Speed Up Your Recovery From Back Pain

As anyone who has thrown their back out and needed physical therapy will tell you, bending over feels rough for several days after.

Putting on socks and even sitting down is uncomfortable as the body attempts to prevent the lower back from moving, especially into flexion.

Flexion of the spine is commonly the most aggravating movement for anyone experiencing an acute episode of back pain. In physical therapy we test this by asking our patients to touch their toes. Once the acute episode subsides, the next step is training and learning to tolerate slow, controlled movements of the spine.

When tolerated well, the reverse crunch is great drill to teach this quality and can be used effectively as a warmup in the gym.

Oftentimes this is where the injury rehabilitation process stops. At this point the body can tolerate all normal daily activities however it has not learned to manage rapid movements of the spine, such as those that occur in sport or in the gym.

The Med Ball slam is a great drill to train the spine to tolerate movements that involve rapid spinal flexion. This drill should be pain free before attempting any heavy Olympic lifts like a clean or a snatch.

Also, remember to avoid using a ball that bounces as we don’t want any broken noses from this drill!

Physical Therapy Didn’t Work…

I tried physical therapy and it didn’t work.

Many of our patients in Bethesda have seen other physical therapists prior to seeing us. In their previous physical therapy experiences, they did not achieve the results that they were looking for and are coming to us for answers.

Personally, I love working with these people because they continue to believe that our profession can help them. However, negative experiences in physical therapy often cause many others to lose faith in the profession.

Perhaps you are one of these people. If so, I don’t blame you as I once was in your shoes!

When I was in High School, I experienced a quadricep injury that was impacting my ability to play football.

I went to my local physical therapy practice searching for help in overcoming this injury and play in my junior season. It was going to be my first season starting on both offense and defense causing this injury to constantly remain in the front of my mind.

My introduction to physical therapy was not what I had hoped for, and I now realize that my physical therapists were not taking great care of me (to learn more about how you can determine if this is the case, see my latest blog here).

Luckily, I was still able to play in my season and was back to 100% by the middle of the year. However, I can’t help but wonder if I would have been fully healthy to start the season if I saw a different physical therapist.

Like all other professions, the physical therapy industry has great professionals and poor ones. Furthermore, some physical therapists specialize with athletes, some with cardiac patients and others with people living in nursing homes.

As a result, my hope is that instead of saying “I tried physical therapy and it didn’t work”, you say “This physical therapist or physical therapy practice didn’t provide the results that I was looking for and I need to find someone that is a better fit for what I need.” 

Where You May Be Cheating Your Pushups (Video Included)

Let’s stop cheating our pushups and making the injury rehabilitation process more challenging! 

There is a simple way to make our pushups easier. Allow for your shoulder blades to pinch together and limit the motion’s range of motion . Less distance required for the push up=less effort. 

However, is this better for you?

Allowing your shoulder blades to pinch together excessively when performing a pushup places more strain onto the shoulder joint and may lead you to a physical therapy clinic like ours. Because the shoulder blades are pinched together, they are no longer able to move effectively and contribute to the exercise. More strain is placed onto the shoulder joint as it is forced to pick up the slack. 

Correcting this common compensation may prevent you from “repping out” the same number of pushups however you will get more out of the exercise. In addition, your shoulders will be healthier in long run!

The video below helps to illustrate this difference.

Video 1: The shoulder blades immediately come together.

Video 2: Begins by reaching away from the floor thus helping the shoulder blades to start in a more protracted (spread apart) position. From there they move slowly together as the body descends to the floor and spread apart again on the way back to the starting position.

A Shoulder Friendly Chin-Up

As we referenced in a recent article (found here), our ability (or lack thereof) to breath effectively will impact the function of our shoulders and is something we often address in sports physical therapy or performance training (as well as with many runners). This can affect our posture or shoulder mobility, and even result in clicking/popping or reductions in strength.

Of all these factors, reduced shoulder mobility is often the most obvious characteristic.

In most situations, a slight reduction in shoulder mobility is not an issue unless you are performing exercises that require a great deal of shoulder mobility.

One of these exercises is the pull-up or chin-up. Proper performance of these exercises requires a great deal of shoulder flexion and overhead pulling strength. The body is then forced to compensate when these qualities are lacking.

It is common to see an individual lean back and puff out their chest up when initiating the movement from the hanging position. As this occurs, the anterior ribs will flare out and impact the position of the shoulder, which reduces overall function.

So how do we ensure that we are properly performing our vertical pulling movements such as pullups and chin-ups?

Simply perform these movements in a tucked position! This position flexes the hips which stacks the pelvis underneath the body. It is very difficult to puff the chest out excessively when the pelvis is in this position.

However, be warned because this position makes chin-ups and pull-ups much harder!

In addition to increasing the amount of work required from the abdominals, any time a position takes away your compensations, the movement becomes much more challenging.

When first performing this movement have your legs or feet supported. After mastering this step, attempt to hold them up yourself.

Check out this video of Dr. Cohen performing these in his training routine.

Be prepared for the tucked position to challenge your vertical pulling ability!


Image Credit

“Pullup” by U.S. Army Europe is licensed under CC PDM 1.0

Does Your Metabolism Actually Slow As You Age?

As we age it is common to feel that it is increasingly difficult to prevent injury or reach our fitness goals. We have spoken to many people in Bethesda that feel the help of a physical therapist is inevitable. Many challenges that are experienced are often attributed to a slowing metabolism.

However, this may not be the case.

There has been evidence that suggests that our metabolism doesn’t slow much, if at all, during adulthood. However, even if we later discover that some of these findings are misleading, a slowing metabolism is not the only reason that it takes longer to recover from injuries or fail to reach our fitness goals as we age.

Many of the challenges associated with aging stem from lifestyle changes.

In modern times humans have become more sedentary as we age. We no longer participate in organized sports, play outdoor games with our friends, and migrate to sedentary desk jobs for much of the day. This results in a large decrease in our daily energy expenditure and increases our risk of injury. Prolonged sedentary activity causes our body to become de-conditioned and less prepared for the rigors of life. As an example, this is why we suggest partaking in a running analysis prior to training for a race.

Another factor we may not realize is that as we get older, we take on a lot more responsibility.

Think back to your teenage years or time in your 20s. Did you have a lot of worries back then? A career? Family commitments? A mortgage? As these “adult things” add up, so do our commitments, resulting in less free time. Less time for exercise, less time for self-care, and less time for sleep.

Countless studies have shown us that as sleep decreases our health is negatively impacted in several ways, including an increased risk of orthopedic injury.

While it may be easy to see all of this as a negative, the good news is that many of the seemingly negative effects of aging are not as inevitable as we may have thought! Furthermore, feeling better and healthier doesn’t require you to be perfect.

As performance physical therapists, we help our patients identify the smallest possible improvement that will make the largest possible impact to overcome an injury.


Image Information

“Tiantan Park-life: The Elderly Exercising in China’s Parks – Parallel Bars” by _chrisUK is licensed under CC BY-NC-ND 2.0


A Window to Cardiovascular Health

“Casual Runner” by Chris Hunkeler is licensed under CC BY-SA 2.0

Resting heart rate paints a vivid picture of cardiovascular health and impacts the body’s response to sports physical therapy interventions. RHR, or resting heart rate, is the number of times the heart beats per minute when the body is not physically active — such as when sitting.

According to the Mayo Clinic, the “normal” range for a resting heart rate is between 60 and 100 beats per minute (BPM), though resting heart rates vary from person to person based on various circumstances. For example, resting heart rate is significantly influenced by mood, environment, cardiovascular fitness, and stress.

As a rule of thumb — as cardiovascular health increases, resting heart rate tends to decrease. Therefore, athletes often have lower resting heart rates than those that do not regularly exercise. That said, resting heart rate is an important measure for anyone looking to improve their overall health.

What Your Resting Heart Rate Says About Your Cardiovascular Health

The heart is responsible for pumping blood and oxygen throughout the body. An elevated resting heart rate causes increased strain on the heart, often  linked to high blood pressure, high cholesterol, and a higher risk of heart disease.

A resting heart rate of more than 100 BPM is called tachycardia, whereas an RHR below 60 beats per minute is called bradycardia.

Other than a few exceptions (for example, medications that lower the heart rate), a lower resting heart rate is an indication that the heart is more efficiently pumping blood, requiring fewer beats per minute to distribute blood throughout the body. Because each beat is more powerful, the heart is much stronger than one with a high resting heart rate.

Fortunately, there are many ways to improve resting heart rate, thus improving overall cardiovascular health.

How To Improve Your Resting Heart Rate

This is where cardiovascular exercise comes in handy. A recent study conducted at the University of Lousiville concluded that regular exercise effectively lowers resting heart rate, which reduces the risk of cardiovascular disease.

We think of cardiovascular exercise as strength training for the heart. Aerobic workouts, like walking, jogging, or swimming, train your body to use oxygen more efficiently, which gradually reduces your resting heart rate and breathing rate — both of which are important factors of cardiovascular health.

A more efficient heart can even help athletes recover quicker between grueling workouts. Plus, it allows many of our physical therapy patients in Chevy Chase and Bethesda to better adapt to the physical demands of their lives.

Final Thoughts

Resting heart rate is an important measure of cardiovascular health. A significantly high resting heart rate often correlates with many health problems such as cardiovascular disease, high blood pressure, and high cholesterol. Conversely, a low resting heart rate indicates a strong, healthy cardiovascular system.

If you’re struggling to improve your resting heart rate, try adding in regular cardiovascular exercise to gradually improve cardiovascular efficiency. Resting heart rate will improve as a byproduct.

If you’d like to work directly with a physical therapist in Chevy Chase or Bethesda to help you with this, please contact us today to schedule a free consultation!