Delicate Body Parts: Ankle Sprains

How many times have you experienced or heard of “rolled or sprained ankles” that happen on a regular basis? There seems to be a stigma around ankles and their susceptibility to sprains. Many believe it is a normal occurrence and will carry on their entire life dealing with constant “rolled ankles” and never be treated for one. However, did you know that people who experiences multiple ankle sprains throughout their life actually lack a key aspect of awareness that can be addressed by a physical therapist and prevent ongoing sprains?

When someone sprains their ankle for the first time, initial swelling and pain occur with pain intensity being dependent on the severity of the sprain. The body attempts to heal itself and goes through its normal inflammatory healing process. Although this initial phase is good, it has secondary effects that cause ongoing ankle sprains if they go untreated. With inflammation, there is excess fluid in the ankle, this causes the nerve endings responsible for detecting spatial awareness to turn off. When this happens our proprioception and kinesthetic awareness – medical terms that mean knowing where you are in space- no longer function correctly. Because of this, our brain is unable to safely detect where our ankles and feet are in space without looking down. This causes a problem as we shouldn’t walk around looking down at our feet to make sure they’re stepping on flat ground! This not only makes us heavily reliant on our vision for stability which isn’t normal, but also makes us susceptible to accidents because we’re not looking up at our surroundings!

If you or anyone you know suffers from constant ankle sprains, let them know physical therapy can help them out!

Jennifer Santamaria PT, DPT
Performance Plus Physical Therapy
P: (619) 482-3000
F: (619) 482-3001

PPPT Comes to Imperial Beach!!!!

Performance Plus Physical Therapy is excited to announce the opening of our 2nd location in the heart of Imperial Beach. Located at the end of the Silver strand and in close proximity to the communities of Coronado, San Ysidro, National City and San Diego, we are committed to providing exceptional service to the people of the South Bay! We are located at 600 Palm Avenue, Suite 126, Imperial Beach, CA 91932. Hours of operation are M, W and TH from 7am-7pm and T/F from 7am-12pm. Early morning and late evening appointments allow those that are employed the opportunity for therapy before or after work. We accept most major insurances including Medicare, Tricare, VA, Workers Compensation, PPO’s and HMO’s. Cash plans are available upon request. At PPPT, pain is no longer an option. Call or stop in today and decrease your pain, improve your movement and return to the activities you enjoy. We look forward to meeting you!

The Muscles No One Talks About

Did you know that the concept of joint movement being controlled by muscles and ligaments applies to our bladder and bowel movements as well? These activities are controlled by a group of muscles conveniently called the pelvic floor muscles. They sit between the coccyx and the anterior pelvis and have a role in our normal micturition, excretion, and sexual functions. These muscles are susceptible to under or over activity just like any other muscle and can alter the normal flow of our bowel and bladder movements causing incontinence, constipation, leakage, and perineal pain. Dysfunction of these muscles are often seen after childbirth, surgical/traumatic/emotional events, pelvic organ prolapse, and diabetes. More so, pelvic floor dysfunction can be caused by repetitive tasks involving heavy lifting, straining, and advanced age.

Treatment for pelvic floor dysfunction does not have to involve surgery or medications; physical therapists are able to specialize in the treatment of pelvic floor dysfunction and assist those with varying diagnoses stemming from the pelvic floor muscles. Research has confirmed that conservative, physical therapy interventions demonstrate the best possible outcomes for those suffering from pelvic floor symptoms more so than surgical or pharmaceutical interventions. Male or female, there is no reason someone should continue suffering from leakage, incontinence, or pain within their perineum and a Doctor of Physical Therapy is the best professional to help you overcome these dysfunctions and improve your quality of life!

Jennifer Santamaria PT, DPT

1.Bo K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother . 2013;59:159-168. (a)

2. Bernards A, Berghmans B, Hove M et al. Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update. Int Urogynecol J. 2014;25:171-179.

3. Bo K, Hilde G, Jensen J, Siafarikas F, Engh ME. Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparious pregnant women. Int Urogynecol J . 2013:24;2065-2070. (b)SOWH PH1B4 Physical Therapy Treatment of Underactive Pelvic Floor Muscles and Prolapse.E Miracle©Section on Women’s Health, American Physical Therapy Association 2016.131

4. Braekken IH, Majida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol .2010;203(2):170e1-7.


Have you received scary MRI results or been told you have degenerative disease/degeneration in your spine?

Have you received scary MRI results or been told you have degenerative disease/degeneration in your spine?

Imaging (MRI) results showing degeneration in the low back are common in asymptomatic individuals (people without pain). Examples of degenerative findings include disc degeneration, disc bulging or protrusion, and facet degeneration. These findings are normal age-related changes (usually unrelated to pain) and are likely an incidentally finding.

Normal MRI findings in the low backs of “pain-free” individuals:

45% of 20-40 year olds
75% of 40-60 year olds
Over 90% of 60-80 year olds
…have disc degeneration

30% of 20-40 year olds
55% of 40-60 year olds
Over 75% of 60-80 year olds
…have disc bulging

25% of 40-60 year olds
Over 65% of 60-80 year olds
…have facet degeneration

Have questions about your MRI findings or what’s causing your low back pain?
A physical therapist can help answer those questions and get you moving again!

Reference: Brinjikji, W. et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Propulations. Am J Neuroradiol. 2015 April; 36(4): 811-816.

Can Your Sleeping Position Affect You Low Back Pain?

Low Back Pain (LBP) is the second most common cause of disability in the U.S. Over 80% of the population will experience a form of lower back pain at some point in their life and one of the biggest complaints that Physical Therapists receive about low back pain is how it can impact one’s ability to sleep through the night.
There are many components that can contribute to low back pain at night such as sleeping surface (mattress quality, mattress pad), pillows, room temperature and sleeping position. Research shows that sleep position can affect the alignment of the spine. Aiming for the proper sleep position can put the body into its neutral, or most natural, body position.
• SIDE SLEEPER: try placing a pillow between your knees. Your knee and hip should be in alignment with each other, so make sure the pillow is not too high or low

• BACK SLEEPER: try placing a pillow or two under your knees. This will put your spine into neutral position.

• STOMACH SLEEPER: try placing a pillow under your hips. This will help take the curve out of your back and put your spine into neutral position.

*Side sleepers can use a regular sized pillow, body pillow, or snoogle which is usually recommended during pregnancy but can be helpful for people with low back pain. For all positions however, the size and thickness of the pillow may vary from person to person based on flatness/density of the pillow. It is best to test out different sized pillows for each position to see which works best for you and your spine.
If none of these positions help relieve your lower back pain after a few nights, schedule an appointment with us at Performance Plus Physical Therapy so our Therapists can help identify the cause of your pain. Other than that, happy resting!

Hydration, Physical Performance & Recovery

With the warmer months rapidly approaching it is important to remember the significance of our daily water intake. Especially combined with physical activity, hydration can play a huge factor in performance and muscle recovery. Approximately 1-2 Liters of water are required to replace obligatory losses for even sedentary adults in a temperate climate. Therefore, almost double that should be consumed for modest amounts of exercise. That means increased activity during sport, a gym workout or even a physical therapy session can further dehydrate our bodies.

Proper hydration can help ensure optimal muscle function and prevent muscle cramps as well as excess fatigue. Along with enough rest, staying properly hydrated can aid in muscle recovery and repair after an injury or workout. Water intake also directly contributes to heat exchange and the demands of body temperature increases with physical activity or environment. This means that when we sweat due to exercise or hot temperatures, we are losing valuable fluids and we should drink extra water to make up for the loss. Studies show that the average male and female should have a water intake of 3.7 and 2.7 L per day, respectively. Although, considering factors such as metabolism, diet, climate and clothing, additional water should be considered for daily consumption.

We also must pay attention to some of the food we eat or the beverages we drink as either helping or hurting our hydration status. When in doubt, enough water can always help meet our bodies’ needs for hydration, peak physical performance, and recovery!

Is Stretching Effective?

Is stretching effective? The short answer is yes! Stretching is practiced frequently here at Performance Plus. However, to completely answer that question we first need to be more precise. What does it accomplish, and how or when should we stretch? Some sources may suggest that stretching is a cure all for muscle soreness, an important step in your pre-workout routine, or aides in increasing ROM (range of motion). These benefits, however, need to be taken with a grain of salt. We will discuss or debunk each of these theories.

Let’s begin with the idea that stretching cures muscle soreness. We all have those days: a couple days after a hard workout, during which we targeted a muscle group that we had ignored for a while. We are sore and seeking relief, when someone suggests a stretch. While it may feel good to stretch a sore muscle, stretching will not actually aide in relieving the soreness. You may develop a tolerance for the pain, but the real reason for muscle soreness is from minute tears in your muscle fibers, which ultimately just need time to heal. Avoid stretching aggressively at this time, as it could do more harm than good by further tearing the muscle fibers.

Next we have the idea that stretching is beneficial –necessary, even – for your pre-workout routine. Do you find yourself doing static stretches, where you hold position for just around 30 seconds? If you do, consider instead warming up in a more dynamic way (if you are physically capable of doing so), such as jumping on a stationary bike for a few minutes. Something light, but enough to get your heart rate up. Stretches will serve you much more effectively after your workout and when done consistently. For the same reason that aggressive stretching should be avoided while very sore, stretching over time will strengthen muscles. As in a dynamic workout (albeit on a smaller scale), stretching contributes to hypertrophy or muscle growth via the minute tears it creates in muscle fibers. Therefore, recovery time is so important for gaining strength.

Lastly, we will tackle whether stretching helps increase ROM. ROM is described as the full movement potential of a joint. Very often after an injury ROM is decreased. While stretching has been long known to increase flexibility, as mentioned earlier, more dynamic stretching will serve you better. It is important to know, especially within a sports setting, that static stretching may temporarily weaken the muscles you are stretching. They will get stronger in the long run, but a quick fix is not found in static stretching. Dynamic stretching, on the other hand, such as squats or lunges, is better backed by science to help increase flexibility, range of motion, and strength.

Remember that stretching is beneficial and effective when done appropriately AND at the appropriate times. Consistency is key. Happy safe stretching!

Is It Normal To Be Sore After Exercise

You have just gotten back from a 6-hour hike, complete with some grueling escalation. “It was a great workout!” You think to yourself, “so why am I not sore?” Many of us look forward to being sore, as a telltale sign of our hard work.

Do not worry, the soreness is likely to come. This is called delayed onset muscle soreness (DOMS) and it is common to feel the height of the soreness 24-48 hours after a workout! This is a completely normal process that is necessary for the muscles to rebuild themselves. Before anyone is too discouraged by the pain and stiffness to keep up with their workouts, here’s what you need to know:

DOMS is the result of tiny, microscopic tears in your muscle fibers and the connective tissue that surrounds it. These tears occur during eccentric exercise, where muscle fibers are being lengthened. Eccentric movement is performed daily, whether by lowering a barbell in a biceps curl or lowering your baby down for bed. The severity of DOMS will decrease once the body adapts to the intensity. Your body will strengthen to accommodate the certain number of sets/reps you’ve been doing at a consistent resistance. Just one exercise can help prime your body for the next exercise and you will find yourself much less sore the next time. To get stronger, however, the intensity must be increased and DOMS will likely occur again.

Learn to listen to your body. Soreness does not equate to ALL pain. Though a great workout will yield soreness – a sign that your muscles are getting stronger- rest days are just as important. While overloading your muscles is necessary for improvement, there is such thing as a tipping point. If a dull pain becomes sharp, shooting pain – you have already gone too far. It may be tempting to push through the pain, but eventually more harm than good will be done and you will be wishing you gave your body that extra day to recover. 

The Great Debate: Ice vs. Heat

It has long been debated whether ice or heat is better to treat pain. A study published by Garra G et al. in 2010 researched the efficacy of heat and ice in treating neck and back pain, concluding that both treatments provide mild relief. According to this study, the best option is whatever the patient feels most inclined to try. Especially in low back pain and neck strain, people are more likely to want heat, so they achieve relief simply by satisfying that need. “The only real leverage hot and cold packs have is on our nervous system — alarming or relaxing, soothing or irritating — and that in turn is strongly determined by context and how we feel about it.” To elaborate, heat is often thought of as comforting, or with a relaxing element. A hot pack therefore does not tend to “alarm” the brain, as would an ice pack being placed onto someone’s bare back. One may think of going to a spa for a full body massage, where warm oils or heated rocks are used as part of the treatment, thus garnering the correlation of heat to being soothing. Versus the shocking and breath-taking element of, say, the “ice bucket challenge” in which thousands of individuals poured freezing ice water onto themselves.

The bottom line?

• Ice should be used to reduce areas of inflammation and for acute injuries.
o The key characteristics are redness, swelling, pain, and warmth.
o To counteract this heat and reduce the swelling, ice is most often used as the initial treatment for soft tissue injuries such as sprains and strains.
o Soft tissue injuries, or STIs, are damages of muscle, ligaments, and tendons.
o Heat will make inflammation worse and will lead to more pain around injury site
o Ice can be applied using an ice pack covered by a cloth, never directly onto the skin in order to avoid further tissue damage.

• Heat is best to relieve tightness, tension, pulled muscles, and chronic pain
o May be better for chronic pain to give temporary relief
o Chronic low back pain, for example, welcomes heat therapy much more than it would ice.
o Chronic pain, stiffness, and soreness can be treated using heat because heat helps the muscles relax, which then improves blood circulation and reduces muscle spasms.
o Heat also treats trigger points. While they are not complete muscle spasms, they are tiny muscle cramps, which tend to be aggravated in the cold. These sensitive areas of soft tissue are likely what individuals are referring to when they mention a “knot” in their neck, for example.
o Heating pads use dry heat and steamed towels use moist heat to provide the soothing heat. Paraffin wax is used to relieve pain, most commonly as a hand dip for those with arthritis.

And why not both! Introducing contrasting therapy:
• Contrasting therapy act of the immediately switching between heat and ice to make muscles more adaptable to changes
o Contrasting therapy is a quick solution mostly used with athletes looking to recover from a competition and get back in game.
o Easy and cheap solution – little risk of harming the muscles, as it allows your muscles to work out, due to the stimulation of the contrast, without the stress of a physical workout.

 However, more research needs to be done
Ultimately, it is best to use “whatever feels best”
o “Ideal uses of ice and heat are roughly equal in potency” (Paul Ingraham,
o Using ice when already cold can lead to more muscle tension, and using heat when the body is already hot may shock the body
o When individuals change their mindset from believing that heat is a cure-all for any and all chronic pain, they may find that ice is able to soothe them as well.

Garra G, Singer AJ, Leno R, et al. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med. 2010 May;17(5):484–9. PubMed #20536800.

The Benefits of Cupping

The Benefits of Cupping

In its simplest description, cupping involves the direct use of cups on the skin to create suction. But what does the suction do? And is cupping a viable source of therapy?

Cupping originated in China, where it was known to facilitate the flow of “qi”, or life force, throughout the body. Some health problems were thought to be due to poor energy flow or stagnant blood. Enter cupping therapy, which increases blood circulation in the areas where the cups are placed, thus alleviating those problems. Most often dark bruises will arise and a common misconception is that they are the result of damage to the body. Instead, the dark marks are the result of the blood having been moved from deep tissue to more superficial layers.

Materials used vary:
o Glass cups, which use fire to create the suction
o Plastic cups, which utilize an air pump to siphon out the air, thus eliminating the need for fire
o Silicone cups, which alone, when squeezed, create the negative pressure needed to stick to the skin and raise the muscle

Two types of cupping:
o Dry
o Wet
o After a few minutes of dry cupping, small incisions are made to the raised areas, which allow for the excretion of toxic blood and fluids when another cup in placed over the same area for a second round of cupping.

Benefits vary from the type of cupping, wet versus dry. Overall, the suction created by the negative pressure inside of the cup draws blood toward the affected area, which can
o Relieve muscle tension
 Loosen muscles
o Improve circulation
 Encourage blood flow
o Reduce inflammation
 Attracts immune cells to the area in order to help aide the recovery process and decrease swelling
o Reduce pain
o Help with anxiety and depression
o Reduce the appearance of cellulite

Who should cup?
• Anyone suffering from chronic pain:
o Back pain
o Shoulder pain
o Other musculoskeletal pain

o Headaches or migraines
o Rheumatism
o Stress

 Tension builds up throughout our daily activities, whether it’s from manual labor at work or as a student hunching over a computer while writing an essay

• Athletes
o Post-workout recovery
o Although an ancient technique, cupping most recently blew up during the 2016 Olympics when swimmer Michael Phelps was seen with intense, purple circle bruises. He swore that cupping was the key to dealing with soreness and pain throughout the competition.

• Those suffering from
o Hypertension
o Diabetes
o Anxiety
o Depression