Are you thinking about competing in a Jiu Jitsu tournament this year? Are you over 30-years old? Have you hurt a tendon or muscle before? Have you been inconsistent with your workouts or training sessions? If you answered “yes” to any of the above questions, this information will be a good read for you. This blog will discuss tendon and muscle injuries, talk about how to reduce your risk of injury, and what to do if you should sustain a tendon or muscle injury.
As a normal part of the aging process, stiffness occurs in muscles, tendons and joints. This starts to occur in a majority of people after 30-years of age. This stiffness is not preventable, but the process can be slowed. So, how do slow this process down? Movement is the key in this prevention. Unfortunately, technology has driven us from a “standing-and-moving” workforce to a “sitting-in-front-of-a-computer” workforce. And then we get off of work to deal with the challenges of life and hopefully get some exercise in whatever free time you have leftover. A recent study found that regular exercise for one hour is not even enough to offset sitting for 6+ hours a day.
So maybe you decide to go train jiu jitsu for an hour class. Are your tendons ready to accept this force after you did almost nothing stressful to your body for most of the day? One advantage here is that the nature of jiu jitsu is lifestyle driven, whereby one continues to train and move through a lifetime. It encompasses flexibility, strength, and agility, so the hope is that when injuries to these areas do occur, we can minimize the length of time that we deal with them.
Over the last 20 years, we have learned more about these tendon injuries than what was previously known. Terminologies have changed as well, which makes it sometimes difficult to follow. These terms include tendinopathy, tendinitis, and tendinosis, which unless you work in the medical profession, most people will use interchangeably. The most common current nomenclature is tendinopathy, which is an umbrella term for an injury to a tendon.
Tendinopathy is one of the more common musculoskeletal injuries that occurs to a tendon, particularly in jiu jitsu. These commonly occur to the patella tendon (anterior knee), common extensor tendon (lateral elbow), common flexor tendon (medial elbow), biceps tendon (anterior arm), and the Achilles tendon (posterior ankle). In jiu jitsu, the more common locations are in the shoulder and elbow because of the constant gripping, pushing, and pulling. However, this can happen to any tendon within the body.
There are several different causes for these tendinopathies, ranging from unaccustomed activity/overloading, direct trauma/contusions, muscle weakness, muscle tightness and other muscle imbalances. There are also intrinsic factors (things inside our body) that predispose us to tendinopathy, which are muscle tightness, muscle weakness, body structure, and our overall training regime. If you train too little, your tendons become weakened and are easily stressed and become injured. Remember the adage “Use it or lose it.” If you train too much, you repetitively stress the tendons excessively, leading to tissue breakdown and subsequent injury.
There are additional extrinsic factors (environmental or what you put in your body) that may make you more predisposed to these as well. These include medications, current/past health status, medical conditions, and social activities.
Medicinal Impact on Tendons
Medications are supposed to help us, but sometimes they can cause side effects or adverse reactions in certain individuals. Antibiotics that contain fluoroquinolones, which are used as an antimicrobial agent, are known to cause tendon damage commonly seen in the Achilles, the quadriceps, rotator cuff, and lateral elbow tendons. Approximately 40% of the cases were in Achilles tendon as rupture injuries. And the onset of this is very rapid, with a median duration of 8 days. If you have had a tendon injury previously, you are also more at risk than those who have not sustained one previously.
Statins are used to control cholesterol and have also been found to cause tendon damage. This problem is not immediate and generally takes 10 months or longer for symptoms to occur, while about one third of these cases are tendon ruptures. Similarly to fluoroquinolones, they affect the Achilles, rotator cuff and lateral elbow tendons.
Corticosteroids, or cortisone, are used to treat injuries, due to their strong anti-inflammatory properties. These can be taken orally or injected directly into the tissue. They are known to negatively affect tensile strength and localized collagen synthesis, which creates a weakened tendon that requires less stress-load to cause injury. This has been shown in both human and animals studies. Unfortunately, people tend to focus on these corticosteroids for the pain relieving aspect, with little thought to the potential negative impact, especially with multiple injections. It has been suggested that if one sustains a tendon injury that is considered chronic or degenerative, that a cortisone injection can cause a tendon rupture, because the tendon is already in a weakened state.
Anabolic steroids have been used for many years to enhance muscular strength and mass. Regrettably, their use can also have a similar effect as corticosteroids. The impact is often repeated tendon injuries, and eventually tendon ruptures while performing under load. This also tends to increase with age if anabolic steroids were used at a younger age.
Your overall health can also impact your tendons. Certain medical conditions may predispose you to tendon and muscle injuries. Here is a chart of some of these medical conditions.
Inflammatory bowel disease
Connective tissue disorders
Social activities like drinking, smoking and the use of recreational drugs can also impact our tendons and muscles. Alcohol is a diuretic, thus depleting our tissues of valuable water for rolling sessions. Smoking causes vasoconstriction of our blood vessels, which means our tissues do not get the nourishment needed to stay healthy. And when we get hurt, our ability to heal is much slower if we smoke. Recreational drugs can impact our ability to heal as well, and the cause will depend on which drugs are used.
Want more info? Contact Dr. Ingstad (Leading BJJ Physical Therapist in San Diego, CA)
Level 4 Physical Therapy
HEALTH ADVICE DISCLAIMER
By reading this publication you agree that following any advice herein is at your own risk and agree to hold harmless Level 4 Physical Therapy & Performance, Inc., its owners, and its employees. We are able to offer you this service at a standard charge. Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this report.
This is one of the most common shoulder questions we get asked in the clinic.
This week I had a question asked by one of our clients Brooke, 49, from Encinitas, who asked…
“For the past several weeks my shoulder feels fine, as long as I don’t use my arm. But as soon as I try to reach or lift something, I get pain down the outside of my arm. Why does my shoulder do that?”
At this point, Brooke sounds like a lot of patients we initially start treating who complain of shoulder pain. Like many others, she thought it would go away on its own. When it didn’t, she attempted to treat it herself with advice she found on Google and YouTube, but was again unsuccessful. Now she’s experiencing a very common presentation of shoulder pain.
When she reaches out, particularly to the side or across her body, she gets a sharp pain in her shoulder that extends down the side of his upper arm.
Other common complaints we hear in the clinic from our clients experiencing shoulder pain are with activities such as:
Do any of these symptom patterns sound familiar?
If it does, you’ve probably wondered what exactly is causing you to have this pain that is interfering with your everyday life. I’m willing to bet that you have also searched the Internet attempting to self-diagnose - in the hopes that you can treat it yourself.
This approach can be dangerous… potentially leaving you more confused than providing a solution . During your search, you will come across many potential causes.
You will read about conditions like:
And on, and on, and on…
There’s so many different diagnosis’ how can you possibly know why your shoulder hurts when you raise it? More importantly, knowing what you should do to treat it?
It’s amazing that as complicated as the human body is, let alone the fact that your shoulder is the most complicated joint in the whole body (to be explained in greater detail below), you are attempting to fix it yourself... neglecting the possibility of making your shoulder pain worse!
Would you do the same thing when your car’s transmission blows up, or if the brakes are malfunctioning… heck, what if you had severe pain in one of your molars - would you perform your own root canal? Do you ask the pilot to move over because you know how to fly the plane better? Of course not, you would leave it up to the specialist… Right!?... Right!? The human body is no different.
Understanding and treating your shoulder when you first begin to feel pain can prevent surgery and costly medical treatments.
It is important to understand why your shoulder hurts the minute it starts to hurt.
The first thing you need to do is find the exact cause of your shoulder pain. Finding the source and the cause of your shoulder pain will help you be able to treat it and prevent further damage. What could the problem actually be?
Neck and shoulder pain are never any fun! In fact, it is the 8th leading cause for disability in the United States and 4th in the world. If the head is not held in the correct postural position, then it exerts about 3.6 times more force than it takes to stand upright with good posture. With the human head weighing about 10 pounds, it means at least 36 pounds of force is required to hold position to the otherwise 10 pounds in good upright positioning. Additionally, neck and shoulder pain account for roughly 10 million medical care visits every year, and growing!
It’s no wonder that neck and shoulder pain are so problematic to so many people around the world. Neck and shoulder pain are often one of those things you never think about until you have the pain and suffer for weeks, even months, before deciding to do something to make it better.
This article will discuss 3 secret strategies to eliminate that neck and shoulder pain. It will explain what you can do and why each is so important for your neck and shoulder health.
This week I had a question asked by one of our amazing clients, Rob, 51, from Carlsbad… And it’s one that we get asked often! It went something like this…
“This past weekend I was skating and I hurt my back. It was so bad I had to call in to work on Monday morning because I was bed-bound with ice packs and taking Advil. I’ve had this type of back pain many times in the past. I usually wait for the pain to magically disappear because I’ve never known when it is okay to exercise when my back is hurting? ”
I understand the confusion “Dr. Google” might bring and more importantly, I also know the thought of doing any movement at all when you’re going through some kind of pain might feel a little scary. You definitely don’t want to run the risk of aggravating your back pain any more in case it turns into something more serious.
It’s very important that you don’t go ‘too hard’ too early, especially if you don’t know what’s really going on.
And you especially don’t want to wake up one day finding yourself unable to roll out of bed easily, having to take you 20 minutes to get dressed, and where standing or sitting has become a nightmare from what YOU did and now made it worse.
But don’t let that worry you too much – that’s rarely ever the case!
An aching lower back doesn’t mean you’ve got to be laid up for days, with heat and ice packs and a bottle of painkillers until it magically disappears.
In fact, you CAN keep moving and on the contrary to common thinking - not moving at all can make your back pain worse!
If you suffer from lower back pain that comes and goes, as little as gentle walking can help. You will notice it will make a big difference versus just lying in bed.
Walking is a completely natural movement that keeps your joints mobile and muscles working – even those in your feet, legs, hips and torso – which play an important role in keeping the muscles strong in your back that help with posture.
Furthermore, appropriate stretching combined with walking will improve your back’s overall strength, flexibility and posture, which in turn, can help stop back pain from creeping up on you when you least expect it. What’s more, it can also reduce how painful it feels and how much it gets in the way of day to day life.
So, here’s the important question to answer now that you know it’s 100% okay to exercise even if you’ve got a bad back…
What exercise can you actually be doing? Because of course, too much exercise, or exercise that’s strenuous could make it worse or keep it hanging around longer.
Diastasis Recti often occurs during pregnancy when the growing baby stretches the abdominal muscles and tissues. Some women’s abdominal area heals on its own after the baby is born, but approximately 33% of women's don't heal completely postpartum by 6-8 weeks. So is your belly pooch because of diastasis or is there another underlying issue? A proper self-assessment or seeing a Physical Therapist is key to finding out.
Click here! Self Assessment Tool
I do hear quite a bit from women that they were told they need surgery to repair diastasis. I would like to inform you THERE IS HELP for this without surgery!
This is not something your OB/GYN will always assess at your 6 week post delivery visit and more moms are inquiring and searching “Google” for solutions.
Physical Problems Caused By Diastasis Recti:
The separation of the abdominal muscles can cause a number of problems including:
At Level 4 Physical Therapy and Performance, it is not unusually for us to hear of people complaining of either pain or numbness while favoring their back. Medical doctors often suggest physical therapy and stretching to help relieve the incredible pain of Sciatica. Treatment can begin while there is still pain, but the hopeful outcome is that the pressure on the Sciatic nerve is relieved through stretching and exercise, relieving the agonizing pain and eliminating the limping.
How does Sciatica Cause Pain?
Sciatica is not a “true” medical diagnosis, but rather it describes a symptom that does not exactly point to the true underlying physical problem. Sciatic pain can originate either in the lower back region or in the buttock and can spread down the back of one or both legs; following the path of the Sciatic nerve.
The Sciatic nerve can be the source of pain when it is compressed by soft tissue, bone, scar tissue, inflammation and/or pressure from a intervertebral disc. The Sciatic nerve travels through the lumbar vertebrae, across the buttocks, and then branches down the legs to the feet.
Problems that generate this type of sciatic pain includes the following:
• pelvic misalignment
• herniated disc
• stenosis (the narrowing of the nerve space)
• decreased flexibility in muscles of the hip joint
Focusing on Pain Relief
Considered one of the most painful conditions that involve the lower back and legs, the Sciatic nerve system consists of the largest nerve (as big as your thumb) and the individual nerve roots branching out from the spine. When this very large sciatic nerve is irritated, it makes simple movements in life a living nightmare of pain.
Different areas of compression along this nerve are often the cause of varying symptoms involving the lumbar area of the back, muscles of the buttocks, back of the thighs, and behind the knees, ankles, feet and toes. Nerve impingement creates numbness, tingling, weakness, and deep pain.
Medical doctors understand that everyone experiences this type of back pain differently. They prescribe physical therapy treatments knowing that professional therapists perform evaluations to discern the best type of treatment modes for each individual. For the specific needs of sciatica patients, a combination of solutions are offered.
How to Manage Sciatica Symptoms
Sciatica pain varies from constant and incapacitating to occasional episodes. This pain varies because of the different locations where the Sciatic nerve can be compressed, pinched or irritated. Some patients experience pain, tingling, and numbness down both legs. Others experience sciatic pain on only one side and down one leg.
First, unlike other types of back injury pain problems, physicians recommend that patients keep moving. But, this is difficult to achieve when certain movements are extremely painful. Patients need to maintain their back and leg muscle strength to prevent further compression in the Sciatic nerve. This is precisely why medical doctors recommend that their patients meet with a physical therapist to determine a set of therapies most appropriate for specific pain areas. Treatments may include gentle pain free exercises, stretching, massage and proper bending and movement instructions, according to when patients experience relief.
This is why at Level 4 Physical Therapy & Performance, we implement Pilates exercises early and safely – to focus on strengthening your core muscles, keeping you flexible and active in a pain free range, and to help assist with pain relief.
Clinical research studies show the sooner a patient begins physical therapy, the better the outcomes are. Physical therapy should begin within 10-14 days of the onset of pain.
If you’re experiencing Sciatica pain, call us now at (760) 503-4440 or email us at email@example.com to arrange a FREE Discovery Visit with one of our back/Sciatica specialists.
Click below to claim your special report with 9 of the top tips to help ease your back/sciatica pain… Click on the red button below.
With roughly 26 million golfers in the United States and about 6.5 million of those being over the age of 65 years, back pain is becoming more prevalent in the game of golf. As we age, natural spinal mobility decreases, which makes us more susceptible to injuries of the spine. It is estimated that nearly 35% of all golf injuries occurring happen in the low back, making it the number one location for golf injuries. In addition, the direct annual costs for low back pain are around $91 billion each year. Read ahead as we discuss 3 secrets to keeping pain away from your golf game.
1. Dynamic Stretches
Warming up properly is so important, especially as you age. We say it often, but so few actually do it. With a growing number of baby boomers wanting to continue playing golf into their elder years, it’s important to implement a preparatory routine before starting your round.
I know what you might be thinking… If I have a 6:30am tee time, how early do I need to arrive at the course to get this stuff done? The routine doesn’t have to be long and we recommend less than 15 minutes. We also recommend doing a routine that is dynamic in nature. One that takes you through large movement patterns, starting off slowly and progressing up in speed. The reality is you will probably spend more time putting your shoes on, getting your bag situated on your cart and hanging out in the clubhouse than you will actually doing a good warm up. Check out the video below on what a good dynamic warm up entails..
There is constant pressure women face to look like their pre-pregnancy self so quickly after they deliver. NEWSFLASH!!..Is that our goal to hurry up and look a certain way to impress others? As busy moms, we dismiss the fact we need to focus on taking care of our body and allow it to heal properly, as it did take 9 months to go through these changes. In the locker room yesterday after a Yoga class, I heard these statements listening to women discuss their postpartum body issues and would love to address them so women can learn the truth!
1. “I had a baby so I’m going to have to deal with peeing when I cough, run, or jump”…
FALSE: This problem is definitely a common one, but no matter how long after you have a baby can continue to be an issue if not addressed. Women dismiss this problem as something they are going to just have to deal with forever. Little do they know it can be assessed and treated rather quickly with the right guidance from a women’s health PT. There is usually a coordination and timing issue between breathing and the ability to contract the pelvic floor muscles. Pelvic floor muscle weakness and lack of endurance may exist as well just like any other muscles in the body. You don’t have to “just in case pee” before you try to run when this can be fixed!
2. “I can jump back into my old fitness routine because I feel fine”…
FALSE: Many women who exercise during their pregnancy can ease back into their fitness routine feeling ok, but be forewarned it took 9 months of changes to your body that don’t automatically go back without time. Your pelvis will be recovering and returning to “pre-labor” state 0-6 weeks postpartum, your uterus is contracting back to its previous state, and your internal organs are returning to their rightful place after being squished out of the way during pregnancy. Any intense activity during this stage could hinder the healing process. Jumping back into that boot camp class right after your 6 week check up may not be the best for all women as abdominal separation and pelvic floor weakness are not assessed by all OB/GYNs. These issues can lead to pelvic organ prolapse, a worsening of diastasis recti (abdominal separation), or back pain if you ramp up your program without proper guidance. Be your own advocate and seek out to be screened by a women’s health PT, who will also provide you with the best exercises to promote healing and prevent injury with high intensity exercise, add gentle stretching, light resistance training, and walking to set you up for success.
3. "My abdominals will get toned with lots of crunches"
FALSE: This is not always the case. Because your deeper layer of abdominals (transverse abdominis) has been stretched for the last 9+ months, it is important to train the abdominals from "the inside out". Crunches work the rectus abdominis (outer layer) and and place unnecessary stress on the spine and pelvic floor without training the "inner core" first. That doesn't mean you can never do crunches, it just means you need specific exercises to heal the inner layer first. Also, something called diastasis recti is very common where the abdominals actually separate during pregnancy, creating a disruption in the connective tissue layer below. In some cases this heals itself naturally postpartum, but it's very common for it to continue to be an issue 3-6 months (and beyond) postpartum. This may case as to why a woman feels like she just can't get rid of her "mommy tummy" even though she is exercising and losing weight.
Click the link to do a self-assessment for Diastasis Recti: https://www.youtube.com/watch?v=sbJN8YjWL3A
Individualized assessment and specific exercises to add to your routine can be prescribed to help heal a diastasis recti by a women's health physical therapist, avoiding the need for surgery!
*Want to get your core strength back to pre-pregnancy stage? Sign up now for the "ReStore Your Core & Pelvic Floor" 6 week series at Cap Wellness Center beginning Mondays August 14 @6-7 pm in Encinitas , sign up here as there is limited availability!: http://www.level4pt.com/events
4. “My back pain will go away eventually”…
FALSE: There are many reasons you could be experiencing back pain. The extra hormones that are released during pregnancy remain in your system up to 4 months after you stop nursing. This will affect the stability in your pelvis and joints. Lack of core strength and muscle imbalances now that you aren't carrying another human inside of you will affect the pressure placed on your back when lifting and carrying baby car seats, strollers, heavy diaper bags, etc! A proper strength training routine and practicing good body mechanics when lifting, holding, and caring for your baby will make a huge difference in your symptoms.
In conclusion, going through pregnancy and labor is a huge feat for a woman...it is important to be your own advocate to your OB/GYN or midwife if you are having these musculoskeletal issues that won't go away. Just know you can directly go see a physical therapist without a referral. In my practice, a Pilates-based approach to improving core and pelvic floor function is the best approach to building a strong foundation, allowing you to return to all those other fitness activities without back pain.
Want more info? Click here to get our FREE report online with tips to ease your Postnatal back pain! http://www.level4pt.com/womens-health
" Surpass Your Limits!
HEALTH ADVICE DISCLAIMER
By reading this publication, you agree that following any advice herein is at your own risk and agree to hold harmless Level4 Physical Therapy & Performance, Inc., it’s owners and its employees. We are able to offer you this service at a standard charge. Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this report.
Over 80% of people just like you will experience low back pain (LBP) at some point in their lives. Unfortunately for many people, LBP becomes a recurrent condition because they think that once the pain goes away, they consider themselves healed… and then a few months later; WHAMOO! It comes back - with each episode becoming worse.
Again, you wait for the pain to go away and only a few weeks later or when you decide it’s okay to return to your normal active lifestyle, your LBP comes back… but now it’s NOT going away as fast as it once did.
You begin to get increasingly frustrated each time the pain returns and now you worry about it happening just about every day. You now begin to wonder if there is something more serious going on in your spine. You no longer feel safe with your workouts and you can’t enjoy the active lifestyle that you once had because either you physically can’t do those things anymore or you worry that if you do, you’re are afraid it will cause your low back pain to return. This downward spiral may continue for many years leaving you with living a life with chronic LBP or worse, taking daily pain pills.
So, why does the pain go away making it seem like you have healed properly and then it comes back? Here are the 7 reasons we have come across most often in our 30+ years of combined practice treating athletes and active people:
1. You Sit Longer Than 20 Minutes
If you consider yourself a “desk jockey”, then this can be a major contributor to your reoccurring back pain. Sitting is currently considered as the “new smoking”. As a matter of fact, current research states that sitting for > 3 hours statically takes 22 minutes off your life. Yikes! Therefore, change your body position often, especially if you have to be in a physically stressful position like sitting. Get up and walk around at least once an hour. Make it a habit by taking a standing/stretching break every 20 minutes. You can even set an alarm or your phone/ computer to help remind you.
2. You Rely Only On Time
This is by far the most common reason why your low back pain cycles on and off. Many of our clients tell us how annoying and frustrating their reoccurring LBP is, yet they do nothing for it besides pain pills and the occasional ice or hot tub treatments.
We understand why a lot of people don’t do anything else. For one, Dr. Google provides so many options – making it confusing and scary to actually make a decision about what to do. That is why we offer a free “Discovery Visit” to people just like you BEFORE they commit to us. It’s a way for you to discover what is really going on with your back, discover what we can do to help you, and discover what options are available and work best for you.