Best Exercises to Alleviate Arthritis Pain

Arthritis is a normal occurrence in the body, but can create very uncomfortable and pain symptoms at times. The best thing is to keep moving through as much non-painful range of motion as you can to keep those joints healthy.

Check out our video on 2 very simple but highly effective drills you can do virtually anywhere to help decrease arthritis pain in your neck, shoulders, back and knees.

For questions about these drills or your specific arthritis symptoms, drop us an email at contact@xcelmp.com.

The truth behind weight loss and arthritis (and how to achieve your health goals in 2019)

This article will give you pertinent information you need to know if your achy joints are holding you back from exercising to lose weight and improve your health.

The first thing you need to understand is that your medical diagnosis of arthritis may not be the reason only your joints are achy. Arthritis or inflammation of a joint space is actually a natural process that occurs in the body. In previous posts we have talked about how even people without pain or stiffness display some type of abnormality on imaging. Therefore having the diagnosis of arthritis from imaging does not have to be something that keeps you from participating in the activities you want, the SYMPTOMS of pain and stiffness are the problem.

One of the reasons you may be experiencing stiff achy joints is because of a faulty movement. This biomechanical breakdown can cause decrease joint range of motion that could lead to decreased lubrication (or loss of synovial fluid) of the joint space. With less synovial fluid and constant loading of the joint surfaces, that’s when we start seeing the wear and tear of joints.

Therefore, to help combat the feeling of achy joints so you can continue to participate in your favorite physical activities, make sure you get your movement diagnosis along side your medical diagnosis. Getting this diagnosis as well will help ensure you have the bigger picture of what is going on with your body so you can function at your optimal performance.

In the video below we dive deeper into this topic and give potential solutions that you can take advantage of for helping to get out of pain and to start moving and burning those calories.

Check out our video below:

For questions about your specific symptoms or if you would like to come in for a FREE orthopedic consultation, email me at contact@xcelmp.com.

 

In your health,

Dr. Chelsea

Understanding Your Insurance 101


Understanding your insurance

Understanding your insurance is about as easy as doing a Rubix cube blindfolded these days. There are so many terms, limitations, and policies that can affect how much you pay and what actually gets covered. We want to help you out by giving you some clear cut definitions and how to actually understand your coverage when it comes to physical therapy care.


What Terms You Need to Know:

Deductible- The defined amount needed to be met before any benefits kick in. For example, $1,000 deductible means you must pay that amount before any insurance coverage begins.

Co-Pay- Pre-determined amount a plan requires to be paid at time of visit for given specialty. For example, a $40 fee before seeing a specialist.

Co-Insurance- Percentage that insurance covers for given service. For example, if the co-insurance is 80/20 and the charge is $100 then insurance would cover $80 and you are responsible for $20.

Out of Pocket- Max amount that needs to be satisfied before insurance covers 100%. Typically this is a significantly higher amount than the deductible.

In-Network (contracted)- The healthcare company has an agreement with the given insurance company for payment of your services.

Out of Network (non-contracted)- The healthcare company does not have an agreement with the given insurance company but can still file claims.


How do I find out MY benefits?

Here is the strategy we recommend to our clients who are looking to see what type of coverage and benefits their specific plan has, this is the order of questions to ask your insurance rep. The number is typically on the back of your insurance card.

1. What are my in and out of network physical therapy benefits?

(They will give you information such as your deductible, co-pay or co-insurance and out of pocket.)

2. How much of my deductible has been satisfied so far?

(The amount that has been satisfied for both in AND out of network.)

3. How many visits am I granted per year?

(Some insurances have limitations or restrictions.)


How do I understand this all?

This infographic can help you see what in vs out of network coverage can look like for physical therapy services. This is taken from one of our recent clients.


How to determine what is best for me?

Given the coverage above, here is a breakdown to give you an idea of what we typically see from an in-network clinic versus our facility, which is an out of network clinic.

Let’s break these down…..

Number of visits- Most in-network clinics on average will prescribed 12 visits for many common diagnoses, where as our specialists on average see clients for 5 visits.

Time with clinician- In-network clinics need to fit more people in during the day so their PT usually sees a client for 15-30 mins individually before ending the session or having the patient do exercises with a PT technician or assistant. At Xcel, we do not use assistants or techs so the entire hour session is spent with our clinician.

Cost- A little math here, the in-network clinic is going to charge the $20 copay every visit, so with 12 visits you’ll have the $240 charge. Now the kicker with this plan is that they would need to satisfy the $2000 deductible before they are covered with only a copay. So, for 10 of those visits, they will be charged $200 per visit to satisfy that deductible. This is hopefully communicated to the patient, and typically comes as a bill after the care has been completed. At Xcel, we have single session price or discounted packages, so for 5 sessions our package is $925. This is the only cost we collect.

Time- Arguably the most important detail because who wants to deal with pain or injuries longer? Accounting 30 mins of travel time to and from the clinic + the 60 min session, you’re going to spend more than double the amount of time away from work, family and achieving the results you need to get back to your active lifestyle with in-network.


In Summary…

This is just an example of one individual’s coverage, so not all insurances will be like this. Some favor in-network with cost, and some do not like this situation. The biggest takeaway is for you to understand that if cost AND value of service is important to you, then do your homework. Make sure you understand your policy and coverage, so you know your expectation of costs.

Also, I truly recommend talking with one of our clinicians at the facility you’re interested in going. Ask them questions about your specific problem or symptoms and make sure you’re comfortable with them before starting your plan. Whether you go in-network or out of network, you’re still going to be spending money AND devoting your time and energy, so you want to make sure it’s with someone you’re comfortable working with.

If you have questions about insurance or want to schedule a free consultation with one of specialists, just click here and we will be happy to help you!

To your health,

Dr. Brian Campbell, PT

Are Your Push Ups Putting You At Risk?


This moderately advanced exercise is great for improving shoulder stability, core strength, and strength in your chest and shoulder muscles. However, if you are performing this exercise with poor movement patterns you are putting your shoulders at risk for injury. I would recommend reading our plank article before this one as this will help improve your scapular mechanics for the push up. Once you have mastered the concepts in the plank article (Can You Plank Without Pain?) it will be easier for you to master the push up and keep your body injury free.


This exercise will help:

  • Increase shoulder stability
  • Improve core strength
  • Improve strength in chest and shoulders

If you are performing this exercise incorrectly you may experience the following symptoms:

  • Shoulder pain
  • Neck pain
  • Knee pain

How to Perform Correctly

If you are having trouble performing the push up correctly from the toes you can drop down to your knees; however, you still need to be able to activate your core from this position. It is very common for people to want to use their quads to perform this movement.  Reference the pictures below for proper placement of your knees to ensure that you are not making this mistake.

Top 3 cues:

  • Keep your shoulders directly over your hands
  • Don’t chicken wing your elbows out
  • Keep your belly button tucked to your spine

Push Up Drills

The following drills will help improve your mechanics and positional strength to help ensure that you are protecting your body from an injury. If you are already experiencing pain during this exercise, focus on these drills for a few days before attempting a full push up from the toes. You can also perform modified push ups while you continue to focus on these drills. This will help decrease some of the irritation you may be experiencing while you work on improving your movement patterns.

Anterior Deltoid Scrub

This mobilization will help decrease some inflammation and pain you may be experiencing in the anterior (front) portion of the shoulder.  This can be caused by poor movement patterns.

Banded External Rotation

This exercise will help increase activation of postural muscles that will help keep your shoulder girdle in proper position to decrease risk of injury.

Dying Bug

This exercise will help engage your deep abdominals muscles. When you are able to activate  your deeper abdominals you will be able to perform your push up with better form and less pressure through your shoulders.


In summary, the push up is a great exercise to build core, shoulder, and chest strength.  When the push up is performed with incorrect form it can cause some injuries.  Try these convenient and effective drills to help decrease your risk of injury. If you are still experiencing any of the symptoms listed above please feel to reach out to us for a free discovery consultation!

-Dr. Chelsea Schuman, PT

Motor Control in Adolescents


Last week we talked about the importance of getting your movement diagnosis along with your medical diagnosis. This week we wanted to touch upon this theory specifically for developing athletes. We are very passionate about ensuring that as athletes start to get into more demanding sports and strength programs they have proper movements patterns. This will help ensure they stay injury free now and in their future.


In this generation people are able to follow all of their favorite athletes on social media. On these accounts they can watch their favorite pro athlete perform more advanced and fun looking movements. However, what they aren’t seeing is the amount of time those athletes are spending building the foundation of proper movements BEFORE heavily loading their bodies. These professional athletes spend most of their workouts performing specific exercises to prime their body for the complex loaded movement they are about to perform. However, all we see as bystanders is them successfully accomplishing an impressive activity or lift.

   


Research shows that, similarly to adults, low back pain and other injuries can be caused by poor motor control of the available range of motion. This is even more important for developing athletes because of the amount of growth they experience. We find it is very beneficial to teach the athlete how to be strong in the range that they have available to them before they are taught how to perform more complex weight training movements.


Our goal is to keep you healthy and injury free in your sport of choice. To help ensure this we recommend getting assessed and receiving your movement diagnosis BEFORE you are experiencing pain. Once pain is present, it becomes much harder to get an individual out of that faulty movement pattern that caused the pain to begin with. Along with that, when you are experiencing pain activities and sports must be limited to help the body heal which isn’t always ideal.


In conclusion, it is very important that developing athletes are being taught proper movement patterns before they start loading their bodies with high level movements and activities. As a parent, be sure that these warm ups or movement primer exercises are being performed at your child’s practices and strength programs. If you are a developing athlete, or an athlete of any age for that matter, be sure you are seeking out what your body needs to stay healthy now and in the long term.


If you are interested in learning more about your movement diagnosis call us or message us to schedule an assessment. If you are experiencing pain and want more information on how your movement patterns are causing your pain, give us a call or message us to set up a free discovery consultation.

As always, if you have questions please reach out to us by calling 919-473-6165 or by clicking here!

Check us out on Facebook and Instagram!

Do you experience pain with overhead exercises?


This article will help you: 

  1. Understand the mechanics behind a barbell overhead press.
  2. Give you cues to perform the movement correctly.
  3. Provide you with a few drills to help prime your body for this moderately advanced movement.

The overhead press is:

A movement that can be incorporated into many different types of programs, whether you are looking to loose weight, gain muscle mass, or just live an overall healthier lifestyle. This lift works on building the muscles around your shoulders and chest while improving shoulder girdle and core stability.


How perform the overhead press correctly

Top 3 cues:

  • Before even starting the movement pull your shoulder blades down and back and be sure to maintain this position throughout the movement. We will be working on this motion in the drills below
  • Keep your pelvis tucked underneath you and your ribs down, do not let your back over arch backward.
  • Do not let your elbows flare out to the sides. Focus on keeping your elbows under your hands. To do this think about driving your pinkies together.

Symptoms

Listed below are some symptoms you may be experiencing if you are not performing this movement correctly

  • Low back pain
  • Sharp pain at the front of your shoulder
  • Neck pain
  • Elbow pain

To avoid these symptoms:

Try the drills listed below to ensure that your body is ready to perform the overhead press.

It is essential that during this movement the barbell follows the correct path to ensure shoulder safety. For this to be possible one must have proper external rotation at the shoulder and neuromuscular control of the movement. The following drills will help accomplish these goals.

After completing the above exercises be sure to perform a few warm up sets of this lift before adding any significant amount of weight to the bar. To gauge these type of warm up sets aim to be between a 9 and 11 on the RPE scale or use about 50-65% of your 1RM, if this is known. Aim to complete at least 2-3 warm up sets before getting into the working sets of this lift. This will ensure that your body is properly warmed up and primed to be able to perform this lift correctly.


Summary

The overhead press is beneficial movement for everyone to incorporate into their fitness routine. However we need to be careful not to perform unsafe movement patterns. Try these drills and use the videos to help guide you to help improve your overhead movement patterns. Performing these drills a few times a week should help improve your mechanics and decrease pain. If you are still having trouble with this movement or are experiencing pain during this movement contact us for a free discovery consultation.

-Dr. Chelsea Schuman, PT

Pain With Pull Ups?


The pull up exercise is very daunting to most people, however; it is a very simple exercise to master when broken down into steps. However, before we even think about stepping up to a pull up bar we want to ensure that our shoulder girdle is in the good a position to be able to properly perform the exercise.

The pull up is a great upper body exercise to help build the strength in your back and shoulders. This exercise specifically help build your latissimus dorsi, trapezius, and deltoids.

 


How to perform correctly

Top 3 cues to be thinking about:

  • Before even beginning the movement set your shoulder blades down and back toward your back pockets; this will be a very small motion but important to protect your shoulder girdle from injury.

  • Drive your pinkies toward each other as if you are trying to bend the bar.
  • Think about pulling the bar down toward you as opposed to pulling yourself up to the bar.

Symptoms

Some symptoms you may be experiencing if you are performing this movement incorrectly are:

  • Shoulder pain
  • Neck pain
  • Elbow pain

Perform the following drills if you are experiencing any of the above symptoms and to help decrease your risk for injury while performing the pull up.


Summary

The pull up is a great exercise to help build overall upper body strength, however; can be the cause of many shoulder and/or elbow injuries if performed incorrectly. You can use the drills provided in this article to help decrease your risk for injury and/or improve your pull up mechanics. If you are still having trouble or experiencing pain call us for a free discovery consultation.

-Dr. Chelsea Schuman, PT

Solve Pain With The Turkish Get Up


The Turkish get up is a great exercise to help improve your ability to connect your shoulders, core, and pelvis. To be able to perform this exercise you need adequate shoulder stability and the neuromuscular control to connect all of the correct movement together. Although this is a fairly advanced movement it can be broken down into phases. In addition each phase has its own benefits and can be performed in isolation.

This exercise is a great whole body exercise to help improve neuromuscular control and positioning strength to be able to perform more complex lifts.


How to perform correctly

Some symptoms you may experience if you are performing this exercise incorrectly are:

  • Shoulder pain
  • Neck pain
  • Low back pain
  • Knee pain

Phases

  1. Half bridge (phase 1)
  2. Starfish (phase 2)
  3. Leg sweep (phase 3)
  4. Windmill (phase 4)
  5. Overhead lunge (phase 5)

Phase 1: Half bridge

This movement is great if you are having pain during your overhead exercises. This is usually indicative of poor scapular movements and stability. This phase will help improve your body’s ability to properly position your scapula so it is able to accept a load overhead.

Main cue from your performance therapist: push through the inside of the foot of the knee that is bent, drive through your bent elbow, and punch towards the ceiling.


Phase 2: Starfish

This phase is a great exercise to perform if you are having trouble activating your glutes and hamstring during your lifts. You will know you are having trouble with this if your low back feels tight after deadlifts or squats. This means that you letting your low back muscles take over the movement. You should not move on to this phase unless you are able to perform five good repetitions of phase 1 without feeling like your back is performing the movement or without having shoulder pain. During this phase your body is working to continue to build tension in your posterior chain to properly perform later phases.

Main cue from your performance therapist: push through the entire foot of the knee that is bent and engage those glutes!


Phase 3: Leg Sweep

The key for this phase is making sure that you are placing your foot in the right place to set yourself up for success during the next two phases. This phase requires the ability control movement of your lower extremity while maintaining tension in your posterior chain and core. Therefore you should not progress to this phase unless you have mastered the above phases.

Main cue from your performance therapist: Place your knee about a foot behind from you planted foot and maintain tension in the glute of your planted foot.


Phase 4: Windmill  

This phase again, is an exercise to help you learn about to use your glutes and not your back to perform a movement (noticing a trend here??). If you are experiencing low back pain or hip pain during your squat (especially if you are going below parallel) this exercise is for you. This movement is a little more advanced than the previous phases so do not attempt this phase until you are able to perform five good repetitions of the previous phases.

Main cue from your performance therapist: drive through the inside of the planted foot and think about pushing that hip down to bring you into that upright position.


Phase 5: Overhead Reverse Lunge

The last phase of your turkish get up is when you will use all of the tension in your posterior chain that you have been working to build up in the previous phases. The key to this phase is to push throughout back leg to stand up. It should almost feel as though you are going backwards first and then standing up. Again, you should not feel this tension in your low back, if you are return back to the beginning of the the turkish get up and master each phase. This exercise in isolation is great if you are experiencing low back pain as long as you are properly using your glute.

Main cue from your performance therapist: keep the tension in your glutes not your low back. It should feel as though you are trying you push the floor away and behind you.


In summary,

The Turkish get up is a great exercise to address many different positional strength issues. Although, it is frequently performed incorrectly which can lead to pain and movement dysfunctions. Use these videos and cues to assist you in performing these movements correctly. If you are still experiencing pain or have any other questions please do not hesitate to contact us for a free discovery consultation.

-Dr. Chelsea Schuman

Can you plank without pain?

The plank is great exercise to help improve your core strength and shoulder stability however it is very commonly performed incorrectly. When you perform this exercise incorrectly you are putting your shoulders at risk for injury and it won’t be as effective in helping to build your core strength.


This exercise will help:

  • Improve core stability so you can perform complex movements more efficiently
  • Improve shoulder stability to be able to perform overhead activities with better scapular positioning

How to perform correctly:

If you are having trouble performing the plank properly up on your toes you can modify this exercise by dropping down to your knees. Below you find the correct way to perform this modification and also a common incorrect way to perform it.


Top 3 cues:

  • Keep your elbows under your shoulders
  • Don’t clasp your hands together
  • Keep your pelvis tucked underneath you

If you are performing this exercise incorrectly you may experiencing the following symptoms:

  • Shoulder pain
  • Hip pain
  • Low back pain

To ensure you are performing this exercise correctly:

Perform the following drills to improve your mechanics and prime your body for the movement.


Summary

The plank can be used to help improve your core and shoulder stability which will in turn will help improve some of your more complex lifts that require this stability. Just as with any exercise our body will find ways to make it easier for us to perform. However sometimes these changes can cause injury to our bodies. Try these drills and use the cues to help improve your movement patterns and decrease your risk for injury. If you are still have trouble or experiencing pain call us for a free discovery consultation.

Why Runners Need Strength Training More Than Mobility.

As endurance athletes, we love the high we get from being able to train hard and finish strong during races. When pain or stiffness keeps us from that, it can really make a difference in our mood and motivation. Trust me, as a triathlete, I experience the same ups and downs as everyone else. Most of the time when we look for a solution, we seek out mobility and stretching first.


Why is that?

Well I believe there are 2 major reasons why:

  1. It’s easy
  2. It feels good immediately

Don’t get me wrong, it SHOULD be in everyone’s training program. But it serves as only a temporary fix to a bigger problem many runners will go through. What is that problem?


Positional strength deficits

Positional strength can be defined as the ability to use the right muscles at the right range of motion to support the desired position without harm to the joints and tissue. The problem with runners, in particular, is the common muscular imbalances created from running. These muscle imbalances create deficits in positional strength, particularly to the low back and legs that create an array of different pain and stiffness symptoms.

The one area of training that can show long term success with correcting these deficits or injuries is strength training, not mobility, for runners. The great news is that for many runners, ANY type of strength training will help. But for those who want to know what will get them the most effect with the least amount of time, the key is to work on the backside, or posterior chain.

The posterior chain consists of your glutes, hamstrings and calves. This group of muscles, while used during running, often do not get enough accessory work during a training week to keep up with the infamous hip flexors and quads. This is where muscle imbalances occur and bring about many different symptoms of pain and stiffness. By adding in just 1-2 days a week of posterior chain training, you will not only see an improvement in your symptoms including mobility, but also performance. So, here’s the top 3 drills we use with our endurance clients who are seeing us for rehab AND also for our new endurance performance programs.


Check these out:

Posterior chain lift:  A great drill to activate the posterior chain while not loading your low back, shoot for 30 good reps while keeping your lower abs engaged and your pelvis in good position!

Banded kneel to lunge: The majority of runners don’t know how to get to true hip extension, this drill will help you find it, feel it AND strengthen it! 30 good reps per side. 

Kneeling KB press outs: Improving the endurance capacity of spine/pelvis position will shave minutes off of your runs while keeping you injury free. Try for 3-4 sets of 25 slow press outs and embrace the burn of your hamstrings, glutes and abs with correct form!


How to Incorporate?

So, the next thing to tackle is HOW do I use these exercises as part of my training?

Well there’s 2 different types of strength training you want to address:

Quick twitch strength

The common misconception is that quick twitch or type 2 muscle fiber is not good for endurance athletes. It is the development of your sprint muscles and quick movements. The reality is that every runner NEEDS these types of muscles trained!

Ever run up a hill and feel more gassed than you should? It’s because you were relying too heavily on your slow twitch muscles, resulting in increased heart rate and loss of cadence. Developing these muscles will give you the “kick” up the hill or at the end of race you need. See the chart below for recommended dosage.

Functional position strength

On the flip side of fast, we want to work your other two fiber types of 1 and 2x. I don’t like calling them slow, but rather smooth twitch. Why smooth? Because when trained properly they can keep you operating at maximal efficiency and have you breaking PRs left and right.

This type of strength training comes from creating the correct position in your body, and then maintaining it for the rep or time count. The better you maintain the position, the more efficient a runner you become. This helps train your volume AND cadence goals while significantly reducing injury risk. See the chart below for recommended dosage.

Quick Twitch Strength

Functional Position Strength

How many days per week

1

1-3

Rep Count

3-5 reps per set

Think fast but controlled

10-30 reps or 60-120 secs 

Think smooth and controlled

Sets

4-8

3-5

Resistance percentages (based on max or perceived max effort)

65-105%

BW or 25-50%

Try these 3 drills on your next non-run day (which you SHOULD have) and let us know how it goes!


Need more guidance?

If you’re looking for more guidance on your specific problem, whether an injury or looking for a boost in performance, we’re here to help. As Raleigh’s endurance specialists, we have several different services to meet your needs. Click below to fill out a simple survey and one of our endurance specialists will give you a call to help you learn what specific solutions we can provide for you!

Click Here to talk with one of our endurance specialists

To your health,

Dr. Brian