What Rehab (and Western Medicine) Got Wrong

When you start your journey in the rehab sciences or medical field of any kind, you have a naive way of thinking of how things are done. It’s not any one’s fault that this happens, it’s just the nature of not knowing. In the follow post, I want to challenge those who are practitioners and their own beliefs. I recognize that some therapists may already be practicing in the way I’m going to challenge you, but the vast majority of therapists do not and I think it’s important for us to truly reflect on how we practice. These are from my personal experiences working with patients and seeing HUGE results.

When I was in school for Physical Therapy many years ago, I had a 5 year plan following graduation: I wanted to work in outpatient orthopedics, specialize in sports and obtain my Orthopedic or Sports clinical specialist title, and open my own practice. I wanted to work primarily with athletes and dove head first into fulfilling these goals, including working as the head therapist for a professional women’s hockey team (Boston Blades of the CWHL). But the more I worked and practiced, the more I realized that we, as a profession and society, know very little about the body and how it works.

It started when I’d notice that for my patient caseload, given a similar injury or diagnosis, some would get better and some would never improve as well as everyone along that spectrum in-between. Many times when I’d seek out an answer, I’d be given many suggestions – of which I’d try them all! – and yet still the same results occurred – some got responded and some didn’t. Of those that didn’t, I remember the co-owner of my first clinic job would say – 20% of all the patients you’ll encounter will contribute to 80% of your problems. And it did seem that way – many got better, but a small portion didn’t and those were my main problems. Some would even say that it was because my patients probably weren’t compliant and to not worry about it. I bought into that belief and continued with my work. However, looking back, I don’t believe that compliance should be the cop out reason that we give when a patient doesn’t improve.

Having run my own practice, I’ve realized that the vast majority of the time if compliance is the suspected issue, then it means that YOU are the problem. Yes, YOU the therapist. Why? Because the patient/client doesn’t see what you’re doing as effective or valuable. Because they aren’t getting better and you telling them the narrative of “it may take months or years to get better” isn’t something they want to hear. And you may say “but it DOES take time”, yes it does. All injuries take time, but having found many methods that provide relief to clients – my average number of visits per client for a plan of care (POC) is 6-8 visits, many with CHRONIC and/or RECURRENT pain – I truly believe that the traditional clinical methods applied by the majority of therapists is ineffective. So what was the difference?

When it comes to physical therapy, we all KNOW that everything is connected to everything, yet when we traditionally practice and treat, we’re concerned with only a few isolated parts of the body related to the injury. In school we were taught to always look above and below one joint – for example, if the elbow was the injury site or area of pain, we’d look to the shoulder and wrist. Once I started practicing and taking continuing education courses, I was more equipped to look at movement as a whole, rather than just at joints. This was a step forward, however it still only concerns itself with biomechanics, how a movement is generated. I believe that as a whole, a society and profession, we don’t ask enough WHYs.

For example, a patient comes in with elbow pain. Through evaluation and assessments (the first why – why is there elbow pain), we determine that it’s due to a “weak” shoulder/rotator cuff activation. Many will stop here and start treating the shoulder. Some will ask “why” the shoulder is weak and potentially trace it to the neck (2nd why), others may jump ahead and recognize that there is a kink along one of the movement changes linking the issue to a hip problem (2nd or 3rd why), and this line of thinking can be thought to be due to a neuromuscular activation issue or a neural tension (tightness the nerve during movement) issue. However, these “Whys” are all within the same line of thought – biomechanics. But the real and most important “WHY” that should be asked is more of a “WHAT”. WHAT ELSE could be causing this movement dysfunction that I see. I think it’s a great step forward that we can recognize that we have to treat beyond muscles and bones – that the nervous system is involved. So it’s established that the nervous system is tightly linked to how we move as well as overall strength. However, has anyone stopped to think how other systems are involved in this scenario? The cardiovascular, lymphatic, GI, or their visceral organs etc…

In the above image, the red and blue are arteries and veins respectively, the green are lymph vessels, the yellow are nerves. They run together, and you better believe that they work together and affect each other!

No two patients with the same complaint (I.e. elbow pain) should follow the exact same course of treatment for rehab because their past experiences are vastly different – Previous trauma, sports they played, movements/reps they’ve performed, even down to the food they eat. So therefore, their systems have been pre-conditioned very differently. This is a known fact. So why are we treating all elbow pain similarly – looking above and below the joint, looking only at this isolated observation – movement. WHAT ELSE can affect movement though?

In anatomy we all know that the organs aren’t just free floating in your abdomen, they’re anchored to the greater omentum and other structures through ligaments. We know that the lymphatic ducts and vessels travel along next to arteries and veins and that the lymph vessels filter venous blood. If you’re just trying to tell someone to “turn on their core”, do you think that maybe if there is rigidity in the mobility of the visceral organs it may make it hard to “activate” the core muscles that lay on top of the organs? It’s known that organs have to be able to move. When you breathe, the diaphragm creates a negative pressure vacuum to allow air into the lungs, forcing the organs below the diaphragm to descend. On exhalation, the diaphragm rebounds upwards and the organs shift upwards as well. This is why there is a shift towards improving someone’s breathing. But this is a two way street – the diaphragm and organs below affect each other, so it may not be enough to just attack the issue from a breathing perspective.

My challenge to all therapists and practicing clinicians – look BEYOND just biomechanics. Look BEYOND movement. Movement is great, but many times, you’ll get farther by looking at what else can affect movement, than just forcing a movement pattern to change in a rigid body. For a profession that actually SEES the entire body (movement analysis in rehab allows us to actually treat all parts of the body) we need to acknowledge that biomechanics and nerves aren’t the only things that influence movement patterns.

I recognize that there is more than 1 way to skin a cat, but there are efficient and inefficient methods too. If you’re not looking to be as efficient as possible, you’re just throwing a bunch of darts at a dart board and hoping that something sticks. You’ll only get the same results – some respond and get better, but many will leave you scratching your head. So ask more WHYs and WHAT ELSE when treating your patients. The examples listed above are only a glimpse at what I would look towards for treatment – stay hungry, stay motivated and learn more about how the body systems work TOGETHER, so you should treat ALL systems of the body.

You are what you eat… Part 2

TL; DR: Eat whole, minimally processed foods to decrease inflammation in your gut so that you can move like you’ve never moved before!

So we’ve established that there is a gut-brain connection – we also recognize this is a 2-way communication system, but we’re only discussing the one direction from the gut to the brain – and that if your gut or digestive system is at all under stress of has any signs of inflammation, it can influence the brain via the enteric nervous system. Since your brain controls EVERYTHING, it is logical that if your brain’s output signals for movement are also affected by your gut. I want to clarify that when I bring up “gut inflammation” it’s not something that you can “test”. By the time it’s bad enough for it to show up on a test, there’s already damage. Dr. Perry Nickelston, DC once said “Lab tests don’t show function, they show damage”. Rather, we look for signs and symptoms of inflammation, things that you may have experienced but brushed off as “not a big deal” – I’m sure you’ve done that a few times!

This list is not exhaustive or all inclusive – there may be symptoms that aren’t listed here that can contribute to inflammation (Dysbiosis is the big word that refers to the negative or unnatural shifts in composition of gut bacteria), but it’s a start:

  • Nausea
  • Diarrhea/constipation
  • Bad Breath (halitosis)
  • Upset Stomach
  • Fatigue
  • Anxiety/depression
  • Foggy memory
  • Difficulty concentrating/thinking
  • Bloating

Long term gut inflammation can also be a driving force behind many diseases that we see commonly such as diabetes, heart disease, cancer etc…

So not only does what you eat affect your movement quality and ability (which, by the way, can make it hard to lose weight in the gym as well as make you more prone to injury) it can be detrimental to your overall health and wellbeing if you don’t take control and treat your body right.

What should you not be eating and what should you be eating to facilitate a healthier gut? Many modern diets are high in simple refined sugars as well as processed foods. To start, I’d say try to eat whole, real foods – foods that don’t come prepackaged, food that you buy in the produce or meat aisle. During this pandemic, try shopping for frozen or canned versions of the foods listed below for better availability! Here’s a brief (and not all inclusive) list of things you should eat to decrease gut inflammation:

  • Dark Leafy Vegetables (I.e. kale, spinach, chard, collard greens etc…)
    • These are high in vitamins B2, 9, A, E and K.
  • Berries (strawberries, blueberries, blackberries etc…) and/or grapes
    • These contain anti-oxidants (anthocyanins) that can help with decreasing inflammation
  • Turmeric
    • This spice is strong so a little goes a long way! It contains the compound curcumin which has anti-inflammatory properties.
  • Tomatoes
    • Lycopene is found in tomatoes and is a very powerful anti-oxidant that can decrease inflammation
  • (Tart) Cherries
    • Another fruit that has plenty of antioxidants and has been shown to decrease overall inflammation

The above list is not all inclusive because there’s an endless possibility of foods you can eat that would help keep your gut healthy. Improving movement ability and/or quality is a process, it takes time. Just because you start eating any of the foods above doesn’t meant it’ll instantly change how you move, but with additional training and exercise to build strength and implementing mobility drills, you CAN move better. Ultimately we know that movement is medicine, but continuing poor movement quality is not the answer. However, if you change your diet to decrease overall gut and digestive inflammation, decrease overall dysbiosis, you’ll start to benefit from all of the training you’re putting in. Your digestive health is important in being able to stay active and improving overall movement. So if you want to FEEL BETTER start with what you put into your body, because if you eat purely for pleasure, your overall health will inevitably suffer.

You are what you eat – Part 1

This saying of “You are what you eat” has been around for a long time. Sometimes we take it seriously, sometimes we don’t, but I bet most of you don’t REALLY know what that means.

As many of you know, I’m a physical therapist. But I’m also a nutrition coach (click here if you want a FREE nutrition consult!). I also approach all of my clients from a HOLISTIC perspective – what does that mean? It means that I integrate and combine many different approaches to tailor a treatment plan for YOU! I don’t go with what works for everyone else – I utilize all the tools at my disposal to find what works for YOUR BODY!

Ok, what does this have to do with what you eat? Did you know that your gut has it’s own nervous system? Different from the one that controls your movements. I bet you didn’t. It’s called the enteric nervous system (ENS). This means that your gut TALKS to your brain! This communication is bi-directional, two-way; meaning that the gut talks to the brain, but your brain also can influence and talk to your gut. We’ll be discussing how your gut talks to your brain and how that can influence your movement.

Fancy graphic showing that the brain and gut are actually connected

Your digestive system starts in your mouth, then travels to your stomach via the esophagus. The stomach then empties in your small intestine, which then dumps into your large intestine. During all of this, your body is breaking down (metabolizing/digesting) the food you’ve put into your body and absorbing different nutrients at different stages of digestion, before you … poop it out.

There are trillions of bacteria in your digestive system that play a role in your body’s ability to digest food as well as support your immune system and overall health. Your appendix (remember how most health practitioners think it’s useless? IT’S NOT!) is like a reservoir of good bacteria and what you eat can also support this microbiome environment. As with anything in life, it’s all about balance – you can’t have too much of any one thing. When the balance of good/bad bacteria is off kilter, we pay the price.

Things like processed sugar (we’ll get more into what you should eat to support a healthy gut in the second part) are not only low in overall nutritional value, they don’t help your gut bacteria maintain a functioning/efficient environment. This can lead to gut irritation or inflammation – things that don’t show up on scans or lab tests (at least not until it’s too late)! Many of us have taken antibiotics at some point in our life, and while they are great for stopping bacterial infection and can save lives, it can also negatively affect your gut bacteria by depleting the good bacteria that supports your digestive system – so it’s important to support your gut following any course of antibiotics (**start with some probiotics)!

When your body has an influx of bad bacteria growing from what you eat (highly processed foods, boxed or prepackaged meals etc…) or external stressors (environmental temperatures, psychological stress, too much physical stress), it can negatively affect your enteric nervous system (the part of the nervous system that connects your gut to your brain). The ENS is a target for short chain fatty acids, a product of metabolizing dietary fiber. These short chain fatty acids can positively affect the the sympathetic nervous system as well as influence memory and the learning process. Certain diets (such as high fat diets), can change the microbiota environment and alter the production of (I.e. decrease) short chain fatty acids to negatively affect the sympathetic nervous system (e.g. create high levels of tension throughout your muscles) or decrease your ability to remember things. Certainly you’ve experienced many instances where you’ve eaten something and had some sort of reaction whether that be bloating, indigestion, increased bowel movements, feelings of sluggishness etc… These reactions are signals from your body that your gut is not adapting to what you put in it.


Your brain controls EVERYTHING in your body. It controls your thoughts, your digestion, your movement etc… When your gut is unable to adapt to the things you eat (e.g. modern world processed foods), it can lead to the production of – or inhibit! – many different hormones and neurotransmitters that influence your brain’s ability to function efficiently. If your brain is being affected by what you eat, it’ll certainly affect how you move. Studies have shown that when the digestive environment is out of balance (good bacteria:bad bacteria), it can alter the production of neurotransmitters such as noradrenaline, and in turn affect the speed of movement. It would be difficult to say that eating “X” will do “Y” to your squat or “Z” to your lifting mechanics, but it would be enough to say that your overall movement quality will be impacted by what you eat.

While more research needs to be performed in this area, we all know that when you drink alcohol, it can negatively impact your body’s ability to control any gross movements such as walking and fine motor patterns such as threading a needle. While unhealthy foods don’t necessarily impact your body in as dramatic a fashion as alcohol does, if it alters the bacterial make-up of your intestines and digestive tract, it can create a cascade of events (overproduction or under production of chemicals in your body) that results in chemical imbalance that negatively impacts your movement ability and quality.

The output signals from your brain that influence movement will surely be impacted by how your gut is performing. While the enteric nervous system doesn’t control movement, it influences the organ that does.

So there you have it, what you put into your body for sure will influence your movement quality and ability, but not just because of weight gain or weight loss. There are many types of foods that can create inflammation in your gut (thereby negatively impacting your movement quality and performance – athletes! eating “healthy” isn’t just about not gaining weight, it’s also about how your body moves!) as well as many foods that support a strong gut microbiome – we’ll discuss those in part 2. If you want to move better, you have to eat better!

Information adapted from research published by Lobinonda, S. et al in Aug 2019 and Mazmanian, S. et al Oct 2018 (NIH).

Nutrition and Rehab

Some of you may know that I went through Precision Nutrition’s level 1 coaching program last year – finished in November 2019. One of the reasons I did was to make me a more well-rounded therapist. I approach rehab and health/wellness from a holistic approach – a mix of Eastern and Western medicine approaches – and adding in nutrition coaching just seemed natural.

Many people don’t understand how nutrition can affect their rehab. When I ask a client how they diet/nutrition is, they look taken aback at first, as if to say “What does that have to do with my shoulder pain?”, and then many follow up by saying “It’s fine, I try to eat healthy”. However, this is usually a coverup for “I think I eat healthy, but I don’t actually know”. Nutrition has a HUGE impact on overall wellness as well as rehab. Many foods can perpetuate inflammation – and many of my clients have inflammation due to pain. What we put into our bodies directly affects how our body is able to utilize those resources to repair/recover from stress as well as regulate the systems that keep us alive. And that’s what we’re going to talk about today – food and inflammation/pain.

Processed sugar and high fructose corn syrup: This isn’t about the natural sugars found in fruits, but rather the white, granular sugar found in candies and desserts. Sugar and High fructose corn syrup is found in so many things that we consume these days that we don’t realize just HOW MUCH we’re actually consuming. Increased amounts of consumed table sugar have been linked to inflammation and then chronic illness. High amounts of high fructose corn syrup have been linked to inhibiting the anti-inflammatory properties of omega-3 fatty acids. Too much sugar in general can also lead to issues like insulin-resistance, obesity, cancer, fatty liver disease etc…

Artificial trans fats: This is probably the least healthiest fat you can consume. From a chemical make up perspective – hydrogens are added to unsaturated fats (liquid) so that they can have the stability of a solid fat and have increased shelf life. Artificial trans fats are found in foods like fries, packaged cakes, margarines/shortenings etc…. all so that the shelf life of the product improves. These fats were created and utilized not for the sake of the consumer, but rather to improve business. Increased artificial trans fats are linked to an increase in inflammatory markers such as C-reactive protein. If you see “partially hydrogenated vegetable oil” on the label of a product, you might want to think twice and put the item back!

Refined carbohydrates: These are carbs with most of the fiber removed from them – fiber is important for regulating satiety, blood sugar levels, and promoting overall gut health. Increased consumption of refined carbs have been shown to increase risk of inflammatory bowel disease as well as obesity. From an embryological perspective, everything started in the center and then branched outwards in development. So your gut (and core!) is important to keep healthy for the sake of the rest of your body and especially the musculoskeletal system.

There are many other food groups in a modern diet that can create inflammation in the body, but the top 3 are listed above. When we have physical pain, it’s usually because the body is trying to get the brain’s attention – it’s requesting a change, and pain is one of the most effective ways for us to take notice and make a change. Our body is constantly give us signals and feedback, it’s up to us to choose whether or not to listen to them. We also have to take care of our bodies. What we put into our bodies becomes the only resources it has to repair any damage from stressors throughout the day, which directly influences how our body can adapt to our ever-changing environment. I always tell my clients that in some cases, the physical symptom is just your body trying to get your attention for something else that is going on inside. Changing your diet can help with a lot of issues that may be brewing in the other systems of the body.

-Dr. James Chen PT, DPT, Pn1

Safety Around Snow Shoveling

The winter is here in New England, so the inevitable will happen… Snow Storms. And with those snow storms, comes shoveling…. unless you have a snow blower. Low back pain is one of the most common injuries during the winter due to the increased volume (and load) of shoveling. Low back pain is also one of the leading causes of disability across the country. Here are some simple tips to help you get through the winter (hopefully) injury free:

  • Make sure to have a shovel that you are able to handle – that may mean getting a lightweight shovel but sturdy enough to handle the wet/heavy snow
  • Make sure to have the proper footwear (I.e. not flip flops, make sure to have a good pair of boots with good grip on the bottom) – this allows you have to have a firm, steady base of support when shoveling so you are able to utilize your legs more in the lifting
  • As with any exercise, try to warm up your joints a bit before jumping into the heavy lifting
  • START EARLY! And continue to clear the snow OFTEN. Don’t wait for the snow to pile up to over 1 foot – that will take a long time to clear. Think about it this way; is it easier to lift 5lbs for 30 reps or 50lbs for 5 reps? It’s easier to clear (albeit tedious) to clear the snow often, than if you waited for it to pile up (and potentially FREEZE OVER!).
  • Pace yourself! If you have a long driveway, or if there’s just too much snow, make sure to take some breaks. Shovel for 20 min, rest for 5 min.
  • Don’t twist and turn while shoveling/lifting
  • Lift with your legs, not your back! Pushing the snow is actually a very efficient/effective, and SAFE, way to shovel!

Try to follow these tips above throughout the winter to minimize your risk for injury. Because with black ice and slippery surfaces – falls increase during the winter and can be traumatic! Take your time (and budget more time) when traveling!

And if the inevitable happens and you do hurt yourself – email me at james_chen@notyouraveragephysio.com to book an evaluation and get yourself on the right track!

A little lesson on “Health Insurance”

Being “out-of-network” (OON) myth #1: I can’t get reimbursed if I go to an OON provider. This is FALSE!!!! It is still possible to get reimbursed, but you will have to call your insurance customer service rep (number is on the back of your card) and inquire about your OON benefits/costs for physical therapy as well as all the information you need to submit in order to get reimbursed. After each visit, at Not Your Average Physio, we can provide a “super bill” with all of that information that you can submit to your insurance for reimbursement. We have just begun utilizing an app called “Reimbursify” that helps you submit claims from your phone in less than 1 minute! Inquire about this option when you set up your evaluation!

Read on to learn what “in network” and “out of network” really means!

I get asked a lot “do you accept my insurance?” and my answer is always “I am out-of-network with insurance companies.” Many will nod their head, but few will actually understand what “out-of-network” means. Answer this: What does out of network mean to you?

If you answered (or any form of the following): It means that you don’t take my insurance and that I need to pay for all services out of pocket. You’re NOT wrong, BUT you’re not right, either.

So, then, what does it mean to be “out of network”? Let’s first define what “in network” means. In network providers (MDs, PTs, Chiropractors, Dentists, etc…) have a choice to contract with insurance – this is being “in network”. When you contract with an insurance company, you’re saying that you will follow the insurance company’s outline of providing care. This can include: how many visits a client can be seen, what you can provide as a service, do you need a referral on file for reimbursement etc… all for a pre-determined price per visit. In exchange, the patient pays only their co-pay at the time of visit (think about what you pay to see your primary care for your physical, this is your co-pay amount usually. It CAN vary between services, ex. dentist vs PT). If you haven’t met your deductible (usually $1K+ for most plans), then that means YOU, as the consumer, need to pay out of pocket for ALL expenses until you meet your deductible, then you will still have to pay your co-pay for every visit after your deductible is met. For most plans, in order to end up with a lower deductible, you have to pay a higher premium (what you pay monthly for health insurance)- so most end up with a lower premium, but higher deductible.

Out of Network means that I have chosen to not allow a third party company dictate what I can and cannot provide my clients, or how long I choose to see them for. As a result, the client is responsible for the full cost of each session. However, the client is able to retroactively get reimbursed for these sessions depending on their insurance benefits by submitting a claim (see above).

EX. A 40 y/o male is experiencing low back pain and was recommended to an in-network physical therapy clinic. Because he hadn’t met his deductible, he was responsible for ALL medical expenses. He was charged by the clinic $367 after the first visit. He attends PT 2x/week for 5 visits before meeting his deductible, having spent a total of $1835. He has a $45 co-pay for each of the remaining 7 visits, bringing his total to $2,150! On top of that, he was one of 2-3 patients with the physical therapist during each of his 12 visits and he left with minimal to moderate improvements in his overall symptoms.

At out of network clinics such as Not Your Average Physio: 6 visits would be somewhere between $990-1,200. All sessions would be an hour, 1-on-1 with a Doctor of Physical Therapy. Sessions would include an individualized plan that is designed with the client’s input, accurate testing to pinpoint the root cause of your complaints, direct access to the PT through messaging and email and many more. Visits are 1x/week with plenty of homework throughout the week and after 6 visits, the above client would be well on their way to meeting their goals with significantly decreased symptoms. Most of all, he will learn about how his body works and will have the tools necessary should this ailment return in the future.

Don’t wait till you’re feeling like these guys! Schedule an evaluation today!

In the end, seeing an out of network provider doesn’t mean higher costs. In most cases, the costs are significantly lower and result in superior outcomes. Don’t believe me? Check out what people are saying about Not Your Average Physio here and here

Thanks for reading and learning more about your Health Insurance!

Dr. James Chen PT, DPT, Pn1

Your body is like a car

It’s true! Your body is very much like a car. This is an analogy I use (one of MANY) with my clients. If you owned a Bugatti or a Porsche, would you ignore warning signs that it was failing or if it needed servicing, would you not take care of it?

Many clients come to me when they are experiencing pain or have an injury. Most think that they should only see a physical therapist when they are having these symptoms. However, our bodies, actually, give us warning signs BEFORE we reach the point of pain or injury. Take your car, for example. When it wants you to know that something needs to be looked at or checked out, a warning sign comes on. It could be as simple as you need to fill the gas tank or put some air in your tires. It could be more complex and ominous such as when the “check engine” light comes on. In any one of these scenarios, you can ignore the warning light for a period of time and nothing will happen. But we all know that it’s not a matter of IF, but a matter of WHEN you’ll need to get your car looked at.

If you don’t put air in your tires, you can run on them for a few days to weeks (depending on how far and often you drive your car), if you don’t fill your gas tank you could probably still run 20-30 miles (depending on how efficient your car is) when the light comes on, and if your check engine light comes on, well, you can probably ignore that for a while depending on what is going on (a number of things can cause your check engine light to come on). The point is that eventually, your car will need to be serviced or something will happen (flat tire – maybe leading to an accident, being stranded on the side of the road with no fuel etc…). But there were warning signs along the way. Your body works the same way – that nagging ache, or that discomfort with certain movements, those chronically tight hips etc… are all warning signs. It’s just a matter of whether or not we recognize the warning signs, and if we choose to act on them.

When we buy a car, an owner’s manual comes with it so that if there’s a light or something we aren’t familiar with in the car, we can look to it for assistance. Some of these lights are things we can resolve on our own – such as filling up our gas tank, or pumping out tires with air – but some of the lights are signs for things we need a mechanic or the dealership to take a look at – such as the check engine light. We’re not born into this world with an owner’s manual to our body and how it works. That’s why I spend so much time educating and explaining to my clients the importance of what I’m doing during our sessions – so that they can have tools to turn to if something similar were to happen in the future (analogous to being able to pump your own gas the next time you run low).

Here are a few questions that I think will help anyone begin to get acquainted with their body’s way of communicating:

  1. Are you under a lot of stress?
  2. Are you sleeping enough?
  3. Do you have to modify certain or all of your exercises during a workout?
  4. Do you have soreness that lasts much longer than it should?
  5. Are there movements you can ONLY do a certain way (decreased ability to adapt)?
  6. Do you have areas of tightness that don’t seem to ever go away?
  7. Do you find that you fatigue quickly with certain exercises?

These questions are just a start – if you answered yes to any of these, you will want to look a little deeper into the issue. For things like being stressed or not getting enough sleep – these will eventually lead to other medical diseases or cause your body to physically lock up a joint (or joints) and manifest themselves as a physical disease if not taken care of ASAP. You can start managing both of these on your own with apps for meditation (stress management) and practicing good habits for better sleep (you can start with these). If those don’t seem to be helping, then you may need to go see a professional.

For the other 5, it’s important to find the root cause of why you’re experiencing these symptoms. Hint: It’s usually never as simple as – stretch it and it’ll feel better. If we ask enough “Why’s” we’ll usually find a deeper reason for the physical ailments. But, whatever you do, PLEASE, PLEASE, PLEASE don’t ignore the symptoms (aka warning signs). We’re so in tune with our cars and maintaining them and keeping them well running, yet we often forget that we only have 1 body and ignore the symptom(s) our body tries to tell us to address.

DC vs. DPT vs. LMT vs. etc… DOES IT MATTER?

Our healthcare system is highly segregated and specific. Every profession has it’s own specialties and even within specialties there are branches. In medicine, you have physicians that are neurologists, orthopedics, internal medicine etc… but even within those you have MS (multiple sclerosis) specialists, stroke/TBI specialists, shoulder specialists, foot/ankle specialists, spine specialists etc… It’s very complicated and it makes it highly confusing for consumers (general public) to understand who to go see for what symptoms. Hell, the professionals, themselves, don’t even know who to refer you to because it’s so specified and divided. You have back pain? Many physicians will send you to a PT (or chiro/DC) but back pain could be caused by MANY things. Many of which aren’t even in the realm of rehab – aka kidney pain, cysts in your colon, bowel dysfunction etc… Many times the consumer is bounced around from specialist to specialist and it can be frustrating.

The reason I bring this up is, often times I get questions from clients who wonder if they should go see a chiro or a massage therapist or physical therapist. My opinion is that in the outpatient realm, there is so much overlap between DPT (Doctor of Physical Therapy), DC (Doctor of chiropractic), LMT (licensed massage therapist) and personal trainers. If we work off the assumption that we’re all trying to keep clients active and moving my explanation will make sense. PTs, DCs, and many personal trainers assess movement of clients and attack the dysfunction from multiple angles. PTs and DCs have different philosophies of approach, but the end goal is the same – improve mobility and strength of the client. It’s a common misconception that Chiros only perform “adjustments” and PTs do soft tissue work/exercise. However PTs can perform “high velocity low amplitude” mobilizations (aka, adjustment with a different name) – though this could be state dependent** – while many chiros will also prescribe exercises to follow up their manual techniques (they do soft tissue work as well!) just like PTs do. Personal trainers help clients reach their goals for strength and often weight loss – but in order to reach these goals they also need to assess mobility of the client and many drills/exercises that personal trainers will prescribe are similar to those of a sport PT/DC.

Many massage therapists, through continuing education courses, will also prescribe exercises to their clients. Through their skills and manual techniques, they also aim to improve the overall wellbeing of the client in front of them through relaxation and decreased soft tissue restrictions. Often times, massage therapists will also have other tools in their tool box – much like DPT/DC/personal trainers do! I also know many massage therapists who don’t do massage work – they do NKT/P-DTR/DNS/SFMA/other continuing education work with their clients and help their clients get better with a similar route that I do – how cool is that?!

Do you see a common theme here? Each of these professions aims to improve the mobility and strength of the client in front of them. So who do you go to? Well, that depends. Within every profession there are good and …. not so good individuals. Not all therapists or trainers are created equal. However, there is a shift currently among all of the above professions (and more) towards a higher standard of care. Many personal trainers are learning more about movement and mobility and incorporating it into their programming for clients. Many con-ed courses will feature students from all professions of PT/DC/LMT. This idea of Chiros do this, PTs do that, LMTs do this etc… is very archaic and there needs to be more understanding that there is a lot of overlap among professions now. The product (end result) is not very different between these professions, yet we have labeled them as highly different from one another.

For me, at the end of the day, go to someone who will get you results! That’s the only thing that matters. It doesn’t matter what their actual “profession” is. There’s more than one way to skin a cat, and while I am a huge proponent of NKT because of the wonders it’s done for my clients, I recognize and acknowledge there are other methods that would also get them the results they are looking for. So, in conclusion – don’t go looking for specific professions – go to who is going to get you results. Period. 


5 Things To Do If You Want to Avoid Injuries

The Rehab profession lives off of people getting hurt – it’s what keeps us in business. BUT, I’m in the business of helping individuals who are currently hurt AS WELL AS preventing injuries from reoccurring. That’s right, I’m in the business of helping YOU not need ME! Crazy, right?

Now, I can’t see into the future and say that if you do “x, y, z” then you’ll never have an injury – that’s not realistic because sometimes…. life happens. While these 5 things I’m about to list are not a comprehensive list and I can’t say that they are absolutes (there will always be exceptions), what I can say is, if you do these following things, you can help your body recover and decrease the likelihood that you’ll get injured – that’s fair right?

1. Sleep

Sleep probably wasn’t the first thing you thought a Physical Therapist would say for injury prevention, right? No worries, you’re not alone in that thought. However, this is probably one of the most important – and EASIEST – things that you can do to prevent injury. If your body is fatigued/tired, your performance will suffer in anything you attempt to do (lift, workout, run, compete, function etc…). By getting enough sleep (recommended 7-8 hours a night), you’re allowing your body to reset, allowing your nervous system to calm down and relax, and giving your muscles/joints a chance to relax/decompress. Good/regular sleep patterns allows your endocrine system to reset your hormone levels. If you’re constantly stressed/fatigued due to lack of sleep, testosterone levels begin to drop and cortisol levels begin to rise, which will negatively impact fitness and performance levels.

You’re also going to want to make sure you get GOOD sleep. This means being able to enter REM sleep efficiently and falling asleep fast. With the rise in technology usage, we have to be conscious of how much stimulation we are getting from it before bedtime. The light emitted from our phones/tablets/laptops/TVs etc… makes our brains think it needs to be awake when we actually need to be shutting down and sleeping. It’s a good idea to stop using any electronic devices an hour before bed time, and engage in some meditation/reading to help create a calm and less stimulating environment for our bodies and minds.


2. Good Nutrition

Another point that isn’t directly related to physical therapy but is HUGELY important to injury prevention. This is along the lines of holistic recovery. If you’re an active individual, you want to make sure that you are treating your body well with good nutrition before/during/after any activity (essentially ALL the time. But cheat days can be allowed ;)). Ultimately – you’ll have to follow this one simple rule; Eat minimally processed, whole foods for a balanced/healthy diet. Fad diets (keto/paleo/intermittent fasting etc… are not long term solutions for good nutrition. But that’s a post for another day).

Before activities, you want to make sure you have enough fuel to sustain the necessary amount of energy required for that activity/sport. Usually this means carbohydrates for quick energy and a good amount of fats if energy is required for a longer period of time. If competing at a high level and elite performance is required, make sure to have your last meal 2-3 hours prior the competition so that you aren’t weighed down and feeling sluggish – but make sure to take in quick carbs prior. During exercise, the same principle applies – quick/simple carbs for energy (complex carbs may be needed for endurance sports/activities) and LOTS of hydration. Hydration is not simply drinking water – you need to replenish the salt and electrolytes lost due to sweat. Add some salt/electrolyte tablets to your water, drink a sports drink (Gatorade, Propel, Powerade etc…). The longer the duration of the sport, the more you will need to hydrate to prevent cramping and thus injury. Post exercise nutrition is often overlooked. Many athletes think they burned x-number of calories and therefore are entitled to a cheat meal. What you take in AFTER exercise will dictate what your body will absorb to aid in recovery of your muscles and joints. Make sure to have a protein dense meal 2 hours after exercise to aid in muscle building, increase salt intake to replenish any electrolyte loss, and make sure to eat a balanced diet.

3. Foam Rolling/Stretching

For those who understand how I practice, you’ll know that I don’t ever recommend a full body stretch/foam rolling session. A full body release like that will only wreak havoc on your nervous system because there will be muscles/ligaments released that don’t need it, and there will be activations required that won’t be done. BUT, as a general rule, you can stretch/roll out muscles after a workout/competition where you’ve overworked certain muscle groups. For example, after playing in an all day volleyball tournament (outdoor doubles), my calves/quads/glute max/back extensors are all overworked due to the numerous repetitions I took in jumping. A gentle, slow roll out/stretching session will help these muscles from being overly sore the next day and aid in flushing out the lactic acid buildup. So if you just completed a workout that stressed certain muscle groups more or if your sport demands more from certain muscles and you just had a long practice/game – make sure to do some stretching/foam rolling to relax these overworked muscles.

4. Exercise/Strength Training

That’s right … MOVE MORE! If we don’t exercise, then when our bodies are tasked with doing something physical, it won’t be prepared to and thus increases our risk of injury. Those who are sedentary are at higher risk of injury than those who are active – and they usually are less healthy than active individuals as well! By exercising more, our joints are being moved through full range of motion (SUPER important), our muscles are working towards increased neural efficiency and strength, and our bones/joints are being loaded and thus bone density improves.

5. Take days off!

You read that right. The final thing to staying healthy and injury free is to know when to take time off from training. This is not to go against the previous point, in fact they go hand in hand. Our bodies require rest and recovery – going hard 7 days a week is not productive (unless it is for a short period of time with a clear and definitive deadline) and doesn’t allow our nervous system to reset (see Point 1) – which leads to higher levels of cortisol and lower levels of testosterone. Training 5 days a week still allows for intense workouts and 2 days of rest during the week. It’s like that analogy with a drawer that is stuck – pulling harder doesn’t open the drawer more efficiently. In fact, if you push the drawer back in and reposition, it pulls open more smoothly. Fitness training is the same in that in order to see gains/make progress, you might have to take a day or two off, as opposed to not taking that time off and working out more.


There you have it – these 5 points, if followed, can help you decrease the risk of your injury. Because let’s face it, no one can 100% prevent injuries from occurring and if they say they can, they’re lying. Life happens, unexpected accidents happen. But these are a good place to start if you want to start improving your overall health!

Why Physical Therapy and Personal Training go hand-in-hand

I’m a HUGE proponent of interdisciplinary collaboration because I think there is value to be had. And while I do feel that our healthcare system has too many “specific” specialties that lead to too much overlap (i.e. DC vs outpatient DPT vs LMT that uses NKT etc… these could all be just 1 professional field since the 3 professions I listed essentially practice the same way), I do think that Physical Therapy and Personal Training go hand-in-hand. Though I should clarify that with the way I practice, I really should say NKT and personal training go hand-in-hand since NKT is practiced by many clinicians of all backgrounds including DPT, DC, LMT, ATC, personal trainers etc…

Regardless of semantics, physical therapy and personal training complement each other SO well! Especially with more and more Americans focusing on trying to be healthy. More and more people, each year, are starting to dive into different diets, signing up for gym memberships, and trying new activities such as running. However, many times individuals have no idea where to start; they just pick a random starting point. For example, with dieting, many will only research the most popular plans that align with their goals and try it out for a few weeks to a few months. With exercising, many will sign up for a gym membership, start looking up workouts online, and test them out in the gym without having a clue what they’re doing. In most cases, people abandon the diet(s) because they don’t realize that the first and most important step to a healthy diet is to just eat whole, minimally processed foods (I know, SHOCKER! Though nutrition is a post for another day) and many will stop lifting weights because they got hurt and will try to find an alternative to losing weight.

Personal trainers are an AMAZING asset and create GREAT programs to help their clients meet their fitness goals. However, if there is an underlying muscular efficiency issue, the client may be lifting weights with no forward progress and that can become frustrating to both the client and the trainer.

But that is EXACTLY why I feel that physical therapists and personal trainers should work more closely together. Many clients that I share with personal trainers at the gym where I treat out of require some sort of modification in some or many exercises. Modifications aren’t bad, especially if the initial problem is a strength issue and you need to modify to allow the client’s body time to adapt and build muscle. But when modifications are prolonged … say, more than 2 months with no progression in the exercise itself, that’s when I’d say there are also muscular efficiency issues underlying their strength issues.

I propose a process (and hope one day this is implemented with every gym that truly wants to help their members get to a healthier place) where someone who seeks out a personal trainer for, say, weight loss (or any fitness goal, really. This would work with performance and even pure strength gains) also be evaluated by a physical therapist to create a plan that addresses their muscular efficiency deficits prior to strengthening in the gym. Why? Because you CAN’T train efficiently if there is an underlying compensation pattern.

I have 2 (out of many) success stories to share that highlight how my collaboration with personal trainers have benefited both us as the therapist/trainer AND the client in a way that many clients would not have thought possible; they would not have sought out a physical therapist concurrently with a personal trainer.

The first is a female in her 60’s who had been training at the gym for ~3 years prior to her first appointment with me. She wanted to work on balance and had never been able to balance on one foot, no matter how hard she tried when working out with her personal trainer. Her balance never got better or worst in the 3 year time span. Turns out, she had several injuries from 20+ years ago that were still contributing to her poor balance. Within 3 visits, she was able to balance on 1 foot with no external support (consistently too!), and her trainer was able to progress to more dynamic exercises, and she continues to CRUSH IT every day she comes to the gym. We worked together for 8 total visits to work on improving her balance in dynamic positions as well as another body part unrelated to her balance concerns.

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Repost with @get_repost I love being able to collaborate and share clients with @christine_h2i and the trainers at @anytimefitness_quincy (@moorelifefitness and @morgancox37) to help clients move better and feel better! ・・・ Want to know what progress looks like? Meet Mary! Two months ago, Mary told Coach @christine_h2i that she wanted to work on balance. Back then, she couldn’t stand on one foot for more than 5-10 seconds. Between her sessions with Christine, and physical therapy with @notyouraveragephysio, Mary is making LEAPS and BOUNDS in the balance and stability department. Way to go, Mary! Let’s hear it for her, team! #positivity#anytimefitness #bleedpurple #afq #strongaf #g2hp #makehealthyhappen . . . . . #fitness #myzone #fit #fitfam #motivation #workout #muscle #gymlife #health #fitnessaddict #fitnesslife #lifestyle #training #fitnessjourney #fitspo #instafit #shredded #fitnesslifestyle #eatclean #gymmotivation

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The second is another female, former college athlete, who had been working out at the gym for about 3-4 months when I first met her. She originally came to me for some knee pain and we worked together for 7 total sessions. Around session 3 she stated she would get shoulder pain during push ups (regular high plank position) and can only do them on her knees. She reported that she hasn’t been able to do a high plank push up for the past 7 years due to tendinitis in her shoulder, but that the modification of her doing them on her knees doesn’t challenge her (could do 30 without breaking a sweat). Finding the source of her muscular inefficiency, she not only did her FIRST high plank push up in 7 years that very session, she was able to do sets of 10, 4 weeks later (thanks to her AMAZING personal trainer who created programs that strengthened her)!

**All videos were posted with client’s consent**

These stories aren’t me tooting my own horn. I’m sure every physical therapist has several success stories throughout their career. But rather, these stories illustrate how collaborating with personal trainers can benefit EVERYONE, and most importantly THE CLIENT! In the first example, she had been working on her balance tirelessly for 3 years. But due to hip/core/ankle inefficiencies, there was 0 progress with her workouts, which frustrated her and her personal trainer. All it took was 3 sessions to pinpoint the source of the problem, and IMMEDIATELY she began FEELING the difference while standing on 1 leg; she was also able to progress to much more challenging exercises in her workouts. She could have continued to practice her single leg balance till the cows came home with no forward progress. The same could be said of the second client, who had a key muscular facilitation/inhibition pattern that, once addressed, unlocked her full potential in her shoulder.

My point in saying all of this is, if we could get EVERY personal training client a few sessions with a highly skilled** physical therapist to address any RELEVANT compensations that would hinder them from reaching their fitness goals (i.e. weight loss, muscle gain, sports performance etc…), we’d see clients reaching their goals not only faster, but efficiently; meaning with less injuries along the way. Many times dysfunctional muscular compensation patterns – if lingering past their expiration date – will lead to pain (not a matter of IF, but a matter of WHEN). But WHAT IF this process could avoid clients from ever getting to that point? Wouldn’t it be worth it to have a system in place that gets EVERYONE to a healthier place?