As unfortunate as it is true, injuries and sports go hand in hand. An average of 8.6 million injuries in sports and recreational activities occur each year, which equates to about 34 injuries for every 1,000 individuals that participate. While some minor injuries might only lead to a short gap in participation, others can end seasons and lead to long-term complications if not rehabilitated properly.

Naturally, this causes most athletes to focus their energies not only on excelling in their respective sport, but also on keeping their risk for injury as low as possible.

One of the best ways to accomplish both of these goals is through an approach called sports periodization. The process of periodization involves planning one’s athletic training using a cyclical format that divides the year into specific blocks, with each block having a particular goal and every aspect of training being based on when the athlete needs to be at their optimal performance level. By designating when training intensity should be increased and when recovery is needed, an athlete can effectively increase their physical fitness while reducing their risk for overtraining and overuse injuries.

Macrocycles, mesocycles, and microcycles

In sports periodization, training blocks are referred to as cycles and training is divided into three primary types of cycles: macrocycles, mesocycles, and microcycles. Organizing and planning these cycles is an extremely individual process that should be based on when peak competition takes place in each calendar year, as well as the athlete’s maximum potential, their previous performances, and goals for the year. This means starting with a firm macrocycle in place and then refining it with smaller meso- and microcycles to guide training for month, week, and day.

Macrocycle

• A macrocycle is usually one calendar year, which should be oriented around the period of time an athlete needs to achieve peak performance (ie, the season or span when most competitions will take place) and build to that point
• It includes several phases and incorporates long-term planning designed to ensure the athlete will reach their maximum potential at the right time
• Phase 1: Preparation
• This phase—which can last a month or more—is designed to help a rested athlete slowly return to training in a slow, controlled manner
• Aim for easy, moderate sessions that are comfortable and steady
• Walking, cycling, hiking, and swimming are all great options during this phase
• Phase 2: Fitness base
• Usually lasts several months
• Focuses on improving all major areas of fitness, particularly building strength, power, and endurance
• Should be more general for the entire body and address any weaknesses
• Phase 3: Sport-specific fitness
• Lasts about two months
• Training becomes much more specific during this phase, with a focus on the skills and techniques needed in the respective sport
• Phase 4: Tapering
• Tapering means decreasing one’s training volume before major athletic competitions
• This phase is only necessary for athletes involved in endurance sports like running, biking, and triathlons, when tapering should be performed before big races
• Phase 5: Peaking
• By this phase, athletes should be at their maximum performance level and ready to compete
• Phase 6: Rest and recovery
• A certain amount of time will always be needed to rest and recover after a big race or event

Mesocycles

• These cycles typically last for about 3-6 weeks and should have a specifically targeted outcome, which is often related to a component of fitness like power, strength, or endurance
• Each mesocycle is further broken down into microcycles

Microcycles

• A microcycle is the shortest training cycle and usually spans one week of training
• These cycles are most specific and guide one’s daily training routines
• Each week should include a combination of light and heavy days, as well as one day for rest or significantly reduced activity

In our next newsletter, we’ll review some other methods that can help reduce your injury risk.

After hip pain develops, movement can become a taxing affair. Standing up from a chair, getting into a car, and walking even short distances may be met with intense strain and discomfort. As a result, some individuals will become less active so as to avoid the pain that comes with it, even though inactivity can lead to worse outcomes in the long run.

In addition to avoiding movements that could potentially be painful, some patients will turn to at–home remedies like ice and heat, pain medications, gentle stretching, or self–massage. All of these interventions may serve a purpose and alleviate pain to some degree, but for pain that persists for several weeks after taking these initial steps, a more systematic approach will be needed.

Physical therapy is one of the many options available to address hip pain, but it is unique in that it teaches patients to overcome their limitations on their own by moving better and more efficiently. Physical therapy can also be performed effectively for patients of all ages and for the majority of conditions associated with hip pain, regardless of the level of severity. For patients with advanced hip osteoarthritis, it represents an alternative to surgery as well, which can lead to significantly lower health costs while producing similar outcomes.

A typical physical therapy treatment program for hip pain

After conducting an initial evaluation, a physical therapist will design a personalized treatment program tailored to patient’s abilities, goals, and preferences. These programs will differ depending on the condition(s) present, but common elements found in most include the following:

• Strengthening exercises that focus on the muscles of the hip, as well as the core and legs, which will also affect hip function
• Stretching exercises to increase the flexibility and range of motion of the hip joint
• Manual therapy, in which the physical therapist will gently move muscles and joints to decrease pain and improve motion and strength
• Movement re–education, which will include self–stretching techniques to help restore normal motion of the hip, back and legs; advice will also be offered on what stretches and movements should be avoided

There is large and growing body of evidence to support physical therapy as an effective intervention for a wide range of hip–related conditions. In one type of study called a systematic review and meta–analysis, researchers collected and analyzed all the available research on two commonly–used physical therapy interventions—manual therapy and exercise therapy—for hip osteoarthritis, one of the most common causes of hip pain. They identified a number of studies that backed up the proposed benefits of these interventions, finding that both exercise therapy and manual therapy reduced pain and improved physical function for patients with hip osteoarthritis.

Therefore, if you are currently impacted by hip pain of any sort that is complicating your daily life, we advise you to give us a call. Let us help you with an individualized treatment program to help empower you and regain your function by using your own capacity for movement.

As we saw in our last newsletter, there are a number of issues that can develop in the hip that can go on to cause pain and dysfunction. These problems can strike at any age, but are more likely to develop later in life and in females, as the highest incidence of hip pain occurs in women aged 40-60 years.

In most cases, a combination of age-related changes and overuse are to blame, while traumatic injury may be the culprit for some patients. Whatever the cause, the toll that hip pain takes is often quite similar, as patients will variably lose their ability to move and function freely. Walking, running, and sitting/standing typically becoming more challenging, and these limitations will only persist if no interventions are taken.

While it’s not possible to reverse or stop natural age-related changes, there are several steps you can take to lower your chances of experiencing hip pain. One of the most beneficial tactics is to regularly perform exercises that focus on the muscles and joints of the hip and its supporting structures. Doing so will improve the strength and flexibility of the hip joint, which will lead to less strain and better overall functioning that equates to a reduced injury risk. Below are the three best exercises to prevent hip pain:

NOTE: Before you try these or any other exercise program, please consult with your physical therapist or physician.

1. Supine hip flexor stretch



• Lie flat on your back on a bed with one leg hanging over the side
• Pull your opposite knee tight toward your chest until a comfortable stretch is felt
• Hold this stretch for 30 seconds
• Complete three repetitions on each leg
2. Sitting piriformis stretch



• While sitting on a chair, cross one leg over your opposite knee
• Slowly bend your body forward until a comfortable stretch is felt
• Hold this stretch for 30 seconds
• Complete three repetitions on each leg
3. Supine piriformis stretch



• Lie on your back on the ground
• Bend one knee up and grab it with your opposite hand
• Pull your leg across your body, toward your shoulder, until a comfortable stretch is felt
• Hold this stretch for 30 seconds
• Complete three repetitions on each leg

Regularly performing these stretches will keep your hips mobile and your risk for hip pain down. But if problems do still manage to arise, it’s best to consult with a physical therapist, who will perform a comprehensive evaluation and design a personalized treatment program that’s suitable for your needs, abilities, and goals.

The hip is a resilient joint that is capable of handling lots of activity and repeated movements, and it can sustain a significant amount of wear and tear. This durability exists because of its complex and multifaceted anatomy that we described in our last newsletter.

But despite these strengths, the hip has a concrete set of limits and is not invulnerable. Repeated activity, not taking enough time to recover, and age can all bring the hip closer to these limits, and when pushed beyond them, the result is injury or pain.

There are a number of conditions that can affect the health of the hip and prevent it from functioning normally, but several problems are seen more frequently due to movement patterns and behaviors that occur in the greater population. Below are 5 of the most common hip-related conditions:

1. Femoroacetabular impingement
• Arises when small bony projections (bone spurs) develop along either the femur or acetabulum, causing these bones to rub against each other directly without protection
• Over time, the resulting friction between these two bones can damage the joint, which will cause symptoms like pain or stiffness in the groin or outside the hip that grows worse with turning, twisting, or squatting motions
2. Labral tear
• A rip in the labrum, which covers the acetabulum and secures the femoral head in place
• The labrum can be torn by sudden trauma or repetitive motion and overuse in sports like hockey, golf, and soccer, age-related changes, structural problems, or some combination of these factors
• Femoroacetabular impingement can also damage the labrum and lead to a tear over time
• Symptoms are similar to femoroacetabular impingement and can include pain or stiffness, pain in the buttocks area, a clicking or locking sound in the hip, and feelings of instability
3. Arthritis
• Rheumatoid arthritis and osteoarthritis are among the most common causes of hip pain
• While the course both these conditions take is slightly different, both involve the wearing away of the cartilage that surrounds the ends of bones in the hip joint, resulting in less protection and eventually friction between them as it progresses
• Symptoms include pain, swelling, tenderness, and stiffness, and a general inability to move the hip and perform routine hip-related activities
4. Hip bursitis
• Each hip joint contains two bursae (singular bursa), which are fluid–filled sacs that ease friction between the bones, muscles, and tendons that comprise it
• Bursitis is the inflammation of one of these bursa, which is typically due to repeated overuse or strain of the hip
• The primary symptom is a dull, burning pain on the outer hip that’s made worse with excessive walking or climbing stairs
5. Hip tendinitis
• Inflammation of any of the tendons that flex the hips
• Usually caused by repetitive strain and overuse, often from sports or other forms of physical activity
• Symptoms include pain that develops gradually over time, tenderness, and stiffness in the morning or after long periods of rest

Read our next newsletter for a breakdown of the three most effective exercises that will help you avoid hip pain.

The hip is one of the most versatile and important joints in the body. It’s extremely powerful due to its robust architecture, which also provides it with impressive stability. But the hip joint is also incredibly flexible, allowing for a massive range of motion that is second only to the shoulder in this capacity.

The hip connects the lower extremities to the trunk of the upper body, and its primary function is to bear the body’s weight during both static (eg, standing) and dynamic (eg, walking and running) postures. Bones, cartilage, muscles, ligaments, tendons, and other structures all work together to allow this to occur.

Bones and cartilage The hip is a ball-and-socket joint—the largest in the body—that is comprised of the head of the femur and the acetabulum.

• Femur: the upper leg bone that connects the knee to the hip; longest and heaviest bone of the body; it has a long shaft and head (femoral head) that serves as the “ball” of the hip joint
• Acetabulum: a deep, cup-shaped depression of the pelvis bone that serves as the “socket” of the hip joint
• Cartilage
• Articular cartilage: the femoral head and acetabulum are covered in articular cartilage at their ends where they meet, which is a strong, slippery, flexible material that allows them to glide smoothly without coming into contact with each other
• Labrum: a strong piece of cartilage that forms a ring around the outer edge of the acetabulum; it deepens the socket of the pelvis and acts as a gasket to provide the hip with more stability, but it is also elastic to permit greater flexibility

Muscles

Large, thick muscles of the buttocks and thighs surround the hip and are responsible for the significant amount of power that the joint can generate. These muscles are typically classified into four groups—the gluteal group, adductor group, iliopsoas group, and lateral rotator group—based on which directions they permit movement in. The complex anatomy of the hip gives it the ability for three distinct types of movement:

• Flexion and extension: moves the leg back and forth
• Abduction and adduction: moves the leg out to the side (abduction) and inward toward the other leg (adduction)
• Rotation: moves the toes inward (internal rotation) or outward (external rotation)

Ligaments and tendons

The bones and muscles of the hip are all connected by a number of ligaments and tendons that further reinforce the joint’s strength while also preventing each structure from moving too far in any direction. The iliofemoral ligament is the strongest in the body and it prevents excessive adduction and internal rotation, while the pubofemoral ligament restricts abduction and the ischiofemoral ligament prevents internal rotation.

Synovial fluid

Lastly, a synovial membrane encapsulates the entire hip joint, which produces synovial fluid that lubricates and circulates nutrients to the hip. This fluid is stored in the cartilage while at rest but is squeezed out when the hip rotates or bears weight so that it moves more smoothly. As a result, it’s necessary to move the hip frequently to keep it healthy and lubricated.

These structures collectively help to keep the hip strong, stable, and flexible, but as we’ll explore in our next newsletter, problems can occur when any of these components break down or fail to properly perform its function.

Most cases of low back pain are short-lived—or acute—and only last for a few weeks before gradually subsiding. Getting regular physical activity and performing targeted strengthening exercises will further facilitate the healing process, and many patients are able to experience significant improvements without any professional intervention.

But for others, the pain does not improve over time, even after making lifestyle changes and increasing physical activity levels. Persistent low back pain that lasts for more than three months is categorized as a “chronic,” which usually means that additional strategies are needed. There are also many patients that aren’t comfortable performing exercises at home without guidance and who may require a more hands-on approach to managing their condition.

For anyone that falls into either of these groups, a more structured treatment program is required, and physical therapists are the professionals best equipped to provide this in a safe and effective manner. Physical therapy uses a variety of movement-based interventions for low back patients, some of which the patient executes independently with guidance, and others that the therapist carefully performs. The ultimate goal of each component of treatment is to teach patients how to move better in order to reduce their pain levels, increase function, and prevent further recurrence.

Seeing a physical therapist as the first point of care for low back pain can also help patients avoid other expensive or unnecessary interventions in the future. Research has shown that individuals who undergo early physical therapy are less likely to have surgery or injections for their pain, and it has also been found to reduce costs, healthcare use, opioid use, and improve health care efficiency.

Each low back pain treatment program is tailored specifically to the patient’s needs, abilities, goals, and preferences, but there are certain features that most share in common. A typical treatment program for low back pain will consist of the following:

• Passive interventions (performed by the therapist)
• Ice and/or heat therapy
• Ultrasound
• Manual (hands-on) therapy
• Active physical therapy (performed by the patient)
• Stretching exercises for the buttocks, back, spine and hamstrings are helpful for keeping joints flexible and should be done twice a day
• Strengthening exercises are needed to build the muscles in the back and core, and should be done for 15-20 minutes every other day
• Low-impact aerobic exercises like walking, biking and swimming are also important and should be done for 30-40 minutes, three times a week
• Education: physical therapists will also provide tips and guidance on how to improve your posture and make other necessary changes that may be contributing to your pain

Low back pain is one of the most common conditions in all of healthcare, and it often becomes a burden for the countless individuals who are impacted by it. But as you can see, there are a number of ways you can take control of your situation and make changes that will greatly benefit you. If you are suffering from back pain give us a call and together we will build a personal plan that addresses your individual need.

As we explored in our last newsletter, low back pain is overwhelmingly common, with tens of millions of Americans impacted by symptoms at this very moment. Each person’s situation is unique and the severity of these individual’s back pain varies, but most frequently experience some degree of disability or limitation that interferes with their normal way of life.

One of the many consequences of having low back pain is that it often reduces physical activity levels. Whether it’s not accepting an invitation to play a pickup game of basketball or avoiding yard work that involves lots of bending and twisting, a sizable portion of low back pain patients will notice a decrease in movement because of their condition. Unfortunately, moving less can actually increase pain levels, making it even more difficult to move and initiating a challenging cycle of pain and inactivity.

On the flip side, moving more and staying active is one of the best things you can do for your pain. Although it might seem sensible to avoid any motions that could lead to pain, the truth is that regular physical activity is crucial because it helps to keep your muscles strong and joints flexible. Exercise will also increase blood flow throughout the body and specifically to the lower back area, which may reduce stiffness and speed up the healing process.

Activating the lower back and core muscles can help with support and stability for the spine, which in effect leads to less strain and less pain. With this in mind, we present the three best strengthening exercises for your low back and hip muscles.

NOTE: before you try these or any other exercise program, please consult with your physical therapist or physician.

1. Glute bridge (bridging)



• In addition to the lower back, this exercise strengthens the hamstrings, gluteal muscles (buttocks), and hip muscles; to perform this exercise:
• Lie with your back to the floor, knees bent with only your feet on the floor
• Dig your heels into the floor a bit and squeeze down on your gluteal muscles
• Lift your hips up until they are 6–8 inches off the ground and hold this position for about five seconds
• Slowly bring your hips back to the floor and give yourself about 10 seconds of rest
• Repeat 8–12 times
2. The Bird Dog



• Bird Dog is a great way to learn to stabilize the low back during movements of the arms and legs; to perform:
• Get on your hands and knees and tighten your abdominal muscles
• With one leg, lift and extend it behind you while keeping your hips level; lift and hold the alternate arm out in front of you; hold for 5 seconds
• Switch to the other leg and arm. Repeat 8–12 times per side.
• For an added challenge, try lengthening the time you hold each lift
3. Lying lateral leg lift



• This exercise strengthens the hip abductor muscles, which support the pelvis and can help reduce strain on the back; keeping these muscles strong can also help you maintain balance and improve stability; to perform
• Lie on one side with your legs together and lower leg slightly bent
• Bring your bellybutton into your spine to engage the core muscles
• Raise your top leg about 18 inches, keeping it straight and extended; hold the position for 5 seconds
• Repeat 10 times
• Turn onto the other side of the body and repeat, lifting the other leg
• Perform 2 sets on each side

In our next newsletter, we’ll look into the role that physical therapy can play when low back pain persists after performing these exercises and for patients that require a more hands–on approach to their condition.

Low back pain is jarringly common. About one-half of all working Americans will experience symptoms at least once every year, and roughly 31 million are affected by it at any given point in time. So if you find it appropriate to place yourself in this category, you’d have an abundance in company.

Dealing with low back pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick something off the ground or twisting your torso when looking to the side might suddenly give you pause and make you less mobile in the process. This development naturally leads to frustration and often shifts to a focus on one main question: “what’s causing this pain?”

As a result, many patients with low back pain start to place a particularly strong—and sometimes unhealthy—emphasis on obtaining a diagnosis. They usually believe that doing so will clearly explain why they are in pain and will allow the right treatments to be performed. Sadly, searching for a diagnosis for low back pain is complicated and often does not lead to the outcomes that most patients hope for. And in many cases, it can do more harm than good.

Why ‘abnormal’ is a relative term

In their hunt for a diagnosis, many patients will decide to have an imaging test performed, which include X-rays, MRIs, and CT scans. These types of tests serve an integral role in diagnosing a plethora of conditions throughout the body, but when it comes to low back pain, their usefulness is not as certain. The primary issue is that an imaging test should serve as only one component of reaching a diagnosis, in addition to a detailed patient interview and thorough physical examination. But many patients—and some doctors—rely too heavily on the results of the test instead.

In addition, the results from these tests are not always as clear-cut as one might assume. Many individuals who don’t have any low back pain symptoms will have “abnormal” findings on an imaging test, while many of those with symptoms will test results that appear to be completely “normal.” To put matters in perspective, below is a brief summary of the findings from an important study that reviewed the MRIs and CT scans of more than 3,000 individuals with no signs of back pain:

• 20-year-olds: 37% had “disc degeneration” and 30% had “disc bulging”
• 50-year-olds: 80% had “disc degeneration” and 60% had “disc bulging”
• 80-year-olds: 96% had “disc degeneration” and 84% had “disc bulging”

These results show that disc degeneration and disc bulging are extremely common in most people without back pain, and the likelihood of having these findings increases significantly with age. When not explained properly and interpreted in the context of an examination and other factors, a patient with back pain may incorrectly believe that these “abnormal” findings are the same thing as a diagnosis, when they may instead be a sign of the natural aging process. The words “bulging” and “degeneration” also tend to create scary images of the spine that could further alarm patients and push them towards undergoing interventions like surgery to fix the problem, even though their results may have nothing to do with their pain.

It’s important to point out that there are several diagnoses that are extremely important and require careful medical intervention, some of which an imaging test will assist with. Spinal tumors, cauda equina syndrome, spinal infection, abdominal aneurysm, and ankylosing spondylitis are among the conditions that typically lead to severe symptoms, but none of these are very common. Two other signs that something more serious could be present are incontinence and or numbness around the groin and buttocks, and any accident that could have fractured the spine. If either of these signs accompany back pain, it’s imperative that you seek out immediate medical attention.

But in the vast majority of cases, patients with low back pain should focus more on addressing their condition with a movement-based strategy and less on obtaining a diagnosis, which is not the silver bullet they might be expecting. In our next newsletter, we’ll provide you with some strengthening exercises that you can perform to alleviate your low back pain on your own.

Some foot conditions come on gradually, like plantar fasciitis, which starts as a stabbing pain in the heel and then often grows more severe over time. Others are more sudden, like an ankle sprain or broken toe, both of which lead to immediate pain and make it difficult to put any pressure on the injured leg. Regardless of the manner in which these symptoms develop, the end result is often the same: an inability to get around and function normally. For active individuals, it also means participating in your respective sport at a lower level or not being able to participate at all.

Everyone responds to pain differently, as some will seek out help immediately, while others delay action until things get worse. One of the good things about foot and ankle injuries is that they are all very treatable, and surgery is not needed in the majority of cases; however, waiting too long to address these conditions is also a dangerous approach. Continuing to exercise despite pain will often add to the damage in the structures of your ankle and feet, which will exacerbate your symptoms and increase the risk for future injuries.

This is why it’s best to take proactive steps any time you’re dealing with foot or ankle pain. For traumatic injuries like ankle sprains, we strongly recommend the RICE (Rest, Ice, Compression, Elevation) protocol in the first 24-72 hours to relieve painful symptoms and reduce your risk for further injury during this time. You should also massage the painful area to improve circulation and reduce soreness, and consider adding shoe inserts and replacing old or worn out shoes, which may contribute to overuse injuries like plantar fasciitis and Achilles tendinitis.

Visit a physical therapist when pain persists

If you’ve taken these measures and pain continues to bother you, the next move you should make is to see a physical therapist as soon as you can. Physical therapists are movement experts that will focus on identifying the source of your pain with a comprehensive evaluation and detailed interview of your injury history. From there, they will design an individualized treatment program to address the impairments identified, which is always based on your needs, preferences, abilities, and goals. A typical rehabilitation plan for a foot or ankle injury includes the following:

• Pain-relieving modalities: ice/heat, ultrasound, and electrical stimulation are often used to reduce pain levels
• Manual therapy: this set of hands-on techniques involves mobilizing and manipulating muscles and joints in specific directions and at different speeds to help you regain lost movement
• Strengthening exercises: these exercises are designed to build back strength that may have been lost in the muscles surrounding the injured area due to reduced activity levels; common strengthening exercises for foot and ankle injuries include calf raises, doming, and scissor hops
• Stretching exercises: stretching out sore, stiff, or painful joints will increase flexibility levels and result in improved function over time; common stretching exercises for foot and ankle injuries include the plantar fascia stretch, towel stretch, and ankle inversion and eversion exercises
• Functional training: if you’re involved in sports, your physical therapist will design specific interventions that mimic the motions and movements involved in that activity, so you’ll be better prepared to handle the demands once you return

So, if you’re dealing with an injury or lingering pain that won’t seem to improve, contact us today to set up an appointment and get started on your path to recover.