• Posted on 6/28/2021

    Whether you’re new to the sport of triathlon or jumping back in after a longer break in racing, many are excited to drop any weight gained during the past year. It’s the perfect time of year to get outside and back to racing.

    While triathlons are a great way to push our bodies and are relatively safe for individuals at any age, athletic background or ability level, participants also need to be aware of the:

    • Pitfalls of overtraining
    • Importance of rest
    • Appropriate time to take some time off

    What defines rest and why is it important?

    Rest comes in many forms. It can be as simple as the time between repetitions, intervals or sets or a scheduled day off in your training plan. And, it can be skipping a workout when you are tired and feeling worn down, physically or mentally.

    If you sustain an injury or have an illness, rest may mean prolonged time away. However, rest doesn’t mean you have to completely stop all activity. You can take time off from typical training to work on mobility, participate in a yoga class, go for a walk, spend extra time on nutrition or enjoy a hot bath and relax.

    Whether planned or forced, rest allows the body to adapt to the stressors and changes in demand being placed on it. It allows muscles to recover and gain strength, our nervous system to adapt to changes and regenerate and our body to replenish our energy stores. Rest ultimately decreases the risk of overtraining, overtraining syndrome and overuse injuries.

    Triathlon training naturally allows our muscle groups to get some rest. When training in one discipline, the muscles involved in the other disciplines naturally get some time off. Spending the day in the pool gives your body a break from the repetitive pounding on the pavement from running, and with cycling or spinning, your shoulders get some needed time off from the resistance of the water.

    When is it time to take off, skip a workout and push training to another day?

    What are the signs of needing a break?

    As you dive into your training plan and are weeks out from the year’s first event, here are some important signs and symptoms that your body is telling you to take a break:

    • You are suffering through workouts that were previously done with ease
    • Notice your form is deteriorating or you are slower in any of your disciplines
    • It is harder to wake up
    • Increased irritability
    • Decreased motivation to train or in your daily life
    • Decreased concentration during work-outs
    • Increased sleeping
    • More frequent soreness or injuries (and it’s not due to an increase in intensity level of working out)
    • Increased illness

    If we don’t listen to these signs, our bodies may just force us to rest. If this happens, we can end up overtraining or sidelined with an injury.

    What is overtraining?

    Overtraining, simply put, is doing more than your body can handle at any given time. There is an imbalance between training, nutrition and rest leading to a decrease in performance, increase in fatigue and a decline in mood. For a well-trained athlete, overtraining may occur when putting in extra training sessions on an already full schedule. If you’re a rookie, it might mean jumping in too quickly with one or two extra days of training.

    Overtraining can be influenced by outside workload when we are stretching our personal schedules and sleep routines too thin. You may see you are underperforming with little to no change in your training program. Or, you may find you have more difficulty sleeping - falling asleep or staying asleep despite fatigue from working out.

    Once this stage or overtraining is reached, athletes will often find an elevated heart rate, especially first thing in the morning as well as deficiencies in vitamins B12 or D, lower iron levels and increase in creatine kinase levels in the blood. All of these can be serious signs of overtraining syndrome and can force an athlete into three-to-eight weeks off from training and treatment by a medical professional.

    What are overuse injuries?

    The most common overuse injuries in triathletes and athletes in general are from overtraining or overuse. Overuse injuries represent the largest percentage of sports-related injuries that require medical attention and are most common in runners and endurance athletes (triathletes).

    Approximately 50-70% of triathlete injuries occur when running, and the majority of those are overuse. These injuries most often occur in the knee, Achilles, foot or back or the shoulder from swimming. They can occur due to a breakdown in tissue that doesn’t have adequate time to repair itself before more use.

    If you are seeing aches and pains that don’t subside in approximately three days in the well-trained athlete or seven days in a new participant (due to new muscles being trained,) it is time to take some time off and seek out your local physical therapist for guidance. A physical therapy plan of care can help you heal, regain/increase strength and flexibility and reduce pain. It can also help you prevent future injury and optimize your sports performance.

    Author: Melissa Bryant, P.T. Melissa serves as the center manager for Select Physical Therapy’s Colorado Springs facility, located in the USA Triathlon headquarters building.

    Select Physical Therapy and Saco Bay are part of the Select Medical Outpatient Division family of brands.

    Resources

    • Vleck, V., & Alves, F. B. (2011). TRiathlon injury review. British journal of sports medicine, 45(4), 382-383.
    • Koutedakis, Y., Budgett, R., & Faulmann, L. (1990). Rest in underperforming elite competitors. British Journal of Sports Medicine, 24(4), 248-252.
    • Gosling, C. M., Forbes, A. B., McGivern, J., & Gabbe, B. J. (2010). A profile of injuries in athletes seeking treatment during a triathlon race series. The American journal of sports medicine, 38(5), 1007-1014.
    • Budgett, R. (1990). Overtraining syndrome. British journal of sports medicine, 24(4), 231-236.
    • O'Toole, M. L., Hiller, W. D. B., Smith, R. A., & Sisk, T. D. (1989). Overuse injuries in ultraendurance triathietes. The American journal of sports medicine, 17(4), 514-518.
    • Collins, K., Wagner, M., Peterson, K., & Storey, M. (1989). Overuse injuries in triathletes: a study of the 1986 Seafair Triathlon. The American journal of sports medicine, 17(5), 675-680. 

     

  • Close up of female hand while playing the piano

    Posted on 6/9/2021

    The first week of June has been annually designated by the American Society of Hand Therapists as Hand Therapy Week. It’s a time for raising awareness of hand, wrist, arm, elbow and shoulder injuries and conditions and the therapists who have specialized training to treat them. This week is also a great time to spotlight the individuals who most benefit from hand therapy, individuals like musicians.

    Playing a musical instrument is emotionally, mentally and physically demanding. Musicians, like athletes, are at risk for career-ending injuries in the neck, shoulder, wrist and hand. In a musicians’ lifetime, 63-93% will experience musculoskeletal symptoms related to their instrument play. Even the most conscientious musician can begin with symptoms or injury at various times through their play and performance season.

    The challenges musicians face are practice and rehearsal patterns established by others (an orchestra conductor, for example) in large segments of time, without rest or stretch breaks. There is also fierce competition for work, and musicians may be reluctant to complain of injury or new symptoms for fear of losing out on an opportunity. Additional injury risk factors include inadequate physical conditioning, poor posture, abrupt increase in play time and patterns, poor techniques or a change in the instrument.

    Symptoms, whether intermittent or persistent, are seen most often when learning to play over the age of 50. In professional musicians, symptoms can present when increasing the complexity or time spent playing.

    Common symptoms include:

    • Pain
    • Muscle cramping
    • Tremors/spasms
    • Inability to control motion
    • Headaches
    • Numbness/tingling
    • Stuck, catching or locking joints
    • Inability to straighten fingers

    Hand therapists have the important skills needed to evaluate musicians and identify abnormal sensation, poor posture and other causes of symptoms.

    A therapist identifies risk factors and develops a rehabilitation program specific to the musician’s instrument, goals and play demand. The plan may start with an active rest period, avoiding activities that cause symptoms while mentally rehearsing and initiating new normal movement patterns. During this stage, the therapist modifies the play/practice schedule and explores pain control techniques and strategies including diet, exercise, sleep and posture.

    When the active symptoms quiet down, the hand therapist begins the advanced rehabilitation phase with a goal to return to play. The therapist monitors play and rest cycle and a home program is developed to provide visual feedback using imagery and mirrors. The advanced rehabilitation phase also involves aerobics and fitness, strengthening, postural exercises and increased duration and complexity of play.

    The hand therapist works with the musician to develop a return to normal play schedule that is timed incrementally. The schedule starts with a slow and easy repertoire and passages, increasing to fast and more challenging passages for up to 10 minutes. Activities that help with return to play include warm-up with brisk walking, cycling and stretching.

    The musician will warm-up with their instrument using easy scales, long movements, slow and quiet play. As rehabilitation progresses, 50 minutes is generally the maximum play time before rest is suggested. The therapist also instructs the musician on symptom management techniques during rest and after play. These management techniques include ice, hydration and stretching.

    Hand therapists identify the root cause of injury, provide a whole-body approach to care and work in collaboration with music instructors to ensure continuity with proper technique and posture. Education and early intervention is key, as early treatment leads to better outcomes.

    If you or a loved one are a musician and suffering from pain or discomfort while playing, request an appointment today and experience the power of hand therapy. Our certified hand therapists will help you get back to doing what you love – creating beautiful music!

    By: Rob McClellan, OTR/L, CHT. Rob serves as the hand program coordinator for Physio.

    Physio and Saco Bat are part of the Select Medical Outpatient Division family of brands. 

     

     

  • woman wearing covid protection mask

    Posted on 5/25/2021

    Have you ever heard the term “mask jaw”? Well, guess what? It’s a thing!

    Mask jaw is the jaw pain and pressure many of us experience as we wear our masks for an extended period of time since the start of the COVID-19 pandemic. Now, while the Centers for Disease Control and Prevention recently put out new masking guidance for vaccinated people, masks will still be part of most of our lives for the foreseeable future. And, all that mask wearing can take a toll!

    If you jut your chin forward or tense your jaw muscles to hold your mask in its proper position over your nose and mouth, you are likely experiencing jaw tightness. Headaches and muscle tension can also be caused by stress, something we’ve all felt more of since March 2020!

    Let’s take a closer look at how your jaw works. Your jaw bone connects to your skull on both sides of your face, and is referred to as the temporomandibular joint, or TMJ. It is a rounded bone, with a disc that provides a cushion to support the joint, much like the discs in your spine and meniscus in your knee.

    When you first open your mouth, your jaw hinges and rotates. As you open further, it glides and translates until you open it fully. This action happens with large muscles from your temples and cheek, to smaller muscles deep within the jaw. At least that’s how it works normally. When there is an issue with the disc, the muscles or the joint itself, it is referred to as temporomandibular joint dysfunction, or TMD.

    TMD includes a wide range of symptoms, such as pain in the jaw or neck, headaches, locking of the jaw in an open or closed position, clicking noises and pain or difficulty with speaking, eating or chewing. TMD symptoms are widely reported by many people, but become troublesome when they start limiting your day-to-day activities.

    Now, let’s dive into how your mask may be the culprit to any lingering jaw pain you may be experiencing.

    1. Maybe you are breathing through your mouth while wearing your mask. Did you know that this places more stress on the jaw from it being constantly open?

      Wearing a mask can feel like you are not getting enough fresh air, but it should not alter how you breathe. Each inhale and exhale should pass in and out of your nose. Your jaw muscles are relaxed in this “resting” position. This means that the tip of your tongue is gently touching the roof of your mouth while your back teeth, the molars, are not quite touching.  

      If you breathe in and out of your mouth, your jaw remains open. To keep your jaw open means your muscles are doing extra work. When you breathe with a mask on, focus on the air passing in and out of your nose.
    2. Maybe the ear loops are too tight. This creates tension and can throw off the alignment of your jaw and, in some cases, cause headache. 

      Masks come in all shapes and sizes, and the fit is important. Whether made of fabric or disposable, it should never feel like it is pulling your ears forward or your chin backward. These compressive forces can easily trigger a headache. Consider a mask extender or “ear savers” to keep the ear loops from tugging and avoid a potential headache altogether.
    3. Are you clenching your teeth more because of stress? This is an easy trigger for TMJ pain and dysfunction. 

      Remember the resting jaw position? This is the most relaxed position for the muscles. When you clench your teeth and hold that bite position for extended periods of time, the jaw muscles can go into spasm. Avoid gum chewing or biting your nails, which can make symptoms worse. Exercise is a key component to overall health and managing stress. Take a walk or jog, meditate or find another way to get moving. Your body and your jaw will thank you.
    4. Chances are, you are moving your jaw in altered positions to adjust how your mask is resting on your face. 

      With a proper fitting mask, you will avoid overusing your jaw. Use a mask that has some moldable wire that can be shaped around your nose. Additionally, avoid masks that are too big and sag on your face, or that are too small and tug on your ears. You should be able to speak and breath through your mouth (wink, wink) comfortably. To avoid jaw pain, make sure your mask is molded to your face and does not slide or move easily.  

      If you are feeling pain or clenching in your jaw, experiencing headaches or are having difficulty with chewing or eating, physical therapy can help. To learn more about our TMD program or to schedule an appointment at one of our centers, please contact us today.

      By: Nicole Romaine, P.T., MPT. Nicole is a physical therapist for Kessler Rehabilitation Center in West Orange, NJ. 

      Kessler and Saco Bay are part of the Select Medical Outpatient Division family of brands.
     

     

  • Posted on 5/12/2021

    “Am I Injured?”

    This is a question I get asked by many runners.

    “How do I know if I’m injured and not just sore from running/training?”

    Short of a physical examination, this is what I tell them...

    There is good pain and bad pain. Good pain stops when you stop. It is generally mild, diffuses and doesn’t affect quality of movement. Bad pain does not stop when you stop. It can get worse during or after activity. It can be sharp in nature, and significant enough to force you to change your gait whether you realize it or not.

    If you have rested or taken time off from running, and the pain has decreased or gone away only to return when you start running again, there is most likely some underlying issue that needs to be addressed. There could be an issue with muscle imbalances, running form, footwear, training schedule, joint mechanics or any combination of these.

    If you are taking non-steroidal anti-inflammatory drugs (NSAIDs) daily or after every run for pain, you may have an overuse injury. Overuse injuries account for the majority of running injuries. They occur when a tissue is loaded beyond its threshold. In bone, this can result in a stress fracture. In tendon, this usually manifests as tendonitis or tendinosis. Excessive stress to a ligament can result in a sprain.

    Overuse is relative and not always obvious. It can be a result of “too much, too soon” with regard to training or mileage. It can also be due to cumulative stress from non-running activities and/or compensation. When a structure takes on additional stress to unload another, it can break down.

    How can physical therapy help? A thorough evaluation by a physical therapist can help identify the underlying problem so that you’re not just treating symptoms.

    A progressive loading program can assist the injured tissue regain the strength needed to resume running and training. Hands-on therapy can also help restore normal joint mechanics so that muscles are functioning more efficiently and inert structures are not unnecessarily stressed.

    Physical therapy can you build strength, endurance and minimize running injuries, so you can achieve your personal best.

    By: Martine Marino, MPT, COMT. Martine is a physical therapist and the center manager for NovaCare Rehabilitation in Bethel Park, PA.

    NovaCare and Saco Bay are part of the Select Medical Outpatient Division family of brands.