That’s a funny cartoon, but back pain is no joke. Chronic low back pain is the leading cause of disability in the world. Throughout our lives, 80% of us will experience low back pain. So why do some recover completely while others have chronic, sometimes debilitating, back pain?
As movement specialists, we (physical therapists) often want to explain the why of pain with muscles, joints, and movement patterns. Sure, we can work on asymmetries in movement and perceived muscle weakness but for chronic pain this is only a small piece of the puzzle.
Back pain can be particularly frustrating for a few reasons. For one, imaging does not directly correlate to pain nor does it change conservative treatment strategies. Also, improvement from back pain often has ups and downs, sometimes with no indication of what causes it.
What NOT to do if you have back pain
Going straight to the orthopedic for back pain, can start a cascade of chronic back pain. Lumbar spine imaging should not be the first line of care for back pain. I see it too often- either the imaging shows something that seems “scarier” than the pain that the patient feels OR the pain is quite intense but the image shows nothing out of the ordinary. The latter tends to be the most frustrating. If there is nothing torn, bulging, ripped, degenerating (insert any other terrible descriptor here), then why the heck does my back hurt SO BADLY?
Our nervous system is extraordinary because it has the ability to adapt and change with our stimuli- inside and out. This becomes a problem when it adapts in a way that we call “central sensitization”. Essentially, the central nervous system (brain and spinal cord) becomes extra sensitive to stimuli. So something that should cause little pain, or none at all, sends serious threat signals to the brain which leads to pain.
The best analogy commonly used is the house alarm. If a burglar breaks the window in my house, I expect the alarm to sound. However, if a tree branch scrapes the window, I do not expect the alarm to sound. But with central sensitization, the alarm does go off. And this alarm is PAIN.
Check out this cool video about chronic pain. It only takes a few minutes: Explain Pain
Is it a false alarm?
Based on the healing rates for tissues in the body, we know that after a few years into back pain, the pain is not stemming from actual tissue damage. If there continues to be pain similar to the original onset, it is likely that there are some central nervous system changes.
When working through this with patients, it always starts with education so that they understand I am acknowledging that they feel the pain but also that they understand pain DOES NOT equal damage. To progress towards improved function and a pain-free active lifestyle, we focus on repetition of basic movements that may or may not be painful. The idea is to train the neurological system that simple bending over should not be threatening or painful. That being said, sometimes it is painful! In that case, I set the following rules: if the pain is low level and constant we are ok to work in that range and if pain begins to escalate throughout the movement we will take a break. But as you build resilience and confidence through the movement range, you will experience less pain and the central nervous system will lessen the threat associated with that movement.
At Athletes’ Potential, we treat a lot of back pain. A story that we hear often is that people have bounced between providers, tried more severe/invasive treatments, long term use of pain meds or anti-inflammatory drugs, etc., but still have pain! We specialize in helping people maintain a pain-free, high-level, and active lifestyle. Whether this looks like running marathons, lifting heavy weights or playing with your kids, we can help you get there. If this sounds like your past and the future you want, give us a call. We would love to help!
Thanks for reading,
We recently had a patient come in who had been dealing with low back pain for over a year. He was super active, training 5-6 days per week, but hurt his back one day simply standing up from a chair. He had seen his family practitioner periodically for steroid injections, which would provide some relief for a couple months but then end up right back to square one. Frustrated with his lingering back pain, he gave us a call and after a thorough evaluation, some manual techniques, and exercise programming, he left our office with decreased pain and improved mobility.
We see patients like this all the time here at Athletes’ Potential… which makes total sense. Back pain can happen with some with some of the most innocuous movements, and in many cases, without warning. In fact, On average 80% of Americans will experience low back pain at some point in their lives and more than a quarter of the population currently deals with low back pain on any given day.
Not only have most people had some form of back pain, but it many cases it is the result of poor movement patterns that have been abused for years causing the root of their problem to be both incredibly complex and multifactorial. Great news though! Whether you hurt your back trying to hit a new deadlift PR or simply bending over to put your kid in their car seat, there’s a profession out there, armed with years of training and knowledge, designed perfectly to help with your low back pain: Doctors of Physical Therapy.
Here are some of the reasons why you should see a doctor of physical therapy the next time you’re experiencing back pain.
Advanced Education: Physical therapists go through seven rigorous years of both academic and clinical training in order to become Doctors of Physical Therapy. We have spent seven years in school studying human anatomy and physiology, kinesiology, biomechanics, and tissue histology. In other words, we know how the body moves, how it heals, and how to optimally restore its strength and mobility in order to get you to your goals.
Multiple Treatment Options: As I mentioned earlier back pain can be pretty complex, requiring multiple different treatment options to not only alleviate your symptoms, but correct the underlying problem that caused the issue in the first place. Unlike other healthcare professionals, doctors of physical therapy have the ability to choose from multiple different tools in their toolbox. Whether this means using corrective exercises, dry needling, joint manipulations (cracking your back), soft tissue mobilizations, taping, or wrapping, a physical therapist has the ability to customize the most appropriate treatment program for you.
Patient Empowerment: More than anything else, a physical therapist's ability to educate you the patient is invaluable to your recovery. There are 168 hours in a week, at most you’ll see a physical therapist 3 times per week for an hour...that still leaves 165 hours where you’re on your own. Compliance is crucial. For true long-term changes to happen versus short-term reductions in symptoms, you have to know what you should and should not being doing, and physical therapists are second-to-none in making sure that is exactly what happens. Additionally, after you’ve had back pain once, there is a 90% chance you’ll have back pain again at some point in the future. Think of it this way, after you roll your ankle once, you’ll more than likely roll your ankle again at some point. Don’t panic though, the education and coaching you’ll receive from your physical therapist will allow you to know exactly what to do in order alleviate most future back pain exacerbations in a few days instead of weeks, months, or even years.
In review, you’re not alone in your back pain. In fact, it’s more likely than not that you’ll experience some form of back pain in your life. However, this doesn’t take away the fact that back pain can hinder your daily activities and keep you from what you enjoy most. Physical therapists are highly trained musculoskeletal experts that not only help patients alleviate their low back pain, but keep it away by empowering them to take their healthcare into their own hands.
If you’ve living in Atlanta, and you’re struggling with back pain, we’d love to help you. Give us a call at 470-355-2106, or fill out the contact request form and we’ll contact you.
Thanks for reading,
If you’re reading this blog post and you are 100% pain free, you can stop reading it right now.
Ok, we lost maybe 1% of people that actually came to this blog post. For the rest of you, here we go!
The question is this. Why are so many people in pain everyday when the resting state of the human body is supposed to be pain free?
Over the past decade, I’ve had the opportunity to work with people as a personal trainer, strength coach, and a physical therapist. One thing in common with all of these people was that every one of them had daily pain. Now, that seems obvious that someone coming to see me as a physical therapist has pain, but what about as a personal trainer or coach? As a trainer I was shocked to see the first thing we needed to do was work on getting back into some pain-free movement.
Solving chronic pain for people long term comes down to two things: Do they have enough range of motion or mobility to perform a task, and do they have enough control over that movement to be able to do it correctly?
It’s a simple answer, yet very complex at the same time.
To make matters worse we are becoming increasingly more sedentary, weaker, and life is over all just becoming easier. Think about it. You don’t even need to drive somewhere to pick up food anymore. You can literally just use Uber Eats to get a pint of ice cream from Jeni’s Ice Cream and some Pad Thai from your favorite Thai restaurant at the same time. Don’t want to go get groceries? No worries, Amazon has you covered and will deliver pretty much whatever groceries you want to your house.
So what does all this cool convenience mean to us? Less and less non-exercise based movement. Unless you have a manual labor job, you use your body far less than it’s designed to be used.
You hear people say all the time about their grandparents that “they don’t make people like they used to.” Those were some hearty Depression Era people. Well, physiologically and genetically we haven’t changed in the last 100 years. What has changed? My grandfather grew up on a farm and stopped going to school in 4th grade to help take care of that farm full time. He then spent 30 years in the Navy and did other manual jobs like a mechanic for the rest of his career after that. He lived what some would consider a hard life, but he was also lucky because he had to use his body day in and day out. He didn’t have to get to the gym and try to engineer work, he literally just worked.
Today we use things like Assault Bikes, Concept 2 Rowers, and True Form Treadmills to build a “bigger engine.” As great as it is to get cardiovascularly fit, it should just be a piece of the equation. A large portion of what we do should be non-exercise based movement. As my good friend Kelly Starrett says, “Train less and move more.”
Here’s some examples of ways to improve your movement during the day.
Standing desk- Even though you aren’t technically moving, it gives you options. You can change your stance, you can stand on one leg, you can move around easier. It’s a hell of a lot better than just sitting all day long.
Walk more- Take a couple short breaks per day and walk around. If you have business calls to make, do them walking. If you eat your lunch fast, you can get a 20-30 minute walk in during your lunch hour. Walk to work if it’s close enough. Walk to the park instead of driving the half mile it takes to get there. Walk your dog, he needs it. Just walk more. We’re the best walkers in the world.
Commute to work- If you live in a city where you can walk or ride your bike to work, that’s huge. Get some of your movement in with something you have to do anyway: be at work! Some big companies like MailChimp here in Atlanta are even incentivizing their employees to ride their bike to work. I think this is a genius idea.
Sit on the ground- Sitting on the ground is kind of uncomfortable. Because of that we have to change positions more frequently and the pressure of the ground in our muscles/fascia can be a really good thing. Get off the couch and watch Game of Thrones on the ground instead.
Hang- Find a tree limb, pull-up bar, or back of a stair case and try to hang for 2-5 minutes per day. We have some amazing shoulders and we rarely do anything overhead anymore. Hanging is a great way to get some movement in your shoulders and build some grip strength at the same time. It’s literally as easy as just grabbing something and holding on until you have to let go.
Try to engineer some more non-exercise based movement into your day and your body will feel so much better. The resting state of the human body should be pain free. If you’re in pain everyday that’s not normal. You should see someone to help alleviate pain and get a game plan together of how to keep yourself healthy long term. If you’re in the Atlanta or Decatur area, we would love to help you with this. If you’re not, seek out the help of a qualified medical professional.
The body demands movement. Either you give it what it wants or it’s going to break down on you. Try and move an extra hour a day for the next week. It may be the most important change you could make to your long-term health.
This is a common question that we are asked at Athletes’ Potential. When delving into this seemingly deep conversation with patients, it becomes quickly evident that many people do not actually understand their benefits or insurance plans. It also becomes quickly evident to the patient that the current healthcare system is not an efficient one.
The short answer to that question is… there isn’t one. In fact, when folks ask if we “take” insurance, what they are usually meaning is, "Can I pay my copay to see you?” Sure, we “take” insurance in the sense that once the deductible is reached, the visit will be covered by a varying percentage. But copays are for in-network providers. What people don’t often realize is that there is still a deductible to be met, out of pocket.
The ideal insurance plan for young, healthy individuals is one that includes an HSA or FSA. Deductibles will be higher but assuming you have low healthcare costs, you will be banking money each year.
An HSA is a health savings account. It is a savings account for money that can only be used for healthcare. Many times, a business will match the amount of money you add to your HSA each month or some percentage of it. The benefit? This money can grow throughout your career into a large sum that is not taxed. So sure, use it as a store of money for healthcare but it is likely there will be some residual.
An FSA is a flexible savings account. Similar to an HSA in that it is a pot of money for healthcare. The biggest difference is that your company will put a lump of money in it at the beginning of the year and whatever is not used in that year goes away.
Other plans- HMO, PPO, etc are also common. It is usual with these that there is a network of providers that have a special rate and are often lower costs per visit—as long as the healthcare provider that you seek out is in the network.
A deductible is the amount of money that must be paid out of pocket before insurance will cover a percentage. Some insurance plans have one deductible and some have separate in-network and out-of-network deductibles.
Example: Sally’s plan has a $2000 in-network deductible and a $4500 out-of-network deductible. She pulls her hamstring and needs PT. If she chooses an in-network provider she will pay out of pocket until she reaches $2000 then her costs are covered 100%. If she chooses an out-of-network provider she is responsible for $4500 before her costs are covered 80%.
For a mild hamstring strain, the national average for visits is 10. At the usual PT clinic, they likely want you to come in 2-3x/week for 5 weeks. This cost per session could be anywhere from $50-300 depending on what the PT does with you and how long you are there. On top of that, your PT may be treating between 2 and 5 people at a time!
Technically this company “takes your insurance” but the payment still comes from your pocket. Until you reach $2000—which likely will not be met with the treatment for the hamstring.
Transparency: At Athletes’ Potential, transparency is important to us. Unfortunately, the healthcare system makes that muddy because of the complexity of plans that leads people to think all healthcare visits are a $20 copay.
The reality is, insurance is meant to be used as a failsafe for emergencies. Just like with the car—bad accident, the insurance helps. But if you need an oil change, that’s on you! Deductibles are so high and benefits are less because healthcare is being over-used. So rather than going to the cheapest place for the cheapest oil (that you will have to change more frequently), why not use the quality shop with the quality oil?
Why should you choose us over your in-network providers?
Our visit average per plan of care is half of the national average. In the long run, you will save money.
One-on-one sessions with a Doctor of Physical Therapy who understands your lifestyle and goals. We have experience with weightlifting, running, CrossFit, sports, yoga, gymnastics, etc.
Better outcomes than your usual PT clinic.
Care from a provider who thinks outside of the box, encourages input from the patient and helps establish long term performance goals.
Complete transparency with costs and plan of care.
Often times, patients that have trouble or pain with squatting can chalk it up to mobility issues. Ankles and hips seem to be the major culprits. But what if mobility isn’t YOUR problem? Even if you have an ATG (deep) squat you may still experience:
Back and/or hip pain
Hamstrings and glutes not getting stronger
Increased soreness in the inner thigh (adductors)
Plateau of performance in squat based activities
Does this sound like you? Keep reading.
Motor control is the process of using the neurological system to coordinate your muscles and limbs as you perform a skill. Without motor control, we will have trouble controlling our body in space. This can lead to undesirable positions while we are under a weighted barbell.
Unfortunately, many of us do not have ideal motor control—particularly as we add fatigue to the system. Fatigue can come in the form of heavier weight or multiple reps. How do we judge motor control from the outside? Technique. Form.
So we know you have an ATG back squat with the chest upright and feet flat. If you add weight and that changes, you need to practice motor control. This is rewiring the system so that as we move our extremities or add weight to lifts, the form looks the same as squat without weight.
Many times this has to do with the initiation of the squat. It should always start with a hip hinge. Now, some athletes who think they are hinging are simply over-extending their back. This means they send their hips “back” by poking the pelvis back and allowing the ribs to flare up. Rather, the space between your ribs and hip bones shouldn’t change as you hinge your hips back.
The same pop of the pelvis back can be a problem as you get close to the bottom of the squat or start to drive back to extension.
A great drill to test out your squat is using a PVC for 3 points on contact. Holding the PVC against your back, you should have contact with the back of your head, midback and pelvis. Keeping this alignment, hinge your hips back then drop into a squat.
Some faults that are common with squatting will be demonstrated when the PVC pipe leaves one of the points of contact. Below, the left picture shows a rounding of the midback that causes the PVC to leave the pelvis. This often happens at the bottom of the squat too. The fault on the right demonstrates over-extending the hips and changing pelvic position rather than hinging the hips. I find this to be more common on initiation of the squat, particularly for those complaining of back pain. If you noticed that the PVC left your body at some point, try filming yourself as you practice!
Improving motor control takes reps and practice. The PVC drill is great as a warm up for squats. You could also perform tempo goblet squats (see video below).
Holding the weight in front will help you engage your deep core and stabilize your ribs and pelvis to keep the torso in the ideal position. Moving at a slow tempo is more challenging to the neurological system and will help engrain that movement pattern. The same rules from the PVC pipe drill still apply!
Inside of thighs really sore after squatting?
The large muscles running along the inside of your thighs are the adductors. They function to bring your leg closer to midline, stabilize the hip and knee, and work synergistically with glutes and external rotators (squats?!). Going along the lines of motor control, be aware of the speed of your descent and “bouncing” out of the hole. The squat should not be a fall to the bottom and a bounce off the calves. You want a controlled descent; taking advantage of the stretch-shortening cycle at the bottom can be helpful but the torso alignment should still be maintained. If you are a free-faller or a bouncer, try to slow it down and control the movement. Similar to the goblet squat, this will improve control but also strength!
If you look like the woman squatting above, this is your starter plan for improving motor control and strength. Take the time to assess your alignment and control through the movement. Cleaning this up will decrease pain and improve your performance drastically.
At Athletes’ Potential, we work with athletes like you every day-- those who just want to move better and those that are in pain. If you are finally ready to feel better and improve at the gym, give us a call. We would love to help!
Thanks for reading,
Running is a part of the culture in the Army. You wake up early, meet at the PT field and go for a run 3-5x a week. We had formation runs where we’d run a few miles with 100 to thousands of other sounds yelling cadences. We even had runs to celebrate important battles or events in our Brigade’s history. The only problem is, most people in the Army have never actually been taught how to correctly run distance.
The statistics on running related injuries are pretty shocking. 75-80% of runners have a running related injury every year. That number bumps up to 90% when you start training for a marathon. With numbers like that you could make the case that we have a running injury epidemic in the US.
These numbers carry over to the Army and when I was active, I had an opportunity to try and solve this issue for the Brigade to which I was assigned to at Schofield Barracks.
Ironically, for someone that’s tall and skinny, I’ve never really been a naturally good distance runner. This led me to seek out a running coach when I was in Hawaii. The man I found was Ed Bugarin (Google search this guy, he’s no joke). Ed was a retired special operations soldier that trained runners and triathletes on Oahu. I spent a couple spent a couple weekends with him working on drills, cadence and getting stronger in areas I was weak.
After a month of running mechanics work, I was running faster for longer and injury-free. In particular I had resolved an issue I’d had since starting in the Army, shin splints. If you’ve never had shin splints before, they suck. It basically feels like someone is sticking a knife in the bone on the front of the lower leg.
After working with Ed, I started teaching soldiers in my Brigade how to run. I’d do this in small groups, 10-20 at a time. First, we’d video them running and break it down on an iPad in slow motion. Next we would go out and work on corrective drills and talk about pacing for longer runs. I did this literally with over 1000 soldiers in my Brigade. After all the classes I taught here’s the most important lesson I learned:
If your run form with shoes on looks like your barefoot running, you’ll be a very resilient runner.
It’s literally that simple. This is something Ed had me do on the road in front of his house until my feet bled. By the way, I do not recommend barefoot running on concrete. Cavemen didn’t run on roads! I’m a much bigger fan of running barefoot on grass.
Here’s why I think it’s so effective: When you take your shoe off and run, your foot gets to move naturally. You have 26 bones in the foot, 3 independent segments that articulate with each other and countless ligament/muscle attachments. Imagine if the Golden Gate Bridge could change shape in a split second and then return to it’s normal shape. That’s basically what your foot does. It’s an engineering marvel.
Going barefoot allows you to let your foot do it’s job. It also doesn’t give any additional support. That way we can start to rebuild the intrinsic muscles of the foot as well as toughen the skin of the bottom of the foot.
Lastly, running barefoot solves the biggest problem for most of the runners I work with- cadence. Cadence is how many steps you take in a minute. You’ve probably been told to just stride it out and try and create as long of a stride as you can. Here’s why.
Stride Length+Stride Frequency(cadence)=Run Pace
If you increase your stride length you will run faster assuming you maintain the same cadence. You’ll also significantly increase your likelihood of having shin splints, plantar fasciitis and running related knee pain.
The better solution is to increase cadence. This would cause us to shorten our stride but increase the number of steps we are taking per minute. Imagine like you’re running on hot coals and pull your feet back off the ground. This also puts the foot landing position under our body instead of way in front of our body.
The Principle of Parsimony- It is pointless to do with more what is done with less.
This is principle is based off the theory of Occam’s Razor, essentially saying the simplest solution is the best solution.
Want to increase your running efficiency, build foot strength and decrease likelihood of injury while running? If so, add in barefoot running once a week to your runs. Here’s how I like to program it:
Find a nice, flat grass field or the inside grass area of a track.
Perform 4 rounds of this:
50 meter high pull drill on the right (start video at minute 1.26 for drill)
50 meter high pull drill on the left (start video at minute 1.26 for drill)
Run 100 meters moderate pace
Put your shoes back on and focus on mimicking the feel of the barefoot run strike and cadence while running your intervals.
Run 4-8 400 meter intervals 80-85% effort.
Rest until you can perform a 7-second exhale breath before starting the next run.
Keep it simple, focus on running as a skill and you’ll be a much happier, injury-resistant runner for years to come.
It seems that almost every runner has experienced “plantar fasciitis” at some point. Although there are many stretches and exercises that provide short term relief, it would be best to find out why the bottom of your foot and heel continue to be painful. Sure, there are quite a few factors that could lead to this pain but what if targeting one joint in your body could change your running and decrease your pain for good?
Your foot is made up of 26 bones and 33 joints. Proper biomechanics of the foot depends on the appropriate strength and mobility of these joints. The great amount of joints allows the foot to conform to the surface so we can walk in the sand at the beach but also through the grass at home. The feet are our foundation; holding all of our body weight and acting as levers to propel us forward in walking and running. It sounds really complicated- and it is- but there is one joint that tends to be overlooked that can significantly impact your foot function. It is the great toe aka the big toe.
The great toe and its mobility are integral in push-off while running. The function is described by the “windlass mechanism”. Essentially, the great toe extends which will tighten the plantar fascia. The tightening of the fascia at the bottom of our foot elevates your arch and keeps the foot from collapsing so that you can effectively push off at each stride.
Without full great toe extension, it will be difficult to allow your weight to advance forward over your foot as you run. Thus, your biomechanics will change. Our body is amazing because it will change and adapt to decrease pain but sometimes these changes are not ideal for long term. Some ways your body will find to get around lack of great toe extension is running with your feet externally rotated (toes out) or taking much shorter stride lengths to decrease the pressure at the toe. Long term changes in running form can begin to effect other joints up the chain- knees, hips, back. The plantar fascia may experience more tension as the toe becomes even more stiff which then can manifest as heel, toe or general foot pain.
What does your great toe extension look like?
One way to check your great toe extension is in a relaxed position as in the picture below. Your foot may be resting on a surface and push your great toe up gently until you feel resistance or discomfort.
Checking great toe extension in a lunge position will be more similar to running and the toe can be pushed back passively by the ground. In the photo below, notice that the left toe extends much further than the right. Ideal range of motion is about 70 degrees of extension, though some people may have more!
If you find that your great toe extension is lacking, try these self-mobilizations at home. Working on these before and/or after a run would be ideal. Spend a few minutes on each mobilization and see how your feet feel:
If you have restriction, 2 min each day of this mobilization can start to chip away decreased mobility.
Using a lacrosse ball, spend 2-3 min each day on the fascia at the bottom of your foot.
As I mentioned before, great toe limitations can greatly affect your biomechanics. Factors such as stride length, foot contact, hip and knee position through swing can each be altered with foot restrictions and pain. At Athletes’ Potential, we perform Run Form Analysis for our athletes to break down their form individually and change any deviations we may see. Even if you don’t have pain currently, having a professional break down your run form can be eye-opening and help prevent speed bumps in training down the road.
We would love to help you stay active and get back to your training throughout the Spring and Summer! Give us a call today to schedule Run Form Analysis or a Physical Therapy appointment to stop your heel and foot pain fast: 470-355-2106.
Keep checking in on our blog weekly; May is all about running!
Thanks for reading,
I hate to say it but I resent our convoluted healthcare system.
We live in the greatest country in the world and yet we have such a confusing and broken health care model. I’m not here to write about my idea for a solution. I’m here to tell you how we are avoiding many of the pitfalls of our current medical model.
First, let me add some context by telling you about a recent experience my family had with a physician group.
My wife had been feeling tired for almost two years. We thought it was just the fact that we have two kids under the age of 5 and we own a business. Both of those things can be rather stressful.
We did blood work and were able to get her feeling better but it was always a short lived response.
Finally, we decided to see an internal medicine doctor and they narrowed it down to either celiac disease or small intestine bacterial overgrowth (SIBO). This was the prognosis because she had been put on antibiotics for a sinus infection around the same time she started feeling excessively tired almost two years ago.
We go to the office visit, the doctor is behind schedule and spends hardly any time with us. He gives us a couple options for testing and we decide to do a blood test to rule out celiac disease. We ask him and the front desk staff what the office visit will cost and what the blood test will cost.
They tell us they do not know.
Fast forward to 1 month later, we get a bill from the physician for $360 for the office visit. That’s $360 for a 15 minute conversation with the physician. The next day we get a bill for the blood test. Grand total for the blood test, $940. One blood test costs $940? What the hell kind of X-Men next level blood test was this?
The results of the test showed there was no celiac disease so the solution was another round of antibiotics to fix the SIBO. Great, let’s fix this thing. So we ask the doctors office how much will the antibiotics cost? They tell us they don’t know. We call the insurance company and ask what the antibiotics will cost, they tell us they don’t know.
Alright, you’ve got us by the balls, let’s just get the antibiotics and wait for another bill in the mail. The good news is, the antibiotics worked great. My wife has been feeling better than she had in years. The bad news is, the bill we got for the antibiotics was $1650.
Let’s add this all up.
One office visit = $360
One blood test= $940
One bottle of antibiotics= $1650
Grand total= $2950 plus hours of office visits and testing and phone calls with the insurance company
Here’s my general feeling throughout the entire process: Are you kidding me?
As much as the cost of everything was, that’s not the part we were mad about. It’s the complete lack of transparency in the entire process. Tell me I’m going to have to get a $1650 bottle of pills that will cause my wife to feel better and I’ll gladly pay that. Send me a bill for the same amount a month later and now you’ve got an angry consumer.
Transparency is the key. Communication is vital. This is a relationship between a patient and their medical provider. It’s no different than any other relationship.
When I opened Athletes’ Potential 3 years ago, this was a core value for us. Transparency in medical care. Why is this so rare?
If you ask me what we charge, I’ll tell you. We charge $190 for an hour long visit and it’s an absolute steal compared to the crappy healthcare you’ll get pretty much everywhere else.
-We’re always on time because we respect the value of your time.
-We’ll never send you a bill a month later for some amount of money.
-You’ll always have email access to your provider to answer any question you have because we want you to feel comfortable through the entire process.
-We treat people the way we would want our own family to be treated.
I see more and more medical providers moving this direction. It’s better for the patients, it’s better for the provider and it sets the precedence for an honest, long-term relationship.
Sadly, many of you have probably gone through the same process my wife did. This isn’t an isolated incident that we can chalk up to bad luck or chance. This is a daily occurrence in our medical system. I hope it continues to move toward a better model but in the meantime we’ll do our part with our patients.
We strive for honest, selfless service of our patients everyday. That will never change.
Warm-ups are important for a few reasons: increase tissue temperature and extensibility, increase heart rate to prep the system for intense exercise and prep specific movements that will be performed at higher speeds. Most often, people do not warm up either for lack of time or lack of knowing where to start! If you have a particular area of pain or tightness, you may want to spend more time there. Otherwise, moving through movements of the whole body is ideal.
For each of the exercises below, I will use the width of the court, going back and forth between exercises.
Try this simple yet comprehensive workout:
Jog Forward 50% max effort (width of tennis court)
Slowly back pedal (back to starting line)
Jog Forward 60% max effort
Slowly back pedal
Run forward 75% max effort
Run forward 75% max effort
Side shuffle (facing opposite way from last time)
Inchworms- moving slowly and deliberately; keep the legs as straight as possible for a good hamstring and calf stretch. Once walked out to the plank position, do a push up (can drop to knees if needed) then walk feet to hands.
Toy Soldiers- standing upright, hands out stretched in front; kick opposite foot to opposite hand; alternate feet and move forward with each repetition.
Walk on toes- just like it sounds, walk on tippy-toes with small steps.
Walk on heels- walking on heels, taking small steps.
World’s Greatest Stretch- a great warm up tool because it hits three areas that need attention for tennis players- hips, hamstrings and back! Go through ten reps of each movement then switch legs.
3-way lunge- also addresses multiple areas, particularly glutes, hamstrings, quads and adductors. Perform 6 reps in each direction per leg.
Leg swings- hold on to something stable at your side; swing leg forward and backward, letting gravity carry it back down. Also, swing to right and left. Preform 10 repetitions each direction.
Arm swings- open arms wide then swing across the front, one arm over the other until your fingers contact your back, swing back to front and cross over the opposite way. Also, swing arms up overhead and then back down past the hips. Again, allow gravity to do the movement, no forcing the range of motion! Perform 10 reps in each direction.
After this warm-up you should notice that your muscles feel warm, heart rate is up, breathing has increased and you are ready to increase the intensity of your movement. A proper warm up may decrease the likelihood of an injury and will get you ready to perform more quickly!
Good luck this tennis season! If you missed the first parts of this 4-part series, be sure to check those out. At Athletes’ Potential we help tennis players resolve pain, improve performance and prevent injury. Like what you’ve read? Give us a call!
Building a solid foundation is important for any structure. Therefore, maintaining healthy, mobile and strong feet is a foundation that athletes cannot ignore. This becomes particularly important for athletes who require agility—moving laterally, side to side, sprinting, shuffling. The problem is, we rarely focus on our feet, unless they already hurt!
I challenge you to add at least one foot mobilization or exercise into your daily routine. Your tennis game will thank you.
Ankle mobility - The ability of your ankle to dorsiflex fully (toes up) is ideal for proper biomechanics during running and cutting. Without proper length in your Achilles, injuries and tendonitis are more likely. The first step is to check your ankle mobility. The wall test is our favorite.
Place your foot a hand width from a wall (in a lunge position), with the foot in that position drive your knee toward the wall making sure that your heel stays down. Can it touch the wall? Due to the structure of the calf musculature, you may find that you lack mobility more when your knee is straight. Be sure to check out your dorsiflexion side-to-side by using a yoga strap or dog leash. If you seem to be lacking range of motion here, try these two mobility exercises:
Foot mobility and strength - The foot is very complex with 26 bones and 33 joints. It is important that the joints maintain the ability to glide on one another so that our feet can conform to uneven surfaces and absorb shock as we run and jump. Years spent in hard dress shoes, high heels and flip flops can take a toll on our feet. So when we lace up the tennis shoes and play a hard 2 hour match, the feet were not prepared! Simply being able to separate the movements of the big toe from the little toes can improve your foot mobility, strength and control.
My favorite set of exercises is Toe Yoga (video below). Try these out, you might be surprised how tough it is!
The great toe - The big toe (or great toe) may seem trivial to some but is essential for function of the foot. More specifically, the importance of great toe extension. Without mobility here, the natural mechanism of the foot is interrupted. This can lead to pain on the outside of the foot, pain of the other metatarsals (top of the foot) and recurrent plantar fascia pain. If your great toe isn’t so great and is lacking some range of motion, try these out:
As you add these to your daily routine, remember that there is no quick fix but you are taking the right steps! If you have knee or hip or back pain, you still need to start at the foundation. The biomechanics of the foot drives the whole system. Try these out for a few weeks and notice the change. You won’t be disappointed!
Thanks for reading,
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.