Want to Improve Health and Performance? Just Breathe!

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.

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

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!

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.

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

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!

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.

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.

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!

Complete Game Physical Therapy: Patient of the Month, Fran

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

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.

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

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

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!

5 Signs Your Back Pain May Be More Than An Ache

We’ve all done it, you wake up with a sore back after doing some yard work or being out playing with the kids and figure it’s just an ache and will go away.  This may be the case but what if it’s not? Today I wanted to give some examples of instances where that ache in the back could be something more significant.

1. Pain radiating down the leg- if you have pain coming down your leg which seems to start in your low back there is likely some nerve involvement.  The nerve can be irritated at the nerve root near your spine or more distally, either way this is more than just a sore back.

2. Severe pain- any time you have pain that is severe in nature it is likely more than just some normal post activity soreness.

3. Numbness, tingling or legs “giving out”- these are signs of more significant nerve damage.

4. Pain that seems to be getting worse- a normal back ache should resolve within a few days of relative rest.  If not you may have something more going on.

5. Recurring episodes of back pain- if your back ache keeps recurring there is likely something more going on.

For the symptoms above your back problems probably aren’t going to go away on their own and you should see a medical professional.  Keep in mind though that this is not an all inclusive list and there are other instances (like recent unexplained weight loss or unremitting night pain) that you should contact your doctor.

Back pain is not unusual.  As a matter of fact 8 out of 10 Americans will experience back pain in their lifetime.  Seeing a physical therapist can be one of the best ways to help with that back ache and make sure it doesn’t turn into something more significant.  A PT will sit down with you, get your history and figure out the best plan to not only reduce your pain but also keep it from coming back in the future.

At Complete Game Physical Therapy we specialize in the treatment of back pain and can help you take control of your back problems today. Visit our website or call our Lowell office at 978-710-7204 to make an appointment.

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.

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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.