 [https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/] Have you ever pulled a muscle or tweaked something playing a sport? Maybe overdid it in a workout and didn’t notice it till after or the next morning? Every single person has experienced a soft tissue injury before – that can be muscle, tendon, ligament, etc. There’s a lot of mixed information out on the internet about what’s the best approach to hand a soft tissue injury when you experience one. For the longest time, it was RICE – Rest, Ice, Compression, Elevation – while this isn’t completely wrong, it doesn’t meet the full standards of what we know today with science and research. Here’s a handy acronym to help remember the essential components of how to manage injuries better in the future: PEACE & LOVE Immediately after injury, PEACE: PROTECT
ELEVATE
AVOID ANTI-INFLAMMATORIES
COMPRESSION
EDUCATION
  Once some days have passed, it’s good to give it some LOVE:
LOAD
OPTIMISM
VASCULARIZATION
EXERCISE
The thought to keep in mind is to try to play the long game. I see athletes often who come in and get out of pain then go right back to high-level activity without taking appropriate measures to progressively build it back up. What happens? Reinjury. Take the time to put in the work and I promise it’ll be worth it in the long run. If you’re dealing with an injury and want more guidance and help, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Cheers, Dr. Ravi Patel, PT, DPT, CSCS References: https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/ Axe MJ, et al. Potential Applications of Hyaluronans in Orthopaedics. Sports Medicine. 2005.
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What if you could experience less anxiety and less stress without a pill forcing your body to calm down? What if you could exercise your heart, lungs, muscles and bones without having to step foot in an LA Fitness? Seems too good to be true... but have you tried HIKING?  To some, hiking may seem like a pointless wandering through the woods, but for many folks the benefits are numerous and welcomed. Mental Health Hiking, or even a stroll through a nature setting, has been shown to decrease anxiety and lower risks of depression. A Stanford study showed that “neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.” That means that annoying repetitive voice in your head telling you that you don’t have enough time in the day can be quieted, maybe even silenced! In the technology-driven world we live in, quiet and empty time is almost non-existent. By taking a walk through a nearby park during lunch or finding some trails on the weekend, you may notice mood enhancement and more productivity when working! Another mental health booster—try taking a friend with you sometime. Personal interactions, without large groups and distractions or cell phones in our faces can help build meaningful relationships that are valuable for mental health. Do you train really hard during the week? Take a hike on your off day/rest day as a way to keep the blood flowing and body moving while also allowing it an exercise input that is not 100% intense the whole time. Your body will thank you! Physical Health Hiking also provides a unique challenge that we don’t see often- an uneven surface. Unless we are still playing some sports as adults, like soccer or lacrosse, we tend to exercise on and spend our days on flat, hard surfaces. Navigating uneven ground challenges our foot and ankle stability, single leg control, and balance, unlike conventional fitness routines. You can search for hikes according to distance and challenge at websites or apps like “All Trails.” I suggest trying some longer and easier hikes as part of recovery from tough fitness routines or as an easy mental release. These trails usually have less obstacles so there is less focus demand for watching your step. Of course, they are not as demanding on the heart and muscles, but that may be desired for an off day! Depending on your fitness level, you can also try to push it to more challenging terrain with obstacles and steeper incline. This will get your heart pumping and lungs working hard!  As we get in our weekly routines of work, gym, dinner, repeat, I think we tend to forget to use our fitness. We are exercising to keep the heart and lungs healthy, manage a healthy body composition and release stress or worry but also to be able to continue being active throughout our lifetimes. So get out and find a nature-filled area to hike or a park to walk through! Your mental and physical health depend on it!
Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS  Shoulder volume. This is the first thing that comes to mind with I have the opportunity to work with youth swimmers. A typical club or high school swim team will average around 40,000 to 60,000 yards in a week of practice and the average athlete will have a stroke count of about 12 to 15 strokes per 25 yards, giving you a range of 19,200 to 36,000 strokes per week...that’s a TON of volume on the shoulders! With such a high demand on swimmers’ shoulders, injuries are incredibly common, so common in fact experts coined the term “swimmer’s shoulder” as an umbrella diagnosis. That being said though there are a number of steps you can take to prevent injury, the most crucial of which being to improve your movement efficiency. Movement efficiency is key to not just preventing injury, put to improving performance. Think of it this way. Performing 36,000 strokes a week with poor mechanics is like trying to drive a Ferrari with the handbrake on; sure, you’ll still be able to move and potentially pretty damn fast, but you’re going to leave a ton of performance on the table, in addition to breaking down way quicker and more often. In order to know to know where a deficiency is happening, you must break down each stroke into its component parts. For the sake of this article, we will focus on freestyle. Each freestyle stroke can be broken down into five main phases:
When looking over all the different component phases that make up a freestyle swimming stroke, something becomes abundantly clear… internal rotation is crucial. From the catch phase all the way through the recovery phase, internal rotation is necessary in order to perform the freestyle stroke effectively and efficiently. That’s why you’re always hearing your coaches scream out cues like: “Keep a high elbow;" “Drag your fingers;” and “Point your elbow to the ceiling.” All are various cues for internal rotation.  The problem is though, we see a ton of swimmers who are missing adequate internal rotation. When you’re missing internal rotation and you try to go into a “hang position” (see picture above) you will compensate by dipping your shoulder forward. This is a big problem because when you dip your shoulder forward you’re putting your rotator cuff in a weakened position, putting unneeded stress on your biceps tendon and labrum, and decreasing your power output. Add all that together and multiply it 36,000 strokes you're doing in an average week and it becomes easy to see why this is a recipe for disaster. So how do you know if you’re missing internal rotation and what can you do if you are? Well, check out the video below to assess your shoulder range of motion and see if you hit the minimum of 70 degrees of internal rotation we like to see our athletes to hit. If you don’t have the needed range or it is a struggle to get there, check out the following two videos for a couple of our favorite ways to improve your shoulder rotation. (Internal Rotation Self-Assessment) (Internal Rotation Superfriend Stretch) (Banded Internal Rotation Stretch)
Lacking internal rotation is one of the main reasons why we see swimmers, especially youth swimmers, in our clinic in Decatur, GA. However, the shoulder is an incredibly complex joint and there could be a number of reasons in addition to a lack of internal rotation causing pain in a swimmer’s shoulders. If you’re still struggling with shoulder pain or noticing a decrease in performance after working on your shoulder internal rotation you live we’d love to help. Simply give us a call at 470-355-2106 or fill out the contact request form below and we’d be happy to contact you. Thanks for reading, -Dr. Jake, PT, DPT, CSCS |
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