Spoiled for restaurant choices, most Bostonians eat for the pleasure of eating, and seldom think of nutrition in terms of building blocks for our bodies’ natural repair process. But if we revisit high school biology or college physiology classes, it’s not hard to see how proper nutrition can play a big part in injury recovery. This week, we look at how nutrition can help with pain management.
“Wait, what? How many did you say?”
Usually, this comment is accompanied by a raised brow and a surprised look. “Yup. That’s right. You’re going to be doing a x reps...but over y-z number of sets.”
That’s the answer that usually follows. The reason this is so surprising for some people is that x is usually somewhere in the range of 75-100 and y-z is anywhere from 3-5. That’s a lot you say? Well, after reading this, it may make a little more sense.
Coming to physical therapy usually means there is some sort of injury, movement, or posture that needs to be addressed or corrected. For the most part, this is concurrent with having a strength deficit, a muscular imbalance, a decrease in endurance, or even compensation for pain with a certain movement pattern. To address these issues, we, as physical therapists, have to develop treatments for 1) increasing endurance, 2) pumping up strength and building muscle, and 3) reteaching proper neuromuscular movement patterns.
Each therapist has his or her own bag of tricks to cater to each and every one of these needs, because there are hundreds of different exercises/activities to reach these goals. However, there are only a handful of parameters that are the most efficient to achieve them.
For the most part, research has shown that performing high repetitions with low weights is a great way to increase endurance. It helps to increase circulation for healing purposes and also begins to push away the inflammatory chemicals produced by recently injured tissues. Repetitions range from 15-25 reps, with the amount of weight dependent on the body part being exercised. The amount of repetitions should be set so that one is pain free and able to complete them without being totally spent after a set. The number of sets ranges from 3-5 sets, depending on endurance and intensity. Rest breaks are on the shorter end, around 15-30 seconds.
Building strength moves towards the other end of the spectrum - lower reps, higher weights. With great strength comes great responsibility...wait...that's Spider-Man. What I meant to say was that building strength comes a with greater exercise intensity. Here, weight and load are increased, and repetition ranges from 8-15. To build more strength and muscle, more load has to be moved. Since the weight is higher, the number of sets are lower, around 3-4. It also comes with a longer recovery period between sets, around 30-45 seconds.
Reeducation of a compensated movement pattern runs a similar gauntlet as endurance training - just beat it up with high repetition. A compensation happens if a certain motion is painful. The body is very efficient in moving itself in the most pain free way, even if it is not the most efficient way. The way to overcome this is to teach the body that it has to move back into its normal movement pattern. This can only occur if we are able to work a client in a pain free/decreased pain range of that certain motion. Once that is achieved, just getting the body to perform that movement over and over, repetition upon repetition, is the way to go. It is essentially telling the body, “Hey, this is a better and more efficient way to do this.” When this is figured out, the body will automatically adopt that pattern.
So that’s why you have to do 100. There is a pretty good foundation of for doing all of those repetitions. I’m not just trying to be mean...usually
;-)
Let me know what you guys think! This is a pretty generalized overview of these topics. To really get a good individualized plan for you, give us a shout. You can email me at sancho@jointventurespt.com or if you live out of town, you can contact your doctor or local therapist!
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Daily Human Dilemma Jim Knoble, above, instructor from Yang's Martial Arts Association www.ymaa.boston.com demonstrating Shaoling White Crane Kung Fu and Rhomboid training using a theraband. (Information taken from John Bondlow our massage therapists blog @ http://integratedtherapy.blogspot.com/
The vast majority of humans are struggling from sore necks. One favorite area of disgruntled discontent is just between the shoulder blade and the spine, the "Rhomboids." When the rhomboids are in working order, they assist with retraction of the scapulae (shoulder blades). Hence, they give the shoulder girdle stability. When they are weak, the other muscles of the shoulder suffer, leading to complaints of neck pain.
The issue at hand (and shoulder)
They come to me. As a massage therapist, I see them often. The issue is the same, over and over, and over again. These same muscles, the same pattern of tension and the same pattern of strain. Why?
Hint: Shoulder bag. 8 ounce mouse.
Primary Causes
The gravitational pull downwards upon the top of the shoulder affects not only that area at the top, but also affects further downwards, causing strain to these Rhomboids. 8 hours of slouching ever so slightly forward using using the muscles in front of your shoulder to move that 8 ounce mouse - creates weakness to the muscles opposite, these muscles in between the shoulder blades.
The Martial Struggle
And you thought you were alone? Martial Artists struggle in a similar manner, though typically not from shoulder bags, but forward thrusts and fists extended outwards, towards their opponent. The same result: weakness to the opposing muscle groups - commonly the rhomboids.
You do not need to suffer.
Strength Training
Often people are training in the gym and are drawing the arm back, though the elbow is outward, away from the body (right.) This works beautifully for White Crane Shaolin Kung Fu, though it does not train the Rhomboid muscles. The proper form for training and strengthening weakened Rhomboids is demonstrated in the photo at the left.
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Return to prior level of function is one of the most common goals a physical therapist will have for his/her patient. But what does prior level of function mean? Prior level of function is the condition you were in before you were injured. For some of you, this may be playing a competitive college sport, running 5 miles a day, rock climbing, or competing in triathlons. For others, this may be playing golf on the weekends, walking the dog, climbing a flight of stairs, or driving a car. Prior level of function is an umbrella term including anything that you could do before the injury that you are unable to do now, even things as simple as getting dressed, sleeping, and performing household chores. It may be something you could do a few weeks ago or something you haven’t done in years. If you haven’t skied in years because you have been living with chronic back pain, then that is considered part of your prior level of function and your physical therapist will work with you to get you back to that level of function.
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My favorite part of being a physical therapist is sharing the experience of a successful rehab experience with my patients. Some of my favorite rehab experiences are post-operative rehab, specifically ACL reconstruction. When someone undergoes surgery to repair a torn ACL (ligament in the knee) they literally need to learn to walk again without the use of crutches. Often times, after an ACL injury, the surgery will not be scheduled until up to a month later.
It is important to start physical therapy during that time, for what we call pre-hab. A physical therapist can work with the patient to gain ROM and build strength prior to the operation in order to promote faster healing after the surgery. Once the surgery is performed, it is usually 6-9 months before you can return to full sport activity. The reason I enjoy working with people who have undergone an ACL reconstruction is because I get to see day one when the patient is barely walking with the use of crutches and a brace to the final day when the patient is running, jumping, and dancing around the clinic. It is a very rewarding experience to be a part of each step along the way back to prior level of function.
I worked with a patient who had torn his/her ACL this past winter. He/she came into the clinic 2 weeks after the surgery and I described what the rehab experience would be like. When I asked the patient what his/her goals were for physical therapy, he/she told me he/she wanted to get back to cage fighting. I knew this was going to be a fun rehab experience, because at the time, he/she couldn’t even go up and down stairs without a railing, crutches, and knee brace, but several months later they would be back to getting into the cage to fight. We started with simple exercises to engage the quadriceps muscle, practiced putting weight on the leg, increased range of motion, and practiced walking without the use of crutches. Weeks later the patient had full range of motion and we worked on more aggressive strengthening, normal walking, and balance exercises. After 4 months, he/she was able to start running and at 5 months we began working on agility, speed, and change of direction while running. After 6-7 months he/she was able to get back in the cage and fight again…until he/she needed surgery to fix an old shoulder injury.
No matter the type of injury you have, how long you have had it, or what your goals are, a physical therapist can work with you to help get you back to doing the things you love to do. The best part of what I do is seeing someone on their final visit for physical therapy and seeing him/her smile knowing he/she is ready to get back to doing the things he/she loves. If you have an injury that is preventing you from doing something you were once able to do, speak to a physical therapist and see what they can do to help you achieve your goal!
Return to prior level of function is one of the most common goals a physical therapist will have for his/her patient. But what does prior level of function mean? Prior level of function is the condition you were in before you were injured. For some of you, this may be playing a competitive college sport, running 5 miles a day, rock climbing, or competing in triathlons. For others, this may be playing golf on the weekends, walking the dog, climbing a flight of stairs, or driving a car. Prior level of function is an umbrella term including anything that you could do before the injury that you are unable to do now, even things as simple as getting dressed, sleeping, and performing household chores. It may be something you could do a few weeks ago or something you haven’t done in years. If you haven’t skied in years because you have been living with chronic back pain, then that is considered part of your prior level of function and your physical therapist will work with you to get you back to that level of function.
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When people think of physical therapy, they often think of treatments for muscle and joint injuries; however, PTs treat nerve pathologies as well. Common nerve injuries include nerve root impingement from a herniated disc in the spine, nerve entrapment in the extremities, such as carpal tunnel syndrome and sciatica, and rapid stretch to a nerve that can occur in athletics or automobile accidents (“stinger”). These injuries to nerves can occur from repetitive overuse of joints and muscles, poor postural habits, or direct trauma. 
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Any Aesthetician worth her weight in potions and lotions knows that problematic skin is a challenge. In fact, this challenge lead me to become an aesthetician. I was constantly working with clients who were using make-up to conceal skin imperfections caused by acne, scarring and aging. In most cases, attempting to hide those imperfections under make-up doesn’t improve the appearance of your skin at all –it just looks like you’re wearing gobs of make-up. The secret to looking good, with or without make-up, is taking proper care of your skin.
Through my years of practice in physical therapy, I have come to terms with the mentality of the “Weekend Warrior.” Whether it’s a less active individual inspired to get off the couch in late fall and rake leaves for 8 hours, or the former college athlete, who hasn’t been out on the court in a few months and thinks her body is invincible, returning to the sport she grew up playing, weekend warriors are everywhere. A great number of my patients feel participating in a sporting activity once a week is enough exercise, and they don’t think about preparing their body for the return to activity after a period of time off.
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