General Blog

Low Back Pain Q&A

Nearly everyone has had or will have a low back problem at some time in their life. Whether it’s a little discomfort or something more serious like a disc problem or a spinal fracture, the prevalence of lower back pain is astounding. The World Health Organization estimates that 60-70% of those in industrialized countries will experience non specific lower back pain in their lifetime, with that number rising. At Complete Game Physical Therapy, we see many patients with lower back pain - anyone from youth athletes to the older population. With that in mind, I thought I would review some of the common questions I get about lower back pain here.

  1. Should I just rest it? Bed rest used to be the common recommendation for cases of back pain. Recent research has shown us that this may not be the best option. The Clinical practice guidelines from the American College of Physicians now strongly recommends those with low back pain stay active. The same goes for the National Institute of Health whose recommendations are to return to daily activities as soon as possible and perform light stretching while avoiding movements that aggravate pain.

  2. Should I use ice or heat? This is a question I get all the time and the answer is really “it depends.” People’s bodies tend to react differently to ice or heat; some may tolerate heat really well and not ice, and for some it’s the other way around. I tend to tell people what ice and heat actually do and typically when each works best. Then they should try for themselves and see what works best for them.  

Heat is a vasodilator which will increase blood flow to the area. This is good to improve mobility but will also increase inflammation to the area. Heat tends to work best if you are feeling stiffness, in the morning and before exercise.

Ice is a vasoconstrictor which will constrict the blood vessels and push blood and inflammation from the area. This will help reduce inflammation but also will increase stiffness in the area. Ice tends to be used best in the presence of pain, at night, and after exercise.

3.) What about “Icy Hot” or “Tiger Balm?” These are topical analgesics which can help temporarily reduce the pain but do not fix the underlying problem. These treatments will dull the superficial nerve endings that send pain signals to the brain and can be helpful to help you sleep or move a little better. These treatments should be only used temporarily while you are returning to your activities and working on what caused the problem in the first place.

These are a few common questions I tend to get in the clinic relating to lower back pain and some strategies to help. If you are experiencing lower back pain, you should be evaluated by a qualified medical professional and set up on a treatment plan to help relieve your symptoms and get you back to the activities you love. At Complete Game Physical Therapy, we specialize in the treatment of athletes and active individuals with any musculoskeletal problem including lower back pain. If you need help, call us today at 978-710-7204.

Patient of the Month: Jaryd

Because we love what we do and who we work with, at Complete Game PT we’ve decided to feature a Patient of the Month each month. May’s Patient of the Month is Jaryd.

Jaryd came to Complete Game after tearing his ACL for the third time in three years. He’s currently working on strengthening his left knee and leg following his last surgery in August of 2016. Jaryd really enjoys his treatment plan at Complete Game. When he comes in, he starts on the stationary bike for a ten minute warm up. “Greg will then stretch my leg and give me a knee massage (which I highly recommend!) Then, Greg will show me a series of exercises that I will need to complete. We are usually really focusing on my left knee and exercises to strengthen that leg. Lots of squats, lunges, and bridges. We end will an ice bath in the game ready ice machine. (Another one of my favorites!)”

Of course, as every physical therapy patient knows, Jaryd has regular PT “homework.” Jaryd works independently at home on the exercises that Greg showed him during his visit, and does the exercises every other day. “My most important homework is not to re-tear my ACL!” Jaryd jokes.

He has definitely noticed a difference since working with Greg. “My discomfort has decreased over the past few months with my visits to Greg. Every scheduled PT visit Greg will increase the workload to a tolerable limit. I’m even (slowly) getting back to playing tennis and running.”

You need to do your PT with Greg at Complete Game,” Jaryd advocates. “Greg will give you his all to make sure you receive the proper care to get back to your 100% - whether it’s getting you back to playing sports or getting you back to being pain-free.” In fact, Jaryd has enjoyed working with Greg so much that he has followed Greg from his old practice to Complete Game. “I got to know Greg at his former practice. He was my PT after my second ACL surgery, and I have loved working with him so much that I followed him up to Tewksbury and to Complete Game PT. Complete Game is different from other practices because you get a one-on-one experience in a small setting with Greg solely focused on you. I have loved my experience at Complete Game PT!

If you or your athlete are recovering from an injury or experiencing any discomfort or pain, give Complete Game Physical Therapy a call at 978-710-7204, email Greg at gcrossman@completegamept.com, or browse our website. Also check us out on Facebook and Twitter for more tips on staying injury-free.

10 Reasons Why People Don't Go to Physical Therapy

 Never fear, physical therapy at  Complete Game  is nothing to dread!

Never fear, physical therapy at Complete Game is nothing to dread!

As you can imagine, we have heard a lot of excuses as to why people don’t go to physical therapy. We decided to compile the top 10 excuses, and break down exactly why they’re false.

1. “I don’t have the time.”

  • It's a misconception that physical therapy consists of 2-3 visits to the therapist a week for hours each visit for months on end. Many also may think that they will be given exercise routines that will take hours a day. Neither is true. We use an individualized one-on-one approach to patient care that has shown to get patients better faster with fewer PT visits needed. We also will tailor a home exercise program to each individual’s needs, making them manageable and convenient for patients. 

2. “I’ll just wait for pain to go away.”

  • Many people take the approach that if they ignore it the problem will go away. This unfortunately, usually never works. Not only do problems that subside often return, but people who compensate for existing problems often have secondary issues that arise. 

3. “It’s too expensive.” 

  • People often think they don’t have or want to spend the money on physical therapy. PT is a much cheaper alternative to expensive surgeries, medications, braces or supports, and return trips to the chiropractor or massage therapist. 

4. “Surgery or medication are my only options.” 

  • PT has shown to reduce or eliminate the need for surgeries, medications or injections, and of these 3 options, PT is the only one that is non-invasive and has no side effects.  

5. “Physical therapy is painful.” 

  • PT is sometimes referred to as “Pain and Torture.” This is a misnomer. The goal of PT is to return people to their proper movement patterns, and this can only be done by reducing or eliminating pain. 

6. “I’ll just take care of the problem myself (or use stretches I found on the internet.)”

  • The internet can be a great thing, or a very dangerous thing.  There is a lot of bad or misleading information out there. And even the good info can be bad if used for the wrong condition. You should be evaluated by a licensed physical therapist prior to starting exercise or stretching for any injury or problem. 

7. “I need to go to my doctor to get a prescription for PT.” 

  • This one depends a little on state regulations and an individuals’ insurance if they choose to use it. However, Massachusetts is a direct access state, so patients can come see a physical therapist without first seeing their doctor

8. “PT is only for after surgery or accidents.”

  • PT is not only used after surgery or accidents. It is also for any movement dysfunction.  Overuse or chronic type injuries are greatly helped with PT, and PT is often a great way to prevent future injury

9. “I’ll just go to my chiropractor to get adjusted.”

  • If you keep going out of alignment isn’t there a reason why? Physical therapists are experts in the evaluation and treatment of movement dysfunction of the musculoskeletal system. They will help you get to the cause of your pain and help fix the problem

10. “PT is just a bunch of exercise.”

  • Physical therapists actually use manual techniques and modalities along with exercise to help people maximize their function. 

Now that we have debunked the common excuses for not seeing a physical therapist, what are you waiting for? Complete Game Physical Therapy is only a phone call away. Schedule an appointment today – call 978-710-7204!

 

3 Keys to Proper Cool Down

I was recently approached by a local youth basketball coach who asked “I have heard so much about the importance of proper warm up before practice and games, but what about cool down?” What a great question. Though I often inform my patients and athletes about the importance of proper stretching and cooling down after working out, I had never been asked by a coach how to properly cool down his or her team. Here are the 3 keys to proper cool down.

1.)  Injury Prevention

At the end of practice or following games is the perfect time to do a few exercises to help reduce the likelihood for injury.  Most non contact injuries, be it ankle sprains or ACL tears, occur when athletes are fatigued. Performing some simple balance exercises can help improve control and reduce the likelihood for injury.

Single Leg Balance:

Simply standing on one leg will help with balance and neuromuscular control.  Focus should be on proper alignment, keeping knee in line with the foot and maintaining an athletic position. 

Balance and Reach:

balance and reach.jpg

Balancing while reaching out with the other leg challenges balance and control even further.  Focus should continue to be on maintaining proper alignment and control with the balance leg.

2.)  Light Static Stretching

Doing some light static stretching is a key part of proper cool down, particularly with youth athletes.  Youth athletes are often going through “growth spurts” where the athlete’s muscle length doesn’t always keep up with bone growth.  This often leads to problems such as Sever’s disease (heel pain) or Osgood-schlatter’s (knee pain).  Here are a couple of stretches that can help with this.

Quad Stretch:

Calf Stretch:

3.)  Breathing

The third key to proper cool down is performing some deep breathing.  During practice and games athlete’s sympathetic nervous system gets fired up.  This is the fight or flight response of the nervous system that can is helpful when in stressful or competitive situations, but can leave the athlete feeling anxious or stressed after.  Taking 10-15 deep breaths will help athletes “wind down” and get in a more relaxed state of mind.  This is also a great opportunity for the coach to talk about the positive things that happened during the practice or game.

This is by no means a comprehensive list of everything that should be included in a cool down, but a few items that can be easily implemented.  For more information on this subject please refer to Mike Robertson at http://robertsontrainingsystems.com/. He does a great job of getting really in depth about this subject.  For more info on breathing, which is helpful both in training and daily life, Brett Jones does a great job reviewing it in the video that can be found here: http://www.functionalmovement.com/articles/Screening/2015-08-19_breathing_corrective_strategies_techniques.

 

If you are interested in having Complete Game Physical Therapy perform a youth injury risk screening on your athletes, or are interested in any of our services, contact us at 978-710-7204. 

Let's Help Reduce Injuries in Youth Athletes

Sports Injury Risk Screening:  What is it and why does my child need it?

Sports medicine for the youth athlete is all too often, a vicious cycle; 

·      The athlete gets injured and sees his or her physician. 

·      The physician refers to physical therapy, recommends rest, or-in the worst cases-refers for surgical consult. 

·      The athlete recovers and returns to sports.

·      The cycle repeats; injury, doctor’s office, recovery, return to sport.

 But there is a better way forward.

 Youth Sports Injury Prevention:

Some of these injuries are difficult to avoid; contact injuries or falls for example.  But many of these injuries to youth athletes are overuse or non-contact injuries.   Overuse injuries account for nearly half of all sports injuries to middle and high school aged athletes.  Non-contact injuries have been reported as high as 36% in college athletes, many of these being ankle injuries and ACL injuries.  When you consider that over 5.5 million kids play sports in the US each year these numbers are staggering. 

The good news is that the likelihood of overuse or non-contact injury can be significantly reduced with proper assessment and training.  Deficits with balance and lack ability to properly perform fundamental movements has shown to accurately predict injuries in youth and college athletes.  Training with proper exercises to address these deficits has shown to improve evaluation, scores in soccer and football players thereby reducing their likelihood for injury.

What Have We Been Doing to Prevent Sports Injuries?

For years athletes have received pre-participation exams (PPEs) by their doctor prior to participating in sports.  High school’s require a physical or they will not let the athlete play.  There are baseline standards for cardiac health and neurologic function to allow for athletes to participate in sports, why do we not do the same for the musculoskeletal system?  Musculoskeletal problems are the 2nd leading cause of disability in the world yet all that typically goes into the musculoskeletal portion of a PPE are quick screens of joint range of motion and pain. 

The two options we have had for youth athletes are to take what we get during the PPE or extensive injury risk screening programs.  These can take up to 4 hours to complete and can cost hundreds of dollars making them prohibitive for most from a time and money standpoint.  What about a quick and cost effective option to musculoskeletal screening that has shown to reduce the likelihood for injury?

A New Approach to Sports Injury Prevention

Physical therapists are experts in assessment and treatment of the musculoskeletal system.  Testing programs such as move2perform provide us with an objective, reliable testing system that can be completed in a timely and cost effective manner.  This program looks at dynamic balance with the y-balance testing system and fundamental movement capacity with the Functional Movement Screen to help identify and address deficits prior to injury.  Proper assessment and adherence to neuromuscular training programs has shown to decrease injury in youth athletes.

Despite these findings injury risk screening is often met with skepticism by both coaches and parents.  Parents are willing to spend whatever it takes in time and money after their child is injured to ensure full recovery, but are unwilling to spend the roughly 20 minutes and minimal cost of testing to help prevent injury.  The biggest predictor of future injury is previous injury; once the athlete is injured it is too late.

 

 

 

At Complete Game Physical Therapy we are working to educate parents and coaches as to the importance of injury risk screening and help break the vicious cycle for youth athletes.  We offer injury risk screening, provide seminars on injury prevention and will use this blog to provide readers with practical ways to reduce likelihood of injury.   With our injury risk screening program we look to help reduce the likelihood of youth sports injury for schools, youth sports organizations and individuals.  Contact us for more information on how you can get your athlete screened. 

 

For more information on youth sports statistics please visit stopsportsinjuries.org and for more information on the research that has gone into move2perform please visit move2perform.com.

 

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Low Back Pain in the Youth Athlete

At Complete Game Physical Therapy, we have performed injury risk screens over the last two weekends for Storm Club Lacrosse, a local girls lacrosse program.  During the screening, we identified several athletes who required further evaluation for lower back pain.  This screening, along with a couple baseball players who see me due to lower back problems, made me think about the prevalence of lower back pain in youth athletes.

Though low back pain is more often associated with an older, sedentary population, it is actually quite common in youth athletes.  An estimated 10-15% of young athletes will experience low back problems.  With over 30 million kids participating in sports, this is no small number.  Here is a brief review of common causes of lower back problems in youth athletes and some prevention strategies to help reduce the likelihood of low back pain occurring.

Posture

Though the exact role of posture in relation to lower back pain has been debated, it is certain that poor posture will lead to problems.  A good way to think about posture is through a comparison to the alignment of your car.  You may be able to get away with your car being out of alignment for a while, but eventually misalignment will cause problems. 

Posture problems can generally be simplified to either overly extended or rounded.  Over extended (or lordotic posture) is often associated with athletes and, in particular, gymnasts, figure skaters and cheerleaders.  Rounded posture is what we commonly think of as slouched posture.  It is especially common in kids who spend a great deal of time playing video games, on computers/phones or watching television.  Either way, I like to simplify posture and tell my patients to just think of keeping your ear, shoulder and hip in line when standing and sitting.  You can also do some gentle shoulder blade pinches to help remind you to maintain good posture, especially when sitting for long periods.

Flexibility

Flexibility can certainly be an issue with youth athletes.  Combine the sitting we mentioned above with the possibility of recent growth spurts where muscle length may not keep up with bone growth and you end up with muscle tightness.  It is particularly common in two muscle groups: the hip flexors and the hamstrings.  

Hip Flexor Stretch

This can be particularly helpful with an athlete with more extended posture.

Hamstring Stretch

This can be helpful with an athlete with rounded posture.

Strength

Strengthening is also important, as many athletes with back pain tend to have weak core musculature.  I will review two exercises:  the pelvic tilt and back bridge

Pelvic Tilt

This exercise is accomplished by gently pressing the lower back down into the floor as you lay on your back.  The pelvic tilt has fallen out of favor with some who prefer to teach more of a neutral isometric exercise.  The pelvic tilt can, however, be very useful, especially with the athlete with extended posture.

Back Bridge

This is a great exercise to strengthen the core and glutes which can help take pressure off your lower back.

The exercises and stretches listed above may be helpful in reducing the likelihood of experiencing lower back pain and keep an athlete on the field.  This information is by no means, however, a complete review of lower back pain.  If you (or your athlete) are having lower back pain, you should be evaluated by a medical professional.

Thank you for reading.  Please sign up for my newsletter to receive more injury prevention tips.

3 Strategies to Reduce Likelihood of Injury in Baseball/Softball

With the baseball season winding down (rather abruptly for my poor Red Sox) now is a good time to discuss injury prevention ideas for youth baseball players.  Proper rest and limiting pitch counts have been talked about frequently in the baseball community and I will refer you to the following resources for more in depth discussion on those two injury prevention strategies (stopsportsinjuries.org and mlb.com/pitchsmart).  Here I want to review three injury prevention strategies that youth athletes can start working on in the off season to help reduce the likelihood of injury and help improve performance for the upcoming season.

1.)  Proper throwing mechanics- improper throwing mechanics have shown to be a major factor in both shoulder and elbow injury in the overhead throwing athlete.  One of the common mechanical faults we often see in youth athletes is them relying too much on their arm and not using their legs and lower body effectively with their throwing.  85% of force should be generated before the shoulder.  Working with a pitching coach, catching coach or fielding coach who is well versed in proper throwing mechanics is a great way to help improve throwing mechanics and reduce stress on the athlete’s arm.   Keep in mind though that throwing a ball is a complex motor pattern meaning that the body needs many, many repetitions with proper form to groove this motor pattern.  Do not wait until one week before the season to start working on this.  Also encourage your athlete to use proper mechanics as often as possible even when playing catch in the back yard, playing with friends or warming up before practice.

2.)  Proper warm up- the offseason is a great time for each athlete to figure out exactly what they need to do to get their body ready for practice or competition.  Improper warm up has show to increase the likelihood for injury.  Most programs will have a team stretch or warm up they use, if not you may want to see a strength and conditioning coach who can help your athlete develop their own dynamic warm up.  I know how difficult it can be getting kids to practice on time but you should be sure that your athlete is never rushed and is always given time to warm up properly.

3.)  Preseason injury risk screening- much research has gone into finding indicators for increased injury risk in the overhead athlete.  Limitations with fundamental movement patterns have shown to increase the likelihood of injury.  Strength or mobility restrictions can relate directly to poor throwing, swinging or running mechanics.  Balance deficits have shown to lead to increased incidence of UCL or Tommy John injury in baseball players.  Being screened for and addressing any deficits found in screen will greatly help reduce the likelihood for injury.

There is no way to prevent injury but there are definitely steps we can take to help reduce the likelihood of injury.  Working on proper throwing mechanics, proper warm up and getting a preseason injury risk screen are great ways to help reduce the likelihood of injury in your youth athlete and help improve their performance.

What Is Physical Therapy?

What is physical therapy?  Are you trainers?  Is massage all you do?  These are all questions that I get when I tell people I am a physical therapist.  Unless you have been to physical therapy people often have no idea what physical therapy is and what a physical therapy visit should be like.  I figure a good place to start my blog posts is to answer some questions people have regarding physical therapy.

What is physical therapy? 

According to Marriam Webster physical therapy is the treatment of disease, injury or disability through physical and mechanical means.  This does little to describe who we are and what we do.  According to the American Physical Therapy Association physical therapists are highly educated, licensed health care professionals that help reduce pain, restore mobility and help patients return to their chosen activities. 

In many cases we will help you recover without the need for surgery or the use of long term medications.  The treatments we use may involve passive modalities such as hot packs, massage, electric stimulation or ice.  They will also likely involve movement-based treatments to improve your strength and mobility.  A home exercise program is also a key component to help you take control of your problem and eventually be able to work on it on your own.

When would I need a physical therapist?

Pain is the most common reason for seeing a PT.  Be it back pain, knee pain, or shoulder pain a physical therapist can help you figure out why you are having pain and help get you on a plan to alleviate your symptoms.  Following surgery physical therapists can help you return to your pre surgery activities.  Functional limitations are another reason for seeking PT services, limited mobility or loss of strength are common limitations.  Wellness screening or injury risk screening can help identify risk factors for injury and if addressed properly may reduce the likelihood for future injury.

How do I get in to see a physical therapist?

Massachusetts is a direct access state, which means you do not need a physician referral to see a PT.  However most insurance carriers do require a doctor’s prescription to reimburse for physical therapy.  So in most cases you will need to see your doctor (either PCP or orthopedist) prior to seeing a PT.  Once you have seen your doctor and they have referred you to therapy you can call and make an appointment.  Be sure to have your insurance card handy along with some basic information so the receptionist can get you started.

What should I expect at my first therapy visit?

You should bring in the prescription from the doctor, your insurance card and your driver’s license to your first visit along with any paper work your therapist may have sent to you to fill out ahead of time.  The receptionist will check you in, expect it to take a little time to set up your account, get your appointments set and review any co-pays, co-insurance or deductibles which you may be responsible (you can always call your insurance carrier ahead of time to check on this yourself).  It is always a good idea to show up 10-15 minutes early for that first appointment to take care of these administrative tasks. 

Once you are checked in you will meet with your PT who will take your history and take you through an examination.  From there you will together figure out a plan to help reduce your symptoms and help you meet your individual goals.  Often times follow up visits will be required which can range from only a few visits to several weeks of therapy depending on the many factors including severity of symptoms, how chronic your problem is or post operative protocols.  You should be clear by the end of your first visit what the plan is and what the expectations are. 

At Complete Game Physical Therapy in Tewksbury, MA we treat every athlete as an individual and every individual as an athlete.  We work with everyone from elementary school children to active senior citizens with the personalized, evidence based approach you deserve.  Whether it’s getting back on the field or back to activities of daily living we will give you the highest quality of care to help you meet your goals.