Why does my low back hurt when I surf?

Let’s break down the movement and see if we can figure it out.

Although there are many factors at play here, the first thing that I want to emphasize is how much hip and ankle range of motion is required to perform a low squat during the pop up.

If you lack mobility in your hips and ankles then you often compensate by rounding your spine which puts more strain on the discs, joints and muscles in your back.

You also have to train your hip and core strength and movement coordination in order to perform the movement efficiently and safely.

For more ideas about how to train your core, hips and lower body visit my online programs and sign up for my fundamental package.

Why does my shoulder hurt with overhead sports?

I lift upper body and I stretch so why does my shoulder still hurt?

The answer is often because you can’t just strengthen the shoulder in isolation.

When treating the shoulder you have to think about how the rest of the body works to facilitate stability at the shoulder.

During sport when you hit a volleyball, throw a baseball or swing a tennis racket your trunk and hips must rotate to create power and assist the shoulder.

When creating rehabilitation exercises you have to keep this in mind.

For example, you can tweak a standard middle and lower trap “Ys and Ts” strengthening exercise by having the athlete perform the upper body movement unilaterally while moving into a SL RDL on the opposite side.

During this combined movement we are working on scapular stability with simultaneous trunk and hip rotation in single limb which requires core control and dynamic stability.

Much like sport, integrated movements like the one described above require strength, stability and movement coordination of the entire kinetic chain.

For more exercise ideas join my online shoulder program or send me an email at theacademypt@gmail.com!

How can other body regions contribute to neck pain?

Did you know your neck pain might not actually be caused by your neck? Here are three things that you didn’t realize can cause neck pain.

1. Tight hips - Restricted range of motion in your hips can cause slouching. The resulting pour posture puts more pressure on the joints, disks and muscles in the neck.

2. Tight pecs - Tight pecs can pull the shoulders forward causing “forward head posture”. This compresses the structures in the back of the neck and weakens the muscles in the front of the neck. 

3. Poor thoracic mobility - Like your hips, poor mobility in the mid back can cause slouching resulting in added pressures on your neck. 

If you are struggling with pain and want to learn some more about potential causes, send me an email at theacademypt@gmail.com.

Stay tuned next week for more insight on rehabilitation, injury prevention and sports performance topics.

Fundamentals of Exercise Prescription

How do you come up with these exercises?

If I had a dollar for every time that a patient asked me this question I just may be able to retire from treating patients. 

The answer is both complicated and simple at the same time. 

First, you have to understand the demand placed on the body during the activity or activities of interest. For example, what does the shoulder need to be able to do in order to hit a volleyball?

Even if you aren’t familiar with the sport or desired activity at hand, my best advice would be to familiarize yourself with the desired movements and ask yourself 3 things: what range of motion is required? What strength is required? What movement coordination is required?

These 3 pillars create the foundation for your exercise prescription. How can you achieve these goals through exercise? Start here and program from this framework. 

Lastly, it is imperative to understand that the desired body region does not function independently. You must understand how the upper extremity, lower extremity and trunk all work together to perform the desired movements. 

Now it’s your turn! What is your target tissue? What is your target body region? What is your target activity? How do these pieces tie together?

The exercise creativity is limitless when you operate with these fundamentals in mind. 

Why paying cash for physical therapy can be better for your body and wallet

A cash-based system allows for more individualized care and one-on-one time with your physical therapist. Instead of getting 10-20 minutes of face time with the PT and then spending the rest of the time on a heat pack and going through exercises with a PT aide, you get 1-2 hours of manual therapy and individualized exercise prescription with a licensed physical therapist. The benefits of corrective exercise prescription and instruction are often undervalued - however the goals of therapeutic exercise should be to correct the movement strategy that likely caused the injury in the first place, and to improve the strength and movement coordination within the range of motion gained following manual therapy. Physical therapists are experts in human anatomy, movement dysfunction, and corrective exercise. All accredited physical therapy programs in the United States are now doctorate programs, and therefore physical therapists are essentially “Doctors of Movement.” 

In contrast, there are no specific education requirements for PT aides, and therefore they are unable to provide the same level of expertise when instructing exercises because they do not have the knowledge base of anatomy, movement, and corrective exercise that a physical therapist does. https://www.ptbc.ca.gov/forms/ptaidsup.shtml Nevertheless, PT aides are prevalently used in many insurance-based practices because there simply isn’t enough time for the physical therapist to provide all the necessary manual and exercise interventions to the 15-30 patients on their daily caseloads. Working at this high volume also takes a toll on the physical therapist’s own body, which is somewhat hypocritical if you think about it because they spend all day trying to fix other people’s bodies at the cost of their own. https://covalentcareers.com/resources/physical-therapy-burnout/ 

So why such high volume if that is not in the best interest of the patients or the therapist? Well, often times insurance reimbursement rates are not high enough to sustain lower volume practices. Furthermore, contracts between insurance companies and PT providers are negotiated independently, and thus there are no standard reimbursement rates across different PT practices in the same sector - that means that different practices are paid different amounts for the same services. Insurance companies tend to give higher reimbursement rates to corporate, or hospital based systems because they have more bargaining power - however interestingly enough, these systems also tend to be the highest volume clinics and therapists may see as many as 4 patients per hour. This discrepancy in reimbursement rates and the lofty process involved to obtain contracts with insurance companies has led to a rising increase in cash-based practices. http://www.ncmedicaljournal.com/content/78/5/312.full 

When all is said and done, your out-of-pocket expenses within an insurance-based system may still be quite high, and might even exceed cash-based pricing although you pay a hefty insurance premium every month. Some insurance plans do not cover PT services until your deductible is met, or place a hard cap on the number of PT sessions allowed. Your co-pay alone may even be comparable with cash-based pricing. https://www.restorationspt.com/blog/pocket-costs-physical-therapy/ 

Our health care system is far from perfect and there is definitely room for improvement, but a cash-based system ensures that 100% of the money that you spend goes directly towards your care. Its up to you to decide what you value in terms of services and how you want to spend your money, but keep in mind that your body is yours for a lifetime and there is some truth in the old saying “you get what you pay for.”

Understanding The Human Body as an Integrated Kinetic Chain -PART 4 The Movement System

The key to injury prevention is understanding that pain is usually a result of a faulty movement strategy resulting in undo stress to the body’s tissues. The body must have adequate mobility and strength in all surrounding joints in order to execute the task at hand. Furthermore, the body must also utilize the right muscles at the right time to perform the movement efficiently and safely.

The logical question that follows is “how do we do that?” I wish that I had a simple quick fix for you, but the truth is that it isn’t that simple. I could give you a list of exercises to do with the goal of targeting the correct muscles, but there is no guarantee that you would use the right muscles to do them. Our bodies are very goal oriented in that if you give the body a task, it will use whatever resources it has to complete it - even if that means perpetuating movement patterns that are causing pain or injury. The other important factor to consider is that everyone’s body is different and therefore there is no cookie-cutter approach to fixing “low back”, “neck pain”, “knee pain”, etc. Re-wiring the nervous system to recruit the right muscles at the right time requires individualized care and guidance by a license physical therapist - and that is what I can offer you at The Academy. 

Understanding the Human Body as an Integrated Kinetic Chain - Part 3 The Shoulder

The shoulder complex serves as the anchor for the upper extremity much like the hip does for the lower extremity, however there are a few key differences. Both joints are ball and socket joints, however the ratio of the ball and socket sizes are very different. The hip is composed of a relatively large socket and smaller ball, whereas the the shoulder has a relatively smaller socket and larger ball. This anatomical difference makes the shoulder inherently less structurally stable than the hip. The socket of the shoulder is located on the scapula (aka shoulder blade) and the scapula and the arm must move in a 2:1 ratio during overhead reaching tasks in order to maintain the normal mechanics of the shoulder and avoid impingement of important structures like the rotator cuff and biceps tendon. Therefore, scapular strength and movement coordination is essential to maintaining a healthy shoulder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445067/.

Understanding the Human Body As an Integrated Kinetic Chain - Part 2 the Hip

Moving outwards from the spine and the pelvis, you have the hip joint which creates the anchor for the lower extremity. The hip is a ball and socket joint that moves in all three planes of motion. Mobility restrictions, weakness, and poor movement coordination at the hip are highly correlated with knee and ankle injuries https://www.ncbi.nlm.nih.gov/pubmed/29116830. The hip and the ankle act synergistically to absorb the shock of ground reaction forces during impact activities such as walking, running, and jumping. Failure to adequately absorb shock due to joint stiffness, muscle weakness, or a poor movement strategy commonly results in injuries to the ligaments, bones, and cartilage.

Lack of hip mobility, weakness, or poor movement coordination can also result in injuries to the spine - especially during flexion activities such as squatting. For instance, squatting deeper than your available hip flexion range of motion allows is a common mechanism for low back injuries such as muscle strains and disc herniations.

Understanding The Human Body as an Integrated Kinetic Chain - Part 1 The Spine

The spine and the pelvis are commonly referred to as “the core” because they are essentially the anchor for your entire body. Low back and neck pain are among the most common and debilitating injuries in our society, and so it’s imperative that we address the underlying pathology. Furthermore, if the anchor of the system is unstable, then a cascade of injury to the extremities is likely to follow. For example, elbow injuries in baseball pitchers have been linked to poor balance and core instability. https://www.jospt.org/doi/full/10.2519/jospt.2013.4680.

If you imagine the spine like a stack of blocks, there are small stabilizing muscles called multifidi that connect each block to the one directly above it. These muscles work to control movement of each segment relative to others and protect the disks, nerve roots, and ligaments around each vertebrae. Larger muscles span multiple segments of the spinal column and attach the top vertebrae to the bottom vertebrae, but may bypass the segments in between. In a healthy system, the smaller and larger muscles work together to provide stability and mobility to the spinal column. Structural injury and pain arise when the smaller stabilizers are over powered by the larger muscles - essentially resulting in shearing of all the structures in the middle when the larger muscles pull on the top and bottom vertebrae. Addressing this muscle imbalance is the first step to laying the foundation for a strong core.

The Fundamentals of Injury Prevention

The first step to preventing injuries is to understand what causes them. Your body is a well oiled machine that requires all parts to work together at the right time in order to move efficiently and safely. 

First, you must have the necessary RANGE OF MOTION available at all joints involved to perform the movement correctly. For example, in order to perform a common body weight squat, you must have enough mobility in your ankles, knees, hips, and spine. Stiffness in one joint can result in compensatory stress and potential injury to the surrounding joints. For instance, lack of mobility at the ankle or the hip are common causes of many knee injuries because the knee is located in between both joints. On the flip side, too much mobility leads to instability - which brings us to the next two components of the body system.

Second, you must have the muscle STRENGTH to execute the movement. In terms of our squat example - your glutes, hamstrings, quads, and calves (among other muscles) must all do their part to support the skeletal system and move the joints. Weakness in one area can result in compensatory overuse of another muscle group, or overload to the passive structures like the bone, cartilage, or ligaments.

The third component of the body system is MOVEMENT COORDINATION - or your body’s ability to control motion and use the right muscles at the right time to perform the movement efficiently and safely.  Much like an orchestra, you may have all the pieces to play a beautiful symphony, but the music won’t sound good if the conductor is off. Instead of a conductor, your body has a system in place called PROPRIOCEPTION which is essentially a feedback mechanism in your muscles and joints that tells your body where it is in space. You can train this system by working on performing each movement correctly so that your muscles and joints learn how to move in a stable way within the available range of motion. 

Finally, your body needs time to RECOVER in between training sessions. Even if your mechanics are perfect, the tissues need time to regenerate and there is no substitute for adequate rest.

Now that you understand the framework of the body system and the fundamentals of injury prevention - lets get started!