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Fix Your Lower Back Pain by Strengthening the Gluteus Medius Muscle

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If you get frequent lower back pain that is not an underlying disease, the issue is likely due to a weak Gluteus Medius Muscle.

The Gluteus Medius is one of the three gluteus (butt) muscles that play a role in stabilizing the hips. The other two areas being the Gluteus Maximus and the Gluteus Minimus. The Medius muscle begins on the outer surface of the Illium, the hip bone, and attaches to the greater trochanter of the femur (a bony landmark at the top/outer side of the thigh bone). Its fibers run in a superior/inferior direction anchoring the pelvis to the femur. 

This matters the most when we remember that the spine rests upon the sacrum, a portion of the pelvis, specifically at the L5-S1 junction. Providing a foundation for the vertebral column can help in reducing back pain that is felt from prolonged standing and/or walking. Instability of the vertebrae can result in disproportionate compression of an intervertebral disc, causing nerve irritation prevalent in low back pain. 

More often than not, a patient will walk through our doors with reports of low back pain, and after some investigative work, we’ll learn that their job requires daily long hours of sitting. Jeong et. al1 demonstrate that the Gluteus Medius provides that stability to the pelvis when our body needs it. However, after sitting in a chair for many hours every day, these muscles will atrophy and no longer perform their designated job for months. This can result in vertebral instability, as mentioned above or worse, to leave a person susceptible to graver spinal cord injury when dealing with bigger movements such as deadlifting or squatting. 

How to Strengthen the Gluteus Medius Muscle

This article aims not to scare you from performing these movements; it is more the opposite. One of our strongest recommendations to those experiencing low back pain is to purchase a standing desk, which now creates a need yet again for those Gluteus muscles to stabilize the hip. We also frequently recommend performing exercises that target the Gluteus Medius, such as clamshells, bridges, sidestepping, side planks, as safe movements that re-introduce the patient to healthy activity while developing the musculature around the hip. 

To conclude, when treating low back pain, often a Physical Therapist elects to focus on establishing “core” strength by concentrating on the Transverse Abdominis and Abdominal Oblique muscles. Choosing to develop the Gluteus Medius is an alternative approach that many patients have experienced more relief than core work. If you’re someone who has no pain but is apprehensive about lifting, or if you are currently experiencing low back pain, the Gluteus Medius is a solid place to start. [1]

  [1] Jeong UC, Sim JH, Kim CY, Hwang-Bo G, Nam CW. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. J Phys Ther Sci. 2015;27(12):3813-3816. doi:10.1589/jpts.27.3813

Debunking Myths behind the Deadlift

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Research shows that doing proper deadlifts DO NOT lead to lower back injuries.

We have all heard the saying that performing deadlifts is the worst thing you can do for your lower back, or you may know people who have horror stories about deadlifting and how it causes your discs to herniate immediately. This statement is not only an extremely outdated way of thinking but more dangerously, it feeds into the rhetoric that the human body is some weak and fragile thing that can break down at any second. Most exercise (whether performed in the gym or a physical therapy clinic) when performed incorrectly or when inappropriately loaded can lead to a potentially devastating injury. Taking that into consideration, the physical therapy community needs to stop shunning the deadlift as the culprit causing lower back pain and transition to using this movement (hip hinging) as a way to relieve pain and restore function.

What does the research say about deadlifting?

You should never blindly believe something just because it is on the internet, so let us provide you with facts supported by research. (Welch et al 2015.) Published a research study looking at the effects of a four-month free weight resistance training routine on patients with chronic low back pain incorporating deadlifts, squats, and step-ups. Their findings showed statistically significant improvements in fatty infiltrate of the lumbar muscles, a 72% decrease in pain scoring, 76% improves in disability measurements, and increases in quality of life assessments. Another study, Asa 2015, took patients with chronic low back pain. It had one group do deadlift training while the other group did low load exercises to target specific impairments, and both groups saw significant decreases in pain intensity as well as increases in strength and muscle endurance measurements.

The Nachemson Chart, which is a measure of intradiscal pressure (pressure on spinal discs) in response to compressive load, shows that prolonged sitting in a slouched position places almost as much compressive load as a deadlift. However, directly sitting leads us to stop activating our glutes due to constant compression on the soft tissue and reciprocal inhibition of the hip flexors. A proper deadlift builds posterior chain strength, core stability, and allows us to train our glutes to reduce strain on our spine with daily activities.

Overall, the main reason I am an advocate for deadlift training is that it can teach the patients a fundamental movement pattern; a proper hip-hinge (getting our hips to move without our low back flexing or rounding). One of the most important things to address when teaching a proper hip-hinge is the ability of your abdominal musculature to maintain a neutral spine (aka core stability). Educating our patients on how to deadlift incorporates lumbopelvic dissociation, core stability, and glute strengthening, and all 3 of these factors are all essential to any proper treatment of the low back.

Who can perform deadlifts?

I am not advising that a 65-year-old osteoporotic person should be performing deadlifts on day one of physical therapy evaluation. However, with proper treatment, education, and guidance, even this patient should eventually be able to complete an appropriate hip hinge. There are parameters for when a person is ready to begin deadlifting under load, such as patients with lower intensity of the pain (<60mm on the pain VAS) and with better lumbar spine endurance (>60 seconds on the Biering-Sorensen Test). A properly trained physical therapist can help a patient with low back pain progress towards doing deadlifts. The physical therapist should be a biomechanics and movement analysis expert and be able to discern which lower back patients would benefit from deadlift training (a vast majority in my opinion).

As a physical therapist myself, I can personally vouch for deadlifts in terms of treating LBP. I suffered a weight lifting injury in 2018 and was experiencing horrible low back pain and shooting pain down my left leg whenever I tried to get into/ out of my car, put on my shoes/ socks, and sit down for prolonged periods. After reducing my pain levels, my home exercises incorporated a lot of hip hinge training, core stabilization, and glute activation for me to properly learn how to deadlift. With time, patience, and progressively loading my spine via deadlifts and squats, I am now completely pain-free and without question much stronger than I was before my injury.

In conclusion, I think it is time to put to bed the stigma behind that deadlifting (especially heavy weight) is dangerous and should never be done in therapy. On the contrary, I think with proper coaching and progression, this exercise is one that will help strengthen your lower back and reduce the risk of future injury.

Contact us today to schedule a free consultation.

New Physical Therapy Office Location Brickell

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Fox Physical Therapy Opens A New Office In Brickell, Downtown Miami Florida

Fox Physical Therapy, Miami’s premier orthopedic and sports physical therapy center, is proud to announce that as of July 30, 2019, we have expanded with the opening of our third location in the Brickell area in Miami, Florida. Fox Physical Therapy is located inside Move Lift live in the stand-alone blue building, the new Brickell location will offer patients a hands-on, results-based approach to addressing a wide range of work, auto, orthopedic, and sports-related injuries or post-surgery therapy. This location will also offer an opportunity for future patients that work in the area to maximize their day by visiting us on their lunch break, before or after work.

“We are excited to be able to bring our expertise into Brickell and the surrounding neighborhoods of Coral Gables and South Miami. We understand the need for top-quality evidence-based care in this area and that is what we excel in!” said Owner and Licensed Physical Therapist Dr. Brett Fox PT, DPT, OCS, COMT.

This location will be led by Clinical Director Dr. Eric Alexander, DPT, OCS, Cert. MDT, CSCS who has been a part of the Fox Physical Therapy team for four years now. “I’m excited to provide specialized orthopedic and spine care to the Brickell community. Our goal at Fox PT is to help active people in Miami return quickly from injury and I feel this clinic fills a pressing need for skilled physical therapy in that area of the city” 

My (insert body part) cracks every time I… Is that bad?

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Does your body often make craking, popping, clicking, grinding noises when you move?

By: Dr. Ashley O’Rourke

This is one of the most frequently asked questions I get on a day-to-day basis. A patient will be on the table and say to me “my shoulder cracks every time I raise my arm…is that bad?” or “I feel a click in my knee every time I extend it…how do I get it to stop?”. The reality is that there are many explanations for these sounds- most of which are often entirely harmless if not accompanied by pain. There are, however, some cases in which the sounds should be addressed with the general rule of thumb being: any of these sounds occurring in a joint that is not accompanied by pain are typically nothing to worry about.

Let’s Differentiate the Noises:

Popping: all joints are surrounded by synovial fluid. Think of this as your body’s natural oil. It lubricates the joints to decrease friction between the surfaces. Changes are pressure- which can occur with movement- can cause gas bubbles to form within the fluid. When these bubbles implode or “pop” the sound associated with “cracking your knuckles” is produced. To physical therapists and chiropractors, this sound is known as a “cavitation”. They are painless, do not cause damage, and often even relieve symptoms (at least temporarily). It takes time for this gas to build back up, which is why you cannot repeatedly crack the same joint over and over and over again. While one should not be worried about cracking their knuckles from time to time, repeated attempts over a short period of time should be avoided as this can eventually cause changes in the joint capsule or train the brain into thinking they “need” to perform this activity over and over again (forming a habit) when in fact it is not necessary.

That being said, a “popping” sound coming from the lower leg that occurs after landing from a jump shot while playing basketball or in the knee after cutting/pivoting on the soccer field could indicate serious injury such as an Achilles rupture or ACL tear- both of which would most often be heard/felt in conjunction with pain.

Snapping: There are other sounds that are not serious, but over time could lead to chronic injury. An example of this could be snapping in the outside of the knee. In the beginning, this snapping sensation may be quite annoying, but not cause any pain. It is by no means an emergency, however, with repetitive motion and frequent activity this friction that occurs as the connective tissue (iliotibial band) rubs against and snaps over the thigh bone can cause inflammation and irritation of the tissue leading eventually to pain. Similarly, people can experience a like feeling in the hip known as the “snapping hip phenomenon.” This can be due to tightness in the muscles/tendons rubbing over the bone.

Clicking: this sound can sometimes be problematic if it is a result of connective tissue abnormalities such as a torn meniscus in the knee or torn labrum in the shoulder/hip. These would both be typically associated with pain. Additionally, sometimes a clicking sensation can be felt in the knee cap which can indicative of a tracking issue where the knee cap does not stay perfectly in the groove that it is meant to stay in. While this may not cause additional symptoms in the short term, it too could cause pain in the long term like patellofemoral pain syndrome (PFPS) or generalized knee pain caused by muscular imbalances that lead to abnormal stresses to be placed upon the knee.

Shift/Clunk: This sound/sensation can be a little more concerning and indicative of instability or laxity in the joint leading to subluxation or full dislocation. People with joints that are “too loose” may experience clunking when the two joint surfaces rub together. Seeking treatment would be indicated to work on the stability of the joint through strengthening the tissue around it in order to prevent dislocations that could result in tissue damage such as torn ligaments/joint capsule damage etc.

Grinding: This type of sound is most often associated with general degeneration of cartilage within a joint, such as osteoarthritis, and occurs when there is bone on bone contact. This sound may increase over time as it is normal for joint surfaces to change with age.

Other Noises: sometimes a painful or non-painful “pop” can be heard during manual therapy- perhaps while a PT is moving a knee after surgery. This sound can be indicative of the breaking up of scar tissue and may be beneficial if it leads to improved mobility.

Free Consultation

If you are uncertain whether you are experiencing a normal joint sound or something problematic, let the qualified doctors at Fox Physical Therapy assess the tissue to determine whether intervention is warranted. Give us a call today for a free consultation.

Spinal Manipulation Treatment for Cervical Radiculopathy

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Randomized Clinical Trials show Thoracic Spinal Manipulation to be an effective treatment for Cervical Radiculopathy

If you have symptoms of pain/tingling/numbness in your shoulder/arm or hand, it is likely a result of a problem stemming from your neck commonly known as cervical radiculopathy, and it is most commonly associated with a cervical disc derangement or other space-occupying lesions, resulting in nerve root inflammation or impingement. As a result of the nerve being compressed, it can send these symptoms down the arm and into the hand. Generally speaking, the further down the arm the signs travel the worse off it is. This is called peripheralization. When pressure is relieved in the neck and upper extremity, hand symptoms may disappear or move toward the area that is producing them- the point of origin (the neck). This concept is called centralization and is a good thing. This means that you are closer to recovering from your condition.

So does something as simple as cracking your neck help?

This is a question that people have wondered for years is does cracking your neck help to relieve the pain? Recent evidence supports that it does! The use of high velocity, low-amplitude (HVLA) thrust manipulation of the thoracic spine- or upper to the mid-back area- is evidenced to increase ROM and decrease pain more than the non-thrust mobilization of the same joints. In a study published in the Journal of Orthopaedic & Sports Physical Therapy, one session of thoracic manipulation resulted in improvements in pain, a disability rating, cervical ROM, and deep neck flexor endurance in patients with cervical radiculopathy. Immediately after treatment and around the 48-to-72-hour window following the procedure, the manipulation group had at least moderate improvements in symptoms compared to the sham manipulation group. The manipulation group also had moderate to substantial changes over time.

But is it safe? Could it worsen the symptoms?

In the same study, adverse reactions were also recorded and indicated that this should not be a concern. No increases in the neck, arm, or hand symptoms were reported immediately after the treatment or at the 48-to-72-hour follow-up. Additionally, no soreness lasting more than 3 hours was reported.

The findings of this study support clinician decision to use spinal manipulation for both immediate and short-term benefits for patients with cervical radiculopathy and support that thoracic manipulation specifically, in patients with cervical radiculopathy, is an effective early treatment option.

What are the sounds you hear with “popping or cracking” joints and where are they coming from?

This has also been a hypothesized subject for quite some time. The “popping sound” phenomenology is still not fully understood. Traditionally it has been accepted that the “popping sound” is a result of gas bubble collapse, but it is unclear whether or not this is true.

When there is a “pop”- formally known as a “cavitation,” it has also been unclear exactly where the sound is coming from until now. The popping sound, or high-frequency vibration, should be expected as the desired effect of HVLA thrust manipulation provided from an external force that creates motion at the joint level. The sound is one of the main features that define an HVLA thrust manipulation.

According to a recent study titled “Unilateral and Multiple Cavitation Sounds During Lumbosacral Spinal Manipulation” practitioners performing spinal manipulation at the low back-pelvis area, or lumbosacral region (specifically L5-S1), should expect multiple popping sounds that most often occur on the upside or the downside facet articulations, but not typically both. There is, however, still question as to whether the multiple “popping sounds” found in this study emanated from the same joint or adjacent ipsilateral or contralateral facet joints. Therefore, it cannot be determined whether or not it is possible to isolate a single spinal segment during HVLA nor whether the relief felt by the patient is due to “correcting” a single-targeted joint dysfunction or multiple at once. The methods also may not necessarily be able to explain all of the audible sounds during HVLA thrust manipulation.

The study WAS able to determine that the “popping sounds” were no more likely to occur on the upside [176 ipsilateral pops] or the downside [144 contralateral] pops) during [60] HVLA thrust manipulations, but they were almost always unilateral with only 2% of cases resulting in “popping sounds” occurring on both sides. Further research is needed to investigate the remaining unknowns.

Who can perform this treatment for me?

At Fox Physical Therapy, all of our clinicians can perform the thoracic manipulation treatment described above. Additionally, Dr. Fox, Dr. ‘O’Rourke, Dr. Alexander, and Dr. Espinosa are all SMT-1 certified having completed additional continuing education specifically in Spinal Manipulation Therapy. Let us help you today!

Why You Should See a Doctor of Physical Therapy When You First Get Injured 

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Why You Should See a Doctor of Physical Therapy When You First Get Injured

Studies show that seeking treatment from a physical therapist can speed up healing time, reduce medical expenses, and lessen the need for pain medication

A Doctor of Physical Therapy is trained to evaluate and treat a variety of conditions ranging anywhere from chronic lower back pain to stroke. But why see a physical therapist before another provider? According to a study of 150,000 insurance claims, patients with low-back pain are actually better off seeing a physical therapist first in regards to alleviating their pain. The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription (therefore avoiding the risk of addiction), a 28 percent lower probability of having advanced imaging services performed (saving the patient money), and a 15 percent lower probability of an emergency department visit. It did, however, show a 19 percent higher probability of hospitalization- but why is this a good thing?
This higher rate of hospitalization indicates proper referrals by PTs to specialized care when pain does not resolve by addressing potential musculoskeletal causes first and, instead, may indicate a more serious issue such as an underlying systemic condition-heart condition, renal failure, cancer etc. Not only can physical therapy make you feel better, but it can reduce the cost of unnecessary imaging, reduce potential dependence on pain medication and “catch” potential underlying conditions early leading to better treatment options and outcomes for such conditions.

Why seek care from a Doctor of Physical Therapy versus a traditional Physical Therapist?

The ability to recognize and properly refer patients who present with conditions that do not appear to be musculoskeletal in nature is one reason why seeing a Doctor of Physical Therapy (DPT), would be advisable versus seeing a traditional Physical Therapist Assistant or Technician. This ability to screen patients for various non-musculoskeletal conditions is one reason why the doctorate level degree was developed in the first place. These DPTs have had additional coursework focused on recognizing yellow and red flags for general medical conditions that may not be treatable with physical therapy. They have also had more education on the nature of such comorbidities leading to a more holistic approach to therapy.

Did you know that a physical therapist can specialize in certain injury types and sections of the body?

Although 42% of patients know that physical therapy can only be performed by a licensed physical therapist, 37% still believe other health care professionals can also administer physical therapy. What they may also not know is that additionally, many Doctor’s of Physical Therapy choose to pursue board certification by the American Board of Physical Therapy Specialties (ABPTS) in specific areas such as neurology, orthopedics, sports, pediatrics, geriatrics, electrophysiology, cardiovascular & pulmonary and/or women’s health. This means that if you are seeking treatment from a DPT with these credentials, you have the opportunity to obtain more specialized care.

Specialty Physical Therapy Credential Designations:

In order to become specialized PTs must: 1) have current licensure to practice physical therapy in the United States, Puerto Rico, or the Virgin Islands; and 2) have at least 2,000 hours of direct patient care in the specialty area (25% of which must have occurred within the last 3 years). Additional specific requirements are required by each specialty area. PTs must pass the specialist certification examination and be recognized by the American Board of Physical Therapy Specialties to use the above designations.
• CCS (Cardiovascular and Pulmonary Certified Specialist)
• ECS (Clinical Electrophysiologic Certified Specialist)
• GCS (Geriatric Certified Specialist)
• NCS (Neurologic Certified Specialist)
• OCS (Orthopaedic Certified Specialist)
• PCS (Pediatric Certified Specialist)
• SCS (Sports Certified Specialist)
• WCS (Women’s Health Certified Specialist)

What is the difference between a Doctor of Physical Therapy and Physical Therapy Assistant or Physical Therapy Technician?

Physical Therapist (PT): Physical therapists are licensed professionals who have completed an accredited physical therapist program (degrees have evolved from 4-year bachelor degrees to 7-year clinical doctoral degrees) and have passed a licensure examination.
Physical Therapist Assistants (PTA): are educated at the associate degree level. Depending on state law, they may be licensed, certified, registered, or unregulated depending on the state. PTAs may only provide physical therapy services under the direction and supervision of a physical therapist (PT). They may not perform evaluations, re-evaluations, discharges or alter the plan of care. They may only execute the plan of care established by the PT.
Physical Therapy Technician: have no regulatory designator. Physical therapy aides and technicians are on-the-job-trained workers in the physical therapy clinic who assist the PT/PTA with tasks related to physical therapy services. They are not eligible for license, certification, or registration.

Selective Functional Movement Assessment

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Selective Functional Movement Assessment Miami Boca Raton

Selective Functional Movement Assessment

Selective Functional Movement Assessment is a series of tests designed to evaluate a patient experiencing chronic pain. The assessments can identify issues in your movement to pinpoint a root cause. We can then use manual therapy, and corrective exercises to fix the problems

The Selective Functional Movement Assessment (SFMA) is a comprehensive assessment used to classify movement patterns and direct manual therapy and therapeutic exercise interventions. Regional interdependence is the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint. Often times, patients present with symptoms in certain locations, however, this particular area is not the cause of the symptoms. The SFMA utilizes a movement-based strategy in order to determine any movement pattern dysfunctions that may be contributing to any particular symptoms. There are numerous studies that have linked dysfunction in one area of the body with pain and dysfunction in another area of the body. The most common of these examples include hip impairments that are related to low back pain and thoracic spine impairments related to neck pain. In short, regional interdependence provides the theoretical support to assess and treat a non-affected body part. Rehabilitation professionals are the most highly trained healthcare professionals to function within this model.

The SFMA consists of 10 defined functional movement patterns that are considered top tier patterns. Shoulder a patient report pain during any of these movements, or exhibit “dysfunctional” movements as defined per certain criteria, the patient pattern will be broken into its individual parts, known as pattern breakouts. Utilizing these pattern breakouts, the rehabilitation professional is able to define impairments as either lack of mobility via Tissue Extensibility Dysfunction (TED), Joint Mobility Dysfunction (JMD), or Stability &/or Motor Control Dysfunction (SMCD). Utilizing this information, we can create a therapeutic plan to address all impairments that may be contributing to a patient’s symptoms.

Here at Fox Physical Therapy, our Doctor’s of Physical Therapy are SFMA certified. This allows us to conduct the highest quality, evidence-based approach to developing our patient’s plan of care. To schedule an appointment in Miami or Boca Raton, please call us at 305-735-8901 or click here.

References: SFMA Selective Functional Movement Assessment, Ver 16 ed. : SFMA, LLC; 2016.

What is Blood Flow Restriction Training?

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What Is Blood Flow Restriction Training?

Can Blood Flow Restriction Training help improve patient recovery time following an injury? Read our post below as we discuss everything you need to know.

Blood Flow Restriction (BFR) Training is a strategy involving the brief and intermittent occlusion of arterial and venous blood flow that occurs with use of a tourniquet placed around the proximal limb of the upper or lower extremity. When performing BFR for resistance training purposes, relatively light loads of around 20-30% of 1 RM allow a person to increase strength without the stress/strain of heavy loads.

blood flow restriction tourniquet

Resistance training with BFR has also been shown to increase post-exercise muscle protein synthesis and elevate growth hormone levels. It can be used to improve muscle strength, size and functional aerobic capacity in shorter amounts of time with less stress on the body than typical resistance training. Blood flow restriction training (BFRT) essentially tricks the brain-body into thinking one is performing high-intensity exercise when, in fact, the loads are much lower. BFR can also be used to reduce muscle atrophy through passive applications and by creating cellular swelling.

Who can benefit from BFR?

BFR can be useful for rehabilitation, fitness, performance training or recovery and is ideal for populations who have limitations to high mechanical loads such as those who are bedridden, casted/braced, pre/postoperative and/ or elderly. In addition to these more fragile populations, BFRT can also be used on the athletic community for performance training.

How is it used? What does a treatment session with BFR look like?

BFR can be used in different ways depending on the goals and limitations of the individual. In all circumstances, the cuff is first applied as proximal on the limb as it can be placed. Next, the loss of pulse (LOP) is calculated using an ultrasound unit to determine at what pressure a person’s pulse in that limb can no longer be detected. Lastly, a pressure in the cuff is set depending on the type of BFR to be performed.

In Passive BFR (no exercise) used to reduce muscle atrophy and stimulate capillary growth, the cuff pressure is set to 100% LOP and a patient sits with the cuff on for 5-minute increments with 5 minutes of rest in between. In Cellular Swelling and Strengthening protocols, the cuff pressure is set between 40-50% for the upper extremity and 60-80% for the lower extremity. When strengthening, the intensity should be 15-30% of a person’s 1 rep max, and 4 sets should be performed (30 reps; 15 reps; 15 reps; 15 reps) with 30 seconds of rest between each set. A total of 5-6 exercises should be performed during the treatment session with 60 seconds of rest between each new exercise while the cuff is deflated.

If the goal is not strengthening, but cellular swelling, which reduces disuse atrophy and recruits muscle fibers (perhaps someone with ROM or WB restrictions), a person should perform 5 sets of 5 minutes with a 3-minute rest in between. This can be achieved with no exercise or while performing isometrics. These are but a few of the ways BFR can be implemented into a person’s rehabilitation or strength training program.

For more information on BFR, contact us today, click here. 

What is Eccentric Strengthening?

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Eccentric Strengthening Miami and Boca Raton

What is Eccentric Strengthening?

Eccentric contraction exercises are an important and often overlooked component of strength training.

By: Dr. Ashley O’Rourke PT, DPT, ATC, LAT

Eccentric strength refers to tension being applied to a muscle as it lengthens. This is also when the muscle’s force-producing capacity is most optimal. Studies show that eccentric exercise results in less oxygen consumption, greater force production, and less energy expenditure than concentric strengthening- or the active shortening of the muscle. The force produced by a concentric contraction is always less than the muscles maximum force. During a voluntary muscle contraction, the speed of the contraction and the ability to exert tension are inversely related. Therefore, the faster a muscle contract concentrically, the lower the tension it is able to generate. An example of concentric strengthening would be a classic bicep curl, whereas the eccentric component would occur as a person lowers the arm into a straightened position (as the bicep muscle lengthens).

 Eccentric Strengthening in Post-Op Knee Rehab:

Eccentric quadricep and gastrocnemius (calf) strength, in particular, are important following knee surgeries such as ACL reconstruction because of their importance in absorbing the weight of your body as they lengthen in order to control your descent- this includes going downstairs, sitting down in a chair or decelerating from a sprint. Without sufficient eccentric control, it would be difficult and, in some cases, unsafe to perform these activities. In regards to running, the primary muscles involved in acceleration and deceleration are quadriceps and gastrocnemius. However, acceleration involves the concentric contraction of these muscles, while deceleration involves the eccentric use of these muscles. Therefore, eccentric strength is important to safely slow down following a sprint or before initiating a rapid change of direction. Research suggests that eccentric strengthening on the non-involved lower extremity is also beneficial for improving both the quadriceps muscle strength and the quadriceps accelerated reaction time in the surgical lower extremity.

Concerns with Eccentric Strengthening in Post-Op ACL:

Though the idea of early post-operative eccentric resistance exercise to the surgical limb has traditionally been contraindicated, due to the potential for injury to the graft, articular cartilage, or surrounding soft tissue structure, recent evidence has shown that the application of early eccentrics to the ACL limb can be used to safely increase quadriceps muscle volume and strength. While eccentric quadriceps strength is important to regain following ACL reconstruction, it does not come without caveats. As with any eccentric training program, careful progression of training volume and intensity in the post ACL reconstruction patient is a necessity and should be performed under the direction of a licensed physical therapist as too much eccentric quadriceps strength could increase the chances of anterior tibial translation if not accompanied by sufficient hamstring strength. Therefore, a comprehensive approach, including both concentric and eccentric training to both the anterior and posterior chains surrounding the knee joint should be considered.

Take-Home Message:

Eccentric exercise has the ability to be an effective means to manage many common orthopedic conditions such as tendinopathies, post-op recovery, and muscle strain prevention. This potential is based on muscle/tendon physiology as it relates to performance. Eccentric exercise, or when the muscle is lengthened and an external force exceeds the force produced by the muscle, has been shown to be more effective than traditional concentric strengthening at minimizing muscle atrophy and improving muscle force production. It results in less oxygen consumption, greater force production, and less energy expenditure and should be incorporated into both a preventative strength training program, as well as, an effective post-op rehabilitation protocol.

Schedule Your Appointment

To learn more about our eccentric strengthening program and to schedule a consultation call 305-735-8901 or click here. 

The Benefits of Functional Range Conditioning

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The Benefits of Functional Range Conditioning

Learn to increase mobility, build strength and prevent injury using Functional Range Conditioning

Functional Range Conditioning MiamiFunctional Range Conditioning is a system of training which applies scientific methods to the acquisition and maintenance of functional mobility, articular resilience, and articular health and longevity. It was created by Dr. Andreo Spina and is quickly growing in popularity due to its effectiveness in training mobility of the human body. Mobility refers to the amount of active, usable motion that a person possesses. The more mobile a person is, the more they can maximize their movement potential safely and effectively. It is the difference between being flexible and able to stretch to specific passive ranges versus having actual control into those end ranges of motion. By training mobility one can capture what was once only passive ranges of motion and make them active and therefore usable. This, in turn, enhances the load bearing capacity of a joint and its ability to withstand the forces of everyday activity and sport.

Not only does FRC help to improve the mobility of the human body and develop improved load capacity in the joints, but it also improves body control. Body control is one of the critical factors in reducing the occurrence of injury and painful conditions that frequent training and sport.

To achieve the improvements in mobility, joint strength, and body control FRC implements two critical principles into the system. They are the principle of progressive adaptation and the principle of specificity. The principle of progressive adaptation states that incremental loads applied to the tissue results in adaptation of said tissue in such a way that the load absorption capacity will improve. This also makes FRC an inherently safe system to use. The loads applied to the tissues early on are scaled only to what that person can tolerate. As their tolerance improves so to will the articular strength of the joint. The principle of specificity states that the adaptation of the tissue is specific to the demand. This means by frequently incorporating end range mobility training into the maintenance and training of the human body, one is effectively injury-proofing themselves. The vast array of musculoskeletal injuries occur when tissue is loaded past what it can tolerate or the new demands on the tissue exceed what was previously the norm. By moving the joints of the body through all available ranges of motion and training into these ranges there will rarely be a situation the body is not already prepared for.

At Fox Physical Therapy we always seek to stay on the cutting edge of evidence-based practice. Dr. Fox and Dr. Alexander became certified in FRC last fall. FRC has seamlessly blended into the daily clinical practice and has only enhanced the already great outcomes expected here at Fox. If you are feeling stiff during sports or experiencing aching joints from a sedentary desk job, we encourage you to give us a call. Once in the clinic, you will learn how to perform the necessary maintenance work necessary to keep your body healthy and operating at optimal function.

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