The slow burn: Eccentric loading for ligament and tendon injuries

Spraining an ankle or a wrist can be a very challenging injury to recover from. Sometimes the injury heals all by itself, and other times it can linger for weeks, months and if bad even years possibly! But it happens... right, and there isn't much you can do about it. If you play hard, you're bound to have some injuries that will haunt you for the rest of your days right?

WRONG.

Sprained ligaments and damaged tendons can be difficult injuries to overcome, but they ARE DEFINITELY overcome-able (not sure if that's a word, but I like it.) The best place to start following a sprain/strain injury used to be rest, ice, compress and elevate. Meaning: take time off from activities, ice the area to minimize inflammation, compress the area to decrease swelling and elevate, again to minimize swelling, and increase lymphatic drainage. We are now finding out, that sometimes, this approach or R.I.C.E. isn't the best way to heal these type of injuries. The new way of looking at things is almost the exact OPPOSITE of this principle.

M.E.A.T.

Movement, Exercise, Analgesics and Treatment.

Let's start with movement. Research has been showing that the sooner you start to re-establish movement in a recently injured area, the quicker and better the recovery will be. Typically, you want to wait approximately 72 hours following an acute injury, and then begin to attempt simple range of motion (ROM) exercises. In that initial 72 hours is where analgesics and treatment come in. Analgesics are simply, pain relievers. Whether those are prescribed medication, over the counter non-steroidal anti-inflammatory drugs (NSAIDs) or topical creams such as icy-hot, bio-freeze, rock-sauce. All serve the same purpose... relieving pain, and all have a place - when and when not to be used! Treatment. Treatment can be a variety of modalities, with best results coming from utilizing a multi-modality approach. Some options include: massage, chiropractic care, cold laser therapy, acupuncture, ultrasound therapy, E-stim therapy, Graston, Active Release Technique and many others! All again, based on the purpose of eliminating pain, and speeding healing time, to allow for pain free movement when beginning the road to recovery with exercise.

Finally we reach the final, but most crucial step, exercise. This is where the REAL improvement occurs. The lasting improvement. Unfortunately this is where everyone seems to fail. No one wants to put in the work, and then they wonder why they always have this nagging injury. Let me say this very clear: YOU DO NOT HAVE TO LIVE IN PAIN. It’s not normal, it’s not "now that I am older, it’s just how it is." No. Will you perhaps have to make some changes? Maybe, but there is no reason that you should need to suffer with a minor injury for the rest of your life.

Now, what kind of exercise do I need to do? The perfect exercise: Any!!! Just get moving and you will see results. For tendinous/ligamentous injuries though, research shows the the best way (not the only way) is to put the tissue on tension. Meaning stretch it, and then load it up! Here at BSSR we like to use various isometric exercises, as well eccentric loading exercises to strengthen and stabilize the tissue. Isometric meaning: non-moving contraction of tissue, and eccentric meaning: lengthening tissue (the down phase of most exercises) while continuously contracting it. As of now, we think that when we do this, we are re-aligning collagen fibers (which is what tendons/ligaments are made of) re-establishing strength. The two pictures below are images of collagen samples. The one on the right is healthy, and the one on the left has been damaged and then healed without any intervention. With exercise and some specific training movements we attempt to turn the right picture into the left picture!

For more information on exercises and generalized healthy tips check out our Instagram and/or Facebook pages! Also go leave us a review on Fb or Google, and share our page/blog! 

I have a rotator cuff injury... now what?

We've all, at one point in time, had a shoulder injury. Whether it be from lifting your child, or lifting 185 lbs over your head! Shoulder injuries are VERY common on our society for multiple different reasons, and in all respects, probably won’t be decreasing any time soon as our general population ages. So how do we correct some of these issues? How can we prevent some of the many shoulder injuries that occur throughout our daily lives? Let’s first dive into what makes up our shoulder joint, and some of the biomechanics that are at work.

The rotator cuff is specifically 4 muscles (supraspinatus, infraspinatus, teres minor and the subscapularis) that create the majority of stability in the shoulder. Now that being said, the shoulder is one of the most mobile joints in the body, which in turn makes it very complex. It is controlled not only by the rotator cuff muscles but also roughly 13 other different muscles! All working together, in a synergistic network, allowing our shoulders to move freely in every plane of motion. If any of the muscles become compromised (overused, micro-trauma, major-trauma) all other muscles in the shoulder complex have to do more work creating a painful, pinching, aching type feeling.

The main goal of the rotator cuff muscles is to keep the humeral head in the glenoid socket. All the other synergistic muscles allow for movement, while the purpose of the rotator cuff is to provide stability. When we lack stability, other synergistic muscles attempt to create it, in turn, creating dysfunction because they are now acting in a way that they are not made to act. The goal then is to create endurance in the rotator cuff muscles allowing them to maintain stability, while the other muscles accomplish motion. The shoulder biomechanics are much more complex when you add in the motion of your clavical, your thoracic spine mobility and as well the relationship between your scapula, humerus and rib cage, but lets save that for a later discussion. 

Research has been showing that with a light to moderate intensity shoulder workout, performed 3-4 days a week, we can decrease the likelihood of shoulder injuries and can create strength and stability in our shoulders! Research has also recently been shown to suggest that proper shoulder exercise has been more effective dealing with pain in the shoulder, than surgeries! This is a HUGE mind set shift! [Exercise>>>>>Surgery] So the question again presents itself: I have a rotator cuff injury… now what? EXERCISE! Utilize the motion in your shoulder! Find a skilled coach/trainer/PT/Chiro that can help you find your weaknesses, give you certain exercises to correct those weaknesses, and allow you to live a happier, healthier life!


For a few exercise tips on shoulder health, head on over to our facebook or Instagram pages and check out some of the videos!

Plantar Fasciitis: What is it? Do I have it? How do I eliminate it?

 

Plantar fasciitis is a common condition that we see on our office, but over half of those cases are actually misdiagnosed, with their pain generator being something other than their actual plantar fascia! So let’s break it down a little bit... What is the plantar fascia? Plantar fascia, according to Webster’s medical dictionary, is a very strong dense fibrous membrane located on the sole of the foot that lies beneath the skin and superficial layer of fat, and binds together the deeper structures of the foot. When this fibrous membrane or band becomes irritated and inflamed, it creates pain at the base of the heel, as well as in the arch of the foot.

With that being said, not all heel pain nor pain in the arch of the foot is automatically plantar fasciitis! There are many other mechanisms that cause pain in these areas. The first area of concern when patients come in with these types of pains, is the tibialis anterior. This muscle can become irritated and inflamed if not properly utilized often, and presents as medial instep pain along the arch of the foot. Another big mimicker of plantar fasciitis pain is caused by a small, relatively unknown muscle called the quadratus plantae.  This is a deep, stabilizing muscle of the foot, which often can become irritated due lack of proper use again.

Lack of proper use? Well what the heck does that mean? How do I properly use my quadratus plantae?! Simple... take your shoes off, and walk barefoot. Now sometimes this isn't practical, but this is the way our feet are suppose to be! Not caged up in synthetic coffin, like a shoe! (My skeptical, eccentric, but brilliant friend used this analogy and I laugh every time I think about it.) If you are unable to walk barefoot, and struggle with pain on the bottom of the foot we have some suggestions for YOU! A few great exercises for the bottom of the foot that we like to use here at BSSR are:

-2 feet up, 1 foot down: Working on eccentric loading of the musculature and soft tissues on the bottom of the foot, as well as working the gastrocnemius and soleus.

-Janda's short foot: this exercises teaches patients to utilize the intrinsic muscles on the bottom of the foot, increasing the medial arch of the foot in an attempt to re-establish stability.

-Storks: Another exercise working on creating the short foot posture, using a wall to isometrically load the glutes as well (SUCH A BURNER!)

-Vele's leans: this exercise is great for your tibialis anterior and intrinsic muscles on the bottom of the foot, reintroducing control and stability to the anterior portion of the foot.

So remember, move those feet as much as possible! Strengthen and create a support network for your feet so you can do the activities you want to do for many years to come! Walk barefoot, squeeze that medial arch, and have FUN! Having fun while exercising is the best way to create positive change! For instructions/demonstrations on all of these exercises head on over to our Instagram page!

Where is the line? Pain vs. Soreness

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No pain, no gain
— Some idiot

I don't know where this old school quote came from, but in the physical medicine world, it definitely does not hold true! We want patients to flow through exercises pain free, but what is pain? And when is it okay, if ever? Lets take a closer look at this topic. 

What is the difference between muscle/joint pain, versus muscle/joint soreness? This is a great question and one that I often have a hard time articulating to patients. There are multiple differences, actually. Let’s start simple. When does the discomfort start? Often times with soreness, the discomfort begins following a movement. It lasts for a period of time, and then it gradually dissipates.  It can take 5 seconds to go away, or maybe a couple of days if you have just gone through an intense training session. Typically when the discomfort last longer than a brief period, we in the health industry consider this type of discomfort Delayed Onset of Muscle Soreness or DOMS. The discomfort usually feels like a tightness, or maybe an achy feeling. Within 24-48 hours the discomfort diminishes and the person becomes free of discomfort, usually feeling great!

 

Now pain is another type of discomfort all together. Pain is the body telling our brain that there is a PERCEIVED threat to the body. Pain often comes on very quickly. It seems sharp, annoying or agonizing.  It typically lasts longer than a couple of days, and doesn't seem to improve throughout the duration of its existence. The interesting thing about pain, is that it doesn't always mean something is injured! It is simply our body saying, "I think this stimulus, is going to hurt me!" Through past experience and perceived notions, the signal is sent to our brains, and we feel the painful sensation. This is important to understand when dealing with pain.  It’s not "just in your head," that's not what I am saying, but there should be an understanding that not all pain is bad as well. Pain can be a valuable tool, and can be used to harness great achievements when understood correctly.


In short, soreness vs. pain--both are okay. Soreness is temporary, while pain is variable. No one likes to be in pain or be sore, but both are vital to our bodies growth mechanisms and are needed. Don't be afraid of either, embrace them. Strengthen your body to withstand many different stimuli so that it understands, not all perceived threats are painful, and that soreness is a temporary discomfort that will lead to greater outcomes!

How training=rehab & rehab=training

Hello everyone and welcome to the BSSR Blog! We decided to write a blog, because often times we have so much information we want to give to our patients, but never have enough time for them to understand the information thoroughly. This platform allows us to share tid-bits of information with everyone, and hopefully will become a great tool for people who are looking to learn a little bit more about exercise, nutrition, strength training and injury prevention. We will try (key word TRY) to add a new post once a month! So be on the look out, and check the website here often, for great new content! Hope you enjoy!


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“Make things as SIMPLE as possible... but no less.
— Charlie Weingroff PT, CSCS, ATC

Charlie Weingroff is a world renowned strength coach, and puts on seminars all over the world. His main message is T=R and R=T (Training=Rehab and Rehab=Training), but what does this mean? Does this mean that I should only do rehab exercises to prepare for my upcoming football season? Should I perform box jumps or wind sprints when I am trying to heal my injured hip? The answer: maybe. ...Unsatisfying isn't it :). The point is when teaching someone how to heal from an injury or how to prepare for an important activity, the coaching process is one in the same. Two different sides of the same coin!  In the sports medicine world, we like to think that training and rehab go together like peanut butter and jelly. Both necessary. Both relaying on simple functional movements that with diligent work, will make the person doing said movements, stronger and healthier in the long run. 

We look at rehab like this. If someone injures there shoulder, what are the movements that cause them pain? Does it hurt to reach in front of you? Behind you? And then also, what motions can you do that do not cause any pain? As a rehab specialist all these questions are answered and then placed into a specific thought process of exercises and stretches that will enable the body to accommodate the injured area. Slowly, each individual exercise performed will re-TRAIN and re-strengthen the damaged tissue so that the person no longer has the pain. 

Now, training is basically the exact same thing! When a person is training for an event whether it be there upcoming volleyball season, there next CrossFit competition or even just a weekend warrior trying to stay in shape, they all should be working on basic movements, functional movements, rehab movements! Understanding the basics, and mastering these movements allow for our bodies to grow and adapt, so that we can add further complexities to our exercise regimen. Think about it this way... how do babies learn to walk? First, they learn to bend their hips and knees (think happy baby pose in yoga). Next they learn how to roll over onto their sides. Next, they roll to their tummies. Then learn to lift their heads up so they can see. Now that they can see, then began to lift themselves up, onto all fours. They then learn how to synchronize their arms and legs, so they can crawl. Next they learn to stand and then learn to walk (There are multiple more steps in the process of standing and walking, but for time sake, and attention span sake, lets just cut to the chase.)

MUCH MORE complicated than you thought that was going to be huh?

You see, small basic movements are the foundation of our fitness. If we break each move down into its core, we find that all major movements (walking, picking something heavy up off the ground, working with our arms over our head) can be trained through simple everyday exercises. And when we focus on doing this exercises well, consistently, we can then begin to interconnect the movement and conquer any goal we set for ourselves.

So, next time you are given a movement exercise by a physician/therapist/rehab specialist approach it with 3 thoughts in mind: 1.) Do I completely understand the movement, to the point where I feel comfortable doing it by myself? 2.) Is the exercise pain free? And finally 3.) Am I determined to complete this exercise everyday, allowing myself to become healthy once more? With the right attitude, the right coaching and the right mindset, nothing is impossible. Rehab increases your ability to perform a certain action well. Training increases your ability to perform a certain action better! You see the connection now? The importance of rehab is just as essential as training for whatever it is you are training for. Learn the basics, connect the motions, complete the task, repeat! 

That is it for this months post, we hope you enjoyed the read, and took some good information from it. Have a great weekend, and thanks for checking out our FIRST BSSR blog post!