Did you catch our last blog? If so, you’ve probably got a pretty good idea about what FAI and labral tears are. Hopefully this will make it easier for you to talk to your physician and physical therapist about your healthcare. There’s a lot of options out there, but everyone involved – patients, surgeons, and rehab professionals alike – agrees that targeted sport-specific physical therapy is essential to a full recovery, with or without medical intervention.
“Calm stuff down, then build stuff back up”. This quote from Greg Lehman, a dual-doctorate physical therapist and chiropractor, basically sums up how a physical therapist works to help you get past your hip pain and back to your sport. First – and we know athletes in particular need to hear this – the rehab process generally needs to start with a de-load. Taking time away from the activities that aggravate your hip is necessary to allow the joint to calm down and get out of an inflammatory state. However, it’s important that you stay active in ways that don’t aggravate your hip to avoid weakness and deconditioning (and to keep you sane, of course). If you have pain with running, for instance, try swimming or cycling; If you’re struggling to play a full 90 minutes of soccer, try decreasing your time on the field or avoiding drills that you know will flare things up. The decrease in load through the joint will help it calm down. If your physical therapist is familiar with your sport, they can take a look at your training plan and/or talk with your coach to determine what might look like for you, and for how long.
A physical therapist can also help decrease joint irritation with manual therapy. Especially when FAI is at play and stiffness is present, a PT can use their hands to move the head of the femur away from the acetabulum, creating space within the joint. This allows fluid to pass through the joint more easily – carrying in nutrients and carrying out waste and inflammatory cells (movement does this too, hence staying active!). Painful joints can also cause muscles to tense up, so a physical therapist can help release and relax those muscles. On the other end of the spectrum, some labral tears occur due to too much motion of the joint versus an impingement. In these cases, joint mobilization is not a good idea, but soft tissue work can be great as the muscles around the joint tense up to protect it.
Manual therapy (and similar adjuncts like dry needling and cupping) feels good, but the secret sauce of physical therapy is targeted strength training. This is how we “build stuff up”. Pain tends to shut down muscle function around the joint. This is your body’s way of protecting yourself (“it hurts, so don’t move!”). Strength training can get those muscles activated again, and research shows that strength training can actually help control pain. Your PT should be working one-on-one with you to find exercises that feel good, and don’t aggravate your symptoms.
Once you have a baseline of pain-free strength behind you, you and your PT will work together to gradually progress you back to your sport. We call this “graded exposure” to movements that become more and more sport-specific as your pain decreases and you get stronger. For most sports this means increasing the range of motion you move through, increasing the load you’re using during training, and progressively increasing your impact activity. We monitor how you feel for 24 hours following an increase in activity to make sure your hip is happy with the load, and just keep climbing the ladder from there. This is why it’s so important, as an athlete, for you to see a clinician who specializes in sports rehab. They are the only ones who understand the demands of your sport and know how to appropriately progress you back to meeting those demands on a regular basis.
If you are struggling with hip pain that’s significantly impacting your ability to train and compete, contact our sports specialist, Dr. Kate. She’s been through this too, and is here to help!
You can email Kate with any questions or comments: [email protected]
What is it exactly, and how can you get back to the things you love? Unfortunately, we hear the phrases above far too often. If you have arthritis and have had an x-ray to confirm your diagnosis, you’ve likely heard one or two of these troubling phrases. The truth is, sometimes these are a poor choice of words. I hope aim to provide you with some peace of mind, by explaining what arthritis is, the reasons why it develops, and what you can do about it.
What is Osteoarthritis?
Osteoarthritis (OA) is a condition that has been affecting an increasing amount of the aging population. It typically affects the larger, weight bearing joints in the body, but can also be found within the smaller joints of the hands, feet, wrists, etc. Development occurs when the cartilage begins to wear down over time. This can lead to increased loading of bony tissue, poor movement mechanics, or even the growth of new bony tissue usually called bone spurs.
Since arthritis usually becomes painful, it is typically associated with a decrease in activity level. This decrease, which I’m sure most of you can attest to, is out of fear of making things worse due to something a doctor or friend has told you. Interestingly enough, reductions in activity can actually increase symptoms, pain, and progression of the disease. Although it is counter-intuitive, it’s true!
Whats the deal with my cartilage?
Cartilage helps our joints absorb forces and move smoothly. Did you know that the cartilage in your joints is actually 10x’s more slippery than ice?! This is what allows our joints to flex and extend without much effort. So, whats the number one thing you can do to keep your cartilage healthy? Move! Every tissue in our body is highly specialized and needs certain stimuli to thrive and survive, and cartilage is no exception.
Lets think about the knee for example: Compression and sliding of the joint surfaces create a sponge-like mechanism for the cartilage. When compressed, metabolites are squeezed out and when relaxed the cartilage expands again taking in nutrients. It’s just like a living breathing tissue! When activity is stopped or avoided, this process no longer occurs which can exacerbate the degenerative process leading to worsening arthritis. So what can movement do for your cartilage?
- Movement stimulates the cells that make cartilage to reproduce, which allows these cells to create more cartilage.
- Movement promotes tissue nourishment.
- Movement reduces the amount of metabolites within the tissue.
Why else should you exercise for arthritis?
Just like cartilage, muscles are important for protecting joints as well. They function to not only help us move and stabilize our joints, but also to help dissipate forces going to the joints. Without adequate strength, these forces need to be absorbed by other structures (think cartilage in our joints). This is another reason why avoiding activity with arthritis can actually make the pathology worse.
People with OA are often told to avoid certain activities including squatting, running, etc. However, I believe this is the opposite of what should be done (see above). OA develops over a long period of time, not after one set of squats. Continuing to squat, run, or any other activity is not going to independently speed up the degenerative process.
That said, there are some ways to begin activity to help set you up for success:
- Slowly ramp up activity within your pain tolerance to allow the cartilage to mature and adapt
- Build a strong base of muscles to be able to dissipate the forces being placed on the joint
- Find activities that may be lower impact to build strength before loading the joint (water aerobics, swimming, etc.)
- Find a great PT to help you along the path to recovery and improvement of function
You should always discuss your options and activities with your healthcare provider before starting any new regimen or treatment. If your skeptical, we challenge you to try increasing your activity slowly, stick with it for one month, and see how you feel. I’m willing to bet you may find you have less pain.
If your not sure where to start, feel free to call to book and appointment or reach out to me at [email protected] to get started!
Here’s a great article that discusses the benefits of exercise for OA and may be a good reference for where to start. I promise it is an easy read!
Chronic back pain is caused by a number of different contributors, and is defined as back pain that lasts longer than three months or that occurs episodically. It can affect people of all walks of life, regardless of age or physical condition.
The medical community doesn’t understand everything about chronic back pain yet. Questions persist on why some people have it and others don’t; or why some episodes last longer than others; and why imaging results don’t always paint the correct picture. Imaging and blood work may even show things like lumbar degeneration or disc herniation, though these findings don’t prove useful because these positive findings often don’t come with pain or other symptoms at all. On the other hand, so many people with chronic back pain will receive no positive findings from blood work or imaging at all.
The good news is that backs are just like any other body part, and the will heal.
We do have a good understanding of some common causes of chronic back pain as well as an understanding of how pain can manifest itself. Many people experience going to bed feeling fine and waking up with significant back pain. This can be caused by swelling of a disc as it re-hydrates during the night. Another common trigger is doing something simple like reaching for the milk carton and the back suddenly spasms. This is the result of poor motor control and the spasm is a protective mechanism. Sometimes it is more obvious and we experience pain during an effort of some kind like sneezing or lifting something heavy. However focusing only on the possibility of what has been “damaged” can lead us into unnecessary imaging, inappropriate treatments and much higher healthcare costs while still not solving the underlying problem.
Pain is defined as an unpleasant physical and emotional sensation that we experience when injured OR when there is a threat of injury and no actual tissue damage present.
It is a protective mechanism our brain uses to keep us from getting hurt. It has biological components, psychological components and sociological components. Unfortunately, we can get stuck in a loop where we get very good at experiencing pain and our brain tells us our back is hurting even when nothing has been done to injure it. This short video does an excellent job of explaining further.
If you experience this, here are some things to consider.
- Your back will heal- just like an arm or an ankle. If you twist your ankle one year, and then several years later you do it again, you don’t become fearful of having a ‘bad ankle’. The same holds true for your back.
- Move around as much as you can as pain allows. Moving is better than resting. If it isn’t resolving quickly, considering seeing a chiropractor or physical therapist. They are trained to help relieve your symptoms and give you the tools needed to reduce the likelihood of future episodes, and help you learn to better manage such things on your own.
If your chronic back pain is constant and not episodic, then a multi-modal approach is best, especially if it hasn’t responded well to individual treatments. There is excellent evidence for a multidisciplinary approach as well as solid evidence for exercise therapy and spinal manipulation. You can read the full guidelines from the American Academy of Family Physicians here.
You should have a team that includes a pain management physician, a chiropractor or physical therapist and a mental health therapist that work with you to help with your symptoms. A psychologist trained in Cognitive Behavioral Therapy can be very helpful in these situations. If you’re having chronic back pain and have questions, please feel free to email me at [email protected]
Samuel S. Spillman, DC
Sleep is becoming an increasingly important issue for Americans. 35% of American adults are getting less than the recommended minimum of 7 hours a night. This affects a wide range of health issues: hormone levels, weight gain, cognitive function, depression, anxiety, irritability, and heart disease.
If you have trouble sleeping here are some tips to help you get those all important ZZZZZsss. Improving your sleep hygiene will improve your life!
- Prioritize sleep, plan to get at least 7 hours a night and schedule yourself accordingly.
- Pick a bed time. Go to bed at the same time every night, even on weekends.
- Make sure your bedroom is very dark. Use blackout curtains.
- Avoid screen time before bed, and don’t check your social media in bed. The blue light from screens will keep you up.
- Keep your room cool- we humans sleep better in a cool environment.
- Limit caffeine in the afternoon.
- And avoid alcohol for several hours before bed.
Try these tips and see if your sleep doesn’t improve over the next week or two. Let us know your results!
Exercise. Some of us love it, some of us don’t. But we all need it. Truth. It was part of daily life for previous generations before technology stepped up and made simple functions far easier. So, now we need to be more intentional about getting our bodies movie for good mental and physical health.
The US Department of Health and Human Services established recommended guidelines for exercise activity to include 150-300 minutes of moderate activity or 75-150 minutes of vigorous/intense activity per week. That’s about 2.5-5 hours of moderate activity and 1.25-2.5 hours of intense exercise per week. Moderate exercise, like a brisk walk or hike, should keep your breathing labored but you should still be able to talk. Intense exercise should have heavy breathing and you shouldn’t be able to talk.
We believe movement is medicine. That’s why we focus on it with our patients. Research tells us it’s good for your heart, brain, and body. It can boost your immune system, balance your emotions, increase your productivity, and helps you maintain a healthy sleep schedule. Exercise brings all of this good for you, but also takes time and many of us find precious time in short supply these days.
So, here are a few of my top tips to help you get your exercise on!
Walk – Take the stairs and park at farthest from entrances. Those extra few minutes of walking will really add up by the end of the week. This is a kind of exercise snacking (see below).
Have a “snack” – Research suggests that even very brief bouts of activity can accumulate to meaningful benefits. The New York Times shares ways you can fit these “snacks” into your daily routine.
Chores – Doing chores like vacuuming and scrubbing the bathtub is great exercise. You can add mowing the lawn to that list as well. So combine those chores with exercise needs and burn 165-200 calories/hour – and you can swap out that yoga class.
Micro workouts – We’re huge fans of the NYT 7-Minute Workout. This high intensity workout takes only a few minutes a day, and can be modified if the intensity is too challenging for your fitness level. We even gave it a try right here in our clinic!
Do something you like or find something new – I love jiujitsu and my love for it motivates me to exercise to keep up with my training partners. There are so many activities that speak to a number of different personalities and interest – martial arts, tennis, basketball, salsa, rollerblading, yoga, hiking, climbing, you name it. If you enjoy doing it, you’re more likely to make time doing. We’ve pulled some local resources together to help you find your groove.
Workout with a friend – It’s a great way to catch up on the latest, and get some good emotional well-being at the same time. Exercise partners help keep us honest with our commitment, and can make that accountability a little more fun at the same time.
Staying in good health is important for physical and mental. So make exercise a priority, because there is no better medicine for life!
Sam Spillman, DC
Frozen Shoulder is real, and doesn’t only occur in the winter! Generally the condition doesn’t have a definite start point, ie. patients often can’t think of an injury that started the pain. Some warning signs to look for include pain and a loss of motion in multiple directions.
Medically termed adhesive capsulitis, frozen shoulder is a condition that affects the capsule surrounding the shoulder joint. The capsule is a sheath of tissue that maintains fluid within the joint and maintains pressure, ensuring relative stability. Inflammation causes the capsule to become more fibrous and thicken. This causes limitations in range of motion and pain. If your shoulder is feeling stiff and painful, with loss of motion in multiple directions, you may be facing frozen shoulder. Identifying it early is the best
way to help effective progress.
Who gets it?
Although anyone can get this condition for a variety of different reasons, there are a few predisposing factors:
- Most prevalent in women ages 45 to 65
- Diabetes and Thyroid disease
- Previous episode on opposite shoulder
- Immobilization of the shoulder following certain surgeries
- This condition can also develop after a minor shoulder injury
There are 3 overlapping stages of the condition called the freezing; frozen; and thawing phases. Each stage has certain treatments that may be beneficial to help speed recovery, which will be discussed below.
Recovery from the condition generally takes anywhere from 6 months to 2 years, and has the following stages and interventions that can help at each stage:
The Start (months 0-3)
What to expect:
- Pain begins with no initial injury, can be sharp and/or dull in nature
- This is when inflammation occurs, but adhesions haven’t formed
- Pain most notable at endrange movements, but can be present at rest
- Trouble sleeping is common
In this stage, you should see a physical therapist for a few visits to learn exercises to maintain range and slow the loss of motion. You will also be educated on the condition and general progression through the stages.
A few tips:
- Use the shoulder as normally as possible without exacerbating symptoms.
- Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain.
- Listen to your body, if your causing a significant increase in pain you’re doing too much
- Keep contact with your PT during this stage; activity or exercise modifications are often needed
Freezing (months 3-9)
What to expect:
- Loss of motion in all directions, with external rotation and raising the arm to the side are usually most affected
- Range of motion becomes progressively worse
- Daily activities (reaching, dressing, bathing, workouts) can become more uncomfortable
- Increased inflammation and blood flow present within tissue
Physical therapy continues to be beneficial in this stage to maintain ROM and function. PT interventions will be tuned to the amount of tissue irritability the patient is experiencing.
A few tips:
- Continue using the shoulder as normally as possible
- Performing range of motion exercises will be helpful in maintaining range
- Listen to your body, if there is an increase in pain with activities and exercising, there may also be an increase in inflammation
- Keep contact with your PT during this stage; activity or exercise modifications are often needed
Frozen (months 9-15)
What to expect:
- Increased fibrosis = increased loss of motion
- Your joint will be much more stiff, but pain will begin subsiding
- Your shoulder is likely to have large range of motion deficits in this stage
You will likely be working with a home program for care at this point. Let your PT know if you have any changes that you have questions during this stage.
A few tips:
- Once again, continue using that shoulder as normally as possible
- Try to avoid movements that are too uncomfortable to complete
Thawing (months 15-24)
What to expect:
- Pain will begin improving, and eventually resolve
- Significant stiffness will remain, but will improve slowly
- Minor range of motion loss may persist after resolution
- Fibrosis of joint capsule, but decreased inflammation
The shoulder will begin During this stage you should begin appointments with your PT for more intensive stretching and manual therapy. Functional strengthening exercises will be used to begin returning the shoulder to normal.
A few tips:
- Intense stretching or manipulation techniques are not advisable in this stage, as they can lead to greater losses in mobility and increases in pain
- Begin a strengthening program that challenges your range of motion as well
- Be sure to work with your PT to develop a comprehensive program to return your shoulder to normal
Treatment of frozen shoulder can be long and arduous, but arming yourself with information can be one of the most effective tools. Make an appointment with your physical therapist or chiropractor to learn more about the condition and how you can manage it effectively. Remember, early intervention and education is essential for recovery.
Bryan Esherick PT, DPT Have questions? Email me at [email protected]
Information adapted from the clinical practice guidelines Shoulder Pain and Mobility Deficits: Adhesive Capsulitis from the JOSPT.
Nine out of 10 Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 95 percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease; the headache itself is the primary concern.
The majority of primary headaches are associated with muscle tension in the neck. Today, Americans engage in more sedentary activities than in the past, and more hours are spent in one fixed position or posture (such as sitting in front of a computer). This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.
What Can You Do to Prevent?
The American Chiropractic Association (ACA) offers the following suggestions to prevent headaches:
- If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion.
- Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics.
- Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headaches.
- Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.
- And of course make sure you are getting regular check ups with your chiropractor! Research shows that spinal manipulation improves migraine and cervicogenic headaches.(1)
(1) Bryans R, Descarreaux M, Duranleau M, et al. Evidence based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011; 34: 274-89.
CBD oil is gaining in popularity and is showing up everywhere – across the web and on store shelves everywhere. But, many of us are just hearing about it and have some questions – so let’s take a closer look.
CBD stands for cannabidiol – and it is a compound found in both cannabis and cannabis sativa (better known as hemp).
While both plants have hundreds of compounds that may be pharmacologically active, the best known is THC, which has a psychoactive component. However, both plants also contain CBD which also has pharmacological effects but NO psychoactive component. The CBD products at health food stores, grocery stores, and doctor’s offices are sourced from hemp and have no psychoactive properties.
OK, but why is it suddenly all over the place?
There are a number of reasons. It has been found to help with certain seizure disorders and recently the Virginia board of medicine has added it to the legal formula and it can now be prescribed for this purpose. But it is also available over the counter. The recent Farm Bill in 2018 among other things, designated CBD products to be “generally recognized as safe” or GRAS, which means it can be added to food stuffs and sold. For the time being the FDA and DEA have not taken any steps to change that, although they could at any time. Common side effects may include tiredness, diarrhea and changes of appetite/weight.
What can CBD oil do and why would anyone take it? Well in addition to the above mentioned anti seizure properties, there is some limited research that suggests that CBD oil can help people with chronic pain, as well as with sleep, and anxiety. Now the research is far from conclusive and there are many more double blind random control trials that need to be performed before the science and medical communities are going to get behind this being a new cure-all. However, as it has been generally recognized as safe and there are anecdotal reports popping up everywhere with people touting its benefits, people are flocking in droves to try it. We began carrying these products after a few patients requested them and they’ve proven to be very popular with patients for pain relief.
Samuel S. Spillman, DC
Have you ever experienced knee pain when beginning a new activity or increasing training volume? Does this pain go away after the warm-up, but come back the day after or when stopping the activity? You may have been of the lucky ones if these symptoms were short lived and went away within a few days. For many, this pain can become a chronic issue and affect everyday activities like sitting, stair climbing, and walking. This chronic condition is characterized by pain in the patellar tendon.
Jumper’s knee, runner’s knee, or patellar tendinopathy are all synonyms for this common condition. It generally affects the adult population ranging from 16-40 year olds, but can affect anyone if a training schedule is not properly developed. The tendinopathy is generally due to overstressing a poorly conditioned tissue, which can eventually lead to tendon dysrepair. Just like your muscles, bones, tendons, and ligaments also have to be trained to meet the demands you are putting on them. The reasons for pain with this condition is poorly understood, but it is believed that the brain and central nervous system play a big role in sensitization of the tissue. Once this process begins it is hard to reverse, which is likely why symptoms can last anywhere from a few weeks up to 2 years.
No matter the activity, whether you are increasing your training volume, load, surface, or equipment the degenerative process may begin. The importance of ramping-up training or allowing appropriate time for tissue adaptation can not be overstated. This is why this injury is more prevalent at the beginning of a sporting season or training regimen. Have you ever wondered why marathon runners are very calculated in their training regimens in terms of increasing mileage? This condition is one of the reasons, as all tissues take time to adapt. Remember, the preseason is what prepares your body, and may be the most important part of the season to reduce injury risk.. Check out our upcoming blog in the spring on how to prevent training injuries.
As always, better outcomes are seen with more timely interventions versus the wait and see method. Treatment is generally aimed at reducing pain, reconditioning the tissue, and improving proprioception in the joint and surrounding tissues. Eccentric and heavy slow resistance exercises have been shown to be the most beneficial in treating this condition, and certain protocols have been established. Since everyone’s tendon quality and pain levels may be different, it’s essential to ensure you are starting at the right level for your state; if the tendon is stressed too much during recovery, the tendinopathy cycle will repeat itself and may become worse. Remember, there is no established timeframe for recovery, so being patient with recovery is important. The good news is that you can usually continue training, but it is best to consult your physical therapist about possible changes in impact training, training load, or training volume. Cookie cutter approaches to treatment won’t work, so be sure treatment is properly adjusted to meet your needs.
Bryan Esherick PT, DPT
As heart health awareness month comes to an end, we want to highlight the wonders of cardiovascular exercise – help clarify exactly what it is – and remind you to keep your heart healthy all year long.
Cardiovascular exercise – or cardio – is defined as any activity that gets your heart rate up. Now, that’s a pretty wide definition which is great because that means you can choose from a ton of different activities – some that you might enjoy more than others, and that means you’ll be more apt to get your body moving more. You could choose anything from: running; dancing; using the elliptical; rock climbing; swinging a kettlebell; playing tennis, basketball, soccer, football; practicing martial arts; taking classes like zumba, kickboxing, or jazzercise… and the list goes on and on – even sex can count! The idea is to choose activities you enjoy, and shift your mind from thinking it needs to be something you don’t like doing.
The benefits are cardio are huge. Most people immediately associate cardio as a weight loss tool, and it’s true that it is a big benefit. But there are so many other wonderful benefits to highlight as well.
Here is a list of health benefits you may have not have associated with cardio:
- MENTAL HEALTH:
- improves mood
- fights depression
- relieves anxiety
- improves cognitive function
- stimulates nerve creation
- boost self esteem
- builds social relationships
- PHYSICAL HEALTH:
- improves cardiovascular health
- lowers risk of all causes of mortality
- decreases risk of heart disease
- improves blood pressure
- lowers cholesterol
- relieves pain as exercise increases pain tolerance
There is also some evidence to suggest that regular exercise effectively slows how quickly our bodies age by helping to repair the little proteins at the end of our DNA strands – called telomeres – which can help to keep us younger and fitter longer. Perhaps we have found the Fountain of Youth after-all!
The secret is to find something you enjoy and like doing, and stick with it. For me, it is martial arts. I’ve trained in it my whole life and get my cardio from Brazilian Jiujitsu and running. Bryan plays hockey and likes to use the rowing machine, while Dongjin plays soccer and Megan opts for aerobic dance. Think about what gets you moving – and of you’re not moving, give us a call and let us help you get started. Who knows, you just might find a new passion or hobby that will help keep you fit for life.
–Sam Spillman, DC