How Intense Should Your Workout Be?

Whether we’re busy shoveling during the winter months, or getting outside for a walk or jog when the weather warms up, we are always advocates of staying active. Today, we want to take the opportunity to answer a question that is not typically asked but is vital to long-term success with any exercise program.  How intense does our workout need to be?

Often, we may feel like every workout has to be max intensity to get the max benefit, but this is far from the truth. Although it is helpful to work up to max intensity, it can be detrimental for every workout to involve maximum efforts.  Effort may be measured by speed, distance, weight, heart rate, working to exhaustion/failure, and many other factors. If every workout is to the max, the time for adequate recovery, as well as likelihood of injury both increase. 

Especially when starting something new, we recommend building the intensity gradually to ensure you learn the technical skill and ensure your body is able to withstand the forces required. For example, couch to 5k running programs all start with run/walk (heavy on the walk) initially to build up to running that distance, and weight lifting programs start with lighter weights with more reps to learn the movements and gain repetition.

Working to max effort can be beneficial, however, as it can provide a baseline for subsequent workouts, which you would then retest max effort again to assess if the baseline measurement has changed.  Many weight lifting programs use a six- or eight-week cycle before retesting maximum strength on a given lift.  When that cycle is broken down further, there is a build-up from 60-70% of 1-rep max (maximum amount of weight for one repetition) building up to 80-90% of that max, with a week of relatively light weight for active recovery prior to another max effort to reset the baseline. With distance running, there is a plethora of research that a bulk of training should occur at or below 70% of your maximum heart rate (see our previous blog on heart rate training).

So how do you get started? If you are starting with weightlifting, find a weight you are able to lift for 10-12 reps for an exercise. It should feel like it challenges you but does not work your muscles to failure. Doing this on a few occasions for three sets of 12 reps, you can increase to the next weight up. If you are not able to get a full three sets of 12, that is alright. Stay at the new weight until you can complete all three sets, then progress again. If you are looking to start running, start with a walk/job combination first. This may be a couch to 5k program, or something similar that you are familiar with, find online, or have a coach help design. If you starting High Intensity classes, be sure to monitor your heart rate to limit your time and/or perceived exertion (RPE) to minimize your time near max heart rate or at 8-9/10 RPE. If you start a group exercise class, talk to the instructor ahead of time so they know you are new and can help with modifications as needed. 

If you have an injury or are not feeling 100% healthy, then you really need to consider adjusting the intensity of you workout. There is still plenty you are able to do for training the different body systems while avoiding aggravation of the injury. Also, gradual return to full function for a joint, muscle, tendon, or ligament is imperative to get back to full function working to maximum efforts safely. This is right in our wheelhouse here at KPT, so if you have any nagging issues affecting max efforts in whatever activity you do, let us know and we will work to help you meet your goals.

Physical Therapy & Parkinson's Disease

How Physical Therapy Helps People with Parkinson's Disease

Parkinson's disease (PD) is a progressive neurological disorder that affects movement, balance, posture, and coordination. It can also cause non-motor symptoms such as pain, fatigue, mood changes and cognitive impairment. While there is no cure for PD, there are treatments that can help manage the symptoms and improve the quality of life of people living with PD.

Physical therapy is one of these treatments. PT can help restore or maintain physical function, mobility, and independence. Physical therapists are trained professionals who can assess, diagnose, and treat movement problems related to PD. They can also provide education, advice, and support to people with PD and their caregivers.

Benefits of Physical Therapy for People with PD

Improve muscle strength and endurance: Both age and PD can weaken and decondition muscles. A physical therapist will prescribe exercises using light weights or resistance bands to improve strength. More strength helps with balance and mobility.

Enhance amplitude of movement: PD can cause people to reduce the size and speed of movements. This can affect walking, speech, facial expressions, and gestures. Physical therapy can help increase the amplitude of movement by teaching overexaggerated physical movements, such as high steps and arm swings. This is a way to retrain the muscles and brain to compensate for the reduced movement that Parkinson's can cause. The LSVT BIG program is a specific set of exercises and activities that has been shown to improve mobility and quality of life.

Reinforce reciprocal patterns: Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. PD can affect these patterns, which makes walking slow and unstable. Physical therapy can help to reinforce reciprocal patterns by using machines like a recumbent bicycle or elliptical machine. Practicing walking with arm swings is another activity that can help restore reciprocal movements. This can improve coordination, rhythm, and fluidity of movement for people with Parkinson's. Dance and tai chi are other activities that involve reciprocal patterns.

Improve balance and posture: PD commonly impairs balance. Your brain uses a complex mix of what you see, your inner ear and sensations from your feet and joints to maintain balance. Physical therapy can help to improve balance using exercises that challenge stability, such as standing on one leg or walking on uneven surfaces. PT will also focus on specific components of the balance system by doing things like having a person close their eyes to focus on the sensations from the feet and joints. Physical therapy can also improve posture by correcting any muscle tightness or weakness that may cause stooping or learning sideways.

Increase flexibility and range of motion: PD also often causes muscle stiffness and rigidity. Physical therapy can help increase flexibility and range of motion with stretching exercises that target specific muscles. Common areas of issue are the hip flexors, hamstrings, and calves. Stretching regularly can also help to reduce pain and spasm.

Provide education and self-management advice: Physical therapy can help people learn more about PD and how it affects their movement. A physical therapist can provide tips on how to maintain safety when exercising, how to cope with fatigue or pain, how to use assistive devices if needed, and how to prevent or manage complications such as falls or freezing.

Sounds Great. Is There Proof?

Yes. Research backs up all these claims. One meta-study (a study that combines the results of many other studies) that covered 1827 participants found that when compared to no intervention, PT significantly improved:

• gait speed

• two- and six-minute walk test scores

• Freezing of Gait questionnaire

• the Timed Up & Go test

• Functional Reach Test

• and the Berg Balance Scale

These results indicate improvements in mobility, endurance, strength, and balance. Gait speed is an especially important measurement. Physical therapists often consider gait speed a "vital sign." This is because low gait speed has been linked to:

• declines in functional mobility

• higher rates of hospitalization

• higher fall rates

• cognitive decline

• increased disability

• and higher risk of death

A larger meta study that included 191 studies with 7998 participants found that PT significantly improved motor symptoms, gait, and quality of life. Specifically:

• Resistance and treadmill training improved gait.

• Strategy training improved balance and gait.

• Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.

Physical therapy is a valuable treatment option for people with PD, as it can help to improve or maintain their physical function, mobility, and independence. Physical therapy can also enhance their quality of life, confidence, and well-being. If you have PD or know someone who does, consult with a physical therapist who specializes in PD to see how they can help you.  

READY TO MOVE BIG?

Kepros Physical Therapy & Performance offers the LSVT Big program for patients with PD and other associated neurological conditions at our North Liberty clinic with Shannon Matasovsky, PT, DPT, who is LSVT Big and LSVT for Life certified.

“Over the last few years, I’ve seen tremendous success with the LSVT Big program. I love seeing how much my patients progress each week, especially when it comes to moving big, developing confidence with their movements, and getting back to doing activities that they love. My patients and I form a partnership, and together, we write goals that are very specific to each person. This program helps individuals establish a life-long exercise routine that promotes bigger and more confident movements and overall improves quality of life. If you or your family member has PD and you are curious about this program but haven’t committed yet, I highly recommend taking the leap and getting registered for this program.”

CONTACT INFORMATION

If you have questions, please call the Kepros North Liberty clinic at 319-383-0322 or send Shannon an email at shannon@keprospt.com.

Shannon Matasovsky, PT, DPT
319-383-0322
shannon@keprospt.com

References:

(1) Physical Therapy for Parkinson’s Disease - Johns Hopkins Medicine
(2) Physical Therapy and PD | Parkinson's Foundation
(3) Physical and Occupational Therapy for Parkinson's: What to Expect
(4) Parkinson’s Disease Treatment Physical Therapy
(5) Physical, Occupational & Speech Therapies | Parkinson's Foundation
(6) Physiotherapy in Parkinson's Disease: A Meta-Analysis of Present Treatment Modalities
(7) Physiotherapy versus placebo or no intervention in Parkinson's disease

Running Shoes: How to pick the perfect pair

I’ve often heard it said that running is a great sport to get into, because all you need is a good pair of shoes. But how do you go about picking that pair of shoes? There are so many different options and price points it can be hard to know where to start.  

Foot type  

The recommendation for running shoe selection used to be based according to your foot type – high arches, neutral arches, or flat feet. Then you’d be put into a cushioned, neutral, or supportive shoe. There have also been attempts to match supportive shoes to those who “over-pronate.” What we’ve found in the research more recently is that again, the best evidence is that the shoe should be comfortable. There was no difference in injury risk between groups of people matched to shoes based on their foot type or strike pattern vs those who were not matched. These recommendations are true when looking for shoes for every day use as well.  

Injury risk  

What it all boils down to is that the pair of shoes you pick should feel comfortable. If you have a pair of shoes you’ve been running in for a while and all of a sudden an injury starts in, the shoe is not likely the cause, and there’s usually not a reason to change the type of shoe you’re running in because of an injury. Your body likes variety, so it’s also recommended to have 2-3 pairs of shoes that are slightly different so that you can get that variation in cushion and impact, and also allow the gel or foam to recover between runs, especially for high mileage runners.  

Minimalist Shoes  

The one time shoes may be a culprit of increased injury risk is switching from a traditional shoe to a minimalist shoe (one that mimics barefoot running) very quickly. Minimalist shoes are ones that have minimal cushioning, minimal to no arch support, and a heel to toe drop of 4 mm or less. Traditional running shoes are much more cushioned and may have a heel to toe drop of 8-12 mm. If you go from running all of your mileage in a traditional shoe then switch to all your mileage in a minimalist shoe, there is an increased risk of injury as the different shoe types load different muscles and structures in your legs. That is not to say that all minimalist shoes are bad, rather a very careful and slow transition to these shoes is recommended to reduce risk of overuse injuries.  

Carbon plate shoes  

In more recent years, carbon plate shoes have taken the running world by storm and lowered records across the board. But do you need a carbon plate shoe? In general, most recreational runners do not need a carbon plate shoe. They are made for racing, and as such they do not last very long – usually about 100-200 miles per pair as opposed to most traditional shoes lasting closer to 400-500 miles. These shoes usually cost $250 or more, so they are a large investment for such a short life. Competitive age group runners or high-level racers with experience may benefit from a pair of carbon plate shoes to shave time off for qualifying races such as the Boston Marathon or other similar races. Carbon plate spikes are making their way into the high school competitive level for track and cross country as well. I think for higher level athletes this may be a worthwhile investment, but the majority of athletes will remain competitive with a regular and more affordable running spike. At the end of the day, you still need to put in the work to run and strength train for the shoes to make a difference.  

The best way to find the right shoe for you is by going to your local running shop to be professionally fitted for your pair of shoes. The employees there can make sure that your shoe fits well before and during a run. They are very knowledgeable about the types/brands of shoes they carry and can answer questions about updates to the shoes from model to model.   

Let us know if you need help with any running-related injuries or concerns!  

– Andrea Low, PT, DPT, SCS, ATC

Body Composition & Fit 3D

What exactly is body composition? Body composition is a measure of the amount of bone, muscle, and fat mass in a person’s body.  As we age, there is a natural increase in fat mass and a natural decrease in lean (muscle) mass. Studies indicate that we begin to lose 0.1-0.5% of muscle mass annually after the age of 30 and increasing to 2% at the age of 50. This age-related loss of muscle mass, strength and power, known as sarcopenia, is strongly correlated with an increased risk of hospitalization, physical disability, falls and fractures. While we can’t stop this process all together, there are things that we can do to slow it down and, in some cases, reverse it.

Bone mass is largely formed by the time you are a teen but can be impacted by your activity level. If you have been diagnosed with osteopenia or osteoporosis (weakening of the bones), it is particularly important to engage in regular strength exercises and impact exercises.

Kepros Physical Therapy has a tool called a Fit3D scan that can help to assess body composition and posture. It evaluates body shape, takes body measurements including weight, balance, and posture by using 3 infrared cameras to take over 1200 pictures and over 400 measurements. It can also predict body fat percentages, which can be useful to monitor any changes in body composition over time. The scan itself takes less than 1 minute. We can use the Fit3D to monitor changes in body composition with patients. Examples of where this may be helpful are in a weight loss or muscle gain attempt, monitoring muscle atrophy (or hypertrophy) after a surgery, or as a baseline for wellness or monitoring osteoporosis.

If you are interested in incorporating the Fit3D as part of your health plan, let one of our therapists know.  

Pickleball injury got you in a pickle?

Are you one of the many people who have picked up the sport of pickleball in the last 5 years? The sport is growing rapidly, and as a recent article reported, injuries due to pickleball are on the rise with estimated costs up to $400 million due to these injuries in 2023.

So is the answer for everyone to stop playing pickleball? Healthcare professionals have spent so much time and effort getting people to exercise. Although injuries are on the rise, I don’t believe the answer is to stop playing pickleball, as we know the many benefits of regular exercise which outweigh the risk of injury.

What can you do? As with any activity, an easy dynamic warm up can help prepare muscles for quick athletic movements. This doesn’t have to take a lot of time – a good warm up can be done in 5 minutes or less. Movements such as walking on your toes and heels, high knee marches, butt kicks, lunges, and side lunges can be sufficient to warm up the major muscle groups of the lower body.

Know your limits: Ease into the activity as you learn to play. I understand the competitive nature that can come out, but it’s ok to let a ball go every now and then rather than to chase it down and end up hurting yourself. Find a group that matches your competitive and ability level so you don’t feel the need  to overextend your current playing ability. If you’re having some aches and pains, follow the traffic light system to help you decide if you should continue to play or if you need to take a few days off.

• Green: no aches and pains while you’re playing

• Yellow: some discomfort that you can keep in the back of your mind while you’re playing; soreness goes away quickly when you’re done playing, you feel back to normal the next morning

• Red: pain while exercising that lingers, you feel painful the next morning as well

Cool down after you’re done playing. An easy 5 minute walk can count as a cool down and helps bring blood flow to your muscles and may reduce post exertion soreness.

Off the court, incorporating general strength exercises for upper and lower body can be helpful to manage the stress of the game. Exercises that challenge your balance may help you reach for a ball that’s out of your normal range.

If you’d like help learning how to strengthen your muscles or if you’re one of the people who’s experienced a pickleball injury, let us know and we’ll help you get back to the court!

Hiding Injuries

Do you have a pain, irritation, or something else that has been bothering you? Ever wonder if this is normal for most people, or if it is something you need to be worried about? What if you tweak something during a workout, practice, or match?

How do you know if the irritation/injury is something to be concerned about or just something to ignore and continue on as close to normal as possible until it goes away? There are a few options available to everyone, including googling your symptoms, asking a friend or relative, asking a professional such as a doctor, physical therapist, athletic trainer, or chiropractor — all are trained to spot the issues that need to be addressed, and it is always our goal to help get patients to the best possible provider for their needs. The one consistent when it comes to injuries and ailments is that no one can help if they’re not aware of the issue.

No one knows what you are feeling at any given time unless you tell that person. If it is something minor, we will be able to advise you to encourage activity as normal. If it could turn into something more serious, we will provide our advice and communicate with the necessary parties to ensure prolonged health and performance. It is always our goal to keep our patients/clients as active in their life as possible. Whether your goals are running, basketball, pickleball, swimming, playing with grandchildren, gardening, or anything else, we want to see you enjoy those things.

So when are we not able to help? If you do not tell us about an injury, pain, or ailment. Why would someone avoid telling a coach or medical provider about an ailment? There are a few common reasons:

• Stigma: “No pain, no gain” is not necessarily something we should live by. Should we always be perfectly comfortable? No, but pain is our body’s response to tell us something is wrong.

• Fear of missing out: If I tell someone about this, I will have to come out of the game or be told to stop what I am doing. As mentioned before, as long as an activity is not making things worse, we will advise you to carry on.

• Competitive advantage: if an opponent knows of an injury, they will try to exploit it throughout a competition.

Although keeping a small injury to yourself may seem the best idea in the moment, is it worth trading completing the task today at the expense of a long-term problem? Not all injuries progress from minor to major in this pattern, but it is always best to seek the advice of a trained professional to know the difference, and if modifications are required.

We are here to help keep you active, and as safe as possible. If you will be putting yourself in harm’s way by continuing, we will advise you to modify. Modifications do not mean you have to stop your activity, as there are often ways to scale to ensure some participation. Although difficult in the short-term, modifications will likely help get back to full strength quicker than ignoring an issue.

As always, our team of therapists is ready to assist you and keep you involved with what you love.

No Pain, No Gain?!

We have all heard the phrase no pain, no gain - but is it true?  As with most things, the answer is not necessarily straight forward and will depend on your specific pain/discomfort, desired activity, and stage of tissue healing/recovery. In general, the first thing when considering whether you should push through pain is to determine if what you are feeling is a sign of an injury or muscle soreness. Muscle soreness because of pushing your body to get stronger is not a bad sign. If pain comes on during an activity, you may not necessarily need to stop immediately. If you can change your pain by modifying the activity (slow down, use less weight, etc), you can carry on. If there is no change with activity modification, there are “rules” to consider to aide in determining if you can continue your activity.  In general, you can keep pushing through pain/soreness as long as it stays within a manageable range.  This is pending there are no signs of serious injury that needs to be addressed prior to safely returning to activity.

Signs of an acute injury (STOP):  severe pain, swelling, numbness/tingling, feeling of a joint giving out or locking up, symptoms that persist despite modification of activity, and tenderness along a bone.  If you are experiencing any of these, it is best to get the injury checked out to determine severity and exercise/activity that can be done safely without causing further injury to the tissue.

General rules:  There are a couple different ways to determine what is an acceptable amount of pain/discomfort when is comes to pushing through symptoms. We like to think of it in terms of attention. 

• If you know pain/discomfort is there, but you are able to keep it at the back of your mind, you can safely carry on. 

• If pain starts to come to the forefront of your mind making it hard to concentrate on a conversation, you need to modify at that point (slow down, change form, etc).  If modification does not help at this point, stop the activity. It may be time to have the injury examined by a healthcare professional. 

• If you are a person more inclined to numbers, you can follow the scale below (0 = no pain, 10 = worst pain imaginable). (1)

When monitoring symptoms, there are three timeframes to monitor for overall progression/regression.  

Immediate – how are symptoms during an activity and the first 1-2 hours following completion.  Are you able to modify symptoms? Are you able to push through without making pain worse?  Does it change throughout an activity (stay same, get better, get worse)?  If you are able to work through without pain worsening or effecting performance/duration, carry on.  Pay attention to how symptoms are after you stop.  Over the 1-2 hours that follow, are symptoms improving, increasing, or decreasing?

Next few days – How does pain/symptoms respond over the next couple days following an activity.  If pain is generally good during/after an activity, but increases over the next days, it is a sign that you likely did too much.  Even though some symptoms are allowed during activity, symptoms should return to baseline by 24 hours after completion. 

Medium/long-term – Overall, are symptoms improving, staying the same, or worsening. If symptoms are improving, you can likely stay on the same track you are on.  If symptoms are staying the same or worsening, reconsider your currently plan overall. 

As with anything, if you have any questions or concerns at all, please reach out for an assessment of your pain/injury.  We are here to help keep you active as much as possible while minimizing risk for injury/aggravation. 

Physical Therapy for Spinal Stenosis

Has your doctor told you that you may have spinal stenosis? This diagnosis can sound scary, but what does it really mean?

Typically, you may be diagnosed with spinal stenosis after reporting lower back or neck pain to your doctor or physical therapist. Your doctor may send you for an x-ray, and the radiology report will reveal if there is stenosis or any other bone conditions present. Even if you haven’t had an x-ray, there are certain things in your patient history that may lead us to suspect spinal stenosis.

Common signs and symptoms of spinal stenosis include:

• Low back pain

• Sciatica - (pain from the back down the leg)

• Cramping or heaviness in the legs

• Numbness or tingling into the legs

• Weakness

• Pain is worse when standing, walking, or walking downhill

• Pain improves when sitting, bending forward slightly, walking with a shopping cart or walker, or walking uphill

Spinal stenosis is a narrowing of the space where the spinal cord sits. It can be caused by arthritis, broken bones or injuries near the spine, a cyst, or tumor. The most common cause is arthritis. If it is suspected that you may have stenosis, your doctor may refer you to physical therapy.

Physical therapy may include working on your spinal mobility, flexibility, and muscle strength. Spinal mobility refers to helping the joints in your back move well with each other. This can help alleviate pain and improve your range of motion. Flexibility will focus on the hamstrings and hip flexors. Stretching these muscles can allow you to stand up straighter and again, alleviate some pain in the low back. Strengthening the muscles of your core, low back, and gluteal muscles (hips) can help support your low back and improve your symptoms all without requiring surgery. We may also try some unweighted walking (at KPT we have a harness on the treadmill that can take off 20% of your body weight to make walking and aerobic exercise easier – insert link to previous blog on light speed). Unweighted walking allows you to get aerobic exercise to improve blood flow and encourages gentle rotational movements of the spine which can help pain as well.

There are some instances where surgery may be indicated, but it is not typically the first treatment option and one that many patients are able to avoid. Your doctor will be more likely to refer you to a surgeon for a consultation if you have leg weakness, loss of bowel/bladder function, or if your symptoms are simply unbearable. If you do require surgery, your surgeon will usually send you to PT after surgery for treatments that are very similar to what we’ve described above. This is why it is a good option to try physical therapy first – the more strength and mobility you have going in to a possible surgery, the better off you are for your recovery. Studies have shown that there are no significant differences in outcomes between those who choose PT versus those who undergo surgery at 2 years after intervention. Both groups demonstrated improvements in pain and function.

If you have low back pain and think you may have stenosis, let us know and we will come up with a plan to help you feel better!

Exercise for Mental Health

We all know regular physical activity and exercise are necessary for optimal physical health. The current physical activity guidelines recommend 150 min of moderate-intensity  aerobic exercise, along with two bouts of muscle strengthening exercises each week. Did you know that physical activity and exercise are also important for our mental health?  When we exercise, our body releases hormones and other chemicals that help with physical and mental function. 

What are the benefits of exercising?

Exercise can be a way to help heal your body (and mind by extension), improve self-esteem and self-image, get motivation (one bout can lead to the next and continue to build), increase energy levels and improve your sleep quality. There are so many more benefits from regular activity, too.   

Do I need to reach the recommended level of exercise in order to benefit from exercise? 

Recent research is finding mental health benefits from single bouts of short exercise or activity. This means when just starting, adding small bouts of increased activity mixed in with your usual routine can be very beneficial. (1)

Do I have to do a specific type of exercise? 

No. Any exercise or activity that you are able to do is beneficial.  For some, that means walking or jogging, swimming, weight lifting, yoga, pilates, high intensity interval training (HIIT), or any other number of activities/workout classes. 

What’s the best way to get started? 

Decide on a mode of exercise/movement you enjoy. Set goals (it may be beneficial to do this with a friend or group to so there is built-in accountability). Talk with your healthcare provider (including us here at KPT) to determine a strategy to get moving safely, and to troubleshoot how to get around different barriers to implementation.    

Rotator Cuff Surgery – What Does PT Look Like?

Rotator cuff repairs are the second most common soft tissue surgery performed in the US, with almost 500,000 surgeries performed each year. Not all rotator cuff injuries require surgery, but for those that do, the rehab process can feel daunting.  

Typically, you will start PT a few days after your rotator cuff repair. Some surgeons prefer to wait a few weeks before starting PT if there is a larger tear. Expect to be in a sling with a pillow for 4-6 weeks depending on the size of the tear you had.  

At the first visit, our goals are to check your incision for signs of infection, change any bandages if necessary, and make sure you know how to get your sling on and off. We may also discuss ways to get dressed, shower, and take care of yourself one handed. Exercises may start with some gentle shoulder blade squeezes, neck motion, elbow motion, and passive shoulder ROM. Passive motion means you use an outside force (movement of your body, a table, etc.) to move the shoulder for you – you are not allowed to use your own muscles to move the shoulder until you’re out of the sling.  

Often pain is higher in the first month after surgery and patients may have a harder time sleeping right after the surgery. Part of this is positioning of the shoulder and part of this is due to having to sleep with the sling on. Some patients find they are more comfortable in a recliner to start out.  

Because a rotator cuff repair requires the surgeon to put stitches in the tendon, muscle, and bone, this is usually a slower recovery process than a joint replacement. For the first 4-6 weeks while you are in the sling, we want you working on passive range of motion of the shoulder.  We will show you how to stretch and move the joint to protect the surgery in a way that still allows movement.  

After you are out of the sling, we can start active assisted range of motion (using a cane or pulleys to help move the arm). Typically, we can start doing some strengthening of the shoulder muscles at around 6-8 weeks post operative. Keep in mind that since you haven’t been able to use those muscles in 2 months, we will start off very lightly and ease into strengthening. Muscle strengthening takes at least 12 weeks, so the total timeline of being in PT after a rotator cuff repair is often in the 4–6-month range depending on the person and their goals.  

If you are hoping to get back to higher level sport activities (baseball, softball, throwing, swimming) we may keep you in PT closer to the 9-month mark or when you can fully return to your sport or activity. We typically see you twice per week until you have full range of motion, then can go down to once per week while working on strengthening. As we get closer to graduation from PT, we will typically space those visits out even further to every 2-3 weeks with focus on doing exercises at home.  

If you have an upcoming shoulder surgery or shoulder pain, let us know how we can help you feel better!  

Your PT Can't Do Your Exercise For You

If you've been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you'll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they're important, adherence to home exercise programs is terrible. It's estimated that only 40 to 50% of patients do their exercises the way they're supposed to. What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.

Plan ahead

Think about what's going to get in your way - your schedule, that you'll forget, or that you don't have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they're no longer problems.

Address pain and beliefs

You'll need to work with your PT on these. If your exercises cause pain, you're not going to do them. When your PT prescribes your exercises, try them out. If there's pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won't help, or that they're a waste of time, you won't do them. Again, work with your PT to understand why they're prescribing those exercises, and what they're meant to do. Once you know why you're doing those exercises, you're more likely to do them.

Get support

People who have social support are more likely to do their exercises. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you're doing your exercises, and how they're going. This will keep you accountable and more likely to do them.

Use technology

If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you've exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.

Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you're one of the 50% of the people who do their home exercises consistently to get the best outcomes.

Source: APTA PPS

References:

https://pubmed.ncbi.nlm.nih.gov/32669487/

https://www.physio-pedia.com/Adherence_to_Home_Exercise_Program

If You Like a Good Bargain, You're Going to Love Physical Therapy

It's no secret that prices have been going up. Gas is expensive. Food is expensive. The housing market is crazy. If you're looking for ways to pinch some pennies or stretch your dollars, physical therapy might be just what you're looking for.

Physical Therapy Saves Cost

A study that looked at the claims data of 472,000 Medicare beneficiaries with back pain found that when PT was the first treatment, costs were 19% lower than when people got injections first and 75% lower than for people who were sent straight to surgery. The study also found that in the year following diagnosis, people who got PT first had costs 18% lower than those who got injections, and 54% lower than those in the surgery group.

Another example happened in 2006 when Virginia Mason Health Center in Seattle teamed up with Aetna and Starbucks. They sent workers with back pain to see both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work and were more satisfied with their care. The cost savings was so great that Virgina Mason was losing money on treating back pain, so Aetna ended up paying them more for PT treatments because they were saving so much money.

Physical Therapy First Means Fewer Visits…

A paper published in Physical Therapy looked at outcomes when patients went to a PT first vs. seeing a physician first for back pain. It found that patients who went to their physician first needed 33 PT visits on average, while those who went to their PT first only needed 20. Seeing a PT first saves money, but it also saves time.

It Also Means Better Outcomes

A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit.

High quality research consistently shows that taking advantage of direct access and getting to your physical therapist quickly leads to better outcomes in fewer visits with lower costs. We think that's a deal worth taking advantage of.

References via APTA PPS

1. https://ww1.prweb.com/prfiles/2010/11/03/4743604/0_ANovelPlanHelpsHospitalWeanItselfOffOfPriceyTests.pdf

2. https://pubmed.ncbi.nlm.nih.gov/33245117/

3. https://www.apta.org/news/2017/07/26/study-says-cost-savings-of-physical-therapy-for-lbp-are-significant#:~:text=Researchers%20say%20that%20not%20only,over%20treatments%20that%20begin%20with

4. https://academic.oup.com/ptj/article/77/1/10/2633027?login=true

5. https://newsroom.uw.edu/news/early-physical-therapy-benefits-low-back-pain-patients

I Just Had a Knee Replacement – What Does PT Look Like?

If you just had a knee replacement, chances are your doctor will refer you to PT. You may be thinking, “I just had surgery, everything is painful – what is going to happen at PT?”

We are going to go through a general outline of what PT may look like. Keep in mind that every surgery and outcome is different – try not to compare yourself to others who have gone through the same surgery. Even if you have the same exact knee surgery on both sides with the same surgeon, the recovery experience may look different between the two as well.

Knee Replacement Surgery

First visit: typically, we will see you in PT two or three days after your knee replacement. The goals of this first appointment are to look at your incision, measure swelling, and make sure things appear to be healing well. We will also make sure you know how to walk or get around with a walker, cane, or crutches. We may work on swelling control, pain relief, and most importantly, getting your quad (thigh) muscles to start working again. We will give you some basic exercises to start working on, but that first visit is nothing to be scared of!

For the first two weeks or so, we will focus on swelling control, range of motion, and getting your quad muscle to work well again. The most important range of motion to get back initially is extension, or getting it all the way straight. This helps you walk without a limp, and it’s usually harder to get back the longer we wait. Knee flexion, or bending the knee, typically comes around easier because we spend more time sitting with the knee bent. Typically, we want range of motion to be around 0-120 degrees by four to six weeks after surgery. Either your physical therapist or your surgeon will remove staples around two weeks post op.

Timeline: The first two weeks after knee replacement surgery tend to be the hardest two weeks. Expect to be more painful (stay on top of those pain meds and icing) and sleep may be more difficult or interrupted right now.

From two to six weeks, pain is usually better controlled, and now we can start working on more functional strengthening. This would include things like getting in and out of a chair, walking up and down stairs, getting up and down from the floor, and walking more normally. Most people are in PT for two to three months depending on how they do and what their goals are. After six weeks, the main goals are to improve endurance for daily activities, work demands, or return to your usual recreational activities. Keep in mind that it will likely take a year for your knee to feel “normal” after a knee replacement surgery and that it may swell off and on as you adjust to new activities.

You and your physical therapist will talk about and establish realistic goals for you to achieve during your rehabilitation, and when you have met those goals, you are ready to graduate from PT with your new knee!

Long COVID: How PT Can Help

The novel Coronavirus (COVID-19), which no longer seems novel, as most of us are far-too familiar with the widespread effects of this virus, continues to evolve with each new variant.

• “Acute COVID” is considered the first four weeks of symptoms.

• “On-going symptomatic COVID” follows that, and lasts four to twelve weeks.

• “Long COVID” is considered any symptoms that last more than twelve weeks and that are not attributed to other medical diagnoses.

Symptoms and severity differ person-to-person and the time in which it takes one person to recover from COVID also differs. One of the most predominant symptoms of Long COVID is fatigue, which can be debilitating and impact quality of life. If you’re experiencing these symptoms, you may be struggling to complete the simplest tasks that used to be easy, like laundry and grocery shopping. Now, you worry that if you try to complete these tasks, you won’t be able to cook dinner for the family or finish your work that day because you’ll be too exhausted. These examples are just a few of the myriad of stories that you’ll hear from people suffering from Long COVID. If you’re experiencing these symptoms, please know that you are not alone, and we can help!

Though there is still so much to learn about the effects of COVID-19 on the body, especially when it comes to long-term effects, research suggests that COVID-19 affects the autonomic nervous system, or the part of the nervous system that controls our internal homeostasis and regulates blood pressure (BP), heart rate (HR), temperature, etc. Autonomic dysfunction, or the dysregulation of the autonomic nervous system, is a result of the virus on this part of the nervous system and consequently leads to dysregulation of HR, BP, and other internal systems. The lack of blood and oxygen to the system can lead to downstream effects like muscle weakness, fatigue, and brain fog, just to name a few, which leaves people feeling overwhelmed and exhausted with simple tasks. To put it simply, the body has a harder time keeping you feeling and functioning like “normal.”

Physical therapy can help mitigate these long-lasting symptoms. At Kepros Physical Therapy, we recently created a program focused on working with individuals who have Long COVID symptoms. The goal of the program is to retrain the autonomic nervous system, improving the body’s ability to regulate HR, BP, etc. and to decrease the effects of chronic fatigue.

What does the program entail?

The program focuses on using symptom-monitored physical activity, which involves monitoring vitals and symptoms and training at a sub-symptomatic level. Unlike graded exercise programs where you exercise based on set number of sets and reps, this type of exercise focuses purely on your symptom level while performing various activities. With the advancements in technology and wearable devices, we can more-easily monitor symptoms.

What does this look like in the clinic?

When you come to your first appointment, we will perform a thorough subjective evaluation to determine your symptoms, triggers, limitations, etc. We will also perform tests to determine your symptom threshold (based on HR or Rating of Perceived Exertion (RPE)), and then give you a recommended threshold under which you will train. As you progress through therapy, the goal is to be able to increase that threshold and get you back to training at your baseline level of function. While this program is new and will continue to evolve as updated literature emerges, we are eager to be able to serve our community with this program and help you get back to living at your maximum potential.

What should you do if you are experiencing Long COVID symptoms?

Give us a call and we can get you started with the Long COVID program right away! Our goal is to meet you where you are in your journey and help get you back to being able to do your daily activities, exercise routine, and participate within your community with decreased limitations and improved quality of life.

Did You Know That Physical Therapists Treat Dizziness?

WHAT TYPES OF DIZZINESS DO WE TREAT?

1) Benign Paroxysmal Positional Vertigo (BPPV)

2) Cervicogenic dizziness (from the neck)

3) Vestibular Hypofunction (when there is damage to the inner ear)

4) Post-concussion dizziness

5) Migraine headache

6) Psychogenic Dizziness

7) Pharmacological

YOUR CYRSTALS ARE “OUT”

BPPV is the most common type of vertigo. This occurs when the otoconia, or small crystals in the inner ear, are displaced and fall into the semi-circular canals. These canals tell us where we are in space. When the crystals are in the canals, they move around causing a spinning sensation to occur. Most patients who suffer from BPPV will complain of the “room spinning” while rolling in bed, bending over, or moving their head quickly. The dizziness does not last long but can be very intense. The good news is that BPPV is completely mechanical in nature. All we have to do is perform repositioning maneuvers to get the crystals out of the canals and back into the sack where they should reside. It usually takes one to two treatments, and the dizziness is gone.

I CAN’T FOCUS AND JUST FEEL “OFF”

Cervicogenic dizziness, or dizziness that is a result of restricted motion in the upper neck, is often hard for patients to describe. When the nerves from the upper neck are being pinched, it disrupts the signal to our brainstem, and can make us dizzy, especially with quick head movements or scanning. People with cervicogenic dizziness will get symptoms in busy environments like grocery stores, driving on the highway, or even scanning at work between computer screens. It will take the eyes an extra second to focus on what is being seen and can make you feel dizzy. It may also feel like you are not thinking clearly, and things aren’t as crisp. Often, with cervicogenic dizziness, people can have headaches. This can even trigger migraine headaches and cause the migraines to be more frequent or intense. With these patients, we must get the upper cervical spine moving better to unkink the nervous system. We will also work on exercises to normalize how quickly the eyes focus with quick head movements, restore normal balance, and stabilize the neck and postural muscles.

I HAVE DIFFICULTY WALKING AND CONCENTRATING

Concussions can happen to people of all ages. Whether it’s a young athlete with a collision on the court, a middle-aged adult with a whiplash from a car accident, or even an older adult falling and hitting their head, concussions do not discriminate. All concussions should be treated differently as many different systems of the body can be affected. Common symptoms after concussion are dizziness, headaches, sensitivity to light and sound, intolerance to exercise, and much more. There are two different types of concussions: a cortical/brain concussion or a labyrinthine/inner ear concussion. As therapists, we do a thorough evaluation to determine which areas have been involved and are impaired so we can come up with the best plan for you and work directly with the whole care team.

IT'S ALL IN MY HEAD

You’re right, sometimes it is. Our brains are incredibly smart. Dizziness can also come from stress, anxiety, medication interactions, and chronic conditions. Our brains can take on a “new normal,” so it is our job as therapists to retrain the brain what is truly normal. We use different strategies to trick the brain and work the brain in multiple directions. Sometimes we cannot fix what is broken, but rather, we give the body and brain ways to adapt and habituate the best way it can.

If you are experiencing dizziness, give us a call and we will see if we can help or point you in the direction of someone who can!

Expect to Get Better — You Probably Will

Research has shown that positive expectations increase the chances of a good outcome. It's the old self-fulfilling prophecy; your attitude determines your approach to situations. If you believe you'll be successful, you'll likely put in more effort. You'll be more willing to try new things, take some risks and keep trying after failures or setbacks. A negative attitude will likely mean that you'll take your first failure or setback as confirmation that what you're trying won't work or isn't possible and you'll give up. Why waste time and effort on something that's doomed to failure anyway?

Your Expectations Influence Your Results

There's some research to prove that positive thinking and expectations make a difference in rehab settings too. A review of 23 articles looking at outcomes for shoulder pain found a few interesting things. First, patients who expected to recover and believed that they had some control of the outcome, ended up doing better than those who didn't. Second, optimistic patients were found to have less pain and disability after completing rehab. Third, patients who believed they'd have pain and disability after surgery tended to have - you guessed it - pain and disability after their surgery. Research says that you tend to get what you expect.

So Do Your Therapist's

Your attitude is important, but what about your therapist's? There isn't much research specific to PT, but there is a study done in elementary schools that might give us some clues. Two psychologists - Rosenthal and Jacobs did a study showing that teacher expectations had an influence on student performance. They told teachers that randomly selected students in their classes were tested and found to be "late bloomers". These students were expected to show large improvements in academic performance during the school year. When the students were tested 8 months later, the students the teachers believed would improve the most, did. Why? When teachers think students have a lot of potential to improve, they hold them to higher standards. They teach more complex materials, don't settle for simplistic answers and are more willing to spend time instructing and working with those students. It's pretty easy to see how this could cross over into a PT clinic. If your PT thinks you can get better, they'll probably put more effort into designing your program, spend more time with you and push you harder than someone they don't believe has a lot of room for improvement. To have the best chance for a good outcome, you and your therapist both need to expect one. You probably will.

Originally published by the American Physical Therapy Association Private Practice Section.

References ● De Baets L, Matheve T, Meeus M, Struyf F, Timmermans A. The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review. Clin Rehabil. 2019 Jun;33(6):980-991. doi: 10.1177/0269215519831056. Epub 2019 Feb 22. PMID: 30791696. ● Rosenthal, R, and L. Jacobsen. Pygmalion in the classroom: teacher expectation and pupils’ intellectual development. New York: Holt, Rinehart and Winston, 1968.

New Year’s Resolutions – Progress Not Perfection

The start of a new year is just around the corner, and we are all ready for 2022 and hopefully looking forward to a better year ahead. With the start of the new year, we are often tempted to make resolutions – to exercise more, or to eat healthier, lose weight, etc. While all these things are not necessarily bad things, sometimes we set ourselves up for failure by resolving to do too much. Here are a few tips to keep things attainable and successful for 2022!   

Start small.

• If your goal is to start a workout plan, make sure it is one your body is ready for. Often the workout plans online are 6 days a week, an hour at a time. If you are just starting out, this is likely too much.  

• The American Heart Association exercise recommendations are 30 mins of cardio five times per week and strength training twice per week. Remember that walking at a steady pace counts as cardio, you do not need fancy equipment like a Peloton or elliptical. At the same time, if you are not used to doing any physical activity, we recommend picking 3 days per week and starting with low intensity exercise.  

• If you are following an online training plan that requires 5 rounds of an exercise, start with 2-3 rounds, and see how you feel. We encourage you to wait and see how you feel the next day before increasing intensity and time to ensure you can do so without increased muscle soreness.  

Pick one thing.

• Again, our tendency is to bite off more than we can chew sometimes with new year's resolutions. We want to eat better and workout more and drink more water and get more sleep. Again, these are all good things, but often it is too much at once. Pick your priority and get good at that before adding anything else to your plate.  

• On the other hand, if overhauling your workout routine seems too daunting, pick something that is very manageable to start. For example, you could aim for 10-minute walk 5 days out of the week or add one serving of fruit or vegetables to your day. Once you have mastered that habit, add in something else small.  

Give yourself grace. 

• Recognize with any new habit that it takes anywhere from 3-6 weeks (or longer!) to make it more routine to you. If you “mess up” one day, start fresh the next day. If you “mess up” a week, start fresh the next day. Remember that January is not the only time it is ok to start a new habit or routine – you can start at any time!  

• “Progress not perfection” is my favorite phrase when it comes to goal setting. Even if you only managed to eat one fruit today and your goal was 5 servings, if it was more than yesterday, count it as progress! Find ways to reward your goal setting and keep it fun to ensure a higher level of success.  

If you are looking for guidance on how best to start a workout routine or have some aches and pains that need to be addressed before jumping in to a new program, reach out to us at 319-200-6102 or info@keprospt.com and we will help you get going. 

Plyometrics for Runners

What are plyometric exercises?  

Plyometrics are exercises that involve repeated cycles of muscle stretch and contraction (think of jumping repeatedly) to increase muscle power. Muscle power is improved by training the muscle to transition between eccentric (lengthening) and concentric (shortening) contractions. This occurs whenever a body or joint changes direction.  

Why use plyometric exercises?  

Plyometrics (or plyos) are a way of training to increase muscle (a combination of strength and speed). They can be useful to improve sport performance, including speed, power, change of direction speed, balance, jumping, throwing, kicking, and bone density.  

When starting a plyometric program, you need to have some basic strength first. When you jump, the ground reaction force during each foot contact can be up to 3-4x bodyweight. Because of this, not everyone should jump into a plyometric training program without guidance. A basic test would be the ability to perform a squat with weight equivalent to your body weight without pain or modification.  

Individuals new to plyometric training should start off with low level plyometrics, including ladder drills and getting used to moving quickly. They should then progress to jumping with 2 feet, then changing directions with 2 feet. From there, single leg plyometrics can be started, again typically with jumping in place first, then changing direction, then working on jumping higher or further. Therapists and participants should keep track of the dose of plyometrics by counting how many times the feet hit the ground and the intensity of jumps within a single training session. The goal is to gradually increase contacts and intensity separately over time. Progressing one variable at a time will help to minimize the risk of injury.  

At KPT, we often use plyometrics prior to starting a return to run progression for athletes who may have been injured or who took a break from running. This helps ensure that their legs and body are ready for the demands and stresses running puts on the bones and muscles in the leg. One place this is particularly important is for those recovering from a stress fracture or stress reaction. It is important to gradually load the bone to promote bone growth and avoid progressing too fast and causing further bony injury. These same principles can be applied to individuals with osteopenia or osteoporosis but are tailored to the needs of each person.  

If you are interested in using plyometrics for training or to get back to running, contact us at info@keprospt.com or 319-200-6102.  

What is BFR?

Blood Flow Restriction (BFR) involves the application of a tourniquet to limit blood flow to a limb while exercises or to assist in recovery from injury or surgery.  Use of BFR can lead to faster recovery during rehabilitation by limiting atrophy from disuse and stimulating strength gains without the demands of heavy lifting.  Due to the limitation in blood flow, muscles are working with a reduction in oxygen, which helps to turn on gene expression to build muscle strength and hypertrophy (muscle size). 

Who should use BFR?

Anyone looking to…

• minimize muscle atrophy after injury or surgery

• gain strength without added stress to joints

• even out large strength or lean muscle mass discrepancies between sides

• gain muscle mass or strength to bridge the gap from recovery/rehab to heavy lifting

• stimulate muscle protein synthesis to limit the effects of aging such as slower walking speed, balance, and decreasing fall risk.

How is it used?

Kepros Physical Therapy & Performance uses the Delfi Personalized Tourniquet System for BFR. It is an FDA listed medical device that meets the same safety requirements as those used in surgical procedures but has been modified for the rehabilitation setting. This state-of-the-art system instantaneously monitors blood flow to the working muscles to maintain the desired blood flow.  This will take into account each individual’s limb size, side of body, tissue density, blood pressure, and tourniquet placement to ensure the most accurate pressure for each person.

There are three different ways which BFR may be used in the clinic.

• Passively – This is early on after an injury or surgery to help limit muscle loss due to inactivity.  Under normal conditions more than 3 lbs of lean muscle mass is lost after 7 days of bed rest.  After two weeks, 30% of quad muscle size is lost.  These protocols will use alternating periods of increased pressure to limit blood flow and relaxation to allow normal blood flow.  This may be combined with other modalities such as electrical stimulation depending on the goal of the treatment.

• Aerobically – This involved walking (easy pace) or arm/leg biking (very low level likely <3 for resistance) and may be done in intervals or continuous.  This can help to improve aerobic capacity through improving muscle oxygen consumption at levels that are usually to light to cause any adaptation.

• Resistance exercise – This may be with or without weight depending on the stage of rehabilitation and goals of the treatment.  This is the mode of exercises that will stimulate the most strength and size gains for a given muscle as a muscle will work to right up to the point of momentary muscle failure. When the occlusion pressure is applied, people can work at 0-30% of their max lift through a rep scheme of 30-15-15-15 (weight adjusted throughout as necessary) to achieve gains normally only achieved with lifting 60-70% or greater of a max lift. Consistency here will likely lead to significant gains over the first 2-4 weeks with the goal of improving strength and size to, decrease asymmetries, and bridge the gap from muscle activation until a joint or limb is able to tolerate lifting heavy loads.

What does it feel like and what are the side effects?

In general, the use of BFR feels like an intense workout, as the goal is to get near or up to momentary muscle failure with the exercise.

• As lactic acid builds up in the muscle burning and soreness will be present.  At times the rest periods may be as difficult as the work periods due to this buildup.

• he occluded limb will swell while the blood flow is restricted (there is no blood return to the heart from the limb)

• Possibly some delayed onset muscle soreness (DOMS)

• You should feel pretty well back to normal within 1-2 hours after a bout of BFR as the loads are light, which means there is no muscle breakdown.

At KPT, we have multiple providers certified in the use of pBFR, and have been able to observe amazing changes in different patients.  If this is something you are interested in learning more about to see if it is appropriate for your situation, please reach out and contact us at info@keprospt.com or call our clinic at 319-200-6102. 

Is Rest Really Best?

If you’ve ever had an injury, ache, or pain, often the advice you hear is to take 2 weeks off, rest, ice if needed, then try again. While rest is sometimes a necessary part of recovery, total rest may not heal all types of injuries, and may in fact worsen other issues. Even if you have an injury, doing some type of exercise is usually feasible, and can help maintain cardiovascular health, full body strength, and weight management. When you are experiencing pain, it is important to identify the pain source, so you know best how to allow it to recover. Let’s look at a few different tissue types and how to optimize healing for each. 

Bone 

In a situation like a broken bone or a stress fracture, rest is truly necessary to allow the bone to heal (typically this process takes 6-8 weeks). However in healthy individuals, total rest weakens the collagen structure and causes decreased mineral density. A better way to build bones is a slight increase in compression forces (think walking, running, jumping, weight lifting) to increase bone mineral density and strength. 

Joint Capsule 

The bones of most joints are surrounded by a synovial capsule, which secretes synovial (joint) fluid to lubricate and nourish the joint while acting as a shock absorber. This can be injured or implicated in arthritis, joint dislocations, or if you are experiencing a lot of stiffness. Rest shrinks the capsule and increases resistance to movement. You can improve the health of the joint and joint capsule by moving through the full available range of motion (either by activity or stretching). Physical therapists are trained in techniques to help mobilize the joint capsule if needed as well. 

Ligaments 

Ligaments are structures that connect two bones (example: your ACL in the knee connects the femur (thigh) to the tibia (shin bone)). A period of rest may decrease tensile strength in the ligament, making it weaker. To increase the strength of a ligament, you want to provide progressive tensile strength in the line of force. Resistance training and weight lifting can improve the strength and function of ligaments. 

Tendons 

Tendons connect muscle to bone. This can be a frustrating injury because when the tendon is painful (ie achilles tendon in your ankle or patellar tendon in your knee) it hurts to do most things, even walking. Taking a few weeks off will improve how it feels, but when you try to do more than walking, it flares up again. This is because resting a tendon causes the structure to be a little more disorganized and decreases the strength of the tendon. This can be improved by progressive strengthening to improve the organization of the collagen fibers. The best treatment for tendons is to avoid the painful activity, but to gradually add in strengthening rather than total rest. 

Cartilage 

Cartilage acts as a cushion between two joints. Injuries to cartilage can include meniscus tears or irritations as well as injuries to a disc in the spine. Resting allows for more swelling to accumulate in the joint, which can cause more pain. To improve cartilage strength and function, the best thing to do is to move through the available range of motion as well as add medium load strengthening in a pain free zone. 

The next time you have pain or an injury, it may be necessary to take a brief period of rest, but there are often things you can be doing as you rest from your favorite sport or activity that will help you get back to it sooner than later. Let us know how we can help you!