Should I Continue to Exercise if I am Sore?

This is a topic that many of my athletic trainer friends have asked me to address. The answer in a nutshell is it depends.  I want to venture to say that everyone who begins an exercise program, that hasn't exercised in a while (or ever for that matter) will experience varying degrees of muscle soreness.  There are two types of muscle soreness:  acute and delayed onset.  It would be prudent to discuss overtraining and overwork here as well.  Before you read any further you must know that if you have "normal" soreness I think it is important to continue exercising, though not to extremes, to decrease the time and severity of the soreness.  That means you shouldn't use muscle soreness to skip your class!   In fact, if you continue to skip class you will continue to get sore every time you restart exercising. 

 Isn't this something you want to avoid? 

Acute -  Acute muscle soreness occurs because there is a build up of lactic acid and potassium in the muscle due to a temporary lack of blood flow (think oxygen) to the muscle.  This is the temporary burn that you feel during exercises that stops once you stop exercising when you get a return of adequate blood flow.  I always feel this when I am attempting to run.  When I am jogging, my quads and calves start to burn but stop once I start walking.    Active Recovery exercise generally takes care of this.  Lactic Acid has been given a bad rap over time and you can read more about that  here  if you are so inclined.

DOMS - Acronym for delayed onset muscle soreness.  This generally occurs when you perform resistance exercise either concentrically (muscle shortening) or eccentrically (muscle lengthening) that you are not accustomed to.  This is the type of soreness you feel 1/2 day or a day after the exercise.  You know the kind I am talking about...when you are standing at the top of the stairs wondering just how you are going to make it down them because your thighs are so sore!  You are sore when you stretch or rub the muscle and you might actually feel a little warmth or some swelling.   This can last anywhere from 2 days to 2 weeks, ouch!   There is a lot of talk in the literature about DOMS and whether it can be effectively treated or prevented.  Most of it is contradictory.  I feel that if you listen to your body, respect your limitations and don't go all out in the beginning that most of this can be avoided.  Just because the old man next to you can do it, doesn't mean you can too, at least right away.  He has probably been training his entire life and you are just starting.

OverTraining - This occurs when you are too aggressive in your exercise program after you should stop.  This happens with people who have neuromuscular problems where they have impaired sensation and in athletes who are overzealous in their training.  This results in a temporary or even permanent reduction in performance.  This is not what you are looking for when you train hard!    Make sure you are eating correctly, drinking plenty of fluids and taking rest breaks.

Overwork -  Believe it or not you can actually overwork your muscles. Anyone is at risk for this especially those with neuromuscular disorders such as post polio syndrome and Guillian-Barre Syndrome which is more common than you think. Anyone who has an autoimmunity problem is also susceptible, which is very scary,  and we have already touched on that.   When you do overwork your muscles you can actually reduce strength permanently and this is not what exercise is about.  When I worked at Charity Hospital, here in New Orleans before Katrina, I actually had several types of patients that I had to be extremely careful with progressing their exercise.  If I were to work them too hard, too soon, they ran the risk of never regaining strength they so desperately needed.

If you are experiencing soreness, increase your magnesium either orally or with Epsom Salt baths, drink plenty of fluids, practice deep breathing,  stretch before and after exercise (active recovery folks),  take your Omega 3's either as a supplement or as food and for Heaven's sake STAY ACTIVE.    It really is all about nutrition and exercise, just in the right doses.  If you have any joint or spinal pain that is limiting your ability to exercise you know what I am going to say.  "You Deserve a Good Mechanical Evaluation!"  Call or text Grimm Physiotherapy to set up your assessment and treatment plan today!

Did You Just Hear That? Why Do My Joints Pop?

Wow, this guy says it better than I can and he is much better looking too!  Plus, he was an athlete at Purdue and we kinda like Purdue athletes around here.   Check out his video.

I have always known that when nitrogen is released from a joint it makes a sound, but I love how he says it is just GAS.  Ha ha!  You gotta smile about audible gas being released.  Anyways, the take home point on this is if it hurts when your joints pop you have to check it out.  If you are in the Sugar Land, Texas area

you need to go see him but if you are in the greater New Orleans area you ought to come see me for those painful "popping" joints.  Like I always say"You Deserve a Good Mechanical Assessment and Treatment Plan!"  Check out grimmpt.com or call 504-228-0524 to set up yours today.

Help I Hurt My Back Deadlifting in the Gym!

First things first, I don't believe that everyone who is experiencing low back pain after a deadlifting workout is dealing with their first episode of low back pain. In fact, I would venture to say that this is true for the majority of people who now have lumbar pain. It has been my experience (28+ years) that people have unresolved low back pain issues that have gone dormant so to speak and are now painful again after their car wreck, marathon, yard work or even working out. My practice which is based on Mechanical Diagnosis and Therapy, prides itself on teaching you how to resolve your low back pain issues once and for all. 

If it were me, and my back was hurting from working out, and knowing what I now know,  I would immediately lie face down (prone) for a few minutes and concentrate on relaxing and deep breathing in this position.   If this didn't ease my pain, I would rest for two days and try this again.  If this didn't work and it was making my pain worse or limiting my ability to move my low back, I would then seek help because there may be more treatment required to resolve your issue.  

If you are willing to heed the advice here, chances are that you can decrease your symptoms dramatically without medications, but will not fully resolve your lumbar problems.  This means next time you workout heavy, drive too far, garden too long, sit at a computer or at your desk in poor posture, your low back pain that has been unresolved or not fully treated will appear again.  Aren't you tired of this cycle?  Do you  know that with low back pain there is generally some type of inhibitory response in your leg strength?  Once your issues are resolved you will be stronger than ever and have opportunities to set personal records in the gym, on the field, and on the track. 

 Let me know how this works for you!  To fully understand your condition, you know what I am going to say..."Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Check out grimmpt.com for more details and call or text me at 504-228-0524 to set up your evaluation today  I got your back!  

Exercise and Changes in the Brain?

I was reading this the other day on the New York Times site and it really got me thinking.  Exercise and a non-sedentary lifestyle really are more important that we think.  I know that I have always felt better and had much clearer thoughts when I exercised regularly and now there is some evidence here to support why this may be so.  This article discusses how inactivity can actually cause changes in your brain!

The take home message would be to get up off the couch, away from the computer, limit the gaming and get some old fashioned exercise in.  It sure sounds like exercise is a more powerful modality than we think it is.  If you read my last blog post,  you know I recommended increasing your exercise and to include cardio, stretching and strengthening.

I regard exercise so highly that I am proud to establish  my office in a CrossFit gym called CrossFit Roux.  I believe that exercise which emphasizes functional varied movements is one of the answers to longevity and health.  CrossFit is only one type of exercise program but it is currently my exercise of choice.  Why? Because it is fun, it is scaleable to everyone's capabilities, adapted to provide for disabilities and is for all ages.  It is challenging, but with good coaching, it will help to increase your fitness level and help to provide mental clarity.  Doesn't that sound nice?  I would love to workout with you.  If interested just shoot me a text or email me so we can workout together sometime.

This commercial by Reebok sums up CrossFit better than I can so take a peek:

Any exercise program that is varied and somewhat intense is sure to expose some underlying dysfunctions or issues you are having with your body. Prolonged sitting at a desk or years of gaming generally won't expose these issues.   Chances are you haven't moved correctly or enough in several years.    If you find this to be the case with yourself or if your exercise regimen  or recreational activity is limited by joint or spinal pain then you know what I am going to say..."You Deserve A Good Biomechanical Assessment and Treatment Plan."  Check out grimmpt.com or call 504-228-0524 to set up your evaluation today.

What you SHOULD Give up for Lent

Your wicked diet and lifestyle ways.  No, seriously, you need to give up all of it. You know what I am talking about.  Don't ignore the messages you have been getting for the last year or longer.  Go Paleo.

That's right, I said Paleo as in paleolithic, as in caveman.  Sleep, Eat, Exercise, and De-stress like a caveman.  It isn't going to be easy, in fact, it will probably be one of the hardest things you will ever do.  You are going to sacrifice like no other, but in the end you will be eternally grateful.  This Lent you might as well do something that will actually be good for your health in the end.

I don't care what is wrong with you right now...body or mind.   If you do the research, and actually commit to this mind, body and soul,  this will  help your health issues to improve.

 Sleep -  Essentially sleep at least 7 hours a night.  Sleep when it is dark, waken when there is daylight.  Take naps if you need to.  Sleep in a cool, dark room with a regular routine.  This is more important than you think.  Don't "wait 'til your old to sleep," cause lack of sleep may kill you first.  I recommend doing your own research on this...



De - Stress -   Take a Chill Pill!  Do what you need to do to keep your stress level in check.  You have heard it before so take this important time for yourself.  Practice relaxation and breathing techniques.  Try meditation. Take breaks.  Go on relaxing vacations regularly.

Clean up your diet!  You are actually killing yourself slowly and painfully eating the way you are now.   Cut out the junk food and processed food of any kind.  Eat what is local, seasonal, organic, and grass-fed. Eat seafood, eggs, meat, vegetables, fruit, berries and some nuts.  Cut out dairy, sugar and sweeteners, alcohol, grains and potatoes.  Use only olive, coconut oils or clarified grass-fed butter.  Don't even think of making excuses about why you can't do this or how this won't work...Yada yada yada.  Find a way and do it.  Period.  If your Great-Grandparents (or Great-Great - Grandparents for you younger people) didn't eat it, you shouldn't either.    You can ease yourself into this way of eating by looking up Paleo or you can go all the way and do a Whole 30, but for Lent it will be a Whole 40 and no taking Sundays off.  My recommendation is to really go all the way.  After all, it is LENT!

Exercise -  You all went to elementary school so you know what this means.  As I am fond of saying you don't want me picking your exercise program for you, because you won't like it (actually you will learn to love it, but that is another topic).  Get off the hamster wheel and go outside.  Your body is craving Vitamin D so give it some the natural way.  Do a blend of cardio, stretching, and weight training.  Make time for this.  Make this a priority.   No excuses. Like Nike says,  Just do it!  Put some effort into it.  Reading a book on the treadmill isn't going to cut it, sorry.

If you are sicker than your friends or have an autoimmune disease (there are hundreds of them so chances are highly likely that you do...)  research the autoimmune protocol and save yourself some more time in regaining your health.  The book I am plowing through now is pictured here.  I highly recommend it for your library.  It is chock full of information and just downright interesting.  (This is not a paid endorsement.)

The "Paleo" lifestyle has changed my life and my family's lives for the better.  There are thousands of testimonials on the web so check them out.  Just remember that "Sitting is the New Smoking," so get up every 15 minutes from the computer and walk around!  If you are still having pain after committing to this lifestyle you know what I am going to say... You owe yourself a good mechanical assessment!  Check out grimmpt.com or call 504-228-0524 to schedule your assessment today.    You will thank me later for this.  I promise!

Are Your Joint Pains Rapidly Reversible?

I didn't really want to get into this quite yet, but I was reading a twitter post from one of my mentors, Jarod Carter, PT, DPT, MCT, on meniscal tears and thought how different it would be if everyone knew this.  Check out the article titled Fake Surgery Just as Good as the Real Thing for Meniscus Tears.  Say What?  This is what my cohorts and I have been saying for many years in our practices!  Not exactly in those words per se, but something close, like I wonder why this patient is doing so well after his meniscal surgery and this one isn't, given that most variables are the same.  As clinicians we see of lot of things that make us say hmmm.  This is one of them.

I  work in a busy orthopedic clinic for 6 orthopedic surgeons 2 days a week where I treat patients for them.  One surgeon there (guess who?) has seen the value in sending patients to PT before operating to see if there isn't an easily treatable condition we refer to as joint derangements.  This improves favorable outcomes for his surgeries.   A derangement syndrome is  defined as "Internal dislocation of articular tissue, of whatever origin, that causes a disturbance in the normal resting position of the affect joint surfaces.  This deforms the capsule and periarticular supportive ligaments resulting in pain, which will remain until such time as the displacement is reduced or adaptive changes have remodelled the displaced tissues.  Internal dislocation of articular tissue obstructs movement attempts towards the direction of displacement."¹  This is just another way of saying that you have something in your joint that feels like a pebble in your shoe.  Will you need a lot of foot therapy or surgical repair once you take that pebble out?  Obviously not!

 Let's look at it this way.  Basically, when we injure our peripheral joints the body will put a little fat in the area to protect it.  When we begin to wear out or degenerate, our body creates nooks and crannies in the bone and, since we don't really like nooks and crannies our body will put fat into these areas for moisture, nutrition, and cushion.  However, if that fat gets too big it is going to get pinched.  Like catching your finger in the door.   Here is a great study by a clinical anatomist that found fibroadipose meniscoids in all joints   Her paper is about elbow joints but she mentions that all joints have these.  I am convinced that most of these derangements (and there is no solid proof of this) are fat based since they are so rapidly changed.    So my question to you is, do you know if this pain and obstructed motion  is from your bone on bone, your rotator cuff tear, your meniscus tear or the extra fat that is sent there to protect you?

We will never really know because when they cut the bone out to give you a new joint they cut all the fat out too, or repair your rotator cuff or your meniscal tear.  It will only take me (or any other certified MDT practioner)  a couple of visits to find out if a fat pad is your problem.   Theses fat pads are malleable, they can change size and shape and you can do it with repetitive movement.  Just like dissolving  a piece of raw bacon by rubbing it between your fingers.

Yum!  BACON!

 Maybe it is the fat that got caught under your rotator cuff tear and not the tear itself causing you all the pain.  You won't know til you give it a try.

In your knee, this derangement could be anything from a fat pad to a torn meniscus that is blocking motion and producing pain. Generally we find increasing symptoms in one direction of movement and decreasing symptoms with increased movement in another.  This helps us to decide what directional preference for treatment would be.  You are then sent home with one or two movements that are designed to abolish your symptoms.  If this works, surgery and endless therapies can be avoided and you can be taught how to self-treat your current problem, how to minimize recurrence and how to manage symptoms if they do happen to reoccur.  Wouldn't you want to avoid surgery if you could?

I would.

Bring your knee, hip, ankle, elbow, shoulder, wrist, hand, finger, and toe pain in today for a mechanical assessment to see if you have rapidly reversible joint pain.  As I am fond of saying "You Deserve a Good Mechanical Assessment!"  Call or text Grimm Physiotherapy at 504-228-0524 to schedule your evaluation and visit us on the web at grimmpt.com.


¹  McKenzie, Robin, and May, Stephen (2011).  The Human Extremities:  Mechanical Diagnosis & Therapy, Spinal Publications, New Zealand Ltd.

^.  

I think I have a Muscle Strain. What should I do?

So I was reading this post yesterday at crossfitinvictus and it got me thinking about muscle recovery after injury.  When you are into muscle strengthening and fitness you tend to walk a fine line between strengthening and over doing it.  For more information on why exercise can make you stronger check out this post.  I know that if you are like me you want to make decisions on your own about recovery so I thought this would be a good time to give you information on muscle injuries and a little on the physiology of muscle healing.  First things first, muscle injuries are known as strains and ligament injuries are sprains.

There are two parts of a muscle:  the belly and the musculotendinous unit.  All skeletal muscles are elastic meaning that they have the ability to lengthen or stretch, extensible which means the ability to shorten but able to return to normal length, excitable which means they respond to nerve impulses, and are contractile which mean they will contract and shorten when a nerve tells them to.  You can tear the muscle belly by over stretching and over doing it and/or over stretch the musculotendinous unit resulting in a muscle strain.

What is important to know about muscles and soft tissue injuries is that they do not regenerate if damaged but are replaced with an inferior and weaker scar tissue.  So listen to your bodies and your coaches!

Muscle strains are classified like ligament sprains into categories:

Grade I - some muscle fibers are actually torn and movement will be somewhat painful but you will still have full motion.

Grade II -  Can you see the depression where
the strain occurred?  

Grade II - Active motion will be extremely painful because more muscle and tendon fibers are torn.  You can actually feel the site at where the injury occurred.  You can feel a divot.  This will probably come with swelling due to bleeding.  Check out the ankle strain here.

 Biceps ruptures

Grade III - This is when there is a complete tear of the muscle fibers in the muscle belly or where the muscle attaches to the bone.  You have heard of biceps rupturing and Achilles tendon ruptures.  Biceps ruptures are fondly referred to as  Popeye muscles.  Pain is usually very severe initally but then subsides quickly because the nerves are separated too.  Movement is severely limited and sometimes totally lost.  A fun fact to know is they rarely operate on proximal biceps ruptures. This just leaves more room for tattoos : )

Achilles tendon ruptures generally require surgery and is a more serious injury.  I have heard that muscles that cross two joints such as your achilles, biceps, hamstrings, and quadriceps are more susceptible to injuries.

So depending on what you are dealing with treatment options will vary but they all start with RICE.
R est  (four-letter word)  I had to say it!  Sorry!
I  ce  (cold pack, frozen peas or corn in a pillowcase) 20 minutes at a time...you don't want frostbite too!
C ompression  (ace wrap)  Snug but not too tight you don't want to cut off circulation!  Wrap from the bottom up to assist with venous flow.
E levation  (injured area elevated above your heart)  Don't go crazy hanging upside down on rings or anything...a nice pillow on the couch will do.        More on the RICE principle

You can begin full gentle range of motion exercises if there isn't any pain.  It would be advantageous to get in at least 5 repetitions every two hours and more often if there is no pain.  Once there isn't any pain then you can begin gentle resistance exercises.  

All injured tissues go through an inflammatory phase which generally lasts less than 5 days.  So ice is really only useful in the first 2 -  5 days of injury.  After that the inflammatory cells are replaced by fibroblasts.  This stage of healing known as the tissue repair stage can last up to 3 weeks.  I like to add gentle range of motion exercises so that the muscle will heal in the line of stress.  You want full movement by the third week so that optimal repair can occur.  However you don't want to overdo it either.  If you do too much too soon you are actually re-injuring yourself and are now back to square one in the inflammatory phase.  Which means the dreaded 4-letter word R-E-S-T again!

The Remodelling stage is very important.  You want to stretch and strengthen the scar tissue so that you will have optimal recovery.  This process can take several months and you may never get full strength back.  So you don't want to mess this process up!  All of these phases have to be gone through to have an optimal recovery.  There really isn't anything you can do to speed this process up other than to proceed with caution and to provide an optimal environment for recovery including nutrition and adequate sleep.

My husband,  Matthew Grimm, MD,  the CrossFitting orthopedic surgeon,  says that if it seems more serious, you don't have to go to the Emergency Room but can wait to see him the next day if there is no deformity.  Check him out at Jefferson Orthopedics or catch him at the gym .

So the bottom line is exercise is good for you and good for healing of strains as long as you don't over do it. We all know how devastating no exercise can be for you.  You know I am going to say that   "Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Here at Grimm Physiotherapy we will teach you how to manage your injuries including strains so that you can achieve optimal healing.  We encourage self-management and don't want this to be a chronic problem for you.

Call or text Grimm Physiotherapy at 504-228-0524, visit us on the web at grimmpt.com  to schedule your mechanical assessment today.