My shoulder pops. Is that bad?

I call these rice crispies. Snaps, crackles, and pops are typical in the shoulder and a concern for many physical therapy patients.

Rice crispies occur in the shoulder for many reasons. The shoulder joint has the most range of motion in the entire body. But with great mobility comes great responsibility!

The large amount of motion in the shoulder provides many ways to compensate. If the quality of shoulder movement is poor, it risks becoming unstable. Excellent movement quality is challenging in such a mobile joint, so the shoulder is commonly injured.

But before you worry too much about rice crispies in the shoulder, ask yourself if it is painful. If it is painless, it may only be a harmless joint noise known as crepitus, simply pressure released from the joint. Crepitus is what happens when you crack your knuckles.

But, if there is pain with the noise, consider seeing a physical therapist like our team here at CHP.

Movement compensations in the shoulder and repetitive use can irritate several tissues within the shoulder. One example is rotator cuff tendinitis, which is a common sports physical therapy injury in Bethesda and McLean.

Tendons are the cords that connect muscle to bone. The rotator cuff tendons can become worn down over time, much like the sole of a shoe that eventually wears apart. If left untreated, the result is a tearing of the rotator cuff tendon, resulting in increased pain and an inability to exercise or train fully. Limitations can progress further, affecting sleep, strength, and the ability to use the arm with daily activities.

The most important thing is to figure out why the pain or rice crispies started in the first place.

Small rotator cuff tears, arthritis, and joint damage is expected within the shoulder. But there is still a great deal that you can do (without surgery) to get out of pain and back to performing the activities that you love.

A great sports physical therapist will help you identify the root cause of your symptoms so that you can continue to exercise and enjoy your active lifestyle.

Contact us if you have questions about how we can help you with shoulder pain/popping and get you back to doing the activities you love.

Why most sports physical therapy for ACL injuries is incomplete

Picture this: Four months ago, you underwent surgery to repair a torn ACL (anterior cruciate ligament) in your knee, and you’ve been diligently attending sports physical therapy ever since. Initially, you were on crutches, with a swollen knee that barely moved. But after several weeks of physical therapy, you regained full range of motion and relearned how to walk normally. You’ve even started running again and are eagerly anticipating the day you can return to practice or the activities that make you feel like an athlete!

But then, your physical therapist informs you that you’re being discharged from therapy…

This scenario is common because insurance companies often don’t classify return-to-sport activities as “medically necessary.” As a result, most traditional physical therapy clinics don’t offer return-to-play programs.

I refer to this crucial stage of recovery as “the gap.” The gap represents the period between completing physical therapy and beginning performance or personal training.

Many athletes aren’t actually ready to return to their sport when they’re discharged from physical therapy because they haven’t yet bridged this gap between rehabilitation and peak performance.

At this stage, athletes may be pain-free, have full knee range of motion, and even have regained much of their strength. However, they still need to train their knee to use that strength explosively and withstand the demands of cutting, jumping, and sprinting.

Unfortunately, many athletes skip this vital phase of ACL recovery, returning to their sport before their knee is fully prepared. This significantly increases the risk of re-injuring the repaired ACL or even damaging the other knee.

Programs designed to help athletes bridge this gap typically start with tests to assess how close they are to returning to their sport. These tests often include hops, agility drills, and movements specific to the athlete’s sport.

In our Bridge The Gap ACL program, we begin with the single-leg hop test. Research suggests that the surgically repaired leg should be at least 90% as strong as the unaffected leg before engaging in sport-specific activities. Ideally, both sides should be equal before an athlete resumes full practice.

Below is an example of a single-leg hop test.

Sports physical therapists use the results of these tests to create a tailored training program that combines elements of physical therapy, strength and conditioning, and sports performance.

Research indicates that the earliest an athlete can safely return to play after ACL surgery is around nine months (even longer for younger athletes). For this reason, most bridge-the-gap programs last between 2-4 months.

Interested in learning whether our Bridge the Gap ACL Program is right for you? If you or your child is recovering from an ACL repair, contact us to find out more!

Cryotherapy: Is It Really Worth the Hype?

A few months ago, I attended a conference with a group of physical therapists and personal trainers. Over a meal, we found ourselves discussing the day’s events. One of the highlights of the conference was a series of product pitches from various companies targeting healthcare providers like us. Among them was a cryotherapy company, and their representative happened to recognize our group.

He approached our table and confidently delivered his pitch:

“Cryotherapy can help your patients reduce pain, accelerate muscle recovery, decrease inflammation, and improve overall wellness.”

Sound familiar? If you’ve ever heard a similar claim and wondered if cryotherapy really lives up to the buzz, you’re not alone. At our physical therapy clinics in Bethesda and McLean, we receive many inquiries about the effectiveness of cryotherapy.

Let’s break it down.

What Exactly is Cryotherapy?

Cryotherapy involves exposing the body to extremely low temperatures for a brief period, usually just a few minutes. While there are several forms of cryotherapy, the most well-known is whole-body cryotherapy. This process involves standing in a chamber filled with liquid nitrogen vapor, where temperatures can drop as low as -200°F to -300°F (yes, you read that right).

The Ongoing Debate

The benefits of cryotherapy remain a topic of debate within the medical, physical therapy, and fitness communities. While some studies have shown promising results, others have found little to no benefit.

Proponents of cryotherapy suggest that it can help manage various conditions, including chronic pain, arthritis, inflammation, and even depression. The theory is that exposure to extreme cold triggers the release of endorphins—your body’s natural painkillers—while also reducing inflammation in targeted areas. In some cases, studies have indicated that cryotherapy may help alleviate pain and inflammation in people with conditions like rheumatoid arthritis. However, much more research is needed to validate these claims.

There are also suggestions that cryotherapy aids in **muscle recovery** after exercise. The idea is that cold temperatures cause blood vessels to constrict, reducing blood flow to the affected muscles. As the body warms up post-session, blood flow returns and promotes healing. While some studies support this, others have shown little to no significant effect.

So, What’s the Verdict?

Cryotherapy is still relatively new, and as with many emerging treatments, the evidence is limited and mixed. Early research shows potential, but more comprehensive studies are necessary to reach firm conclusions.

It’s also important to remember the risks. Exposing the body to such extreme cold comes with hazards, including potential skin damage and frostbite.

If you’re thinking about giving cryotherapy a try, it’s crucial to consult your physician first to ensure it’s a safe option for you.

3 Tips to Help You Find the Best Shoe

Minimalist shoes, running shoes, cross-training sneakers, weightlifting shoes. As sports physical therapists, personal trainers and performance coaches in McLean and Bethesda, we are asked all sorts of footwear questions. If you are like me, and do several different things, it may seem that you need a special shoe for each activity.

In my closet you can find running, hiking, cross-training, basketball, and special weightlifting shoes. But these days I mostly use 1 pair for all of my training.

I’m more of a generalist now. I dabble in many different things but spend most of my “fitness time” exercising in the gym. Sorry ego, my days of being a specialist are behind me.

If you are training for a particular sport or are a high-level runner, you are a specialist and likely need a special shoe for your sport (and the footwear recommendations in a sports physical therapy setting will be different). But if you are a generalist like me, you need a shoe that is comfortable, designed for your foot type, and can do everything that you need.

Here are 3 things that you should look for to choose the right shoe for you.

It must have a firm and snug heel cup. Your heel sits at the base of the shoe, in a place called the heel cup. The heels cup should fit snugly around your heel and should not be much wider than your heel itself. This prevents your heel from sliding within the shoe, which may negatively impact foot mechanics.
The shoe must have a toe break that bends where you toes bend. Place your shoe on the ground and hold it there. Pull the front of your shoe up from under it. The folding point of the shoe should be located where your toes bend. If your shoe folds at another location, your shoe is not accommodating to the mechanics of your foot and can lead to breakdown within the structure of the foot itself.
You should be able to feel the entirety of both your feet on the ground as you are standing still in your shoes. People are often unable to feel their arches, which results in more stress on the areas that have more contact with the ground.

There are 26 bones and 30 joints within the foot. This results in many ways that our foot can compensate but these 3 tips can help solve these issues.

Would you like help finding the right brand and model shoe for you? Our performance physical therapy team would be happy to provide you with recommendations based on the brands and models that are on the market right now!

Nails on a chalkboard to me

“It Will Hurt Your Knees if They Go Past Your Toes”—Debunking the Myth

Recently, while working out at the gym, I overheard two young men discussing their barbell squats. One of them mentioned that he had just finished physical therapy, and I hope the following advice didn’t come from his therapist…

After completing a set, one of the lifters (let’s call him Lifter 1) was chatting with his friend (Lifter 2). Lifter 2 advised him not to let his knees go past his toes during squats, claiming it would be bad for them.

This belief is widespread in fitness circles, the personal training industry, and was even common in physical therapy. However, it’s simply not true.

Your knees naturally go over your toes when you walk or run. In fact, proper squat technique requires your knees to move well past your toes.

Attempting to prevent this by pushing your hips back and arching your lower back only shifts more stress onto your lower back, increasing the risk of back pain.

But you might wonder: does allowing your knees to move past your toes increase stress on them?

The answer is no! In fact, research shows that training your knees to comfortably move past your toes helps build healthier knees and reduces the strain on your back.

Check out the squat tutorial below to retrain your squat technique and get your knees accustomed to moving over your toes as they naturally should!

Remember, there’s no such thing as a “bad” or “good” exercise. The suitability of an exercise depends on various factors, including your fitness goals, injury history (consult your physical therapist), unique body traits, and movement capabilities. Keep this in mind whenever you hear generalized or “one size fits all” advice about exercise.

Create Your BS Meter

I’m lying on the couch as I got sucked into Instagram and all of their sports physical therapy videos. While scrolling, one exercise video grabbed my attention. This wasn’t because it was good information. It was because it wasn’t and had thousands of likes.

There is so much information out there and anyone with a social media account can have a platform. You have access to the best and the worst information. It is overwhelming!

You need a BS detector so that you aren’t doing bicep curls while standing on a ball, blowing up a balloon (not far off what I saw the other day).

So how do you determine when you should ignore a social media post?

Speaking in absolutes. Most times, the best answer that a professional can give you is “it depends.” Rarely is there a correct answer for every situation. For example, stretching or mobility is often promoted as a “fix” for a given injury. Yet, many people have more important problems to solve. For more information, check out our post, Is Mobility Overrated? It is impossible to know of every possible factor that could be contributing to pain or injury. Even the best among us cannot be 100% certain, especially on social media.

It is too complicated. An expert can take a complex topic and break it down so that it makes sense to you. Complicated medical jargon is a red flag that the presenter does not understand what they are posting.

Promoting personal success stories as evidence. Personal success stories are subjective and ignore the facts and research. Many influencers post personal success stories as evidence for their approach. This ignores all the other factors that may have contributed to the results being promoted (genetics, differences in lifestyle, priority differences, etc.). Quality research requires thousands of trials before it is valid. A case study of 1 or 2 people only applies to those 1 or 2 people!

P.S. If someone is promoting a “quick fix”….run!