Can You Treat A Labral Tear?

Labral tears of the hip or shoulder are generally regarded as very detrimental injuries. A result of significant trauma to the joint, such as from a car accident or sport impact, these tears to the joint cartilage are considered to be structurally limiting and requiring surgery in nearly all cases.

With that being said, many people tend to assume that there is little to be done in terms of rehab before (or unless) the operation has been done.

It's good to point out, however, how often labral tears are completely asymptomatic in individuals. For perspective, one study found 43% of tested subjects without symptoms to have a labral tear in their hips while another recorded that rate as high as 69%! As far as the shoulder goes, we found results of up to 72%.

So what does that imply?

It means that, while conservative therapy can't repair a torn labrum, that there is a possibility of relieving the symptoms as if it they weren't there. After all, look at those numbers of people walking with damaged labrums and had no idea!

Manual therapies such as massage in combination with active rehab and exercise can recondition the joint, in many cases, to perform its functions with minimal or no discomfort. True, other cases will certainly require surgery, but it goes to show that it's well-worth exploring the conservative options first.

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Remember, Scar Tissue Doesn't Break Down

Scar tissue is a natural product that comes out of a tissue injury. Skin, muscle, tendon; most of the body's bits and pieces will scar over when an injury occurs.

Realistically, the song, "Scar Tissue", probably also resulted from some type of past deep-hurt.

A lot of therapy claims center around the ability of a technique to break down scar tissue.

However, let us remind everyone of the deep, dark secret of the therapy world: Scar tissue does not "break down".

And it doesn't have to! (Just putting that out there before you lose hope and close your screen.)

To be quick and make things simple to understand, consider when you have a large cut on your skin which then scars over. Do you think any amount of aggressive massage would make that scar go away? Does manual pressure cause either that scar OR the skin to "break apart"?

No? Then you can imagine how counter-intuitive it is to think that those same forces can break down a scar inches beneath the skin.

However, this doesn't need to mean that all hope is lost in the recovery process, as we mentioned. Consider this; does the scar on your skin continue to be tender and cause pain years later, even when it remains visible? Does it do a poor job replacing the skin that was damaged?

No, that scar is an effective bridge between the gaps in healthy tissue. And the same goes for scarring that occurs within muscle, tendons, and ligaments.

Yes, muscles and ligaments are more complex in their functions to hold the joints securely together and will typically cause more pain at the onset of injury. But that's where the manual therapies come into play. While they do not physically break down any of that scarring, what these techniques do do is decrease the sensitivity and pain in the area to allow the healthy tissue to learn to carry on its function despite the presence of that scar.

(Remember, these therapies have a more direct effect on your nervous system rather than the tissue itself.)

In the end, none of this really changes the way that treatments work except for providing a better explanation behind them. That knowledge comes in very handy, however, in order to have the confidence to accelerate in your own recovery and to avoid false claims and money-grabs.

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Weightlifter's Guide To Warming Up

We're returning to the second-busiest season of the year for the fitness industry. As such, we created a quick guide to warming up for the weight room based on facts that aren't typically discussed in the mainstream.

1: Going heavy? The warm up should be heavy.

Working with athletes, Athletic Therapists see the difference between a good and bad warm up once the game starts.

The fact is, the light going-through-the-motions warm up commonly seen at the gym is often not going to be enough. Especially when intending to do a very heavy and hard workout, the warm up should build up to be equally so.

Realistically, a hard workout (or competition) should require a warm up that leaves you sweaty and out of breath. It seems counterproductive, but this is the only way to truly prepare your muscles for the work it's about to do.

2: Warm up all the joints you intend to work. As well as many that you don't.

Warm ups should be specific. If you plan to have a heavy arm workout, then 20 minutes on the treadmill won't effectively get your shoulders ready for the load. While getting a nice, systemic bloodflow effect, warming up should target the joints you intend to use.

But, let's remember that other joints are at play during exercise, even when you're not specifically exercising them. The shoulders are under a lot of stress when doing barbell squats on leg day. The lower back is under a lot of use when picking up your dumbbells for a shoulder workout. You'd be surprised how often injuries to the non-targeted joints occur during workouts.

As such, while you want to target the bulk of the warm up on the joints that are going to be worked the most when in the gym, a broader focus on the rest of the body, in general, will help avoid unexpected strain elsewhere.

3: Stretching? Well...

It's fairly common knowledge that an active warm up should be utilized prior to exercise while stretching is best reserved for after.

BUT, did you know that static stretching (stretch and hold) may not even be as beneficial as once thought when done at any time?

But how will everyone know that I just worked out if I don't stretch?

In reality, static stretching hasn't been shown to result in significant decreases in injury rates or long-term gains in range of motion.

In contrast, we actually see greater range of motion increases as we strengthen our muscles through their full range. As well, greater injury prevention rates have been found by means of an active warm up prior to exercise and an active cool-down after. (So basically a warm up, except backward.)

4: Don't mobilize in ranges you don't intend to use.

This is a fun one. "Mobility" is a big hot topic in gyms these days, and a lot of us assume that mobilizing and freeing up all the joints in every direction is the key to keeping them healthy.

However, this is a concept taken out of context. If you don't intend to use and strengthen through a particular range, then you shouldn't be trying to mobilize it. By increasing range and not replacing restriction with strength, all we're doing is creating laxity.

Preparing to do all those resisted shoulder hyperextensions
that we see ALL the time at the gym.

What's more, remember to mobilize gradually, even when hitting the properly-targeted joint. Otherwise, we see the same issue of too much laxity being created too soon before the musculature is ready to accommodate for it.

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Willingness To Change

In essence, a willingness to change is mandatory when seeking any expected new outcome.

But is it mandatory right from the start?

A client once came to us with absolutely no expectation that she could ever get better and vocalized her adversity to any type of exercise. Essentially, she let us know to not expect her to follow an exercise routine for treating her pain at all.

Ok, pressure was on.

Like we discussed previously, we're not proponents of the, "Just do it" approach with clients. We can guarantee that this client would have walked out of our door at the end of the session and we would have never seen her again after that.

Props to her, however. She was willing to discuss her unwillingness to exercise and the reasons behind her pain prognosis.

And as the professionals, it was our job to work with her from her starting point. Wherever that starting point was.

That starting point revolved mostly around pain and body education coupled with some gentle movements to do when getting out of bed to limber up the joints. Nothing that we would normally consider exercise.

From there, it was a building process. As results started to trickle in, no matter how minor, it became apparent to the client that success was based upon her own input. After starting with the most minor of homework requests, we slowly developed a willingness to change.

Today, this client is still on her road to recovery, but feeling much better than she did on day-one and feeling proud that she is adhering to an exercise routine for the first time in her entire life. In fact, she's close to perfect when it comes to sticking to her rehab plan every day!

And so we digress: A willingness to change isn't necessary from the start, but a willingness to discuss it is.

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That First Step

Whether it's pain, diet, or general health, people are constantly seeking solutions for improvement.

Unfortunately, the world is full of trolls spouting the whole, "Just do it!" approach.

Which is know, as a fact, is a flawed philosophy.

It's a sad reality; even among the educated professionals that serve the public are individuals who are telling patients and clients that improvement is a flicked-switch away. There's an implied expectation that an individual can change every required habit in a matter of weeks.

Have you been anywhere outside a gym lately? You would know that it's easier said than done.

And that is just demeaning. The fact that it's easy (or at least routine) for one person to stay healthy does not, at all, speak to another person's lifestyle.

As pain and injury professionals, we want our clients to feel comfortable that visiting us will not result in a guilt-trip on your habits or an expectation that you need to change overnight.

Rather, all we need from you is that first step to come and ask for help. As mindful professionals, it's not our job to judge OR to dictate. We work for you,  so it's not our job to simply write the manual for you and hope you'll follow it. It's our job to assist you with mapping your own game plan with as small of steps as required.

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Is Sitting Really Killing Your Back?

Welcome to the 21st century, where the average hours of sitting per person seem to be on the rise. And with that, we increasingly discuss the role of all of those seated hours on our health.

We've all heard about how sitting is the new smoking, and it makes perfect sense. More sitting automatically means less exercise, which is a clear pathway toward an all manner of health concerns such as cardiac illness and obesity.

But what about the effects of sitting, specifically, on our back pain?

It should be of no surprise that an increase in the number of sitting hours is correlated closely with an increase in back pain.

With that being said, standing desks are the answer, right? Well, unfortunately, standing without the option to sit is also shown to relate to back pain.

What information online usually fails to show us is how other factors, such as frequency of breaks from the static working posture, come into play.

In fact, the larger increase in back pain is shown to occur in prolonged sitters who have fewer interruptions from their positions. Meanwhile, those who regularly moved from their chairs (whether it was for work away from the desk or a deliberate break) were shown to circumvent back pain much more easily.

We found one small study that looked closely at cycling between three different static working postures to show a significant decrease in overall discomfort.

All in all, it should be emphasized that the only bad posture is the one held for too long. Regular breaks from your working position, whether it's sitting or standing, will be the most effective piece of the puzzle to avoid discomfort.

It's time to quit worrying about how we sit and just take those quick moments throughout the day to interrupt the sitting.

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Learning To Move

It's the understanding that your therapist is going to be the expert in teaching you how to exercise.

But there's a step further that's vital when recovering from an injury.

After you learn how to exercise, you must learn how to move.

We wrote before on how exercises in the gym tend to not practically mimic our day-to-day movement habits.

It's one thing to know how to deadlift weight. But it's also necessary to learn how to drop form and allow the body to comfortably and naturally move outside of an exercise setting.

For instance, it's common at our clinic to have to teach even very fit and strong individuals how to comfortably round their spines.

The answer is, "No".

This hesitancy (and sometimes inability) for even healthy individuals to be unable to attain these textbook-IMperfect positions doesn't boil down to either a strength or a flexibility deficit. It's simply a trained response that we've taught our bodies.

Oftentimes, a conditioned fear of movement develops, whether it's appropriate or not. It's regardless of whether we teach it to ourselves or it's a doctor or fitness professional that instilled it; telling the brain that rounding the spine, lifting overhead, or jumping is going to be harmful enough times will result in your body having a poor reaction when those movements are attempted. And it doesn't matter if the raw strength or flexibility to perform those actions is present or not.

So while we therapists are the experts in how to exercise, the right one will also be the expert in how to move. It goes beyond strengthening and stretching muscles; it's about teaching the body how to be tolerant of movement beyond what we see in the weight room.

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