Thoracic Mobility and You

 

Is it just back pain?

If there’s one universal ailment in the world, it’s pretty safe to say that it’s probably back pain. Whether it’s your low or upper back, you’ve probably experienced back pain at some point in your life. Today we’re going to take a look at upper back pain — in particular how mobility of your thoracic spine contributes to upper back pain, and its effects on your overall well being.

First thing’s first, let’s talk about the anatomy of our spine. Our spine is broken up in three parts: cervical, thoracic, and lumbar. Under normal conditions, the cervical spine (neck) and your lumbar spine (lower back) should be functionally stable. While your thoracic spine (upper back) should be mobile. What we see all too often is the exact opposite; gross instability in both the lumbar and cervical spine, which leads to compensations. These instabilities send our brain and central nervous system in a panic. Our body is constantly trying to maintain some form of homeostasis. This more often than not results in the normally mobile thoracic spine to become rigid as to support ourselves.

Why is having a mobile thoracic spine important?

Well, it’s all a balancing act. We want to maintain optimal spinal health throughout our daily activities, without the need to compensate for the lack of mobility. Having an adequately mobile thoracic spine will allow you a greater quality of life within your daily activities. If you’re experiencing a knot after a long day at the office, for example; a more mobile thoracic spine will keep your back feeling like new. For athletes, greater spinal mobility will allow you to train harder, squat deeper, or even out drive your friends on the golf course.

Where physical therapy is concerned, a detailed evaluation can determine why exactly it is you have restricted mobility in your thoracic spine. Once we find the cause — which could be muscular, or joint related — we can apply the appropriate manual therapy techniques to allow you to restore that missing mobility. With increased mobility, and reduced pain as a result, we can tailor an extensive exercise program to address your specific needs, and allow you to progress towards meeting your personal goals and prevent your back from tightening up on you again.

Below, we’ve prepared some mobility self-tests, as well as a sample of some exercises that we use in the clinic, that you certainly can use at home to work on your thoracic mobility.

 

Thoracic Mobility Self Test

 

Thoracic Mobility Exercises

 

 

 

It’s not this position…It’s the “Next” positon

I’m uh…working from where now?

It’s a peculiar thing; the entire workplace dynamic has really been shaken up in the past few months. Millions of people around the world suddenly find themselves in a completely new work environment their home.

 

Home is where the heart is, and working from home certainly does not come without benefit. In fact, a 2017 study suggests that adding 20 minutes more to your work commute each day is the equivalent of taking a 19% reduction in pay. So certainly one could infer that taking it away entirely — well, that sounds like it would be great. But on the other hand, working from home can have its fair share of cons as well. Your habits change and, all of a sudden, you find yourself, more often than not, sitting around more. 

 

Okay, but what about back at the office?

There exists this certain stigma regarding desk jobs. This constant need to “maintain correct posture; an overwhelming focus on proper ergonomics. Over the years this has spawned many trendy office concepts. There’s the physioball in lieu of an office chair; the standing desk, which is slowly but surely becoming more pervasive. They’re great—don’t misunderstand. But we want to place a greater emphasis on keeping the body moving. It’s not necessarily that any one position is healthier than the other, but prolonged time in any posture can negatively affect the body.

 

Think about this way: is it realistic to spend eight hours or more holding yourself in what’s considered “correct posture”. Absolutely not. It’s much more reasonable to plan time to get up and move around. Take a lunch break, walk outside; sit down, relax if you’ve been on your feet all day. It’s okay to slouch. Because it’s not about the position you’re in, it’s about what you plan on doing next. Keeping your body moving is the answer.

 

As always, we at Gold Medal Physical Therapy sincerely hope the information in this blog helps you. If you find yourself in need of more assistance, do not hesitate to reach out to your doctor or a trusted medical professional.

Headaches: The Webinar You Can’t Miss!

 

It’s just a headache…Right?

I’m sure we’ve all been there at some point. You had a long, stressful day at work — and almost as if to add insult to injury, you find yourself with a nagging headache. It really just makes everything miserable, doesn’t it?

 

Headaches are incredibly common and have an almost unlimited repertoire as to why they happen. It could be that stress; you may have even taken a blow to the head! Or maybe your blood pressure is a little high? Some headaches come and go without much impact on a person’s life. A good night’s sleep, proper hydration, and exercise can often clear up those “low level” headaches.

But what about those Chronic Headaches? Now those can be downright debilitating! They may linger around, or even continually come back; they can be felt alongside neck pain and/or jaw pain as well. It can be difficult to figure out why you’re having headaches in the first place, which is something a Physical Therapist can help you understand. If you are at a point in which headaches are making it hard to concentrate at work, making it tough to spend quality time with your friends and family, or making it tough to relax at the end of your work day you should consider reaching out to a Gold Medal Physical Therapy for an evaluation.

 

How can Physical Therapy Help Me?

Physical Therapists are qualified to help people with certain types of headaches to overcome their pain. They can perform an evaluation to determine whether or not someone is appropriate for treatment in Physical Therapy, what kind of headache a person is experiencing, and relevant limitations that are contributing to the pain. As such, we have the ability to determine if there are any “red flags” present that would warrant a referral to another type of medical practitioner. And by coming in for a Physical Therapy evaluation, if you need referral to another type of medical provider, we can help get you in front of the right type of person that can help and save you a lot of time and energy. Our goal is to understand why you’re in pain, help improve your pain, and teach you about things you have control over that can improve your pain and function over the long term. During treatment for headaches, we use patient education, specific exercises, and hands-on techniques to help people get past pain.

 

The good news is that people can get relief from headaches, there is a lot that you have control over that can help, and our therapists at Gold Medal Physical Therapy are here for you!

 

Tune in for the Webinar!

Gold Medal Physical Therapy will be holding a Headache Webinar next Thursday, 6/11/2020 at 5:00 p.m.

Click the link below to reserve your spot now!

https://go.mywebinar.com/lbrp-xwdv-ztvk-qebj

 

More Resources

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Diastasis Recti: What can you do fix it?

A woman’s body is an amazing thing. During pregnancy, many curious changes occur to prepare expecting mothers for child birth — some wonderful, and some not quite ideal. Today, we’re going to talk about one of the most common post-pregnancy maladies: Diastasis Recti.

What is Diastasis Recti?

Simply put, Diastatis Recti is the condition in which the rectus abdominis — the muscles that make up the center of the abdominal wall, more colloquially known as the six pack — separate. Typically, this is caused by weakness or stretching of the Linea Alba, the connective tissue of the rectus abdominis.

Generally speaking, all women experience some form of abdominal separation during pregnancy. Hormonal changes in the body are what causes the uterus to expand in order to facilitate the growing fetus. The issue, however, is whether or not the abdominals return to their pre-pregnancy form. To which there are a variety of factors that influence its development. The condition is most common in women over the age of 35, and there exists an increased risk for pregnancies of a higher birth weight, as well as having more than one child.

How Can You Tell if You Have It?

The tell tale sign of Diastasis Recti is the ever famous belly bulge — a ridge at the mid-line of the abdomen, as well as low back pain and pelvic pain with certain tasks. There’s actually even a handy way that you can test yourself right at home! Simply lay comfortably on your back, with your knees bent. From this position, lift your head and shoulders from the floor, and take a look at your abdomen. If you see a separation or gap in the middle, then you most likely have Diastasis Recti.

But Can Physical Therapy Help?

Definitely! Physical therapy is all about education: teaching patients how their body works in the context of their condition, and empowering them both physically and mentally. So sure, you may be suffering from Diastasis Recti right now; however, that’s not to say it’s a lifelong problem. As a result of Diastasis Recti, it’s not uncommon for the surrounding muscles of the core to become tight and painful. Think of it as your body’s way of protecting you; the stronger muscles try to pick up the slack of the weakened abdominal muscles.

While attending physical therapy, your clinician can create a diverse training program geared toward your needs, with a focus on improving your core strength and endurance. They may also take you through a range of postural exercises and scenarios to ensure that you’re utilizing your muscles in the most effective way possible. Let’s say, for example, that you struggle with getting out of bed. A physical therapist may teach you how to “log roll,” a technique to get out of bed without flexing the spinal column and putting more stress on your abdomen.

If you’re concerned about your condition, we advise you to contact your doctor. A conversation with your primary care physician may be helpful in deeming if physical therapy can help you, and start you on a road to recovery.

Our Top Five Tips to Stay Active During Lockdown

Being stuck at home during this lockdown can really take its toll physically and mentally. You may find yourself falling into some less than savory “Pandemic” habits or routines. Luckily, research has shown that exercise is not just vital to your physical health — but it even has great benefit for your mental wellbeing! With gyms and many other facilities closed during this time, it can definitely be hard to stay moving. But don’t fret! Check out our tips below to keep yourself active, and sow your own seeds of wellness.

 

Create a System for Yourself. Pursue Habits as Opposed to Goals.

Habits can be a tricky thing. It’s often that we humans adapt a mentality that’s geared toward the extreme; the more we do the better, and any less than that means we’re not even trying. But you don’t always have to set the bar high. Consistency is key in this realm: starting with smaller habits is how we foster a system for success. Let’s say you’re looking to work on your upper body strength. Avoid scenarios where you’re trying to hit some lofty ideal such as 40-50 pushups a day. Instead, start with something smaller, such as 10 a day. It may not seem like much at first, but you’re setting a foundation for yourself. As these habits become integrated into your daily routine, then think about increasing the reps or intensity.

 

Motion is Lotion: Bodyweight Exercises are Essential.

Bodyweight exercises are fantastic to implement into any program or routine. Since they can be done without any equipment, they’re extremely accessible. They also offer many progression paths to ensure we’re appropriately challenged; and they allow us to focus on unilateral strengthening. Feel like one leg is lagging behind in your deep squat? Think about adding in Bulgarian Split Squats to work on building strength in the affected leg. Our own YouTube channel offers a plethora of bodyweight exercises that we love, such as the squat, dips and lunges. Check it out!

 

Use the Buddy System

I’m sure many people are missing their friends and family during this time. We certainly miss many of our patients as well. But we understand that everybody must do what’s best for them. Safety is the most important thing! But we live in the digital age now. Enter teleconferencing programs: with just the click of a button, you can communicate face-to-face with just about anyone that has a phone, tablet or computer. We’ve even been using such programs to offer telehealth to our patients that can’t make it into the clinic. Take advantage of this software. Communicate with your friends, and plan times to workout with each other over Zoom, Skype, Facetime. Having someone to workout with will keep you motivated, and add an element of accountability to keep you on track!

 

Bring the Gym Home

If you’ve been on the fence about whether or not to buy home workout equipment, now may be the time to pull the trigger. Many online markets, such as Facebook, Craigslist and Ebay offer many pieces of equipment at reasonable prices, and can be a gateway to building your home gym. The cost may seem daunting at first, but it may be cheaper in the long run. Replace that expensive gym membership with a brand new squat rack, or dumbbells. Place them somewhere in your house you pass by constantly. It’ll serve as a nice reminder to knock out a few sets of your exercise of choice.

 

Find Your “Why”

When starting anything new, it’s important to take a moment and reflect on what drives you. It’s different for everyone, and it can be anything you want — that flicker of flame in you that fuels your willingness to succeed. It’s yours and yours alone to figure out. No one can tell you what it is.

For our own Tim Russell, PTA, CSCS, CSST, it’s his family that drives him to stay active:

“It’s all for my daughters. I have to stay in shape, stay healthy — because I want to be there for them, and give them the best possible. Being active keeps my energy levels high so I can keep up with them. I can get down on the floor, I can play with them. I don’t want to end up injured and miss out on that. They’re my light and what keeps me going.”

 

We sincerely hope these tips help you. If you ever have any questions, please feel free to reach out to us by email at wellness@goldmedalpt.com. We’re happy to answer any questions you may have. We don’t have all the answers, but we will try our best to help you through this difficult time. Stay safe.

ACL Injuries — Prevention Programs

I used to be an adventure like you…Until I took an arr– tore my ACL

Following our blog post from the previous week highlighting Achilles injury prevention, today we are going to take a look at another one of the world of sports medicine’s most recurrent injuries: the ACL tear.

ACL injuries have become a hot button topic in the world of amateur and professional sports. With 100,000 to 200,000 injuries in the US per year, this injury has become a household name — a heavyweight among orthopedic afflictions. An all too feared reality for all sports practitioners — an ACL tear can have deleterious impact on an athlete’s physical, mental and economic well being.

A Quick Look at the Numbers

It’s estimated that, in the US alone, 350,000 ACL reconstructions are performed each year.1 Athletes with a prior orthopedic knee surgery were estimated to miss more practice days on average than their counterparts, as well as have an increased rate of incident for knee injury and knee surgery overall.2 3

There also appears to be a correlation of the sport played, as well as gender, with girl’s soccer having the highest injury rate, slightly beating out boy’s football, which trails not too far behind; boy’s basketball and boy’s baseball were among the lowest. On top of that, here’s the most interesting part: 38% of ACL injuries occurred as a result of non-contact injuries.4

As we spoke about in our last post — contact injuries are unavoidable by nature; we can’t plan for the unexpected. But we can work to prevent non-contact injuries. Poor bio-mechanics and conditioning play a significant factor in non-contact ACL injuries and, in fact, the research shows that ACL prevention programs demonstrate a risk reduction of 52% in female athletes, and an 85% reduction in male athletes.1

How Can We Prevent These Injuries?

There are many ACL prevention programs that already exist — such as the PEP Program. In general, ACL programs strive to improve overall neuromuscular mechanics, as well as plyometrics and strength training for the legs. Below, we’ve included a few exercises we really like in regard to preventing ACL injuries. If you’re interested in a complete ACL prevention program, the internet is a pretty vast resource in regard. But, as always, check with your medical provider for more information.

Exercises

Step Hop

Turning Hop

Ladder Drills

References

1. ACL Injury Prevention: What Does Research Tell Us?
2. Effects of prior knee surgery on subsequent injury, imaging, and surgery in NCAA collegiate athletes.
3. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.
4. A Multisport Epidemiologic Comparison of Anterior Cruciate Ligament Injuries in High School Athletics

The Achilles — Preventing Non-Contact Injuries

Achilles’ Heel…Or Rather, His Tendon?

The injury you’ve probably heard of — rupturing the Achilles tendon. It’s an injury that plagues professional sports in all facets; no one is immune. Just last year, following the New Orleans Saint’s acquisition of former Dallas Cowboy star, Dez Bryant, the wide receiver would go on tear his Achilles in practice, his season over before it even began, from a non-contact injury.

In Baltimore, our players are no stranger to Achilles injuries: former Ravens linebacker (it really pains us to write “former”) Terrell Suggs tore his left Achilles in 2012 and then, three years later, tore his right Achilles in the 2015 season opener. Jimmy Smith also tore his Achilles in the 2017 — ending his season.

In the scheme of things, majority of these players ultimately return to the field. By way of medical intervention — surgery, or conservative care — we can assist their recovery. But it doesn’t change the fact that we’d like to prevent these injuries from happening at all.

It’s impossible to plan for contact injuries; they are, in most cases, freak accidents, and as much as we would like, we can’t always prevent them from happening. But non-contact injuries we can try to prevent. And, the best way to prevent injuries of this nature, is by proper conditioning and strengthening the muscles associated with these tendon tears.

What is the Achilles Tendon?

The Achilles tendon is located in the back of the leg; it’s the thickest and strongest tendon in the human body. It begins around the middle of the calf and serves to connect the plantaris, gastrocnemius and soleus muscles to the heel bone.1

The tendon can take force of up to 3.9 times body weight when walking and up to 7.7 times body weight in running!2

Who is at risk, and how can I prevent it?

The Achilles tendon is also the most commonly rupture tendon — with the incidence of ruptures being in the range of 5-10 per 100,000 people.3 Barring the obvious young athletes, the population most at risk for Achilles tendon injury are actually men in their 40s.4 Think of the weekend warrior type person — they’re trying to play a pickup game of basketball — and all of a sudden, they feel a pop in their lower leg.

Below, we’ve prepared a few exercises for conditioning: strengthening and recovery in the context of the achilles

 

Loaded Gastroc Stretch

Loaded Lunging

Plyometric Jumps

References

1. Functional anatomy of the Achilles tendon
2. Calcaneal loading during walking and running.
3. The incidence of Achilles tendon ruptures in Edmonton, Canada.
4. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients.

Quick Fix: Shin Splints

 

You’ve probably heard of shin splints — heck, you’ve probably experienced them. Shin splints are incredibly common, and they affect athletes in a multitude of disciplines; running, dancing, gymnastics, just to name a few. The term is thrown around so frequently, it begs the questions, what are shin splints exactly? Barring the obvious “it’s just pain in your shins,” shin splints are an overuse injury that can cause micro tears and inflammation in the soft tissue surrounding the bone lining of the tibia. Many factors, such as muscle weakness and even the shoes you wear can contribute to the development of shin splints.

Strengthening and Recovery

We’ll spare you all the of the usual platitudes associated with posts like these — today, we’ll move straight to the strengthening and recovery component.

Here are two easy and novel exercises that you can add to your workouts, to hopefully help ward off the ever vexatious shin splints.

 

Clinic Highlight — The Core Stix

 

Mike Kadar wanted something different — as the strength and conditioning coach for the Pittsburgh Penguins, he was searching for a way to train himself and his athletes in a way that would functionally pertain to their craft. Mike sought the expertise of Kregg Koch — a design engineer for NASA’s Space Shuttle Program — to turn that desire into reality.

The Core Stix would become the fruits of their labor; the brain child of these two individuals. Its design based on what they a call a simple, yet profound philosophy:

No one has ever shot a puck, taken a three-pointer or thrown a touchdown lying down, so why are so many core exercises done with your back on the ground or in a seated position?

Usable strength comes from your ability to directly tie your training motions to real-life performance movements, which means you need to train standing up to get optimal results.

Applying the same principals of upright functional training to healing and recovery, physical therapists and seniors quickly started incorporating Core Stix into their routines in order to provide a safe and stable way to build usable strength.

Here at Gold Medal, we couldn’t agree more. Which is why the Core Stix have become such an integral part of clinic, for all of our patients, no matter their age or activity level.

Whether we’re working on functional strength — rehabbing young athletes to return to sport, or providing our elderly patients with exercise progressions, the ever innovative Core Stix knows no bounds. We couldn’t be more proud to offer this at our clinic.

Below, we’ve taken some videos showcasing the versatility of the Core Stix, as well as a companion video to accompany the post.

Tim and Bryan Explain it All

Examples

  • Push/Pulls
  • Resisted Split Squats
  • The Forward Drive

The Art of Warming Up – Dynamic Stretching

Warming up is an art that presents itself in many forms. Anything from cardio to stretching, and many other countless activities come to mind, in the context.

But for our blog post today, we’re going to be talking about dynamic stretching and its impact on your workout.

What are Dynamic Stretches?

The most common type of stretching you’ve probably heard of is ‘Static Stretching’. Static stretching refers to holding a muscle under tension — in a specific position — until a stretch is felt, and rinse and repeat. On the other hand, dynamic stretching involves moving the limbs through their full range of motion, and is repeated several times. An excellent an example of static stretching is something like the doorway stretch for your pecs, as shown below. Whereas an alternative and more dynamic stretch, would be these foam roller snow angels, also shown below.

The Case for Dynamic Stretching

Now that we have an idea of how these two stretching sub-types differ, you may be wondering, why should I consider dynamic stretching?

Static stretching and Dynamic stretching have both shown efficacy in increasing range of motion.1 2  But here’s where the two really start to contrast: while such a benefit to range of motion can be attributed to both, some studies actually suggest that static stretching may decrease overall performance prior to a workout.3 4 And in some cases, dynamic stretching has been shown to even increase overall power output.5

Given the potential for increasing range of motion and a potential boost to overall power output, athletes may want to consider dynamic stretching as a regular part of their warmup. In fact, a 2012 meta-analysis published in the International Journal of Sports Physical Therapy had this much to say:

…To increase ROM, all types of stretching are effective, although PNF-type stretching may be more effective for immediate gains. To avoid decrease in strength and performance that may occur in athletes due to static stretching before competition or activity, dynamic stretching is recommended for warm-up.6

Below, we’ve prepared some examples of dynamic stretching that you could potentially include in your warmup, depending on the activity.

Examples

Good Morning and Air Squat Superset

Leg Swings

Lunge with Thoracic Rotation

References

1. A comparison of two warm-ups on joint range of motion.
2. Acute effects of dynamic stretching, static stretching, and light aerobic activity on muscular performance in women.
3. The acute effects of static stretching on the sprint performance of collegiate men in the 60- and 100-m dash after a dynamic warm-up.
4. Effects of stretching on maximal anaerobic power: the roles of active and passive warm-ups.
5. Acute effects of static, dynamic, and proprioceptive neuromuscular facilitation stretching on muscle power in women.
6. CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION