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Jim earned his Doctorate of Physical Therapy from Saint Louis University. He is a certified Orthopedic Clinical Specialist and trained in the Selective Functional Movement Assessment (SFMA) and Functional Movement Screening (FMS) systems. His educational and clinical background have made him an expert in manual and manipulative physical therapy as well as functional movement. Jim opened Heafner Health Physical Therapy in February, 2016.  ​When Jim is not treating patients in the clinic, he focuses his attention on educating fellow physical therapists in the profession, teaching manual therapy courses in Arizona and Texas, and writing. Jim has authored 3 books, including “Making Sense of Pain” and “The Yoga Fix”. Additionally, his Student Physical Therapy based blog attracts upwards of 65,000 views per week. His areas of expertise include Orthopedics, Manual Therapy, Chronic Pain Management, Functional Movement, Patient Education.

David Mesnick is a licensed Physical Therapist with over 25 years experience in owning and operating multiple outpatient physical therapy practices. David is originally from Toledo, Ohio and was raised in Palm Beach Gardens, Florida. David graduated from the University of Florida in 1997 with a B.S. in Zoology and then again in 1999 with a B.S. in Physical Therapy.
David’s clinical emphasis is in manual osteopathic physical therapy with a focus on spine and sacroiliac joint dysfunction (SIJD). David is a board Certified Orthopedic Specialist (OCS) as well as a certified McKenzie Therapist (CMDT). He is also a Certified Functional Dry Needling Practitioner (FDN) and a certified Selective Functional Movement Assessment (SFMA) practitioner.

He has taught several continuing education courses to other health practitioners, and Has authored both articles and books on SI joint dysfunction. David has also authored Cash-Based Physical Therapy: A Step by Step Guide to Your Successful Start Up.

Melissa graduated with a Bachelor’s Degree in Movement Science and completed her Masters in Physical Therapy from Touro College (now University) where she received the “Maimonides Award for Excellence”. She attained a Doctorate of Physical Therapy (DPT) from Simmons College. She worked at NYU Langone’s Medical Center/Rusk Institute of Rehabilitation with orthopedic and neurologic patients, and transitioned to the outpatient physical therapy setting. She is known for her compassion and great listening skills.

Occupational Therapist specializing in Pelvic Health

Tennis Elbow Queen, Olympic / Team GB physical therapist and best-selling author, healing tennis players and golfers around the world.

Melissa is a physical therapist at the Veterans Hospital in Dover, Delaware. She works in a community based outpatient clinic.

Hi, I’m Mitch! I’m a PT, and strength coach based out of Miami, Florida! Currently I work for Old Bull Athletics as a clinician and performance coach. Additionally I teach a CSCS prep course at the university level with Gifted Education, and I have my own online fitness coaching business.

My background started at the University of South Carolina, where I studied exercise science and got to do sport science with their D1 athletics programs. Additionally I facilitated the creation of Apex Athletic Performance’s sport biomechanics lab during this time.

I have my doctorate in physical therapy from the Medical University of South Carolina. During this time, I got experience working with EXOS and professional athletes. I also have experience working with the University of Florida’s running medicine staff.

Personally, my sport background includes competing in martial arts as a junior at the national and international levels. Currently, my sport focus is on powerlifting and general athletic development. 

On my page you can expect a biopsychosocial approach to fitness and rehab, as well as a pragmatic view of the current evidence.

Jan, I'm going to answer this for relation to swimming. So if this doesn't answer your question please, give me a follow-up because I'm not quite sure if you're asking this in relation to swimming or just dry land in general. But if I can explain external rotation is where you open up some regards, this shoulder here, this is opening up and I think about opening a book, okay? And About closing, the books of bringing my shoulders, and my hips, towards the side, that's internal rotation, and in swimming. There's two forms of rotation, open Rotation. That's what people get on their sides allows and for younger, the younger swimmers that's great for hydrodynamics and getting distance per stroke, but for power, it's not. And so I almost think about the first stroke is the most important stroke and to work on internal. Station whatever hand is obviously below, I obviously put with my left, so I'm going to move this hip, okay, to this shoulder, and that's going to get this cross connection, okay? A lot of people do the opposite and they open up and that's actually where you're kind of weak. So you really want to be closing the hip in. So sometimes I have people hold onto a stretch called or Resistance in this lifetime and connector and that's where the vaulting over your hand. Instead of pulling them towards putting their hand towards their head. And so in swimming that's really, really important. Other direct easy technique. I taught him to do is stand on one leg or one and a half legs, which is means your tiptoes on this side and just get them to Twisted belly button to the right and twist her body button to adapt. That's internal rotation. That's external rotation and then eventually they should be able to stand on one leg and do that. Okay? Hopefully, that makes sense. If you've got any other clarifying questions, please don't hesitate to reach out.

External rotation is when you open the shoulder and internal rotation is when you close the shoulder. In swimming, this is important for power and hydrodynamics. To work on internal rotation, a good exercise is to stand on one leg and twist the body.

What cues do you use when discussing and teaching hip internal rotation?

Unlocking Power: Teaching Hip Internal Rotation for Optimal Swimming Performance

When discussing and teaching hip internal rotation, I'll focus on its relation to swimming. If this doesn't address your question, please let me know for further clarification.

In swimming, there are two forms of rotation: open rotation and internal rotation. Open rotation, where the shoulders and hips open up, is beneficial for hydrodynamics and distance per stroke, especially for younger swimmers. However, for power, internal rotation is crucial.

To emphasize internal rotation, I encourage swimmers to imagine closing a book by bringing their shoulders and hips towards the side. This creates a cross connection and helps generate power. It's important to avoid the opposite movement of opening up, as it can weaken the swimmer.

One technique I use is having swimmers hold onto a stretch cord or resistance band while pulling their hand towards their head instead of away from it. This helps reinforce the closing motion of the hip.

Another exercise is to have swimmers stand on one leg or one and a half legs (with the tiptoes on one side) and twist their belly button to the right and left. This twisting motion represents internal and external rotation, respectively. Eventually, they should be able to perform this exercise while standing on one leg.

I hope this explanation makes sense. If you have any further questions or need clarification, please feel free to reach out.

The most common shoulder injury that I see with swimmers tends to be a biceps tendinitis and usually that kind of falls under the umbrella of a stability related injury because a lot of swimmers are just really hypermobile. They have a lot of movement in their shoulders, that's not really well controlled and that ends up causing some extra stress to tissues. Namely, your biceps tendon when you're in an overhead position or doing a lot of things that require some external rotation of the That arm and so that that tends to be something that we see a ton of and so how do we treat that? Well, that's kind of a long complicated answer and it depends on where you're starting from and typically speaking a lot of swimmers are going to start with pretty low level. In terms of the stability set that they need to be working on. It's kind of what you think of traditionally with PT banded exercises, internal external rotation, the kind of boring stuff. But if you never progress Press past that and you're never progressing to doing things in overhead position or apply metric work or even things with real weights like kettlebells and barbells and things like that. Then you're not really getting that shoulder to the place that it needs to be to handle the stress that that you're going to be putting on it.

Biceps tendinitis is the most common shoulder injury seen in swimmers, and it is usually caused by hypermobility and lack of stability. To treat this injury, physical therapists typically start with low-level exercises such as banded internal and external rotations. Swimmers should progress past these exercises to incorporate overhead press, plyometric work, and weighted exercises into their routine for proper shoulder strength and stability.

What is the most common shoulder injury you see amongst swimmers? How do you treat it?

Swimmers Beware: The Key to Treating Common Shoulder Injury

The most common shoulder injury I see among swimmers is biceps tendinitis, which is often related to stability issues. Swimmers tend to have hypermobile shoulders with excessive movement that lacks control, leading to added stress on the tissues, particularly the biceps tendon during overhead movements or external rotation.

Treating this injury depends on the individual's starting point, but typically, swimmers begin with low-level stability exercises. These may include traditional physical therapy exercises using resistance bands for internal and external rotation. While these exercises may seem mundane, they are essential for building a foundation of stability.

However, it's crucial to progress beyond these basic exercises. Swimmers should incorporate overhead movements, isometric work, and exercises with actual weights like kettlebells and barbells. These advanced exercises help strengthen the shoulder and prepare it to handle the stress placed on it during swimming activities.

In summary, biceps tendinitis is a common shoulder injury among swimmers due to stability issues. Treatment involves starting with basic stability exercises and gradually progressing to more challenging movements and resistance training to ensure the shoulder can handle the demands of swimming.

Why might somebody's ankles hurt and feel stiff? Two reasons, because of a tight muscle in the back or a joint and how you'll figure that out is if you stretch your calf muscle and you do some stretches like this or your Achilles muscle where you bend your knee and then you can do some triplanar movements and if that improves it then you know that that's a stiff muscle. If it doesn't then you may need to do mobilizations to your ankle. A lot of times when you have an unresolved ankle sprain there's a joint here or a bone called your fibula and sometimes that gets stuck and in order for you to be able to squat which is one of the main things that I find that people lack the ability to do which can affect the whole kinetic chain. So I sometimes mobilize or put a tape on here and then see if you can do your activities. Some causes of this are wearing heels or a lot of people do jump rope and then it puts tightness on here and then when they're trying to squat it limits this ability to move over here which then affects their lower back when they're squatting and sometimes people come in with back pain but it's caused from their ankle.

Ankles may hurt and feel stiff due to tight muscles or joints, which can be treated with stretching and mobilizations. Common causes include wearing heels and jump roping.

Why might someone's ankles hurt and feel as if they're stuck?

Uncovering the Root Causes of Ankle Pain and Stiffness

Ankles can hurt and feel stiff for two main reasons: tight muscles in the back or joint issues. To determine the cause, you can perform stretches for the calf and Achilles muscles. If these stretches improve the pain and stiffness, it indicates a tight muscle. If not, mobilizations may be necessary for the ankle joint.

Unresolved ankle sprains can lead to a stuck joint, particularly the fibula bone. This can affect the ability to squat and impact the entire kinetic chain. Mobilization or taping techniques can be used to address this issue and improve mobility for activities.

Wearing heels or engaging in activities like jump rope can contribute to tightness in the ankle. This tightness limits movement and can affect squatting ability, which in turn may lead to lower back pain.

By identifying the underlying cause of ankle pain and stiffness, appropriate interventions can be implemented to address the issue and alleviate discomfort.

How do I teach a neck breather? How to change the way that they breathe, obviously for a more efficient Breathing, by changing the position and eliminating their head, and their neck? What I mean by that is a couple of easy positions are taking the head out of it. If you just rest your head, put your hand on your stomach and ask the athlete to breathe into the floor and fill this space. So it's a looks like this. So, you're going to breathe. And you want them to fill this whole area and then you can observe and also put your hands on their neck. You don't want this to be happening. You want the movement to come here and then into the floor or you can get them to put their hand down here and get them to breathe and so, just relax their neck. Another position would be on your stomach, I'm going to turn my head but normally I put my head down and I call it belly breathing. So you're going to see. I'm going to take a breath in Can you feel that your belly pushes into the floor and this raises up. So here goes again. And then the last position would be on your back. Same thing breathing into here and here relax.

To teach a neck breather to breathe more efficiently, have them rest their head and put their hand on their stomach. Ask them to breathe into the floor and fill the space. Have them practice belly breathing while lying on their stomach and back, focusing on relaxing their neck and pushing their belly into the floor with each breath.

How do you teach neck breathers how to change the way they breathe?

Revolutionize Your Breathing: Transforming Neck Breathers for Efficiency

To teach someone who breathes primarily through their neck how to change their breathing pattern for more efficient breathing, I focus on changing their head and neck position. Here are a few techniques:

1. Resting the head: Ask the person to rest their head and place their hand on their stomach. Instruct them to breathe into the floor and fill the space in their stomach. Observe their breathing and ensure that the movement is happening in the stomach rather than the neck.

2. Belly breathing: Have the person lie on their stomach (you can turn your head to demonstrate). Encourage them to take a breath in and feel their belly pushing into the floor, causing it to rise. Repeat this exercise to help them become aware of breathing into their belly rather than their neck.

3. Back position: Instruct the person to lie on their back. Similar to the previous techniques, guide them to breathe into their stomach and relax their neck.

By practicing these positions and focusing on breathing into the stomach rather than the neck, individuals can gradually change their breathing pattern for improved efficiency.

Well, several techniques working with amputees, with arm and legs. First thing you could, you know, depends on how much leg. You might have a single leg. Amputee he said you always can add fins, I like throwing stuff on people so fins paddles you can look at flotation to help balance all those elements out like a person's stroke and exactly where you put that flotation on the body as you know, very important as far as like double Amputees, and it's all upper body and some of those workouts. Again, use adaptive equipment and that's not so adaptive, the paddles and the fence. So quite accessible.

Techniques for amputees include adding fins or paddles, using flotation to help balance out their stroke and using adaptive equipment.

What is your technique for working with leg and arm amputees?

Adaptive techniques for working with amputees: adding fins, flotation, and more!

When working with arm and leg amputees, there are several techniques that can be employed. For leg amputees, adding fins can be beneficial to help with balance and stroke. Flotation devices can also be used strategically to assist with maintaining balance and positioning in the water.

For arm amputees, adaptive equipment such as paddles can be utilized to enhance upper body workouts. These tools are not only accessible but also provide support and assistance during exercises.

Overall, the key is to adapt the training approach based on the specific needs and abilities of the individual. By incorporating appropriate equipment and techniques, it is possible to create a tailored and effective workout routine for amputees.

Dr. Cunningham here, Ben asks, what are some good dryland exercises for breaststrokers? I'm going to give you three examples that I work on with breaststrokers. You're going to kneel and your knees are going to be in a regular position. Then the next one, your knees are going to be outside your shoulder position. And then the last one is your knees are together and your feet are turned out. I'm going to turn sideways and you can do it in a couple of different positions. You can just do regular rocking back like this, okay? Knees regular position, then knees wide and coming up and you can go even wider. That will help to open up your groin because you obviously need the mobility. And then bring your knees together with your feet turned out, okay? And rock back and forth. You can see how limited I am. And the next variation is you're going to work on hip hinging, both for on land and in the water. So your knees are together. You can come down as you drive up, come up into a streamlined position. You can even do some breaststroke arms. The next one is where your knees are out wide, which would be bad breaststroke position, but your feet are together. Again, hip hinge and drive up. And the last one is your knees are together, your feet are turned out, sit down and then come back up. I think mobility is very important before you do some strengthening. Hopefully that works for you.

Dr. Cunningham provides three exercises for breaststrokers to increase mobility: (1) regular rocking back with knees in a regular position, (2) rocking back with knees outside of shoulder width, and (3) hip hinging with knees together and feet turned out.

What are some good dryland hip exercises for breaststrokers?

Unlock Hip Mobility and Strengthen Your Breaststroke!

For breaststrokers looking for good dryland exercises, I recommend three examples. The first exercise involves kneeling with your knees in a regular position. The second exercise is performed with your knees outside your shoulder position. Lastly, you can try bringing your knees together and turning your feet out. In each position, you can rock back and forth to work on mobility. Opening up the groin by widening the knees can be beneficial for mobility as well. Another exercise is hip hinging, which is important both on land and in the water. With knees together, you can come down and drive up into a streamlined position, incorporating breaststroke arm movements if desired. Similarly, with knees wide and feet together (a position not ideal for breaststroke), you can practice hip hinging and driving up. Finally, with knees together and feet turned out, you can sit down and then come back up. Remember that mobility is crucial before focusing on strength training. Give these exercises a try and see how they work for you!