 Our past couple blogs have revolved around neck pain. Why? Because it’s 2021 and we are a year and half into our “new normal” caused by the global pandemic, which means more time working from home, which means increased time spent behind a computer screen, which means more neck pain and more headaches. Throw on the added stress that people are experiencing and it’s starting to feel like there’s a different kind of pandemic going around with all the neck pain and headaches we’ve been treating at Athletes’ Potential. In our previous blogs this month we’ve given a ton of great information about how your neck is the source of your headaches and why looking down at your phone all day may not be the best idea. (If you missed those, you can find them here.) While all that may be great, there’s one area that frequently gets missed when people get their necks looked at by a medical professional, and that area is their back. While there are certainly fasial lines, misaligned joints and muscle tensions in the low back that can cause changes “up the chain” that lead to neck pain, those situations are a little fewer and far between and aren't necessarily the part of your back that I’m talking about. Instead, we’re talking specifically about your thoracic spine, or your upper back.  A little anatomy lesson for you to make sure we are all on the same page. Your spine is divided into three separate segments: cervical (neck), thoracic (mid back), and lumbar (low back)...in other words your thoracic spine connects your neck to your low back. Now, there are a couple of things that are pretty cool when we’re talking about your thoracic spine.
Going back to that first fun fact...the upper portion of your thoracic spine has to be able to move along with your neck. Hypomobility leads to pain. In other words, if one joint isn’t moving properly, then that causes other joints (above or below the stiff joint) to have to move in an excessive range of motion (hypermobility), which leads to pain in those joints. That is exactly what we see when it comes to the upper thoracic spine and its ability to cause neck pain. If your upper back has excessive stiffness then that causes your neck to have to rotate, extend, etc in excessive ranges of motions to do simple tasks (think looking over your shoulder to check a blind spot), which will inevitably lead to pain. Luckily there a ton of drills you can do to help improve your thoracic spine mobility and two of my all time favorites are listed below: Thoracic Spine Self Release: Open Book Exercise: The second way your thoracic spine can cause neck pain actually has more to do with that second fun fact. One of the most important functions of your rib cage is to protect some very important structures such as your heart, lungs, liver, diaphragm, etc. Your lungs and diaphragm in particular are what we want to focus on here. You see, when people sit at a desk for prolonged periods of time or are experiencing high amounts of stress, what tends to happen is people start taking shorter breaths and use the accessory muscles found in the neck when they breath instead of the more appropriate muscle being their diaphragm. When this happens we’ll start seeing muscles like the scalenes, sternocleidomastoid (SCM), and subclavius start to develop too much tension which will lead to neck pain and even referred pain causing headaches. Lucky for you, we have some favorite drills that can help with that too and a lot of them focus on proper breathing. Now, before you roll your eyes and think, “proper breathing?! Breathing is breathing!”, That’s what I used to think too but thanks to our good friends over at Shift, in addition to the thousands of people we’ve helped improve their breathing, I can promise you, that thought process couldn’t be further from the truth. Give the drills a shot and see for yourself, you’ll be amazed at how effective cleaning up your breathing patterns can be. 90/90 Diaphragmatic Breathing: Psoas/Diaphragm Release: In review, improving your upper thoracic mobility and appropriate breathing patterns could be effective treatment options for you if you’re dealing with neck pain and, at a minimum, will help you live a healthier life. However, these treatment options are just pieces of the ever elusive puzzle that make up neck pain. If you’re dealing with neck 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 at Athletes’ Potential 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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 Every day, all day, you are carrying a bowling ball with you. Not literally of course. Hear me out. You wake up, you go to work, you care for your kids, and the entire time you have this massive ten pound object sitting on your shoulders for which you are responsible! It’s propped up by a few supportive structures, each of which are organized and arranged to be wonderfully supportive of this object. You can probably guess by now, I am talking about your head and neck. Your head being the bowling ball and the neck being the structures that support it! Now if I was to tell you to arrange this head and neck in an ideal way, you would likely put the head perched nicely on top of the neck without much lean. Intuitively as well as seen in the research, if you see a neck that’s leaning, you know that neck is likely working harder than a neck that is more upright.  We are living in a world that is more phone-focused than ever, and in the world of physical therapy, we are seeing a HUGE uptick in phone and screen related pain. So what are a few things you can do to help alleviate this “text neck” that we see so often at Athletes’ Potential? Try a few of these things and see how you feel after a week: 1. Foam roll your upper back 1-5 minutes 1-2x/day. These will help relieve tension in your upper back that can throw your neck and head forward. Enjoy these!  2. Chin tucks 3x10-15 with light effort 1-2x/day. These will help align and exercise your neck by putting it in the right position. Be gentle! Feel the deep muscles lightly working to pull your chin down and back. Aim for a “double chin!"  Moral of the story: care for your bowling ball. Over time, you will lose strength, coordination, and mobility if you don’t work on them occasionally. These two simple exercises can help start to get you out of your text neck positioning. If you are still having problems, feel free to reach out to us at any time to help you improve your neck issues. Thanks for reading,
Dr. Marcus Rein, PT, DPT, CF-L2  About ⅔ of the population will suffer from neck pain and headaches at some point in their lifetime. Stress, posture, and muscle tension can all lead to headaches. Some common causes that can predispose you to headaches are: staring at a computer screen all day, lifting heavy weights overhead at the gym, or limited mobility of the neck, upper back or shoulders. Tension headaches refer to headaches related to muscle or fascial tension, and the postural changes that accompany the muscle tension. This increase in tension might be from stress, a physically demanding job, or poor posture and muscle fatigue at the end of the day. Tension and stress can lead to trigger points and tightness in your postural muscles. This muscle tightness can directly refer pain into the head and face creating headaches on one or both sides of the head. Muscle tension in the neck can result in compression and squeezing of the nerves going into the base of your head. Compression of these nerves can lead to pain behind the head, along the temples, as well as behind the eyes. Usually this compression is felt directly below the base of the head in the upper neck region, and is associated with a more forward head posture.
You can also get headaches from dysfunctional jaw mechanics (TMJ) associated with upper neck stiffness. The upper neck region can tilt the head and jaw creating abnormal muscle tension in the neck, jaw and face. If you have headaches associated with eating, notice your jaw clicking this may be an indication of neck and jaw dysfunction, also termed TMD. Incomplete mechanics of the joints of the neck and upper back, as well as shoulder stiffness can create additional stress on the muscles of the head and neck. What steps can you take to relieve or reduce your chances of getting headaches caused by incomplete mechanics?
If you have tried these methods of headache relief, but continue to have symptoms contact us below to see if physical therapy is a good option for you. Thanks for reading. Dr. Sam Gillespie Part 2: The Hip’s Role in Low Back Function A car needs a good road to function at its best. A house needs a good foundation to stay strong. A tree needs solid roots to stand tall. By only focusing on the low back you are having low back pain, you are missing the big picture! The hips play an absolutely crucial role in low back pain. If they are weak or stiff (or both!), the foundation of your house has major issues in providing your low back what it needs to function pain-free. This is very much supported by the literature. Two major reviews found that in patients with low back pain, there was a high prevalence of weak hips (1) and that by strengthening those weak hips, you can improve your back pain (2)! Furthermore, a lack of hip internal rotation has been found to be correlated with low back pain as well (3). So, if hip strength is found to be directly associated with low back pain, we’ve gotta strengthen our hips! If I were to choose two exercises for you to try for hip strength that can help with low back pain, here’s the two I would choose to target these potential impairments. Single Leg Hip Thrust:  Keeping your core tight, squeeze your butt as you push your hips up to the sky. Try to not let your spine move. Let your hips do all the movement (no arching your back!). Try 2-3 sets to moderate levels of fatigue. If this is too hard or too uncomfortable, regress to trying these on the ground without your back elevated. Clamshells and/or Side Plank Clamshells:   Clamshells are often looked down on as easy basic exercises (which they can be). However, if you know how to progress them, they can be downright challenging! These are two variations I enjoy in the clinic and both involve a band. Try 2-3 sets on each side to mild to moderate levels of fatigue. Both exercises should have discomfort levels below 2/10. More is not better with these! By combining a healthy lumbar spine and hip complex, you have the best chance to improve your low back pain for the long run. If you still feel like you’re getting stuck, feel free to reach out to us and we can get you the care you need to get your back to the place you want it to be! Thanks for reading, Dr. Marcus, PT, DPT, CF-L2
 Part 1: The Lumbar Spine’s Fundamentals If you are reading this blog post, you likely are having back pain or have had back pain in the past. You understand how debilitating it can be. You understand how much it can take away from you. You are not alone. Eight percent of all adults experience chronic back pain. Back pain is the sixth most costly condition in the United States. Back pain accounts for over 12 billion dollars of medical expenses every year. So yes, lots and lots of people have back pain! It is rare that a day goes by in my practice that I do not see a client with some sort of low back pain. So, in this short two-part series, I’m going to go over some quick things you can do to consider if you are having low back pain and are continuing to want to exercise or play sports. Fundamental 1: Resume activities as tolerated One of the biggest factors to accelerate recovery in low back pain is to resume functional activities as tolerated. It’s not bed rest. It’s not stretching. It’s using your back and body as tolerated. This tells us three things: First and foremost, we are resilient! Even with pain and dysfunction, if we are able to do things as tolerated, we will recover faster! Second, it tells us that despite the pain and dysfunction, we need to look at ways we can improve our mechanics in order to return to functional activities faster. Resting for too long is not the best option to regain our activities that we’ve lost due to the pain. And third, it tells us that we need to figure out a way to still respect the pain while not being fearful of it. Simply listening to your pain, being brave, and trying things out gently is a key part in progressing as tolerated. Fundamental 2: Coordinated Movements This is where my expertise as a doctor of physical therapy comes into play. I am an expert at understanding movement. Both functional and dysfunctional movement patterns come into my clinic every day, and it is my job to ensure that even with the pain that your back is experiencing, you are still able to do things as tolerated to best get you back on your feet. So how do I do that? I ensure that your coordination at remaining in neutral spine position is solid before anything else. Try the “bird dog” or “dead bug” exercises to see if you have reasonable spine coordination. If your spine moves significantly from its normal resting position during these movements, you definitely have a coordination deficit. Bird Dog:  Dead Bug:  Of course there are many more tests I use to assess for appropriate lumbar coordination; however, these are just two that are tried-and-true in my practice. Fundamental 3: Strength Once you have gained a reasonable amount of coordination in keeping in neutral, we add some intensity. Longer holds, more variance, more load… all are options depending on the goals of the client. Aim for two minutes of great coordination with dead bugs and bird dogs to understand what a strength requirement standard should feel like. The key variable is the coordination. Once coordination falters, you have to work harder or regress to something easier. Once these three fundamentals are working at a reasonable level, your function should definitely be improving. If you’re still having difficulty after working on your day to day activities, your coordination, and your strength, you may need more guidance from a physical therapist. My job is to guide you through low back pain that isn’t responding to basic exercises. If you think that you’ve tried all you can, feel free to reach out to receive some more specific guidance to you and your situation. We’re here to help! Look out for Part 2: The Hip’s Role in Low Back Function - coming soon! Thanks for reading, Dr. Marcus Rein, PT, DPT, CF-L2
 Many people run because it can be done anywhere, is a year round activity, requires minimal equipment, and has excellent cardiovascular benefits. Over half of all runners will sustain a running-related injury while training and around 90% of marathon runners will experience a running-related injury. Reasons to increase your step rate, and reduce your step length, while running:
Small changes in your step rate, or running cadence, can have a major impact on your running resilience. Your step rate refers to how many steps you take in a minute while running. Increasing the step rate while running at a constant speed will decrease your step length. Think about walking across the room vs. jumping across the room. Taking more steps while walking requires less impact forces than hopping the same distance. “Overuse” injuries due to running are often a result of these higher loads of force while landing. Some people can even hear themselves landing with louder steps as they run. Your speed and stride length will influence the impact forces your joints, tendons, and ligaments are required to absorb while running. Increasing step rate has a positive impact on the ankle, knee, and hip joints. The knee joints were most positively affected by increasing step rate, with a 20% reduction in impact forces with only a 5% increase in step rate. This increase in step rate will create a reduction in stride length while maintaining the same running speed. There are many positive benefits of running with a shorter stride and higher step rate. A smaller stride length allows for you to land with your body’s center of mass over the landing foot. This will lead to less impact forces in the knees, hips, and ankles while running. Increased step rate leads to more efficient running mechanics. Improve your running economy with reduction in “up and down” wasted motions while running. You can also reduce the risk of shin splints due to the reduction in shock absorption during landing while running with smaller strides. Things to think about after committing to increasing your step rate and reducing your stride length:
Thanks for reading, Sam Gillespie PT, DPT, OCS Today we are going over one of our favorite treatment styles at Athletes' Potential- Blood Flow Restriction Training, or BFR. We use the Owens Recovery Delfi units in our office.
What are we doing with BFR? We are essentially restricting the blood flow that goes to a particular limb, in this case, Dr. Sam's arm by about 50%. What that does is restrict the blood flow coming out. Now when we do that, there are very interesting things that happen hormonally with exercise. You can get up to 200% increase in your human growth hormone. This won't make you look like The Rock but you will start to recover faster and build your connective tissue in a quicker way that wouldn't normally happen in a regular gym setting. If you haven't tried this or you'd like more information on this, please reach out to us! At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! Have you been looking to find ways to improve your vertical jump? Once you start jump training, there are a few key principles in place. Be sure to watch the first video on these principles with Dr. Jake Swart. Once you have done these exercises for at least two weeks, progress your jump training with these loaded jump exercises! Keep the weight light, the technique clean, and the reps low! Remember, to improve your jumping, you MUST train at 100% every rep, so as soon as you feel your output decrease even 1%, rest for 2-3min.
Jump training should be done for 3-5 sets per jump training day and should not be done daily. Just three times a week max! https://youtu.be/rx0i9H_R9zg At Athletes' Potential we help active adults and athletes in the Atlanta area get back to the workouts and sports they love... without surgery, stopping activities, or relying on pain medicine. Life is too short to avoid doing the things that you love. Reach out to us at: www.athletespotential.com info@athletespotential.com 470-355-2106 Let us help you figure out to live your best active life today! The shoulder is a very dynamic region. To put it to the test on the daily, either through sports, such as swimming and tennis, or through workouts, means that you have an awareness of how dynamic it really can be. In this complex, there's a lot of range of motion and even more potential for strength/power output so there’s plenty that can go wrong! This short write-up is a summary of a concept that you can start learning today to help your shoulder complex function more efficiently and effectively. Learn these coordination cues and then start to look out for other opportunities where you can connect your core to your fingertips!  Every shoulder action is anchored to the core. From the fingertips all the way through to the lumbar spine, every push and pull, throw and press… ALL involve the core. The more aware and coordinated you are with this, the more efficient your shoulder motions can be. This heightened coordination also improves force distribution throughout the entire chain of movement, therefore decreasing chances of wear-and-tear on a specific tissue such as the rotator cuff. Two simple drills I like to do to help identify how much the core can affect the shoulder complex is the plank in both passive and active positions and then compare those positions to a functional test, such as pushing a car.   The plank with passive shoulders and relaxed core is disconnected from the lumbar spine and your power output will suffer. Using this coordination pattern while pushing a heavy object, such as a car that has run out of gas, would surely be weak as it does not fully take advantage of your core strength during the push! Let's compare that to an effective plank with an active core.   The power output of this position is clearly higher! By using the musculature from the core initially to stabilize my center of mass, my shoulder complex can successfully attach to this foundation and press much more effectively. Next time you’re in the gym or you are playing your sport, try to see if you can find other actions that you can connect from your core to your fingertips. You’ll be surprised at how much more effective your swimming stroke, tennis serve, or pullups can be with an active core. Give these approaches a try and let us know what you think! Thanks for reading,
Marcus Rein, PT, DPT, CF-L1 Here are my 10 favorite baseline prerequisite screens for runners. These screens test for mobility, strength, and your ability to control your trunk, pelvis and hips. Making sure you are able to pass these screens is a good way to reduce your risk of injury and to enhance your running performance and economy. These tests can also provide an opportunity to assess areas you may need to focus on during your strength and mobility training. 1. Big Toe Extension (see above below): The ability to extend through the big toe is important for progressing your body over your planted foot while running. If you cannot extend your big toe, you will often see compensatory strategies from the leg or lower back above. We would like to attain ~70 degrees of big toe extension. Using a wall or doorway, try stretching your big toe, allowing the ball of your foot to reach the floor.  2. Ankle Dorsiflexion Wall Test: The same concept applies for progressing through your ankle. If you have calf tightness or limited ankle joint mobility, you may struggle to progress your shin forward. You will often see compensations from the leg and back above or from the midfoot below. For running, we would like to attain ~30 degrees of forward mobility (ankle dorsiflexion). 3. Hip Extension: Hip extension is the third aspect of progressing the body forward over the stance leg during running. Since running is mostly a mid range sport for the hip, ~five degrees of hip extension would be adequate, as long as there is no compensation from the lower back muscles. Keeping the front of the pelvis on the floor during this test should help assess hip mobility without compensating from the lower back. 4. Single Leg Heel Raise: Assessing calf strength and endurance is vital for distance running. During this test, perform the heel raise at a tempo of one second up/one second down per heel raise. Set up using a small plate, or step, to achieve a small amount of ankle dorsiflexion. Come up to a complete calf raise for each repetition and stop if you are unable to elevate to the top of your calf raise height. We would like to see ~30 repetitions. 5. Single Leg Hop Test: This test assesses the ability to absorb loads and create tension in the calf complex. We would like to see one-second hops for at least one minute. 6. Lateral Heel Tap: This test assesses your balance, pelvic and hip muscle control, and also assesses the mobility needs at the ankle required for running. Using an eight-inch step, tap the ground with your heel directly to the side. 7. Rear Foot Elevated Split Squat (RFESS): This is another good test for balance and hip control, as well as the ability to generate force through the leg complex. We would like to achieve 10 repetitions without compensation and to maintain good balance throughout each rep. 8. Single Leg Hamstring Bridge: The repeated hamstring bridge is a great way to assess the strength and endurance of the muscles behind the leg. During the test, perform a single leg bridge at a tempo of one second up/one second down per rep. Perform from regular 18” bench/chair height. Try to create a straight line from the knee/hip/shoulder, showing good hip extension each rep. We would like to see 30 repetitions. 9. Single Leg Bridge Hold: During the single leg bridge hold, we are assessing your ability to maintain good hip, pelvis, and lumbar control while engaging the gluteal and hamstring muscles. Hold for 30 seconds without compensating at the hip, pelvis, or lower back. 10. Side Plank This is a good test for assessing muscle endurance of the lateral hip and oblique abdominal muscles. Without proper hip and core muscle endurance, there will likely be compensatory pelvic drop or lower back muscle use to maintain pelvic and hip control. Perform a side plank from the floor with the opposite leg raised. This can be performed on a GHR machine if you have shoulder issues. We would like to see comfortable holds for longer than one minute without dropping the pelvis. You should be looking for any difficulty maintaining these test positions, any loss of balance issues, or any mobility restrictions required during these tests. If you notice any of these deficits, this is a good opportunity to address your needs during your strength and mobility training sessions. If you are unsure of your results, or would like an expert eye for your assessment, feel free to contact us! Thank you and happy running!
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