Upper Cross Syndrome (UCS) is defined as a phenomenon that occurs as a result of muscle imbalance between your neck and shoulder muscles. UCS is the result of weak deep neck flexor muscles and mid back muscles as well as tight upper trap muscles and tight chest muscles. UCS often results in a rounded shoulder and forward head posture. UCS is fixed by strengthening the weak musculature and lengthening or stretching the tight musculature. Specifically, stretching out the pectorals, upper traps, and levator scapula muscles while also strengthening the deep neck flexors, lower traps, and serratus anterior muscles. Tools such as foam rollers and manual stretching may aid in lengthening the necessary musculature, while exercises such as chin tucks, serratus punches, and prone Ys may assist in strengthening the necessary muscles.
If you are experiencing an ache or pain that is persistent, you want to see a medical professional to determine your treatment plan. In the state of Maryland, you can see a physical therapist without seeing a physician first. If you choose to do this, a physical therapist will perform an evaluation to determine your plan of care. If a physical therapist feels seeing a physician is necessary based on your evaluation, it will be recommended. This is the same for an MRI. If you see a physical therapist first, we are unable to prescribe imaging but we will recommend you see a physician to ultimately get imaging. Most people go through a round of conservative treatment, such as physical therapy prior to receiving an MRI. An MRI is recommended when physical therapy is not improving symptoms or you are hitting a plateau with improvement. Most insurance companies will not approve paying for an MRI without the patient having physical therapy first. If you are unsure of what you need to do for the next step in your treatment plan, make sure to make an appointment with a physician or physical therapists to help guide you.
Many patients come to physical therapy with back pain. They come in asking the question, “why does my back hurt?” Well, the answer is not the same for everyone. A physical therapist has to perform a thorough evaluation to determine the cause of the patient’s back pain. The evaluation consists of finding out specific details from the patient about their back pain. This leads the therapist into a specific evaluation of the patient’s range of motion, strength, flexibility, and stability. Typically back pain comes from a lack of mobility, strength, and flexibility. For some patients, it is more of a decrease in flexibility, for others because of strength deficits, and some folks it is a combination of both. Once this is determined, your therapist will develop a plan of care to improve upon the deficits found during your evaluation. On average, it takes 4-6 weeks of consistent physical therapy to achieve the ultimate goal of decreased pain and improved function. The key as a patient is to be patient and stick with the plan. If after a month of physical therapy you do not notice any improvements, make sure to speak with your physical therapist to determine the appropriate continued treatment plan.
The answer is YES! Muscle soreness after exercise is called DOMS (delayed onset muscle soreness). This happens when you exercise a muscle that has not been used stressfully in awhile. The soreness results from tearing and or stress on the muscle fibers and as the body repairs these small tears your muscles become stronger. After exercise, you will normally feel muscle soreness anywhere from 24 to 72 hours after the activity. The intensity of the muscle soreness you experience will depend on how intense your workout was and if that muscle group has experienced a workout before of this variety/intensity.
If your symptoms of muscle soreness linger longer than 72 hours and either get worse or stay the same, then you want to consult with a medical professional. The reason for this is your exercise possibly caused a muscle strain, ligamentous sprain, or injury.
A meniscus tear is a common injury that occurs to the cartilage in the knee. Each knee contains 2 menisci that help to absorb shock in the knee and stabilize the joint. An injury to these structures can occur as a result of a quick movement such as forcefully twisting the knee while putting weight through it. This can cause pain, swelling, stiffness, and difficulty extending the knee fully.
If the tear is severe enough, surgery may be necessary. However, research studies have shown that improvements in pain and function are similar whether you have surgery or physical therapy. With that being said, going through a course of physical therapy first is the best course of action in the majority of cases and will help to determine if further action such as a surgery is necessary if you do not fully recover from the injury.
If you have suffered from a meniscus tear, a physical therapist will help you to decrease your pain, restore the movement in your knee, and work on strengthening and stabilizing your knee joint. The goal of physical therapy is to allow you to return to all of the activities that you enjoyed previously while simultaneously decreasing the risk of an injury occurring again.
Written by: Dr. David Reymann
Staff Physical Therapist at Harbor Physical Therapy
Arthritis — or, more specifically, osteoarthritis (OA) — is one of the most common causes of joint pain and stiffness. It primarily affects knees and hips due to their nature as high load-bearing joints; however, it is known to impact nearly every joint in the body including the spine, shoulders, and wrists. Many people diagnosed with OA are told that their X-rays show “bone-on-bone” joint degeneration. This may sound quite scary and even unsolvable without joint replacement, but the current osteoarthritis research may surprise you when it comes to risk factors for pain and the effectiveness of non-surgical interventions.
Let’s use knee OA as an example: according to epidemiological data, over 50% of people with X-ray confirmed OA (loss of the cushioning cartilage that protects the knee joint) do not report experiencing pain, stiffness, or activity limitations. Furthermore, progression of OA severity on X-ray does not correlate with progression of clinical symptoms. In other words, the way someone’s knee looks on an image does not predict how much pain they will have. In fact, it is so common for people older than 30 years old to display OA on an image that practitioners have begun calling the diagnosis “symptomatic knee OA” rather than just “knee OA.” You are more than just your X-ray!
One variable that does predict the amount of pain and disability experienced with OA is one’s activity level. The cartilage that helps protect your joints requires nourishment to stay healthy; this nourishment is supplied in part by the movement of the joint. Every time you take a step or do a squat, protective fluid is forced in and out of your knees and hips. As you move more and more, the joints become healthier as more nutrients are supplied to the tissues. Even if there isn’t much cartilage left (“bone-on-bone”) the lubricating fluid can do its job more effectively when you keep the joints moving. This is the reason many people with OA start to feel better with moderate amounts of exercise!
If pain should occur, numerous research studies have found exercise-based interventions, including physical therapy, to be extremely helpful to manage OA. By increasing muscle strength, improving how well joints are being lubricated, and maximizing the health of the remaining joint cartilage, a rehabilitation program can be quite helpful to those in pain. The most important thing to remember is don’t be afraid to move! If you are experiencing joint pain, contact Harbor Physical Therapy to learn what specific exercises can help improve your symptoms.
Dr. Scott Newberry
For many avid exercisers, delayed onset muscle soreness, or DOMS, is used as an indicator of a successful workout; however, for those unfamiliar with its symptoms or who have an underlying injury or pain condition, DOMS can be a discouraging, unpleasant, and sometimes frightening experience. DOMS is defined as muscle pain, stiffness, swelling, and weakness beginning 12-24 hours after a workout, peaking around 48 hours, and persisting up to 7 days. It is typically a subclinical condition, meaning most cases resolve without the need for medical intervention. Most people have experienced such soreness at some point in their lives — whether due to starting a new exercise routine or from pulling weeds in the garden on the first day of spring. My goal is to demystify* DOMS and provide tips on reducing your chances of having your fitness or rehabilitation goals derailed by this temporary condition. By the end, you’ll feel confident to march on with exercise despite the soreness!
*Spoiler alert: there is currently no scientific consensus on the specific cause of DOMS.
Break Down to Build Up
To provide some context for the discussion that follows, it will be helpful to take you through an abbreviated journey (think: The Magic School Bus) from the moment you perform an exercise, such as a biceps curl, through the first few days of recovery. When you lift a heavy weight for the first time in a while, you inflict exercise-induced damage, also known as microtrauma, to the muscle tissue. While this may sound scary it is a normal, typically healthy form of “injury” that leads to desirable adaptations including increases in muscle strength and size. (Curiously, the extent of microtrauma does not seem to correlate to the severity of DOMS1.)
In the hours/days that follow, like an episode of Extreme Makeover: Muscle Edition, your body gets to work not only repairing the affected tissue but making improvements to ensure that the next time you work out you’re prepared for the challenge. It accomplishes this through the action of immune cells, inflammatory enzymes, and genetic activity. The nerves and blood vessels that supply the muscle also become more active, increasing strength and power in as few as 1-2 weeks. Within 6-8 weeks of repeated exercise, visible changes such as increased muscle mass (AKA hypertrophy) become evident.
Getting Back to DOMS
Now let’s zoom back in to what’s going on the first 2-3 days following your biceps curl when you’re so sore that brushing your teeth is a struggle. I’d like to reiterate here that researchers are not in full agreement about the mechanism of DOMS. However, it’s still worth discussing a few of the more plausible hypotheses.
(Debunked) Theory #1: Soreness is the result of accumulated lactic acid in the exercised muscle. This is a popular one but is not accurate. While lactic acid plays a role in the burning sensation that occurs while you are lifting weights, it is not directly involved with the development of DOMS.
Theory #2: The aforementioned muscular microtrauma results in inflammation, sensitizing nerve endings and leading to pain. While this seems plausible, several studies have shown that the level of inflammation actually increases following subsequent workouts despite decreased levels of microtrauma and soreness2. It’s worth pointing out that while inflammation often gets a bad rap, it’s an essential part of recovery — it’s your body’s modus operandi for healing tissue and adapting to life’s stresses. Certain elements of the inflammatory process may be involved with DOMS, but inflammation alone does not seem to be an adequate explanation.
Theory #3: Physical and metabolic stresses during exercise cause microtrauma to the nerves that attach to the involved muscle fibers, which are then sensitized by a number of molecules spurred into action by the repair/rebuild process. This theory is hot off the press, having been published shortly before this post (September 2020)3. The idea is that, following exercise, nerves (depicted by the green and orange lines in the image below) are traumatized in a manner similar to muscles. Then, increased levels of nerve growth factor (NGF) and other restorative compounds sensitize the injured nerve endings. These compounds are distinct from inflammation, distinguishing this theory from the one above.
Theory #2 and #3 both have merit and the truth may be a combination of these factors. Nerve growth factor has been experimentally validated as a sensitizer of nerve endings and is produced in response to exercise, so this is likely to be a factor in DOMS. However, the extent to which muscle or nerve microtrauma and inflammation are involved is unclear.
If at first you’re sore, try, try again
Even though we don’t know exactly why DOMS happens, we do know that it’s a temporary condition as part of your body’s adaptive process. By executing these steps to recovery like a well-trained military unit, your body is able to adapt to new loads with remarkable efficiency. Within 1 week, a protective buffer allows you to repeat bouts of exercise with decreased soreness. This shield of DOMS protection can last as long as 4-12 weeks post-exercise and is referred to as the repeated bout effect4. The repeated bout effect is dose-dependent, meaning the greater the intensity or duration your first time exercising, the more protection you have for future efforts. However, even low loads (as few as 2 repetitions) can reduce the risk of DOMS the next time you work out. This should be encouraging to those who may be reluctant to start or continue exercising due to DOMS.
Can I work out when sore?
Yes. Exercising a sore muscle in moderation is not harmful to the muscle tissue nor the recovery process, though you may find you’re unable to exert as much force due to the strength deficits that accompany DOMS. Aerobic exercise is totally safe and will often help reduce the intensity of soreness in the affected areas5. While there is not much evidence to say that you shouldn’t work out a sore muscle, if you’re experiencing undue pain or fatigue while doing so it may be best to target another muscle group.
While the very first workout for an untrained individual is likely to result in DOMS, the repeated bout effect protects from perpetual soreness, and individual factors such as genetics also impact one’s susceptibility6. Furthermore, certain muscle groups are more likely to experience soreness than others. The fact is there isn’t much evidence that soreness is necessary for increasing strength or building muscle7. On the contrary, there is convincing evidence that strength and size can increase without muscle soreness8. So you don’t have to go searching for soreness to make gains.
Isn’t there a magic pill I can take?
Much time, effort, and money has been spent to reduce the incidence and severity of DOMS. However, many of these remedies have been deemed ineffective by science. For instance, stretching before and/or after exercise does not prevent DOMS9. Nor does massage10, ice11, Epsom salt12, or bee venom13 (yes, that’s a real study). This doesn’t mean that a good massage, stretch, ice bath, hot pack, (…or bee sting?) won’t curb symptoms once they set in. They just won’t reduce your chances of getting DOMS in the first place or decrease the duration of your misery.
If you really can’t stand DOMS, there are a few strategies to try. Some research has found that omega-3 fatty acid, caffeine, and taurine intake can potentially reduce symptom severity14 (disclaimer: discuss dietary supplementation with a medical provider). Light to moderate aerobic exercise such as riding a bike or jogging may help reduce DOMS when used as part of a warm up routine15. However, the best solution may be the most obvious: ease your way in. A 1- to 2-week preparatory exercise phase using lower volume and intensity reduces the soreness experienced with subsequent sessions16.
If you try all of the above and still get a case of the DOMS, do not fear. Father Time will take care of the soreness and your body will ensure that the next time you work out, the pain won’t be quite so bad. Trusting in your ability to repair and adapt will allow you to reap the numerous benefits that exercise has to offer.
Written by: Dr. Scott Newberry
Strains and sprains are common musculoskeletal injuries that can develop from a variety of everyday activities. Although these injuries can be similar, they involve different types of soft tissue in the body.
A strain is an injury to a muscle or tendon that has been overstretched or torn. A tendon is a tough cord of fibrous tissue that connects muscles to bones. A strain can develop over time from repetitive use of a muscle or can develop acutely from a sudden overstretching of a muscle.
A sprain is an injury to a ligament that has been overstretched or torn. A ligament is a tough band of fibrous tissue that connects bones to other bones in your joints. The ankles and knees are common area of sprains due to abrupt pivoting and twisting motions.
Physical Therapists treat sprains and strains with exercise, manual treatment, and modalities. If you would like to learn more about your injury, contact Harbor Physical Therapy at 443-524-0442.
Written by Dr. David Reymann
There are some common misconceptions out there about physical therapy. This list was created to help clear some of those up!
- I need a referral from a doctor before I can see a PT. FALSE
Because of direct access in the state of MD, you are able to schedule an appointment with a PT without a referral from your PCP.
- Any medical professional can perform PT. FALSE
Physical therapy services must be provided by a licensed physical therapist.
- Physical therapy is the same thing as massage therapy. FALSE
If you have been to PT before, you may have had some massage incorporated as part of your treatment. This is only one tool that some therapists may incorporate into your treatment. PTs are trained as movement experts and are focused on improving function. A lot of PT is exercised based and may incorporate strength training or balance training for example.
- PT is only for injuries. FALSE
PTs are trained to treat a myriad of different conditions and many PTs go on to specialize in specific fields. A few different areas that PTs can work in include pediatrics, geriatrics, sports rehab, chronic pain, vestibular, orthopedics, neurological, and cardiopulmonary to name a few.
- Surgery is my only option. FALSE
There are many studies that show that physical therapy can be as effective or more effective than surgery in many cases. Trying physical therapy first is a safe and smart approach to treatment for several different conditions.
Written by: Dr. David Reymann
The rotator cuff, an often neglected muscle group, is a group of four muscles and tendons that surround the shoulder joint. The rotator cuff helps to keep the head of your upper arm bone firmly within the shallow socket of the shoulder joint. In addition to keeping your shoulder stable, these muscles help to lift and rotate your arm. Injury to this muscle group is common, particularly in those who perform repetitive overhead motions as you would in a sport like tennis or a profession like painting.
The key to preventing shoulder pain or injury to these muscles is maintaining good rotator cuff strength in addition to good posture to improve your shoulder mechanics. Here are four simple exercises that you can start performing at home to start building better shoulder strength and stability.
- Side-lying External Rotation with Weight
If you are currently suffering from shoulder pain, the physical therapists at Harbor Physical Therapy will help you to develop an exercise program that is specific to your injury.
Dr. David Reymann
Staff Physical Therapist
Harbor Physical Therapy