A physical therapist’s key to chronic shoulder pain

Recently, I’ve been hanging at a local gym, providing physical therapy in Bethesda and McLean to their members and the most common injuries involve their shoulders.

If you do a lot of weight training or CrossFit or are interested in having healthy shoulders for years to come, keep reading!

Shoulder injuries often occur when the shoulder is repetitively challenged at the limits of its motion, where joints are most vulnerable.

Many people attempt to solve this issue by stretching. Instead, focus on these two areas.

End-Range Strength Training

When your shoulder is pushed to its extreme ranges of motion, the muscles responsible for controlling the shoulder joint are challenged. These muscles struggle to generate the force needed to maintain stability because they are weaker in these positions. This weakness increases the risk of overuse injuries and may create wear and tear on the joint.

Physical therapy is the key to addressing these issues effectively. Rather than focusing solely on increasing flexibility, it’s about training the muscles to handle these extreme positions and generate the necessary strength to support the shoulder. Here is a drill I recently taught a weightlifter struggling with shoulder pain when lifting weights overhead to address this issue.

Get the rib cage moving

The rib cage is the foundation that your shoulder blade rests on, and the position of your rib cage will direct your shoulder where to go as you move.

As you reach overhead, your upper chest should expand. Unfortunately, many weightlifters or people who sit at desks all day have stiff chests that prevent this, resulting in extra stress to the shoulder joints.

If you love to crush chest workouts or are sitting a lot, give this exercise a shot as part of your daily routine or warmup.

What to do if you have months or years of shoulder pain

Work smarter, not harder.

Many people I’ve worked with have seemingly tried everything but didn’t first learn where the pain was coming from. They could have saved a lot of time and effort by first discovering the root cause. If you want to finally solve your shoulder pain, contact us to schedule a physical therapy evaluation today!

New Bethesda physical therapy and performance space is almost here!

As the band Europe said, it’s the final countdown!

Our new sports physical therapy and performance training facility in Bethesda, located at 5272 River Road, is 3 weeks from opening!

We can barely contain ourselves anymore as we prepare to move to this beautiful 3100-square-foot facility, complete with the CHP Performance Center and Physical Therapy clinic.

In addition to our physical therapy services, CHP Performance will be offering:

Performance University

Performance U is a small-group program designed for high school athletes who dream of playing in college. It is uniquely tailored and designed using recent advances in sports technology. This personalized approach ensures that athletes receive the training they need to excel in their sport while minimizing the risk of injury. Learn more about this program here!

Peak Performance Blueprint

This state-of-the-art assessment provides athletes with a customized blueprint for optimizing their athletic potential. Incorporating our years of experience working with elite athletes and force-plate technology (more info about that here), the PPB will show, using clear metrics, how an athlete compares to collegiate athletes in their sport. They will also receive customized recommendations on improving their score to be better prepared for collegiate athletics. Learn more here!

Adult Strength and Conditioning

If you are worried about re-injuring yourself when exercising or are looking for a more scientifically designed training program, this is for you! Our one-on-one sessions are under the direction of a Doctor of Physical Therapy and Certified Strength and Conditioning Specialist. Learn more here!

Keep an eye out for an announcement coming soon about our grand opening.

I would love to see you there!

Is there one physical therapy intervention for running related foot injuries?

Ice baths, massage, compression socks, orthotics, rolling your feet out on tennis balls…

Have you tried one or more of these without much help?

This is Dr. Kelly, and as a passionate runner, sports physical therapist in McLean, and someone who doesn’t want to be interrupted by injury, I’ve learned foot pain is complex- there’s usually not “just one thing” contributing to it.

Here are a few things I’ve found to be most important in physical therapy when diagnosing foot injuries:

Foot Type, Biomechanics, and Shoe Type: Each runner has a unique foot structure and biomechanics. High arches, flat feet, overpronation, and supination can affect how your foot strikes the ground. It’s crucial to understand your foot type to choose appropriate footwear and support. Here is a link that better explains foot type. Ensure that your shoes provide adequate cushioning, arch support, and fit your foot shape properly. Regularly replacing of worn-out shoes is essential for injury prevention (recommended replacement after 400 miles of running).
Running Surface: The type of surface you run on can impact foot pain. Hard surfaces like concrete can be harsh on your feet, while softer surfaces like grass or trails offer more cushioning. Varying your running terrain can help reduce the risk of repetitive strain injuries.
Running Form and Mechanics: Variations in running form can strain muscles and joints differently. Understanding your form and what muscles are dominating during your run is important to building strength and endurance as well as overall mechanical balance. A Marching, Skipping, and Single leg hopping are great drills that help enforce foot strike directly under your center of mass and tendon elasticity while running.
Training Intensity and Volume: Overtraining or increasing your running intensity too quickly can stress your feet. Gradual progression and adequate rest are essential for preventing overuse injuries. In general, the best guideline to follow is to increase your volume by 10% per week.

Remember that everyone’s body is unique, and what works for one person may not work for another.

If you would like to finally solve the lower body injuries that are interrupting your ability to run successfully, don’t miss this FREE workshop..
“CHP’s Running Performance Lab”
Saturday, October 21st at 9am
Cohen Health and Performance
1401 Chain Bridge Rd, Suite 203
McLean, VA 22101

In this workshop, you will discover the root cause of your injuries and learn exercises to solve them.

We only have 5 slots left, so don’t miss your chance to sign up here.

New Bethesda location coming soon!

CHP-Bethesda is getting bigger and better!

I am so excited to finally tell you about our new physical therapy and sports performance facility in Bethesda. We are moving 2 miles down the road to 5272 River Road.

You may wonder why we moved so soon after opening our McLean facility.

Our new 3100-square-foot, state-of-the-art facility will allow us to have a sports performance center and physical therapy clinic. This will help us to continue our mission of helping active people like you conquer injury while providing opportunities to train in a setting like none other.

This amazing new facility is being built and is expected to open in mid-November.

Stay tuned for updates on our grand opening and all of the new services we will be providing at the new and improved CHP Bethesda!

P.S – If you need help with something now, we have openings available!

What is that pinch in my hip?

Have you ever felt a pinching sensation in the front of your hip? This is one of the most common symptoms that our sports physical therapy hears from people with hip problems.

We hear about it from all ages and populations – field athletes, powerlifters, weekend warriors, etc.

Our physical therapy patients in Bethesda and McLean note that they feel an uncomfortable sensation in the front of their hip whenever they flex their leg, squat, or bear lots of weight on one side. This may happen during running, lifting weights, or getting on and off the floor.

The hip is a big, complex joint with lots of moving (and not moving) parts! “Pinching” symptoms often involve a few structures. Some to note are the hip labrum, the hip flexors, and the shape of your hip ball and socket itself. While it may be difficult to diagnose the exact cause of those symptoms, your physical therapist can perform a physical exam to differentiate what is giving you problems and how we can address this in physical therapy.

Often, it is a combination of the 3 factors above. Muscle testing, range of motion, and a deep dive into your symptoms and history inform us about the cause of your pain. Findings we see include:

1. Decreased hip flexion or internal rotation range of motion
2. Discomfort and difficulty with deep squatting or lunging
3. Weakness of the hip flexors, abdominals, or hip abductors/adductors

But why does this happen?

As mentioned, the hip is a big, complex joint supporting much of your body weight. As we move throughout the day, from walking to running to sitting to standing, our hips and pelvis adapt to the changes in the load being placed on them. Our joints are lined with cartilage that helps absorb shock and protect the joint. The muscles around our joints help to manage additional stress and decrease the amount of pressure on the joint. If one of these three pieces is affected – the hip labrum (cartilage), the hip muscles/tendons, or the bony structure of the joint itself, the other pieces will be affected as well. This can progress to labral tears, hip flexor tendinopathy, and chronic hip impingement symptoms.

In simple terms (although none of this is simple!), there is too much pressure in one spot. As physical therapists, our job is to teach you how to manage this pressure better, protect the structures that are giving you problems, and gradually progress you back to the activities that you want to do while respecting the healing process. A few interventions we use to do this are:

1. Hip range of motion drills

Hip flexor/adductor isometric strengthening

Dynamic hip flexion progressions

If you have been experiencing a consistent pinching sensation in the front of your hip, see a healthcare professional, preferably a sports physical therapist. These symptoms commonly become more intense and limiting over time. Contact us now for help solving your chronic hip discomfort!

What do I do if my athlete got injured?

What Should My Athlete Do After an Injury? How Can They Safely and Quickly Get Back on the Field?

To answer these questions, let’s explore the sports physical therapy process for one of the most common soft tissue injuries in soccer: a quad strain. For more details on soft tissue injuries and the differences between strains and sprains, check out last week’s article here.

Soccer players are prone to soft tissue injuries due to the sport’s high demands of sprinting, kicking, and sharp directional changes. Kicking injuries are particularly common, with the rectus femoris muscle, part of the quadriceps group, being the most frequently injured.

The rectus femoris muscle spans both the hip and knee. When an athlete winds up to kick a soccer ball, this muscle quickly stretches and contracts to execute the kick. Any muscle that repeatedly lengthens and shortens rapidly, especially across multiple joints like the hip and knee, is at a higher risk of injury.

Immediately following an injury, the athlete should be evaluated by a physical therapist or sports medicine physician to assess the severity and determine the appropriate course of action. While imaging can be useful, it’s not always necessary.

The rehabilitation process for a muscle strain can be broken down into three distinct phases:

1. Injury Management Phase

The goals of this phase are to reduce pain and inflammation, restore the muscle’s range of motion, and reintroduce pain-free functional movements. While the injured tissues need time to heal, complete rest isn’t the answer. Light strengthening exercises and mobility drills are essential to stimulate the healing process, making early physical therapy crucial.

Examples of early-phase exercises for a quad strain might include:

– Isometric knee extension with hip extended

– Split squat isometric

– Single-leg bear hold

Once athletes regain a full range of motion without pain and can perform basic bodyweight movements, they move on to the next phase of rehabilitation. Unfortunately, traditional physical therapy often stops here, leaving many athletes struggling to bridge the gap between rehab and full performance.

2. Strength Training Phase

At the beginning of this phase, many athletes still face significant strength deficits.

Strength training is vital for improving the quality of the injured tissue and reducing the risk of reinjury. This is the time to hit the weight room.

Strength training exercises for an athlete recovering from a rectus femoris or quad strain might include:

– Reverse Nordic curls

– Lateral step downs

– Safety squat bar step-ups

3. Sport-Specific Training

What must the injured tissue be able to do for a safe return to sport?

This phase of rehab demands a deep understanding of the athlete’s sport, ensuring the injured area is prepared for the challenges ahead.

Since the rectus femoris is often injured due to continuous, rapid lengthening and shortening, this movement pattern must be replicated and trained during rehab to prepare the athlete for the demands of soccer.

Some examples of exercises used in this phase might include:

– Alternating split squat jumps

– Banded deceleration drills

While these three phases apply to all muscle strains, the recovery timeline varies based on factors such as the injured body part, the severity of the injury, and other individual factors.

If your athlete is dealing with a muscle strain, it’s essential to schedule an appointment with a physical therapist or sports medicine physician as soon as possible. Early treatment has been shown to get athletes back on the field faster and more effectively. If you suspect that you or your child has a muscle strain, schedule an evaluation with us right away.

Performance University

Peak Performance Blueprint

Adult Strength and Conditioning