Preventing Arm Injuries By Improving Your Posture

Shoulder and elbow injuries are incredibly common in overhead sports such as baseball and softball.  The American Orthopedic Society for Sports Medicine reports fivefold increase in serious shoulder and elbow injuries in youth baseball and softball since the year 2000.  Though there is no way to completely prevent these injuries from occurring there are things youth athletes can do to help reduce the likelihood of injury.  Improving posture is one simple way to help reduce injury risk. In this blog, I will explain why having poor posture is so bad for throwing and a couple of simple ways to improve posture.

A postural assessment is one of the first things we look at as part of our physical assessment when someone comes in for PT.  It is common to see kids come in with forward head, rounded shoulder posture as seen here.

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This posture is often related to playing video games for extended periods and we even with refer to it jokingly as “Fortnight Posture.”  There is a good article in the Wall Street Journal from August 2018 that refers to a study that related youth baseball shoulder and elbow injury directly to playing video games.

Though there is debate on what the “ideal posture” is for the pitching delivery it is quite clear that rounded slouched position is not desirable.  Rounded posture has been shown to reduce shoulder range of motion. You can test this yourself by simply sitting with rounded posture and trying to lift your arms as high as you can.  

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Then sit up with good posture and try again.

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You will be able to gain 20-30% more motion simply by improving your posture.  Several studies have shown that reduced shoulder range of motion increases the risk for shoulder and elbow injury.

By simply  improving your posture you can reduce your risk for shoulder and elbow injury.  An exercise we often give to our patients is shoulder blade pinches. By sitting up straight and gently pinching your shoulder blades back you will improve your posture.

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Do this throughout the day, after being on the computer or on your phone (or playing Fortnight) for long periods and you will improve your posture.

Complete Game Physical Therapy works with overhead athletes, athletes who take part in all sports, and anyone needing physical therapy. To make an appointment, please call our office at 978-710-7204.

Complete Game Physical Therapy Patient of the Month: Pam

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Complete Game Physical Therapy is happy to announce our Patient of the Month, Pam.  

Pam came to us after years of dealing with a hamstring problem.  After taking a detailed history and performing a thorough exam, we used several techniques and video analysis of her running form to help us figure out what was going on. We then worked with Pam to create a plan that would work into her busy lifestyle and most importantly, get her feeling better.

Pam is a member of the Sole Sisters Running Club, an all-women’s running club that gathers to train together, participate in various races, and to be social together. She certainly wanted to feel better to keep up with the group! “I thought the hamstring pain I had for over three years was something that would never go away. I’m happy to say that after working with Complete Game for a few months, I feel like a new person!”

During each visit, we have seen all of the improvements that Pam has made as she worked in the clinic and followed her at-home instructions. “I am so impressed with how closely Complete Game listened to me and helped me achieve my goal of being able to continue running during treatment,” she stated. “The staff at Complete Game is extremely knowledgeable. They came up with a plan to not only heal my injury but to find the cause and help me correct it. I feel confident that I’ve been given the tools to remain injury free.”

Pam, we wish you many more miles of happy running! It was our pleasure to work with you!


Choose PT First for Back Pain

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Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication

Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common.

  • 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not

  • In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge

  • Just getting an image increases the chances that you’ll have surgery by 34%

Surgery

The US has sky high rates for back surgeries - 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible!

A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t. The surgical group had:

● A 1 in 4 chance of a repeat surgery

● A 1 in 3 chance of a major complication

● A 1 in 3 chance of never returning to work again

Physical Therapy

Current clinical practice guidelines support manual therapy and exercise

  • Research proves that early PT lead to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids

  • A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%

  • Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

If you have any questions or would like more information, contact Greg at Complete Game Physical Therapy, 978-710-7204 or gcrossman@completegamept.com.


Complete Game Physical Therapy Patient of the Month: Josh

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This month we welcome Josh as our Patient of the Month! Josh came to us after having Tommy John surgery. He naturally had some concerns after the surgery. “I didn’t know if I was going to be able to pitch again,” Josh explained. “I expressed my concerns to Dr Oh who then recommended that I should start physical therapy with Greg.”

We worked closely with Josh’s surgeon and developed an individualized plan that addressed his specific needs. We worked as a team with Josh to make sure that he was 100% getting back on the mound! Some of what we must overcome with each injured athlete is the psychological aspect of injury. Athletes worry about not being able to return to a sport they love. Since we work with so many athletes here at Complete Game, we understand how to make them comfortable, provide support, and help keep them motivated to get back in the game.

“Greg is an expert of arm care and understands the time it takes to recover from surgery, “ Josh continued. “Without Complete Game Physical Therapy I wouldn’t be able to compete at my highest level. If anyone is looking for a great, experienced physical therapist who is going to take the time to make sure you are 100 percent, Greg and the team at Complete Game should be your first choice!”

Thank you, Josh! We are excited to see you back on the mound and hope you have a great season.


Injury Prevention for the "Older" Ball Player

There’s nothing like the feeling of jogging out onto a baseball or softball field to take some grounders or shag some fly balls.  The smell of fresh cut grass, the feeling of the dirt under your cleats, the crack of the bat. If it doesn’t make you feel like a kid again nothing will!  These sports are not just for the young. An estimated 10 million participants take part in casual baseball and softball leagues in the U.S. each year. Most articles on injury prevention in baseball and softball are designed, however, for youth players or high level professional, college or high school players.  This article will give some tips to the recreational players who truly just play for the love of the game.

Whether you are in your 20’s and want to play ball after a college or professional career, or in your 40’s or 50’s and want to return to play after years away from the game, here are a few specific considerations, as well as some exercises and stretches to address them.

You are very likely not as active during the day as you were when you last played.  You may now have a job where you sit for much of the day at work and then sit again during your commute to and from the office.  All this sitting does a number on your posture and poor posture has been shown to lead to an increased risk for shoulder and elbow injury in baseball players.  Doing some exercises to offset forward posture such as the row exercise (pictured below) is very important for not only the health of your shoulder, but also for your elbow, neck and back.

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Another consideration related to sitting is hamstring tightness.  Sitting leaves the hamstrings in a shortened position. When left in this position for long periods, your hamstrings will become tight and inflexible.  If your hamstrings are tight and you try and sprint to field a grounder in the hole or leg out a double, you can end up with a hamstring tear. Performing a simple hamstring stretch (shown below) will help improve hamstring flexibility.

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A third injury consideration for the recreational baseball and softball player are calf and achilles tendon tears.  Baseball and softball are sports that require athletes to go from standing relatively still to a full sprint. Tight calves can lead to muscle strain or, even worse, an achilles rupture.  The stretch shown below can help loosen up tight calves and reduce your likelihood of injury.

These exercises and stretches should be performed throughout the day and can easily be done at home or in the office.  You simply can’t offset a day’s worth of sitting with a few quick stretches or light warm up before you go on the field.  Incorporate these stretches into your daily routine regularly and they will help keep you on the field and feeling like a kid again!

If you have any questions or would like more information, contact Greg at Complete Game Physical Therapy, 978-710-7204 or gcrossman@completegamept.com.


Complete Game Physical Therapy Patient of the Month, Joanna Schlansky

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Introducing our March Patient of the Month, Joanna Schlansky!

Joanna has just completed six weeks of PT with us after having meniscus surgery on her knee.

“My doctor prescribed PT. I knew I had many options to choose from in my area and after doing some research and reading reviews online, I knew that Complete Game Physical Therapy was the right place for me.”

Greg created a plan to help Joanna gain her strength while being very sensitive to the pain from her surgical site. “Complete Game Physical Therapy were absolutely wonderful and treated me in the way I expected. From their admin, Bonnie, on the front desk scheduling appointments and answering all of my insurance questions to their PT practitioners, my experience was nothing less than professional and they gave me the care and attention my knee needed.”

We enjoyed working with Joanna and we understood her job and responsibilities could cause some time constraints, after all we are all very busy!  “I have a very demanding job with a lot of last minute fires to put out, and there were many times that I was a little late for my scheduled PT appointment. When I arrived there late, they never made me feel uncomfortable or rescheduled me. I would definitely recommend Complete Game Physical Therapy to all of my friends, family and clients; they won’t be disappointed.”

Joanna, we are all so happy that you are feeling better and it was our pleasure to work with you!


Training the Core to Prevent Back Injury and Improve Performance in Baseball

Baseball and softball are highly repetitive sports in which both throwing and hitting can place a great deal of stress on the lower back.  In younger populations, these repetitive actions can lead to injuries such as muscle strains and stress fractures. In older populations, the stress can lead to disc herniations or disc degeneration.  Proper training of the core not only reduces the likelihood of injury, but also improves performance.

In baseball and softball, two primary functions of the core muscles are to 1.) stabilize and protect the spine and surrounding structures and 2.) transmit force generated from the legs to the shoulders and, ultimately, to the bat or the ball.  To perform these tasks, all the muscles of the core, including the gluteal muscles, the lower back muscles, the obliques (or muscles on the side of the trunk) and the rectus abdominis or ab muscles, must work together.

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Training these muscles in the traditional way with sit ups or oblique twists does not tend to be as effective for injury prevention or performance in baseball and softball.  Sit ups and oblique twists train the muscles as movers not stabilizers. The following exercises will help you train your core properly. If you have had back problems in the past or are currently having back problems, please consult a medical professional before trying any of these exercises.

Posture and Position

Before you begin core training, check your resting posture.  If your lower back is too arched, you are at higher risk for stress fractures.  If it is too flat, you are at higher risk for disc problems. For the best function, you need proper resting position with all your core muscles.  A simple self check of your back position is to stand up against a wall with your head, shoulders and butt back against the wall and your feet out about six inches from the wall.  You should have about a hand width of space between your lower back and the wall. More than a hand width means that the arch in your lower back is too big; less means your back it too flat.  Think about maintaining that position of one hand width of space with all exercises.

Bridge

The back bridge is a great exercise that focuses on the glutes.  Laying on your back with your knees bent, first tighten your core, then squeeze your glutes and, finally, lift your hips so there is a straight line from your shoulder to your knee.  You should feel most of the effort in your glutes and only slightly in your hamstrings. You should not feel it in your lower back.

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Side Plank

The side plank is a good exercise for the lateral spine stabilizers.  Laying on your side propped up on your elbow (make sure your elbow is directly under your shoulder), lift your hips so your body is in a straight line.  Make sure your hips don’t drift too far forward or back.

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Bird Dog

This is a great exercise for the anterior and posterior stabilizers of the spine and also gets  the arms and legs working together while stabilizing. Start from your hands and knees and, while keeping your core tight, slowly extend the opposite arm and leg.

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These exercises can help reduce your likelihood of back injury and improve performance.  For any questions, please contact Greg or Andy at Complete Game Physical Therapy 978-710-7204 or gcrossman@completegamept.com.

Hockey Injuries and Prevention by Andrew Levanti, DPT, ATC

Hockey season is in full swing with playoffs coming up for most high school and youth leagues.  A contact sport, hockey can be very physical, and as the season progresses, higher fatigue levels increase the risk of injuries to the shoulder, knee, and hip/groin.  This article breaks down a few of the most common injuries to provide insight into causes, treatments, and injury prevention tips.

Shoulder Injuries

  • AC Joint:  The Acromioclavicular (AC) joint is located on the top outside of the shoulder and is the joint between the clavicle (collarbone) and the acromion which is the top portion of the shoulder blade.  An injury to the AC joint is commonly known as a shoulder separation. This joint is frequently injured in hockey by a fall directly onto the "point" of the shoulder, hitting this part of the shoulder into the boards, or a direct blow received during a check. These injuries are characterized by tenderness at the AC joint, bruising/swelling, pain with shoulder motion, and, with more severe injuries, gapping at the outside of the shoulder also known as a step off deformity. The treatment and recovery times of an AC joint depends on the severity of the injury. Most often there will be a grade one sprain which involves minimal separation at the joint and only slight stretching or tearing of the ligament. These types of AC sprains typically take about 2-4 weeks to fully heal and are treated with a short term use of sling to decrease pain, followed by physical therapy for shoulder range of motion and strengthening. AC joint injuries are best prevented by properly fitting shoulder pads. The nature of this type of injury limit the effectiveness of using exercise as a prevention method. However, it is very important complete a full rehab program before returning to play following an injury to help prevent recurrence of injury.

  • Dislocation: Shoulder dislocations involve the of head of the upper arm coming out of its socket on the shoulder blade. The most common type of shoulder dislocation is an anterior dislocation which is when the shoulder comes out the front of the socket. This type of dislocation typically occurs due to a fall on an outstretched arm, a direct blow on the shoulder, or a forced external rotation of the arm.  Treatment for shoulder dislocations begin with reduction of the dislocation. Typically, this takes place following imaging in the emergency department of the hospital rather than directly on the ice to ensure that no nerves or vascular structures are impinged upon reduction of the shoulder. A sling is used for a few days to allow pain and swelling to stabilize.  Physical therapy will follow, with a focus on regaining motion and strengthening the muscles surrounding the shoulder to help support the ligaments and capsule that was stretched during the injury. A concern following shoulder dislocation is the development of chronic shoulder instability resulting in subsequent dislocations. Compliance with rehab protocols and not returning to play too soon following a first time dislocation is key to preventing the development of chronic shoulder instability.  The focus of rehab and prevention of shoulder dislocation is to increased the strength of the muscles around the shoulder and shoulder blade to provide increase stability. Ensuring that the rotator cuff and the other muscles around the shoulder blade are working properly can help increase stability at the shoulder. The following exercises can be used strengthen the muscles of the shoulder blade and the rotator cuff to improve stability at the shoulder and help prevent dislocations.

    • Prone Shoulder Abduction

      • Start position: lay on your stomach with your arm hanging over the edge of the table or bed. Your head can be off the head of the table/bed, or relaxed with your head on the table/bed facing away from the arm performing the exercise.

      • Movement:  Keeping your elbow straight and thumb pointing up, raise your arm out to your side at a 90 degree angle. Slowly lower your arm back down.  Repeat the movement 10-15 times for 2-3 sets on each side.

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Sidelying Shoulder External Rotation

  • Start position: Begin lying on your side with a towel roll between your arm and side, your elbow bent to 90 degrees, and your hand resting against your stomach.

  • Movement: Slowly rotate your forearm upward. Make sure to keep your elbow bent and tucked in at your side as you lift your forearm.  Avoid shrugging your shoulders. Pause briefly at the end of your range of motion. Then return to the starting position and repeat 10-15 times for 2-3 sets on each side.

Knee Injuries

  • ACL/MCL: Knee injuries in hockey typically involve tearing of the medial collateral ligament (MCL), the anterior cruciate ligament (ACL), or both. These injuries can occur with or without contact and involve a twisting motion (with or without external pressure) or direct pressure onto the outside of the knee. An isolated MCL injury typically will heal on its own and not require surgery unless there is a chronic stability issue following the injury. The time of recovery and missed ice time is dependent on the severity of the injury and can range from 2 weeks to 8 weeks, longer if surgery is required.  Physical therapy following injury will include controlling swelling, regaining range of motion, and building strength of the knee and hip. Non-contact ligament injuries can be prevented through on and off ice prevention programs. Injury prevention programs should focus on hip strengthening to provide support at the knee. Squats and lunges are an easy way place to begin.

    • Double leg squats:

      • Start position: Standing, feet shoulder width apart with your hands at your side

      • Movement: Bend your knees, sitting back as you lower your bottom toward to the ground until your knees are bent to about 90 degrees. Return to standing position. Repeat for 2-3 sets of 10-15 reps

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    • Lunge:

      • Start position: Standing, feet shoulder width apart with your hands at your side

      • Movement: Take a large step forward, lowering into a lunge position by dropping your back knee down toward the ground with your knees bent to 90 degree angles. Then raise yourself up and take a step backward with your lead foot returning to the start position. Repeat motion with your opposite leg. Repeat 10-15 times of each side for 2-3 sets.

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Hip/groin Injuries

  • Hip flexor and Adductor Strains:  The muscles used most for skating are the glutes and quads/hip flexors.  When either of these muscle groups are weak, an imbalance occurs and can result in the overuse of other hip muscles which leads to tightness and possible injury.  Hip and groin injuries in hockey are commonly caused by overuse and weakness of muscles around the hips. Hip flexor injuries involve small tearing to the psoas muscle and/or tendon of the rectus femoris.  Adductor strains also known as groin strains involve small tearing of the adductor muscle group on your inner thigh. Treatment of these injuries involve rest, ice, gentle stretching, and general hip strengthening.  Depending on the severity of the injury, typical recovery times range from 2-6 weeks. Once again, it is very important not to return to play too quickly following a mild hip flexor or adductor strain as this can result in re-injury possibly more severe than then the initial injury.  Injury prevention for hip and groin injuries involve stretching and ensuring proper strength throughout the hips. Dynamic warm ups can help to loosen up muscles and increase blood flow before getting onto the ice and prevent injury. For specific hip flexor and adductor injury prevention, give these two stretches a shot.

    • Hip flexor stretch

      • Start position: Half kneeling with the knee of the side you are stretching down on a mat and the other knee out in front of you.

      • Movement: Tighten your abdominals, tilt your pelvis backward, and gently squeeze your glutes together. You should feel a stretch in the front of your hip. Make sure to keep your hips facing forward and back straight during the exercise. Hold for 10-15 seconds and repeat 3-4 times per side.

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    • Adductor stretch

      • Start Position: Quadruped (on hands and knees)

      • Movement: slide the leg that you are going to stretch out to the side until your knee is straight. Then rock your hips back and to the opposite side. Hold a comfortable stretch for 15-30 seconds and repeat 3-4 times on each side.

Injury prevention is a continuous process that should take place leading up to the season, throughout the season, and after the season. Each phase is unique in its focus, but all have the common goal of keeping the player on the ice and healthy.  At  Complete Game Physical Therapy , injury prevention is one of our primary goals. We provide injury prevention screens to ensure that your body is moving properly and efficiently. With the results of the screen, we are able to provide you with a set of corrective exercises to improve your mobility and keep your body moving the way it should and you or your player out on the ice.  If you are are interested in an injury prevention screen or have any questions, please contact us at 978-710-7204 or via email at  alevanti@completegamept.com . For video demonstrations of most of the above exercises please check out our Tip Tuesday YouTube Channel by typing Complete Game Physical Therapy into the YouTube Search Bar.

Injury prevention is a continuous process that should take place leading up to the season, throughout the season, and after the season. Each phase is unique in its focus, but all have the common goal of keeping the player on the ice and healthy.

At Complete Game Physical Therapy, injury prevention is one of our primary goals. We provide injury prevention screens to ensure that your body is moving properly and efficiently. With the results of the screen, we are able to provide you with a set of corrective exercises to improve your mobility and keep your body moving the way it should and you or your player out on the ice.

If you are are interested in an injury prevention screen or have any questions, please contact us at 978-710-7204 or via email at alevanti@completegamept.com. For video demonstrations of most of the above exercises please check out our Tip Tuesday YouTube Channel by typing Complete Game Physical Therapy into the YouTube Search Bar.


Want to Improve Health and Performance? Just Breathe!

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What if I told you that you may be doing something 20,000 times a day that is compromising your sleep, recovery, performance and health?  In fact, if you are breathing improperly, that is exactly what you are doing. Breathing pattern disorders are common, but also relatively easy to fix.  Let’s review proper and improper breathing mechanics and give you some strategies to improve your breathing pattern.

Caution: If you are experiencing chest pains, breathlessness or dizziness, you should contact your doctor to rule out more serious causes of your breathing dysfunction.

Proper Breathing

In proper, or diaphragmatic, breathing, inhalation is initiated by the downward movement of the diaphragm and the outward movement of the abdomen and lower ribs.  The rib cage should expand in a 3D pattern top to bottom, back to front and side to side. Expiration should be effortless as the abdomen and lower ribs descend and the diaphragm moves back to its original domed position.

Chest and Neck Breathing

The most common breathing pattern disorder we see in the physical therapy clinic is neck or upper chest breathing.  This occurs when you use the accessory muscles of the neck and upper chest, rather than the diaphragm, to draw in air.  These muscles are not designed for a highly repetitive task and this pattern can lead not only to difficulty pulling in enough air for proper recovery or athletic performance, but also to problems such as neck pain, arm pain, back pain or headaches.  

Breathing Pattern Assessment

To assess your breathing pattern, lay on your back with one hand over your belly button and the other over your upper chest.  Take a deep breath in and see where you feel movement under your hands. You should feel your belly move into your bottom hand and very little movement in your top hand.  If you feel most of the movement in your top hand, then you are using a neck/upper chest breathing pattern. If you feel the muscles of your neck and jaw tighten during inhalation, this indicates that these accessory muscles are kicking in.

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Retrain Your Breathing

Retraining your breathing pattern is pretty straight forward. Return to the same position you were in to test your breathing pattern.  Fully exhale and, once all the air is out of your lungs, slowly count to four. As you draw your breath back in, you should feel your abdomen and lower ribs expand.  If this movement is difficult and you feel your neck and upper chest muscles kicking in, you can bend your knees up and place your hands behind your head. Next, practice this exercise while sitting or standing.  Hands can be placed behind your back to relax the neck and upper chest.

Try to take “breathing breaks” throughout the day and consciously work on your breathing pattern.  You will be amazed at how much better you feel physically and mentally when you breathe properly. Though breathing is something we often take for granted, improving this movement pattern can dramatically improve both your health and performance.

If you have any questions or would like more information contact Greg at Complete Game Physical Therapy, 978-710-7204 or gcrossman@completegamept.com.



Complete Game Physical Therapy Patient of the Month: Pete

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Complete Game Physical Therapy introduces our patient of the month, Pete.

Pete came to us following a hip injury that had been giving him issues since the fall. Pete is a Andover High School graduate in his first year at University of New Hampshire where he is a member of the varsity lacrosse team. He had been rehabbing and resting is hip for much of the fall lacrosse season but it continued to limit his performance on the field. Upon returning home at the end of the semester Pete came to Complete Game Physical Therapy to focus on getting back to 100% before having to return to UNH for what will be is first season with the team.

Pete’s hard work both in the clinic with his exercises and compliance to his prescribed home exercise program allowed him to steadily progress back to game speed. As a freshman varsity athlete at UNH Pete continually said that he wanted to be able to complete all activities from day one of practice in order to try and compete for some playing time as a freshman.

Now he is able to sprint, cut, and all complete sport related activities at 100% effort. With Pete heading back up to school with would like to honor him as our patient of the month. It was a pleasure working with an athlete with such strong determination and we are glad we were part of your rehab process.
Good luck this season Pete and the UNH Wildcats!

New Year… New (Injury-Free) You!

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Five tips to avoid overdoing it with New Year’s fitness resolutions

Every year we see patients come into the clinic who had the best intentions with New Year’s resolutions to get in shape, but who, instead, end up injured.  We’ve seen muscle strains, tendonitis, back injuries, and even tendon and muscle tears in people who overdo it with their fitness resolutions.  So whether your plan is to run more, lift more, or do more yoga, here are some tips to reduce the likelihood that you will suffer a setback due to injury.

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  1. Make stretching part of your routine.  Often, especially with running and weight lifting, people don’t plan an appropriate amount of time for stretching.  You should allow enough time for a short, light stretch before exercise, and 5-10 minutes for more thorough stretching after your workout.

  2. Ease into it. Trying to jump back into the same kind of workouts you did 10 years ago is a sure way to get hurt.  Take it slow and gradually build up your workouts.  This will give your body time to adjust to your new program.

  3. Build a well rounded routine.  Running, lifting weights or even yoga every day is not good for your body.  If you tend to be a tighter, less flexible person, look to incorporate stretching into your regular routine.  If you tend be more flexible, add some strength training.  Building balance between strength and flexibility will help your body be more resilient and reduce your likelihood of injury.

  4. Careful with group classes. Though group classes are a great way to work out because they are fun, motivating and reasonably priced, be careful when working out in the group setting.  Especially around the new year, there tends to be a big influx in people signing up for these classes.  If the trainer hasn’t assessed you, they may not know what exercises your body can and can’t do.  Also, be careful if you have a competitive nature. The person next to you may be lifting a 60 pound dumbbell overhead, but that doesn’t mean you should too!

  5. Get a movement assessment.  Starting up a new fitness routine without a clear understanding of your specific deficits in strength, flexibility and balance will make your workouts less efficient and can lead to injury.  Many personal trainers and all physical therapists are trained to assess your fundamental functional movements.  Find a trainer or PT near you who offers movement screens. The small price in time and money you spend will pay off in the long run.

Happy New Year and good luck with your fitness goals!


If you have any questions or would like more information on setting up a movement screen please contact Greg at Complete Game Physical Therapy, 978-710-7204 or gcrossman@completegamept.com.

Complete Game Physical Therapy: 2018 In Review

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2018 was a great year here at Complete Game Physical Therapy! We completed the move from our Tewksbury, MA location to our new location here in Lowell. As we settled in, we were able to concentrate on expanding and continuing to provide the best physical therapy services to all patients. Here are just some of the highlights from our year!

We have two new full-time staff members. Bonnie is our receptionist and admin and is the first face that most people see when they come through the door. Dr. Andrew Levanti, DPT, ATC joined us in August and sees patients along with Greg. The additions of Bonnie and Andy have contributed to our success this year!

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We have cultivated exciting partnerships with the Lowell Jr Spinners Baseball, Mill City Volleyball, Boston Jr Rangers Hockey, Dracut High School Baseball, Northern Essex Community College Baseball organizations. In addition, we made some great connections with local fitness centers and gyms including New England Strength Performance, Choice Fitness, J&K Custom Fitness and Zone Fitness.

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Greg and Andy currently write columns for the Tewksbury and Wilmington Town Crier to give readers a better understanding of physical therapy and treatments.

We continue to focus on and expand our youth sports injury prevention services with screenings for area youth sports organizations and to speak to youth sports organizations about youth sports injury and injury prevention.

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As 2018 comes to a close, we are excited about the upcoming year! We hope that you all enjoyed a very Happy Holiday! Be sure to follow us in 2019 as Greg, Bonnie and Andy share news about Complete Game!

Keeping Healthy in the Baseball/Softball Off Season

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Though the winter is in full swing and it may seem way too early to be thinking about the baseball or softball season, many players and teams will have started their offseason training.  Here in the northeast, indoor training facilities are filling up fast with players getting ready for next season. Check out these tips if you or your child is starting offseason training.

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Training Considerations for Youth Baseball and Softball

Ages 12 and Under

A research review published in the American Journal of Sports Medicine in 2017, entitled “Sport Specialization at an Early Age Can Increase Injury Risk”, not only found a higher rate of injury in those that specialize early, but also found that those who waited to specialize tended to reach higher levels of athletic achievement.  Playing multiple sports, especially at younger ages, has clear benefits.

Be careful though.  Playing 3-4 sports in the same season is not necessarily beneficial and can, in fact, lead to overuse injuries or burnout.  We often see kids (and their well intended parents who let them play 3-4 sports in the same season) in the PT clinic with overuse type injuries (tendonitis, muscle strains, etc.).  Pick and choose what you play so as not to over do it.

Strength and conditioning training at this age is helpful, but should be done only under observation with a trainer who is used to working with children.  Training at these ages should not focus on traditional “weight lifting” and instead should focus more on the A, B, Cs (Agility, Balance and Coordination).

Ages 13-14

This age group is a challenge.  We see more injuries in the clinic in this age group than any other group of athletes.  For baseball players, this is the age when they move to the big diamond. The longer throws in particular can be very taxing on their arms.  It is important at this age that athletes get in the gym and start some sort of strength training to help withstand the longer throws. They should also consider working with a coach on throwing mechanics.  We often see kids whose poor throwing mechanics become problematic when they move from small diamond to big diamond and have to make longer throws.

Softball field dimensions do not change as much, but this is the age where the female body begins to change and girls are at a higher risk for ACL injury.  The hips tend to widen, leaving the knees at an angle that is more susceptible to injury. Strength training programs or even ACL injury prevention programs can help reduce the risk of injury.

Ages 15+

This older age group should be involved in a more traditional strength and conditioning program.  Be sure, however, that your athlete is working with someone who has experience training “overhead athletes” like baseball or softball players.  There are many considerations that should be taken into account with this group. For example, because of the high level of stress that is placed on the front of the shoulder, care should be taken not to overstress the front of the shoulder in the weight room as well.

Another consideration with this group of athletes is that though it is still beneficial to play multiple sports, these athletes should be getting themselves ready for baseball or softball prior to the start of the season.  In the northeast, high school tryouts are typically in March and games often begin a week or two later. This is not enough time to prepare the body for high demand activities such as pitching. Athletes should be doing some throwing such as an interval throwing program to prepare themselves along with a strength and conditioning program.

At Complete Game Physical Therapy we help athletes and active individuals of all ages get back to the sports and activities they love without missing valuable playing time or losing their competitive advantage.  For more information or to make an appointment call 978-710-7204 or email Greg at gcrossman@completegamept.com.





Complete Game Physical Therapy: Patient of the Month, Fran

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Complete Game Physical Therapy introduces our patient of the month, Fran.

Fran came to us following her hip replacement surgery. As you can imagine, recovery from this surgery is a process and patients gradually add more to their daily routines.

Fran worked very hard at her exercises in our clinic and she was sure to follow her prescribed home exercise program. She was focused on getting back to her favorite activities. “I wanted to get back to cooking, going out with my friends, and playing with my grandchildren,” she said. “When I came here, I couldn’t go up or down the stairs regularly or even make my famous meatloaf because bending to lift it out of the oven was too painful.”

Now she is back to 100% and doing everything that is important to her! And her family can enjoy her wonderful cooking again.

It was a pleasure to have you in our clinic, Fran, and we are so glad we were part of your recovery process.


WARM-UP Before the Chill by Dr. Andrew Levanti, DPT, ATC

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The days are getting shorter and colder which can make sticking to your training program tough. Cold weather training can also lead to unwanted injuries, slowing down your progression and keeping you from participating in your favorite winter sports. A good dynamic warm up prior to activity is key to keeping your body healthy. Not warming up prior to your workout can leave your muscles feeling tighter throughout the workout and at an increased risk of injury. Below is a quick way to warm up and get keep you going through those chilly workouts.

Get the Blood Flowing:

Getting your heart rate up and the blood flowing to the muscles is the first step to a good warm up. A review of literature published in Sports Medicine concluded that increasing muscle temperature prior to activity can improve performance by decreasing the stiffness of muscles and joints, increase the transmission rate of nerve impulses, and producing a positive change of the force-velocity relationship (Bishop, 2003). Increasing blood flow and muscle temperature can be done in a few ways and really doesn’t require much space at all. If you have a stationary bike or elliptical at home you can hop on there for a quick 3-5 minutes at low intensity to get your heart rate up and blood flowing. If not, give these a try:

  1. Jumping Jacks:

    1. Start position: standing with your hands at your side.

    2. Movement: Start doing jumping jacks, raising your hands over head and jumping with your feet wide at the same time.

  2. Burpees:

    1. Start position: standing with your hands at your side

    2. Movement: Bring hands on the floor in front of you, then kick both of your legs backward, landing into a plank position. Perform a push up, then hop your legs back in toward your hands. Jump off the ground raising your arms overhead, then gently land, and repeat.

  3. Mountain climbers:

    1. Start position: Push-up position.

    2. Movement: Quickly alternate bringing your knees to your chest.

Dynamic Stretching:

The next step to a good warm is dynamic stretching to loosen up the muscles in preparation for the work out. A review of literature published in Current Sports Medicine Reports by the American College of Sports Medicine recommended dynamic stretching immediately prior to activity for a majority of athletes (Peck, 2016). Dynamic stretching consists of functional movements to bring the muscles into a lengthened position. They differ from static stretching in that the stretch is not held for prolonged amount of time. Once again, a ton of space is not needed to get this done in the house before heading out into the cold. It can be done in a hallway or even right in the living room. Here are a few dynamic stretches to try out.

  1. Walking Knee Hugs:

    1. Start position: Standing in a open and flat area.

    2. Movement: While walking lift one knee up to your chest and hug it with your arms. Hold 2-3 seconds, release, and take 2 steps, then repeat on the other side. Repeat 10-15 times of each side.

  2. Walking Quad Stretch:

    1. Start position: Standing in a open and flat area.

    2. Movement: While walking, bend one knee bringing your ankle to your bottom grabbing it with your hand. Hold 2-3 seconds, release, and take 2 steps, then repeat on the other side. Repeat 10-15 times of each side.

  3. Frankenstein's:

    1. Start position: Standing in a open and flat area.

    2. Movement: While walking kick one leg straight out in front of you hip high while reaching with your opposite arm to touch your toes on the leg you are kicking up. Take 2 steps, the repeat on other side. Repeat 10-15 times of each side.

  4. Walking Lunge Twist:

    1. Start position: Standing with your hands behind your head in a open and flat area.

    2. Movement: Take a large step forward, lowering into a lunge position with your knees bent to 90 degree angles. Keeping your chest up, twist your trunk to the left, then right, and back to center. Then raise yourself up and take a step forward with your other leg without letting your foot touch the ground in between and repeat motion. Repeat 10-15 times of each side.

  5. Walking Hamstring/Calf Stretch:

    1. Start position: Standing in a open, and flat area.

    2. Movement: Take a step forward placing your heel on the ground in front of you with your leg straight. Slowly bend forward at your hips with your back flat reaching your hands toward your toes until you feel a gentle stretch in the back of your thigh and calf. Then keeping your back flat return to as standing position as you reach your hands over your head before bringing them back to your side. Take 2 steps and repeat motion on other side. Repeat 10-15 times of each side.

At Complete Game Physical Therapy injury prevention is one of our primary goals. We provide wellness movement screens to ensure that your body is moving properly and efficiently. With the results of the screen we are able to provide you with a set of corrective exercises to improve your mobility and keep your body moving the way it should. If you are are interested in a wellness movement screen or have any questions please contact us at 978-710-7204 or via email at alevanti@completegamept.com

*Bishop, D. (2003). Warm Up II. Sports Medicine, 33(7), pp.483-498.

*Peck, E., Chomko, G., Gaz, D. and Farrell, A. (2014). The Effects of Stretching on Performance. Current Sports Medicine Reports, 13(3), pp.179-185.


Complete Game Physical Therapy: Patient of the Month, Kimberly Herbert

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Complete Game Physical Therapy welcomes our Patient of the Month, Kimberly Herbert.

Kimberly is quite an athlete! While training for her Ironman Competition, she tore her hamstring.

“I was devastated, and unsure if I was going to be able to make it to the starting line, let alone cross the finish line!” Kim says about her feelings after her injury. There was a silver-ling, though. “Due the expert knowledge and compassion of Complete Game Physical Therapy,  I was not only able to compete, but also crush my goals!”

We focused on a personalized treatment plan for Kim and that seems to make all the difference in her recovery. “Being a multi sport athlete, it was important that my therapist understood the need for personalized treatment plans.  They were able to help me focus on what I could do, not what I couldn't do. I am extremely thankful to them and will without a doubt go to them again!”


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Thank you, Kim! We are so proud of what you accomplished and wish you many more competitions in the future.



Hitting for Power and Pitching Velocity… It’s All in the Hips!

“It’s all in the hips.”  Not just a great line from the movie Happy Gilmore but also a great way to create more power hitting a baseball and increase pitching velocity in a safe manner.  I had the great pleasure of taking the Titleist Performance Institute (@mytpi) certification course over the last few days and they spend a lot of time talking about how pelvic tilt relates to power in the golf swing.  I of course immediately think of how it relates to baseball and with golf and baseball both being rotational sports they relate pretty closely. There must be something to this if TPI is currently training the top 60 golfers in the world!

Pelvic Tilt

Pelvic tilt is simply the position of the pelvis or hip bones in relation to the ground when standing.  An anterior tilt can be pictured as simply an increased arch in the lower back. A posterior tilt is the opposite and decreased arch in lower back or flattening of the spine.  A neutral spine is the spot right in between the two.


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How Pelvic Tilt Occurs in Throwing and Hitting

When our front leg lands as we throw or our back hip rotates around as we hit our pelvis is in an anterior tilt.  Doing this allow our hips and shoulders to rotate separately from each other to help create power. This leaves us in a position of lower back extension or increased arch.  As we come to release point in throwing or contact point in hitting we need to get out of that arch of the lower back and move into a more neutral or even slightly posterior pelvic tilt.  This allows us to use the power we generated with our lower half effectively and deliver it to the ball. Eric Cressey (@ericCressey) and Matt Blake do a great job of giving a detailed explanation of this in a blog post here: https://ericcressey.com/pitching-performance-trunk-position-foot-strike-1.

What We See in the Clinic

At Complete Game PT we have started off season screenings for area youth baseball players and we are seeing a lot of trouble with control of pelvic tilt.  Whether it’s due to poor anterior core strength, poor glute strength, tight hip flexors or just poor motor control kids have a really hard time moving from an anterior pelvic tilt to posterior.  This can lead to poor performance due to lack of power hitting or throwing or even worse injury to the back or hips. Problems with core control have also been related to shoulder and elbow injuries in throwers.

Pelvic Tilt Test

A simple test you can do to see if you or your athlete has trouble with controlling pelvic tilt is to stand in your hitting stride or pitching stride position and simply see if you can tilt your pelvis by arching your low back, then flattening your low back, then try to find the neutral position right in between.  If you have trouble doing this stand with your back against a wall with your feet about 18 inches from the wall and try to flatten your back against the wall. If you have trouble with that next step is to try doing the same thing laying flat on your back with your knees bend and feet flat on the floor. You should be able to move from anterior tilt to posterior and back to neutral easily and smoothly.

This test turns into a great exercise to work on if you have difficulty with the pelvic tilt in any of the positions mentioned above.  It is also a great example of how problems further down the chain like hip and core control can relate to poor performance or even injury further up the chain in the shoulder or elbow.  If you have any questions or would like to get you or your athlete assessed give us a call at Complete Game PT 978-710-7204 or email me at gcrossman@completegampt.com.




Complete Game Physical Therapy Patient of the Month Allie

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Complete Game Physical Therapy introduces our September Patient of the Month, Allie Indingaro. Allie came to Complete Game after she had ACL Reconstruction. After working very hard on her recovery after this surgery, she was able to return to playing soccer this Fall.

We worked with her to not only get her knee better but also to stay positive and focus on her goals of returning to sports. She had plenty of inspiration from all of the athletes and active individuals that we have in our facility. She was motivated by all of the positivity throughout her recovery!

Allie’s mom was there throughout the recovery process. “At first it is hard to see your child in pain and struggling but that quickly changes to happiness and pride when you see them growing stronger and stronger. Greg is so focused on the patient he is with and my daughter felt he was focused solely on her and her recovery."

It was so great to work with you, Allie! We can’t wait to see on the soccer field this season.


Tips to Help Prevent Injury for the Ex Ballplayer Returning to the Field

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After a few years away from playing baseball, I’ve decided to join a men’s adult baseball fall league or, as my kids affectionately call it, the “old man baseball league.”  Having seen many former players who have returned to baseball or softball in the PT clinic over the years, I thought I would put together some tips to help reduce the likelihood of injury.  Here are a few things to keep in mind if you plan to return to the field.

  1. Warm up.  We may remember the days where we could just show up to the field and get right out there and play.  Unfortunately, as we age, those days are over. Having some form of warm up is key to preventing injuries such as muscle strains and tears.  Do some light jogging and follow with gentle stretching or a dynamic warm up such as body weight squats and lunges to get the blood flowing and loosen up your muscles before you play.

  2. Be careful with sprinting.  As we age, we lose muscle mass, particularly the fast twitch muscle fibers that are used with sprinting type activities.  Combine that with tight hamstrings due to sitting at a desk all day and you have the perfect situation for hamstring tears.  Don’t let your first sprint be when you are trying to leg out a double. Practice some sprints before you play by slowly progressing your sprinting.  Start at 50% speed, increase to 75%, and then build to full speed.

  3. Build up throwing slowly.  Just as you should increase your sprint gradually, you should build your throwing slowly as well.  Overhead throwing is not a natural motion for the body and, again, if you sit at a desk for much of the day or just generally have bad posture, the throwing motion is even less natural.  When you return to throwing, slowly build the number and distance of throws you make. If you start to feel pain in your shoulder or elbow, stop, get some ice on it and rest. If the pain doesn’t go away, see a medical professional.  I’ve seen many people who returned to throwing after a long lay off, tried to throw through pain and ended up with shoulder impingement or rotator cuff tears.

These tips are not only helpful for baseball but also soccer, basketball or even playing back yard touch football.  Follow these tips to help stay injury free and on the field!

 At Complete Game Physical Therapy we help athletes and active individuals of all ages get back to the sports and activities they love without missing valuable playing time or losing their competitive advantage.  For more information or to make an appointment call 978-710-7204 or email Greg at gcrossman@completegamept.com.

Complete Game Physical Therapy Welcomes Dr. Andrew Levanti

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Complete Game Physical Therapy welcomes our new Physical Therapist, Dr. Andrew Levanti. Dr. Levanti will be starting to see patients in September and we are taking appointments now.

Dr. Andrew Levanti, DPT, ATC has practiced physical therapy for the past year and has been a certified athletic trainer for the past 4 years. He completed his undergraduate in Athletic Training at Stony Brook University in New York prior to continuing his education at UMass Lowell graduating with his Doctor of Physical Therapy degree in 2017. During his time at UMass Lowell he served as the Head Athletic Trainer for Club Sports. For the past year he has been working as a physical therapist in a sports orthopedic clinic in New Jersey. Andy’s passion is in sports medicine with special interest in shoulder and knee injuries. When not in the clinic he enjoys mountain biking, skiing, and enjoying the outdoors. Andy is very excited to continue to grow his career at Complete Game Physical Therapy!