Ongoing calf pain in New York City is common in runners and other athletes, but we can get to the bottom of the issue

For most active individuals who make fitness a regular part of their routine, occasional pain and soreness is expected.  Runners and anyone else who incorporates lots of running into their regimen are usually accustomed to pain in several parts of the leg, including the calf. Calf pain in New York City tends to feel like a sudden pull on the lower leg that comes about when walking or running, often interfering with one’s ability to keep active.  In some cases, calf pain may become an ongoing—or chronic—issue that does not improve over time.  When this occurs, it’s best to see one of our physical therapists so we can determine what’s causing the problem and create a treatment program to resolve it.

The calf is not a single muscle, but actually consists of several muscles that each has a unique function.  The three primary calf muscles are as follows:

  • Gastrocnemius: the big, bulky muscle that most people think of when referring to the calf; the gastrocnemius has two heads and spans from the lower end of the thighbone (femur) to the back of the heel, where it connects to the foot through the Achilles tendon; this muscle allows you to push your foot downwards—which is called plantar flexion—and helps you bend your knee
  • Soleus: this long, flat muscle lies behind the gastrocnemius, along the back of the shinbone (tibia); the soleus also helps to plantar flex the foot—especially when the knee is bent and the gastrocnemius is being used—and helps to keep the body upright when standing
  • Plantaris: this very small, thin, rope-like muscle lies on the outside of the calf area and crosses over both the knee and ankle; it assists the gastrocnemius with both plantar flexion and flexing of the knee

A calf strain occurs when one of these muscles is overstretched or overworked to the point where the muscle is damaged.  Any calf muscle can be strained, but the gastrocnemius is most commonly affected because of its size and the significant role it plays in both the ankle and knee joints.  A sudden, traumatic calf strain is referred to as an acute injury, and symptoms usually include swelling, weakness, tightness, and pain that tends to get worse with movement.  In some cases these symptoms may go away on their own but then return some time later, especially with repeated physical activity that involves the calves.  This is called a chronic or repetitive calf strain, which may be more difficult to address than an acute injury.

Alleviating symptoms and improving function for calf pain in New York City

Fortunately, our physical therapists are adept at diagnosing and treating calf pain in New York City.  When addressing these injuries, our goal is to first identify which calf muscle is damaged, as targeting the wrong muscle can lead to delays in healing. From here, we will craft a unique treatment program based on the calf muscle that’s been injured and your personal goals and abilities.  Most programs will include the following:

  • Pain-relieving modalities: ice, heat, ultrasound, taping, heel lifts, and other interventions will be applied to immediately reduce your pain levels
  • Manual therapy: your therapist will use variety of hands-on techniques that target the calf and surrounding area to alleviate symptoms and improve function
  • Strengthening exercises: your physical therapist will prescribe specific exercises intended to improve your strength and agility, which may include cuff weights, stretchy bands, weight-lifting equipment, and cardio exercise equipment
  • Flexibility exercises: your therapist will also recommend specific activities to help restore the flexibility of your knee and ankle, which is often lost with calf injuries
  • Home-exercise program: additional strengthening and flexibility exercises may be prescribed for the calf, toe, knee, and ankle to prevent future injury of your calf

Calf pain in New York City can be a nuisance to your exercise routine, especially when you think you have the problem under control but it eventually returns in full force.  If you’re dealing with any type of calf issue, our physical therapists can figure out what’s going on and address it with a targeted treatment program.  Contact Dynamic Sports Physical Therapy in New York City to schedule an appointment today at212-317-8303, or click herefor more information on calf strains.

Success stories from Dynamic Sports Physical Therapy in New York City: Mason is able to return to his normal activities after just four treatment sessions

Mason came in to see us at Dynamic Sports Physical Therapy in New York City complaining of stiffness, pain, and spasms on the right side of his abdominal muscles.  These symptoms were bothering Mason and interfering with his ability to turn in and get out of bed, which led him to seek out treatment.  He also pointed out that he had a limited ability to rotate his torso and reach overhead and across his body, which was affecting his upper body workouts, rowing, and playing golf.

After hearing Mason explain these symptoms, his physical therapist performed a complete evaluation of his abdominal muscles, shoulders, and mid and lower back.  This evaluation revealed that Mason had severely limited range of motion when rotating the mid back and moving the shoulder in a number of directions.  He also had increased sensitivity, pain, and stiffness in the mid-back, shoulder, and right abdominal muscles, and significant muscular restrictions throughout a number of other abdominal muscles.  Additional findings included a reduced ability to dissociate mid and lower back rotation movements, inefficient breathing—with lots of breath holding—during rotational maneuvers, and poor strength in some key muscles of the spine and core.

Before beginning treatment, Mason stated that his goals were to reduce his pain levels, improve his posture, and regain flexibility throughout his upper body and torso.  He also wanted to improve his golf swing and flexibility habits for the long term.

Mason’s treatment program from Dynamic Sports Physical Therapy in New York City

Mason’s treatment program began with manual therapy that was applied by the hands of the physical therapist and followed an impairment-based approach.  Treatment sessions would start with manual therapy and then rapidly progress to include a home program that was to be performed as a pre-exercise/golf routine in the long term.  These sessions would include any or a combination of the following techniques:

  • Bed mobility techniques to protect the site of injury
  • Joint manipulation and mobilization of the thoracic spine and diaphragm/rib cage
  • Soft tissue massage
  • Taping to improve posture
  • Heated ultrasound
  • Cupping and the Graston technique
  • Assessment and training in golf swing components and ergonomics through a Titleist Performance Institute golf screen
  • Postural restoration and integration techniques
  • Stretching and strengthening exercises of the hips, shoulder, upper back, and diaphragm
  • Exercises for flexibility and stabilization of the core muscles throughout spine

After just four physical therapy treatment sessions, Mason began to notice a reduction in his abdominal oblique pain. He reported feeling more mobile and stronger when turning in and getting out of bed, and was also able to resume his upper body workouts, rowing and playing nine holes of golf without any injury recurrence or setbacks.

Mason had this to say about his treatment experience with us: “I am so glad I came to Dynamic after I got injured.  It was amazing that I started to feel noticeably better after a couple of visits! Now I can get back to working out, playing golf, and being with my three kids this summer without losing a beat.”

We couldn’t be happier that Mason experienced this type of outcome after such a short period of treatment, and wish him continued success in the future. If you’re dealing with any painful issues of your own, we invite you to give physical therapy a try and see what kinds of results you can experience.  Contact Dynamic Sports Physical Therapy in New York City today at 212-317-8303 to schedule an appointment, or click here to read our last blog on oblique abdominal strains.

Our New York City physical therapists explain why strains of the oblique abdominal muscles are so common in rotational sports

If you were to think about what regions of the body that are most likely to get injured in sports, the abdominal muscles would probably not be the first one that comes to mind.  Injuries to the knees, ankles, shoulders, and elbows are indeed far more common and typically worthy of the attention they receive, but they are certainly not the only areas where injuries occur.  Strains of the abdominal oblique muscles—or side strains—may not be all that well known, but they are actually quite common in sports, particularly those that involve rotational movements.  To give you a better sense of who’s at risk and how we can help, our New York City physical therapists dive into the mechanism of these strains in the athletic population.

Your body’s core is made up of lower back, abdominal, pelvic and hip muscles, which together provide balance and trunk stability that allows for certain movements of the limbs to occur, such as throwing and swinging.  The oblique muscles are found on the side of the rectus abdominis, which is the six-pack muscle that most people associate with the abs.  There is an external oblique that lies on top and an internal oblique that lies underneath both sides of the rectus abdominis, and these muscles play a significant role in flexing and rotating the trunk, as well as stabilizing it during complex sports movements.

Most abdominal injuries occur in either the external or internal oblique muscles through a number of possible ways.  Having poor mobility of the hips or mid-spine can put excessive strain on the trunk during swinging and throwing movements, which can result in compensation by other muscles.  An imbalance between the right and left oblique muscles is also common in sports like golf and baseball, which can put additional stress on the lead side oblique muscles.  This is why athletes involved in sports that involve rotational movements like throwing a ball or swinging a bat, club, or racquet are at a particularly high risk for experiencing an oblique abdominal strain.

The internal oblique is more likely to strain than the external oblique, and after the injury, patients typically experience a sharp, sudden pain in or around the rib cage.  The abdominal muscles are also tender and a bruise may develop.  Twisting and bending motions are usually painful, which can make it difficult to perform basic everyday tasks.

Treatment and prevention from our New York City physical therapists

After an oblique abdominal strain, athletes should stop participating in their sport to avoid further damage and seek out further assistance from a physical therapist.  Here at DSPT, our New York City physical therapists can provide you with an exercise program to alleviate symptoms and reduce the chances of further injury.  Most programs will include the following:

  • Cold therapy
  • Heat therapy
  • Compression
  • Strengthening exercises
  • Stretching exercises
  • Advice on what exercises and sports to stay away from
  • Guidance on how to modify your form to prevent future injuries

Even though oblique abdominal strains may not get the same attention as some of the more common sports-related injury, they can still be just as bothersome and frustrating for patients.  If you’re an athlete in a rotational sport dealing with symptoms that may suggest an oblique strain, our New York City physical therapists would like to help you.  Contact Dynamic Sports Physical Therapy at 212-317-8303 to schedule an appointment today, or click here for more information on oblique abdominal strains.

Success stories from Dynamic Sports Physical Therapy in New York City: Mark overcomes pelvic floor issues after completing a course of acupuncture

Mark came in to Dynamic Sports Physical Therapy in New York City after experiencing symptoms of pelvic floor dysfunction.  He complained of urinary frequency, tension in his pelvis, pain when sitting, and tightness in his buttocks.  He explained that he had suffered a tailbone injury in college and believed it was the event that led to the onset of his symptoms.  Mark also reported that stress, as well as a lack of sleep, both seemed to make his symptoms worse.

After learning of Mark’s injury history and set of symptoms, his therapist performed a full-scale evaluation to gather a clearer understanding of what was bothering him.  When palpation was performed—in which the therapist examined the size, shape, and other features of various body parts with touch—it was found that Mark had a lot of sensitivity and tightness in pelvic floor muscles, abdominal muscles, lower back muscles, buttocks, and hamstrings.  Palpation in the pelvic area also brought on symptoms of an urge to urinate.  Mark’s tailbone was shifted and sensitive to touch, and his pelvis was shifted as well.

Before beginning treatment, Mark stated that his primary goals were to reduce discomfort with sitting, reduce his urge to urinate, and alleviate some of tightness and pain.  Based on Mark’s condition, it was decided that acupuncture would be the most appropriate treatment to help him accomplish his goals.

A total of 14 acupuncture and cupping treatments were provided to address Mark’s symptoms. It was also found that Mark had a habitual pattern of clenching his buttocks when he was stressed, and when he became aware of the behavior, he started to work on eliminating the habit.  Mark was also advised to do yoga that specifically targeted the pelvic floor five times a week.  Finally, he was instructed to keep a food journal, and together, we worked through it to help him eliminate inflammatory foods from his diet.

After completing acupuncture, Mark reported that he no longer experienced pain with sitting.  His urinary urgency now only occurs occasionally, when he is very stressed or drinks too much coffee, and he no longer feels any pain or sensitivity around his tailbone.

Mark had the following to say about his treatment experience with us: “Thank you for making me feel so comfortable and allowing me to open up about my symptoms.  I am very happy to be pain-free and thank you for showing me how much lifestyle can have an impact on health.”

Experience similar results at Dynamic Sports Physical Therapy in New York City

Mark’s story shows that some physical issues may somewhat uncomfortable to bring up to a healthcare provider, but once they are shared with us, we can always find the best solution to address them.  We wish Mark continued success in the future, and encourage any of you dealing with physical ailments of your own to visit us at Dynamic Sports Physical Therapy in New York City to get started on a clear path to recovery. Contact us at 212-317-8303 to schedule an appointment today, or click hereto read our last blog on pelvic floor dysfunction.

A comprehensive physical therapy treatment program is the best way to address pelvic floor dysfunction in New York City

Many common physical ailments—like sprained ankles and low back pain, for example—can usually be discussed with a healthcare provider and addressed without much pause.  But other health issues are a bit more personal, and as a result, aren’t always easy to bring up to your doctor.  One condition that usually falls in the second category is pelvic floor dysfunction in New York City, which is more common that you probably think.  Fortunately, our physical therapists see patients with this complaint often, and we can offer an effective, comprehensive program to address it.

Approximately one in five individuals in the U.S. suffers from some form of pelvic floor dysfunction at some point in their life, but the problem is not always addressed due to its personal nature.  This means that millions of Americans are currently dealing with pelvic floor-related symptoms, and many are simply living with the pain and discomfort because they may not entirely understand what’s wrong or how to fix it.

The pelvic floor is made up of muscles and other tissues that form a “sling” from the pubic bone to the tailbone.  These structures assist in supporting the abdominal and pelvic organs, and help to control the bladder, bowels, and sexual activity.  While most people think of the core muscles as the abdominal and perhaps the lower back muscles, the pelvic floor is another major group that will affect the rest of the body.  Good pelvic stability will have a positive effect on spinal alignment, knee stability, hip function, and many other areas of the body, while poor stability can throw the entire system out of whack.

Pelvic floor dysfunction refers to a wide range of problems that occur when these pelvic floor muscles are weak or tight, or if there’s an impairment of the lower back and/or hips.  In these cases, the tissues surrounding the pelvic organs may have increased or decreased sensitivity, or there may be some irritation, which can result in a variety of symptoms.  Pelvic floor dysfunction may be due to pregnancy or childbirth-related issues, poor posture from low back or hip pain, direct trauma, or surgery, or in many cases the cause is unknown.  Symptoms and potential complications may include:

  • Pain in the lower back that is unrelated to other causes
  • Ongoing pain in the pelvic region, genitals, or rectum with or without a bowel movement
  • Painful urination
  • Constipation
  • Pain during sexual activity (for both males and females)
  • Leakage of stool or urine during exercise or exertion
  • Tailbone pain
  • Nerve pain in the pelvic region
  • Infertility/reproductive issues
  • Abdominal surgery
  • Cancers of the pelvic region 

Typical physical therapy protocol for pelvic floor dysfunction in New York City

Pelvic floor dysfunction in New York City can be a complex issue that requires the care of experts who are familiar with its many possible nuances.  Our physical therapists and acupuncturist see patients with pelvic floor issues frequently, and we are committed to identifying the source of the symptoms and then developing a personalized and comprehensive treatment program that addresses them.  Each program is unique and depends on the patient’s evaluation, but most will include the following components:

  • Pelvic floor strengthening exercises
  • Manual therapy
  • Posture retraining and education
  • Transcutaneous electrical stimulation (TENS)
  • Biofeedback
  • Myofascial release

So if you’re dealing with symptoms that may be related to pelvic floor dysfunction in New York City but are no sure what to do about it, we are here to help. Contact Dynamic Sports Physical Therapy at 212-317-8303 to schedule an appointment today, or click herefor more information on pelvic floor dysfunction.

After a rough accident and a series of setbacks, Jason is finally beginning his return to full activity

Hang around enough physical therapy places in New York City, and you’ll eventually hear a cyclist—and now patient—telling his story of the car that T-boned him at an intersection. Race director of the Westchester Triathlon and avid cyclist Jason Twedt was that unlucky biker just one week following the 2017 event.  According to Jason, he had been “left crossed” by an oncoming minivan.

“I was on my way home from a hard training ride,” he said. “I was tired, glycogen-depleted, grumpy, and I really just wanted to get home and have a beer. It happened in slow motion. I had the lane and a green light, and then a blue minivan driving the other direction made a left turn directly into me. I went flying. The driver was a woman about my age who got out the car and stood over me saying, ‘Oh my god, oh my god, oh my god.’ I was like: ‘Oh my god! You hit me!’ My first thoughts were, Am I okay? Can I move my fingers and toes? And man, the rest of this ride is going to be annoying! But then I looked down and saw my knee, couldn’t move my big toe, and was like, Oh crap. It’s also difficult to ride a bike that is in two pieces! Being laid out on the pavement on your back is a lonely place after your life flashes in front of you. I had never felt so alone.”

Jason had sustained an ACL tear in his left knee and crushed the bones in his left big toe.  He was sidelined from cycling, and had to take time away from his bike shop, which he had just opened in Bethel, CT.  He had two separate surgeries, one to fuse together the bones in his toe and another to repair the torn ligament in his knee. His initial progression through the typical ACL rehab timeline was slow because he couldn’t bear weight on his healing left toe.  Nonetheless, he was aggressive with the exercises he was able to perform, and once his toe could bear weight, his program advanced.

Eventually Jason was able to get back on his bike trainer indoors, though not without pain and stiffness.  He had a screw in his toe that made walking and cycling painful, and running impossible.  He had also developed excessive scar tissue in the knee joint that limited his motion, caused pain and swelling, and inhibited his quadriceps muscles. Together, this further added to the obstacles of running.

According to Jason’s physical therapist, Bridget Dungan, DPT, “Scar tissue and swelling in the knee has an inhibitory effect on the quadriceps muscles, which decreases muscle fiber activation and makes it really hard to build strength,” she said. This is why even basic everyday tasks had become difficult to Jason because of his decreased range of motion and inefficient quads.

“Stepping over the ledge of a bathtub and going down stairs was really tough,” Jason said. “What once had been simple everyday motions became challenging. I was beginning to learn what old age must feel like!”

Back ‘under the knife’ once again

Jason is not only a cyclist, but also a triathlete, so returning to running was a priority.  The only option to fix the toe pain and improve his knee bending was to go “under the knife” again.  One year after the accident, Jason was back on the operating table to remove the screw from his toe and clean out the scar tissue from his knee.  And once again he was back in physical therapy.  This time, the priority was knee range of motion and then strengthening his left leg.  Despite his three-day-a-week treatment program after the first surgeries, he never fully regained his quadriceps muscle strength due to inhibition from scar tissue and pain.  He had a lot of catching up to do.  Luckily, the second surgery didn’t involve any repairs, so he could be relatively aggressive with his therapy right from the start.  And with the screw out of his toe, he was no longer held back by pain from the hardware.

“Getting Jason’s knee to bend to its full potential after that second knee surgery was a delicate balance between pushing his limits but not over stressing the joint and causing it to swell,” Bridget explained.  “It was important to regain and maintain his motion within the first two weeks after surgery, otherwise scar tissue could form again.”

Jason finally felt he had hit the home stretch, but was then faced with another unexpected trip to the operating room. He had been feeling some neck and arm pain since the accident, which gradually started to worsen. A minor surgery fixed the problem, but sidelined him for a few more days, giving his knee some unwelcomed—thought probably beneficial—rest. If you see Jason running around at the Westchester Triathlon, you know he doesn’t take well to sitting still!

A long-awaited shift in focus to full recovery, followed by training

Finally back on track, Jason could focus his energies on his physical therapy. His rehab approach was comprehensive: Bridget performed manual (hands-on) therapy for range of motion—which included Active Release Technique, Graston Technique, and joint mobilization—three times a week, and Jason performed self-stretching and range of motion exercises (including time on the stationary bike) several times a day. He was on a progressive strengthening program targeting his legs and core muscles, with a focus on his left quadriceps. Strengthening his hip muscles was also important, so that he would have a stable pelvic base when he eventually returned to running.

One key element of his strengthening program was the use of blood flow restriction (BFR) training, which is beneficial for building muscle strength after surgery. It involves the use of a controlled tourniquet system that occludes a percentage of blood to the limb while performing exercises, so that the muscles are working in a deprived oxygen state. This makes the muscles work harder, without having to load the joint. Jason used BFR training in the leg press with a very low weight, which taxed the muscles but not his knee, and helped him to quickly regain his quadriceps strength.

Retraining Jason’s balance and proprioception was also a priority, since these are usually impaired after joint injuries. Emphasis was placed on single-leg functional tasks with careful attention to using proper form. When the strength of his left leg returned, he was ready to start agility training and plyometrics, and is now on a return-to-run program. Soon, his workouts will be less about rehab and more about training, as he prepares for his first race back.

“I’m a better athlete now,” Jason said. “Going through rehab and basically starting over forced me to look at old habits and really address weaknesses. It made me do things I probably should have done from the beginning, and that’s made me even stronger. I take a much more defensive approach to riding. It made me think about what was important in life. But the most rewarding and important lesson was when I finally realized I had the courage to let go of what I can’t change. I might never be as fast, run a marathon again, or probably see the podium in a race…or perhaps I will. But regardless, I am still here to enjoy the ride!”

Jason is the Race Director of the Westchester Triathlon, which will be held this year on September 22. For more information, visit www.westchestertriathlon.org.

For common triathlon injuries in New York City, our physical therapists can provide the treatment and training guidance needed to bounce back

Most athletes strive to push themselves to their physical limits—and sometimes beyond them—but it can be argued that triathletes are in a class all their own. Triathlons, which consist of a grueling combination of swimming, running, and cycling, are all-encompassing events that require the use of practically every part of the body. Training also tends to be equally intense, with many avid triathletes logging hundreds of miles total in these disciplines each month. It should come as no surprise, then, that triathlon injuries in New York City are quite common. These types of injuries can sideline triathletes and get in the way of their aggressive training regimens, but our physical therapists can provide the treatment and guidance needed to help them recover and get back on the saddle.

Triathlon participation rates vary from year to year, but more than 2 million individuals complete at least one triathlon on a consistent basis every year. There is also a great deal of variation in the distances of the events in each triathlon in order to accommodate all skill levels. These range from the shortest triathlon (the “sprint”), which usually consists of a 0.5-mile swim, 12.4-mile bike ride, and 3.1-mile run, to the Full Ironman, which features a 2.4-mile swim, 112-mile bike ride, 26.2-mile run (a full marathon).

The vast majority of triathlon-related injuries are classified as “overuse injuries,” which means the culprit is training too much or too hard without enough time to recover. In fact, one study found that in the six months leading up to a triathlon, 87% of participants reported experiencing some type of overuse injury. The primary issue here is that triathlon training repetitively stresses the muscles, tendons, and tissues around bones and joints, and this continuous stress produces small amounts of trauma (microtrauma) in these structures. The body can only do so much to keep up with this repetitive microtruama, and when it can’t repair all the damage done through training, the result is pain, weakness, and inflammation that are associated with an overuse injury.

Triathletes are subject to the wide array of overuse injuries that can occur in swimming, cycling, and running, but some injuries tend to crop up more frequently than others in this population. These include:

  • Rotator cuff tendinitis: an inflammation of any of the tendons of the rotator cuff, this injury is typically due to repeatedly performing the freestyle swim stroke
  • Iliotibial band syndrome: the iliotibial band, a large tendon that runs from the top of the hip to the top of the shinbone, can get irritated or inflamed from rubbing against the kneecap; increasing running mileage too quickly is usually the culprit
  • Achilles tendinitis: the strongest and longest tendon of the body—the Achilles tendon—takes on a great deal of impact in triathlon training, and when it wears down from tight calves or too much training, the result is pain above the heel
  • Patellar tendinitis: the tendon that connects the kneecap to the shinbone can also get inflamed, often from an improper bike fit or tight quadriceps muscles
  • Stress fractures: these injuries, which are small fractures (usually in the feet), occur when increasing your training without taking enough time to recover

How our physical therapists can help with triathlon injuries in New York City

Addressing triathlon injuries is not as straightforward as the process usually is in single sports, as active triathletes are working out their entire bodies, and the cause of the injury may be difficult to single out. Treating these injuries requires an intimate knowledge of each sport involved and the common injuries that may be seen in them, which is something we happen to pride ourselves on here at Dynamic Sports Physical Therapy. For triathlon injuries in New York City, we can provide the following:

  • An assessment of your swim stroke, running form, bike, and cycling position; if any of these components are out of balance, it may be contributing to your injury or pain, and we will work with you to identify the issue and correct it
  • Advice on training duration and intensity, with a particular focus on avoiding drastic changes in your training program, which is often associated with overuse injuries
    • One benefit of triathlon training is that—depending on the injury—if you can’t perform one sport, you may be able to compensate by spending extra time with the others
  • Injury-specific treatment, which may include any of the following:
    • Pain-relieving modalities like ice, heat, ultrasound
    • Stretching exercises
    • Strengthening exercises
    • Sport-specific education and rehabilitation
    • Manual (hands-on) therapy

Competing in triathlons and putting in the training time needed to excel is a serious undertaking that comes with plenty of payoffs, but injuries are unfortunately a part of the whole bag as well. Treating triathlon injuries in New York City requires the expertise and experience of professionals that understand why these injuries occur and how best to overcome them, which is something we have in abundance here at Dynamic Sports Physical Therapy. So if you’re currently dealing with any triathlon-related pain or soreness that’s holding you back from your training, we’d like to help you get back on track. Contact Dynamic Sports Physical Therapy at 212-317-8303 to schedule an appointment today, or click here for more information on common triathlon injuries.

Our New York City physical therapists break down post-concussion syndrome, in which symptoms continue long after the injury

A concussion is a mild traumatic brain injury caused by a direct or indirect hit—usually to the head—that aggressively moves the brain within the skull. This sudden movement can stretch and damage brain tissue and trigger a series of harmful chemical and cellular changes that may interfere with normal brain activities. Concussion symptoms like headaches, fatigue, and brain “fogginess” usually come about after the injury and then gradually dissipate within about two weeks for most people. But symptoms can last for much longer for others, and when this occurs, it’s usually referred to as post-concussion syndrome. Unfortunately, there are many factors that are not completely understood about post-concussion syndrome, but our New York City physical therapists offer what is known about the condition and what types of treatment approaches may be used.

The Centers for Disease Control and Prevention (CDC) estimates that about 3.8 million concussions occur in the U.S. each year, but this figure may be even higher since many individuals fail to report concussions. Concussions can result from any traumatic force that causes the brain to move within the skull—such as a fall or car accident—but the majority occur in sports and recreational activities like football, rugby, soccer, hockey, and boxing. Less than 10% of concussions result in a loss of consciousness, which is why anyone who experiences a blow to the head should be evaluated and monitored afterwards for symptoms.

Concussions often lead to both physical and mental symptoms

The immediate physical symptoms of a concussion may include headache, dizziness, nausea/vomiting, fatigue, difficulty sleeping, double or blurred vision, sensitivity to light and/or sound, and problems with balance. Other cognitive and emotional symptoms may include confusion, problems with memory and concentration, fogginess, irritability, depression/anxiety, aggression, personality changes, and mood swings. For about 80-90% of individuals, these symptoms will usually subside within 7-10 days after the concussion. But when symptoms continue to be a problem, individuals are often diagnosed with post-concussion syndrome.

Post-concussion syndrome is a complex disorder in which various physical and mental symptoms—like fatigue, headaches, dizziness, and fogginess—remain long after the concussion has occurred. These lingering symptoms usually only last for a few additional weeks, but can continue for up to 3-6 months in some individuals. Patients with post-concussion syndrome can experience symptoms at rest or in response to too much physical or cognitive (brain-related) activity, which can have a major impact on their social, personal, and professional life.

Studies have shown that approximately 10% of high school athletes experience post-concussion syndrome, while occurrence rates in other age groups range from 5-30%. The causes of post-concussion syndrome and what makes some individuals more likely to experience it than others are not completely understood, but there are some theories as to what might be responsible. Some experts believe that symptoms are caused by structural damage to the brain or a disruption of messages sent by nerves due to the impact of the initial injury. Others believe that symptoms are related to psychological factors, especially because most of these symptoms are similar to those that are often experienced by people with anxiety or depression. In many cases, both the physical effects of the trauma to the brain and the emotional reactions to these effects play a role in the development of symptoms. Older adults, females, and individuals with a history of prior concussions are also at a greater risk for developing post-concussion syndrome.

Managing post-concussion syndrome usually includes a period of rest and allowing the brain’s natural recovery process enough time to heal the damage from the concussion. After this period of rest, active therapies are often prescribed to help alleviate symptoms, but there is no single treatment that’s effective in all cases. Instead, treatment should identify the patient’s worst symptoms and then target them with specific therapies to reduce the symptoms or eliminate their cause. This can be accomplished through acupuncture or a comprehensive physical therapy program, which may include vestibular (balance) therapy, vision therapy, and/or aerobic therapy, depending on what symptoms are most troubling.

Contact our New York City physical therapists if you have lingering concussion symptoms

If you’ve recently experienced a concussion and your symptoms have not yet subsided, you might be dealing with a case of post-concussion syndrome, and our New York City physical therapists would like to help. Contact Dynamic Sports Physical Therapy at 212-317-8303 to schedule an appointment, or click here for more information on post-concussion syndrome.

Post Operative Rehabilitation

This program was developed for active individuals who intend to return to athletics and athletic style training following a hip surgery. It is intended to bridge a gap between traditional rehabilitation and return to sport. Once you have achieved adequate range of motion, flexibility, and muscle strength (usually 10-12 weeks following surgery) the next step is using what you have achieved in physical therapy and start moving well enough to return to sports.

The TRX suspension trainer is a great tool to help you reach your goals and return to athletics.

  • It uses your own body weight as resistance.
  • It can be used to unload your body to decrease joint stress.
  • It’s portable and can be used anywhere.
  • It engages important core musculature that is necessary to move properly.

Click here to download the TRX Hip Program.

5 Post Operative Tips
  • Ice as often as possible to reduce inflammation.
  • Listen to your body. If something hurts it is best to avoid it. You may feel tired in the weeks following surgery. Don’t try to push through, give your body the rest it needs.
  • Follow Doctors Instructions regarding precautions, weight bearing, lifting, and return to activities.
  • Don’t compare yourself to others who had similar procedures. Remember everyone heals at a different pace and you need this time to let your hip recover.
  • Avoid pivoting on involved leg and avoid sitting in low chairs or couches.
Post-Operative Rehab

This program was developed for active individuals who intend to return to athletics and athletic style training following a hip surgery. It is intended to bridge a gap between traditional rehabilitation and return to sport. Once you have achieved adequate range of motion, flexibility, and muscle strength (usually 10-12 weeks following surgery) the next step is using what you have achieved in physical therapy and start moving well enough to return to sports.

The TRX suspension trainer is a great tool to help you reach your goals and return to athletics.

  • It uses your own body weight as resistance.
  • It can be used to unload your body to decrease joint stress.
  • It’s portable and can be used anywhere.
  • It engages important core musculature that is necessary to move properly.

5 Post Operative Tips
  • Ice as often as possible to reduce inflammation.
  • Listen to your body. If something hurts it is best to avoid it. You may feel tired in the weeks following surgery. Don’t try to push through, give your body the rest it needs.
  • Follow Doctors Instructions regarding precautions, weight bearing, lifting, and return to activities.
  • Don’t compare yourself to others who had similar procedures. Remember everyone heals at a different pace and you need this time to let your hip recover.
  • Avoid pivoting on involved leg and avoid sitting in low chairs or couches.

Success stories from Dynamic Sports Physical Therapy in New York City: after several failed treatment attempts, Danielle finally finds a path to pain relief with us

Danielle is a female swimmer who came in to see us with a chief complaint of right hip and knee pain. Her pain began after running a half marathon two years ago, and afterwards, she attended physical therapy at another practice and experienced a reduction in her symptoms. But while training for an upcoming half marathon, her symptoms returned once again and began to intensify. An MRI revealed that Danielle had a tear of a structure called the labrum in her right hip, and a joint injection was performed, which led to only a minimal reduction in symptoms. She also underwent another course of physical therapy, but this did not lead to any significant reductions in her pain either. Once Danielle decided to first visit Dynamic Sports Physical Therapy in New York City, she could not run or attend yoga classes due to pain on the side and front of her hip.

While performing a comprehensive evaluation, Danielle’s therapist Jon found that she had signs of both hip dysplasia and joint laxity. Hip dysplasia is a condition in which the socket of the hip doesn’t fully cover the ball of the upper femur (thighbone), while joint laxity is a term used to describe joints that are too loose, or lax. Danielle also displayed too much internal rotation of both her hips, stood with significant knee recurvatum (too much backwards motion of the knee), and had poor stability of her core muscles while performing exercises that postured her in right hip extension. Finally, it was found that she had limited external rotation of her hip, weak hip muscles, and squatted with right lower extremity valgus. After completing this evaluation, Jon confirmed her diagnosis as a right hip labral tear and greater trochanteric bursitis.

What we did at Dynamic Sports Physical Therapy in New York City to help Danielle improve

Before beginning treatment, Danielle stated that her primary goals were to return to her running routine, independent gym workouts, and yoga classes after completing her program. Danielle’s treatment started with an aggressive hip and core strengthening routine that focused on exercises to improve the extension of her right hip and strengthen a specific set of muscles called the hip abductors. Next, Jon incorporated some strengthening exercises at the end range of her hip internal rotation. Although the goal here was not to necessarily increase her range—since it was already too great before she started treatment—it was still important to focus on end range strength here so that Danielle was strong through her entire range of motion. This was key a key component of Danielle’s treatment and different than what she had worked on with previous physical therapists. She also worked on maintaining the flexibility of several muscles on the outside of her hip, including the iliotibial band, tensor fasica latae, and quadriceps muscles.

Once Danielle completed her personalized treatment program, she noticed a significant reduction in her pain levels and was able return to her running routine without noticing any pain. Getting to this point took a great deal of one-on-one time with Jon and further evaluation of her condition and response to treatment. Eventually, this process helped Danielle understand that her hip laxity/dysplasia was the main obstacle that was interfering with her ability to improve, which unfortunately cannot be changed by physical therapy because it’s an anatomical problem. However, Jon told her that if she continued with her core strengthening exercises in specific positions, hip strength at the end range, and flexibility exercises for the muscles of her hip, it is possible for her to become pain-free in the future.

Danielle had this to say about her physical therapy experience with us: “Jon was attentive and knowledgeable in diagnosing the source of my injury and how to resolve it. We worked together on a movement treatment plan that reduced my pain and allowed me to more my hip more easily. Now, when I do my exercises regularly, I can run, ski, do exercise classes, and stand for long periods of time (all previously problems!) without pain.”

Jon and the rest of the staff at Dynamic Sports Physical Therapy in New York City are thrilled to see Danielle finally find an effective solution for her condition, and we wish her continued, pain-free success in the future. If you’re dealing with some pain of your own that’s holding you back in any way, we’d like to help you next in achieving similar outcomes to Danielle. Contact us at 212-317-8303 to schedule an appointment today, or click here to read our last blog for more information on hip dysplasia.