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Exercise Tips

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.


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 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, 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.


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.


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, 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.


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!


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.

3 Signs Your Shoulder Pain Is Actually Coming From Your Neck And What To Do About It

3 Signs Your Shoulder Pain Is Actually Coming From Your Neck And What To Do About It 1279 853 ResilientRx

Shoulder pain is a very common part of the human experience that many of us have or will experience. It’s estimated that anywhere between 18-26% of adults will have shoulder pain at some point in time (Linaker, et al, 2015). It can range from a mild, temporary issue, to a debilitating problem that impacts work, recreation, and daily life. Since pain in the region of the shoulder or shoulder blade (known as the scapula) is so common, it is very easy to assume the problem is located in that region, and thus remedies you may try will be directed at the shoulder.

Person touching shoulder in pain,  It’s estimated that anywhere between 18-26% of adults will have shoulder pain at some point in time

However, there are instances where the shoulder may be the painful part, but the neck (also called your cervical spine) is actually the source of the issue. This can be due to irritation of the nerves that branch out from your spinal cord and travel through the arm as a result of a disc herniation, for example. These nerves control functions like sensation and movement, which can cause painful movement (more on this below).

Not only do nerves travel from the neck into the shoulder and arm, but the neck and the shoulder share muscle attachments which could also cause pain to be present at the level of the shoulder. 

If someone has been experiencing nagging shoulder pain and has tried lots of remedies such as heat, ice, massage, or exercises on the shoulder to no avail, they may want to investigate to see if the issue is actually coming from the cervical area. To help understand why this may be the case, let’s do a quick review of how we classify pain that can “travel.”

Radicular Pain vs Radiculopathy vs Referred Pain – Know The Difference!

You may have heard health and wellness providers use these terms interchangeably, but they are each distinct and can be the underlying reason for pain going into the shoulder or arm. Here’s a very simple breakdown of these terms:

  • Radicular pain is pain caused by a problem at the nerve root (the part of the nerve that exits the spinal cord between the vertebrae and then branches out down the entire arm)
  • Radiculopathy is weakness or numbness caused by a problem at the nerve root. Radiculopathy can also be painful, but not always
  • Referred pain is pain caused by a problem in a region such as a muscle or joint (not the nerve root) that is felt in a nearby area

So now that we’ve talked about how and why pain can exist away from the source of the problem, here are three (3) signs that your shoulder pain is actually coming from your neck (and what to do about it)!

Shoulder Pain Is Accompanied By Other Symptoms

This one seems like it may be noticeable right away, but you’d be surprised. Oftentimes these accompanying symptoms may be subtle or intermittent so they may slip under the radar, or you may feel that they are seemingly unrelated. Symptoms like numbness, tingling, and/or pain further down the arm can be indicative of a neck issue.

Another symptom to be on the lookout for is weakness in the shoulder, arm, or hand. While difficulty raising your arm could be a sign of something like a rotator cuff injury, it also can be due to irritation of the nerves. Another possible symptom could be if you notice changes in grip strength – like difficulty opening jars or dropping objects frequently.

Person touching shoulder

Head Or Neck Position Changes Symptoms

Sometimes change in your neck position can either aggravate or ease shoulder pain. For example, if turning the neck toward the same side as the painful shoulder is limited or increases pain in the shoulder, this could be a sign the neck is the culprit (Wainner, et al, 2003). There may also be circumstances where tucking the chin back (referred to as cervical retraction) actually reduces pain in the shoulder. The neck may be involved in this shoulder pain scenario as well if this is the case.

woman touching back, shoulder pain can move around sometimes.

Shoulder Pain Is Vague Or Tends To Move Around

Issues like a rotator cuff tear or bicep tendinitis tend to have very specific points of pain and activities or movements that cause an increase in pain. If pain in the shoulder region seems to be more diffuse or changes locations on any given day, the cervical spine should be considered as a possible contributor.

If any of this resonates with you or a loved one, here’s what you can do right now:

  1. First and foremost, don’t panic! The chances of it being something really serious are very low and can most often be treated with conservative measures such as physical therapy. It’s very similar to when we have low back pain in this sense – see our other blog article on LBP and MRIs.
  2. Temporarily avoid or modify things that aggravate your pain or symptoms. No need to drastically change your life, but if things are painful or flared, it may help to take a pause on some things.
  3. Contact your physical therapist or physician. If your shoulder pain is coming from your neck, it doesn’t mean you’ll need imaging or surgery, nor does it automatically mean you have a disc issue. Your physical therapist or physician can assess your situation and make recommendations on the course of action to take.

*Not medical advice – everyone’s situation is different, so consult with your healthcare provider*


Linaker, C. H., & Walker-Bone, K. (2015). Shoulder disorders and occupation. Best practice & research Clinical rheumatology, 29(3), 405-423.

Wainner, R. S., Fritz, J. M., Irrgang, J. J., Boninger, M. L., Delitto, A., & Allison, S. (2003). Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine, 28(1), 52-62.

Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., … & Torburn, L. (2017). Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1-A83.

Finding time to work out can be tough, this article should help

3 Quick Exercise Tips for Parents with Infants

3 Quick Exercise Tips for Parents with Infants 1280 853 ResilientRx

If you are brand new to parenting or have added a new child to your growing family, you probably feel that there is barely enough time during the day for just about anything, let alone time for yourself. 

This is especially the case for exercising. 

Our children mean the world to us, but they also consume a lot of our time, and personal care activities such as going to the gym can easily fall by the wayside. Not to worry because we’ve got you covered in this blog! Keep reading for 3 quick exercise tips for parents if you can’t make it to the gym.

Prioritizing exercise with a little one is tough, these tips should help.

Turn Playtime Into a Mini Workout

If you are spending time on the floor with your child working on things like tummy time, head control, rolling, etc, it is the perfect opportunity to perform some functional movements for yourself.

3 bodyweight floor movements that can be easily performed are:

  • Pushups: Whether it’s a standard pushup or from the knees, you can do these on the floor while your baby lays or plays. Be sure to include plenty of funny faces and sounds!
  • Planks: Similar set up to the pushup, these can be done in a tall plank or plank on your forearms. To add more fun and challenge, perform small reaches toward your child. Depending upon where your child is at developmentally, you can either hold small toys over their head or hand them a toy.
  • Bridges: Double and single-leg bridge variations are always options and can be done on the floor right next to your kiddo. Depending upon your skill and comfort levels, you can hold them on your lap or in your arms during the bridge movement.
Finding time to work out can be tough, this article should help

Invest in a Baby Carrier and Use Your Baby for Some Resistance!

Baby carriers are a safe and effective way to add resistance to typical bodyweight exercises. They typically are worn much like a weighted exercise vest and can be used just the same. They will free up your hands and allow for some bonding time with your child while you get some movement in for yourself!  So in our opinion, they are worth the investment. You could even put it on your baby registry! Dads (and moms too) may especially love something like the Tactical Baby Carrier.

Here are 3 movement options to try with your little person along for the ride:

  • Squats – start with a comfortable amount and depth. You can touch down to a chair or simply to an air squat to an appropriate depth.  
  • Lunges – similar things to consider as the squat, but if you need extra help with balance, you can always use a free hand to hold something sturdy like a chair or countertop. 
  • Walking – ditch the stroller for a walk or two. Walking while wearing some type of weight, also known as “rucking,” can be a great way to build cardiovascular endurance and strength.

Schedule Times With Your Partner to Workout Together or “Trade Off”

This may be a tough pill to swallow (because we’re all guilty of it), but there are better ways to spend time together as a family that doesn’t involve a TV or being glued to a phone. One healthy way is to exercise and move together! 

Supportive partners can motivate one another and hold each other accountable, all while spending quality time with their children. You can each take turns playing with your child while the other gets their reps in, or do a tandem workout with any of the suggestions above.

Now with that said, despite some of the creative and fun ways you can incorporate fitness into time at home spent with your child, sometimes it just can’t work. Perhaps schedules don’t align or you simply need time to yourself. We highly recommend you take every opportunity to do so as needed, so a supportive partner is crucial to make this happen. This is where you can “trade off” watching your child while your partner gets their workout in. 

If you don’t have a partner to trade off time with, ask a fellow parent, friend, or family member to lend a hand. Asking for help is never a bad thing.  You can also look into local programs or online fitness instructors/trainers that offer child-friendly workouts.

This is where you can “trade off” watching your child while your partner gets their workout in. 

It doesn’t take much to get going, but that sometimes is the hardest part. So to make things easy, we recommend you plan ahead. Sit down with your significant other before the week starts to plan out days/times you each are able to work out while the other is on kid duty. Maybe trade off mornings or evenings, or simply tag them in and work out back to back. Don’t forget about weekends as this may allow for more flexibility in your schedules. Also, consider options outside of your house like the park or playground!

We hope this was helpful in giving you some options to still stay on track with routine exercise while juggling life as a parent. As a reminder, never do any exercises out of your skill set or comfort zone, especially ones that could jeopardize your child’s safety. Consult with your healthcare provider if you have any doubts or questions. Happy moving!

If you have pain, limitations, or don’t know where to start- contact us today.

How to Stay Hydrated During the Summer Months

How to Stay Hydrated During the Summer Months 1920 1280 ResilientRx

60% of our body is made up of water, but when we’re enjoying our favorite outdoor summer activities, all the water inside of us won’t be enough to keep us hydrated. Summer activities and sweltering heat lead our bodies to lose more fluids than normal — through our sweat. If you don’t replace the moisture that your body is losing, you can eventually become dehydrated. 

Hydration is the body’s first defense in maintaining good health, especially as we age. Water isn’t just to parch thirst — it’s critical for our muscles, bones, tissue, and organs. That’s why we are regularly told to drink at least 8 glasses of water a day. In reality, this is an arbitrary number; some bodies might need more and some bodies might need less depending on all different factors.

Let’s dig into what it looks like to be hydrated and dehydrated so you can find the proper amount of water intake for you, your body, and your summer activity levels.

Is your body hydrated or dehydrated? Know the signs

Water is never a bad idea. And while it may feel better to cool off from the scorching summer sun with an ice-cold soda, alcoholic beverage, or juice, these beverages won’t provide anything in the way of hydration. In actuality, they’ll just quench your thirst momentarily while causing further dehydration. 

The key is to drink enough plain old water to hydrate your body properly. Whether that’s 8 glasses of water or 12, your body will also give you signs that you are properly hydrated. These include:

  • Improved brain performance and function
  • Reliable digestive harmony 
  • Decreased/eliminated joint pain 
  • More energy
  • Weight management 
  • And so many more! 

When you’re dehydrated, though, your body will begin to show warning signs, some more obvious than others. Some of the dehydration dangers that you should look out for include: 

  • Muscle cramps – When you become dehydrated your body can no longer send water to your muscles, causing them to be more likely to constrict and cramp involuntarily due to hypersensitivity. 
  • Constipation – Dehydration will make it harder for your body to break down food as it moves through your intestines. Because your body is in panic mode, it will start extracting what liquids it can from the food waste, essentially making it harder to move through your body. 
  • Depression – Dehydration doesn’t just affect your body, it also affects your mind. Your brain requires the most water out of any other part of your body (your brain is made up of 85% water). When there’s a deficiency in that water supply, your brain will lack the energy it needs to fight fatigue and, yes, depressive thoughts from occurring. 
  • Color of your urine- If your urine is a dark yellow, this means that you are dehydrated. In other words, your kidneys are retaining water from being excreted (peeing it out), in order to keep the body hydrated. This is why the urine is concentrated. The goal is to have your urine be a slight yellow color, not dark yellow and not clear. 

The importance of electrolytes in staying hydrated

Electrolytes are minerals found in your blood, sweat, and urine. The minerals are dissolved in fluid and form into electrolytes – which are the positive or negative ions used in metabolic processes (turning food into energy).

There are several different types of electrolytes found in the body that are responsible for keeping up with important bodily functions, including nerve and muscle function, acid-base maintenance, and keeping you hydrated

Within your body, you have electrolytes like sodium, potassium, chloride, calcium, magnesium, phosphate, and bicarbonate. Of these, sodium is the most important to the process of staying hydrated. 

Without the proper amount of sodium, your body cannot maintain fluid balance (your kidneys are in charge of this) — because sodium is needed to carry H2O across our cell membranes. Remember high school biology? This process is called osmosis.

Without osmosis, your body doesn’t know which cells to send water to and which ones need to be filtered through. Without this information, cells are at risk to either burst from too much water or to shrink due to dehydration. 

The most common cause of electrolyte imbalance is dehydration caused by extreme heat exposure (other causes include being physically ill, like vomiting or diarrhea). Electrolyte imbalance can be anywhere from mild to fatal, which is a scale that should be taken seriously.

Side effects of an electrolyte imbalance include:

  • Fatigue (this is the most common)
  • Irregular heartbeat
  • Muscle cramping
  • Headaches
  • Convulsions 

This delicate balance happening within your body is not something you want to challenge. Electrolytes are more than just a word you read on a bottle of Gatorade — they can impact your health and wellbeing.

How to rehydrate with food and water

Dehydration during the summer doesn’t have to happen. While sweating is great for removing toxins from our body and even proving that we’re getting a great cardio workout, sweating too much is not necessarily a good thing. You’ll need to replenish everything you sweat out by drinking water (no, drinking a Gatorade after a workout isn’t necessarily what your body needs!).

If you are sweating or intensely working out for over an hour, supplementing electrolytes is recommended. We often use nuun tablets (less sugar) after completion of exercising for an hour, or Liquid IV if you are continuing to exercise over an hour because it has sugar (glucose) to help provide extra energy to keep moving. 

How much water should you drink?

By taking half of your body weight and turning that number into fluid ounces, you have the perfect amount of water that your body needs to operate at functioning capacity at a baseline.

You’ll also want to consider your activity level or heat outside. Whether you’re playing sand volleyball one day or walking outside another, you should add 12 ounces of water to your daily water intake for every 15-20 minutes you work out or are sweating in this Texas heat!

Water-rich food sources

However, hydration doesn’t only have to be about incorporating your 8 (or more) glasses of water into your day. You can also include more water-rich foods in your diet. Summer fruits such as watermelons, strawberries, cantaloupe, and peaches are great water-rich options for snacking during hotter months. Most vegetables also fall into this category, too, with the top three water-rich veggies being cucumbers, lettuce, and celery. 

Active all year-round? We want to help.

We know that, for many people, summer is a very active season. Alongside dehydration comes the risk of injuries, from muscle strains to unidentified pain and even bone breaks or ligament injuries.

Here at ResilientRX, we believe that you can recover from your injuries — and even prevent future injuries with the help of a physical therapist. 

When working with one of our Doctors of Physical Therapy, you will undergo a comprehensive evaluation that will look beyond one body part and assess multiple regions that may be contributing to the problem. We’ll talk about your activity levels, hydration and diet, history of injury, and more.

Your physical therapist will walk you through every step of the assessment and will ensure you feel comfortable, but push you when needed during each treatment session.

If you want to make sure you can stay active and strong throughout the year, now’s the perfect time to start working with a performance-focused physical therapist. Learn more about our PT services for athletes and active folks here.

And remember, all of this is general advice, please consult your physician if you have any questions about whether or not these supplement suggestions are right for you.


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.


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.


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

Hamstring Stretch

What Causes Tight Hamstrings?

What Causes Tight Hamstrings? 1200 799 ResilientRx

Why do my hamstrings feel tight?

Is it because the muscle length is actually in a shortened state?

What about for those of us who have stretched our hamstrings regularly, but there isn’t much change in pain, how tight they feel or improvements in flexibility?

Complaints of tightness in the hamstrings and not being able to bend over and touch the toes, for example, is one of the most common complaints I’ve heard patients report in my clinical practice over the past 10 years.

Stretching can be good in some of these cases, especially if it helps alleviate pain. However, I’d estimate the majority of people with tight-feeling hamstrings don’t have a true muscle length issue, but rather, are feeling tightness for a completely different reason: their hamstrings are underloaded and hypersensitive.

Brief Hamstring Anatomy Review

The hamstrings are actually 4 muscles combined: the biceps femoris (long & short head), semimembranosus, and semitendinosus.

The hamstrings are a 2-joint muscle, originating at the ischial tuberosity of the pelvis (the bone you sit on), and inserting into the tibia and fibula bones of the lower leg. They are innervated by the sciatic nerve (more on this below).

The basic actions of the hamstrings are knee flexion and hip extension. Since the hamstrings attach to the pelvis, pelvic positioning and control can influence how the hamstrings feel and function. For example, if the pelvis tilts anteriorly excessively due to poor lumbar spine control during a weightlifting exercise, it may irritate the hamstrings or sciatic nerve.

What is Neurological Tightness?

A muscle that is truly shortened or lacking length is different from tightness that the muscle is holding due to a neurologic reason. This neurologic, or perceived tightness, happens when the nervous system is alerted to the “threat” from an injury or feels the need to continue to guard the body due to factors such instability, weakness or pain. This protective response comes 100% from the brain.

Neural structures like the sciatic nerve can be responsible for persistent hamstring tension, since its pathway lays within the hamstring bed of muscle tissue. So when there is any sort of stretch or pressure, the sensitized tissue will cause you to feel tension, pain, or even numbness & tingling.

One important thing to note about this neurologic or perceived tightness is that it is STILL tightness and not all in your head (Kuilart, et al., 2005).

Strengthen To Lengthen

  • Toe-touch progression (test/retest)
  • Reverse toe-touches
  • RDL (loaded)
  • Kickstand RDL
  • SL RDL
  • Dead Bug (to improve lumbopelvic position and control which influences the anterior and posterior muscles of the pelvis)

All of these exercises are demonstrated and explained on our YouTube channel.

Written by Nick DiSarro, PT, DPT, OCS


Kuilart, K., Woollam, M., Barling, E., & Lucas, N. (2005, September 09). The active knee extension test and slump test in subjects with perceived hamstring tightness. Retrieved February 02, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S174606890500060X


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

Weight Wall

How many sets per workout?

How many sets per workout? 1200 799 ResilientRx

Are you confused on how many repetitions you should be doing when you are working out? How much weight is too much weight? Should I be doing higher repetitions or more weight?

Many people work out regularly and wonder why they aren’t getting the results they want. How do you figure it out? Well, the big question that needs answering is: what are you trying to accomplish? Depending on your answer, you will change the way you train.

The different ways to progress or begin an exercise program are based upon two things: weight + repetitions.

The below image is the Holten curve which describes how to gauge your weight and repetitions:

Strength training is based upon 1 repetition max. This is the amount of weight that you can lift once before you experience max fatigue. It is hard to do this without causing potential injury if you have not lifted heavy before.

The best way to determine this is how many repetitions you can complete before your maximum fatigue (i.e. when you physically cannot do it anymore).

For example, if you can complete 20 repetitions, you are more focused on endurance and if you can complete only 8, then you are focusing on building strength.

We will dive into this more below:

Higher repetitions and lower weight: targets endurance, improves blood flow (vascularity) and lean muscle mass

This is ideal If you are starting a new exercise routine. First, you want to make sure you can perform the exercise properly without any weight.

It is important to master the form because adding load (weight) to the exercise can increase the potential for injury.

In this case, you would do higher repetitions (like 20 repetitions) with lower weight. As you can see on the curve, you are targeting more endurance while focusing on your form. This will help you ease into a workout routine to start or after an injury. This is also helpful if you are aiming to develop more lean muscle mass. If you are building strength with higher repetitions, it is important that you may have to train to failure (ie. inability to perform more without rest).

Once you have mastered your form, and wanted to be able to lift heavy, moving on to higher weight may be ideal for you. For example, if you can perform a proper squat without limitations, you could start add weight.

Higher weight and lower repetitions: builds strength and larger muscle mass

It’s important to note that even when you add weight to your exercises, the switch from high repetitions to low repetitions isn’t a sprint! When you are ready, add weight on little by little. With that weight added, it can still be good to first start with higher repetitions until you can reassess and can lock down proper form with your new weight.

Once you have done that, you can continue to load heavier and you will slowly shift from lower weight to higher weight.

Keep in mind, everyone is different. If you are having any concerns about your exercise form or experiencing limitations in your exercise program, reach out to us. We have extensive experience in helping people return to their normal fitness routines safely.

Written by Mary Grimberg, PT, DPT, OCS

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


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?

Written by Nick DiSarro, PT, DPT, OCS


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.


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.

Running on Track 2

Postpartum Running: When Can I start?

Postpartum Running: When Can I start? 1200 629 ResilientRx

After delivering a baby, you might be wondering when can I start running again? This is a very common question clients ask at the clinic. It’s important to consider a more gradual return to pre-pregnancy fitness levels, especially when it comes to running.

According to a group of physical therapists’ research on returning to running postnatal, they recommend that “returning to running is not advisable prior to 3 months postpartum or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running” (Goom et al 2019).

Why wait 3 months?

For many, this may be hard to follow. However, consider that women require adequate time to heal and regain strength after giving birth. Pregnancy and birth (whether vaginal or cesarean) have a huge impact on the abdominal and pelvic floor muscles, often leading to muscle weakness, incoordination, and dysfunction.

During pregnancy and early postpartum, increased body weight has allowed for a forward shift in your center of gravity causing your body awareness in space to be totally thrown off and your body learns to compensate. During this 3 month period, you’ll likely notice that doing certain activities you did before now feel completely different. In addition, you may be experiencing pain, discomfort or urinary leakage with those activities.*

Low Impact Exercises Postpartum:

During your three month healing period, the following can be generally helpful:

  • Basic core activation
  • Walking
  • Squats
  • Lunges
  • Lifting
  • Swimming
  • Cycling

What’s next?

Prior to getting back to running, your physical therapist will help you achieve adequate strength and control of your pelvic floor and hip musculature and help you manage impact and load on the body.

Once cleared by your physical therapist, a “graded return to running” plan (e.g. starting with short distances to longer distances) can be implemented. During this period, you should continue to monitor for signs and symptoms while building training volume.

At ResilientRx, we offer 1:1 care and work with you to meet your individual needs. If you are experiencing symptoms of urinary incontinence, pain, pelvic organ prolapse, or any other musculoskeletal issues, and want to get back into running again, seek help from us to guide you in the right direction.

Written by Michelle Andoy, PT, DPT

*Remember to reach out to your healthcare providers, including a pelvic health physical therapist, to figure out the root causes and address these symptoms. Although not traditionally routine after every birth, there is always an option to receive a comprehensive pelvic health assessment from a pelvic floor physical therapist.

Sources: Goom, T, Donnelly G, Brockwell E (2019). Returning to running postnatal–guidelines for medical, health and fitness professionals managing this population. Retrieved from: https://www.researchgate.net/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population