 A very common problem we see at Athletes’ Potential is low back pain. What comes with low back pain are a lot of questions about the best ways to manage the pain when it first occurs, as well as the best ways for our athletes to rehabilitate. What I want to focus on in this blog post is how important it is to get back to gentle activity sooner rather than later when dealing with low back pain. A Timeline of Back Pain T0: Back pain! You feel a sharp ache in your lower back. You may have been lifting something heavy or you may have been reaching for your shoes. Back pain can come about for a variety of reasons! Whatever the case… your back “went out.” No matter the presence or absence of pathology (disc irritation, facet irritation, muscle strain, etc.), your brain and nervous system are going to go into overdrive trying to protect your back. This is where many people will experience a tightening sensation or spasms in their lower back. This is a normal, protective mechanism! Your brain is doing its best to shield you from further motion by tightening up all the musculature in your back. Thank you, brain! This phase is known as the “acute” phase of pain. Typically this lasts for a day or two. It's where pain is the worst and rest is indicated. The goal of this stage is to get the pain to stabilize. When I say “stabilize” I mean that it still might be quite painful, but you are able to do more than you previously could, such as get out of bed and do short walks, where before that was near impossible due to the rapid, sharp pain that occurs with motion. Many athletes believe that rest is best at this phase, but many studies suggest the opposite. In a 2018 review of best practices surrounding low back pain, 6 out of 11 studies support avoiding bed rest during acute bouts of low back pain, four studies were inconclusive, and only one suggested bed rest.1 Great news! Get active as soon as you are able. At this point, it's best to work on breathing exercises, gentle core exercises such as bracing and bridges, and try to get on your feet when tolerable. If this is unsuccessful and your high level of pain is lasting for more than three days, I would contact us at Athletes’ Potential or your PCP for further assessment and treatment. Once the pain begins to stabilize, and you’re able to do some gentle activities as tolerated, you’ve entered the subacute phase. T1: Less Back Pain! You’re feeling slightly better but you’re still hesitant to do anything beyond baseline. You would like to get back to your workouts, your sport, or just simply getting into and out of a car without increased ache. This is the subacute phase and is also where physical therapy is incredibly helpful in accelerating your rehabilitation. In lieu of physical therapy, this is where so many athletes choose one of two directions:
Luckily, we have a good bit of evidence supporting option number two. Those that choose light activity as compared to bed rest have a statistically significant improvement in their overall recovery timeline as supported by a cochrane review of the literature2. Once again, get active. Do a light workout as tolerated. Listen to your symptoms and stay within what your body is telling you. If you want guidance, reach out! This is what Athletes’ Potential is here for! Hopefully by day 5-10, you’ve slowly progressed back to a reasonable level of capacity. T2: Light to Moderate Activity Once again, this is where physical therapy at Athletes’ Potential excels! You’re feeling better but just need a bit more guidance to push you over the edge to get back to your activity or sport. Core stabilization, strength training, and flexibility drills are all part of this phase. This is where we can really make some quick strides in your recovery. – I won’t go into this last phase too much, as this phase isn’t the intent of this blog. Overall, I want readers of this post to know that if they are having an acute bout of back pain, stay gently active as tolerated! Don’t go out and progress too fast, and don’t ignore your back pain. Listen to what it's telling you. If it's slowly getting better, go do things such as walks, light exercise, and gentle stretching. And if you ever need guidance with this recovery, feel free to reach out to us at any time! Thanks for reading, Dr. Marcus Rein PT DPT Physical Therapist Athletes’ Potential
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 Are you like 50% of women who have an anatomical pelvic organ prolapse? That means you may have one and you do not even know it, and that is okay! However, if you are experiencing symptoms such as heaviness in the pelvis or a bulge, this new sensation can be troubling. I’m here to tell you to have no fear because there is a lot we can do to help! One of the best things you can do is begin or return to strength training - however it needs to be at the right intensity and load for your body right now. You may be thinking, “I don’t want to pick up that heavy thing, that’s going to make my prolapse worse.” Well I am here to tell you that it will not make it worse under the right circumstances. We’re going to go over what prolapse is, why strength training is important, and 3 modifications you can implement during your resistance training. What is pelvic organ prolapse? Also known as POP or just prolapse, is when there is a descent of one or more of the pelvic organs toward the vaginal opening. What this is NOT is your organs falling out of the vagina. Rather, due to life circumstances such as multiple vaginal births, hysterectomy, advancing age, we can lose the internal support structure that suspends our viscera along with general core weakness. There are different kinds of prolapse where it affects more of the anterior wall of the vagina, posterior wall, or the superior wall like the roof. Regardless of your presentation, we will work to find the best ways to relieve symptoms and get you stronger.  https://www.healthymumma.com/blog/pelvic-organ-prolapse Strength Training Helps You may have been told that you should be careful or to not lift weights at all as it will increase pressure in your abdomen and you may bulge more. Although anything is possible, with the correct training on breathing techniques, load management and positioning, I’m here to tell you lifting weights is not only possible but it’s necessary. Having a strong core and legs in the long term will put less pressure on your pelvic floor because what was once a heavy or straining activity (i.e. getting up from the floor, picking up your toddler, picking up heavy items) will be easier with your gained strength. The pelvic floor muscles do not work in isolation and strengthening the external pelvic muscles will help reduce symptoms and increase quality of life!2 3 Modifications to Try
By now, you can see there are plenty of options to try to keep you doing your workouts even though you may have a prolapse. Our goal in physical therapy is to keep you doing your loved activities as long as possible and feeling your best. People often ask if they need surgery for their prolapse and it depends on how much this taking away from your life in terms of bowel/bladder/sexual function and overall quality of life.3 Some individuals do well with a pessary fitting, which is an internal device that can help support the vaginal walls, or anecdotally, some women find relief with wearing a tampon, menstrual cup or flex disc while exercising to decrease symptoms successfully. I am helping women overcome their pelvic heaviness or bulge symptoms at our clinic in Decatur, GA. Having a specific plan for your unique situation will lead to the best results. Give us a call to schedule your appointment! In health,
Krystal Fannin PT, DPT, CMTPT, RYT-200 1Gorji, Z, Pourmomeny, AA, Hajhashemy, M. Evaluation of the effect of a new method on the pelvic organ prolapse symptoms. Lower Urinary Tract Symptoms. 2020; 12: 20– 24. https://doi.org/10.1111/luts.12277 2Maher CF, Baessler KK, Barber MD, Cheong C, Consten ECJ, Cooper KG, Deffieux X, Dietz V, Gutman RE, van Iersel JJ, Nager CW, Sung VW, de Tayrac R. Surgical management of pelvic organ prolapse. Climacteric. 2019 Jun;22(3):229-235. doi: 10.1080/13697137.2018.1551348. Epub 2018 Dec 21. PMID: 30572743. What do you think of when you hear the word core? I think of something that is central, vital, or the most important part of something. We can also think of the innermost layer, take fruit for example. Cutting an apple and removing the core, or coring a pineapple. You get the idea. Commonly, when people refer to their core, they touch their abs, their front abdominal wall. And that is just one piece of our innermost muscular layer. What is your core? It consists of four major muscle groups that work together through our movements. Beginning with the obvious is our front abdominal wall, however the deepest layer is the transverse abdominis muscle. This muscle has horizontal fibers parallel to the ground that wrap around to the back. There they meet one of the deepest layers of spinal stabilizers called the multifidus muscle or multifidi for plural. I imagine that these two muscles make an internal corset around our trunk for stability. If we think of the core as a cylinder shape similar to a soda can, we’ve described the sides. The top consists of the diaphragm, a thin flat muscle, which relatively moves up and down with our breath. The bottom of the cylinder is our pelvic floor muscles. What is your pelvic floor? This is a trampoline like structure, consisting of three layers of muscles at the bottom of the pelvis and our cylinder. The pelvic floor functions to stabilize the spine and pelvis, support the abdominal organs including our reproductive/urinary/bowel systems, controls sphincters that prevent leaking of urine/feces/gas, allow healthy sexual function, and circulates blood flow back up to the heart. How do they work together? When we breathe in, our diaphragm contracts, descending down into the abdominal cavity, which is why we may feel our belly rise or our bottom ribcage expand. As we exhale, our diaphragm returns back to its original dome shape into the thoracic cavity. Our diaphragm and pelvic floor muscles work together in functional movements like a piston. As one descends, so does the other and vice versa. This creates stability and protection to all of these muscles and structures.  Why should you care? The pressure that we manage in our intra abdominal cavity will go to the area of weakest support. In this image, the front abdominal wall commonly begins to lengthen and without proper counterpressure, that can lead to increased stress to the tissues surrounding our linea alba where our abs attach. If this is left unchecked, this can lead to a diastasis recti (DR), hernias, pelvic floor dysfunction, low back pain, and hip instability to name a few things. Having balanced forces across the torso with our everyday movements is vital for protecting your body and keeping you moving your best. However, after periods of not training, pregnancy/postpartum, prolonged sitting postures, can leave us vulnerable for these issues listed above.  If you feel like you’re experiencing the symptoms above, difficulty getting your body to “bounce back” postpartum, leaking with running and workouts, give us a call to identify your specific imbalances and begin a path toward recovery. In health,
Dr. Krystal Fannin PT, DPT, CMTPT, RYT-200 [1] The “pop can” core. Digital Image. J Smeaton. Apr 2019. [Accessed 2022 August 30]. Available from: https://www.depthtraining.ca/the-pop-can-core/. [2] Breathing variations. Digital Image. S. McLaughlin. Aug 2019. [Accessed on 2022 August 30]. Available from: https://www.alignforhealth.com/self-care-for-pain/category/core%20stabilization  Did you know that our bladder is one of the most trainable muscles in our body? This is for the good or the bad. Not that anything is that black and white, but sometimes with our lifestyle and behaviors, we can teach our bladder habits that are holding us back. Does this sound like you?
If it does, these are extremely common sentiments. However, there are ways to overcome them and treat our bladder and pelvic floor in the most compassionate way. As a pelvic floor physical therapist, here are my recommendations in accordance with the American Urological Association guidelines:
Consider making these adjustments and see if they help your symptoms. I will say that specific adjustments are needed for each individual depending on their lifestyle or where you fall on the incontinence spectrum. Seeing a local pelvic floor physical therapist, like myself, can assist you on the right exercises to be performing and steps to overcome urges or stress related leakages you experience. Thanks for reading! Krystal Fannin PT, DPT, CMTPT, RYT-200  When we first meet our clients, the usual conversation we have surrounds pain and injury. As PT’s, we are honored to be able to work with people to help them heal their injuries. Once healed, we are also honored to be able to work with these same athletes to take them to the next level in their training. From Clinical Strength Training classes to form-checks to strength training sessions, we offer so much more than a standard PT clinic! When we are working with these clients on performance and high-level training, questions routinely come up. The most common questions I get regularly are about protein and they are: “Should I take protein?” “How much protein should I take?” “What kind is best?” Let's go through these questions one by one. “Should I take protein?” Great question! What is your intent? Typically we see two different motivations for this question:
If you are an active human (most of our clients and most likely the person reading this), the answer is an absolute and definitive YES! Here’s an exhaustive list of all the well studied benefits of whey protein supplementation:
The only risks are if you have current or previous kidney or liver damage. If so, consult your physician prior to doing any supplementation. https://examine.com/supplements/whey-protein/research/#sources-and-composition “How much protein should I take?” Great! Now you want to supplement protein. How much? A general rule that has been well verified in research is that between 0.5-1g per pound of bodyweight per day is appropriate for active individuals. The more active and intense you are, the more likely you’ll want a higher amount of protein per day (more towards 1g/day). My advice? Ignore the specific grams of protein when starting. Unless you’re a bodybuilder or really enjoy the details, don’t count your grams of protein. Start simple by having one or two scoops of protein twice every day. DON’T WORRY ABOUT SPECIFICS WHEN STARTING. Just find small successes, then build off of those. If you can start with a simple habit, and are finding success by doing that habit for at least a month, you can start getting curious about specific grams of protein you are intaking per day. “What kind is best?" The most well-researched and most value-conscious (in general) as compared to meats, tofu, and beans, is whey protein. There’s a TON of different types. Don’t worry about that. Simply pick one that says “whey protein” and start taking it as I described above (1-2 scoops two times per day). If you are able to finish the first container... success! You’ve begun this journey of a thousand miles! You can build off this first step and now start looking for more specifics! I would then look for whey proteins with low cholesterol, relatively low-calorie, and between 23-30g of protein per scoop. My favorite is Optimum Protein (it's a big black and red bag in Costco) but there’s DOZENS of other great proteins that are cost-conscious and value-conscious. Hopefully this has been enough to get you started with protein supplementation. Happy fitness! Marcus Rein, PT, DPT Athletes’ Potential 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! No drills or techniques here! Today, we're going over SLEEP. We highly suggest getting that (ideal!) 8-10 hours of sleep each night, however, we understand that sometimes that isn't possible. There are a couple of things that you can do to help with those sleep deficits.
1. Tactical napping- 20-30 minute nap followed up with a quick hit of caffeine. 2. Sleep Banking- This is ideal when you know you'll be missing out on sleep soon (think time-changes or travel). To combat this, for 6 straight days, bank sleep by getting an extra two hours of sleep each night. Give these two a shot if you are short on sleep or you know you'll be short on sleep and let us know how it goes. 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 What does icing do and not do? If you have an injury that needs attention, does icing help? Unfortunately, right now, the evidence is very mixed. Some research shows that immediately following an injury and it the affected area is swollen, icing is not the best thing to do. You want blood to flow to that area and begin the natural healing process.
After a few days, icing works great to numb the pain. But the best bang for your buck is to let that area heal naturally! As always, let us know if you have any questions. We're here to help. Remember, Movement is Medicine! Reach out to us at info@athletsespotential.com or 470-355-2106. As you wander through your bedroom in the early morning, reaching for shelves that seem to shift as you approach, you realize how helpless you are without your eyesight. Instead of walking, you carefully scootch your feet step by step, hands forward like a zombie, into the inky outline of a bathroom door. Now it may come as a ‘duh’ kind of question, but why would we do this? Why would we modify our behavior to accomplish a goal that could easily have been accomplished much faster and efficiently if we just marched right through the dark towards what we thought was the bathroom? I’ll allow these gifs to speak for me:   We modified our behavior based on those memories of SLAMMING our toe into that damn table one too many times, just as we modify our behavior when anything incredibly painful happens to us. Remember that time you sprained your ankle when trail running? I’m sure you learned to be more careful with your steps! Remember that time you played volleyball for four hours and woke up like a train rolled over you, backed up, then body slammed you? Sure you do. You remember. Your body remembers. And, due to these memories, we do our best to make good decisions to avoid these painful problems in the future. The reason I’m telling you these stories is to paint a picture that our body and mind remember injuries, and that these injuries that may have occurred decades ago are still affecting our bodies today. Don’t believe me about your body remembering injuries? Research shows a good ability to predict osteoarthritis in patients decades before it occurs… the main predictor is if they’ve had a knee surgery or injury.1,2 That osteoarthritis is your body’s ‘bad memory’ of your bad night you messed up that knee. And your mind remembers injuries just fine as well… just think of one of your many injuries and I’m sure it’s as vivid as a firework on the 4th. Growing from these painful metaphorical and literal memories is a major challenge, and that challenge is met daily with the help of proper physical therapy treatment; to reset your body’s movement and your mind’s pathologically-based control of your body in order to imprint a new patterning system that accommodates your injury. In short: Unlearn old patterns. Build new ones. Grow. Let’s go through a typical case of how I teach my patients to build these new patterns: Bob Smithy Jones Fake Name Jr III comes into the clinic with back pain due to paratrooping since he was 5. He’s now 31 and his lumbar spine is comprised mostly of Legos and popcorn. He likes to deadlift small horses and fight yoga instructors to pass the time, but his lower back isn’t letting him do the things he loves. Bob is desperate. He knows he has to live with this spine for the rest of his life and is concerned with what the future holds. After going through a thorough physical movement and manual assessment, I see half a dozen regions that are contributing to Bob’s pain and dysfunction. His mechanical memories are leaping out at me from each of my assessments, and his compensations are showing me exactly how he has been subconsciously “avoiding stubbing his toe” for decades. His mental memories are evident every time he guards, takes a sharp breath, or shows hesitation when trying a new exercise. The good news is, the more time I spend with him, the more I can help him! Breaking these movement dysfunctions down, one by one, session by session, into compartmentalized pearls of digestible information for him to relearn movement is the treatment program. Some of these memories need to be processed with manual therapy, stretching, and motor control training. Some of these memories need to be processed with a good dose of strength training. Through time, grit, and trust, these memories no longer have their teeth around the throat of Bob’s aspirations. The “memories” such as osteoarthritis will always be there, but with the dozens and dozens of pearls in his toolbox, he is able to manage and grow into a new version of his old self. He is also better able to step back and contextualize the different types of pain he feels and is less fearful of his future. This is growth. Our mind is a powerful thing. Our bodies are equally powerful. Each of them twist together into a complex story that many times involves loss, pain, fear, and sadness. As a working clinician, I see this day in and day out, which is why I am so motivated to help my patients’ minds and bodies learn new movement memories they need to better live the lives they deserve. With work, these old movement memories are reprogrammed into a new movement system that can give a fresh capacity to the function of the previously painful and weak movement patterns. Thanks for reading, Marcus Rein, PT, DPT, CF-L1
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