You are NOT your diagnostics. What hurts isn't always what is on your MRI. Treat the symptom generator not the “abnormal” findings, you will be pain free sooner.
Mechanotherapy is what you are looking for, you just don't know it yet!
You have water in your row boat. What’s the best solution: find the hole and fix it or bail the water out? This is the classic question of treating the symptom versus treating the source of the problem.
What causes pain?
If you have pain, is it chemical or mechanical? Mechanical pain is overwhelmingly more frequent than chemical pain. Something stiff or something weak will cause pain. The chemical reaction or some say “inflammation” is the consequence of the mechanical problem failing. Ultrasound, dry needles, electricity, lasers, are some of the examples of what we might use to treat a mechanical problem with chemical means. There are no double blinded, good studies to show any of those things are any better than a placebo. Clinical experience shows they don’t help.
Mechanical fixes (mechanotherapy) are joint “mobilization” and muscle and tendon “progressive loading.” (both described below) What is unfortunate is the American Physical Therapy Association doesn't even recognize mechanotherapy as a possible treatment option. We as a profession cannot agree on what is best for patients so we end up losing patients to other professions because we don’t address the real problem. Managed care doesn't want LESS things to bill for they want MORE. The equipment used to treat chemical problems cost lots of money. Expensive buckets to remove the water spilling into the boat.
Mechanotransduction (The scientific word for mechanotherapy) is defined by Khan and Scott as “the physiological process where cells sense and respond to mechanical loads.” These mechanical loads induce stress on the tissues to which they are applied, and this stress induces a response in the tissue to create a stronger structure in order to withstand that stress in the future. One of the most common examples of this concept being applied is through Wolff’s Law. Wolff’s Law states that “bone grows and remodels in response to the forces placed on it.” In other words, weight-bearing bones, such as femurs and tibias, are made stronger in loaded, weight-bearing positions--think squatting with a barbell. Not only are you squatting your body weight, but you are also squatting the additional weight of a heavy bar. Your bones thrive on this type of stress and they thank you.
Wolff’s Law is often only associated with loading bones to prevent conditions such as osteoporosis. However, it can be applied to other tissues as well, such as tendon, muscle, and cartilage. Therefore, another way of looking at this concept is that the application of Wolff’s Law to the entire musculoskeletal system is mechanotransduction. By utilizing a great enough stress to drive cells to respond in order to build and develop stronger tissues, we can create a progressive loading program through which the body trains to adapt to increased forces.
Mobilization is a form of stretching that changes the amount of range of motion of the joint as opposed to the flexibility of the soft tissue around the joint. Allowing for flexibility through stretching and not stabilizing the joint causes a temporary change in pain that requires more attention.
Stabilizing the joint through progressive loading then, once the joint is working better, loading the joint with heavy loads is how the hole in the row boat is patched. Low load-high rep exercises will cause the connective tissue to grow. Low rep-high load exercises require sound connective tissue integrity. This will improve the body’s ability to tolerate activities of daily living as well as the ground reaction force of running, lifting, or sports.
Restoring high level activities cannot be performed by chemical means, it must be done using mechanical means like loading. Squatting, deadlifting, and push press are key to a body that can tolerate some force. Here at MVPT, we do not use any modalities to treat your mechanical problem. We do a thorough evaluation, find the stiffnesses or weaknesses and then put a plan together to help you correct the abnormalities in joint position or weakness. Call 702-998-2900 to make an appointment today!
Want to read up?
Khan, K. M., & Scott, A. (2009). Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 43(4), 247–252. https://doi.org/10.1136/bjsm.2008.054239
How Wolff's Law Is Used During Fracture Rehab in PT. (2018). Retrieved from https://www.verywellhealth.com/wolffs-law-in-physical-therapy-2696151
Generations ago kids played outside. They ran, jumped, climbed trees, and rode bikes. They played baseball in the spring and football in the fall. And they played many other sports in between. Neighborhood kids would gather after school, find a ball and some open area, and they would play a game. The kids these days have incredible technology and dangers that were not around 20 years ago. A pick up game nowadays is an old thought. They simply cannot play without supervision. So what is a parent to do so their kids will exercise? Many turn to organized sports - some to an extreme. Kids are more competitive at younger ages than 5 years ago, 10 years ago, 20 years ago. Club coaches mistakenly educate parents the kid must play year round to be competitive when the scholarships are handed out or big competitions come up. That is simply not true. Athletes, especially young ones need a diversity of physical activities. 81% of D1 college athletes were multisport athletes in high school. The trend in collage recruiting is to PASS on one-sport athletes. They are a risk to the investment the school makes in that athlete due to injury. Single sport athletes typically get injured when they are sophomores or juniors in college. Because kids don’t know any better (and don’t read blog posts), it falls on the parents to seek out the information that will maximize their kid’s chances of success.
They say that life is 90% how you react to the 10% of the things that happen to you. I can say that over my lifetime, that is very true. Today’s blog post is using that metaphor in a business sense. While MVPT is still the community leader in running medicine and the Las Vegas valley’s only running specialty clinic, something interesting happened when MVPT opened its doors in 2014. Kids came. A lot of kids came. The more kids who came, the more their parents talked to other parents. The valley is full of kids who are training for sports. Since the weather of Las Vegas is tolerable for the majority of the year, kids train year round. That could be a problem. Kids over-train the one sport they play. Over specialization is a huge nationwide problem and Las Vegas is no different.
Injury “prevention” is almost an impossible goal. Accidents and injuries happen. “Minimization,” is a better goal. While the spirit of prevention is alive and well, educating an athlete to do this or that to eliminate any chance of injury is simply incorrect. I have been guilty of doing this. Every day, I read research and study, and now I realize that is false hope. Your young athlete will be injured. That is a fact. Can we make it a sprain instead of a fracture? YES. Can we get tenonosis instead of an ACL tear? YES. How? Strength. There is no situation ever where an athlete is ‘TOO STRONG” and therefore a detriment to his or her performance. However, there are limits. If the kid just picks up a barbell and loads it up he may be doing more harm than good. The key is in the details. Originally, the idea for MVPT was formed when a lot of the so called “sports trainers” were hurting kids left and right. Not just asking them to lift, but asking them to lift too much too soon, or choosing inappropriate exercises.
You see, the demands of the sport shouldn’t be replicated in training, it adds to the over use. Understanding the movement patterns of the skills of that sport is the skill of training athletes. Anatomy, physiology, and proper periodization are the key. The skills have to have a progression. The load of weight lifting is a major component health AND performance. Weakness hurts. Since the motor development of kids is hampered by NOT going outside, they are left to figure it out on the field. Then that demand is specific to the sport. The athletes flounder.
Then comes the cross training. The cross training should be movement specific, loaded when it is appropriate, and must compliment the sport. The feather in the cap at MVPT is a physical Therapist who is trained in barbells and human movement. A life-long multi-sport athlete himself, the program can be tailored to athlete specifically. The movement for an individual will depend on many factors. The experience to deal with these factors comes from 15 years of clinical experience. There are no short cuts - no models that can predict with certainty whether or not an injury will or will not occur. There is simply no evidence with any predictive power that short cuts help. They cannot prevent an injury nor do they help with performance. The athlete’s nervous system has to learn and adapt to a new method. Hard work, dedication, adaptation to loads, and movement correction are the keys to sports performance. So the question is at what age can a young athlete begin a strength program? The answer is, as soon as he or she has the movement maturation to tolerate such a load. Some kids are ready at 8 while others need more time. Age is not as important as movement when it comes to making this decision.
We at MVPT pride ourselves in “evidence based” care. Which means the interventions that actually help are the interventions we delegate. We offer a “functional” evaluation to screen a healthy athlete and make recommendations on minimizing trouble. We would love an opportunity to use our vast knowledge and experience to help your child perform better. Discounts apply to teams. Please go to the website at maxvelocity.com for more information or you may call the clinic at 702-998-2900 to make an appointment. Please feel free to share, comment, or like! Help us spread our message!
This post could easily be twice or three times longer but I am going to give you the short and sweet version. This post will bounce around from me and my personal life to me as a professional. Each topic will have a personal and professional section kept short for brevity sake.
Childhood and the Wide World of Sports
Personal-When I was a kid sports on TV was new. The broadcast companies didn’t think people would watch hours and hours of sports. So on Saturdays after cartoons they had a show called “The Wide World of Sports.” They showed off the beaten path sports like skiing, track, ping pong, and once a year they spotlighted what we know now as the Ironman world championship in Hawaii. I was enamored by it. I thought/think THOSE athletes are amazing, I could never do what THOSE athletes can do. They do long, I do power, it will never work for me. I wanted to watch more and more of it but we simply did not have the access to it.
Professional-Since I was bigger than any other kids I was educated with I had to play offensive and defensive line, play the outfield and hit homeruns, play forward and specialize in rebounds, and basically any other power athlete job. I was absolutely enamored by mechanics of sports throwing, hitting a baseball, and running etc. I loved the human muscle anatomy of sports. My life as a clinician began with coaching and being coached as an athlete. I had some junior college looks for baseball and was a very good athlete but nothing panned out.
Personal-Like most people college was a fantastic time in my life. I made great friends and tried to figure out who I was. It was during this time that I figured since my “athlete” days are over I was not an athlete. I ate, drank, and trained like my athlete days were over (no training). I met my wife and we decided that since we were happy together we can eat and drink together! We did not exercise and we started our life together.
Professional-I struggled to get into PT school because of my “brain.” I didn’t believe I belonged there and If it wasn’t for some key people to push me and give me some confidence, I may not have made it. I got into PT school and my goal was to become an expert clinician. I did not recognize my diet, exercise, and fitness level affected my learning. I wanted to learn the most advanced manual therapy skill, I surrounded myself with excellent clinicians and took some advanced orthopedic courses to further my clinic skills. After a few years of getting my license I had more continuing education credits than most PTs out for 5 or 6 years out of PT school.
Personal-I was missing something. I wasn’t myself. I was sick all the time. I had ballooned up to about 300 pounds and I was not a happy guy. I had a runner who was a very important to the clinic (VIP) and she said “If you know so much about this why aren’t you doing it?” OUCH. She was right, I was unhappy and it was because I checked out from my body. I was a hypocrite. Walking turned into running, running turned into more running, and then the weight started to come off. I was starting to reconnect with the athlete that I am. However, the weight loss stopped abruptly. 4 ½ marathons, 1 sprint, 2 olympics, and silverman/1/2 Ironman in 2009 and no weight came off despite the healthiest diet possible according to American standards. I was still sick and then I decided to get some help. 3 nutritionists later and I am no lighter and I feel even sicker. That is when I found metabolic efficiency. Metabolic efficiency is a cutting edge daily nutrition strategy that supports endurance training, weight loss, and performance. Metabolic efficiency has the evidence behind to show that it is the wave of future of healthy lifestyle. When I learned how to properly nourish myself I became ultra aware of where our food comes from and how it is prepared and realized that nutrition is the key to a healthy life. It is far more important than any medicine or chemical and I also learned from another perspective our bodies are amazing. Another 50 pounds comes off and my mind, body, and spirit are in a brand new place. My whole life I did not know what it meant to feel good. Feeling better, more confident, I quietly asked myself what I was capable of. I knew that the ironman was a long way away, but could I get there? With more and more experience with training, coaching, and nutrition the plan was to complete the ironman. After 5 ½ Irons, 4 marathons, 25ish ½ marathons, and new body chemistry I was ready. In 2013 I volunteered at Ironman Arizona and was able to sign up for 2014. My A race for 2014 was Ironman Arizona and finished. While I was not as prepared as I could have been and with rough race conditions I did not reach my time goals, but I finished and completed my dream of doing something only “those” athletes could do.
Professional- After 5 years or so of continuing education in spine or pain I decided I would look for a course that specialized in triathlon. I wanted help with my training and thought maybe I would learn something that I could use in the clinic. I found a course in Charlottesville Virginia that would prove huge in my clinical development. Turns out this course attracts the top running health professionals in the country and presents cutting edge research. I would go back the next 3 years in a row. Every year more and more cutting edge research and high level training. This training would drown out the status quo information in mainstream training, physical therapy, and medicine I was learning along the way. This revolutionized my clinical brain. Running is the hardest thing to do on our musculoskeletal system and the orthopedic skills to train people to run requires high level skill. At the same time I fell into the network at UNLV and started coaching with the cross country and track programs. In that time I was able to coach at the 2012 Olympic trials and watch Americas top athletes prepare and recover. At that moment I knew I had something to offer. Our most skilled athletes needed an upgrade in training and I wanted to be at the forefront of change. I want to bring cutting edge information to the ground level of where people who need this training are. Why can’t “regular” everyday athletes benefit from high level training? Elite athletes are no more skilled than age groupers. Wouldn’t it be fun to inspire people to reach goals using cutting edge education and training techniques? As I got better at treating this population of people, using high level orthopedics, run training, and latest running literature it became apparent. Why can’t I work at a place where I can do this all day? Maximum Velocity Physical Therapy is born.
In summary, the personal journeys of chasing my dream of training for and completing an Ironman and the quest to become a master clinician has intertwined themselves and produced Maximum Velocity Physical Therapy. Big business is ruining healthcare, insurance companies are dictating to healthcare to work in a factory kind of way. There is no way to conduct high level of care at a factory pace and when the orthopedic skills to apply to running are high level something had to change. At MVPT, your health and progression are the focus of our day. You can go to the website www.maxvelocityPT.com and request an appointment or call 702-998-2900 for any inquiry.