By Dr. Sarah Greenwell, PT, DPT, CSMPT

​As clinicians, we should be saying “how”, not “no.”
How many times have I heard a patient tell me that they can never do ‘x’ again?

• "I had my knee replaced, and my surgeon told me never to kneel again"
• "I fractured my ankle a couple years ago and the doctor told me never to run again"
• "I herniated a disc in my back a few years back, and my chiropractor told me never lift anything over 20 lbs"
• "I have a labral tear in my shoulder, so my old PT told me not to play baseball with my kid anymore"

As healthcare professionals, we need to take a holistic approach to treating our patients. While these professionals may have been looking out for the physical interests of their patients, they neglected to remember that we are not a sum of our parts. Our mental and psychological health is equally important and intertwined. 

 ​When that patient was told never to kneel again, she refused to practice getting up and down from the ground with me in my clinic because she would not put weight on her knee in a half kneel position – even for the 10 second transition (and with hand support on a table). The surgery happened over 10 years ago; and she was now at a point where her balance was not good and she was afraid of falling. I was trying to show her in a controlled environment how to get up if the worst were to happen (sometimes the fear of falling is equally the fear of not being able to get back up).

Or the 65 y.o. patient who was told never to lift anything over 20 lbs... His 3-year-old grandson was 34 lbs and wanted to run into Papa’s arms. Rather than being taught to strengthen his core and learn good lifting mechanics, Papa just reminded the little guy that grandpa has a bad back and will settle for a high five.
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In a world where the Paralympics continue to show us how resilient the mind and body are and how the once inconceivable are not only attained but gold medalists -why are we so willing to accept no as an answer?

As physical therapists, I would hope that my colleagues, as well as other professionals, start realizing the impact that what we say can have on an individual’s self-identity and future ambitions. 

The body is so amazing and was designed with the capacity to heal itself. Tissues heal. Chronic pain is usually brought on by an overactive nervous system that may have been conditioned under stress, conflicting medical opinions, fear of imaging results, ongoing legal battles, growing medical bills, and family pressures. Not always. Some things do result in life-long tissue damage- but this is more rare than we are led to believe.

As PTs, our goals are to

1. Help your tissues recover faster through education (knowing what is going on can significantly help reduce neural response), manual techniques to improve tissue mobility and circulation, and strategies to reduce further stress to the healing tissue.
2. Teach you ways to rebuild proper movement patterns and strengthen surrounding tissue to support return to normal activity without further risk of injury.

OR
    3. If severe trauma or a progressive condition causes a true inability to resume prior function at your previous capacity, then it is our job to show you modifications or tools to continue to allow you to perform within your current abilities.

​So.. to help preserve the longevity of a total knee replacement, you shouldn’t garden on your knees for 30 minutes at a time. But, you could use a low bench, planters, or a raised garden bed. If you had your knees replaced early so you can be more interactive with your grandkids, then use your knees to help lower and raise yourself from the ground to play with the legos.

If you are a runner who used to run 5 miles each morning to help improve mental focus for the workday ahead; or at the end of the day to help relieve anxiety -being told not not to run feels like give up the best mental health practice of the day. Some fractures are linked to increased risk for developing osteoarthritis, but what is the health risk from not exercising, losing the mental support of a running club, and turning to more passive stress relievers at the end of a long day (high sugary foods, alcohol, TV). Instead, maybe you start with a 2 mile hike in the morning and a 1 mile jog at the end of the day.

If your shoulder has a torn labrum, it might be irritated throwing consecutively for 20 minutes at a time. But you can start with 5-minute intervals while building up strength in your rotator cuff and doing daily mobility practices to make sure your shoulder moves freely without stressing the internal structures. Or you can be the batter and let your son practice fielding and running the ball back.
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Yes, your back might have a herniated disc. It might have more than one. But does it hurt all the time, or is it just fear of reinjury holding you back? Were you told you will need major surgery if you ever hurt it again? What if I told you that some disc herniations get reabsorbed over time (Altun & Yuksel, 2017).  Your deep abdominal muscles and spinal stabilizer muscles act like a weight belt at the gym. Instead of preventing abdominal hernias, when working properly, they support the internal spinal column and allow you to lift with very little risk of injury. 

​So if you have ever been told no, and you are sick of sitting on the sidelines in the game of life, I hope you can find a PT that tells you “how” instead.

Hint: you can come see us anytime at RecoverRx Performance Physical Therapy, where our motto is:

Reference: Lumbar herniated disc: spontaneous regression. Idiris Altun and Kasım Zafer Yüksel. Korean J Pain. 2017 Jan; 30(1): 44–50. 

Thanks for reading!
Dr. Sarah 

Email me if you have any questions about how we can get you back the things you love! sarah@recoverrxpt.com

As I look ahead to this upcoming Golf Season, I can’t express enough how excited I am to implement all the stuff I have learned over the last year going through the Grey Institute Golf Performance Specialist program. The information I have gained has allowed me to not only become a better golfer myself but also begin to help others unlock their full potential out on the course. ​

A couple very common questions I get from my patients who are golfers include “how can I increase my mobility in my swing” and “what can I do to become more flexible to help my golf swing.” Many times I hear this from the aging golfer who has started to see their mobility decrease in their backswing and finish and as a result has seen their distance decrease off the tee and with their irons as well as notice a decrease in their endurance for playing multiple rounds. ​

​I’ve very much changed the way I approach mobility with my golfers. I used to have them lay on the ground and perform the “open book” stretch or give them a club and put it over their shoulders and rotate. Don’t get me wrong, these isolated activities are better than nothing and can certainly give you an improvement in your mobility and swing, but I really like to emphasize the importance of swing specific mobility in all three planes of motion.

So now that you have an idea of the planes of motion needed for a golf swing, you are probably asking yourself, “how do I know if I have adequate motion in these planes?” Well, great question and that is why I’ve put together a quick self-assessment to see what your motion looks like. ​

By Dr. Sarah Greenwell, PT, DPT, CSMPT 

I truly believe that fitness and health are a journey, not a destination. But there is no fast track, and we are constantly learning new research about what things are healthy and what things we thought were healthy, are really not (ie diet soda, fat free dressing, frozen meals). We decide every day what choices to make and in turn, we are making choices that either push us toward a healthier lifestyle or away.

But it does not have to be all or none. We are used to New Year Resolutions, 6 Week Challenges, and fad diets that cut out whole food groups. And we think that if we stick to this one change, we will get the results we want. But when we fall off the wagon, that wagon keeps going and we stay right where we are – or worse, go right back to where we started.
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Rather, we can make small choices every day that move us up the hill of health. And if we stumble along the way, we don’t roll all the way back down to the bottom. We pick ourselves up and try again. 

​Although these are easily stated (and picture posted on my refrigerator), they are not so easy to follow 100% of the time. I also read somewhere that it is not ‘watching what you eat’ that is so hard, but ‘watching what other people eat.’ We are surrounded by temptation every day. We pass a hundred fast food restaurants, Starbucks coffees, & billboards of fried food every week. We are invited to birthday parties, dinner dates, holiday get togethers. We plan to be good, then we get in a situation where it seems like the polite thing to do is to join the fun. Or we go out to eat and shy away from getting the salad because we don’t want to be ‘that person’. But you only get one life to live and one body to live in. It doesn’t matter what other people eat or what they think of your meal – it is your job to make this body last and stay functional for 80+ years.

And it doesn’t have to look like a model or athlete. Eating right is not just about losing weight or keeping weight off. It is about fueling your body to have a productive day. I learned the hard way that Pop-Tarts in the morning are not a good idea on your first day of inpatient clinical rotation – I walked into that first wound care patient’s room and passed out because the simple sugars I ate for breakfast did not prepare me for the day ahead. Eating right is also about preservation. We know that it is cheaper to buy boxed foods (sometimes in bulk) than it is to buy fresh produce and meats. But the money you spend now will be much less than the cost of hospital bills and medications down the road if poor food choices lead to diabetes, heart disease, stroke, and dementia.

Again, from personal experience, I have my doctorate in a health science degree (DPT), read nutrition research, have watched documentaries, and constantly listen to my wise husband tell me all the reasons I should eat better and what things to avoid. But do I do it all the time – no. Could I switch to the perfect diet in 1 month and maintain it -unlikely. It has been years of trying to make better choices and realizing that I want better choices for my kids too. (Let’s just say I have come a long way from eating boxes of mac n cheese multiple days a week in college).

I propose that the best way to approach nutrition is with goal stacking. Maybe you take a 12-month calendar and mark off one goal for each month [not starting next year, next month, or next Monday; just pick today and go from there][tip: use your phone calendar so you won't lose your plan]. For example: this month, choose breakfast options that include a protein and fruit to help fuel your day. Next month, pack a lunch for work at least 4/5 days instead of eating out. Month 3 – watch portion size by avoiding seconds at dinner and saving half of your meals from restaurants for leftovers. So far, you are 90 days in without eliminating any major food groups and making better choices. By focusing on one thing for 4 weeks, you are more likely to turn it into a habit that will be maintained when you move on to the next phase. Other options for stacking on your habits:

• Month 4: Check the labels on your food and limit anything with added preservatives, sugars, high fructose corn syrup, chemicals, and additives (things you cannot pronounce) 
• Month 5:  Give up the sodas, sugary drinks, extra cream in your coffee 
• Month 6: Drink at least 4-5 glasses of water per day (will help curb hunger cravings) 
• Month 7: At least 5 days per week, avoid processed grains in bread, pasta, pizza 
• Month 8: Try to get at least 3 dinners/week with lean meats (poultry, fish) or a couple vegetarian nights 
• Month 9: Try to reduce your cheese and milk intake   
• Month 10: Start to buy organic meats to avoid the added chemicals and hormones 
• Month 11: Try to get in 2-3 servings of vegetables per day Month
• 12: Try to prepare your own meals at least 75% of the time 

The order is not important, but all of the steps are. Start with what will be the easiest for you to maintain and end with the hardest. Each month you make a change, you will feel the pride of doing something good for yourself (and likely your family), and hopefully start to feel and see the results as your energy improves, your self confidence improves, your skin improves, your mental clarity improves, and your body improves.

So I’m not saying you can never have a slice of pizza again; or you can’t get the cheesecake at the Cheesecake factory after dinner. But if you make better choices 75-90% of the time, you won’t have to feel bad about having an occasional treat. And it won’t mean that you failed and have to quit. If you get one flat tire, do you slash the other 3? No, if you mess up or have a set-back, you fix it the next day and keep going on your journey. Think of where you could be in a year with only making one change every 30 days. And if you create lasting habits, think of where you could be in 2, 3, 10 years. 

Thanks for reading!
Dr. Sarah
-I may not be there yet, but I am closer than I was yesterday.-

In April 2021, one of my patients told me I had to listen to this podcast because it was right up my alley- simple and effective health advice. My patient was right, I loved the podcast and bought the book. It is called Feel Better in 5, Your Daily Plan to Feel Great for Life by Dr. Rangan Chatterjee. He laid out why new years resolutions typically fail within the first weeks even with the best intentions. ​

If you are interested in delving deeper into sustainable health habits, please check out Dr. Chatterjee’s book or the Iron Strong Podcast for tips and advice on creating long lasting health.

Here's to a Healthy 2022! 

By Dr. David Bokermann

When trying to find relief for a headache, knowing what type of headache you are dealing with is crucial to fully alleviating your pain. Our role as a PT in headaches is to identify the exact type of headache you are dealing with to provide the most individualized treatment approach.My personal headaches described above would be considered tension or “stress-related” headaches. There are in fact 10 other common headaches, including: ​

Please don't hesitate to reach out to us your healthcare provider if you have additional questions regarding headaches and/or the types of treatments that you should be receiving. Thanks! 

By: Dr. David Bokermann, PT, DPT, C-PS

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If you or someone you know is dealing with a recent concussion or one that hasn’t recovered the way they would like please don’t hesitate to reach out or call so we can identify the profile, prescribe specific exercises based upon the examination and tailor a return to play/life protocol that is based on tests and measures supported by research! 

You can reach out to us via email: info@recoverrxpt.com
                   or reach us by phone: 331-253-2426
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​What’s going on people! It’s been a minute since our last blog post, but we are back at it trying to get more regular here. In today’s blog, we are going to discuss the Top 3 CrossFit injuries not healed with rest. If you don’t CrossFit, well this might not be the article for you, but there are certainly parallels to other exercise modalities such as Olympic Lifting, Powerlifting, Bodybuilding, Gymnastics, and Sports Performance Training that may entice you enough to keep reading on! 


First off, it goes without saying that there is an inherent risk of injury with CrossFit (yes this is true). However, generally speaking incidence is not more common than things like distance running, biking, or weekend warrior sports. Like many sports and high level activities though, injuries occur, and there is generally a common pattern or mechanism of injury for most of the injuries we come across in the box and gym. For the most part, the CrossFit community tends to preach injury reduction tactics such as being smart with your weights, warming-up, staying in your lane when it comes to competition during workouts, and of course the recovery component. But... even with all these tools and education thrown at us CrossFit athletes and weightlifting athletes, INJURY OCCURS. There is no ultimate method that will prevent all injuries, believe it or not. They happen! But, if we continue to educate people on the most common causes of injury in the box and gym, then hopefully we can continue to mitigate the risk for serious injury or loss of gym time that will occur. No one gets into CrossFit with the intention of doing everything they can to get stronger even if that means injury, so let's try to do our best to not get injured. Ok, ok. enough with the soap box about injuries occurring. Oh wait, did I mention diet, sleep, and overall stress levels can also contribute?? Well, maybe that is best saved for another post. 

Let’s dig in to the top 3 CrossFit Injuries not healed with rest and how we can hopefully decrease these occurrences. 

1. First and most common injury in CrossFit is the dreaded “Shoulder Impingement Syndrome.” I use this term in parenthesis because I’m not a fan of the term but it is best recognized by the general public so we will stick with it for now. Most of us that have been CrossFitting or lifting for sometime have experienced that episode of “pinching” pain at the top of the shoulder when pressing overhead, attempting to do a pull-up, or any movement with load and demand at the shoulder. Can this get better with rest though?  When this acute injury occurs only once, there is a chance that it was just a freak occurrence of something not moving like it should or your body was not warmed-up well and prepped for that highly demanding movement. In this case, yes. But, if the episodes are repetitive in nature and continue to occur over the course of a couple days or even weeks, the likelihood that it is just going to resolve on its own is poor. The pain you are feeling is an output from the brain in response to a signal from the shoulder that something is not right. There needs to be an action to alleviate the symptoms and restore the normal movement in the shoulder sooner rather than later. This is important in order to not develop compensatory and chronic movement asymmetries that could lead to further more severe injury down the road. So what should you do, besides initially attempting some self soft tissue mobilization (see Kelly Starrett’s Stuff) with a lacrosse ball, basic stretching, and low load exercise, you should see a specialist like a Performance Physical Therapist who can help you address the acute inflammatory symptoms, restore normal active shoulder motion, and then retrain the shoulder blade and shoulder complex to move correctly in these specific movements that initially hurt it, and then load it in class. That is the progression back to normal. Rest is not the answer, unless you are wanting to rest for an extended period of time  (>6 months) then relearn to move correctly. I really don’t know a lot of people that want to do that though. So be proactive to your response to this type of pain! 

 

1. The second most common injury, acute low back injury. Typically the mechanism of injury here occurs during a heavy lift from the floor while your body is fatigued. Think of a heavier deadlift or power clean at the end of an AMRAP where you have fatigued the other systems of your body. Throw some “race against the time” in there, and the risk increases. The typical presentation is central or one sided low back pain that can refer a bit in to the buttocks. This pain worsens as the day goes on and into the next couple days. Rest is needed early on for the first day or two, but then active recovery should begin to take place. Walking is great for this injury, and should be your go to active recovery. In any case though, your best avenue is to see a specialist (the aforementioned Performance Physical Therapist) to get your acute inflammation down, provide guided active stretches specific to your movement preference and needs, and then develop a progressive loading plan that will get you back safe and efficiently to the gym. Remember, injuries occur and this one likely is a result of core fatigue leading to poor form and stress on spinal tissue that is not made for loading that weight. In any case, be proactive and seek help! 

 

1. One that many of us have experienced, non-specific knee pain, specifically around the knee cap and front of the knee. This generally prevents us from squatting, jumping, lunging, among other movements. Swelling can occur here. The mechanism of injury here is generally not associated with one specific incident, but is a build up overtime of chronic overload, poor hip strength, and/or poor flexibility and mobility around the knee and ankle as you progress through heavy load and dynamic activities required for CrossFit. This syndrome is one that people really tend to try and wait out or modify the movements to avoid the pain. The problem with this approach is that you slowly begin to eliminate many of the movements and activities that you got into CrossFit to perform and that are actually healthy for the knee. Yes, bending your knee past 90 degrees under load is healthy :). Many people want to jump to imaging or medication for resolution of symptoms, and in some cases this may be part of the equation, but generally speaking, I’ve seen this presentation hundreds of times in my career, and a combination of acute inflammatory control via manual hands on care, a targeted self mobilization and flexibility routine, and gradual progression of loaded exercises to strength the supporting musculature of the knee can return you back to the gym and movements that you want to perform. So again, be proactive and seek help from a specialist to help you come up with a plan to tackle your issues. The guessing game is a tough one to win. 

To Conclude, I want you as the reader to understand again that injuries do not mean you have to stop or go get imaging or take up knitting for fun instead of CrossFit. Injuries occur (you’re not alone)  and a majority of the time do not have to have medical intervention such as medication, injections, or surgery to help you return. Identification of early symptoms and help from a specialist can take care of 95% of your issues that you may run across during your life. Also, understanding these common issues and the common mechanism will hopefully help you be more cognizant of your movements during CrossFit and reduce your chances of injury down the road. 

As always, I’m available via social media @recoverrxpt or via email Luke@recoverrxpt.com to answer any questions you may have.

All the best,
Dr. Luke

By: Dr. Jesse Espe, PT, DPT, CSCS, CIDN

So... What Is BFR exactly? 
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In order to fully understand what blood flow restriction (BFR) training is and how it works, first we need to brush up on how the cardiovascular system works. In a nutshell, your arteries carry oxygenated blood to your working muscles, then your veins carry the deoxygenated blood back to your heart. BFR was originally developed in the 1960’s in Japan, known as KAATSU training there, to play with this system and try to hack your physiology. Essentially it involves applying a band or cuff proximally to the muscle(s) being trained, typically upper arms and legs. The cuff is then inflated to a determined pressure. This pressure then will limit the amount of venous return out of the muscle while still allowing the arteries to carry oxygenated blood to the working muscles. Once applied, the athlete will complete a low load (20-30% of 1 RM), with high repetitions (15-30) with a short rest interval between sets (30 seconds).

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We are currently in a day and age, where people want to know exactly what is going on with their body and the "why" behind it. We want answers and we want them now. Look at the increasing number of "wearable technology," DNA tests, rapidly accessible blood panels, and different imaging scans available. This is especially true when it comes to pain and lack of performance. Many times when an injury occurs in an area of the body or lack of strength or mobility is apparent in a certain area, we have tunnel vision in looking only at the area directly related to where the pain or lack of strength is located. Many times the area of pain or weakness is not the source of pain or weakness. Where should we be looking and why?

Think about this, 26 bones, 33 joints, and over one hundred small muscles and small tendons; and that’s just one of them. The human foot is one of the more intricate, complex and fascinating parts of the human body. 

I mean we really only get 2 of these things to walk on for the entirety of our human existence. These are the two things that keep us in contact with the Earth. They are our main connection, but do we really pay attention to this connection? Are we in tune with foot/ground connection and how it plays a role in our every day function as well as performance in whatever sport we like to partake in. 

There are many reasons why we need to pay attention to our foot and ankle in this kind of way. 

Thanks for checking back in to the blog. I hope the last month has treated you well. 

Today I wanted to talk about the topic of mobility, no not your ability to move around the country, but your ability for your body to move freely and without pain. Many of you have at one point in your life been told you are "too stiff" or "too flexible" or that you need to "Stretch more" or "stop bending like that." I, for example, had the nickname of "Gumby" because I was tall, lanky, and pretty flexible (which by the way lead to some injuries including chronic ankle sprains). Anyways, these are general terms directed at our physical "mobility." Now many different anatomical structures can effect our mobility such as our joints, muscles, ligaments, and tendons as well as other clinical conditions, but in general when people start to refer to your mobility, they are referring to how much range of motion you have in your joints. 

Physical Therapists are trained professionals in assessing your mobility and how it is effected by all these different anatomical structures, but you for the most part are not and don't/can't have a physical therapist there for you to assess it every time. So it is a good idea to have a general understanding of where you are at on the "spectrum of mobility." ​