"No Pain, No Gain" Fallacy

I've had new patients (and potential patients) ask me if physical therapy treatment will hurt. I explain to my patients that our first goal is to reduce their pain levels before we restore any lost functionality. Many times I will start with hands-on techniques to reduce pain, restore tissue pliability, and generally prepare the patient, so they can advance without hindrance through exercise and activity training toward their ultimate goal.

Depending on the patient’s needs, we may spend considerable time in our gym or workout area. When I show a patient how to use a certain weight machine, I emphasize that while the exercise may feel uncomfortable, the patient should never experience pain, particularly in the tendon and joint areas. With the first hint of pain, my patient stops lifting that particular weight, and we adjust the joint angle of the movement to a pain-free range. In some cases, the patient may need to stop and work on joint and tendon lubricating exercises before the strength training is resumed for that session.

If you injure yourself, especially as a beginner, you may give up on strength training, fearing that you will hurt yourself again. So, it is important that you know the proper form to avoid injury and that you listen to your body's pain signals. If something hurts, stop and review that your form is correct. If it is, you may need to lower the weight or adjust the movement you're making to put less stress on your tendons and joints in particular. You may want to hire a professional weight trainer so that you can be sure that you are lifting properly and avoiding potential injury. They may also help you adjust certain lifts to put less stress on your joints and tendons.

The Talk Test

At Aptitude Physical Therapy, we are constantly encouraging our patients and social media followers to walk more, mostly because it’s one of the easiest and cheapest forms of exercise to adopt. The CDC recommends 150 minutes or 2 1/2 hours of moderate-intensity aerobic activity per week. We recommend working toward that goal, for example, by walking for 10 minute intervals a couple of times per day. But how do you know that your walking is considered exercise and not just going for a stroll?

According to the CDC , one of the best ways to determine the intensity of your workout is to use the “Talk Test.” If you are able to talk but not sing during any physical activity, you are performing a moderately intense activity. If you have trouble saying more than a few words without pausing to catch your breath, then you are doing a high-intensity workout.

The more you walk every day, the easier it will become. So, going up a hill by your house may at first be a high-intensity workout for you. You may want to find a flat surface to walk on and slowly increase your speed until you notice that walking has become easier.  At that point, if you try the hill again, you may notice the hill isn’t as daunting as before, and you may be able to carry on a conversation going up the hill.

As always, be sure that your physician approves of any physical activity and your exercise plan before you begin. You may also want to ask a friend to join you on these walks so you can test the intensity of your workout with the “Talk Test.” Having a friend along may also help pass the time more easily.

For more information and guidelines for exercising, we recommend the following links.
Exercising with High Blood Pressure
CDC Measuring Physical Activity Intensity

The Bad Rap on Physical Activity

“I ought to workout more.”
“I would lose weight easier if I would just exercise more.”
“I know it’s healthy to exercise, but I just don’t have the time.”

Any of these sound familiar? If so, you’re not the only one who feels pressured or guilty about not being more physically active. After too many failed attempts to go to the gym, you may feel like being physically active is just impractical for you. Even if you magically find extra time one day, you may opt for some pajama bottoms to relax at home instead of changing into workout pants to go to the gym. For many of us, we view exercise as something that drains us and makes us hot, sticky, and tired; instead of viewing exercise as rejuvenating or relaxing.

A recent study conducted by BMC Public Health looked at how women, age 22 - 49, view physical activity on their to-do list. Not surprisingly, low-activity women often viewed physical activity as conflicting with their bigger goals, like family time or work. In contrast, women who were highly active viewed physical activity as contributing to their bigger goals, which were also family time and work. At the same time, some highly active women still reported that they felt pressured or guilty about not being active enough.

The good news for all of us, whether we consider ourselves physically active or not, is that physical activity is not defined by three 30-minute workout sessions per week. Simply moving more (e.g. taking the stairs instead of the elevator, taking the dog on a walk) contributes to a healthier lifestyle.

So how does a person start becoming more active? The recent study by BMC Public Health suggested that the best tip for women to become physically active is to include people in your exercise. Whether you go outside to play with your kids or go on a walk or bike ride with friends, your feelings toward physical activity may become more positive because your physical activity is aligning with the priority of relationships. In turn, the positive thinking and emotions about physical activity will help you stay consistent and see those health benefits.

For more tips and encouragement to become more physically active, follow us on Facebook, Google Plus, or LinkedIn; and subscribe to our YouTube channel. Our goal at Aptitude Physical Therapy is to give you the practical information so that you can better enjoy life.

To read the study, click on the following link.
Rethinking Physical Activity Communication: Using Focus Groups to Understand Women's Goals, Values, and Beliefs to Improve Public Health"

The Benefits of the Buddy System

We frequently hear about the physical benefits of regular exercise, but exercise can also give you social benefits. If you have a workout buddy or go to an exercise class at the gym, you are more likely to keep exercising regularly by simply being with people who have similar goals. Workout buddies can also give you words of encouragement for those days when you don't feel like you're at your best. On top of that, the people you see at the gym may have similar interests and may become good friends with whom you can enjoy other activities.

If you work from home, if you are a stay-at-home mom, or if you live alone; consider signing up for an exercise class, or ask a friend to participate in an exercise program with you.

National Heat Awareness Day

While summertime is a fun time for physical activity outdoors, the heat can be potentially dangerous causing heat cramps, heat exhaustion, or heat stroke. There are several things you can do to protect yourself, your family, and your pets from heat-related illnesses and even death.

Watch the weather

Either check the weather daily or download a weather app onto your phone so you will get weather advisories from the National Weather Service such as Excessive Heat Outlooks, Excessive Heat Watches, Excessive Heat Warning/Advisories.

Avoid exercising at the heat of the day

If at all possible, stay in the shade or indoors when it’s hottest outside. If you want to go outside for your daily exercise, a good rule to follow is to be sure that your shadow is longer than you are.

Drink plenty of water throughout the day

Many of us can be dehydrated even when cool outside. Signs of moderate dehydration are a dry mouth, sleepiness, thirst, decreased urine output, dry skin, and headaches. When it’s hot outside and when you workout, you need to be even more cautious that you keep replenishing your body with water, as your body is made up of approximately 65% of water.

If you believe someone is experiencing a heat stroke it is important to call 911 immediately.

For more information about heat safety tips, check out the National Weather Service Heat Safety Tips and Resources.

Picking Out Walking or Running Shoes

My daughters frequently tease me about how picky I am when shopping for shoes. When they were younger, we created a system for how we would pick out their shoes, especially for walking/running shoes.

1. Make sure you have enough toe space.

When you're walking or running, your foot will naturally go forward in the shoe. So, you want to make sure you have enough space for when you're walking or running so that your toes won't get squished or stubbed.

I would have my girls try on the shoe size we thought was correct, and then I would test them with the "thumb test." I would press at the toe of the shoe to see how close the big toe was to the tip of the shoe. I wanted them to have about a half inch of space.

2. Check where the shoe bends.

Because our feet naturally bend at the ball of the foot whenever we walk or run, I want to make sure that the shoe will also bend where my foot naturally bends. As seen in the photo below, I take the shoe with one hand perpendicular to the front of the shoe and the other hand perpendicular to the back of the shoe. If the shoe bends anywhere but at the ball of the foot, I put the shoe back on the rack and keep looking.

3. Check where the shoe doesn't bend.

I also always check the arch of the shoe to make sure that it does not bend. I grab the bottom of the shoe with my hands on either side of where the arch of my foot would be. I pull to see if the shoe gives or moves. If it does give, I put the shoe back on the rack and keep looking for a shoe that will give proper support.

4. Does your foot "pop" out of the shoe?

While this point isn't necessarily a selling point for me, I also take note if my heel tends to slide up in the back of the shoe. This can cause blistering, especially when you start wearing the shoe for long periods of time to walk or run. However, if I am comfortable that the shoe fits all of my other requirements listed above, I may still get the shoe. I can add a cushion or layer of material at the back of the shoe to take up the extra space that is causing my ankle to "pop" out of the shoe.


For more tips on how to pick out comfortable shoes that you can wear all day long, check out our YouTube video "Choosing the Right Shoes."

Gardening Counts As Exercise

This time of year, more people are going outside to do yard work or to start their gardens. Whether you're mowing the grass, weeding, or planting new flowers; you can get some great exercise. However, because injury is possible with any physical activity, we must take the proper precautions to avoid injury while working in the yard or garden. Here are some tips that I try to keep in mind whenever I am out in my backyard.

Stay Hydrated

Whether you keep a water bottle outside with you or if you take frequent breaks to go inside to get a drink of water, you need to make sure you stay cool and hydrated, even if it doesn't feel that hot outside. If you struggle with muscle cramps, you may want to drink something with electrolytes.

Use Knee Pads

If you're going to be down on your knees in your flowerbeds, you may want to invest in high quality knee pads or a knee mat. However, if you still experience knee pain afterward, be sure to ice your knees. For tips on safe ways to ice, check out a previous blog, "Ice vs Heat."

Avoid Twisting

If you are planning to be weeding or hoeing,  it can feel natural to twist in order to reach more area. However, twisting can cause injury to your back. Instead, move your whole body so you can reach the area easier without twisting. Again, if you find you twisted without realizing and have injured your back muscles while working outside, be sure to stop to ice your back.


Yard work and gardening can bring great satisfaction as well as great exercise. Just be sure you stay hydrated and avoid injury.

Exercise through Volunteering

When you volunteer to walk or run for a 5K, you know that you will also personally benefit from the physical activity. Yet, there are more ways that just walking or running to get a little exercise while volunteering. You may be able volunteer at a local kitchen to wash dishes, serve meals, and organize the pantry, all of which fight our sedentary habits. Other organizations may need help with landscaping or janitorial cleaning. Even something as simple as sweeping can give you a decent workout.

A few things to be aware of while doing manual labor to reduce the risk of injury:

1. Lifting heavy objects. Squat down to lift heavy objects. Read Kelly's blog for more information about Lifting Properly to avoid injury.
   
2. Refrain from twisting. It's easy to injure your back by twisting quickly while doing manual labor. Instead of twisting, try to turn your whole body, whether you're moving a box or sweeping.
3. Take breaks. Even though you're volunteering, you still need to be able to take breaks. Be sure to use that time to stay hydrated.

If you ever experience pain, stop whatever you're doing to prevent further injury. I suggest using ice on the injured area as soon as possible. For more tips on how to properly use ice on an injury (and when to use heat instead), check out our blog Heat vs Ice.

To add variety to your exercise routine, look for volunteer opportunities and get exercise at the same time.

Dancing for Valentine's Day

Finding a non-cliché way to celebrate Valentine's Day can be difficult, especially if you're on a diet and trying to avoid the chocolate sweets. While we may not think of exercise as a fun way to celebrate, it may just get your heart rate up and fill your heart with laughter and love, especially if you ask some loved ones to join you.

When my kids were little, we used to have impromptu dance parties. Sometimes we would waltz, twirl, jump around, or all of the above! Our dance form didn't really matter; we were just having fun spending time together as we got in some good cardio exercise! If you have kids of your own, you can start up an impromptu dance party to the radio or attend a local daddy/daughter dance.

Even if you don't have kids, you can still have some fun dancing this Valentine's Day. If you feel like staying home, you can purchase a dance exercise videos on DVD or you can stream one online. If you can't dance, there are some good walking videos set to music. However, if you do feel like going out, you may look for a contradance or a Zumba class. Whether you invite a friend or go to make friends, it'll be sure to get your heart rate up as you have some fun celebrating Valentine's Day.

Ways to Stay Active Throughout Your Day

Sometimes, we have trouble motivating ourselves to stay active, yet one of the best ways to fight a sedentary lifestyle is to simply plan activity throughout your day. Here's some ideas you can try to add to your day-to-day activities.

Walking to Get the Mail

It's easy to drive down to the mailbox, but taking the time to walk to the mailbox everyday can help benefit your health and fitness. Or, if you have a post office box, try parking out farther and walking in to get your mail.

Toe Raises While Brushing Teeth

Whether you're getting ready for your day or getting ready for bed, try doing toe raises while at the sink. You can use the counter to help keep your balance as you workout your calves. You can also try this when you hand-wash dishes.

Get Up Off the Couch

When you are watching TV, get up during commercials or set a timer to prompt you to get up at least once an hour. You can do squats, stretch, take out the dog, or walk in place or around the couches. You can even try dancing to the music of commercials, which may give you an ab workout from laughing! :)

Take Breaks at Work

In this Age of Information, many of us have desk jobs. When you're having a busy, stressful day, it's easy to forget to get up to take breaks. Research shows that we need to get up at least once per hour to walk around for five minutes. Walking around every hour helps save the lining of your arteries and vessels in your legs, which helps increase blood flow. For more tips on how to reduce pain related to sitting at workstations, read our blog "Workstation Tips."

Remember, the most important aspect when trying to become more active is to take small steps. Choose one lifestyle change until it becomes a habit. Then, you can add another lifestyle change or additional exercise. As long as you aren't experiencing pain, any physical activity counts!

Warming Up This Winter

When most people think of staying warm during the winter, they think of putting on more layers of clothing, turning up the heater, starting a fire in the fireplace, or cuddling underneath blankets. We tend to forget that activity can also warm our bodies up.

When my twin girls were younger, they would put on sweaters and wrap up in blankets whenever they were cold while doing their homework. I suggested every time they felt a little cold to get up and do a set of squats. By the end of the day, they would work in quite a bit of exercise and help themselves stay warm through activity.

Try finding exercise that you enjoy. You can walk around the house for a few minutes, maybe even picking up some clutter as you go, or you can do your home exercises from your doctor or physical therapist. Even stretching can help you warm up. Just remember to have proper form with whatever exercise you choose to keep yourself from injury.

Make a fresh start when necessary

Do you make New Year’s resolutions? Some people are so discouraged from failed goals from the past that they don’t even attempt to make resolutions in January. Developing a healthy lifestyle is a goal worth making permanent. The most important habit is not quitting, but starting again whenever necessary. If you ate too many sweets at holiday parties, start again planning healthy snacks. The present is always a great time to start a new exercise program. If you find yourself feeling sluggish in June, try making a mid-year resolution! If you need motivation and direction for healthy exercise, you can always call and make an appointment with your physical therapist. When you find yourself suffering the consequences of poor lifestyle choices, resolve to start again.

Stay Active During Holiday Activities

Have you made plans for the holidays? Most people do travel planning and meal planning, but what about fitness planning? Holiday exercise sessions are not on most people’s holiday agendas. After all, holidays are for rest, relaxation, and fun! Right?

Well, exercise can be fun, and has been proven to help you feel better and rest better. Why skip it over the holidays? Schedule some holiday exercise sessions for fun and relaxation. What about ice skating or Christmas caroling around your neighborhood? If you can’t handle the outdoor temperatures or activities, don’t forget that walking done indoors at a shopping mall counts as exercise, but stopping to browse in the stores doesn’t! Don’t look for parking places near the store entrance. Park out in the lot and walk. You may get in the store faster than searching for a close parking space anyway. Plan fun-filled holiday activities, especially ones that keep you moving.

Exercising Tips: Dead Lift and Squat

I try to remind my patients that when they exercise, they need to be careful on posture or form to be sure that they do not injure themselves further. In the video below, I show how I do two different lifts - dead lift and squat - so that I protect my back.

I demonstrate the dead lift using a dumb bell. The key things to remember are

• Contract the abdominal muscles throughout the lift
• Keep the back straight
• Tuck the chin
• Keep the chest lifted up

Similarly, for the squat, I demonstrate the key component is to draw the abdominal muscles in and keep them contracted throughout the whole lift. I squat down to create a 90 degree angle with my knees.

Practice these lifts with a dumb bell or object to train yourself to use your abdominal muscles when you're lifting. Make using your abdominal muscles a habit to prevent injury.

Everyday Core Strengthening

Finding time to exercise is difficult. The good news is that you can make small habits throughout your day to help improve your strength and posture. Today, I want to share one "exercise" that I personally use to help with back pain.

We all need abdominal wall support to support our low backs. Research has shown that people who have back pain do not nautrally activate a muscle called transverse abdominis which go around your sides. For people who have not injured their backs, they naturally contract this muscle when they stand up or lift objects.

So, to re-train my transverse abdominis to contract when I stand or lift objects, I work throughout the day to draw my abdominal muscles in toward my back. You can think about it as pulling your belly button toward your spine. Before I stand or lift something, I consciously think about pulling my abs in. I keep them about 25-30% contracted. Before too long, I don't have to think about it anymore.

Lifting Properly

Whether you're lifting weights or just picking up around the house, it's important to have good posture when lifting heavy objects. To demonstrate, I've made a short video where I'm squatting to lift up a dumbbell.

Notice how in the video I squat down so that my legs make a 90 degree angle. If I was lifting weights, like I was in the video, I'd be sure to keep my elbows slightly bent to keep them from locking. I have an upcoming video and blog coming soon to demonstrate a modified dead lift.

If I was moving a box at home, I would squat, pick up the box and carry it close to my body, and then walk to where I want to place the box. I would be careful not to twist my back, as that can be strain on my low back.

For more pain prevention tips, check out our YouTube playlist.

Workout Tips for Athletes' Ankles

Several years ago, I was helping a football team that had lots of ankle injuries in one particular sports season. If I remember right, it was 20 to 25 ankle injuries in one sports season. We gave the young athletes a 60-second exercise that I describe in the video below. After implementing this exercise, the team had only 2 or 3 injuries the whole season.

Exercise with Your Child Week

Did you know that August 7 - 13th is Exercise with Your Child Week? With school right around the corner, finding fun ways to exercise with your children this week will give them wonderful summer memories. Get creative!
Some ideas:

• Go for a bike ride
• Walk at the park
• Organize a scavenger hunt
• Have a dance party
• Play catch in the backyard

And of course, don't forget to drink plenty of water to stay hydrated!

Electrolyte Hot Days

Summertime is a fun time to go to ball games and enjoy the outdoors. If you and your family are out and about, you want to be sure to not only drink enough water but also get electrolytes so you can continue to enjoy your summer activities without muscle cramps or feeling drained. Many sports drinks have electrolytes, but be sure to check the label if you are counting your calories. You can also find some flavored waters that have electrolytes with little to no calories.

Exercising Tips to Improve Shoulder Blade Posture

I like to help my patients find ways that makes it easier to maintain good posture throughout the day. In many cases, we can strengthen targeted muscles so that we naturally sit, stand, and walk with good posture. By having good posture, we avoid a lot of potential future complications and pain.

In the video below, I show you how to use a Total Gym to strengthen the muscles between your shoulders which will help with shoulder blade posture. Below are the steps I outline in the video.

• Step 1: Retract or pinch your shoulder blades together, and hold that throughout the exercise.
• Step 2: Tuck your chin.
• Step 3: Pull yourself up by pulling your arms into your body.
• Bonus Step: Have a work out buddy. In the video, you'll see my dog try to help me out. :)