Author: Dr. Wade Rinehart

During the recent downpours and thunderstorms, a significant number of our patients reported increased join and musculoskeletal pains. Some arthritis sufferers claim that they can predict weather conditions with accuracy surpassing local meteorologists. In spite of widespread beliefs in weather change-induced pain, scientific evidence on the matter is sparse and non-conclusive. During the conducted studies, some patients with chronic pain claimed increased pain on rainy days, some before the weather changes, while others have not experienced any correlation to the weather pattern.

Although there are limited clinical trials, and their data is not statistically significant, physicians and physical therapists working with patients who have arthritis have to consider changes in pain behavior in their clinical treatments. One leading theory points out how atmospheric conditions, such as barometric pressure and humidity, can affect symptoms of painful conditions such as arthritis, fibromyalgia, or migraine headaches. Barometric pressure is the pressure exerted by the air around us. To illustrate the phenomenon, imagine the barometric pressure as the compression stockings that are worn on our lower extremities. The high barometric pressure pushes against the body, and prevents tissues from expanding, similar to the way of a compression stocking. If the barometric pressure drops before a storm and the compression subsides, the internal expansion around an arthritic joint may irritate the nerves, causing pain.

According to J. Parvizi, MD., PhD, director of clinical research at the Rothman Institute at Jefferson, and associate professor of Orthopedic Surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia, the pressure change in the environment causes the pressure inside of the join, and the amount of fluid to fluctuate. This especially effects patients with arthritic joints, as they have less cartilage to provide cushioning. Change in barometric pressure may also cause loss of equilibrium in body pressure, which can result in sensitization of nerve endings.

Psychosomatic nature of pain complaints should also be considered. On rainy and gloomy days, we lack vigor and fell more anxious and depressed. With the return of the sunny weather, spirits tend to rise and we start to feel better. By going outdoors and resuming our activity level, we produce more endorphins, and our brain tends to override an unpleasant sensations of pain. During weather changes, some patients will need to increase their pain medication, but they should still try to take proactive steps to manage their pain with alternative measures. So, to our patients, our advice is to keep moving, go to the gym, or exercise at home to loosen up stiff joints. Always try to prevent swelling by using compression stockings, make sure to elevate painful joints, and use ice to reduce inflammation. If the rainy weather keeps you indoors, lighten up your diet, reduce sodium intake, and don’t let the weather affect your mood! Be patient, the sun and barometric pressure are both going to be up soon!

Maggie Garbiec, PTA

Thomas Jefferson University Hospital (2008, June 3). “People With Joint Pain Can Really Forecast” Retrieved July 2.

[caption id="" align="alignnone" width="150"]It is common knowledge that stretching your muscles for athletic and fitness activities is an immensely important part of the exercise process. What most people don’t know however, is that prolonged stretching after properly warming up is just as important a factor, especially when it comes to improving flexibility and reducing incidental muscle and tendon injuries. For years, the standard instructions for stretching muscles prior to athletic/fitness activities was to hold the stretch for ten to thirty seconds, without any type of warm up beforehand.

Dr. Brett Frank is a graduate of the University of South Florida’s Physical Therapy Doctorate Program. He has had extensive training in orthopedics, and is highly experienced in orthopedic diagnosis, spinal manipulations, as well as Golf Specific Sports Enhancement. Brett has been at First Choice since 2003.[/caption]

Research done over the last thirty years or so has consistently shown that prolonged stretching is the key to improving muscle and tendon flexibility and length. The body’s tendons are charged with the task of attaching muscle to bone, with your fascia binding together muscle fibers. Tendons and fascia are made of a connective tissue known as collagen, which is a viscoelastic tissue. A viscoelastic tissue is a type of tissue made up of “Viscous” and “Elastic” properties, meaning it has the ability to stretch and lengthen, and then return to its normal form slowly. If a constant load or stretch is placed upon a viscoelastic tissue, it will lengthen and maintain that length for a certain amount of time even after the load has been removed, depending on how long the load was present. The tissue will stretch, and then it will stay stretched for awhile before returning slowly to it’s original length.

For the increased length to be maintained, the tissue must reach what is known as “Creep.” “Creep” is a phenomenon in which the connective tissue deforms and “creeps” in length, typically occurring after stress relaxation of the muscle has taken place. During those ten to thirty second stretches that many people consider to be efficient stretching, the only tissue lengthening that occurs is due to stress relaxation of the tissue, and does nothing to improve flexibility and decrease injury risk.

When it comes to stretching, the rate of deformation is load, frequency, and time dependent. Low Load prolonged stretching is considered ideal because it is more comfortable, and the tissue will elongate without causing tissue breakdown. To properly perform a low load prolonged stretch, one should begin the stretching motion until you feel the initial stretching sensation, holding the stretch in that position. As that stretching sensation lessens, you should gradually increase the stretching motion until the mild stretch sensation returns. An effective duration of a stretch is anywhere from three to five minutes per stretch, but can be maintained for as long as thirty minutes. (Some research indicates that these thirty minute stretches can help to achieve greater tissue elongation in a shorter period of time.) Remember that stretching is time and rate dependent, so the less time the stretch is held, the more frequent the stretch will have to be performed in order to increase flexibility. The opposite is also true, that the longer the stretch is held, the less frequently the stretch must be performed. You should consider performing a warm up at least eight minutes prior to stretching; but keep in mind that stretching is also ideal during or after a work out as well, because your tissue temperature is peaked during these times.

Here at First Choice Physical Therapy, our patients are instructed to perform their injury specific stretches for at least three to five minutes, twice a day, in order to improve their flexibility. Our patients are also educated on why this particular length of stretching is ideal, along with the notation that stretch durations less than three minutes require more frequent stretching sessions.

If you currently have an injury, or history of a reoccurring muscle or tendon injury, poor flexibility is likely one of the factors contributing to the problem. If you think this sounds like you, any of our Doctors of Physical Therapy would love to help heal and treat your injury, all the while instructing and educating you on how to reduce the occurrence of these injuries and the disruption they cause in your every day life!

Brett Frank, PT, DPT

[caption id="attachment_475" align="alignleft" width="150"] Brent Holtgrewe is a board certified Athletic Trainer from St. Louis, Missouri; with extensive knowledge and training in orthopedic assessment, sport specific injuries, and sports enhancement training. Brent runs First Choice’s MVP Sports Enhancement program, and has been an employee since 2004.[/caption]

It is the year of 2013, and the marvels of developing technologies, as well as the knowledge accompanying these developments is breathtaking if not slightly overwhelming. Take, for example, the astonishing developments in modern medicine, and the velocity of speed at which it continues to adapt and develop along with the times, and the ever present human need for medical care and attention. Modern medicine is helping us to live longer, it is curing diseases that consumed entire nations of people and were once thought to be in-curable, and those who practice medicine are able to perform spectacular surgical feats; such as total joint replacements and the use of prosthetics for those who lose an appendage, allowing them the ability to return to things like running or simply walking their dog.

However, even with such amazing technology and extensive knowledge of the medicinal process, athletes still manage to get injured. Injuries as simple as a muscle strain, or an ankle sprain, along with injuries that are as complex as they are devastating like an ACL tear, often require the work of an orthopedic surgeon, effectively plaguing our youth and ending careers that never really even began. Even with the progress in bio-mechanics, kinesiology, physiology, and the perfection of proper techniques for the body, we cannot, for some reason, keep our athletes healthy.

Twenty years ago, it was unheard of for a twelve year old to have an elbow injury that required surgical intervention, or surgery to replace a torn ACL due to sports at such a young age, but unfortunately across our country, this has become commonplace. Why? As a people we are smarter and more informed than we have ever been before; with fancy gadgets and flashy toys marketed specifically for younger athletes, promising to give them the upper hand, and make them the best possible player for their chosen sport as quickly as possible. This leads to injuries for an athlete, which are being treated, but what about prevention?

One issue that has been recognized by many is the new competitiveness of athletics, even at the beginning levels of a sport. There is a demand placed on our children to compete at high levels, forcing them to play their sport year round without a break, without a change of pace, and without an off season, all in an effort to never lose the upper hand. Our kids no longer play to just play the game. During my childhood, summers consisted of riding bikes for hours, jumping off ramps and over ditches, playing pickup games of basketball, soccer, hockey, and football; and that was all in one day! We jumped rope, played dodge ball and hop scotch, and swam in the local rivers. This “Play time” is what allowed us to develop naturally into athletes, teaching us to climb, jump, cut, dodge, hang, and run, creating the building blocks from which an athlete is formed and injury prevention begins. In our modern age however, children seem to be losing this “play time”. As a result, the “Multi Sport” athlete has faded away, and our children are forced to choose what their sport “identity” will be (a soccer player, a baseball player, a football player, and so on), as young as the age of ten. Children are losing the basics of athletics and injury prevention by losing their inherent ability to be children; instead spending their summers playing multiple games in tournaments every weekend, attending weeks long camps and grueling practices, losing the chance to naturally gain those building blocks necessary for an athlete.

Instead of trying to make our children into the next Tiger Woods, Peyton Manning, or Alber Poujols, we need to instead encourage our kids to “play”, and not consume themselves into one sport. Too many kids never learn basic things like how to jump rope, skip, bound, or gallop until they are in high school. These activities are vital building blocks that a child needs to help them develop and prevent many potential injuries along the way of their athletic career. One of the key components in developing a successful training regimen is muscle confusion. If all a child does from the age of six is play baseball four seasons a year, the muscles never get a chance for such muscle confusion, but rather become over used, leading to a high risk of injury. Urge your children to play a sport that is out of their comfort zone (and perhaps even yours!), to just play something for fun, or taking the season off to be a kid. Even Professionals have an off season, and for good reason. Preventing an injury is a much better treatment than having to rehabilitate one, so find an off season, actually take if OFF, and play!

Brent Holtgrewe BSC., ATC, LAT, PES

Its summertime!! Now that everyone is outside being more active, it’s time to be careful when beginning new endeavors. When you begin to walk, run or jog for exercise, make sure you stretch to loosen up those muscles you haven’t used in a while. Rest days are also important for your body to recover from the previous days’ activities. Also, listen to your body.

If you feel any aches or pains that don’t ease up after the usual 2-3 days after you participate in any new activities, you might have pushed too far initially. Back off and put some ice on for 20 minutes, 3 to 4 times per day. If it goes away on its own, ease back into that activity. If it continues, it might be time to see someone about it.

Physical Therapists are excellent at identifying muscle and joint issues caused by repetitive activities. They can help you return to your pain-free lifestyle with helpful tips and advice to keep you pain-free for years to come.

Dr. Stephen Peaden, PT, DPT