Author: Performance Optimal Health

Low back pain and injury in dancers

Dance is a popular and physically demanding pursuit, inclusive of all genders and ages across the lifespan, around the world. Dancers are increasingly recognized as both artists and athletes; however, unlike their athlete counterparts, dancers may not have ready access to trusted medical practitioners when injured, especially those familiar with dance-specific terminology, movements, styles, and injury patterns.

May 26, 2023 | Elisa LaBelle, PT, MSPT

Dance is a popular and physically demanding pursuit, inclusive of all genders and ages across the lifespan, around the world. Dance is both artistic and athletic, requiring a combination of extreme strength, flexibility, and coordination, for the purpose of making intricate movements appear effortless. Dancers are increasingly recognized as both artists and athletes; however, unlike their athlete counterparts, dancers may not have ready access to trusted medical practitioners when injured, especially those familiar with dance-specific terminology, movements, styles, and injury patterns.

The lumbar spine, or low back, is a common site of pain and injury in all athletes, and the second most common site of injury in dancers.1 Repetitive flexion (forward bending), extension (backward bending), and axial loading (compression) through the spine are thought to contribute to increased rates of low back pain and injury in physically demanding sports such as football and dance.1,2 A recent systematic review by Swain et al found indications that approximately 73% of dancers experience at least one episode of low back pain per year; however, back pain only led to time loss or medical attention in 11% of the cases.3 Simply put, dancers appear to be able to maintain high levels of performance despite pain, and low back pain and its impact may be underestimated in this population.2,3

Common causes of low back pain in dancers

Spondylolysis and Spondylolisthesis

Sometimes referred to as “spondies,” these injuries are prevalent in activities that involve repetitive hyperextension of the spine and occur more often in adolescent dancers compared to the general population.2 Spondylolysis is a stress reaction or stress fracture in part of a vertebra called the pars interarticularis, and spondylolisthesis is the forward or backward slippage of one vertebra relative to another. A dancer with a “spondy” may experience dull pain on one or both sides of the low back that worsens with activity and is often provoked by spinal extension and impact.2 Medical imaging is warranted to diagnose and stage injury severity, and frontline treatment is usually conservative, including relative rest and physical therapy.1,2

Facet Sprain / Sacroiliac Joint (SIJ) Sprain

These injuries also occur due to repeated lumbar hyperextension which causes compression of the posterior elements of the spine and pelvis. Symptoms include lower back and buttock pain, muscle tenderness, and occasionally pain that radiates into the thigh.2 Jumping, hyperextension of the back, and abduction of the hip as in développé à la seconde can all exacerbate pain.2 Treatment includes physical therapy with an emphasis on hip and core strengthening, manual techniques, and gradual reinstatement of dance maneuvers that previously aggravated pain.2

Discogenic Back Pain

Accounts for 40% of mechanical back pain and is attributed to repetitive spinal flexion and compression such as occurs in lifting a dance partner overhead.1,2 The dancer with discogenic pain may report dull, diffuse lower back pain that is aggravated by forward or backward bending, rotation, and prolonged sitting. Symptoms may progress to include radiating pain down the leg and neurologic deficits such as muscle weakness and loss of sensation.1,2 Treatment typically includes early return to pain-free activities, core strengthening, and a stepwise return to full dance.1,2

Lumbar Strain

Muscle spasm is a common cause of lower back pain that should be considered a diagnosis of exclusion in adolescent dancers.2 As with most other lower back pain, muscle imbalances and overuse are common contributing factors, and adolescent growth spurts may play a role in the onset of pain.2 The dancer with a lumbar strain might complain of sharp pain located adjacent to the spine, tenderness to touch through affected musculature, and pain and difficulty with movement.2 Treatment includes physical therapy focusing on correcting muscle imbalances around the hip and core and addressing faulty technique.

Prevention

Dancers as artist-athletes have a paradoxical mindset towards pain: tending to accept it as part of their artistic pursuit and deny it out of fear they will be told to stop dancing.4 Specialized knowledge of dance and the ability to work with dancers to minimize their time away from dance are key to managing dancers’ health and recovery from injury2, as well as becoming a provider of choice in the dance community. To reduce risk of low back pain and injury, physical therapists specializing in dance medicine often recommend: 1) safe training loads to minimize overuse and fatigue; 2) cross-training and technique re-training to correct muscle imbalances and reduce repetitive strain; and 3) healthy lifestyle to manage stress and promote adequate rest and recovery. These recommendations not only serve to reduce risk and occurrence of low back pain and injury, but also to enhance performance and longevity in the dancer.

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References

1. Ball J, Harris C, Lee J, Vives M. Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations. Sports Medicine - Open. 2019;5(1):1-10.
2. Gottschlich LM, Young CC. Spine Injuries in Dancers. Current Sports Medicine Reports (American College of Sports Medicine). 2011;10(1):40-44. Accessed May 23, 2023.
3. SWAIN CTV, BRADSHAW EJ, EKEGREN CL, WHYTE DG. The Epidemiology of Low Back Pain and Injury in Dance: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(4):239-252.
4. Aliberti A, Milidonis MK, Long KL. Performing with Pain: Tools to Guide Rehabilitation and Injury Prevention for Professional Ballet Dancers. Orthopaedic Physical Therapy Practice. 2020;32(4):197-201.

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Elisa LaBelle

Elisa LaBelle, PT, MSPT, is a board-certified clinical specialist in orthopedic physical therapy practicing in New York City, with a specialty in performing arts medicine.

Meet Elisa

What you need to know about torticollis

At Performance we care for patients throughout the lifespan, starting as early as infancy. One of the most common diagnoses in babies that can require physical therapy intervention is torticollis.

May 17, 2023 | Maddy Mazoue, PT, DPT, CSCS

At Performance we care for patients throughout the lifespan, starting as early as infancy. One of the most common diagnoses in babies that can require physical therapy intervention is torticollis.

What is it?

Torticollis, also referred to as “wry neck” or “twisted neck,” is the term for a condition in which there is tightness in the neck causing one’s head to tilt to one side. This condition is typically associated with babies and some sources say that can affect up to 16% of infants. The most common muscle involved is the sternocleidomastoid (or scm) which causes babies to tilt towards one side and rotate to the opposite.

Torticollis can happen for a variety of reasons, including positioning in the womb, time/position spent in car seats or carriers, breastfeeding preferences, or abnormalities within the neck muscles. Although this is a condition related to the muscles of the neck, torticollis has implications for the overall growth and development of your child. Tightness on one side of the neck can lead to changes in head shape, difficulty with developmental milestones including rolling, sitting, crawling and walking.

Prevention

The best way to prevent the development of torticollis is to encourage your baby to spend time in a variety of positions! One way to do this is to switch the location of toys in the crib or car seat every few days so they are encouraged to look in different directions. Also, make sure to take note of what position you are feeding your baby in. Try to balance the amount of time feeding on each side whether that is breast or bottle feeding. One of the best ways to limit torticollis and associated head shape changes is to encourage your baby to participate in tummy time. The NIH recommends starting with several 2–3 minute sessions throughout the day with newborns and steadily increasing the frequency and duration of sessions until they are reaching at least 1 ½-2 hours per day by the time they are 6 months old. Children’s Healthcare of Atlanta has a great resource on tummy time and positioning techniques.

Signs to look out for

Typically, torticollis develops over the first few weeks of life, so be on the lookout for the signs! Torticollis will typically present as a head tilt to one side and a rotation in the opposite direction. Though that is the most common presentation, you should also look out for:

• Strong preference for breastfeeding on one side
• Difficulty rolling to one side/always rolls over one side
• Trouble turning the head to look in one direction
• Flat spot on the side of the head
• Facial asymmetries

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Treatment

The good news is, if caught and addressed quickly, babies typically respond very well to physical therapy. PT for this condition includes stretching, education on positioning, strengthening exercises, and promotion of developmental milestones. Your physical therapist will work with you to implement stretching techniques and identify ways to encourage symmetry and age appropriate development at home. If you have any concerns about your baby’s neck or head shape, reach out to your pediatrician or physical therapist so they can get your baby the care they need!

Image credit: ChoosePT.com

Maddy Mazoue

Maddy Mazoue, PT, DPT, CSCS, is a physical therapist and strength and conditioning specialist who specializes in developing athletes’ return to sport programs.

Meet Maddy

The benefits of pre/post-natal fitness

Pre-natal fitness under the guidance of a skilled professional is essential in training the body in a safe but challenging way to prepare one’s body for the intensity of labor.

Apr 28, 2023 | Danielle Pasquale, DPT

We have heard the myth for a long time that you need to decrease your workouts during pregnancy. I’m sure most women have heard, “don’t let your heart rate get higher than 140 while pregnant.” The typical heart rate of a women during labor is between 110-160 beats per minute. But if a woman never trains their body to prepare for the intensity of labor, how will they be able to handle the challenges of it? Pre-natal fitness under the guidance of a skilled professional is essential in training the body in a safe but challenging way to prepare one’s body for the intensity of labor.

There are so many benefits to exercising during the entirety of a pregnancy. It can help ease the symptoms of pregnancy aches and pains like low back, sciatic pain, and sacroiliac joint pain, and will decrease the risk of complications like gestational diabetes and preeclampsia. Exercise will also allow a woman to maintain a healthy weight range and increase the likelihood of an easier delivery. There’s also research to show that exercise during pregnancy has benefits for the baby as well. It shows that there’s a positive effect on a newborn’s motor and coordination development, and the baby gets the same heart benefits as the mother during cardiovascular training.

Exercise during each trimester will vary and will feel different on one’s body as it changes through the pregnancy. In the first trimester, it’s more likely to feel symptoms of nausea and extreme fatigue. Exercise during this time may look more restorative like going for walks, gentle yoga, and focusing on continuing to move. A woman may feel more energy for true exercise during their second trimester. These exercises will look more like the exercise they previously enjoyed prior to the pregnancy. One thing to consider during this phase of exercise, however, is preventing the severity of diastasis recti, or separation of the rectus abdominis muscles before and after pregnancy. Working with a professional to learn ways to prevent this and how to keep your pelvic floor strong during this time is essential.

Staying active and fit during pregnancy will allow a faster recovery after delivery. No matter how fit you were before, post-partum exercise presents with new challenges that women must learn to adapt to. Once cleared by your doctor (typically around 4–6 weeks post-partum), a woman will be able to return to exercise. This will need to be a gradual return to prevent injuries and adapt to the changes a woman’s body has after pregnancy. Learning gentle core activation, pelvic floor exercises and functional parenting activities can assist in a safe return to exercise and prevent injuries. Exercising post-partum helps to improve energy levels, sleep, manage stress more effectively and to lose weight.

Fitness and exercise during and after pregnancy have so many physical and emotional benefits for the mother and the baby. Prioritizing this in a safe and effective way can help to ease the challenges of bringing a baby into this world.

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Danielle Pasquale

Danielle Pasquale, PT, DPT, is a physical therapist who is certified in women's pelvic health, dry needling and pre/post-natal fitness based in Greenwich.

Meet Danielle

Tips for tapering your spring marathon training

It's the last few weeks of your spring marathon training; whether in the middle of your peak week or your 2-3 week taper, it is important to trust your training up to this point and avoid adding unnecessary stresses to the body. Here are some tips for this crucial period of time.

Apr 3, 2023 | Performance Optimal Health

One of my favorite sayings related to the final three weeks of training leading up to a race is “the hay is in the barn.” This saying refers to the idea that the bulk of the training has already been done, and now it’s time to make sure there is adequate recovery. This process is called the taper. About three weeks before the day of the marathon, the overall volume of training should significantly decrease. There might be a couple of hard workouts 10-21 days out depending on the runner and the intensity of training reached prior, but the key component is that the volume of work decreases. Workouts at this time are geared towards making sure that you still have some stimulus in order to maintain fitness, but don’t put as much stress on your body.

Another piece of the taper that is important is nutrition. Carbohydrate loading starts 3-7 days before the race and is the gradual increase in the percentage of fuel that is coming from carbs. It takes time for the muscle cells to absorb adequate glycogen from the increased carb intake, so just loading up the day before is not enough. Similarly, appropriate hydration for a race is started multiple days before. Both hydration and increased carbs play a role in maximizing the availability of energy while racing. With the combination of dialing in your nutrition/ hydration with decreased volume of training your body should be primed to race your best.

— Brendan Copley, CSCS, ATC. Brendan is a personal trainer who specializes in working with endurance athletes and post-rehab clients.

That's exactly right, Brendan. You’ve spent months ramping up your mileage, perfecting your fueling plan, and preparing your race-day shoes. You’re ready. Whether in the middle of your peak week or your 2-3 week taper, it is important to trust your training up to this point and avoid adding unnecessary stresses to the body. During your taper, it is normal to feel more tired, more hungry, or more aches and pains than earlier in your training. This is because your body is using this time of lower load to heal, ultimately preparing itself for the best racing conditions. Listen to your body: consume adequate calories, sleep more, drink enough water, and say “no” a little more than usual during this time. Resist the urge to run a little farther, or go for a difficult hike with a friend simply because you have more time or energy. Instead, use your extra time to get that massage you’ve been wanting. Resist the urge to suddenly decide to wear a different super shoe, or a different fuel on race day. Instead, pack up your tried and trusted race day shoes and carbohydrates. The hay is in the barn. Trust your training and preparation and allow yourself to have a successful marathon.

— Britt Gunsser, PT, DPT, OCS, CSCS. Britt is a board certified orthopedic clinical specialist, certified Schroth therapist and dry needling specialist. She has completed extensive work on running rehabilitation and is an RRCA Running Coach.

How Jon Rahm, a Master’s favorite, prepares his body for play

The current world’s third ranked golfer and popular Master’s favorite Jon Rahm is the pinnacle of golf fitness, and the perfect example of how to best optimize the body-swing connection.

Apr 3, 2023 | Larry Piretra, PT, DPT, CSCS, TPI-M2

The current world’s third ranked golfer and popular Master’s favorite Jon Rahm is the pinnacle of golf fitness, and the perfect example of how to best optimize the body-swing connection. Rahm was born with a club foot (a congenital condition in which a baby is born with their foot typically turns inward and downward), which meant he had to have corrective surgery. Because of this, Rahm lacks mobility and stability in his right ankle, which along with limited right hip internal rotation, directly impacts his backswing. Instead of accepting this as a permanent limitation, Rahm was able to work with his team of golf, fitness, and health professionals to modify his swing and build up other aspects of his body for the most efficient swing possible. As you watch him, you will see his patented short backswing, with which he is still able to generate significant power with his bowed wrist and strength throughout his upper and lower body.

Jon Rahm’s current fitness regimen is a balance of mobility, stability, motor control, and sequencing. Rahm credits a lot of his success to his team from Titleist Performance Institute, including his trainer Spencer Tatum, swing coach David Phillips, and health professional Greg Rose. He notes the collaborative communication was vital in everyone adjusting their work depending on everyone’s feedback within their respective field. Rahm ensures his workouts are structured all around compound movements and asymmetries within the exercises specifically, with balance and stability as a specific focus, as these are vital within the golf swing.

Throughout his long 4-day tournaments, Rahm credits his mobility routines and physio-based massage to keep his body in high performance playing shape. He credits much of his in-season success to his offseason programming and putting in the time which directly translates into his in-season performance. Rahm has also worked with nutritional experts to formulate a plan for a proper eating and hydrating schedule for before, during, and after his round. He constantly snacks through his round on trail mix, dried fruit (pineapple, mango, raisins), and pistachios or almonds. This allows him to keep his constant energy without being too lethargic, along with eating a full peanut butter sandwich at the 9-hole turn (the halfway mark).

Jon Rahm’s pre-round routine may look like most individual’s full workout routine. Through a resistive and dynamic warm-up, Rahm ensures his muscles are activated and primed for optimal performance. He focuses on low reps and high intensity-based exercises which include medicine ball toss, kettle bell swings, banded rotations, reactive hip twists, and Turkish getups. This aligns with the current research of resistive warm-ups resulting in longer distance played, compared to isolated or dynamic warmups.

This health and fitness journey is one of the main reasons Jon Rahm is always in the hunt to win, especially in the Master’s Tournament this week. He is the epitome of optimizing your swing based on how your body moves; while there are a million ways to swing the golf club, but based on you and your body, there is one, most efficient way. Along with his team around him, Rahm is constantly improving his body, and in turn, improving his swing.

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Larry Piretra

Larry Piretra, PT, DPT, CSCS, TPI-M2, is a physical therapist and strength and conditioning specialist who serves as the Manhattan Site Lead and splits his time between the city and Fairfield County. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

The benefits and risks of early sports specialization

Organized youth sports are becoming increasingly competitive and early sports specialization is becoming more popular among young athletes. However, there are many factors to consider when talking about early sport specialization at a young age, as there are both benefits and concerns about early sports specialization.

Feb 22, 2023 | Jacob Ober, PT, DPT, ATC

TOrganized youth sports are becoming increasingly competitive and early sports specialization is becoming more popular among young athletes. Athletes are focusing on one sport at a young age with the hope of increasing their chances of success in the sport, and it’s not uncommon to see youth athletes focusing on one specific sport for a large portion of the year.

There are many factors to consider when talking about early sport specialization at a young age, as there are both benefits and concerns about early sports specialization.

Injury

The biggest concern with early specialization is the greater risk for overuse injuries, especially if your athlete hasn’t gone through puberty, because their muscles and tendons are still developing. Participating in multiple sports allows athletes to develop different neuromuscular patterns and increase their adaptive skills. Moving and falling differently when playing a variety of sports can also be a preventative for injury in your chosen sport.

While early sport specialization can help with skill development in one particular sport, it can also be detrimental in developing overall athleticism. An increased amount of volume of one specific movement while the body is growing can lead to imbalanced development and a higher chance of overuse injury. Athletes that play one sport constantly put their bodies under unique stress specific to that sport. Sports that involve a lot of repetitive tasks, especially unilateral tasks like throwing or swinging, tend to result in muscular and even sometimes skeletal imbalances. "Specializing is not wrong or dangerous. But specializing without adding a good strength and conditioning program is asking for trouble," Andrew Leddy, director of sports performance at Athletic Republic Naples, said. By incorporating that strength and conditioning program, you can address and those imbalances, decreasing stress on the muscles and bones as well as decreasing the risk of future injury.

Repeating the same movements over and over, like pitching a baseball, can put stress on the ligaments, muscles, tendons, and growth plates. According to the data, because kids’ bodies are not the same as adult bodies, those who specialize in a sport have the additional risk of sustaining overuse injuries. For example, in a study of 546 teenage female athletes who played basketball, soccer, or volleyball, there was an increased rate of anterior knee pain in those who had specialized in the individual sports at an early age than those who played a variety of sports. (1)

Burnout

Another issue that can result from early specialization is that it often leads to “burnout.” The pressure for kids to be “committed” to one sport can cause emotional burnout which leads to them quitting the sport. Once they quit, they rarely return. About 70 percent of children drop out of organized sports by age 13. (1) It can be way too much pressure for someone so young.

Young athletes experiencing burnout report:

• Having less input into training and sport related decisions
• Practicing with less motivation
• Motivation becomes extrinsic (pressure from parents or coaches) and based on trying to get a scholarship, not because they derive joy from the sport
• More stress and less ability to cope with high demands of the sport
• Overall less enjoyment of the sport
• Drop in grades or reduced peer interactions

Recommendations

The National Athletic Trainer’s Association’s official statement was in support of the following recommendations relating to the health and well-being of adolescent and young athletes.

1. Delay sport specializing in a single sport for as long as possible: Adolescent and young athletes should strive to participate, or sample, a variety of sports. This recommendation supports general physical fitness, athleticism, and reduces injury risk in athletes.
2. One team at a time: Adolescent and young athletes should participate in one organized sport per season. Many adolescent and young athletes participate or train year-round in a single sport, while competing in other organized sports simultaneously. Total volume of organized sport participation per season is an important risk factor for injury.
3. Less than eight months per year: Adolescent and young athletes should not play a single sport for more than eight months per year.
4. No more hours/week than age in years: Adolescent and young athletes should not participate in organized sport and/or activity more hours per week than their age (i.e., a 12-year-old athlete should not participate in more than 12 hours per week of organized sport).
5. Two days of rest per week: Adolescent and young athletes should have a minimum of two days off per week from organized training and competition. Athletes should not participate in other organized team sports, competitions, and or/training on rest and recovery days.
6. Rest and recovery time from organized sport participation: Adolescent and young athletes should spend time away from organized sport and/or activity at the end of each competitive season. This allows for both physical and mental recovery, promotes health and well-being, and minimizes injury risk and burnout/dropout. (2)

References

1. Woo, M. (2017) Why kids shouldn't specialize in one sport too early, Lifehacker. Lifehacker. Available at: https://lifehacker.com/why-kids-shouldnt-specialize-in-one-sport-too-early-1797954410.

2. Schaeufele, B. (2021) Sport specialization in Young Athletes, The National Sports Medicine Institute. Available at: https://www.nationalsportsmed.com/sports-specialization/.

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Jacob Ober,

Jacob Ober, PT, DPT, ATC, is a physical therapist, dry needling specialist and certified athletic trainer based in Central Naples who subspecializes in working with athletes.

Meet Jake

What does scoliosis management look like?

Scoliosis is a common diagnosis that we will see in the office and can be managed in various ways, both conservatively and surgically, if necessary. Here's how you can manage it.

Jan 27, 2023 | Robert Mahlman, DPT

Scoliosis is a common diagnosis that we will see in the office and can be managed in various ways, both conservatively and surgically, if necessary. A three-dimensional torsional deformity of the spine and trunk, scoliosis can result in curvatures isolated to the neck, mid back or lower back and even all three. Scoliosis is a progressive disease that affects the alignment of the spine, motion of the trunk and overall symmetry of the human body. About 80% of cases are idiopathic, and most commonly we see it in the younger population, which is known as adolescent idiopathic scoliosis.

Diagnosis

Diagnosis of scoliosis is done through radiographic imaging to examine the anterior-posterior view of the spine in standing and assess a specific angle of the spine called the Cobb Angle. This is the angle formed between a line parallel the uppermost vertebral segment of the curve and the lowest vertebral segment. Clinically, diagnosis of scoliosis is a Cobb Angle greater than 10 degrees. This angle is important to know as it can help with managing treatment and understanding curve progressions over time depending on the age of someone. Diagnosis is in the adolescent population is usually done by the child’s pediatrician and screened by an Adam’s Forward Bend Test, where the child slowly bends forward, and the clinician assesses for curvature of the spinous processes or rib prominence.

Management

While scoliosis is a progressive disease that needs to be managed over a lifetime, it can be done so conservatively. The overall goal of any physician and physical therapist working with someone with scoliosis is decreasing and preventing further spinal deformity, along with a management strategy. Depending on a person’s age, skeletal maturity and Cobb Angle, measurements between 10–25 degrees are recommended scoliosis-specific exercises to manage curvature. Those with curvatures greater than 25 degrees and up to 45 are recommended scoliosis specific exercises and bracing. Those with curvatures greater than 45 degrees are usually recommended surgical intervention, as there is a greater negative effect on the persons skeletal structure and function.

Schroth Method

When it comes to managing scoliosis, there are a couple strategies we will employ that have been shown in the literature to be effective. First is an education of scoliosis which needs to be specific to the person and as stated earlier, their age, skeletal maturity, and Cobb Angle. From there, we determine the best management strategy, be it scoliosis-specific exercises, bracing, or surgery. A form of scoliosis-specific exercise some physical therapists are certified in is the Schroth Method. This method was first developed by Katharina Schroth in Germany during the 1920s. The Schroth Method focuses on the specific three-dimensional scoliotic curve pattern, deviations in the various planes, and breathing techniques. A meta-analysis in 2018 looked at the effects of the Schroth Method on idiopathic scoliosis and noted that it is beneficial for those individuals with Cobb Angle of 10-30 degrees, but less beneficial for those with Cobb Angles greater than 30 degrees. These exercises should be practiced for at least one month to have an effect on core muscle strength and structural deformity.

Pilates

In conjunction with the Schroth Method, we have also found positive results in both the office and in the literature with Pilates. Pilates focuses on core stability, flexibility, posture control, and breathing, similarly to exercises done using the Schroth Method. In the literature, Pilates has been seen to improve symptoms in those with spine related issues and reduce pain/disability in those with chronic lower back pain. In a systematic review which assessed the use of Pilates exercises training and its ability to improve spinal deformity and quality of life, there is evidence that Pilates can assist in reducing Cobb Angle, trunk rotation, decrease pain, and improve overall quality of life. In our review, evidence of Pilates independently managing scoliosis is not yet proven, but in conjunction with other exercises such as Schroth Method and bracing, it improves the results.

Every person with scoliosis is different and should be managed individually, as there are multiple variables that can affect their care. To ensure someone with a scoliotic curve is managed most appropriately, it is recommended they work with someone who specializes in the spine and, if possible, are certified in the Schroth Method. While dosage and recommendations vary, a comprehensive evaluation is necessary to address a person’s scoliotic curve, related musculoskeletal impairments, quality of life, body image, and pain. Ultimately it is also a team approach where communication with the physician, patient, and the parent (if an adolescent). Striving to provide a treatment regimen that matches the persons needs is vital and allows them to succeed.

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Robert Mahlman

Robert Mahlman, PT, DPT, OCS, is the Westport Site Lead and a board certified orthopedic clinical specialist and certified Schroth therapist who specializes in the treatment of various orthopedic injuries, along with scoliosis and concussion management.

Meet Robert

Don’t let your golf game deteriorate over the winter

Just because the way you train during the winter is changing temporarily doesn’t mean the quality has to suffer. There are ways to make the most of the wintertime, and to do so, having a team around you is just as important as the time you put in yourself.

Dec 14, 2022 | Larry Piretra, PT, DPT, CSCS, TPI-M2

With the cold weather upon us in the northeast, the golf season shifts from on-course play to off season work within the gym, home, or local simulators. Whether you are looking to lower your handicap, improve your distance, or simply play more golf pain free, it is imperative to put the time and effort in, even if you don't have access to a golf course. Just because the way you train is changing temporarily, doesn’t mean the quality has to suffer. There are ways to make the most of the wintertime, and to do so, having a team around you is just as important as the time you put in yourself. The ideal situation is having both a golf professional and a health or fitness professional to work on all aspects of your game, from swing mechanics to improving your bodies efficiency to move within the swing.

The first important aspect that shouldn’t be ignored is any kind of pain, but particularly low back pain, which is the leading injury amongst golfers, accounting for 25% of all golf injuries. Low back pain may be the source of the pain, but that does not necessarily mean it will be the cause of your pain. The low back is a stable set of joint with the segments above and below (thoracic spine and hip respectively) being mobile joints. Your body requires muscular strength stabilization at stable joints and smooth motion at the mobile joints, and if there is impairment to either of these then dysfunction and pain will ensue. The only way to determine where your dysfunction may be is through a full and comprehensive evaluation, teasing out bits and pieces of impairment you may never knew you had. It is vital to understand the cause of your pain/dysfunction because this changes how your treatment or training plan will be structured.

Most golfers have a goal of gaining yardage on their swings, but do not have a firm plan in place to do so. Approximately every mile per hour gained of ball speed equates to driver carry distance of two yards. Naturally, this means the faster your ball speed, the longer carry distance of your driver. There are a variety of other variables in place that will affect carry distance (club speed, impact, dynamic loft, smash factor, etc.), but ball speed is most often studied. Tour averages for the ball speed on drivers are men at 168 mph and women at 140 mph. Meanwhile for your 10 handicappers, it is 138 mph for men and 119 mph for women. The good news is, an eight-week individualized golf physical fitness program for recreational golfers has previously been shown to improve ball speed by 7.3 mph, which by our calculations, would lead to potentially 14.6 yards of carry distance.

The final piece of the puzzle of improving your golf game is honing in your golf swing itself. This can be done through working with your local golf professional or practicing on a golf simulator, a handy tool during the cold months. Using a TrackMan golf simulator, for example, you can objectively measure whether your swing is improving. TrackMan metrics give you real time feedback on your swing, with approximately 40 metrics, including ball speed, club speed, carry distance, face angle, club path, impact location, and more. You can also play full courses within the TrackMan, thus allowing you to get as close to the course as possible without having to play on the snow.

All of this goes to show that even though you can’t play on the golf course over the winter, there’s no reason not to continue improving your game, addressing deficits, eliminating pain, and optimizing your swing. Putting all those factors together can actually leave you more prepared than ever to get back onto the course. I often recommend to my clients a comprehensive evaluation and Titleist Performance Institute screen, which will examine your body’s mobility and stability, overall power/strength, and assess your swing with metrics from TrackMan’s technology. Finally, by bringing a golf pro and a health and fitness professional onto your team, they can ensure you successfully meet your goals. This collaboration between your golf pro and health/fitness professional is vital to making sure everyone is on the same page and working in sync to make your golf game as efficient as possible.

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Larry Piretra

Larry Piretra, PT, DPT, CSCS, TPI-M2, is a physical therapist and strength and conditioning specialist who serves as the Manhattan Site Lead and splits his time between the city and Fairfield County. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

Prevent and manage prediabetes through exercise

Approximately 10% of the American population has type II diabetes — and 1 in 3 Americans have prediabetes. Fortunately, diabetes can be prevented and managed by living a healthy lifestyle of proper eating and exercising.

Nov 1, 2022 | Michele Tenney, CPT

Approximately 10% of the American population has type II diabetes — and 1 in 3 Americans have prediabetes. These staggering numbers reveal a common issue among the population: lack of sufficient exercise and a poor diet. Fortunately, diabetes can be prevented and managed by living a healthy lifestyle of proper eating and exercising.

Exercise is strongly recommended for people diagnosed with type II diabetes or prediabetes, and for good reason. Exercise helps lower blood sugar levels and ward off symptoms that are affecting people with type II diabetes. Too much rest and lack of movement contributes to higher blood sugar levels, as glucose is not being used up by the body. So, living a sedentary life is not beneficial to anyone, least of all people with prediabetes or type II diabetes. Additionally, exercise reduces stress and encourages weight loss and better cardiovascular fitness.

In addition to those benefits, exercise also helps with mental health and boosts not only our mood, but also our immune system, helping ward off other diseases such as stroke, cancer or heart disease. Exercise also helps aid in a better night’s sleep which also contributes to overall better health as well.

After a diagnosis, it is important to go slow and not jump into strenuous exercise. A quick 30-minute workout is ideal, and if you can get through it without a break; great, but take breaks if you need it. Cleaning and gardening can also count as exercise, but being fully committed to a 30-minute workout every day should be the goal. If you need help with motivation, find a personal trainer to help jumpstart a routine for you. Knowing your weakness and when to ask for help is a strength.

Once you have adopted a good routine and are committed to it, the American College of Sports Medicine recently released new recommendations for more strenuous workouts four to five times per week. However, it is important to discuss these options with your doctor and physical therapist if you are recovering from any injuries, as there are modifications that can be made to your workout routine to prevent further injuries.

The battlefield is in your mind: change the way you think, use self-affirmations, remember how you feel once you’re finished exercising and remember that you are worth every bit of effort you put into yourself. Your body will thank you for it. Repetition becomes a habit and habits become lifestyles, which means there is hope for those who want to prevent and manage prediabetes and type II diabetes. Should you get sidetracked or out of your routine for a period of time, don’t throw in the towel; begin again. Life has detours, and it’s important to learn how to maneuver them.

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Michele Tenney

Michele Tenney, CPT, is a personal trainer based in Hamden who enjoys working with all populations. As a trainer, Michele takes care to talk about the importance of nutrition in achieving goals.

Meet Michele

Pilates exercises for healthy joints

Oct 19, 2022 | Rebecca Deeley

In honor of Bone & Joint Health National Action Week, Pilates Instructor Rebecca Deeley shares a few exercises on the Pilates Reformer that strengthen the muscles around the joints without stressing out the joints themselves. These exercises are perfect for those who are recovering after an injury and require low impact methods of gaining strength back.

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Optimize your golf performance at any age

Oct 12, 2022 | Health & Wellness Magazine

The best way to optimize golf performance at any age is to optimize total body performance through an integrated team approach. The first step is completing a golf-specific health and fitness screen, which can identify potential impairments or impairments. Once they are identified, a team should be built around the golfer to address not only the impairments, but also to improve general fitness, proper form, hydration, muscle recovery, and mental performance.

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Why you should start treating exercise as medicine

Exercise isn’t just for regular gym goers or athletes; it is a useful tool for people of all ages and abilities to maintain health through every stage of life. Engaging in an appropriate level of regular physical activity can help prevent, treat, or even reverse, chronic diseases as we age.

Sep 16, 2022 | Jamie Stuart

Much like the changing of the seasons, our bodies change and adapt year after year. With September being Healthy Aging Month, it is important to focus on how we can create healthy changes to our bodies over the years. For example, many illnesses often associated with aging are actually the result of sedentary lifestyle and can be avoided by moving and staying physically active (Gonzales et al., 2017). Most people are probably aware that exercise is a great way to stay in shape, build muscle, and burn calories, but the benefits of exercise go well beyond losing weight, running faster, or getting stronger. The American College of Sports Medicine believes that “exercise is medicine” and engaging in an appropriate level of regular physical activity can help prevent, treat, or even reverse, chronic diseases as we age (Swisher, 2010).

Regular exercise is associated with reduced resting heart rate and blood pressure, increased HDL (good) cholesterol and decreased LDL (bad) cholesterol, reduced total body fat, reduced blood platelet adhesiveness and aggregation, improved glucose tolerance (decreased insulin resistance), decreased workload on the heart, and increased bone density (Nystoriac & Bhatnagar, 2018). According to the American Heart Association and the CDC, adults who participate in at least 150 minutes of moderate intensity aerobic exercise (brisk walk or light weight training) or 75 minutes of vigorous exercise (jogging or playing basketball) have a significantly reduced risk of developing type II diabetes, cancers, and cardiovascular diseases.

The idea of exercise serving as medicine does not only apply to adults. Children and adolescents who participate in regular supervised weight training have a reduced risk of developing osteoporosis when they are adults. Young individuals who exercise and participate in sports also have decreased body fat percentage and increased fat free mass (muscle and bone) later in life, compared to those with a sedentary lifestyle. Furthermore, regular aerobic exercise at a young age can reduce risk of developing high blood pressure and cardiovascular disease later in life (Drenowatz & Greier, 2018).

Speaking of cardiovascular disease: it is the leading cause of death worldwide. In the United States, an average of 2,400 people die from cardiovascular disease every day, accounting for 1 out of every 2.8 deaths. Poor health outcomes resulting from cardiovascular disease such as coronary artery disease, chronic ischemia, stroke, and arterial stiffness are on the rise globally, and cardiovascular disease related healthcare costs are expected to increase from 172 billion in 2010 to 276 billion in 2030 in the United States (Pagidipati & Gaziano, 2013; Heidenreich et al., 2011). However, exercise can help reduce mortality from heart disease by increasing the elasticity of arteries which results in greater control over blood pressure. Exercise can also increase blood flow to the heart by increasing the number of branches between blood vessels feeding the heart. These collateral branches can then help supply the heart with oxygen-rich blood in the event of a coronary occlusion which may prevent or lesson the severity of a heart attack (Meier et al., 2013).

To learn more about the direct and indirect effects of exercise on the body, we turn to the field of exercise physiology. Exercise physiologists are medical professionals who prescribe plans that can maximize the benefits of exercise in people struggling with chronic disease. They work with doctors, nurses, and physical therapists to design exercise programs to treat cardiopulmonary diseases such as congestive heart failure and metabolic diseases such as diabetes. Cardiac and pulmonary rehabilitation programs last roughly three months and patients are encouraged to perform moderate intensity aerobic exercise three times per week for one hour under close supervision. In addition, education on health topics such as exercise, recovery, and nutrition are provided, and vitals are continuously monitored to ensure the prescribed exercise is having a positive and significant enough effect. Patients that successfully complete exercise programs designed by exercise physiologists often have significant improvements in their heart and lung function, as well as greater control over blood sugar levels (Bozkurt et al., 2021).

Exercise isn’t just for regular gym goers or athletes; it is a useful tool for people of all ages and abilities to maintain health through every stage of life. Exercise should be seen as a requisite to living and just like regular maintenance of your car, it is necessary to ensure our bodies function properly over time. Staying active and adhering to the recommended exercise guidelines is essential, and some people dealing with complex health issues may need extra guidance and care. Exercise physiologists can prescribe a safe and targeted exercise plan for those suffering from chronic disease or other health issues to ensure they meet the recommended dosage of exercise.

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References

Bozkurt, Biykem et al. “Cardiac Rehabilitation for Patients With Heart Failure: JACC Expert Panel.” Journal of the American College of Cardiology vol. 77,11 (2021): 1454-1469. doi:10.1016/j.jacc.2021.01.030

Drenowatz, Clemens, and Klaus Greier. "Resistance training in youth—benefits and characteristics." Journal of Biomedicine 3 (2018): 32-39.

Garber, Carol Ewing et al. “American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.” Medicine and science in sports and exercise vol. 43,7 (2011): 1334-59. doi:10.1249/MSS.0b013e318213fefb

González, Karimé et al. “Physical Inactivity, Sedentary Behavior and Chronic Diseases.” Korean journal of family medicine vol. 38,3 (2017): 111-115. doi:10.4082/kjfm.2017.38.3.111

Heidenreich, Paul A et al. “Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.” Circulation vol. 123,8 (2011): 933-44. doi:10.1161/CIR.0b013e31820a55f5

Meier, Pascal et al. “The collateral circulation of the heart.” BMC medicine vol. 11 143. 4 Jun. 2013, doi:10.1186/1741-7015-11-143

Nystoriak, Matthew A, and Aruni Bhatnagar. “Cardiovascular Effects and Benefits of Exercise.” Frontiers in cardiovascular medicine vol. 5 135. 28 Sep. 2018, doi:10.3389/fcvm.2018.00135

Pagidipati, Neha J. and Thomas Andrew Gaziano. “Estimating Deaths From Cardiovascular Disease: A Review of Global Methodologies of Mortality Measurement.” Circulation 127 (2013): 749–756.

Swisher, Anne K. “Yes, "Exercise is Medicine"….but It Is So Much More!.” Cardiopulmonary physical therapy journal vol. 21,4 (2010): 4

Five tips for injury prevention

As fall sports pick back up, there is often an uptick in injuries associated with the increase in training load after a slower summer. Here are some helpful tips to help make the increased load feel more workable and prevent injuries from destabilizing your season.

Aug 16, 2022 | Brendan Copley, CSCS, ATC

As fall sports pick back up, there is often an uptick in injuries associated with the increase in training load after a slower summer. Here are some helpful tips to help make the increased load feel more workable and prevent injuries from destabilizing your season.

1. Listen to your body

While this is one of the most common recommendations you will hear — especially in the endurance sports realm — it is also one of the most commonly ignored. In the initial stages of getting back into your sport, it can be challenging to understand the difference between the normal discomfort of muscle soreness and injury-related pain.

On one hand, if you pay attention to every little ache and pain, you may not be able to reach the performance goals you desire. On the other hand, if you ignore your discomfort, you could be setting yourself up for injury and time away from your sport. This is where it can be helpful to work with an athletic trainer or physical therapist. As experts in the field, they will help you sort through the signals your body is telling you and brainstorm a plan of action.

2. Monitoring training load

Another place people can get stuck is the idea that because they have taken some time away from their sport, they need to work overtime to get themselves back into shape. So, they perform the most intense workout they could possibly fathom and are so sore that they are unable to walk for the next three days. Instead of pushing yourself, the more helpful (albeit more challenging approach) is to prioritize consistency over a long period of time

Consistency helps make your sport more of a habit; the more it is a habit, the less motivation is needed to perform the activity. The initial stages of training are all about building a base, and the more consistently you can get out there and recover appropriately, the bigger that base will be. One analogy is thinking of training as compound interest: if you can invest little amounts over a long period of time, eventually that interest will compound. On the flip side, if you must keep removing money from the bank, the interest will never add up.

3. Proper warm up and cool down

Performing an appropriate warm-up can also play a role in warding off soft tissue injury. Warm-ups increase the heart rate, increase blood flow to tight muscles, improve tissue elasticity, and prime the body for activity. The warm-up should consist of:

• Five minutes of an activity that increases your heart rate. This may consist of using a stationary bike, elliptical, running, jumping jacks, etc.
• Dynamic warm up which entails stretching targeted muscles through movement, while progressively promoting strength in functional movement patterns
• Pre-activation: this is a method of activating the hips, core, rotator cuff, and scapular stabilizing muscles depending on the sport and injury history. Pre-activation involves only one or two sets of movement with light to moderate resistance to prime muscles that help prevent the typical compensation patterns.

Performing an appropriate cool down usually includes performing some variation of very low intensity cardio for 5–10 minutes and some light static stretching.

4. Rest and recovery

Having the appropriate amount of sleep and time off are good methods to help make sure that your muscles have had time to restore the amount of energy needed before returning to training. The recommended amount of sleep for athletes is between seven and nine hours. As part of the recovery, it can also be beneficial to incorporate methods that either promote tissue elasticity or venous return. Some examples of these recovery methods are:

• Normatec
• Cryotherapy
• Foam rolling
• Massage therapy
• Trigger point release therapy

Nutrition and hydration also play an integral role in injury prevention. Nutrition can affect the recovery of the muscles, as well as the availability of energy while performing an activity. Here are some common nutrition-related concepts to keep in mind for fueling your body for optimal performance and injury prevention:

• Eat foods that are nutrient dense and have a variety of vitamins, minerals, and antioxidants
• To decrease inflammation, eat foods that are high in omega-3 fatty acids such as fish, ginger, turmeric, and nuts/seeds
• Eat foods that are high in protein approximately 30 minutes to an hour after the activity, but don’t disregard carbohydrates! Protein works best when it is eaten in 3:1 carb to protein ratio.
• Eat the appropriate ratio of fats, carbs, and protein for the type of sport being performed.
• The USDA recommends for the general public a macronutrient ratio of 45-65% carbs, 20-25% fats, and 10-35%
• Refer to a sports dietician who can perform a comprehensive evaluation to help determine your specific macronutrient needs
• In general endurance athletes tend to need a slightly higher percentage (60-65%) of their calories from carbohydrates.
• To avoid over or under fueling, have the appropriate caloric intake based off your Basal Metabolic Rate (BMR) and intensity of the exercise.

Regarding hydration, even mild dehydration can increase the likelihood of injury while also decreasing your body’s speed, strength, and cognitive function. Here are a few hydration facts to drink up to help feel your best and decrease injuries.

• It is important to hydrate throughout the day, not just right before activity. Dehydration is cumulative and the hydration status the day before affects the hydration of the day of.
• Aim to have 8–16 oz of water the hour before exercise, 4 oz per 15 mins of activity during activity, and 16-20 oz for every pound lost during exercise.
• For particularly hot time periods with intense training, it can be helpful to consistently weigh yourself both before and after the activity to make sure you are making up the fluid weight lost before starting up the next activity.
• In the heat it is also important to combine water intake with electrolytes drinks that have plenty of (sodium, potassium, magnesium and calcium.)

Unfortunately, both hydration and nutrition recommendations vary depending on the individual’s needs. Therefore, working with a nutritionist or dietician can be invaluable in curtailing recommendations specific to your situation.

The best type of treatment for injuries is a preventative plan. Building healthy habits around activity load, rest/recovery, listening to your body, warm-ups/cool downs, and nutrition/hydration can make a significant difference in your long-term health and well-being. You don’t have to take steps towards change alone. A good healthcare team should be able to work with their patient proactively to help determine a plan, before the injury even happens.

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Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients.

Meet Brendan

Have low back pain? Here’s why you shouldn’t wait to address it

Everyone seems to experience low back pain at some point in their lives, but often wait to address it. Here's why you should get help sooner rather than later.

Jun 23, 2022 | Payden Houser, DPT, CSCS

Let's talk about low back pain, something that everyone seems to experience at some point in their lives. It seems like you could stack the articles, studies, papers, blogs, and textbooks dedicated to low back pain and reach halfway to the moon. Studies show that the prevalence of low back pain worldwide has risen over the last two decades. A global disease burden study from 2010 found that out of 291 conditions, low back pain ranked highest in terms of disability and sixth in terms of overall burden. (1)

Meanwhile, musculoskeletal are the second most common cause of disability worldwide, increasing 45% from 1990 to 2020, and that number is expected to climb. (2) Researchers anticipate that with a rise in sedentary lifestyle, lack of exercise, as well as poor nutrition and sleep health, conditions like low back pain will continue to affect the lives of a large percentage of the global population.

But things are not all doom and gloom. Let’s shed a little light today on what low back pain is, what it isn’t, and how creating a proactive strategy can not only help manage your pain but can help you make sustainable healthy lifestyle changes for the future.

What is low back pain, exactly?

Low back pain is discomfort, tightness, or stiffness in the area below the costal margins of your ribs (the arch formed as your ribs connect to your sternum), and above the lower portion of the gluteal muscles. Pain stemming from the low back can also include leg pain.

The point to make clear is that low back pain is a symptom, not a disease, and can result from several known or unknown sources. Symptoms can be short-lived for only a few weeks or chronic, persisting for several months to years, and can, unfortunately, reoccur if not managed. The good news is that a 2017 JOSPT study showed that although low back pain can be recurrent (ranging from 24%-58% likely to reoccur at 2 years), in most cases, individuals tend to recover quickly. (3)

So what is the cause of low back pain? It can originate from a variety of structures in the body: muscle, tendon, ligament, joint, spinal disc, nerve, and visceral organs. There is also a long list of risk factors associated with contributing to low back pain including prior low back pain, obesity, poor health, manual jobs, and poor work satisfaction, just to name a few. Reading all of the possible contributors to low back pain can be daunting, but rest assured that symptoms can be managed as long as you are willing to make some lifestyle changes and have a plan of action.

Get help without the wait

One of the most significant decisions you can make to address your low back pain is to seek conservative care early. If symptoms are not improving on their own in a few days, then it is best to seek out a provider who understands the anatomy of the spine and how the human body moves.

All 50 states in the U.S. have provisions that allow for what is called "direct access" to see physical therapists; meaning you do not have to see your physician first. Take Connecticut, for example. You are allowed to see a therapist for six visits or 30 days before requiring a prescription from a physician to continue care, which is quite a head start. This provides you with the opportunity to receive guidance from a trained professional quickly, saving you precious time, money, and avoiding unnecessary co-payments and imaging, and surgery.

A physical therapist will perform an initial evaluation seeking to first rule out any potential "red flags" (more serious underlying conditions that require the help of a physician), and then assess your overall status to try and provide you with insight on what could be causing your pain and how to best address the problem.

If you came in with a prescription from your doctor for physical therapy, great! Your therapist can then communicate with your physician on what they believe to be going on and create a solid plan of action.

If you came in via direct access, that's awesome too! Your physical therapist can then help you find an appropriate orthopedist, physiatrist, or other musculoskeletal specialists, to assist in managing your care if imaging or other treatments are necessary. Either way, within a short period of time you will have a robust team of professionals to help you along the way.

Every case of low back pain is different, and they can all be very frustrating in their own way. When your activities and social life become limited, or there is a loss of work and financial hardship, it is easy to feel overwhelmed. It is important to understand that you are not alone in this experience. At some point in life, nearly everyone will experience low back pain. With early action and a good team of healthcare providers around you, your symptoms can be managed effectively and you can be well on your way to returning to the things you love with a renewed sense of confidence and better equipped with the knowledge of how to manage symptoms in the future.

References

1.Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann 2.Rheum Dis. 2014 Jun;73(6):968-74. doi: 10.1136/annrheumdis-2013-204428. Epub 2014 Mar 24. PMID: 24665116.
Storheim K, Zwart JA. Musculoskeletal disorders and the Global Burden of Disease study. Ann Rheum Dis. 2014 Jun;73(6):949-50. doi: 10.1136/annrheumdis-2014-205327. PMID: 24790065.
3.da Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. 2017 May;47(5):305-313. doi: 10.2519/jospt.2017.7415. Epub 2017 Mar 29. PMID: 28355981.
4.Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1. doi: 10.1590/S0034-8910.2015049005874. Epub 2015 Oct. 20. PMID: 26487293; PMCID: PMC4603263.

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Payden Houser

Payden Houser, DPT, CSCS, is a physical therapist and strength and conditioning specialist based in New Canaan who has been practicing since 2015 in the outpatient orthopedic and home health settings.

Meet Payden

Maddy Mazoue

Maddy Mazoue, PT, DPT, CSCS, is a physical therapist and strength and conditioning specialist who specializes in developing athletes’ return to sport programs.

Meet Maddy

How to transition into the outdoor running season

With the spring coming up, many are transitioning to outdoor running. Here's what you need to remember for a successful transition.

Mar 17, 2022 | Britt Gunsser, DPT

Winter running, especially in the Northeast, requires planning, flexibility, and mental grit. Spring races, such as the Boston Marathon and NYC Half Marathon, require 25,000-30,000 participants to train through the winter. As a participant in the latter, I’ve battled it out with winter training the past few months. The temperatures get well below freezing, the roads get icy, and the sunlight gets scarce. All of these variables require runners to have a plan: is it safe to run outside? Is it smart to run outside? Will I accomplish my training goal running outside today? Do I want to run outside?

If the answer to these questions is “yes,” then comes the planning. Visibility, warmth, traction, and water resistance need to be accounted for depending on the conditions of the day. Running in the morning or at night requires a reflective or illuminated vest to be seen by cars. Running in snow and ice requires shoes with better traction, and possibly a decrease in pace. Temperatures below 40 degrees require layering techniques, with increased layers as the temperatures grow colder. Hands and ears, receiving the least circulation, need to be covered. Warmups need to be thorough to truly warm up your body before heading out into cold temperatures. Putting all of that together, the end of my winter runs looked a lot like this (featuring ice on hat, runny nose, double layered gloves, triple layered shirts):

As hours of sunlight and temperatures start to increase, so does the appeal of outdoor running. It becomes easier to choose the pavement over the treadmill, which can help a runner prepare for race-like conditions. For most, running feels best in the 40s and 50s with low humidity, giving March and April the potential to have great running conditions (aside from the occasional late northeast snowstorm).

Though the weather conditions improve, certain things remain constant no matter the weather: warmups, strength training, proper fueling, and recovery are all necessary. While it is advised to warm up inside during the winter months, your warmup can now be done outdoors when the sun is up and the temperatures are warmer, but it should still be thorough and run-specific. Strength training (advised two days/week during a race training cycle) should still be done on hard workout days, involving leg, core and upper body exercises.

Fueling, which includes pre-, during, and post-workout, remains crucial to recovery between sessions. Fueling is often the most difficult variable for runners to independently plan. I recommend working with a registered dietician with experience with endurance athletes to discuss fueling strategies and decide which is best for you. These strategies should be practiced during the training cycle, and nothing new should be tried on race day. As training cycles ramp up, caloric intake (specifically of carbohydrates) should also increase. Runners are often unknowingly under-fueled because of day-to-day nutrition. A dietician can provide strategies to combat this.

Recovery and rest days are also extremely important. They allow the body to make beneficial adaptations to hard training sessions to truly begin to show improvement. Recovery runs are often assigned in training cycles, and should be kept at a very easy, conversational pace to promote recovery. Full rest days should be exactly as they sound: full of rest. Though rest and recovery days are not as active as workout days, nutrition remains equally as important as the body tries to replenish from the previous workout and prepare for the next one. These are also perfect days to utilize recovery tools available to you. My Hypervolt remains within arm’s reach and I often sit with NormaTec boots on these days to get my legs feeling better and ready for my next workout. I also like to use an infrared sauna, which has been proven to promote recovery from high-level endurance performance training (and feels great during the cold winter months).

As spring approaches, I look forward to shedding the layers in comfortable running conditions, seeing everyone out on the pavement and seeking a personal best in the half marathon!

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Britt Gunsser

Britt Gunsser, DPT, OCS, CSCS, is a board certified orthopedic clinical specialist and dry needling specialist. She is a certified RRCA Running Coach who has run multiple marathons and half-marathons.

Meet Britt

How athlete screens prepare a team for their season

Athlete screens are essential to mitigating the risk of injury and optimizing performance prior to a season. Here's what one coach had to say about the process.

Mar 17, 2022 | Performance Optimal Health

Athlete screens are an incredibly useful tool in helping mitigate the risk of injuries, optimize movement and maximize performance — just ask Ray Marschall, coach for the Greenwich High School Boys’ Tennis and Soccer teams.

Ever since he started coaching 13 years ago, Ray has dealt with athletes starting off their seasons with injuries. Years ago, at the soccer team’s first match, nine of the roster’s players were injured, the majority of whom had quad and hamstring strains. And in tennis, he’s seen too many early-season shoulder injuries.

“There’s little reason for healthy and fit teenagers to have those types of injuries,” Ray said. He started thinking about how to prevent future injuries and decided to develop an off-season training program to help the players be in shape and ready for future seasons.

The following year, only three athletes started the season off with an injury.

Recognizing a need for injury prevention programming

While Ray was able to lower the number of athletes who started off their seasons with injuries on his own, three was still too many. Over the years, he has realized the need for preventative care; teenagers often find it difficult to keep up with the changes their bodies experience as they mature and gain muscle mass and strength.

“From a coaching perspective,” Ray said, “I really don’t want any player to have an avoidable problem at the start of a season.”

So when Ray, who himself has done physical therapy at Performance multiple times, found out that Performance Optimal Health offered athlete screens, he jumped (well, jumped is a bit of exaggeration given that he’d just come off his second hip replacement surgery!) at the chance to help his athletes. “This was a great opportunity for my guys to hear honest, unbiased and professional medical feedback about their physical strengths and limitations and learn how to listen to and take care of their bodies,” he said.

What is an athlete screen?

For twenty years, our team at Performance has worked with youth athletic teams in Connecticut and New York to maximize player performance, optimize competition readiness and minimize injuries through sport-specific training and injury prevention programming.

Athlete screens are an essential part of this effort; we screen teams in our communities right near the end of their off-season to ensure they are prepared for the season ahead. Every athlete’s readiness and physical state is unique, requiring personalized prescription for training and recovery. Our team of specialists perform a set of functional movement screenings on each athlete to evaluate the following key performance areas:

• Speed and agility
• Endurance capacity
• Power output and strength
• Mobility and range of motion
• A results report and personalized action plan is provided to coaches, parents, and athletes, detailing areas of risk and areas for optimization.

“The goals are to analyze the requirements of athletes to move and perform within the demands of the sport, and then inspect each deeply. From there, we identify if there is pain or dysfunction that needs to be addressed. Finally, we provide recommendations to help address the issues picked up on the screen,” Shane Foley, DPT, said. Shane is the Greenwich Site Lead who develops athlete screens for the Greenwich community and led the charge with the most recent screen for the Greenwich High School Boys’ Tennis team.

Paving the way forward

Ray was pleased with the results of the screen, to say the least. “The consistency Shane Foley and the other physical therapists provided was terrific. They’re always completely focused on the physiology and what is best for each patient or athlete,” he said.

Now, he hopes that his athletes will be able to take the results and recommendations from the screen and apply them in their play. By looking at the results “in the green,” the athletes will know that they can continue doing what they’ve been doing. But what they will need to pay attention to are the yellow — and especially the red — areas that need improvement.

The results are also helpful to Ray as a coach, who is eager to use them in his training. “I always ask the guys during tennis matches, ‘What’s working? What’s not? What do you need to change?’ I want them to recognize what’s going well, such as their forehand is solid today, but also recognize what is not working and why, like missing some deep overheads, which might be due to a lack of flexibility or upper body strength, all the while using Performance’s recommendations and exercises as a guide.”

“I really hope that at the end of the season, they will be able to look back and say ‘wow, that screen really helped me,’” Ray said. (He even hopes they’ll admit it to him, but he’s not holding his breath!)

Why you should care about your heart rate variability

Your heart rate variability can tell you a lot about your health, including stress levels, sleep quality, general readiness and more. Here's how to improve it.

Feb 24, 2022 | Michael Semancik, DPT, TPI-M2

You may have heard about a new metric in the health and wellness world: heart rate variability (HRV). Various wearables like the Oura ring, Apple Watch, FitBit and the WHOOP strap measure your HRV, making it more accessible for the average person. But what is HRV exactly, and how can it impact your health?

First, we need to understand resting heart rate (RHR). RHR is the number of heart beats per minute while, as the name suggests, you are in a resting state. The American Heart Association defines normal RHR for an adult is anywhere between 60-100 bpm, but this can be even lower in a trained individual (such as a high level marathon runner whose RHR rests typically in the 40s).

What is HRV?

While RHR measures the number of beats per minute at resting, HRV measures the fluctuation in time between successive heart beats. On an electrocardiogram reading, we will see a number of spikes within each heartbeat. First is PR interval (atrial polarization or activation), followed by the QT interval (ventricular depolarization and repolarization). Within the QT interval is the QRS complex, as seen in the large spike on the picture. The top of this spike is the R wave, and the distance between R waves is known as the R-R interval, which is then used to calculate HRV.

HRV can be a tough concept to fully understand, so we will break it down with this example:

Let’s say that your RHR is 60, meaning that your heart beats 60 times in 60 seconds. One would likely assume that if this is the case, then your heart is beating every second, or 1000 ms. However, your heart does not beat in a uniform fashion. One heartbeat could be 980 ms after the prior, the next could be 1050 ms after, the next 945 ms after, and so on. This is what heart rate variability looks like.

Sympathetic Nervous System

To understand HRV and what influences it, first we need to dive deeper in the nervous system as a whole. The nervous system is separated into two systems: the somatic (voluntary actions/movements) and autonomic (involuntary) nervous systems. For the purposes of this article, we will look more into the autonomic nervous system. The autonomic nervous system is what controls all the involuntary processes in your body, such as breathing, your heartbeat, digestion, etc. This is then further separated in the sympathetic and parasympathetic nervous systems.

This is the “fight or flight” response in your body; when activated it leads to an overall elevated level of activity and attention. This includes constriction of the blood vessels, dilations of the pupil, increase in blood pressure and heart rate, digestion slows down, etc.

Parasympathetic Nervous System

The parasympathetic nervous system is responsible for the “rest and digest” functions in the body. Conversely, heart rate and blood pressure decrease, digestion starts, etc. Lower parasympathetic activity is associated with multiple cardiac and chronic disorders.

What Influences HRV?

HRV is good measure of physiological readiness in the body. In a healthy, trained individual, there is a “tug of war” between the sympathetic and parasympathetic nervous systems. At times, the sympathetic branches will be more dominant and increase HR temporarily, and other times parasympathetic system will take over and decrease HR. When these are equally balanced, we then see a higher HRV variability, which means that your body is more ready to take on stress at any given point. If one of these systems starts to become more dominant than the other, then we will see less variability in the heart rate.

Here's an example:

If you are experiencing a period of higher stress, either physically (increasing training load and volume), or emotionally/mentally (high stress at home, work etc.), your sympathetic nervous system will be much more active even at rest, and will win this tug of war against the parasympathetic nervous system. Now, your sympathetic nervous system is constantly telling your body to maintain a higher RHR, which results in less variability of your HR.

What do HRV scores mean? What is a good HRV score?

HRV scores are highly individualized to the person, and differ based on age, fitness, or other intrinsic factors. It is more important to look at trends in your HRV over a longer period of time. A low trend can indicate that your body is not fully recovering; this can be due to stress, increased training load/volume, poor sleep, dehydration, etc. A higher trend means that there is better balance in your system, and your body is more “ready to go” at any moment, and can adequately adapt to its environment.

How can you use HRV to modify lifestyle, exercise?

HRV can be a very helpful tool in modifying your exercise routines and daily habits. This is a good tool to show to your physical therapist, trainer, or other professional to help modify your routine or program in order set you up for success.

If you are overtraining and not taking time to recover properly, you may see a downward trend in your HRV. You should:

• Use this metric as a guide to incorporate more active recovery in your workouts
• Focus on sleep and relaxation methods
• However, in some instances, you may want to see a downward trend
  • If you are intentionally going through a high volume or high load training period, you may want to see HRV temporarily decrease during that period

If you are seeing an upward trend in HRV, that means:

• There is better balance in your system
• You can start to increase training load, but you should still continue to focus on activities that promote recovery

In order to improve your HRV, you will need to improve the balance between the sympathetic and parasympathetic nervous systems. In many individuals, the sympathetic nervous system is going to be more active compared to the parasympathetic nervous systems. Most of what we deal with is increases in work or home-related stress, poor sleep quality, poor nutrition, or increased training volume.

Strategies to improve input from the parasympathetic nervous system include:

• Breath work/meditation
  • Relaxation methods that help bring down heart rate
  • Improve parasympathetic input to the body
• Sleep
  • People who sleep six or less hours per night had lower baseline HRV values than those who slept more than 7 hours
  • Those with low sleep efficiency also had lower baseline HRV scores compared to those with high sleep efficiency
• Clean eating
  • Foods that increase inflammation in the body will increase sympathetic nervous system activity
• Hydration
  • Hydration levels have shown to improve HRV scores acutely following exercise
• Exercise
  • Increasing cardiovascular and muscular fitness will help improve HRV
  • HRV can also help guide exercise choices and help you get the most out of a session
• Cryotherapy and cold-water immersion
  • Studies to show that whole body cryotherapy has a large influence on parasympathetic reactivation
  • Whole body cryotherapy elicits a high parasympathetic activity due to an acute sympathetic response
  • In one study, researchers found that HRV was likely to increase following one session of whole body or partial body cryotherapy

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Michael Semancik

Michael Semancik, DPT, TPI-M1, is a physical therapist and certified dry needling specialist who works with young athletes, specifically with rowers, hockey players and football players.

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Preventing and treating common knee injuries in the winter

Learn about common knee injuries and what we can do before, during, and after to stay active and optimize your health during the winter.

Dec 15, 2021 | Jonathon Mendola, DPT

Much like the shocks in your car help soften your ride down the road, your knees absorb most of the shock during everyday activities and sports alike. Taking a look at winter sports in particular, we can all agree that the knees take quite a beating out on the slopes, the rink or on the court, making it all the more important to take care of them. With the winter sport season in full swing, we sat down with one of our doctors of physical therapy, Jonathon Mendola, to discuss common knee injuries and what we can do before, during, and after to help keep our clients active and optimize their health through the winter season.

What are the most common knee injuries that you see during the winter season?

During the winter, we tend to see an uptick in injury of the anterior cruciate ligament (ACL) suffered while skiing. This type of injury, can range from a partial tear of the ACL only, to a full rupture, sometimes even involving injury to the meniscus and/or the medial collateral ligament (MCL) within the knee. Other common winter sports injuries to the knee include fractured kneecap, or patellar dislocation, common in many winter sports.

What can clients do to help prevent knee injury?

Do we wait until we have engine trouble to change our oil or wait until our tires are flat to get new ones? Of course not! There are plenty of things that people can — and should — do to prevent injuring their knees. For starters, they can take a driver’s seat in injury prevention by meeting with a movement professional such as a physical therapist or qualified personal trainer to go through a movement screening in order to assess their overall functional movement mechanics and thus possible warning signs for potential injury.

What I think many athletes don’t realize is that just because you don’t have pain, doesn’t mean that you are in tip-top-shape. The most common areas for improvement that we see in the physical therapy realm are the hips and core. We often see that those clients who have either poor glute or core strength/endurance are often the ones who come through with injuries to their knees. This lends the question, “why?”

In an ideal world of biomechanics and kinesiology, our bodies are meant to move in a synchronous manor from one segment to the next; a chain if you will, from one link to the next. Here, the time old saying “as strong as the weakest link” rings true. With poor stability in the core or glutes comes poor transitioning of forces and control of load through the knees.

What should someone do if they have knee pain but do not think that they have an acute injury?

Sometimes we experience pain. There is nothing wrong with having some soreness after we go hard on the court are had a day full of moguls on the slopes; you earned that soreness! With that said, it is on you to make sure you give your body the recovery it needs after what you put it through. Recovery comes in many forms; while some may yearn for a good drink in the lodge/paddle hut, there are a few options I recommend to my clients.

Some simple low-tech options include Epsom salt baths, ice packs or sports massages. If you are a bit more adventurous or into tech, you may pair well with vaso-pneumatic compression devices such as Normatec, infrared sauna, or nitrogen-driven cryotherapy. Now while those are good for post activity recovery, it is also important for athletes to take things such as their nutrition, sleep and stress into account as these three factors play a huge role in the body’s capacity and speed of restoration on a global level.

What if a client falls while participating in their sport and thinks they hurt their knee? What should they do?

If a client suffers an acute injury, they should seek medical attention sooner rather than later. Depending on the severity of the injury, athletes can see a number of professionals varying from their primary care physician to a physical therapist directly. What many athletes don’t realize is that in many states, including Connecticut, a client can be seen by a physical therapist without a prescription from the doctor for up to six visits, which means you can get access to physical therapy much more quickly. One of the most exciting parts of my job is being able to be that catalyst to help clients not only get better but also to help them get into the right doctor for their injury — while some injuries can be handled without seeing one, there are often times when the right doctor is crucial to your recovery. At the end of the day, having a good team around you can make all the difference, whether you are working to prevent injuries or treat them.

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Jon Mendola

Jonathon Mendola, DPT, PT, CSCS, is a detail-oriented physical therapist and certified strength and conditioning specialist. He is particularly interested in working with patients post-op.

Meet Jon

Winter warm-ups anyone can do

Here are some simple winter warm ups that involve mobility work, dynamic stretches and activation exercises from our personal trainer.

Dec 15, 2021 | Brianna Clifford, CPT, CSCS

While warm ups are always essential parts of any workout, they are especially important during the colder months. With colder temperatures dropping, our tendons and joints tighten up, decreasing mobility and increasing soreness. But by stimulating blood flow through dynamic stretches and activating your muscles, you can lower your risk of injury.

Whether you play paddle tennis, hit the slopes on the weekend or simply go to the gym to exercise, make sure you warm up before you start your workout. Don't know where to start? Here are some simple warm ups that involve mobility work, dynamic stretches and activation exercises from personal trainer Brianna Clifford, CPT, CSCS.

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How to burn more calories during your walks

Walking is a great way to burn calories, but there are ways to increase that caloric burn.

Nov 1, 2021 | Performance Optimal Health

(CNN)-It’s no secret that walking is good for you. Many of us are trying to get in those recommended 10,000 steps a day that our wearable fitness technology urges us to achieve.

But how many calories are we actually burning, and how can we get the most out of those steps?

There are a lot of different wearables and online calculators to assess how many calories are burned walking. However, they are not entirely accurate, research has shown.

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Why do my muscles shake during a workout?

When you start to feel your muscles shake, you may feel like you can't finish your workout, but that doesn't mean you should stop. So what exactly happens when you start to shake?

Oct 14, 2021 | Nicholas DiMeglio, CSCS

I know you’ve felt it before, that feeling when you’re in the last few seconds of a plank, or that last set of a hard workout and you’re trying to squeak out those last few reps. All of a sudden, you feel your muscles start to tremble and shake — and you’re not sure if you can finish what you’ve started. You wonder to yourself, why am I shaking like this and what can I do to keep it from happening?

To fully understand why your body reacts this way when you push outside of your comfort zone, you must think beyond the physical exercise and muscles themselves. The brain remains the commander in chief of the body and will dictate how to best accomplish whatever task is thrown its way.

Activate your muscles

When doing any sort of exercise, the brain first has to send a signal through the nervous system to recruit the muscle fibers needed to complete the activity. You may have heard of “muscle activation” as part of a warmup before doing heavier or more intense training. If your plan is to do squats in your workout, you will likely do lower-level exercises, such as glute bridges or hamstring curls, to start the process of recruiting muscle motor units.

Think of muscle recruitment like your favorite restaurant. How do they provide staff for the restaurant? Does the manager schedule the staff on a Tuesday morning? Or do they schedule the majority of their staff on Friday and Saturday evening? My guess is the latter. They need to have enough staff on hand during peak hours and fewer staff on hand during the slower parts of the day and week.

All hands on deck!

This is the same way that muscle fibers get recruited: on an “as needed” basis. The more strenuous the activity, the more motor units are needed to complete the task. As the exercise becomes more fatiguing towards the end of the workout, more muscle fibers have to step in to take the place of the other depleted motor units. This is where the shaking and trembling comes into play.

So, you’re in the middle of your plank and so far, so good. You feel comfortable and capable of holding the position because you have yet to tap into those reserved muscle fibers. Only half the staff are working since it’s a Tuesday morning and the restaurant isn’t packed. And that’s when suddenly things ramp up. You’re starting to fatigue; the lunchtime rush is starting to make their way through the door. So, you call on more staff, more muscle fibers start to get recruited and give the other fibers a break so they can recover. Your body shakes because your muscles are constantly alternating between states of contraction and relaxation to give you the best chance of finishing that minute long plank or last set of bicep curls.

How do you prevent these muscle shakes from happening? You keep pushing yourself outside of your comfort zone and embrace the shaking because that’s the moment where you get stronger. Training never gets easier, and it’s not meant to. Training is meant to constantly challenge you to be better than you were yesterday, so if that 60 second plank starts to seem less daunting, keep pushing past that until you find yourself outside your comfort zone once again.

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Nicholas DiMeglio

Nicholas DiMeglio, CSCS, is a personal trainer at our Greenwich and New Canaan locations. He has a passion for sports, which led him to become a trainer, and he now seeks to quarterback his clients' care in order to help them succeed.

Meet Nick

Why is there an increase in work-from-home injuries?

Though many Americans are working from home, there has been a seemingly counterintuitive increase in work-related injuries. The reason may lie in your commute — or lack thereof.

Oct 1, 2021 | Kiera Klaum, DPT

With recent events, working from home has become a new normal for many Americans. With this change, varying data has come to light amongst this massive lifestyle change. One would posit that working from home should result in no work-related injuries, right? Recent studies have hypothesized no, not really. Instead, we’ve seen a rise of injured in people working from home — but what is the culprit? What mistakes are we making?

Part of it may lead back to where we choose to sit. A recent survey taken by NuLab amongst 856 participants working from home during the COVID-19 pandemic found that about 40% are not performing their work duties from a desk, with almost 30% of them reporting working from their bedroom.

There is also a common thread between the common injuries being reported to me in the clinic from the working-from-home population, one of which being back and neck pain with onsets that become worse at the end of the day. Having the ideal ergonomic set up in your workspace at a desk is still only a part of the equation. (For more, check out our article on how to achieve proper workspace ergonomics.)

With fewer employees coming into the office and total step counts on your daily travels decreasing as you only move from one room of your home to another, the answer may be as simple as it seems: the culprit may be your commute — or lack thereof.

But what does your commute have to do with this? More than you may think. With decreased commute times comes decreased activity for all those working from home. Current medical research supports that decreased activity results in deconditioning of our bodies, which results in strength and endurance losses. Prolonged immobility within the first week is proven to result in a significant decrease in muscle mass, bone density and higher rates of reported pain.

Yet many situations arise with low levels of reported pain, not enough for someone to feel a need to for medical attention. Often, individuals avoid addressing the issue until the pain interferes severely with their daily functioning. For example, a person new to working from home may not have the appropriate desk chair and starts to feel pain in their lower back but ignores it while the pain is manageable or not always noticeable. Once the situation lasts for long enough, the pain increases and the person has no other choice but to seek medical attention, even if they manage to get a better chair.

Successfully managing pain early is proven to be a key component in recovery and decreased risks of developing chronic conditions associated with it. Being active, getting up and moving can do the body a world of good. Resistance exercise especially is proven to lead to greater muscle mass increases and increased quality of life. Standing up from your home set up and doing hourly walks are all examples of ways to better incorporate more movement into your daily life until normalcy is attained in your working environment.

And what does physical therapy have to do with all of this? Finding the root of the problem quickly and effectively can significantly decrease your risk of further issues. Don’t wait until it’s too late.

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Kiera Klaum

Kiera Klaum, DPT, is based out of the Darien office. She focuses on orthopedic physical therapy, has experience with post-operative and post-COVID care and has worked with people of all ages and backgrounds, including athletes.

Meet Kiera

The four best running belts

With Autumn in reach, it's time to stop using treadmills and take advantage of the cooler weather and take your runs outside. Here are the four best belts to make sure you can still have your essentials on your runs.

Sept 15, 2021 | Performance Optimal Health

A running belt lets you bring your phone, keys, and even water on a run while keeping your hands—and pockets—free. A good one does its job with zero bouncing or discomfort. We tested 37 belts and bands to find those you’re likely to notice the least while logging miles. We recommend the SPIbelt Large Pocket for daily runs. If you want an everyday belt with more pockets, we like the Nathan Adjustable-Fit Zipster. The waistband-style Naked Running Band is our pick for runners who need added capacity, and if you want a belt with two water bottles, we think the Nathan TrailMix Plus is the best.

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The myth of “no pain, no gain”

No pain, no gain, right? Wrong. While you may think soreness after a workout means it was effective, the pain may not be necessary for gains.

Sep 1, 2021 | Christopher Nolan, CSCS

I am sure many of us have all heard the phrase, “no pain, no gain” at some point in our lives. Whether it be from a coach, trainer or anybody attempting to motivate us during a workout or convince us to work through soreness during a subsequent bout of exercise. This leads to the notion that if we are not very sore following an intense workout, then we simply didn’t work hard enough. The idea is that the soreness you are feeling post exercise is ideal and a great indicator of gains to come in the form of muscle growth (hypertrophy) and will lead to an increase in overall performance.

But what if I were to tell you that this in indeed simply a myth? Pushing through muscular fatigue and pain in order to achieve optimal gains not only has no evidence to support it, but could potentially show an adverse effect on your athletic performance. This does not only pertain to the athletes out there, but also to the general exercise practitioners. First, let’s tackle what exactly muscle soreness post-exercise and hypertrophy are, and if there actually is any direct correlation between the two.

Delayed onset muscle soreness

A common occurrence following bouts of new or vigorous physical activity is delayed onset muscle soreness (DOMS). DOMS is routinely recognized by individuals who regularly perform resistance training as one of the best indicators of an effective training session. Some view DOMS as a necessary precursor for muscle remodeling and growth. Soreness can become evident six to eight hours following a training session and peak approximately 48 hours post-exercise, but can be highly variable depending on factors such as exercise intensity, training status and genetics.

Hypertrophy is the growth of skeletal muscle in response to repeated bouts of resistance exercise. This will be characterized by an increase in the cross-sectional area of individual muscle fibers as well as the volume of the entire muscle. Force production (strength) is a function of the cross-sectional area of muscles, so the result of increased hypertrophy will include an increase in overall strength.

Can you train without pain?

The series of events which leads to muscle remodeling and growth following exercise is thought to be initiated by muscle damage. In a study of subjects performing an eight-week lower extremity eccentric resistance exercise program, Flann et al. aimed to investigate if muscle hypertrophy and strength gains were possible without the evidence of symptoms of damage.

They tested two groups of participants (14 healthy college students, eight males and six females, of equalized age, sex, height, body mass, and quadriceps strength) who were separated into pre-trained and naive participants. The pre-trained group was initially introduced to a three-week ramp-up program to prep their body for the same subsequent eight-week resistance program that both groups would follow together.

Their results showed that both groups demonstrated significantly differing levels of muscle damage, with the pre-trained group having no demonstrable muscle damage throughout the eight weeks, whereas the naive group showed muscle damage well above normal levels and much greater levels of perceived muscle soreness. Even with the naive group presenting with more measurable muscle damage and perceived DOMS, both groups show equal gains in quadriceps muscle strength and size. Concluding that muscle damage and elevated levels of perceived soreness are not required for gains in strength and hypertrophy, therefore disproving the notion of “no pain, no gain.”

More pain, more loss?

According to Schoenfeld and Contreras of the Strength and Conditioning Journal, “high levels of soreness should be regarded as detrimental because it is a sign that the lifter has exceeded the capacity for the muscle to efficiently repair itself. Moreover, excessive soreness can impede the ability to train optimally and decrease motivation to train. Thus, the applicability of DOMS in assessing workout quality is inherently limited, and it therefore should not be used as a definitive gauge of results.”

Increased levels of soreness shouldn’t always be the desired result of bouts of exercise nor should it be used as a gauge of the effectiveness of a workout. However, DOMS is not necessarily a bad result and is very common amongst those participating in resistance training or long bouts of aerobic exercise. Increases in hypertrophy and force production can be achieved without the onset of DOMS or elevated levels of muscle damage. Don’t immediately think you didn’t work hard enough if you don’t end up sore following exercise sessions. Gains can be made without pain.

References:

Schoenfeld, Brad J. MSc, CSCS, CSPS1; Contreras, Bret MA, CSCS2 Is Postexercise Muscle Soreness a Valid Indicator of Muscular Adaptations?, Strength and Conditioning Journal: October 2013 - Volume 35 - Issue 5 - p 16-21.

Kyle L. Flann, Paul C. LaStayo, Donald A. McClain, Mark Hazel, Stan L. Lindstedt; Muscle damage and muscle remodeling: no pain, no gain?. J Exp Biol 15 February 2011; 214 (4): 674–679.

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Christopher Nolan

Christopher Nolan, CSCS, is a personal trainer and certified strength and conditioning specialist based in Westport. He is passionate about exercise science and sport-specific training, and is working toward a certification as a Functional Strength Coach.

Meet Chris

Does a cup of joe a day keep the doctor away?

Chances are, there's probably a coffee shop within five minutes of where you are currently located. It seems like everyone drinks it — with creamers, syrups and plenty of caffeine. But what exactly does it do to your body and how much is safe to drink?

Aug 15, 2021 | Performance Optimal Health

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Tips on avoiding joint pain during exercise

Experiencing joint pain during exercise is not inevitable. Here are some tips on how to keep your joints moving, loose, fluid and pain-free.

Aug 15, 2021 | Carter Bushway, CPT, CSCS

The joints in your body are made up of muscle, cartilage and ligaments that connect your bones together and allow for all the movement your body needs to perform throughout the day. On an average day, these movements go on without a hitch. However, there are days where you can feel every move you make, and those joints feel like they need a whole quart of oil to function properly. Let’s take a quick dive into how and why those days happen, and what you can do to help prevent and manage those symptoms.

Joint pain can be a result of a few primary causes:

1.Arthritis – Swelling, pain, decreased range of motion and stiffness in the joints are the most common symptoms associated with arthritis. There are over 100 different types of arthritis and over 22.7 million people in the United States are affected by one of them (via the International Association for the Study of Pain, 2016).
2.Injury – Whether it is muscular, skeletal or ligamentous, any damage of the tissues surrounding the joint can cause pain.
3.Being overweight – Having extra weight for your body to carry around can result in an increased amount of strain and stress on the body and a significant amount of pain.

These primary causes can affect a lot of us via genetic predisposition, in which we have little to no control over. However, what we can control is how we manage this joint pain and protect ourselves from making it worse or getting the symptoms altogether. Often, we look towards the complete stoppage of activity to alleviate pain, but in recent years studies have shown that exercise can provide a great benefit to those experiencing joint pain by keeping the joints moving, loose and fluid.

Before you get started with any sort of planned exercise, make sure that you warm up properly. A 5–10-minute warm up routine will be crucial to not only your performance during the workout, but also your joint’s ability to perform all the movements you have ahead of you. This warmup should consist of lighter exercises that are a mini version of what you’ll be doing in the main part of your workout. For example, if you’re doing a strength routine for the day and have weighted squats planned, add in some bodyweight squats and a wall sit to help get those quads firing and put your hip, knee, and ankle joints in the right position. Sprinkle in 5 minutes of light conditioning to get your heart rate up (stationary bike is a great option to keep impact on the joints low) and you and your joints will be prepared for your workout!

Exercise selection is tricky for anyone, especially when given restrictions and having to think of workarounds for your joint pain. A lot of the time we tend to eliminate the more traditional exercises such as squats, hip hinging and planks and try to seek out the perfect exercise that gives us what we want without any sort of pain. But most traditional exercises can be modified to fit those needs and still protect those joints. Putting a wedge under your heels to help with ankle mobility during squats can help you put more emphasis on driving through your heels, which will result in less pressure on your knees. A half foam roller under your hands can help make your wrists more comfortable during push ups or plank variations. If you need help with modifying the exercises you want to do, consult a personal trainer or physical therapist for your exercise selection.

What is just as important as before and during exercise is what you do after, and this is where a few major steps can be taken to help improve your joint health. Don’t take your cooldown from your workout for granted, and always stretch to end the workout. It is a great way to steadily decrease your heart rate and decrease tension in your muscles post-workout, which will in turn increase overall joint range of motion. During that stretching, try to incorporate foam rolling into your cooldown routine. Foam rolling targets not only muscles, but fascia, which is the connective tissue that surrounds muscles and joints to keep them in place. Tightness of fascia in certain areas can results in restrictions and pain within the associated joints.

While all these adjustments you can make during your workouts will help with your joint pain, making that extra effort and taking care of your body between exercise sessions is just as important. Many times, we tend to isolate our activities and forget that everything we do effects everything we do. Improving on our recovery, nutrition and sleep will provide just as many positive benefits to our joint health as reshaping the way we exercise. Using a hot pack or sauna in between workouts will increase blood flow and loosen up tight muscles. Following an anti-inflammatory diet can improve your body’s healing response and reduce that chronic joint inflammation and pain. Getting those eight hours of sleep will allow your body to physiologically recover from that workout and be ready for the next day ahead. All these little things outside of the exercise can help improve our body’s response to the exercise and decrease the overall pain and discomfort many of us experience.

Joint pain can be inhibiting and frustrating for anyone who experiences it. We feel like we can’t do things that we used to be able to do, and that we must flip our lives upside down to meet the new expectations of our body. But there are some things that we can do to help maintain control, and keep doing the things we love to do, for as long as we love to do them. If you’re looking to do just that, start a conversation with your friendly neighborhood health professional, and we’ll get you on the right track!

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Carter Bushway

Carter Bushway, CPT, CSCS, has a passion for sport-specific training, plyometrics and explosive movements, and is studying to become a Certified Strength and Conditioning Specialist.

Meet Carter

Yes, you can treat tennis elbow without surgery

Surgery is not always the first solution to treating tennis elbow. There are numerous established treatments you can try instead, including physical therapy, dry needling and local cryotherapy.

Aug 1, 2021 | Ken Rubin, DPT

"Tennis elbow,” or lateral epicondylitis, is a common condition that presents with pain and tenderness around the lateral elbow at the site of the common wrist extensor tendon. This condition is frequently associated with a backhand motion in tennis and forced wrist extension, hence its name. It is also common in people who perform repetitive gripping activities, such as manual laborers. In the first three months of symptom onset, the condition is associated with an acute inflammatory process taking place at the insertion of the common wrist extensor tendon as it attaches to the humerus. The extensor carpi radialis brevis is the most commonly implicated muscle. The pathology appears to be consistent with degeneration of the long extensor tendons near the insertion to the humerus when symptoms last greater than three months. Up to 20% of cases persist after one year.

Tennis elbow affects between 1-3% of the general population, 7.4% of industrial workers, and 40-50% of tennis players. People between ages 35-50 years old are at highest risk.

However, it is important to speak with your physical therapist or physician to rule out other possible causes of lateral elbow pain. One common differential diagnosis is radial tunnel syndrome. This is a condition where the posterior interosseous nerve is being compressed as it travels under the supinator muscle which will also present with lateral elbow pain.

The good news is that there are numerous established treatments for tennis elbow. Symptoms can often be managed conservatively with physical therapy, but in some cases medical intervention is indicated. These interventions include, but are not limited to, the use of non-steroidal anti-inflammatory drugs, corticosteroid injections, protein-rich plasma injections, or in rare cases, surgery. This article will focus on physical therapy interventions. Your therapist will be able to refer you to another medical provider if you are not appropriate for therapy.

There is strong evidence for the use of strengthening exercises in the treatment of tennis elbow. Specifically, eccentric strengthening of the wrist extensor tendons. Eccentric strengthening refers to loading a muscle with resistance while it is lengthening. Conversely, concentric strengthening refers to loading a muscle while it is shortening. In a study where subjects had symptoms for greater than three months, the group that was prescribed eccentric strengthening demonstrated a faster regression of pain and a greater increase in muscle strength when compared to a group that was prescribed concentric strengthening. These results were persistent through the 12-month follow up period. Your physical therapist can help guide you in how to correctly perform these exercises, how much volume to complete and the appropriate resistance to use.

Exercises prescribed by your therapist will not be limited to your elbow. Research supports the use of scapular and rotator cuff strengthening in the treatment of tennis elbow. Training the lower and middle trapezius muscles can assist with scapular stabilization that will reduce stress on the elbow when participating in gripping activities and racquet sports.

Various manual therapy techniques are supported in the literature as part of a comprehensive treatment for Tennis Elbow. These include deep friction massage (DFM) and dry needling (DN). DFM is a technique intended to increase blood flow to a tendon in order to facilitate healing by increasing the supply of oxygen transported to the tissue. The goal of DFM is to prevent abnormal fibrous adhesions and abnormal scarring. This has been shown to decrease pain and improve grip strength in patients with tennis elbow.

Dry needling is a procedure in which a physical therapist penetrates the skin with a thin monofilament needle to treat underlying myofascial trigger points to manage neuromusculoskeletal pain and movement impairments. Trigger points refer to tight bands of muscle that disrupt function, restrict range of motion, cause local tenderness or refer pain. When comparing patients who received dry needling in addition to standard physical therapy in the treatment of tennis elbow to patients without DN, the DN group demonstrates an increased rate of pain reduction. DN has also been shown to be comparable to corticosteroid injections for patients with tennis elbow and actually may be superior in terms of perceived benefit from the patient. Both treatments were shown to be effective; however, there was a significantly higher rate of adverse reactions to those treated with corticosteroid injections compared to DN.

Various modalities may be beneficial in treating tennis elbow in addition to exercise and manual therapies. Local cryotherapy has been demonstrated to reduce the intake of analgesics and improve physical activity levels on those being treated for tennis elbow. This is due to reduction in inflammation in the target tissue, amongst other physiologic effects.

In conclusion, tennis elbow is a common condition trademarked by lateral elbow pain that is oftentimes associated with repetitive gripping activities and racquet sports. It is important to see a physical therapist once symptoms present to prevent tendon degeneration, development of chronic symptoms and to establish a comprehensive program to address the underlying impairments. Your physical therapist will establish a patient-centered treatment plan consisting of progressive exercise, manual therapies and modalities to reduce pain and restore full function.

7 nutrition and training strategies Olympic athletes use

We can all learn from Olympic athletes' nutrition habits. From staying consistent to avoid fad diets, their advice comes from experience

Jul 15, 2021 | Performance Optimal Health

It's no secret that becoming an Olympic athlete isn't easy. Seemingly superhuman genetics? That's status quo. An Olympianalso has to treat training like a full-time job—because it is, in fact, a full-time job at their level. And while their training and motivation to come out on top and bring a gold medal home may be a notch (or quite a few notches) above your level, the core strategies they follow aren't complicated.

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The training regimen that qualified Allyson Felix for the Olympics

To be the best of the best, you need to perform at peak performance, & Allyson Felix is well aware. Take a look at her intense training regimen.

Jul 15, 2021 | Performance Optimal Health

The grueling training regimen in the pursuit of qualifying for Olympic Games is not meant to be done at a sustainable pace. It’s a carefully calibrated push to prepare to perform at peak levels.

But when the 2020 Tokyo Olympics were postponed until 2021 this past March due to the ongoing Covid-19 pandemic, four-time Olympian and sprinter Allyson Felix was at the height of her training. What exactly does that entail? How about three hours of endurance training on the track followed by two more lifting in the gym?

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On your period? Here’s how you can maximize your training

Depending on which phase of your menstrual cycle you're in, you should approach your training — or recovery — differently.

Jun 15, 2021 | Jessica Klecki, DPT

So, you started your period; great! Cue the tampon hiding in the sleeve trick, the constant paranoia of leakage and finding every excuse in the book to eat that extra piece of chocolate. It’s been happening monthly like clockwork (maybe) since puberty, but do you actually know what happens in your body during this phase of your cycle? That’s right, PHASE. Your cycle is more than menstruation itself (the bleeding part).

The average menstrual cycle spans anywhere from 21–35 days and consists of two phases. The first is the follicular phase, which begins the first day of your period and ends at ovulation. The second is the luteal phase, which begins at ovulation and ends on the first day of your period. Ovulation occurs around 12¬–14 days after menses (your period) begins. The length of these two phases can vary based on the length of your entire cycle and when ovulation occurs.

Many women find it helpful to track their cycles with a tracking app (Clue, Flo, Ovia) — and some smart watches even come with a built-in feature now! It’s important to note that usage of oral contraceptives or IUDs can alter your natural cycle length and its characteristics because they alter the hormone levels in your body.

Your cycle is dependent on these hormones. Estrogen and progesterone are both sex hormones responsible for the development and regulation of the female reproductive system. You can see how the levels shift in the images below:

During the follicular phase there is a gradual rise in estrogen until ovulation. At ovulation, there is a steep drop in estrogen levels. Throughout the follicular phase progesterone levels stay relatively low.
Then, in the luteal phase, a sharp rise in progesterone occurs as estrogen levels stay low. If an egg is not fertilized and implanted, progesterone levels dip and shed the uterine lining, resulting in your period. If an egg is implanted, your progesterone levels continue to rise, pausing your cycle and preparing you for pregnancy, causing you to miss your period.

Higher levels of estrogen (follicular phase) prepare the body for ovulation and can have many effects on the body, including: increased glucose (sugar in the bloodstream for immediate use) usage, increased pain tolerance, increased tolerance to intense exercise, improved endurance and increased joint laxity (more mobility in joints). This means when estrogen levels reach their peak in our bodies we have more energy, recover quicker and can tolerate more before experiencing fatigue.

On the other hand, higher levels of progesterone (luteal) prepare the female body for when an egg is fertilized and implanted. These effects can include: increased fat storage, heart rate, breathing rate, glycogen (stored glucose for energy later) storage and joint laxity, as well as slowed muscle growth. Unlike peak estrogen effects, our bodies store more energy and tolerate less when progesterone peaks.

Since these hormones are affecting our performance, how can we use this information to our advantage?

The follicular phase (including your period week) is the time to train hard! Think higher intensity exercise including heavy/high intensity strength training and higher volumes for cardiovascular-based exercise (HIIT workouts, running, rowing, swimming, etc). Now is the time to reach for your personal best and really push yourself. We often avoid exercise during period week, but a little movement could be just what you need. You have enough energy stored from the luteal phase to fuel your workouts, and you may notice you are able to perform better than you thought!

The luteal phase is the time to rest and recover. If you feel like you’re dragging and are tired, listen to your body! Focus on lighter resistance exercises and low-effort cardio (LISS). This is the perfect time to take out your yoga mat or head outside for a walk.

While these are just a few tips to guide you, remember that Olympic gold metals, the U.S. Open, and NCAA championships have been won by women in all phases of their cycles.

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Jessica Klecki

Jessica Klecki, DPT, is a pelvic health specialist whose unique approach involves creating comprehensive treatment plans that incorporate various exercises, breathing techniques and stretching methods.

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Progress does not stop with age: how to train for life

Age-related declines in physical fitness and health are not a sure thing — here's how you can subvert expectations and stay fit as you grow older.

Jun 1, 2021Mathew Welch, ATC, CSCS

May 26, 2023 | Elisa LaBelle, PT, MSPT

“Oh yeah? Well, just wait until you’re my age…”

“That routine won’t work for someone in their 50s.”

“This is what happens! As you get older, things start to break down.”

• How many times have you been told this from a friend, colleague or worse, a fitness or healthcare professional? Here are some cold, hard stats that matter:
• Strength and muscle mass can begin to decline as early as age 30 — between 3–8% per decade. At age 50, these losses may exceed 40% and 15% (respectively) every decade after (1,2,3).
• Adults can lose power 1.7x faster than their strength as they age (4).
• Individuals with below-average grip strength in one study were 50% more likely to die earlier than their stronger counterparts. Researchers concluded, “muscle weakness is a serious public health concern.” (5)

What if I told you that these age-related declines in physical fitness and health are not such a sure thing as we have all been led to believe? A recent meta-analysis of 47 studies of individuals 50 and over showed after 18 weeks of strength training, the average increases in upper and lower body strength were 49% and 62%, respectively (6). Another meta-analysis observed older adults who performed full-body strength training and found that it is possible to achieve an up to 13.5% increase in lean muscle mass (7). In terms of power development, one study showed that older adults can improve their maximal muscle power by 51% after 12 weeks of explosive and ballistic resistance training (8).

This is evidence that you can still crush your fitness goals well into your 30s, 40s, 50s and beyond while mitigating pain or injury. In this article, I will debunk the myths associated with exercise and aging. I will also give you a fitness and recovery blueprint that will help you set clear training goals, train intelligently and optimize your recovery so you can build resiliency to train for a lifetime.

You’ve been lied to

Using health-related buzz words (HIIT training, circuit training, low carb, keto, vegan) or recommendations is common in popular men’s health-related articles and magazines. And they have large audiences who are prone to listening to what they say. The most popular magazines, Men’s Health and Men’s Fitness, reach an estimated 71 million readers worldwide!

However, you should be cognizant when implementing recommendations provided in these magazines and those alike. According to a study published last year, out of 160 recommendations made across several volumes by these two popular men’s health-related journals, only 38 (23.6%) were supported by available medical literature findings (9). This literature was extensively reviewed by a panel of health experts across multiple disciplines.

While I have nothing against these two magazines and acknowledge that they have incredible reach, I recommend you speak with a fitness or healthcare provider before implementing any medical interventions obtained from a magazine. At Performance Optimal Health, we pride ourselves on being teachers and scholars. That involves educating ourselves on current research and practicing what we preach so that we can be a credible resource to help you maximize your health and fitness!

The remainder of this article will serve as a blueprint for you to navigate the wild west of health and fitness in search of answers to help set you on the path of accomplishing your health and fitness goals.

Goal Setting

First stop — it’s time to set clear training goals. This means digging deeper than “tone-up” or “get back into shape.” The biggest issue with goals like this is that they aren’t specific or measurable. As a result, you have no way of knowing whether your training is really working because there was no clear goal or process from the start. A better way to set training goals for yourself requires two steps. First, use the SMART method and then describe the skills or behaviors you will need to adopt that will help you accomplish this goal.

S – Specific
M – Measurable
A – Aggressive but Attainable
R – Realistic
T – Time-orientet

When you apply this method to the vague goal of “losing weight” it turns into:

“I will lose 10-pounds a month from today. I will do this by exercising 4–5 days per week and planning my meals at the beginning of the week. I will get 7–8 hours of quality sleep by adhering to a sleep schedule and use the heat sauna once every week on my off day for recovery.”

While this goal is clearly defined, we all know that life happens. It’s one thing to write down or verbalize your goal and how you will go about it, it is another to actually follow through There will be times when you are stressed, confused, frustrated and even exhausted.

Accomplishing your goal will require a balance of self-knowledge, task knowledge and grit. You must be honest with how much you are willing to give. You must be honest with how much you actually know about what it is you’re trying to do. If you don’t, consult a professional! Lastly, you must realize that failures are merely results. Understand that accountability, consistency, effort and the ability to learn from failures is the key to accomplishing any long-term goal.

Training principles

When it comes to training, progression and overload are the name of the game. More reps, more sets, more weight, more difficult exercise variations, completing a workout in a shorter period of time (training density) are all forms of these principles. However, training is not linear. If this were the case, we would all be squatting and bench-pressing thousands of pounds by now from cumulative increases over the years. Intelligent training involves manipulating specific training variables (volume, intensity) based on training goals, experience and most importantly, your ability to recover.

Furthermore, diminished returns are inevitable when you have been training for several years. You will no longer reap the same benefits (muscle growth and strength) with the same methods you once used. If you’ve been doing the same fitness routine for the past 6 months, it’s unlikely you’re getting the desired results. Therefore, subtle variations in training methods and exercises over time are critical in keeping your body strong and resilient.

Given all this, however, more training does not always equal more results. You can only train as hard as you can recover! Training itself is a catabolic process (breaking down muscle fibers) while recovery is anabolic (improved tissue strength and resiliency). However, most people have no plan for the 23 hours they spend outside of the gym. Taking this into account, creating the right balance between exercise and recovery is a critical piece of how we approach our client’s programming at Performance.

Training program

A typical training program at Performance Optimal Health follows the R7 method created by Mike Robertson. This involves dedicating a specific amount of time to multiple fitness qualities: flexibility/mobility, dynamic movement, Corrective exercise, power, strength, conditioning and recovery. The amount of time dedicated to each component of the program depends on the client’s goals and current fitness level.

Even when considering injuries, we find a way to maximize each client’s 60-minute session incorporating all of these components. As you age, you don’t have to stop doing certain exercises, methods or trade strength training for pure cardio. In fact, the research tells us we should be doing everything we can to stay fit for life by balancing the qualities previously mentioned. Here are some examples of one of our awesome clients, Paul Steed putting this on display:

Doing HIIT workouts? Know your limits

Have you noticed that your energy or power production is decreasing, but you haven't changed your exercise routine? You might be overdoing high-intensity interval training (HIIT).

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May 15, 2021| Performance Optimal Health

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Finding her way in the world of physical therapy

May 1, 2021 | Ashley Moriarty, DPT, OCS

I wish I had a positive story of why I became a physical therapist – an injury I overcame, a family member who inspired me, a teacher who really pushed me, but my story is a little more negative (but it turned positive in the end!). I did in fact have physical therapy as a kid, but was it knee pain or shoulder pain, I can’t remember? It was boring and my physical therapist never talked to me. It didn’t really help, I stopped going, and I moved on with my life. Overall, a negative experience.

Exploring the world of physical therapy

Fast forward a few years to high school, college visits and thinking about the future. Physical therapy was always stuck in the back of my mind, but in a way that made me think, “physical therapy has got to be better than what I experienced.” I knew I wanted to work with motivated people and be constantly learning, with every day looking different than the last.

I started looking more into what physical therapy could be and jumped into a six-year program at Boston University. After many classes and clinical rotations and a first job, I kept thinking, “there’s got to be more than this.” Which is how I found myself at Performance, where it’s more than just physical therapy.

I’m lucky that I found a place where the team mentality is that physical therapy is just one aspect of care, one piece of the puzzle. Of course, sometimes physical therapy is the big puzzle piece, but sometimes it’s smaller one or just the first one. Sometimes it’s not even something that you’re missing. Either way, it’s a team approach to care, and everyone works together to connect with our clients and each other.

Never does a day go by that is filled with silence; I aim to make physical therapy a pleasant, welcoming endeavor where my client also sees me as a friend, helping them on their journey. Every day, I work hard so that I do not recreate my own experiences with physical therapy for others. I want to be the glue in their health puzzle, not just a part that may get lost.

Putting together the puzzle of health

And in helping my patients and clients put their health puzzle together, I’ve tweaked how I look at my own. It’s easy to say that optimal health is finding a balance between the four pillars (exercise, nutrition, recovery and stress management). It’s also easy to say that it looks different for everyone based on their individual goals and lives.

What’s harder to understand is that even for myself, the achievement of optimal health looks different day to day, year to year. Life is constantly changing and I am constantly adapting, so my journey toward optimal health should also be flexible. What I need today is not what I need tomorrow, and it may look completely different than what I needed six months ago and what I will need a year from now. I’ve learned rest days are good for you, and what you feed your soul is just as important as what you feed your body. Trying a new recipe, walking my puppy, catching up on The Bachelor, or getting a new personal record in a Peloton ride are all aspects of my optimal health.

My takeaway: find what’s important to you and for you, and get started today.

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Ashley Moriarty

Ashley Moriarty, DPT, ATC, is a physical therapist and certified dry needling specialist based in New Canaan. Before joining Performance, she worked in Boston with both high school and collegiate athletes.

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Couch to Competition: Webinar Series

Watch our Couch to Competition webinar series on getting back to lacrosse, baseball, golf, rowing and running.

Apr 14, 2021 | Performance Optimal Health

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Finding the right balance

Carolyn Surgent is a mover by nature, so it’s no surprise she became a physical therapist. What could be better than helping people get back to moving the way that matters most to them?

Mar 15, 2021 | Carolyn Surgent, DPT

I’ve always been a mover, so it’s no surprise I ended up a physical therapist. What could be better than helping people get back to moving the way that matters most to them? But as I approach twenty years in physical therapy, I am all the more aware that there’s so much more that makes coming to work such a pleasure. It means never having the same day twice. I am continually learning, meeting new people, teaching and partnering in others’ journeys to optimal health, helping them find the right balance.

A lifetime of movement

Most of my happiest memories as a kid involve movement: dance class, monkey bars, riding my bike to the beach, splashing in the waves, running for home base in tag. Through my school years and beyond, physical goals have been a constant. From years as a dancer, I learned about discipline, technique and the importance of having a strong core. From years on a mat, yoga has taught me the importance of practice and a deep understanding of structure, function and alignment. From competitive triathlon seasons, I found a deep appreciation for endurance and the importance of preparation. And what a surprise when I found out I was pregnant just days after my securing a personal best in a local triathlon!
Some physical goals have just been for fun, like the year of learning to do a decent push up, or the months spent mastering a handstand. I even tried a season as an adult beginner at Row America here in Greenwich.

The lessons I’ve learned from movement run through the many years spent in school and professional training, meeting my husband on a NYC subway, and starting our family here in Greenwich fifteen years ago. I love how full these years have been with work, community commitments, family and friends, and always, movement.

Finding balance in life — physically & mentally

When the days are filled with things and people that matter, the notion of balance looms large. Inevitably, you can’t make everything a priority and stay sane – even when you have the best intentions. Balance becomes a fluid thing, not a goal. I see it more like posture: no point striving for some ideal. It’s probably best to just increase the time you’re spending in a good position.

In fact, you can look at optimal health in the same way. You can see it is a process — one of making choices, doing what feels right and works for you. For me, that’s trying my best on any given day to learn something new. I strive to stay curious and surround myself with people and things that fill my tank: getting outside, spending time with family and friends, moving. My middle years so far have been about learning to do a better job of taking care of myself, getting better rest and time being still.

My family grew up with a saying my grandfather loved: “Good, better, best. Never let it rest.” Through my 20’s, 30’s and 40’s, I pressed through almost everything by working harder. As I start my 50’s, I’d like that mantra to evolve. Maybe “good, better, best. Remember to get some rest” is a better version!

Keys to success?

• Trust the process
• Keep practicing
• Enjoy the journey!

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Carolyn Surgent

Carolyn Surgent, DPT, is a mover by nature and loves to explore how the body works and moves. She holds a deep curiosity on helping people and enjoys educating others on the importance of taking care of your mental and physical wellbeing..

Carolyn

A laundry list of injuries uncovered a passion for athletic training

As a young athlete, Megan Kudrick sustained many injuries. But instead of slowing her down, they helped her find her passion: athletic training.

Mar 1, 2021| Megan Kudrick, ATC

Ankles, hips, knees, the brain. All places of past injury and all things that shaped me into the person I am today and helped me get to where I am today. Aside from turning into a laundry list of injuries, this guided my career path in more ways than one.

My introduction to the world of athletic training

In high school, I sprained and broke my ankle two times; this made me become close with my athletic trainer, so much so that I decided I wanted to go to school for athletic training. During my senior year of high school, I even decided to intern with my mentor as a way of accumulating class credits. I went on to college and fell in love with the world of athletic training, continuing my athletic career as a triathlete and collegiate rugby player. I also came to realize that helping athletes after an injury wasn’t enough: I wanted to be able to help even more.

I was at my internship at a high school doing rehab for two soccer athletes during pre-season, in charge of creating their return to play strengthening program. As I did that, I noticed that these athletes were sorer than they had been all pre-season from doing basic, bodyweight exercises. This was when I realized that they were weak and deconditioned; no wonder they got hurt. It was then that I decided I wanted to be on the other side of injury, on the side of prevention. I want to train people, help them become more resilient and better athletes. Now, I am applying to grad school to pursue exercise science with a concentration in strength and conditioning.

Putting myself in my athletes' shoes

Not only have my past injuries led me to this career path, they mentally shaped me to be tough, resilient and understanding. I was able to connect with my athletes in all facets of training: from the tough games to the losses and controversies, the injuries to the wins, etc. I had lived it in some ways, and being a collegiate strength and conditioning coach, I grew and experienced it with my athletes. My goal is to always help others get better and improve themselves and to give them confidence in themselves and their athletic abilities. What better way to do so than bandaging and rehabbing them after injury, and getting them better, faster, and stronger?

A career path that led to personal growth

My career path has also helped me grow as a person. I used to be extremely shy in front of crowds; I became uncomfortable and was unable to speak publicly. I gained my voice through coaching and athletic training. It was a voice that talked to parents and helped shape young adults going through some of the most transformative years of their adult lives. It became the voice of reason when things weren’t going right during a training season, or when I had to solve issues between teammates and coaches.

Athletic training truly shaped me into the person I am today, and not just by providing me with experience. I took that experience, reflected upon it, and found value in it to add to my professional career. I have been wrong plenty of times or have not always have the right answer or didn’t know what my next move was. But ultimately, I ditched any type of ego, learned from my mentors and colleagues and grew as a trainer and person. This meant going to other athletic trainers to collaborate on a return to play program for a baseball, acrobatics or tumbling athlete. It meant reaching out to fellow coaches who have mastered their craft to get their opinions and wisdom and starting conversations and using my voice to help others. And that is where true growth and learning comes from.

The key to success? Collaboration

This is one of the biggest reasons that I am part of Performance Optimal Health; it truly is an optimal program. We huddle, we collaborate and bounce ideas and knowledge off of each other. My experiences have made this collaboration all the more important to me. During my senior year of college, I got a severe concussion where I was unable to finish a sentence. I couldn’t go to class, write or even function as a college student. If it wasn’t for my athletic trainer’s constant communication with my doctor, professors and coach, I would be in much worse shape than I am today. They all worked together to help me recover and took a whole-body approach to it, as well. My physical therapist did not just work on my hip, they focused on the whole body. Better yet, they communicated back with my doctor so we were all on the same page, and I got the best care possible.

Throughout this, I learned that the body does not operate separately: the muscular system doesn’t operate without the nervous system and the nervous system does not operate without the brain. Learning all of this at a young age allowed me to bring that knowledge with me later in life. I took it to my athletes, my teammates, and now my work at Performance. We are all constantly bettering ourselves, and I never want that to end.