RecoverRx Performance and Recovery BlogThis blog is dedicated to all things from recovery to performance. Our industry expert Physical Therapists provide evidence based information and opinions educating our readers on how to optimize their health in order to be able to overcome injuries and live the life they were meant to live!
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By Dr. David Bokermann, PT, DPT, C-PS Over the past 6 weeks, I have become addicted to pickleball. My wife and co-workers can definitely attest that my thoughts, attention and conversations have been geared around my new hobby. My only connection to pickleball was in high school gym class. I remember liking it but didn't hear anything about it until about 6 months ago. Some of my patients were telling me that they started to play and I became curious. I was playing ping pong with my wife a lot over winter break and I started to see more pickleball videos plastered over social media. I bought a racket, took a week long class and am now taking private lessons. I am excited to take you along this journey with me, but first we must talk about what pickleball is and why it is such a great sport for so many people of different ages and abilities.  Pickleball is America’s fastest growing sport for the 3rd year in a row. More and more people are starting to play, stores are starting to carry the equipment, and athletes and celebrities alike are sharing their love for the easy to pick up sport. This blog will be the first of several blogs that will dive into the basics of pickleball, my personal pickleball journey and ways to maximize performance and injury prevention in a new sport.  Pickleball is a rapidly growing sport that combines elements of tennis, badminton and ping pong. It is played on a court with a net, a wiffle ball, 2 hard plastic paddles used to hit the ball over the net. It is played both indoor and outdoor and requires little space and time to set up and get playing. Pickleball is a fun, low-impact sport that offers a range of physical and mental benefits for players of all ages and abilities. Let's explore some of the many Benefits of Playing Pickleball. 1. Low threshold for entry. Part of pickleball’s rapid rise in popularity is that almost anyone can jump in a game and play. All you need is a racquet and a general understanding of the rules. As an example- when I was playing at open play at a local recreation center, one of the best players brought his old college buddy to come out and play. He had never played before but he and I played in a competitive game against 2 veterans of the sport. Best advice- get on out there and just try it. 2. Pickleball is great for agility and flexibility. Players have to move forward and back, side to side, cross 1 leg over or behind the other, turn backwards and rush forward under control. As a physical therapist, I love the sport for all populations as the ball is not traveling incredibly fast but you still have to move your body to get where you want to be. It is a fun way to improve your balance.  3. Improves heart health and cardiovascular stamina. Singles pickleball is more intense than doubles pickleball in terms of fatigability, but both can provide positive effects. Pickleball improves heart health through increasing your heart rate above a resting state. Frequent participation in moderate intensity activity has been shown to decrease the risk of heart attack, strokes and even lower cholesterol. 4. Promotes socialization and positive mental well-being. I can attest to this aspect of the game. Honestly my best work days are when I play pickleball before my day or over lunch. Pickleball is a social sport especially in recreation leagues and in open play games. When you go to play, you put your racquets in a waiting line, then the first 2 or 4 racquets get pulled and you have to talk amongst each other to figure out who will play together. This requires you to get to know other people and develop friendly conversations between teammates and opponents.  5. Lowers stress and anxiety levels. Exercise and community participation is very healthy for our bodies and our minds. Exercise helps to release endorphins which make us feel good. Being a part of a community helps to create a stronger identity and lowers feelings of anxiety or loneliness. I could continue to go on and on with other talking points that demonstrate rewards one receives from pickleball. I will end this blog by saying: if you are at all curious about playing, take a beginner class at your local recreation center, YMCA, or local tennis club. If you currently play pickleball, post a comment about what you like best about the sport. If you are looking to get started, leave a comment and I may be able to assist you in where to start the process. Happy Pickling, Dr. David Bokermann 
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If resistance training is part of your fitness routine, you may be motivated by the actual muscle gains this type of exercise provides. From feeling stronger and more efficient in daily activities to actually seeing more definition in your muscles when you look in the mirror, some benefits of resistance training are obvious. But building strength through activities like lifting weights, using resistance bands, or even performing bodyweight exercises like push-ups goes beyond muscle gains. From establishing more mobility to supporting your metabolism and even improving brain function, the benefits of resistance training are plentiful and diverse. If you’ve been looking for a reason other than muscle gains to begin a resistance training routine, or maybe just need some reasons to continue yours on days you’re lacking motivation, here are six unexpected ways that this type of exercise can support your body. 1. It’s good for your heart. It’s a common assumption that in order to achieve cardiovascular benefits, you have to be engaging in heart-thumping cardiovascular activity, but resistance training can support your heart and blood vessels too. Lifting weights and other forms of strength training reduces risk of heart attack and stroke, lowers blood pressure, and improves overall cardiovascular health. Increased lean muscle mass also provides more surface area for blood to flow, which in turn puts less pressure on arteries. 2. It keeps your metabolism humming. Many people associate caloric burn with cardiovascular exercise like running, biking, or swimming, but resistance training helps support energy burn (i.e. your metabolism) in a big way. The increased muscle mass gained from resistance training increases your basal metabolic rate, or the number of calories your body uses when it is at rest. So, if you have more muscle mass, you will burn more calories - even when you’re sleeping.  3. It increases mobility. A decline in mobility can often come with age, and it can put you at risk for falls and injury. According to the American College of Sports Medicine, resistance training improves mobility, especially in older adults, and when combined with aerobic training it has been proven to reduce falls as well. Mobility can also help you perform everyday tasks, such as carrying bags of groceries or lifting a small child, with more efficiency and with a lower chance of injury.  4. It strengthens your bones! Not only does resistance training support the strength of your muscles, but it also helps maintain density and strength in your bones as well. Regular strength training has been shown to improve mineral bone density, which lowers your risk of fractures. It also slows bone loss and helps prevent diseases like osteoporosis, which is a major cause of disability, especially in older women. 5. It improves cognition and mood. When it comes to your brain, resistance training could be your ticket to sharper cognitive function and even mood improvement. Lifting weights and other types of muscle-building exercise have been shown to increase memory, enhance the ability to handle life’s challenges and stress, and ease depression symptoms. Research shows that resistance training can restore cognitive deficits and even slow or halt dementia and Alzheimer’s. 6. It helps prevent type 2 diabetes. In addition to your bones, muscle mass also comes into play in your blood sugar levels and insulin sensitivity as well. Low muscle mass is associated with insulin resistance, and chronic insulin resistance can lead to type 2 diabetes. Gaining and maintaining muscle mass through resistance training can help prevent this disease, and can also help regulate blood sugar levels.  With so many benefits beyond just muscle gain, resistance training can absolutely be a key component to feeling your best, preventing disease and injury, moving with integrity and mobility, and even keeping your metabolism efficient as you age. Combining aerobic training or cardiovascular exercise with resistance training in a balanced fitness program can help you achieve the results you’re after, whether short-term, long-term, physical, or mental. Dr. Sarah Greenwell, PT, DPT, CSMPT  Medical advice can be confusing at times. Seems like the answer changes over the years and depends on who you talk to. Like what should you do after an injury to a tendon: Should you use ice or heat? Should you rest or should you push through the pain? Well, I'm here to help clear up some of that confusion. And this time I have the evidence to back up the recommendations. Achilles tendinopathy is one of the most common overuse injuries to the foot and ankle in sport, especially in runners. It presents as pain and swelling, tenderness with a possible lump, weakness during heel raises, difficulty running and jumping, and symptoms usually are worse with the start of movement and improve with light activity.
One of the most common causes is a sudden change or increase in training intensity or duration. However, contributing factors include decreased plantar-flexor strength, decreased hip control, abnormal ankle and midfoot range of motion, increased pronation (or flat foot), and increased body weight. Typical passive (non-active) treatments involve rest, ice, ultrasound, cryotherapy, heel lifts, orthotics, and nonsteroidal anti-inflammatory drugs (NSAIDs). However, research indicates that heel lifts, night splints, orthotics, and taping are not recommended due to lack of evidence that they actually provide positive impact (3). Rather, the treatment with the highest level of evidence for Achilles tendinopathy is physical therapy (1). Activity modification (cross training such as cycling instead of running or modifying run programs), stretching, and eccentric training can decrease pain while maintaining aerobic capacity, improving ankle mobility and correcting strength deficits. (3) So when it comes to tendon recovery, rest is catabolic and activity is anabolic. Taking 2 weeks to 3 months off running/exercising does not lead to tissue repair. Rather, tissues just get weaker and lack the oxygen rich blood flow that helps promote healing. On the other hand, appropriate and progressive exercise and activity levels help to stimulate healing. The first step is to modify the training regimen for appropriate load management and avoid aggressive stretching early on (excessive compression). Then, provide appropriate load to the tendon to promote remodeling, decrease pain, improve calf muscle endurance, and strengthen the lower leg. This can be achieved through a variety of exercise techniques (isometric-strengthening without movement, concentric-strengthening through muscle shortening, or eccentric-strengthening through lengthening muscle and tendon) and should be tailored to the individual’s needs and tolerance. Accepted guidelines are to maintain pain levels below 5/10 during therapeutic exercise and/or recreation/sports (swim, bike, run, walk). Finally, address any biomechanical issues (running mechanics, neuromuscular control/stability, proper footwear) that could contribute to symptom return.  It is important to note that depending on the severity of the tendinopathy, full recovery can take a year or longer, and reinjury is common if return to sport is rushed (1). However, if symptoms are addressed early, severity can be reduced with smaller effect on sport performance and a shorter recovery time. Therefore, if you are feeling pain or stiffness in the back of your calf/Achilles:
Thanks for reading and reach out to me if you have any questions! -Dr. Sarah email: sarah@recoverrxpt.com Resources:
 The benefits of getting enough sleep may seem obvious. You will feel more alert, energized, and even less impatient or agitated when you are giving your body an adequate amount of rest in the form of sleep. But did you also know that sleep can help improve your fitness? It’s not necessarily as easy as sleep more to get more fit (we wish!), but incorporating this tool into your wellness practice can pay dividends in helping you achieve your fitness goals. Sleep allows the body and brain to recover from daily activities, and it also helps you see more benefits from your workouts, maintain a healthy weight, and even make better, healthier decisions. Your hormone levels play a key role in various processes in your body, and adequate sleep and healthy hormone levels go hand in hand. One hormone in particular that is responsible for promoting healing, recovery, and growth in muscle tissue is the human growth hormone, or HGH. Research has discovered that a surge of HGH occurs every two hours of prolonged sleep, aiding your body in reaping the benefits of your workout earlier that day or week. In addition to HGH, sleep also promotes protein synthesis to help your muscles repair from the microtrauma of overload strength training.  Another important hormone affected by sleep is cortisol, a stress hormone that can become elevated when you are low on sleep. Cortisol is linked to both weight gain and increased blood pressure, so keeping it in check is an essential part of health and wellness. Two other chemical messengers, ghrelin and leptin, communicate with our brain about when to consume calories. These neurotransmitters can trigger hunger cues when we are sleep deprived and not necessarily in need of calories, which is why inadequate sleep can cause weight gain. In addition to hormone health, sleep also provides you with an essential foundation for healthy decision-making, especially when it comes to nutrition. Studies have shown that when both men and women were deprived of sleep, they were significantly more likely to make poor food choices. These poor nutrition choices hinder optimal fitness recovery, which means you may not get all the benefits from your workout that you could with enhanced nutrition. Research suggests that these decisions were due to a decrease in executive functioning, reinforcing the fact that fatigue and “mental fog” from a lack of sleep doesn’t just make us tired - it also makes it harder for us to think. Sleep also provides your body with enough energy to tackle your next workout with integrity and focus. Sleep deprivation can lead to fatigue, which makes even lacing up your sneakers to exercise feel like a challenge, and it can also put you at a greater risk for injury while exercising due to a lowered ability to concentrate. So, how much sleep should you be getting to maximize your time spent in the gym and feel your best? You may be familiar with the age-old recommendation of 7-9 hours a night, but everyone has individual needs. Still, acquiring fewer than 7 hours on most nights will not set you up for success when it comes to your health and fitness. To get the most out of your time in bed, developing a sleep hygiene routine is essential. Try to avoid caffeine in the afternoon, power down all screens at least 30 minutes before bed, and create a relaxing wind-down routine. You could try a cup of caffeine-free tea, a warm bath or shower, or simply just reading a book in the time leading up to when the lights go out. This may take some practice or forward-thinking at first, but the quality sleep that will likely follow an intentional bedtime routine just may be the part of your fitness routine you’re missing.  |
AuthorsDr. Luke Greenwell, Dr. David Bokermann, Dr. Sarah Greenwell, & Dr. Ariel Sernek are Performance Based Physical Therapists with extensive backgrounds in treating the injured athlete. At RecoverRx, they are passionate about returning people to the sports & activities they love. Check out more about them by visiting our About Us page. Categories
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