How does Movement Help Injuries Heal? Tendons and ligaments.

If you’ve ever been to a physical therapist, you know that exercise is usually prescribed as the primary treatment for a number of injuries and conditions. Clearly exercise has numerous benefits, but it can sometimes seem counterintuitive to place resistance or load through an injured area — doesn’t it need time to rest and heal? The short answer to that question is generally yes, especially immediately following the injury; however, the right amount of movement and exercise can actually promote healing and recovery from injury. This is where PT comes in.

My goal is to help you understand just how exercise helps restore normal functioning of injured body tissues. This article is part of a series that will discuss how various types of tissue depend on movement to recover. Today’s subject is injured tendons and ligaments.

Tendon and ligament injuries range in terms of type and severity and are broadly categorized as tendinopathies or ruptures in the case of tendons and sprains in the case of ligaments. Examples of tendinopathy include tennis elbow, golfer’s elbow, and Achilles tendinopathy. You may have also heard the term “tendinitis” used with these conditions. Though complex and multifactorial in nature, tendinopathies often involve tissues that have become weakened and painful through repetitive usage. Ligament injuries are usually due to trauma — you’ve likely heard of athletes injuring their anterior cruciate ligament, or ACL.

Tendons connect muscle to bone, transferring the force produced by a muscle into a nearby bone to create movement. Tendinopathies often develop in situations where a person puts a repetitive load through a tendon over a sustained period of time. It is most likely to occur when the level of activity is increased relative to baseline (i.e., too much too soon), such as someone taking up tennis for the first time in a while or playing more matches than usual.

The sustained tendon stresses can cause areas in the tendon to become disarrayed and no longer align with the direction of applied force. In other words, the fibers aren’t able to convert muscle energy into movement as efficiently. The gold standard strategy to disrupt this process is to load the tendon through slow, heavy resistance training which stimulates the tendon to remodel itself and repair the injured areas. Eventually, the tendon becomes strong enough to handle loading without pain.

Ligaments connect one bone to another, protecting joints from moving in directions they shouldn’t. While ligaments are not exactly the same as tendons, the loading principles discussed with tendons allow them to handle higher loads through similar mechanisms — by increasing their thickness and the amount of force they can handle.

One very important thing to keep in mind is that immobilization is very detrimental to the strength and health of tendons and ligaments. Therefore, seeing a PT after injury may give you the best shot at retaining as much function as possible in the injured tissues.

Look out for the next article in the series about bones.

Written by: Dr. Scott Newberry

How does Movement Help Injuries Heal? Cushion for the Pushin’.

If you’ve ever been to a physical therapist, you know that exercise is usually prescribed as the primary treatment for a number of injuries and conditions. Clearly exercise has numerous benefits, but it can sometimes seem counterintuitive to place resistance or load through an injured area — doesn’t it need time to rest and heal? The short answer to that question is generally yes, especially immediately following the injury; however, the right amount of movement and exercise can actually promote healing and recovery from injury. This is where PT comes in.

My goal is to help you understand just how exercise helps restore normal functioning of injured body tissues. This article is part of a series that will discuss how various types of tissue depend on movement to recover. Today’s subject is cartilage, specifically the type that protects your joints from impact and is implicated in the onset of osteoarthritis. This type of cartilage is called articular cartilage. The scope of this article is how exercise helps a joint that is painful due to age- or activity-related changes, not acute articular cartilage injury due to trauma.

Articular cartilage covers the ends of bones where they connect to each other at joints. For instance, there is cartilage covering the end of your femur and the top of your tibia (shin bone) where they meet to form the knee joint. Over time, a loss of thickness in this tissue is normal and not always associated with pain. However, for many people, particularly those who aren’t very active, the loss of tissue can become painful and inflamed. This is termed osteoarthritis. It may seem counterintuitive that something often referred to as “wear and tear” is most common in people who don’t move very much and thus aren’t exerting much wear or tear on their joints. However, there is a distinct explanation for this phenomenon.

Cartilage receives most of its nourishment from nutrients being diffused or pushed into it from the fluid inside the joint. It does not have a very good blood supply like most of our other tissues. Therefore, it is reliant on movement to provide it with a fresh supply of nutrients; if you don’t move often, it doesn’t have a chance to receive adequate nutrition and degenerative changes can take place. The cushioning ability of the cartilage in terms of thickness and strength depends on frequent movement! Therefore, your PT will often address pain related to osteoarthritis using a graded exercise program.

Look out for the next article in the series about tendons and ligaments.

Written by: Dr. Scott Newberry

How Does Exercise Help Injuries Heal? Put some muscle into it.

If you’ve ever been to a physical therapist, you know that exercise is usually prescribed as the primary treatment for a number of injuries and conditions. Clearly exercise has numerous benefits, but it can sometimes seem counterintuitive to place resistance or load through an injured area — doesn’t it need time to rest and heal? The short answer to that question is generally yes, especially immediately following the injury; however, the appropriate amount of movement and exercise can actually promote healing and recovery.

My goal is to help you understand just how exercise helps restore normal functioning of injured body tissues. This article is part of a series that will discuss how various types of tissue depend on movement to recover. Today’s subject is muscle.

Muscle injuries are quite common. A “pulled” muscle occurs when a force strains the muscle fibers beyond their limits, resulting in tears that can range in size from very small to large. A common example of this in the sports world is a strain of the large muscles on the back of the thigh: the hamstrings. Muscle strains usually recover in a matter of weeks, though can take longer depending on severity.

So how does movement help? After the acute stage of the injury passes, generally within 5-7 days, a return to minimally painful movement helps stimulate the building of new proteins which repair the damaged areas. Movement also helps push inflammatory enzymes, many of which can cause our nerves to become more sensitive, out of the affected area while bringing a fresh supply of blood — and with it much-needed oxygen and nutrients — to the healing tissues. Lastly, moving a muscle is critical to maintaining its range of motion and preventing increased stiffness or motion loss. As more movement is tolerated, exercises should be progressed to continue facilitating the healing process, eventually allowing restoration of strength that matches or exceeds the pre-injured state.

Look out for the next article in the series about how cartilage responds to movement.

Written by: Dr. Scott Newberry

Making an Exercise Routine Fit Into Your Lifestyle

The World Health Organization (WHO) recently updated their exercise guidelines for adults to include 150-300 minutes of moderate intensity exercise and/or 75-100 minutes of vigorous intensity exercise. While this is the gold standard recommendation for maximizing the health benefits associated with staying physically active – and there are many such benefits – 2.5-5 hours of exercise per week can prove to be an intimidating prospect for many who don’t have a history or habit of hitting the gym (or home gym) on a regular basis.

I thus want to provide a less intimidating message for you to kickstart the habit of exercising on a regular basis: anything is better than nothing! The fear of failure associated with committing the time and resources associated with the WHO’s recommendations can foster an all-or-nothing mentality. This ultimately results in exercise “kicks” and burnout for many people, even when they have the best intentions of staying committed to fitness. I thus offer you an out: start small. Recent research has found even 30 seconds each of pushups and squats in the morning can yield benefits when it comes to strength and aerobic fitness. If you establish a routine this simple, you can gradually begin adding more exercises over time. Before you know it, it’ll become an embedded part of your day much like brushing your teeth or taking a shower. With time, you may even find yourself incidentally adhering to the WHO guidelines. No better day than today to get started!

Written by: Dr. Scott Newberry

What is a Meniscus Tear?

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

The Importance of Prehab

Prehab, short for pre-habilitation, is a type of intervention intended to prevent injury or to prepare one for surgery in order to optimize post-surgical outcomes. In the world of physical therapy and athletics, this can include incorporating strength and stability exercises into athletes’ training programs to prevent injuries when they are on the field.

Prehab can also be helpful for those requiring any type of orthopedic surgery such as a joint replacement or ligament reconstruction. By building up strength and general fitness prior to surgery, the risk of complications post-operatively decreases and the functional recovery tends to be quicker. During prehab, patients are educated on what to expect after surgery which can help them feel more prepared for any adjustments they may have to make including any activity modifications.

Prehab is covered by all health insurances.  This is due to health insurances also seeing the benefits of prehab as it cuts down on sport injuries and duration of physical therapy required after a surgery.  If you are interested in learning more about how you could benefit from prehab, feel free to email Harbor Physical Therapy at info@machtmedicalgroup.com to learn more.

Written by,
Dr. David Reymann

 

What Does “Bone-on-Bone” Arthritis Really Mean?

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.

Written by:
Dr. Scott Newberry

Why So Sore? The Curious Case of DOMS

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.

Chasing soreness

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

You can’t go wrong getting strong…no matter your age!

Strength training, also known as progressive resistance exercise, is a safe and effective way to improve your health, regardless of age. In fact, research has continued to support that strengthening is safe and effective for older adults*.

The benefits are far greater than simply improving aesthetic appeal (though this is a favorable side effect). They include:

  1. Counteracting age-related declines in muscle strength and function
  2. Increased muscle strength and power to help maintain or improve function, reduce disability, and maintain independence
  3. Increased bone mineral density, helping to combat osteopenia and osteoporosis
  4. Reduced fall risk
  5. Reduced risk of serious injury if a fall should occur due to improved tissue and bone health
  6. Improvements in psychological health, cognitive function, and sense of well-being

All of these add up to an increase in healthy lifespan and overall quality of life!

Despite all of these benefits, it can still feel intimidating to get started on a strengthening program. Strength training induces fatigue and muscle soreness, both of which can be uncomfortable and discouraging for a novice. However, with repeated training sessions over several weeks, you will find that such discomforts will give way to boosts in energy and improvements in function. Likewise, the soreness that occurs early on will typically improve and become less severe as your body adapts.

Here are a few tips to get you started:

  1. Anything is better than nothing. Start small and gradually build the amount and intensity of exercise. Strengthening 2-3 days per week is adequate to make improvements.
  2. Muscle soreness that begins the day after you exercise and persists for 2-3 days is normal and necessary to build strength. Don’t worry, the soreness will pass!
  3. Keep it simple. Many of the best exercises are those that have withstood the test of time including squats, push-ups, lunges, biceps curls, and arm raises.
  4. Have fun! Get friends and family involved, track your progress in a journal, or follow along with a YouTube video to keep things interesting.

If you need help developing a program, our staff at Harbor Physical Therapy can help you get on your way to a stronger, more resilient body!

*One caveat to the above: if you have a medical condition, orthopedic injury, or are generally uncertain about the safety of strength training for you, be sure to consult a medical professional before beginning a program.

Written by Dr. Scott Newberry

Strain vs. Sprain- What is the Difference?

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