As physical therapists, we often view the imaging results of of our patients.

Many times, these images (X-Rays or MRIs) cause people to feel as if they are broken and need fixing.

Maybe you have had an X-Ray or MRI that made you feel that surgery is inevitable, or that your pain is something that you will always have to deal with. Perhaps you are thinking that you are no longer capable of performing the sport you love, or exercising at a high level.

X-Rays are used to gain information about bones and general information about joints. For example, the X-Ray of someone with lower back pain will give us information about how much space this person has between each vertebra, and if they have any fractures in their lower back. However, this will not provide information regarding the state of soft tissues (muscles, tendons, ligaments), or much information about intervertebral discs.

An MRI, will give us much more detailed information. This image provides more specific information about the state of intervertebral discs, or damage to soft tissues.   Despite, all of this great and detailed information, many times it is not useful.

Research shows that many of us have meniscal tears in our knees, labral tears in our shoulders, and damage to the discs in our lower backs, without any idea that these issues are even there!

In other cases, people have X-Rays or MRIs for a painful area of the body, and nothing significant is found!

In fact, research shows that 90% of lower back pain is non-specific. This means that according to images, we have no idea what causes 90% of lower back pain!   The moral of the story is that findings on images are not always correlated with the pain or the limitations that you may be experiencing.

So, does the image even matter? In these cases, the answer is….not really.

This is not to say that images are useless. X-rays and MRIs are extremely useful when the findings coincide with the symptoms you are experiencing. The images and your symptoms should fit together and contribute to tell the same story.

If you have had an X-Ray or MRI, take that with a grain of salt and understand that it is just one piece of the puzzle. A decision to have surgery, or another invasive procedure should not be made solely on the findings of an image.

Even if an image shows a large amount of damage, it is still possible to feel great and remain active by addressing what caused the damage to build up in the first place! As physical therapists, and strength and conditioning professionals, this is of greatest concern to us.

Damage does not accumulate in a tissue without a reason for doing so, and it is our job to figure out this out! If you have an X-Ray or MRI that is of concern to you, it may be most useful to figure out why these findings have occurred, and learn what you can do to address it!

This will help you get out of pain and back to performing the activities you enjoy, despite what your X-Ray or MRI says!

We had a blast hosting the CHP deadlift lab right here in Bethesda!

During the workshop we learned how to optimally create internal pressure in order to protect our lower back when lifting weights. This is one of the first things that we teach in physical therapy and is of particular importance for people that lift weights or play sports.

As human beings, we protect our lower backs by creating intra-abdominal pressure. This is the pressure that we create within our abdominal cavity and increases the stability of the spine.

As an example, imagine that you are going to lift the heaviest object that you can off of the floor. What is the first thing that you do?

Most people take a big breath in and then brace their abs.

The purpose of this action is to create as much pressure as is possible within your abdominal cavity, thus creating the maximum amount of stability possible for the spine.

This is a great thing to do as you are performing one repetition of an activity with maximal effort, however is not sustainable for a longer period of time.

In the video below, Dr. Cody is teaching us how to most effectively create pressure when deadlifting so that we can protect our lower back. The principles Dr. Cody is teaching applies to all activities that we perform in the gym, and many out of the gym as well!

How to brace effectively

The next time you are lifting something, it may be worth asking yourself if you are feeling your lower back. If so, attempt to exhale fully to find your abs before inhaling to build pressure. In addition to abdominals, you should be feeling hamstrings and glutes.

Now give it a shot!

Every winter here at Cohen Health and Performance, we see a rise in a very specific type of injury that brings people in for physical therapy.

Bethesda is full of skiers and related injuries start as soon as the snow starts falling.

The injury rates in skiing and snowboarding are particularly high for a variety of factors.

Many new skiers or snowboarders simply do not know how to fall properly. Falling is a part of these sports and there is an effective way to do it. This is typically the first thing that a ski or snowboard instructor will teach a student and may be worth a second lesson!

Most injuries that higher-level skiers or snowboards experience are related to overuse injuries.

These overuse injuries often occur due to mobility restrictions in the hips. Both sports (specifically skiing) require an adequate amount of hip mobility as the body bends into and out of turns. Furthermore, ankles are locked into bindings that limit ankle movement and place more emphasis on the hips to take up the slack.

How do you know if you have enough hip mobility? I’m glad you asked!

The video below illustrates a drill called a hip CAR (Controlled Articular Rotation). This drill provides an opportunity for you to explore all of the available range of motion that your hip currently has. It is also a great drill to do daily to keep the hips moving!

Hip CARs

With this drill you may notice that your hips feel stiff. If so, it would be beneficial to increase your available hip motion so that you can reduce your risk of skiing or snowboarding related injury.

Commonly hip internal rotation and hip external rotation are limited. If you noticed limitations in either of these motions, give the exercises below a try! Remember to stop the activity if any pain or discomfort is present.

Hip External Rotation PAILs

Hip Internal Rotation PAILs