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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!

Why Mouth Breathing Can Be a Problem

There are a variety of circumstances that can contribute to increased levels of stress. Some common examples include work pressures, family problems, money issues, and health concerns. But in recent years, athletic physical therapy has proven that a lesser-known stress contributor is actually how you breathe.

According to Seth Oberst, DPT, there are two primary ways humans breathe — either through the mouth or the nose. When mouth-breathing is your primary mode of respiration, you are actually stressing your system more than if you were to breathe through your nose.

When you breathe through the mouth, your head is forced to move forward to maintain an open airway. Unfortunately, this causes a cascade of negative effects that can put even more stress on the body:

  • Taking air in through the mouth isn’t effectively mixed with nitric oxide, so you have to inhale more air than necessary.
  • This over-breathing increases your sympathetic nervous system (fight or flight) activity.
  • As you inhale more and more air, your heart rate increases, along with muscle tension and stress levels.
  • While you may be physically or mentally exhausted at night, you end up tossing and turning — waking up feeling more tired because your brain is starving for oxygen.

All this to say, how you breathe is important. While you can certainly survive by mouth-breathing, it will be difficult to thrive. If nose breathing is difficult for you, start by doing 3–5 minutes of dedicated nose-breathing per day to increase your comfort levels.

If you want to learn even more about proper breath-form and reducing stress, our experienced athletic physical therapy team in Bethesda/Chevy Chase can help!

Surprising Benefits of Walking for Mental and Physical Health

“Morning Walk” by /\ltus is licensed under CC BY-NC-ND 2.0

One important but often overlooked aspect of a healthy lifestyle and even injury rehabilitation is walking. Walking is a simple way to improve physical fitness and health while reducing the risk of various diseases.

The Benefits of Walking

Physical activity doesn’t need to be complicated. Although walking is often overlooked, science shows that putting one foot in front of the other can have some impressive mental and physical benefits.

  • It helps to maintain a healthy weight and trim body fat.
  • Increases energy levels and improves mood, memory, and sleep.
  • Reduces stress and tension in the body.
  • It eases joint pain and boosts immune system function.
  • Improves cardiovascular health and muscle endurance.
  • Reduced risk of common health problems such as heart disease, obesity, diabetes, and high blood pressure.

You may be asking yourself, “That sounds great, but how much should I be walking to reap all these benefits?”

How Many Steps Should You Get Per Day?

Walking is one of the best low-impact forms of exercise that can be done on a lunch break, while talking on the phone, or to get to your favorite coffee shop down the street.

Although the exact number of steps per day can vary based on age, health, and fitness goals, most experts recommend at least 10,000 steps per day. As a general rule of thumb, the faster, farther, and more frequently you walk, the greater the benefit you’ll experience.

By completing 10,000 steps per day, most adults can burn an extra 2,000–3,500 calories while also reaping the incredible benefits of additional cardiovascular exercise.

Not only is walking a great time to disconnect and unwind, but it will also improve your mental and physical health. 10,000 steps per day is a great goal for anyone looking to jumpstart a healthy lifestyle. However, if you want a more personalized approach, a physical therapist from our clinic in Bethesda can help!

3 Critical Questions To Ask Your Physical Therapist on the First Visit

Physical therapy (both in person and virtual physical therapy) is most effective when you are actively involved. While the physical therapist is responsible for identifying issues and developing a plan, the patient should be actively involved by asking questions and providing necessary background information. Here are three important questions to ask your physical therapist to get the most out of your session in Chevy Chase or Bethesda.

1. Why did this happen, and how can we ensure it doesn’t happen again?

Solving the underlying issue and resolving any pain or discomfort is essential when working with a physical therapist. But beyond that, you also want to ensure that the problems don’t resurface. By asking about the root cause of the injury or pain, you’re able to better prevent the problem from becoming a long-term issue.

2. What do I need to be doing at home?

Unfortunately, time with a physical therapist is limited. Outside of a few hours a week, most time is spent away from your PT. When meeting with a physical therapist, it’s vital to clarify any exercises you should or shouldn’t be doing at home. A great physical therapist will make sure you have the tools and exercises needed to take control of your health, both inside and outside of the session.

3. How can you be sure I’ll make progress?

If you decide to work with a physical therapist, the intention should be to progress towards your goal. Oftentimes the  healthcare system will establish general objectives, such as reaching a “baseline” or returning to ADLs (active daily activities). Although these standard guidelines are a good starting point, the purpose of physical therapy is to reach your goals, not the goals of the insurance companies! By asking this question directly, you set a clear intention for the results you desire.

Physical therapy works best when there’s an active partnership between you and the PT. The more engaged you are in your health, the more progress you will make. By asking these three essential questions, you’ll set clear intentions for your physical therapy and build a better working relationship as a result.

Fact or Fiction: Do our bodies actually fall out of alignment?

We are excited to begin a series of posts discussing common myths in the realm of athletic physical therapy. Today’s myth commonly applies to back pain physical therapy as well.

Many of our patients have been told that their body may be “out of alignment”, or that their joints need to be “re-aligned.” Unfortunately, this is not the greatest advice.

Human beings are never in a static position. Even at rest, the simple act of breathing creates movement. By definition, being in alignment means that our bodies are in a straight line, or that all parts of our body are consistently in the appropriate relative positions to one another.

We cannot consistently be in alignment because we are always moving. If our body was constantly aligned, we would be unable to move anywhere.

Your body can feel as if it is out of alignment when you overuse or rely upon specific movement strategies or body positions. This can happen for a myriad of reasons and results in feelings of stiffness and discomfort that often temporarily feel better with an adjustment.

An adjustment can be helpful if the causes of stiffness or discomfort are also addressed. The root causes of stiffness or discomfort are typically addressed by focusing on movement limitations that are present.

Any relief provided by an adjustment will be temporary when the root cause of the discomfort or stiffness is left unaddressed. Check out the article below for some activities that may help!

3 Home Exercises to Help Your Back Pain

We hope that this provided some insight into a common rehab myth. Stay tuned for more to come!

Do your running shoes pass the test?

You don’t need performance physical therapists like us to tell you that footwear makes a large impact on running performance. The correct running shoe can reduce your race times and lower your injury risk.

When walking into any running store in Bethesda or Chevy Chase, you will find many different shoe brands and several different models of shoes within each brand. Among this wide array of shoes, how do we determine which is best for you?

The answer is different for each person and is dependent on a multitude of different factors. However, any running shoe must meet a few requirements to be considered and these are the first things we look for when assessing any running shoe in physical therapy for runners.

The first is that 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 around within the shoe, which would negatively impact foot mechanics.

Next, the shoe must have a toe break that folds where your toes bend.  Place your shoe on the ground and hold it there. Pull the front of your shoe upwards from underneath. The folding point of the shoe should be located where your toes bend. If your shoe prefers to fold at another location, your foot is being encouraged to bend somewhere else. This alters foot mechanics and can lead to breakdown within the structure of the foot itself.

Finally, you should be able to feel the entirety of both 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 are receiving better ground contact.

There are 26 bones and 30 joints within the human foot. This results in a large number of ways that our foot can compensate, and therefore, a large number of factors that we need to be mindful of when choosing the correct running shoe.

The 3 factors outlined above are a good place to start when choosing the right shoe, however there are many other factors that may also need to be considered.

Please contact us for help assessing your foot and determining the best running shoe for you!