Myths Regarding What Physical Therapy Is All About

 

With the high demand for quality physical therapy services there still remains many questions and myths to when physical therapy is warranted and how it is delivered to a sometimes misinformed public. A recent survey conducted by the American Physical Therapy Association (APTA) revealed common misnomers adults have regarding physical therapy:

  • Physical Therapy is painful
  • Physical Therapy is only for injuries or accidents
  • A Physician referral or prescription is required to see a Physical Therapist
  • Physical Therapy is not covered by health insurance
  • Any healthcare professional can perform physical therapy
  • Physical Therapy can be done entirely by the patient (with or without surgical intervention)
  • Surgery is the only option

Other findings of the survey include:

  • 71% of people who have never visited a Physical Therapist think physical therapy is painful. That percentage significantly decreased among patients who had visited a physical therapist within the past year.
  • 19% of consumers think physical therapy is only for rehabilitation, despite 81% recognizing physical therapist diverse skills
  • Although the survey found 42% of consumers are aware physical therapy can be performed only by a licensed Physical Therapist, 37% still believe other healthcare professionals can provide physical therapy. The remaining 21% were unsure. (This is scary as some other healthcare professional and even personal trainers tout themselves as performing rehabilitation and restorative therapy).
  • 79% of people who recently have seen a Physical Therapist believe physical therapy can be a viable alternative to surgery.

 

For information on what quality Physical Therapy is please contact:

Greg Sterner, Board Certified Orthopedic Clinical Specialist in Physical Therapy, Owner

San Diego Sports Physical Therapy

2750 Dewey Rd. Ste 101

San Diego, CA 92106

Why Your Muscles Shake During a Hard Workout

If you think you may be straining yourself during a workout, take a look at this article by Jay Cardiello. Then come see us at San Diego Sports Physical Therapy to get your work outs under control.

Pushing yourself during a workout is never a bad thing, and going so hard that your muscles start to shake is certainly a sign that you’re at your max—but your body may also be trying to tell you something. While many people pass this off as a simple sign that they’re out of shape and a majority of my fitness colleagues would agree that this trembling is not a great cause for concern, it could also lead to injury if you’re not careful to use proper form.

Let’s explore why your muscles may quiver during a barre class, Pilates, strength workout, or other type of exercise—and what to do about it.

1. Inadequate sleep. If you are heading into a cardio or strength training session feeling lethargic or lacking a good night’s rest, you will probably experience tremors at some point in your routine. [Tweet this fact!] The body continues to grow and heal when you get the proper amount of sleep. Disrupting this can cause your muscles to stay in a catabolic-like state. If you’ve been skimping on sleep, I recommend you skip the gym and stay in bed (if you work out in the morning) or head to bed (if you’re a p.m. exerciser).

2. Going to extremes. With fitness crazes like CrossFit and endurance events like Tough Mudder becoming the staple in mainstream fitness, people are really pushing themselves to the extremes these days. However, take caution and implement mandatory rest days into your fitness routine. Check out my last blog for the proper way to rest so you can keep up a sustainable workout routine and stop the shakes.

3. Too new, too much, too soon. If you try a new fitness class or jump into a new routine, at some point during your workouts you may feel your body start to wobble because working different muscles than you’re used to may be too much, too soon. While it may not be a cause for great alarm, it’s probably best to lighten up. You could place stress on other parts of your body in order to compensate for weaker muscles, which may cause injury. For example, if it’s your first time performing burpees, by the fourth or fifth one your legs may start to shake. Instead of resting, you decide to continue but with bad form, which can strain your lower back. Bad idea.

4. Dehydration. Your workout can be one of the best indicators of whether or not you are hydrated. When your body is low on water, your muscles and connective tissues have difficulty performing what they are meant to do, as improper hydration can cause an imbalance of your electrolytes, which are involved in muscle contraction. [Tweet this fact!] I recommend drinking half of your body weight in ounces daily. Remember, if you’re thirsty, you’re dehydrated.

Shoulder Pain Prevention

If you experience shoulder pain, here may be why it’s happening. Then come see us at San Diego Sports Physical Therapy for rehabilitation and improvement!
By Brian Sutton MS, MA, PES, CES, NASM-CPT

Is shoulder pain stopping you from, playing your favorite sport or achieving your personal fitness goals? Chances are, if you are experiencing shoulder discomfort or pain, you’ll have to alter your lifestyle to accommodate this dysfunction. Shoulder pain can occur in a multitude of ways and is prevalent in 21% of the general population (1,2) with 40% of that population having injuries persisting for at least one year (3). The treatment measures of shoulder pain can accumulate to an estimated annual cost of $39 billion (4).

Shoulder injuries have many different mechanisms or pathologies ranging from acute trauma to chronic overuse injuries. Acute trauma typically comes from a direct force, such as falling directly on the shoulder, or from an indirect force, such as landing on an outstretched hand. Either of these mechanisms may result in fractures of the humerus, clavicle, scapulae and glenoid fossa, or dislocations and tears of the capsular ligaments or labrum. However, the most commonly seen injuries in athletes or the active population stem from overuse syndromes.

Overuse Injuries

Overuse injuries (aka cumulative trauma disorders) are any type of muscular or joint injury caused by repetitive stress that surpasses the body’s natural repair processes (i.e., tendonitis, stress fractures). Overuse injuries of the shoulder are common among athletes who consistently perform overhead movement patterns (i.e., baseball pitchers, swimmers, tennis players) and individuals who repeatedly work with their arms raised (i.e., painters, construction workers) (5-9). Among the overuse injuries, shoulder impingement is the most prevalent diagnosis accounting for 40-65% of reported shoulder pain (10).

Common symptoms of shoulder overuse injuries include (11):

Minor pain during activity and at rest
Pain observed at the top or front of the shoulder during overhead activity (i.e., overhead presses) or during chest activities (i.e., incline bench press)
Tenderness on the lateral aspect (outside) of the shoulder
Loss of strength and range of motion (ROM)
Pain during throwing motions
Poor Posture
In addition to overuse injuries, individuals who exhibit poor static posture of the upper body are at risk for shoulder dysfunction. A common postural distortion of the upper body identified by Janda is the Upper Crossed Syndrome (UCS) and is characterized by protracted shoulders and a forward head (12). UCS generally involves tightness (overactivity) within the anterior chest region (pectoralis major/minor), latissumus dorsi, and cervical extensors (sternocleidomastoid, levator scapulae, scalenes), coupled with lengthening and weakening (underactivity) of the mid-and-upper back muscles (mid/lower trapezius, serratus anterior, rotator cuff) and deep cervical flexors. Individuals who sit for extended periods working on a computer may be at risk for developing upper body dysfunction and poor posture if certain precautions are not made such as taking frequent breaks and working at an ergonomically sound work station (13).

Exercise Selection
Similar to overuse and poor static posture, improper exercise selection can also contribute to shoulder dysfunction. For example, if a baseball pitcher tries to increase velocity of his pitches by only strengthening the superficial muscles of the shoulder (prime movers) that produce internal rotation (pectoralis major, latissimus dorsi) more than the stabilizers/external rotators of the shoulder (infraspinatus, supraspinatus, teres minor), these stabilizers become reciprocally inhibited (underactive) and fail to stabilize the glenohumeral joint during the throwing motion. Without adequate stability the athlete may develop a subacromial impingement, leading to subacromial bursitis, rotator cuff tendonitis, and possible tears of the external rotators (14).

Another example of poor exercise selection involves the over reliance on uniplanar, isolated resistance training exercises. Athletes and fitness enthusiasts oftentimes place too much emphasis on uniplanar exercises strictly focusing of concentric force production (e.g., presses and pulls) while neglecting total-body movements that integrate the entire kinetic chain (lower body, core, upper body) in multiple planes of motion (sagittal, frontal, transverse). Everyday activity occurs in all three planes of motion (front-to-back, side-to-side, and rotational) and only training in one plane (predominately the sagittal plane) will not effectively improve the individual’s ability to move in a coordinated fashion in the frontal and transverse planes. This form of program design may lead to muscle imbalance and faulty movement patterns increasing the individual’s risk of injury and/or joint dysfunction.

Using these two examples, fitness professionals should design exercise programs from an integrated (all-inclusive) perspective. An integrated exercise program encompasses both uniplanar and multiplanar movements; single, compound and total-body exercises; and adequately targets on all muscle groups (prime movers and stabilizers).

Shoulder Injury Prevention Strategies
If a client presents pain or dysfunction the fitness professional should never attempt to diagnose the problem but rather refer his or her client to a qualified medical professional. However, utilizing various movement screens, fitness professionals should assess their clients to identify potential muscles imbalances (muscle weakness and muscle tightness) and faulty movement patterns and subsequently implement a corrective exercise strategy to proactively address these concerns. For a list of comprehensive movement screens and corrective strategies for the shoulder complex see NASM’s Corrective Exercise Specialist.

Following a comprehensive fitness assessment (including a battery of movement screens), fitness professionals should implement a corrective exercise program that is individualized for their client:

Step 1: Inhibitory techniques (self-myofascial release) should be used to decrease tension and effects of latent trigger points of the overactive muscles surrounding the shoulder complex.
Step 2: Static stretching should be performed for a minimum of 30 seconds on identified overactive muscles to help facilitate optimal joint ROM and muscle extensibility.
Step 3: Isolated strengthening exercises should be used to facilitate the underactive muscles of the scapulae. Auditory and tactile feedback while performing these exercises can also help develop neuromuscular activation with proper kinetic chain positioning and control.
Step 4: Lastly, exercises are progressed by incorporating activities that integrate the entire kinetic chain (multijoint, compound movements). During these exercises clients should be instructed to maintain scapular retraction, depression, and posterior tilting while limiting winging by keeping the scapula on the costal surface. Refer to Figure 1 for an example shoulder corrective exercise program.
shoulder prevention

References:

1. Bongers PM. The cost of shoulder pain at work. BMJ. 2001;322(7278):64-65.
2. Urwin M, Symmons D, Allison T, Busby H, Roxby M, Simmons A, Williams G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis.1998;57(11):649-655.
3. Van der Heijden G. Shoulder Disorders: A state of the art review. Baillieres Best Pract Res Clin Rheumatol.1999;13(2):287-309.
4. Johnson M, Crosley K, O’Neil M, Al Zakwani I. Estimates of direct health care expenditures among individuals with shoulder dysfunction in the United States. J Orthop Sports Phys Ther. 2005;35(1):A4-PL8.
5. Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. The recognition and treatment of superior labral (slap) lesions in the overhead athlete. Int J Sports Phys Ther. 2013 Oct;8(5):579-600.
6. Reinold MM, Curtis AS. Microinstability of the shoulder in the overhead athlete. Int J Sports Phys Ther. 2013 Oct;8(5):601-16.
7. Reinold MM, Gill TJ, Wilk KE, Andrews JR. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment. Sports Health. 2010 Mar;2(2):101-15.
8. Reinold MM, Gill TJ. Current concepts in the evaluation and treatment of the shoulder in overhead-throwing athletes, part 1: physical characteristics and clinical examination. Sports Health. 2010 Jan;2(1):39-50.
9. Stenlund B, Lindbeck L, Karlsson D. Significance of house painters’ work techniques on shoulder muscle strain during overhead work. Ergonomics. 2002 May 15;45(6):455-68.
10. van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract.1996;46(410):519-523.
11. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00032. Accessed November 12, 2013.
12. Janda V. Muscles and Motor Control in Cervicogenic Disorders. In: Grant R, ed. Physical Therapy of the Cervical and Thoracic Spine. St. Louis, MO: Churchill Livingstone; 2002:182–99.
13. Cho CY, Hwang YS, Cherng RJ. Musculoskeletal symptoms and associated risk factors among office workers with high workload computer use. J Manipulative Physiol Ther. 2012 Sep;35(7):534-40.
14. Cowderoy GA, Lisle DA, O’Connell PT. Overuse and impingement syndromes of the shoulder in the athlete. Magn Reson Imaging Clin N Am. 2009 Nov;17(4):577-93.

– See more at: http://blog.nasm.org/cex/shoulder-pain-prevention/#sthash.mPXeZhdS.dpuf