My Road To Recovery After A Weightlifting Injury

As told by Jason Bourgeois, former patient of Therapydia NOLA physical therapy and wellness clinic. 

Last March, I tore my left quadriceps tendon (see injury below). I’d had an old injury that caused some scar tissue build-up and calcification. While doing some routine training, that scar tissue finally had enough and ruptured.

The Injury:

 

After getting the news from the doctor in the Ochsner ER, I figured my weightlifting days were over. After surgery, I connected with Jonathan Burke, a physical therapist at Therapydia NOLA. I wanted to work with him because of his background in CrossFit. It was important to me that my PT understand what I was trying to work back to.

Seated Bike in April:

 

Airdyne in May:

 

Putting In The Work

We first worked on gently restoring passive range-of-motion (ROM) on my affected side. When we reached the first set of ROM goals, we then focused on the kinetic chain – ankle, hip and lumbar spine – and restored strength to each of these areas.  During each treatment session, I worked one-on-one with Jonathan. Therapydia’s individualized approach to physical therapy really sets them apart from other PT clinics.

After several months of hard work, I was able to squat for the first time at the end of May. I worked with Jonathan to restore my range of motion and movement patterns during that time. We set the goal of getting back to 80% of my previous lifts in one year.

First Squat (May):

 

Squat 135lbs (June):

 

Nine months to the day from my injury, I exceeded my goal by a significant margin and completed a Snatch 286 lbs in December:

 

I honestly did not believe I would get back to that kind of weight in such a short time, if ever. Working with Jonathan helped me immeasurably. He understood what I was going through, what I wanted to accomplish and helped me get there. He pushed me when I needed it and restrained me when I wanted to go too quickly. I cannot recommend Jonathan Burke, DPT and Therapydia NOLA highly enough.

Why Ab Separation Happens During Pregnancy

Pregnancy Ab Separation Treatment Therapydia

What is a Diastasis Recti?

Most of the physical changes that come along with pregnancy are strictly temporary. Unfortunately, some physical issues don’t resolve immediately after you give birth. Abdominal separation, or diastasis recti formation, is commonly seen within the pregnant/postpartum patient population with 2/3 of women experiencing some degree of separation pre or postpartum. Abdominal separation happens when your rectus abdominis or abdominal muscles become lax and disconnects midline at the linea alba. If you recently had a baby, it’s key to know how to identify if you have abdominal separation before returning to any workout routine in order to prevent injury and further separation.

Unbalanced Abs, Unbalanced Body

Abdominal separation is usually something a new mom might not even know she has. However it is important to check seeing how it interferes with the way your core muscles work together, leading to postural deficiencies and increased risk of injury centered around your body having an inability to stabilize your core. These deficiencies can result in or contribute to a variety of symptoms such as:
• Low back pain
• Sacroiliac pain
• Hip pain
• Stress incontinence (urine loss when laughing coughing or sneezing)
• Prolapse (when internal organs fall or slip out of place)

How To Check If You Have Ab Separation?

You can identify if you have a diastasis recti by doing a simple self-test.

• Lie down on your back with knees bent at 90 degrees and feet flat
• Place fingers of one hand horizontally across midline of abdomen at the belly button
• Slowly raise your head and shoulders a few inches off the floor
• If a separation exists your fingers will sink into a gap/ditch with your right and left muscles to the side
• Note the number of finger-widths that can be placed between the muscle bellies
• Check at your belly button, above, and below

If you feel a separation of 2 to 3 finger-widths or greater you are considered to have a mild Diastasis Recti, and 4 to 5 fingers width is a moderate to severe separation.

Healing Your Deep Core

First of all don’t panic or stress if you feel you have an abdominal separation. This is a very common problem where there are specific exercises that can help with the healing process and facilitate for full abdominal closure. To enable healing it is important to limit abdominal stressors involving lumbar flexion. This is characterized as the forward movement of your body such as crunches or when moving from your back to sitting upright when getting out of bed. Movements like this potentially lead to greater abdominal separation rather than closure. Correct movements are targeted towards having strong deep core activation with targeted transverse abdominis activation.

Transverse Abdominis Activation

Therapydia Pregnancy Physical Therapy

• Maintain a flat back with a chin tuck and shoulders over wrists
• Keep your hips and toes tucked under
• Inhale while causing for outward and upward movement in your back body/ribs
• Then exhale and pull your ribs up and in from your stomach
• Perform 6 to 7 breaths of 3 sets while being careful to not over breathe to limit any lightheadedness or dizziness

Closing The Gap

Your abdominal separation is something that should be reassessed every 2 to 3 weeks checking for closure with a proper exercise program established.

Experiencing ab separation postpartum is unique to everyone’s body and pregnancy journey. If you feel limited or uncomfortable because of the weakness in your core, don’t hesitate to contact us if you have any questions. Although some cases may be mild enough to solve on your own, some cases may need to be seen by a physical therapist who specializes in women’s health and pelvic floor therapy.

By Whitney Braswell Fedor, PT, DPT, Specialized Woman’s Health Physical Therapist via Herman and Wallace Institute, Kineticore Dry Needling Level 1 and 2 certified practicing at Therapydia NOLA in Metairie. She can be reached at (504) 324-8345.

Self-Assessment Episode 3: Squat Mobility Vs. Stability

In the first post we looked at ankle mobility. We demonstrated the half kneeling ankle dorsiflexion assessment to see if poor ankle mobility was a contributing factor making it difficult to deep squat with proper form. We then moved up the kinetic chain with the supine knee to chest assessment and the seated tibial internal rotation test to see if the hips or knees were making it difficult to deep squat with proper form. If you passed those tests with flying colors, but your deep squat remains less than perfect; you could fall into the group of athletes that have great mobility but lack the ability to control/stabilize movement through these ranges. By definition mobility is the ability of a joint to be moved through its range of motion. Stability refers to the body’s ability to control movement through the available range of motion.

Goblet Squat & Stability

Today we will assess an air squat versus the goblet squat. This serves as a quick assessment to see if the athlete/client is able to achieve full depth while squatting. Clients often times demonstrate the ability to sink into a full squat, but will reveal some type of movement fault. One of the most common faults we see is the loss of lumbo-pelvic position, the dreaded “butt wink”. This position is not optimal for loading. Now we assess the goblet squat using a 20 lb. kettle bell. The kettle bell acts as a counterbalance and allows the athlete to keep their hips underneath them. If the athlete is able to maintain proper positioning throughout the entire movement you can conclude the athlete has the mobility to squat, they many need to work on patterning and stability of the abs, pelvic floor, and diaphragm to create the counterbalance.

The goblet squat is used as a teaching tool for the athlete to work on proper position during the deep squat. As patterning and stabilization increases the athlete should reduce the weight of the kettle bell, reducing the external counterbalance. Goblet squats are a great warm-up exercise for squat day. I will demonstrate some stability drills in quadruped and half kneeling in the following videos to help with and create the counterbalance needed not to lose proper spinal positioning while squatting.

Quadruped Reach

• Start on all fours
• Rock back until your hips are lower than your knees to mimic the bottom of the squat
• Maintain a neutral trunk position
• Reach one arm straight ahead slowly while trying not lose balance or rotate trunk
• Alternate arms or complete a same side series
• 10 repetitions

Half Knee Chop

• Attach tubing at a high point of attachment
• Kneel with outside knee down
• Both knees should be flexed to 90 degrees
• Narrow your base to within 6-inch width of knee of one leg and heel of the other
• While maintaining a tall/upright position, pull tubing down and across the chest while keeping it close to your body
• Shoulders should turn minimally and your head should face forward
• All action should be done with the arms
• Tubing should come across the body from shoulder to hip, keeping your hands close to your chest throughout the movement
• 5-7 controlled repetitions on each side
• If to challenging, can also perform in tall kneeling position (both knees on the ground)

Half Kneel Lift

• Attach tubing at low point of attachment
• Kneel inside knee down
• Both knees should be flexed at 90 degrees
• Narrow your base to within 6-inch width of knee of one leg and heel of the other
• While remaining tall and upright, pull tubing up and across the chest while keeping it close to your body
• Shoulders turn minimally and your head should face forward
• All actions done with the arms
• Tubing should come across the body from hip to opposite shoulder
• Keep your hands close to your chest throughout this movement

Goblet Squat

• Hold kettle bell with two hands in front
• Keep kettle bell close to your chest
• Base of support feet are shoulder width apart, feet slightly turned out
• 3 points of contact big toe/little toe/heel
• Squat straight down keeping kettle bell close
• Spine is in neutral from neck through upper back and lower back
• Trunk will be positioned slightly forward to mimic the bottom position of a loaded barbell squat
• Knees track over 2nd and 5th toes
• A variation to promote an upright torso would be to stand 6-8 inches in front of a wall and perform goblet squats
• 3 sets of 5 slow repetitions
• Can also be performed in-between warm-up sets on squat day before hitting your work sets

Resources:
SFMA (Selective Functional Movement Assessment).
Voight ML, Hoogenboom BJ, Cook G. The Chop and Lift Reconsidered: Integrating Neuromuscular Principles into Orthopedic and Sports Rehabilitation. North American Journal of Sports Physical Therapy : NAJSPT. 2008;3(3):151-159.

Preparing Your Body For Pregnancy

Pregnancy Physical Therapy Therapydia

Pregnancy is a time of wellness accompanied with tremendous musculoskeletal, physiological and emotional change. Many women experience these changes with pain and discomfort, which can actually be prevented. There are specific muscle groups that can be trained to help you adapt and better prepare your body for pregnancy. The idea is to combat the strain that is put on the areas of the body that are carrying the weight of the growing baby by improving muscular support and strength. These areas include the lower back and sacroiliac joints.

How Does Your Body Change During Pregnancy?

During pregnancy there are many different changes that occur within you body, but for the sake of this blog, let’s focus on the changes related to the musculoskeletal system.

Most important of all the connective tissue changes occur primarily with the release of hormones, relaxin and progesterone. These hormones cause tendons and ligaments throughout your body to become more elastic, allowing for a greater stretch to occur across joints, and in turn causing for overall joint hypermobility. This “stretch” is a good thing because it allows your body to accommodate the growing baby, and also helps facilitate the baby coming out during delivery. However, with this increased elasticity comes your body’s need to rely more on muscular support and stability within the pelvis to combat joint hypermobility.

Also, core muscular changes occur primarily due to the stretching of muscles, specifically within your abdomen and pelvic floor. This stretching increases as the baby grows, which in turn, decreases your ability to elicit a strong muscle contraction due to the muscle tension relationship. However, if these areas are trained and/or strengthened prior to or during pregnancy, they can help combat this stretch for decreased episodes of lower back pain and stress incontinence.

In this article, we are specifically looking to help decrease the occurrence and severity of the common issues of pregnancy:

• Lower back pain
• Sacroiliac/pelvic pain
• Hip pain
• Urinary stress incontinence

Building Body Core Strength

Avoiding strain on your body during pregnancy involves strengthening the muscles around your core and pelvis area. If you go into pregnancy with strong core and hip stability, you’re going to be able to help combat these issues allowing for an easier time carrying the baby and for a faster recovery post-baby.

Clams:

Therapydia Pregnancy Physical Therapy

Therapydia Pregnancy Physical Therapy

• Lay on side with hips in a stacked position towards the ceiling
• Knees at a 90-degree angle and hips in line with knees
• Keeping ankles together, raise top knee towards the ceiling
• At the same time, lift at the hip and keep hips forward
• You can place your hand behind your hip to keep your hips from rolling backwards
• Return to start
• To increase resistance you can add a cuff weight around the lateral thigh or apply an elastic band slightly above both knees
• Perform 30 repetitions once a day

This is important with pregnancy to help strengthen the muscle surrounding the sacroiliac joint by helping to prevent sacroiliac issues with enhanced glute and hip external rotator stability.

Kegal/Abdominal Bracing:

Therapydia Pregnancy Physical Therapy

• Lay on back with knees bent
• Pull up and in with the vaginal opening as if you are trying to stop the flow of urine
• Make sure to not squeeze your bottom and to not tighten your muscles in a way that will change the neutral position of the spine
• Perform 30 repetitions with a 2 second hold 2 times a day

This is what I call a secret exercise because when performed correctly the outside observer will see no movement. This exercise is important to help counterbalance the stretching of the pelvic floor that occurs with pregnancy which can help to decrease incontinence issues during and post-baby.

Quadruped Multifidi Activation:

Therapydia Pregnancy Physical Therapy

Quadruped Multifidi Activation

• Start on your hands and knees (shoulders and hips at 90 degrees)
• Tighten your back and your stomach by pulling your belly button to your spine internally and holding
• Without shifting your pelvis and keeping the neutral position of the spine, pick one knee up slowly while also making sure to hold the opposite hip in the same position
• Then perform with the other knee as well
• Perform 20 repetitions on each side (pain free exercise)

When performed correctly, this exercise helps to strengthen your core in the back and abdomen region. It also helps to strengthen your hip external rotators causing for greater sacroiliac and hip stability.

Mobilizing Your Pregnancy Muscles

Knowing how your body is going to change is key to preventing physical discomfort and pain during pregnancy. Strengthening specific areas can lead to a smoother pregnancy, birth, and rehab post-baby by combatting any musculoskeletal imbalances.

Contact Whitney Braswell at Therapydia NOLA if you have any questions about prenatal care and strengthening. We can work with you to design a treatment program that’s unique to your body and your pregnancy.

By Whitney Braswell Fedor, PT, DPT, Specialized Woman’s Health Physical Therapist via Herman and Wallace Institute, Kineticore Dry Needling Level 1 and 2 certified practicing at Therapydia NOLA in Metairie. She can be reached at (504) 324-8345.

Self-Assessment Episode 2: Squat Flexibility In Your Hips & Legs

CrossFit Deep Squat

In Part 1 we found out if limited ankle mobility is a contributing factor limiting full depth in your squat. Hopefully, the ankle mobility drills shown in the second video of Part 1 have been helpful.

From here we will move up the kinetic chain to assess the hip and knee. The test we will review came from Gray Cook’s Selective Function Movement Assessment (SFMA). Once we have checked ankle mobility, we then proceed to assessing the hip and knee. These tests are done in a non-weight bearing position without contribution from the ankle. If you are able to achieve the full supine knees to chest position with grabbing both shins (thighs to lower ribs, calves to hamstrings, without low back losing contact with the floor) you do not have to perform the knee screen. This position indicates your hips and knees are able to move through the range of motion required for deep squatting.

Hip Mobility Assessment

• Supine knees to chest holding shins
• Bring both knees up to chest, this should mimic squat stance by separating feet to shoulder width
• Grab shins and try to touch thighs to lower rib cage and calves to hamstrings
• If can’t get calves to touch hamstrings due to knee tightness have athlete grab thighs instead of shins and repeat pull
• Do not allow for low back to raise off the ground
• Assess for painful pinching in the groin or front of the hip compared to a stretching in the back of the hip

4 Hip Mobility Drills

Hip Opener

• Start in a push up position
• Bring the knee of the side you are mobilizing up to the same side hand
• Rotate the leg so that the shin and foot are forward toward the opposite hand
• Rock body bak until pull is felt in the lateral aspect of the forward leg
• 3-5 second holds 10-15 repetitions

Spiderman Crawl with Glute Activation

• Start in push up position
• Step right foot outside of right hand
• Foot should remain in contact with ground (three points of contact big toe/little toe/heel)
• Back leg remains straight
• Squeeze glute of front leg and bring knee out to the side
• 10 repetitions each side

Adductor Rock Backs

• Start on all fours
• Bring right knee out just outside of right hip
• Right hand in line with right knee
• Straighten left leg out to the side try to position left foot so it is in line with left hip
• Rock back as far as you can feeling pull in the left leg
• Progress to elbows
• 10-15 repetitions each side

Wide Squat

• Start with a wide stance
• Rock your body over to one side maintaining three points of contact with the foot. (big toe/little toe/heel)
• Modify range if you notice you lose three points of contact or knee drives inward over big toe
• 5-10 repetitions each side

Tibial Internal Rotation Test

• Sitting on a box with knee flexed (choose a box that allows you to obtain your full squat depth)
• Keep the knee flexed and the torso upright
• Rotate foot in maximally keeping entire foot in contact with the ground
• The fifth toe should be able to clear the midline of the kneecap

Tibial IR Mobilization

• Start in half kneeling position
• The leg that is forward is the one we are mobilizing
• Three points of contact with the foot, big toe/little toe/heel should be touching the floor throughout mobilization
• With both hands right below knee take up the slack in the tissues moving shin into internal rotation
• Maintaining this position drive knee forward over 2nd-5th toe, not letting knee move inward
• Perform two sets of 20-30 reps
• Mobilization can also be performed with a mobility band

Physical Therapy First With Direct Access

Therapydia Physical Therapy New Orleans

On June 6th, Governor Edwards of Louisiana signed a Direct Access bill that allows patients to see a physical therapist without needing a doctor’s referral or prescription. With Direct Access, being able to see a physical therapist without a doctor’s referral or prescription reduces treatment delays. Most musculoskeletal issues, sprains, strains, or movement imbalances can be effectively treated with physical therapy.

What Do Therapydia NOLA Physical Therapists Do?

Our physical therapists treat a wide range of conditions. They work one-on-one with patients using hands-on techniques, or manual therapy, as the foundation for treatment to diagnose and heal soft tissue and joints. They complement manual therapy with corrective exercises. The therapists use a combination of methods to be able to customize your treatment to your injury or condition as much as possible. They’ll collect baseline measurements of how exactly your body moves with your injury or condition and tailor your treatment so you have complete range of motion and pain relief. Because of our unique one-on-one care, the patient is assessed and reassessed at every visit, enabling us to see progress or make changes to treatment plans as needed.

Why Is This Good For You Athletes?

Most sports these days require athletes to reach higher and more intense performance levels. Pushing yourself hard to reach your training goals is a part of being an athlete. Unfortunately, this could also increase your risk for sports-related or overuse injuries. Having physical therapy services directly available gives athletes the option of having a full-body assessment and treatment before they even have an injury. Physical therapists are trained to analyze an athlete’s movements within their specific sport and mobilize areas of muscle weakness with manual therapy. They’ll know exactly which muscles need strengthened across the entire body for an athlete to have more power and prevent any injuries. A preventive program will allow an athlete to spread the force of training across all of their muscles instead of overusing a specific set.

Why Should You See A Physical Therapist First?

If your injury is related to the way your body moves, a physical therapist can treat it. They mainly focus on healing your injury by using non-invasive manual techniques to build stability, flexibility, and strength across your entire body. Besides just treating your injury, they treat movement dysfunctions all across your body to prevent any future injuries. Therapydia NOLA will work with you to create a unique treatment program and help you reach your wellness goals. Call us at Therapydia NOLA if you have any questions on how to get started with a physical therapy program.

Swimmer’s Shoulder: How To Prevent The Pain

Swimmer's Shoulder Treatment Therapydia

Swimming is a popular activity for both recreational purposes and athletic endeavors. It provides a great cardiovascular and “full” body workout in a pleasantly buoyant environment. Unfortunately, as with any form of exercise, some participants can experience pain and discomfort. Pain in the shoulder is the most common complaint among swimmers. This pain is typically in the front of the shoulder and can be felt when the arm is lifted overhead.

Shoulders Are Key Spots For Injury

Swimmer’s shoulder can be due to a condition called shoulder impingement. Impingement occurs when we have a tendon (part of a muscle) get compressed against a bone. In swimming, this can occur during different phases of the swim stroke.

Swimmer's Shoulder Treatment

Normally, the tendons of the shoulder glide easily between two bones when a person lifts his or her arm overhead. In the case of swimmer’s shoulder, the tendons can become pinched which causes pain.

Factors That Throw Your Shoulder Off-Balance

So what causes shoulder impingement? Here are some potential contributors:

1. Muscle Weakness

The rotator cuff muscles are supposed to pull the arm bone (humerus) down so it can clear freely underneath the top of the shoulder when a swimmer lifts his or her arm overhead. If those muscles are weak or get fatigued from swimming long sets, they can’t do their primary job of controlling the humerus and impingement can occur. The muscles of the trunk and those surrounding the shoulder blade (scapula) provide a stable base for the shoulder to move effectively. If those muscles become weak or do not function normally, the shoulder can be at risk for impingement.

Shoulder Impingement Physical Therapy Treatment

From this side view, we see the limited space the supraspinatus and biceps tendons have to clear underneath part of the scapula during arm movements.

2. Muscle Imbalances

The muscles in the front of a swimmer’s chest become strong during the pulling phase of swimming. On the contrary, the muscles of a swimmer’s upper back may become stretched and weak. That muscle imbalance can cause our shoulder to move forward in position and lead to poor alignment causing pain with overhead movements. Another sign of muscle imbalance is a forward head posture.

Swimmer's Shoulder Posture Treatment

Poor posture affects the position of the shoulder and limits the space it has to move.

3. Poor Spinal Mobility

An adequate amount of movement in the bones of a swimmer’s neck and thoracic spine (the middle section of the spinal column) is necessary to move successfully through the water.

Swimmer's Shoulder Treatment

If there is a limitation in a swimmer’s spine, the shoulder may become more mobile to make up for the loss of motion. This increase in shoulder joint mobility can lead to impingement.

4. Faulty Swimming Body Mechanics

Poor swimming technique can contribute to the aforementioned problems. Breathing to just one side, poor body rolling, and significant increases in training volume can all lead to faulty body mechanics and result in shoulder problems.

How Do We Fix Impingement?

The first step in properly diagnosing and treating shoulder pain is to schedule an evaluation with a physical therapist. He or she will assess the causes of the shoulder impingement and implement appropriate treatments to decrease pain and improve function.

Appropriate exercises to improve rotator cuff strength are necessary to address weaknesses. In addition, the muscles of the trunk and those surrounding the shoulder will likely need strengthening and stability exercises. For stiff spinal joints, the physical therapist will provide joint manipulations to improve range of motion. Tight musculature can be addressed with soft tissue mobilization, dry needling, and passive stretching. Discussing strategies to improve shoulder position in the water during swimming will also help assist in the reduction of pain and prevention of future injury.

Jessica Hernandez, PT, DPT, MTC, CSCS is a Doctor of Physical Therapy working at Therapydia Nola in Metairie, LA. She competes regularly in triathlons and is a 2x Ironman 70.3 finisher. You can read her complete bio at therapydianola.com.

Self-Assessment Episode 1: Breaking Down The Deep Squat

CrossFit Injury Prevention

Often times I see athletes in the gym or speak with clients in the clinic that are spending precious time performing mobility drills that aren’t improving their pain or increasing their performance. If your shoulder feels tight while performing an overhead squat, you must have a shoulder mobility limitation, right? There are numerous studies that have linked dysfunction in one part of the body with pain and dysfunction in another part of the body. Without an assessment, we are blindly spinning our wheels in the hopes of improving our performance.

I am very excited to start this assessment series to share with coaches and athletes some of the things I see in the clinic that contribute to pain and dysfunction. This assessment is geared to the pain free athlete to help them move more efficiently, decrease risk of injury, and improve performance. If you are injured or experiencing pain, you should seek medical attention before athletic activity. I encourage everyone to perform assessments and reassessments as part of their daily routine to ensure that the applied mobility is beneficial.

Assess Your Squat Flexibility

I want to kick off the assessment series by breaking down the deep squat. We will start by assessing closed chain dorsiflexion, which is the position the ankle is in during the bottom of the squat. Dorsiflexion describes the movement when you bring the top of your foot and your shin closer together.

When this motion is limited or stiff, an athlete may toe out excessively. They’ll have trouble keeping their knees over their toes or their heels may lose contact with the ground which will force them forward. If you’re not as flexible and it’s difficult for you to move your knee forward align with your toe, you’ll compensate by putting more strain on your knees and hips. Besides pain in your knees and hips, these imbalances could lead to pain in your back as well. Depending on where you feel limited around your ankle, this assessment will give you an idea as to whether you need to improve flexibility. You might need to work on mobilizing a joint or specific muscle around your ankle. The goal is to have no pain and fluid movement when going into your deep squat.

Finding Your Ankle Limitation

Key Points:

• Find the issue that’s affecting your deep squat
• Start four inches from the wall and perform in half-kneeling
• Drive your knee forward and keep it in line with the second toe
• Neutral arch and heel in contact with the floor
• Repeat on opposite leg
• Do you feel a stretch in the calf or above your heel?
• Or do you feel more of a restriction in the front (joint)?

Stretching Out Your Feet & Ankles

Key Points:

• Self-myofascial release techniques with foam roller
• 5 to 10 passes from heel to knee on outside/middle/inside of the back the leg
• 10 to 20 repetitions on each side of half-kneeling ankle stretches
• 10 to 15 repetitions on each side of elevated foot stretches
• 10 repetitions of squatting while elevating balls of the feet
• 5 repetitions of goblet squat

This post was written by Jonathan Burke, DPT, the Clinic Director at Therapydia NOLA. His primary professional focus is sports medicine and treating musculoskeletal injuries and conditions. Jonathan is certified as a CrossFit Level 1 trainer and coaches at a local box in the New Orleans area. Additionally, he’s Manual Therapy Certified, a Certified Strength and Conditioning Coach, and Functional Movement Systems Certified.

Sciatic Pain, Are You Suffering? Louisiana Residents Now Have Direct Access to Physical Therapy!

LOUISIANA RECENTLY PASSED A BILL ALLOWING PATIENTS DIRECT ACCESS TO PHYSICAL THERAPY WITHOUT A DOCTOR’S REFERRAL! CALL US TODAY TO SCHEDULE AN APPOINTMENT WITH ONE OF OUR DOCTOR’S OF PHYSICAL THERAPY AND LET US HELP YOU GET MOVING IN THE RIGHT AND PAIN FREE DIRECTION!! 504.324.8345

Top 10 Most Burning Questions for Sciatica

Therapydia NOLA
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1. Q. How long is this going to take to go away?
A. It depends…it depends on YOU.

In general, it takes 4 to 8 weeks to go through the first 2 phases of healing (no pain, all movement and strength back to normal.

It may take another 1 to 4 months to get back to all activities you want to do…depending on how active you are. This is the third phase of healing.

Here are some variables that determine how fast someone can heal;
√ Overall health. Healthy people heal faster. Young people heal faster.
√ Other health issues such as diabetes, heart disease, high blood pressure, tobacco use, alcohol abuse and body weight all influence healing rates and make the time to heal longer.
√ Diet. People who consume more nutrients in their calories (Dr. Joel Fuhrman calls this “Nutrarian”) heal faster than those who primarily eat processed foods.
√ Rest levels. Our bodies need sleep and rest to rebuild. A lack of sleep slows healing time.
√ Stress levels. People who have high levels of stress heal more slowly.
√ Sedentary lifestyle. People who sit all day for work or to watch TV heal more slowly.
√ People who follow advice and instruction from top level healthcare professionals heal more quickly than those who do not follow through with care.
√ People who are highly aware of their daily postures and habits heal more quickly, because they can adjust habits such as sleep or sitting positions more quickly.

2. Q: How long before I see improvements?
A: Most people we see in the clinic feel better in 2 to 3 visits or within 1 to 2 weeks. If you go longer than 2 weeks without feeling better or moving better, you may be wrong about the cause of your sciatica.
Because we offer one on one care with our patients, your therapist can and will reassess you progress before and during you visit to assure you are getting the care you need to meet your goals.

3. Q: Can I be completely healed or will this come back again:
A: Most people we see who complete the 3 Phases of Healing (meaning they no longer have pain, motion and strength are back to normal and they’re back to doing all the activites they want to do without pain) have a minimal chance the pain will return. The stronger the person is, the less likely the sciatica symptoms will come back.

Your body is a bit like a car. If you take care of it, regularly change the oil and keep it running and fine tuned, there is little chance it will break down. If you ignore it, it is very likely to break down and be in need of repair.

4. Q: Do I need any special equipment?
A: At Therapydia NOLA we use a minimalist approach. We do no use big fancy equipment. [Our model focuses on one on one hands on physical therapy.] We use a variety of techniques including, manual therapy, instrument assisted manual therapy, dry needing, SFMA, and if needed, we have a traction unit in our private treatment room. All patient treatment plans for both in clinic and at home exercises are tailored to each individual and monitored closely by their Doctor of Physical Therapy. Our patients are never handed off to an assistant or tech.

5. Q: Should I use heat or ice on my leg?
A: The cause of most sciatica (pain, numbness or tingling in the leg) is in the lower back. Ice or heat on the leg will not change this.

Consider that sciatica is “inflammation”. So if you’re inflamed, do you want to put heat on it and make it more inflamed? Or ice to calm the inflammation down? We have seen some people use ice on the lower back to calm down the inflammation temporarily.

6. Q: Which exercises should I do:
A: The best exercises for you depend on what the cause of your sciatica is.

We cover the 3 most common causes;
Herniated discs
Stenosis, arthritis
Pelvic or SI joint problem

Each has a series of gradually more advanced exercises. Your therapist will address this and design your exercise program.

7. Q: How often should I do the exercises: And do I need to do them forever?
A: Most people we work with in the clinic for sciatica do the exercises at least once per day, every day. Some will do them up to 3 times per day.

Doing the same exact exercises for years without changing could be a mistake. In general, to get stronger, your exercise should progress and get more difficult. With training your body adapts.

Keep in mind, there are 2 rules for training;
1. Everything works.
2. Nothing works forever.

One of the best programs you can move on to once you complete the 3 Phases of Healing for your sciatica is a consistent walking program. People who walk every day have less risk of reinjuring their back and sciatica.

8. Q: What do I need to do for complete care? Am I going to relapse?
A: The best thing to do for sciatica, if you are worried about it coming back again in the future, is to complete all 3 Phases of Healing.

Phase One is where you focus on getting rid of the pain, numbness and tingling.
Phase Two is where you focus on getting normal movement back and full strength.
Phase Three is where you go back to previous activities you want to do.

We will want to know what your previous activities were before your sciatica, once you are at phase 3 we will guide you back into those activities slowly, after a couple of months we will want to re-check your progress. However, it is very important that you also continue your home program of exercises to insure your body continues to get stronger.

Some people will have a relapse. We will then take a look at the activity and at the program to help them get back on the right track. As mentioned before, people who are stronger recover more quickly. It is usually only one to two visits before that person is on the right track again.

9. Q: How do I know the cause of my pain?
A: There are 3 common cause of pain and here are some general guidelines for each;
-People with sciatica from herniated disc usually have pain bending forward, twisting, coughing or sneezing. The sciatic pain they experience is usually sharp and runs specifically down the back of the leg, possibly into the foot. Herniated disc sufferers are usually 35 years of age or younger.
-People suffering from sciatica because of stenosis or arthritis usually answer yes to these 3 questions;
50 years of age or older?
Pain with standing or walking?
Relief with sitting?
-People suffering with sciatica from SI Joint or Pelvic problems usually have pain with sitting for long periods of time. The sciatica they experience is usually on the outside of the thigh. Symptoms may include heaviness of one leg or feeling twisted.

10. Q: Which position should I sleep in?
A: On your back is best. Next would be on your side. Last would be your stomach.
Regardless, it is best to keep your spine in a neutral position and not twisted to the left or the right, keeping it’s natural curve. Pillows or folded towels can be placed under your knees, side, or feet to help you sleep in the least painful position for you.

Look Below The Surface With Dry Needling

Therapydia Dry Needling Injury Treatment

Dry needling is a form of physical therapy that involves inserting a thin needle through the skin and into the muscle. It’s also known as trigger point dry needling. Trigger points are hyperirritable spots in our muscles that are usually painful to the touch. Some people refer to trigger points as “knots” in the muscle. These areas can also refer pain to other places in our body when palpated. Why do we have trigger points or “knots”? Typically these areas are initiated by trauma or injury to a muscle. There are chemical and physiological changes that occur within the muscle after injury or trauma that develop a pattern of dysfunction. Sometimes the “trauma” is as simple as having poor posture while sitting at a computer all day.

Am I Talking About Acupuncture?

No. The only thing dry needling, performed by a physical therapist, and acupuncture have in common are the type of needles used. They are thin, solid, filament needles. Physical therapists never inject medicine or other fluids into the patient’s body. Just getting the needle safely in the right area of the muscle does the trick. Acupuncture is based on traditional Chinese medicine techniques that involve needles being used to affect energetic pathways (meridians) in the body. Acupuncture uses the needle to balance one’s energy or life force. As neuromusculoskeletal specialists, physical therapists will use dry needling for the musculature in a way that will decrease pain, release tension, improve range of motion, and assist in improving the muscle’s overall function.

How Do Needles Help a Muscle Heal?

Typically when a muscle becomes injured, an inflammatory process occurs. This involves chemical changes in the muscle, compromised circulation (decrease in oxygen), and an accumulation of waste products that build-up in the muscle tissue. Once this happens, your muscle shortens and begins to cause pain and discomfort. With needling, your muscle responds biochemically to the direct needle by releasing certain chemicals. Therefore, the muscle is able to release tension very quickly once a needle is inserted into a trigger point. Your muscle begins to contract and relax the way a healthy muscle normally would. A patient may feel minor discomfort during needling and experience soreness within 24 to 48 hours after needling.

Dry needling is a way for physical therapists to treat multiple muscles quickly and effectively. It also helps physical therapists reach deep muscles that are difficult to manually treat. Dry needling is a valuable complementary treatment to other techniques such as manual therapy and therapeutic exercise.

Is Dry Needling Right for Me?

Dry needling must be performed by a licensed physical therapist that has successfully completed a certification process. Most people with musculoskeletal issues or pain are eligible for dry needling and experience significant relief. Your physical therapist will be able to discuss your medical history and perform an evaluation to determine if dry needling is right for you!