Clutch PT + Performance Blog

The Perfect Dynamic Warm-Up for Baseball Players — Clutch Physical Therapy

Clutch PT — Sat, 01 Aug 2020 04:00:00 GMT

How to protect the rotator cuff and shoulder joint in pitchers, catchers and ball players.

Arm care programs, shoulder health and how to warm-up before a baseball game are all hot topics, particularly for pitchers and catchers. But too often, baseball players (sometimes even pros) default to warming up with some static stretches and a few sprints before jumping right into throwing motions and hitting practice. This is no bueno.

Even if we cut less experienced players some slack, presuming the issue is that they just don’t have a clue what they should be doing, failing to bring your A-game starting with the warm-up puts players at a massive disadvantage. You won’t be as fast and explosive out of the box or on the base path, and you’re also taking massive risks for sidelining yourself with muscle strains, a rotator cuff tear, a Tommy John's or hip/back injury.

But before we dig into the optimal pre-game warm-up for baseball players, with a specific focus on protecting the shoulder and rotator cuff from overuse injuries, let’s back up for a second and discuss overall arm health.

Arm Health

Beyond a proper warm up, there are three key factors to zero in on when it comes to protecting baseball players' arms:

Throwing volume
Efficient force transfer through the kinetic chain
Efficient mechanics

Optimizing these factors will ensure total arm and total body health for all baseball players, as weak links in the chain will be eliminated and excess stresses will be removed. (Check out our previous post about preventing elbow pain in pitchers.)

We can’t hammer this point home enough:

The best way to protect your arm is to have a sound, full body program in place.

Doing some arm circles, dynamic stretches and resistance band exercises to activate the rotator cuff are only a fraction of the battle. The whole point of of a warm up is to make sure the body is ready to react and throw a ball HARD.

That doesn’t mean that using some band exercises for muscle activation isn’t an integral portion of the warm-up routine — it absolutely is. But it’s almost a moot point if we don’t have a quality strength and conditioning program in place and quality mechanics on the field. Focusing solely on the warm-up would be like putting a Sunday shine on a car that has a busted engine. Let’s build strong engines with efficient training programs that prioritize increasing physical capacity! If you need help crafting the right strength program to address your personal inefficiencies and improve your mechanics, let's talk. Reach us anytime at FixMe@ClutchPT.com.Back to the business of getting ready to dominate.

Baseball-specific Warm-Up

A quality warm-up for baseball looks much like the warm-up for any other sport, but we have to make sure we incorporate baseball-specific movement patterns to foster carryover to the game.

A solid baseball warm-up should get the heart pumping, up your core temperature, enhance range of motion and light up your whole central nervous system. The goal is to improve strength, power, mobility and reduce risk for getting hurt — avoiding shoulder injuries in particular.

Here's what we need to include to get the job done (starting from the top and working our way down): cervical spine (neck) mobility, shoulder mobility, shoulder activation, shoulder stability, thoracic spine mobility, hip mobility, ankle mobility, core/glute/rotator cuff/scapular activation, rotational power, and sprinting. That’s a lot to cover — so let’s get to work!

See our dynamic warm-up in action as Dr. James demos how to get the whole body fired up and protect the shoulder/rotator cuff. And yes, order matters.

Hip Mobility: 90/90 Hip Switches
Thoracic Spine Mobility: World’s Greatest Stretch
Ankle Mobility: Leg Swings
Core Activation: Shoulder Taps
Glute Activation: Single Leg Bridges
Rotator Cuff Activation: Side Plank with Band ER
Scapular Activation: Hinge “Y’s” with Band
Rotational Power: Knee to Hip Skips
Sprints

Try out this baseball-specific warm-up before your next game or practice. Then let us know how you play!

By the way, all of this is relevant for softball players, too, unless you're a pitcher. Since softball pitchers don't throw overhand, the mechanics and stresses are different, and need to be addressed individually. Hang tight, we'll focus on softball specifics soon!

Go get em.

— Dr. James Sinodinos, PT, DPT, CSCS

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31 Easy Ways To Avoid Injury And Be a Better Athlete. — Clutch Physical Therapy

Clutch PT — Tue, 21 Jul 2020 04:00:00 GMT

Here are 31 ways to avoid injury and become a better athlete in one month.

Stay healthy and avoid rookie mistakes by incorporating these simple suggestions into your daily routine.

LIFESTYLE

STRIKE A POSE. Every time you’re on a train platform, stopped at a light or trapped in line at Trader Joe’s for cauliflower gnocchi, check your posture. Unlock your knees, tuck your tailbone and lift your chest. You’ll automatically engage your core. Ladies, we’d put money on you standing with your weight to one side and jutting your hip out… Improving your daily posture will improve your core and overall athletic performance. It’ll also make you look at least 27% taller and more effective at your job. Probably.
BALANCE ON ONE LEG OR IN TREE POSE WHILE BRUSHING YOUR TEETH. It’s a super easy way to work on balance and core stability during your daily routine, and challenge key muscles that support your spine. If you have trouble balancing while brushing for a minute, imagine how hard your brain and body are working to keep you upright while pounding miles and miles of trails. No bueno. Want to up the ante and work on proprioception? Shut your eyes and try not to topple over!
TAKE THE STAIRS. Don’t be the one who gets out of the elevator on 2. Enough said.
EARN that fancy coffee by walking to the location that’s not quite so convenient.
Schlepping laptops, heavy bags or purses? ALTERNATE SHOULDERS REGULARLY OR USE A BAG WITH 2 SHOULDER STRAPS as often as possible to avoid developing imbalances in strength. That Jansport full of textbooks you were sporting on one shoulder only from 1992-2002 was a terrible idea.
DON’T LET WORK LITERALLY KILL YOU: CHECK YOUR DESK ERGONOMICS. Back straight, toosh all the way back in your seat, monitor 1″ below eye level and 18″ from face, knees and elbows at 90° with arm rests, feet flat on floor (or footrest.) And take breaks from sitting every 30 mins. Better posture at work will make you look smarter and more productive, totally justifying a fat raise. Maybe.
In all seriousness, how you’re working from home will have a huge impact on your long-term well being. Let’s get you set up properly with a Home Workspace Ergonomics Evaluation, especially during this time of “new normal” that isn’t normal at all.
PLANK WHILE BINGE WATCHING. Offset the guilty pleasure of watching trash TV by planking before you hit play – just :90 of planks (:30 front, :30 each side) each day will change your core and improve your stability. Need to progress the movement? Add some shoulder taps to the front plank and lift each leg into a star plank on each side. Already checked off your core workout? Swap planks for a Figure 4 stretch. Trust us, you need it.
PRACTICE AMBIDEXTERITY. Brush your teeth, reach for that glass or try using chopsticks with your non-dominant hand. It will improve your balance, particularly on the bike. Can you grab a bottle with either hand and still handle the bike with the other hand? If not, try this!
SLEEP. Shut eye can help improve performance more than extra intervals. Rest is critical for recovery, as is consistency. Try to turn in at the same time every night, shut off the tech and let yourself wake without an alarm as often as possible.

TRAINING

DOMINANCE ISN’T ALWAYS A GOOD THING. We all have one side that’s stronger than the other – which can lead to imbalances in form, and possibly injury over time. Use the off-season to target your weaker side and strengthen it. Not sure where yours is or how to fix it?Come see us. Every initial eval at Clutch PT + Performance includes a full postural and structural assessment.
NAVIGATE SLIPPERY SURFACES BY SHORTENING YOUR STRIDE AND INCREASING YOUR CADENCE. If you do fall, resist the urge put your hands out to catch yourself – you could wind up with broken wrists along with that bruised ego. Tuck your arms in and try to minimize impact by landing on your shoulder or hip.
When it comes to recovery, ORDER MATTERS: Stretch. Roll. Ice. THEN shower.
LISTEN TO YOUR BODY. We listen to coaches and to smack talk from friends and to our stubborn brains. But make sure you’re tuning into what your BODY is telling you, too. It’s called gut instinct for a reason.
UPPING MILEAGE TOO FAST (by more than 10% a week) UPS THE RISK FOR INJURY TO ODDS VEGAS WOULDN’T TAKE. We’ll be here to fix you if you do it, but we’re just sayin’.
A 10-MIN ICE BATH WILL DO MORE FOR YOUR RECOVERY THAN A WHOLE AFTERNOON IN COMPRESSION SOCKS. And no one has to be subjected to your questionable fashion sense. Here’s how: Run a cold bath. Bundle up and put on a hat. GET IN QUICKLY – the longer you dilly-dally, the worse it is. Dump in the ice. Suck it up for 10 minutes. Let skin come back to room temp before taking a warm shower.
DROP IT LIKE IT’S HOT. Squats are the foundation for all fitness. Do them daily with proper form: Keep your weight in your heels, back straight, legs parallel and knees over your toes. Don’t let your knees dive in. If you’re a parent, sneak in squats with activities like picking up the endless small plastic toys that have accumulated around your home.
CHECK YOUR LACES. If you’re not racing a triathlon and are prone to feeling tightness or pain across the top of your feet when you run, keep regular laces in your running sneaks instead of bungee ones. While great for transition, they’re not so great for properly distributing force in the foot on a regular basis. Laces that don’t come undone could be your undoing.
NEVER COME TO A STOP IN YOUR BIG CHAIN RING. Shift down – it’ll be a lot easier to get moving again. You’re welcome.

NUTRITION

DRINK A FULL GLASS OF WATER AS SOON AS YOU WAKE UP IN THE MORNING. Leave it on your bedside table the night before as a visual reminder when the alarm goes off. You’re at your most dehydrated first thing in the morning, and downing a full glass will get your whole system moving. It will also help you digest your breakfast more efficiently. (You weren’t thinking about skipping breakfast were you?)
There’s no magic involved in achieving race weight: CALORIES IN vs. CALORIES OUT. Get a handle on how many calories you’re really taking in, and burning. Apps like#MyPlate make it super easy to track.
DON’T BONK. Your body needs a steady intake of calories and hydration to function properly. Starving yourself or not drinking because it’s too cold/inconvenient/insert-excuse-here is ineffective and can encourage reward binge eating later on and really mess with your metabolism. Set an alarm on that fancy sports watch to remind you to eat/drink at regular intervals of 10-30 minutes, depending on activity.

MINDSET

SET GOALS. They could be performance based, like PR-ing a 5K, but they could also be habit-based, like going to bed at a reasonable, consistent hour or doing 20 push-ups while the shower heats up. Small goals can become great habits quickly, and meeting them gives you a boost of confidence.
GET YOUR HEAD IN THE GAME. Mental prep is just as crucial as all those intervals. Visualizing a perfectly-executed race from start to finish not only improves performance, but builds confidence and calms nerves. Solve problems mentally ahead of time so you’ll know what to do on instinct if they actually happen.
IT’S OK TO FAIL. JUST DON’T QUIT. Sometimes we win, sometimes we learn — not every event should be an A race. If you never fall over the edge, how do you know exactly where it is? (It’ll hurt, but if you feel pain, particularly if it’s sudden, cool it.)
PAIN HAPPENS FOR A REASON. Don’t ignore it or train through it – your body is trying to tell you something. If it’s persistent and/or sharp and sudden, see a medical professional.

RECOVERY + TREATMENT

SOMETHING HURTS? Try RICE first. Rest, Ice, Compression, Elevation plus an over the counter anti-inflammatory like Advil or Aleve, or a natural one like cherry juice. If it’s persistent, then get it checked out by a medical professional. We’re happy to help.
THIS IS HOW WE ROLL! Make that foam roller your BFF. Use the pressure of your own body weight to release adhesions in your soft tissue – those things that feel like muscle kinks. Roll slowly, methodically, 2″ up, then 1″ back down, til you reach the top of the muscle. If you hit a spot that’s particularly sore, hang out for a few seconds right on it and breathe deeply (cuz it’ll hurt like a @#$!) Stretch, roll, ice, sleep should be your recovery mantra.
LIKE FRANKIE SAYS, RELAX. THERE’S NO QUICK FIX FOR INJURY. It’s hard to be a patient patient, and we get why some jump from PT to acupuncture to chiropractors to unicorn tears in a desperate attempt to get better faster. But the best plan is to trust your medical professionals and build an integrated treatment protocol together. Good clinicians have a network of providers to help tackle pain from multiple angles.
If you’re not sure you’re getting the care you need, speak up. But recovery often just needs more time and rest rather than additional treatment (which we know you hate hearing.) Focus on the long term goal, like having a body that works for the rest of your life, and trust that we want you back out there ASAP too.
S-T-R-E-T-C-H. Blah, blah, blah, right? We all know we should, but we often blow it off. Without proper post-exertion stretching and recovery, we’re just sabotaging our next workout and risking injury. Get it done. And have a phenomenal, healthy year!
COMPRESSION SOCKS ARE FOR RECOVERY. NOT PERFORMANCE. For most people, compression socks constrict crucial blood flow to muscles and could actually hinder performance.
TAKE FULL ADVANTAGE OF YOUR HEALTH INSURANCE BENEFITS. Use your off-seasons or down periods to address lingering aches and pains – especially if you’ve already met that deductible for the year. (Not sure if you have? Shoot us a note and we’ll check for you.)

Here’s to new starts and lots of strong finishes!

Happy training! See you out there.
— Team Clutch PT + Performance

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How to reduce the risk of elbow pain in pitchers as baseball resumes. — Clutch Physical Therapy

Clutch PT — Thu, 25 Jun 2020 04:00:00 GMT

Baseball is coming back! With so much uncertainty around how the course of the season will play out amidst the ongoing pandemic, all you ballplayers out there need to be prepared for anything.

Hopefully, every baseball player at every level has dedicated this time off to improving physical strength and mobility in order to adequately prepare for the upcoming season. (If you haven’t, consider this a wake up call and reach out to me ASAP!)

All players, coaches, and parents should be on high alert for injury as we get dirt on our gloves again. We have some data from the 2011 NFL lockout about increased injury rates when play resumed, so we must be highly vigilant about the shape players are in when they take the field again, and how they ramp up. My personal concern is that we could see an increase in elbow injuries in our pitchers, if appropriate precautions are not taken to maintain player fitness and progressively build volume.

As a baseball player, and specifically as a pitcher, what can you be doing right now to get back in shape and reduce your risk of elbow pain as play resumes? There are three important categories that we can optimize to decrease the risk of elbow injury:

Throwing volume
Efficient force transfer through the kinetic chain
Efficient mechanics

Elbow pain arises in baseball players when an acute workload outweighs chronic workload. In simpler terms, a pitcher can experience elbow pain when they throw too much without building up an adequate base. For instance, if a pitcher has only been throwing 25 pitches over the course of 4 bullpen sessions, and is then asked to throw 50 pitches in a game situation — that’s a recipe for trouble. My best advice for athletes that I work with is to be over-prepared for the demands of the sport. You want to feel so confident when you step out on the field that when you dig deep, you know you have the capacity in the tank to succeed without risking injury.

So what can you do to reduce the risk of elbow pain and injury? Continue to throw, and when a specific timeline for return arises, gradually build up your throwing volume. That way, any one particular game will not overwhelm your capacity. Always be over prepared for the demands of the game!

Elbow pain is tricky in the sense that it often does not come from the elbow. Baseball requires an efficient transfer of energy from your feet to your hand for optimal power output. If we have any weak links in the chain, it can expose the elbow by placing higher demands on it to create force.

Here are some awesome ways to build strength throughout your chain and prevent elbow pain:

Perform explosive med ball drills
Get really strong in lunge and deadlift patterns
Perform push ups and pull ups with pristine form

If you have any questions on your form, how to program these into your workouts, how much weight you should be doing, and what your goals should be, hit me up for a consultation.

Lastly, it is crucial to evaluate your throwing mechanics right now, and determine if your technique is optimal for you and your body. Mechanical inefficiencies can both decrease performance and increase elbow injury risk. Thus, it’s critical to use this time to clean things up. We could talk for hours about pitching mechanics, so I’m not going to dive into detail here. But the most important takeaway is that suboptimal mechanics can contribute to elbow pain and decreased performance, so reach out to me to set up a consultation to review your throw.

Elbow pain in baseball players is highly prevalent already without a forced hiatus. Undergo the necessary steps to decrease your risk of elbow pain as you prepare to start your season!

— Dr. James

For a limited time, we’re offering an introductory special for young athletes that includes a virtual consult with Dr. James to review athlete history, screen movement patterns, identify goals, and map out a training program. It also includes 4 weeks of at-home personalized, sport-specific programming. Find out more here.

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How to Fix Knee Pain by Minimizing Tensor Fascia Latae (TFL) Activation
— Clutch Physical Therapy

Clutch PT — Fri, 19 Jun 2020 04:00:00 GMT

— Clutch Physical Therapy" class="hs-featured-image" style="width:auto !important; max-width:50%; float:left; margin:0 15px 15px 0;">

Target the glutes to reduce Tensor Fascia Latae (TFL) Activation

The tensor fascia latae (TFL) is basically a drama magnet — an easily-worked-up, overactive muscle that leads to the development of both hip and knee pain. The TFL has been clinically misdiagnosed as trochanteric bursitis, patellofemoral pain syndrome and Iliotibial band syndrome (ITBS or IT band syndrome), just to name a few. These common diagnoses are a result of compensatory patterns that develop from a combination of joint dysfunction and muscle weakness. But strengthening the glute muscles can minimize the activity of the tensor fascia latae (TFL), and giving this particularly sensitive muscle less to do minimizes the likelihood of pain.

Research shows that a combination of gluteal muscle dysfunction and hip joint dysfunction causes the TFL to be overused. Thus, impacting the entire kinetic chain from the foot to the low back. The frequently experienced patellofemoral pain commonly seen with runners occurs due to abnormal loading of the knee joint. The hip muscles control dynamic medial knee tracking which is commonly seen when this type of knee pain.

The TFL starts at the top of the hip and runs down the outside of the thigh into the knee. It functions as a secondary flexor, abductor and internal rotator of the hip. Its job is to control the IT band and prevent overpronation, but that’s a pretty hefty ask of a muscle that’s not nearly as big in size as it is in attitude. Dysfunctional glutes often lead to poor movement patterns that causes the TFL to be overactive. And when the TFL gets fed up, you’ll feel it!

The best way to eliminate pain is to minimize the activation of the TFL in the first place. Here are 6 exercises that are great for isolating and strengthening the gluteal muscles to do exactly that:

Clamshell

o Starting by lying on one side.

o The hips are flexed to 45 degrees and the knees to 90 degrees.

o Raise the top knee up slow and controlled while keeping both heels in contact with each other.

o Hold for 10 secs.

o Slowly return to starting position.

o 10 reps.

o Repeat on the opposite side.

Single Leg Bridge

o Start by lying on your back with the leg raised in the air.

o Then push the other foot into the table to raise the pelvis until a position of 90 degrees of knee flexion is achieved.

o Try to keep the pelvis in neutral with the motion smooth and controlled.

o Hold for 5 sec.

o Slowly and controlled return to the starting position.

o 10 reps.

o Repeat on the opposite side.

Quadruped hip extension with knee bent

o Start by being on your hands and knees.

o Then lift one leg up and backward, extending the hip and knee to 90 degrees.

o Making sure to keep the pelvis in neutral and the motion controlled.

o Hold for 5 sec.

o Slowly and controlled return to the starting position.

o 10 reps.

o Repeat on the opposite side.

Forward lunge

o Starting position with the feet/toes pointed straight ahead.

o Then step forward so the front knee and hip are flexed to 90 degrees as well as the back leg without contacting the floor.

o Make sure the movement is smooth and controlled.

o Return to starting position.

o 10 reps.

o Repeat on the opposite side.

Side stepping with band

o Start in a squatted position with a band tied just above the knees.

o Then step to one side with one foot, followed in the same direction by the other.

o The step lengths should be about 50% of the starting-position distance between the feet in the squat position.

o Take 10 steps to one direction and go in the opposite direction.

Forward Step Up

o Start with one foot on a step.

o Then pushed that foot down on the step to raise the other foot off the floor to the level of the step, without resting it on the step.

o Make sure to keep control and balanced.

o Then return to the starting position.

o 10 reps.

o Repeat on the opposite side.

To sum up, because of multiple planes of motion at the hip joint and the number of muscles involved, a dysfunction can occur that leads to pain in the hip or knee. But awareness of compensatory movement patterns and being able to control them decreases the likelihood of developing pain. Reducing the overactivity of the TFL by correcting those motions and strengthening the glutes will decrease the strain on it.

These exercises should help reduce discomfort. But if issues persist, we recommend a thorough evaluation to pinpoint the underlying causes of your pain.

The TFL is also the primary culprit in IT Band Syndrome (ITBS). Symptoms of ITBS include sharp, stabbing or burning pain in the hip, groin or outer knee. Check out our stretching and strengthening protocol to help eliminate ITBS by getting the TFL to chill out here.

Have more questions or want to come in for a full movement analysis? Give us a call or shoot us an email. We’d love to help.

Happy training!
Raymond Delacruz, PT, MSPT, CSCS, CMTPT, FAAOMPT
Team Clutch PT

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What I Learned from Quarantine: The "Normal" I Want Back Isn't Exactly the Same — Clutch Physical Therapy

Clutch PT — Fri, 19 Jun 2020 04:00:00 GMT

As a human being and spin instructor, I am very much in tune with the energy of others — how people respond and react to events and occurrences in their daily lives, and how people share it with the world. It’s a huge part of what I talk about in the classes I teach: how do we digest information that is constantly being thrown at us, and spin it in a way that works for us? How do we soak things in, and use them in a way that makes sense for us, then help make sense of the bigger picture? It always starts with one step, one pedal stroke, one breath. All it takes is one heartbeat, and the rest follows.

At the start of the pandemic, I told myself “just a few weeks of this, and then we’ll go back to some version of normal that I can recognize.” There was a lot that I’d been working through, after a particularly scary health diagnosis, multiple surgeries, and months of rest that stripped away a huge chunk of me. I had returned to teaching just one week before quarantine started; not a heck of a lot of time to feel like you’re finally putting the pieces of yourself back together again.

Unwilling to hit pause on the comeback journey I was so desperately clawing toward, for both for my body and my mind, I jumped into teaching virtual cardio dance classes that made people smile while we worked our tails off. We were living our favorite girl band back up dancer truths. I was so far outside my comfort zone, but those classes were very much a way for me to find purpose in a time that felt, and still does, feel very much like a black hole. It gave me a reason to put together movement and music, one of my favorite ways to sort through so much of what has happened to me in my life.

But the pandemic wore on, and I quickly wore out. The energy and joy I was so used to from exercise (hello, endorphins) started to slip. There really is no substitute for an in-person exchange of the electricity you can create when you look up and see a whole room of people moving to the beat of the music. Why? Because even though we’re all listening to the same song, everyone moves in their own way, in the way that makes sense for them based on the information they are taking in. MY walk will never look like someone else’s, and neither will my sprint or my climb, or the way I twirl when I’m dancing around my living room. And try as I might, there was something significant missing from the experience once the technological aspect of a screen put so much distance between the people I was so used to connecting with when they were only a few feet away. And that realization that the opportunities we were sharing together would never be the same crushed me. Suddenly the classes that I started out of necessity to hold onto any shred of normal turned into an experience that I resented for doing the exact opposite. With the end of each class came this overwhelming dread that we were sinking farther and farther into this so NOT normal space together.

One of the biggest reasons I ride and love to teach spin is for the community it's allowed me to create. You start out not knowing the person next to you at all, then 45 minutes later, you're slamming on their handlebars in celebration. It’s a gift to see someone take your class for the first time who starts off shy and winds up hooting and hollering whether they nailed the workout or not. No one’s afraid to spill their guts, no one’s holding back — it's a beautiful explosion of self-expression that I am lucky to facilitate. That energy, those interactions, those moments — they seemed irreplaceable. No amount of virtual classes or hang outs can substitute how it feels to share energy and electricity with someone in real life. Period. And even though we were all smiling and sweating together and moving, I craved that connection that I was so used to getting. I missed the souls in the room, and the reason behind the movement, not just the movement itself.

I voluntarily took a few weeks off from teaching, for maybe the first time in my life, to take a crack at digesting. I’ve always been a firm believer of not being able to pour from an empty cup. With our country and the world suffering on so many levels, the chances of my cup ever having a drop in it again were looking slim. Admitting that I wasn’t motivated to power through for others gave me an opportunity to reflect. I’ve always found that when I’m stuck, moving is the last thing I want to do, but always the thing that helps with the process of becoming unstuck. Moving to move forward. Moving with a purpose.

Getting back to movement is never easy — but especially this time, when the whole world seemed to just shut down and stop turning, wasn’t the easiest process. I’ll admit that I tried everything to find inspiration and motivation again — taking fitness classes from people I admire was both helpful and hurtful, like a one step forward, two step back sort of pattern. I had a weird reaction where I was either incredibly grateful for the experience, or jealous that I couldn’t craft those feelings for myself, even when I was doing the things I loved. Frustrated and at my wits end, I ended up starting to journal, which I thought would never work for me. But I found a connection in the ability to release my mind that directly related to my willingness to release my body. Journaling started to give me the permission I needed to move for myself, and I’m realizing now that sometimes these internal releases, even if it's just pen to paper, are so much more necessary and powerful in jumpstarting the external releases when you feel like you’re out of options.

Feeling alone and isolated on top of not feeling like myself already was truly daunting. Quarantine held so many ups and downs, both personally and professionally, that it’s almost hard to give myself credit for the amount of growth that occurred, too.

I discovered there’s an enormous difference between being alone, and being lonely. It’s easy to confuse the two. But just because you’re alone in a space doesn’t mean that a heart’s not beating for you somewhere, or that you don’t occupy someone’s headspace at any given moment. And vice versa. Just because the room is full of people doesn’t mean it’s always going to be full of passion, or fire, or fight. That has to come from the inside.

I used to rely on the motivation and energy of others to want to show up. But now I can say that I’m giving myself the permission to do exactly what I usually ask of others — dig deeper, and go farther. Don’t get me wrong, the energy of others DEFINITELY makes the experience a million times more special than words can ever describe. I just don’t think it will hold as much power in the equation as it once did. I’m diving into the notion that I can move FOR MYSELF with others present, not for others because they’re there. We’ll see where that takes me, and see if starts to feel “normal.”

Taking the pressure off myself to help other people, even though my ability and desire to be able to do that is something that gives my life purpose, made me realize that there has to be more balance in my “whys” and my reasons for moving. It’s no longer just about other people; I’m inviting myself into the mix as well. Leading and creating for others, to make them feel good about themselves and what they accomplish, without sacrificing myself in the process. I’m learning to be way more intentional with the time I spend moving my body for me, and I’ve found that even if I am dancing or riding, it’s become a much more meditative experience than it used to be. Empty room, or full.

Quarantine has given me the opportunity to learn from myself in ways that I never could when I was going 100 miles a minute. Barreling through life and moving through life are two different ideas, and that’s a new concept for me. I’m recognizing that moments of stillness lead to more meaningful moments of movement. The disruption in my routine was enough to make me uncomfortable, but not enough to debilitate me. It’s hard to be apart from the people I love the most in this world. I feed off their energy to fill my soul. But that absence has also given me the unique opportunity to pay an incredible amount of attention to myself, and see how I can fill holes myself that I used to use others to fill. All it takes is one heartbeat, and the rest follows.

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How to Prevent Ankle Sprains for Basketball Players. Hint: Don't get one in the first place. — Clutch Physical Therapy

Clutch PT — Tue, 16 Jun 2020 04:00:00 GMT

Sports have always served as a unifying entity in this country, and some hope arrived when the NBA announced that they will be returning to action on July 31st in Orlando, FL. Unfortunately, my New York Knicks did not make the cut as only 22 teams will be participating in this abridged version of the remainder season, but it will be interesting to observe the injury rates when play does resume.

I’d like to highlight one of those common basketball injuries — ankle sprains — and break down how to decrease the risk of injury when returning to the court.

Let’s start with defining what we’re discussing. An ankle sprain is a sliding scale from microscopic tear to full rupture of a ligament surrounding the ankle joint. The most common ligament sprains are on the lateral (outside) portion of the ankle.

There are three grades of ankle sprains that correlate with degree of injury and recovery time. Grade I is considered mild and is characterized by some local tenderness and swelling without a large impact on function. An athlete may not have to miss time for a Grade I ankle sprain, but the usual timeline for recovery is 1-3 weeks. A Grade II ankle sprain will have more notable tenderness and swelling, and will also impact function by decreasing joint range of motion and stability. Recovery time is on the order of 3-6 weeks. A Grade III sprain is a full rupture of an ankle ligament which requires months of healing time, but usually does not require surgery. Inability to walk can be a key dissociating factor between a Grade II and Grade III ankle sprain.

Ankle sprains are the most common basketball injury and lead to missed playing time. At the professional level, they occur at an alarmingly high rate. Approximately 25% of pro ball players sustain an ankle sprain over the course of a season.* It doesn’t matter how good you are if you can’t be on the court! So it’s incredibly important to prioritize reducing injury risk in the first place, especially since the major prognostic indicator for an ankle sprain is a history of ankle sprains. This study in the British Journal of Sports Medicine shows that over 70% of athletes who sustained an ankle sprain experienced recurrent ankle sprains. This further highlights the importance of ankle sprain injury risk reduction.

Do the work to prevent the first one from ever happening.

Based on my own personal anecdotal evidence, here are several physical capabilities that, if optimized, will decrease the risk of ankle sprain injury:

Ankle Range of Motion
Glute Strength
Landing Ability

Ankle Range of Motion

When self-assessing ankle range of motion, stand facing a wall with your big toe 5 inches from the wall. While keeping your heel planted into the ground, drive your knee forward in a straight line as far as you can. If you can touch the wall with your knee, awesome. If you can’t, that’s absolutely something to work on. Range of motion can be limited due to limitations in flexibility or in the ankle joint itself, so if you fail this test, reach out to me for a consultation. We’ll get to the root cause and customize drills to your needs.

Glute Strength

Glute strength is critical for ankle stability. Ever heard of a guy named Steph Curry? After struggles with chronic ankle sprains, he worked diligently to strengthen his glutes, and the rest is history! Weakness in your hips can create suboptimal biomechanical patterns that can place excessive torque on the ankles. Check out my glute activation series on IGTV here, where I cover:

Side plank clamshells
Isometric squats
Isometric fire hydrants
Lateral band walks

The hip hinge “Skills and Drills”series is a great watch, too. I demonstrate a progression of drills to work on the hip hinge pattern:

Kneeling hip hinge
Deadlift
Staggered stance deadlift
Single leg deadlift
Single leg deadlift to knee drive

Landing Ability

The majority of ankle sprains occur while landing from a jump, so optimizing landing technique is critical. Landing should be practiced in different types of environments with varying parameters in order for maximal carryover to game play. Simply practicing your landing with squat jumps alone does not simulate the chaotic nature of a basketball game, so practice landing from hurdle jumps, box jumps, single leg jumps, lunge jumps, etc. and in multiple planes (vertical, horizontal, linear, lateral, rotational). Watch me discuss and demo landing mechanics and drop squat drills here.

I strongly encourage you to take the time to self-evaluate your mobility, strength, and landing technique to fully optimize your play on the court and decrease your risk of injury. Please don’t hesitate to reach out for guidance!

Team Clutch PT

For a limited time, we’re offering an introductory special for young athletes that includes a virtual consult to review athlete history, screen movement patterns, identify goals, and map out a training program. It also includes 4 weeks of at-home personalized, sport-specific programming. Find out more here.

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How to avoid pain and "ouchiness" when returning to normal activity after quarantine. — Clutch Physical Therapy

Clutch PT — Mon, 01 Jun 2020 04:00:00 GMT

COVID-19 and enduring lockdown has had a detrimental impact on all of us in more ways than I could ever do justice to in a blog post. But as things start to re-open, I want to highlight one specific aspect that’s been affected greatly: walking and activity level.

A daily step count seems insignificant in the grand scheme of what’s happening right now, but I wanted to share a brief personal anecdote in the hopes that it will help at least one of you reading this right now.

My personal average daily step count, sorted by months over the past year, can be seen below:

Without consciously thinking about a daily target, I hovered around that common default 10,000 step goal (about five miles.) But then the pandemic hit. Notice the steep downward trend in March, and the cliff dive in April. Based on my own personal data and a hunch that this trend was generalized across most people during quarantine, I did some digging for data. According to Fitbit, the pandemic had a major impact on physical activity levels for over 30 million of their active users around the globe. This sedentary period affected all of us, both physically and mentally.

The good news is, we are starting to see a return to some activity. In May, I returned to work, which means my 0.8 mile walking commute to the clinic was re-integrated into my daily routine, sometimes multiple times per day. As a result, my step count spiked considerably (over 4,000 more steps/day) when compared to the previous month, without a ramp up period. Consequently, I developed some ouchiness — a highly technical physical therapy term — in my plantar fascia.

Our bodies do an amazing job of sending signals (PAIN!) when something isn’t quite right, but we don’t do an equally amazing job of listening.

It’s fairly easy to conceive that your body wouldn’t be thrilled with a jump from a 225-pound deadlift to a 405-pound deadlift one rep max without a proper ramp-up period. Yet we are apt to dismiss a similar aggressive spike in other types of movement. My own step count increase is analogous to the weightlifting example.

Here’s the takeaway. No matter how excited you are to get back to some normalcy, jumping straight back into a higher activity level following a prolonged sedentary period can lead to ouchiness.

Be mindful of the changes in your activity, and where possible, resume gradually. Start with a lower volume than your pre-Covid level, at an easy pace, then work back up gradually. In my example, I could have chosen to ride a Citibike for some of those commutes instead of doing them all on foot.

In addition to monitoring volume, take care of your feet with some self-massage, Trigger Point ball rolling, and calf stretching. If you start to feel any twinges of pain, pay attention to what your body is telling you and reach out to us before it comes a bigger issue.

If you’re getting back to running or cycling outside after a prolonged break from training, don’t expect to jump back into the same volume or intensity where you left off, or you’ll risk injury. If your body is fatigued and fighting soreness, it can also affect your immune system. Cut your volume back to about 50% of where you were, at an easier pace, and cut yourself some slack. Working back up gradually will benefit you more in the long run. After a training hiatus, it’s even more important to get your body ready to move with a dynamic warm-up. But don’t overthink it or create excuses about not having time. Go ahead and head out the door. Just spend the first couple blocks of your run incorporating a few drills like high knees, glute kicks, skips and carioca (also known as the grapevine.) Save the static stretches for after your workout.

If you have concerns about your readiness for activity, or if you have more ambitious training plans to tackle, hit us up for a check-in.

— Dr. James Sinodinos, PT, DPT, CSCS

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Your knee pain might not have anything to do with your knee. — Clutch Physical Therapy

Clutch PT — Thu, 21 May 2020 04:00:00 GMT

Wouldn’t it be great if the thing in your body that hurts was actually the thing that’s hurt? Wouldn’t it also be great to hit the Powerball?

Knee pain is super common, but unfortunately, the cause of it is not. In most cases, the pain you feel is being “referred” to your knee, but the real source of the issue lies somewhere else.

Unless you geek out on biomechanics like we do, most people don’t really consider the combination of muscles and joints that are involved in basic activities like walking, squatting, running or taking the stairs. But they’re pretty complex, and can place increased strain on the knee. When one of the structures involved gets thrown off — whether its a joint dysfunction or an angry muscle — your body will find a way to compensate to keep you moving. But eventually, the repetitive stress from that wonky compensation pattern will lead to pain.

That pain might feel dull, achy, sharp, stabbing, numb or radiating — and each type of pain can mean something different. Being able to differentiate which structures of the body are involved is the first step toward solving the real problem.

Let’s start with the hips and ankles. Ground reaction forces initiate at the foot and work their way up the leg to the hip and re-distribute back down. If either the ankle or hip is not working efficiently and lacks mobility, those two forces will meet in the middle. Meaning, your knee is toast.

Kneel down with one knee grounded and the other bent with your foot planted. Can you lean the bent knee over your toe? Does your heel pop up? If so, you’ve got ankle issues. Try Dr. James’s 90/90 rotation assessment and check out what’s happening with your hips. No bueno? That could be the source of your pain.

But the investigation doesn’t stop there. The lumbar spine can also refer pain from the back, down the leg and into the knee. This could happen because of a disc, pinched nerve or muscle issue. Along the lower extremity kinetic chain, forces are moving through lots of soft tissue structures that can be involved — the psoas, QL, TFL/ ITB, glutes, hamstrings, and the calf muscles. Did your head just explode?

Bottom line, if you’re having recurring knee pain, pay attention to it. But your knee could just be the unfortunate soul stuck in the middle of a nasty cat fight between other structures of the body. Your knee pain could actually stem from issues in the:

Hips
Ankles
Lumbar spine (disc, pinched nerve or muscle)
Psoas / Hip Flexors
Quadratus Lumborum (QL)
Tensor Fascia Lata (TFL)
Iliotibial Band (ITB)
Glutes
Hamstrings
Calves

You may need a skilled practitioner to sort out what’s really going on. If you continue to only treat the symptom (pain), you won’t get to the root of the real issue. We’re here to help you fix it for good.

— Ray Delacruz, PT, MSPT, CSCS, CMTPT, FAAOMPT

BTW, not sure what’s an OK-ish pain and what should stop you in your tracks? Refer to our pain scale.

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How to build athleticism in youth athletes during a pandemic. — Clutch Physical Therapy

Clutch PT — Mon, 04 May 2020 04:00:00 GMT

Young athletes can still improve their athleticism without stepping onto the field.

During this unprecedented time, we have all had the opportunity to self-reflect and take stock of what’s truly important to us. We’ve fantasized about what we’ll do when some degree of normalcy is restored. Personally, I think about spending time with my family, playing spikeball in Central Park with my friends, and sitting at a ball game on a beautiful summer night. But until we can get back to all that, we have to make the most of our current situation and foster healthy habits.

One particular aspect of this mess that’s weighing on us is the impact on our youth athletes. It is an absolute shame that kids are missing out on spring sports, and most likely, prime training opportunities like summer camps and tournaments. Families who are used to structuring their lives around youth athletics are left without their compass.

But this is our chance to redefine what it means to win, and find success against the odds.

We must stay active and build our athletic capacity without stepping on the field or getting in the water. The silver lining here is that we’ve been handed an opportunity to better understand how the body moves, identify the weak points, and attack those issues with strength and mobility work to become a better athlete.

Right now, every single kid should evaluate if they can do a:

These fundamental movement patterns are crucial to performance. (Click those links to our demos to get a sense of how thoroughly we evaluate them.) If you don’t move well in these patterns, attack the basics! Take 30 minutes every single day to mindfully crush these patterns, so that when you get back on the field, court or in the pool, you are stronger than you were before.

That said, executing reps with improper form will only reinforce bad habits. Start with an orthopedic screen and movement analysis. (Both can be done virtually as well as in person.) We’ll use that data to create a custom program (ranging from bodyweight exercises to elite-level weight lifting) to help you make the most of this weird time.

Challenge yourself to do the basics savagely well! Get more in tune with your body, hammer these patterns, and become a better athlete than you’ve ever been. When this is all over, don’t let anyone be able to say they’ve worked harder than you. That’s the mark of a champion.

Need help with programming or motivation during this surreal time? Give us a call to discuss the specific issues you’re having, or shoot us an email. We got you.
Team Clutch PT

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The Most Effective Self-Care Treatment Techniques for Getting Rid of Plantar Fasciitis. — Clutch Physical Therapy

Clutch PT — Wed, 22 Apr 2020 04:00:00 GMT

If you feel a stabbing pain in your feet when you take your first few steps in the morning, that’s a red flag symptom of plantar fasciitis. Also known as morning foot pain, first step pain or simply “holy ...!”, plantar fasciitis pain is the most common foot problem in the United States, affecting roughly 2 million people each year. It involves inflammation of a thick band of tissue that runs along the bottom of the foot (the plantar fascia) from the heel to the toes and can lead to loss of ankle mobility, decreased foot strength, and a lot of frustration.

The onset of plantar fasciitis pain is usually attributed to an increase in frequency, intensity, and duration of activities like running or jumping. (When social distancing ends and racing resumes, we’ll all have to be wary of what can happen when we up our volume too quickly.)

Plantar fasciitis pain often sidelines athletes for long periods. We’ve had patients come to us desperate for a solution, having been unable to run pain-free for years. The average case lasts over 14 months. But here’s the thing most people (practitioners included) don’t understand.

Plantar fasciitis is not the problem. It’s just a symptom.

Orthotics and injections are often sought out as treatment options for plantar fasciitis symptoms, but they are merely short term fixes. They provide a crutch that the body relies on and gets used to, but the problem doesn’t go away. To resolve plantar fasciitis once and for all, it’s imperative to work with a physical therapist to find the underlying cause as to WHY you’re getting the pain.

Usually, the culprit for plantar fasciitis pain is calf tightness. If the calf muscle can’t let go enough to allow the plantar fascia to do its job, you wind up with those muscles and tendons pulling on the heel bone in opposite directions. Ouch. If you’re experiencing pain in the foot and/or heel, the calves are where you want to start. Dr. Josh Grahlman and Ray Delacruz outline some self-care tips and very specific rolling and stretching techniques that help ease that nasty heel pain in most cases.

FIRST LINE OF TREATMENT FOR PLANTAR FASCIITIS:

First line of treatment is a shock-absorbent heel cup.
Try night splints.
Avoid walking barefoot, especially first thing in the morning. Unless you’re a masochist. (If you’re a triathlete, that’s probably debatable.)
Check your shoes for excessive wear and tear. All of your shoes. (We see you and your closet.) If they’re worn out, choose a pair that’s more supportive.
Back off activity and intensity, and ice the area. We know that’s your least favorite directive.

IN ORDER FOR THESE PLANTAR FASCIITIS SELF-TREATMENT TECHNIQUES TO BE MOST EFFECTIVE, PERFORM THEM IN THIS ORDER:

Roll out the calf. (Watch our demo.)
Find the knots and tender spots, and rest on them. Overlap with the opposite leg and add an ankle pump to floss the muscle. Relax. Breathe. It’ll suck, but it’ll also help. Be careful not to roll over the achilles tendon and roll both sides of the calf muscle.
Stretch the foot fascia. (Watch our demo.)
Use a half roller or grab a rolled up yoga mat or beach towel. Put the base of the ball of your foot on it, so your toes are pointing up and your heel is on the floor. Drive the knee as far forward as you can without your heel coming off the ground. Hit different areas of the calf and foot by varying the angle of the knee drive. Do 3 knee drives in each plane (9 total), twice a day.
Stretch both calf muscles. (Watch our demo.)
Start with a runner’s stretch against the wall with the knee straight, perpendicular to the wall. Lean in for 30 seconds. Then bring the back foot forward, keep the hips back and drive the knee forward so it moves the stretch down to the other muscle. Hold for 30 seconds.

STRENGTHENING EXERCISES TO TREAT THE CAUSE OF PLANTAR FASCIITIS:

Heel raises:
Stand on a step. Lift heels to the top end of your range of motion. Slowly lower down to the end of your range of motion. Hold for 10 seconds. Repeat 10 times. You should feel a stretch in the back of the lower leg, ankle and foot.

If these treatment techniques and stretches are not relieving your plantar fasciitis pain, it’s time to see a sports and orthopedic physical therapist for an evaluation to determine what’s going on. If you choose to see a physician or podiatrist instead, and they recommend cortisone, steroids, orthotics or surgery, PLEASE reconsider giving physical therapy a shot first. Our Athlete Mechanics can work with you in person or via virtual PT to find the root cause of your issue and teach you additional techniques to solve your plantar fasciitis pain. Invasive procedures should be an absolute last resort, not a first line of defense.

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How to reduce the risk of elbow pain in pitchers as baseball resumes. — Clutch Physical Therapy

How to Fix Knee Pain by Minimizing Tensor Fascia Latae (TFL) Activation — Clutch Physical Therapy

Target the glutes to reduce Tensor Fascia Latae (TFL) Activation

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What I Learned from Quarantine: The "Normal" I Want Back Isn't Exactly the Same — Clutch Physical Therapy

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How to Prevent Ankle Sprains for Basketball Players. Hint: Don't get one in the first place. — Clutch Physical Therapy

How to avoid pain and "ouchiness" when returning to normal activity after quarantine. — Clutch Physical Therapy

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Your knee pain might not have anything to do with your knee. — Clutch Physical Therapy

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How to build athleticism in youth athletes during a pandemic. — Clutch Physical Therapy

Young athletes can still improve their athleticism without stepping onto the field.

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The Most Effective Self-Care Treatment Techniques for Getting Rid of Plantar Fasciitis. — Clutch Physical Therapy

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How to Fix Knee Pain by Minimizing Tensor Fascia Latae (TFL) Activation
— Clutch Physical Therapy