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Do you ever feel a tingling sensation that starts at the base of your spine and goes down the backs of your legs? It can also get pretty painful, right?  This is sciatica.  Sciatica is a common yet debilitating condition that affects millions of people worldwide. Up to 40% of people deal with sciatica pain at some point in their lives. Usually characterized by pain that radiates along the sciatic nerve, it can significantly impact daily activities and overall quality of life. If you're struggling with sciatica pain, understanding its causes and learning some effective home exercises can help you find relief quicker than you may think. What is Sciatica? Sciatica is a condition that occurs when the sciatic nerve is irritated, compressed, or inflamed. It typically manifests as pain that travels from the lower back down through the buttocks and into one or both legs. This pain can vary in intensity, ranging from mild discomfort to severe, debilitating pain that makes walking or even sitting difficult. Possible Causes of Sciatica: Herniated Disc: One of the most common causes of sciatica is a herniated or bulging disc in the lower spine, which can press against the sciatic nerve. Spinal Stenosis: Narrowing of the spinal canal can put pressure on the sciatic nerve, leading to pain and discomfort. According to the National Institute of Health (NIH), spinal stenosis affects an estimated 10-15% of the population over the age of 50. Piriformis Syndrome: A tight or inflamed piriformis muscle can irritate the sciatic nerve as it passes underneath. Degenerative Disc Disease: Age-related wear and tear on the spine can lead to disc degeneration, which may contribute to sciatica. Muscle Imbalances: Weak core muscles and tight hamstrings or hip flexors can place undue stress on the lower back and sciatic nerve. *Looking for a physical therapist to help you with your sciatica pain? Speak with one of our client specialists today and learn how Next Level Physical Therapy can help YOU get pain-free! What’s the Deal with the Sciatic Nerve? The sciatic nerve is the longest and thickest nerve in the human body. It starts at the lower lumbar spine (L4-S3) and travels down through the buttocks and into each leg. This nerve plays a crucial role in movement and sensation in the lower extremities. Functions of the Sciatic Nerve: Provides motor function to the muscles of the lower leg, including the hamstrings, calves, and foot muscles. Enables sensation in the lower back, buttocks, legs, and feet. Helps with reflex actions like knee-jerk and ankle reflexes. Since the sciatic nerve runs through several different parts of your body, any compression or irritation can result in severe pain and functional limitations. 12 Home Exercises for Sciatica Pain Relief Doing targeted exercises at home can alleviate sciatica pain by improving mobility, reducing nerve tension, and strengthening supportive muscles. Here are 12 effective home exercises that can help with sciatica pain relief: 1. Sciatic Nerve Flossing Sciatic nerve flossing helps to improve the mobility of the sciatic nerve by gently gliding it through the surrounding structures. Sit upright on a chair with both feet flat on the floor. Extend the affected leg straight and point your toes upward while tilting your head back. Slowly lower your leg and flex your head forward. Repeat 10 times on each side. 2. Seated Sciatic Nerve Flossing Sit at the edge of a chair with one foot on the ground and the other extended straight. Flex and extend your foot while tilting your head forward and backward. Repeat 10 times per leg. 3. Prone Elbow Rested Position Lie face down and rest on your elbows, keeping your hips in contact with the floor. Hold this position for 30 seconds to 1 minute. This helps to reduce pressure on the lower spine and sciatic nerve. 4. Prone Press-Up Lie face down and place your hands under your shoulders. Press your upper body up while keeping your hips on the ground. Hold for 10 seconds and return to the starting position. Perform 10 repetitions. 5. Frog Leg Press-Up Start in the prone position on your belly. Place your hands under your shoulders and press up while slightly spreading your knees apart. Hold for 10 seconds and repeat 10 times. 6. Press-Ups with Hip Shift Perform a standard press-up but shift your hips slightly to one side. Hold for 5 seconds, then switch sides. Do 10 repetitions per side. 7. Lumbar Side Glide Stand with your affected side next to a wall. Place your elbow against the wall and gently press your hips away. Hold for 5-10 seconds and repeat 10 times. 8. Side-Lying Hip Lazy Roll Lie on your side with your knees slightly bent. Roll your top hip slightly forward, then return to the starting position. Perform 10 repetitions per side. 9. Single Leg Bridge Lie on your back with one foot flat on the floor and the other leg extended. Push through your grounded foot and lift your hips. Hold for 5 seconds and repeat 10 times per leg. 10. Glute Foam Rolling Sit on a foam roller with one ankle crossed over the opposite knee. Roll gently back and forth for 30 seconds. Switch sides and repeat. 11. Piriformis Foam Rolling Sit on a foam roller and position it under one glute. Roll back and forth to release tension in the piriformis muscle. Spend 30 seconds per side. 12. Kickstand Romanian Deadlift (RDL) Stand with one foot slightly behind the other for balance. Hinge at the hips while keeping a neutral spine. Lower until you feel a stretch in the hamstrings, then return to standing. Perform 10 repetitions per leg. Join our Facebook page to watch our Physical Therapist, Dr. Rich, explain these exercises in detail! Don’t Let Sciatica Pain Hold You Back Sciatica pain can be frustrating, but incorporating targeted exercises such as sciatic nerve flossing, foam rolling, and glute strengthening can significantly alleviate symptoms. If your pain persists or worsens, don’t hesitate to seek professional medical advice. By staying active and maintaining proper spinal health, you can keep sciatica pain at bay and enjoy a pain-free lifestyle. FAQ How is sciatica pain treated? Sciatica pain is usually treated by a combination of approaches, including physical therapy, medications, and in some cases, injections or surgery, with the goal of reducing pain and improving mobility. Speak with your doctor to determine the best course of action for you. Will sciatica pain go away? For many people, sciatica pain improves within a few weeks with proper care, including rest, stretching, and strengthening exercises. However, if left untreated or caused by more serious conditions like a herniated disc or spinal stenosis, it can persist for months or even become chronic. Does Next Level Physical Therapy treat sciatica pain? Yes! We help you get to the root cause of your pain so you can begin your journey to recovery while also giving you the tools to avoid future sciatica pain, setting you up for success in your active lifestyle. Speak with one of our Client Specialists today to begin your pain-free journey.

If you’ve ever had an injury, surgery, or condition that affected how you move or perform daily tasks, you’ve probably heard the terms occupational therapy (OT) and physical therapy (PT). But let’s be honest, unless you're in the healthcare world, these two can be really easy to mix up. Both OT and PT are essential rehabilitation services that help people regain function and independence, but they have distinct focuses and approaches.  Whether you're recovering from surgery, helping a child with developmental delays, or dealing with chronic pain, understanding the difference can help you choose the right path for your health journey. Let’s break it all down. Key Differences: Occupational Therapy vs Physical Therapy While OT and PT share some similarities, the biggest difference lies in what they focus on helping you to do: Occupational therapy focuses on helping you perform the activities or "occupations" that matter most in your daily life. Physical therapy focuses on improving your physical movement, strength, and mobility to help you function better. Let’s dig a little deeper into each to really understand the distinctions. Occupational Therapy 1. Focus: Function in Daily Life Occupational therapy is all about functional independence. It helps people of all ages participate in the activities (aka "occupations") that they need or want to do in their daily lives. Whether that’s brushing your teeth, cooking dinner, typing at work, or even playing a musical instrument. If something, be it an injury, illness, or disability, is getting in the way of those everyday tasks, an occupational therapist helps you work around it or through it. 2. Scope: Mind, Body, and Environment OT takes a holistic approach. It considers not just the physical limitations a person may face, but also cognitive, emotional, and environmental factors that may affect function. For example, someone with a traumatic brain injury might need OT to relearn how to manage time, use tools, or navigate social situations. A child with sensory processing issues might work with an OT to regulate sensory input during school tasks. 3. Example: Helping After a Stroke Let’s say someone has a stroke and loses partial use of their right arm. An occupational therapist might work with them to: Relearn how to dress using one arm Use adaptive equipment to cook safely Modify their home or workspace to reduce fall risk or fatigue 4. Goal: Independence and Meaningful Participation The ultimate goal of OT is to help you live your life with as much independence and meaning as possible. It’s not just about surviving, it’s about thriving in the roles and routines that matter most to you. Physical Therapy 1. Focus: Movement and Physical Function Physical therapy, on the other hand, zeroes in on restoring movement, strength, flexibility, and balance. PT is especially common after surgeries, injuries, or any condition that limits how your body moves. Physical therapists work to reduce pain, improve mobility, and help you avoid future injury or disability. Want to learn more? Speak with one of our Client Specialists to find out how you can avoid future injury with Next Level Physical Therapy! 2. Scope: Musculoskeletal and Neuromuscular Systems PTs focus primarily on your muscles, bones, joints, ligaments, tendons, and nerves. While they may consider emotional or lifestyle factors, the approach is typically more biomechanical. Whether it's post-op rehab for a torn ACL or strengthening muscles around an arthritic joint, PT is about helping your body move better. 3. Example: Recovering After Knee Surgery After ACL reconstruction, a physical therapist will help a patient: Regain range of motion in the knee Rebuild strength in the leg muscles Learn how to walk properly again Progress to running, jumping, or playing sports if applicable 4. Goal: Restore Physical Capacity and Prevent Re-injury The goal of PT is to get your body moving at its optimal level so you can live, work, and play without pain or limitations. It’s about performance, recovery, and prevention. Similarities: Occupational Therapy vs Physical Therapy Even though OT and PT focus on different things, they do have some key similarities: Both Aim to Improve Quality of Life Whether you're seeing an OT or a PT, the ultimate goal is the same: to help you function better and live a fuller, more independent life. Both Can Be Used Together In many cases, OT and PT work hand-in-hand. For example, a person recovering from a spinal cord injury might see a PT to work on core strength and leg mobility, and an OT to learn how to adapt to tasks like getting dressed or cooking. Both Require Personalized Treatment Plans No cookie-cutter plans here. Both therapies involve individualized assessment and goal-setting to meet the specific needs of the patient. Both Are Evidence-Based Both professions rely on research and clinical evidence to guide treatment decisions. Whether you're working on movement patterns or task modifications, the approach is grounded in science. How to Know Whether You Need Occupational Therapy vs Physical Therapy If you're wondering whether you or someone you love should see an occupational therapist or a physical therapist, here are some tips to help you decide: When to Consider Occupational Therapy: You’re having trouble with daily tasks like dressing, cooking, writing, or bathing You’re recovering from a stroke or brain injury You or your child has sensory processing difficulties or developmental delays You need help with adaptive strategies or equipment to stay independent You're experiencing challenges with cognitive function that affect daily life When to Consider Physical Therapy: You’re recovering from an orthopedic injury or surgery You’re experiencing chronic pain, limited mobility, or balance problems You’ve been diagnosed with a neurological or musculoskeletal condition You want to improve your strength, posture, or athletic performance You're at risk of falls or have mobility limitations When You Might Need Both: Sometimes, the line between OT and PT blurs. For example: A child with cerebral palsy might need PT to build strength and OT to learn to use a spoon or get dressed. An older adult recovering from hip surgery might need PT for walking and balance and OT to safely bathe or cook at home. The good news? You don’t have to figure it out alone. A medical provider, or even the therapists themselves, can help guide you to the right combination of care. Let’s Review: Occupational Therapy vs Physical Therapy Occupational therapy and physical therapy are both powerful tools for regaining independence, improving function, and living your best life. While they serve different roles, they’re often complementary, and in many cases, working with both types of therapists offers the best outcomes. Still unsure what you need? That’s totally normal. Your first step is talking to a healthcare provider or reaching out to a rehab clinic that offers both services. Your recovery isn’t one-size-fits-all… and your therapy shouldn’t be either. FAQ 1. Can occupational therapists and physical therapists treat the same conditions? Yes, sometimes. But they approach the condition from different angles. For example, someone recovering from a car accident may have both a PT and an OT on their care team. The PT might focus on restoring strength and range of motion, while the OT helps with daily tasks like getting dressed or using utensils again. It’s like two sides of the same coin: same condition, different goals. 2. Do I need a referral to start OT or PT? That depends on your state laws and insurance. Some states allow direct access, which means you can see a physical therapist without a referral. Occupational therapy often requires a referral, especially if it’s being billed through insurance. That said, even if you’re not sure, it’s always okay to reach out to a clinic. They can guide you through the referral or insurance process. 3. Is occupational therapy only for kids or people with disabilities? Not at all! While OT is well-known for helping kids with developmental challenges or adults with disabilities, it’s also incredibly useful for anyone who’s having trouble doing the things they need or love to do. That includes older adults recovering from injury, people with arthritis, stroke survivors, or even someone dealing with burnout or cognitive changes. If an activity is important to you and you’re struggling with it, OT might be able to help.

Hips are not born to be “tight,” but with how often people describe their hips as feeling more like rusty gears than Stretch Armstrong, it is easy to believe they are. The good news is that, for most people, hip mobility issues can be significantly improved by shifting how you think about what is actually limiting your motion. Before we talk about solutions, let’s look at the anatomy of the hips and then break down how to identify what deserves your attention. Anatomy Think of the pelvis as the house that your hips live in. It is made up of two wing-like structures called innominates, which are connected by the sacrum. Your lower back connects directly into the top of the sacrum, forming a complex relationship between the spine, pelvis, and hip joints. In a previous post, we talked about why “stretching” a muscle that has the perception of tension, or that might be a contributor to a reduction of joint motion might be a simplistic, reductionist way of viewing how the body creates movement. Muscles attach to tendons, which attach to bones. If we only pursue the feeling of a stretch in an area that feels restricted, we may miss the underlying factor that is actually driving that sensation. To make this more actionable, let’s break hip mobility into a few buckets. Bucket 1: What Does My Total Hip Rotation Look Like? One of the easiest ways to assess hip mobility is to look at total hip rotation. This means adding together your hip external rotation and hip internal rotation. (Figure 2).  [caption id="" align="aligncenter" width="882"] Figure 2: Hip ER and IR measured on an examination table.[/caption] A general benchmark for most people is around 100 degrees of total rotation between these two movements. When this is present, it suggests that the innominates can move well relative to the sacrum and that the hips have access to a wide range of positions. If you are missing a significant amount of total hip rotation, a good starting point is learning to move with less muscular tension and restoring relative motion between the pelvis and sacrum. A simple and effective option is sidelying rolling with lateral pelvic compression. This exercise helps reduce unnecessary muscular effort, restore rotation, and build awareness of how your hips actually move. That awareness becomes incredibly valuable as exercises become more challenging. [embed]https://youtu.be/oeLwLrrsSI4[/embed] Figure 3: Sidelying Rolling with Lateral Pelvic Compression Other commonly used movements that serve a similar purpose include the supine cross connect and the hooklying two arm reach. [embed]https://www.youtube.com/watch?v=TcsiqnDrd0g[/embed] Figure 4: Supine Cross Connect [embed]https://youtu.be/C7hLRzrWF_4[/embed] Figure 5: Hooklying Two Arm Reach  Both of these exercises help reorient the pelvis as a unit and can rapidly restore access to hip rotation when position is the primary limitation. If you are missing total hip rotation, start here. Restoring potential movement comes first. Bucket 2: What Are My Tissues Calibrated To Do? Think about guitar strings. Their tension changes depending on how they are used and how the guitarist prefers them tuned. Your body works in a similar way. Beyond muscles and bones, connective tissues play a huge role in absorbing and transmitting force. These tissues adapt to the demands placed on them. If you recently restored hip rotation but still feel stiff or restricted, it may be time to recalibrate how your connective tissues handle force. A great starting point is a goblet box squat with a rockback. This symmetrical movement encourages the body to absorb force and reduce stiffness by relaxing into the bottom position. [embed]https://youtu.be/R26W48oflok[/embed] Figure 6: Goblet Box Squat with Rockback Once that feels comfortable, a lateral lunge with a static hold introduces similar demands but emphasizes side-to-side motion. This helps the body learn to manage force in frontal plane positions that are often undertrained. [embed]https://youtu.be/wXljK0b7vhM[/embed] Figure 7: Lateral Lunge with Static Hold Putting It All Together If you are missing a large amount of hip rotation, focus first on getting the pelvis into positions that allow that motion to exist. This restores your potential to move freely in multiple directions. Once that potential is there, the next step is tuning your body’s connective tissues to do what you actually need them to do. That means being able to absorb force when necessary and create force when needed. Both qualities matter. Mastering them is what allows you to move well, train hard, and stay active without constantly feeling stiff. Give these strategies a try and see how your hip mobility changes when you stop chasing stretches and start respecting position and force instead.

Carpal tunnel syndrome is a collection of symptoms that most commonly appear in the thumb, index finger, and middle finger on the palm side of the hand. The hallmark symptom is aching, tingling, or a loss of sensation in those three fingers specifically. These symptoms most often occur because the median nerve is experiencing prolonged compression as it passes into the hand through the carpal tunnel. The carpal tunnel is a narrow passageway formed by bones and connective tissue near the wrist that also contains several tendons and muscles, along with the median nerve. Because this space is small, even subtle changes in position or tissue behavior can increase pressure on the nerve. (Figure 1). [caption id="" align="aligncenter" width="600"] Figure 1: Anatomy of the carpal tunnel region and the median nerve. The nerve in the middle that runs to the thumb and middle finger is the median nerve. Source: https://qph.fs.quoracdn.net/main-qimg-2effc0be8c4ff02f065339aebda08596-c[/caption] The most common treatments we see recommended include prolonged static stretching of the muscles on the front of the wrist and forearm, active range of motion exercises for the wrist and hand in all directions, stretching of the thumb muscles, and tendon or nerve gliding activities. What all of these interventions have in common is their shared goal of reducing compression on the median nerve. Nerves thrive on movement, blood flow, and adequate space. The intent behind these treatments is sound, which is why the surgical option for severe cases involves cutting the connective tissue that runs across the carpal tunnel to create more room for the nerve. While there is nothing inherently wrong with these approaches, not all interventions produce the same effect. If the goal is to create space around the carpal tunnel, it is critical to consider the relationship between the position of the hand and the wrist. Many of the muscles and tendons that influence carpal tunnel pressure either cross through the tunnel or attach directly to the bones of the hand and wrist. Static stretching primarily increases a muscle’s tolerance to being lengthened. According to current research, it does very little to change how muscles or tendons behave or function in daily movement (PubMed ID# 28801950). In addition, applying prolonged tension to a nerve that is already compressed can be similar to stretching an already tight rubber band. Increasing tension does not reduce stress on the structure and may actually worsen symptoms. Rather than focusing solely on muscles that are labeled as tight, it is often more effective to focus on positioning the bones of the hand and wrist in a way that reduces tension on the nerve. This approach helps “unstretch” the rubber band and gives the median nerve more room to move freely. The image below shows an example of a thumb that is internally rotated relative to the wrist, highlighted in yellow. The blue arrow shows a thumb that is better able to externally rotate relative to the wrist. (Figure 2) [caption id="" align="aligncenter" width="960"] Figure 2: An example of differing thumb and wrist orientations. Source: https://i2.wp.com/plasticsurgerykey.com/wp-content/uploads/2020/06/10-1055-b-002-98003_c049_f001.jpg?w=960[/caption] Can you see how stretching the muscles of the yellow hand might produce a completely different result than stretching the blue hand? Applying the same solution to two different presentations does not lead to the same outcome. In the next part of this discussion, we will explore how to create a more effective strategy to improve space and movement around the median nerve. This approach may help reduce or eliminate carpal tunnel symptoms by addressing the specific presentation shown in the yellow hand.

If you are here to read about your knee, you have come to the wrong place. We are not here to talk about your hips and ankles either. Well, not entirely true. We are really here to talk about your diagnosis: patellofemoral pain syndrome, or PFPS, which typically describes pain in the front of the knee. Unfortunately, PFPS is more of a description than a true diagnosis. Before diving deeper, let’s briefly review the relevant anatomy. A joint exists anywhere two bones meet, and the knee is no exception. The knee joint is formed by the femur, or thigh bone, and the tibia, or shin bone. While it may look like the knee moves like a simple hinge, it does not. Like every joint in the body, the knee relies on rotation. As you straighten your knee, the femur rotates inward while the tibia rotates outward. When you bend your knee, the opposite occurs. The top of the tibia is relatively flat, while the bottom of the femur resembles two rounded surfaces resting on it. Ligaments and muscles work together to keep the joint stable. Although many muscles influence knee position, the quadriceps are often the main focus in PFPS discussions because the patella, or kneecap, sits within the quadriceps tendon itself. Now that we understand the anatomy, here is the part that matters most. Why Force Management Matters More Than Anatomy What truly matters in PFPS is not the knee structure itself, but how forces move through your body. Every time your foot contacts the ground, force travels up the leg and through the body. To move forward, you must then push force back into the ground. This is walking. When done at higher speeds, it becomes running. The same principles apply to strength training, even when your feet stay planted. How efficiently your body absorbs and redistributes force determines how much stress is placed on the knee, muscles, ligaments, and surrounding tissues. There is no need to fear normal tissue stress. Strain is a natural and necessary part of being human. It is how tissues adapt and become stronger. The issue arises when the amount of stress exceeds your ability to recover from it. You can think of this like a budget. Small withdrawals are normal and manageable. Over time, if withdrawals exceed deposits, you slowly go into debt. That accumulated debt is what often shows up as pain. Why PFPS Does Not Explain the Real Problem PFPS tells you where your pain is located, not why it exists. Because of this, the label itself offers very little guidance on how to actually resolve it. The most common advice given for PFPS is to strengthen the quadriceps, hamstrings, calves, and glutes. The reasoning is that stronger muscles will better tolerate force and reduce strain on the knee. Strength training absolutely matters, but this approach is often incomplete. Strong muscles are only useful if they activate at the right time, in the right sequence, and in coordination with the rest of the body. Strength alone does not guarantee proper force distribution. Many people do find relief through strengthening programs. However, if you have already gone down that path and are still dealing with pain, something important was missed. Even the presence of old injuries such as meniscus tears, arthritis, or ligament damage may not be the main driver of your symptoms. Improving how your body manages and distributes force through the knee can lead to meaningful improvements, even when structural issues exist. The Takeaway If you have persistent pain in the front of your knee, PFPS does not mean you are stuck with it forever. Mechanical pain always has a source. When the focus shifts away from isolated structures and toward improving how forces move through your body, real change becomes possible. With the right approach, anterior knee pain can absolutely be resolved.

Wrist pain, especially on the thumb side of the wrist, can range from a persistent nuisance to something truly limiting. For some people it is an annoyance, while for others it becomes debilitating and interferes with daily activities. You may have already tried stretching the muscles on the front of the wrist, icing the area, or even wearing a brace or splint. While these strategies can provide temporary relief, wrist pain often requires a more deliberate assessment to ensure you are addressing the right components at the right time. So where do you start? Use the simple screens below to begin understanding what movement options your wrist and hand currently have available. This helps prevent wasting time chasing the wrong issue. Understanding How Your Wrist Moves  Below are simple self exams you can use to get a clearer picture of how your wrist moves and which motions may be limited. [caption id="" align="aligncenter" width="1500"] Figure 1: Movements at the wrist. Source: https://www.crossfit.com/essentials/movement-about-joints-part-3-wrist.[/caption] The wrist is capable of flexion and extension, as well as radial deviation, which is movement toward the thumb side, and ulnar deviation, which is movement toward the pinky side. The wrist joint itself is formed by the connection between the carpal bones of the hand and the radius and ulna of the forearm. (Figure 2) [caption id="" align="aligncenter" width="1024"] Figure 2: Bony Anatomy of the Wrist and Hand. Source: https://www.assh.org/handcare/servlet/servlet.FileDownload?file=00P5b00000tFPX8EAO[/caption] Step 1: Assess Your Wrist Motion Take your wrist through each of the motions listed above. Pay attention to whether any movement reproduces discomfort near the radius. Also notice which motions feel limited compared to the others. In many cases, wrist pain near the radius is associated with limited wrist extension and limited radial deviation. To better understand why those limitations exist, it is important to consider the position of the hand relative to the wrist. This brings us to the Pistol Test. If you have a positive Pistol Test, your hand is positioned in more internal rotation relative to the radius. This biases the wrist toward flexion rather than extension. Many people with this presentation notice wrist pain when trying to extend the wrist, such as at the bottom of a pushup or during weight bearing positions through the hands. When the hand is internally rotated relative to the wrist, it is like starting wrist movement partway up the range instead of from neutral. Imagine the wrist as an elevator in a ten story building. Starting on the fourth floor and trying to go ten floors higher quickly leads to a hard stop. That same type of constraint can create a jam where the wrist meets the hand when end range extension is challenged. Instead of relying solely on icing or bracing to avoid painful positions, it is often more effective to address the movement limitations creating the problem. In other words, take the elevator back to the ground floor. Step 2: Restore Hand Position The first goal is to improve the ability of the hand to externally rotate relative to the wrist. Staggered stance curls are a useful exercise for this. Use a light weight and hook your thumb behind the dumbbell handle. This helps lock in external rotation of the hand while you perform the movement. [embed]https://youtu.be/N4WWxUmvcw8[/embed] Step 3: Rebuild Wrist Motion and Load Tolerance Once hand position improves, restoring wrist extension requires learning how to internally rotate the radius relative to a fixed hand. The low oblique sit with pronation is a helpful drill for this. This side plank variation uses a towel to keep the hand fixed while the forearm rotates. [embed]https://youtu.be/D7LhuuTcMD0[/embed] After you have recaptured hand position and learned to move the radius relative to the hand, it is time to challenge wrist position under load. Bear crawling is an effective progression at this stage. [embed]https://youtu.be/1HdyUZsZr_c[/embed] As you load one side, focus on feeling your weight shift from the outside of the hand toward the inside without losing contact along the outside edge of the hand. Start by understanding what motions your wrist can and cannot perform, then train the specific movement strategies needed to restore those motions. Giving your wrist more freedom to move is often the key step toward lasting wrist pain relief.

The foremost principle that guides rehabilitation is the SAID Principle, or Specific Adaptations to Imposed Demands. Simply put, this principle of physiology tells us that the body adapts to the specific demands placed upon it. Perform enough aerobic exercise and your heart adapts by increasing the size of the muscles in the left ventricle. This allows more blood to be pumped with each contraction, lowering resting heart rate over time. Similar adaptations occur within the nervous and hormonal systems and often lead to decreases in resting blood pressure as well.¹ The tendons of sprinters become increasingly stiff as they train to run faster. This is a positive adaptation. Think about the last time you struggled to change the roll of bathroom tissue because the spring was stiff and kept snapping back quickly. A stiffer spring, much like a stiffer tendon, releases more energy when stretched and recoils, helping the sprinter move faster and more efficiently. When an injury occurs to a muscle, tendon, or another joint structure, it is usually because that tissue was exposed to a level of stress that exceeded its ability to adapt positively. When you trip and roll your ankle in the classic position shown below in Image 1, the ligaments and muscles on the outside of the ankle are injured because they were loaded too quickly and with too much force for what they were prepared to handle. Meanwhile, there are well documented examples of martial artists being able to break stone with their shins without injury because they have spent years gradually adapting their bodies to those compressive forces. [caption id="" align="aligncenter" width="652"] Image 1: Despite this being Klay Thompson of the Golden State Warriors, my left ankle was in this same exact situation about a year ago. Source: https://i2.wp.com/b-reddy.org/wp-content/uploads/2016/07/klay-thompson-right-ankle-sprain.jpg?ssl=1[/caption] How does this relate to a shoulder injury? If we want to restore shoulder function and allow the joint to tolerate increasing physical stress without negative adaptations like pain or injury, we need to apply the Goldilocks Principle of rehabilitation shown in Image 2. The stress must be just right. Too little will not create change, and too much will drive setbacks. The chart below is a helpful way to visualize this concept when restoring strength and range of motion following injury. Image 2:  Volume vs intensity threshold for gaining an adaptation. (Joel Jamieson’s “Ultimate MMA Conditioning”)  Resistance tubing, often referred to by the commercial name Theraband, is one of the most common tools people associate with physical therapy. Despite the title of this article, we are not against the use of resistance bands. For individuals in the early stages of shoulder rehabilitation, tubing can be extremely useful. It provides a low level of resistance that may be enough to rebuild initial strength or improve control of the arm through a safe range of motion. Bands can also help provide external feedback so you can better feel your shoulder moving into different positions, which can be valuable when restoring range of motion. However, if the goal is to build a shoulder that can produce and absorb meaningful force, bands alone are often not enough. At some point, greater resistance is needed to apply the appropriate combination of volume and intensity required for long term strength gains.   Sidelying Kettlebell Arm Bar Exercises like the kettlebell or dumbbell arm bar are an excellent entry point for retraining shoulder rotation with heavier loads. They also help retrain coordinated movement of the shoulder blade, allowing smoother and more controlled motion of the arm. Hooklying Dumbbell Pullover The hooklying dumbbell pullover is another effective way to improve overhead range of motion while building strength through a large arc of movement. This exercise is commonly used to help clients regain overhead motion without compensating through excessive lower back arching. It also builds confidence when holding weight overhead. Staggered Stance Landmine Press Landmine pressing is a highly effective way to load the muscles around the shoulder with progressively heavier resistance. This variation also allows easy modification to train coordination between ribcage rotation and shoulder movement, which is critical for many athletic and daily activities. If you are returning from a shoulder injury, it is important to understand the purpose behind each exercise you choose. Not all rehabilitation needs to look like bands and two pound weights. Your program should be challenging enough to prepare your shoulder for the real world demands you place on it. Make sure the time you invest in rehabilitation is producing the adaptations your shoulder actually needs. References Farrell C, Turgeon DR. Normal Versus Chronic Adaptations To Aerobic Exercise. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572066/

There is much more to elbow pain than blaming the sport you play or the equipment you use. If you have experienced elbow pain, you have likely heard terms like tennis elbow or golfer’s elbow. Despite being named after sports, neither condition has much to do with the sport itself. Yes, golfers and tennis players commonly experience elbow pain, but there is another major common factor these sports share that is far more relevant to elbow pain. That factor is often the key to finally resolving it. When searching for solutions, you will find no shortage of advice. Stretch your forearm. Perform isometrics. Strengthen your grip. Unfortunately, many of these recommendations miss the real issue and often fail to resolve the pain long term. Anatomy Overview Golfer’s elbow, also known as medial epicondylitis, refers to stress and pain in the wrist flexor tendons that attach to the inner portion of the elbow. Tennis elbow, or lateral epicondylitis, involves stress and pain in the wrist extensor tendons that attach to the outer elbow. While symptoms vary depending on which side of the elbow is affected, common aggravating activities include gripping, pushing or pulling, and throwing motions. A commonly referenced concept in physical therapy is the joint by joint theory. This theory suggests that joints throughout the body alternate between primarily requiring mobility and primarily requiring stability. For example, the wrist and hand need a high degree of mobility to perform daily tasks. The next joint up the chain, the elbow, is designed more for stability. The elbow is primarily a hinge joint, meaning it mainly moves through flexion and extension and has limited rotational capacity. When excessive motion occurs outside of this hinge function, problems tend to arise. This contrasts with the shoulder, which sits above the elbow and requires a large amount of mobility to function properly. This creates a challenging situation. The elbow, which is not built for large amounts of movement, sits between two highly mobile joints. When mobility is lost where it is needed most, the body compensates by finding motion somewhere else. Often, that compensation shows up in the joints closest to the restriction. A Shoulder Issue Masked as Elbow Pain  One of the most commonly missed components in resolving stubborn tennis or golfer’s elbow is shifting the focus away from the elbow itself and asking why the elbow is being overloaded in the first place. Frequently, limited shoulder motion in specific directions forces the elbow to make up for that lost movement. This results in increased stress and strain at the elbow joint and its surrounding tissues. A helpful example of this can be seen in baseball pitching mechanics. A pitcher who lacks adequate shoulder external rotation to reach the proper arm position during the throwing motion often compensates by creating excessive motion at the inner elbow. This results in a gapping force that places high stress on the wrist flexor tendons. Over time, this excessive load can lead to tendon irritation, tendonitis, or even damage to the ulnar collateral ligament that may require surgical intervention such as Tommy John surgery. In this scenario, the elbow is not the true problem. The lack of shoulder motion forces the body to find movement in the next available place, which happens to be the elbow. Addressing factors like forearm flexibility and tendon strength may provide temporary relief. However, those components are usually far more effective once the underlying shoulder mobility limitations have been identified and addressed. The next question then becomes how and why shoulder mobility was lost in the first place. To learn more, refer to our article on the missing piece in resolving shoulder pain.