Category: Blog

Stephanie Soete

Stephanie Soete, CPT, is a personal trainer based in Westport. Her approach to her clients revolves around setting goals. She underscores the fact that not all goals have to be big, just attainable. By empowering her clients to be goal-driven, Stephanie empowers them to achieve victories every day, no matter how big or small.

Meet Steph

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. She also believes that proper nutrition is medicine for the body, and that one’s food intake needs to adapt to support the person’s current goals, age and limitations.

Meet Michele

Jennifer Bohn

Jennifer Bohn is a Pilates Instructor based in North Naples who is certified in a variety of Pilates disciplines, including mat, Reformer, Cadillac, and more. She enjoys working with clients of all ages, especially young athletes, and has been teaching Pilates since 2018.

Meet Jennifer

Optimizing cardiovascular fitness: a collaborative approach for health and performance

At Performance Optimal Health, we value a collaborative approach to improving cardiovascular fitness. Through personalized programs and adherence to ACSM guidelines, clients have seen significant improvements in their cardiovascular health and overall well-being.

February 6, 2024 | William Manzi, CEP

At Performance Optimal Health, our work revolves around collaboration, including doctors and other healthcare professionals in order to create a team for the client. When someone comes through our doors, we identify a baseline estimated V02 max, in order to establish a baseline of cardiovascular fitness. VO2 max is the amount or volume of oxygen your body uses while exercising vigorously, and it's a common tool to understand your fitness level. Knowing your VO2 max can help you train for sports, track your fitness improvement, and improve your overall heart health.

Once this number is established, we work with you and your healthcare team hand in hand in order to directly increase this number. That can involve checking in with the client's doctor, working with one of our nutritionists to establish a healthy diet, or collaborating with our physical therapists to address any potential musculoskeletal issues. Putting it all together allows for the best results for our clients, no matter their goals.

For example, in our 3 month cardiovascular care program where we work with you one on one, monitoring your heart rate, blood pressure, EKG, and MET levels, we have seen one individual increase her numbers by 155%! Another individual even increased her MET level from 32.4 to 50.2 mL/kg/bw in her 3 month program. Protocols were as followed, laid out by the American College of Sports Medicine (ACSM) FITT-VP principle.

At the end of the day, it's about establishing an exercise prescription given to you by your trainer who works with you extensively one on one and communicates with your healthcare team. In our initial intake we sit down to not only get to know you, but also to discuss the four pillars of health — exercise, recovery, nutrition, and stress management, to get a complete picture of your health. At Performance, we look at the body as whole and try to understand what the root cause of the problem is, and not just treat the underlying symptoms.

Here is what a FITT exercise program for cardiovascular exercise looks like:

• Frequency: 3-5 days per week of moderate to vigorous exercise
• Intensity: Low is 40-60% of MaxHR (Heart Rate); Moderate is 60-80% MaxHR; Vigorous is 80-95%MaxHR
• Time: At a moderate intensity, minimum of 150 minutes per week or minimum of 75 minutes per week at a vigorous intensity. This could be 30 minutes of moderate exercise per day or 15 minutes of vigorous exercise per day.
• Type: Aerobic, continuous, rhythmic exercises that incorporate large muscle groups, i.e treadmill, elliptical, rower, bicycle
• Volume: Increase total duration of exercise 2-10 min each week
• Progression: Increase duration before intensity, pushing from 150 min/week to 250 min/week of total duration

William Manzi

William Manzi, CEP, is an exercise physiologist and personal trainer who specializes in the ability to take care of any individual, regardless of any limitations. Over the past ten years, he has trained a variety of different individuals for over ten years, including US Navy SEALs, heart attack patients, and more.

Meet Will

Larry Piretra

Larry Piretra, PT, DPT, OCS, CSCS, TPI-M2 is a physical therapist and strength and conditioning specialist who serves as the Naples Site Lead. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

Garrett Rasmussen

Garrett Rasmussen, CPT, TPI-F1, is a golf trainer based in Naples who specializes in strength and conditioning. He has worked with a diverse population in one-on-one settings as well as small group training, having taught over 10,000 group fitness classes and worked with hundreds individually. As an avid golfer, he is constantly pursuing higher levels of education around the sport, and he is currently working to achieve the TPI Level 2 Power Certification.

Meet Garrett

Garrett Rasmussen

Garrett Rasmussen, CPT, TPI-F1 is a golf trainer based in Naples who specializes in strength and conditioning. He has worked with a diverse population in one-on-one settings as well as small group training, having taught over 10,000 group fitness classes and worked with hundreds individually.

Meet Garrett

Telehealth is here to stay: a client interview

Telehealth and virtual training over platforms like Zoom have proven to be more than just a temporary solution; they are here to stay. The convenience and accessibility offered by remote health services make them particularly beneficial for individuals who travel frequently. Virtual sessions eliminate geographical barriers, allowing people on the move to access personalized training or healthcare guidance seamlessly. Here's how one of our trainers works remotely with his client.

December 7, 2023 | Carter Bushway, CPT

Telehealth and virtual training over platforms like Zoom have proven to be more than just a temporary solution; they are here to stay. The convenience and accessibility offered by remote health services make them particularly beneficial for individuals who travel frequently. Virtual sessions eliminate geographical barriers, allowing people on the move to access personalized training or healthcare guidance seamlessly. This shift not only accommodates the demands of a mobile lifestyle, but also underscores the enduring value of remote health services in providing flexibility and continuity for individuals on the go.

A great example of a client of mine who primarily works with me remotely is Tara N., who we interviewed for this article. Tara has been a phenomenally dedicated client that has been with me for the last three years. She started with me in person as a client coming off of physical therapy with Todd Wilkowski. She's always looking for challenges, but knows her own limitations and what is smart for her to do. To be able to work with someone who not only wants to push herself, but is also smart about how she goes about it and really cares about the how and why of what we are doing every session, it’s been such a privilege for me.

At first, coming out of physical therapy with Todd for a meniscectomy, we initially focused on regaining strength in her legs and stability in her knees to hopefully eventually return to playing tennis. This resulted in a lot of accessory work, focusing on her glutes and inner hip muscles to stabilize gross movement, as well as heavier compound lifts such as squats and deadlifts. As she went to grad school, and then later moved across the country for a job, I shifted programming her workouts that would prepare her for other activities, like volleyball and hiking.

When she moved for grad school, we shifted to all Zoom, with her coming back for evaluations and check-ins during her breaks. Now that she lives across the country, we are basically 99% Zoom, and whenever she comes back to the area to visit family, she stops in and has a session with me, which always warms my heart. We've always been open and honest about what she can do with her schedule, and we've always found a way to make things work.

I think that one of the reasons Tara is doing so well is because she has a great support system around her. Even though she moved locations, she still had her support system with them no matter where they go. I am always a text, phone call, or Zoom call away, and if she ever needs any help, guidance, support, or confidence boost, I'm there for her. Training is tough, anybody who tells you otherwise is selling you something. So, for anyone looking to train virtually, continuing to have their support system to help them do the tough stuff makes all the difference.

Technology is here to stay, and it's up to us to make the most of it.

Our interview with personal training client, Tara N.

1. How did you first join Performance?
   I first joined Performance when I was about 14 years old. I had sustained an injury while I was rowing in high school and shortly after, was recommended to visit Todd. Fast forward a decade or so, I ended up tearing my meniscus in graduate school and came in for physical therapy and got set up with Carter!
2. What has your recent training experience been like?
   Carter is genuinely the best. I am a relatively reserved person when working out; all I want is to be worked hard, and for someone to push me when I need to be pushed. Carter did exactly that and more. When I would feel low and not comfortable in my body, or unhappy with my post-surgery recovery progress, Carter would always be quick with encouragement, and a kind word. He truly understands his clients and is not only an amazing trainer, but a friend as well.
3. What are your goals?
   Funnily enough the very first goal was to just walk comfortably and without pain again. The second goal was to be able to do one pushup! But my serious, overarching goal was to just feel strong, to not have any pain, and to become a better athlete by working on my full body conditioning. I am happy to say that I'm good on goals 1 and 2, and am very happy with my progress on 3.
4. Now that you are training virtually, do you miss coming to your workouts in person?
   Personally, I do love being in person. However, I moved out west for a new job, and being virtual has allowed me not only to stay connected to Performance, but has also allowed me to continue working with Carter! While I do miss coming in and the routine of going to a physical location, I have found that remote working gets rid of any of my excuses to workout and instead has allowed me to really flourish in my space.
5. How did training virtually impact or improve your journey or your goals?
   Initially it was challenging. Coming into the Performance location in Greenwich was so much fun, and I loved using the equipment. That said, Carter's expertise and ability to use what was available to me to achieve the same results was impressive! If anything, training remotely also helped me realize that I can be just as strong, just as productive in my home and that I can achieve physical success anywhere if I know how to look for it.

Carter Bushway

Carter Bushway, CPT, has channeled his passion for exercise into everything he does. Carter has a passion for basketball, balance and stability training, group fitness classes and working with older adults.

Meet Carter

Revolutionizing physical therapy: the transformative role of AI in diagnosis, treatment, and patient care

As we look into the future, the field of physical therapy stands on the brink of a profound revolution, driven by the potential of AI. Much like a skilled practitioner, AI can play a pivotal role in differential diagnosis, determining prognoses, developing personalized treatment plans, and in communication, monitoring and progression of treatment plans from afar.

December 7, 2023 | Shane Foley, PT, DPT, OCS, CSCS

In the ever-evolving landscape of healthcare, the integration of artificial intelligence (AI) has already proven to be a transformative force. Many large hospital organizations are already utilizing this these technologies in things like reading x-rays and MRIs, and for pattern recognition in diagnosis disorders. As we look into the future, the field of physical therapy stands on the brink of a profound revolution, driven by the potential of AI. Much like a skilled practitioner, AI can play a pivotal role in differential diagnosis, determining prognoses, developing personalized treatment plans, and in communication, monitoring and progression of treatment plans from afar. AI is poised to elevate the practice of physical therapy into a more dynamic service offering, by improving precision and efficiency in diagnosis and treatment while fostering enhanced communication between therapists and patients.

One of the primary challenges in orthopedic physical therapy lies in consistency and accuracy of diagnosing a condition, and then developing the best treatment plan to return back to activity without pain and mitigate risk of injury recurrence. AI, with its ability to process vast datasets, synthesize research and identify patterns beyond human capacity, becomes a powerful tool in this regard. Physical therapists, Board Certified Orthopedic or Sports Clinical Specialists, those in Residency or Fellowship post-doctoral training, can all benefit from this tool. By analyzing patient history, imaging, and clinical data, AI algorithms can assist therapists in pinpointing the root cause of musculoskeletal issues with specific accuracy. With this, from the evaluation, patients can know that best guidelines are used to create the framework for the therapist to begin care. This then allows the experience and true artistry of the therapist’s manual therapy and patient specific rehab program design to come into play. This is the real differentiator!

The marriage of human expertise and AI prediction capabilities promises a more dynamic and responsive approach to patient care. This will allow both synchronous and asynchronous analysis of technique and form with prescribed exercises, communication, and the assimilating patient data, lifestyle factors, and treatment responses. AI models can help to forecast the likely trajectory of a condition in real time, providing foresight that enables therapists to proactively adapt treatment plans, optimize outcomes and potentially prevent the exacerbation of symptoms.

Personalization is the cornerstone of effective physical therapy and in high quality patient care. With the busy clinic environment in many physical therapy practices across the country, too often, a 16 y/o patient who tore their ACL and a 65 y/o patient with a knee replacement begin their treatment with the cookie-cutter “Knee Program.” AI helps to develop an evidence based framework for the patient, that the therapist can then use their creativity and expertise to tailor treatment plans to individual needs.

Continuous learning capabilities enable real-time adjustments to treatment plans based on patient progress. Although there is an expected timeline of recovery, as we have seen many times in professional sports, there are many specific and individualized factors which may cause someone to be on one side of the rehab timeline or the other. This iterative and adaptive approach ensures that therapy evolves dynamically, addressing the unique challenges each patient faces throughout their rehabilitation journey and that the determination of time to return to activity is appropriate.

Effective communication is integral to a successful therapeutic alliance between physical therapists and their patients. AI contributes to this aspect by facilitating seamless and personalized communication channels. AI-powered platforms can offer patients real-time guidance, support, and educational resources. These tools not only empower patients to actively participate in their rehabilitation, but also foster a continuous feedback loop between the therapist and the individual. The result is a collaborative and informed approach where patients feel engaged and motivated throughout the treatment process.

As we look toward the future of physical therapy, the symbiotic relationship between human expertise and artificial intelligence promises a paradigm shift in healthcare delivery. The integration of AI in differential diagnosis, prognosis determination, treatment plan development, and patient communication holds the potential to revolutionize the field, providing practitioners with unprecedented tools for precision and efficiency. Utilization of AI in physical therapy is the evolution of their field, a progression to a true hybrid-rehab model.

The hands-on manual artistry of a physical therapist will always be an irreplaceable skill to not just fact-check AI, but to help alleviate pain, decreased muscle tightness, improve mobility, provide tactile cuing for correct exercise performance, and build a trusting relationship between two human beings. It is my position that in the hands of a highly educated, experienced clinician, the utilization of AI is the future of best practice in clinical base healthcare. The utilization of AI across all levels and experiences of clinicians in the field of physical therapy helps to raise the floor, and overall quality of care that can be provided by anyone, anywhere. Thus, helping more people get better both completely and faster.

Shane Foley

Shane Foley, PT, DPT, OCS, CSCS, is an orthopedic specialist who is certified in strength and conditioning, dry needling, and the Schroth Method. He has a deep passion for building relationships, helping people accomplish their goals and leading people to optimize their performance.

Meet Shane

Best approaches to treat your low back pain

Low back pain is one of the most common conditions someone will experience at some point in their life. The good news is that majority of individuals with low back pain will experience complete recovery, especially when utilizing various conservative treatment approaches.

October 6, 2023 | Renee Lascarides, PT, DPT

Low back pain is one of the most common conditions someone will experience at some point in their life. Studies have found lifetime prevalence rates for experiencing low back pain range from 70-84%. While low back pain initially may be scary, there is no reason to worry. The good news is that majority of individuals with low back pain will experience complete recovery, especially when utilizing various conservative treatment approaches that can be customized to fit someone’s needs and interests. These treatments will help control pain, improve disability, and improve quality of life. Surgery is usually only indicated for a small percentage of people with low back pain, and is not the go-to treatment option.

Stay on the move

The spine is built to be strong and resilient. When someone is experiencing low back pain, the first thought is usually to stay in bed and let it rest. However, he best thing to do when low back pain starts up is to modify, not restrict, activity, and keep moving. Avoiding painful movements or activities is okay, but bedrest is going to prolong pain and limitation of daily activities. Motion is lotion for our joints. The more we move, the better our bodies will feel. This is why exercise is the best treatment for low back pain. It may initially seem scary to exercise while you are in pain, but it will not cause any damage or further the injury, especially when it is under the guidance of a trained professional, such as a physical therapist.

Use hands on techniques

Utilizing physical therapy and massage therapy can also drastically reduce pain levels. In the early phases, hands on techniques in physical therapy can help improve how the joints in the low back move and reduce pain levels. It can also help mobilize tight and restricted muscles. Exercises can include gentle and progressive strengthening of the core, hip musculature, trunk, and legs. Aerobic exercise has been found to be one of the most effective treatments for patients who have been experiencing chronic low back pain. This can include walking, swimming, or riding a bicycle.

Other exercise methods that help people with low back pain include Pilates and yoga. Building strength will help reduce pain, restore disability, and improve robustness of the spine. Exercising also allows the body to release pain alleviating chemicals, which reduces the amount of medication needed to control pain.
Another very important aspect of recovering from low back pain is sleep.

Encourage good sleep hygiene

Good quality sleep will allow the body to heal and recover. Good sleep hygiene is crucial for us to function at our highest capacity. There are things we can modify to set us up for success; a cold, dark room along with a consistent sleep and wake time are ideal for good quality sleep.Creating a routine before bed can help signal to our body that it is time to start winding down. Taking a hot shower or bath, stretching, meditating, or doing breathe work are all good activities that will help prime our bodies for sleep and reduce low back pain. Performing this routine at or around the same time every night also helps create a regular sleep schedule. Try to avoid caffeine four to six hours before bed and avoid eating a late dinner. All these tips can help prime our body to reach REM sleep and deep sleep, where our muscles repair and grow and our body and mind recover. This is why good quality sleep will optimize recovery from low back pain.

Overall, there are a variety of methods you can use to decrease your back pain without resorting to surgery unless necessary. Remembering to stay mobile and avoiding bed rest is crucial, as well as getting a good night’s sleep and using hands on recovery methods such as massage or physical therapy.

Renee Lascarides

Renee Lascarides, PT, DPT, is a physical therapist in the Hamden office, as well as an adjunct faculty member at Sacred Heart University. As a youth athlete, Renee was constantly active and played soccer and participated in cheerleading and gymnastics.

Meet Renee

Claire Petri

Claire Petri, CPT, is a personal trainer based in Greenwich and Darien who specializes in strength training and functional fitness. She enjoys working with both athletes and general population clients, and has experience with Pilates techniques, weight loss and pain management, helping clients overcome gym anxieties and learning proper movement patterns.

Meet Claire

Marathon Mondays: Listen to your "foot brain"

Megan Searfoss, owner of Ridgefield and Darien Running Company, joins Britt and Brendan to dive into the rigorous running shoe fitting process that includes a 3D scanner, detailing why the brand and type of shoe matters for the wearer. The trio also discuss the latest trends in footwear, including carbon plating, as well shoe life expectancy and how to deal with companies updating your favorite pair of running shoes.

August 21, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC

On this episode of Marathon Mondays hosted by physical therapist and RRCA Running Coach Britt Gunsser and personal trainer Brendan Copley engage in a discussion about running footwear with Megan Searfoss, the owner of Ridgefield and Darien Running Company.

Megan dives into the rigorous running shoe fitting process that includes a 3D scanner, detailing why the brand and type of shoe matters for the wearer. The trio also discuss the latest trends in footwear, including carbon plating, as well shoe life expectancy and how to deal with companies updating your favorite pair of running shoes.

They dive into the advantages of visiting a running store over buying shoes online, emphasizing the importance of a personalized fitting process, such as using a 3D scanner to determine arch height, size and width, as well pressure points, pronation, supination, and foot flexibility while walking. The purpose of the shoe is also evaluated during the fitting process to determine whether road, trail, cross-training, or walking shoes are right for the customer based on their different needs.

No one shoe will work for everyone, and depends on personal style preference (traditional vs. minimalist vs. maximalist shoes), how they run (forefoot running vs. heel striking) and how much support their feet require. Megan discusses the purpose of shoe rotation, wear and tear considerations, and recovery time for shoes, as well as her specific recommendations for marathoners.

Near the end, Megan touches on the phenomenon of "super shoes," or high-tech sneakers that claim to make their users run faster, explaining who they benefit and their key differences from regular training shoes. She also goes over common myths and misconceptions about running shoes, finally answering the question, "which brand or shoe is the best?"

Finally, the hosts address common myths about running shoes and seek Megan's response to the age-old question of what constitutes the best shoe or brand. The episode concludes with a fun question about pump-up songs for races, offering a well-rounded and informative exploration of the world of running footwear.

Listen here, or wherever you get your podcasts.

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, 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.

Meet Britt

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

Marathon Mondays: Building a marathon training plan

In this introductory episode, Britt and Brendan dig into what you should be looking for in a thorough training program, answer frequently asked questions, and debunk common myths. They cover developing a personalized training plan, the importance of different types of runs, how to incorporate strength training, and more.

May 8, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC

The inaugural episode of the Marathon Monday podcast, hosted by physical therapist Britt Gunsser and personal trainer Brendan Copley, sets the stage aimed to prepare runners at all experience levels for their next race, hosted by marathoners themselves. Their goal is to be as helpful as a post-race banana, offering insights into topics like personalized training plans, types of runs, strength training, and more. They discuss various options for training programs, including pre-formulated online plans, hiring a coach, or going the DIY route, each with its pros and cons. They also touch on how to find the right coach, emphasizing factors like experience, coaching platform, and finding the right personality match.

The episode delves into the five main workout categories in a training plan: long runs, interval training, easy runs, cross training, and recovery runs. They discuss the importance of not overemphasizing the long run, debunking the myth that the long run is the only critical workout. Britt and Brendan also discuss interval training, easy run percentages, and the purpose of recovery runs and cross training.

For those who are just starting out, Britt and Brendan also provide insights into what a typical beginner's strength and conditioning program for runners might look like, stressing the importance of starting with bodyweight or light weights for those new to strength training. They also touch on how strength training requirements might change when training for a marathon, including adjusting to busy schedules or integrating running into other fitness classes effectively.

Listen here, or wherever you get your podcasts.

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, 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.

Meet Britt

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

The vital role of physical therapy after regenerative medicine procedures: exploring the benefits of blood flow restrictive therapy

Regenerative medicine procedures have revolutionized the field of healthcare, offering innovative treatments for various conditions. While these procedures hold tremendous potential for tissue repair and regeneration, it is important to understand the critical role of physical therapy in optimizing outcomes and facilitating a successful recovery.

July 5, 2023 | Ashley Moriarty, PT, DPT, OCS

Regenerative medicine procedures have revolutionized the field of healthcare, offering innovative treatments for various conditions. While these procedures hold tremendous potential for tissue repair and regeneration, it is important to understand the critical role of physical therapy in optimizing outcomes and facilitating a successful recovery. In recent years, emerging research has highlighted the benefits of incorporating blood flow restrictive therapy into the aftercare following regenerative medicine procedures. In this article, as a physical therapist, I will emphasize the importance of physical therapy after regenerative medicine procedures and shed light on the evidence supporting blood flow restrictive therapy.

The significance of physical therapy after regenerative medicine procedures:

Physical therapy plays a vital role in maximizing the benefits of regenerative medicine procedures. These procedures, such as stem cell therapy and platelet-rich plasma (PRP) treatments, aim to promote tissue healing and regeneration. However, without proper rehabilitation, the potential benefits may not be fully realized. Physical therapy helps optimize the healing process, prevent complications, and enhance overall function and mobility. In addition, a comprehensive physical therapy evaluation will help to identify the root cause of tissue breakdown in the first place. Mobility restrictions, muscle imbalances, and poor neuromuscular control all can lead to poor movement patterns which result in excessive stress to certain structures. It is these structures that break down and may require regenerative medicine procedures. However, without addressing the source of the problem these treatments may only lead to transient relief. When combined with physical therapy, a lasting outcome and full resolution is more likely.

Evidence supporting blood flow restrictive therapy:

One particular physical therapy technique that has gained attention in the realm of regenerative medicine aftercare is blood flow restrictive therapy (BFRT). BFRT, also known as occlusion training or KAATSU training, involves the use of specialized cuffs or bands to partially restrict blood flow to a specific limb or muscle group during exercise.

Research studies have demonstrated the benefits of incorporating BFR into the rehabilitation process after regenerative medicine procedures. A study published in the Journal of Orthopaedic & Sports Physical Therapy in 2019 revealed that BFR, combined with traditional rehabilitation exercises, led to significant improvements in muscle strength and function after ACL reconstruction surgery, a common regenerative procedure. The study reported greater quadriceps muscle size, improved knee function, and reduced muscle atrophy compared to traditional rehabilitation alone. Furthermore, a systematic review published in the Journal of Science and Medicine in Sport in 2020 examined the effects of BFR on muscle strength, hypertrophy, and endurance. The review included studies on both healthy individuals and patients with musculoskeletal injuries. The findings suggested that BFR, when properly implemented, can enhance muscle strength, size, and endurance even at lower exercise intensities, making it a valuable tool in the post-regenerative procedure rehabilitation process.

The benefits of BFRT can be attributed to the unique physiological response it elicits. Partial blood flow restriction during exercise creates a hypoxic environment, triggering metabolic and hormonal responses that promote muscle hypertrophy, increased capillarization, and improved muscle fiber recruitment. A study in the Journal of Applied Physiology also found that circulating hematopoietic stem/progenitor cells (HSPC) were increased following BFR compared with control, which may enhance outcomes after regenerative medicine procedures.

Incorporating blood flow restrictive therapy into aftercare:

To incorporate BFR into the aftercare following regenerative medicine procedures, it is crucial to work with a qualified physical therapist who is experienced in this specialized technique. They will assess your condition, develop an individualized rehabilitation plan, and guide you through the appropriate exercises while monitoring your progress and ensuring safety.  It is important to note that BFR should only be performed under the guidance of a trained professional, as improper use or excessive pressure can lead to complications. The appropriate pressure and exercise intensity will be determined based on your unique circumstances, ensuring optimal benefits without compromising your safety.

Physical therapy is an indispensable component of the aftercare process following regenerative medicine procedures. It helps maximize the benefits of these treatments, promoting tissue healing, and restoring function. Incorporating blood flow restrictive therapy into the rehabilitation process has shown promising results in optimizing muscle strength, hypertrophy, and endurance. Preliminary evidence indicates BFR leads to enhanced stem cell migration which may enhance outcomes after regenerative medicine procedures. As always, it is crucial to consult with a qualified physical therapist who can develop a tailored rehabilitation plan to ensure a safe and successful recovery.

Ashley Moriarty

Ashley Moriarty, PT, DPT, OCS, is a board certified orthopedic clinical specialist who is certified in dry needling and pre- and post-natal fitness. She has a passion for helping people move better and stay active, especially new moms.

Meet Ashley

Golf and Lower Back Pain

June 8, 2023 | Larry Piretra, PT, DPT, CSCS, TPI-M2

Golf is a popular pastime for thousands of Americans. It is also a source of pain for many of those thousands. The torque and force used to swing a golf club can create significant risk for developing lower back pain, and this pain most commonly develops over time.

Some believe that back pain is just a side effect of their golf habit. It is the most often reported injury among golfers. In fact, as many as 25% of golfers over the age of 65 report lower back pain. However, it is important to know that it can be avoided with proper technique and training.

Visit The Original Article >

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

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.

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.

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

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.

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.

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

Your Longevity Guidebook

If you want to live the longest, healthiest life, there are certain steps that will contribute to overall longevity: proper exercise, diet, and stress management. Here's your guidebook for increasing your longevity and staying healthy as you age.

Mar 2, 2023 | Will Manzi, CEP

If you want to live the longest, healthiest life, there are certain steps that will contribute to overall longevity: proper exercise, diet, and stress management. Here's your guidebook for increasing your longevity and staying healthy as you age.

Advancing in age is accompanied by an accelerating decline of aerobic exercise capacity, best quantified by peak VO2. This decline in aerobic capacity is exacerbated by many comorbidities common to the elderly. However, numerous observational and interventional studies have demonstrated the beneficial effects of exercise training in older adults, both in healthy and diseased individuals.

If you want to live the longest, healthiest life, there are certain steps that will contribute to overall longevity. There are three simple steps to promote longevity, and these three steps are some of the most cost effective, long term, and preventative measures you can take. The three key factors to this outcome are proper exercise, diet, and stress management. If you can take care of your cardiovascular risk factor profile and increase your VO2 max, you can reduce your biological age by 3.23 years, starting as a healthy individual. (Fitzgerald, Kara N et al. “Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial.” Aging vol. 13,7 (2021): 9419-9432. doi:10.18632/aging.202913.) Beginning as an individual with multiple comorbidities, there can potentially be a reduction in 5–10 years. The problem we see in our society is that there is a lack of education and participation into programs that focus on an optimal health approach. We currently have a community in crisis. However, in the Chinese language, the word “crisis” is composed of two characters, the first “danger”, the second… “opportunity!” So, take the opportunity to improve your health today.

VO2 Max

According to the World Health Organization, the average lifespan is 77.8 years, yet the average health span is only 66.6 years. This means the last 10+ years of our lives we are dealing with at least one, but more likely two or more, risk factors. In order to combat this, there needs to be a focus on cardiovascular exercise, more precisely, increasing your maximal oxygen uptake or VO2 max. VO2 max is related to functional capacity and human performance and has been shown to be a strong and independent predictor of all-cause and disease-specific mortality. (Barbara Strasser, Martin Burtscher. Survival of the fittest: VO2 max, a key predictor of longevity?. Front. Biosci. (Landmark Ed) 2018, 23(8), 1505–1516.) VO2 max is most accurately measured in a lab. During a VO2 max test, you wear a special face mask that measures the amount of air you breathe in and breath out while you exercise. You work at progressively harder intervals until you reach your limit. However, there is another accurate representation of VO2 max through an estimated Bruce Protocol Stress test that we can perform at Performance Optimal Health. The test begins with walking and then increases in speed and incline every three minutes until the individual can no longer continue, either due to physical limitations or achievement of 85% maximum heart rate. Originally, the test was made by American cardiologist Robert A. Bruce in 1963 as a non-invasive test to assess patients with suspected heart disease. In more recent years, the test has been used more to help identify a person's aerobic capacity. It is simple: if you want to be in the best shape possible at 85, start increasing your VO2 max now at age 50. In the figure below, you can see how VO2 max decreases over lifespan.

Nutrition

In combination with exercise, what is just as important to longevity is a healthy diet. A heart-healthy diet such as a Mediterranean based diet or the DASH diet is recommended in order to reduce risk and decrease inflammation in the body. You want to eat a healthy balance of carbohydrates, healthy fats, and lean protein. The general recommendation for someone doing moderate to vigorous exercise is a 50%, 30%, 20% split respectively. You obviously want to incorporate healthy greens and colorful vegetables, as well as low sugar fruits such as avocados, blueberries, and grapefruit. You can get a majority of your carbohydrate intake through these foods. Lean protein choices such as organic chicken, grass-fed beef, and turkey are exceptional. Healthy fat choices include foods high in omega-3 and omega-6 such as nuts, seeds, avocados, and wild caught salmon.

Stress Management

Lastly, a big component of this longevity equation is the management of stress. First and foremost, there are two different types of stress. Positive stress, or eustress, is beneficial to the body. Negative stress is detrimental to the body, and has been shown to increase cortisol levels, which in turn activates our “fight or flight” response. This reaction has been proven to increase blood pressure and heart rate, muscle tension, and the digestive system slows down. Some symptoms may result in nausea, vomiting, and diarrhea. Positive stressors such as exercise, meditation, and yoga have been proven to have the opposite effect. Exercise has proven to decrease resting heart rate, blood pressure, and cholesterol levels, as well as decrease inflammation of the body. Sleep is probably the biggest component to recovery; per CDC guidelines, children 13-18 should get 8-10 hours per night, while the average adult needs 7-9 hours per night.

All in all, there are three main things to focus on. One: make sure you have at least 150 minutes per week of cardiovascular exercise in your target heart rate. Two: eat a well-balanced diet rich in anti-inflammatory foods and antioxidants, foods such as turmeric and ginger have been proven to decrease the body's inflammation. Finally, having tools to cope with stress can help the body with anti-inflammation, muscle recovery, and increased energy. Some tools include cryotherapy, infrared sauna, exercise, and meditation.

Quick Guide

Target Heart Rate:

• 220-Age= Maximum Heart Rate
• Maximum Heart Rate x .60 = 60% Target Heart Rate
• Maximum Heart Rate x .80 = 80% Target Heart Rate

Healthy Diet Tips:

• Low fat and low sodium diets help decrease inflammation.
• Limit salt intake to < 2,000 mg / day.
• Bake, broil, steam, roast, or poach foods without salt; add vegetables lemons, herbs and spices for flavoring;
• When you eat out, try to order baked, broiled, steamed, or poached without breading or sauces.
• Stay away from fast foods.
• Read food labels.
• Hydrate, hydrate, hydrate.
• rack weight weekly or monthly.

Exercise:

Exercise should be coupled with diet to maximize the effects of weight loss and create a healthy lifestyle. The appropriate amount of exercise an individual of your age should be getting is described below under the FITT principle.

Frequency: Greater than or equal to 3-5 days/week of moderate to vigorous exercise.

Intensity: Moderate 40-60% max effort(V0^2R) or Vigorous <60% max effort (VO^2R)

Time: Moderate 30-60 minutes; Vigorous 20-minute maximal bouts before rest

Type: The primary mode of exercise should be cardiovascular in nature, incorporating large muscles being used (bicycling, rowing, and running). The secondary mode is strength training and flexibility/mobility training.

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/.

William Manzi,

William Manzi, CEP, is an exercise physiologist who specializes in the ability to take care of any individual, regardless of any limitations. Having worked with cardiac patients for the past 5 years, Will has developed a speciality in cardiac training and rehabilitation, as well as reading EKGs.

Meet Will

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

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

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.

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.

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.

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.

Watch now >

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.

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.

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.

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!

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

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.

Meet Michael

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.

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.

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