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Physical Therapy

Trauma-Informed Physical Therapy: Fostering Healing and Empowerment

Trauma-Informed Physical Therapy: Fostering Healing and Empowerment 1920 1080 ResilientRx

Physical therapy is often viewed as a means to recover from injuries, manage chronic conditions, and regain physical function. However, for individuals who have experienced trauma, the journey to physical well-being can be more complex than the physical ailments that they may be facing. Trauma can have far-reaching effects on a person’s physical, emotional, and psychological state, making traditional physical therapy approaches potentially challenging or even re-traumatizing. This is where trauma-informed physical therapy comes into play, offering a compassionate and sensitive approach to healing.

What Is Trauma-Informed Care?

Trauma-informed healthcare recognizes the prevalence of trauma and its potential impact on a patient’s ability to engage in therapy. Nearly 90% of individuals seeking healthcare services have experienced at least one traumatic event in their lifetime, with 20-30% going on to develop PTSD (Al Jowf GI, et al, 2022). These experiences can range from physical or sexual abuse, domestic violence, combat exposure, or natural disasters, which can leave lasting imprints on the mind and body.

The core principles of trauma-informed care focus on creating a safe environment, emphasizing choice and collaboration, adapting treatment approaches, and promoting self-care and coping strategies. By understanding the signs and symptoms of trauma, such as hypervigilance, avoidance behaviors, or emotional dysregulation, physical therapists and other providers, can tailor their interactions and treatment plans to meet the unique needs of each patient. This is no easy task and takes time to develop individually as the provider and the relationship with the patient.

What Does Trauma-Informed Physical Therapy Look Like?

A positive example of trauma-informed physical therapy in action might look like this:

Sarah, a survivor of domestic violence, arrives for her first physical therapy session after sustaining a shoulder injury. The physical therapist greets her warmly and takes the time to explain the treatment process, emphasizing that Sarah has the choice to pause or stop at any time. The PT creates a comfortable space by allowing Sarah to choose where she would like to sit and provides a private treatment room as opposed to out in an open gym in front of other patients and staff.

Throughout the session, the physical therapist maintains open communication, frequently checking in with Sarah and allowing her to guide the pace and intensity of the exercises. If Sarah exhibits signs of distress or discomfort, the PT promptly adjusts the treatment approach or suggests a break. Fostering a sense of control and empowerment helps Sarah build trust and confidence in the therapeutic process.

In contrast, a less-than-ideal interaction might unfold like this:

John, a combat veteran struggling with PTSD, attends a physical therapy session for a back injury. The therapist, unaware of John’s trauma history, proceeds with a rigid treatment plan without considering potential triggers or emotional responses. The PT’s commanding tone and forceful adjustment of John’s body position could inadvertently trigger flashbacks or a heightened stress response, leaving John feeling overwhelmed and unsafe.

Without a trauma-informed approach, the physical therapist may miss critical cues or fail to create an environment that promotes trust and empowerment, potentially hindering John’s progress or even causing further distress.

Why Provide Trauma-Informed care?

Imagine 3 patients, each with a limp. One has a splinter in their foot, the second has sciatica, and the third had a knee replacement 4 weeks ago. They all may appear to have a similar gait, but treatment for each is wildly different because of their underlying root causes. The same is true for patients with trauma. We know that no two individuals are the same, so we must take the time to view them through a holistic lens, every single time.

Research has shown that trauma-informed care can significantly improve patient outcomes and engagement. A study by Reeves in 2015 found that individuals who received trauma-informed care reported a greater sense of safety, trust, and overall satisfaction with their treatment. Although trauma-informed care (specific to physical therapy) has been studied very little, a growing body of research supports the positive impact of trauma-informed approaches on reducing dropout rates and improving treatment adherence among trauma survivors.

Most physical therapists you’ll find are “people persons” and are empaths, so a good PT should naturally incorporate principles of trauma-informed care (Heywood, et al, 2024). However, integrating trauma-informed principles into physical therapy requires ongoing education and training for healthcare professionals. It involves developing a deep understanding of trauma’s impacts, recognizing potential triggers, and implementing strategies to create a safe and empowering environment for patients. 

It Takes A Village

Collaboration with mental health professionals and other members of the interdisciplinary team is essential, and can further enhance the effectiveness of trauma-informed physical therapy, while addressing the physical and psychological aspects of healing. As healthcare providers, it is our responsibility to recognize the profound impact of trauma on an individual’s well-being and tailor our approaches accordingly. By embracing trauma-informed physical therapy, we can foster an environment of compassion, trust, and empowerment, enabling individuals to embark on their healing journey with dignity and resilience.

If you are in need of physical therapy, but need more focused care in a safe and welcoming environment, contact us today, or book an initial evaluation.

References:

  1. Al Jowf GI, Ahmed ZT, An N, Reijnders RA, Ambrosino E, Rutten BPF, de Nijs L, Eijssen LMT. A Public Health Perspective of Post-Traumatic Stress Disorder. Int J Environ Res Public Health. 2022 May 26;19(11):6474. doi: 10.3390/ijerph19116474. PMID: 35682057; PMCID: PMC9180718.
  2. Reeves, E. (2015). A synthesis of the literature on trauma-informed care. Issues in mental health nursing, 36(9), 698-709.
  3. Heywood, S., Bunzli, S., Dillon, M., Bicchi, N., Black, S., Hemus, P., … & Setchell, J. (2024). Trauma-informed physiotherapy and the principles of safety, trustworthiness, choice, collaboration, and empowerment: a qualitative study. Physiotherapy Theory and Practice, 1-16.

Empowerment in Recovery: Self-Efficacy Can Make A World of Difference

Empowerment in Recovery: Self-Efficacy Can Make A World of Difference 1920 1080 ResilientRx

Embarking on a journey of physical rehabilitation to overcome pain or injury is not just a matter of mending the body; it also involves cultivating a mindset that fosters resilience and belief in one’s abilities. In this blog, we delve into the realms of self-efficacy in rehabilitation, explore helpful strategies and the powerful connection between the mind – all of which could be a game changer!

What is Self-Efficacy?

Self-efficacy is one’s belief in their ability to succeed in specific situations or accomplish a particular task [1]. It is having confidence in yourself and your skills. Imagine you’re attempting to learn a new sport, such as rock climbing. If you believe in your ability to master the techniques (by practicing and getting coached) despite initial struggles, that reflects higher self-efficacy. However, if you doubt your capability to improve and feel overwhelmed by the challenge, harboring thoughts like “I’ll never be able to do this,” that indicates lower self-efficacy. This belief in your potential directly impacts how you approach the goals of scaling tougher routes, navigating roadblocks  like fear or fatigue, and persevering when plateaus arise in your skill development. Persistent pain or an injury is very similar. They require nurturing self-efficacy – having courage to try, make mistakes, learn and grow despite uncertainties.

Mindset & Its Role in Healing

A positive mindset and fostering self-efficacy can play a pivotal role in the healing process. Numerous research studies have demonstrated the powerful influence our mental state and beliefs can have on physical outcomes. In a study published in The Journal of Pain, researchers found that patients with higher levels of self-efficacy experienced less pain and disability after undergoing surgery compared to those with lower self-efficacy [2]. This suggests that believing in one’s abilities to manage pain and recovery can positively impact healing trajectories.

Another study in the Scandinavian Journal of Pain examined the effect of cognitive behavioral therapy (CBT) aimed at boosting self-efficacy beliefs in individuals with persistent (aka chronic) pain [3]. The results showed patients who received CBT reported significantly less pain, disability and depression compared to control groups. Cultivating a mindset focused on coping capabilities rather than perceived limitations facilitated better quality of life.

The mind-body connection is strong. Mental practices like positive self-talk, imagery, and relaxation techniques can modulate pain pathways in the brain and reduce physical tension [4,5]. By learning to reframe negative thought patterns through mindset work, patients become better equipped to manage pain sensations during rehabilitation.

Ultimately, patients who adopt an optimistic, determined outlook and maintain beliefs in their potential for recovery tend to adhere better to treatment regimens, persist through challenges, and experience better long-term outcomes [6]. One important point is that this does not replace or deemphasize hard work and consistency on the physical level, but rather serves as an enhancement to the entire process.

Set Realistic Goals With SMART Criteria

Goal-setting is crucial for rehabilitation. Physical therapy is a very goal-oriented process. One strategy to enhance self-efficacy and stay motivated is to establish realistic, achievable goals using SMART goals:

  • Specific: Define the goal clearly, e.g. “Run an 8 minute mile pace around Lady Bird Lake without knee pain.”
  • Measurable: Establish tracking criteria to measure progress e.g. “distance, pace, and pain levels are all objective, measurable and easily tracked.”   
  • Achievable: Ensure goals are realistic based on your capabilities, e.g. “you’ve done this before and have a passion & experience with running.”
  • Relevant: Align goals with overall priorities and well-being, e.g. “running is your outlet and you understand all the positive physical & mental health benefits of it.” 
  • Time-bound: Set a timeframe for added focus and accountability, e.g. “by the end of this year.”

Celebrate Small Wins To Build Big Confidence

Achieving incremental success cultivates a sense of accomplishment, reinforcing the process [7]. Celebrating the mini victories boosts confidence and self-efficacy and each small step forward provides evidence that improvement is possible. Acknowledging this is a highly motivating tool [8]. When we acknowledge even the small milestones along the way, it triggers feelings of pride and intrinsic motivation, which helps sustain effort. Savoring the small wins also helps combat unhelpful thought patterns that can hinder self-efficacy. Simply noticing or internalizing successes, no matter how small, makes it harder for self-doubt to take root [9]. Positive reinforcement deepens the belief of “I can do this,” and even takes it further to “I will do this.”

Overcome Challenges With Support

Healing and recovery are unfortunately rarely linear. Ups & downs and even setbacks are very common, but they don’t have to define your journey. Building resilience and maintaining perspective allows overcoming challenges without losing sight of goals. In addition to the strategies listed above, having a supportive network through friends, family, and your physical therapist (or other healthcare provider) is immensely powerful. The therapeutic alliance forged between patient & therapist significantly impacts treatment outcomes [10]. And no matter what your circumstances are, chances are you are not alone. There are people out there dealing with very similar issues that may be worth connecting with through avenues like the internet, social media, or local support groups.

The Big Picture

Cultivating self-efficacy acts as an empowering force throughout the rehab process. By setting realistic goals, celebrating small wins, maintaining a positive mindset, and leaning on a supportive network, individuals can nurture an unwavering belief in their ability to heal and overcome adversity. This sense of self-efficacy becomes an invaluable tool for persisting through challenges, adherence to treatment, and ultimately achieving meaningful recovery. With patience, resilience, and an empowered perspective, the path to optimal healing is wide open!

Whether you’re on your healing journey with new or old aches, pains, or injuries, we’re here to help! Book with us today to help you reach your goals and improve your quality of life!

References:

  1. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman.
  2. Oyefeso, O.O., et al. (2017). Effects of preoperative self-efficacy among patients undergoing total knee replacement. The Journal of Pain, 18(7), 844-853.
  3. Helminen, E.E., et al. (2015). Cognitive impairment, maladaptive coping styles and recovery over one year in first-ever stroke patients. Scandinavian Journal of Pain, 9(1), 144-152.
  4. Elkins, G., et al. (2007). Mind-body therapies in integrative oncology. Society of Integrative Oncology, 71(2), 167-173.
  5. Hassett, A.L., & Finan, P.H. (2016). The role of resilience in the clinical management of chronic pain. Current Pain and Headache Reports, 20(6), 1-9.
  6. Nicholas, M.K., et al. (2012). Self‐efficacy and chronic pain. Pain management: A practical guide for clinicians, 141-159.
  7. Amiot, C. E., et al. (2004). Integrating the self and identity: Processes of self-validation and the cognitive structural model of the self. Self and Identity, 3(1), 57-75.
  8. Amabile, T., & Kramer, S. (2011). The power of small wins. Harvard Business Review, 89(5), 70-80.
  9. Peen, C., & Wong, P. T. P. (2021). Self-Efficacy as a Positive Youth Development Construct: A Conceptual Review. The Journal of Positive Psychology and Wellbeing, 5(2), 194-221.
  10. Ferreira, P. H., et al. (2013). The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Physical Therapy, 93(4), 470-478.

Getting The Spring Back In Your Step: Understanding & Treating Achilles Tendinitis (AKA Tendinopathy)

Getting The Spring Back In Your Step: Understanding & Treating Achilles Tendinitis (AKA Tendinopathy) 280 474 ResilientRx

Achilles tendinitis refers to painful overuse injury of the tendon that connects your heel to your calf muscles. It impacts numerous people – from athletes in running and jumping sports, to individuals who lead less active lifestyles. The pain and stiffness can greatly impact basic quality of life including activities like walking, exercise, and going up and down stairs. 

Before we dive into common treatments for this issue, it’s worth discussing exactly what it is, right down to how clinicians define and classify it. Having a better understanding of the diagnosis makes for more effective treatment approaches. We’ll start with the changing terminology – it turns out that “tendinitis” doesn’t quite capture what’s happening since the underlying issue is not quite black & white. Without further adieu, let’s break down the evolving terminology and science-backed treatment approaches:

What’s Up with the Changing Terminology?

Let’s first describe the key differences between tendinitis, tendinosis and tendinopathy, because these terms are NOT interchangeable. 

  • Tendinitis has historically been used to describe inflammation of a tendon, with treatments focused on reducing that inflammation. 
  • Tendinosis refers to more degenerative changes and microtears of the tendon, without inflammation present.
  • Tendinopathy is the most broad term that encompasses all tendon disorders, including inflammatory and degenerative features. It can involve inflammatory elements right after injury, but typically it’s more to do with dysfunctional healing and tissue remodeling over time. 

What we have a better understanding of now is that there is a spectrum of issues that can impact tendons, many of which are improper remodeling or healing of the tissue, as opposed to simply inflammation. Treatments (as discussed later) should focus more on remodeling and regeneration of the tendon rather than simply reducing inflammation. We need to get that tissue strong and resilient again!

What Causes Achilles Tendon Issues?

Simply put, it’s an overuse injury from repetitive strain. Micro-tears in the tendon outpace the tendon’s ability to repair itself properly, thus resulting in pain and dysfunction. Things like calf tightness, overpronation, sudden jumps in activity (i.e. couch to 5k), and poor leg strength may contribute over time. 

Most patients do not experience a single event or injury, but rather smaller insults over time. Pain can set in over days to weeks, and may worsen depending upon the person’s activity. So oftentimes a cycle of rest or stopping activity completely followed by resuming activities without the proper interventions in between causes people to stay in this unfortunate pain cycle. Complete rest actually increases tendon dysfunction!

Pain usually goes through a “warm-up phenomenon.” This means that pain can improve with exercise/activity a bit, only to return with a vengeance later on or the next day. This is where a structured program and guidance from an expert clinician is crucial. 

How Does Physical Therapy Get You Back on Track?

Your physical therapist should develop a customized treatment plan aligned with current evidence-based clinical guidelines and your goals (We do at ResilientRx)! Properly dosed strength exercises, mobility training, biomechanical corrections, and guidance on gradual return to activity aim to spark tissue regeneration/remodeling while minimizing flare-ups. Guiding the optimal balance of rest and activity helps manage load demands. It’s an intricate puzzle tailored to each patient. It’s also important to note that rehab will not be PAIN-FREE. It’s actually safe to have mild levels of tendon pain lasting less than 24 hours after activity. We often use a simple scale to monitor pain levels, which helps to dose exercise appropriately and push things forward without compromising progress. Every patient will respond differently, so communication is key.

Here’s what the framework for achilles tendinopathy rehab looks like:

  • Early stage: hands-on modalities to calm symptoms such as soft tissue work/massage, joint mobilizations, dry needling and taping. Here we also introduce gentle strength and mobility exercises to start the tissue remodeling process
  • Mid stage: progressive loading via strength exercises to the gastroc and soleus (calf muscles). Isometric and eccentric exercises are advanced to further expose the tendon to more time under tension Stretching may be more tolerated in this phase compared to when symptoms are more acute. 
  • Late stage: we start to move more toward plyometrics exercise and sport-specific or functional training as needed, including more “traditional” strength training principles

The Bottom Line

Tendinopathy rehab is load-related and dose-dependent. We want the achilles tendon to tolerate higher loads over time, so this is a gradual process that requires patience and diligence. The unfortunate truth however, is that progress with Achilles tendinopathy is almost never linear. There will be ups, downs, and plateaus. Sometimes consistent strength training may need to be done for anywhere from 3-6 months before returning to plyometrics. Anti-inflammatories and complete rest are discouraged as this leads to further deconditioning, weakness, and more susceptibility to flare-ups. The good news is that over 75% of tendinopathy patients achieve resolution of symptoms through dedicated rehab and avoid surgery! It can be a long road for many of us, but we’re here for you!

Have you been struggling with Achilles tendinitis or chronic tendon pain in general? Schedule an appointment with one of our Doctors of Physical Therapy to get you back to doing the things you love! CLICK HERE or call 512-777-0330.

References:

1. Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg. 2014;20(3):154-159. doi:10.1016/j.fas.2014.03.002 

2. Morrissey D, Roskilly A, Twycross-Lewis R, et al. The treatment of mid-portion Achilles tendinopathy: a systematic review. J Foot Ankle Res. 2021;14(1):3. Published 2021 Jan 11. doi:10.1186/s13047-020-00440-5

3. van der Plas A, de Jonge S, de Vos RJ, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46(3):214-218. doi:10.1136/bjsm.2010.083428

4. Rowe V, Hemmings S, Barton C, et al. Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning. Sports Med. 2012;42(11):941-967. doi:10.1007/BF03262301

5. Doral MN, Alam M, Bozkurt M, et al. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):638-643. doi:10.1007/s00167-010-1083-7

6. Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22(4):727-741. doi:10.1016/s0278-5919(03)00034-7 

7. Padhiar N, Achana F, Davies A, et al. Eccentric exercises reduce the risk of Achilles tendon overuse injury: a systematic review and meta-analysis. Br J Sports Med. 2021;55(21):1180-1188. doi:10.1136/bjsports-2020-103426

Heel Pain? Oh Heel No!: Breaking Down Plantar Fasciitis and Best Treatments

Heel Pain? Oh Heel No!: Breaking Down Plantar Fasciitis and Best Treatments 1920 1080 ResilientRx

WHAT IS THE PLANTAR FASCIA AND FASCIITIS?

If you’re dealing with pain and stiffness in your heel and arch, you’ve probably heard the term “plantar fasciitis” used quite a bit. It’s one of the most common causes of heel pain that we see, with over 2 million Americans struggling with it every year(1). The plantar fascia is a thick fibrous band of connective tissue originating from the heel bone that extends along the sole of the foot towards the toes. It provides support for the foot’s arch, acts as a shock absorber, and aids with gait mechanics. It is typically described as sharp stabbing pain in the heel or arch area, often worse when taking the first steps in the morning or after long periods of sitting (2).

WHY PLANTAR FASCIITIS IS NO LONGER AN ACCURATE LABEL

Plantar fasciitis by definition, implies swelling and inflammation of that tissue. However, recent research found that only about 5% of cases actually show inflammation on imaging tests(4). There seem to be more factors at play than simply inflamed fascia. Other tissues can also be involved, which is why plantar heel pain has become a more popular diagnosis. It leaves room for other variables. The precise cause is often unknown, but plantar heel pain frequently results from repetitive strain and overuse dysfunction of multiple plantar structures including the fascia itself, the fat pad on the bottom of the foot, muscles, and nerves. Factors such as running, increased weight, or increased time spent on the feet are just a few possible contributors (3).

SO WHAT WE CALL IT A DIFFERENT NAME – HOW DO WE TREAT IT?

Bottom line, that deep heel and arch soreness stems from straining the fascia and structures around it way too much. It’s difficult to point to one exact mechanism for your pain, but there are plenty of options to get things feeling better!

Recent high-quality studies have evaluated rehabilitation strategies for plantar heel pain. Treatments now should emphasize progressive tissue loading and remodeling exercises rather than anti-inflammatory modalities. For example, a 2020 randomized trial demonstrated that plantar fascia-stretching using a towel or resistance band combined with calf and foot soft tissue massage led to decreased pain and improved function when compared to no treatment (5). The specific stretching targets and tension loads the plantar fascia itself, while massage techniques mobilize tight calf, arch, and plantar muscles. Other potentially helpful interventions include taping techniques to support the arch and reduce strain on the plantar fascia, dry needling, night splints, and relative rest/activity modification to avoid aggravating activities (7). Additional research supports use of prefabricated arch-support orthotics, which redistribute pressure away from irritated heel tissues out to the midfoot area (6). Orthotics worn during daily activities allow for graded loading and exercise progression.

WHAT PT CAN OFFER COMPARED TO MEDICAL INTERVENTIONS

It may be tempting to get a “quick fix” especially if the pain is really intense and impacting quality of life. It may come as no surprise that treatments like corticosteroid injections typically do not provide long-term benefit and do come with possible risks and side effects(8). Something more invasive like surgery should be the absolute last resort after 9-12 months if high-quality conservative treatment fails (7)

Physical therapists tailor and monitor the progressive loading process to stimulate tissue adaptation, while minimizing symptom flare-ups as best as possible. It is important that rehab strategies also consider the patient’s goals and lifestyle. Every patient is unique – what works for a 25 year old triathlete might not be best for a 68 year old retiree who wants to walk the golf course comfortably. Together we’ll get your foot feeling good based on your needs and goals. The ultimate goal is to coax those overloaded plantar tissues to remodel and repair themselves. 

When addressing heel pain, it is crucial to identify and address the underlying cause of the pain. Often, heel pain can stem from impaired biomechanics or limited mobility in areas above the foot, such as the ankle, knee, hip, or even the lower back. Additionally, the pain may be a result of radicular pain caused by nerve impingement along the L5/S1 region.

Therefore, it is essential to receive treatment that not only targets the symptoms but also addresses the root cause of the pain. By doing so, you can achieve long-lasting relief and prevent further complications. Seeking comprehensive care that considers the entire kinetic chain and factors contributing to the heel pain will ensure that you receive effective and tailored treatment for optimal results.

While this may be all just semantics, calling it plantar fasciitis does get the point across. Just know it’s more of a “plantar heel pain” these days. But most importantly, we’ve got loads of ways to kick it to the curb!

Have you been diagnosed with plantar fasciitis or foot pain that just won’t go away? Schedule an appointment with one of our Doctors of Physical Therapy to get you back to doing the things you love! CLICK HERE or call 512-777-0330.

References:

1. Buchbinder R. Plantar Fasciitis. N Engl J Med. 2004;350(21):2159-2166. doi:10.1056/NEJMcp032745

2. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85(5):872-877. doi:10.2106/00004623-200305000-00015 

3. Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med. 2006;36(7):585-611. doi:10.2165/00007256-200636070-00004

4. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234-237. doi: 10.7547/87507315-93-3-234.

5. Renan-Ordine R, Alburquerque-Sendín F, Rodrigues De Souza DP, Cleland JA, Fernández-de-Las-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41(2):43-50. doi:10.2519/jospt.2011.3504  

6. Lee SY, McKeon P, Hertel J. Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Phys Ther Sport. 2009;10(1):12-18. doi:10.1016/j.ptsp.2008.09.002

7. Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44(11):A1-A33. doi:10.2519/jospt.2014.0110

8. David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD009348. Published 2017 Jun 29. doi:10.1002/14651858.CD009348.pub2

9. Sweeting D, Parish B, Hooper L, Chester R. The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review. J Foot Ankle Res. 2011;4:19. Published 2011 Jun 24. doi:10.1186/1757-1146-4-19 

Are Deadlifts Safe To Do With Low Back Pain?

Are Deadlifts Safe To Do With Low Back Pain? 1038 694 ResilientRx

The deadlift is a popular strength training exercise that involves lifting a weighted barbell off the floor to a standing hip position. However, it is also one of the most debated exercises due to concerns about risk of injury, with plenty of misinformation across the internet. Does the evidence support deadlifting for low back pain patients under a professional’s guidance? Is it an all-or-nothing exercise where the risks outweigh the benefits? Let’s unpack these questions and more!

Deadlifts ≠ automatic injury

First, examining injury rates will provide us some insight. Weightlifters do show a higher incidence of back injuries compared to other athletes, with deadlifting as a common precipitating factor(1). Not surprising that the people doing it the most are more likely to face injuries. However, a 2020 systematic review found that in trained lifters, deadlift injury rates are low at just 0-5.9%(2). Aside from good recovery practices that emphasize sleep and nutrition, proper progressive loading and technique can help to minimize injury risk(3).

What about for people with back pain?

Individuals with low back pain often experience limitations in their ability to perform daily activities or participate in recreational or sports-related endeavors. For these folks, research increasingly supports deadlift retraining under supervision. Several studies demonstrate the deadlift can reduce pain and disability when added to physical therapy programs. A 2015 study had patients follow a 16-week rehab protocol of mobility exercises plus hip hinge movements progressing to deadlifts. 83% saw clinically meaningful improvements in pain and function(4). A 2018 randomized controlled trial added deadlifts to standard PT care for 3 months. The deadlift group improved significantly more than controls on pain and disability scores(5)

These benefits are thought to occur because deadlifts dynamically load and strengthen the spine’s supporting musculature in a safe, controlled manner(6). Proper form also trains coordinated hinging movement patterns useful for everyday activities. Simply put, the deadlift is a functional exercise for all!

Ideal strategies to consider when utilizing the deadlift in a rehab program

  • It may be helpful to supplement a client’s program with graded loading and baseline mobility, stability, and movement pattern training (7)
  • Use low loads and high repetitions if needed initially – no maximal lifts early on, especially to clients new to this lift (8) 
  • Closely monitor form, provide cues, and avoid overloading (9)
  • Equally as important to the above, allow the client to safely explore nuances in technique and positioning. This will build confidence and adaptation to the exercise while building injury resilience. 
  • Progress slowly over 8+ weeks up to heavier loads based on response (10)

While more research is still needed, evidence indicates deadlifts can play a helpful role in rehab for low back pain under proper PT guidance and load management. No exercise is ever risk-free, but deadlifts performed correctly offer unique benefits that may outweigh their potential risks for select clients.  

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!

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.

References:

1. Raske A, Norlin R. Injury incidence and prevalence among elite weight and power lifters. Am J Sports Med. 2002;30(2):248-256. doi:10.1177/03635465020300020601

2. Calhoon G, Fry AC. Injury rates and profiles of elite competitive weightlifters. J Athl Train. 1999;34(3):232-238.

3. Siewe J, Rudat J, Röllinghoff M, et al. Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011;32(9):703-711. doi:10.1055/s-0031-1277207

4. Kim D, Cho M, Park Y, Yang Y. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med. 2015;39(1):110-117. doi:10.5535/arm.2015.39.1.110

5. Steele J, Bruce-Low S, Smith D. A Rehabilitation Program That Integrates Modified Resistance Training and Motor Control Retraining in Chronic Low Back Pain Patients Improves Muscular Endurance, Strength, and Pain: A Randomized Controlled Trial. BioMed Research International. 2015;2015:1-8. doi:10.1155/2015/30764

6. McGill S. Low back stability: from formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev. 2001;29(1):26-31. doi:10.1097/00003677-200101000-00006

7. Hales M, Johnson BF, Johnson JT. Kinematic analysis of the powerlifting style squat and the conventional deadlift during competition: is there a cross-over effect between lifts?. J Strength Cond Res. 2009;23(9):2574-2580. doi:10.1519/JSC.0b013e3181bc191a 

8. Schoenfeld BJ, Grgic J, Ogborn D, Krieger JW. Strength and Hypertrophy Adaptations Between Low- vs. High-Load Resistance Training: A Systematic Review and Meta-analysis. J Strength Cond Res. 2017;31(12):3508-3523. doi:10.1519/JSC.0000000000002200

9. Swinton PA, Stewart A, Agouris I, Keogh JW, Lloyd R. A biomechanical analysis of straight and hexagonal barbell deadlifts using submaximal loads. J Strength Cond Res. 2011;25(7):2000-2009. doi:10.1519/JSC.0b013e3181e73f87

10. Contreras B, Vigotsky AD, Schoenfeld BJ, Beardsley C, Cronin J. A comparison of gluteus maximus, biceps femoris, and vastus lateralis electromyography amplitude in the parallel, full, and front squat variations in resistance-trained females. J Appl Biomech. 2016;32(1):16-22. doi:10.1123/jab.2015-0194

Does Icing for Injuries Work?

Does Icing for Injuries Work? 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.