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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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
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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 ariel@recoverrxpt.com 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 ariel@recoverrxpt.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. References:
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). By Dr. Sarah Greenwell, PT, DPT, CSMPT As a physical therapist, I cannot prescribe medications. However, as a Doctor of PT, I am here today to prescribe a daily dose of M.E.D.S. But not the kind that comes in a pill. The MEDS I am talking about are: Mindfulness Exercise Diet Sleep  Most people come to physical therapy because of pain. Or because they cannot workout or participate in life the way they want. But along with strengthening muscles and mobilizing joints, many of these issues can be significantly improved with a healthy and daily dose of Mindfulness, Exercise, Diet, and Sleep. And along with improving joint and muscle pain, daily M.E.D.S. can help improve stress, anxiety, lack of energy/motivation, poor mood, and upset stomach. Let’s quickly break these down. Mindfulness: is achieved by focusing on the present moment, accepting your thoughts and feelings, and being able to focus on what you CAN control. Instead of mindlessly going through the motions of your day, take time to think about what your goals are for the day. In the morning, ask yourself: What do you want to accomplish or what do you have to do to overcome the day’s challenges? Or in the evening, reflect on what went well, what didn’t, and what can you learn from today to make tomorrow better. Don’t focus on the obstacles. Focus on the progress. Progress gives you purpose, energy, passion, enthusiasm, joy, gratitude, and hope for the now and the future.  Exercise: It is recommended that adults get at least 150 minutes of moderate to intense exercise per week. But if you are not there yet, start with something. Make it a daily routine to do at least 20 minutes of physical activity. Try to include a mix of flexibility, strength training, and cardiovascular exercise. A daily walk or a beginner yoga session is one place to start getting your body moving. We are learning more about the protective effects of muscle mass and strength on lifelong health and aging while maintaining an active and Independent lifestyle. So make sure to pick up some weights a few times a week. If you need any help or guidance, shoot us a message or give us a call today! 331-253-2426  Diet: We are not talking about a short-term weight loss strategy. Rather, your diet is the way you fuel your body to perform. Although it can be confusing and conflicting in today’s world to know what is healthy, most nutritionists would agree that if it is a plant – eat it; if it was made in a plant – don’t. Try to stick to food in its more natural form and with ingredients that are found in nature. And although added sugars may taste good, they do not provide your body with nutrition. Instead, they add inches to our waistline and increase inflammation in our gut and skeletal system.  Sleep: Adults need 8-9 hours each night to function at our best (and kids need even more)
Any less, and our bodies struggle to repair tissue, store memories, support immune function, and fight fatigue. Napping and caffeine do not replace the need for consistent quality sleep. The physical and emotional stress that we put our bodies through during the day needs a full night of rest to recover and prepare for the next day. So instead of an ‘apple a day to keep the doctor away,’ try to take your M.E.D.S daily, and reach out to us if you have any questions or would like some trusted resources on any of these topics! Dr. Ariel Sernek, PT, DPT DRA stands for Diastasis Rectus Abdominis. It can be tricky to pronounce but you can just call it DRA, and we’ll know what you’re talking about. First, it helps to understand a bit of the underlying anatomy and terminology. Your “six-pack” muscle is called the Rectus Abdominis and diastasis means “the separation of normally joined parts” (Dictonary.com). So a DRA is a separation of your six pack abdominal muscles. Now, your muscles are not actually splitting apart, there is a ligament between your right and left sides of your rectus abdominus called the Linea Alba. The linea alba is meant to be flexible and this structure is what stretches and recoils back to its original size. Pretty Cool, right?  How common is this? DRA is most commonly seen around pregnancy and post-partum, in fact 100% of pregnant women will have a DRA to accommodate for the growing baby after 35 weeks gestation. Fun fact: men can also have this too; think “beer belly.”  "Do I need surgery?" This is something I hear all the time. Surgery can fix this, but primarily if there is an abdominal hernia. This is when part of your intestines protrudes through a hole in the linea alba. This can cause abdominal pain and dysfunction with bowel movements because there is now a kink in your bowels limiting stool from moving as it should. Surgery is not the only fix, physical therapy can also help! How does physical therapy help? First, we need to get a global assessment of your rib angle, your thoracic spine mobility (your mid back), posture, abdominal strength, and MOST importantly- how you manage pressure through breath work and correct timing of your core. Your core is not just your abdominals, but your diaphragm, your pelvic floor and your lower back muscles. These muscles have to work together in order for pressure to be managed and your body to work properly. Imagine the last time you coughed or sneezed, you probably felt your belly pooch out and maybe down. That’s the internal pressure we have to manage that can pull apart your rectus abdominis muscle.  Picture a can of pop, it’s pressurized until you open the tab and then the pressure can escape. Now, imagine the middle of your abdominal wall being the open part of the can. Pressure is going to travel wherever there is weakness or an opening. This is why surgery does not always fix the issue. Sure they can stitch the rectus abdominis muscle together, but if you cannot manage abdominal pressures, the surgery can fail and you can separate again. This is not a good situation.  People don’t like to hear this, but the distance of the muscles is not my main concern. The strength and tension created by your linea alba ligament and how you manage abdominal pressure with your daily activities is my main concern. Some people have separation, just as some people have stretch marks or looser skin. These are normal changes with pregnancy and post-partum and are okay to have. Genetics, diet, water intake, previous history of exercise and training regimen, and current exercise can all influence the cosmetic look of your abdominal wall. In addition to pressure management and addressing core dysfunction, we also address urogenital symptoms of urine leakage, urgency, pelvic organ prolapse, constipation, musculoskeletal pains, and anything else that can influence your core. We are then able to load and progress your abdominal muscles based on where you are at with your activation and control. If the activity is something that causes you to have coning, we back off. That just means your body isn’t ready for that exercise yet. We would also need to address gluteal strength, posture management, strengthening your deep core and pelvic floor, how you move in/out of positions, and teach proper bracing to address… you guessed it, PRESSURE! Hopefully this article has answered some of your questions surrounding DRA and how you can address your symptoms without the need for surgery. 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 ariel@recoverrxpt.com or check out our Pelvic Health page https://www.recoverrxpt.com/pelvichealth.html Also, check out our youtube Curiosity Corner!
David Bokermann, PT, DPT, C-PS All members of RecoverRx have successfully completed the 75 Hard Challenge. We all agree that we are happy the 75 days are over, but glad that we stuck through it. The final results are in for myself: I lost 11.5 pounds but I gained a tremendous amount of appreciation for time management and structure. 1 year ago, I would have never imagined having 3 kids and a full time job and being able to get in 2-45 minute workouts a day while also finding time to read 10 pages a day, as well as drink no booze and only water. I could not have done it without the support and encouragement of my co-workers and my wife Jen (she also completed her version of 75 Hard as well). I learned that if you prioritize your health and you prepare ahead of time, you can find the time. Now, I am lucky that I work in a gym so I have access to working out over my lunch or during my workday but finding the time became easier and easier week over week when I prioritized getting it in no matter how crazy my day became.  I prepared a couple of questions for each member of the team to get a better understanding of individual experiences. Below are the answers. What are you looking most forward to, now that it is over? David: Potato chips- they are my guilty pleasure Sarah: 1 workout/day & Ice cream Luke: I’m not going to lie, Ice Cream and Pizza What was your least favorite aspect of the challenge? David: the total time being 75 days. The days from 50-70 are a grind- your body gets pretty tired and worn down, finding motivation becomes harder and harder. Sarah: Not preparing for the day and doing a 45 minute workout after 8 pm; especially when it is outside with the mosquitos Luke: I would say it actually ended up being the second workout as I realized many days I did not plan my time accordingly and I had to do a late night workout. What was the most enjoyable part of the process: David: I woke up early on the weekends and got in a nice walk early in the morning. It was a great way to ease into the weekend and created a consistent mindset. Sarah: Outdoor walks with family or neighborhood moms Luke: I think it was the 45 minute walks with my dog as well as late night Yoga sessions on the back patio with Sarah :)  Did 75 Hard Meet your expectations? David: Yes, I am very proud of committing to the challenge and completing it entirely. Truthfully the first 45 days my mind and body felt really good. I had a lot of energy and felt like I created so much more time in my day. As the challenge wore on, it got harder and harder; if I missed a workout in the morning, making it up in the evening was pretty rough. Drinking that much water for so long was pretty daunting, I would use a LMNT packet as a treat. I would say keeping committed, focused and motivated for 75 days was very challenging but doable. Sarah: Yes, It was a great way to set workouts as a priority and nutrition guidelines (eat real ingredients, no processed foods) and force myself to stick with them for a long period. Honestly, sometimes it is nice having an external excuse for why you are sticking to those guidelines when you are out with family and friends. Somehow, the “I just want to be healthier” reason gets more probing from people than saying “I am in the middle of a challenge.” Luke: Yes it did. It was at times very challenging more mentally than physically. This is exactly what I was looking for when I signed up, something to make me uncomfortable and force me to embrace the discomfort and overcome it. We live in a first world country with comfort all around us, and I feel it is essential to put yourself in uncomfortable situations more regularly than you would like. What aspects of the challenge would you like to continue? David: I would say the commitment to a specific goal and duration was very empowering for me. I plan on attempting another challenge next January simply because I enjoyed the process, liked pushing myself physically and mentally, and found a lot of personal growth through pushing my comfort zone. Sarah: Setting priorities and making it happen, especially when it comes to getting in a workout and reading. The hours are there, you just have to make them work for you. Luke: I will definitely continue the water intake around 100 oz as well as significantly minimizing my alcohol intake by continuing to turn to non-alcoholic beers on a more regular basis. I am also going to attempt to maintain the daily walking to some degree as this has had significant benefits mentally and with recovery. 
Do you have any tips for anyone that is contemplating trying it out? David: The juice is worth the squeeze. The reward of gains in discipline, time management and health prioritization is worth the hard days. Sarah: Know that it will be a long journey, but one that will show you how physically and mentally strong you can be if you put your mind to it. Luke: Just F’ing Do It! I hope you enjoyed reading about our experiences with the 75 Hard challenge, please leave a question or comment for our team. We would be happy to connect and continue this discussion. David Bokermann, PT, DPT, C-PS Fitness challenges have been around for countless years, but have been gaining popularity in the age of social media with a large part of the population sharing their stories and results of such challenges. As the team at RecoverRx is committed to personal health and wellness, Dr. Luke, Dr. Sarah and myself, Dr. David, have decided to give this latest fitness challenge a shot. The 75 Hard challenge is a self improvement plan created by Andy Frisella, the CEO of 1st Phorm supplements. The challenge lasts 75 days and consists of completion of 5 daily tasks.
 As part of this blog, I will interview both Dr. Luke and Dr. Sarah about their individual journeys to check in with their progress, discuss any wins, and analyze any pitfalls. But first, I will begin with my take away being 2 weeks into the challenge. First, for the nutrition component- I elected to focus on my personal habits and not follow a restrictive diet. The nutrition plan I am following is having to have a fruit or vegetable at every meal. May not seem like much, but with 3 kids at home and different early and late shifts at work, it has been easy in the past to grab something convenient versus healthy. In addition, in order to address my specific habits, I have also challenged myself to not eat any potato chips during the challenge, which is my guilty pleasure. Not going to lie, that has been harder than the water. For the fitness component, completing both workouts is definitely a challenge. I am very lucky in that I literally work in a gym, so I can rather easily get in at least 1 workout at work over lunch. To get the 2nd one in, I got back to my Peloton routine early in the morning or after the kids' bedtime. To accommodate for my family’s needs, we do go on a 15-30 minute walk on most nights I am home which I am counting towards my outside time and part of my 45 minute workout. To also get in the outside component, I have made it a point to get out of the office and walk for short periods to help bridge the gap if I haven't hit my 2 45 minute workouts. The fresh air has been great. As a PT, I am acutely aware of the consequences of muscle soreness and the need for recovery. It is never fun to be limping around for a couple days or have trouble bending forward because your body is so tight from overworking, so I have been adding in sessions of yoga and whole body recovery sessions. The gallon of water was a little tough for the first 5-6 days, but now I have hit my stride and have been finishing the requirement before 8 o’clock. The goal being don’t wait until the end of the day so you are not getting up in the middle of the night to use the bathroom. My advice though is to get the largest bottle you can get and carry it around with you wherever you go. I purchased a 64 ounce bottle from Aldi that hasn't really left my side. Reading at night has been an inconsistent activity over the past couple of years that is really enjoyable but sometimes hard to get in daily. I enjoy the night-time task and look forward to gaining some knowledge on topics that interest me. I am currently reading “The Subtle Art of not giving a F*!$,” which has had some interesting thought provoking ideas. On the daily picture taking, I elected to do a weekly picture and weekly weigh-in instead of the daily picture of progress. I don't feel like I am missing out or changing the parameters but wanted to do what makes the most sense for me. If you are interested in doing the 75 hard challenge yourself, leave a comment or ask a question below. Keep an eye out for the follow up interviews with Dr. Luke and Dr. Sarah in the next couple of weeks. By Dr. Sarah Greenwell, PT, DPT, CSMPT I listened to a podcast recently where the speaker mentioned that the more invasive a treatment is, the more expectation there is for improvement. In our culture, we generally consider surgery to be the gold standard fix for an orthopedic problem, followed by a shot, a pill, and rehab. We also live in a culture that wants immediate results. The problem is that orthopedic surgery can sometimes do more harm than good. (https://theconversation.com/3-orthopaedic-surgeries-that-might-be-doing-patients-and-their-pockets-more-harm-than-good-179370) And other times, it has been proven in research to be no better than conservative rehabilitation. In some cases, short term results are seen but... many times long term results are often the same. We really should be asking ourselves is the cost is worth the outcome? And that cost includes the financial burden of surgery; time off work, sports, exercise, recreational activities with family; and cost of the rehab often needed following the surgery. Not to mention the temporary increase in pain immediately following a surgical procedure, the impact it can have on sleep for several days to weeks following the procedure, risk of complications on the operating table, blood clot or infection risk during recovery, and often the need for help from friends and family for basic self-care and driving in the early days post-op. Dr Travis Maak on the JOSPT Insights podcast even said that most surgeons will prefer to avoid surgery. They recommend conservative care first. I once had an orthopedic surgeon who performs total knee replacements on a daily basis, tell me that he personally would never have the procedure because he has seen some of the bad complications. Converse to the complications from surgery, the side effects of physical therapy -specifically exercise- can include: improved strength, flexibility, cardiovascular function, weight management; improved balance, bone health, endurance, mood; improved blood pressure and cholesterol; improved circulation; reduced stress; improved posture. Doesn't sound too bad does it? The catch – it sometimes takes time and consistency. Based on the severity of pain, how long it has been a problem, and the underlying cause: some patients get pain relief in the first 2-4 therapy sessions. For others, it takes more time. But for everyone, true improvements in strength and tissue health take at least 6-8 weeks. If you want to fix the underlying problem and keep it from coming back, you need to put in the work and time. We have a quote on our clinic wall that says:  It has also been shown in research that although the pain might improve following a procedure such as a total knee replacement, often an individual’s overall activity level does not change. So although you might believe that the knee pain is holding you back, and once it is gone you will be able to do so much more… it is actually up to YOU to do more. One of the benefits of conservative rehabilitation over surgery is that the healing process is also setting the foundation for long term improvements in mobility, strength, exercise motivation, and a habit for moving more. Often, the results of imaging, like x-ray and MRI, scare us into believing that we are broken. “Bone-on-bone”, “tendonitis”, “bulging discs”, “muscle tears”… we have been led to believe that these things need to be fixed for the pain to go away. But we know through research that ‘abnormal’ findings are actually very normal and common:
Imaging shows a picture, but the findings are not always a direct correlation to the source of pain. So sometimes surgery that addresses something on an image, might not actually change the pain. It is possible to have arthritis, worn tendons and ligaments, and a history of injuries- and still recover without surgery and go on to exceed prior fitness levels. I just watched a youtube video (link https://www.youtube.com/watch?v=zv9OneDrB4Q) of a 100 year old man competing in a sprint event this April 2022. I am sure that his cartilage is frayed, the bones are arthritic, the muscles have chronic changes --- but he is still performing and enjoying it!  This is not to say that surgery is never appropriate or helpful. There are certainly times when surgery is the best option. But for most orthopedic injuries, 6-8 weeks of conservative therapy should be tried first. And not the kind that you just show up and someone else does a bunch of passive treatments (ultrasound, electric stimulation, massage and stretching only) – but the kind that makes you work!
If it doesn’t challenge you, it won’t change you. Put in the effort to help accelerate the tissue healing, and build a better foundation for future performance! If you or someone you know is dealing with an orthopedic issue and you are considering surgery or wondering what other options you have, you can reach out to us via email, info@recoverrxpt.com, give us a call 3312532426, or sign up for a Free Discovery Visit to see if our personalize therapy can help. Thanks for reading! Dr. Sarah 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?
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. 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
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. 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 |
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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