Who Should See a Physical Therapist?

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Short answer- if you’re reading this, probably you.

 

Most people, including those in the fitness community, don’t really know what it is that we as Doctors of Physical Therapy, actually do.  Until recently, I think most people thought it was something their grandmother did, or only if you had surgery.

If you get injured and don’t see a physical therapist first, typically the first thing people do is go to their primary care doc or other medical doc.  Usually they end up seeing an orthopedic surgeon who suggests expensive imaging that can elevate fear but also can lead to unnecessary procedures. While that is an unlikely outcome for most people, it does happen.

Many times, people will wait a few weeks (or months!) to get their injury checked out.  For most injuries or pains, physical therapy sooner rather than later will decrease the time it takes to get you back in the game and decrease your cost.  A 2012 study showed that people who started PT within 14 days after injuring their lower back were able to save $2700!

But what about those that have had pain for 6 months… or 6 YEARS!?

Physical Therapists are movement specialists.  That means whether its walking down the street, picking your kids up, or being able to perform your fitness routine, we can help you!  The best results you’ll see is from working with us on how you move by correcting any dysfunctions and gradually reintroducing non-painful movements and load!

Case Example: A middle aged, male patient who does CrossFit with chronic shoulder pain for over 5 years!  Imaging showed a massive rotator cuff tear and labral tear.  His orthopedic surgeon was ready for surgery ASAP; just to be clear, this is a pretty severe injury so surgery is often first thing on the table.  However, this patient did not want to stop working out and wanted to try anything BUT surgery.  After 12 weeks of commitment to rehab homework, coming in weekly for hands-on work and a slow return to CrossFit, he was pain-free and beginning to have full range in his shoulder.  Now a year later, he has no shoulder pain and a new PR in his shoulder press. We focused on decreasing pain and improving function rather than harping on “fixing” the tear. It takes patience, dedication and active involvement from the patient—but it is possible!

Physical Therapy at Big League is different from your usual PT clinic:

– One on one with a Doctor of Physical Therapy
– One hour visits
– Skilled hands-on techniques
– Personalized homework- not just therabands and hamstring stretches!
– No referral needed

Bottom line- If you’re having pain with sitting, while you’re working out, or walking down the street, don’t wait for it to go away, and don’t let it take you away from the things you love to do!  Get assessed and the earlier to can address it, the sooner you can get back in the game!  Less time and money spent than the other options!

Your rehab shouldn’t just be about therabands and pelvic tilts- it should be focused on YOU and your goals! If you live in the Washington DC area, give us a call and let’s see what we can do for you! Click Here to book your initial evaluation!

High Intensity Interval Training- HIIT or MISS

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High Intensity Interval Training, also known as HIIT took the number ONE spot on the list of major workout trends for 2018. This probably isn’t news to many, especially here in the Washington DC.
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Benefits of HIIT classes include:

  • Burning TONS of calories
  • Boosting metabolism
  • Time efficient workouts
  • Make quicker cardiovascular gains than with longer, less intense workouts
  • Can slow down aging at the cellular level by increasing mitochondrial levels
  • Creating a judgement-free community where everyone is excited to workout

Now as exercise trends grow, HIIT has made its way to the mainstream, as this happens more and more people end up trying it.

The biggest problem I have is when new or “untrained” individuals jump into these classes without any prior experience. There should be some understanding of fundamental exercise techniques such as the ability to perform a squat, hip hinge, overhead press, etc before jumping into a class.

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4 Key factors to watch out for when doing a HIIT class:

  1. Inadequate warm up or preparation- everyone of us has different needs whether it’s mobility or stability, and jumping right into a program without addressing those needs can have negative effects.
  2. Bad programming/instruction- Unfortunately not all coaches/trainers are created equal. This can lead to programming mistakes such as working the same body part or motion repeatedly over back to back classes and not giving enough rest time either in or between workouts. An example of this is that CrossFit HQ recommends that workouts consist of 1 strength/skill exercise OR a metabolic conditioning workout with a 2 days on, 1 day off or 5 days on, 2 days off schedule. However most boxes will schedule a strength AND a conditioning work out 6 days per week.
  3. Improper Form- This is the biggest risk, especially for newer exercisers. The intensity and speed of the class will not allow you to focus on proper form and this is where injuries can happen. That’s why I stated before, that individuals beginning HIIT class should have solid understanding of fundamental movements patterns beforehand.
  4. Not enough recovery- While you might think you need to work out every day, the risk of overtraining can increase. Many people who utilize this type of training will work out above their maximal recoverable volume, which is “the highest volume of training an athlete can do in a particular situation and still recover.” While they may progress for a while and hold up for a period, eventually it catches up to them in the form of an overtraining injury. It’s recommended to attend these classes 3-4/week MAX? There should be time spent working on imbalances and restorative activities such as yoga, foam rolling, and strength training.

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With all that said, here are some ways to stay safe when trying out HIIT training:

At Home:

  • One of the best things about HIIT is that you don’t need to be in a gym to do it. However if there is a move that you haven’t done before or don’t feel comfortable with, it’s definitely best to go over with a trainer or your instructor first. Even simple moves like push ups and squats are commonly done wrong, so there’s nothing the matter with a form check beforehand. The last thing you want to do is be in the middle of class and have no idea how to do a certain move when you’re already tired from everything else in the class. Also maintaining form is even harder when you begin to add weight to that exercise.  So that means if you’re incorporating dumbbells, barbells, kettlebells, or any other type of weights into your at-home workouts, it’s a good idea to check your form with an expert first.

In Class:

  • Being in a class gives you the advantage of having a teacher or trainer who ideally will be watching you. Its definitely a plus having a trainer or instructor who is experienced and can make sure you’re doing everything correctly. And if you’re new to HIIT, definitely let your instructor know so that they can keep an eye on you!
  • Remember to listen to your own body and go at whatever speed/intensity is comfortable, It’s definitely easy to get caught up in the excitement and competitive nature of these types of classes, but there’s no need to be a hero. No rep/time/PR is worth getting injured.

 

At the end of the day, there are some risks associated with this type of training, however, there are a LARGE number of benefits in taking these classes! Research has also shown that exercise if more fun when its more challenging!

 

If you’re in the Washington DC area and trying to stay healthy/fit but can’t because of pain stopping you from exercising, or if you’re worried an injury will prevent you from doing activities you love like CrossFit, Bootcamp, or Spin Class, Send me an email- Mike@bigleagueperformanceandrehab.com and let’s talk about what’s the right plan of attack for you!

My MRI Says I Have a Herniated Disc… Now What?

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Now WHAT!?

Now Keep Moving!!

When I talk with patients, friends, family members who all tell me about their MRI and “how bad their back is”, I’m always disappointed to hear that they’ve cut back or even completely stopped working out.

“I stopped exercising because my MRI results show moderate disc degeneration in my lower back and my doctor told me it could make my back worse.”

Pain, especially in your back, can be frustrating, annoying, and depressing, and when your MRI results come back with structural damage, it can seem even worse.

However,  as the medical community continues to do more and more research, were beginning to learn that the findings on an MRI don’t always correspond with your symptoms or pain!  There’s been numerous studies done, with MRI’s performed on asymptomatic populations, that showed severely herniated discs and advanced disc degeneration.  Similarly, there’s been studies done on patients who have very real pain, but their MRI is completely clean!

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Why Mike, WHY am I in pain then!?

 

Pain is a very complex, multifactorial experience that involves a lot more than just what your MRI says.  Pain is a feeling we experience, which means it’s an output from our brain.

The International Association for the Study of Pain defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in such terms.”

Now, I’m not saying the pain is in your head, it’s definitely VERY REAL, no doubt about that!

What happens then, is in the body part that you injure, there are these little receptors, called nociceptors, that detect changes in tissue.  They then send a message to your brain saying, “Hey, somethings off here”.  Your brain then interprets that message and gathers a whole collection of other info, including but not limited to- current situation, force of tissue change, current stress level, diet, sleep, personal/family beliefs about pain- and then in an instant will send a message back to that original area, either sending a feeling of pain or “eh not a big deal, just carry on with your day.”

Here is a great video from International Pain expert, Lorimer Mosely, entitled “Why Things Hurt”.

 

Ultimately, I’m not trying to say that diagnostic imaging is useless, it can be extremely important in helping to rule out other serious red flags, as well as in rule in diagnoses. In my opinion though, as rehab and medical professionals, we need to do a better job at educating our patients and changing the narrative, just because you have a “herniated disc” or “disc degeneration” doesn’t mean you’re broken!

Physical Therapy for Lower Back Pain

Outcomes for patients with lower back pain who continued to move and be active after injury are significantly higher than those that were prescribed bedrest.  Now I’m not saying continue to do the same exact things that are making your back painful.  What I am saying is talk to a rehab professional about what you can do to move better and pain free.  We’re experts in movement and well versed in terms of pain education, tissue loading, and gradual exposure to exercise.

If you like to exercise, but pain has been keeping you out of the game, and live in Washington DC, Big League Performance and Rehab is here for you!  We specialize in helping active people like you get back to doing the things they love to do!

If you’re interested in talking with a Doctor of Physical Therapy about what you’ve been dealing with, you can contact Dr. Mike right here- Contact Dr. Mike

 

 

 

CrossFit Injuries: Are There Really That Many?

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CrossFit Injuries

As a Physical Therapist who works in a CrossFit box, I get asked this question a lot. Both by people who are members, as well as outsiders, so I figured it was time to share my thoughts.

If we look at injury rates in CrossFit, a 2017 study by Klimek showed that injury rates are very similar to other popular sports such as soccer, ice hockey, powerlifting, gymnastics, and even, yes, running!

CrossFit Vs. Running

Now I’ve never heard anyone say that running is unsafe or that we should never run, but injury rates for runners have been reported at 2.5-12.1 per 1000 training hours, vs 2.1-3.1 per 1000 training hours in CrossFit. (Moran 2017, Hak 2017, Montalvo 2017, van Mechelen 1992).

CrossFit injuries occur because we are training with increased intensity and load for a longer duration of time. Montalvo found that competitors and those who trained more frequently were more likely to experience an injury. A lot of boxes will program more intense workouts than what @crossfit actually recommends.

With that said we need to look at load and volume management. Tim Gabbet showed a 70% increase in injury risk when training volume is too high or there is a big spike in volume.

Workout Volume

Due to the high volume in many workouts that also require a high degree of technical precision, we tend to see increased injuries as a result of technique errors as well as from a lack of muscle strength/endurance.  I think this is due to the fact that a lot of athletes will train above their maximal recoverable zone, which will allow them to build up strength for a period of time, but eventually catch up with them in the form of a CrossFit injury.

In CF Level 1 classes coaches are taught to compose workouts with a single strength or skill exercise or a metabolic conditioning workout with a 2 days on/1 day off or 5 days on/2 days off schedule.

However most gyms will program a strength component as well as a conditioning component on the same day 6-7 days/week.  This is significantly higher than what CrossFit HQ actually recommends and I believe this puts athletes above their maximal recovery zone and makes them more susceptible to injury.

Common Medical Opinion

If we look at what most medical professionals say when it comes to CrossFit, AKA “Just Stop”, then we shift to the other end of the spectrum and we know that an inactive lifestyle can be associated with higher risks of: Chronic pain, obesity, depression, heart disease, diabetes, shorter lifespan, etc.

I think its pretty obvious which one is better.

Overall, a comprehensive approach needs to be taken to prevent CrossFit injuries. An individualistic approach to volume and load management, technique, and muscle strength/imbalances can have a real positive impact on this sport which has already done a great job encouraging millions to live a healthy, active lifestyle!

If you’re a CrossFitter, live in Washington DC, and have suffered an injury, you don’t have to suffer in pain.  Big League Performance and Rehab is here for you!  We specialize in helping active people like you get back to the things they love to do!

If your interested in talking 1 on 1 with a Doctor of Physical Therapy about what you’ve been dealing with you can email Dr. Mike right here- Contact

4 Keys to Picking the Right Physical Therapist

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Being a Physical Therapist in a CrossFit gym has given me a great opportunity to talk to many athletes about the sport as well as current issues they may be having.  It’s always surprising to hear how grateful they are when you spend a couple minutes listening to their situation.  It makes me think what are we, in the medical community, actually doing that no one has been able to answer these questions.

Unfortunately, in the state that Physical Therapy is right now, seeing patients in a one on one environment is very rare.  It’s just too hard to maintain a profitable business with this type of strategy due to insurance reimbursements.  What happens instead, is we move from a patient centered model of care to a therapist centered model of care, where the Physical Therapist  is seeing anywhere from 3-5 patients an hour.  What happens then is the PT will get to spend about 10 minutes per patient before having to move on to the next one, while you get handed off to an assistant, aide, or volunteer.  The PT ends up just running around putting fires out all day, instead of actually getting to listen and talk with you about what’s going on.

As we’re learning more and more about pain.  We’re learning it’s a very complex, multifactorial thing that isn’t always connected to biomechanical factors, other variables such as sleep, diet, and stress also play a role.  These are things your Physical Therapist should be talking about with you and how to manage them.  In the therapist centered model of care, it’s easy for a PT to get caught up in the injury and forget about the whole person.  The focus should always be on you, not just your injured body part!

With that said, these are the 4 things I recommend checking out before you commit to a Physical Therapist:

 

  1. Pick a Physical therapist who will work with you 1 on 1 for an hour.

    • Physical Therapy isn’t unlike any other business. The saying “you get what you pay for”, definitely applies.  It’s very unlikely, you’ll see a business  advertising that they treat 4 people/hour.  Would you go to an accountant that set up 4 different meetings at the same time?  I hope not, because why would it be ok for people to treat your most important asset, your body with less respect than your accountant gives to your tax return.
    • Due to poor Insurance re-imbursements, many clinicians will practice in fee for service type model or accept limited insurances. The reason they do this is out of necessity.  They refuse to sacrifice quality for quantity.
      • Not just Physical Therapists but many physicians, dentists, and chiropractors have also begun to shift to this model of care. This allows them to treat patients, the way they deserve.  Some lady in Iowa who works for Blue Cross, should not be determining how many visits of PT you get!
    • Medical Providers with a true passion for helping other are shifting to this model every day. It’s good for them, and even better for the patient.  You should work with someone that treats you the way they would treat a family member.
    • Understand that you have a choice in the matter, do your own research and choose a PT that you feel comfortable working with.

 

  1. Pick some who performs hands on treatment

    • The act of putting your hands on someone can be very powerful. Sometimes to get the nervous to relax, the best way is just putting your hands on someone.  Think about when you go to the doctor, you wouldn’t like it if they just stood there and said what’s the matter.
    • From my experiences, putting my hands on people has definitely helped them get better quicker. Your PT sessions shouldn’t consist of getting a hot pack, some ultrasound, e-stim, and some dumb leg raises that don’t even make you feel tired.  These are the kind of places that give physical therapy a bad name.  Leave and don’t ever go back!
    • When looking for a PT, a safe bet is someone who performs manual therapy. Other key words are mobilizations, manipulations, as well as soft tissue or fascia techniques such as Active Release Technique.

 

  1. Pick someone who has experience in working with people who are similar to you

    • Pretty easy, if you’re a crossfitter, make sure they’ve worked with crossfitters before. If you’re a runner, make sure they’ve worked with runners before.  If you’re a baseball player, make sure they’ve worked with baseball players before.
    • You don’t want to get attached to a PT that doesn’t understand A) your goals and B) the demands of your goal.
    • If you do CrossFit or Olympic lifting, your PT clinic should have a squat rack and barbells to help prepare you for a return to your sport. Just as if you want to be able to walk up the stairs pain free, they should be able to help you accomplish that as well.
    • Even though, we all have that same sheet of paper from an accredited university, there can be a massive difference in physical therapists. Pick one that understands your sport and your goals.  You should feel comfortable with them and if they tell you to stop doing CrossFit or to stop running, tell them no thank you and kindly get up and leave.

 

  1. Ask your prospective physical therapist, how much they dead lift.

    • This is a recommendation from Kelly Starrett at MobilityWOD. Danny Mattas of Athletes Potential in Atlanta, GA think you should ask them how much they snatch.
    • Realistically, if you’re a crossfitter, your therapist should have knowledge of both. As well as squatting, thrusters, pullups, double unders, etc.  You get the idea, they should be well versed in what you’re trying to do.  If they don’t know what a snatch or a clean is, you’ve definitely gone to the wrong place.
    • Many physical therapists will tell you to stop doing CrossFit. This is like telling a runner to stop running, it just isn’t going to happen.  If you look at injury rates from CrossFit, they’re no different than the rates for running, soccer, and hockey to name a few sports.  No one is trying to end those sports!  Make sure they understand that return to your sport is vital.
    • I’m not saying that they need to be able to deadlift twice their body weight, but they need to be well versed in what you’re trying to achieve.

 

If you’re injured and seeking out a physical therapist, I hope this post helps you.  No matter where you are in the country, you have the right to take these principles and apply them to your search.  Don’t let anyone tell you, you’re resigned to only 1 place whether or not their interests align with yours.

If you’re in the Washington D.C. area and have been struggling with an injury, we can help.  You don’t have to live with pain, no matter how severe or nagging, you deserve to do the activities you enjoy.  We help people just like you get back to the CrossFit gym, back to playing with their kids, and back to waking up pain free every morning!