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, https://www.ncbi.nlm.nih.gov/pubmed/27544666) and Gilbert et al (2016), https://www.ncbi.nlm.nih.gov/pubmed/27587598) 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 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.
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.
TAPING FOR NYC MARATHON RUNNERS
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!
Though water is still the best, this antioxidant-rich liquid has been an answer to pain, inflammation, swelling, and sleeplessness. Tart cherry not only has important nutrients but also contains many antioxidants and anti-inflammatory agents. It aids in cancer prevention, heart health, and as an anti-inflammatory, which can help alleviate a variety of ailments like asthma symptoms, arthritis pain, and regulate metabolism.
Cherry juice concentrate:
- Soothes pain, prevents muscle damage and fastens recovery
Runners, here is something useful for you. Cherries could be the solution to post-run muscle soreness. It is naturally high in potassium, which conducts electrical impulses throughout the body. This mineral also helps maintain blood pressure, hydration, muscle recovery, nerve impulses, digestion, heart rate, and pH balance. Cherries contain about 330 mg of potassium per cup, which is almost 10 percent of how much you need each day.
- Treats insomnia.
Let this juice help you get a good night sleep. A lot of healing takes place when you sleep .The fruit is naturally rich in melatonin which is responsible for sleepiness and regulates your body’s internal clock and tryptophan, an amino acid the body uses to create even more melatonin. Also, a class of pigments called anthocyanins found in the fruit is able to slow the breakdown of tryptophan, thereby lengthening its sleep-inducing effects.
- Prevents gout, fight inflammation and arthritis
Research shows that the antioxidants in tart cherry juice can reduce pain and inflammation from osteoarthritis- gout. The fruit lowers the levels of uric acid—the chemical that causes gout in high concentrations—and c-reactive protein, a biomarker of inflammation. Researchers give credit again to anthocyanins, which also give the fruit its dark red hue.
- Boosts Immunity
Cherry concentrate and cherries pack a powerful antioxidant and anti-viral punch. Flavonoids, a type of antioxidant in cherry juice, are made by plants to fight infection and have a significant impact on immune system function.
But wait, the potential side-effects of tart cherry juice include abdominal discomfort and diarrhea. While studies show that anthocyanins act against the development of obesity and can help reduce abdominal fat, and lower the risk of metabolic syndrome, the 140-calorie per 8-ounce serving juice may also affect your weight. If you’re looking to lose some fat, stick to eating the fruit rather than drinking the juice.
Ekta Lund, PT, MSPT, CSCS, CKTP – Co-Director, Upper East Side location
Concussion diagnosis and treatment has been an important topic of discussion recently as new research points to the potential long term effects of concussion. Concussion and Post-Concussion syndrome prevention have been all over the news; and schools, athletic organizations, as well as professional leagues are all creating new rules and guidelines to help prevent and treat concussion.
At Recovery Physical Therapy’s Upper West Side location we are proud to announce our new Concussion Management Program.
A concussion is defined by the Centers for Disease Control as “a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.”
Any type of head trauma can cause concussion; from falls, to motor vehicle accidents, bicycle accidents or sports collisions to name a few.
While the majority of people who sustain a concussion have relief of symptoms in about two weeks, for some the symptoms can persist for weeks or even months post-concussion.
As Physical Therapists we can assist in relieving the symptoms of concussion including headache, loss of balance, dizziness, visual problems, vestibular problems, and exercise intolerance.
Physical therapists can provide a vital service to promote healing, a return to work or school and a safe return to physical activity and athletics as soon as possible.
Once a referral to our specially trained physical therapists has been made by the doctor or health care practitioner, patients will receive a detailed initial evaluation. An individualized treatment plan will be created based on the patient’s symptoms, impairments and specific goals.
We will work together so that you, or your patient, can return to everyday activities, school, work, and safely return to athletics after a concussion.
If you would like to learn more about our concussion program, or to make a referral or appointment please call, 212-874-1550 or email us at
With Winter soon coming to a close and with Spring upon us, many things come to mind…baseball, the return of flowers and foliage, warmer temperatures, and for a good number of us, golf. The sport generally consists of three different types of players, recreational, amateur, and professional. Although much attention goes to the pros such as Tiger Woods and Phil Mickelson, the vast majority of players are recreational.
I had been training for a mid-March half marathon when my left leg began hurting before, during and after all of my training runs. Last year I suffered from Achilles tendonitis in my right leg, so when this pain started flaring up, much to my disappointment I stopped running and consulted the experts. It turns out that I have a soleus strain on my left leg this time around.
I reached out to John Wilbert, MSPT, Director of our Flatiron District facility to get a better understanding of this new setback.
So John, what causes a soleus strain?
JW: A soleus strain is caused by overloading your calf by landing on your pointed foot with the knee bent, such as when descending stairs or running downhill. It’s not as common an injury as a gastro or Achilles injury/tendonitis.
How should I treat this injury, aside from picking up the phone and calling my colleague?
JW: As with a gastro/Achilles injury, you should avoid stretching and overloading that leg in the acute stage, about 48-72hrs after the pain begins. Icing and using a foam roller will help, but do not use NSAIDS in the initial stage.
After 72hrs, if still limping and painful, or any bruising present, a MD or PT should do a proper evaluation. The injury may be a tear and need bracing or more aggressive treatment and a layman may just do more damage than good.
Can I continue to run? I have a race in a few weeks.
JW: Absolutely no running or jumping until walking and stairs are pain free. You may do exercises involving muscles higher than the knee, if when you’re painless on a flat foot.
So the race is out?
JW: Yes, if the pain sticks around. You risk further injury.
What are exercises I should do to relieve my pain and prevent this from happening in the future?
JW: Once you are out of the acute stage, calf raises with knee straight and bent (seated calf raise machine is the easiest) with a focus on the eccentric, or lowering, phase should be performed 2-3x/wk. A PT should also evaluate your running form since that may have been the primary cause. Also a proper stretching routine for the calf and hamstring should be initiated only after the initial 72hrs of injury, not sooner for fear of aggravating a possible tear.
Do you have any other clinical advice?
JW: Listen to your body: if an injury worsens after running, don’t keep pushing. You risk making the injury much worse which will sideline you far longer than just skipping that day and seeking professional advice.
1. Adjust your program daily based on your perceived exertion.
Some days you have it and some you just don’t. Even if you are working at the same speed or resistance you’ve done with ease, variables such as the time of day, your level of fatigue, what you’ve had to eat, when you last ate, whether you are adequately hydrated and your general health can impact your ability to exercise. Fine-tune exercise accordingly so that while your program remains challenging, you avoid overdoing it. Set yourself up for success by establishing a routine that works for you and that includes proper nutrition, adequate rest and sufficient water intake.
2. Quality over quantity: When lifting weights or doing other forms of strength training, execute each exercise with precise form.
This ensures that the targeted muscles actually benefit. Though core muscles and others may assist with balance, providing a stable base from which to work, pristine form helps avoid substituting or compensating with additional muscles. This not only enables safer postures and stresses, it helps you achieve the desired results.
Gains aren’t only about upping the ante, but about how you isolate. For instance, if you must arch your back to do bicep curls or hike your shoulders to do various forms of arm lifts, then you are probably lifting too much weight. If your knees go beyond your toes when doing a squat, scale back to an easier exercise. Repetitive stresses when overdoing it will likely cause your fitness program to veer off into injury and keep you out of action.
3. Establish a foundation before advancing your program.
For instance, muscles that stabilize your scapulae (shoulder blades) must exhibit a baseline level of strength before you include lifting above the horizontal (the level of your shoulders). These muscles include the middle and lower trapezius, the rhomboids, and the serratus.
Likewise, another example would be having sufficient quadriceps strength to perform wall squats (with a ball) before attempting standard squats and then step-downs or lunges. Skipping steps in a progression may have unintended consequences.
4. Shoot for slower, safer exercise progressions.
When accelerating your program, increase the difficulty of one variable at a time. Measure your response and then continue to adjust and advance in subsequent workouts. For instance, with cardio, avoid drastically increasing variables such as pace, distance, incline and resistance in combination. Likewise with weight lifting — avoid increases to your resistance, reps and sets simultaneously. If you take on too much change at once, you may not realize you’ve done so until it is too late and an overuse injury results.
5. Explore reputable resources to guide you as to how to execute exercises properly.
Keep in mind that the guy working out next to you, or even a trainer in your gym, may not be the ideal advisor. Talking a good game and looking the part are no substitute for knowing (and effectively implementing) the science that sets the foundation. Publications and online resources written or compiled by recognized sports and orthopedic physical therapists might be a great place to start.
6. Avoid using momentum when strength training.
Working quickly through an arc of motion when lifting and lowering weights lessens the challenge to your muscles. This diminishes the benefit of the exercises. Though you’ll get through your program faster, it isn’t worth the diluted return on your investment of time.
Particular attention to the slow release or lowering of weights has an added benefit. These are eccentric contractions, when a muscle exerts a force as it lengthens. Muscles have an increased capacity to sustain tension when working eccentrically and this type of strength training has a significant benefit to function and injury prevention. Faster speeds factor in primarily if training with specificity for a high-speed activity (e.g., using resistive bands to replicate the pitching motion, or a weighted or resisted tethered club or racquet for golf or tennis strokes). Otherwise, keep it slow and steady.
7. Steer clear of high-risk, low-reward exercises that live on and deserve to die.
8. Mix it up!
There’s more than one way to get it done. In fact, surprising your body with different approaches to strengthening will jump start your improvement and prevent plateaus if you are trying to make steady gains. Likewise, cross-training when doing cardio will lessen the likelihood of overuse injury. The caveat? Point number nine.
9. Listen to your body!
The menu of exercises is vast, and even all the healthy options aren’t universally appropriate. Your particular structure, injury history, age, current level of muscle strength and flexibility and your joint ranges of motion all are factors that determine the ideal exercises for you. If you have musculoskeletal complaints, avoid any exercises that trigger pain, whether it occurs while exercising or in the hours/days following. See an orthopedist to assess any complaints of pain you may have. Avoid working through your symptoms to prevent conditions from worsening or becoming chronic.
10. Take a break!
Muscles need a day off from strength training to recover from the assault. It is this recovery that allows the healing of the muscle fibers to occur, leading to the benefits and minimizing risk of injury. For cardio training, at least consider one day of rest each week to allow your body to recoup. If you are shooting for exercise nearly every day, cross-training will enable you to utilize muscles in different ways and minimize impact to your joints, both of which will lessen the likelihood of overuse issues.
Lower back strains and muscle spasms are a common injury that dancers experience. Dancers require such enormous amounts of flexibility in their lumbar spine that over time it may get over stretched and thus become victim to micro-trauma or small tears. These tears can result from practicing the same move over and over again or rehearing a difficult lift repetitively. Once the muscles are injured, they will tighten up and go into a protective muscle spasm, which is the bodies’ natural response to injury.
A thorough evaluation by a physical therapist is essential to determine the cause of lower back pain. The musculature and fascia will tighten and become stiff in an effort to protect the area, so regaining the flexibility of the soft tissue is essential to complete recovery. In addition, joint mobility, general flexibility, core strength and training technique, such as an increased lordosis (aka sway back), will be addressed to flesh out any other contributing factors. A physical therapist will determine individual needs and treat accordingly. Treating the low back is a multi-factorial process, but if done properly, the dancer will be bounding across the floor in no time.
Robert Kotraba, PT, DPT, OCS