The term "shoulder impingement" may be a new concept to you, but the pain from shoulder impingement is something you have probably experienced. If you've ever experienced a sharp pain in the front of your shoulder, mostly occurring with reaching your arm above your head, then it's safe to say you've experienced shoulder impingement. To fully understand where this pain comes from, you must first understand a little anatomy.
Shoulder Anatomy 101: The shoulder joint is a "ball-and-socket" joint, involving the shoulder blade (socket) and head of the humerus (ball). Directly above this ball-and-socket is the clavicle, or collarbone. Besides these three bones, you have several muscles which are designed to hold the ball-and-socket joint together, which make up the Rotator Cuff muscles. One of these muscles, along with the biceps muscle, runs directly through the space between the ball-and-socket and collarbone. Next, it's important to understand the function of these muscles. Functional Anatomy 101: One of the primary roles of the rotator cuff muscles is to keep the balll-and-socket joint in proper alignment, and keep the space between the bones open, especially as the arm is moving. If the rotator cuff muscles fail to do their job properly, there is excessive movement between the ball and socket, which then makes the space between the bones smaller. When this space gets smaller, the muscles running through the space end up getting pinched between the bones of the humerus and collarbone. This pinch is then experienced as the sharp pain I mentioned earlier. What Happens When the Muscle Gets Pinched? Muscles are made up of multiple individual fibers, similar to a rope. If I were to hit a rope against a rock, very little, or no, damage would occur to the rope. However, if I hit the exact same spot of the rope on the rock repeatedly, eventually, more and more of the fibers from the rope would begin to break, until the rope was cut in two. This example is a perfect match to understanding what happens to the muscles in the shoulder when impingement is occurring. It is not a single pinch that is going to cause damage to the muscles. However, pinching the muscle in the same spot every time I raise my arm or reach for something, overtime will eventually cause more and more damage to the muscle until it is cut in two. When the damage gets to this point, the only treatment option is a rotator cuff repair/surgery. What Can I Do to Avoid Surgery? The solution to shoulder impingement, and avoiding surgery, involves addressing the problem before too much damage has occurred. Research suggests that rotator cuff tears, even half-way through the muscle, respond just as well with conservative treatment (i.e. physical therapy) as it does with surgery. Therefore, surgery is not the only treatment option. Physical therapy for the rotator cuff and shoulder impingement should focus on regaining full strength in the rotator cuff muscles. Then, restoring balance in the coordination of the muscles and bones to keep the spaces properly opened to avoid the pinch with arm movement. When this pinch no longer occurs, the body can begin to heal and resolve the damage. Eventually, the muscle is restored, the painful movement no longer occurs, and the problem is resolved. While this pinch is very common, it is not "normal." And, it is something that can be resolved without injections or surgery. If you experience this pain and it is currently holding you back from enjoying your favorite activities, schedule your evaluation today and begin your journey back to a pain-free lifestyle.
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9/10/2019 0 Comments "No Pain, No Gain"“No Pain, No Gain” is a common “motivational” saying I see written on the walls of gyms, in the text of fitness advertisements, and said from people of all athletic types. While this may motivate people to workout harder, it also gives people the idea that pain is a normal response to exercise, or that you’re doing it correctly because it hurts. However, there are different types of pain and the type of pain you are experiencing should determine whether that exercise is helping or hurting you. This blog is intended to help you get a better understanding of acceptable “pain” during a workout and what types of pain should be avoided.
Unacceptable Types of Pain: Pain is perceived on an individual basis, meaning that what you are experiencing can only be understood by you. You may be working with a trainer or coach and you tell the trainer “it hurts.” Without describing what you’re feeling in more detail, the trainer may think you are getting the effect he/she is looking for with that exercise. In reality, the type of pain you may be experiencing is really your body telling you to stop before injury occurs. Better communication is the key to avoiding injury. Pain with exercise SHOULD NEVER:
Experiencing any of these symptoms during an exercise, or workout, should be viewed as a warning sign to discontinue that exercise. If you’re exercising with a trainer, or coach, use these descriptions so appropriate modifications, or adjustments, can be made. Acceptable responses to exercise: Rather than using the word “pain,” I like to use the word “discomfort” to describe acceptable responses to exercise. The use of this word, instead of “pain,” allows me to quickly distinguish between a desirable or undesirable effect with my clients during a workout and saves time and confusion. Discomfort, within a tolerable level, is normal with exercise and indicates that the desired training effect was achieved. Your body can recover, rebuild, and get stronger from discomfort. Discomfort is described by:
Key Point to Remember: Everything should remain within a tolerable level! What is your purpose for exercising? No matter what your individual purpose is, there is always a way to achieve that goal, even if it means leaving certain exercises or movements out of the workout. If something is too difficult, too painful, or beyond your ability to tolerate it, you’ll most likely quit before the goal is achieved. The majority of clients I help fall into the category of regular exercisers, who experience pain, stiffness, and/or instability. But rather than having to modify, or exclude, certain exercises or activities, they want solutions to resolve the problems. My role is to resolve these barriers, optimize their physical abilities, and give them the greatest chances for success in the gym, and more importantly, life. What are the 2 most popular sports for people aged 50+?
Answer: Golf and Tennis What do both of these sports have in common? Answer: They are rotational sports, AKA, sports that require frequent twisting or rotating of your body. What these two sports have in common is also the key to playing these sports as you age: Maintaining and/or improving the spine and body’s ability to rotate properly. Where does rotation come from? Answer: The 2 greatest areas of proper rotation comes from the hips and the thoracic spine (upper back). The Dilemma: As you age, the two most common areas that lose range of motion are the hips and the thoracic spine. While loss of motion in these areas is not due to aging, it is more of a cumulative effect that occurs over many years. Most of our daily routine involves sitting, doing activities in front of our body, with very few activities involving twisting, reaching behind, reaching overhead, and extending the spine. As these motions become less and less frequent, we begin to lose the ability to go into those directions when we want to. The body is really smart at figuring out other ways to get the desired action, even if motion from the correct areas is lost. When you set up to hit a golf ball, or do a tennis serve, your body knows the action it needs to make to rotate and swing the club/racket. However, if there is not enough mobility in the hips and thoracic spine, your body will find other areas to move from in order to perform the task. In this most common example, the body typically will make up for the loss of motion by getting more motion from the lumbar spine (lower back). Unfortunately, the lower back was not designed for twisting. As with most low back injuries, it is not 1 golf swing, and twisting of the lower back, that will result in injury. It is the cumulative effect. In a typical round of 18 holes, it is assumed there will be 60-70 strokes involving woods or low irons, which will involve full, or harder swings compared to chipping and putting. 60 swings that involve twisting the lumbar spine may be enough to develop low back pain or at least a temporary soreness. Add in the frequency of playing, and the risk for injury becomes much more likely. The Solution: Bulletproof your golf and tennis swing by optimizing hip and thoracic spine mobility. Once full range of motion is achieved, developing the stability and coordination needed to perform a correct swing with increasing speed and power. Step 1: Get all the pieces needed for a proper swing. Step 2: Put the pieces together during the task itself. To find out exactly what YOU need to do, sign up for a free movement assessment. I will identify the areas and motions most limited and give you the steps needed to make improvement and maximize your swing, while reducing your risk for injury. 7/10/2019 0 Comments I Was Told I Shouldn't Run AnymoreThink of your favorite type of exercise and the joy you get while doing it. Then, you develop pain in one of your joints. The pain doesn’t seem to be going away, and as much as you don’t want to, you decide to see a physician to figure out what is causing the pain. After getting an X-Ray, and possibly an MRI, the physician comes back and says, “Nothing is broken, but you do have some arthritis in there.” The physician then gives you an anti-inflammatory to take and ends the conversation with, “You should stop doing that exercise.” Now what? You leave the physician’s office with the same pain you had when you went in, been told you have something wrong, but can’t be treated other than taking some pills to limit the pain, and you’ve been told to give up your favorite exercise. What a terrible and helpless feeling that leaves you with! You have 2 choices: Option 1) You take the physician’s advice and stop exercising and take the pills to limit the pain. But, you’re left with a feeling of loss because you no longer have the enjoyment you received by doing the exercise. Option 2) You decide to keep doing the exercise because you aren’t willing to give it up. But, it continues to be painful and causes more damage. Both options have pros and cons, but neither option seems like a good long-term solution. What if there was a 3rd option? Option #3 is the solution I implement every single day. Option #3 comes from the belief that you shouldn’t have to give up your favorite exercise; that there is a reason you started having pain and when that reason is identified, it can be changed. To be more specific, if an individual has the required strength, flexibility, coordination, stability, and muscular endurance needed to complete a desired activity, it would be expected that he/she could perform that activity without pain or increased risk for injury. A deficiency in one, or more, of these areas will increase your likelihood of pain or injury. Therefore, when we identify the deficiency and return it back to an optimal level, it is realistic to think you could return to your favorite exercise again. In my opinion, this is the only option full of pros and no cons. It is the option if you are not willing to give up the activities you love! Click the link below if you'd like to be contacted to set up a free Movement Assessment and find the solutions you need to keep you out of pain and enjoying your favorite activities. Every time I open my news feed, there is a new article with a headline stating something like, “The 5 Best Stretches Every Person Should Do” or “The 10 Best Exercises for Stronger Legs,” etc. Out of curiosity, I open the article to see what these “Best Exercises” are and if the live up to their claim.
While most of the exercises suggested in these articles are good exercises, and ones which I incorporate into my practice, there is one similar thought I have after each article I read. That thought: These are advanced exercises/stretches that should only be performed by people that don’t have pain, and already have a more advanced level of strength or mobility to begin with. The problem, with any awareness of health statistics, is that the majority of people don’t meet these minimum requirements necessary to safely perform the recommended exercises. I see it with patients as a physical therapist, but also see it all the time as a CrossFit coach, with people who would be considered “healthy.” My advice for you and how to apply this information: If you come across one of these articles and you really want to improve in the area mentioned, give the exercise a try. But, pay attention to how your body feels when trying it. If it is painful, or too difficult, stop! Don’t force your body to do something it is not able to handle. Every exercise or stretch has several variations, or modifications that can be made, to make the exercise easier or harder. The creative process of what I do, is finding the most appropriate variation/modification for each individual, knowing where they are today and where they eventually want to get to. If you don’t know how to modify the suggested exercises to fit your current ability level, find someone who can help. Find someone to be on your team, who knows your body, knows what areas need to be improved, and can show you how to do that every step of the way. Having that trusted professional will help you to see progress faster, keep you safe and healthy in the process, and save you a ton of time in the long run not having to deal with frustration and uncertainty. Every person has the potential for improvement. How each one of us makes that improvement is what makes us different. Something unfortunate happens and you get injured. You have to stop your exercise routine, so you can heal. After sufficient time passes, your body is healed and the pain is gone. Now, it’s time to start exercising again… But, you’re afraid. You’re afraid of re-injuring yourself; you’re not sure if you can do it because of all the time off. What do you do?
This is a conversation I had recently with an individual, who recently had abdominal surgery. She made the decision she was going to get in “better shape” and had started an exercise routine at a local group exercise studio. She was doing really well and enjoying these new workouts. Then, an unfortunate medical event required her to have abdominal surgery. She tells me that she’s afraid to start exercising again, even though her abdomen is healed and no longer painful. She then asked, “Do you help people in this situation?” The short answer is, yes. The majority of individuals I help are active people who have a new injury, or are trying to overcome an old, chronic injury, so they can get back to exercise, or improve their performance with certain exercises. What can you do about it today? If you decide to jump right back into an exercise class, take 5-10 minutes before class to speak with the instructor or coach. Make sure they are aware of the situation and can make appropriate modifications during class to avoid re-injury. In fact, with great coaching, people can often continue exercising throughout the course of the healing process by training around the painful areas. If it hurts, stop! Feeling pain in the previously injured area, does not mean you have re-injured it. It is most likely your body’s way of protecting itself, telling you it was too much stress too soon. As long as the pain stops within 5 minutes after discontinuing the painful movement, there are no reasons to suggest a serious injury has occurred. My advice is to begin an exercise routine that slowly begins to stress the previously injured tissues. Your body will adapt to this gradual increase in stress and become more resilient and less likely to be re-injured. The exercises selected should be easy enough that you can successfully complete 10-15 repetitions without pain, or your movement quality breaking down. After completing these exercises for the first time, you wait. See how your body responds over the next couple of days and adjust accordingly.
The goal of this article is to provide you with principles to follow with returning to a full, unrestricted exercise routine. There are too many body parts and different exercises to give you specific information on what exercises would be appropriate for each individual. If you are unsure how to apply this information specifically to you and what exercises are safe exercises to start with, I am here to help you. Complete the short form below, I will get back to you and help you any way I can. 5/30/2019 1 Comment Bench Press and Shoulder PainIt’s Chest Day!
Even if you are a casual gym-goer, I’m sure you’re aware of Chest Day. The day where everyone “patiently” waits for their turn on the bench press or pec machine. This day usually consists of 3, 4, 5+ different exercises all targeting the chest muscles. Unfortunately, anyone who has joined in this well-known routine, has probably also experienced the shoulder pain that comes along with it. It’s the pain, sometimes sharp, that you get in the front of your shoulder. What Does This Pain Mean? A little lesson on shoulder anatomy: The shoulder joint is a ball-and-socket joint. Within that socket, lies several muscles, called the rotator cuff. The primary role of the rotator cuff muscles is to keep the ball and socket together. When these muscles are weak, you get excessive movement between the ball and socket. That excessive movement results in the rotator cuff muscles getting pinched between the bones. The pinch is the sharp pain you experience. Pinched enough times, you end up with a rotator cuff tear. How Does This Happen? The rotator cuff muscles are infrequently trained in most people’s exercise routines, mostly because they are not visible like the larger muscles around the chest and shoulders. (Nobody ever got complimented for having large rotator cuff muscles) Without strengthening the rotator cuff muscles, and spending more time strengthening the larger muscles around the shoulders, the rotator cuff muscles get weak and eventually lose their ability to stabilize the ball-and-socket. What Can I Do About It? The good news is this can be resolved rather quickly, as long as a rotator cuff tear hasn’t occurred. Three exercise tips you can implement right away are:
The overall goal is to strengthen the rotator cuff muscles and have more balance between the front- and back-side of your body. Implement these strategies right away and see if the shoulder pain goes away. If you continue to experience discomfort with bench press, or similar movements, I recommend further evaluation to look more closely at the shoulder, so more specific action can be taken to help YOU. For further questions, click the button below, and complete the form. I will be able to get back to you soon and answer any questions you may have. Or, call me directly at 973-885-3893 to schedule a time for evaluation. Your purse, a child, several bags of groceries, any heavy object… the list could go on. Now, stop and think for a second. When you carry any of these objects, do you always carry them on one side of your body? If you’re like most people, the answer is yes. You have a dominant side you seem to always carry objects on.
This is a question I ask any new client who is seeking my help for back pain, more specifically, back pain that is only on one side of the body. It isn’t just coincidence that they answer “yes” to the above question and have a preferred side to carry everything on. It’s also not coincidence that when they tell me which side their back hurts, I have very high accuracy with correctly “guessing” which side of their body they carry most objects on. Of course, I do additional testing to identify the specific problems. Before I go into the mechanisms of how this back pain happens and what you can do about it, I will briefly mention who is most susceptible to this type of pain. There are 2 types of people who I most commonly see with this complaint. The first, which is less common, is heavy laborers. Their job requires a lot of carrying and moving heavy equipment. The second, more common, type of person I see with this complaint is women, particularly mothers. They have a tendency to spend a lot of their time doing activities one-handed, holding their small child on the other side. My wife is a perfect example of this; she always carries my daughter on her left side, usually while she’s also trying to do what seems like 1,000 other things at the same time. When it’s not carrying my daughter, it’s her purse, always hanging off her left shoulder (and you know, everyday purses aren’t typically light). What do these two groups of people have in common that could cause this one-sided back pain? The amount of weight being carried and the amount of time spent carrying it. It may not seem like a 5-pound purse could cause that much to change in your body to the point that your back hurts. While 5 pounds is not a lot, it becomes a lot over the course of weeks, months, and years of having a weight constantly pulling you down on one side. So how does this happen? When you hold an object in your right hand, your body automatically creates an equal-and-opposite force to counterbalance the weight of the object. Without a counterbalance, you would fall over. This counterbalance primarily comes from the muscles in the back and hip on the left side of the body. This increased muscle activation on the left side of the body results in increased strength in those muscles. Another change that occurs, sticking with this same example, is the right side is placed in a shortened position, while the left side placed in a lengthened, or stretched, position as the weight pulls down on the right side. The end result is a muscle strength and length imbalance between the two sides of your body. The side that becomes irritated and painful, is typically the opposite side objects are carried on (the left side in this example). What can you do about it? Simply put, the imbalance must go away so the spine can return to its neutral position. Therefore, the shortened side needs to be stretched. The stretched side needs to be shortened. And, the two sides need to develop equal strength in this neutral position. If that’s confusing, it’s okay. That’s where I come in, to teach people exactly how to do this. A much simpler, easier way to go about correcting this imbalance is… Become more aware of how much time you spend carrying objects on one side. Then, make small steps to becoming more comfortable carrying objects on the other side, until you are carrying objects with as close to a 50/50 split as possible. If you’re looking for a more immediate solution to this problem, Clarkston Physical Therapy has the solutions! What Do I Do When My Exercise Routine Hurts?
Some people exercise because it's their favorite hobby. Other people exercise because they are training for a race or competition. However, everyone that exercises does it because they have committed to, and invested in, their health. As with any commitment, there will be challenges everyone will face when trying to improve their health and fitness. The ability to overcome these challenges will determine a person's ability to persist, and ultimately, achieve their fitness goals. One challenge in particular that can easily throw a person off course from meeting their goals is pain. When certain exercises or movements become painful, you are faced with some choices. Do I stop exercising to prevent further injury, or keep going despite this risk? Do I stop going to my favorite class, or take the risk of more pain and injury? Unfortunately, neither choice has the outcome you want, which is to keep exercising, keep going to your favorite class, and do so without pain. 2 Better Questions to Ask Yourself: 1) “How can I keep exercising, in a way that will not increase my pain or cause injury?” My advice to this question is quite simple: if it hurts, don’t do it! There are endless exercises and movements you can perform to improve your fitness level. If there is a specific movement you notice that causes pain, leave it out of your routine and replace it with an exercise that is not painful. If you participate in an exercise class, speak to the instructor prior to the class so they can become aware. This also allows the instructor time to modify your routine when your painful movements come up in the class. Example: your lower back hurts with forward bending during a yoga class. With a simple modification of using one or two yoga blocks, you may be able to bend forward within a range that is no longer painful. 2) “How do I get rid of this pain so I don't have to give up my favorite class, exercise routine, or goal to improve my health?" Seek help. There are many resources available to treat and calm painful areas. These modalities are often short-term and will provide temporary relief. The solution to your pain problem lies in addressing the root cause of the pain. As a physical therapist, and movement specialist, I discover the root cause by identifying muscle imbalances, mobility restrictions, and instabilities that have led to impaired movement. Impaired movement, performed repeatedly or with increased weight applied, will eventually cause a breakdown of the joint or tissues. By addressing and resolving these restrictions, you are then able to return to proper movement without pain. 6/13/2018 0 Comments The CrossFit MisconceptionWhen most people think about CrossFit, the same 3 ideas seem to always be mentioned.
As a physical therapist and a CrossFit coach, I get to see how the two worlds are not that far apart from one another. In fact, many of my patients are performing the same movements, or variations of the same movement, as individuals perform in CrossFit. So, what do these two have in common? Function! CrossFit is the performance of functional movements, programmed in a way to develop strength, flexibility, stamina, speed, coordination, balance, power, cardiopulmonary endurance, agility, and accuracy. An individual receiving physical therapy will be working to improve in the same areas, but the improvement may be specific to a more localized area of the body to reduce pain, or following an event that left them debilitated. In general, physical therapy helps an individual return to a prior level of function, while CrossFit will help an individual go beyond their normal level of function. Misconception #1 I could never do what the people do on TV. While this may be a true statement, the good new is, you’re not expected to do the same things you are seeing the individuals do in the CrossFit Games. These individuals are athletes, who over the course of several years and training hours, were able to perform skills above and beyond the general population. It would be similar to saying you’ll never draw a picture because you couldn’t paint the Mona Lisa. No matter your ability level, CrossFit is scalable, meaning you are performing movements specific to your current ability. For every functional movement, there are several options to increase or decrease the difficulty. While one athlete may be performing a 300-pound back squat, another athlete may be performing body-weight squats without additional weights. What’s important: the two athletes should experience the same relative difficulty because each one is performing according to their own ability level. Misconception #2 I hear people get hurt easily. As with any sport, there is a risk of injury. However, many of the injuries that occur in CrossFit can be avoidable. With a good coach who knows your ability level and can scale exercises accordingly, your risk of injury is minimal. It is the responsibility of the coach to program and modify exercises appropriate for the athlete. It is the athlete’s responsibility to inform the coach if anything is ever painful. No matter what fitness activity you’re doing, if something is painful, stop! Misconception # 3 I’m too old to do that Did you know there are CrossFit classes specific to the geriatric population? As well, it's quite common to have a class with individuals ranging in age from their 20s to 60s. No matter the age, the fundamental principles remain the same and are applied appropriately for each individual's ability. My goal as a physical therapist is to help you recover from injury, or debility, to maximize function and quality of life. My goal as a CrossFit coach is to help you maximize health and function. To me, that is a continuum that most people fit into. |
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