RecoverRx Performance and Recovery Blog
This 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!
Breathwork certainly has received a lot of attention in the fitness and health scene in the past few years, and for good reason. Diaphragmatic breathing, which involves allowing your diaphragm and abdominal muscles to move with your inhales and exhales, has been shown to have positive mental and physical health outcomes. When it comes to strengthening the muscles in your core in order to move well and prevent injury, your breath is an essential piece of the puzzle. Creating and maintaining proper intra-abdominal pressure helps protect your spine, and this pressure has a lot to do with your breath.
When you breathe in, your goal is to use your primary inspiration muscles. These include your diaphragm and the muscles that connect your ribs. Instead, many people use more of their secondary muscles - the muscles in and around your neck and chest - to breathe in, which can cause tightness in the shoulders, tension in the neck, and even hand numbness. By focusing on utilizing your primary inspiration muscles when you breathe in, along with gently bracing your abdominals and engaging your pelvic floor when you exhale, you are setting yourself up with a breathing pattern that supports you both at rest and while exercising, keeping your body both efficient and safe.
Have you ever held your breath during a tough exercise or while lifting something heavy? It can be a natural response in the body. By mindfully incorporating a diaphragmatic breath (inhaling to prepare, exhaling on the exertion), you not only protect yourself from back injuries, but you also help keep your intra-abdominal pressure regulated to avoid injuries like hernias, pelvic organ prolapse, and diastasis recti. If that doesn’t motivate you enough, your deep breath helps you engage and utilize your abdominals more than if you hold your breath or only breathe with your secondary inspiration muscles, which helps your core be even stronger.
Correcting a shallow breathing pattern can take time, so be patient and practice daily to establish a new pattern. To practice, find a comfortable place to sit with your spine tall or lie on your back. Place your hands on the sides of your rib cage, thumbs behind you and four fingers wrapping around front. Take an inhale, intentionally expanding into your hands, allowing your inhale to travel down and gently expand your belly and relax your pelvic floor. Your diaphragm will move down along with it. As you exhale, think about gently guiding your hands in, bracing your belly, and gently lifting and contracting your pelvic floor. Repeat 10 times.
Your breath is truly the foundation of everything you do, and when you establish a proper breathing pattern, it can help with many other processes and movements of the body as well, allowing your core muscles to fire for stabilization and support.
If you feel like you need more help with coordinating your breath, core, and pelvic floor, reach out to us today to schedule a FREE discovery visit!
Do I need an MRI for shoulder pain?
In order to effectively treat so many people with shoulder pain, we need to be able to diagnose the problem, create a clear path for treatment, and establish steps for the resolution of pain. We do this on a daily basis without the use of X-rays or MRIs. Although we don't utilize medical imaging in creating our clinical diagnosis, I will explain to you why 2 other aspects of the evaluation are more important than an expensive image. Those 2 aspects are the subjective history and physical examination.
When a patient presents to the clinic, the first thing we do is listen and let the patient explain their story- we are looking for key features which help to explain common causes of pain. Subjective history includes:
Physical examination includes:
The information gathered from the subjective history and physical examination will create a clear picture if an MRI is warranted or if treatment can begin in the clinic.
Let's break down 2 patient examples of how a physical therapist would use their skills to determine if an MRI would be necessary.
Patient 2: Shoulder pain began 3 months ago without a known cause, but started to hurt when bench pressing and military press. He denies any history of trauma. Pain is not present at rest but only hurts during reaching in the backseat of his car or at the gym. His pain is the same but not constant. If he avoids bench press and military press his shoulder does not bother him in the gym. Physically he has limited active motion overhead and in rotational motions. His strength is appropriate in all motions but has pain and a little weakness when resisting motion with arm away from body. His joint mobility is limited in rotation in 1 direction and has tenderness along his rotator cuff muscle. He occasionally has numbness in the outside of his arm after sleeping on his side.
Hopefully reading through the subjective history and physical examination of 2 different patients, you can see that these patients' recommendations may be a little different.
I would recommend an MRI for patient 1, but I would not recommend an MRI for patient 2.
For patient 1- his injury was traumatic- there is a known cause for a potential significant tissue injury due to the force from a fall. His functioning is very poor with inability to lift arm, his strength indicates a potential significant injury to his muscle system, and his pain is not improving whatsoever even after 7 days.
For patient 2- there was no injury that caused the pain so the likelihood of significant tissue injury is very low, his biggest limitation is weakness caused by pain which is typically related to mechanical issues versus structural issues. His functioning is appropriate, his pain is not constant, and it does not limit him outside of the gym.
As you can see, there is a lot of information needed to determine if an MRI is appropriate and warranted for each individual case. Seeing a skilled physical therapist for your shoulder pain is the Best First Step to set you on a path to recovery. We will use your subjective reports and physical exam to create a clear diagnosis for you, as well as a treatment plan to resolve the pain and get back to the things that matter most.
Learn more about our unique approach to resolving shoulder pain: https://www.recoverrxpt.com/shoulder-pain.html
For more on this topic, check out our YouTube Curiosity Corner. Or give us a call to set up a visit: 331-253-2426
Improving sleep during pregnancy
Sleep is an essential part of our healing process and very important for our energy levels. During pregnancy, like always, it is recommended to get 8-10 hours of sleep for optimal functioning of the mother and baby. Sleep helps with digestion, energy levels, growth and progress of the baby, and to healthily adjust to biological and psychological changes.
'I haven't been sleeping well, and I figured my body is just preparing for sleepless nights ahead with a newborn.' Not true! Lack of sleep can actually increase risks of high blood pressure which can lead to pre-eclampsia and preterm labor and delivery. It can also prolong your laboring process, worsen labor pains, lead to higher Cesarean delivery rates, and increase chances for postpartum depression and anxiety.
Research does indicate that women are experiencing worse quality and quantity of sleep further into their pregnancy. But, at the same time, the body adapts better to the lack of sleep. However, there are strategies to optimize your sleep despite these pregnancy related changes.
First, you want to find a position that is comfortable for you. During the first trimester, you can still sleep on your back and stomach if you feel comfortable doing so. Your baby is safely guarded within your pelvis for the first 12 weeks. After this milestone, make sure you are not laying on your stomach to protect your baby from too much pressure. Most health care providers will recommend you lay on your left side the further you progress in pregnancy because the weight and size of the baby can press on your internal vessels, the abdominal aorta and inferior vena cava. These are very large and very important circulatory structures as they transfer blood to/from your heart to your legs, pelvis and the placenta. These vessels lay more on the right side of your spine traveling vertically through your trunk, so laying on your back and right side the baby can narrow those vessels giving your legs and baby less blood. Your body will ultimately let you know that you need to move, by making you feel very uncomfortable.
Finally, a few tips to promote a comfortable sleep environment:
Please reach out to us if you need help with this condition. We offer 1-on-1 sessions to look at your specific situation and invest in helping you live a healthy, happy life where you are confident to care for yourself and your family. If you know of others who could benefit from this information, please share this article with them.
You can also reach out to me directly at firstname.lastname@example.org or check out our Pelvic Health page https://www.recoverrxpt.com/pelvichealth.html
This time of year is marked by so many feelings and experiences. From joyful celebrations to memorable traditions, the weeks leading up to the New Year certainly keep people busy, and oftentimes healthy habits are the first things to get dropped when plates get too full. Despite so much focus on festive gatherings, many people find themselves feeling less than merry and more stressed during December than they do the rest of the year. Targeting January 1st as the day to reset and focus on health is tempting, but there’s really no time like December to incorporate small but impactful strategies to help you feel your best and minimize holiday stress in the process. Here are three easy ways to prioritize you and your mental health this month:
1. Exercise daily.
According to Mayo Clinic, exercise has proven health benefits when it comes to destressing. First, it may help increase the production of your brain's feel-good neurotransmitters called endorphins. Sometimes referred to as a “runner’s high”, this effect can be triggered not just by running, but even by a walk outdoors or a game of paddle tennis. Exercise can also be a moving form of meditation, as it often requires you to engage in an activity that is repetitive and focus on the task at hand instead of worrying about all the holiday gifts you still need to purchase. Physical activity can also help complete your body’s stress cycle, or fight-or-flight response, resulting in your cardiovascular, digestive, and immune systems getting a boost of protection. Finally, regular exercise has been linked to improvement in sleep, which is often disrupted by stress and anxiety.
2. Practice gratitude.
Dr. Robert Emmons, a scientific expert on gratitude, confirms that people who have a regular gratitude practice are happier, healthier, and can cope with stress and anxiety better than people who don’t. You don’t need anything formal or fancy to reap the stress-busting benefits of a gratitude practice, but if you’re not sure where to start, consider simply pausing and reflecting the next time you find yourself worrying, and ask yourself, “What opportunities do I currently have that I am grateful for?”, “What did I get to experience in the last month that brought me joy?”, or “What has someone done recently that helped me?” If you prefer a practice that is a little more tangible, you could keep a gratitude journal and write down three things you are grateful for each night before bed.
3. Set Boundaries with your Calendar
Schedules can fill up quickly this time of year, so it’s important to take inventory of your family’s calendar and keep expectations reasonable. Every family is different, so discuss with yours how many activities or events feel good to participate in each week or weekend, and then prioritize obligations with your boundaries in mind. By giving yourself some down time each week, you will be better able to rest and recharge before the next family event comes around, which will prevent your stress level from becoming overwhelming. Plus, you might even end up starting some low-key family traditions without even leaving home.
While stress may be an expected part of your holiday experience, it doesn’t have to be. By taking small steps to care for your body and mind, you can start a new tradition of feeling well from the inside out this holiday season. Whether it’s endorphin-filled exercise, a new habit of gratitude, or setting boundaries with your social calendar, put yourself at the top of your priority list this month, and get ready to start the New Year feeling less stressed and more energized!
Learn more about how exercise can help eliminate and prevent stress in Dr. Sarah's Curiosity Corner:
By Dr. Ariel Sernek, PT, DPT
Urinary incontinence (UI) is very common. In fact, incontinence is reported in 48% of young female athletes (Rebullido, 2021), 41% of pregnant women (Moossdorff-Steinhauser, 2021), and 37.1% of older adults around the world (Batmani, 2021). However, these percentages are likely underestimated because most people do not want to report that they are having issues. This issue can be embarrassing, demoralizing, and just out right disappointing. Why isn’t my body working how it should?
There are a multitude of reasons why this might be occurring, but let’s look at some risk factors that might influence why some people experience this more than others. The most important factors that the above studies found included age, obesity, diabetes, women’s education, delivery rank, hypertension and smoking. When we are talking about age related changes, this is due to a decreased ability of our bladder to hold larger amounts of urine and our bladder and pelvic floor muscle getting weaker. Obesity can cause leakage because of the added weight and load to the bladder and pelvic floor muscles. I found the education of women to be a very interesting risk factor, but ultimately the more people are educated to seek help or know that these symptoms are not normal the more likely they are to improve their symptoms and ultimately their quality of life. Diabetes can cause nerve damage to the bladder if not under control, and elevated sugar in your bloodstream increases the amount of urine you produce.
In order to answer the question as to why you are having UI, it’s important to know the type. Stress urinary incontinence (SUI) is when there is a force or pressure on your bladder that cannot be controlled and urine is lost. Urge urinary incontinence (UUI) is when the bladder gives such a strong sensation to use the restroom and you cannot make it on time. Mixed urinary incontinence means that both types are present. I also see overflow urinary incontinence which is when your bladder is so full that any normal activity could cause leakage, but the important part here is that you are not aware that it’s happening.
SUI is treated by identifying the stresses that cause the leakage. Sometimes that could be a jump, cough, sneeze, laugh, or picking up heavy objects. Once we know the stress that causes the leakage, then we have to train you to control that pressure. We do this through retraining your diaphragm and how your body moves through the event that causes leakage. We also strengthen your core, hip, back, and pelvic floor muscles and address postures that can make it harder for your muscles to work together.
With UUI, we have to identify the cause of the urge. Is it an environmental trigger: running water, pulling into the driveway, or putting your hand on a door knob? Is it a food/drink trigger: carbonated beverages, caffeine, tomato based products, acidic fruits? Or is it a change in medication? Once we have the cause, then we train you to manage and overcome that urge with brain, bladder, and body strategies so that you can safely make it to the restroom without an accident.
When it comes to overflow urinary leakage, we have to retrain your bladder to go at a normal frequency and to recognize when your bladder is full. We may also have to release the pelvic floor muscles and soft tissue tension to help your ability to evacuate normally and with less retention of urine. There may be some other factors influencing the leakage too, including urgency or inability to manage pressure that we have to address and treat.
Ultimately, urinary leakage can be treated in a variety of ways, but we have to find the root cause of the leakage first. A full head to toe evaluation, addressing posture, strength, range of motion, pelvic exam, and movement patterns can help us find the cause of leakage. Come in for an evaluation and let’s address this very common, but NOT NORMAL symptom!
Thanks for reading the blog, and please don't hesitate to reach out with additional questions. You can reach out to me directly at email@example.com or check out our Pelvic Health page https://www.recoverrxpt.com/pelvichealth.html. Also, view our Curiosity Corner on this topic, and be sure to subscribe to our YouTube channel for more great health videos.
Rebullido, T; Gómez-Tomás, C; Faigenbaum, A; Chulvi-Medrano, I. (2021) The prevalence of urinary incontinence among adolescent female athletes: A systematic review. J. Funct Morphol Kinesiol. 6(12).
Moossdorff-Steinhauser, H, Berghmans, B, Spaanderman, M et al. (2021) Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: A systematic review and meta-analysis. Int Urogynecol J. 32, 1633–1652.
Batmani, S, Jalali, R, Mohammadi, M et al. (2021) Prevalence and factors related to urinary incontinence in older adults women worldwide: A comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr. 21(212).
Dr. 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.