First we NEED to know how often you’re going to the bathroom. Most people don’t realize that we should be going 6-8 times in a whole 24 hour period. If you are going 3 times a day, we may need to increase how often you go so you are not over stretching your bladder muscle. We may need to cue you to go less if you’re going 10-15 times per day. We also assess what your input and your output is, so how much you drink and how long it takes you to pee. To know how your bladder is functioning, we use a bladder diary or tracker. 

Next, we have to identify and become aware of our triggers. These could be running water, warm showers, pulling into the driveway, touching a door knob/handle, or a simple thought about using the bathroom. Sometimes the triggers may not be environmental, but diet related. Carbonated, caffeinated, sugary, alcoholic, and acidic beverages can also trigger our bladder to want to contract and get that irritating fluid out as quickly as possible. These factors may be different from person to person which is why we have you fill out a diary, because no person is the same. 

The next treatment step is to use our pelvic floor, prefrontal cortex, and autonomic nervous system to control the urgency and bladder contractions. First, you want to STOP moving and stay still whether you are sitting or standing. Next, you want to contract your pelvic floor muscles 5 quick times in a row. This will communicate to your bladder to relax and stop to fill. The third thing you will do is take 2-3 deep breaths making sure to exhale slowly. This will stimulate your autonomic nervous system to decrease stimulation to the bladder and decrease the bladder contractions causing urgency. The last thing you will do is to distract yourself with a to-do list, for example - counting backwards from 100 by 3s; something that takes your prefrontal cortex away from the thought of your bladder and onto another task. This is why urinary urgency and bladder control is better at work than at home. You are more distracted by work tasks and things to do that it’s easier for your brain to put off going to the bathroom. Again, we still want to maintain a 6-8x frequency throughout the day and night. 

If you are still having issues or complaints with this, please reach out and I can create a customized program for You! You can reach me directly at ariel@recoverrxpt.com or check out our Pelvic Health page https://www.recoverrxpt.com/pelvichealth.html to learn more or set up a visit. 

What is Inflammation?
Inflammation has a bit of a bad reputation, but it is actually a necessary and healthy part of your immune system. Your inflammatory response kicks into gear when your body comes into contact with something it perceives as harmful, such as a pathogen, irritant, or chemical. While inflammation can occur from a physical injury, like when your toe swells up after you stub it, it can also result from your body helping you get better when you catch a cold. Both of these are examples of acute, or short-term inflammation, which, again, is a necessary and important part of life. On the other hand, chronic, or long-term, inflammation can cause problems for your health. If your body is regularly exposed to inflammatory components through food, environmental toxins or other sources, your inflammatory system has a hard time turning off. 

Foods that Fight Inflammation
According to Dr. Frank Hu, professor of nutrition and epidemiology in the Department of Nutrition at the Harvard School of Public Health, "Many experimental studies have shown that components of foods or beverages may have anti-inflammatory effects.”

This research is important because it shows that prevention is vital to health, and being proactive in preventing disease can start in the kitchen. Other studies have supported the idea that dietary polyphenols in a variety of foods can help lower inflammation in your body and improve the function of cells that line your blood vessels.

While most fruits contain a variety of vitamins and minerals that support your body, a few fruit families are especially known for their antioxidants and polyphenols, which are protective compounds found in plants. These include berries, which have been linked to lower risk of heart disease, Alzheimer’s disease, and diabetes; and stone fruits, such as cherries, plums, apricots, and peaches, which contain fiber, vitamin c, potassium, and a variety of phytochemicals. In addition to many fruits, brightly-colored vegetables like kale and spinach can improve the function of cells that line the blood vessels, helping your body combat damaging inflammation. 

Nuts and seeds, along with olive oil, fatty fish like salmon and sardines, and spices like turmeric, ginger, garlic, and rosemary, are other options that have been associated with reduced markers of inflammation and a lower risk of cardiovascular disease and diabetes among people who consume them regularly. Some beverages are also known to be rich in antioxidants and are thought to have anti-inflammatory benefits, including coffee, green tea, and drinks containing cocoa. Even supplements containing curcumin (found in turmeric) may reduce inflammation that causes pain like arthritis. 

​So if you have pain or inflammation that seems to come and go and is not always related to your activity level, consider adjusting your diet to include more anti-inflammatory foods and less of the other. Also, give us a call and we can help you find other long-term solutions to your pain and discomfort!​

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.

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:

1. Do not stop all exercise!
2. Reach out to us at RecoverRx Performance Physical Therapy where we can help you maintain your fitness levels while actively treating and improving your Achilles symptoms!

Thanks for reading and reach out to me if you have any questions! 
-Dr. Sarah

email: sarah@recoverrxpt.com

Resources:

1. Silbernagel, KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. Journal of Athletic Training. 2020 May; 55 (5): 438-447
2. Martin RL, Chimenti R, Cuddeford T, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. Clinical Practice Guidelines Linked to the International Classification of Functioning Disability and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2018 April; 48 (5): A1-A38
3. Kedia M, Williams M, Jain L, et al. The Effects of Conventional Physical Therapy and Eccentric Strengthening for Insertional Achilles Tendinopathy. International Journal of Sports Physical Therapy. 2014 Aug; 9(4): 488-497

By Dr. Luke Greenwell, PT, DPT, CSMT, CSCS

​Can dry needling help my shoulder injury? Dry Needling can be a very effective treatment strategy for men and women with musculoskeletal pain including rotator cuff injuries with or without tears. 

What is Dry Needling??
Dry needling treatment involves insertion of solid (non-hypodermic) needles into the muscle or fascia below the skin. “Dry” refers to the fact that there is no medication in the needle. There has been plenty of research to support dry needling (also known as trigger point dry needling, intramuscular dry needling, and needling) as an effective way for Licensed Practitioners (Physical Therapists, Chiropractors, Physicians, and Acupuncturists) to:

• Decrease pain and sensitivity 
• Decrease muscle tension
• Improve range of motion in joints
• Increase strength and force production
• Improve coordination 
• Improve pain perception​

​There has been a historical misconception that dry needling is used only for patients with myofascial trigger points as a way to “release the trigger point.” However, recent evidence is out there to support other neurophysiological mechanisms for pain relief and muscle tension reduction. 

​Rotator cuff injuries can either be traumatic (falls, weightlifting, or throwing) or chronic degeneration (small tears that add up over time). Once the rotator cuff is compromised, the normal biomechanical movement properties of the shoulder are affected and can lead to pain, weakness, and compensatory movement strategies. In many cases, strains and small to medium tears can heal with the right treatment strategies but in some cases, with large tears surgery is warranted. I won’t be covering surgical recovery cases in this article, but will mostly focus on how we utilize Dry Needling in our Rehab for our patients with rotator cuff strains or small to medium tears. 

How Do We Utilize Dry Needling to Treat Rotator Cuff Injuries?
Let’s talk about how we address these injuries in the clinic while utilizing Dry Needling as a therapy. The most important start to our process is to develop an accurate working diagnosis of rotator cuff injury via a comprehensive shoulder evaluation. From there we are able to identify

1. Areas of increased muscle tension (trigger points, tightness, increased tone)
2. Areas of  weakness (which rotator cuff muscle is weak or compromised) and
3. Compensatory movement patterns developed because of pain and weakness. 

Based on these findings, we are then able to hypothesize that treating the referring hypersensitive trigger point with an intramuscular dry needle will help decrease pain and muscle tension in the area as well as allow for improved neuromuscular activation. 

Typically after 1 session of dry needling (this can involve multiple needle insertions to multiple muscles) we do see a very immediate change. With that being said, we typically need multiple sessions over the course of a couple weeks. We like to educate that there will be some soreness in the areas where we see a significant response (known as a muscle twitch response). 

What do I need after I receive Needling treatment?
After the dry needling is performed to the identified areas, we can use the rest of the session to focus on:

• Restoring normal range of motion in the shoulder with passive and active stretching
• Progress to re-education of normal movement patterns with hands-on cueing to avoid compensation patterns. 

Once we have decreased the pain, restored ROM, and reestablished normal shoulder movement without compensation, we can progress to different strengthening exercises targeting areas of weakness. 

This Strategy Works!
It’s a tried and true strategy that has worked for thousands of patients we have seen for shoulder pain and although every patient is different, we find this system to be very effective in helping patients recover from rotator cuff injuries. Our 3 step process of Recover (from painful limitations), Rebuild (functional movement patterns) and Redefine (future strength and performance) could never be more true for our patients with rotator cuff injuries. 

Check out this videos of a Dry Needling Technique: www.youtube.com/shorts/cfXC0UI6xGY. To see even more, subscribe to our YouTube Channel and Follow us on social media @recoverrxpt.

If you would like more information on our approach to treating shoulder pain in addition to rotator cuff injuries, please feel free to reach out to us via email at info@recoverrxpt.com.

Thanks again for checking in and be on the lookout for our next Badass Blog! 

Use Every Setback As A Comeback! 
​-Dr. Luke

What is intermittent fasting?
The health and wellness landscape is certainly full of trends, and one nutrition strategy that has gained a lot of attention recently is intermittent fasting. Intermittent fasting, or “IF”, is defined as when a person alternates between periods of eating and periods of fasting. The terms “patterns” or “cycles” may also be used to describe this almost rhythmic type of diet.

Using intermittent fasting as a tool does not necessarily mean you are cutting your caloric intake way down, but rather you are consuming your calories in designated windows of time, usually with longer stretches between consumption, and these windows are consistent day to day or week to week. For example, you may choose to only eat between the hours of 9am and 5pm each day. Some methods of this type of diet suggest you decrease caloric consumption on certain days, while also adhering to specific eating windows

What are the potential health benefits of IF?
The belief behind this approach to nutrition is that your body may become satisfied with smaller portions, and cravings for less healthy foods may also decrease. The outcome of IF may be weight loss, which can also help lower the risk of diabetes, sleep apnea, and some types of cancer. According to Mayo Clinic, some research suggests that intermittent fasting may be more beneficial than other diets for reducing inflammation and conditions such as Alzheimer’s disease, arthritis, asthma, multiple sclerosis, and stroke.

What are the potential risks?
Intermittent fasting is not recommended for everyone. Those who should avoid this type of diet include pregnant or nursing women, people with a history of eating disorders, people with risk of hypoglycemia, and those with certain chronic diseases. It is always important to consult with your healthcare provider before beginning any dietary changes.

What are the different types of IF?
According to Cleveland Clinic, there are a few different approaches to intermittent fasting, which is a benefit of the diet overall - there is no one-size-fits-all way to incorporate it into your life. Below are some ways this type of diet is utilized:

1. Time-restricted eating (16/8 or 14/10) method: This method is set up so that you fast for a certain set of hours and eat within another set of hours. For example, with the 14/10 method, your fasting window could be 7pm-9am (14 hours), and your eating window could be 9am-7pm (10 hours). This approach is convenient to many people because sleeping hours are factored into the fasting window, which helps it be a bit more attainable. You could practice time-restricted eating every day or one or two days a week and still potentially see benefits to your health.
2. Twice-a-week method: This requires you to consume 500 calories on two days a week, with “normal” caloric intake on the other five days. Your two fasting days should have at least one non-fasting day between them, and you should focus on consuming a healthy diet full of fiber and protein, especially on fasting days.
3. ​Alternate day method: This variation involves “modified” fasting every other day. It is recommended to consume 500 calories one day, a normal amount the next day, 500 calories the following day, and so on.
4. 24-hour method: This method requires you to completely fast for 24 hours once or twice a week. Negative side effects can certainly come into play, from headaches to low energy to irritability, so you will want to be sure this method is for you and supports your health journey. Most people who utilize this version of IF fast from breakfast to breakfast or lunch to lunch.
   

How do you know if IF is right for you?
Just like no two people are the same, no two diets are either. Everyone’s lifestyle, preferences, and resources are different, so intermittent fasting may or may not be a good strategy for you. With several methods of IF, it’s important to be open to some trial and error if you decide to give it a shot - one method may work and feel much better than others. Consulting your healthcare provider and being open to trying something new when it comes to your approach to nutrition are great ways to start exploring this diet.​

What is NEAT?
Non-exercise activity thermogenesis (NEAT) is the energy your body uses to do everything other than sleep, eat, or formal exercise. In other words, it is the calories that are burned by the movements you make by going through your daily routine, not including those expended at the gym. There are a vast number of activities that fall into this category, including typing at a computer to walking around the grocery store to performing yard work. While some types of movement or activities you do during the day may not seem significant, NEAT can have a big impact on your metabolic rate and overall health. 

The Benefits of NEAT
Research shows that incorporating more informal movement into your day - like biking to work or taking a phone call while walking around the block - could be a critical piece to the weight management puzzle and also help you stay more mobile, agile, and feel better overall. Higher levels of NEAT are also connected with lowered risk of metabolic syndrome and cardiovascular events. A study in 2018 showed that a low level of NEAT is associated with obesity, and that a higher level of this type of physical activity enhances lifestyle. People who report having a moderate-to-high level of activity throughout the day outside of formal exercise also report feeling more energetic and an improvement in mood versus when they experience days of low levels of physical activity. From disease prevention to feeling good both physically and mentally, it’s clear that NEAT is a useful tool.

​Ways to Boost Your NEAT (and Still Be Productive)

• Consider taking your work meeting outside for a walk. Need to touch base with a colleague about an upcoming project? Making plans for the next quarter with your team? While not all meetings will allow for you to be away from your computer or desk, get creative about when you could take your meeting on your phone outdoors for some movement, or even invite your colleague to come with you to chat in person if you’re not working remotely.
• Try a standing desk. While the thought might seem impossible, many people have reaped the benefits of swapping their desk chair with a place to stand, some comfortable shoes, and an elevated desk. Standing is a great way to incorporate more NEAT into your day, and it doesn’t take you away from your desk while you work.
• Walk or bike to run nearby errands. Take an inventory of small errands you run on a weekly basis - can any of them be checked off with NEAT? Dropping off dry cleaning, stopping by the grocery store for a last-minute item, even picking your kids up from school could be the perfect opportunity to sneak in some extra movement or bonus steps.
• Don’t outsource all your housework. Which physical tasks around your house do you hire someone to do (or ask your partner to do)? Activities like pulling weeds, watering flowers, cooking dinner, and even vacuuming are tasks that many people outsource to others if they have the resources. But doing some of these yourself will help your body move functionally and burn energy, especially if your job leaves you sedentary most of the day.
• Play with your kids. Throw a ball, swing a bat, pull them up the sledding hill, have a dance party in the kitchen. Moving with your kids not only increases your own NEAT, which boosts your energy and wellbeing, it also gets them moving and boosts their own while setting an awesome example of an active lifestyle.

Whether you have a goal to lose body weight, prevent cardiovascular disease, or feel more energetic, NEAT could be your ticket to get there. Little choices and small steps taken repeatedly can add up to big achievements when it comes to your health. There’s no one-size-fits-all approach to wellbeing - find what works for you and your health journey and stick to it!