Debunking the Bone on Bone Myth

“Best Walking Shoes for Knee Pain for Women” by gm.esthermax is licensed under CC BY 2.0

I’m sure you’ve heard someone say it before:

“My knees are in such bad shape. It’s pretty much just bone on bone down there.”

Although this is a commonly held belief, athletic physical therapy speaks to the truth: “bone-on-bone is largely a myth.

Many patients complain of knee pain because they are “bone-on-bone” assuming there is nothing they can do but get surgery.

Fortunately, this common misconception just isn’t true. If a person is experiencing joint pain, one of the first treatment measures is X-rays or another imaging study of the joint. If the joint damage on the X-ray is severe, you may be told you are “bone-on-bone.” However, all that term means is that there is some amount of cartilage loss in the joint.

As the cartilage deteriorates, there is less cushioning between the ends of the bone that form the joint. This “rubbing” of bones against each other with less cushioning causes pain and discomfort. However, rarely, if ever, is the cartilage of the joint completely destroyed.

A doctor at the Core Medical Center in Blue Springs, MO, conducted more than 1,000 knee X-rays and discovered only one case where the cartilage of the knee joint was completely destroyed. The other 999 cases were simply deterioration of the cartilage, but it remained intact and functioning.

The truth is that “bone-on-bone” is just a fancy way of saying the cartilage is slowly deteriorating. Very seldom does it ever completely disappear. This term is used by doctors and physical therapists to better describe the situation to patients and the severity of their pain points.

If you’re experiencing joint pain or discomfort, our injury rehabilitation clinic in Bethesda/Chevy Chase can help! Whether you’re looking to overcome a recent injury or sick of joint pain preventing you from enjoying an active lifestyle, our team of physical therapists can help!

Can Hiking Make You A Better Runner?

If you’re running is starting to feel stale or boring, it might be time to switch things up. Officially known as “cross-training” in sports physical therapy, hiking can be an effective training strategy to help prepare for running. From both a physical and mental standpoint, there are several benefits that hiking will have on your running performance.

Aerobic gains with less chance of injury

Hiking is the perfect low-impact cardio alternative to running that vastly decreases the impact on the joints and muscles. Doing this low-intensity activity over long periods can help improve your aerobic engine, which helps new runners.

Engage different muscle groups

In our experience with performance physical therapy in Bethesda and Chevy Chase, we’ve noticed that runners can sometimes rely heavily on certain muscle groups while ignoring other important ones. The uneven terrain of hiking requires lunging and squatting movements, which help activate different muscle groups. Adding hiking to your training can help to utilize less-utilized muscles.

Improves balance and leg strength

Hiking, specifically on uphill climbs, requires you to use your glutes and quads to get over hills. This motion is similar to the act of running and gives the body a chance to exert itself without the added stress of actually running. Maintaining a steady pace while hiking also engages the core and stabilization muscles, improving balance and running form.

Stress relief

Let’s be honest — most runners choose time-saving routes in the neighborhood or treadmill rather than getting out on a trail. Though this is great in a pinch, being in nature can help alleviate stress and anxiety, improve productivity, and increase creativity. By cross-training with a hike, you’ll not only improve your performance but your mental health as well.

Make the most of your visit: 3 questions to ask your physical therapist

Whether you’re attending in-person or virtual physical therapy, your success largely depends on how engaged and involved you are in the process. A physical therapist’s role is to identify issues, develop a personalized treatment plan, and guide you toward recovery. However, as the patient, your active participation is just as crucial. Asking the right questions during your sessions can empower you to take control of your health and recovery journey.

Here are three essential questions to ask your physical therapist to ensure you get the most out of your sessions in McLean or Bethesda.

1. Why Did This Happen, and How Can We Prevent It from Happening Again?

One of the key goals of physical therapy is not just to treat the symptoms but to address the root cause of your pain or injury. Whether it’s a recurring injury, chronic pain, or post-surgery rehabilitation, understanding *why* the issue occurred in the first place is crucial to preventing it from becoming a long-term or recurring problem.

By asking your physical therapist about the underlying cause, you’ll gain insights into the factors that contributed to the issue—whether it’s poor posture, repetitive strain, muscle imbalances, or even lifestyle habits. With this knowledge, you and your PT can develop a plan to not only treat the current problem but also take proactive steps to ensure it doesn’t happen again. This might include correcting your movement patterns, strengthening weak areas, or making adjustments to your daily activities.

2. What Should I Be Doing at Home to Support My Recovery?

Physical therapy sessions are often limited to a few hours per week, but your recovery continues long after you leave the clinic. The majority of your time will be spent outside of the physical therapist’s office, which is why it’s critical to know what exercises, stretches, or adjustments you should be doing at home.

Ask your physical therapist for a clear and detailed home exercise program that complements your in-person treatment. This plan should be tailored to your specific needs and capabilities, ensuring you’re doing the right movements to support your progress. A good physical therapist will not only show you the exercises but also explain why they are important, how to perform them correctly, and how often you should do them.

On the flip side, it’s equally important to know what not to do. Certain activities or movements could slow down your recovery or even worsen your condition. By clarifying both the “dos” and “don’ts,” you’ll feel more confident in managing your rehabilitation at home.

3. How Can You Measure and Ensure I’ll Make Progress?

The ultimate goal of physical therapy is to make meaningful progress toward your recovery goals, whether that’s reducing pain, improving mobility, or returning to your favorite activities. However, many healthcare systems focus on generic benchmarks, such as returning to basic activities of daily living (ADLs) or reaching a general “baseline.”

While these objectives are important, physical therapy should go beyond just meeting minimum standards—it should be about helping you achieve your personal goals. By asking how your progress will be tracked and measured, you set the expectation that the focus is on your individual needs, not just generalized outcomes set by insurance companies.

Your physical therapist should provide a clear roadmap for your recovery, outlining the specific milestones and indicators they’ll use to track your progress. This could include improved range of motion, increased strength, reduced pain levels, or functional abilities tied to your lifestyle. Regular check-ins and reassessments will ensure that your treatment stays on track and is adjusted as needed.

Physical therapy is a partnership, and the more actively engaged you are, the better your results will be. By asking thoughtful questions and staying informed, you’ll not only deepen your understanding of your treatment plan but also enhance your ability to manage your health outside of therapy sessions.

Athletic injury rates are on the rise

As the weather warms up, COVID-19 cases decline, and spring sports resume, many young athletes are eager to return to their favorite activities. While the excitement to get back on the field is high, it’s crucial to prepare your body properly to avoid injuries and maintain good health. In the Bethesda and Chevy Chase areas, proper performance training can make all the difference between a dream season and being sidelined.

After a long break from sports, the risk of injury is elevated because the body isn’t accustomed to the demands of sport-specific activities. That’s why it’s essential to spend time before the season starts preparing both mentally and physically for peak performance.

Research shows that strength and conditioning training can reduce sports injuries by 33% and overuse injuries by nearly 50%. Therefore, it’s important to begin with simple, manageable exercises to get back in shape and stay injury-free.

A smart approach to preseason training starts with individual sport-specific drills focused on conditioning. From there, athletes can gradually progress to drills with a partner or opponent. Eventually, they can increase their activity level to include team drills, scrimmages, and full game play. This gradual increase in activity, similar to what is seen in professional and collegiate sports, allows the body to adapt and handle the cumulative stress.

The best way to develop a sport-specific training program that meets an athlete’s individual needs is to consult a professional who can tailor the program to their unique strengths and weaknesses. If you’re looking to optimize your performance after a long offseason or recovery from injury, consider seeking performance training in Bethesda or Chevy Chase to kickstart your dream season.

Here’s to a fantastic new season—don’t forget to enjoy it!

An Essential Part of Athletic Physical Therapy: Strength Training for Runners

Many of the runners that we work with at CHP supplement their running with strength training. Strength training is a large component of athletic physical therapy and provides a host of benefits including, but not limited to; reduced injury risk, increased muscular endurance, and faster running times. Research shows that regular strength training improves a runner’s speed and VO2 max. VO2 max is a measure of the maximal amount of oxygen that a person can use during exercise.

However, there is one important caveat to all of these great benefits. A runner’s strength training program must be designed and executed appropriately, and according to the runner’s goals and individual characteristics.

Luckily, most runners have similar goals. They wish to run faster and/or farther, and avoid injury.

Strength training programs for runners should consist of exercises that improve qualities specific to running.

When running, there is never a time when both feet are touching the ground simultaneously. The arms and legs are constantly moving in opposite and alternating directions as the body transitions from one foot to the other.

Therefore, we commonly advocate for runners to include more single leg exercises into their training.

These exercises include, but are not limited to: lunges, single leg squats, split squats, and single leg RDLs (Romanian deadlifts). Simply adding one of these activities into each of your strength training sessions can have a large impact. Take a look at the videos below for examples of these activities.

https://www.youtube.com/watch?v=aazACzyUR-Q

https://www.youtube.com/watch?v=KK05iugeIDE

https://www.youtube.com/watch?v=EjDtPek261c

Furthermore, runners should not neglect upper body training. Arm drive is an essential component of running and helps to drive leg action. An effective runner cannot have one without the other!

A thoughtful and more scientific approach to strength training, specifically designed for runners, may be all that is needed to drastically improve your running performance.

How Tom Brady Approaches Off-Season Training

Tom Brady is a marvel to the world of Sports Physical Therapy and performance training.

As you may know, Tom Brady is about to make his 10^th trip to the Superbowl at the age of 43. The opposing Quarterback in this game will be Patrick Mahomes. Mahomes was in kindergarten when Brady played in his first Superbowl back in 2002!

Athletes like Brady approach their off-season training with very specific goals in mind. These include sport and position specific goals (ex. Improving footwork, accuracy, throwing mechanics), as well as goals related to health and fitness.

The greats across sports such as Brady, Lebron James in basketball, and Wayne Gretzky in hockey focus their off-season training on staying healthy throughout the upcoming season. They understand the classic saying that “the best ability is availability.”

They realize that attributes that make them more resilient to injury will also improve their performance on the field, court, or ice.

Brady requires a great deal of mobility to best absorb the hits that accumulate throughout a football season. An increase in mobility will also allow him to throw accurately from the variety of awkward positions that the body is contorted into throughout a game, thus improving his performance as well.

Lebron James possesses an incredible amount of single leg control and strength. This is necessary to propel his nearly 270-pound body into the air as he jumps off 1 leg. This control and strength are equally important to avoid injury as he lands and must quickly adapt to awkward situations (players falling under him or contact him in the air).

Much like Brady, Gretzky must also be capable of contorting his body into a variety of different positions to pass or shoot from varying angles, absorb contact, or maneuver around opponents. These abilities require lots of mobility and strength throughout a variety of different positions.

The actual off-season training for Brady, James, and Gretzky will look different for each. However, the bulk of their training likely will not include commonly performed gym-based exercises, such as deadlifts or bench press. These are fantastic exercises when performed in the right context, however do little to help with the performance of these athletes.

It is essential for more athletes, specifically youth athletes to think more like Brady, James, and Gretzky when approaching their own off-season training. What are their goals for the off-season? What attributes best contribute to success on the field of play and help the athlete to stay there? Are the exercises being performed the best choices for this?

The optimal off-season program is unique to each individual and will even be different among athletes that play the same sport. However, it is essential that the previous questions are asked at the start of the off-season to ensure that weight room improvements will be transferred to the field of play.

Would you like help determining the attributes that you must work on this off-season to take your performance to the next level for the upcoming season? A custom designed off-season training program may be what you need to blow your coaches away.