Ann Arbor Physical Therapy

Doctor Recommends Neck Surgery....But She Said No! Woman In Her Early 40s Overcomes Neck Pain and Numbness Without Pills (Learn How)

Dealing with chronic neck pain is very common for many people.

Some choose to ignore it, others use medication, and others “just deal with it”.

That is…. Until the pain becomes so unbearable that it’s impossible to ignore!

We hear this story all the time, and it’s what eventually caught up to Jill in her early 40’s.

Jill.jpg

Suddenly one day waking up and having excruciating neck pain with numbness, tingling, and shooting pain running down the arm.

She could not sleep, drive, focus, work, or do simple daily tasks around the house. Medication didn’t even dull the pain the slightest.

Being scared that she did something serious, she did what anyone would do…

Went to her Doctor, who recommended a neurosurgery consult. An MRI was ordered and she was diagnosed with a cervical disc herniation. The Surgeon then said “Surgery is the only thing that will help.”

Not comfortable with having surgery, Jill decided to seek out care from someone else. Luckily On Track Physio was her first stop!

Our approach is very different then many others out there, which is why we can get results even when a surgeon says her “ONLY option is surgery”….

Today Jill no longer experiences neck pain!

She has lost over 50 lbs with a new fitness routine, and is in the best physical shape of her life. To stay on top of the issue and protect herself from anything like this from occurring in the future she continues to see On Track Physio less than once a month to just check in and get a “tune-up”.

Much like a car needs an oil change, even though the body no longer experiences pain. It does well getting the occasional tune up to make sure everything is operating well!

Listen to Jill’s Story below:


*** If you’d like to find out exactly how we can get results for you. Then we suggest starting with a FREE Discovery session just like Jill did.

Shoulder Rehab Part 1

Chances are if you have been to Physical therapy, you have probably seen someone performing the exercise below working on their shoulder. Okay, so maybe not with their shirt off. But nevertheless it seems to be a staple of every physical therapy program for the shoulder.

While this is certainly a useful exercise, and it will defiantly get some patients feeling better. However, the vast majority of the patients that walk through the door need a more comprehensive program than this.

Maybe just as bad, the physical therapist or assistant will hand you 2-3 pages of similar exercises, tell you to do 3 sets of 15, 2-3x per day.  Ever heard of the shotgun approach?  Your health care provider is hoping and praying that one of these might just work and make you feel better. That being said, the exercises do have some legitimacy and are very useful for the sedentary population. However, if you are reading this then chances are you take an active roll in your health and you have found these exercises work, but don't always cut it when it comes to getting you back to 100%.

So here is the reality of the rotator cuff:  It’s job is to stabilize the humeral head (the ‘ball’ of the shoulder) in the glenoid fossa (the socket). Its secondary job is to assist with actual movement.

What most health care providers are going on are fancy EMG studies that measure how hard a muscle can fire in isolation during a specific activity.  There is certainly great evidence that the rotator cuff muscles are firing during these exercises.  The problem as I alluded to before is that these muscles do not function solely in this way in real life.

These smaller rotator cuff muscles are stabilizers, not movers(like the larger deltoids, pecs, lats, etc).  The traditional rotator cuff exercises train the muscles like ‘movers’ which is not their true function.  

The reality of the rotator cuff again is to stabilize the humeral head (the ‘ball’ of the shoulder) in the glenoid fossa (the socket).  It performs this task reflexively, meaning it happens without you having to think about it.  All four muscles quickly fire and relax in a specific sequence (depending on the activity) to stabilize the shoulder joint.  They never work in isolation.

So what are the best ways to fire the rotator cuff reflexively?

1) Compression – this means putting weight through the arm.  Examples would include exercises that involve hands or forearms on the ground holding your body weight up (think pushup, plank, or a variety of other variations. Another example would be actually pressing a weight when deemed appropriate.  

2) Distraction – this would include anything that pulls downward or outward on the shoulder (think traction).  This would include carrying weight by your side, pull-ups, horizontal rows, lifting from the floor, etc.

In any of the above activities, the brain immediately recognizes the need for stability and reflexively fires the cuff to prevent bad things from happening like dislocating your shoulder or falling on your face.  Now obviously I’m not trying to actually do these things to you, but forcing muscles to fire reflexively always works better when there is some sense of urgency.

I’ll leave you with a few of my favorites below, and in part 2 I’ll tackle more as we start to look deeper.

Arm/Leg Diagonals – a.k.a. the Bird Dog – Shoulder Compression for Reflex Stabilization

Bottoms up Carry – Downward distraction with instability to elicit reflex stabilization

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Box Squat with Single Leg Concentric

Last week I contributed this exercise to the article: Great Exercises You're Not Doing. In case you missed it, here is the summary below.

Want to improve your squat without your knees and hips always feeling so beat down. We all know squats are important for performance. However, performing heavy squats multiple times per week can become brutal on your joints. The box squat with a single leg concentric is an excellent way to still train the squatting pattern with high effort, but utilizing a lighter load that decreases the compressive stress on the joints.

How to perform the exercise: Set up a bench/box to an appropriate height/skill that allows you to squat to a depth of near parallel. Squat down to the box. Move one leg in closer towards mid-line, and extend the opposite leg out keeping the heel on the ground. Subtly shift your sternum toward the working leg, and push through the entire foot to stand up tall. Repeat on one leg for desired number of reps before performing on opposite side.

When performing the exercise you may notice that one side feels much easier than the other. You may also notice that one knee displays greater control or balance on one side compared to another. These are a couple of asymmetries you will want to improve upon prior to increasing the amount of weight you put on the bar.

Follow On Track Physical Therapy at:

Youtube: https://www.youtube.com/channel/UCzXQcUcMiYsrEJkPVYb_SIA

Facebook: https://www.facebook.com/ontrackptandperformance/

Instagram: https://www.instagram.com/sportsrehabexpert/

Does Gaining Range of Motion Really have to Hurt?

Not all physical therapists are created equal. Nor does gaining range of motion have to be extremely painful! Unfortunately there is this idea among the public that physical therapy has to hurt to be effective. In most cases, nothing could be further from the truth. Sadly enough there are plenty of physical therapists out there who also believe "no pain, no gain" to be true.

Before we go any further, I need to clarify that pain is very different then a "stretch", "pull", "pressure" or "fatigue/workout soreness". Just because I don't believe in "no pain, no gain" doesn't mean I'll vouch for laziness or sub-par effort.

So here is why gaining range of motion does not have to hurt:

–  When the brain starts feeling ‘stress’ it goes into protection mode.  A pain response results in signals sent to muscles, fascia, and joint capsule to literally tighten down to protect the painful structure.  So the entire time your PT is cranking on your new rotator cuff repair, knee replacement, or you are cranking on it at home per their instructions. Your brain is busy fighting back.  The result is lots of pain and minimal progress.

– Pain fires up your sympathetic nervous system, the part of the system that handles ‘fight or flight’ situations.  To complicate matters, research has found that a lot of people are already in this sympathetic state even at rest. These individuals tend to exhibit increased stress hormone levels that result in poor sleep patterns and poor recovery from workouts and games (If you are coming off of surgery, I would argue that you are already in this state to some capacity anyway).  This elevated level of stress over the long term can have some serious effects and implications on rehabilitation.

Balance is good!

The moral of the story here is that increased pain levels correlate with increased stress levels which can delay healing and recovery.  Some pain is going to be present when you’re dealing with an injury or surgery, but your therapy should not be making you consistently feel worse! Increased pain is not an ideal situation for someone trying to gain range of motion, strength, and returning to work or athletics.

So how do we avoid the "no pain, no gain" philosophy! For starters, you still need to put forth maximal effort. Laziness will not get you out of pain. If you are post surgery then you should expect some type of "stretching" or "pulling". It is very important to distinguish between this and actual pain. The surgical limb has to move (when appropriate) and move frequently in order to start improving and building back up normal tissue resiliency. However, you want to avoid jamming your limb through further ranges of motion putting yourself into a further stressful (sympathetic) state then you already are post surgery.

Taking this a step further, in both surgical and non surgical folk we want to consider other areas which could be contributing to your overall dysfunction and pain on movement. This means looking at the joints above and below the injured area to make sure they are functioning optimally. Assessing the difference between active and passive movements also plays a role on distinguishing between actual soft tissue restriction or just lack of motor control or coordination in those end ranges of motion.  Muscle strength, endurance, work capacity, and timing are all important factors as well.

Next time you go through a physical therapy treatment, or any treatment for that matter, ask yourself if all these things are being assessed? If your program feels like a cookie cutter program then it probably is! Find a provider that understands pain and will take the time to assess/reassess movement. In most cases, there are better ways to gain range of motion and strength than trying to push through restrictions and pain.

Plank Exercise Progressions

A lot of people will perform planks as part of their exercise routine.  The front and side plank get a lot of love, and for good reason! For a lot of people these exercises are challenging enough. However, once you've mastered the basics, you may need to step it up a notch. Here are some challenging progressions that I feel really carry over to athletics and can get you closer to your training goals. Each of the following plank progressions add hip motion to the equation so you will be supported on one limb for a period of time.  It’s the support leg that is most important for stability and will be working the hardest.  With all of these exercises, you must maintain a stable core.  So in other words, when you lift a leg your trunk should remain motionless.  If you have to lift your butt up or it sags down then either it is too much for you or you are getting fatigued and need a break.  Perfect reps, nothing less.

The other great thing about these exercises is that they give you a chance to look at symmetry.  By this I mean how does your right leg compare to your left leg when doing a front plank, or how about right and left sides when performing a side plank?  It should be just as easy or difficult on both sides.  Right-Left asymmetries are a huge predictor of injury so work to limit these.  Typically I will have patients or athletes perform an extra set on the weaker side to bring that side up to par.

Alright, done with the lecture.  Check out the plank progressions below.

Prone Plank with Hip Extension -alternate lifting legs about 4-6 inches off the floor.  Nothing moves but the hips.  Shoot for 10 solid reps each leg without losing form.  And if you’ve been paying attention in previous posts, hold the leg up long enough to cycle a breath, then set it back down.  That will be the true test of your inner and outer core working together.

Side Plank with Hip Abduction – I really like the side planks as they test your entire lateral kinetic chain for stability.  Post up through the forearm by pressing it ‘through the floor’.  Now lift the top leg keeping the hips high.  Shoot for 10 quality reps with proper diaphragmatic (belly) breathing throughout.  When you can achieve that, now hold the leg at the top and cycle a breath before bringing it back down. 

Side Plank with Hip Adduction –this is another great variation that I think gets overlooked.  The bottom leg will be off the ground in this case so the adductors (inner thigh muscles) of the top leg will be carrying more of the load.  Breathing is crucial again so get it right.  Start with 10 second intervals if necessary shooting for 30 second holds ultimately.  If you’ve achieved that, then progress the exercise by moving that bottom leg back and forth.  It should look like a running stride – flex the hip up and then extend it back.  Adding the front to back movement will make your core have to work that much harder to remain stable.  I’ll shoot for 10 reps here again as well.

Three great ways to challenge yourself!  Remember to play close attention to those side-to-side differences.  Cleaning those up will bring the greatest benefits.

Physical Therapy - Ann Arbor, Mi

So what should Physical Therapy look and feel like? There are many things to consider when choosing which physical therapy clinic is right for you.  Over the next few weeks I’m going to offer a few suggestions for things to think about, or even ask other therapists about, prior to beginning a course of physical therapy.

Some things should be fairly obvious such as will you see the same therapist each visit? How much time each visit will I spend DIRECTLY with my therapist (not supportive personal)? How many visits per week? and so forth.

What I want to discuss are the things most people would not normally consider (in fact, most therapists and physicians aren’t thinking this way either!)

1) Movement Based Approach:  my previous blog entries Don’t Put Fitness on Dysfunction and Movement Proficiency and the Ankle describe how looking at patterns of movement are critical to narrowing down where the cause of the pain is coming from.  Just because your back hurts doesn’t mean it’s the back’s fault.  Your back may just be the victim of poor hip mobility below and poor Thoracic and ribcage mobility above just to name a couple.

A simple model I discuss in those previous posts is the Joint-by-Joint model of alternating mobility and stability requirements.

Following the traditional physical therapy model, you’re probably not going to find the connection (Instead the pain in the low back is generally the only focus). Don't get the wrong impression. It's not that the low back does not deserve to be treated to reduce pain and inflammation.  That absolutely must be done! But if that is all that is addressed, then chances are your low back symptoms will be back sooner than later.

The Selective Functional Movement Assessment is a quick and effective way to determine the person’s most dysfunctional movement pattern.

The object is to determine which pattern is the most dysfunction, and then break that pattern down into it’s component parts to find the impairment.  So for example, if someone cannot touch their toes, it could be a lack of mobility in the spine, hips, hamstring, or even a lack of core stability and poor breathing mechanics.  Your therapist must have a way to find that answer!

If you’ve ever been to physical therapy for your back, I can almost guarantee you were told you must stretch your hamstrings. Am I right?

Well if you can’t touch your toes, of course your hamstrings will feel tight.  Lacking mobility in your spine or hips will limit your toe touch and make it seem like your hamstrings are tight.  It’s probably only the hamstrings 25% of the time at the most.

Unfortunately many people are spinning their wheels in physical therapy because they are not working in the right place at the right time. I can’t tell you how many people have told me that they have failed a trial or two of traditional PT, injections, massage, etc.

2)  A Soft Tissue System:  at On Track Physical Therapy I use the IASTM because of the great results I’ve had treating all types of soft tissue injuries from tendinopathies. From plantarfasciitis, to contusions, scar management, and more.  I also utilize Dry Needling to address soft tissue dysfunctions. Granted this treatment is not for everyone, but it defiantly could be a viable option.

Some sort of soft tissue release may be needed to allow for a window of opportunity to access greater movement. It is the exercises job to then lock the new movement into place. Very often even above and below the site of pain there will be significant soft tissue restrictions that should be addressed.  As I mentioned earlier, using a movement based approach will allow a physical therapist to pin point restrictions. This way time is not wasted treating irrelevant areas.

For example, we know from the literature that very often trigger points in the gastroc/soleus complex (calf) will contribute to plantarfasciitis and even radiate pain to the bottom of the foot.  Limitations in hip extension and glute strength will also contribute to the condition.  Is your therapist looking that far up the body?

So what difference does all this make?  Ultimately it can be the difference between actually ‘fixing’ the problem or just addressing symptoms.  When we can ‘fix’ the problem (the ultimate cause of your pain), we may never see you again and that’s a good thing.  When only the site of pain is addressed, very often you will find yourself back in the Dr. office and back for another bout of physical therapy a few months down the road.

At On Track Physical Therapyour goal is to ‘fix’ the problem, and to give the patient the tools necessary to prevent a recurrence.  Contact us anytime with questions about our methods, and how we can help you if you’ve been unsuccessful with other methods of treatment in the past. This is why we offer a Free 15 minute consultation to address any of your concerns!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

(Part 4) The Setback, The Comeback, and Staying On Track!

Learning The Value Of Physical Therapy – A Patient’s Perspective

Let’s Recap:  Last week you heard about my successful experience with physical therapy, and how I was ready to ride off into the sunset. You can read Part 3 HERE (or maybe you missed Part 2 and Part 1).

This week I talk about how I thought I was good to go, acted like I was invincible, needed a reality check, and finally put an end to all the madness!

Prior to what I refer to as “The Setback”, I had taken big steps to improve my overall health. The PT I worked with was also a fitness trainer, and I didn’t’ hesitate to hire him for this venture. He understood my ability and history of injury, and took this into consideration when developing a fitness regimen. Everything was going great for about six months. I had lost 50 pounds, gained a lot of strength, and was feeling awesome! This was the best shape I had ever been in, and I was starting to feel “invincible”.  I started doing too much, too often, and taking things too far………

The Setback

After a few weeks of being “invincible”, I woke up one morning feeling a very familiar pain.  My right arm was aching and I felt some pain in my back and neck area. I didn’t panic right away….. but then three days passed and the pain was still there. Now I started to panic. The thought of re-living that pain was terrifying to me. My anxiety went from 0-100 in a matter of days, and the pain started to increase. I saw the physical therapist, and he did a brief evaluation. He didn’t seem overly concerned, and thought I had just overdone it with exercise. He encouraged me to do the PT exercises and stretches again for a few weeks.  This calmed me down, but that would be short-lived. I did what he told me to do, but I was full-on freaking out and things started to get worse. The pain was similar to before…….but different…… not as consistent in level or location, and I didn’t have any weakness……. but range of motion in my neck was decreased (the pain I had before was constant and unrelenting). My fear and anxiety about the pain returning took over, and I threw myself back in the ditch!

I went back to the physical therapist and insisted I had another herniated disc. I had been in pain for over two weeks, and was starting to feel like I was in a vicious circle. He agreed that my range of motion was decreased and something was going on, but not for the reason I thought. I argued with him about my previous MRI, cervical disc problem, and my pain. He had me sit down to try to explain something to me……. but I didn’t get what he was saying.  All I heard was “Your body has an alarm …. blah blah blah…. brain thinks there is a problem……blah blah blah……not a herniated disc.”  It sort of sounded like he was saying the pain was all in my head. I was certain it was caused from the disc issue, and I didn’t have a clue why he would be thinking anything else. Did he not believe me?

I got home and started thinking about what he said, and of course went on the internet. I found myself on websites that talked about something called “pain science”. I didn’t grasp this concept, but I was intrigued.  I saw him again for another appointment, and we talked more about pain science. He explained that he DID believe that I was having pain, but my clinical symptoms weren’t consistent with a herniated disc. He used some different analogies that made more sense to me, and went into more detail about this “alarm” going off. I still was having a hard time with the concept that this pain wasn’t necessarily coming from the area I was feeling it, but I was determined to find a way to understand this.

The Comeback

It was time to move on to getting me out of trouble yet again. This PT was standing there by the ditch, but he wasn’t going to pull me out this time. He was going to throw me a rope, and make ME pull MYSELF out! He gave me a “reality check” and said I needed to get my fear and anxiety under control if I wanted to change what was happening. He gave me more information on pain science, as well as reputable websites and professionals who had written about it. I read some very good books on the subject, and realized that I was the person in the books……..and the light bulb turned on!

My pain was definitely real, but was being magnified by my brain “thinking” I was in danger, and not from an acute injury. My prior injury had “sensitized” my neurological system, and pushing myself too far with exercise alerted my brain that I may be in danger, thus setting off this alarm. This was why my pain was so inconsistent and would wax and wane depending on what I was doing, or my emotions (and also why no weakness was present).  Sometimes the brain can be a little too protective and respond with pain even if there is not an actual injury, this is because it remembers the previous injury. (Pain science is a whole other blog post!)

Grasping the pain science concept and knowing that I didn’t have an acute injury reduced my symptoms significantly, but there was still work to do. My neurological system had gone haywire, and it would take some trial and error to reset it. I did the exercises and stretches, got my anxiety under control, and the PT did some manual therapy.  Before I knew it, I had pulled myself out of the ditch and turned the alarm off.  It would still take a little time until I got the hang of this “alarm” in my brain. My neurological system was really sensitive now, and I had to be careful not to flip the switch.  I tried going back to my fitness routine, but every time I did, it would trip the alarm and the symptoms would return.  I finally realized I needed start over and do what the PT said and what I had read in the pain science books…….“graded exposure”. I needed to start out very slow, take small steps, and work my way back up. This drove me crazy, because I had no patience and wanted to be back to the level of fitness I was at prior to the setback.  It took an entire year, and there were bumps along the way, but I finally got there!

Staying On Track

It took me almost two years to fully appreciate the value of physical therapy and how it improved the quality of my life. There are so many lessons learned, that I have lost count! This experience forced me to develop patience, which I definitely needed. I learned to understand my body, how it works, and that I need to listen to it when it is trying to tell me something.  I learned that doing things the right way might take longer, but I will get a better end result. I learned that anxiety and emotions can have a big impact on me physically. I learned that I need to participate in my own healthcare, and what I want in a healthcare provider. I learned that physical therapy is an excellent choice as a first-line treatment for pain and movement problems, and it will ALWAYS be the first place I go before considering other interventions.

I could waste time thinking about what I should have, could have, or would have done differently, but I’m not going to do that. The fact of the matter is, there are a lot of times that “You don’t know.....what you don’t know”.   You find out things along the way that help you make better choices. You can’t go back, only forward, and use what you have learned in the future. I wouldn’t go back and change any of the events that happened, because then I wouldn’t know what know now.

I ended up meeting that physical therapist by happenstance, and I feel like I dodged a bullet because of it. There are several different unpleasant scenarios that could have played out here. I could have had an unnecessary surgery gone wrong.  I could have ended up dependent on prescription pain medications or injections. If I hadn’t learned about pain science, I may have ended up as a chronic pain patient, living in a terrible vicious cycle. Instead, I went to physical therapy and met a smart PT who helped me learn how to help myself. I am very grateful for that, and now I have a healthcare professional I trust who I can use as a resource.

If I have to be totally honest here, I’m pretty sure I initially went to physical therapy out of pure spite towards that neurosurgeon, because he said it wouldn’t work. This will probably be the only time in my life where being spiteful actually worked in my favor! Regardless of how I got there, I made it to that first appointment, continued going, and learned the value of what physical therapy can do for a person.  I may have shown up on that PT’s doorstep looking like a “train wreck”, but I left that experience with the information, education, and tools that are going to help me stay “on track”……..and the rest is history!

(Part 3) - PT Tow Truck "Versus" Skeptical Train Wreck Patient

Learning The Value Of Physical Therapy – A Patient’s Perspective (PART 3)

Let’s Recap:   Last week I talked about my interactions with all the healthcare providers who rode with me on that awful merry-go-round, and why I eventually decided to jump off of it(Read Part 1 and Part 2).

I am now sitting in this ditch holding the “Referral” for Physical Therapy. I stopped popping the pills prescribed at the ER because they didn’t really help, and turned me into a zombie. I was back to using Motrin and frozen bags of vegetables to help control my pain.  I have now had enough healthcare experiences to know what I DON’T value, and am ready to find out what I DO value!

It was time to get this show on the road and call the physical therapy clinic. I explained the situation, and the receptionist said they treat patients with my type of problem all the time. Wait……what? This seemed WAY too easy, but I liked what she said. This literally was like the feeling you get when your car is broken down, and the tow truck finally shows up to help get you out of trouble.  My “PT Tow Truck” was on the way, but would it really be able to pull me out of that ditch?

The day of my first appointment, I showed up on the PT clinic doorstep looking like a “train wreck”.  I was in pain, hadn’t slept in weeks, anxiety ridden, and probably hadn’t showered that morning because squeezing a shampoo bottle proved to be too exhausting due to weakness. I’m a skeptical person by nature, had now developed some trust issues, and didn’t have the best attitude walking into this PT clinic. You can imagine my dismay when an extremely “youthful-looking” young man approached me, stating he would be my physical therapist.  I was thinking “Great…. I got the new guy…. it figures!”  I remember quickly scanning the walls for a diploma or license with his name on it. Sure enough, it was hanging right near the clinic entrance.  Nobody my age or older had been able to help me yet, so I decided to let him take a crack at it.  I’m sure he had an opinion about me as well, and probably thought “Great….. I have to deal with this anxious, possibly un-showered, skeptical, train wreck patient today…. perfect!”  This physical therapist would have his work cut out for him………

At the first visit, he spent over an hour actually listening to me, asking questions, evaluating me, and performing different tests and therapy techniques. He didn’t seem alarmed with my diagnosis, and that worried me. I pressured him about the MRI results and what the other specialists said, but he still remained calm. He explained that “WE” were going to work on getting the pain under control, addressing the weakness and movement limitations, and see how things go. I was anxious and skeptical, and questioned everything he said and did. He performed something called “cervical traction” on my neck that day, and this helped my pain. He said this “pull” on my neck was creating some space between the cervical vertebrae. He also had me do some weird-looking exercises and stretches that I was to start doing at home. I wasn’t a fan, and didn’t want to look dumb doing these. He ignored my unwillingness, and encouraged me anyway. I reluctantly complied and did these stretches, chin-tucks, sliders, and side-bends. I have to give him credit, because he held up pretty well considering my behavior.  I felt better after that first appointment, but the pain would start to return that night, and my next appointment was two days away.  He had a plan though, I was included in it, and this was a nice change.

At the next few visits, we did a lot of the same things, and it was the hands-on therapy and cervical traction that helped my pain the most. He was able to help my “new” primary doctor get a home traction unit for me to use in between visits, and this provided a lot of relief. It was now about a week and a half into treatment and I was starting to feel better and was making progress. My pain was reduced, I could sleep again, and I was starting to “buy in” to physical therapy.

We talked at each visit, and I would ask A LOT of questions. He did his best to explain the in’s and out’s of my condition and the therapies he used. I took the knowledge he shared, and researched the internet for more information. I was starting to understand my condition, what caused it, how to treat it, and how to prevent the symptoms.  Years of improper movements, incorrect posture and body mechanics, mismanaged stress, and a bit of genetics all piled on top of each other to help create this problem. I was learning that these physical therapy techniques were the key to recovering, and that I would have to be an active participant in the process if wanted it to work.

Now that the pain was better controlled, it was time to work on the weakness in my right arm caused by nerve compression in my neck, and also treat the underlying cause of my movement limitations. He added strengthening exercises to my regimen, and still made me do those weird exercises at EVERY appointment AND at home.  He explained that the exercises were re-training my brain to know that it was okay for me to move my neck and head in certain directions, but I still looked ridiculous doing them! He would assess my progress at each visit, try new therapies and exercises, and see which ones were working the best. I was always expected to hold up my end of the bargain, and do a home program in between visits.

He then started a new hands-on therapy, which had me thinking he might be off his rocker…… It was a soft tissue therapy called “IASTM”.  He used an odd-looking metal tool with lotion to sort of “brush” in different patterns along my back, neck, shoulders, and arms. He explained this would “Increase blood flow and reduce my sensitivity to stretch” allowing me to move better in these areas.  I couldn’t see how this would work, but I skeptically let him proceed with this therapy at my visits.  As it turned out…. this actually worked quite well.  I never realized how “restricted” my range of motion had been, until I was backing out of a parking spot one day, and it dawned on me that I could turn my head all the way to the right to look behind me. I hadn’t turned my head this far in probably 10 years!  It was now becoming very apparent that this PT knew what he was doing. My skepticism and anxiety diminished, and he gained my trust as he was pulling me out of that ditch. 

Guess what?  Six weeks of physical therapy went by, andI consistently got better without prescribed medications, injections, or surgery………. The hands-on manual therapy, cervical traction, weird exercises, and stretches worked. The pain was gone, strength was returning, and range of motion had greatly improved. This therapist not only addressed my acute situation, but also the underlying soft tissue problems that had built up over the years, and I now felt better than I did even before my initial symptoms started!  I was quite puzzled as to WHY physical therapy was only mentioned to me as a last resort, and was told it probably wouldn’t work?  PT should have been my first stop……… not the last.

I was thankful I gave this physical therapist a chance to help me, and also restore some of my faith in the healthcare system. I had just experienced first-hand, the value of physical therapy.

I was now ready to put this all behind me and ride off into the sunset, but my neurological system had OTHER plans, and this would not be the end of my story just yet. I would throw myself back into that ditch for a moment, get a BIG reality check, and then hopefully put an end to all the madness! There was another lesson to learn before I would completely grasp how valuable physical therapy really was………

Fun Term Of The Week - Train Wreck:  A chaotic or disastrous situation that holds a peculiar fascination for observers.

UP NEXT WEEKThe Setback, The Comeback, and Staying On Track

Stay Tuned for the Final Conclusion of this 4 Part Series!

Movement Proficiency and the Ankle

What are the basic movements that someone should be proficient with to train or compete in athletics? What are some ways to address these movements in my training?

There are quite a few movements I feel are quite necessary to move well enough to keep injury risk low and to enhance speed, power, jumping ability, etc.  I’ll get into all of them in time, but for now I’m going to spend more time on the ‘Big 3’ from the Functional Movement Screen.

1.Deep Overhead Squat

2.Hurdle Step

3.In-Line Lunge

These are larger patterns with many component parts but what it really comes down to is we need a great deal of mobility from certain joints and stability from others

Mobility – ankles, hips, thoracic spine, and shoulders

Stability – knees, lumbar spine (a.k.a the Core), and scapulae

As you can see from the pictures above, a great deal of mobility is required from each of those areas I listed.

This is simplifying things a bit but if you do not have the requisite mobility then there is no way you will move well in these patterns and the way you run, lift, jump, and throw will be compromised.  We also know that poor mobility leads to poor ability to stabilize the joints listed above as the body searches for compensatory strategies (ways around those stiff joints).

Let’s use ankle mobility as an example.  From a half kneeling position, you should be able to get your knee 4 inches past your toes while keeping the heel down.  See the picture below (the stick in line with the big toe forces you to take the knee outside the stick).  Full ankle mobility will allow the rest of the lower extremity to stay in great alignment while running, lifting, etc. If the ankle is stiff, the foot will pronate (flatten out) and the knee will cave inward all in an attempt to work around the ankle.  All the athlete is thinking is “I have to run fast” so the brain will find a way whether it is right or wrong.  Over time this leads to instability at the foot, knee, possibly even higher up the chain, and ultimately decreased performance and injury.

Ideal = knee 4

So if you find yourself struggling to move through the ‘Big 3’ patterns discussed above, ankle mobility should be the first place to look.  So what to do if you’re short of that magic 4″ past the toes?

–  self myofascial release – rolling a lacrosse ball along the bottom of the foot and foam roller/massage stick to the calf

–  stretching for the calf with the knee extended (traditional calf stretch with hands on the wall) and with the knee flexed to get the soleus/Achilles (as in the picture above or standing knee to the wall)

If those just aren’t cutting it, or you experience pain in front of your ankle, then you may have some joint and/or soft tissue issues that will not be solved by just exercise.  Then it’s time to see your physical therapist or chiropractor who has the ability to address these areas.  Here at On Track Physical Therapy, I use techniques like IASTM and Dry Needling which have been shown to quickly improve range of motion. We then follow this up with specific exercises to build control through the newly acquired range of motion to help lock the changes in.

As with any intervention, be sure to go back and re-check the patterns when you are done.  As ankle mobility improves then your squat, hurdle step, and lunge should all improve as well.  Maybe not to ‘perfect’ yet because there a number of other components involved here, but definitely will have you on the right path.

Patellar Tendinitis (a.k.a. Jumper’s Knee) – Ann Arbor, Mi

Ann Arbor, Mi - Maybe you have heard of Osgood Schlatter Disease, Patellofemoral Pain Syndrome, Patellar Tendinitis or “Jumper’s Knee” before? These diagnoses are very similar, and are common diagnoses given to athletes or active individuals of all ages. Osgood Schlatter’s Disease is a diagnosis commonly given to children, to boys between the ages of 12-15 and girls between the ages of 8-12.  This is generally due to the rapid changes in body composition these adolescent children are experiencing in conjunction with increased participation in sports1.

Patellofemoral Pain Syndrome is a fancy way of saying that the kneecap (patella) is having issues tracking properly across the knee joint, thus causing your pain. More on this a little later.

Patellar Tendinitis or “Jumper’s Knee” explains everything you need to know in the title about one of the possible causation factors. Sports involving dynamic activity such as jumping, bounding, plyometrics, and change of direction inherently places you at a higher risk for developing this type of painful experience. However, it is also very possible to manifest itself in the general population as well, with frequent bouts of activities such as squatting, lifting, or carrying objects up and down stairs.

Related Article: Is Plyometric Training Causing Knee Injuries?

All these types of diagnoses tend to have very similar limitations and symptoms, and error on the side of overuse injuries. No matter your age or activity level, a painful experience can generally be explained by a sudden increase in activity that your body was not prepared to handle, or an accumulation of repetitive physical stress without ample rest.

With that being said, there are usually very predictable limitations that occur in the body which predispose an individual to any of the previously mentioned injuries. In most cases, when these limitations are addressed and external causation factors are managed properly, the outcomes tend to be very positive.

Maybe you have noticed that most of these diagnoses make mention of the patella. In fact, one of them actually has a syndrome named after it (Patellofemoral Pain Syndrome and Patellar Tendinitis). Unfortunately for the patella, it is the most prominent and superficial part of the knee. As such, it usually takes the brunt of the criticism for causing knee related pain. However, if we take a deeper look into how the body operates, we understand that the patella really is just the result of an underlying positional problem. Understand that the patella is just a sesamoid bone (free floating), that rides on the groove of the femur as it connects to the tibia to create leverage in the quad muscle.

The common analogy used for the patella is that it acts like a “train” that rides on the “tracks” of the femur. If the femur or “track” is in a poor position, then the patella cannot run properly across its groove. This analogy holds true not just for Patellofemoral Pain Syndrome, but rather every one of the diagnoses mentioned (Osgood Schlatter’s Disease, Patellar Tendinitis/Jumper’s Knee). If a person is unable to maintain proper position with various demands the body may encounter, then a lot of torque is placed on the knee and patellar tendon, which may result in a painful experience over time.

We all know the function of the knee is to bend because it’s a hinge joint.  However, it also has rotational capabilities because of the hip and the ankle. This rotational component from the hip and ankle when functioning on all cylinders is how the knee absorbs forces. Without it, the adaptability of the knee is minimal. Think about hitting a pothole with your car. Without shocks, chances are your car goes out of commission pretty quick.

As part of a physical therapy treatment, we can perform different manual techniques such as taping, active release, IASTM or dry needling that can help modulate pain. However, if we never address other limitations above and below the knee joint, then pain may remain or linger much longer than necessary. This is why a detailed assessment is required, so specific interventions can be given to restore optimal function and abolish pain.

At On Track Physical Therapy, we provide a one-on-one treatment approach unlike any other. Full one-on-one, uninterrupted hour long treatment sessions with a Doctor of Physical Therapy at every appointment. This allows for detailed assessments and frequent reassessments during the treatment session, to ensure we address the issue appropriately.

Click the image below for your FREE sports injury report and discover how pro athletes recover from injury FAST!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Is Plyometric Training Causing you knee Pain?

On Track PT and Performance featured this week on John Rusin Fitness Systems. In this article we go over how to keep your knees happy if your sport or training involves a lot of plyometric activity. Be sure to check it out and share it with a friend! 

Plantar Fasciitis Treatment – What are my options? Ann Arbor, Mi

Plantar Fasciitis (Ann Arbor, Mi) - Anybody who has ever experienced plantar fasciitis before knows that it can be a very frustrating process. Heel pain impacts just about every daily activity that involves standing or walking. Maybe your pain is not quite as bad, but it has prevented you from running or working out as you love to do so much. It is estimated that approximately 1 million patient visits per year are due to plantar fasciitis. It is also estimated that it may account for 8% of running injuries. 

(The point of this video was not to confuse you. This article is geared towards a more conventional approach to treating plantar fascia. However, I do hope this video opened your eyes a little that there are many more factors influencing plantar fasciitis that you may have never considered before.)

Plantar fasciitis refers to a strain in the muscle tissue on the bottom of the foot. Often times the area that becomes strained is on the inside portion of the heel. This is the area where most of the pain occurs and can often be very sensitive to pressure, touch, or weight-bearing. What causes this painful experience to occur?

Generally, it comes down to three things:

1) A sudden increase in activity that your body was not prepared to handle.

2) A lack of variability in movement.

3) An accumulation of repetitive physical stress without ample rest.

However, once you have reached the tipping point and pain has occurred, your body will start to heal itself naturally through a very normal process called inflammation.

Yes, you read that right! A very beneficial and normal process called inflammation. The inflammation process is needed for the body’s natural healing process to start.  Insulin growth factor is brought to the injured area for new collagen to lay down and build tensile strength back up.

If you never addressed the three causation factors described above, or never did anything to help influence the inflammation, repair, and remodel phases the body naturally goes through; then chances are the pain will linger on longer than normal.

Maybe you have experienced plantar fasciitis for quite some time now, and had an x-ray performed. Upon results of the x-ray, you may have been told that you have a “heel spur.” If you get one thing out of this article, please do not be intimidated or frightened by a “heel spur.” It’s not like what it sounds. I will use quotations around “spur” because you will not hear me say this word.

Understand that a “spur” most likely develops due to a failed healing response. The inflammatory response probably was triggered from one of the three causation factors listed previously. Again, inflammation is good because it will start the healing process. However, if then never allowed or influenced to both repair and remodel, the cycle may restart all over again as the body tries to autocorrect. Multiple restarts during this process can lead to an excessive buildup of osteophyte formation. This excessive buildup can start to form what would be considered a “spur”, but don’t get too anxious on me! Research has shown that this doesn’t necessarily always correlate with plantar fasciitis.  A study by Cornwall & McPoil, reviewed x-rays of 1,000 patients and found only 13.2% had heel “spurs”. Of these, only 39% reported heel pain. Yes, you read that right. Less than 50% of “spurs” caused pain.

So what can we do about all this?

The recovery process can be slow at times. Resolution for a case of true plantar fasciitis has been reported as long as 6-18 months in some cases.  This can become increasingly frustrating when each waking morning you take the first few painful steps. Chances are you have been told that you need better shoes and have to perform a series of stretches religiously throughout the day.

While both are great suggestions and often provide some, if not complete relief in the long term, the short-term results tend to be less than desirable.

High load strength training to the plantar fascia appears to be beneficial as well.

Self-myofascial release also gets a lot of publicity to treat plantar fasciitis. Maybe you have been told to roll a tennis ball or lacrosse ball on the arch of your foot.

This method can be effective, but not for the reasons you may have been told. Contrary to popular belief, you are not elongating the plantar fascia or breaking up scar tissue. Research has shown that it takes 460kg of force to increase the plantar fascia length by 1%6.

I doubt someone’s thumb or a lacrosse ball is going to create this amount of force. Rather, there is probably a neurological mechanism that occurs which temporarily reduces tone/guarding in the musculature.

While the research definitely supports these methods to reduce pain, it still can be a time consuming process. Furthermore, all these strategies can be implemented without a healthcare provider. This is where On Track PT and Performance is different. We know you can perform these methods in the convenience of your home, so we don’t expect you to come in 3x per week and watch you perform exercises that you are already doing at home. We treat patients 1x per week, every other week, or in some rare cases 2x per week.  For treatment, we focus on highly trained techniques with research that has shown to decrease recovery time.

Less therapy visits and a potentially faster recovery time! Sound interesting?

Instrumented Assisted Soft Tissue Mobilization (IASTM)

Again, the chances we are actually deforming fascia are slim here, as mentioned in the research above. If a clinician thinks they need to perform this technique aggressively and cause an excessive amount of discomfort to get results, they should reconsider why they have chosen this treatment modality. Rather, what is probably happening via mechanical stimulus is increasing blood flow, temporarily reducing tone, and influencing cellular mediators to start remodeling tissue in a more resilient way. With all these benefits, it is understandable why this, in conjunction with stretching/strengthening, has been shown through research to possibly speed recovery times.

Dry Needling to the Plantar Fascia

Admittedly, this treatment is not for everyone. Everyone always asks how painful it is? I will start by saying that anywhere I use dry needling; I have personally had it done on myself. So from personal and anecdotal experience, I can say that in some areas dry needling is actually very comfortable. However, the plantar fascia tends to be one of the areas where there are some sore points that elicit a “deep ache” or a “bee sting.”

Physiologically, it has a much greater physiological and neurological effect than IASTM. This is due to the increased stimulation that occurs when a needle penetrates the skin.  Even more stimulation occurs when therapeutic electrical stimulation is then hooked up. Dry needling in conjunction with electrical stimulation has been shown to have an inhibitory effect on pain through opioid release.  These effects can potentially lead to much better short term results.

Click the picture below to find 9 ways the pro's recover FAST from injuries!

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

References

Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study.J Bone Joint Surg Am. 2003 May. 85-A(5):872-7.

Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med 1987;15(2):168-71

Cornwall, Mark W., and Thomas G. McPoil. "Plantar fasciitis: etiology and treatment." Journal of Orthopaedic & Sports Physical Therapy 29.12 (1999): 756-760.

Fasciitis, Plantar. "Plantar fasciitis: diagnosis and therapeutic considerations."Alternative Medicine Review 10.2 (2005): 83-93.

DiGiovanni, Benedict F., et al. "Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain." The Journal of Bone & Joint Surgery 85.7 (2003): 1270-1277.

Rathleff, M. S., et al. "High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up."Scandinavian journal of medicine & science in sports (2014).

Chaudhry, Hans, et al. "Three-dimensional mathematical model for deformation of human fasciae in manual therapy." The Journal of the American Osteopathic Association 108.8 (2008): 379-390.

Looney B et al. Graston instrument soft tissue mobilization and home stretching for the management of plantar heel pain: a case series. JMPT. 2011;34(2):138-142.

Cagnie, Barbara, et al. "Physiologic effects of dry needling." Current pain and headache reports 17.8 (2013): 1-8.

Tillu, A., and S. Gupta. "Effect of acupuncture treatment on heel pain due to plantar fasciitis." Acupuncture in Medicine 16.2 (1998): 66-68.

Why am I doing this exercise?

Most patient's assume I hate answering this question. Just let me do my Job! Right?

Wrong.

In fact, I enjoy hearing this and really do not mind your curiosity.  A few things run through my head when I hear this question. 1) It usually forces me to take a step back and better educate the patient on what exactly we are trying to accomplish. If the patient understands where we are going, they are usually much more willing to actively participate in their rehabilitation, which in the long term provides much better outcomes.

2) (Along similar lines) Maybe the patient does not fully trust me and has not bought into the treatment program…..this is important for me as a therapist to realize and again educate. In the grand scheme of things, patients spend very little time in my office and much more time on their own working, competing, exercising, and just living life. Without trust, there is no carry over from my office to their daily life.

3) If I or any therapist cannot give you a detailed answer as to why, then it is probably not worth your time. If you ever get the feeling that a therapist hasn’t put any thought into the exercise selection or treatment, then you are probably being placed into a cookie cutter program.  That being said, there are times when a cookie cutter program does work.  However, I believe that if you are actively seeking out treatment then chances are you did not respond previously to a cookie cutter program or you are not looking for a cookie cutter answer.

At On Track Physical Therapy your treatment should never feel like a cookie cutter program, and we welcome the questions that start with “Why”!

Exercises for Athletes #3 - Single Leg Box Jumps

Single Leg Box Jumps - This exercise is a mid-level explosive jump or plyometric that is great for athletes to develop explosive power. This is a great exercise for athletes, and can be easily implemented into a youth athlete's strength and conditioning program Find a box that comes up to your kneecap or one that is appropriate to skill level. Explode off of one leg, and land on the opposite foot as softly as possible. Knee should stay in line with your middle toe upon landing.

Prior to implementing this exercise into a youth athlete’s program, be sure they have developed competency to jump and land under control from a two footed jump first.  This way the athlete can properly demonstrate the ability to adequately decelerate from two legs prior to progressing to a single leg explosive activity.

It also acts as a great preventative exercise because it teaches the athlete to decelerate dynamic forces under control. This is why the athlete should focus on trying to land as softly as possible absorbing forces on their opposite leg.

Be sure to keep the reps fairly low here 3-6 reps per leg to allow for recovery, maximal exertion during exercise, and solid technique. The amount of sets will be dependent on the athletes fitness levels and the goal they are trying to accomplish from the particular workout.

ACL Prevention. The Importance of Youth Coaches

For top notch ACL rehabilitation in Ann Arbor, Mi contact On Track PT and Performance.

Calling all you coaches, athletes, therapists and trainers out there, it's time for us all to face facts; we've failed as an industry in protecting our clients from ACL injuries.

Even with all the BS "ACL Injury Prevention" programs specializing in reducing the incidence of non-contact injuries, the most recent statistics show an INCREASE in ACL injuries in active populations.

Time to stop patting ourselves on our backs (coaches and researchers) and realize that what we've been doing over the last two decades to combat this monumental problem is just not working.

You know what will work and has been a proven track record for hundreds of years? Old school, traditional strength and conditioning. Maybe try and master that, ingrain some sound movement patterns in your athletes and just maybe then they can stay on the field long enough to make a dent in their athletic potential.

Full article available  via DrJohnRusin.com by Dr. Greg Schaible.

Exercises for Athletes #2 - Goblet Squat

The Goblet Squat is a great lift to teach proper technique to a youth athlete or beginning lifter while still eliciting a training effect.  Due to the anterior load of the weight, it allows the lifter to better obtain a squat position as the weight will act as a counter balance. For this reason, a Goblet Squat will actually start to improve squat mobility by gaining control over deeper ranges of motion in the squat position while still maintaining a neutral spine. Once optimal squat depth is obtained with a neutral spine you can then start to focus on increasing load and time under tension. The amount of load you can perform with this lift is limited. However as youth athlete or beginning lifter, ultimately your main goal is time under tension.  In other words, performing set/rep ranges of 3-5 sets x 8-12 reps will give you a baseline level of strength needed to then progress to a lift that will allow for greater loads such as a box squat. As the athlete progresses in his strength and lifting technique, the Goblet Squat will remain a great tool for warm ups or accessory lifts. 

Stix and stones may break bones but words CAN hurt you

Interactions between health care providers and patients have a huge impact on a patient’s recovery. Unfortunately not all Doctors, Physical Therapists, Chiropractors, Insurance company’s realize how their words positively or negatively can impact a patient.  How a musculoskeletal or physical problem/injury is described to a patient has a great impact on how much pain is perceived. Pain is ultimately the body’s output to a perception of threat.  The way an injury is described to a patient often has a profound impact, either increasing the perception of threat or decreasing the perception.  Countless times I have heard patients say that Doctors have told them their MRI or X-ray is the worst they have ever seen.  Countless times I have heard patients say that a Physical Therapist told them that my “nerve is pinched” or “bending forward is terrible for the back.” Countless times I have heard patients say that their chiropractor told them their spine was out of alignment. What do all these conversations do? Increase fear of movement and increase avoidance of activity.  Never once do I hear a patient tell me that anybody actually took the time to explain to the patient what pain actually is, and how it relates to their injury.

pain-bear.jpeg

First understand that all musculoskeletal injury has the capacity to heal no matter if it’s bone, muscle, tendon, ligaments, discs, etc. These are all human tissues that physiologically heal in time. Much like when you were a kid and scraped your knee outside playing, physiological damage to tissue occurred and the skin healed in time.  Inflammation is normal, it is how the body starts to heal itself. The nerves being sensitive is a GOOD thing. If you stepped on a rusty nail, wouldn’t you like to know about it?  The nerves are just doing their job. The increased sensitivity to movement is only because the nerves are “pre-warned.” Much like sunburn on the shoulder increases the sensitivity of the skin when you get in the shower. The water is not actually burning the skin, it just feels that way because the skin is very sensitive at that point in time during the healing process.

Movement stimulates blood flow. Movement done frequently, in a non-threatening manner reduces sensitivity. Threatening descriptors such as “bad back”, “blown disc”, “bone on bone”, or “torn a muscle” increases sensitivity.

Here is a link to a post by a colleague. It also does a great job of explaining everything mentioned above. The post also contains a very interesting MRI photo demonstrating how words can impact pain. Take a look HERE!

 

Low Back Pain - Ann Arbor, Mi

Ann Arbor Physical Therapy Low back pain is one of the most common ailments in the United States. A number of contributing factors can play a role in this type of dysfunction. One of the most common reasons that your back may hurt is due to your hips. More specifically the lack of range of motion in your hips. In a study published by the Institutional Journal of Sports Medicine titled Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. The authors found that typical range of motion in the hip lacked -4 degrees of extension from a neutral position. In those subjects without low back pain, they had 6 degrees of hip extension available beyond neutral. All totaled, this is a 10 degree difference in hip ROM. These findings are common in individuals for a number of reasons. One in particular is the tendency for people to sit for long periods at work, school, or home which puts your hips in a flexed position (opposite of extended). This is a video of one technique we use at On Track PT and Performance to help improve hip extension through neurological inhibition.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.