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

Pitcher’s Dilemma — Preventing Injury in America’s Pastime

It’s a sport etched in the very heart of our country’s history; it brings us joy and — more often than not — can have us feeling downright dejected. And here in Baltimore, we know a thing or two about the latter…

But regardless, countless kids each year will step up to the plate for the first time in their lives with hopes of emulating their favorite players. Many will find a quick exit from the sport; but some may continue into their High School years, and others may venture past that to achieve even greater success. For those that continue, injuries will be — just like any other sport — part of the game.

When we think injuries, one position in particular brings to mind a myriad of orthopedic affliction: the pitcher.

Young pitchers are in a particularly tough spot. They’re at risk for serious injury, with no clear cut reasoning as to why.1 Many signs point to limiting the inning count to lower than 100 per season, and barring pitchers from playing catcher, as a means of reducing these injuries; and other concepts, such as pitch count, arm angle, and throwing a curveball have become topics of contention in the context.

Perhaps most famous for injuries such as the “Tommy John” (Ulnar Collateral Ligament Sprain), pitchers are also no stranger to the likes of Rotator Cuff Tendonitis, just to name a few. And although we’ve no concrete way of preventing such maladies from happening, proper movement and strength screening, such as Functional Movement Screening (FMS), or Selective Functional Movement Assessments (SFMA), can help to identify areas of problem. With such knowledge in hand, practitioners could focus their efforts on what they need most.

Cue the concept of ‘prehabbing’

Pitching is one of the most complex arts in the world of sports. Similar to the golf swing, for example; it requires timing between the arms, legs and torso, to achieve consistency in the most efficient manner. Lacking the required strength, endurance and mobility in the muscles utilized to execute these movements, plays a role in the breakdown of mechanics as the inning/pitch count rises. Distance running, the long toss, and dynamic exercises that target both the upper and lower body musculature, should be emphasized.

Below, we’ve prepared some awesome exercises and recovery techniques that may help you through the season!

Strengthening

The Prone “Y” & Squats

Recovery

The Posterior Capsule Stretch & Instrument Assisted Soft Tissue Massage

References

1. Risk of serious injury for young baseball pitchers: a 10-year prospective study.

Obligatory — The Bench Press

“Hey bro, how much do you bench?”

Perhaps the most famous verbiage in a gym rat’s arsenal.

And perhaps for good reason — because what would the world of powerlifting be without the bench? It’s the quintessential exercise; it’s the one everyone and their grandmother knows in the context of lifting.

While not being as flashy as the snatch or clean and jerk, it’s still a complex movement with a lot of variables to consider when performing. Your chest, arms and shoulders are all an active component — and focusing attention onto these areas independently can give you that true strength to help you reach your potential with this exercise.

These are are a few exercises that we really like as supplemental work or as substitutes when dealing with pain.

The Floor Press

The Floor Press is the absolute bomb, especially if you’re having shoulder pain or are limited by your shoulder in general when performing the bench. It’s great because it requires you to push through a smaller range of motion to perform. If you’re rehabbing your shoulder, for example, this would be a great replacement for the bench.

The Dumbbell Chest Fly

Awesome supplemental exercise to train your pecs for hypertrophy — with dumbbell in each hand, the chest fly allows you to train each arm independently. Time under tension is important to keep in mind when performing this exercise.

The Close Grip Press

The close grip press can be a great supplemental exercise to train your pecs for hypertrophy, also. Think about pressing the dumbbells together throughout the movement. Time under tension is, again, important to keep in mind when performing this exercise.

Lift Heavy – The Deadlift

The year is 2016 — the stage is set at the Giants Live World Deadlift Championships. Eddie Hall is poised to make history — becoming the first man to deadlift 500kg.

The strain of the lift so great, Eddie would pass out almost immediately after.

While this is on the extreme side of weight lifting — the deadlift at its core is the same at all skill levels. If we were to break it down further, we can isolate the mechanism to the hip hinge.

The hip hinge is the fundamental pattern when lifting anything heavy off the ground. And the range can apply to all weight levels; from lifting a heavy box from the ground to Eddie Hall deadlifting 500kg — the hip hinge is the most efficient and safe way to lift.

Below our some of our favorites for showcasing the hip hinge.

The Hip Hinge

  • Kettlebell Deadlift
  • Kettlebell Swings
  • Single-Leg Deadlift