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Chronic Pain

Should You RICE Your Injury?
Should You RICE Your Injury? 1920 1080 ResilientRx

Most of us at some point in our lives have probably sprained an ankle or twisted a knee, and were inevitably given the advice to “RICE” (Rest, Ice, Compression, and Elevation). We’ve also been advised to take anti-inflammatory medications such as ibuprofen. This has been the go-to self treatment for minor injuries for as far back as many of us can remember. However, this method has evolved into something different, the details of which may surprise you.

Based on some newer research, the RICE method may not be the most effective way to treat acute musculoskeletal injuries. In place of RICE, the new proposed acronym is PEACE and LOVE: Protection, Elevation, Avoid Anti-Inflammatories, Compression, Education and Load management, Optimism, Vascularization and Exercise. This updated approach offers more detailed guidance, which we outline below.

Protection

This involves taking steps to prevent further injury and reduce pain. Options such as bracing, taping, or crutches will limit range of motion and deload the affected area, to allow things to calm down as the healing process begins. Outside of assistive devices like the ones listed above, protection also entails scaling back or temporarily refraining from activities that may irritate the injury such as sports or certain exercises. It is important to note that protection does not mean complete inactivity or bedrest as we will discuss a little later in the process.

Elevation

Elevation of the affected area is still a key part of early injury recovery. Elevating the region helps to reduce swelling and pain, which helps facilitate the body’s healing process. It is recommended that the injured area be elevated above the heart whenever possible to promote blood flow and reduce swelling.

Avoid Anti-Inflammatory Modalities

The advice to take anti-inflammatory drugs such as ibuprofen has long been coupled with the RICE method. The PEACE and LOVE approach advises against this, specifically with higher doses and longer duration of use  This is because the various phases of inflammation activate white blood cells that initiate tissue healing and repair (neutrophils and macrophages, for example). If possible, it may be beneficial to avoid anti-inflammatories such as ibuprofen, to allow your body’s natural processes to do their job. This also includes the use of ice. We believe that ice can certainly be useful for pain relief, but prolonged and excessive use with the intention to reduce inflammation, is not ideal because it has the potential to delay or disrupt revascularization and the arrival of those tissue-healing white blood cells. Use ice sparingly for pain management and try to wean off quickly.

Compression

Compression, like elevation, has remained an important component of early injury management. Compression helps to manage excessive swelling of the joints and hemorrhaging (bleeding) that has occurred in the soft tissue. It can provide general support to the injured area which may make it more comfortable to start moving and weightbearing, further facilitating the healing process. Compression should be applied gently and not be too tight, as excessive pressure can impede blood flow and cause some discomfort.

Education

Unlike the RICE method, which simply recommends rest, the PEACE and LOVE approach emphasizes the importance of active recovery strategies. It is important to understand the role of early movement and not rely excessively on passive modalities. Things like manual therapy and electric stim can be useful in reducing pain and swelling, but they should be used as supplements to exercise and load management. Education also entails encouraging the individual to avoid the mindset of “needing to be fixed” which can lead to overtreatment, and instead empowers them with knowledge and clear expectations for recovery.

Load Management

For nearly all patients with musculoskeletal problems, an active approach that includes movement and exercise is beneficial. Mechanical input (load, weightbearing, etc.) should be encouraged as early as safely possible along with resuming normal activities as soon as possible. Optimal loading means we are engaging and using the affected area without exacerbating pain. This promotes tissue repair and tolerance, which leads to restoring the individual’s function as a whole.

Optimism

Injuries can impact all aspects of a person’s life, including their mental health. Maintaining a positive outlook and belief in one’s ability to recover can have a significant impact on the healing process. Research has shown that patients who are optimistic about their recovery tend to have faster and more complete recoveries. There can be many mental and emotional barriers to recover, especially for someone who leads an active lifestyle. Don’t ever be afraid to ask for help or talk to someone if you are ever dealing with depression or fear after an injury.

Vascularization

Vascularization, or promoting blood flow to the injured area, is also crucial in the PEACE and LOVE approach. Blood flow helps to bring oxygen and nutrients to the injured area, which are essential for the healing process. The previously mentioned strategies of elevation, compression and load management can help promote vascularization. Even moving parts of your body that are uninjured are helpful throughout the recovery process. Another very important strategy that will promote vascularization is exercise, which is discussed next.

Exercise

Last, but certainly not least, is exercise. Exercise is crucial for a number of reasons, from promoting blood flow and swelling reduction, to strengthening the muscles and joints around the injured area – all of which lead to improved function and less pain. It is important to consult with your physical therapist or physician before starting any exercise program, as the type and intensity of exercise will depend on the specific injury and the stage of recovery.

We feel that compared to the traditional RICE method, PEACE and LOVE is more beneficial because it provides more detailed guidance when recovering from injuries, promotes a more active recovery approach, and creates an advantageous environment for the body’s natural processes to perform their duties.

Here are some additional quick tips:

  • Ice is still okay to use, especially if it helps reduce pain. We just may not need to ice for extended periods of time, multiple times per day after an injury. Your time is better spent moving within your tolerance, even if it’s not the directly injured area early on. Use ice sparingly and try to wean off as quickly as possible.
  • When the goal is pain reduction for non-acute injuries, either ice or heat is fine to use – whichever you find more soothing.
  • Pain-free aerobic exercise should be initiated within several days after a musculoskeletal injury if possible, to promote blood flow and boost mental/emotional well-being. When in doubt, always ask your PT or other healthcare provider

For ankle sprains in particular, consult with your physical therapist or other healthcare provider if you have any questions on whether or not you will need an Xray. Here are some helpful tips from Dr. Nick’s Instagram!

If you have a new or nagging injury or are not sure where to start, book a FREE discovery session (in person or virtual) with one of our Doctors of Physical Therapy!

References:

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73.

Please note: The content in this blog is intended for educational purposes only and is not medical advice. See a healthcare professional if you have any questions about your individual needs.

A Mom pointing in the air carrying a child with a serene stress free field overlooked by a beautiful sunset

Why You Might Be Tired All the Time, and What to Do About It
Why You Might Be Tired All the Time, and What to Do About It 1920 1280 ResilientRx

Why am I exhausted and in pain all of the time??

US culture puts a ton of stress on moms and women in general.

There is a constant underlying shame and/or guilt that you are not doing enough. And to top it off, the narrative that “doing something for yourself is selfish” is perpetuating these thoughts.

This causes moms to lose their own identities. You are not only a mom, you may be a runner, singer, pianist, artist, dancer etc.

However, along the way we lose touch with ourselves, regardless of if you are a parent or not. 

Urgency culture is wreaking havoc on our bodies.

I am here to tell you that you ARE doing the best that you can with the resources and information that you have at this moment. 

And many other people feel the same exact way as you.

A Mom pointing in the air carrying a child with a serene stress free field overlooked by a beautiful sunset

How our bodies perceive danger

But first, I want you to imagine what the chronic ongoing stress can be doing and how it can be affecting your body.

I want you to imagine how you would feel if you saw a tiger chasing you.

Tense. 

Frozen to the spot.

In times of stress – whether it’s running for our lives or running late for work – our bodies don’t know the difference and process the panic in the same way.

There’s a perceived danger, and our body’s sole responsibility is to keep us alive. 

If you’re always in this mode – up against deadlines, worries about money, dealing with ongoing family drama – you don’t have the time to rest and digest. 

Imagining a tiger chasing you is the best way to understand stress response

How Stress Is Impacting Your Body

This constant tension can also lead to chronic bloating and heightened cortisol – a hormone created by the adrenal glands that can up your blood sugar levels, increase belly fat and decrease your body’s response to insulin – which could eventually lead to prediabetes or Type 2 diabetes. This essentially is leading our bodies to being burnt out.

Signs you are in this “fight or flight” response include:

  • Constant fatigue
  • Craving sweets or carbs
  • Anxiety
  • Chronic headaches/jaw pain
  • Chronic neck pain
  • Chronic low back or pelvic pain
  • Constipation
  • Constantly feeling hungry
  • Bloating
  • Brain fog
  • Constantly needing stimulants (like coffee)
  • Weight gain in the mid-section (unable to lose)
Woman who is overwhelmed by her stress levels can't focus on work so she covers her face in dispair

The Body-Mind Connection

This isn’t to scare you, but to reiterate the importance of well-being, as our bodies and minds are interconnected. 

Chronically living in a stressed-out state can lead to chronic pain and illness.

As we come to the end of the month of January, coming out of the fog of New Year’s resolutions, bombarded with ads for new exercise routines or diets – I want you to think about your stress levels.

Exercising is only one form of health.

For our bodies to be in optimal health, focusing on ourselves is vital. 

I understand time, finances, work, kids, etc can be time-consuming, but just connecting with yourself can make a world of difference. 

How this applies to physical therapy

You might be thinking… How does this apply to physical therapy?

There is a direct correlation with chronic pain and chronic stress on our bodies. 

If I just treated someone’s low back without asking about the stress they are under, I am missing a huge piece of their recovery process. It doesn’t matter how many times that person is massaged or if they do their exercises, the muscles are going to go back to a tense state unless the root cause is addressed.

Busy woman sitting at desk trying to finish her work

So what can I do to support myself and my stress levels when I don’t have much time?

Here are a few questions to help you re-align yourself back to YOUR needs.

  1. Do I need to go to _______ today? (insert optional event here)
  2. Does ________ serve me or am I doing it to please someone else?
  3. Am I taking time for myself today? (even if it is 5 min in the car)
  4. What hobbies have I engaged in outside of work and the kids?
  5. Have I laughed recently?
  6. Do I sit and enjoy the food I am eating?

I know these things may sound insane, but after surviving cancer, I cannot relay this message enough.

I was diagnosed with Hodgkin’s Lymphoma in 2019. I remember sitting in the chair getting chemo and thinking….

“Why did I care so much about what people thought of me”

“Why wasn’t I more present with the people I love”

“Why was I so worried if everything wasn’t perfect”

Nothing was scarier than not having my health. Thankfully my 3 year scans were clear.

The point is life is meant to be enjoyed. Leave the dishes in the sink, wait to reply to that email tomorrow, leave the laundry for another day… and just BE.

Your body will thank you.

The Benefits of Dry Needling
The Benefits of Dry Needling 2560 1707 ResilientRx

Have you ever had a deep tissue knot in your shoulder or back? Or perhaps you’ve had a muscle strain or even a herniated disc that was causing you significant pain. Others may even experience nerve pain in parts of their body that physical therapy and exercise don’t seem to relieve. Rather than using different exercises or manual therapy to treat these problems alone, many PTs are turning to dry needling to help their patients recover faster and restore mobility to the body.

Dry needling can mitigate pain caused by a number of issues – arthritis, nerve pain, trigger points, ligament strains, headaches, muscle spasms, and more. Before we dive into the benefits of dry needling, though, let’s start with the basics of what dry needling actually is.

What is Dry Needling?

Dry needling can be used as a part of a comprehensive plan to help restore movement and function in the body. It’s a skilled practice that uses filiform needles to penetrate the skin and stimulate trigger points. A trigger point is a place of muscular dysfunction, causing pain and impacting mobility. They can be tender to the touch and difficult to eliminate as these tight bands of skeletal muscle can cause pain to permeate into other parts of the body. 

How do trigger points form? Inflammation builds up in muscles that are injured or overused, causing tension and depriving the muscles of oxygen which occurs from the impaired blood flow. This causes the muscle to be taut, limiting normal movement of the muscle.

How Dry Needling Works

To perform dry needling, a PT will insert super-thin needles into the skin. The needles stimulate the myofascial trigger points, creating twitches and muscle reflexes. These reflexes decrease muscle tension, reducing irritation and pain while improving flexibility. This increases blood flow to the area to promote healing.

By using dry needling, a Doctor of Physical Therapy can target these areas and stimulate them in a way they can’t do with regular physical therapy techniques. It can be painless but most people say the cramping is more of the sensation which can be slightly painful for some. Some patients also report some soreness around the needle sites for around 24-48 hours, while others don’t feel any soreness.

Benefits of Dry Needling

By inserting needles into trigger points on the body, the muscles relax, boosting blood flow, diminishing inflammation, and triggering an immune system response. There are four specific benefits to dry needling:

Relief of pain

Looking for immediate pain relief? Pain improves as blood flow is restored, moving acidic wastes away from the muscle and providing those areas with oxygen and nutrient-rich blood. Many people report immediate relief after one session, but some do require additional sessions.

Improving mobility

When you have tight knotted muscles, the tendency is to stop moving and limit your mobility and movement to avoid pain. By combining dry needling with physical therapy, strength and mobility are restored and future trigger points can be avoided.

Quicker Recovery 

Regardless of the injury or pain, restoring movement is the best way to heal and recover. While physical therapy can be the main component of treatment, adding dry needling to the treatment plan can help speed up your recovery time. 

Assists with Chronic pain

Dry needling specifically helps with chronic conditions such as back or neck pain. This can result in trigger points and tenderness. Patients with chronic pain who have had dry needling report significant pain improvement. It helps to increase blood flow to these areas that are impaired and help improve mobility

Dry Needling vs. Acupuncture 

While both dry needling and acupuncture use the same filiform needles, they are vastly different practices. Acupuncture is based on eastern medicine principles, and it’s focused on different points and meridians throughout the body. Needles are used superficially to assist with the flow of energy. Based on western medicine, dry needling inserts needles into a specific part of the muscle that is causing dysfunction and pain. 

Is Pain Holding You Back?

Are you limited in mobility and function because of pain impacting daily activities? We can evaluate your movement, strength, and function to form a plan of care, whether that’s dry needling, PT, or home exercises, that can get you back to doing the things you love. If you are struggling with pain or an injury, our physical therapists can help! Start moving again with help from ResilientRx. Book a consultation online today!

How Stress and Anxiety Affect Pain
How Stress and Anxiety Affect Pain 2560 1707 ResilientRx

Anxiety disorders, commonly associated with chronic stress, are the most common mental illnesses in the United States. In fact, anxiety disorders affect nearly 40 million adults each year. People suffering from anxiety are three to five times more likely to visit the doctor than those without anxiety disorders.

The reason?

Stress and anxiety do not just have an impact on the mind. Together, they cause or enhance chronic pain. Many of us forget that anxiety or worry can cause several painful physical symptoms — chronic fatigue, heart palpitations, muscle aches and weaknesses, headaches, and more. 

Here’s a deeper look into the impact chronic stress and anxiety have on the body.

Man really feeling how stress and anxiety affect pain

How can stress and anxiety impact pain response? 

Have you ever noticed that your muscles hurt more when you’re worried about work or family? Do you get headaches more as you think about something too much? These are all small signs of how anxiety and stress can impact our body’s pain levels.

Research has also proven that stress and anxiety can influence pain perception (how we perceive pain). Some people, when their cortisol levels spike, experience stress-induced analgesia — which suppresses our sensation of pain. 

Stress-induced hyperalgesia, on the other hand, occurs when stress, anxiety, or even fear, are already present, elevating pain and increasing intensity and duration. 

The fight or flight response affects pain

We all know the “flight or fight” response our bodies experience when we undergo stress. When our bodies activate this response, it dumps higher levels of cortisol into the bloodstream which spikes our blood sugar. Your body also experiences an increased heart rate and adrenaline output. Over a period of time, this influx of cortisol can harm your body and cause you to be more susceptible to injury and pain. 

In the fallout of this response, people tend to feel exhausted, which can heighten mental and physical ailments and decrease their immune system response. 

The nervous system and stress

Stress is very closely aligned to the nervous system. Your body’s reaction to stress can tip off pain perception in the body and, because the nervous system extends into the brain, can impact the way your body responds to pain. Over time, your body may develop a more sensitive nervous system reaction to stress and anxiety, which could be the cause of chronic pain. 

Woman sits at computer looking very stressed out and anxious because of how stress and anxiety affect pain

Common physical symptoms of stress and anxiety

The longer a person experiences chronic stress and anxiety the more intense the symptoms may be. You could equate it to heart health — the longer you eat fatty, high-sugar, and highly processed foods, the greater your chances are for heart disease. So, the more often you’re stressed, the more vulnerable your body becomes because of the wear and tear that results. 

Symptoms of stress and anxiety often go unnoticed or are mistaken for something minor. However, consistently experiencing the following systems can wear out your body. 

Fatigue

This is the most common symptom associated with stress and anxiety. Because the mind is in a constant state of alertness, it tires out much faster than the mind of someone who may not often experience stress and anxiety. Even after healthy sleep, people can still feel exhausted because of mental fatigue or the physical symptoms that come along with prolonged high-cortisol levels in the body. 

Heart palpitations

Having heart palpitations can be distressing, which may cause a continued increase in cortisol levels and can increase heart rate. Heart palpitations feel as though your heart is pounding too fast and skipping beats. 

Muscle aches and weakness

Tension is usually to blame for muscle and joint pain caused by stress and anxiety. Prolonged periods of these emotions cause muscles to tense up and leave you feeling stiff. A high level of stress consistently can impact immune system functions, making it more difficult for your body to fight off inflammation. 

Muscles also tend to become weak, especially in the legs and arms. During a fight or flight response, blood flow is increased to the limbs to make it easier to take action against a perceived threat. After the adrenaline response has ended, muscles can become sore and painful. 

Woman laying down clutching her head and stomach feeling sore from stress and anxiety

Headaches

Headaches and migraines are other common results of chronic pain and anxiety. Because other systems, such as teeth grinding, tension in the face, and poor posture often accompany stress and anxiety, prevalent headaches and migraines that are extremely painful are likely. Sharp pain or dull aches accompanied by pressure in the head and eyes are usually the headaches caused by stress and anxiety. 

Find relief for your pain

Stress and anxiety are common ailments in the U.S., but if you’re experiencing pain that you believe is associated with stress, it’s time to get help — for both your brain and your body. The key is to manage daily habits to ensure this type of pain does not get out of hand. 

If you are experiencing pain that is impacting your daily life, our team can help. With extensive training in treating patients with chronic stress and anxiety disorders, we can get you back on track to feeling calm, relaxed, and healthy in no time. 

To find relief from your chronic pain, book a free consultation today!

Namaste

Sleep and Athletic Performance
Sleep and Athletic Performance 1200 799 ResilientRx

Quality sleep is an important consideration when it comes to pain, injury and recovering after a workout. Research supports that individuals who get a bad night’s sleep (especially those with chronic sleep issues, insomnia, etc.) are more likely to have pain the subsequent day. In fact, two thirds of people with chronic pain suffer from sleep disturbances.

Sleep influences our pain experience and internal function.

Studies suggest that disturbances in sleep may hinder key physiological processes in the body that contribute to the development and maintenance of chronic pain, including your body’s ability to inhibit or regulate pain. A recent review showed the role poor sleep patterns can play in causing acute injury to transitioning into chronic pain in adolescents. Many of the substances in our bodies that help regulate our sleep-wake cycles such as serotonin also regulate pain signals (Andreucci, et. al, 2021). So if we constantly are in a depleted state due to lack of sleep, this can disrupt the balance of these processes in our bodies and therefore lead to persistent pain and inability to recover from an injury in a reasonable amount of time.

Poor sleep, especially over time, can also have negative impacts on things like cognitive function, emotions, immune function, energy conservation and synthesis, immune function, and cardiovascular health (Wei, et. al., 2019).

Injury Risk in the Athletic Population

Even for patients without chronic pain, the risk for overuse injury increases with lack of quality sleep. A recent 2020 study showed that less than 7 hours of sleep led to an increased injury risk in endurance athletes (Johnston, et. al., 2020). They found that there was a 2 week delay from the period of poor sleep to the time of the new injury!

Oliver, et. al. in 2009 found that for athletes with 30 hours of total sleep deprivation, they experienced a 2.9% decrease in running performance. Another study looked at 2 groups of endurance athletes performing a stationary cycle test to failure. One group had normal sleep and the other group was sleep-deprived. The athletes in the sleep-deprived group showed a 9% reduction in endurance (Temesi, et. al., 2013).

How about effects on weightlifting performance? One study showed that limited sleep to 3 hours per night for just 2 nights, reduced lifting performance in multiple upper and lower body exercises (Reilly & Piercy, 1994). Other important factors such as motor control, coordination, and athletic response time have also been shown to be negatively impacted due to lack of quality sleep, all of which can lead to injury (Mah, et. al., 2019).

The take-home message for the above examples is that with poor sleep not only are you at increased risk for injury, but your athletic performance will suffer.

Adequate sleep can increase athletic performance.

A great example of what consistently good sleep can do for you can be found in Stanford’s men’s basketball team. The players participated in a 2011 study by Mah, et. al. where they increased their sleep an average of 2 hours per night for 5-7 weeks, with the goal of getting about 10 hours of sleep per night. As a result, the team saw a 10% increase in sprint performance and 9% increase in 3-point and free-throw accuracy!

Helpful Sleep Tips
  1. Go to bed and wake up at the same times every day
  2. Go to bed and wake up at the same times every day
  3. Keep your bedroom dark and cool
  4. Limit screen time – no cell phone or TV 30-60 minutes prior to bed
  5. Keep caffeine intake to early in the day
  6. Meditation/mindfulness practices

If you are struggling with pain or an injury, physical therapy can help! We can evaluate your movement, strength, and function and come up with a plan to help get you out of pain and back to doing what you love!

Written by Nick DiSarro, PT, DPT, OCS

Sources: Wei, Y., Blanken T.F., Van Someren. Insomnia really hurts: Effect of a bad night’s sleep on pain increases with insomnia severity. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30210367/

Finan, P., Goodin, B., & Smith, M. (2013, December). The association of sleep and pain: An update and a path forward. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/

Johnston, R., Cahalan, R., Bonnett, L., Maguire, M., Glasgow, P., Madigan, S., . . . Comyns, T. (2019, November 01). General health complaints and sleep associated with new injury within an endurance sporting population: A prospective study. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1440244018308545

Oliver, S. J., Costa, R. J., Laing, S. J., Bilzon, J. L., & Walsh, N. P. (2009). One night of sleep deprivation decreases treadmill endurance performance. European journal of applied physiology, 107(2), 155-161.

https://www.academia.edu/download/43130932/One_night_of_sleep_deprivation_decreases20160227-2241-1o288ei.pdf

Andreucci, A., Groenewald, C. B., Rathleff, M. S., & Palermo, T. M. (2021). The Role of Sleep in the Transition from Acute to Chronic Musculoskeletal Pain in Youth—A Narrative Review. Children, 8(3), 241.

https://www.mdpi.com/2227-9067/8/3/241/pdf

Temesi, J., Arnal, P. J., Davranche, K., Bonnefoy, R., Levy, P., Verges, S., & Millet, G. Y. (2013). Does central fatigue explain reduced cycling after complete sleep deprivation. Med Sci Sports Exerc, 45(12), 2243-53. http://karen.davranche.free.fr/pub/Temesi,%20Arnal,%20Davranche_et_al_MSSE_2013.pdf

Reilly, T., & Piercy, M. (1994). The effect of partial sleep deprivation on weight-lifting performance. Ergonomics, 37(1), 107-115. https://pubmed.ncbi.nlm.nih.gov/8112265/

Mah, C. D., Sparks, A. J., Samaan, M. A., Souza, R. B., & Luke, A. (2019). Sleep restriction impairs maximal jump performance and joint coordination in elite athletes. Journal of sports sciences, 37(17), 1981-1988. https://pubmed.ncbi.nlm.nih.gov/31122131/

Mah, C. D., Mah, K. E., Kezirian, E. J., & Dement, W. C. (2011). The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep, 34(7), 943-950. https://academic.oup.com/sleep/article/34/7/943/2596050?TB_iframe=true&width=370.8&height=658.8

Sleep for Rehab; YouTube video presentation by E3Rehab https://www.youtube.com/watch?v=OAaAnWB-3jY

Self Care

Why is Self Care Important?
Why is Self Care Important? 1200 799 ResilientRx
Surprise– eating clean and exercising doesn’t make you a “healthy” person.

Healthy living is beyond exercising.

Living healthily is a conscious effort to take care of your physical body and mental health. “Self-care” is a phrase you have probably heard often, especially lately, and with good reason! Self-care addresses your physical health- lack of sleep, limited exercise, diet, etc., as well as mental health- stress, relationships, life changes, etc.

We have two main automatic regulatory nervous systems (autonomic nervous system):

  • the sympathetic nervous system
  • parasympathetic nervous systems

These systems help to regulate breathing, digestion, heart rate, etc. without a conscious effort. In other words, these things happen without us thinking about them or deciding they will happen.

The sympathetic nervous system is known as the stress response. You may have heard of this as the “fight or flight” response. The parasympathetic is the “rest and digest” response- the system that calms you down.

Here is an example of how the sympathetic nervous system works:

Imagine being stuck in traffic when you are late to work. You might start to clench your jaw or grip your steering wheel. In that moment you are feeding your body stress.

This stress activates the sympathetic nervous system and causes the body to tense up and release cortisol. Cortisol is released during any stressful event from the adrenal glands that sit above the kidneys.

Whether you are stuck in traffic or being chased by a tiger, bodies react in the same way.

Chronically stressing our bodies, can cause:

Keep this in mind if you are experiencing chronic pain. It could be caused by stress and not just misalignment. Although there are many things that are out of our control, you can use some of the tips below to help manage your stress.

Tips on reducing stress:

  • Diaphragmatic breathing: Place your hand on your chest and your lower belly/ribs. As you inhale, feel your lower belly and ribs expand. This helps to activate the parasympathetic nervous system
  • Planning ahead: Try to avoid running late when possible. This gives you ample time to get you’re your destination without being stressed by traffic and other factors that you cannot control.
  • Mindfulness: Check in with yourself, do you feel tense in your body? Take a minute to breath and ask yourself why you are tense and focus on relaxing the muscles that feel tense.
  • Avoid foods high in sugar: Try to maintain your blood sugar levels. Eating too much sugar and caffeine can spike your cortisol levels.
  • Exercise: Go on a 15 to 20-minute walk outside in the sun. This will help to calm your sympathetic nervous system. (Zankert S., Kudielka, B., Wust, S., 2020)

Of course, this just scratches the surface and we are here to help along the way! Stress can also exacerbate issues with your physical body that you might already have. In our office, we look at our clients holistically to see how all elements can add or take away from feeling your best. Ready to start feeling better? Book an appointment with us now!

Written by: Mary Grimberg PT, DPT, OCS

Sources:

Squatting in Gym

Knee Pain When Squatting?
Knee Pain When Squatting? 1200 799 ResilientRx

“My knee hurts when I lift weights or run- what’s going on?”

It’s incredibly common for people who engage in fitness activities, like weightlifting and/or running, to experience anterior knee pain. This is pain in the front of the knee in the area around the knee cap (the patella). In fact, as much as 85% of the population may experience some type of anterior knee pain! The onset can come on both slowly over time or acutely. And as the title of this blog implies, it is a nagging issue because there is up to a 90% recurrence rate in affected people (Willy, et al., 2019). Both acute and chronic anterior knee pain can be quite debilitating when in a flared state, making simple daily activities such as standing up from a chair or climbing stairs daunting.

Common diagnostic labels you may have seen (or even have been told you have) are:

  • Patellofemoral Pain Syndrome
  • Chondromalacia
  • Jumper’s Knee
  • Runner’s Knee

The good news is, that despite the different diagnoses listed above, they tend to have similar qualities and contributing factors and therefore are treated similarly.

Individuals often will experience pain with activities that involve loaded, impactful, or repetitive movements that involve knee flexion such as running or squatting. The pain felt in the knee is often anywhere along the borders of the patella, referred to as the peripatellar region, or felt behind it, referred to as the retropatellar surface. Anterior knee pain is often poorly defined, meaning that it may jump around and change locations and severity at any given point.

What is the cause of knee pain?

According to the research, there is no single definitive cause of anterior knee pain. Multiple factors are thought to play a role and can be divided into physical and nonphysical influences.

Physical factors may include:

  • Hip and quadricep strength
  • Hamstring flexibility
  • Ankle/foot stability
  • The capacity of the knee’s tendons to handle external load.

These physical factors can increase or alter how the patellofemoral is mechanically loaded.

Non-physical influences include:

  • Stress
  • Psychological state

These affect the nervous system and can sensitize the body’s tissues and keep them in a persistent painful state

How to treat knee pain

Studies show that the most effective treatments for anterior knee pain include exercises that strengthen the muscles of the hip and quadriceps. Typically, the exercises start out by gently working the muscles without placing too much stress on the knee joint or increasing symptoms. Then gradual loading and progressive strengthening exercises over time are utilized to improve the mechanics of the entire leg. Other interventions such as patellar taping and foot orthoses along with exercise can improve pain, but should only be used for a short period of time early-on.

Make a plan

For the majority of patients, the “educate and wait” approach of simply avoiding pain-provoking activities has been shown to be ineffective in improving pain and function in the short, medium, or long term. This is what leads to recurrence of pain/symptoms and keeps people sidelined longer than they should be. Early physical therapy intervention, along with proper guidance on modifications to activity and exercise, can speed up the recovery process and get you back to a pain-free lifestyle.

Struggling with knee pain?
CLICK HERE TO BOOK AN APPOINTMENT

Written by Nick DiSarro, PT, DPT, OCS

Sources:

Willy, R. W., Hoglund, L. T., Barton, C. J., Bolgla, L. A., Scalzitti, D. A., Logerstedt, D. S., … & Torburn, L. (2019). Patellofemoral pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American physical therapy association. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1-CPG95.

Disclaimer:

The content in this post is intended for educational purposes only. No information in this post is to be taken as medical or health advice. See a healthcare professional if you have any questions about your individual needs.

Back Pain

Lumbar MRI: Do I need one?
Lumbar MRI: Do I need one? 1200 799 ResilientRx

Many people with low back pain (LBP) have asked this question and wondered if an MRI will help guide them down the right path to recovery. Up to 80% of us will experience some form of LBP at some point in our lives. The great news is that the majority of low back pain cases are not serious.

What should I do if I have a new onset of low back pain?

DON’T PANIC.

While you may have to temporarily refrain from more intense activities such as running or weightlifting, avoid complete bed rest and try to maintain gentle movement and activity within your tolerance.

Consult your healthcare provider.

Preferably, consult one who will manage your case conservatively first, like a physical therapist (PT). PTs are trained to do a thorough subjective interview, medical history intake and physical assessment to rule out red flags. From there they will either proceed with treatment or make the appropriate referral to a specialist.

Degenerative disc disease and bulging discs are common.

In 2015, researchers took MRIs of the low backs of over 3000 people who did not report back pain and found some interesting results- of the subjects in their 30s, 50% had “disc degeneration” and 40% had “disc bulges” although they were asymptomatic. The study noted that these percentages increase across decades of life. For example, 60% of people in their 50s had these findings, 70% of people in their 60s, and so on (Brinjikji, et al, 2015).

What we know is that LBP has multiple contributing factors that extend beyond structural changes alone. In the study mentioned above, we can conclude that the “disc degeneration” described should be considered a normal part of human aging- like “wrinkles on the inside.”

Treat the Human, Not the Image.

Scans have their place and they are also just one snapshot in time. They don’t always tell us the entire story of the person that stands before us. It’s been found that early & unnecessary imaging for LBP is expensive and actually leads to poorer patient outcomes (Jacobs, et al, 2020). Not to mention that the average cost of care when getting an MRI first is $6,664, compared to $1,871 when physical therapy is sought first (Fritz, et al 2015).

TLDR:

  • MRIs have their place and are useful in detecting more serious conditions such as tumors, fractures, and infection.
  • Other findings such as degenerative changes and bulging discs, although commonly seen, offer very little information on a person’s overall condition and correlate poorly with a person’s pain and function.
  • Premature imaging of the lumbar spine in an episode of LBP is costly and in most cases, can do more harm than good.
  • We never disregard someone’s MRI findings or their concerns, but instead place more emphasis on looking at the individual from a holistic perspective.
Struggling with lower back pain? Have some questions?
CLICK HERE TO BOOK A PHONE CONSULTATION TODAY

Written by Nick DiSarro, PT, DPT, OCS

Sources:

Fritz, J. M., Brennan, G. P., & Hunter, S. J. (2015). Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: associations with future health care utilization and charges. Health services research, 50(6), 1927-1940.

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

Jacobs, J. C., Jarvik, J. G., Chou, R., Boothroyd, D., Lo, J., Nevedal, A., & Barnett, P. G. (2020). Observational Study of the Downstream Consequences of Inappropriate MRI of the Lumbar Spine. Journal of general internal medicine, 35(12), 3605-3612.

Disclaimer:

The content in this post is intended for educational purposes only. No information in this post is to be taken as medical or health advice. See a healthcare professional if you have any questions about your individual needs

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