How to Modify Exercises after Injury and When Can I Start Exercising Again?

Patient’s often ask, when can I go back to the gym? Can I take spin class? Can I do yoga? It would be great if there were some in depth analytics behind the answer or some quantifiable YES markers to measure. But the answer is unbearably simple and always the same:

You can do anything that doesn’t cause pain.

Pain means irritation, inflammation and tissue damage. Our body is even sometimes smart enough to give us pain BEFORE tissue damage happens but it’s still a sign of poor function and increased inflammation that will lead to stiffening/local swelling. So if you are injured, feeling pain at the sight of injury or anywhere related to it, is like scratching a scab that is trying to heal. It will set back the healing process and promote increased inflammation.

So don’t feel pain, but this is not to be confused with don’t move. The full correct answer on how to modify exercises or workout after an injury is: move the affected area as much as possible with NO pain. This sometimes means wiggling your ankle 1/2 an inch back and forth for 30 minutes. This would be a great way to help heal an ankle sprain as you provide circulation and mobility with zero pain.

It’s so simple yet so hard for people to accept and adhere by. There is only one modification once injured or when returning from injury, Don’t Cause Pain.

Hope this helps,
Daniel Padmos, MM, PTA

Physical Therapy for Runners: Tuning the Ankles for Lighter Running

Do you want to feel lighter and more free when you run? Then you need to ask yourself, do you know where the front of your ankle joint is? Find the tibiotalar joint labeled ankle in the picture below. This is the front of your ankle. Notice how in the picture on the right, the soft tissue that covers that area is being displayed. All those tendons are what you see pop off your foot and ankle when you bring your toes and foot towards your shin (dorsiflexion).

If you want to be able to run lighter, you need to be able to feel softness in this area and learn how to release the muscles and tendons along the front of the ankle joint when you walk and run.

Take a look at the trailing leg of each of the elite runners above. They are each about to start swinging their back leg forward by flexing the knee and hip. At this moment, you can see how the first thing they have to release before swinging the leg forward, is the front of their right ankle. They have moved into a more pointed foot position not by pushing with their toes into the ground but by releasing the front of the ankle.

Continue reading →

Best Breathing Method for Health

Buteyko Breathing Method

The goal of this breathing method is to affect not only the muscles in the body, but also the physiology of the body. While this breathing technique will produce relaxation and energy, it is important to remember that the fundamental concept is to limit your breath. If you would like to understand more about the physiology of this technique, you can start here: http://www.buteyko.co.uk/.

While it is best to do focused sessions of 15-20 minutes to help recalibrate your natural breathing rhythm, we find that any amount of this breath work will begin to improve your overall health.

How to Perform the Exercises:

All breathing should be done through the nose with mouth closed at all times. The mouth is for eating and the nose is for breathing. Focus on taking the smallest and most silent breath possible. Ultimately your breathing should be unnoticeable.

1. Begin by gently exhaling with little to no force. Don’t try to squeeze any air out, just let yourself deflate. If you exhale too far, you will feel your abdominal muscles contract to push extra air out, this is too much effort. Only release the air until you reach a natural resting state

Continue reading →

Managing Pain and Function Following Joint Replacement Surgery

knee-scar

More than 1 million patients undergo total knee or hip replacement surgeries each year in the US and numbers continue to climb. The trend might be easily explained by an increasing number of elderly people, but reports are showing that there is a growing trend for younger patients to opt for surgery.

No matter how old you are when you go for surgery, one thing is certain: you will feel pain.

For most patients this is not a new sensation. The majority of patients seek joint replacement surgery because they have been living with pain for extended periods of time. It is easy to think that surgery is a quick fix and in some ways it is. The new joint is ready to function immediately and many patients are beginning their physical therapy rehabilitation on the same day as their surgery. But what most people do not expect is how much recovery it will take to overcome the damage caused by the surgery.

The nature of joint replacement surgery involves deep penetration into the body that requires tissue cutting, splinting, stretching, stapling, nerve severing, and bone scraping/removal to name a few. Having a clear understanding of what you are getting into, and how much pain to expect following the surgery, will help you recover quicker and help you manage post-operative pain more effectively.

Continue reading →

Is your in-network insurance going to cost you more for physical therapy than going out of network?

health-insurance

When you decide to go to a physical therapist, you have taken the first step toward feeling better. Admitting you need help with your body from a professional is a big decision — but then what?

You ask Google who the best therapist is. You turn to friends and family for suggestions. Maybe you even call a few places to see if your insurance covers treatment there. Sooner or later you find the great divide in our healthcare system. Do I stay in network or do I go out of network?

When most people hear “out of network” there is a cringe response followed by dollar signs fading into the distance. This gut reaction exists because information on how insurance companies can dictate your treatment is largely swept under the carpet, leaving the consumer undereducated and under-served.

Continue reading →

Treating wrists and forearms hurt from playing the violin

violinist-treatment

Tatz醫生的醫式好像中西醫運合的。他好像中醫會用全面的方法，但他也會用現代的機器而不會只是依靠傳統。

我是由於拉小提琴傷了手腕及前臂。我看了西醫物理治料而感到它們慣例的伸展活動和超聲波沒有效， 而Tatz醫生這樣完全明白。他第一眼見到我已經說我整身體緊。這個我已經知道，而我都下意識知道這個問題對我平常一舉一動有挺大的影響。可是，從來都沒有人(過去的物理治料師，健身教練等等)跟我應對過這個全面的問題。

Tatz 醫生會動生幫你按摩及鬆解你的肌肉。第一天他沒有對我的手腕或前臂做任何東西，他跟我說不想一天醫好我，而他只按了我的腰和背部。他也教我一些超輕柔的“運動”，是很微細的整體左右擺動。每次最後的15-20分鐘，他會放你在一部磁性機器下“睡覺”。下來的預約，他有按鬆我超繄的肩膀，腿等等，及教我多些擺動的運動。第三個預約，他按了我的手腕(不是無痛的!)，而我的手腕這大半年沒感到過這樣好。但是， Tatz 醫生也說，“We have a big project” (我們有一個大工程)。他要我用八星期，二十次見他。

Tatz 醫生是一個好人，也想醫好你。 他會多說，人愈用腦多，身體就愈繄。他多強調，我們的身體自然懂得動。他也說，身體放鬆“loose”,比強的身體好。

Dr Tatz’s style seems like a mix of Eastern and Western philosophies. He takes a holistic approach like Chinese doctors, but he also uses modern technology and doesn’t rely on tradition totally.

I hurt my wrists and forearms from playing the violin. I had been to a physical therapist and found that their prescriptive methods of stretching and ultrasound useless, and Dr Tatz understood completely. The moment he looked at me he already said that my whole body was tight. I was already aware of this, and I already had a suspicion that this affected a lot of what I did in life. But, no one (including previous physical therapists, fitness instructor etc) had ever addressed this for me.

Dr Tatz heals you hands-on, massaging you out and loosening your muscles. Our first appointment he didn’t do anything to my wrists or forearms; he said he didn’t want to heal me in a day, and he worked on my core, front and back. He also taught me some super mild “exercises”, which were sort of micro movements that involved shaking/twisting left and right fairly quickly. The last 15-20 minutes, you are almost always put under some magnetic machine to “sleep”. Our next appointments, he loosened my shoulders which are super tight, and my legs, etc, and gave me more similar exercises .On our third appointment, he massaged out my wrists (it wasn’t painless), and over the last 6 months my wrists haven’t felt better. But, as Dr Tatz says, “We have a big project.” He wants me to come for 20 sessions over 8 weeks.

Dr Tatz is a nice man, and he wants to get you better. He says often, that the more you use your brain, the tighter your body. He emphasizes that our body naturally knows how to move. And, he also says, that a loose body is better than a strong body.

Physical Therapy: The Ancient Practice and Overlooked Modalities of Insurance Companies

greek-body

It was the Ancient Greek Doctor and Founder of Western Medicine, Hippocrates, who first introduced Physical Therapy as a form of healing. But it wasn’t until the 1970’s that Western Medicine would formally allow Physical Therapists to have their own practices. Before then, most Physical Therapy was done in hospitals.

Alternative therapies these days are referred to as just about anything outside Western Medicine and hospitals, such as Acupuncture, Chinese Medicine, Ayurvedic Medicine, Naturopathic, Chiropractic. The list goes on. But lost somewhere between medicine and alterative is Physical Therapy: PT shouldn’t be overlooked, as it is one of the true and natural modalities there is.

A skilled Physical Therapist can examine, evaluate and treat patients from chronic illnesses to severe and mild injuries. Physical Therapists are known to reduce or eliminate pain. Benefits of PT can include recovering from falls, injuries and fractures; recovering from strokes; managing vascular conditions including diabetes; heart and lung problems; headaches and migraines; age related limitations including arthritis, facial nerve paresis, fibromyalgia, gastritis, insomnia; as well as ankle, knee, back, disc, shoulder, neck and TMJ pain. The list goes on and on.

Continue reading →

Holistic Mind Body Treatment: Relieving Head, Knee and Hip Pain

My aches and pains have been steadily diminishing since seeing Shmuel Tatz, PT, PhD for the first time but they hadn’t vanished completely – yet. Only because it’s been a long and winding road of minor injuries over the decades. This being my tenth visit, I didn’t know what to expect since there are a variety of problem areas in my small frame. Tatz, usually a man of little words, surprised me when he sat down and spoke at length before my treatment began. He was insistent that I understand, “People don’t always want to hear what their real problem is.” I was a little worried he had something unpleasant to tell me about my own health, but I listened.

First he told me that sometimes people have psychological problems and not physical problems. “I always tells my patients the truth but sometimes they get upset with me.” Very recently, he told one of his patients that she might want to consider talking to a professional about her emotional problems; she left in tears. He explained in cases of the mind, doctors such as bestselling author Dr. John Sarno are very good at helping people understand that they can heal themselves by addressing underlying emotional issues. He also noted that can only happen if there is not an underlying physical problem. He was very concerned about this patient of his.

Continue reading →

Alternative Physical Therapy Treatment for Dislocated Elbow

Bonnie had been a regular patient of Shmuel Tatz, PT, PhD for twenty-plus years. She has enjoyed an active life of dance, hiking and yoga and only used to go see Tatz for tweaking her aches and pains away. Always successfully. She recommended Tatz to her friends for years. It wasn’t until Bonnie was injured that she fully appreciated just how truly gifted Tatz is.

It was a typical snowy, icy, New York City afternoon. Bonnie was carrying too many heavy bags, going back to her office, when she tripped over a pothole in the sidewalk. She tried to regain her balance, but the bags made her into a twirling top and she spiraled into a terrible fall dislocating her elbow. She was in excruciating pain and her arm swelled up two times its normal size.

Bonnie immediately went by ambulance to the emergency room, where her orthopedic doctor took x-rays. He told her to gently move her arm up and down, then to go see him again when he returned from traveling in two weeks time. Nothing more, no physical therapy other than his suggestion to move her arm up and down. That turned out to be laughable as her arm was so swollen and so tender, she really couldn’t move it all.

Continue reading →