Hi, I'm Doctor Jo, a licensed Physical Therapist and Doctor of Physical Therapy. I hope you enjoy my video demos of stretches & exercises for common injuries and syndromes. If you have a question, just ask! Be safe. Have fun. And I hope you feel better soon.

No Pain, No Gain?

I received an email the other day from Jackson M. “I am recovering from a hamstring strain, and my dad keeps saying, ‘No pain, no gain.’ Do you agree?”

Hey Jackson! Thanks for sending in your question. Hopefully the video above will help with the strain, but as for "No Pain, No Gain," I actually hear people say that often, and it usually makes me cringe. I am sure you will hear different answers from different therapist or trainers, but for the most part that is not my philosophy.

Let me explain. There are certain times, like after a surgery – rotator cuff repair, total knee arthroscopy, etc – that you do have to follow that mentality. That’s one of the reasons doctors prescribe such powerful pain medications. When you have a surgery, there is a small window before adhesions (scar tissue) build up. You have to push your way through the movements for your body to be able to heal properly. These are the only times I would tell a patient “no pain, no gain.”

In most other situations, I do not believe this is true. Pain is your body’s way of saying, “don’t do that.” Pain can also lead to increased inflammation and muscle guarding. Both of these can slow the healing process and actually increase pain. Now I am not saying you are not going to be uncomfortable or feel pressure, maybe even some burning sensations, but when your body tells you to stop doing something, you should probably listen.

Again, this is why it is very important to let your therapist know if something is truly painful. Remember, we can always modify a stretch or exercise and progress as the pain decreases. Please go check out the hamstring stretches video to help you along in your recovery. Have fun, be safe, and I hope you feel better soon!

Don't Hold Your Breath

I had a patient come in the other day, and she had been to different PT clinics in the past. She asked me, “Why do people keep telling me ‘don’t hold your breath while exercising?’ It’s just natural for me to do it.”

Don’t hold your breath!! This is called the Valsalva Maneuver. The Valsalva Maneuver is dangerous for two specific reasons. It increases pressure in the thoracic cavity. This reduces the amount of blood flowing into the thoracic cavity, especially in the veins leading to the heart. This can cause a drop in blood pressure. That is why many times you feel light-headed when you hold your breath and push forcefully. The maneuver can also cause blood clots to detach, bleeding, irregular heart rhythms and cardiac arrest. Have I said enough to scare you yet? I hope so. Please don’t hold your breath when you are using the restroom either. Among those scary possibilities above, it can also cause hemorrhoids.

The key is to take a nice deep breath in, and as you are exerting your force, breath out. For example, if you are doing exercises to correct a pelvic rotation, like in the SI joint dysfunction video, you want to take a breath in, and then breath out as you are squeezing into the ball or pillow. If you can’t talk while you are doing your stretches or exercises, then you might be holding your breath.

Quality Over Quantity

This next question is a continuation from the last post. I feel like I actually don’t hear this question asked enough, “What if I can’t do the exercise because it is too hard?” Often I feel like patients are not going to ask this question. Many times, they want to work hard and think they can just push through it. Other times, I think they don’t want to be seen as weak. And then there are times where they just might not care. However, I feel like this is a very important question, and you should never feel like you can’t ask this question. If your therapist gives you an exercise to do, and then walks off to do something else, if you feel like you can’t do it correctly, stop and wait until they get back.

If you feel like you are sacrificing your technique or compensating to do the exercise, stop immediately! That is how people end up hurting themselves. You can always modify an exercise, and this is why it is important to tell your therapist if you are having difficulty with an exercise. Any exercise can be modified by reducing the resistance or decreasing the motion. Once you have perfected it at that level, you can then build yourself back up to the full range or resistance.

Please do not try to continue to do an exercise if you truly feel like it is too hard. Compensating will not make it better, and you might end up hurting yourself even more than you started, or even hurt something else. Remember quality over quantity!

Hamstring Stretches

The hamstrings are very important muscles, and they work with the knee, hips, and back. When they are sore or painful, they can cause many problems. Hamstrings can be strained, sprained, or even completely torn. Many times people will feel pain in the back of their legs, behind the knees, or in the butt area. There are several ways to stretch your hamstrings, and some work better for some people than others. You don't have to do all these stretches, just pick one or two that work best for you. When you are stretching, make sure to hold the stretches for at least 30 seconds and do them 3 times. This video will show you ways to stretch your hamstrings lying down, sitting, and standing.

First, will be the stretches on your back. This stretch is called an active assisted stretch because you are actively doing the stretch. Grab the back of your thigh, and bring your hip to about 90 degrees. Slowly start to straighten your leg until you feel a good stretch as seen in the video. Not everyone will be able to straighten their knee completely. Do three sets of 30 seconds on each side. If your legs starts to shake and it is too hard to hold up, try using a belt or dog leash to help hold the stretch. This time you want to keep your leg straight the whole time. Try not to bend your knee, and gently pull your leg towards your head until you feel a good stretch.

Next, you will see some stretches sitting up. The most important part of this stretch is to keep your back straight. Many people try to curl their backs to be able to touch their toes. Your hamstrings are attached to what is called the ischial tuberosity, or your butt bone. So if you bend at your back, you are not going to get a good hamstring stretch. Try to bend at your hips. You can also do this stretch sitting on a couch or the side of a bed as shown in the video. Finally, you can stretch your hamstrings standing up. You can prop your leg on a step or chair. It is still important to bend at your hips and not your back. 

You may also want to check out the Hamstring Strengthening Exercises.

 

Repetitious Repetitions

Very often I will get asked, “How many repetitions should I do of each exercise?” This is a great question. Many times you will hear 3 sets of 10 reps (repetitions) or 2 sets of 15 reps. The truth is it really depends on what you are trying to accomplish with the exercise. If you want to tone your muscles, you want to do low weights with high reps (15-20), and if you want to build muscle, you do heavy weights with low reps (8-10). However, in the world of therapy and rehab, I usually tell my patients go until you feel a good burn, and then do 2 more reps. If you can do more than 20 reps without a burning feeling, aka your muscles fatiguing, then add weight or resistance.

The main goal over anything else is to use correct form and a controlled motion. If you are not able to do both of these, then you are using too much weight or resistance. Depending on the type of injury you have, just doing the controlled motion without any weights will work your muscles.

Remember, it’s about the quality of your exercises, not the quantity of your exercises. For example, five repetitions of a straight leg raise done with correct form and controlled motion will be more beneficial than fifteen done incorrectly. It is very important to tell your therapist if you feel like the exercise is too hard and you are sacrificing form to complete it. A skilled therapist should always be able to modify an exercise so you can perform it correctly without losing correct technique.

Have Knee Pain? This video may be able to help.

 

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