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.

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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.

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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?

Do YOU have Chronically Tight Muscles?

If I had a dollar for every time someone said to me “I’ve just got really tight muscles” I’d be pretty rich by now. Many people also believe, wrongly (no offense, but it’s true), that tight muscles are either 1) something that is genetic or, rather, just how their body is, 2) tight muscles don’t contribute to their injury risk and/or 3) they will always be tight – as in they can’t do anything to decrease the tightness.

So in order to understand why the above thinking is wrong, we need to understand some neurophysiology and anatomy. The first truth that I am going to lay out is SUPER important and something that you’ll see in many of my posts. That is, the brain controls EVERYTHING. And by everything, I mean EVERYTHING. But for the sake of this post, every muscle contraction/activation or lack of contraction/activation is controlled by the brain – can we all agree on that? Good.

Since the brain controls everything, then at the basis, if we can get the brain to turn off the tight muscles, theoretically those muscles should not be tight anymore – right? So the question isn’t “why are my muscles so tight” but rather “why is my brain keeping my muscle(s) tight?”  And if we can figure out that answer, we’ll be golden.

The brain is a creature of habit and likes to take the path of least resistance (i.e. the easy way out). If it can get out of recruiting the biceps at 100% during a biceps curl, it will. It may recruit the deltoids and pecs (to stabilize) at an increased rate of 20% and decrease full on biceps recruitment to, say, 80%. This example may result in a bicep curl that looks more like the whole arm is moving a bit more, than a straight up bicep curl; instead of seeing just the elbow bend, it may look like the person is leaning back, their shoulder may move forward a bit etc… Don’t get bogged down by the numbers I just listed – I made those up, but the concept is still accurate. So, depending on your age, your brain will have created hundreds of thousands/millions of movement patterns (i.e. muscle memory) and stored them in a bank where it will draw upon them when necessary.

Now, oftentimes, the brain usually will keep a muscle – or muscles – tight for one of the following reasons (yes, there are other reasons the brain might do this, but these are the most common):

  1. To keep in the body in a protective state. So the follow-up question to this is “why does my body want to protect ‘x’?” It could be that the tight muscle is turned on due to inhibition or weakness in another part of the body. So rather than fix the problem (which would take actual work!), the brain does what’s easiest, keep a muscle tight. Example: Many times (certainly not the only times), tight hamstring(s) can be holding on to the pelvis for dear life because the core muscles are inhibited. So the solution wouldn’t be to stretch the hamstrings till the cows come home (bc, hopefully you’ve guessed it by now, the hamstrings will come back tighter the next day or a few hours later), but rather to figure out why the core is not efficient (I utilize NKT to figure out what muscles are facilitated/inhibited)
  2. Another reason the brain keeps a muscle turned on is because of over utilization. If you go to the gym and only work your chest, well guess what? The muscles utilized in all of those exercises (pec major/minor, some anterior delt, some biceps, some neck muscles etc…) will be overworked (and even more depending on if you had any compensations to begin with). With each repetition, your body is RECORDING that movement and the muscle activation patterns required – and saving them to your hard drive. Overtime, these muscles that are over utilized become …. well…. tight. And if something is tight or overworked, it can be facilitated or inhibited – NKT helps me in my assessment process. So the lesson here is, make sure you work ALL muscle groups, the back and the front!

One thing I want to clarify – compensations aren’t all BAD! This is something I’ll elaborate in a future post. But know that our bodies compensate all the time, it’s called adapting to life! It’s when a compensation has served it’s purpose, but still sticks around and is no longer aiding your body in anything in particular, that it becomes a “problem”. This is a loaded topic that can’t be expanded upon in this particular post, but I promise, I’ll get to it in the future. Just know, I may be addressing compensations in a negative light right now, but that they aren’t all bad!

All in all, we have to re-frame our mindset and the questions we ask. Instead of “Why are my muscles tight?”, ask yourself “Why is my brain keeping my muscles tight?”. This allows you to trace the problem back to the source. While I don’t know the specifics of your problem, hopefully with these pointers, you’ve realized that tight muscles 1) don’t resolve on their on 2) don’t resolve with constant stretching alone, and 3) you should see a clinician (I would love to help you!) if your problem doesn’t resolve.

 

5 Things You Should Do If You Have A Desk Job

If you have a desk job, you know that it can be a pain … literally. Sitting all day can make you feel stiff/tight/sore etc… all over! Therefore, sitting must be BAD, right? WRONG! Any posture sustained for a prolonged period of time will create stiffness/tightness/soreness etc… That’s why when those with desk jobs switch to a standing desk, their problems still don’t go away! That’s because standing for 8-10 hours a day can be just as problematic! **MIND BLOWN**

But, there are things you can do – AT YOUR DESK – that can help ease the pain and stiffness.

1. Neck Range of Motion

This means that you should be moving your neck through it’s full Range of Motion … OFTEN. Look up towards the ceiling (extension), look down towards your chest (flexion), look to your left/right (rotation), and combine these motions (i.e. draw some circles with your head/neck). Do this often, and you won’t get stiffness in your neck at the end of the day! This is because the articular cartilage (cartilage on the joint surfaces of your spinal segments) will be getting the nutrients it needs from the synovial fluid around it to stay happy!

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Cervical spine side view (neck)

The above video is just one example of how to do some gentle neck range of motion (ROM) exercises in a seated position.

2. Levator/Upper trap stretch

Your upper traps tend to get tight after sitting at a computer/desk for a long time. This muscle is what people commonly point to as “top of their shoulder”. It actually starts up at the base of your skull, runs down one side of the spine and across the region between your shoulder and neck. Your levator scap muscle starts on the top corner of your shoulder blade and runs up towards your skull and attaches on the cervical spine (neck). These two muscles will get tight and start to elevate your shoulders up towards your ears. They can also be common causes of neck and/or shoulder pain.

To stretch your upper trap, sit on the hand of the side that you want to stretch (this will keep your shoulder from rising up). Keep your gaze forward. Take your other hand and put it on the side of your head that you’re looking to stretch, and gently pull away.

upper trap stretch

To stretch your levator scap, your starting position will be similar – sit on the hand of the side that you are looking to stretch. Now look away from that side and down towards the opposite arm pit. With your opposite hand, place it on the top/back part of your skull. The motion will be one of pulling the skull down AND away from the body. Commonly individuals will say they feel this stretch go down their neck and into their shoulder blade when performed correctly.

levator stretch

3. T-spine Range of Motion

Your T spine (thoracic spine) is the section of your spine that is known as your mid/upper back (just above your low back). It is connected to your neck (duh, your entire spine is connected!), and many times this area can feel tight after sitting or standing for a long period of time – mainly due to the misconception that there is such thing as “good posture”. Short answer – there is no such thing. Long answer – topic for another post. But “good posture” (I hate calling it that, but everyone immediately knows what I’m talking about when I say that) puts your T spine in mainly an extended position (upright/straight). Below you’ll see ways to incorporate increased flexion (bending/rounding of the spine) while at your desk. Using your desk to support you, round through your shoulders, bring your chin to your chest, and round out your back while sitting (or standing!). Then arch through your back and look up towards the ceiling (increasing extension)

seated cat cow

4. Get up … Often

This seems like a no brainer, but I am willing to bet that you don’t do this often. If you’re sitting for a long period of time, not only will your spine become “compressed” and stiff, your hips will feel tight in that flexed position. I recommend that you at least stand up and stretch every 30min for 15sec, but if possible, stand up and walk around for a few min ever 30-45min. However even just standing up and stretching can decrease the tension on your hips. This is also a fairly non disruptive movement in the office work environment but SO SO SO helpful to keeping your body happy and improving your employees’ longevity in the work place.

5. Breathe

Another super simple tip. When I say breathe, I don’t mean … breathe. That sounds confusing. I mean that you should, every hour, take some MINDFUL, deep breaths. Sometimes it helps to close your eyes to take away all visual distractions (similar to meditating) and take 3 FULL breaths at a slow pace. Whether you’re standing or sitting, you may notice that after a while at your desk, your shoulders will have crept up to your ears creating some of that neck tightness we talked about earlier. Aside from stretching your upper traps and levator scap, mindful deep breaths can help you become more aware of the tension in your shoulders and focus your attention on relaxing them. Doing this every hour (at some point) can help decrease overall tension and stiffness that would, otherwise, build up by the end of the day.

Give these a try tomorrow at work and hope you feel great!

Return to Sport

Hot topic of the day – Kevin Durant’s lower leg injury (suspected R achilles tendon rupture) from last night’s Game 5 of the NBA finals.

Here are some things to know prior to passing judgement and assessment of his injury:

  1. Mechanism of Injury: Usually results from sudden forceful increased stress on the Achilles tendon – in Kevin Durant’s case, he was planting with his R leg as well as making a move to his L, forcing increased dorsiflexion into his ankle (relative forced stretch of the achilles).
  2. He had not played in the 9 games prior to this game due to a R calf strain.

So this begs the question(s): Are his two injures (calf strain and now achilles rupture) related? And, did he return too soon? We’ll take a look at both of these questions.

First – Are his two injuries related. Absolutely. Everything in the body is connected and if you think that anything in the body functions independently of any other part in the body then … you’re wrong. This is an absolute truth and there’s no room for argument. Now, how are his two injuries related? There are a couple of parts we need to examine. It’s easy to see that he had strained his R calf and now he has a ruptured R achilles tendon. Your calf muscle (gastrocnemius and soleus) tendons turn into the achilles tendon and insert onto the back of your calcaneus (heel bone):

Gastrocnemius-Muscle

With the way I practice – utilizing NeuroKinetic Therapy (NKT) – his R calf (gastrocnemius or soleus, medial or lateral) would have been found to be either inhibited or facilitated. It’s important, then, to figure out the other half of that equation – if it’s inhibited, what’s facilitated and inhibiting the muscle? If it’s facilitated, what is it inhibited? This is VERY important to figure out because after an injury (ANY injury), the body will go into a protective state and start to compensate. Compensations are not bad inherently – in fact our bodies constantly will compensate when we start off learning a new movement pattern or if it’s a short term pattern. However, once the compensation has done its job, are our bodies able to let go of that pattern? If not, that’s when – given enough time – the compensation pattern can become a problem.

If his R calf was either facilitated or inhibited – it has become inefficient. Now, with inefficiency the muscle can be either tight or not and either one can lead to this injury we now see that he’s suffered because inefficiency just means that the muscle can’t do it’s job at 100%. I recently read a quote from Perry Nickleston, DC who wrote “we mistake being able to function for healthy”. Kevin Durant may not have had any more pain (or he may still have had discomfort, it is the NBA finals and athletes can be stubborn), or he may have been able to walk/run with no limp, or he may have passed all of his return to sport tests – but our bodies are amazing at compensating and hiding dysfunctions. Professional athletes are EVEN better at it. But just because he was able to pass these tests or run with no visual impairments doesn’t mean he was 100% healthy.

This leads to the second question: Did he return to sport too soon? In my opinion yes. He only practiced once at full speed prior to last night’s game. However, there’s much more to it. Having worked with professional athletes and teams in the past (Boston Blades, professional women’s hockey 2016-2017), something that many in the rehab world fail to understand (unless you’ve worked with athletes of this caliber before) is the athlete’s mentality. With regards to rehabbing an athlete (amateur or professional) I always followed the mantra of “Maintenance during the season, rehab in the off season”. This means that during the season, there’s not much you can do (or should do – a post for another time, but in short there’s always a learning curve with movement patterns and that takes TIME, which athletes in season don’t always have) but to keep them healthy enough to play with any means necessary (usually this means symptom treatment, taping etc…). But the key here is what part of the season are we in? If this were the regular season, I’m sure Kevin Durant would have sat out until he was completely healthy since Golden State was going to the make the playoffs anyway, and there’s more TIME. Post season, it’s do-or-die for the athlete. If this was a first round, though, Golden State may feel confident enough to not play him and still win. However, this is the NBA FINALS. There’s a lot on the line. Him and his team have worked hard all season to get to this point. I’m sure Kevin Durant was willing to do anything if it meant winning last night to keep their season alive (they were down 3-1 in the best of 7 series going into that game).

Kevin Durant left it all out on the court last night – ending his season to help keep his team’s season alive. He did it because he didn’t want to let his team down. Did he know he wasn’t 100% – absolutely. But to him, he wanted to end his contract with GSW on a high note, even though now he is injured and free agency is only days away. That is the mentality of an athlete – to do WHATEVER it takes for your brothers, your team. Not everyone will understand that unless you’ve participated in team sports at a high enough level.

So do I think he returned too early? Yes. Do I understand why he came back early? Yes. And the latter is more important in this case than the logical/obvious answer. Because to him, this was worth it at the time. So before we start to judge Kevin’s decision, or his medical staffs’ abilities, understand that this is the athlete’s mentality in season.

I welcome any comments you may have on this topic.

 

What We Say Matters

In the physical therapy world, we do a lot of listening (or we should … if you don’t, then you should start – there will be a post in the future about listening), but we also do plenty of talking – mostly educating our clients. However, not all words are created equal. We, as professionals, have to be very careful with our word selection because that can directly influence our outcomes with the client.

Words and language are a form of external, auditory stimulus. All stimuli (external, physical, etc…) are processed in the brain and then a response is sent out. If the stimulus is a touch of another person’s hand, the output response is that it is human touch. If the stimulus is a paper cut, the output response is pain. The same works for auditory stimuli – the brain has to decide how to respond to certain words and phrases. The output is usually emotion – how we feel towards hearing these words; do we feel happy/sad/neutral?

pain words

Think about this scenario: if you were a client (no healthcare background, unfamiliar with medical conditions or rehab guidelines in general like much of the populations we serve) and you found out you had a rotator cuff tear. You get an MRI and the MD tells you that you tore your RTC, you may need surgery, you may not be able to lift your arm without pain, they may ask “how much pain are you in?” etc… The same can be said of chronic pain clients. When these words are processed by the client, the brain’s output of emotion is negative and can heighten the pt’s perception of pain. There is an article published by Thomsen, R. et al in 2011 “Impact of emotion on consciousness” where they found that “participants were more confident and accurate when consciously seeing happy versus sad/neutral faces and words” with “evidence of interaction between emotion and conscious experience”.

If the client is predisposed towards having negative emotions with regards to their injury, we have to do better as PTs to change their overall outlook. We interact with the client on a more consistent and frequent basis than the MD does, so what we say matters more – if we are consistently conscious of our language use around the client, it can re-shape how they perceive pain. However, if we are consistently asking the client “how bad is your pain today?” or “do you have pain with overhead lifting?” or “don’t run/don’t lift heavy objects” – we are feeding into the client’s negative emotions towards their injury. Instead, ask these questions with different phrasing such as: “how’re you feeling today?”, “Are you able to perform any overhead lifting?”, “Modifying your run schedule or working on pacing during your run can decrease your discomfort”.

pain

By turning some of these questions into “open-ended” ones, the client is forced to become more aware and mindful of their current status – over time, the client may start responding in a more positive manner. They may say “I still get a little pinching with overhead lifting” to which you can respond “that’s a positive improvement, when you started overhead lifting was a very difficult movement for you!” Positive language can help your client become more mindful of their current status. Luiggi-Hernandez et al published a paper in 2017 on mindfulness for chronic low back pain where they found that mindfulness helped participants decrease negative emotions towards chronic low back pain, decrease fear of pain, reduced significance of pain etc…

During a client’s first evaluation (especially chronic pain clients), I set the expectations very clearly – I know that pain will persist for a while, however, I don’t want the client to search for improvements on a day-to-day basis. Even if they still have the same level of “pain” or “discomfort” what I want them to look for, weekly/bi weekly, is if they can perform more functional tasks – tasks that they weren’t able to do prior to starting PT. This, in itself, is improvement. This sets the tone for all of my future sessions because the client won’t focus on the pain – they know it’ll still be there. Once they begin to follow through with my plan of care, they will – all of a sudden, usually – realize they have less pain with movements and it becomes an “A-HA!” moment for them.

Now, I don’t want people to read this post and think they can talk someone out of pain. The idea is to be aware of our choice of words and use guided mindfulness to decrease the client’s sensitivity and allow you, the PT, to treat their impairments and dysfunction. You still have to address their deficits and strengthen weak areas, cue proper movement patterns etc… but having the right word choice can open up new opportunities for gains.