How Focusing on Mental Health Improves Physical Therapy Outcomes

Can focusing on mental health improve outcomes in physical therapy?

Yup!!

This concept is challenging to grasp because the medical system often tries to attribute physical pain to a direct cause. However, it isn’t that simple and this is important for every physical therapist to understand.

Humans are complex and physical pain is influenced by several different factors. One of which is the brain.

An individual’s mental state has a large impact on their physical state and the effectiveness of physical therapy interventions.

Do not miss the latest episode of the CHP Spotlight Interview series with Dr. Kelly Forys Donahue and Dr. Danielle Miro from DC Health Psychology (www.dchealthpsychology.com).

Check out the full interview here.

Photo Credit

“World Mental Health Day Observance” by United Nations Photo is marked with CC BY-NC-ND 2.0.

1 Trick to Perfect Running Foot Strike Position

If you ever experience back pain when running, are a runner that has been to physical therapy, or are curious about foot strike position, this article is for you!

One of my favorite workshops to conduct is the CHP Running Technique and Performance lab. I have a blast throughout the workshop, but the Q&A portion is my favorite. I have gotten the opportunity to answer many different questions which have forced me to expand my knowledge and has helped me to create a better workshop over time.

While the questions that I receive consistently differ, one topic remains consistent. Someone inevitably asks about foot strike position and my answer often surprises them.

There is no correct foot strike position.

Among other things, foot strike position is dependent on an individual’s body dimensions (limb length as an example) and the position of the body above.

While we cannot change your anatomy, we can change the position, aka the posture, of our bodies.

A “stacked” posture will facilitate a foot strike that occurs directly underneath the body. This foot strike position results in a more efficient stride and minimal stress to the body. To learn about the stack, check out a previous article that I wrote on Learn to Stack Like a Snowman.

Attempt the drill below to feel what it is like to have a stacked posture while running.

Grab a partner and ask him/her/they to stand behind you (you are also standing)
Have your partner press down on your shoulders with a moderate amount of force and do not let them squish you
As you resist them you should feel your abs engage and feel as if you are standing tall
Next, attempt to shift your weight onto 1 leg and pick up your opposite foot while resisting the force of your partner
Try the other leg

For a video on this drill, click here.

After performing this drill, you should have a better sense of your optimal running posture. Try to replicate this feeling the next time you go on a run!

Learn to Stack Like a Snowman

Learn to stack like a snowman….

The “stack” is one of the prerequisite positions to master in physical therapy or performance training. This position is essential for movements like squats, split squats, hip hinging and pretty much anything one might perform in the gym.

Think of the stack like a snowman. The 3 balls of a snowman represent the head (top ball), rib cage (middle ball), and pelvis (bottom ball). The goal of the stack is to center each of the 3 balls over one another.

The weight bearing surfaces of all 3 balls are larger when they are centered over one another. This means that the weight of the snowman is spread over a larger area (ie. less stress in each individual spot).

Now imagine that one ball starts to roll forward or backward. The ball above and below must roll with it to avoid falling to the ground and keep the snowman standing upright. This adjustment changes the weight bearing dynamics for each ball and more weight is now directed onto a smaller amount of space. This produces more stress onto these new weight bearing areas and may cause these areas to break down faster (think discs in our lower back).

This same dynamic happens in our body. As one of our balls (head, rib cage, or pelvis) rotates away from center, the other balls must accommodate. This places more stress onto the body as a whole and often results in discomfort.

Achieve the stack by practicing the following steps.

Imagine that you are wearing pants with back pockets. Without bending your knees further, roll your back pockets underneath your body (you should feel your abs turn on)
Without hunching over take a relaxed breath in, followed by a long and relaxed breath out. Feel your anterior ribs move down, back and in. Ensure that you can gently maintain this position while inhaling and exhaling
Imagine that someone is standing behind you pressing hard down onto your shoulders.

The stack can be a challenging position to master and integrate into your training routine. However it is often the secret to avoiding back pain with common activities in the gym.

Contact us to learn other adjustments to common exercises that may become your hidden secret to overcoming pain and optimizing your performance.

How We Train With Back Pain Physical Therapy

Back pain is one of the most common issues encountered in sports physical therapy and injury rehabilitation, especially among runners. Those with sensitive lower backs often need to carefully manage the total amount of activity they perform over time.

It’s particularly important to pay attention to exercises that involve significant axial loading, which refers to weight bearing directly down onto the spine.

Exercises with high axial loading, such as barbell squats, typically involve supporting the weight on the shoulders.

For individuals with back pain, it’s crucial to keep the volume of axial loading reasonable. However, reducing the number of exercises that can be performed may limit progress for those who want to achieve their fitness goals.

The trap bar squat is an excellent exercise that targets the legs and, when executed correctly, keeps the back feeling great.

Here’s how to do it:

1. Set up a trap bar with a box placed in the center.
2. Stand on the box and position yourself inside the trap bar.
3. Exhale to engage your core by bringing the ribs down and activating your abs.
4. Inhale as you squat down by pushing your knees forward to reach the bar—this is not a deadlift!
5. If needed, reset your abs, take the slack out of the bar, and stand tall as you exhale.
6. Repeat.

What Touching Your Toes Really Says

Can you see the difference in these photos? The toe touch is a simple test that is often performed in injury rehabilitation and sports physical therapy settings.

However, important parts of this test are commonly missed. Simply touching your toes doesn’t tell the whole story. If you can touch your toes, great, however there are different ways that you can get there.

Have you stretched your hamstrings to such a degree that they allow you to nearly palm the floor?

If you are a gymnast that may be a great thing. However field sport athletes (ex. Lacrosse, football, basketball, baseball) and weight lifters need a level of hamstring stiffness for explosive movement.

Is your lower back straight or does it flex into more of a C curve to allow you to more easily touch your toes? Is your lower back bending in certain areas but not in others?

Your lower back consists of multiple bones (vertebrae) that are stacked on top of each other. Our backs are built this way to allow for movement of one segment on the next. However many times these small movements do not occur and the lower back moves as one unit. The result is a lower back that looks straight in places despite being bent over. Over time, a lack of lower back movement can increase the risk for injury.

The toe touch is a great test and can be made even better when directed by a professional with a trained eye.

Contact us for more information about how a customized movement assessment may help you optimize your training and avoid injury!

Why We Need to Stop Comparing Adult Movements to Children’s

It has become common in fields of physical therapy and performance training to compare adult movement to the ways that babies move. You may have spoken to a professional that uses this comparison in their approach.

The logic usually goes something like this…“Humans were born with the ability to squat fully, and our modern lifestyles robbed us of that ability, so we need to regain it.”

Sounds understandable, right?

I thought so too. I even took a couple of continuing education courses based loosely upon this concept. The class instructors showed pictures of babies at various development stages and attempted to teach movements that mimicked these phases. The idea was to help adults gain back some of the movement capabilities that they once had as children and this new freedom of movement would help to alleviate pain and resolve injury.

Adults Are Not Babies

While I think we’d all love to be able to squat to the floor, crawl around all day, and never get tired, the truth is that we are not babies anymore.

Babies have a large amount of joint laxity that allows them to get into a variety of different positions, that we don’t have as adults. Babies also have a very large head in relation to the body, which helps to provide a counterbalance for easy squatting. In fact, according to Healthline, many of a baby’s bones are composed of cartilage, a type of connective tissue that is tough but flexible. This cartilage turns to bone as we grow.

Their bodies are still growing and changing. They fall often and make mistakes (essential for learning), which flexibility and mobility help with. Because of this, the ability to squat to the floor is normal for a baby. The same cannot always be said for adults.

Adults are not babies, and we cannot use a baby’s movement as a model for how an adult should move. Not only do babies have much different bone and structural compositions, but all adults have different movement capabilities due to variations in torso lengths and body proportions (among other reasons). Using singular movement standards would overlook this critical aspect.

It is nice to think that we could be able to squat to the floor like we once did when we were a toddler. However, adults are not babies, and our bodies are not the same as they once were.

Because of this, we do not expect our physical therapy patients to squat to the floor. It is essential for all of us to set realistic movement standards that will help to live pain-free and healthy lives. For help in the arena, talk to our experienced physical therapy team in Bethesda!