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Part Two: Fighting Inflammation With Nutrition

Eggs – Good Bad or Indifferent?

The push to cut down on eggs, particularly yolks, has tapered, with eggs now shown not to have the impact on cholesterol as previously thought. Most of the cholesterol in our bodies is produced naturally and does not come from our food. Eggs (especially those that are pastured & local) are a great source of essential amino acids. These unique building blocks of proteins cannot be produced by the body and must come from food.

Two caveats on the benefits of eggs… Though some recommend yolks as part of a brain-healthy diet, when consumed more than moderately, eggs (particularly yolks) and poultry (with skin) have been shown to correlate with a higher incidence of prostate cancer recurrence or progression. Men, particularly those who fall in higher risk categories, beware.

In addition, some people have unknown food sensitivities. Sensitivity to eggs – which often exists below the pain threshold but can have adverse physiological and biological effects – is more common than many realize. Those with such a sensitivity who consume eggs (especially frequently or in greater volume) may see they adversely impact cognition, or exacerbate headaches, upset stomach, etc. If you notice persistent symptoms or those that fluctuate along with things you eat, it might be a good idea to be tested for food sensitivities.

Anti-inflammatory Diets

One of the more distinctive and restrictive anti-inflammatory diets is The Bulletproof Diet. It replaces sugars with healthy fats, incorporates a focus on organic food, is gluten free and does not allow beans. Eliminating all processed foods and grains limits sugars dramatically, as does moderating natural sugars by limiting fruit intakeGhee (pictured above), which is butter minus the milk solids and water, leaving only butterfat, is another healthy fat that is a staple of this program. Bulletproof Coffee, can keep you feeling full and focused. I’ve gotten first hand reports!

There is much advice out there regarding diet, some of it conflicting. However, there are some commonalities.

Getting the most attention for what are often termed heart healthy diets are the Mediterranean and DASH diets. Each has been shown to be effective and personal preference may play a role in which to choose if you if you want a specific food program. A Mediterranean Diet is rich in vegetables, fruits, nuts, olive oil, beans, legumes and herbs and leans more toward fish for protein. In this diet, dairy, poultry and then lean meat are at the top of the food pyramid, to be eaten in measured amounts. It is a plan that has been shown to have anti-inflammatory properties.

The DASH diet (DASH stands for Dietary Approaches To Stop Hypertension) has some similarities but is less restrictive of low fat dairy. Here is a comparison between the two.


Both diet plans, like the generic anti-inflammatory and brain-healthy recommendations, include a lot of fiber from vegetables and fruits. All heart healthy food plans limit sugar and salt. Sodium, which can cause water retention, may result in an increase in blood pressure, placing greater strain on the heart and blood vessels. High blood pressure is one of the common cardiac risk factors.

Red Meat

Many of these diets limit intake of red meat, though pastured grass-fed meats are recommended as a staple of the Bulletproof Diet. Red meats (particularly processed meats) are often restricted in other diets because some research has tied larger consumption of it to increased risk for colon cancer. However, it has been shown that these studies were unable to control for other poor dietary or health habits that were confounding factors influencing outcomes.

One high fat, low carb diet is that recommended by Gary Taubes, who wrote The Case Against Sugar, Why We Get Fat. He and Fred Pescatore, MD, creator of The Hampton Diet, advocate low carb, higher fat eating plans that do not place as much restriction on red meat. I’m a fan of Dr. Mark Hyman, who wrote Eat Fat Get Thin (amongst other books) and whose recommendations make a lot of sense. Like all the authors mentioned here, he explains why prior studies led to inaccurate conclusions and points to newer research supporting the fact that a heart healthy diet can include grass fed beef without adverse consequence.

What They Said About Vegetable Oils (Like Canola)? Never Mind. All Oils Are Not Created Equal

Stick to extra virgin olive oil or coconut oil. Especially when cooking. Heating vegetable oils alters their structure causing oxidation and the formation of aldehydes. Oxidation results in free radicals (which were addressed in Part One), which then result in cell damage that causes a host of adverse effects on the body. High levels of aldehydes have been shown to correlate with an increased risk of heart disease and cancer.

Olive oil has the lowest oxidation rate of the cooking oils and has also been shown to raise HDL and lower LDL cholesterol, changes that are good for heart disease prevention.

Another healthy cooking note is to avoid charring foods (particularly meats/fleshy foods) because that too can have a carcinogenic effect.

Part Three, the final blog of this nutrition series, will be posted on Wednesday, March 29th. It covers specific food recommendations and nutritional issues related to brain health and post concussion care, for those with gastrointestinal issues (Irritable Bowel Syndrome (IBS) and Gastric Reflux), as well as nutritional guidance for eye health.

Fighting Inflammation With Nutrition

Whether dealing with the aftermath of an injury or simply seeking to optimize one’s health and wellness, there is wisdom in following a diet rich in foods considered to have anti-inflammatory properties. Chronic inflammation is now recognized as a major contributor to a number of illnesses, including diabetes, metabolic syndrome, hypertension and atherosclerosis, which predispose to cardiovascular events. Also Alzheimers, Parkinson’s, and autoimmune disorders, such as Lupus and Multiple Sclerosis. Conditions affecting the musculoskeletal system (such as rheumatoid and osteoarthritis) also play into this dynamic. Even depression and cancer correlate strongly with levels of inflammation.

How we eat can play a role in protecting us from illness by minimizing chronic inflammation and boosting brain and heart health. Weight control is a secondary, but welcome, byproduct of this thoughtful way of eating. Armed with the knowledge we now have, nutritional guidance should be a part of care delivery in every medical discipline, including physical therapy and orthopedics.

The world of nutrition and health has been turned upside down in recent years.

The Skinny On Fats

The old school emphasis on reducing all fat intake – but especially saturated and trans fats – has been replaced with an emphasis on eating healthy fats (including some saturated fats, like that in coconut oil). Other healthy fats include those in olive oil, avocados and nuts. In fact, your body needs these fats to function optimally, fight inflammation, and even to lose excess pounds.

Several articles I’d recommend on the subject include this one on why we need fat in our diets, this one on Facts About Fats, and this one on why carbs and not fats cause fatty liver disease.

Sugar Is The Enemy

Sugar is now thought to be the evil ingredient and the most significant dietary contributor to inflammation. It seems that this line of thinking, supported by a great deal of research, is going to prevail for the long haul.

Sugar comes in many forms, whether from refined carbohydrates, or that added to beverages, or even the natural sugars in fruits or dairy. They might be listed on an ingredients label as sucrose, corn syrup, glucose, fructose and galactose, lactose or maltose. Once ingested, these other sugars become glucose. Though both are processed by the body into sugars, refined carbohydrates are more of an issue than whole grains in our diet because much of the fiber, nutrients and essential fatty acids are eliminated in the refining process.

A rise in blood glucose triggers a release of insulin and other substances that create an environment conducive to inflammation. More on this can be found here.

Carbs also produce more belly and liver fat than dietary fat itself. In addition, excess sugars contribute to cholesterol imbalances – elevated LDLs and lowered HDLs, contributing to heart attack risk.

Omega-3 Fatty Acids Rule

Found in fish (salmon is king – pun intended), nuts (particularly walnuts), certain oils, leafy greens and flax seeds, Omega-3s are an essential part of our diet. They serve a multitude of purposes and our bodies don’t produce them. They are in the cell membranes of all our cells and are integral to the production of certain hormones that do everything from assisting with regulation of blood clotting, blood vessel function and control of inflammation to impacting genetic function. Also integral to the findings is that Omega-3 Fatty Acids are an important nutrient for optimal brain health.

Here is one piece on Omega-3s. Here is another that describes their impact on many disease processes. Their antioxidant properties and the impact they have on inflammation have been explored in a significant amount of research, some of which is discussed here.


Chemicals in our bodies called free radicals can wreck havoc by damaging our cells, thus altering their structure and function. Antioxidants, extracted from foods that we eat, combat free radicals to limit that damage which, left unchecked, contributes to a host of chronic conditions. Other than for prevention of age-related macular degeneration, studies involving antioxidant supplements did not show them to be beneficial. However, evidence has shown that a diet rich in the naturally occurring antioxidants found in vegetables, fruits and whole grains does offer protection against cognitive decline and the diseases associated with aging.

More on specific foods (like eggs and red meat), as well as diets for brain health/post concussion care, heart health and for those with gastrointestinal disorders in Part Two of this post, coming Monday!

MLB Injuries: Pitchers – vs – Position Players

An MLB team has a five man starting rotation but in the course of a season may start as many as 12 or 13 different pitchers due to injury. That requires great depth, and that players at the Triple A and maybe even Double A levels be ready for action. lists 70 player injuries as of this writing, and 45 of those – 64 percent – are to pitchers. Looking at that from another angle, at least at the moment, pitcher injuries overwhelm those to all the other position players combined.

One reason for this is that the pitching motion is extreme and the constant repetition required to prepare and to compete creates undue demand. This can cause tissues to break down, particularly

Those at the shoulder, elbow and forearm. Even hips and knees are vulnerable because of the generation of power from the lower extremity; and ankles can be prone to sprain.

With shoulder and elbow surgery to pitchers fairly commonplace, and because of the extensive rehab required thereafter (anywhere from 11-30 months), pitchers, on average, stay on the DL for longer periods. This also skews the statistics.

So what is it about pitching that creates vulnerability?

According to Dr. James Andrews, renowned orthopedic surgeon, the single most important factor resulting in elbow injuries to pitchers is overuse: daily, weekly and annually. He notes other primary factors as being insufficient rest, pitching while fatigued and poor mechanics. For younger athletes, playing on multiple teams or increasing demands by playing catcher when not pitching contributes to lack of rest and resultant overuse.

Though in Dr. Andrew’s interview he cites throwing curveballs and sliders as potentially increasing the likelihood of elbow injury, he is likely referring more to younger athletes who are not physically mature and whose mechanics may be faulty. It is generally understood that, in the pro ranks, fastball pitchers – who throw at an increased velocity – generate forces that place the greatest strain on the structures of the elbow and forearm. Thus there is danger in consistently throwing at maximum effort.

The doctor does point out an interesting conundrum however, in that “players with higher velocity have longer careers and also perform better. Therefore, it would be unrealistic to recommend that pitchers simply not throw as hard. However, varying speeds might improve a pitcher’s effectiveness and conceivably also reduce injury risk.”

While some never return to competition after Tommy John surgery (studies show anywhere from 7-17 percent), others go on to complete as well (which is the goal) or even better than they had pre-operatively. Performance improvements may be attributable to the strength and conditioning programs during rehab or to a player having played with mild or undiagnosed injury pre-operatively.

About half of the pitchers who have Tommy John surgery subsequently go on to have other arm injuries (many requiring surgery) – whether to the elbow or shoulder.

Surgeons are keeping an eye on an alternative procedure to repair the Ulnar Collateral Ligament (UCL) at the elbow. It is referred to as a “primary repair” and is still in an experimental phase for professional athletes. Dr. George Paletta, who performed the surgery on former Cardinals reliever Seth Maness last year, believes it could replace Tommy John surgery because of the shorter rehab time. In place of a graft reconstruction of the UCL, the injured ligament is preserved and repaired to the bone. So far, with a smaller sample of (mostly younger) patients, the doctor reports a high success rate. However, earlier studies demonstrate that the procedure may necessitate a selection process that excludes older athletes with ligament damage that is not limited to either end of the UCL.

As for the shoulder…

If you take a look at the list of MLB injuries at any given time, the majority of players dealing with shoulder issues are bound to be pitchers. Just as with the elbow, repetitive motion at high velocity can make surrounding tissues vulnerable. With extreme ranges of motion and rapid deceleration added to the equation, as they are with pitching, the shoulder is at risk. Less than ideal mechanics can also set the stage for breakdown. Whether impingement syndrome, rotator cuff strains / tears, a torn labrum, or tears of the joint capsule, all are unfortunately fairly commonplace.

The Pitching Motion

At the end of the cocking phase of pitching, the pitcher’s shoulder is at its maximum degree of external (outward) rotation. Though 90 degrees of outward rotation is considered normal for most of us, pitchers have a good deal more motion into this plane (consequently, many have more limited internal (inward) rotation than is classically “normal”).

For a thorough but basic understanding of pitching mechanics take a look here. If you’d like to scroll through a comprehensive medical review correlating mechanics during specific phases of pitching with injury, this article provides more detail.

During the movement of external rotation, the head of the humerus glides forward, putting stress on the front (anterior) of the joint capsule and the ligaments. These are the restraints that provide joint stability. When a pitcher moves forcefully to his end range of outward rotation with his elbow at shoulder height, these structures are stressed to their limits. This can cause injury.

A pitching shoulder that has anterior instability creates undue stresses on the rotator cuff tendons (and the bursa in that region). This creates inflammation or ultimately tears.

Weak rotators – lead to impingement, as they no longer serve to effectively position the humeral head and keep it from riding upward. Other muscle imbalances at the shoulder girdle also predispose to inflammatory conditions and impingement syndrome. Impingement then puts the cuff tendons at risk.

The labrum is a fibrocartilagenous structure that deepens the socket of the shoulder, providing additional stability while also enabling the motion this ball and socket joint requires for function. If the labrum is torn, the resulting instability can cause the shoulder to sublux or dislocate.



Protect Your Back! Avoid Injury When Shoveling Snow

Happy snow day to you! Are you stuck with the unwelcome task of shoveling snow? We’ve got your back! Snow can be pretty heavy, especially the really wet stuff. If you haven’t been hitting the gym regularly or training for snow shoveling as your sport of choice, you may be waking up with some aches and pains. Here are a few tips to dig yourself out a little more safely.

1. Avoid holding your breath
Optimize the function of your respiratory system and utilize the more efficient aerobic mechanism for supplying your muscles with energy. In addition, you may get lightheaded or feel a headache coming on if you hold your breath.

2. Bend from your hips and knees, NOT your back
Just as when you do a squat, ski, or even sit back into a chair, lean your upper body forward from your hips and knees while you balance your weight over your feet by leading and reaching back with your butt. Practice by doing squats to a chair without allowing your rear end to touch the chair.

3. Maintain a neutral spine
That means neither bending nor arching away from your midrange comfort zone. For some, neutral is a flattened low back, for others a very mild arch, but it is never the very rounded back you will see when you observe some people shoveling.

To maintain neutral you will have to engage your abdominal and low back muscles, working the low back extensors most as you bend, to stabilize your low back and keep it from rounding. Emphasize (contract) your abdominals as you reach and rise. The heavier the load you are shoveling, the harder your muscles should work to keep your spine in neutral.

4. Avoid reaching too far
Shovel the snow close to you – the more outstretched your arms are when you lift, the heavier the snow effectively becomes, placing a greater strain on your low back. To understand this better, imagine playing on a see-saw when you were a kid. The farther you sat from the center axis, the “heavier” you became, making it possible to keep your friend on the other end up high off the ground.

5. Lift from your legs
Just as when you lift a heavy box from the floor, rise from your knees and hips to avoid overdoing the effort on your arms and back.

6. Consider wearing an abdominal belt
Some studies have shown that wearing a belt for heavy lifting activities raises intra-muscular pressure of the back muscles (erector spinae) and in doing so helps to stabilize the low back (lumbar spine) during lifting exertions.

7. Pivot to avoid excess twisting of your trunk
Just as with a golf swing, allow your hips to move with your shoulders so that you require less rotation of your spine. For example, a right-handed golfer pivots over his right foot during his swing and follow-through while his left foot remains firmly in contact with the ground. When you are moving the snow from here to there, pivot over your back foot while turning your trunk toward the opposite side.

8. If the snowfall was a big one, lift and move it in layers to limit the weight
You don’t have to dig all the way down to the sidewalk with each maneuver.

9. Take rest breaks and be sure to stay hydrated
You may not realize how much you are actually exerting when you shovel snow. Drink before you get thirsty to avoid dehydration and rest to stay strong and refreshed.

10. Buy a snowblower, hire the kid next door or move to California!

11. A final caution: delegate the shoveling if you have a cardiac history, a significant history of low back problems or are suffering from a shoulder or knee injury.

Shoulder Impingement. David Wright’s Latest Injury?

Thirty-four year-old NY Mets third baseman David Wright has struggled these last few years, sidelined with a number of injuries and diagnoses. Wright’s latest ailment was reportedly diagnosed as a right shoulder impingement. However, accounts indicate that Wright is seeking a second opinion from orthopedists outside the Mets’ family. The result of this consult is not known as of this writing.

Wright’s most serious issue to date has been spinal stenosis, which can have significant implications for anyone, but particularly so for an athlete. He underwent a cervical discectomy and fusion last June to alleviate pressure on one or more spinal nerves as a result of a disc herniation as well as the stenosis. The fusion would have been performed to restrict mobility in order to limit stresses to the region and prevent instability that might otherwise lead to further nerve compression and irritation. However, stenosis is a narrowing of the spinal canal housing the spinal cord and is something that doesn’t resolve. It can lead to cord compression resulting in weakness, or in extreme cases, paralysis.

The presence of stenosis can also increase the incidence of less severe neurologic symptoms such as stingers, or cause episodes of neuropraxia. The latter is the complete block of nerve transmission though the nerve fibers remain intact. Though both are transient conditions, they are painful, with the latter generally taking a longer time to resolve. Cervical stenosis has ended the career of several football players, primarily due to the frequency and intensity of their symptoms. Interestingly though, sufferers are said by some not to be more at risk of serious spinal injury than their peers. Even when playing football.

David Wright is getting off to a halting start in his comeback from surgery. According to David Waldstein of the New York Times, Mets Manager Sandy Alderson noted that Wright had been experiencing shoulder soreness all spring. He reported that the Mets medical staff believes that resuming throwing after having not done so for so long during his recovery from the neck procedures was the catalyst.

Alderson also reportedly said that Wright had some instability in his right shoulder, which may have predisposed him to impingement. In addition, Mets’ doctors evidently pointed to an incomplete functional recovery of the surrounding musculature as a factor.

CBS reported that due to his prior injuries, Wright had altered his throwing mechanics, adopting more of a sidearm delivery. This too might have been part of what led to his current complaints.

Ed Coleman of WFAN reported that Wright’s throwing program has been suspended for at least two weeks and he was advised to focus on a strengthening program. It remains to be seen if any change to the plan will be effected once the newest diagnostic opinion is in play.

What is clear however, is that Wright is unlikely to be ready for opening day, may not be able to play every day when he does come back, and may have to consider a move to first to limit the need for him to throw longer distances with greater frequency. Wright is reportedly willing to do whatever is asked of him.

So what is impingement syndrome?

The word impingement tells you much of what you need to know – structures are being compressed or pinched. Pain occurs in the upper joint, especially when the arm is elevated and the shoulder rotated inwardly. Overhead and throwing athletes are prime targets. Rotator cuff tendon(s) and a bursa are generally what are impinged in the narrow space formed by the acromion (a portion of bone that appears like a hood over the shoulder), a prominence on the head of the humerus (the bone of the upper arm) and the ligament that connects the clavicle (collar bone) to the shoulder blade at the acromion.

Chronic impingement can lead to wear and tear of the rotator cuff tendons that pass through this (subacromial) space – not a great scenario. If rotator cuff tendons become inflamed, swelling will further compromise the joint space, creating more impingement. Degenerative rotator cuff tears can result in complete rupture and are often associated with biceps tendon rupture as well.

Ignoring symptoms of shoulder pain or soreness while remaining active generally exacerbates the problem. Though an injection can calm the acute inflammation and rest will allow it to do its job, rehab is paramount, and a two-week layoff (as has been suggested) isn’t likely to resolve the underlying causes of the condition.

Weakness of the outward (external) rotators also has an adverse impact on shoulder joint mechanics. Strong outward rotators stabilize and depress the humeral head, keeping it from gliding upward and narrowing the space the tendons and bursa require. Thus weakness can create impingement. So too can a forward head posture and shoulder blade (scapula) that is tilted forward (anteriorly) narrowing the joint space at the shoulder. It becomes a vicious cycle…

Rehab for shoulder impingement always entails working to reduce inflammation while normalizing joint mobility and addressing muscle strength and flexibility. If the rear portion of the joint capsule is tight, restricting internal rotation mobility, joint mobilization proves helpful. The presence of significant instability of the shoulder, generally in the front (anterior) compartment, complicates matters and may require surgery. Likewise, surgical intervention may be necessary if bone spurs or a hooked shaped acromion contribute to impingement. If there is something such as a spur in the way, strengthening alone isn’t likely to resolve symptoms.

What is the significance of a hyperextended knee?

Kevin Durant reportedly suffered a hyperextended knee less than a minute into last night’s contest against the Wizards in D.C. and exited the court shortly thereafter. An MRI is scheduled. The injury occurred when Washington Center, Marcin Gortat made contact with Golden State’s Zaza Pachulia who then stumbled, landing on Durant’s left leg.

Though the MRI may not reveal any significant injury beyond a mild sprain, there is a range of diagnoses possible in this situation.

What is the significance of a hyperextended knee?

Ligaments – which attach bone to bone – provide stability by restraining excessive movement in our joints. When a joint goes beyond its normal range of motion, the integrity of certain ligaments becomes compromised, resulting in a sprain. In the case of the knee, forceful or traumatic hyperextension into a bowed position stresses the anterior cruciate ligament (ACL) – which is the primary stabilizer of the joint – and may also impact other secondary stabilizers. Worst-case scenario for Durant would have been a Grade 3 sprain, otherwise known as an ACL tear. A Grade 3 sprain is actually a complete rupture. Best case would be a Grade 1 sprain, with only mild tweaking of the ligament.

When the knee hyperextends, the tibia (the larger bone in the lower leg) glides forward excessively on the femur (the thigh bone) at the knee joint. This abnormal movement, whether caused by trauma or a non-contact situation, can also result in a bone bruise, or contusion. As with a sprain, the extent of the contusion would be proportional to the degree of hyperextension that occurred and whether trauma played a role. Another factor is the athlete’s baseline – or normal – range of motion.

A prior history of ligament sprain that results in persistent joint laxity predisposes an athlete to excessive joint mobility. This may set the stage for a non-contact injury. Many people – particularly ballet dancers and gymnasts – have hypermobile knees, enabling extension beyond a level plane and into a hyperextended position. This expanded range of motion is their “normal”. For a hyperextension injury to occur in these populations, the tibia would have to glide that much further forward, still stressing its restraints.

It is important for an athlete or dancer to have exceptional muscle strength, particularly in those muscles surrounding a less than stable joint. It is also vital that strength is optimized at the end-ranges of motion. The hamstrings become particularly vital in the case of the knee, for in their role as knee flexors. In addition to bending the knee, the hamstrings also act to extend the hip. However, as knee flexors they provide a degree of dynamic restraint to limit hyperextension of the joint.

Concussion and How a PT Expert Can Help

In recent years it has become more apparent that any impact to the human body, whether a fall or a bicycle accident, can have more lasting effects than previously thought.  Concussions are among the many injuries resulting from trauma that are not physically apparent and are not easily recognized by victims and those around them. Concussion recognition during football, from the little leagues to the professional level, has gained media attention in the past decade. However concussions can also result from accidents, falls, and other types of impact sports. Soccer, hockey, volleyball, and basketball are just a few sports where aggressive play and bodily contact can lead to biomechanical brain injury. Coaches and health practitioners have the ability to help preserve athletic participation and future brain function by recognizing symptoms and by taking the appropriate action to help with healing.

Concussions are often difficult to diagnose without the proper tools and individuals may be reluctant to voice their symptoms. Competitive conditions make players fearful of being sidelined while workers or students may not want to delay projects at hand. Many others underreport or fail to report their symptoms because they lack the knowledge to recognize a true concussion. Players, coaches, and caregivers need to be educated in concussion symptom recognition and how to support these individuals.

Doctors of Physical Therapy are musculoskeletal specialists who can guide individuals and athletes recovering from concussion in a safe transition to daily activities, exercise, and sports.  Besides increased risk of a second more severe concussion, there exist other post-concussive risks that can be detrimental to a person’s well-being. Recent studies by Herman et al. (2016) and Gilbert et al (2016), have demonstrated a relationship between concussion history and lower extremity injuries in athletes. One concussion can disrupt a person’s balance and equilibrium as well as their strength and mobility. When this is paired with subsequent lower extremity injury, a repeating cycle is created where rest, muscle atrophy, and decreased mobility contribute to re-injury and further physical decline. Physical Therapy eliminates this cycle by targeting strength, endurance, and balance deficits in the core, hips, knees, and ankles that persist after concussion. With an individualized rehabilitation program provided by a trained Physical Therapist, a patient recovering from concussion can return to function and return to their sport with confidence and decreased risk of future injury.

Elizabeth Lamontagne PT, DPT, SCS, CKTP

Staff Physical Therapist at Recovery Physical Therapy



Herman, D.C. Jones, D. Harrison, A., Moser, M., Tillman, S., Farmer, K., …Chmielewski, T. L. (2016). Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes. Sports Medicine. Doi: 10.1007/s40279-016-0607-9.

Gilbert, F.C., Burdette, G.T., Joyner, A.B., Llewellyn, T.A., Buckley, T.A. Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes. Sports Health: A Multidisciplinary Approach. 2016;8(6):561-567. Doi: 10.1177/1941738116666509.

Myofascial Release

Myofascial Release is a highly effective technique developed by John Barnes, an icon in the physical therapy world. The technique emphasizes  gentle prolonged sustained stretching of the fascial system and myofascial elements to release restrictions that may be causing symptoms throughout the body.  Fascia is continuous throughout the human body, so a restriction in one location may cause symptoms elsewhere.  Fascial restrictions do not show up on MRIs or other diagnostic imaging, so the therapist performs a comprehensive evaluation,  starting with posture to determine where fascial restrictions may lie.  

Myofascial Release is used to treat all types of diagnoses ranging from low back pain, neck pain, TMJ, patella-femoral issues, tennis elbow, headaches, to name a few.   It is estimated that the fascial system can create pressures up to 2000 lbs of pressure per square inch, thus causing pain, numbness, tingling, edema, and decreased strength.  Myofascial release is a safe, gentle treatment which consistently produces lasting results. 

Dr. Robert Kotraba, PT, DPT, OCS utilizes Myofascial Release at our Rockefeller Center location.  For more information, please call 646-562-0617.

Six Opioid-Free Chronic Pain Management Methods


Opioids are the most common form of chronic pain management for patients in the U.S. Unfortunately, they also are highly addictive with a number of detrimental side effects. Alternative methods of pain management often are not provided in mainstream medicine due to the presence of pharmaceutical companies in healthcare. However, there are several ways you can manage your chronic pain without risking addiction or relapse if you already have recovered from an addiction to painkillers.  Here are a few of your options for managing pain without medication.

Exercise is Highly Effective

Though it can be very difficult to exercise with chronic pain, the more you exercise, the less pain your will experience. Regular exercise will stretch the muscles, reduce inflammation, and improve range of motion.

Mind Over Matter is Real

Meditation is another great way to manage pain. With practice, you will be able to move your mind to a place that does not feel the pain. Furthermore, meditation reduces stress and tension, two common contributors to chronic pain. It will not have an immediate effect because learning to meditate takes time. However, if you incorporate meditative practice into your daily routine, you will notice a difference.

Herbal Remedies May Help

For some people, herbal remedies can be very effective in managing pain. Turmeric, in particular, is known for its powerful anti-inflammatory properties. You either can add these helpful herbs into your diet or take supplemental capsules. Just be sure to steer clear of homeopathy as it has been proven completely ineffective.

Physical Therapy Can Make an Important Impact

Some worry that too much movement will amplify their pain, but physical therapy can relieve many kinds of chronic pain conditions, including rheumatoid arthritis, migraines, and fibromyalgia. Physical therapy helps strengthen muscles and increase flexibility. It can also teach patients to avoid painful movements or postures throughout the day so they can proactively prevent issues on their own. The results aren’t instantaneous but with commitment and patience, you and your therapist can find the best techniques for your condition and decrease pain over time.

Watching Your Diet May Be an Easy Fix

Inflammation is typically the main cause of chronic pain. If you aren’t watching your diet, you may be unintentionally eating foods that cause inflammation and not getting enough of those that reduce inflammation. Try combing through your diet and collecting new recipes. You might just be surprised by how much your diet affects your pain levels.

Consider Treatment for Underlying Issues

Studies are beginning to show that there may be a link between mental health problems and chronic pain. People with anxiety tend to experience chronic pain as do people with poor health overall. If your chronic pain has not been explained, seek out other forms of treatment. With holistic care, you can get to the source of the problem rather than treating the symptom.

Suffering from chronic pain can make daily life difficult. Being faced with few options outside opioids certainly doesn’t make things easier. Rather than risk addiction to painkillers, try out a few of these methods. Keep in mind that not all chronic pain is the same and not every method will work for each situation. Test new methods until you find one that works.



Kinesio Taping for NYC Marathon Runners at our Upper East Side office, Sat Nov 5th


When: Saturday, November 5th, 2016

Where: Recovery Physical Therapy Upper East Side Location

157 East 86th street 2nd floor, New York, NY 10028

(Entrance next to Steve Madden Shoe store)

What: 30-minute kinesio taping by a licensed Physical Therapist to enhance performance and decrease pain for those running the NYC marathon.

Who: If you have neck, shoulder, back, hip, knee, foot, or ankle pain, there are taping techniques that can help with pain and enhance performance.

Cost: The cost includes a 30-minute session where the therapist will evaluate taping needs and administer the tape (tape will be provided by Recovery Physical Therapy.)  $50 self-pay fee.

There will be no massage, stretching, joint mobilizations or manipulations, or any other modalities/treatments.   If you feel you do need any of these services before or after the marathon, please contact us at (212) 831-3315 to schedule an appointment.

Contact: Please feel free to contact us at (212)831-3315 or come in to make an appointment!