Physical Therapy

Triathlon

More evidence is showing neuroplastic changes in the brain with ACL tear. As PTs, how can you tailor rehab for this?

Tailoring ACL rehab: Focus on neuroplastic changes

More evidence is showing neuroplastic changes in the brain with ACL tears. As PTs, how can you tailor rehab for this? That's a great question. I would say the biggest thing that you can do is start to do work on those neuroplastic changes early. So, for example, adding balance. So whether that's balance on a foam pad or on a balance disc or even just on hard ground, getting some of that neuromuscular proprioceptive feedback in early, essentially as soon as they can stand on that leg. So, for example, if they have an ACL reconstruction, I will get them in and on a foam pad or just even on the ground as soon as they're able to weight bear, according to the surgeon and surgery. From there, then we'll go up to a balance or a foam pad and then onto a balance disc. And I'm doing this every single session. And as soon as they can do it, I'm having them do it at home as well. So that's one of the best ways I can kind of start to tailor that rehab for this. There's a lot of other things, but at a high level, that's the first thing that you can do, is make sure that you're balancing.

To tailor rehab for ACL tears, the best approach is to incorporate balance exercises as early as possible. This should include balancing on a foam pad, balance desk or hard ground, as soon as the patient can stand on the leg. Balance exercises should also be done at home.

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A growing body of evidence is indicating neuroplastic changes in the brain with ACL tears. As physical therapists, how can we tailor rehabilitation for this? To address this, one effective approach is to focus on early interventions for neuroplastic changes. This includes incorporating balance exercises into the rehabilitation process. Whether it's utilizing a foam pad, a balance disc, or simply working on a stable surface, introducing neuromuscular proprioceptive feedback as soon as the patient can bear weight on the affected leg is crucial. For example, after an ACL reconstruction, I start with having them stand on a foam pad or on the ground as soon as they are able to according to their surgeon's instructions. Progressively, we advance to using a balance pad and then a balance disc. These exercises are performed during each session and gradually incorporated into their home exercise routine once they are able to do so. While there are other aspects to consider in tailoring rehab for this condition, prioritizing balance training early on is key.


What is a good exercise to increase SI joint mobility?

Increasing SI Joint Mobility: Myth or Reality?

What is a good exercise to increase SI joint mobility? So that's a really tough question because the SI joint itself actually only moves a couple of millimeters. So there's not really a good exercise particularly to increase SI joint mobility. However, you can definitely stretch and strengthen all the muscles around there. You can stretch and strengthen the low back. You can stretch and strengthen the pelvis, including like glute med, glute min, and a whole bunch of other muscles within there, within that pelvis. But those are probably your best bets. If something like that is bothering you, the best bet is to probably go to a physical therapist and get a proper diagnosis on it. But in terms of good exercises, there really isn't any because the SI really doesn't move.

The best exercises to increase SI joint mobility are stretches and strength exercises for the low back and pelvis, including glute medius and glute Min. If you are experiencing pain related to your SI joint, it is best to consult a physical therapist for a proper diagnosis.

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Increasing SI joint mobility through exercise is a challenging task because the SI joint itself only has minimal movement. However, you can focus on stretching and strengthening the muscles around the joint. Exercises that target the low back and pelvis, including muscles like glute med and glute min, can be beneficial. It's important to keep in mind that if you're experiencing issues with the SI joint, it's best to consult a physical therapist for a proper diagnosis. They can provide guidance on specific exercises tailored to your needs. In summary, while there aren't specific exercises to increase SI joint mobility due to its limited movement, stretching and strengthening surrounding muscles can help alleviate discomfort.

What techniques do you use to help athletes with muscle imbalances and fatigue?

Unlocking Peak Performance: Techniques for Treating Athlete Fatigue

What techniques do you use to help athletes with muscle imbalances and fatigue? So I use a variety of different exercises in helping athletes with imbalances and fatigue. The biggest one that I'll use is strengthening. So obviously as a physical therapist, our job is to try and identify weaknesses and strengths within the human body in terms of muscular and joint. And so with the muscles, we'll try and identify which ones are weak or which ones fatigue really quickly. And then we'll try and correct those with any either corrective exercises and or manual therapy. There are other things that we'll do as well to help correct muscle imbalance, such as like muscle injury techniques to try and help get a muscle firing that maybe isn't firing before. And in terms to speak more towards like the fatigue aspect of it, that's when we start diving into sets and reps and how much to do and how much rest to give a patient or an athlete and kind of go from there. So there's a lot of different techniques that we can do to use. But the biggest one that I use is essentially strengthening, identifying weaknesses and then strengthening that actual muscle.

I use strengthening exercises, manual therapy, and muscle energy techniques to help athletes with muscle imbalances. For fatigue, I focus on sets and reps and how much rest to give the athlete.

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In helping athletes with muscle imbalances and fatigue, I utilize a range of techniques. The primary approach is strengthening exercises. As a physical therapist, my role is to identify weaknesses and strengths in the muscles and joints of the body. For muscles that are weak or fatigue easily, I employ corrective exercises and manual therapy to address those imbalances. Additionally, I may use techniques like muscle injury techniques to help activate muscles that are not firing properly. To target fatigue, I focus on determining appropriate sets and reps, as well as prescribing adequate rest intervals for athletes. While there are various techniques available, strengthening exercises and identifying weaknesses are the core components of my approach.

If a competitive triathlete has a budget of $5000/month to spend how should it be optimally allocated?

Optimal allocation of a triathlete's $5,000/month budget

If a competitive triathlete has a budget of $5,000 a month to spend, how should it be optimally allocated? I would say the first thing you want to do is you want to make sure you get a really good coach, somebody who's going to be able to cater the training specifically to you and not just give you a blanket plan to go. I would also spend a good chunk of that money as well on recovery. So whether that be with a physical therapist, whether that be with a massage therapist, those would all be really good things to do. I would also spend some money on strength training and making sure that you have a really good strength coach because that can make a world of difference in injuries and injury prevention. So for example, I do strength training as well for competitive triathletes and I'll take them in, I'll test them, find what's weak and then cater my workouts specifically to them. I think that's a really – some that really not many competitive triathletes really do but that definitely helps give an edge. With $5,000 a month, I would also say to plan on upgrades for some parts. Plan on a nutritionist. That would be another really good one. A lot of triathletes don't take nutrition seriously and if you really want to help optimize, I would say a nutritionist. So a coach, a physical therapist for some recovery, a strength coach and then also to a nutritionist. That's how I would start with that $5,000. You probably have a little bit extra. So you can do other recovery modalities and things like that, Norm Tech, ice bath, that kind of thing, infrared sauna but that's how I would start with $5,000 a month.

A competitive triathlete with a budget of $5,000 a month should allocate it towards getting a coach, physical therapist for recovery, strength coach, and nutritionist. They also can use some of the money to plan for upgrades and other recovery modalities.

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With a budget of $5,000 a month, a competitive triathlete can allocate their funds optimally. The first priority would be to invest in a good coach who can provide personalized training tailored to the athlete's needs. This ensures effective and customized guidance. A significant portion of the budget should also be allocated to recovery, such as sessions with a physical therapist or massage therapist. Prioritizing recovery helps in maintaining peak performance. It is also recommended to invest in strength training and work with a qualified strength coach to prevent injuries and enhance performance. This approach of identifying weaknesses and tailoring workouts accordingly can provide an edge. Additionally, setting aside funds for equipment upgrades and hiring a nutritionist would be beneficial. Many triathletes neglect nutrition, so having expert guidance can optimize performance. With the remaining budget, the athlete can consider other recovery modalities like NormaTec, ice baths, or infrared saunas. Starting with these key areas - coaching, recovery, strength training, and nutrition - provides a solid foundation for utilizing $5,000 a month effectively as a competitive triathlete.

How often should you do cupping for it to be beneficial?

Unlocking the Benefits of Cupping: How Often is Key?

How often should you do cupping for it to be beneficial? Hey, this is going to be all over the board. So some people say you can do it up to twice a week. I normally recommend for my patients and athletes once a week or once every other week. The main reason for that is cupping also creates bruising, and I don't want to cup over bruises again, because then what you're going to do is you're going to get bruises on bruises on bruises if you keep doing that. You want to make sure you give the body enough time to flush out those bruises and flush out that blood flow that is stuck there, which is creating the bruise. And then after that, then you can start cupping again. But overall, I'd say probably once a week to once every other week is what I would consider cupping to be beneficial. You might have to do it for two, three, four weeks, maybe even a little bit longer. But in terms of frequency, once, maybe once every other week.

Cupping should be done once a week or every other week for it to be beneficial, depending on how long you need to do it for.

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To ensure cupping is beneficial, the frequency can vary. Some suggest doing it up to twice a week, but I generally recommend once a week or once every other week for my patients and athletes. Cupping can cause bruising, so it's important to avoid cupping over existing bruises to prevent a buildup of bruises. Sufficient time should be given for the body to flush out the blood flow and heal the bruises before cupping again. Overall, I find that cupping is often beneficial when done once a week or once every other week. It may be necessary to continue cupping for several weeks or longer depending on individual needs.

What is the difference between Acupuncture and dry needling?

The Key Difference: Theory Behind Acupuncture vs Dry Needling

What is the difference between acupuncture and dry needling? I get this a lot, I get this question a lot. The biggest difference is the theory of where we're placing the needle, okay? I'll say that again, the theory of where we're placing the needle, okay? Dry needling tends to be more of a westernized approach. So we will put them into what we call trigger points or fascial points, which are different points along the body that where fascia connects or it's tightened and kind of like knotted up a little bit, if you will. Acupuncture works more on easternized medicine. So they're going off qi points and meridian points, which is more nervous system based. So those are kind of the big like view at 10,000 feet of like what the difference is between the two, but they overlap a lot. So a lot of those qi points and meridian points are also fascial points or trigger points. So there's a lot of different ways that you can use those needles, but that is probably the biggest difference is the theory behind where we're placing the needle. The needle themselves are the exact same. Normally they say acupuncture needle on them. They say dry needle on them, but the biggest difference is the theory of where we're placing it and how we're placing it.

The biggest difference between acupuncture and dry needling is the theory of where the needle is placed. Dry needling tends to be more of a westernized approach, focusing on trigger points or fascia points, while acupuncture works more off qi points and meridian points, which is more nervous system based.

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The difference between acupuncture and dry needling lies in the theory of needle placement. Dry needling follows a westernized approach by targeting trigger points or fascial points, which are areas where the fascia is tight or knotted. Acupuncture, on the other hand, is rooted in eastern medicine and focuses on qi points and meridian points, which are related to the nervous system. While there is overlap between the two, with some qi and meridian points coinciding with fascial or trigger points, the theory behind needle placement sets them apart. The needles themselves are typically the same, labeled as acupuncture needles or dry needles. The primary distinction lies in how and where they are placed based on differing theories.

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Dr. Sam Rauchwarter is a Physical Therapist and Sports Clinical Specialist. He graduated in 2010 from the University of Maryland with a Doctorate of Physical Therapy and achieved Board Certification in Orthopedic and Sports Physical Therapy in 2018. Sam has 8+ years of experience in physical therapy, specializing in manual therapy, biomechanics and sports rehabilitation. He is Multi-Site Clinic Director at Bodycentral Physical Therapy & Sports Medicine in the Greater Tucson Area, and an active member of the American Physical Therapy Association. Sam is a passionate advocate for physical therapy, volunteering with the Special Olympics. He holds a Doctorate of Physical Therapy from the University of Jamestown and a Bachelor of Science in Exercise Science from the University of Saint Thomas. He has worked with USA Triathlon, Salpointe Catholic High School, Summit Orthopedics, Impact Physical Medicine & Aquatic Center, HCR ManorCare, and the University of St. Thomas.

Neither AnyQuestion nor its Experts provide medical advice, diagnosis or treatment or otherwise provide professional healthcare services.

Dr. Sam Rauchwarter, PT, DPT, SCS