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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

“Did you take a weekend course to become a Physical Therapist”

I am often asked “do you have a certificate to practice physical therapy?” or “did you have to take a weekend course to do this?” I can’t help but chuckle and remind the patient that they are in good hands and in fact, most licensed Physical Therapists now hold a doctorate degree. To be clear, the profession has evolved over the years and at one time a bachelor’s degree was the norm. Next came a master’s degree and currently most accredited universities offer a doctorate degree. A Physical Therapist now completes roughly 7 years of education. All Physical Therapists complete a rigorous doctoral program and are equipped to begin to treat patients. However, Physical Therapists vary in their skill sets, post doctorate educational levels and certifications as well as experience. We highly recommend you seek a licensed Physical Therapist that performs hands on, manual physical therapy and holds a Board Certification or regularly participates in continuing education. Do your homework and don’t be afraid to ask about your therapist prior to your evaluation. Like any profession, therapist vary greatly in their experience, techniques, skill level and of course personality. Find a therapist that you connect well with and most importantly feel comfortable with. It may help to ask to have a brief phone conversation with your potential therapist to get an idea if he or she is the right fit for you. At PPPT, we will gladly jump on a phone call with any potential new patient. We feel it’s also important on our end to assure the patient that their condition, or complaint is something we can handle. We understand that physical therapy may not only be a financial commitment, but also a time commitment and it is important that the patient understand the value of what they will be receiving prior to committing.

5 Ways to End Back Pain Today Without Medication or Surgery

1. Maintain good posture and monitor your computer health.

A) Keep feet flat on the ground. Knees should be at a 90 degree angle.
B) Sit up straight. Avoid tension in and around neck and upper back.
C) Keep your eyes level with your screen. Remember the top of your head should level with the top of your computer screen.
D) Keep forearms parallel. Your elbows should be at 90 degree and your arms resting on you chair’s armrest.
E) Keep your shoulder blades settled and resting on your ribs.
F) Keep your mouse close to your keyboard so you don’t have to reach for it.
G) Rest eyes from time to time. Look away from the computer and take frequent breaks.

2. Wear proper shoes.

A) Sorry ladies, but avoid high heels.
B) Limit flip flops and shoes with no arch support. Add an orthotic if necessary.
C) Consider a gait analysis or professional shoe fitting.

3. Purchase a new mattress every 5 years and find a sleeping position that limits or abolishes your pain.

A) Consider side sleeping with a pillow between your legs.
B) Do not sleep on your stomach

4. Stretch, strengthen and move daily.

A) Switch positions often to avoid prolonged standing, sitting or walking.
B) Walk at least 10-15 min daily.
C) Stretch your back, hip and legs daily.
D) Strengthen your body.
E) Remember if you don’t move it, you lose it.

5. Give physical therapy a try!

A) Be sure you are getting one on one care with a licensed physical therapist for at least a portion of your full session.
B) Be sure you receive manual hands on treatment. 99% of patients benefit from manual hands on techniques to improve muscle and joint mobility as well as reduce pain, be sure you are not missing out.
C) Be sure your physical therapist thoroughly explains what he or she believes is your problem and outlines a full treatment plan for you. If you have questions, ASK.

4 Myths About Physical Therapy

Four Myths About Physical Therapy

1. Physical therapy is painful.
If I had a dollar for every time I’ve heard someone say, “does physical therapy stand for physical torture?” I would be a rich man. Physical therapy should in fact very rarely be painful. Contrary to popular belief, Physical therapy is intended to reduce or abolish pain and not create or increase one’s level of pain. Yes, there are times and treatments that may cause brief periods of discomfort or residual soreness, but you should experience very little pain at the time of treatment or anytime after your session. If you do experience an increase in pain, it is important to communicate this to your therapist immediately.

2. Physical therapy treatments provide only temporary changes.
There is nothing further from the truth. Physical therapy does in fact result in long term changes in pain, mobility and function. In addition, Physical therapy can allow you to stop taking pain medication and reduce unnecessary injections or surgeries. Now, lets be clear, a few hours of physical therapy a week is not enough. You must supplement your physical therapy with a complete, individualized home exercise program and a daily commitment to your health.

3. Any healthcare professional can perform physical therapy, or all Physical Therapists are the same.
There are many different healthcare providers claiming to be able to perform physical therapy. However, did you know that to become a licensed Physical Therapist in the United States, you must hold a Doctorate Degree. A Physical Therapist completes 7 years of education. All Physical Therapists complete a rigorous Doctoral program and are equipped to begin to treat patients, however, Physical Therapists vary in their skill sets, post doctorate educational levels and certifications as well as experience. We highly recommend you seek a licensed Physical Therapist that performs hands on, manual physical therapy and holds a Board Certification or regularly participates in continuing education. Don’t be afraid to ask about your therapist prior to your evaluation.

4. A Doctors referral is necessary prior to seeing a Physical Therapist.
In most cases, a Physicians referral is not necessary to be evaluated by a Physical Therapist. Although some insurances require a referral, many do not and often an initial evaluation is allowed prior to obtaining a referral. If you are not using your insurance, a referral is not necessary for the first 12 visits or 45 days, whichever occurs first. Laws vary from state to state, so be sure to consult your local physical therapy office.