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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


Postpartum Urinary Incontinence

Postpartum Urinary Incontinence 1200 799 ResilientRx

Will I ever get back to working out without leaking?

“Why did I just pee all over myself after exercising?”

”I want to get back in shape after just delivering my baby!”

”Will I ever get back to working out without peeing myself?

These questions are all too common when we speak to our postpartum patients and their sentiments are completely valid! We’ve some exciting news- YES! You can get back to working out without peeing yourself!

It is critical to know that pregnancy and delivery may affect pelvic floor function, including urinary incontinence.

Particularly, the abdominal and pelvic floor muscles are stretching throughout pregnancy and during labor, which can lead to weakness and incoordination of the muscles. Due to these changes, returning to certain activities and getting around in your new postpartum body may lead to urinary leakage. Overall, the pelvic floor and core musculature may not be functional enough to support activities that increase pressure on the bladder, like running or jumping.

Types of Urinary Incontinence:


This is the involuntary loss of urine due to increased pressure on the bladder. This pressure can come from coughing, sneezing, jumping, running, etc. With stress incontinence, the pelvic floor muscles have to be strong enough to withstand increases in pressure.

In the clinic, I notice some clients who may think they have strong pelvic floor muscles, however they are actually over-activating or tightening their muscles and in return, the muscles become weak. It is important to note that your pelvic floor muscles need to be able to fully relax in order to fully contract. Additionally, holding your breath during physical activity also increases pressure on the abdominopelvic system which is another cause of leaking urine- don’t forget to breathe!


This is a sudden urge to urinate and involuntary loss of urine. These urges can be associated with exposure to the cold, running water, walking by a bathroom or putting a key in a lock. Often, the muscles of the bladder contract and relax and result in urinary leakage. Urge incontinence can also be associated with frequent bad bladder habits such as going to the bathroom “just in case”. Doing this a lot can lead to mixed signals with the brain and the bladder thinking that you have to pee even when your bladder isn’t full with urine. Urge incontinence can be associated with urinary frequency or urinary urgency.


This is a combination of stress and urge incontinence mentioned above.

Urinary incontinence after delivering a baby is common, but that doesn’t mean you have to continue to endure this for the rest of your life.

Whatever your activity level was, is or could be, pelvic floor physical therapy can support you in getting to where you want to be. It’s all about baby steps!

If you continue to have persistent incontinence after 6 weeks from delivery, it may be a good idea to get evaluated by a pelvic floor physical therapist in order to educate yourself on your pelvic floor and learn what you can do to exercise without leaking again.

Written by: Dr. Michelle Andoy, PT, DPT,

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 and improves blood flow (vascularity)

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.

Higher weight and lower repetitions: builds strength

Once you have mastered your form, moving on to strength building is ideal. For example, if you can perform a proper squat without limitations, you could start add weight.

It’s important to note that even when you add weight to your exercises, the switch from high repetitions (endurance) to low reparations (strength building) 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 endurance training to strength training.

For example, if you max fatigue at 8 repetitions, you are in your ideal zone for building strength.

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


Don't Panic

Postpartum Body Changes

Postpartum Body Changes 1200 799 ResilientRx

After giving birth you probably thought your body was ready to get right back in the swing of things, or you were even told that after 6 weeks everything would be “fine.”

You might have asked yourself, “Then why am I peeing my pants?” or “Why does lifting anything hurt my back?” You are not the first and unfortunately not that last person to give birth and have these questions– but have no fear!

There is no need to continue to live with pain or peeing your pants.

A task force for the American College of Obstetricians and Gynecologists (ACOG) says it’s time to frame postpartum care as an “ongoing process” requiring a personalized, cross-disciplinary approach—including the use of physical therapy when appropriate (APTA, 2018). A physical therapist specializing in postpartum care can help you get to where you need to be.

How does the body change during pregnancy and postpartum?

Throughout pregnancy, there is increased pressure and stretching in the abdominopelvic region. High levels of Relaxin hormone in the body lead to more movement in the pelvis, and in addition to this, increased weight results in the center of mass shifting the body forward. These changes allow for greater muscle activation and the body to compensate in new ways.

After giving birth (either vaginal or cesarean), the pelvic floor and abdominal muscles may have become weakened and uncoordinated. Furthermore, any perineal trauma such as an episiotomy or tearing, or tissue scarring/adhesions from a c-section also affect muscle movement and ability to contract. Because of this, it is vital to allow time for your postpartum body to heal but also recognize any signs and symptoms of the body if they continue to persist for more than 2-3 weeks.

Common postpartum problems and diagnoses:

  • Pelvic Floor Dysfunction
  • Dyspareunia (pain with sex)
  • Incontinence (involuntary urinary or fecal leakage)
  • Back Pain
  • Pelvic Girdle Pain
  • Pelvic Organ Prolapse
  • Diastasis Recti (Midline separation of the connective tissue at the 6-pack muscles)

Although these matters are common, they are not normal.

Oftentimes after giving birth, there is no conversation of these issues and women are left to deal with it on their own during such a significant phase in their lifetime. By identifying these problems, it may be necessary to seek further treatment options if it continues to get in the way of living your life.

As a physical therapist specializing in prenatal and postpartum care, I encourage women to seek help following birth. It is important to know there are solutions to get you to where you need to be.

At ResilientRx we perform a whole body evaluation, which includes analyzing your mobility, range of motion (ROM), posture, strength and stability. Furthermore, we figure out what is going on in your body, the root of your symptoms, and come up with a personalized treatment plan so you return to a functional lifestyle.

By: Michelle Andoy, PT, DPT


APTA. (2018, July 11). OB-GYN group Embraces ‘Fourth TRIMESTER’ Concept, ACKNOWLEDGES role OF Phys… Retrieved January 7, 2021, from https://www.apta.org/news/2018/07/11/ob-gyn-group-embraces-fourth-trimester-concept-acknowledges-role-of-physical-therapy-in-postpartum-care

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.

PH Scale

Why do I keep getting yeast infections?

Why do I keep getting yeast infections? 1024 540 ResilientRx

Chronic UTIs, bacterial vaginosis and yeast infections can occur for a variety of reasons.

In order to understand why chronic vaginal infections occur, we need to review the pH scale.

The scale goes from 0-14:

  • 0 being acidic
  • 7 is neutral
  • 14 being alkaline (or basic)

In its natural state, the vagina is more acidic, with a pH of about 4. Changing the pH of the vagina can have a direct effect on the vaginal environment which can cause a variety of symptoms.

Here are a few things that can change the vaginal pH:

  • Sperm: This is more basic, ~7 pH. Some may think they are allergic to sperm, but in reality that their vaginal pH is off which is causing a reaction to the sperm.
  • Stress: Increased blood sugar
  • Soap
  • Detergent
  • Lube
  • Diet: Foods high in sugar
  • Douching
  • Wet clothing
  • Tight clothing: Clothing that traps moisture
  • Medications: Like antibiotics
  • String from the IUD
  • Decreased estrogen: Menopause, breast feeding and taking oral contraceptives decrease estrogen, which decreases acidity (Harvard Health Publishing, 2019)

Decreased acidity in the vagina can cause:

  • Dryness
  • Yeast infections
  • Recurrent UTIs
  • Bacterial vaginosis
  • Pelvic pain

Maintaining healthy bacteria in the vagina is important in reducing risk of infections.

Lactobacillus is the most dominant bacteria in the vagina (over 70% in asymptomatic reproductive age women). It also produces lactic acid which causes the acidity in the vagina and this is what keeps the vaginal environment in equilibrium. Loss of lactobacillus is linked to chronic bacterial vaginosis (Tachedjian, et al., 2017).

In addition, bacterial vaginosis (BV) can cause issues with fertility.
“Bacterial Vaginosis is three times more common in infertile women than fertile women” (American Pregnancy Association, 2020). BV, and other infections in general, can decrease fertility in a number of ways:
  • Increasing inflammation and immune system activity, making a toxic environment for reproduction
  • Causing damage to sperm and vaginal cells
  • Interfering with the production of healthy cervical mucus during ovulation
  • Blocking the fallopian tubes through scar tissue damage from infections, so that sperm and egg can’t meet” (American Pregnancy Association, 2020).
If you are experiencing chronic pelvic infections, you may want to consider looking at some of the suggestions above to see if restoring your normal vaginal pH can help reduce your chronic infections.

Tips to reduce chronic pelvic infections:

  • Only wash your vulva and vagina with water
  • Try to use unscented detergents without harsh chemicals
  • Try a low sugar/carbohydrate diet
  • Reduce your stress levels
  • Air out your vagina: Try going without underwear to reduce bacterial growth from excessive moisture
  • Avoid tight or wet clothing for long periods of time
  • Talk to a pharmacist or your physician about a vaginal probiotic, especially if you are taking an antibiotic
  • Change out your tampons regularly.
  • Don’t douche

As always, you should consult with your physician first.

Written by: Mary Grimberg PT, DPT, OCS

Sources: Harvard Health Publishing. (2019, March). Vaginal yeast infection. Retrieved February 3, 2021, from https://www.health.harvard.edu/a_to_z/vaginal-yeast-infection-a-to-z

Tachedjian, G., Aldunate, M., Bradshaw, C., & Cone, R. (2017, April 20). The role of lactic acid production by probiotic lactobacillus species in vaginal health. Retrieved February 3, 2021, from https://www.sciencedirect.com/science/article/pii/S0923250817300839#bib18

American Pregnancy Association (2020, October). Bacterial vaginosis and fertility. Retrieved February 3, 2021, from https://americanpregnancy.org/getting-pregnant/bacterial-vaginosis-and-fertility-68826/

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?


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).


  • 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?

Written by Nick DiSarro, PT, DPT, OCS


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.


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