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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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What do you call a pig’s leash? A HAMSTRING Now that I have your attention, let’s dive into this much-needed blog post. I’ve been seeing a number of hamstring injuries in the clinic and on the field, so this blog will focus on what you can do to recover from a hamstring injury. Disclaimer: This should not be used as medical advice. If you are dealing with an injury, please seek out a local Physical Therapist or healthcare provider. So, let’s get started: Anatomy of the Hamstrings: The hamstrings are comprised of 4 different muscles (5 if you include the adductor magnus, but we’ll keep it simple here). These 4 muscles are:
All cross both hip and knee joints except for the short head of biceps femoris and are innervated by the tibial/fibular divisions of the sciatic nerve. These muscles work together to extend the hip and flex the knee. Mechanism of Injury: If you watch any video with a hamstring strain, it typically occurs when an athlete is decelerating (slowing down). The muscle is being loaded while it is lengthening (eccentric loading) – which is where we tend to be the weakest. Acute Stage: When someone first strains their hamstring, there’s a few things you can do to help optimize the recovery process. Follow the guidelines of POLICE:
Once you’ve put some of this in play, you can start to implement some soft tissue and mobility techniques. It’s important to note, loading is going to be the most important component in this process. Soft Tissue and Joint Mobility The goal here isn’t to release any adhesions or scar tissue. We’re just trying to decrease some sensitivity and pain to allow other movement opportunities and progressive loading. Tack and Stretch Loading This is where we build strength and resiliency in the hamstrings. Here’s our loading progressions in a nutshell: Isometric Loading 🡪 Isotonic Loading 🡪 Heavy Slow Resistance Training (high load/low velocity exercise) 🡪 Slow Stretch-Shortening Cycle 🡪 Fast Stretch-Shortening Cycle Isometric Loading Glute Bridge – Isometric Hold Variations (Dosage: 3-5 sets x 15-45 second holds) Isotonic Loading (Dosage: 3-4 sets x 10-20 reps) Glute Bridge Straight Leg Glute Bridge Band Pull Through Hamstring Roll Out Heavy Slow Resistance Training (high load/low velocity exercise) Kickstand RDL Nordic Hamstring Curl Half-Kneeling Hamstring Slide Slow Stretch-Shortening Cycle 🡪 Fast Stretch-Shortening Cycle Band Step Down Kettlebell Swing Supine Band Kickdown Standing Band Kickback – Slow Standing Band Kickback – Fast Single Leg Plyometrics Hamstring Tantrum – Supine Hamstring Tantrum – Prone Knee Bend What’s the biggest risk factor for a hamstring injury you ask? A previous hamstring injury. Make sure to take the appropriate steps to get your hamstrings taken care of. You don’t want to be that person that looks like a sniper took them out. 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 Did you know that 70-85% of ACL injuries are typically non-contact? Or, that female athletes have a greater risk of ACL injury compared to males playing similar sports? It seems like every week you hear about another athlete who tears their ACL. In the NFL, 36 season-ending ACL injuries have been reported this year. Three took place this past Sunday, including a non-contact ACL injury by 49er’s QB Jimmy Garoppolo. What’s even worse is when it comes from a celebration… A contact ACL injury seems to justify itself more so than a non-contact ACL injury. These season-ending injuries can have a huge impact on an athlete. Not only is it a long and costly process, but it can take a toll on you as an individual from a physical and mental standpoint. Take it from someone who has had two ACL injuries himself. I’ve even talked to parents who keep their kids out of sports due to the risk of an ACL tear. After my first ACL injury, my mom begged me to stop playing football and cheer my team on from the stands…HA! Love you Mom, but no way was that happening. I had to come back to play my senior year and it was 100% worth it. My second ACL tear was non-contact and didn’t come until six years later – which has fueled me on a path to help those who have suffered this same injury. So……Can ACL injuries be prevented? Prevented? Not really. Reduced? Definitely. Prevention means that we can stop something from happening, which means we can predict it. We’re not quite there yet. Reduction means we are making it smaller or less in amount, degree, or size. We have proof of this. For simplicity's sake, you will still see prevention and reduction used interchangeably, but keep in mind what we discussed above. A powerful research study came out this year by Webster et al. 2018 - Meta-Analysis of Meta- Analyses of Anterior Cruciate Ligament Injury Reduction Training Programs. It conclusively shows that 50% of all ACL injuries and 67% of non-contact ACL injuries in females can be reduced with the simple implementation of 2-3x per week of injury reduction/prevention programs. Some important components of these programs are: Dynamic Warm-Ups Foundational Strength Proprioceptive Training Plyometric and Power Development Acceleration/Deceleration, Multi-directional Sport-Specific Training In later posts, we will break down these different components of a well-designed injury prevention program. At Athletes’ Potential, we design and implement these programs often to help our athletes, whether you’re someone who has had their first surgery or an unsuccessful rehab experience. It is our goal for the athletes we work with to return to their sport not only physically prepared, but mentally as well. Please feel free to reach out to our Docs if you have any questions. Cheers, Dr. Ravi, PT, DPT, CSCS |
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