Do you know the difference between soreness and pain?

The attached article describes the difference between soreness and pain. People often don’t seek help until they are experiencing pain that limits them from participating in their fitness regimen of choice. We can help you stay injury free on your path to becoming the best version of yourself.

Our bodies move in the path of least resistance, meaning if you have limited range of motion in one area of your body, another area will pick up the slack. This is often referred to as a compensatory movement pattern. Over time with increased training loads and volume this can lead to injury. By having a movement assessment performed prior to starting a fitness program we can help you restore movement patterns and decrease your injury risk while improving your performance.

Call us today to schedule your movement assessment and let us guide you to optimal performance. 504.324.8345

http://www.moveforwardpt.com/Resources/Detail/soreness-vs-pain-whats-difference

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.

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

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
504.324.8345
hello@therapydianola.com

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.

Understand Your MRI Results

shutterstock203524102Getting MRI results can sometimes be intimidating. Big words and diagnosis’ that can be scary. Here is a GREAT article that is certain to ease the anxiety of MRI results.

http://breakingmuscle.com/health-medicine/you-are-not-your-mri-results

Movement Monday: Start Your Mornings Right

Running from the bedroom to the kitchen to pour a hot cup of coffee is not the ideal way to start your day. We think it is, and I can’t go more than five minutes of being awake before pouring the first cup. But after being sedentary for our hours of sleep, we should start our day with a few stretches, deep breathing, and hydration to get our bodies and our minds ready for whatever our day will entail. So instead of reaching for the coffee first, have some water and do these simple stretches to start your day off right and healthy. You can have your coffee afterwards!
HAPPY MOVEMENT MONDAY FROM THERAPYDIA NOLA!

http://www.sparkpeople.com/blog/blog.asp?post=rise_and_shine_8_stretches_you_should_do_each_morning

 

Weighing In On Wednesday: Not Everyone Likes to Exercise

If you do not like to exercise, or even the thought of doing so, you are not alone. There are as many excuses as there are stars in the sky to get out of doing it. But our overall physical health depends on a combination of both exercise and nutrition. So if you haven’t exercised in a while or you have been thinking you should begin an exercise routine, just take the first step! The first step is always the hardest, you cannot run before you walk. Here is an article that gives simple steps to beginning a work out routine that you will stick with, EVEN IF YOU DON’T LIKE TO EXERCISE!
HAPPY WEIGHING IN ON WEDNESDAY FROM THERAPYDIA NOLA!!

http://summertomato.com/how-to-start-working-out-when-you-dont-like-to-exercise/

Movement Monday: Boot Camp at Therapydia NOLA

Therapydia NOLA will be starting our next boot camp on Tuesday, March 31 at 5:30 p.m. Sessions will last six (6) weeks and will be held on Tuesdays and Thursdays at 5:30 p.m. It is not too late to join! Whether you are a beginner or have participated in boot camps in the past, we would love to have you. Our boot camp is uniquely tailored by our Doctor of Physical Therapy to meet the level/needs of every individual in a small group setting. Call us today to reserve your spot 504.324.8345! Or you can send us an email @ hello@therapydianola.com. Space is limited.
HAPPY MOVEMENT MONDAY FROM THERAPYDIA NOLA!