Pain

Injuries vs. "Wobby Jobber"

This is a quote which really resonates with me as it relates to injuries:

“You have to listen when it whispers as opposed to waiting for it to yell!”

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The idea is simple: if you ignore minor aches and pains, they rarely just magically disappear.

Instead, they start to amplify by volume or intensity. Causing you to reach a painful threshold where a TRUE injury happens and more extensive intervention is required. The research actually supports this concept - but only if you know how to dig a bit deeper.

One study in particular is this Scandinavian study of patellar tendinopathy in junior basketball players. This study had 134 teenagers (268 total knees examined) and found that only 19 tendons presented clinically with symptoms.

However, under ultrasound diagnostic examination, 22% of the remainder of the group who had no pain, could be diagnosed with tendinopathy. In other words, "ultrasound tendon abnormality is 3 times as common as clinical symptoms or being in pain."

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This study just looked at teenagers, who are markedly less likely to have tendinopathy than older individuals.

What if they did this study on middle-aged men playing hoops at the local YMCA. The point is that whether you have symptoms or not, you likely have some changes in your tissues.

Now to be honest, this study isn't particularly shocking to anyone who's looked at MRIs of asymptomatic (not in pain) individuals.

I’ve seen loads of x-rays, MRIs, and Diagnostic Ultrasounds in non painful people but according to their diagnostic image they have a rotator cuff tears or spondylolysis (stress fractures) or torn labrums or herniated discs. This list goes on and on…

The point I am making is that if we just treat a person’s image we are missing the boat.

It’s also a reminder that we often have several issues that might just be waiting to reach a painful threshold if we aren't cognizant of our training volume and intensity - and our movement quality.

The country background in me refers to these slight movement problems as a bit "wobby jobbered". In other words, something is a bit “off” and not necessarily a problem currently but could be a contributing factor to something down the road.

Maybe it's that cranky knee first thing in the morning, but feels good after you warm it up. Or, it's that stiff neck you get after a few hours of working at the computer, but feels better after your spouse massages your neck (ha yea right!). Or maybe its a shoulder that bugs you only when you bench press, but feels pretty good when you do rows instead.

Maybe it's seeking out some extra manual therapy in a specific area that we provide at On Track Physio. Maybe it’s a more individualized home program or warm-up to address movement issues. It might even be that you strategically drop particular exercises from your program at various points during the year.

If nothing more, understand that good training and movement teaches your body how to spread stress over multiple joints. Instead of that cranky knee taking on 90% of the load, we work on hip and ankle mobility and strength so that it might only have to be 30%. Spreading out the stress ensures that one area is less likely to feel “wobby jobbered”.

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Distribute stress requires you understand what quality movement actually looks like, and that's unfortunately where a lot of healthcare professionals fall short. Which is why we offer a Free Discovery Session to all new clients in order to experience the difference at On Track Physio!




4 Biggest Mistakes To Avoid When Recovering From Injury

Ann Arbor, Mi

To many people fall to these 4 common mistakes when getting out of pain. Ultimately leading to longer recovery times, frustrations, and unnecessary dollars spent at the doctors office.

When you get these 4 things right, often times you get back to the things you enjoy most in life much sooner!

#1) Don’t treat the symptoms….Treat the cause

This may sound counter intuitive, but stick with me here. Treating the symptoms may momentarily help your pain. But more than likely it does not solve the root problem which put you in this situation. Solving the root problem is the key to never having to deal with the issue again. While we do things at On Track Physio to help ease your pain. We also always talk about solving the root problem, and we are always testing movements out to make sure this is actually what we are accomplishing.

#2) Jumping the gun

Reach for some medication, go to your primary care physician who prescribed the medication. You go to a surgeon who recommends surgery. Is surgery and reliance on medication what you really want? Broaden your horizon to other options that are out there which can solve your problems. People spend more time searching for hotels on vacation then they do a healthcare provider. Do your due diligence, don’t assume, and trust the person giving you medical advice.

#3) Settling

“Everybody deals with it”….. “Your getting older”…. “That’s just the way it is.”

Media, our family and friends, facebook, etc they all give us preconceived notions which aren’t always true. A lot of times healthcare providers and people in general will be searching for just one problem. When in reality, our bodies are much more complex than that. Focusing in on one things is doing your body an injustice. Focus on treating the human body as a whole and you will get a much better outcome.

#4) Focus on the wrong things

Focus on the cost??

How long will it take??

Will my insurance cover it??

But let me ask you this…..What is you pain costing you right now?

What are you currently missing out on right now because of your pain? What relationships is it affecting? What activity with friends and family can you not do because of the limitation? What is that costing your right now???

What is the cost of not taking action?

The cost of not taking action will be exponentially worse than the little things you are focused on right now.

Again, go back to #3. Do your due diligence and find someone you trust to give you the outcome you desire.

Then take action!

If you’d like to see how On Track Physio can help you, we make it as easy as possible to remove barriers. Our goal is for you to start taking action. We provide a FREE Discovery visit to give you clarity on what the problem is, so that you can take action (whether that’s with us or someone else). Our goal is simple, give you clarity on the steps necessary to improve and start taking action.

What Pain, Legos, and your Mom have in Common

Simple analogy for one of the most often questions I'm asked on a daily basis. "Why did (insert body part) get hurt when I didn't really do anything to cause it?

Watch to video below to learn more.

It's about recognizing what needs work, and picking 1-2 things that are most efficient at addressing it to help prevent "stepping on the lego". If pain is present, then finding 2-4 things to do which are most efficient and do them often until the mess is cleaned up.

My job is to find what it is that will be most efficient to helping you clean up the mess and keep in cleaned up for the future.

Ann Arbor, Mi

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

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.

When Pain Happens

Here's a riddle. Nobody wants it, but everybody has experienced it at some point in time. It acts oddly and seems to come on for no rhyme or reason.  It is vastly misunderstood by the general population as well as healthcare professionals from all fields.

You guessed right, the answer is pain.

If you are reading this post and currently in pain, I genuinely am sorry and have empathy for your situation.  But understanding pain is the first step in combating it, so you are in the right place.  My goal is to educate people on pain. In my profession I deal with pain every day, so in order to treat it, I need to do my best to understand its complexity. I have learned a great deal about the subject of pain from books by David Butler and Lorimer Moseley. These two guys are at the forefront of the research on this subject.

So what is pain?.......  A short but loaded question.

First let's get some context. The body is constantly gathering information from sensory receptors about the body's internal and external environments.  It is also interpreting how these two environments are interacting and how they relate to one another. All these signals are ultimately sent to the brain to make heads or tails of the information. These inputs can range from actual tissue damage, chemical changes, past experiences, emotional/psychological distress, lack of sleep, hunger, your mother yelling at you, or seeing a snake on a plane.

Snakes on a Plane

The brain's job is to then interpret all of these signals and determine if a threat is present. If the body perceives there is a threat, a number of different responses are possible.  One of the possible responses is pain.

Pain is felt as a survival mechanism to encourage you to take action. However, it does not always mean damage has actually occurred.

Consider this example Lorimer Mosley gives: A fractured wrist is often very painful until it is put in a cast. Once casted, the pain is almost always gone quickly thereafter.

Interesting!

The problem with this is that we know that bone will take 6-8 weeks to fully heal (depending on age and other factors).  Yet, pain is no longer present, and in some cases instantaneously gone once placed into a cast.  So why is this? Very simply, the need for protection is now gone because the cast acts as an external protective device.

In this example the pain is gone but damage is very much still present. The opposite can also be true. The body can be in pain, but no longer damaged.

We must consider other factors such as social influence, past history, fear, future consequences, stress to name a few. All these signals can trigger the body to feel it is under threat and notify you via pain. For this reason you can experience pain with no tissue damage at all.  I’m sure you have heard the term phantom limb pain.  Even though the limb is gone, the body still has the ability to sense pain in this area.  This reinforces the fact that if you can experience pain without a body limb, then tissue damage is not necessarily a prerequisite for pain. Furthermore, just because you are experiencing pain in a particular area does not mean that is in fact the source of the pain.  This is why it is important to find a clinician who does not focus solely on the area of pain, but looks for other areas of dysfunction which may contribute to the brains overall perception of threat.

Another possibility is that tissue damage could have very well occurred which initially started the pain cycle.  However, because the body is great at healing itself at the cellular level. It is also possible that the tissue may have healed. Yet the brain still has the perception of threat because non-threatening inputs were never sent up to the brain to override the previously painful threats.  This may explain why people often feel pain long after normal tissue healing time has passed. This is also why it is important to not treat pain with pain.

Here is some research that backs the theory: tissue damage does not equal pain. Jensen and colleagues performed a study titled: MRI of lumbar Spine in People without Back Pain. They found that 52% of people without back pain had at least one bulging disc or MRI abnormality.  Templehof and colleagues performed a study titled: Age-related prevalence of rotator cuff tears in asymptomatic shoulders.  The authors found that 23% of people with asymptomatic (non painful) shoulders actually had a rotator cuff tear. These are just two examples. Numerous other studies could be cited to help support that tissue damage does not have to cause pain.  

So the next time you experience pain, please understand that there may be a number of contributing factors. Remember that pain is perfectly normal, it’s your body’s alarm system. Pain can be present with or without tissue damage. Providing the body with novel non-threatening stimulus's to remove the body’s need to produce a protective response is a great place to start if you are currently experiencing pain.

Let's take the example of elbow pain, lateral epicondylitis a.k.a tennis elbow. It's not uncommon for lifters to experience elbow pain. I have noticed it becoming more prevalent now as people spend more time on their tablets using their fingers instead of a mouse.

Holding a tablet in one hand, and constantly using your fingers to swipe, type, navigate, etc. will place your wrist/elbow musculature on constant stress. Over a prolonged period, this can be perceived as a threat to the brain. Especially if you are lifting heavy weight in conjunction and require a high volume of grip strength for your workouts.

So applying the knowledge we learned about pain, and how it may or may not relate to tissue damage.  Here is a very simple and extremely effective solution to a lot of cases.

1st) Reduce the threat. In this example altering body mechanics while using a tablet and modify your workout routine with less grip intensive activities for the time being.

2nd) Provide a novel and nonthreatening stimulus.  In this example, I will use a wrist extensor stretch.

While this exercise may not seem like much, it's very effective when applied correctly.  Flexing your wrist and turning it to the side obviously places a stretch on the outside of the elbow or to the wrist extensors.  In addition, you are also placing some tension and loading a nerve which flosses through the tissues at the elbow called the radial nerve.

So we now have our novel/nonthreatening stimulus.

3rd) Here is the kicker. You can do all the above, and get zero results unless you get this third step correct.  You MUST perform the novel/nonthreatening stimulus frequently.  To the tune of every 1-2 hours for best results.  Here is why it's so important.  When the body is in pain, it is very good at making memories of pain.  This is because the body is very protective over itself, and rightfully so.  The only way to reduce the threat is to perform a stimulus frequently enough that if no longer feels the need for protection.

This example can be applied to many other pain scenarios as well if you follow the steps correctly. 1) Remove as many threats as possible while in pain 2) Pick a novel/nonthreatening stretch or exercise 3) The exercise should be simple enough so that you can perform it frequently throughout the day (in some cases every 1-2 hours).