 What’s up, everyone! Doc Jake here. In the spirit of Halloween, I wanted to take a moment to talk about some of the common “scary” comments my patients have heard from other providers, or seen on imaging, and why you shouldn’t be afraid at all. I know we’re all busy getting costumes and candy ready, so let’s jump right in: “Worst case of bone on bone I’ve ever seen!” If I’ve heard this once, I’ve heard it a thousand times. “The doctor said I’m bone on bone!” “Worst case of arthritis he has ever seen!” Most often your physician or other healthcare provider is referring to something called osteoarthritis (also called Degenerative Joint Disease or DJD) in situations like this, and guess what… it is totally normal to have arthritis! More and more studies are coming out that show many active adults have some form of DJD and that calling this a “disease” is incredibly misleading. While DJD cannot be reversed, it’s often not the main pain generator and can easily managed with education on symptoms, appropriately prescribed exercise, and just plain out staying active. Walking the dog, playing with your kids, gardening… all great examples of non-exercise based movement that keep your joints moving. As cheesy as it may sound, the old adage of “motion is lotion” is spot on and is the reason that “worst case of arthritis I’ve seen” shouldn’t get you weak in the knees. Torn Meniscus This one hits close to home. At the young age of 14, I actually had two knee surgeries. One to attempt to repair my meniscus and one to remove it once the repair failed. Looking back on it and relating my symptoms I was having to what the research is now showing, I had no business getting any of those surgeries and you most likely don’t need one either. Once again, a torn or frayed meniscus is a normal sign of aging and is often found on imaging with people who have NO knee pain at all. Even in an acute situation where a tear is found on an image after injuring your knee, as long as you don’t have a physical “block” in your knee, where that meniscus has essentially turned into a door stopper and impeds normal motion at the knee, you will be absolutely fine without surgery. In fact, research consistently shows that conservative treatment will have equal to (or better) results as surgery AND you won’t be setting yourself up for future complications associated with missing portions of your meniscus. Herniated Disc I’ll keep this one short. Simply put, in most situations, herniated discs do not require surgery. In fact, multiple studies have demonstrated that you can take 10 random people off the street with no back pain, give them an MRI, and an average of 7 out of 10 people’s images will come back with some variation of a herniated disc. In fact, “large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years” (Jacobs et al). Our bodies are incredibly resilient and will heal just fine with appropriate treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065612/ “You’ll never be able to do ‘X’ again.” This is the most frustrating thing for me and the rest of the staff here at Athletes’ Potential. We are constantly hearing people come in and say something like, “My doctor said I’ll never be able to deadlift again,” or, “My physical therapist said I shouldn’t do CrossFit.” This is absurd and is a fallacy you shouldn’t fall for. We constantly get people coming into our office and we are constantly getting them back to the activities they love. So, in review, there are a lot of scary phrases out there that, in reality, have no right to be scary. New research is being pumped out every day that our bodies are incredibly adaptable. If you’re in the Atlanta area and you’ve heard one of these phrases before, give us a call or fill out the contact request form by clicking the button below. We’d love nothing more than to help you get back to what you enjoy. Thanks for reading, Dr. Jacob, PT, DPT, CSCS
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 I remember the feeling like it was yesterday. A sharp popping sensation in my back and then an odd, almost warm tingling feeling down my left leg. I knew it wasn’t good, and I should have known better. This was my first week at an infantry brigade I had been assigned to in 2011. I was the only physical therapist assigned to a group of 3,500 soldiers. My job was to treat all injuries, teach injury prevention classes, and help with human performance optimization. I was also attached to an infantry brigade so that meant a lot of physical training and ruck marching. On my fourth day assigned to this group, I went on a Thursday morning ruck march. For those of you that don’t know, ruck marching is basically walking around while wearing a 50-pound backpack. This morning we had gone on an 8-mile ruck march. When I finished, I dropped my rucksack (i.e heavy ass backpack) and stood around talking with the other soldiers. As I was leaving, I bent over to pick up my rucksack and that’s when I felt the pop. I immediately knew something was wrong, but the last thing I wanted to do was get hurt in front of all my soldiers. I was the guy assigned to this group to make sure people didn’t get hurt and there I was in excruciating back pain trying to act like I was fine. I managed to make it to my car before collapsing into my seat. I drove straight to the troop medical clinic to see a fellow physical therapist friend of mine. There was no unringing this bell… the damage was already done. Over the next six months, I did everything to help fix this back injury I had given myself. Fatigue from the ruck march followed by picking something heavy up, like an idiot, was a recipe for a pretty serious disc injury. I had what’s called an L4-L5 disc prolapse. This caused me to have a lot of numbness and weakness in the back of my left leg. With a combination of dry needling, hip joint mobilizations, and time, my pain resolved in about six months. It took me roughly another six months before I could get back into deadlifting heavy. 12 months of rehab/recovery from picking up a rucksack wrong. As much as this wasn’t fun, I’m glad it happened to me, and here’s why. I learned a lot about why I had this back injury in the first place and was able to correct those issues. This injury lead me down the path of better understanding complex movements. I became obsessed with treating my own back and developing protocols to help other people with their back injury. Lastly, I can relate to anyone I see with a back injury on a much deeper level than someone who’s never hurt their back. I also got to see first hand that disc injuries do heal. Even when I was in school, the thought process was that a disc injury wouldn’t heal. I have an MRI from one month after the injury and three years after the injury. The MRI from one month post injury shows a significant disc prolapse that’s pressing on a nerve. The MRI from three years post injury looks completely normal. The body heals on the inside just as it does when you get a cut on your skin. It fills in, heals, and you have a scar as a reminder of the thing that happened. Dealing with a disc injury can be extremely frustrating. Here’s my advice to you if you’re currently dealing with one from my own experience and from all of the back injuries I’ve seen:
I hope this helps and I hope you realize that you can heal. Your body is incredible and often times it just needs time and the right approach to do so. If you’re in the Atlanta area and are currently dealing with a back injury, we need to talk. We’ve helped thousands of people in Atlanta get back to a pain-free, active life, and we can help you as well. Click the “Get Started” button below, leave us your information and one of our team members will reach out to find out if you’re an ideal fit for what we do. Thanks so much for reading,
AP Team  So, let’s talk about the shoulder: It is a very dynamic joint with little surface area between the humeral head and the glenoid fossa. The analogy we often use is a golf ball on a golf tee. There’s a reason why you hear more about shoulder dislocations than hip. We have numerous muscle attachments and ligaments that surround the joint itself. These can be broken down into active (muscles/tendons) and passive stabilizers (ligaments). When we are going through different movements at the shoulder (whether that’s an overhead press, push up, clean, etc.), if we do not have the requisite range of motion, coordination or strength, then our passive stabilizers take on a lot of that stress. As I’ve said before, every single tissue (muscle, tendon, ligament, bone, etc.) in our body has a certain capacity and threshold. Stress is how we build those thresholds up. Stress is also how we break those down. When those thresholds are surpassed significantly or repeatedly, pain and injuries start to pop up. The dosage is the difference in having the poison or the antidote (- quote from someone smarter than me). Now, how can we create more buffer room or bandwidth to withstand these stressors? Smart and well thought-out training. Sure. But, what about creating more freedom and control at the shoulder joint? Then, those tissues are less prone to getting overstressed and everyone is doing their jobs. Today, our focus will be on the overhead archetype – which is an expression of shoulder flexion and external rotation. This can be anything related to pressing, reaching overhead, hanging, or throwing overhead. I see people in the clinic every day that have pain with these movements and when we break these positions and joints down, we tend to see a limitation in one or both flexion and external rotation. Next, we’ll go through a test that you can utilize to see how your overhead position checks out. Wall Test: Common faults we see related to this are:
Try to avoid these mistakes and see where your true baseline overhead position is. After the techniques provided below, come back to this test and re-test the movement. Can you go further? How does the quality of getting there feel? Next, we’ll look at some strategies to improve the mobility aspect of the shoulder joint. Subscapularis Mobilizations: Shoulder Overhead Opener: When discussing the shoulder joint, I would be remiss not to mention the thoracic spine. The shoulder blade and thoracic spine/ribcage are very intimately related which directly impacts shoulder mechanics and position. Next, we’ll go through some techniques to address the thoracic spine. T-Spine Mobilization: Half-Kneeling Wall T-Spine Rotation with Lift Off: Lastly, we will cover my favorite component in the performance process which is the strength and control of the shoulder joint for the overhead position. Supine Eccentric Shoulder Flexion – Dowel or Single Arm with Plate: Dowel Shoulder Flexion PAILS/RAILS: Chaos Overhead Band Carry: Now, you may be thinking, "These are great exercises, but how do I implement them?" Try them as movement prep prior to an overhead workout, accessory work on upper body days or even on recovery days. Do you have to do all of them? Nope. Find the ones that you feel had the best impact on you via the test-retest on the Wall Test and start implementing them in consistently. An active approach tends to work better in the long term compared to the passive approaches and exercises. You’ll be surprised how quickly your overhead position will improve and your overall shoulder health.
If you’re dealing with an injury, 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  Tennis is a sport that demands an incredible amount of strength, stability, and performance out of one of the most unstable joints in the human body… the shoulder. Not only do you need to drive your shoulder through some truly incredible velocities with something like a serve, but you need to be able to control that power through finely tuned movements in multiple planes of motion with an almost endless list of types of swings. The demands on the shoulder are pervasive in tennis and because of this we have successfully treated endless amount of shoulder related injuries from the tennis players we see at Athletes’ Potential. However, through all these injuries that we’ve worked with, we have started noticing some trends in common strength deficiencies and biomechanical limitations that, when addressed, can have serious impacts on reducing injury risk and improving performance. Trend #1: Inadequate Shoulder External Rotation Range of Motion Arguably the most violent swing in tennis is the serve. To generate the amount of torque required for this swing, you need to have an appropriate amount of external rotation at your shoulders. The video below goes over a quick and easy drill to assess your shoulder external rotation. Essentially you should be able to lay on the ground and get the back of your wrist to the ground while keeping your low back pinned to the floor. Some common mistakes to avoid when doing this assessment include:
If you can’t bring your wrist to the ground, or you have pain when you do or feel like you really have to fight to get there, then try some of my favorite drills to improve shoulder external range of motion. Drill #1: Front Rack Opener Drill #2: Lat Stretch Drill #3: Upper Back Mobilization Trend #2: Upper Back Strength In order to have a strong, effective swing you need to have a strong back. This may seem a little counter-intuitive, but let me explain. Your body is innately intelligent and it’s not going to let you produce more force than it feels it can control. Therefore, to have a better swing, you need to have a strong back to be able to eccentrically control your arm as you go through the swinging motion. Some of my absolute favorite exercises to make sure you have a strong upper back are listed below. Exercise #1: Deadlifts Exercise #2: Pendlay Row Exercise #3: W, Y, Negative Trend #3: Lack of Rotational Core Strength Your power in your swing comes from having a strong core. If you don’t have a strong core, then you have no foundation to deliver a strong swing, and if you are trying to have a strong swing without a solid foundation, well, you’re begging for an injury. Check out my favorite exercise to improve rotational core strength. Exercise #1: Med Ball Rotational Throws Exercise #2: Deadbug Pallof Press Exercise #3: Landmine Twists If you’re a tennis player struggling with shoulder pain (and yes, even elbow pain) or are looking to improve your performance, these drills are a great place to start. They are the three main problem areas that we find ourselves addressing with the tennis athletes who come to us for help. However, 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. Thanks for reading, Dr. Jake, PT, DPT, CSCS  [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. 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 It is not uncommon for a patient to come into the clinic and say they were told by a medical provider that they have unstable hips (generally referencing their pelvis). This is often followed by a laundry list of movements they “should not do”, possibly ever, to avoid making their pain worse. These patients often report frequent visits to have their body worked on and “put back together” in order to go through life without constant pain or joints “going out.” Sometimes these patients haven’t seen any medical providers at all, but describe their pain as if something is unstable, slipping, shifting, etc. Perhaps they googled it and this is the best way they could find to verbalize the sensations they felt. What this shows is a widespread assumption that our back/pelvis/hips can suddenly shift and change position and are “unstable." Look at all these strong and beautiful ligaments. The strength of these is so great, could bad posture or lifting something in a “bad” way really cause that much movement? Research shows that we are unable to accurately palpate (feel with our hands) if a joint position is “out of place” or moving in an “unstable” way. The linked systematic study found that “current clinical methods utilizing palpation for diagnosing SIJ pathology have been found to be unreliable and invalid in the literature and may have limited clinical utility.” Through research, we know that the SIJ can move on average about 2 degrees or 3-4 mm. That is such a small amount, I challenge the notion that we can actually feel that with our hands- through skin and fat and muscles. So why do some people believe that our hips and pelvis are all willy-nilly and unstable?
As humans, we relate to stories. However, pain is not something that is easily understandable for everyone and may not have a concrete explanation- particularly when one has been in pain for years and it affects their daily life. Humans want a WHY. An easier explanation is that your SI joint is painful because of instability and movement at the joint. This seems relatable to folks because it might FEEL just like that- like it’s moving too much. While explaining pain in this way can be helpful in some respects, the problem is that it snow balls into the “things I can’t do” list because if my pelvis is unstable, then I probably shouldn’t workout and DEFINITELY shouldn’t run. But one thing that we DO have research supporting is exercise to decrease chronic pain and improve quality of life. So if you have pain, don’t panic! Go MOVE. If you need guidance for where to start, find providers that will encourage you to be active and strategically help you return to the activities you love. (Pro tip: This rarely entails the word “never." As in “you should never lift weights or “you should never run."). Let us know if we can help you! Thanks for reading, Dr. Jackie, PT, DPT, OCS, CSCS  I recently attended a continuing education course called Functional Range Conditioning (FRC). It was one that has been on my list for quite some time and it was awesome to finally check it out. In this blog post, I’m going to expand upon some of the principles and techniques I learned and how you can start to implement this in your daily movement practice. First, let’s define a few words. What is flexibility? What is mobility? Are they the same thing? We hear these words used interchangeably. However, they are in fact different.
The foundation of the FRC system is based on the acquisition and maintenance of functional mobility and articular health. It is very dependent on your passive and active range of motions. Basically, the goal is to make your AROM and PROM the same. PROM is the prerequisite which will allow you to improve your AROM. FRC utilizes a concept called “bioflow.” While I don’t get too caught up in systems or their coined terms, I’m cool with this one. It basically talks about tissue continuity (gross tissue --> cellular --> intracelluar) calling it STUFF. Stuff being cells, fibers, and ground substance. Composition of these components dictate the type and physical properties of a certain tissue whether it's bone, fascia, ligament, tendon, muscle, capsule etc. Cell signaling and progressive adaptation is how these cells change into these different structures. Think about an ACL graft that is harvested from a patellar tendon – do you think it stays a tendon over time or evolves to becoming a ligament just like the initial ACL? Yeah, science is pretty cool. I could geek out on this stuff all day, but let’s move on to the application of improving your mobility – there’s a few techniques used to start working on making your passive movement more active. Insert Controlled Articular Rotations (CARS) - Active, rotational movements at the outer limits of articular motion. There’s 3 levels for CARS which are related to isolated blocking, external resistance and amount of irradation. Irradation simply put is the amount of tension you create throughout your body – in nerdy science terms this is also called Maximum Voluntary Contraction (MVC) often expressed in percentages. The best example of irradation is to give someone a hand shake. First, squeeze using your hand, then hand and forearm, then hand, forearm and shoulder, etc. Your grip gets stronger and stronger the more musculature you recruit. The more irradation, the more force you exert. You can use this to dial in higher levels of recruitment while doing your CARS or other FRC techniques. “Force is the language of cells” – one of my favorite quotes at the course. CARS can be implemented different ways whether that is by focusing specifically on a certain joint or you can take part in the morning CARS routine to give all your synovial joints in your body some love each day. The next step to continue to work on improving your joint integrity and control is via PAILS and RAILS. PAILS and RAILS are isometric contraction efforts (sometimes combined with stretching) used to communicate with both the connective tissue & neurological systems. 2-3 minutes of stretching to build stretch tolerance, then:
This is a great video by Joe Gambino from Par Four Performance going over the Hip 90/90 PAILS/RAILS. I see PAIL/RAILS as a way to safely acquire and create control into these newly stretched positions without movement. Basically isometric holds to own a position with increased stretch tolerance. The next and my most favorite part of the course and system is the End-Range Control techniques. End range is where we see a lot of injuries and tissues breaking down. Why? Well, from a physics standpoint, we’re just not able to produce as much force at these end ranges due to length-tension relationships. Another big factor is because we rarely go there. And when we do, we typically aren’t ready for it and are pushed there by accident – which is why we need to train these end ranges. It allows us to build better tissue resilience and reduce the risk of injury. Here’s how we break down end-range control: End-Range Control: PALS/RALS
Passive Range Holds
Passive Range Lift-Offs
Hovers
End-Range Rotational Training
My suggestion is don’t get too caught up on the wording of these different techniques, but understand the conceptual framework and you’ll be able to implement this immediately. We all know that we have certain aspects of our joints where our active and passive is not the same. If you’re wanting to improve your squat or overhead position, or if you just want to build up resiliency in different tissues, then give your joints some love with some of these different techniques. Cheers, Dr. Ravi Patel, PT, DPT, CSCS Breathing. Seemingly, the most innate skillset you have as a human being. So innate that it’s used as a benchmark for being a healthy newborn and your first time taking in a breath happens within 10 seconds of entering the world. Fast forward to adulthood and you’re breathing an average of 12 to 20 times per minute without a single thought. With all that practice, we must be pretty good at it; right? Not exactly. Stress, lifestyle choices, and mechanics all play a huge role in how we breathe, and all breath is not created equal. Just like any skill, practice makes perfect, and I routinely see the opposite. I constantly see people who can only breathe into their chest, who don’t know how to take appropriate deep breaths, and who have no control over their diaphragm. This is a problem for many reasons and let me tell you why. First and foremost, deep breathing has profound effects on your autonomic nervous system. Your autonomic nervous system includes your sympathetic and parasympathetic nervous systems which control your fight-or-flight responses and your rest-and-digest responses, respectively. In the world we live in, it’s easy to feel the weight of stress - stress from your job, driving in traffic, relationships, finances, etc. Here’s the crazy part though: our brain can’t decipher between the stress of being chased by a bear and the stress of being behind for an important work deadline. To the brain, stress is stress and breathing short, shallow breaths is one of the main ways our brain interprets stress. All this to say that shallow breathing is both a cause of increased stress and a symptom of increased stress responses, creating a vicious negative feedback loop leading people to live in a chronically stressed state of mind. No bueno. Not only are there serious cardiac, mental, and metabolic diseases linked to chronic stress, but chronic stress can also put you at a higher risk of injury AND slow down your rate of recovery from current injuries. Here’s the good news though: Something as simple as taking longer, deeper breaths using your diaphragm has been demonstrated time and time again to not only prevent the effects of chronic stress, but also significantly decrease non-specific mechanical low back pain. But don’t take my word for it:
Training your diaphragm is relatively easy. Below I’ve listed my three favorite drills to do so. While doing these drills, I’ll often have my patients perform something called an “apnea breathing” pattern, which is designed to slow down your breathing, increase your parasympathetic nervous system, and decrease your levels of chronic stress.
In review, taking deep, long breaths could be an effective treatment option for you if you’re dealing with low back pain and, at a minimum, will help your live a healthier life. However, diaphragmatic breathing is just a piece of the ever elusive puzzle. If you’re dealing with low back pain, reach out with any questions. We design and implement programs to help people just like you, 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 get out of pain and return to their sport or activity performing better than they did before. Thanks for reading, Dr. Jake, PT, DPT, CSCS |
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