Injuries don’t just go away on their own

Contrary to popular belief, when you injure yourself and are experiencing pain, things don’t just go away on their own. Can you sense the sarcasm in that statement? Our bodies don’t work like that. My wife has been having some hip and buttock pain for the past few months. Initially she strained her hamstring trying to race my son…not a good idea! I treated her a few times at home and gave her some things to do on her own. Since then she has developed some hip pain which again I looked at and gave her a few things that would benefit her. Just last night she was telling me how these things were still bothering her. I proceeded to ask her how the things I told her to do were going. She said she was not doing them. WHAT???? I told her that she is no different than a lot of the patients I see. Thinking these things are just going to go away on their own without any type of treatment is a common problem that I run into.

Rest at times can help an injury. For instance, when you sprain your ankle, you need to rest it. If you continue to walk on it, the inflammation will never go away and the healing process will take twice as long. But as that inflammation starts to subside you need to load the tissue and test it to keep it’s strength and flexibility. If you were to just stay off of it and not walk on it, it will take twice as long and could turn into a chronic issue. The same goes for all injuries. Things just don’t go away.

Don’t say physical therapy and treatment didn’t work for you if you never put in the work. I get this statement a lot from patients who have had PT in the past. I went to PT for a week and it wasn’t helping so I stopped going. Or better yet, they had me do a few exercises and they didn’t work so I stopped doing them. I know we all just want things to go away as quickly as they came, but that’s just not going to happen. Healing, strength training and diet all take a certain amount of time to start working.

This isn’t a new concept. They all take work, effort and a certain amount of self discipline to see any type of results. I said this to my wife and I will say it to all of my patients. I don’t want to hear your complaints when you never took what I said seriously and did what I asked you to do. Only after you have worked hard and failed can you start to complain to me about what didn’t work. Then we will refocus and try something new, because you can’t just give up when one thing doesn’t work.

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What to do when you experience low back pain


I get this question a lot. “Nick I have no idea what I did to my back but here is what is going on”. “What should I be doing?” “What should I be avoiding?” Unfortunately, it’s really not that simple when it comes down to it. Without first evaluating someone I can’t just give out things to do, but I can suggest things that are pretty common in the treatment of low back pain. This can be a starting point to see if they get any relief. Once we have accomplished that, then we can look into more detail as to what the problem is. So what should you be doing if you start to experience low back pain? And what should you avoid so that the symptoms don’t get any worse?

Rest: how much is too much? In my opinion, rest with any injury is needed to allow for the inflammatory process to subside as well as for the tissues to start to heal themselves. Now, when I say rest I don’t mean bed rest. I am talking about rest from activities like running, lifting, carrying or any activity that seems to irritate your low back. And the length of time is important as well. 1-2 days is plenty because I then want you to slowly get back into your routine. Light walking, lifting, carrying activities.

Ice or Heat: I always advice ice for the first 48-72 hours. At that point you can mix the 2 back and forth if you want to. Some people, like myself, love ice. I hate being hot and ice always makes me feel better. So after that initial few days I say whatever makes you feel better is what I would recommend.

Change positions: you want to change positions frequently. If not you will tend to stiffen up or cause yourself more pain. When you are in pain your body and muscles are most comfortable tight. This, in turn, will cause you more pain and discomfort. If you sit for your job I suggest to not sit for more that 45 minutes before changing your position. Move in your chair, or get up and take a walk to change the position of your spine. This will decrease stiffness and load the spine and injured tissues so that they do not get stiff.

Light stretching activity: a light stretching program can help as long as you are not causing new symptoms to occur. Stretching also keeps the spine loose as well as the structures that surround it. As I said above your muscles like to stay tight when your body is in pain and this will help combat that. Sometimes back pain is accompanied by leg pain and we don’t want that. I always suggest to see your physical therapist to get evaluated and determine what best suits your back when you have these types of symptoms.

Avoid lifting heavy: If you work in an environment that you do a lot of heavy lifting this should be avoided for at least 2 days. Like I said about rest, it’s good for a short amount of time and then we need to start to load these tissues in order for them not to continue to get weak.

See your physical therapist: I suggest that you see a physical therapist right away when you experience low back pain. Our profession is so underutilized in this aspect considering that only 7% of patients with low back pain are referred from their physician to come to physical therapy. Where are the other 93% going? Or better yet are the other 93% not even doing anything about it? These are great questions and should be thought about in order to fully understand what it is that you can do when experiencing low back pain.

Do I need a prescription for physical therapy?


For the longest time, to come to physical therapy you had to get a prescription. First you had to make an appointment with your PCP and take time out of your day. They would take a look at you and say I think you should go see a physical therapist. They would write you a prescription and send you on your way. Nowadays, there is something called direct access for physical therapy. Patients can come right off the street without seeing a physician and get physical therapy treatment. So does this mean that you no longer have to see a physician to be able to come to physical therapy? Well it kind of depends.  

The short answer to if you need a prescription is no. Direct access is meant for just that, to not have to worry about seeing a physician to get permission to come to physical therapy. Now, what will decide that is your insurance. Some insurance companies still require you to get a prescription, Medicare being one of them. My best advice to people that are wondering if their insurance accepts direct access is to call the number on the back of their card and ask. If patients do call in we can check for them, but it is much easier for them to call on their own.

How does direct access help the patient? For one, it takes an extra visit to the PCP away. This means they can just come straight to the PT and not worry about seeing an extra health care provider. Another way direct access helps is that it cuts costs for the insurance companies. Unnecessary visits are avoided and this in turn makes them happy. Direct access also saves patients time. Again taking away another visit can be the difference in an entire afternoon or evening for some patients. Busy schedules require efficiency and direct access does just that. And finally, it eliminates barriers to entry. If a patient wants PT, there should not be anything that stands in their way of getting it. This, in turn, opens of and enables people to seek this service without having restriction.

So the next time you get injured call your physical therapist so that they can properly evaluate you and get you on the right path to better health!

Why is form so important with exercise?

I have people ask me this question a lot especially if I am correcting them as they do a specific exercise. Why do I have to do it this way? This way is harder for me to do it. It’s easier if I do it this way. These are just some of the things my patients say during their time with me. Now I’m all for doing something a certain way if it is easier and more efficient. But when it comes to exercise there is some form that we all must follow. So why is it so important that we follow proper form while doing exercise? And what can happen if we don’t?

Injury prevention: this is the number one reason why form during exercise is important. If you continue to do an exercise incorrectly, you run the risk of injury. In my world of physical therapy most people that come to see me are already injured or have some form of pain. The last thing we want to do is cause another problem.

Efficiency: with proper form comes efficiency. We all want to be efficient with things because this makes things work more smoothly, it saves time and helps to not overwork yourself. Being efficient with exercise allows our body to adjust quicker and avoid fatigue. This, in turn, will prevent injury as we talked about above.

Accessory muscle use: if proper form is not used this can cause you to use accessory muscles. These muscles are the ones that start to kick in if the other is either too weak or your form is not correct. The best example I can give is when someone is doing a bicep curl with a barbell. If the weight is too heavy or their biceps are just weaker they start to rock their back and extend back and forth. This causes them to start using muscles in their back and increases risk of injury. My advice is always quality reps increased weight. It’s better to do 20 quality reps with a lighter weight than 10 reps of heavy weight with poor form.

Increased joint mobility: form plays a role in mobility of our joints. Deep squats for instance, are a great example. Deep squats are an excellent exercise to get more mobility in your hips, knees and ankles. If the goal is to increase the mobility in those joints then this exercise is for you. But if we decide to just do squats to 90 degrees of knee flexion this could cause a decrease in the mobility of the hips because they are not going through that entire range of motion. Now mini squats and squats to 90 are great for strengthening but if you want increased mobility this will cause those structures to tighten and not allow for full mobility. In turn, causing you limitation and sometimes pain.

As I tell all of my patients. I am not interested in how much weight that you can do or how many reps. I just want you to have proper form while doing your program.

Is there a fountain of youth?


If you look all over the news especially on ESPN there is no way you are missing all the hype behind Tom Brady the quarterback of the New England Patriots. Now, let me preface that I am a huge Pittsburgh Steelers fan and it pains me to even talk about him. But it is really amazing what he has done for the length of time that he has done it. How has he been this good for so long? How is he getting ready for his 17th season in the NFL and 16th as a starter? Brady is 40 today August 3rd and in football years that is an eternity! The average NFL career is between 3-6 years depending on position and ability of play. Brady has broken records, won 5 Super Bowls, is a two-time NFL MVP and has the most wins as an NFL quarterback EVER! So how does he do it? How has he been able to keep up with all of these other younger more versatile quarterbacks? And how does it seem that he just has a knack to win the big game?

To be an NFL player you have to be special! You don’t just luckily get drafted and you don’t just get a starting job because you made the team. You have to work and work hard if you want to be successful in the league. There are many players that have gone past their years as a football player trying to get that one last season before leaving the game that they have loved to play for so long. Payton Manning comes to my mind right away. Even though he won a Super Bowl to end his career he was a shell of himself that year. His defense carried him most of the way and he did what he needed to do to win, even if it wasn’t pretty. Tom Brady has evolved as the exact opposite only getting better and more focused with age.

Let’s start with his diet and how he decides to fuel his body. It is no secret that he eats vegan most of the year. Now I’m not saying this is the option for ultimate health because there is no way that I could go without meat. But this is his secret to success. Diet plays a huge rule in your health and weight control. I have posted in older blog about the 80/20 rule that most should follow. 80% diet and 20% exercise. There is no need to kill yourself at the gym 6 days a week if you are not eating the right things to fuel your body. Next, his workout regimen is very strict requiring him to wake up very early each day because of his busy schedule as an NFL player. His workouts along with him being very conscious of his health play a huge rule in how he is able to keep going. He is a very focused individual and it shows through all that he does.

If you want to get serious about your health and the way that you feel I suggest you take a look at what this man has been able to accomplish. Tom Brady is an extreme case, but he is a perfect example of what hard work and dedication to your body and health can get you. Is 40 really the new 25? If so, Patriots fans would seem to think he might have at least 10 years left in the league! We all wonder how much longer he will be in the league for. The short answer, as long as his body will let him be. Truth is there is no telling how much longer he will play. He’s like the damn energizer bunny! All that I know is as a Steelers fan his retirement can’t come soon enough!

Things aren’t always impossible!

This past week was one of the best youth baseball experiences I have ever been a part of. Our 9 year old little league team went to the state playoff tournament. If you would have asked any one of us coaches at the beginning of the season how we expected to do I think we would have all said we probably wouldn’t make it past districts. Our team is made up of all 9 year olds and this was a 10 year old tournament. In youth baseball 1 year makes a huge difference. Some of these kids are a whole head taller and have at least 50-70 pounds on some of our kids. Our 10 year old team decided they did not want to be a part of this so we decided why not? If we go and get crushed at least they get the experience.

Districts were against a bigger North Allegheny team. It was a best of 3 series so we knew we would play at least 2 games. The first game was at our field. We came out and competed very well and won the game 9-2. We looked at each other and said we have a shot at this. 2 days later we won districts 16-15. That game was a lot closer but we battled back and won with a walk off hit! Now it seemed like we really had a shot!

A week or so later sectional playoffs started. This was a 4 team double elimination tournament. The first game was also against a much bigger team from Sharon, PA. This game was a very close game back and forth all game. Again, we ended it with a walk off win! It just kept getting more real! The goals we had set forth seemed attainable. Our second game was the next night against Carmichaels. We were down 4-0 after the first 2 innings, but that didn’t stop our boys! They came out on fire the next inning and continued that throughout the game. We ended up winning the game 7-4! It was awesome! We were in the winners bracket and had to be beaten twice now. 2 days later our boys didn’t disappoint. At this point we all believed we were going to win. We won 12-5 and won the PA section 2 championship! On to Morrisville, PA!

The experience all week in Morrisville, PA was awesome! Not only for us coaches but the kids had an absolute blast! From the banquet opening night, to opening ceremonies and the first game it was great. At this point the boys did feel some pressure and it was obvious from the first inning. We gave up 6 runs in the first inning and had to play catchup all game. We ended up losing 12-5 a very disappointing opening game and now we were in the losers bracket. We came back the next day ready to fight until the end and that is what these boys did. Coming back from being down 10-3 scoring 7 runs in one inning to tie the game. We just couldn’t hold them off for long. We ended up losing our second and last game and our run was over. It was sad to see these kids work so hard to come up short, but I was so proud of what they accomplished!

This entire season was very special and I am so glad that I got to be a part of it. Seeing how hard these boys worked to get where they did was awesome! They committed to a goal and they went for it without ever questioning themselves! They were never intimidated by any team that they faced and never let the spotlight get the best of them. I am so very proud of this team for never giving up.

When you have a goal that you want to attain ,whether it’s physical therapy related or not, you need to realize that things are not always impossible. It’s easy to look at something and say there is absolutely no way I can do that. It’s also very easy to not even try. We could have easily said lets just wait until next year and just enter in another tournament. But we decided to believe in our boys and just go for it and try. I am so glad that we did because they will never forget this, and neither will I!

Who doesn’t like a walk off?!?!

As long as I can remember I have always loved the Pittsburgh Pirates. I grew up in the 80’s and 90’s with the Killer B’s, Bonds, Bonilla, Bream and Bell! That was a great era of baseball to be a part of! The pirates were so competitive and seemed like they made the playoffs just about every year! Once free agency really took it’s tool on the Pirates they seemed to have nothing left but a farm system for the rest of the major leagues. Every year it seemed obvious, if a player started to do well it was certain they were getting traded by mid season. And every year that was the case. 20 years of losing was upon us! Do you even understand how long that is to suffer from losing? It hurts to even think about it. Even though it was rough I continued to watch my team get pummeled every year. I may have lost hope for about a year until they brought up Cutch! That was a great time because you knew he was something special! Even after they brought him up the losing continued up until 2012.

The Pirates actually had a great shot that year! They started out slow as usual, but at one point in the season they were 16 games over .500 with 7 walk off wins! They hadn’t had a winning season in 19 years and we were that far over! We were all going to win that year! And then the wheels fell off. They had a total collapse the last month and a half of the season and ended up in forth place in the N.L. Central with a record of 79-83 4 games under .500. Another losing season in the books!

2013 was a different story. They added some pieces that were going to prove to be key! Francisco Liriano and Russell Martin were added to help and boy did they ever. Again the pirates had 9 walk off wins that year! Liriano went 16-8 revitalizing his career and Martin ended up with 15 home runs! The key home run being in the wild card game when he belted a 2 run HR over the left field wall off of Johnny Cueto! It was still by far the best game I have ever seen. I was in my living room jumping up and down screaming! 20 years of losing can do that to a fan let alone a town! It was awesome! They lost in the divisional series against the Cardinals but it was still a great season. Their record was 94-68.

2014 started off just as strong in and out of first place of the division all year with the Cardinals. They ended up with with a record of 88-74 and made the wild card game for a second consecutive year. They had 10 walk off wins that year! They ended up losing to the Giants that day, but it was still a great season. Winning baseball was back in Pittsburgh!

2015 was even better then the year before. This time the national league central was stacked and between the Pirates, Cardinals and Cubs it was a battle all year. The pirates had 11 walk off wins that year and ended up with a record of 98-64! And they didn’t win the division! They made the wild card game for the 3rd consecutive year and lost to the Cubs. It was a very promising year!

2016 was very disappointing. They had just came off of a 98 win season and just didn’t look good. A lot of blown opportunities and they finished the season with only 4 walk off wins and a record of 78-83, another losing season! I personally was very upset and frustrated about it. How can you have a 98 win season and lose that many games the following year? Do walk off wins play a part in momentum?

As most of you know I help coach my sons travel baseball team. This past year has been a blast and I have enjoyed being a part of every moment. This year alone they have had 4 walk off wins that I can think of. One of them was just the other night in the sectional little league tournament. My son came up and hit a single into right center to win the game. It was great to be a part of! The next day those kids carried that momentum into another win and a birth into the championship! Last night we came in and totally dominated! A 12-5 win and a birth into the PA state little league championship! I am a big believer in momentum and feel that the experience these kids have will give them a huge advantage.

When I talk to my patients in my office about their success and failure I try and relate it to the walk off hit to win the game. If you have a great day or week or month of physical therapy you need to celebrate it! You need to use that as fire to build upon. Mindset alone can change what you believe and how you think. If your down it will show in your effort. If you use it to your advantage nothing can stop you!

So far this year the pirates are 48-48, 3 games out of first. They have had 7 walk off wins so far this year. One of them coming two nights ago. The momentum is starting to show because they have won 11 out of their last 13 games. Hopefully the walk off will hold true as to what type of season they will end up having.

Could bi-yearly follow ups with your physical therapist be the key to musculoskeletal health?

 

I had to go to the dentist the other day to get my teeth cleaned. Yes it was that time of year again, my 6 month check up and cleaning. As I was leaving the office I went to the front desk and scheduled my appointment for the next 6 months not even thinking about it. I said good bye to the office staff and went on to work. As I was driving to my office I started thinking about how natural it was for me to schedule a follow up visit with my dentist. It’s drilled into our brains that maintenance on our mouth and teeth will prevent us from having problems in the future. Catching things early can prevent pain, decrease cost of care and keep our mouths healthy overall. If we have an issue in the mean time we just give the dentist a call. Can this work with physical therapy?

 

As the day went on I thought about it more and more. What if I started to set up a follow up check up after discharge for all of my patients? Six week, Six month and one year is what went through my mind. This is what is done at your PCP, dentist, surgeon, dermatologist and many more health care professionals. I know first hand what happens when patients are discharged from PT. 95% of patients stop there home program the day after they are done. 6 months to a year goes by and all of a sudden they have a problem again. Who do you think they call? Not me! They call their PCP or their surgeon. That is what people think of when dealing with pain, strains, weakness, functional deficits. Finally patients will come back to me after going through the chain to be treated. Look at the time and money it takes for someone to get to me.

 

Now, what if I discharge someone and set up a 6 week follow up to see how they are doing? Add certain things as well as make sure they are continuing to improve. Just doing this would prevent them from having to spend insurance money to go to their PCP only to tell them to come to me. This would also help patients be held accountable to what they should be doing knowing that they will have to come to see me in 6 weeks. This can train patients to think about follow up appointments. This can help patients understand the importance of their health and know who they can come to for their musculoskeletal needs. We as physical therapists have to do a much better job of keeping in contact with their patients, making trusting relationships and making sure people are getting everything that they can out of us. We are such a valuable asset that most people don’t know how to use. Take advantage of it!

What can a good night sleep do for me?

A good night sleep makes you feel so good. The importance of a good nights sleep goes beyond feeling good the next morning or relieving exhaustion. Getting the right amount of sleep is a huge part of having a healthy lifestyle, and can benefit your mind, heart weight and more. So really what could an extra hour or two of sleep really do for you? If you are not getting the recommended 7-8 hours of sleep per night here are some reasons why you should consider going to bed an hour earlier tonight.

Improved health:

Getting a good nights rest is not going to cure you from disease or even make you immune. But many studies show there is a link between not getting enough sleep and health problems such as heart disease, diabetes, heart attacks and diabetes. These are usually after a longer period of time of not getting enough sleep. Shift work alone can cause interrupted sleep patterns causing you to lose sleep and in turn can cause health risks.

Less pain:

Getting the right amount of sleep helps you heal better and faster. Injuries take long enough to heal, why would you make it harder for your body to recover? I always tell my patients to try and find the most comfortable position to sleep in. If it’s in a recliner chair that’s fine. The more sleep you get the better you will heal and the less pain you will be in.

Better weight control:

Getting the right amount of sleep can help control your weight better than you think. If you wake up exhausted you are less likely to be physically active and go for that workout you planned on. You also might skip that healthy meal you wanted to make and grab a quick less healthy meal instead.

Lepton, the hormone that helps us feel full, is decreased in those that do not get enough sleep. So in turn those that do not get enough sleep tend to be more hungry than those that do.

Thinking more clear:

It’s a proven fact that if you get a good nights sleep you wake up refreshed and free of mind bogging information. Being rested clears the mind and helps with what you need to accomplish for the day. If you have that big test the next day, try to go to bed a bit earlier so that you can stay focused and rock it!

Reduces stress:

Sleep helps lower your blood pressure and stress hormones. Sleep helps encourage our bodies to relax. You know how it feels after a good nights sleep right? You wake up refreshed, in a good mood and ready to start your day. This is all due to decreased stress levels.

These are just a few reasons that an adequate amount of sleep can help your body and your mind. I encourage you to try and at least go to bed an hour earlier than normal each night this week. It will be difficult at first, but once you see the results you will see the benefits that it can have. Sleep should become a priority and can make a huge difference in the quality of life that you have.

Is physical therapy going to be painful?

Before I leave the room after all of my evaluations I always ask my patients if they have any questions. I also ask, if what I just explained to them makes sense? At least 50% of the time, if not more, I get “ is this going to hurt? It is a very good question considering the majority of people have no idea what to expect from physical therapy. When people are already in pain to start the last thing they want is to have more pain. Also, at this point, people can be fearful of movement. Therefore, it can become challenging trying to explain what to expect. Let’s talk about this question of pain and if it’s really something to expect when you go to PT.

I absolutely hate when people say that I love putting them in pain! I also get very upset when patients and PT’s alike will state PT stands for pain and torture. Or a PT is a physical terrorist. Really? Is that what most people think we are and do to people? Let’s get one thing straight. My job is to promote movement, function and mobility using your own body to heal itself. I am not here to try and put you in the most pain possible. I have no desire to try and increase your pain nor do I get excited when I do. This is a misconception that a lot of people have and it needs to stop.

Yes, there are times that you may have some discomfort from certain movements, activities and treatments. Take the shoulder for example. A patient that has RTC surgery is going to have pain during PT because you have to move the joint in order for you to gain motion. The shoulder is healing from surgery and that is another reason that it is going to be painful. Any time you have limited motion you are going to experience some sort of pain/discomfort because the joint is not moving properly. It’s not a sign for me to see how much pain I can put you in. It’s just a guarantee that you will be in some sort of discomfort because of the limited motion the joint has.

Will you experience some sort of pain during PT? Depending on what you are coming for the answer is yes. Other times PT can and should be very relaxing and calming. General soreness from activity and exercise is not what I consider pain. It’s just your bodies way of telling you to move your ass more often and you wont feel this way. If you are seeing someone that calls themselves a pain and torture expert or refers to themselves as s physical terrorist I suggest you find a different place to go.