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!

Going To Have Surgery? Think Prehab First

Therapydia Pre-Surgery Treatment

Preparing to go under the knife is filled with a lot of to-dos. Scheduling your surgery date, going to pre-op surgery appointments, and talking with others about their surgery experiences. A main concern for everyone is—how long will it take me to bounce back after surgery? What many people don’t know is that going to physical therapy before surgery increases their odds of a having a successful outcome and quicker recovery. 50% of having success post-surgery is due to the surgeon—and the other 50% is the patient’s commitment to recovery. This starts with pre-rehabilitation physical therapy, or “prehab”. One study looked into patient outcomes between groups of patients that underwent ACL surgery. The patients that participated in prehab had better knee strength and range of motion at 12 weeks. On average, those patients returned to sports 2 months before the group who didn’t participate in prehab.

Get In Shape Before Surgery

Research has shown that prehab before surgery helps patients regain their baseline strength levels faster. Those who participated in a prehab physical therapy program were able to stabilize their pain, increase strength, and improve their range of motion before surgery. Therefore, after surgery, the only way to go is up. Prehab is a physical therapy program that can be started 2 to 6 weeks prior to surgery depending on the type of operation you’re having. Patients normally expect physical therapy after their operation. Therefore, prehab may feel like a new concept. Yet, the goal of both prehab and postoperative physical therapy are the same.

Physical therapy for prehab focuses on increasing strength and flexibility of the muscles in your surgery area. After surgery, your muscles can become weaker and stiff. If your muscles are stronger and more flexible before surgery, the post-surgical effects can be less severe.

Here are some surgeries that could highly benefit from prehab:
• Hip and knee surgeries or replacements
• Rotator cuff repair
• ACL/MCL reconstruction (if not completely torn)
• Neck and back surgery

Recovering successfully means having better strength and range of motion going into surgery. For example with knee surgery, you’ll typically need quadricep strength to balance and move your knee joint after surgery. By beginning to build up quad strength before surgery, you’ll see greater knee stability and faster recovery. Prehab extends to preparing you to use assistive devices like a walker or crutches post-surgery. For example, you might need to be shown how to navigate obstacles such as stairs or curbs with crutches and learn how to move with them without putting strain on your injured limb.

The Sooner, The Better

Anyone can elect to go to prehab physical therapy before surgery. If your condition doesn’t require immediate surgery and is scheduled ahead of time, prehab is definitely an option for you. There’s usually a waiting period prior to any surgery to accommodate facility and surgeon schedules, your schedule, preoperative visits, and insurance clearance. Take advantage of this time to be as physically prepared for your surgery as possible. Prehab can and will allow you to have better functional outcomes and the ability to start moving again faster.

Why Kegels Aren’t Enough: Pelvic Physical Therapy

Therapydia Pelvic Pain Treatment

Many women do not normally associate pelvic pain with physical therapy. They feel pain and notice the symptoms, but can’t tie a physical reason to the discomfort they’re feeling. Unfortunately, conditions related to pelvic health can take years to diagnose and treat. This gap develops because most of the time it’s hard for providers and patients to realize that musculoskeletal problems are at the root of their pain. At least a quarter of women suffer from a pelvic floor disorder—and these are just the reported cases. Considering the statistics and how these conditions can affect a woman’s quality of life, it’s important to educate women about what can be done.

Breaking Down Pelvic Pain

Anything related to pelvic health has to do with the bladder, bowel, sacroiliac joint (joints at the bottom of the spine), and low back. The pelvic floor is a sheet of muscles suspended from the SI joint in the middle of the pelvis to the tailbone. It provides support for your core and internal organs. These muscles can dysfunction in many different ways, but in general they are either hypotonic (weak) or hypertonic (tight/painful) which causes for pelvic floor dysfunction. Someone with a weaker pelvic floor could present to physical therapist with issues of incontinence while someone with a tight pelvic floor could present with pain.

A pelvic disorder doesn’t necessarily only cause pain in your pelvis. Organs in your pelvic area (i.e. bladder) could also be experiencing discomfort. Any muscular problems you’re having could manifest as incontinence or prolapse, when your pelvic organs drop down from their normal positions. You may also feel increased urgency or pain when urinating or during bowel movements. Having unexplained pain the the lower back and pelvic area may also be a sign.

Kegels Aren’t For Everyone

There’s a general myth that only older women or women who have had children need pelvic floor treatment. The truth is these conditions are common in many different age groups. Numerous situations can cause dysfunctions that may have no connection to childbirth. Kegel exercises help to strengthen your pelvic floor, but that’s not all treatment comes down to. Are you really performing your kegel exercises correctly? Chances are that you aren’t.

Pelvic floor physical therapist can ensure you are performing your exercises with the proper techniques. Additionally, there are some women with pelvic floor disorders, where kegel exercises should be avoided. In these cases, doing kegels may actually make the pain worse. This is why you should always seek the help of a physical therapist to ensure proper guidance is in effect.

Empower Your Pelvic Floor

Physical therapy is a great way to get your life back—and feel like you again. Consider when you would ever go to a physical therapist. If you had injured your lower back or had some knee pain, you would most likely go see a physical therapist for treatment. The same applies to pelvic disorders. It all comes down to relaxing, strengthening, and healing muscle tissues. Treatment can include the use of hands-on treatment methods that can range from manual therapy and therapeutic exercise to dry needling. Devices for electrical stimulation and biofeedback electromyography (measuring muscle response) can also aid with healing.

Having incontinence, pelvic pain, and lower back pain are not a natural part of the aging process. These are certainly not conditions one should just have to deal with. If you feel you may be suffering from a pelvic floor dysfunction, follow through with physical therapy treatment.

Ready For The Open: Workout 16.5

The last Open Workout of 2016 is… a repeat of 14.5! Are you having flashback to 2 years ago? Workout 16.5 is all about having hip mobility and proper front rack position. Remember to keep your upper back and chest nice and tall. With Thrusters, when fatigue sets in, elbows tend to drop forward causes the upper and middle back to drop forward as well. This causes strain in these areas and this type of inefficient position not only hurts performance but can lead to injury. Jonathan is a CrossFit Coach at CrossFit Roux and a common tip he gives CrossFitters is to widen hands out a bit (outside your shoulder) to get your elbow up in a better position.

Hip and back problems comes about with high rep or high load. With Burpees, your body is undergoing a quick succession of a closing and opening motion. Making sure your mid-line is stable will save your back and save you time.

To get joints lubricated prior to doing 16.5, here are a couple of exercises we recommend.
• Split-lunge: Get hip and groin open.
• Goblet squat: Practice getting to the bottom of squat
• Workout 16.1 warmup exercises are also relevant for this 16.5: T-spine over medicine ball, Thoracic spine extension, Burpee Prep

CrossFit Athlete Mat Fraser finished his Workout 16.5 in a little over 8 minutes. What’s your goal? Thanks for including us as part of your 2016 Open Workout journey!

Ready For The Open: Workout 16.3 Pre-Workout Warmup Exercises

Open Workout 16.3 has arrived. This workout consists of completing as many rounds and reps as possible in 7 minutes of:
10 power snatches
3 bar muscle-ups

Men use 75 lb.
Women use 55 lb.

Lots of pulling motion required in this Open Workout.

Watch 2 exercises you can do you prior to your workout to prevent injuries and increase your reps.

Mobilize lateral border of your scapula

  • Tools needed: Ball (lacrosse or tennis) and wall
  • Reps: 15-20

Stretch anterior shoulder

  • Tools needed: PVC pipe
  • Reps: 15-20

Crossfit Open Workout 16.2 Injury Prevention Tips

In this Hangout, we will review how to properly warmup for 16.2 and the proper movements to complete 16.2 injury-free. This workout is cardio-focused – your heart rate will be elevated after Toes-to-Bar and Double-Unders, but it is important to conserve energy for your Squat Cleans.

Toes-to-Bar: Strength and Flexibility

– Midline stability is key to doing this exercise

– Note: Pulling your hamstring is the biggest injury to watch out for in this exercise. Supermans, planks and other exercises to that help lengthen your hamstring will him avoid this injury.

Double-Unders: Technique

– Keep elbows close in and  shoulders relaxed

Squat Cleans: Strength

– Jonathan demonstrates exercises to activate your hips prior to starting your rep

More details on 16.2 Workout here: http://games.crossfit.com/workouts/the-open/2016#tabs-2

CrossFit Open 16.1 Workout Tips

The Open is upon us – are you ready for 16.1? Hear from our PTs around how to do Open 16.1 with proper form and without injury. This video includes demonstrations on hip, shoulder and upper back mobilization and activation exercises. These exercises are also good for your workout cool downs.

      Exercises include:

    • Thoracic spine extension over a medicine ball
    • Couch stretch
    • Thoracic spine extension
    • Burpee prep
    • Shoulder activation
    • Split-squat lunge position

Each of these exercises will prepare you for the 16.1 Workout; complete as many rounds and reps as possible in 20 minutes of:

  • 25-ft. overhead walking lunge
  • 8 burpees
  • 25-ft. overhead walking lunge
  • 8 chest-to-bar pull-ups