First of all, you need to understand the difference between aerobic and anaerobic exercise. Aerobic exercise requires oxygen, is low powered and lasts for greater than 15-20 minutes. Anaerobic exercise, like Cross Fit, does not require oxygen, is high powered and each exercise lasts less than 2 minutes.
The Positives: Recent studies have shown that anaerobic exercise is a vastly superior protocol for fat burning than it’s less intense aerobic counterpart. There is evidence that shows that anaerobic exercise is evenly matched to aerobic exercise with regard to cardiovascular benefits. Check out the evidence in an article in the Journal of Strength and Conditioning. More evidencethat comparable calorie burning effects can be achieved in half the time with anaerobic exercise.
The Negatives: Potential for INJURY! The article in the Journal of Strength and Conditioning also states that 16% of the participants dropped out due to “injury or overuse”. In addition, in 2011, the U.S. military, in conjunction with the American College of Sorts Medicine, advised soldiers to avoid CrossFit, citing “disproportionate musculo-skeletal injury risk.” You can read it HERE. In 2009, the US Military was encouraging training programs such as CrossFit. You can read it HERE. So what happened?
CrossFit goes out of its way to warn people that if they can’t maintain proper technique, they should back off. After all, the CrossFit mantra is “Mechanics, Consistency, Intensity”. Backing off , however, is a hard sell for many participants because workouts are viewed as a competition. The 2009 US Military study states that “Properly trained coaches are fundamentally important in both establishing an effective training program and developing proper movement mechanics in athletes.” It sounds like something, or someone, went wrong between 2009 and 2011.
So I guess the biggest question that you should ask (before joining a local Cross Fit gym) is WHO is running the classes and HOW they are trained. Make sure they at least have Level I or Level II Cross Fit training. A power lifting background is very helpful as power lifters are obsessive about proper form. Make sure you observe a class or two to witness how or if the instructor is scrutinizing and ensuring proper form. The proof is in the puddin’.
I have created several videos to demonstrate HOW and WHY we make custom foot orthotics at WalkWell Foot Orthotics to treat various foot pain conditions. You can share the links to these videos with friends or family members who may be suffering from foot pain and who are looking for answers. The conditions I cover are:
1. Plantar Fasciitis
2. Metatarsalgia ( ball of foot pain )
3. Supinated or High Arch Foot
4. Specialized Foot Orthotics
5. Sesamoidits ( pain under big toe )
6. Posterior Tibialis Dysfunction ( pain on inside of ankle )
7. Hallux rigidus / Hallux Limitus ( Big Toe Pain )
In my last post, I highlighted elbow injuries in the throwing athlete. Lets review!
“For many pitchers, the first sign of impending trouble with the UCL(ulnar collateral ligament on inside of the elbow) is pain or stiffness in the flexors of the forearm. The flexors and pronators of the forearm are the active restraints and the UCL is the primary passive restraint to the extreme valgus forces that occur at the elbow during terminal cocking phase and early acceleration. Did you know that when the UCL is tested in isolation during cadaver studies that it only takes 32 newton/meters of force to rupture it? Guess how much valgus stress is on the inside part of the elbow during terminal cocking phase….64 newton/meters!! It has been shown that the UCL takes on 35 newton/meters of that force. Yikes!! So why doesn’t it rupture? It doesn’t rupture because the rest of that stress is controlled by the active restraints…your muscles in the forearm. You can probably guess what happens when you ignore your forearm muscles?”
It is my job as physical therapist to not only emphasize prevention of an injury but to provide the most effective treatment of an injury. This video demonstrates the use of Active Release Technique, Graston Technique, and a compression flossing technique to treat elbow pain. Check it out!!
Is surgery the next step? We read a study that found no statistical difference in the outcomes of people with knee pain that received arthroscopic surgery and those that received a ‘sham’ surgery! So, before rushing to go under the knife, be sure you convince yourself that all conservative resources have been exhausted and you have truly given your body a chance to heal. Check out the study by clicking HERE.
We reviewed an ARTICLEin Precision Nutrition about the effects of chronic inflammation and how to combat it with exercise. Researchers are using the term “cold inflammation” to describe chronic inflammation because it doesn’t have the typical hallmarks of acute inflammation such as fever, heat, or swelling. Cold inflammation is an inflammatory process caused by every day exposure things such as pollution, nutritional deficits, and chronic stress (what’s that?). An uninterrupted cycle of cold inflammation has been linked to obesity, diabetes, and heart disease.
This article presents a study published in the Medical Science of Sports and Exercise Journal. The study looked at two groups of healthy, yet obese, post menopausal women. The control group was given patient education and sedentary activity. The other group was given a moderate general resistance training routine to be done 3 times a week for 12 weeks. The results included a reduction of specific inflammation cells between 18% – 33% and an increase in an anti-inflammation markers by 20%!
By working with a health care professional or personal trainer to develop a safe resistance program, you can significantly improve your health and reduce your risk of disease.
Crunches are not the answer! The Huffington Post put out an ARTICLE on ‘traditional’ abdominal exercises and how they can actually injury the connective tissue in your core. The strength of a muscle is only as good as the structural support system around it. The article give some general exercise but for a more detailed foundation on how to train the core muscles refer to our blog post HERE.
Throwing a baseball is the fastest known human movement. The speed of the throw from a professional baseball pitcher can be upwards of 7000 degrees per second. Now that’s fast! In addition to that, the shoulder is the most mobile joint in the human body. So what does this mean?
For those of you that “feel a need for speed”, you need to beware of the risks. In anarticle from the Journal of Sports Medicine, twenty-three professional pitchers were followed over three seasons. Those pitchers who were throwing at the highest maximum velocity suffered the highest incidence of elbow injuries. So how does that effect you? It is vitally important for the throwing athlete to understand the stresses that repetitive throwing places on young as well as mature joints. In the words of baseball trainer phenom Eric Cressey, “injuries occur when you ignore the things that need to be addressed, plain and simple.” In one of my previous blog posts, I talk about how it has been scientifically proven that strength training enhances athletic performance. Shoulders and elbows become problematic not only because of muscular weakness, but also from poor flexibility, poor tissue quality ie scar tissue and, of course, faulty mechanics. For example, consider the dreaded inverted or upside down “W” exhibited by the Yankees’ Joba Chamberlain or the National’s Stephen Strasburg.
Just because a joint is flexible does NOT mean that it is stable. Consider the six phases of throwing and all the potential areas of instability when throwing at maximum velocity. Our objective should be to achieve dynamic stability during ALL phases. Yes, if you are stiff we are going to stretch you and if you are loose we are going to stabilize you…but what about the gray areas? Every major league pitcher suffers from a loss of shoulder internal rotation for at least 3 days after an outing. This is a situation when you do NOT stretch. The resulting loss of motion is due to the micro-trauma of eccentric load during deceleration and needs time to heal. It has been shown that the posterior aspect (the back part) of the shoulder joint capsule actually thins out after repetitive throwing. So let me ask you, should we ever stretch the posterior aspect of the shoulder joint? Or should treatment focus more on the scar tissue that results in the decelerators?
So what are the most common upper extremity baseball throwing injuries? These injuries include the problems associated with overuse or improper training such as: • Impingement syndrome • Rotator cuff tendonitis • Biceps tendonitis • Medial elbow pain from flexor-pronator tendonitis
These overuse injuries can lead to more serious conditions such as: • Rotator cuff tears • Labral tears • Ulnar collateral ligament (UCL) tears
We have many manual tests that we can perform in the clinic to differentiate and determine what structures may be involved in YOUR specific case. In the case of impingement syndrome, I have previously posted a BLOG articleon the different types of impingement syndrome as well as a VIDEO demonstrating the tests that we use to differentiate rotator cuff versus labral dysfunction. It should be noted that a condition called scapular dyskinesis can lead to impingement syndrome. This condition is characterized by an imbalance of scapular motion relative to shoulder motion. It is the result of weakness in the muscles that stabilize the scapula during the throwing motion. I have also listed some of the best, evidence-based exercises in a previous postfor specific shoulder and scapular retraining.
It is very important for your therapist to differentiate between what we call active restraint or passive restraint structures. Active restraint structures are those things that contract and relax like your muscles and tendons. Passive restraint structures are things like ligaments ie UCL, cartilage ie labrum and meniscus, and discs ie intervertebral discs. I would like to highlight the UCL of the elbow as one example of this. For many pitchers, the first sign of impending trouble with the UCL is pain or stiffness in the flexors of the forearm. The flexors and pronators of the forearm are the active restraints and the UCL is the primary passive restraint to the extreme valgus forces that occur at the elbow during terminal cocking phase and early acceleration. Did you know that when the UCL is tested in isolation during cadaver studies that it only takes 32 newton/meters of force to rupture it? Guess how much valgus stress is on the inside part of the elbow during terminal cocking phase….64 newton/meters!! It has been shown that the UCL takes on 35 newton/meters of that force. Yikes!! So why doesn’t it rupture? It doesn’t rupture because the rest of that stress is controlled by the active restraints…your muscles in the forearm. You can probably guess what happens when you ignore your forearm muscles?
As mentioned earlier, imbalances in flexibility, tissue quality, biomechanics, or weakness can lead to stress on both active and passive restraints during the throwing motion. Invariably, the process of repetitive throwing leads to the development of scar tissue. There is a constant state of break-down and build-up that occurs during sport specific activity. I have blogged on problems with scar tissue and the debate on whether pain arises from tendonitis or not. I have also explained the benefits of the Graston Technique as a way to ensure that scar tissue does NOT inhibit your ability to throw.
Now, what blog post is complete without a little twist. After listing the most common injuries that we see in the throwing athlete, I would like to share a list of conditions that have been confirmed via MRI in athletes that have NO pain:
* 79% of overhead throwing athletes have labral tears * 34% of athletes have rotator cuff tears * 82% of athletes have disc herniations
Does this mean that you may ALREADY have a tear and that you are currently asymptomatic like the athletes in the previous studies? Yes, you may. Does this mean that your future hall of fame career is over? No, it doesn’t. Some practitioners are of the opinion that you may very well need a labral lesion to throw hard in the first place. The biggest challenge with this is ensuring that the throwing athlete develops all the things that we have talked about in this post:
It is ALL these reasons that make it vitally important to be as educated as you can about your shoulder mechanics and to be aware of the important role that training and physical therapy play in keeping you healthy. It is our role as your physical therapist and performance specialist to guide you with you in this process. Here is an example of an effective warm up program for baseball players by the former trainer for the Boston Red Sox, Mike Reinold,PT. CLICK HERE.
Understanding throwing biomechanics in combination with a thorough knowledge of the anatomy and function of the shoulder and elbow is imperative to properly diagnose and treat the throwing athlete. Your prognosis for a healthy return to competition after arthroscopic surgery or ligament reconstruction has dramatically improved especially when you are in the right hands during recovery. My job as a physical therapist is not only to effectively rehabilitate your body after surgery but, more importantly, to help PREVENT the need for surgery in the first place. Of course, this is a two way street. I can only be your coach if you are a willing and motivated player.
I have treated a lot of foot pain over 22 years as a physical therapist. Because I make custom foot orthotics, I am exposed to foot ailments much more than other PT’s. Geoff and I treat a lot of these problems in the clinic every day. One of my patients even went so far as to nickname us the “foot whisperers” and another patient coined OrthoWell as the “doctors of knotology”. Can you feel the love? I have spent a lot of time researching the BEST strategies to treat foot pain. This has culminated in the release of my Ebook entitled “Physical Therapist Discovers the Truth about Plantar Fasciitis“ as well as my self-help DVD on the treatment of Foot Pain & Plantar Fasciitis. Both of these are now available and are on my HOMEPAGE.
The Ebook includes a complete review of the literature on the treatment of plantar fasciitis as well as a description of the the most effective treatment strategies. This book is not a re-tellling of on-line information about plantar fasciitis. It is the missing link! You can read more by clicking HERE.
The DVD is a collection of videos that will “take you by the hand” and teach you specific methods and exercises to resolve your foot pain. It is designed for those people suffering from foot pain who cannot come to see us or who have not responded to other practitioners. It is a great way for our SUCCESS STORY patients to help friends and family members who have foot pain but cannot come to see us directly. You can read more HERE. Watch the intro video below. Talk to you soon!!
I am excited to announce a new program being offered at OrthoWell Physical Therapy. It’s called our Friends and Family Appreciation Program. We’ve been really fortunate to have received much praise and appreciation for the quality of our physical therapy services. You can see for yourself at our website on the Patient Testimonialsand the Patient Satisfaction Survey pages. We are truly grateful for all the kind words that our patients have shared with us and have shared with their families. Truly, the best way that our patients can say thank you is to refer a friend or family member to OrthoWell for physical therapy or to WalkWell for custom foot orthotics. A very important part of our mission statement is to “establish lifelong partnerships with our patients and with the community in optimizing health and wellness.”
It is only fair that we show OUR appreciation for your referrals by offering YOU a referral discount that can be applied to a maintenance physical therapy session or to your next pair of custom foot orthotics. We are offering a 20 dollar appreciation discount on each and every friend or family member that you refer to us who either starts physical therapy services or purchases a pair of custom foot orthotics. All you have to do is make sure your friend or family member mentions YOUR name and we will keep the running tally of all of your referrals. It’s that easy!
So why should you refer to us? Hopefully, you refer because you want your friend or family member to receive the same quality of service that you did. I would like to share with you two recent patient stories as further reason WHY you should refer to us.
Patient #1: This patient received physical therapy at two different clinics within the past 6 months for a diagnosis of low back pain. She came to OrthoWell because her symptoms were unresolved. Upon evaluation, it was determined that she presented with a 1 cm undiagnosed leg length discrepancy which was contributing to her lumbar scoliosis. She was issued a heel lift. She also was not thoroughly reeducated in lifestyle and work modifications in order to control the biomechanical stresses that were being placed on her lumbar discs as a result of her gardening. She responded extremely well to a McKenzie extension program in combination with manual traction and spinal stabilization exercises. Her pain was completely resolved after 7 visits! Lesson #1: don’t assume that you tried physical therapy and it didn’t work! It is all about the RIGHT physical therapy!
Patient #2: This patient was a graduating physical therapy student who came to us for treatment. She acknowledged that upon completion of her PT program she did “not feel confident with her training in outpatient orthopedics.” She reported that her orthopedic physical therapy teacher in PT school “hadn’t been in the clinic for years.” Unfortunately, this lack of experience is the result of inadequate training with some of our PT training programs. Lesson #2: don’t assume that your physical therapist is adequately trained. Know it…by coming and referring to OrthoWell!!
The other part of our mission statement is to “maximize your results in minimal time using the BEST in evidence based care, comprehensive evaluations and patient education.” At OrthoWelland WalkWell, you don’t have to worry whether you are receiving a comprehensive evaluation or whether your therapist is properly trained. So, please, refer your friends and family members so they can experience the same quality results that you did.
What do you think of when you visualize someone who is really stressed out? It sure seems like some people are wound tightly these days. I have had my own issues with stress. I’m sure you have too. I find myself talking more and more with my patients about the effects of stress and how beneficial diaphragmatic breathing and proper nutrition can be. We will discuss nutrition in an upcoming post. You also need to be aware of other possible manifestations of stress like increased muscle tone, rapid heart rate, palpitations, increased blood pressure, GI distress, mood swings, loss of appetite, and sleep disturbances to name just a few. These symptoms make living a happy, relaxed and “normal” life much more difficult.
So what about the relationship between stress and breathing? Breathing occurs at a very primal level. If you don’t breathe, you don’t live! Your body will do whatever it takes to draw air into the lungs. Instead of using the diaphragm, it may recruit other accessory muscles in your neck or low back. This pattern reinforces poor posture and causes impaired flexibility which can promote shallow, ineffective breathing. It prevents the ability to exhale fully and to perform a proper, full diaphragmatic breath. Lets review what that means.
First of all, when performing a diaphragmatic breath, your belly should expand outward. This is due to the downward movement of your diaphragm as you inhale. Secondly, your lower ribcage should expand. Thirdly, your upper ribcage will expand during a maximal inhalation. Your ribcage should expand as a unit. It should NOT elevate. Movement of your ribcage upward, shoulder shrugging, or contraction of your neck muscles are all signs of faulty breathing patterns. Remember that slouched sitting and forward head posture encourages shallow breathing and prevents full, complete expansion of your ribcage. We discussed breathing pattern disorders in relation to CORE activation during my last post and video demonstration. Here it is in case you missed it:
So what does the research say about the link between pain and breathing disorders? A very interesting phenomenon is the prevalence of pain syndromes that are NOT caused by a specific organic illness. Katon & Walker (1998) noted that patients with the most common physical symptoms (i.e. abdominal pain, chest pain, headache, back pain), are responsible for half of all primary care visits in the USA, and yet only 10%–15% of these are found to be caused by organic illness! All these symptoms are well recognized as capable of being the result of breathing pattern disorders.
Perri and Holford (2004) evaluated 111 patients attending a chiropractic pain clinic and found 56.4% demonstrated faulty breathing on relaxed inhalation, increasing to 75% when taking a deep breath. 87% reported a history of various musculoskeletal pain problems. Based on this population, they observe that: “Chances are 3 in 4 that new patients seen today will have faulty breathing patterns.”
So what does the research say about the effects of breathing exercises on stress? Remember, stress reactions are controlled by our autonomic nervous system i.e. sympathetic and parasympathetic. Fight or flight? In Pal and colleagues, breathing exercises were shown to enhance the parasympathetic (inhibitory or calming) effects and decrease the sympathetic (excitatory) effects of muscles and nerves. They improve respiratory and cardiovascular function and improve both physical and mental health. Convinced yet?
So how do you begin breathing exercises?The first step is understanding that the relaxation response has to be relearned. You need to learn how to identify and turn off the stress response. As stated by Kabat-Zinn, “you need to learn how to replace negative thoughts and physical tension with regular practice of ‘calm stillness of mind and body’ “. Buddha is in the house! The next step is to schedule regular daily practice. You need to invest 10-15 minutes at least one time every day. According to Leon Chaitow, we need to “restore an energy-efficient, low chest, nose-breathing pattern with a relaxed pause at the end of exhalation”. He calls it “low slow nose breathing”. Initially, lay comfortably supported by pillows in a quiet room. Progress to sitting once a positive outcome is achieved in lying. You need to reinforce proper posture at home, work, and car and realize that breathing and relaxation techniques only help eliminate the symptoms, not the causes of stress. Be honest about making realistic lifestyle changes. The video below demonstrates a method that uses both breathing and physical relaxation techniques.
Remember that breathing drives everything that happens, both good and bad, throughout our entire bodies. So breathe right to live right!!
