Traveling hurts!

Recently, I was working with a physical therapy client who was sharing her Thanksgiving travel plans with me—multiple rest stops and long hours in the car.

If you enjoy crowded airports and endless traffic, then this is almost your favorite time of year!

But, if you’re like most people, holiday travel isn’t exactly your idea of fun.

It seems like delays are inevitable. Remember the Southwest fiasco last year?

All that extra time sitting in the car or waiting at the airport can be uncomfortable. Your back stiffens up, your hips ache, and you start to feel tight all over. We hear about this a lot at our physical therapy clinics in McLean and Bethesda.

Holiday travel is already stressful, and discomfort is the last thing you need.

So, what can you do?

Move around! There’s no such thing as a perfect sitting posture—what’s important is to keep changing positions.

In our daily lives, we naturally shift from side to side as we stand and move. But this decreases when we’re sitting in a car, at the airport, or on a plane, causing discomfort in more sensitive areas of the body.

When sitting, try to locate your “sit bones”—the bones at the bottom of your pelvis that you sit on. Every 10-15 minutes, shift your weight from one “sit bone” to the other, and occasionally distribute your weight evenly for 5-10 minutes.

As a physical therapist, I often recommend alternating between having your legs straight and bent, and whenever possible, get up and take a walk. If you’re on a flight with me, you’ll see me stand up as soon as the seatbelt sign goes off!

If your neck, chest, or upper back starts to feel tight, remember the 20/20/20 rule!

Staring at your phone for too long can cause upper body discomfort.

The 20/20/20 rule, which comes from optometry, suggests that for every 20 minutes of focused activity, you should take a 20-second break and look at something 20 feet away.

This reduces strain on a single point and helps alleviate upper body tension.

These strategies should help reduce the tension that comes with holiday travel. However, they might not be enough if you have areas of your body that are recovering from an injury or are particularly sensitive.

Reach out to us to find the ultimate solution to your discomfort and start feeling your best this holiday season!

Why I don’t coach belly breathing anymore

If you have worked with me as a physical therapy patient in McLean or Bethesda, you know I love talking about breathing.

This is usually well received, but sometimes people look at me like I have two heads.

I get it because I used to think the same thing. “I’m here in physical therapy because my shoulder hurts, and now you are giving me breathing exercises.”

I bring a breathing component into many drills that I prescribe because our body adjusts to the position where it feels most comfortable. That position is the one it can best breathe in.

Sometimes, these adjustments impact the body’s ability to move, resulting in joint pain.

As physical therapists, we can help you correct these problems with drills that assist you in breathing more effectively where you are restricted.

Let’s start by focusing on where the breath comes from.

The lungs are located inside the rib cage. Our rib cage is designed to expand in 360 degrees when we breathe in and compress in 360 degrees when we breathe out. Think of it like an accordion.

When an area of our rib cage is restricted, our breathing is also.

Sometimes, our entire rib cage is stiff, causing people to compensate with an exaggerated belly breath.

While the belly is meant to move with the rib cage, it should not move in place of it. Don’t forget the lungs are in the rib cage, not the stomach!

Pay attention to my breathing cues in this 90/90 hip lift video, beginning at the 50 second mark. I begin with a silent inhale through the nose and a long sigh through the mouse before pausing for 5 seconds. This ensures that my chest and stomach rise as I inhale and reverse as I exhale.

Try including this breathing strategy in your stretches or mobility work, and nasal breath when at rest. Here is an article on the importance of doing so!

A physical therapist’s key to chronic shoulder pain

Recently, I’ve been hanging at a local gym, providing physical therapy in Bethesda and McLean to their members and the most common injuries involve their shoulders.

If you do a lot of weight training or CrossFit or are interested in having healthy shoulders for years to come, keep reading!

Shoulder injuries often occur when the shoulder is repetitively challenged at the limits of its motion, where joints are most vulnerable.

Many people attempt to solve this issue by stretching. Instead, focus on these two areas.

End-Range Strength Training

When your shoulder is pushed to its extreme ranges of motion, the muscles responsible for controlling the shoulder joint are challenged. These muscles struggle to generate the force needed to maintain stability because they are weaker in these positions. This weakness increases the risk of overuse injuries and may create wear and tear on the joint.

Physical therapy is the key to addressing these issues effectively. Rather than focusing solely on increasing flexibility, it’s about training the muscles to handle these extreme positions and generate the necessary strength to support the shoulder. Here is a drill I recently taught a weightlifter struggling with shoulder pain when lifting weights overhead to address this issue.

Get the rib cage moving

The rib cage is the foundation that your shoulder blade rests on, and the position of your rib cage will direct your shoulder where to go as you move.

As you reach overhead, your upper chest should expand. Unfortunately, many weightlifters or people who sit at desks all day have stiff chests that prevent this, resulting in extra stress to the shoulder joints.

If you love to crush chest workouts or are sitting a lot, give this exercise a shot as part of your daily routine or warmup.

What to do if you have months or years of shoulder pain

Work smarter, not harder.

Many people I’ve worked with have seemingly tried everything but didn’t first learn where the pain was coming from. They could have saved a lot of time and effort by first discovering the root cause. If you want to finally solve your shoulder pain, contact us to schedule a physical therapy evaluation today!

Is there one physical therapy intervention for running related foot injuries?

Ice baths, massage, compression socks, orthotics, rolling your feet out on tennis balls…

Have you tried one or more of these without much help?

This is Dr. Kelly, and as a passionate runner, sports physical therapist in McLean, and someone who doesn’t want to be interrupted by injury, I’ve learned foot pain is complex- there’s usually not “just one thing” contributing to it.

Here are a few things I’ve found to be most important in physical therapy when diagnosing foot injuries:

Foot Type, Biomechanics, and Shoe Type: Each runner has a unique foot structure and biomechanics. High arches, flat feet, overpronation, and supination can affect how your foot strikes the ground. It’s crucial to understand your foot type to choose appropriate footwear and support. Here is a link that better explains foot type. Ensure that your shoes provide adequate cushioning, arch support, and fit your foot shape properly. Regularly replacing of worn-out shoes is essential for injury prevention (recommended replacement after 400 miles of running).
Running Surface: The type of surface you run on can impact foot pain. Hard surfaces like concrete can be harsh on your feet, while softer surfaces like grass or trails offer more cushioning. Varying your running terrain can help reduce the risk of repetitive strain injuries.
Running Form and Mechanics: Variations in running form can strain muscles and joints differently. Understanding your form and what muscles are dominating during your run is important to building strength and endurance as well as overall mechanical balance. A Marching, Skipping, and Single leg hopping are great drills that help enforce foot strike directly under your center of mass and tendon elasticity while running.
Training Intensity and Volume: Overtraining or increasing your running intensity too quickly can stress your feet. Gradual progression and adequate rest are essential for preventing overuse injuries. In general, the best guideline to follow is to increase your volume by 10% per week.

Remember that everyone’s body is unique, and what works for one person may not work for another.

If you would like to finally solve the lower body injuries that are interrupting your ability to run successfully, don’t miss this FREE workshop..
“CHP’s Running Performance Lab”
Saturday, October 21st at 9am
Cohen Health and Performance
1401 Chain Bridge Rd, Suite 203
McLean, VA 22101

In this workshop, you will discover the root cause of your injuries and learn exercises to solve them.

We only have 5 slots left, so don’t miss your chance to sign up here.

Fitness watches: what stats should you care about?

Dr. Kelly Henry here. I work with lots of runners in McLean as physical therapy and performance training clients. We all know a runner who is obsessed with their watch, and with all the technology these days, your fitness watch can tell you just about anything.

This is informative and overwhelming at the same time.

So many statistics are provided, but how many of them are relevant? And if they are relevant, what do they mean? After doing a deep dive into my own watch (a Garmin Venu Square), and some market research on other running watches’ statistics, here is what you should care about:

Resting heart rate

What this means: How fast your heart beats when you are not doing any activity.

Why you should care: A normal heart rate ranges from 50-100 beats per minute, but more importantly, your watch is learning what is normal for you. Fitness watches usually do a good job of tracking this. Knowing your resting heart rate is a good indicator for helping you determine what your heart rate should be when you’re exercising. A raised heart rate can indicate a number of things, but regarding your training, it can indicate overtraining and a lack of recovery.

Heart rate zones

What this means: Most fitness trackers divide your heart rate into Zones 1-5. These are determined based on your resting heart rate and a hypothetical maximum heart rate derived from a standard calculation.

Why you should care: You can use your heart rate zones to guide the intensity of your training. Most of your workouts should be performed in Zones 2-4. If you are performing cardiovascular exercise, exercising in Zones 1-3 will provide more of an aerobic benefit (lower intensity, longer duration), whereas Zones 4-5 should focus more on anaerobic systems and power development (fast runs, sprints, or interval training). If you aim to address certain improvements (speed vs. endurance), using heart rate zones can be a great objective way to determine how to adjust your perceived effort. Keep in mind heart rate can be impacted by other factors, including heat and time of training.

Cadence

What this means: Simply put, cadence is how many steps you are taking in one minute. Aka, how fast your feet are moving.

Why you should care: Measuring cadence helps to make you aware of your stride length and energy expenditure while running. A longer stride often results in a lower cadence and vice versa. Research has shown that patients with knee pain after running often benefit from a shortened stride by increasing stride length. An ideal cadence for most people is 170-180bpm (beats per minute).

Distance

What this means: How far you ran/walked/moved.

Why you should care: Tracking distance ensures that you are progressing your exercise appropriately and is one of the main things runners care about. While some people prefer time-based exercise, distance may be easier to track if you are working on maintaining a consistent pace. Tracking distance over time is important to ensure there is adequate training volume and can prevent over or under-training. Generally, you should aim for a ratio between 0.80-1.20 when comparing month-to-month averages. This means that the weekly average of this month’s distance is not less than 80% or more than 120% of the weekly average of last month’s distance. Your watch should calculate your weekly mileage for you! Use this mileage in the following formula:

(Week 1 distance + Week 2 distance + Week 3 distance + Week 4 distance) / 4 = Average Workload)
Then divide this number by the average workload from the previous month. This is more accurate for more experienced runners, while less experienced runners or those who run shorter distances may be able to increase their distance more liberally.

Heart Rate Variability (HRV)

What this means: The variation in time between heartbeats. Although our heartbeat is often described as a metronome, it is not. There are small differences in the intervals between each of your heartbeats, which are impacted by your sympathetic nervous system. HRV depends on multiple readings, including core body temperature, circadian rhythm, metabolism, and sleep cycle, to make the best estimate.

Why you should care: In a broad scope, increased HRV can be correlated with better aerobic fitness (if there is no underlying pathology). While it’s difficult to properly measure HRV strictly from a wearable, it can indicate training adaptations and improvements in cardiovascular health. HRV is good supplemental data but shouldn’t be the basis for any training changes since the sensitivity of this measurement is limited, and the most accurate HRV reading will come from a controlled clinical setting. Multiple comorbidities can impact HRV, including chronic pain, inflammation, insomnia, concussions, depression and anxiety, and other stress.

These 5 statistics only scratch the surface of what your fitness watch can do for you. If you are a runner searching for an advantage over your competition, schedule a consultation by replying to this email. In this consultation, she will help you determine how to use technology to your advantage and other ways to improve your performance.

What is that pinch in my hip?

Have you ever felt a pinching sensation in the front of your hip? This is one of the most common symptoms that our sports physical therapy hears from people with hip problems.

We hear about it from all ages and populations – field athletes, powerlifters, weekend warriors, etc.

Our physical therapy patients in Bethesda and McLean note that they feel an uncomfortable sensation in the front of their hip whenever they flex their leg, squat, or bear lots of weight on one side. This may happen during running, lifting weights, or getting on and off the floor.

The hip is a big, complex joint with lots of moving (and not moving) parts! “Pinching” symptoms often involve a few structures. Some to note are the hip labrum, the hip flexors, and the shape of your hip ball and socket itself. While it may be difficult to diagnose the exact cause of those symptoms, your physical therapist can perform a physical exam to differentiate what is giving you problems and how we can address this in physical therapy.

Often, it is a combination of the 3 factors above. Muscle testing, range of motion, and a deep dive into your symptoms and history inform us about the cause of your pain. Findings we see include:

1. Decreased hip flexion or internal rotation range of motion
2. Discomfort and difficulty with deep squatting or lunging
3. Weakness of the hip flexors, abdominals, or hip abductors/adductors

But why does this happen?

As mentioned, the hip is a big, complex joint supporting much of your body weight. As we move throughout the day, from walking to running to sitting to standing, our hips and pelvis adapt to the changes in the load being placed on them. Our joints are lined with cartilage that helps absorb shock and protect the joint. The muscles around our joints help to manage additional stress and decrease the amount of pressure on the joint. If one of these three pieces is affected – the hip labrum (cartilage), the hip muscles/tendons, or the bony structure of the joint itself, the other pieces will be affected as well. This can progress to labral tears, hip flexor tendinopathy, and chronic hip impingement symptoms.

In simple terms (although none of this is simple!), there is too much pressure in one spot. As physical therapists, our job is to teach you how to manage this pressure better, protect the structures that are giving you problems, and gradually progress you back to the activities that you want to do while respecting the healing process. A few interventions we use to do this are:

1. Hip range of motion drills

Hip flexor/adductor isometric strengthening

Dynamic hip flexion progressions

If you have been experiencing a consistent pinching sensation in the front of your hip, see a healthcare professional, preferably a sports physical therapist. These symptoms commonly become more intense and limiting over time. Contact us now for help solving your chronic hip discomfort!