Performance training for knee pain

When your knees are acting up, how could using them more possibly help? Many of our patients have the same concerns during the injury rehabilitation process, especially when they first start physical therapy.

Knee pain often stems from a reduced ability to tolerate stress. This stress can occur during activities like squatting, lunging, running, or jumping.

Every tissue in the body has a certain stress tolerance—the amount of stress or load it can handle before pain or injury occurs. When this tolerance decreases, it takes less stress to cause discomfort or injury. However, when the tissue’s loading tolerance increases, it can withstand more stress. In sports physical therapy, finding the right balance between these factors is crucial.

The only way to increase a tissue’s loading tolerance is through training—or in other words, applying stress to the tissue!

The key is to apply the right amount of stress to the targeted tissues. Too little stress won’t prompt the body to adapt, while too much could lead to further injury.

It’s similar to weight training. To build stronger muscles, you need to lift weights, which stresses the muscles. This stress triggers an adaptation, allowing the muscles to handle more in the future.

In cases of chronic knee pain, people often avoid loading the knees. Over time, this avoidance leads to a decrease in the loading tolerance of the tendons and tissues around the knees. As tolerance decreases, the likelihood of pain increases, creating a snowball effect.

We can reverse this by introducing pain-free exercises that challenge the tissues around the knees. Isometric exercises, which involve holding a challenging position for a set period, are particularly effective.

Another type of exercise that often benefits those with chronic knee pain is eccentric exercises. These exercises work the tissues as they lengthen slowly. One of my favorites, which we frequently use, is the Eccentric Step Up.

When dealing with knee pain, there aren’t inherently “good” or “bad” exercises. The goal is to find the exercises that apply the right amount of stress so the surrounding tissues adapt appropriately.

Our team of Performance Physical Therapists would love to help you find the best exercise routine to improve your knees’ loading tolerance. Contact us to receive a comprehensive home program tailored to you!

P.S. Don’t forget to subscribe to our YouTube channel and check out our new and improved Instagram page @cohenhealthandperformance!

Pullup and keep your shoulders happy

The Impact of Breathing on Shoulder Function and Pull-Up Performance

As we discussed in a recent article (which you can find here), our ability (or lack thereof) to breathe effectively can significantly influence shoulder function. This is a common area of focus in sports physical therapy and performance training, particularly for runners. Breathing can affect posture, shoulder mobility, and even lead to issues like clicking, popping, or decreased strength in the shoulders.

Among these factors, reduced shoulder mobility is often the most noticeable.

In many cases, a slight reduction in shoulder mobility isn’t problematic unless you’re engaging in exercises that demand extensive shoulder movement.

One such exercise is the pull-up or chin-up. Performing these exercises correctly requires substantial shoulder flexion and overhead pulling strength. When these abilities are lacking, the body tends to compensate in ways that can affect form and function.

A common compensation is leaning back and puffing out the chest when initiating the movement from a hanging position. This causes the front ribs to flare out, altering the position of the shoulders and reducing their overall effectiveness.

So, how can you ensure proper form during vertical pulling movements like pull-ups and chin-ups?

The key is to perform these movements in a tucked position. This position flexes the hips, aligning the pelvis underneath the body, which makes it difficult to excessively puff out the chest.

However, be prepared—this position makes chin-ups and pull-ups significantly more challenging!

Not only does it increase the workload for your abdominals, but anytime you eliminate compensations, the movement becomes more demanding.

When starting out, try supporting your legs or feet. Once you’ve mastered this, progress to holding them up on your own.

Check out this video of Dr. Cohen incorporating these techniques into his training routine.

How to “Fix” Rounded Shoulders

As physical therapists, we often answer questions pertaining to “poor posture.” One of the most common reports from our patients in Bethesda and Chevy Chase is having “forward shoulders.”

The solution to this, which is often taught by other physical therapists, is to stretch the muscles in the front of the shoulders. The most common of these muscle groups is the pecs.

The logic goes something like this. “Your pecs are tight and pulling your shoulders forward. If you stretch them, your shoulders can move back and correct your posture.”

While this reasoning isn’t necessarily wrong, it is shortsighted. It fails to question why muscles like the pecs became tight in the first place. Simply stretching these muscles won’t correct the root cause of the issue.

The shoulder complex rests on top of the rib cage and the pecs attach to the sternum (ribs 1-7 attach to the sternum) as well as the ribs on the front of the rib cage.

As we breath in the rib cage should expand in 360 degrees and as we breath out it should do the opposite.

People with forward shoulders and stiff pecs often have difficulty expanding the front part of their rib cage during a relaxed breath in. This prevents the pecs from lengthening fully and often causes them to remain stiff, pulling the shoulders forward.

If you are looking to improve your posture and “pull your shoulders back”, the solution must include breathing exercises that emphasis relaxation and expansion of the chest/front part of the rib cage.

Here is an example from our YouTube page that illustrates this concept.

If you are looking to improve your posture or shoulder function, contact us now!

Photo Credit

“Orlando’s Poor Posture” by hewy is licensed under CC BY-NC-ND 2.0

Special guest post on regenerative medical treatment

The fields of athletic performance physical therapy and regenerative medicine frequently intersect. Today, we’re featuring a special guest post by Dr. Mayo Friedlis, a renowned physician at Stem Cell Arts in Chevy Chase and a certified Regenexx provider. With over 20 years of experience in regenerative therapies, Dr. Friedlis has been practicing since 1983 and brings a wealth of knowledge to the table.

At CHP, we often receive questions about regenerative medicine—a relatively new and exciting field. You might be wondering: What exactly is regenerative medicine? Does it really work? Could it benefit me?

Dr. Friedlis graciously took the time to address these questions and more. Check out the valuable insights he shared below!

What is Regenerative Medicine?

Regenerative therapies harness the body’s natural ability to heal itself by using growth factors, stem cells, or platelets from the patient’s own body. These treatments stimulate healing and tissue regeneration, offering a non-surgical solution for many injuries. But when should you consider regenerative medicine?

Many injuries naturally heal over time with proper exercise and rehabilitation. However, when pain persists despite these efforts, regenerative therapies might be the next best step.

It’s important to think of regenerative medicine differently from surgical interventions. Surgery is often considered a last resort, something we turn to only when all other options have failed and our quality of life is significantly affected.

Regenerative therapies, on the other hand, are most effective when used earlier in the recovery process. By stimulating the body’s healing mechanisms, these treatments can prevent further damage and degeneration of tissues. If first-line treatments aren’t enough and you’re still unable to return to the activities you love, it might be time to consider regenerative therapies.

The Importance of Early Intervention

The earlier you explore regenerative therapies, the better your chances of fully recovering from an injury. For athletes, managing pain alone isn’t enough; it’s critical to address the root cause of the injury. Regenerative therapies, much like sports physical therapy, focus on healing the source of the pain rather than just masking symptoms. This is where these therapies truly shine.

What Type of Regenerative Therapy is Right for You?

A common question is which type of regenerative therapy to choose. The answer depends on the specific injury and the structure involved.

– Prolotherapy and PRP (Platelet-Rich Plasma) are particularly effective for ligament and tendon injuries, such as rotator cuff tears, hip labrum issues, meniscal tears, or other ligamentous injuries.

– Stem cell treatments are more suited for conditions like joint degeneration or osteoarthritis, where more advanced tissue regeneration is needed.

The severity of the injury also plays a role. For example, smaller tears in ligaments, tendons, or the meniscus often respond well to PRP or prolotherapy. However, more significant tears may require the use of stem cells. Similarly, mild arthritis can be treated with PRP or prolotherapy, while severe arthritis typically benefits from stem cell therapy.

– Dr. Mayo Friedlis, MD

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!

Want to return to running after an ankle sprain?

Ankle sprains are often dismissed as minor injuries, yet they frequently lead runners and other athletes to seek physical therapy.

The seriousness of these injuries is frequently underestimated, with athletes returning to their activities too soon.

The most common type of ankle sprain that we see in physical therapy is an inversion sprain, where the foot typically remains planted as the ankle turns inward, causing the outer edge of the foot to roll onto the ground—hence the term “rolled ankle.” This motion damages the ligaments on the outside of the ankle, often leading to varying degrees of tears.

The severity of the injury and the number of ligaments affected determine the grade of the sprain, ranging from grade 1 to grade 3.

After an ankle sprain, it’s crucial to rule out a fracture. Athletes should seek an X-ray if they are unable to bear weight on the injured leg or experience severe pain around the malleolus (the prominent ankle bone on the outside).

If no fracture is found and the aforementioned symptoms are absent, the focus can shift to gradually returning to running.

During running, there is never a moment when both feet are on the ground simultaneously. This means the body is continuously bouncing from one leg to the other, placing repeated stress on the ankles as they absorb the full impact of the body.

Unfortunately, after an ankle injury, the capacity of the affected area to handle stress (the cumulative amount it can bear before re-injury) is significantly reduced. As a result, recovery from an ankle sprain often takes longer than expected, with many athletes attempting to run before their ankle has fully healed.

To ensure a safe recovery, injured tissues need to gradually reacclimate to the stress associated with running or other sports.

A careful and progressive return to running might start with non-weight-bearing movements, gradually advancing to low-impact, weight-bearing exercises such as squats, split squats, and lunges. From there, single-leg activities like balance drills and single-leg squats can be introduced, followed by plyometric exercises involving two-legged jumps, and eventually, hopping on one leg.

Finally, activities such as jump roping, short runs, and longer runs can be reintroduced into the routine.

In summary, every ankle sprain is unique, making it essential to have a trained medical professional assess the injury to rule out a fracture. This professional can then design a personalized return-to-sport program tailored to your needs.

For further assistance and information on how we can help, you know where to find us!