“Should I Push Through Pain?” One Simple Analogy to Guide You

“No Pain, No Gain.” We’ve all heard it from old coaches or trainers, for better or for worse. While the quote does have some merit…maybe…it often makes me, as a physical therapist, cringe to hear it when people describe their exercise habits. There is truth in the phrase. To make changes, i.e. gain strength, your body needs to be pushed to its limit in  order to come out stronger. This is where soreness comes into play. Many of us have felt that good soreness after a workout. That’s science coming into play. Wolff’s Law, to be exact-the body adapts to the changes put upon it.

So that’s great, right? No pain no gain must be true? You need to stress tissue for it to adapt and come back stronger, correct. However, too much pain can be detrimental to that tissue. This is where overuse and overload injuries occur. When the muscle cannot tolerate the load placed on it, what happens then? The answer is injury and pain. 

Navigating the seas between pain and gain is a tough and choppy journey. You can ask any physical therapist, personal trainer, exercise physiologist, chiropractor, strength coach, etc. and they will tell you that they have been asked numerous times, “How do I know when it’s too much? When should I stop?” Many will give you different answers, depending on what field they are in and what the clients’ goals are. But, there is one specific analogy out there that I find to be extremely helpful in how to think about this. You’ve seen it everyday all over Baltimore.

The Stop Light

Green means go; Red means stop. Yellow (well that depends who you ask) means slow down. We’re going to use these signals as a way to think about when to keep going on an exercise, and when to hit the breaks. 

First, you need to ask yourself this, how bad is my pain right now? Rate that answer 0-10, 0 being no pain at all, 10 being I need to go to the emergency room it hurts so bad. Your number is your number-be honest with yourself. Don’t compare that number to what you think others may feel, just go with your gut. That number will guide you through this analogy.

Green Light (0-3/10 Pain): Green light means continue on. This may feel like typical soreness or achiness on a low level. When doing an exercise that causes this low of pain, you are most likely safe to continue with it. This level of pain is healthy and may be promoting the changes you are looking for when working out.

Yellow Light (4-6/10 Pain): Yellow light means slow down. It does not mean stop (yet), but it definitely does not mean hit the gas and blow through the light. 4, 5, or 6 out of 10 pain is pretty significant, so what you should be thinking is, “What can I do to get back to a green light?” The answer may be a few things. First, check your technique. Make sure posture and form are correct. You can also lighten up your weight, change grip, or take a short break and return to the exercise afterwards. If you are able to return to the exercise following the modifications you made and the pain has dropped into our “Green Zone” you can continue on. If you cannot, you should stop the exercise and attempt to do something else. If it continues to linger you should make an appointment with a physical therapist to be assessed and find out how to turn your pain around.

Red Light (7-10/10 Pain): Red light means stop. Your pain has now reached a level where it is likely unsafe to continue this exercise. This is especially important if your pain has become sharp, burning, numbness or tingling. You’re in the danger zone where injury can occur. Your next step should be making an appointment with one of our doctors of PT in order to be assessed and figure out why this pain is happening when you’re exercising. 

Hopefully, this analogy helps gives you some guidance and clarity when navigating the choppy seas between pain and gain. There are always exceptions to these types of rules, so feel free to contact any of our doctors of physical therapy for further guidance on how to avoid injury and reach your goals. 

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Recovery. How Much Is Enough?

Foam Rollers. Lacrosse balls. Massage guns. Heat. Ice. Stretch. Don’t stretch. Rest, but not too much rest. Got that?

The world of ‘recovery’ is a confusing and at times overwhelming area of health and wellness that can make it difficult to actually understand what you should be doing to ensure you’re balancing the natural push/pull of breaking your body down through working out and building it back up through your recovery regimen.

So let’s take a step back and understand what recovery actually means.

When you workout you (ideally) challenge yourself to the point where your body has to respond in some way to better prepare it for the next time you hit the gym. Too little (or too infrequent) and your body won’t receive the stimulus needed for it to improve. Too much (or too frequent) and you risk over training your body and finding yourself set back by injury. For example, after a heavy strengthening workout you’ll naturally break down muscle fibers (leaving you temporarily “weaker”) but your body will rebuild “stronger” than before. This recovery process requires time and nutrition. Without enough of either of these, your body will actually be less prepared for your next workout because it hasn’t properly recovered from your last bout. If you just keep squatting heavy back to back days, you’ll find out that you can’t keep up with the same workout because your body isn’t getting the chance to recover. 

So how do we handle recovery?

Don’t worry, it’s not as hard as it seems (we’ll get to the gizmos later)

First, let’s look at short term recovery.

Short term recovery (for the purposes of this blog) is referring to your weekly workout routine. It’s important to give muscles time (approximately 1-3 days depending on the intensity of your workout, the level of your conditioning, and how “used” you are to your current programming) to recover before hitting them again. The heavier you go the more time your body will need. The newer you are to working out the more time your body will need. If you’re starting a completely different type of programming than you are used to, you’re likely going to need a little more time as well. 

So how do you know when you’re sufficiently “recovered?”

There are some cues your body will give you to let you know. Still sore from the last workout? Give yourself a rest, workout a different area of your body, or back off the intensity. Are you no longer sore but the weight you lifted a few days ago feels a lot heavier today? Your body is telling you it needs a bit more rest. Are you feeling fatigued and not as ready as you usually are? You likely need to check in with your body before progressing your workouts. This can be frustrating, but understand that your nutrition, your hormones, your mood, your sleep, all these things play into your recovery so if you haven’t been sleeping well or you’re more stressed than usual, you may find that it’s harder to squat the same weight you did last week….if that’s the case, pushing yourself to lift even heavier is probably not the right answer. Listen to your body, drop the weight to a difficult but tolerable challenge, get a good workout, eat a healthy meal, get some sleep and come back next time ready to push.

*Caveat* As your body adapts to consistent exercise, you may find that you may need less recovery than you used to. Seasoned athletes can handle practice 4-5x a week. Seasoned Crossfit athletes are sometimes hitting the gym 5x/week. High level athletes, however, typically also have trainers, mico and macro training cycles, monitored nutrition and sleep. So before you put yourself through that kind of gauntlet, make sure you’ve given your body the time, nutrition, and consistency it needs to have adapted to that level of training. 

Long-term Recovery (for the purposes of this blog) refers to the rest breaks you’ll take every couple months to give your body a good chance to fully recover from the punishment you’ve been putting it through on a consistent basis. Think of this as your clean slate. As noted above, challenging the body forces it to adapt. Eventually, you’ll likely get to the point where your body is “plateauing” and you’re finding that making big gains isn’t coming as quickly as it used to. This is a cue that A) it’s probably time to change your programming and B) it’s likely time to take a week off (note: taking a week off doesn’t mean only binging Netflix and eating bonbons.) Active rest for a week could entail any of the following – your typical workout at about 50% intensity / volume, moderately challenging yoga, or even just engaging in some low-level recreational activities such as bike riding or walking. 

As for the gizmos?

Do you need to spend 30 minutes after every workout hitting the foam roller, lacrosse ball and massage gun? Probably not. Sometimes in PT we may use these for specific issues revealed by an in-depth evaluation but foam rolling your whole body after you’re done squatting is likely overkill. Are you hurting yourself by using them? No. Do they feel good? Absolutely. If you feel like they help you perform better – go for it. 

The big takeaway here is to push yourself consistently and gradually, listen to your body, eat well, sleep well, take rest days throughout the week and take a week off every 2-3 months.

*As always, everybody is different. This discussion on recovery talks about general rules of thumb broadly applicable to the general public. Some people require tweaks to this approach so If you have any questions, ask your friendly PT at FX Physical Therapy and we’ll make sure you’re on the right track. 

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Poor Home Offices are a Pain in the Neck

Throughout quarantine, I have heard of so many people coming in with neck pain because they work from home. Poor ergonomic setups in home offices are finally starting to take their toll. When a joint faces prolonged stresses in the same position all day long, muscles and structures will eventually become aggravated. Much like any other joint in the body, the neck can be treated with exercise and movement.  

The goal is not to be the posture police, but to describe why posturing is important. In an ideal posture position, each segment of the body is appropriately stacked over one another. This allows forces to be dispersed throughout the body evenly. When we sit in a stereotypical position such as the one below, certain segments of the neck must absorb all forces while other areas do not. This creates excess strain in one or two areas, which will cause that nagging neck pain you feel when hunched over your computer during the workday. Notice how the weight of the head is dangling in front of the body, causing our muscles and joints to work overtime in order to stop our head from succumbing to gravity. My philosophy has always been “work smarter, not harder”. By keeping in mind this principle when it comes to positioning all day, we can save our bodies a lot of wear and tear.  

Left: (red shows gravity going directly through the neck)

Right: (red shows the weight of the head in front of the neck. Blue shows gravity stressing the bottom of the neck/top of the upper back) 

So how do we get rid of this dull ache? The answer is simple: movement. Our bodies crave movement in all directions. If we are stuck in one position all day, certain areas of the joint move while others stay completely still. Just by taking standing breaks throughout the day, we can greatly reduce the chance of getting pain in our necks. Here are a few exercises that promote movement in areas that are stereotypically limited: 

1. Chin tucks
   1. Elongate neck in a seated position with good posture 
   2. Push chin into throat
   3. You should feel muscles engage in the front of the neck with a light stretch in muscles in the back of the neck
   4. Hold for 5 seconds and complete 5 reps 
2. Upper trap stretch
   1. Grab one side of upper head with opposite arm 
   2. Gently pull head toward the same side of your arm
   3. You should feel each segment bend as you pull (starting with your head and working down the neck)
   4. Complete 30 second holds for 2 reps
   5. Repeat on the opposite side
3. Seated thoracic stretch 
   1. Sit in proper postured position with hands behind head 
   2. Slowly slouch forward with elbows moving forward 
   3. Try to “get tall” from a slouched position with elbows moving into a position where they point out to either side 
   4. You should feel like your chest is opening up and a stretch in the upper back region 
   5. Hold for 2-3 seconds and complete 10 reps 

Tests to see if you are limited in your neck range of motion:

1. Can you touch your chin to your chest when looking toward the ground? 
2. Can your nose reach a 90-degree angle when looking up towards the ceiling 
3. Can you move your head to 90 degrees when looking over your left/right shoulder? 

Although these exercises are generally good exercises, they might not be exactly what you need. This is when we recommend seeing a physical therapist. Any movement is good for the body. However, if you want to get better faster, have a professional assess the movements YOU need. 

For a customized therapy plan to address your specific needs – Call our team today at 443-595-7798 or click here to request an appointment.

 

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Conditioning for Mountain Bikers: Improving your Engine

Mountain biking is a rare sport in that it has a long aerobic endurance requirement with multiple intense bouts of anaerobic work. What this means is that the rides you perform are overall working your cardiovascular system at a consistent rate – then at times you come to a tough section of trail which requires a sprint, jump, or other technical move that breaks this consistent effort. This requires your cardiovascular system to work at a consistent pace, have a rapid spike in work-load, and the need to be able to recover enough in order to not drop the pace you were holding beforehand. 

The best way you can improve your performance on the trail is to perform workouts on or off the bike that work your aerobic system and anaerobic system: 

1. High Intensity Interval Training (HIIT) – Anaerobic 
   1. These are quick, maximum intensity bouts of training with long recovery periods. Research has shown that a cumulative 1 minute of max effort training 3 times per week has given VO2 max benefits in as little as 6 weeks. Now, sprinting for 1 minute straight at maximum intensity is near impossible so you need to break it up into 10 or 20 second rounds and allow sufficient time to recover between rounds. This form of training is a fast and effective way to simulate those tough technical sections in the trails. 
2. Steady State Cardio – Aerobic 
   1. These types of rides are more for improving your cardiovascular capacity and consistency throughout longer rides. Steady state rides are more beneficial on a less technical trail or a gravel road, so you can keep your cadence and heart rate in a semi-consistent zone. Unfortunately, these rides are not for stopping at the top to chat with your friends before the downhill. These are pure aerobic rides where you should be going for 45+ minutes without stopping. A good rule of thumb for these types of rides is to be able to have a conversation on the bike – if you can’t breathe enough to talk, you are going too hard. 
3. Strength Training 
   1. Strength training has been shown to have significant benefits to mountain biking and all endurance athletes – check out our “Strength Training for the Mountain Biker” blog post for more information! 

If you want to compete in racing, or just have a better time out with your friends – try out some of these training strategies. The concepts listed above will not only make you more competitive, but I guarantee that you will have more enjoyable rides once your engine becomes better tuned for mountain biking! 

Author: Dr. Colin van Werkhoven, PT, DPT, CSCS

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Why Wait For Rehab If You Can Prehab?

When people hear “physical therapy” their minds generally go right to treatment after an injury or pain. And that is the majority of what currently fills our schedule.

But it’s not all we can do.

Physical therapy can also include prehabilitation. No, we promise we didn’t just make that up. Prehabilitation, or “prehab,” may be therapy to avoid injury or pain or therapy to prepare for a surgery. It can address limitations in strength, stability, range of motion, balance, and overall function—all of the same things we may address after you have an injury or surgery, but basically taking a proactive approach instead of waiting for something to happen. 

So, if you work on similar things, what’s the difference? You’re likely wondering how prehab can benefit you. Why take this proactive approach? 

For someone who has a surgery scheduled, there’s a common belief that physical therapy can’t help until after surgery. And if you have a surgeon with a good reputation, that may mean you’re waiting around for a while. We should probably more accurately call it a common misbelief, because the reality is that therapy before a surgery can help in a number of ways.

Studies have shown that following a prehab program before surgery can lead to shorter hospital stays (by up to 4 days!) and increased chances of going straight home after surgery, rather than to a rehab facility. It can also reduce the risk of complications from surgery and reduce overall medical costs. But while statistics are great, prehab can also help you on a more personal level by increasing your post-op safety and addressing any concerns you may have about your surgery. We tend to be foggy right after surgery, thanks to anesthesia, which seems to coincide with when the doctor tells us how everything went and what precautions we need to take—not a spectacular time to rely on memory.

During prehab, your physical therapist can teach you all of your precautions and modified ways of going through your daily routine, as well as fall prevention for any lower extremity procedures before your operation. That way they can make sure there’s no confusion about what you should or shouldn’t do right after surgery and you’ll be much more prepared. Your physical therapist can also answer any questions or ease any concerns you may have about the operation so that you can head into it more relaxed and confident.

Doing a bout of prehab before a surgery has also been shown to result in better outcomes and a more rapid return to regular life. Research shows that those who do prehab before a total hip or knee replacement show improvements in pain, function, length of hospital stay and strength, and often reach functional range of motion sooner. For athletes, similar benefits have been seen with ACL reconstructions. Pre-op quad strength can help predict functional outcomes after ACL reconstruction.

Basically, those with greater quad strength going in to surgery tend to have better function of their knee after reconstruction. Since you lose some ability to activate your quads after injury due to pain and swelling, prehab can help you gain that strength back before your surgery so that you give yourself the best chance at optimal recovery in the long run. Those who do prehab before their ACL reconstruction tend to have better functional outcomes not only weeks after surgery, but as far as 2 years later.

Following a prehab program can increase your chances of returning to your pre-injury activity level and may help you return to your sport sooner than if you wait until after surgery to start the rehab process. So while you’re waiting what can be weeks or months before your scheduled surgery date, why not put yourself in the position to get the best outcome you possibly can?

And prehab isn’t only for those with an operation on their calendar.

Working with a physical therapist can benefit many athletes. Muscle imbalances can change the way your joints are loaded and the mechanics of your movement. But when one area is limited, your body will still find a way around it to move the way you want to. It will compensate by using other joints or muscles, and compensations can lead to dysfunction over time. Following a prehab program with a physical therapist can help you strengthen the correct muscles, find mobility in the right joints, and perform your sport or activity with optimal form to reduce your chances of pain and injury later on. 

Why wait for rehab if you can prehab?

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Physical Therapy for Temporomandibular Dysfunction

What Is TMD?:

Temporomandibular Dysfunction is a collection of symptoms that involve the mouth, jaw and supporting structures. While not typically associated with physical therapy, these symptoms can affect eating, talking, yawning and singing which can make a large impact in daily life! TMD can often send referral patterns, or different areas of pain, all throughout the head, neck and face and sometimes cause headaches.

Below are some important things to consider when faced with symptoms surrounding jaw dysfunction.

Team Approach:

It is incredibly important to have a team approach with all healthcare providers associated with TMD.

What does this mean?

While your dentist is usually the first point of contact here, it is integral to have communication between your physical therapist and possibly orthodontist if there is one involved so that everyone is making informed decisions regarding treatment. 

Physical Therapy For TMD:
You can have physical therapy for your jaw? Absolutely! The jaw is closely influenced by the position of our neck. Doing posture retraining and stability exercises for the neck can improve TMD symptoms. There are also a significant amount of muscles that are responsible for coordinating movement for chewing and talking, and like any other muscles those can get tight or be weak. We can guide our patients through movement retraining, stretching and mobilization of the muscles and joint itself and then resistance exercises. 

What To Do If You Have Jaw Pain:

• If you are already in physical therapy, mention this to your PT! They may be able to make some suggestions on home exercises to start with. 
• Schedule an appointment with your dentist.

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