 So you’ve been crushing it at the gym over the past few months. Your body is getting stronger and your conditioning is improving. You can do a ton more now compared to when you first started working out. You’re finally starting to feel like an athlete! Until one day you begin to notice some nagging pain after your finish up a workout. At first it's not bad and you ignore it, but then it starts to progress and interfere with your lifts. All the sudden you’re modifying all your workouts and you’re experiencing pain through non-gym activities as well. Now a couple of weeks have gone by and your shoulder continues to get worse. You’re frustrated! You’re also not alone. By some estimates, as many as 67% of people experience shoulder discomfort at some point over the course of their lives. It's also the most commonly injured body region in CrossFit athletes. And by all accounts, I agree. 3 out of the last 4 new patients that have come to see me were for shoulder issues. Below I listed some things to consider if you’ve been dealing with nagging shoulder pain -- check them out, and make adjustments as needed.  Do you have an appropriate balance of shoulder mobility and stability? First things first, let’s clarify what these terms mean. “Mobility” refers to the ability for you to access a particular range of motion, whereas “stability” refers to the ability to be strong and sturdy throughout the range of motion, including end range (ex: when the arm is fully overhead). CrossFit, for example, is a unique sport in that not only demands extreme end-range mobility, but also adequate stability at those end ranges to handle heavy loads. If you lack the appropriate mobility to get your shoulder into the positions required to perform the exercise -- don’t force it! While i’m certainly an advocate of working into an exercise with a limitation (ex: front rack position), you don’t want to force it, repetitively, under load, during a high intensity workout. That’s just a recipe for an injury.  Do you have balanced programming? Whether you design your workouts yourself, or follow a gyms programming (such as CrossFit or weight lifting), its very easy to develop strength imbalances between opposing muscle groups. The two most common shoulder imbalances that arise are pushing vs pulling strength and “large muscle” vs “smaller muscle” strength, so let’s talk about each. Pushing exercises include those that push weight away from you -- the push-up, bench press, shoulder press, push press, etc. Pulling exercises are just the opposite; those that pull weight towards you -- pull-ups, rowing, power cleans, deadlifts, etc. If you’re programming has a tendency to overwork one particular direction, imbalances can develop over time and pain can arise. Another important imbalance involves over-dominance of the larger muscle groups -- particularly the lats, pec major, and teres major. A healthy shoulder is one where the ball (upper arm bone called the humerus) stays centered in the socket (shoulder blade, aka the scapula) during movement. When these larger muscles over-dominate over the smaller ones (specifically the rotator cuff and scapular muscles), the ball moves and glides excessively, failing to stay centered in the socket, and often leading to impingement and pain. While the “beach” muscles are fun to train, attention needs to also be directed towards stabilization and accessory exercises of the little guys.  Do you sleep on your shoulder? Our bodies heal and recovery while we sleep. If you’re dealing with nagging shoulder pain, the last thing you want to do is sleep on it. Studies have shown that sleeping on your shoulder literally cuts off the blood supply to the rotator cuff tendons, which commonly are the irritated structures that cause shoulder pain. Make it a point to not sleep on your shoulder at night, or on your stomach with your arm overhead for that matter (just as bad, if not worse). Try sleeping with your injured shoulder towards the ceiling and a pillow between your arm and your body. You should wake up everyday feeling refreshed and pain free. If this isn’t the case, adjust accordingly!  Do you also have neck pain or pain that radiates down the arm?
Most shoulder pain results from an injury or condition in the shoulder itself. However, pain in the shoulder region can also stem from elsewhere in the body, especially the neck. If your shoulder pain is also accompanied by neck pain or stiffness, it may be the neck that’s the primary issue, particularly if your pain is located in the upper trap, near the shoulder blade, or radiates down the arm. Each area of the body requires different treatments. To help you better pinpoint what the source of the problem is check out these lists below: When the shoulder is the suspect:
When the neck is the likely culprit:
So what should you do if you’re dealing with a shoulder injury? The best answer is to get yourself checked out before starting some significant training. The shoulder is one of the most common areas of the body we treat. If you’re in the Charlotte area and you’ve been dealing with a shoulder injury, give us a call. We can help get you back to do what you love faster than any other medical group in the area.
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Part 4 - Shoulder Pain(Including Rotator Cuff Tears and Shoulder Impingement) The shoulder complex is a tricky body region to picture the moving parts and understand how they are all interrelated. I find myself teaching basic shoulder anatomy and kinesiology to almost all of my shoulder patients because most people don’t understand what the shoulder actually looks like and how it is attached to the rest of the body. I’ll kick-off this post with the same education I give my patients. First off, take a look at the pictures below. It is important to appreciate that the “ball-and-socket” joint doesn’t have much of a socket. And it is also important to appreciate how the shoulder blade has only one small boney connection to the rest of the body (the AC joint), and otherwise the entire scapula is just gliding over the ribs at the whim of the periscapular muscles that attach to it. Finally, we can see the thorax in which the shoulder blade sits on top of. This has a natural kyphosis, or forward bend, to it.
So take that third picture. Imagine that the thorax doesn’t have the ability to straighten out. You can see how this may limit the ability of the shoulder complex to perform in an overhead position. The thorax is the foundation for shoulder movement. If this are isn’t operating properly, then we can’t expect a fully functioning shoulder. Now let’s address the second pic. This shoulder blade isn’t your typical joint. The shoulder blade can move into MANY motions; upward rotation, downward rotation, elevation, depression, abduction, adduction, external rotation, internal rotation, anterior tilt, posterior tilt, retraction, protraction, winging, and any combination of the above. With a typical presentation of shoulder impingement, the main motion that is limited is upward rotation. And lastly, look back at the first pic. You can see the socket is actually part of the scapula. So you can imagine, in reaching overhead, the ball will roll up, and the socket should move too. If the ball moves too much with relation to the socket, you can get some nasty pinching type pains in the shoulder. Looking at this picture below, you can see that it is the rotator cuff tendons that suffer from this as they are located in this region. If this goes untreated, this may result in a tearing of these tissues. Sometimes, people can have a tear in these tissues, and walk around without any pain or symptoms! In fact, having a rotator cuff tear that goes unnoticed is extremely common. However, the treatment should be directed towards treating the aforementioned underlying issues instead of focusing solely on the tear.  So how may conventional powerlifting training help? Now that you have a better understanding of the injurious cascade of untreated shoulder pain. Let’s answer the question, “How can Powerlifting training be therapeutic?” The quick answer is, powerlifting training, with correct form, will address each of the typical impairments that you see in the textbook shoulder impingement patient.
How do I get started? Sold already, but don’t know where to start? No worries! I have posted directories below that will point you in the right direction so you can find skilled practitioners in your area. The Charlotte Athlete - If you’re local to the Charlotte Area, The Charlotte Athlete is a group of healthcare providers and highly accredited sports doctors that specialize in various sports setting including Powerlifting, Bodybuilding, Strongman, Olympic Weightlifting, Crossfit, and recreational athletes and youth athletes. There is also free, quality, information on how to improve your lifts and ways to work around common aches and pains. APTA Specialist Directory - This is the directory for the American Board of Physical Therapy Specialties (ABPTS). There are options to search within each specialty. An orthopedic specialist would be able to help best with nagging aches and pains and help get you back to sport specific training. A sport specialist may help you overcome, manage, or avoid injury within your sport. Some Sport Specialists have a subspecialty with a specific sport, or set of sports. The Clinical Athlete - This is a directory of healthcare providers that happen to be athletes themselves. Again, you can search by location and filter for specific providers. Peruse each providers website to see who is the best fit for you. RSCC Registry - This is a directory of Strength and Conditioning Specialists that are registered with the National Strength and Conditioning Association (NSCA). This directory allows you to filter by location and search based on years of experience. Peruse this directory to find a Strength and Conditioning Specialist in your area. Author: Dr. Michael Masi Masi Fitness, LLC IG: @Masi_Fitness Part 3 - Knee Pain(Including: Patella Femoral Pain Syndrome, Patellar Tendinopathy, Arthritis)The knee is arguably the largest joint in the human body. It is comprised of four bones, the patella, femur, tibia, and fibula. The three most common knee pain diagnoses I treat are Osteoarthritis, Patella Femoral Pain Syndrome, and Patellar Tendinopathy.  Osteoarthritis (OA) is part of a natural degenerative cascade that effects everyone. This is not to be confused with rheumatic arthritis which is an auto-immune related, chronic inflammatory disorder. Imaging reveals OA in both symptomatic and asymptomatic patients in various body regions, sometimes beginning as early as the third decade of life. Prevalence is highest amongst those over 65 years of age. Before becoming painful and restrictive, arthritic joints are often joints that get utilized most in the body. This is sometimes portrayed as a protective mechanism against uneven wear and tear on the body, perhaps due to an inability or unwillingness to allow neighboring joints to contribute to motion. Patellar Tendonitis is a pathology characterized by inflammation of the patellar tendon. Unlike arthritis, this is an acute condition that is reversible. It is brought on by improper loading of the tendons secondary to either poor mechanics of movement or improper loading rate/frequency. Patella-femoral pain syndrome (PFPS) is knee pain around the patella that otherwise cannot be attributed to anything else. It is a diagnosis that literally translates to “pain around the knee cap.” Unlike the aforementioned knee pathologies, with PFPS there does not have to be a compromise in structural integrity of the joint or its surrounding tissues. Oftentimes, symptoms are resolved with improving the quality of movement that the patient or client is performing. To be succinct, all of these diagnoses involve poor movement, stressing various tissues, and manifesting as knee pain. The knee joint is fundamentally a hinge joint, meaning, similar to opening your front door, it moves in one plane. With the exception of some rotary motion, the knee primarily flexes and extends (i.e. bends and straightens). For a hinge joint to get faulty motion, there is usually a force being enacted on the joint in directions outside of its intended range; think of hanging from your front door as its opening. But how and why are these sub-optimal forces placed on the knee? Well, most of the painful knee movements involved closed chain activity, meaning that the foot is affixed to a surface as the knee is moving (i.e. going up/down a flight of stairs, squatting, or stooping). Considering the foot is fixed, the main joint that determines where that knee will be in space, is the hip. The hip moves the leg side to side and will ultimately determine which forces are imposed at the knee. A commonly seen problem, is that when the hip is weak, the knee may move inwards during a lunge, squat, or a step.  So how may Conventional Powerlifting training help? Almost all main powerlifting movements involve utilizing the hip musculature. Even in a bench press, the client is trained do drive through the legs, utilizing the hips to improve stability of the body during the exercise. In order to generate more force, the hip must be trained to stabilize the knees in a neutral position, as the knees come outside of the position, the body sacrifices its structural integrity, which will result in poor performance. Proper alignment during movement and exercise will also yield increased joint space which is imperative when a space occupying lesion, such as osteoarthritis, is present in the joint. So, moving with proper mechanics will increase pain free range of motion within these movements. Many of the lower extremity movements we perform throughout the day involve a squat or hinge, which are key components of the back squat and deadlift exercise respectively. Mal-alignment of the joint may also result in PFPS considering the forces enacted around the patella may be stronger on one side than the other. Considering the patella is a free-floating bone, this may create issues on how that patella tracks during movement. One of the principles of a sound squat and deadlift includes aligning the knees with the toes in order to generate more force. When done correctly, this promotes proper strength and stability around the joint, and optimal movement around the functional patterns being trained. This also enables the hips to contribute more to the movement, which involves muscles that have larger force generating capabilities than those that surround the knee joint. Literature currently suggests that hip strengthening should be a key component of PFPS rehabilitation likely for the aforementioned reasons. As stated before, tendons respond to improper loading. Sometimes the form can be perfect, but the body is asked to do to much over too short of a time without the proper conditioning. This is usually seen when the total volume of work is increased beyond the body’s ability to recover. During rehabilitation, volume is scaled back considerably and exercise intensity increases as per the patient’s tolerance. This very closely emulates the programming of powerlifters! How do I get started?
Sold already, but don’t know where to start? No worries! I have posted directories below that will point you in the right direction so you can find skilled practitioners in your area. The Charlotte Athlete - If you’re local to the Charlotte Area, The Charlotte Athlete is a group of healthcare providers and highly accredited sports doctors that specialize in various sports setting including Powerlifting, Bodybuilding, Strongman, Olympic Weightlifting, Crossfit, and recreational athletes and youth athletes. There is also free, quality, information on how to improve your lifts and ways to work around common aches and pains. APTA Specialist Directory - This is the directory for the American Board of Physical Therapy Specialties (ABPTS). There are options to search within each specialty. An orthopedic specialist would be able to help best with nagging aches and pains and help get you back to sport specific training. A sport specialist may help you overcome, manage, or avoid injury within your sport. Some Sport Specialists have a subspecialty with a specific sport, or set of sports. The Clinical Athlete - This is a directory of healthcare providers that happen to be athletes themselves. Again, you can search by location and filter for specific providers. Peruse each providers website to see who is the best fit for you. RSCC Registry - This is a directory of Strength and Conditioning Specialists that are registered with the National Strength and Conditioning Association (NSCA). This directory allows you to filter by location and search based on years of experience. Peruse this directory to find a Strength and Conditioning Specialist in your area. Author: Dr. Michael Masi Masi Fitness, LLC IG: @Masi_Fitness Part 2 - General Low Back PainLow back pain (LBP) is the number 1 most common orthopedic issue treated by physical therapists and seen by sports medicine physicians. This is an extremely common problem, as the lifetime prevalence of LBP is upwards of 70%! This suggests that up to 70% of the population have, at some point in their life, experienced LBP. Furthermore, most people who experience activity-limiting LBP go on to have recurrent episodes. Estimates of recurrence at 1 year vary, but studies suggest these numbers may be as high as 80%. LBP causes more global disability than any other condition. This is the leading cause of activity limitation and work absence throughout much of the world, imposing a high economic burden on individuals, families, communities, industry, and governments. Let that sink in for a bit. LBP is a pandemic, experienced at some point by the majority of the population, which limits people from performing their activities at work and their activities of daily living. These activities primarily include, lifting, carrying, squatting, pressing, pulling, reaching, and prolonged positioning. So, it makes sense, when training for health and injury prevention, to use these movements in your training and to perform them well. It would not be a stretch to suggest that repeatedly performing these movements incorrectly, or not being conditioned appropriately to handle the stressors of these movements, can generate the symptoms of LBP. Let’s take a brief look into the anatomy of the lower back as it relates to the regions above and below. The lumbar spine is made up of 5 boney segments, otherwise known as vertebrae. These vertebrae are separated by gelatinous discs that absorb shock and allow considerable flexibility. If you look at the cross section of this area below, you will see the spine is not in the middle of the body. It resides along the back side. Leaving considerable surface area to be supported by the residing musculature.  The body region immediately above the lower back is the thorax. The thorax consists of the 12 thoracic vertebrae with their coinciding discs, and a rib on either side that wraps around the body connecting to the sternum or the surrounding cartilage. Some of these ribs do not connect, but still provide support and protection for the organs housed within. Though mobile, the thoracic spine provides considerable stability due to the its circumferential distribution.  The body region directly below the lower back is called the pelvis. The lumbar spine sits directly atop the sacrum, which is 5 boney vertebrae fused together to create a triangular structure. Connecting to the sacrum are the remaining pelvic bones that, much like the thorax, create a ring and attach together in the front of the body. Each articulation is supported by a network of ligaments that prohibits any substantial movement. These bones are also referred to as the hip bones because the femur articulates with them as well.  Considering the anatomy, one can’t help but appreciate the juxtaposition of the lumbar spine as it relates to the adjacent body regions. The lumbar spine is an inherently mobile, and relatively unstable, area of the body. The thorax and pelvis have some of the largest muscles of the body (Latissimus Dorsi and Gluteus Maximus respectively) as well as some of the strongest inert tissues (Sacroiliac Ligament, and the Y-ligament). It makes sense that low back pain is a very common problem, and the number 1 most treated orthopedic condition.
So how may conventional powerlifting training help? Well, first consider the seven most trained movements within the sport (i.e. squat, bench, deadlift, overhead press, pull-up, carry, and bent over row). These emulate functional tasks that we perform daily, tasks that my patients complain they cannot do well without pain (i.e. picking up objects, carrying child or briefcase, standing or sitting to various surfaces, lifting and reaching into cabinets overhead, pushing open doors, etc.). Next, consider that strength is the primary objective for powerlifters. That means that it would be in the competitors’ best interest to use muscles that have a greater ability to produce force. The glutes, being incredibly stronger than any muscle spanning the lumbar spine, create motion at the inherently stable hip joint. In this sport it is encouraged to exhaust the range of motion utilized from these joints and to mitigate motion from the lower back in an effort to produce the most force and move through heavier resistances. This requires incredible strength and control of core musculature and the ability to disassociate the hip from the lumbar spine during movement; two attributes that most physical therapists will be assessing and improving on most of their LBP patients. Lastly, lets look at the identified modifiable risk factors for low back pain; occupational posture, depressive moods, and obesity. That means these attributes are the risk factors somewhat without our control to modify in an effort to alleviate or avoid LBP. Exercise in general is effective at modifying mood by releasing endorphins, increasing serotonin, and normalizing sleep. Exercise is also effective at combating obesity, though powerlifting specific training may have the capacity to burn more calories per time spent training. This is in comparison to other styles of training that do not address multiple muscle groups and body regions simultaneously with little, if any, external support. Furthermore, body weight is an important factor considered when determining the best lifter in a powerlifting competition which may require athletes to manage their weight to remain competitive. How do I get started? Sold already, but don’t know where to start? No worries! I have posted directories below that will point you in the right direction so you can find skilled practitioners in your area. The Charlotte Athlete - If you’re local to the Charlotte Area, The Charlotte Athlete is a group of healthcare providers and highly accredited sports doctors that specialize in various sports setting including Powerlifting, Bodybuilding, Strongman, Olympic Weightlifting, Crossfit, and recreational athletes and youth athletes. There is also free, quality, information on how to improve your lifts and ways to work around common aches and pains. APTA Specialist Directory - This is the directory for the American Board of Physical Therapy Specialties (ABPTS). There are options to search within each specialty. An orthopedic specialist would be able to help best with nagging aches and pains and help get you back to sport specific training. A sport specialist may help you overcome, manage, or avoid injury within your sport. Some Sport Specialists have a subspecialty with a specific sport, or set of sports. The Clinical Athlete - This is a directory of healthcare providers that happen to be athletes themselves. Again, you can search by location and filter for specific providers. Peruse each providers website to see who is the best fit for you. RSCC Registry - This is a directory of Strength and Conditioning Specialists that are registered with the National Strength and Conditioning Association (NSCA). This directory allows you to filter by location and search based on years of experience. Peruse this directory to find a Strength and Conditioning Specialist in your area. Author: Dr. Michael Masi Masi Fitness, LLC IG: @Masi_Fitness  Sprain your ankle, tweak your back, sharp knee pain at the bottom of your squat? For many, the next step is to slap an ice pack or a bag of frozen peas on it. It's even likely that your doctor recommends that you “RICE” (Rest, Ice, Compression, Elevation) the injury, which has been the go-to post-injury treatment for almost 40 years. But does ice really help the healing process? What if RICE is wrong? Nearly everyone who ices today believes they're doing it to prevent inflammation, reduce swelling, and control pain. But here’s the problem - icing doesn’t prevent inflammation or swelling, it may even delay it. Though icing has been considered a mainstream treatment by everyone from physicians to athletic trainers, a closer look reveals the practice to be more of a habit than based on scientific evidence. Even the physician who coined the term RICE (Dr. Gabe Mirkin in his 1978 sports medicine book) has officially retracted his stance on rest and ice. In fact, a 2012 review in the British Journal of Sports Medicine stated, “Ice is commonly used after acute muscle strains but there are no clinical studies of its effectiveness.” We know far more now about the role of inflammatory cells and healing then we did in 1978, and we’re discovering that applying ice can not only delay healing, but may even increase the overall recovery time. Let's take a closer look why. How inflammation works The human body is one of the most resilient machines in existence. Over thousands of years, we have become extremely efficient at healing following an injury and really good at recovering. When you damage a tissue through trauma or injury, your body produces inflammation, and for a good reason. Inflammation is the body’s natural response to protect itself from harm. It does this through your immunity, the same biological mechanisms that you use to kill germs. If you have an infection or disease, your immune system dispatches potent chemicals, cells, and repair proteins into the infected area to kill the germs. Similarly, when you suffer tissue damage or an injury, your immune system sends the same army of inflammatory cells and potent chemicals to sweep away cellular debris and deliver healing nutrients. Those chemicals and cells set off a cascade of reactions that we refer to as inflammation. More importantly, this is also what initiates the HEALING process. What about swelling? Swelling occurs as a waste byproduct of the inflammatory cascade that accumulates around the injury. Swelling is a sign that the repair processes are at work, but you want the body to naturally remove it as quickly as possible. Swelling reduces naturally via the lymphatic system, one-way vessels that remove waste products from our body. However, the lymphatic system is passive, meaning it relies on the natural contraction and compression of muscles to pump out fluid. When ice is applied to a body region for a prolonged period, nearby muscles suffer a decrease in their ability to contract and waste doesn’t get removed. Further, ice inhibits lymphatic pump opening. Applying ice to an inflamed area essentially hits the pause button on and may actually delay the healing process.  But ice makes it feel better
No doubt, ice can reduce pain and make you feel better. One thing ice has been shown to do effectively is reduce pain. Studies have shown that even people with chronic pain feel better after using ice or cold therapy. However, if the goal is to help the lymphatic system evacuate trapped waste from the damaged area or to help deliver fresh blood and nourishment to the region, ice should be used sparingly. Remember, ice only dulls the pain, so it also may create a false sense of security, which may tempt you to work out again before your body is ready. Bottom Line Ice is a cheap, effective, drugless method for taking the edge off the pain of fresh injuries. Safe application of ice to your skin can relieve symptoms from sprains, strains, bruises, and tendinitis. But the fact of the matter is, icing appears to have no effect on recovery at all, good or bad. What few studies we have on this just show - no difference. My Recommendation - The Active Recovery Alternative So what is the alternative to icing and resting? The answer is active recovery. The loading (mechanical stress on tissues caused by muscle activation and contraction) of tissues associated with active recovery has been shown to accelerate healing of bone, fibrous tissue, and skeletal muscle. Tissue loading will bring in nourishment and supplies, remove waste products, improve production and release of healing hormones, and remodel the injured tissue. If you suffer an acute injury, stop exercising immediately. If the pain is severe - you are unable to move or bear any weight through it - you should seek out medical attention. If swelling is present, I recommend intermittent icing (no more than 10-12 minutes) off and on for the first 24-48 hours. After this initial phase, icing has not been shown to do any good. Since the lymphatic system relies on muscle activation to remove waste, light exercise and pain-free movement can jumpstart the healing process. Recent research has shown that active recovery is effective for reducing inflammation and cellular stress post- exercise and post- injury. The simple act of getting your heart rate up will increase circulation and assist in flushing out swelling and inflammation. While icing may be helpful to decrease pain in the acute phase, increasing your amount of movement and exercise in a progressive, controlled, pain-free manner, is paramount to a fast recovery, and will assist in getting you back to your sport as fast as possible. Hope you enjoyed the read! -Dr. Andrew Part 1 - What is Powerlifting?Powerlifting is a strength-sport in which competitors attempt to lift as much weight as they are capable over three different exercises; the back squat, the bench press, and the deadlift. Most programming also involves big comprehensive movements to compliment these three lifts, including; the overhead press, bent over row, pull-up, and weighted carry.
This, at face value, may sound dangerous, daunting, and possibly scary. I mean, one of the exercises has the word dead in it! And, you know, people on the internet say that lifting weights can’t be good for your back, and you should never lift weights overhead. Also, your friend knows a jacked guy that has injuries so, how can this possibly be therapeutic? Well, it’s true that if you perform these exercises incorrectly, you may be risking injury. But if you break it down, you are performing these movements multiple times throughout the day anyway! Reaching into cabinets overhead, picking items up off the ground, moving your couch, getting in/out of your car and on/off the toilet, carrying in groceries, etc., all of these movements require some derivative of the aforementioned exercises. If you think of this from the perspective that you already perform these movements, you might as well learn how to do them well in an effort to mitigate risk for injury. So how does this translate to rehabilitation from injury? As a physical therapist I treat an array of orthopedic issues every day. The purpose of this blog series is to go through the top ten orthopedic injuries that I treat, and show how conventional powerlifting training may be the best intervention for these issues from a rehabilitative perspective. The top eight issues I see, in no particular order, are:
This blog series will be set up to address each of these orthopedic issues individually within each blog post, highlighting the benefits of skilled powerlifting training with regards to rehabilitation from injury along the way. How do I get started? Sold already, but don’t know where to start? No worries! I have posted directories below that will point you in the right direction so you can find skilled practitioners in your area. The Charlotte Athlete - If you’re local to the Charlotte Area, The Charlotte Athlete is a group of healthcare providers and highly accredited sports doctors that specialize in various sports setting including Powerlifting, Bodybuilding, Strongman, Olympic Weightlifting, Crossfit, and recreational athletes and youth athletes. There is also free, quality, information on how to improve your lifts and ways to work around common aches and pains. APTA Specialist Directory - This is the directory for the American Board of Physical Therapy Specialties (ABPTS). There are options to search within each specialty. An orthopedic specialist would be able to help best with nagging aches and pains and help get you back to sport specific training. A sport specialist may help you overcome, manage, or avoid injury within your sport. Some Sport Specialists have a subspecialty with a specific sport, or set of sports. The Clinical Athlete - This is a directory of healthcare providers that happen to be athletes themselves. Again, you can search by location and filter for specific providers. Peruse each providers website to see who is the best fit for you. RSCC Registry - This is a directory of Strength and Conditioning Specialists that are registered with the National Strength and Conditioning Association (NSCA). This directory allows you to filter by location and search based on years of experience. Peruse this directory to find a Strength and Conditioning Specialist in your area. Author: Dr. Michael Masi Masi Fitness, LLC IG: @Masi_Fitness  At some point or another we’ve all woken up with a “crick in our neck” or finished a workout with neck pain. Why is that? What are we doing that’s causing these annoyances? Unfortunately, it’s much more then to just stop smacking our head into the ground during handstand push-ups. When it comes to the neck, we often set the stage for an injury or pain to occur because of what we are doing outside of the gym, without even realizing it. You see, when it comes to a healthy neck, we more or less want all our the cervical joints to contribute equally to movement (ex: turning to look around). However, we can develop stiffness in certain areas because of the prolonged postures and repeated movements we engage in day in and day out. The human body is extremely resilient and rather than limit total motion because of those stiff areas, other joints will start to compensate and move more to pick up the slack. It’s often these “over-working” segments that cause the pain you experience, which can also lead to issues with the muscles surrounding them (muscle tightness/ spasm). Here are 3 causes of why neck pain occurs in athletes. We Sit Behind a Computer All Day When we're stuck behind a computer screen for hours on end, we almost all fall victim to the dreaded forward head posture. We get lazy and our posture falls apart. This forward head position is one of the main culprits behind those stiff joints I mentioned earlier. It’s not just computer work either, driving posture can also wreak havoc. In both situations, we end up hunched forward which tightens up certain areas, and then rotate our neck to look around (ex: checking your mirrors). Repetitive rotations in bad posture causes micro-trauma and irritation that builds over time, eventually leading to pain and discomfort. We Have Poor Sleeping Positions You’ll hear me say this time and time again – sleep is the time our bodies heal and recovery. If we end up on our stomach, or in a position with a lot of neck rotation, the beat-down we put on our necks during the day will never get back to square 0. You should always wake up feeling fresh and pain-free, with no stiffness. If you don’t, you did something wrong and attention needs to be placed on getting it right. We Have Poor Head/ Neck Position While Working Out The position you put your head in while exercising and working out plays a major factor whether or not you’ll experience neck pain. Any time you fall into that forward head position, you are at risk. The most common exercises where this can happen includes pressing weight overhead, at the bottom of the squat or deadlift, during Olympic movements, and while performing pull-ups and handstand push-ups. If you can just modify these bad head/ neck positions, the benefits will have a compounding effect on your health and prevent injuries from even occurring in the first place. Make adjustments as needed! For any additional questions, please reach out and sent me an e-mail! -Dr. Andrew andrew@thecharlotteathlete.com Often when I bring up the technique of Dry Needling with my clients, they either cringe or start to nervously ask what I’m talking about. Being that it’s a powerful technique at The Charlotte Athlete, I thought it was only fitting to write our first blog post on this topic. Hopefully after reading this article you will have a better understanding of what it is, how it works, and how it may benefit you.  What is it? Dry needling is a unique physical therapy treatment that involves the use of a thin, flexible needle to address underlying myofascial trigger points within muscular and connective tissues, for the management of musculoskeletal pain and movement impairments. It’s called “dry” needling because there is no solution injected (versus a hypodermic needle during a flu shot). With dry needling, the needle itself and the effects it produces within the tissue is the treatment. The primary goals are to alleviate pain, stimulate tissue healing, restore muscle function, decrease muscle tension, desensitize supersensitive structures, and improve muscle contractility. In the hands of a skilled physical therapist, this powerful tool has the ability to create pronounced changes in athletes and greatly improve their ability to perform their activity or sport. What is a trigger point? A trigger point is what we target within muscles. It’s basically an irritable or taut band of dysfunctional muscle tissue that is usually the result of overuse, postural abnormalities, muscular imbalances, or nerve impingement. When an injury occurs from repetitive use or acute trauma, inflammation will be produced from the damaged tissues. The damaged tissues will often go into a protective tension state or contracture to guard against further damage from utilizing the injured tissue. This contracture and inflammation inhibits microcirculation which limits both the oxygen rich blood reaching the injury and the waste products leaving the injury. Increased waste products created by the hypoxic and acidic environment are caustic to the tissues. This limits the tissues ability to fully function (contract/ relax) which may inevitably lead to biomechanical disturbances throughout the body which can limit function and decrease range of motion and performance.  Is dry needling the same as acupuncture?
Absolutely not! Dry Needling is completely different from acupuncture. While we do use the same types of needles, our methodology and rationale is different than that of an acupuncturist. Traditional Chinese Medicine explains acupuncture as a technique for balancing the flow of energy, or Chi, through meridians, which are pathways within your body. By inserting needles into specific points along these meridians, acupuncturists believe that your energy flow will be re-balanced. Dry needling, however, is a technique used to treat the neuromusculoskeletal systems based on pain patterns, muscular dysfunction, and other orthopedic signs and symptoms which depends upon the clinical presentation. Most if not all of traditional acupuncture is based on pre-scientific ideas, whereas dry needling is based on modern scientific research and a deep and thorough understanding of anatomy. While I’m not trained in acupuncture, I am trained in the anatomy of the human body, which is what guides the choice for where to perform dry needling. How dry needling can help you So how does dry needling cause muscle pain to resolve so quickly? There are a couple of theories on how this happens but I want to explain it in terms most of us can understand. Think of a trigger point similar to a glitch on a computer. Something isn’t working right which causes other things to not work right. What fixes most computer glitches? The restart button! Dry needling is like the restart button to the musculoskeletal system. If we have an irritated trigger point and we put a needle in it, it resets. Dry needling can also be thought of as the “sniper” of manual therapy. Like a gunman with the extreme precision and skill of a sniper, we can use a needle to pinpoint and eliminate the problem area. We can use dry needling to treat just about any orthopedic issue that presents in our clinic. From cervicogenic heads to lower back pain to plantar fasciitis, dry needling can help manage a large variety of impairments. Anyone suffering from tight muscles, muscle spasms, nerve impingement, tendinitis, or bursitis are excellent candidates for dry needling. By resetting the muscle with dry needling, the muscle is allowed to function as designed and the stress and inflammation on the bursa, tendon, or nerve is relieved. While results can happen instantly in many cases, dry needling is NOT a be-all-end-all treatment technique, and typically is a part of a larger treatment plan. Identifying and treating the underlying cause, along with addressing areas like mobility, strengthening, and improving movement patterns are critical to sustain long term pain-relief. If you are experiencing pain or restrictions, regardless of your fitness level, I highly recommend seeking out a physical therapist in your area who performs dry needling. It is a great tool in the hands of a skilled physical therapist to alleviate pain that otherwise would prevent an athlete from performing certain movements or exercises. If you live in Charlotte and are struggling with pain, contact one of our Doctors of Physical Therapy. We offer free phone consultations and free 20-minute discovery visits to ensure you are a good candidate. Please do not hesitate to reach out with any questions! Thanks for reading, Dr. Andrew |
This where we share our expert opinion on hot topics in physical therapy, injury prevention, sports performance, strength and conditioning, nutrition, and sometimes other random thoughts. Enjoy.
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