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Thoracic Rotation Assessment

At Complete Game Physical Therapy, we frequently work with baseball and softball players who have experienced shoulder and elbow injuries.  When we evaluate these athletes, we don’t simply look at the area of injury. It is important to consider the whole body for deficits or asymmetries that may have contributed to the injury or may leave an athlete at increased risk for future injury.  In overhead athletes that come to us with arm trouble, for example, we consistently find restrictions in thoracic spine mobility. Today’s blog is dedicated to one method we use to assess thoracic spine rotation mobility and a treatment we would use for thoracic restrictions.

As you watch these videos, please note that 1) individual evaluations are crucial in identifying an athlete’s specific restrictions.  General exercises provided to a team or exercises found on the internet will not properly address each individual's deficits. 2.) The process we use at Complete Game Physical Therapy is to evaluate, perform treatment and then re-evaluate.  This protocol is essential to ensure that a treatment is having the intended effect.  For example, in the video you will see that there is a slight increase in Ryan’s rotation after a brief treatment.  At Complete Game, we would continue to follow up with additional treatment and re-evaluation to continue to improve his rotation.

For more information, contact Greg at 978-710-7204 or gcrossman@completegamept.com.



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.


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.



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.



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!

3 Ways to Avoid Knee Injuries in Baseball and Softball

Though shoulder and elbow injuries tend to get the majority of attention with overhead throwing sports such as baseball and softball, knee injuries also do occur. During the World Series last year, Kyle Schwarber got a lot of attention after returning to play 6 months after tearing his ACL during a collision with another outfielder. Just this season in Boston, both Dustin Pedroia and Pablo Sandoval have gone down with knee injuries. The Mayo Clinic performed a study last year and found over 2,000 knee injuries in the MLB from 2011-2014.

Common Knee Injuries In Baseball and Softball

Ligament Injuries: These have been found to be the most common injuries to knees in baseball/softball. The MCL is the most common ligament injured - this is the ligament that runs along the inside of the joint. The ACL the second most common ligament injured, and this is a major ligament that runs through the center of the joint. Injury to knee ligaments can occur through contact injuries or non contact injuries where the knee buckles.   

Cartilage (Meniscus) Injury: The cartilage in the knee provides padding and a smooth covering for the joint surfaces. Injury to the meniscus often occurs when the foot is planted and the player pivots on the leg, and also can happen due to falling directly onto the knee.

Patellofemoral Syndrome: Patellofemoral syndrome is pain around the kneecap area and is most common with catchers.

Ways to Help Avoid Knee Injury in Baseball and Softball

  1. Proper warm up and preseason training: Research has shown that strengthening certain muscles around the hip and knee can help prevent knee injuries from occurring.  Proper warm up is key as well; some injury prevention programs such as Fifa 11+ is designed for soccer can be adapted to baseball.

  2. Proper technique: Using proper form with running bases, fielding the ball, or especially catching goes a long way to prevent knee injuries. Working with a coach or instructor on proper form then practicing it on your own will help you reduce the likelihood of injury.

  3. See a physical therapist: Physical therapists are experts in assessing movement and identifying imbalances that are likely to lead to injury. They will help you with exercises to address imbalances and help not only reduce your likelihood of injury, but also improve your performance. Having a therapist who is familiar with the movements associated with baseball and softball is key.

At Complete Game Physical Therapy, we’re experts in the treatment of baseball and softball players. Contact us at 978-710-7204, or shoot us an email at gcrossman@completegamept.com, or browse our website. Also check us out on Facebook and Twitter for more tips on staying injury-free this season.

INTERESTED IN LEARNING EVEN MORE ABOUT DEALING WITH KNEE PAIN IN BASEBALL OR SOFTBALL ATHLETES? ENTER YOUR INFORMATION BELOW TO RECEIVE MY FREE REPORT, "7 QUICK AND EASY WAYS TO STOP KNEE PAIN"

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