 As a physical therapist, my job is to interact with pain and discomfort all day long. Most people don’t come to see me when they’re feeling great! They come to see me when they are injured, sad, and without a clear path forward. They come to see me when pain is not only slowing them down, but possibly taking away something that they love, such as running or sport! The pain they feel is a warning light that is flashing bright, and every patient I’ve ever seen has needed some guidance on how to interpret the signals that their pain is trying to convey. Seeing as every experience of pain is unique to the individual, I won’t go into specifics on these subjective experiences, as they are so varied! What I do want to share is what we now know about pain science that we didn’t know even just ten years ago, and more importantly what can we do with this knowledge of pain science! As it turns out, there are reasonably well-performed studies that support the use of short bouts of mindfulness to manage pain tolerance.(1) A huge review came out in 2020 that may be worth looking through if you have the time (see citations). Now, within my treatment room, I’ve seen tons of evidence that mindfulness helps pain tolerance! Any time I perform any type of manual therapy treatment -- dry needling, voodoo band application, Graston, or cupping -- I’m very aware of my patient’s pain tolerance. It is very important that my patients be able to relax while I’m performing these techniques. I’ve seen time and time again, if a patient is not breathing deeply in a relaxed state (or at least attempting to!), the technique is less effective. This makes sense. In one of my favorite books on pain science, “Explain Pain,” by David Butler, the “fight or flight” system is the sympathetic nervous system. This system can be triggered by various stimuli, such as loud noises, fearful emotions, and other things that we determine as possible threats. Once this system is triggered, our muscles tense as we are getting ready to fight or run. This is the exact opposite system we want triggered when we are receiving physical therapy treatments! What we would like to trigger is the parasympathetic nervous system, as it is the system responsible for our “rest and digest” capacity. As a side note, if you have any interest in pain science, I’d highly recommend you purchase the book, “Explain Pain.” It has been incredibly formative in my practice and is written in an approachable, well-explained manner that can give you a great understanding of our pain system. Ok, back to the systems! If my patients are able to tap into this parasympathetic system, their muscles relax and absorb the treatments that I am providing. So, what is the best way to access this parasympathetic system? While I wish we could access this system with a light switch, we cannot. But, the most effective way to coax it into action is through deep breathing and mindfulness. Many times, I can simply hold onto a trigger point and ask my patients to breathe deeply, and with no motion and the proper application of pressure, we work as a team to access their parasympathetic system, thereby allowing the trigger point to release more rapidly than if I were to be fighting with their sympathetic system! So, the next time you’re on that foam roller, lacrosse ball, or receiving dry needling, do your best to breathe deeply. You’ll be accessing your parasympathetic nervous system, getting more results more rapidly, and getting yourself to where you want to be with your muscle tissue. If you have any questions on this mechanism in our body or think you would like to experience the effect that breathing and “downregulation” has on physical therapy treatments, reach out and schedule a session with me today! Thanks for reading,
Dr. Marcus Rein PT, DPT 1. Shires, Alice, et al. “The Efficacy of Mindfulness-Based Interventions in Acute Pain: A Systematic Review and Meta-Analysis.” Pain, vol. 161, no. 8, 2020, pp. 1698–1707., https://doi.org/10.1097/j.pain.0000000000001877. 2. Butler, David S., et al. Explain Pain. Noigroup Publications, 2019.
0 Comments
 Halloween is this weekend, which means there are going to be a lot of tricksters out there (and maybe one giant treat...I’m looking at you Braves!). While harmless pranks and scary decorations are all fun in games, there is no place for scaring people with bad, dated medical information. Our bodies are incredibly resilient and some of the common “scary” comments our patients have heard from other providers, or seen on imaging, really aren’t anything to be afraid of at all. Okay, 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 be easily managed with education on symptoms, appropriately prescribed exercise, and just good ol’ fashion exercise. 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 the symptoms I was having to what the research is now showing, I had no business getting either 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 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, in most cases, 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. A provider quickly dismissing an activity you do without any context is lazy, myopic, and an easy sign that you need to get a second opinion. 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 readily 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  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 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! 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!
Today we're working on our running mobility issues in our feet and ankles. We all know these can get stiff after miles and miles of running. We're going to work on our big toe, or our first ray. When you toe off in a run position, you have to get about 70 degrees of dorsi-flexion in your big toe. If you do not have that much flexion in your toe, you'll start see problem creep up up stream. To prevent this, grab your favorite lacrosse ball or Yoga Tune Up ball and really warm up your plantar fascia on the bottom of your foot. After that, get into a runners stretch against a wall and focus on stretching your big toe. You can also try toe walking around your house. 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! Foot strength is super important for runners. Our feet are what propel us forward so in order to generate a lot of power or strength in running, we have to have strong feet. Intrinsic foot strength- simply put, it's the muscles of the foot. Far too often we neglect this part of our body a lot but we need to show it some TLC. To help us gain foot strength, we've got a simple exercise for you to try at home or the office to start building up that strength. It's called the short foot drill. We want to make our foot as short as possible. Go back and forth between squeezing that foot together and relaxing. Do about 15-20 reps at a time. Watch the video for the all tips and get after it. 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! Today we're covering mobility for foot and ankle issues. If you've been struggling with this or you don't know that you have been, give these exercises a shot.
Massaging and stretching are great but there's one important technique that you might be missing. The first ray needs to be mobile! In order to be an efficient runner, you need about 70% dorsiflexion in your big toe. Any less that that, will cause pain. Try these two foot exercises to improve that mobility. 1) Grab your favorite Yoga Tune Up ball or lacrosse ball and get it under you foot, moving it side to side across your plantar fascia. 2) Do a wall stretch, but lift your heel off the ground to stretch that big toe. 3) Do some toe walks around your house! Hit these for 1-5 minutes. 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 Today we're going over one of our favorite drills to teach spinal neutral when performing a squat. Grab a PVC pipe or broomstick. This will help give you some real-time feedback.
Align the PVC pipe against the back of your body and go into a squat position. Did you lose contact with the bottom of the pipe? If so, you might have tight hips and your back is overcompensating. Give some of our hip opener exercises a try and see if it helps. Again, align the PVC pipe against the back of you body. Does it lose contact in the middle of your spine? (Think arched back). If so, you might need to do some core exercises and engagement. Check out some of our core stability videos. 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! Today we're working on our foot and ankle strength. These can be done around the house- it's that easy!
The first one- single leg balance. While you're brushing your teeth or standing at your work desk, practice your balancing on each leg. If that gets too easy, progress to balancing only on the ball of your foot. As that gets easy, you can progress to standing on an angled- surface to continue the single leg balance work. Get this done throughout the day and you'll notice that your foot and ankle are stronger! 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!  A hot pan - don’t touch it! A wet slippery slope - probably should avoid it. A cactus - definitely avoid it. The experience of pain has taught us these simple rules, and we should be thankful! Burning our hand, slipping on rocks, and getting poked by a cactus’ spines are all three damaging things that we do our best to avoid to ensure our own health. These examples are the easiest way to understand pain, in that it is an alarm system that is designed to protect us from damage by giving us a quick response from which we can learn. Let’s go one level deeper. What happens if you go on a big hike and wake up the next day with your legs in pain? It’s a deep soreness that you haven’t felt before and it’s really bothering your hips and knees. Is this cause for concern? Is this damage? What kind of pain is this? What if you are simply sitting down in the gym after a workout and turn to pick up your water bottle and your back spasms, causing intense discomfort? Is this cause for concern? Is this damage? What kind of pain is this? How about just waking up with shoulder pain for no reason, but it lasts for 10 years? It won’t respond to medication or injections, and resting it just makes it worse. Is this cause for concern? Is this damage? Why the heck is this pain still around? As you can see, the alarm system pain provides is activated in all of these scenarios. This alarm system provides a symphony of sensation that plays its tune and it's up to you (and maybe the assistance of a professional) to decode the symphony. Let me share with you the things I look for in a patient’s presentation to help decode their sensations: 1. Numbness, tingling, or burning? If you are having numbness, tingling, or burning that does not resolve quickly or returns regularly, you likely need an assessment from a professional to determine its root cause. PTs are very skilled in caring for this type of pain! However, if this sensation is with progressive weakness or progressive loss of sensation, you should contact your primary care provider for assessment quickly. If it is rapidly progressive, you should go to the hospital. 2. Pain that's slowly getting better but still around? As long as the pain is getting better overall, healing is occurring. If it's slow, it's still progress, so don’t discount it! If you are frustrated in the pain’s slow speed of improvement, it might be time to come in to see us as we are also very skilled at finding ways to more rapidly accelerate your healing. 3. Pain that is not getting better for over a month? If you’ve been having pain that has not been improving for over a month, it is definitely time to see a professional. PTs are fantastic at diving into the mechanical issues that are causing your pain and improving the painful region’s overall capacity to provide you a higher healing potential. As a final note… there are SO many factors that can affect pain! Here’s a short list of proven secondary factors that have a direct effect on the subjective interpretation of the pain alarm system: Modifiable Factors Proven to Affect Pain*:
Non-modifiable Factors Proven to Affect Pain
As you can see, this complex experience doesn’t just include the local injury but so many other factors! If you would like to read more about the pain experience and its study, I highly recommend "Explain Pain." It is a short read that is well researched and provides a great contextualization of the entirety of the pain experience. So, if you are having pain and want to better understand it, start with contextualizing it as an alarm system that you must learn to interpret. If you’d like to understand your pain further, “Explain Pain” is a great option. And, finally, when you’re ready to have your pain improve, come see us at Athletes’ Potential! Thanks for reading, Dr. Marcus Rein, PT, DPT, CF-L2 * van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology - where do lifestyle factors fit in?. Br J Pain. 2013;7(4):209-217. doi:10.1177/2049463713493264 |
PT Knowledge
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts. Categories
All
Archives
March 2022
|
RSS Feed