Musculoskeletal

Physical Therapy

What recovery tools would you recommend to athletes?

Unlock Optimal Performance: Sleep, Hydration, Nutrition as Top Recovery Tools

What recovery tools would you recommend to athletes? This falls into something that I have to deal with a lot in physical therapy. People think that recovery is what I would consider sensory changes. So like a massage gun is not necessarily a recovery tool. Or foam rolling-- kind of a recovery tool, but really you're changing your body's perception of tightness and soreness in an area. You aren't doing anything to help that muscle perform better. So the best tool that you can do is get good sleep, stay hydrated, eat healthy. Those three things are 100% in your control, and they cost nothing. So that's my two cents on that.

Getting good sleep, staying hydrated, and eating healthy are the best recovery tools for athletes.

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When it comes to recovery tools for athletes, I often deal with misconceptions in physical therapy. Many people believe that tools like massage guns or foam rolling are effective recovery tools, but they primarily provide sensory changes rather than actually improving muscle performance.

In my opinion, the best recovery tools for athletes are simple and within their control. Prioritize getting good sleep, staying hydrated, and eating a healthy diet. These three factors have a significant impact on recovery and performance, and they don't cost anything.

So, my recommendation for athletes would be to focus on these fundamental aspects of recovery rather than relying solely on external tools or gadgets.

Any tips or exercises to help with glute activation when running?

Activate Your Glutes for Stronger Running

This is a great exercise that really challenges the core and the glute to work together and you can really fatigued the glute and the core by working on this. It doesn't take very many reps. This uses that same side plank position to challenge not only the core and glute but also the external rotators are the top hip single-leg RDL. Variations are great for runners as well at improving glute strength. And this last one is Actually a hip extension exercise, but we like to use hip extension, whenever people are working on glute strength because you need to be in a position of hip extension to maximally engage that glute muscle. So if you have tight hip flexors, this is a great way to lengthen those hip flexors under load and access. Your, your maximal hip extension so that you can use your glutes. Wha so these are all exercises that can help you in improving your quotient. Load glute activation. However, I'm going to challenge the fact that people think that their glutes are not active when you're running because they have to be active if you're standing on one leg for any amount of time. So the the myth that your glutes are inactive is definitely a myth and these are just some exercises to help improve the coordination of your glute in and your core to help you and improve your Running ability the last exercise. I know that's not a glute exercise that is helping you to access more hip extension because we cannot adequately use our glutes to their maximum ability without being in a good position of hip extension.

This exercise is great for challenging the core and glute muscles and can be used for runners to improve their strength. It doesn't take many reps and it utilizes a side plank position. Variations of this exercise can help lengthen hip flexors under load and access maximal hip extension to use the glutes. The myth that the glutes are inactive when running is false, as they have to be active for any amount of time that one stands on one leg.

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Here are some exercises that can help with glute activation when running:

1. Side Plank with Single-Leg RDL: This exercise challenges the core and glutes to work together. It fatigues the glutes and core effectively. Perform a single-leg RDL while maintaining a side plank position. This exercise targets the glutes, core, and external rotators.

2. Variations of Single-Leg RDL: Single-leg RDL variations are beneficial for improving glute strength in runners. They help activate the glutes and enhance their strength.

3. Hip Extension Exercise: Hip extension exercises are great for targeting the glutes. Engaging in hip extension maximally activates the glute muscles. This exercise also helps lengthen tight hip flexors and allows for better glute engagement.

It's important to note that the belief that glutes are inactive during running is a myth. When standing on one leg while running, the glutes are actively engaged. These exercises aim to improve glute and core coordination, enhancing running performance. Remember, being in a good position of hip extension is crucial for optimal glute activation.

By incorporating these exercises into your routine, you can improve glute activation and enhance your running ability.

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 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.

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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.

Key predictor of injury: Previous injury and lack of sleep

What's the best predictor of injury? Several other people have already commented on this one and I'll kind of echo their thoughts a little bit with a little caveat so yes. Previous injury is always going to be the best predictor of injury. But I would also say that an athlete's sleep also contributes greatly to their injury, there's there was a research article forget when it was published but something astronomical In terms of your risk of getting hurt, if you were not sleeping, you know, seven to eight hours athletes that slept less than that were seven or eight times as likely to get hurt compared to athletes, who didn't. So that's something that you have full control over. So if you're looking for low hanging fruit to not get injured, make sure that you're sleeping.

Previous injury and quality of sleep are the best predictors of injury. Sleeping seven to eight hours is key for athletes to stay healthy and reduce their risk of getting hurt.

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The best predictor of injury is previous injury. This is a widely acknowledged factor that can indicate an increased risk of future injuries. However, I would also like to add that an athlete's sleep patterns can significantly contribute to their risk of injury. Research has shown that athletes who do not get sufficient sleep, typically seven to eight hours, are at a much higher risk of getting hurt. In fact, athletes who slept less than the recommended amount were found to be seven to eight times more likely to experience injuries compared to those who prioritized proper sleep. This is something within your control, so if you want to reduce the risk of injury, ensuring you get enough sleep is a crucial step to take.

How do you address the challenges of rehabbing injuries in a high-stress, high-performance environment such as elite level swimming or triathlon?

Unlocking peak performance: Rehabbing injuries in high-stress sports.

How do you address the challenges of rehabbing injuries in a high stress, high performance environment such as elite level swimming or triathlon? So this is majority of what I see on a daily basis in our clinic. And I think that how I deal with it is you need to number one, be really confident in your skills as a provider. But you also need to be a really effective communicator so that everyone's on the same page. And I think that talking to the athlete with confidence breeds confidence about their rehab and having a successful outcome. Unfortunately, PTs as a whole aren't a super confident bunch. And how we talk to people is kind of like maybe a little bit more of a concerning or anxious conversation and breeds some anxiety about their injury versus coming up with a plan and executing the plan and having a lot of confidence in the plan. And athletes respond really well to that. So I think on top of just being a really sound clinician and feeling strong in the fundamentals, you need to be confident and communicate confidently as well.

In order to address the challenges of rehabbing injuries in a high-performance environment, it is important for providers to be confident in their skills and to be effective communicators. This means talking to athletes with confidence about their rehab and having a plan of action that is executed with confidence. Doing so will help alleviate any anxiousness or concerns the athlete may have.

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Addressing the challenges of rehabbing injuries in a high-stress, high-performance environment like elite level swimming or triathlon requires a combination of skills and effective communication. As a provider, it's important to have confidence in your abilities and be a strong communicator to ensure everyone is on the same page.

When working with athletes, instilling confidence in their rehab and the potential for a successful outcome is crucial. Unfortunately, as a whole, physical therapists may not always exude confidence, which can create anxiety for the athlete. Instead, it's important to develop a plan, communicate it confidently, and execute it with conviction. Athletes respond well to this approach.

In addition to being a skilled clinician and having a solid foundation in the fundamentals, being confident and communicating confidently are key factors in addressing the challenges of rehabbing injuries in high-performance environments.

What are the underlying causes of sciatica?

Unraveling the Mystery of Sciatica: Understanding the Underlying Causes

What are the underlying causes of sciatica? So sciatic is just a really bad vague term. That just gets thrown around on the internet for pain going down your leg from your back and really it doesn't even need to come from your back, but we can have several different forms or really causes of that will start kind of Central. So you can have a central origin coming from the spine where you can have Of spinal stenosis, which is basically just a narrowing of a opening. So you can have stenosis actually around the spinal cord, which is a serious condition and that would usually cause symptoms on both legs. If you had that going on, you can also have foramen ovale stenosis, which is where the nerve root comes out between the two vertebrae. If that hole is smaller because of degenerative changes or maybe your Disc height is a little bit less and that kind of brings the whole closer together that can cause nerve symptoms, like, sciatica down one leg. You can also have nerve entrapment symptoms which are more peripheral. So the the sciatic nerve runs all the way from your back and all of its branches go all the way down to your feet, right? So anywhere along that pathway, we can have muscles that are tight that restrict the slide and glide of that nerve and that can kind of caused some of those symptoms too. So saying what I really don't like, when people say I have sciatica what can I do? Well, we need to figure out where it's coming from first and that's really going to dictate what you can do to help yourself.

Sciatica is a vague term used to describe symptoms of pain going down the leg from the back. The underlying causes of sciatica can vary and may include spinal stenosis, foramen ovale stenosis, or nerve entrapment. It is important to identify the source of the pain in order to determine the best treatment options.

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The underlying causes of sciatica can vary, and it's important to understand the specific origin of the pain. Sciatica is a broad term often used to describe leg pain that radiates from the back, but it doesn't necessarily originate from the back. There are several potential causes to consider.

One possible cause is central origin, which originates from the spine. This can include spinal stenosis, where there is a narrowing of the opening around the spinal cord. This condition can lead to symptoms in both legs.

Another potential cause is foraminal stenosis, which occurs when the nerve root exits between two vertebrae. If the opening is smaller due to degenerative changes or reduced disc height, it can cause nerve symptoms like sciatica down one leg.

Nerve entrapment is another possibility, where tight muscles along the pathway of the sciatic nerve restrict its movement. This can also contribute to sciatic symptoms.

It's important to note that simply saying I have sciatica, what can I do? is not sufficient. Determining the specific cause and origin of the pain is crucial in order to develop an appropriate treatment plan.

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Dr. Nick Hadinger is an Arizona native and licensed physical therapist with expertise in orthopedic and sports rehab. He holds a Doctor of Physical Therapy from Northern Arizona University and an undergraduate degree from the University of Arizona. As a former Division I athlete, he competed at the US Olympic Trials in 2012 and now races in triathlons. Nick specializes in non-operative and post-operative injuries involving the shoulder, back, hips, and knees, aiming to keep his clients active. He is certified in various techniques, including Dry Needling, Blood Flow Restriction Therapy, and Functional Movement Screen (FMS). He is also a certified USA Weightlifting Coach and a member of the NSCA and the USA Swimming Sports Medicine Network. He has been a Clinical Instructor for doctoral students at George Fox University and the University of the Pacific.

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