Do you have pain when you squat? Are you afraid to squat because you are afraid it’s going to hurt or afraid you don’t know how to do it properly? Have no fear! We, the movement specialists, are here to the rescue.
Squats as an exercise are a beneficial way to build lower body strength and improve core stability. Squats are also a movement that everybody does on a daily basis without even realizing. Think about every time you get into and out of a chair, on and off a toilet, in and out of your car; you are actually performing a squatting movement. These repetitive movements, if done incorrectly, can eventually lead to break down of your joints.
The point of this post is to briefly talk about proper squat mechanics and to mainly give tips and cues on how to properly perform a pain-free squat.
The squat is a compound movement that involves movement at the hip, knee, and ankle simultaneously without allowing the spine to either flex or extends.
The initial movement of a squat is actually a hip hinge; the hips glide backwards without allowing the spine to be involved as the chest comes forward. Following the hip hinge, the knees flex and the ankles dorsiflex to complete the first half of the squat. The second half of the squat initiates with an extension from the hips and then the knees follow as you bring your chest back up to a neutral position. Break down in the squat usually occurs at two different points; during initiation of the squat and coming up from the bottom of the squat. The following are a set of cues and tips I give my patients to allow a pain-free squat.
Set-up Tips :
Feet should be about shoulder width apart, core engaged (throughout the whole movement), and head in a nice neutral line with the spine (chin down, back of the head up). Some people prefer a wider than shoulder width stance which is okay.
Initiate the squat by keeping the back nice and straight and allowing your hips to glide backwards. It is okay to allow your chest to come forward, but keep your head in a neutral line with your spine. I usually cue to “sit your hips back”. Once you have initiated the hip hinge you can allow your knees to bend. Do not allow those knees to buckle in and try to keep those shins vertical. I cue people to “drive those knees out”. The knee-cap should track in line with the 3rd toe. If this is hard for you with your toes completely straightforward you can angle them slightly outward.
Bottom of the Squat Tips:
Only go as low as your body will allow. For the general public, this will probably be above parallel which is okay. I would you much rather work on proper mechanics than to try to break parallel. Do NOT bottom-out or do the dreaded “butt-wink”.
The “butt-wink” usually occurs when the core stops being engaged and the hips stop gliding backward. If you notice this happening, stop your movement before you get to that point. Once you get to the bottom of the squat, your core should still be engaged, the head is still in line with your spine, and you want to initiate the movement by extending your hips. I cue people to “push through your heels” to get the posterior chain to fire. Once the hips begin to extend the knees can then follow to allow the return to neutral.
If you are having difficulty or pain with performing squats I would recommend coming in and seeing one of our highly trained physical therapists at Austin Manual Therapy Associates for a movement screen and assessment. We know SQUAT and can get you back into pain-free squatting!!
Check out this video for a quick demo.
Elaine Tsay, PT, DPT, FAAOMPT
For anyone who has ever laced up a pair of cleats, running shoes, or as my boys like to tease me, “sneakers”, then almost all of you have probably suffered an ankle sprain at some time in your life. The most common variety: Inversion ankle sprain, which is more casually referred to as “rolling your ankle” (where the foot turns in while all the weight goes to the outside of the lower leg). Other ankle injuries can occur, but let’s stick to the more common type.
First priority: determine if it is simply a low grade type of ankle sprain, and not something more serious. One of the classic signs of a serious injury is the inability, or refusal, of the individual to bear any weight immediately after the injury. This may indicate the need for more formal diagnostic imaging and medical care.
Second priority: control the swelling. This is most likely caused by small vessel damage and subsequent bleeding. This is the best time for ice, compression, and elevation to be used. Once 2-3 days have passed, and more serious conditions are eliminated, switching to heat and gentle movement is probably best. But the swelling and soreness from the initial vascular injury are not the only causes of ankle pain.
Third priority: assess for joint dysfunctions and nerve irritability. Some ankle pain may linger for a time after the initial bruising and swelling have cleared. Causes could be the joint is stuck out of position, or shifted. In fact, a one-degree deviation from the normal resting position of the ankle increases the forces in the ankle by 42% when your full weight is on it (ACSM, 2017). Manipulation to restore proper alignment and mobility may be needed.
In base level orthopedic physical therapy, nerve pain is often overlooked when treating the ankle. The Intermediate Dorsal Cutaneous Nerve, a branch of the Superficial Fibular (peroneal) Nerve, travels directly over the front of the talofibular ligament, and may also be what is tender when pressed (see bottom left portion of image). Austin Manual Therapy Fellowship-trained Manual Physical Therapists are specifically trained to examine and evaluate every potential source of pain for a “simple” ankle sprain, including nerve pain.
At Austin Manual Therapy, we provide a uniquely thorough and holistic evaluation for every patient, every time (no two ankle injuries are the same). We have the highest expertise, the most advanced specialized training in Orthopedic Physical Therapy comprehensive examination and diagnosis to get to the root of the problem, the “cause of the cause”, if you will. Whether you wear sneakers or not, our treatments will address your immediate needs, and add preventative measures to help reduce likelihood of a recurrence.
Ask yourself the next time it happens, if your “simple” ankle sprain is just that; simple. Come see us at Austin Manual Therapy and we’ll help you figure out what the problem is, correct it, and help you protect the ankle in the future. You can reach us at (512) 832-9411, or www.austinmanualtherapy.com.
One of the unexpected “benefits” of being a physical therapist is that family, friends, and strangers ask your advice on all sorts of health related topics:
“What kind of exercises should I do for my back?”
“Why does my knee hurt right here?”
“Should I use heat or ice?”
“What medication should I take for pain?”
“Does this look normal?”
While I love that people trust my opinion and want my advice, most of the time there is a lot more to answering those questions than just a simple recommendation. Often times, my answer begins with, “Well it depends…” and after a few follow up questions the person who wanted a simple answer is no longer that interested because I have made the situation more complex. But here’s the thing, it should be complex and also comprehensive.
There’s a reason that becoming a PT requires 4 years of undergraduate education, 3 years of a clinical doctorate, and in the case of Austin Manual Therapy Associates, 3 years of advanced training in manual therapy to become a credentialed Fellow of Orthopedic Manual Physical Therapy. Bodies are extremely complicated; it takes a lot of knowledge, experience, and training to properly evaluate, diagnose, and treat the complexities of the musculoskeletal and nervous systems. I’d be doing someone a disservice if I answered their questions with a simple response without taking the time to ask specific questions and gather more information. That’s also why I advise people not to rely on google, instagram, facebook, and other social media for self-treatment approaches; a one-size fits all approach to treating injury and pain is not always the best option.
The benefit of going to a PT with advanced training and experience is that they will take the time to ask the right questions, get a comprehensive history of your injury and pain experience, identify your goals, assess and evaluate the body as a whole system working together, address any soft tissue or joint dysfunctions, and develop a personalized and achievable treatment plan. A good PT can give you advice on how to treat that shoulder pain that you developed while doing yard work last weekend, but a great PT will take a comprehensive look at your movement system as a whole and work with you and educate you to prevent that injury from reoccurring.
So if you’ve been dealing with aches, pain, injuries (new or recurring) or have had similar questions like the one above for a PT or consulted “Dr. Google”, give us a try at Austin Manual Therapy Associates and let us show you the benefit and difference of being treated by highly qualified PT’s. After all, we are the movement experts!
Jacqueline Stine, PT, DPT
Hiya! My name is Sam. I am a patient coordinator and a PT tech at the Barton Springs clinic. My blog entry this month won't offer any technical PT advice because I would feel as though I were breaking the law if I did. It will, however, talk about my experience with a personal injury and how the battle to be won extended further than the physical pain. Essentially, this is an account of how a new physical limitation can upset the balance in one's personal life, and how it can sour our happiness. The goal of it: To relate to those of us who feel the twinge of depression when we feel the twinge of our pain. So I'd like to start the story with a few words that I needed to hear myself:
You are not your injury.
I say this, though I had become mine. I was a sprained ankle, a burning knee, a crooked back. I was held hostage indoors; fearful I might make myself worse and full of pity because I could not see beyond the imprisonment of a physical limitation. I was to be this way forever. Life sentence, man.
Here's the thing, I was wrong. Of course I was wrong!
So I write my story as an easy little lesson I learned difficultly over a long time, as silly stubborn folks often do. Here's the mantra, and I'll say it again, you are not your injury.
Prior to my injury I would spend a lot of my free time bumming around the out of doors. I also enjoyed jogging as my evening catharsis and I exercised daily. Let's say I was "active-ish." I enjoyed freedom of movement. I could climb rocks, sprint, jump, and swim without worry. I was armored and carried kiddish energy at the hilt. Open fields or dense woods or muddy mud were invitations for me to rush across and investigate what lay there and beyond.
It was out there in my own jam, exploring the great Appalachian Trail when I badly sprained my ankle. Ah, the AT had claimed another one.. or so it thought! Yessiree, I hiked another 2 full days with an 80lb backpack. I had to see this hike through, plus I could handle the pain after the swelling filled my ankle when my body began to realize it was walking another 7 hours or so (not a good idea, do not do that.) So if you recall me mentioning something about being stubborn, it was that stubbornness that set all of this into its terrible motion.
This fool writing to you knew nothing about how the body worked. If he had, he may have sought treatment immediately. Since he hadn't, 8 months of walking around on a clubbed foot had not only knocked his knee out but rotated his hips and weakened his lower back. I didn't know this, of course. All I knew is that I was in too much pain to go for a half-mile walk. My knee started to click and my back started to tighten and my ankle swelling hadn't gone down in a few months. Everything was becoming worse. Top it off with the enervating fact that I was currently in between jobs and had no income, I became smothered with the feeling of a total loss of self-worth. It was depression. The rot of my future spread unencumbered, and my mind asked itself sad questions. How could I promote myself to employers if I struggled with the loss of what made me happy? How could I enjoy time with my friends who all love the same activities I could no longer do? How could I feel good about myself when what made me feel good was moving around?
I felt left behind, and it was consuming what seemed like any sanity there was left. With the mind dark, limits only grow. Dr. Seuss said it well in the best book ever written!
Oh the Places You'll Go!,
You can get all hung up
in a prickle-ly perch.
And your gang will fly on.
You'll be left in a Lurch.
He can sum it up in 4 lines. He's a darn genius, but those words only confirmed my feelings. They didn't offer any advice! I was surprised at how easily I lost myself in this mindset, but even more surprised that I couldn't get out of it. The pain became the definition of who I was to myself and everything around me. I was what I could not do. I was my injury. But I must tell you, it gets better. As it turns out, the Seuss does proffer some encouragement:
On and on you will hike.
And I know you’ll hike far
and face up to your problems
whatever they are.
Gosh he just gets it. I didn’t, however. Fortuitously, I found myself employed by our very own Austin Manual Therapy. It was not long, perhaps a week, before I was forced to do physical therapy by my coworkers. I was showing off my lumpy ankle too often I suppose, but it was all for the better. Immediately after the first day I could feel the depression lessen. It wasn’t gone, however. I was just glad I knew what was wrong with me. I became consistently conscious of where the pain was and how to help prevent it throughout my day. In about a month I could walk as long as I wanted. Eventually I could do some light jogging. Then I could hike, I could swim, I could climb. All of these activities were moderated, of course, but I was getting back to my old self nevertheless. Little by little did my injury stop affecting the way I thought about who I am.
I am better now. I am not perfectly put back together just yet, but I am better. Since I had waited so long to help myself, my progress will take me awhile. So far, the journey has been about a year and a half. However, this firsthand experience has taught me that pain is not only physical. Pain is debilitating to us in a myriad of ways. Pain creates limitations to our relationship with the world and with ourselves. We can, unfortunately, be felled by the sword of our injuries. I hope that anyone reading this can relate, and at the very least is encouraged to not waste time like I had. It took me getting a job at a physical therapy clinic to begin healing myself. So if you are reading this, you are way better now at taking care of your body properly than I was. You are on the right track. Always remember, you are not your injury.
Also, it is never a bad idea to readOh the Places You’ll Go!
Sam Jaklich, PT technician
I first heard this saying spoken by Dr. Laurie Hartman, DO at the annual conference provided by The American Academy Of Manual Physical Therapists in San Antonio, Texas, about four years ago. I have subsequently discovered it is a widely-known phrase that has been used in many instances and by many individuals in various contexts. Nevertheless, it gave me a renewed interest in striving to further help our physical therapy patients accept this concept: Experiencing pain without truly suffering.
For a lot of people, orthopedic pain is an experience as common as breathing. What to do about this pain is the driving force behind countless analgesic pharmaceutical commercials, as well as seemingly endless infomercials about the latest gadget that will make pain disappear without any real effort. The heart of this axiom in deciding whether to attempt to relieve the pain itself, or to seek to discover the primary cause of the pain.
Manual Therapists, Physical Therapists who are fully credentialed Physical Therapists in the specialty of Manual Therapy, strive to find what we frequently call finding the “cause of the cause”. The designation ‘Manual Therapist’ indicates this is someone who has received the highest level of Orthopedic Physical Therapy training available.
What does this mean for the general public attempting to proactively determine their best course of action to fight pain? As a fully credentialed Manual Therapist, I am partial to recommending you come to our clinic, Austin Manual Therapy Associates. We have some of the very finest Orthopedic Manual Physical Therapists in Austin. The level of training is more than most Orthopedic Physical Therapists will seek, as it is equally as grueling as it is time-consuming to complete.
Regardless of whether you choose Austin Manual Therapy Associates, I would like to offer a little advice when seeking the best physical therapy care for your aches and pains.
Do your research.I know it is easier to get word-of-mouth advice from social media forums, as well as public review sites, but you can also look for the credentials of the therapist you are seeking through the Texas Physical Therapy Association, including any disciplinary issues of any particular therapist. Also, I would recommend to seek a Physical Therapist that has the FAAOMPT credentials…the best of the best. In any case, find out as much as you can about that therapist before proceeding.
Be RealisticEspecially about promises made by a practitioner offering to have you pain-free within 2-3 visits when you have had this dysfunction and pain for years. Usually, if it seems too good to be true, it is. Instead, seek consultation from a number of therapists until you find the one who seems to understand your pain and has a plan that is unique to your needs. You deserve that consideration.
Be actively vested in your recovery.The details you provide to your Physical Therapist will enhance the rationale for their recovery plan for you. The behavior of pain is often one of the most telling aspects in leading to the best treatment method.
Finally, be strong.Pain is designed to get your attention that something is not right. Physical Therapy has been shown to be the first choice for pain control. If you want the best care, you have to search for it. Manual Therapists can provide the highest quality of Orthopedic Physical Therapy care, and we assure you that we offer the best Orthopedic Manual Physical Therapists at Austin Manual Therapy Associates. Give us a call at (512) 832-9411. Remember, “Suffering is a choice”. Choose wisely.
Spring is in the air, birds are chirping, the sun is shining, and Texas is showing off its bright blue skies and sunny days. What does this mean?? IT’S GOLF SEASON. Winter has come and gone and it’s time for you to hit the links!
Golf has always been a passion of mine, and is something I enjoy on a weekly basis. It is one of the few sports that people of all ages can enjoy; grandparents and grandchildren can play right along-side one another, and it’s a sport that you can continue to play as you age. The real kicker is… how do we keep your back safe as golf season ramps up?
There are 2 occasions where keeping your back in a strong, stable position is important:
- The golf swing is a very fluid motion and is based heavily on your ability to rotate into your backswing, pause, and then change direction rotating down into contact with the ball. Rotation of your lumbar spine places a higher stress on your intervertebral discs, as only 1/2 of the collagen fibers that make up the disc can resist rotation in one direction at any given time. THEREFORE, it becomes very important to place your back in the most optimal position when setting up to begin your swing, so you can keep your back safe and stable.
- Another time it’s crucial to protect your back is after you make that ever elusive hole in one, and you bend down to grab that golf ball out of the bottom of the cup.
HOW CAN WE KEEP YOUR BACK SAFE?? Here’s a quick tip to help keep you out on the course week after week… BEND AT THE HIPS!
When setting up for your next shot, or when bending over to grab your golf ball out of the cup, think of keeping your back “straight” as you hinge at the hips. For most of us, it will feel as if you’re sticking your bottom out to sit back into a chair. Don’t let your back curve in the shape of a “C”! If your hamstrings feel a little stiff when you do this, don’t panic, just bend those knees a little when bending over. If you can do this, you can keep your back nice and safe, feeling strong for that next round!
Having difficulty figuring out how to hinge at the hips? Fighting off some low back pain, stiffness, or tension? Contrary to popular belief, back pain/stiffness/tension isn’t normal, so come on in to Austin Manual Therapy and one of our highly trained physical therapists would love to help get your back feeling strong, get you hinging at the hips, and back out on the course again!
When Should I Go See A Physical Therapist?
As physical therapists we often hear patients ask questions such as, "why didn't I come in before?" or "if I had come in right after this happened I'd have been better by now, right?" Most folks dealing with an injury have usually waited for several weeks employing the age old adage "I can work IT out" or my personal favorite "when I was younger these things would go away with rest." Unfortunately this has led patients to possibly hurting themselves even further and making matters worse.
When we get injured, a physiological process occurs right away to protect us from further harm. As a part of this process, adaptation occurs and can create faulty movement patterns. Often times it was the faulty movement that set us up for the injury in the first place. When we ignore this we tell our body that it is okay to continue these poor mechanics and episodes can reoccur. If you’ve ever experienced multiple episodes of back pain or have sprained the same ankle over and over again, you are probably nodding your head yes to this explanation. But it doesn’t have to be this way.
Current research in our field has shown that early intervention following episodes of injury tend to show favorable outcomes for patients, including quickly decreasing pain, improving movement, and helping people return to performing activities they enjoy with little to no limitations. There are other benefits as well including the cost-savings of dealing with your injury. Often, early intervention will require LESS treatment visits and can also decrease the likelihood of having to undergo expensive surgical procedures.
So to answer the question, you should seek treatment from us immediately following injury for every episode. Our fellowship trained and experienced manual physical therapists at Austin Manual Therapy Associates are here to help get you back to the things you love to do most. Contact us today or simply stop by any of our locations to speak directly to a physical therapist about your needs!
Have you ever taken a step first thing in the morning and felt like you had a sharp knife stabbing you in the heel? Have you gone on a long walk to find hours later you have a burning or aching pain along the bottom or backside of your heel? Heel pain is by far the most common foot problem we see in the clinic. It can be debilitating and can greatly affect your quality of life. Differential diagnosis of heel pain is essential, as treating the correct tissue is incredibly important to ensure proper healing and faster results.
More often than not, patients with heel pain come into the clinic with a diagnosis of “plantar fasciitis.” However, this is not the only cause of heel pain. The plantar fascia is a fibrous tissue that runs along the bottom of your foot, originating at the inferior surface of the heel and ending at the toes. Typically, when this tissue is involved, the pain is sharp and intense, located directly at the bottom of the heel and sometimes into the arch of the foot. Pain is usually only present when weight-bearing through the foot and almost always painful with the first few steps in the morning.
The inferior calcaneal nerve (ICN), otherwise known as “Baxter’s Nerve,” also runs in the same area as the plantar fascia. Baxter’s nerve can cause burning, aching, or numbness and tingle in the heel or foot. Initially, this pain is present hours after activity, but when highly aggravated, the pain can be constant. Baxter’s nerve will also be painful at rest, unlike the plantar fascia, which will be painful only when the foot is in use.
If you have heel pain, call Austin Manual Therapy Associates to make an appointment today. Our expert physical therapists are fellowship trained and can help correctly diagnose the underlying cause of your heel pain.
The Science Behind Pain
Pain is a common occurrence. Except for those rare individuals who have no sense of pain, everyone else will experience some sort of physical discomfort in their lifetime. According to data synthesized from information provided by The Manual Therapy Institute and Physiotherapist David Butler, the simple concept that tissues must be injured to cause pain is the most commonly held belief as to its source and has been around for centuries. But recent research shows that the source of pain may be from a multitude of other factors, rather than automatically associating it with tissue injury.
Sure, tissue injury in the body causes physical pain, but it is hardly the entire spectrum. When information is sent from the injured area of the body to the brain, it is simply received as “danger”, or “no danger”. It is not necessarily perceived as what we think is “pain”. The brain analyzes the significance of the signal and then “decides” if it warrants further attention, or if the signal can be dismissed.
Prolonged and repetitive pain experience over time causes the spinal cord to get more efficient at sending this “danger” signal to the brain, instead of simple sensory information. This means the “threat” message is more easily and frequently delivered, even if there is no threat. If this process goes on long enough, without being checked, any type of touch stimulus may eventually be perceived as a danger, even if the stimulus is intended to be comforting and soothing.
The brain then has a hard time keeping up with the demand for more and more endorphins to be released to control this ever-increasing “threat” surplus. The brain is overrun by this constant influx of nociception. This phenomenon can be part of the clinical picture of many physical disorders such as Fibromyalgia, Complex Regional Pain Syndrome, and other autoimmune disorders. The vague pain distribution (sometime subtle and sometimes intense) is characteristic of what is now identified as Central Sensitization Syndrome.
As Fellowship-trained Manual Therapists, we at Austin Manual Therapy have the training and skill to help most everyone manage these often intrusive and unrelenting pain symptoms. Give us a call at (512) 832-9411 to discuss ways we may be able to help anyone whose life is interrupted by any type of pain experience.
Crossfit and Manual Therapy
How can Manual Therapy benefit Crossfit City Limits’ members in their quest for “ultimate fitness”? And what is Manual Therapy? These are sample questions many people have about our physical therapy practice at Austin Manual Therapy, and why we show up at Crossfit City Limits every few weeks with a table set up for injury screening.
In principle, Manual Therapy is a philosophy inasmuch as it is a set of manual techniques. According to the American Physical Therapy Association, the definition of Manual Therapy is the skilled passive movement of joints (joint mobilization/manipulation) and soft tissues (soft tissue mobilization/specific localized massage). This also includes movement analysis and restoration of appropriate movement patterns. OMPT (Orthopedic Manual Physical Therapy) is currently the only certified therapy recognized by the American Medical Association. The training for Manual Therapy specialization is very similar in nature with didactic and residency training for a Medical Doctor specializing in a particular medical domain.
In essence, Manual Therapy is a treatment philosophy which treats the whole patient, utilizing the most advanced cutting-edge techniques with the highest order of orthopedic physical therapy problem-solving. Simply stated, it is the most effective holistic approach to Orthopedic Physical Therapy. What does this mean to Crossfit City Limits? It means that our training and attention to detail mirror that with which you strive in every workout.
Crossfit City Limits fundamentally is focused on generating exceptional fitness, while at the same time improving efficiency of movement with every front squat lift, muscle-up, and power clean, etc. To that end, it is evident that you must perfect your form before progression in workout volume and intensity can be achieved, most especially to avoid injury. But we all know that, even in the best of attempts, injuries are part of the process. Usually, these injuries are related to lapses in small details of particular dynamic movement, not a weakness in the larger muscle groups. Learning from the mistakes that lead to these particular injuries is what ensures progress more consistently.
We at Austin Manual Therapy strive for the same movement mastery you do with your Crossfit program, beginning with establishing a strong base of stabilization control and aerobic capacity of the working tissues, then progressing to more challenging dynamic movements to more closely mimic and correct the activities in patient’s lives which caused the breakdown and injury in the first place. Ultimately, we at Austin Manual Therapy are after the same things that you at Crossfit City Limits pursue. Everyone needs a little help and coaching along the way, and that is the help that we provide with our injury screenings and subsequent treatment approaches. We would assert that asking for help is a sign of strength. Ask yourself if you are strong enough to ask for this help.
We are always ready to answer your questions and provide relief of your symptoms. Contact our office at (512) 832-9411, or simply stop by to speak to us at our exam table during the next Saturday morning open-gym workout. Your health will thank you!
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