Could your tight hip flexors be the source of your hip or back pain?
Have you ever been checked?
Fall has arrived. Amazing colors once again. Should you stretch your hamstrings before hiking thru the fall colors? Read on to see if you should…or if you shouldn’t….
I want to share with you what my staff and I have learned to maximize your health and wellness and to keep you up-to-date on the happenings at OrthoWell. So read on and let’s keep you on track.
Do you really need to stretch your hamstrings??
So what if I told you that there is actually very little research that substantiates any long lasting effects of stretching? What if I also told you that you may not even have to stretch your hamstrings to get a release of the stiffness? Would that make you stop stretching or does stretching actually make you FEEL good?
I have been practicing PT for 26 years and I can honestly say that my patients have had some pretty amazing results with the soft tissue work that we do in combination with stretching exercises. Just look at our Success Story page. If you are reading this right now, you may actually be one on them. There are some things that get our patients better that may not have a lot of research-substantiated evidence.
In a 2010 article by Wepppler and Magnusson, they point out that there is only a transient mechanical increase in length of tissue after stretching. In other words, the muscle stretch recoils after the stretch is removed. How long the stretch lasts depends on the magnitude and the duration of the stretch. So then, how hard should you stretch and why do we only hold our stretches for 30-60 seconds?
We have used the evidence gathered from the study of tissue deformation or biorheology to determine that the optimum amount of time to acquire the most dramatic “viscoelastic” elongation of tissue is between 30-60 seconds. Yes, there is a much more gradual elongation after that time but who has the time to wait…right? There was a study in 2004 by Guissard and Duchateau that showed partial maintenance of tissue elaongaton 30 days after the program when patents were performing 20 minutes of stretching 5 days per week. So yes, you reap what you sow when it comes to the time spent stretching.
The Sensory Theory of stretching means that we achieve an increase in length while stretching due to a “stretch analgesia” effect in which “it doesn’t hurt as much” so you FEEL as though you can stretch further into the range. So what is wrong with that? If you stand all day and your hamstrings are working overtime to keep you upright and stable, what happens to the tissue? It becomes “stiffer”. This may be due to scar tissue, waste products, and trigger points that form due to this constant state of contraction. Intuitively, it makes sense to perform massage and stretching to counteract these effects. However, is this the cure for the stiffness? Gary Cook, a world renowned PT, who has revolutionized the way that we that we think of functional training would say unequivocally NO!
Gary Cook claims that the “stiffness” we feel is reflexive. It is due to the stabilizing effect that our muscles need to perform on a daily basis in order to control faulty movement patterns and faulty postures. Some parts of our bodies are stabile and other parts are very mobile. For example, your lumbar spine tends to be mobile or “sloppy” as Gray Cook would say. Many people are unaware of how to engage their core or how to perform proper body mechanics to prevent stress to the lumbar spine. Our hamstrings can be the first line of defense when it comes to stabilizing the spine.
If you are unaware of how you stand, you could be placing your pelvis in an anteriorly rotated position. When your pelvis rotates forward, it places a “pinch’ or a stress on your lumbar spine. Your hamstrings will consequently contract in order to correct your alignment and “pull” your pelvis posteriorly. What happens when you squat or roll out of bed? If you are not engaging the proper core and hip muscles then your hamstrings continue to fire in order to stabilize your spine. There you have it. The viscous cycle for constant hamstring stiffness.
So how do you become more stabile? First of all, you need to become reacquainted with your core. Just doing planks may not be enough. You need to be evaluated to determine any faulty movement patterns. If you don’t correct the faulty patterns, then you are reinforcing bad habits and putting yourself at risk for injury. Gray Cook has developed Functional Movement Screens to determine exactly where your deficiencies are. In addition to this, we have put together a version of the Selective Functional Movement Screen in our clinic. Based on the results of our screen, there are many types of corrective exercises that can be instructed to get you back on track.
In conclusion, you need to realize that “stiffness” anywhere in your body could be multifaceted.- especially with your hamstrings. Does this mean that you should never stretch or massage your hamstrings? NO. Stretching can certainly make you FEEL better but you need to realize that stretching alone may not be the cure. In the words of Gray Cook
“If the body doesn’t stabilize correctly, it will figure out another way to get stability: it’s called stiffness.”
So what you THINK is causing your stiffness may NOT be the reason. We all need to think outside the box. You are guaranteed that when you come to see us at OrthoWell PT
All the Best!
Drinking the Cross Fit Kool-Aid!
Harry feels better now than ever before…
I enjoy CrossFit because it consistently gives me a good workout. The workout ideology of CrossFit prides itself on never falling into a routine. This means every workout is something new that will not only work you out in a new way, but also help you to identify some new skill that you could improve upon. When working out with good form and responsible weight/volume, the benefits of Crossfit also translate to your functional daily activities. After a year of Crossfit I can truly say I have witnessed these benefits during my day to day activities.
MOUNTAIN RUNNING CHAMPION..
As many of you have heard in the clinic I do a lot of mountain racing. This past weekend I had the luck to have a repeat win at one of the hardest races in the circuit. Check out my interview on levelrenner.com to get a little glimpse into the head of the Female winner Leslie and myself about how the race went down and up in this case.
Prevent Your Pain from EVER coming back
Click the link to read about
this new option at OrthoWell
Our wellness maintenance program is for those of you who want consistency of care after being discharged from physical therapy in order to prevent any reccurence of pain. We have three different plans the we offer that you can read about by clicking the link above.
SUCCESS STARTS HERE!
“I would like to thank Chris, Katie and crew for the outstanding care I received after my Achilles surgery. Their knowledge, experience and attention to detail allowed me to expedite my recovery. Thank you.”
– Marc S.
FREE INJURY SCREENING
Dont forget to take advantage of our Try Before You Buy program.
We offer a FREE, no obligation injury screening for YOU, a FAMILY MEMER or a FRIEND. Just click the link below or send it to someone who may need our help.
I want to share with you what my staff and I have learned to improve your experience at OrthoWell and to remind you how awesome you CAN feel. Read on and let’s get you back on track.
Are you looking for a way to help those in need this holiday season?
Here’s how we can do it if we work together.
As a way of serving our community, OrthoWell Physical Therapy will be donating $10 for each new patient that comes through our doors through the end of 2015 to either of two awesome organizations in Beverly called Beverly Bootstraps or in Amesbury called Our Neighbors Table.
Let’s do this together!
Over the past several months I have been noticing a trend of increased number of patients complaining of neck pain which has sparked my interest to participate in continuing education focused on neck pain in order to get the best results for my patients. I recently completed a 16 hour course focused on cervical (neck) pathology at the Institute of Manual Therapy where I was able to refine my skills and apply new knowledge to all of my patient with neck pain.
So if you or someone you know is suffering from neck pain because life can certainly be a “pain in the neck”, then come on in. You are always guaranteed the most up-to-date, comprehensive and holistic physical therapy at OrthoWell.
“OrthoWell PT has given me my life back, no doubt! After 3 months of knee pain with every step I took, I feared for my job as a nurse and my normally active lifestyle was severely curtailed. Surgery was an option, but without guarantee for improvement.
After just one session of PT and 1 laser treatment i was able to walk without limping. After 1 month of therapy and new orthotics, I am closing in on 100% return of function and I am thrilled with the progress.
The holistic approach used by Chris and his team is unique compared to other PT experiences I have had. I highly recommend OrthoWell PT as the best option out there!”
For those of you who don’t know, we are offering another specialized service at OrthoWell PT. It is called Trigger Point Dry Needling. Our new PT, Katie Moulison,DPT, is certified in dry needling and she has been performing this technique for 2 years as well the past several months in our clinic. I have created a comprehensive web page devoted to trigger point dry needling. CLICK HERE. It is another one of those techniques that not everyone knows about. It is a technique that can have a profound effect on the chronic pain associated with trigger points and myo-fascial restrictions.
Here is a video that we made in-house about trigger point dry needling. It includes an explanation of trigger points as well as a demonstration of the actual trigger point dry needling technique. It will give you a much better understanding of the technique and may even encourage you to come in for a FREE session to try it out. Just give us a buzz and we will get you in the schedule. The video will be available on our trigger point dry needling web page as well as a comprehensive Q&A section. Don’t forget to share with your friends!!
CANCER- I FOUND A CURE!!
My subject line is no joke. I really did find a cure for cancer!!
The realization will come as quite a shock to many of you.
I spend a lot of time reading and talking about health and fitness. I thoroughly research each and every blog post before I share it with you. Patient education is a top priority at OrthoWell and it is an integral part of our mission statement. We really DO care about you and your health. For this reason, I feel obligated to share the following information.
I was introduced to a book by one of my patients that may change or even SAVE your life! The title of the book is Outsmart Your Cancer by Tanya Harter Pierce. I have had the unfortunate experience of getting a phone call by my father that he has bladder cancer. The realization, of course, was more unfortunate for him. This came up in the conversation with my patient as we broached the cancer subject. She shared her experiences regarding her own cancer history and then she began to open my eyes, my mind, and my anger to the realization that our medical establishment is intentionally misinforming the public about cancer. Some of you may be saying “yeah, right, why wouldn’t my doctor tell me if there was a cure for cancer?” or, like my father said, “yes, I have heard these things before” but then he dispels the “myth” and decides to go through with his radiation and chemo. Don’t get caught up in the “disbelief factor”. I am telling you, from the bottom of my heart, not to be naïve and not to stay ignorant to this realization. You NEED to read this book as my words alone will not do it justice.
Outsmart Your Cancer is not a promotional vehicle for a new cancer pill or a new cancer prevention diet. As a matter of fact, the author does not promote any one single approach to curing cancer. Her objective is to share with us all that has been hidden from us. Yes, there are MANY alternative treatment options to both prevent and to cure yourself of cancer. Her introduction to cancer was the same as mine. The realization that a loved one may die from cancer! I would like to share some excerpts form the book regarding the misinformation campaign that has been waged on the public.
In the author’s words:
“I have also discovered that for many of these cancer approaches, the way they work has been proven by rigorous scientific research performed by highly respected physicians, brilliant biochemists, and Nobel prize-winning scientists. Effective alternative approaches to cancer ARE obtainable today, and they are not bogus methods developed by quacks and kooks as the public has been led to believe.’
“During my research, I spoke to over 100 people who had recovered from their cancers using the alternative treatments presented in this book.”
“The suppression (of information) has been carried out in many different ways by many different organizations and is simply the result of business economics and common unethical tactics that tend to occur when large money interests are involved in any field.’
‘Surgery, chemotherapy, and radiation involve billions of dollars of profits for the industries that supply them… the cost of developing and bringing a new cancer drug to market is close to $1 billion… A treatment made up of natural ingredients is not patentable… A natural form of treating cancer will never be pursued by a drug company… alternative treatments will always be considered an economic threat to the multibillion-dollar cancer establishment.”
If you want to watch a YouTube video to convince yourself of the misinformation campaign that has been waged by the FDA and American Medical Association, then watch this video on Dr Burzynski’s treatment for cancer. CLICK HERE.
So when should you start an alternative treatment approach if you’ve been diagnosed with cancer?
As soon as possible! Unfortunately, most people start with conventional treatment before they try alternative approaches. It is the fear and shock factor associated with “I have Cancer” that makes people decide prematurely regarding the BEST treatment option. They usually start with the big three…chemotherapy, radiation therapy, and surgery. Don’t become a statistic. Get educated!
So how do you make an educated decision on what treatment path to follow after you’ve been diagnosed with cancer?
Outsmart Your Cancer spells it out in simple terms and in black-and-white. There ARE options…successful options that have cured thousands of patients with cancer. All you need to do is read and/or listen (a DVD of patient testimonials comes with the book).
So when do you start a cancer prevention program?
NOW!! Outsmart Your Cancer will empower you to start a prevention program today. Scrutinize what you put into your body. Yes, you ARE what you eat. Don’t forget to read my post on Vitamins-To Take or Not To Take for more information.
Because I WANT to be your advocate for health and wellness and because I WANT you to stay cancer-free, I am stocking Outsmart Your Cancer in my clinic. I feel that strongly about the information in this book! I have purchased them in bulk so the wholesale cost is only $20 per book. Don’t delay! Get the facts!
Other things that could change your life that are discussed in the book include:
ACIDIC vs ALKALINE
Did you know that it has been scientifically proven that cancer cells cannot survive if the environment is alkaline enough? Did you know that the QUALITY of what you consume determines whether your body becomes acidic or alkaline? Many people, either with cancer or attempting to prevent cancer, strive to maintain their body pH at an optimal alkaline range between 7.0 and 7.5. Your body pH can be evaluated by a simple saliva test using pH strips in the privacy of your own home. So how do you do this? I’ll give you the answer even though you need to read more about it…CALCIUM. One of the most important roles of calcium is to help our bodies maintain proper pH levels. In addition, the absorption of calcium into the body is completely dependent on the levels of vitamin D in the intestinal tract.
WOMEN -THE PILL – HORMONE REPLACEMENT THERAPY
Do you really understand the effect of synthetic hormone replacement therapy? Outsmart Your Cancer discusses what every woman NEEDS to know about the effects of The Pill and hormone replacement therapy. You need to really be aware of the things that your doctor is NOT telling you. Long-term clinical studies have proven the cancer-causing effects of synthetic hormone replacement therapy. Get the facts!
MEN-TESTOSTERONE & PROSTATE CANCER
As for the men, did you realize how controversial conventional treatments are for prostate cancer? There are studies in the medical literature which contradict the current use of testosterone inhibiting drugs to lower your PSA level. It has been shown that testosterone actively INHIBITS cancer growth and that elevated PSA is actually a man’s defensive strategy for fighting prostate cancer. So then, why does the medical establishment advocate the exact opposite approach?
DENTAL FILLINGS & MERCURY
Did you know that the main component of silver fillings is mercury and that mercury is one of the most deadly substances on earth if ingested? Did you know that your dentist is not required to tell you that your filling contains mercury? Did you know that several European countries have band silver-mercury amalgam feelings for decades but they continue to be used in the United States? The toxic nature of amalgam feelings has been down-played by the American Dental Association for a century in spite of warnings to dentists to “never touch the amalgam with your fingers” and “it must be disposed of under strict toxic waste protocols.” Dentists who have been outspoken against amalgam fillings have lost their licenses to practice. Outsmart Your Cancer references a book written by one such dentist who describes the alleviation of multiple sclerosis and Parkinson symptoms as well as cancer via the removal of amalgam feelings. Once again, get the facts.
There is SO MUCH more in Outsmart Your Cancer. The rest is up to you!!
DEEP TISSUE LASER THERAPY IS HERE!!!
For those of you who haven’t been in to see us recently, we have been using a demo class IV laser device from Litecure since the beginning of June and have been getting some amazing results. We were so impressed with the results that we “bit the bullet” and purchased our own laser. A very worthwhile investment for OrthoWell and for the health of all of our patients.
I have added a page on our website that provides a comprehensive explanation and videos of the benefits and effects that a class IV deep tissue therapy device provides. In a nutshell, the laser uses photon energy to stimulate chemical reactions at the cellular level. Research has demonstrated an increase in metabolism, a decrease in inflammation, a decrease in pain, and an acceleration of healing at the treatment site. In other words, the application of laser in combination with our manual therapy and exercise techniques is getting our patient better even FASTER! It has also been extremely beneficial to conditions that have NOT been responsive to our traditional physical therapy interventions.
If you are interested in trying laser or if you feel that your symptoms have plateaued, then laser may be the answer that you are looking for.
We want you to experience the benefits of deep tissue laser therapy so we are announcing a special offer. Call us now to schedule a FREE laser treatment. We will introduce you to laser therapy and provide a laser treatment FREE of charge. Let us know what works for you!
(Courtesy of Freedigitalphotos.net)
CROSS FIT 101
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 evidence that 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’.
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?
EXCESSIVE SPEED + EXCESSIVE MOBILITY = POTENTIAL PROBLEMS
Image courtesy of FreeDigitalPhotos.net
For those of you that “feel a need for speed”, you need to beware of the risks. In an article 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.
Guess what happened to them? Yup….Tommy John surgery to fix a torn ligament in their elbows. So then…
EXCESSIVE SPEED + EXCESSIVE MOBILTY + BAD TECHNIQUE = DEFINITE PROBLEMS
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 article on 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 post for 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:
• Dynamic stability
• Proper flexibility
• Maximum strength
• Proper tissue quality
• Proper throwing mechanics
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.
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!!