how the core works.

If we think of the core as a cylinder the diaphragm is on top, the pelvic floor on the bottom, and a number of muscles including the transversus abdominus make up the sides of the cylinder.

The diaphragm’s role is to regulate the amount of intra-abdominal pressure.

Try this: Contract your core and then try to take a slow breath in through your nose.  Your core gets tighter, doesn’t it?

That’s the diaphragm doing its job to increase the pressure within your core. This helps stiffen the spine and hold it in position.

This concept is backed by scientific evidence that demonstrates improvement in core strength with diaphragmatic breathing exercise. (5)

It is no surprise then that poor breathing patterns have been linked to neck pain, thoracic, pain, low back pain, and even balance dysfunctions. (4)

If your core isn’t functioning properly, how can one expect to stay pain free?

It should also be no surprise that there are studies that show that regular diaphragmatic breathing can improve pain and balance. (1,4)

Diaphragmatic breathing to reduce stress.

Diaphragmatic breathing has been basking in its stress reduction glory for years.  Buddhist monks, à la Tich Nhat Hanh, have been preaching about the effects of slow deep diaphragmatic breathing on stress reduction, mindfulness, and peace for decades.

But how does it work?

The answer lies with the Vagus nerve.

The Vagus nerve innervates the diaphragm, along with a number of other organs throughout the body.

The Vagus nerve is intimately linked with the parasympathetic nervous system.

The parasympathetic nervous system is responsible for rest and recovery. When the parasympathetic nervous system gets activated heart rate slows down, good endorphins are released, and capillaries dilate. This allows for our bodies to relax and recover. (3)

When we breathe with our diaphragm, we stimulate our Vagus nerve. Specifically diaphragmatic breathing massages our Vagus nerve as it passes near and through the diaphragm. This sort of massage to the Vagus nerve can only occur if our diaphragm is contracting and relaxing. When the Vagus nerve is stimulated in this way it sends signals throughout the body to do all the wonderful things that we relate to the parasympathetic nervous system. (2)

So now we know that diaphragmatic breathing can activate the parasympathetic nervous system and improve core stability.

What else can it do?

Diaphragmatic breathing to improve muscle recovery

Diaphragmatic breathing normalizes blood chemistry and improves blood flow and oxygen to your muscles. (7)

Muscles need good blood flow, oxygen, and balanced blood chemistry to heal properly.

Regular diaphragmatic breathing can be a simple daily exercise that you do to promote good muscle recovery.

Excited to try it? Here is how to get started:

The diaphragm is a muscle, a strong muscle, and you can consciously control how quickly, slowly, or forcefully it contracts.

First, envision you have a belt or rubber band that wraps around the lower part of your rib cage.

Next, take a slow deep breath in through your nose and try to expand out against your imaginary belt or rubber band in 360 degrees.

Then slowly exhale through your nose

If done correctly you will feel like you are pulling into your lungs through your rib cage rather than sniffing it in through your nose! A well controlled diaphragmatic breath should be relatively quiet.

Work over the next couple minutes to lengthen the breath in and out to around 3-5 seconds. Over time you can work to increase this length to upwards of 7 seconds.

As you do this over the next couple minutes feel your heart rate lower and your mind getting calm. Amazing right?

Start by adding a couple minutes worth of diaphragmatic breathing in throughout your periods of rest each day.

Then begin to be more conscious of your breath throughout longer portions of the day. Before you know it, you will be a true diaphragm breather (and probably a lot calmer!).

Other amazing benefits of diaphragmatic breathing:

Did you know that diaphragmatic breathing can reduce the effects of motion sickness(8).

Diaphragmatic breathing has been showing to reduce the symptoms of irritable bowel (IBS) and GERD(6).

Want more? check out this vid below:

References:

1.      Anderson BE, Bliven KCH. The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain. J Sport Rehabil. 2017;26(5):452-458. doi:10.1123/jsr.2015-0199

2.      Bordoni B, Morabito B. Symptomatology Correlations Between the Diaphragm and Irritable Bowel Syndrome. Cureus. 2018;10(7):e3036. Published 2018 Jul 23. doi:10.7759/cureus.3036

3.      Bordoni B, Purgol S, Bizzarri A, Modica M, Morabito B. The Influence of Breathing on the Central Nervous System. Cureus. 2018;10(6):e2724. Published 2018 Jun 1. doi:10.7759/cureus.2724

4.      Bradley H, Esformes J. Breathing pattern disorders and functional movement. Int J Sports Phys Ther. 2014;9(1):28-39.

5.      Cavaggioni L, Ongaro L, Zannin E, Iaia FM, Alberti G. Effects of different core exercises on respiratory parameters and abdominal strength. J Phys Ther Sci. 2015;27(10):3249-3253. doi:10.1589/jpts.27.3249

6.      Eherer AJ, Netolitzky F, Högenauer C, et al. Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized, controlled study. Am J Gastroenterol. 2012;107(3):372-378. doi:10.1038/ajg.2011.420

7.      Schleifer LM, Ley R, Spalding TW. A hyperventilation theory of job stress and musculoskeletal disorders. Am J Ind Med. 2002;41(5):420-432. doi:10.1002/ajim.10061

8.      Stromberg SE, Russell ME, Carlson CR. Diaphragmatic breathing and its effectiveness for the management of motion sickness. Aerosp Med Hum Perform. 2015;86(5):452-457. doi:10.3357/AMHP.4152.2015

Is your headache from neck pain or your neck pain from a headache?

How often do people experience neck pain?

Neck pain is very common in the U.S. with some estimates suggesting that 70% of the population will experience neck pain at some point.  Though not as common, 1 in 6 Americans are likely to suffer from severe headache or migraines. 

We commonly see clients who suffer from both neck pain and headaches.  It turns out that these two seem to go hand in hand. 

Are neck pain and headaches linked?

Studies have shown that 90% of people with tension type headaches have neck pain, 75% of people with migraines have neck pain, and 84% of people with self reported sinus headaches have neck pain(1,2,3).

So what is causing what?

Is the headache coming from the neck pain or is the neck pain being driven by the headache? The answer; it depends.

There have been numerous studies, based on the work of Janet Travel, that have looked at myofascial (muscular) origins of headaches.

Similarly, there is research that links joint mobility issues in upper part of the neck to headache symptoms(4). 

It’s not so easy, especially in a blog post, to be definitive of the origin of every headache or neck pain. 

The best bet is to have a skilled physical therapist perform a thorough evaluation to look for all possible contributing factors to your headaches.

Conclusion:

The take home message is this: Your neck pain or headache, or both, is treatable! If you thought that there was nothing else you could do for your headache or neck pain besides rest and medication, you were wrong. 

Muscles and joints can both be common causes of neck pain and headaches. Both sources of pain are treatable. It will take a skilled clinician to determine the source, or sources, of the pain and treat them accordingly.

References:  

1.      Ashina, S., Bendtsen, L., Lyngberg, A. C., Lipton, R. B., Hajiyeva, N., & Jensen, R. (2015). Prevalence of neck pain in migraine and tension-type headache: A population study. Cephalalgia, 35(3), 211–219. https://doi.org/10.1177/0333102414535110

2.      Burch, R., Rizzoli, P., & Loder, E. (2018). The prevalence and impact of migraine and severe headach in the united states: Figures and trends from government health studies. Headache, 58(4), 496-505.

3.      Malo-Urries, M., Tricas-Moreno, JM., Estebanez-de-Miguel, E. et al. (2017). Immediate effects of upper cervical translatoric mobilization on cervical mobility and pressure pain threshold I patients with cervicogenic headache: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics, 40(9), 649-658.

4.      Shannon M. Petersen, Gwendolen A. Jull & Kenneth E. Learman (2019) Self-reported sinus headaches are associated with neck pain and cervical musculoskeletal dysfunction: a preliminary observational case control study, Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2019.1572987