How to get to the Root Cause of an Injury

Injury can quickly sideline any runner by causing pain, frustration, and disappointment over lost training days and unmet goals.

Injuries can be classified as accidental or as a result of overuse.

Some injuries occur due to accidents (such as tripping or falling).  Accidents are unfortunate, but mostly random.  Using common sense can help you to avoid repeating similar injuries.

Overuse or overload type injuries are preventable if you reduce your risks.  By avoiding injury, you can better train and ultimately, meet your running goals.  Continue Reading

Do I have Morton’s Neuroma in my Foot?

Do you have pain between your toes?  Does it feel like you are always standing on a pebble or have a lump in your socks between your toes?  This may be Morton’s neuroma.  A neuroma is a thickening of the tissue that surrounds the digital nerve bundle.  Morton’s neuroma is one of the most common types of neuromas and typically occurs between the third and fourth toes.

Morton’s neuromas occur due to repeated stresses, irritation, and/or pressure at the ball of the foot which affects one of the nerves that leads to the toes.  There typically isn’t any swelling, bumps or bruises with Morton’s neuroma.  Learn how to determine if you have Morton’s neuroma in your foot and how to self-treat it.

Morton’s Neuroma Symptoms include:

  • Numbness or tingling which is affecting the ball of the foot, between the toes, and/or the toes themselves.
  • Sharp, stabbing and/or burning pains that are intermittent and only affect either the ball of the foot and/or toes (usually the third and fourth toes).
  • The sensation of standing on a pebble or marble or having a lump in your shoe or sock.
  • When running, the pain is often felt during the push off from the toes prior to the swing through phase.

Common Risk Factors for developing Morton’s Neuroma:

  • Sports and activities that involve repeated impact affecting the feet (such as jogging and running sports).
  • Poorly fitting footwear.  This is particularly true for high heel shoes, but it’s also very common in athletic and running shoes.  Most commonly, the toe box is too small.  A sole that is overly flexible in the wrong location can cause excessive give in a location which isn’t in proper alignment with the metatarsals of the foot.
  • People with common foot deformities, such as bunions, hammertoes, flat feet or overly high arches, are at risk for developing Morton’s neuroma.
  • Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
  • Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
  • Women are eight to ten times more likely to develop Morton’s neuroma.  High heels are a likely culprit.

Do I have Morton’s Neuroma in my Foot?

Morton’s neuroma is often diagnosed through a physical examination and imaging.  However, a very thorough history and physical examination can be quite conclusive.  The imaging is typically only to rule out other possible causes of the pain such a stress fracture.

The physical examination includes palpating between the toes.  The painful area will feel “thicker” on the affected foot in comparison to the other.  There is often an associated clicking of the bones when the area is squeezed or moved back and forth.  When the forefoot is squeezed and held for several seconds for a Morton’s Neuroma test, it will often reproduce or worsen the symptoms of burning and or tingling.

How to Self-Treat Morton’s Neuroma:

Avoid wearing tight fitting, ill-fitting, and high heeled shoes.  Be sure that your shoes have an appropriately sized toe box.  In the case of athletic shoes (particularly, for distance running), extra room in the toe box can be beneficial as the foot will often swell during the course of the run.  If you wear high heeled shoes, consider wearing them less frequently and/or switching to a shorter heel.  Even wearing socks that are too small can potentially cause too much compression and lead to increased symptoms.

Orthotics.  Many people respond well to a rigid orthotic with an extension underneath the first metatarsal bone.  You may not necessary need custom orthotics.  Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles.  The blue tends to fit most feet, but a variety of options are available for customization.  In my experience, these insoles can last 1,000 to 1,500 miles easily.  If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.  Seek assistance from a professional who is a runner and has experience with treating other runners.

Metatarsal buttons and pads.  Adding a metatarsal button or pad may be enough to spread out the metatarsal heads and alleviate the pain for those who don’t want a full orthotic.  Although often a metatarsal pad may be incorporated into a custom orthotic.  I recommend these Pro-Tec Athletics Metatarsal Pads.

Anti-inflammatories.  Initially an anti-inflammatory may be necessary.  Speak to your physician about the best type of anti-inflammatory for you.  In severe cases, a cortisone injection may also be warranted.  However, you must address the biomechanical causes for the pain in order to prevent it from recurring.

I am a supporter of natural supplements and remedies.  Many supplements include herbs which are designed to help reduce inflammation and support the healing response. 

My most recommended supplement to help recover from injury is Mt. Capra CapraFlex.  Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation and support healing.  CapraFlex can be taken long term or intermittently.

Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation.

Another supplement I frequently recommend to help recover from injury is Tissue Rejuvenator by Hammer Nutrition.  It contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation.  It’s a fantastic supplement.

I recommend taking either CapraFlex OR Tissue Rejuvenator, not both concurrently.

I initially recommend trying a 30 day protocol.  If the supplements are aiding your recovery, you may choose to continue taking them for an additional 30 days.  I sometimes implement this protocol as part of a prevention strategy during times of heavy volume or high intensity training.  (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol.  Herbs could interact with some medications particularly if you are taking blood thinners.)

Improve your foot mobility and strength.  Complete with instructions and photos, this guide, Morton’s Neuroma Rehabilitation Exercises, outlines how to safely perform exercises in order to improve your mobility and strength.

Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) is often found in the case of Morton’s neuroma as part of the biomechanical issues that led to its development.  I recommend initiating a complete ankle/foot strengthening protocol.  Please refer to Ankle Resistance Exercises Using the Elastic Exercise Band.

Improve your balance.  Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature.  Weakness and balance deficits can lead to poor foot biomechanics.  Standing on one foot can be an excellent way to improve your balance.  This technique is demonstrated in the Morton’s Neuroma Rehabilitation Exercises.  For additional ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle.

Research concludes that nearly 80% of all cases of Morton’s neuroma can be treated through conservative measures (as outlined above).  In the rare cases where conservative measures fail, then one may need to consider surgical options.

One surgical option offered is decompression surgery.  During this surgical intervention, the surgeon can relieve the pressure on the nerve by cutting nearby structures (such as the ligament that binds together some of the bones in the front of the foot).  Unfortunately, this alters the shape of the foot and may affect foot dynamics into the future.  Another option is to resect or remove the nerve.  Surgical removal of the nerve is usually successful, but the procedure can result in permanent numbness in the affected toes.

If you’re not experiencing significant relief from Morton’s neuroma upon changing your footwear and addressing other risk factors while progressing into your exercise program, please consult a medical professional.  I recommend a physical therapist that specializes in feet.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for Morton’s neuroma helped you?  Which treatments haven’t worked for you?  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

10 Strategies for Avoiding Injury

http://marathontrainingacademy.com/avoid-injury

Marathon Training Academy

May 16, 2017

In this guest post for Marathon Training Academy, you will learn which strategies to implement in order to reduce your risk of injury while taking your training and exercise program to the next level.

An ounce of prevention is worth a pound of cure. –Benjamin Franklin

As a physical therapist, I help people who have suffered from an injury through the process of rehabilitation. Yes, accidents will happen, but being proactive can help you to avoid and limit the chance of an injury.

Nothing derails a perfectly designed training program like an injury. One key to being a Resilient Runner is to optimize your health and lessen your risk of injury by being proactive upfront. Continue Reading

The Injury Episode!

With Special Guest Dr. Ben Shatto

http://marathontrainingacademy.com/injury-episode

Marathon Training Academy

May 11, 2017

In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss the prevalence of running injuries, the top mistakes we see runners make, and answer injury related questions from runners.

In this episode we talk injury prevention with our friend and physical therapy doctor Ben Shatto. Plus we answer injury related questions from real everyday runners like you. Glutes, calves, hamstrings, IT Band, foot and knee pain . . . we cover it all! Listen to the podcast

Disclaimer: This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

The Truth About Running Injuries

http://marathontrainingacademy.com/truth-running-injuries

Marathon Training Academy

May 3, 2017

In this guest post for Marathon Training Academy, you will learn how to identify the risk factors and potential causes of overuse running injuries so that you can avoid training errors which can result in lost training days, missed races, and unmet goals.

Running is one of the most popular sports and hobbies in recent times.  In the U.S. alone, there are more than 500,000 annual marathon finishers and up to 40 million people who run regularly.

Of those 40 million people, more than 10 million are running at least 100 days a year!

Running can be enjoyed by almost anyone despite age.  Not only is running fun, but it has many health benefits including (although not limited to) the following:  Continue Reading

Why You Won’t Heal – Part 6

Risk Factors and Causative Factors are still affecting the Condition

During the recovery process, it’s important to reflect on how the injury or illness occurred.  What were the causative factors that led to the specific injury?  What choices did you make that would have caused this illness?  In order to optimize the healing response, all risk factors and causative factors must be addressed.  In the final Part 6 of the series, Why You Won’t Heal, you will learn how to discern if the risk factors and causative factors that led to the injury and/or illness are still present and affecting your current condition.

You may be getting the best quality care and treatment regime for your specific condition, but if the original causative factors are still present then your ability to recover is significantly impaired.  When possible, always address the root cause of the problem and then determine the appropriate rehabilitation program.

The ultimate goal is to eliminate the leading causative factors and then establish the proper care and treatment.  This includes addressing any potential psychological beliefs associated with the injury as well as insuring that you are consuming quality nutrients and getting enough sleep in order to recover properly.

As a physical therapist, I continue to see countless examples of individuals who may be getting the right treatment, but yet he/she still struggles to heal because the risk factors and causative factors that led to the injury and/or illness are still present and affecting his/her current condition.

The following example illustrates what happened to one of my prior physical therapy clients.

A 30 year old man presents with frequent headache pain and neck pain.  Together we work on restoring proper thoracic and cervical (neck) range of motion as well as proper strength through the cervical and thoracic spine.  He feels much better, but yet he continues to experience intermittent pain and headache symptoms.

His pain levels are worse while at work.  He takes pictures of his office, and a coworker records a short video of him working at his desk.  Upon viewing, I discover that his office set up is incorrect with the keyboard and monitor not properly positioned (poor ergonomics).  He’s working in a slouched posture which causes a forward head and rounded shoulders.

If this is his typical posture throughout a majority of his work day, is there any wonder why his headaches persist?  His posture is causing excessive strain on his neck and upper back every day while at work.

Once his work ergonomics were improved and he was more mindful about his posture, he was pain-free and headache-free.  If the underlying reason for his ongoing pain and headaches hadn’t been correctly addressed, then his recovery would have been less than optimal and his symptoms would have likely persisted or eventually worsened.

The reasons why a person may not recover are vast and complicated.  Your rehabilitation protocol will vary and is dependent on the type of injury or illness you have.  Regardless of the specific injury or illness, it’s critical that the following six categories of common reasons why a person will not fully heal and recover or take an extended time are addressed.

6 Categories of Common Reasons Why You Won’t Heal:

  1. You’re getting the wrong treatment for your condition.
  2. The injury or condition isn’t capable of healing.
  3. Physiological and social conditions are affecting your healing.
  4. Poor nutrition.
  5. Poor sleep quality.
  6. The risk factors and causative factors that led to the disease and injury are still present and affecting the current condition.

The body’s ability to heal and recover is dependent on many things.  To maximize your ability to heal and recover from illness and recovery, it’s important to be proactive and help your body in any way possible.  Getting to the root cause by utilizing these strategies for recovery will insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

Have you experienced a prolonged recovery or rehabilitation process?  If so, can you share any strategies that helped you to handle it?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

How to Avoid Overtraining Syndrome (OTS)

http://marathontrainingacademy.com/overtraining-syndrome

Marathon Training Academy

April 28, 2017

Don’t let an injury or overtraining syndrome (OTS) derail your running plans or affect your performance.  In this guest post for Marathon Training Academy, you will learn which strategies to implement as you self-treat and manage any potential injury safely and quickly.

Nothing can derail your best laid training plans and goals like an injury or suffering from Overtraining Syndrome (OTS).  OTS usually starts with muscle soreness and a feeling of fatigue.  Then it quickly progresses into a case of overtraining syndrome or injury.  Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from.  Many common running injuries are directly associated with OTS.  It’s always best to prevent OTS rather than attempt to recover from it.  Continue Reading

Why You Won’t Heal – Part 5

Poor Sleep Quality

The ability of the human body to heal and recover is nothing short of amazing.  The body has an innate way of healing despite our actions.  However, it’s important to realize that what we do and how we treat an injury or illness can significantly affect how well the body is able to heal and recover from it.  In Part 5 of the series, Why You Won’t Heal, I address how poor sleep quality can negatively impact how one heals from an injury or illness.

Although I am not a sleep expert, I have regular discussions with my physical therapy clients regarding sleep quality and hygiene.  Adequate sleep is one of the most important components to a person’s recovery post illness and injury.  On average, a person requires between 7-9 hours of sleep.

Although there are different stages of sleep cycles, a typical sleep cycle lasts between 70-120 minutes.  The actual amount of sleep needed will vary and is dependent on how long your particular cycles are.

It’s interesting to note that if you wake up just as you are coming out of a sleep cycle that you will typically feel more rested and alert.  On the other hand, if you wake at the start or halfway through a cycle, you will probably wake up feeling tired and grumpy (hence the term “waking up on the wrong side of the bed”).  We should probably term this “waking up on the wrong half of the sleep cycle” instead.

Throughout your recovery and rehabilitation, try to sleep and rest more than you typically would.  This shouldn’t be confused with bed rest though.  As a physical therapist, I rarely encourage bed rest, but at times, bed rest can be medically necessary.

Activity and frequent movement is extremely important during your recovery as is getting adequate rest and sleep.  Many important body processes occur while you sleep.  One of the most important aspects of sleep is how it affects your hormonal regulation.  Hormones, such as human growth hormone (HGH), play a critical role in how you will recover from injury.  Adequate rest and sleep is necessary for HGH and other critical hormone systems to be at the optimal level.

Poor sleep or inadequate amounts of sleep not only affect the healing response, but are also a risk factor for many chronic diseases and illnesses including:

  • Metabolic syndrome
  • Diabetes
  • Heart disease
  • Depression
  • Chronic pain
  • Dementia

How to Improve Your Sleep Quality

If your recovery and rehabilitation is starting to slow down or just not progressing like you would expect, taking a look at your sleep quality is an important next step.  In order to insure quality sleep, be proactive about the environment you sleep in and how you prepare to sleep.  This is known as your sleep hygiene.  The following tips can help you to get a better night of rest:

  • Avoid caffeine later in the day.
  • Black out your room.  Darkness sends important hormonal signals to the brain to prepare for sleep.  Even small amounts of light can disrupt sleep patterns, so cover up any potential sources of lights (even those that may be present on smoke detectors or electronic equipment).
  • Avoid any use of electronic equipment for at least two hours before bed as the light (in particular, the blue light) emitted by the screen is very stimulatory to your system.
  • Avoid watching television for at least two hours prior to bed as the light emitted by the screen is also stimulatory.
  • Establish a rule of no electronic equipment in your bedroom.  Many of us feel as though we must have our TV or tablet, but your sleep quality will improve without it.
  • Do not read or watch anything (like the evening news) that would be stimulating or anxiety producing prior to bed.
  • Try supplementing with magnesium prior to bed.  Most people are deficient in the amount of magnesium they consume on a regular basis.  Magnesium can help reduce muscle soreness and improve your quality of sleep.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate can also be beneficial.
  • Get on a schedule.  Your body thrives on a routine, so preparing for bed shouldn’t be any different than your other daily routines.  Try to go to bed at the same time each day.  In order to increase your time sleeping, go to bed a little earlier (like 5-10 minutes) each day versus sleeping in longer in the morning.  Try to gain extra rest at the beginning, not the end, of the sleep cycles.
  • Keep your room cooler.  If your room temperature is too hot, you are likely not to sleep well.  Usually cooler is better than warmer, but not cold.
  • Get regular exercise.  Regular exercise can help to keep you on a good sleep schedule.  Just don’t exercise right before bed.  When recovering from an injury, the type of exercise may vary and is dependent on your specific injury.

An adequate amount of sleep shouldn’t be considered a luxury, but instead as a critical component to proper healing and recovery.  An adequate amount of quality sleep is one of the most critical factors when you’re trying to recover from injury and illness.  It’s also a critical component to avoiding overtraining syndrome.  Don’t underestimate the importance of sleep in your recovery!

Which tip can you implement in order to get a better night of rest?  Do you have any tips to share?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Why You Won’t Heal – Part 4

Poor Nutrition

There are many reasons and factors that affect a person’s ability to heal and recover from an injury or illness.  One of the most common, yet the most basic, reason is poor nutrition.  The healing tissue and the body may not be receiving the proper base components to actually heal.  In Part 4 of the series, Why You Won’t Heal, I address how poor nutrition can negatively impact how one heals from an injury or illness.  Consuming the right foods to provide the proper nutrients for your body is critical in order to fully heal and recover from an injury or illness.

Two Reasons Why Nutrients aren’t getting to the Injured Area:

1. The injured area or tissue just isn’t getting adequate nutritional and growth factors to the actual tissue. 

This is a logistical delivery issue.  For example, the blood supply to the injured area may be compromised.  Without a proper blood supply to the healing tissues, the area will not receive vital nutrients and healing factors which is a critical component of the healing process.

One possible reason for poor blood supply may be due to dysfunction in one’s cardiovascular system (such as heart disease or atherosclerosis, the hardening and narrowing of the arteries).  Another reason may be that the injury is to a tissue that inherently has a poor blood supply such as cartilage tissue.  In the case of lumbar discs, they rely more on movement than blood supply to circulate nutrients.

If it’s not a delivery issue, then there are cases where it may be an absorption issue.  This can occur in the case of a digestive related issue that affects the body’s ability to actually get the needed nutrients from the consumed food into a useable form in the body.  This includes conditions such as Crohn’s disease and leaky gut syndrome.

2. A person’s food choices and lifestyle are not allowing for the body to have the base nutrients needed to actually heal from the injury. 

Sadly even in western societies where food is overly abundant, so is malnutrition.  I work with clients who are obese and have access to an adequate amount of food with plenty of caloric intake to survive, yet they are so nutrient deficient that their rehabilitation potential is very poor.  An abundance of food and calories does not necessarily equal adequate amounts of nutrients and micronutrients to be healthy.  This is the primary problem behind our obesity epidemic including metabolic syndrome, diabetes, and heart disease.

As a physical therapist, I help to educate my clients about a wide variety of strategies from advice on exercise, hands-on techniques (such as myofascial and joint mobilizations), and self-care techniques (such as basic nutrition) because it’s a critical component in how a person can heal and recover from an injury or illness.

Many of my clients have the following conditions which have a nutritional component to them:  osteoporosis; sarcopenia; autoimmune diseases; metabolic syndrome; diabetes; and heart disease.  Even when a client doesn’t have a specific systemic condition, proper nutrition is still a factor on how an injury will heal whether it’s from an ankle sprain or from a knee or a shoulder surgery.

Often times, I will work with a physician, registered dietitian or nutritionist to help educate my client on proper eating habits.  I also commonly refer clients to certain books, such as Dr. Josh Axe’s Eat Dirt: Why Leaky Gut May Be the Root Cause of Your Health Problems and 5 Surprising Steps to Cure It, which can help to educate them on number of different topics.

As a physical therapist, it’s not uncommon for me to see someone who is struggling with healing from an injury.  He/she may be performing the right exercises and receiving the proper treatment, yet he/she is unable to properly heal because his/her body doesn’t have the proper nutrition level to allow the healing to occur.  It is important to remember that poor eating habits not only sabotage your results, but can also lead to severe chronic illnesses.

Focus on your Recovery Nutrition

In order to fully heal and recover from an injury or illness, consuming the right foods to provide the proper nutrients for your body is critical.  The majority of your diet should be from real food.  My personal belief is that food which is minimally processed, organic and/or home grown is likely to have a higher nutrient load and will therefore be healthier for you.  Your body simply cannot heal and recover quickly or adequately when substandard fuel “food” is consumed.

In today’s society, it’s possible to have an overabundance of calories and still be nutritionally deficient and malnourished.  It’s critical to focus on nutrient rich food and avoid “empty” calories.  That includes food which has no nutritional value (junk-food).

Maintaining muscle mass is critical for recovery and rehabilitation as well as for injury prevention.  Initially, focus on macronutrients (fat, protein, and carbohydrates) when it comes to food.  During the rehabilitation process, focus on a diet high in protein from many sources (plant and animal-based), high in fruits and vegetables, and low in processed carbohydrates.

Newer research concludes that as a person ages, his/her protein needs do not actually decrease, but remain elevated as the body’s ability to process protein decreases.  It’s important to have higher amounts of protein available for use.  During recovery, additional protein is often needed to insure healing tissues have the building blocks necessary for recovery.  For more information on protein supplementation, please refer to How Much Protein Do I Really Need?

Each person is different as is the recovery process and one’s prior health status.  The diet should be tailored to your individual needs.  There isn’t just one perfect diet plan—these are only guidelines.  Please discuss your dietary concerns with your medical provider.

Supplementation

The ultimate goal with supplements is to aid your body in improving health and nutritional status.  Try to choose the most natural products as possible and experiment to see what works best for you.  Look for supplements that don’t contain extra fillers, sweeteners or additives.

The following list includes my most common recommended supplements to take during the rehabilitation process:

Protein

Protein is a critical macronutrient that is highly important in maintaining the building blocks needed to support the muscular system (including skin and tissue).  Additional protein is often helpful during the recovery process if you have experienced a muscle or tissue injury.  Additional protein in your diet can stabilize blood sugars and satiate your appetite.

Capraflex

My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra.  It combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently.  I use it to help recover from acute injury.

Magnesium

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.

You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.  Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Vitamin D3

Vitamin D3 is critical to the absorption of calcium through the intestinal wall which is important for bone health.  It’s also a critical nutrient in maintaining a healthy immune system.  However, there are potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).

Vitamin K2

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function within the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected (including heart function).  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.  Vitamin K (best found in green leafy vegetables) has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Coconut Oil

In past years, there has been a real push for toward a low fat diet.  However, people have forgotten that fats are a critical macronutrient when consumed at reasonable levels and via real foods (such as coconut oil or avocados).  The nervous system relies on adequate levels of fats and cholesterols to be present.  Insuring the proper amount of fat consumption is critical when healing from a neurologic injury or condition.  It’s also helpful for weight loss because it can satiate your appetite.

Super Greens

Green super foods, such as spirulina algae, chlorella algae, and wheat grass are packed high in antioxidants.  They can have a cleansing and an alkalizing effect which will decrease your inflammation level and aid in recovery.  Super greens boost your immune system and are generally good for you.  I think the argument can be made that algae is the king of “super” foods.  It is likely the most important food/supplement most people are not taking.

I am particularly fond of supplementing with algae as a super food because it addresses many of the most common nutrients needed during rehabilitation.  Algae have high levels of protein as well as magnesium and other critical micronutrients in order to help you recover.

My new favorite way to add greens and protein in general is a supplement called ENERGYbits® and RECOVERYbits®.  They are made from organically grown NON GMO spirulina algae or chlorella algae.  Spirulina algae have a high concentration of plant-based protein (64%).  It also contains 40 vitamins and minerals including iron, nitric oxide, Omega-3, and all of the B vitamins.  Chlorella is high in protein.  It also has detoxing properties and an impressive micronutrient profile.

Because of their overall nutritional profile I now consider spirulina and chlorella algae a top rehabilitation and recovery supplement.  I recommend taking 30-45 of these small tablets per serving.  I recommend swallowing them whole, but you can chew them.

If you want to learn more about algae be sure to listen to Ben Greenfield’s interview with the founder of ENERGYbits®, Catharine Arnston, on the benefits and importance of algae.  Please refer to Is This The Most Dense Source Of Nutrition On The Face Of The Planet?

In full disclosure, I am now an affiliate for ENERGYbits®.  I signed up primarily to get the same 20% discount I can offer you.  You can only purchase them online, so when you check out, just enter discount code PTAdvisor for 20% off all products.

BUY NOW

Adequate nutrition is an important component to the rehabilitation and recovery process.  There is a direct correlation between your nutritional status and your ability to heal.  Each of us has different needs based on our individual health status.

As a physical therapist, I offer general guidelines based on what has worked for my past clients.  However, I recommend that you find a nutritional expert to be part of your rehabilitation team as well.  If you are not healing from your injury, it’s very important to insure that any and all dietary concerns are properly addressed.  Don’t skip this step as poor nutrition can and will derail your recovery process.

Have your food choices positively or negatively affected your recovery from an injury or illness?  Which supplement might you consider taking?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Why You Won’t Heal – Part 3

Psychological, Emotional, and Social Conditions are affecting your Healing

The human experience is a web of how we relate to our surroundings as a physical, social, mental, and spiritual being.  So it comes as no surprise when we recognize that a person’s ability to overcome injury and illness isn’t purely physical.  There are very strong psychological, social, and spiritual elements to it.  It’s nearly impossible to separate the different aspects of our being or experience as a human.  The human body is a complicated.  To fully recover and heal from an injury or illness, all aspects of our being must be addressed at some level.  In Part 3 of the series, Why You Won’t Heal, I address how and why physiological and social conditions can affect your healing.

Your belief in your ability to heal and recover is a critical component to how you actually will heal and recover.  If you fully believe that you will make a recovery and return back to a pre-injury state, then you truly are more likely to do so.

So often I work with individuals who have fear associated with a full recovery.  A common example is someone who has severely injured his/her low back.  It’s common to be overly fearful and afraid that the pain may return if you do the wrong thing.  Consequently, that person will not push his/her rehabilitation and recovery.  And therefore, he/she doesn’t return to his/her prior baseline and will likely never fully recover physically as well as mentally and psychologically.

Because of this large barrier to recovery, most progressive back rehabilitation programs will address fear avoidance beliefs and the fear of disability from pain versus true musculoskeletal disability from injury.  The fear of re-injury is very powerful not only to the general population, but also for elite athletes.  Many elite athletes have failed to return to pre-injury glory because of fear and psychological dysfunction associated with his/her injury.

Other psychosocial issues that I have encountered include identity issues.  Many conditions become chronic because the condition and injury lingers for a long period of time.  As a person maneuvers through the health care system, this sick phenotype becomes ingrained in who the person is at a deeper psychological level.  The person forgets what life was like without the condition and now they become a person with that particular injury or illness.

Once a person takes on this type of deep routed feeling about who he/she is, it can be nearly impossible to actually heal from the condition as the condition is no longer only physical, but now psychological.  The condition and illness becomes part of his/her emotional psychological state and part of a new altered identity.  Subconsciously, this becomes an emotional and psychological paradox to recovery which affects the person physically as well.

Motivations also play a key role in a person’s ultimate recovery.  Are there secondary gain issues?  If a person dislikes his/her job, maybe he/she isn’t really motivated to return to work after a workers’ compensation injury.  Is a person depressed about other issues in his/her life, so he/she isn’t really that motivated to recover or improve?  All of these factors need to be addressed to insure optimal recovery.

However, it’s important to keep in mind that a person’s rehabilitation process can be highly variable even within those who are recovering from the same type of injury.  While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who took significantly longer to heal.

This is completely normal within a course of recovery.  Each person’s physical ability to heal and recover is different.  Unfortunately, there are some who were never able to recover to any significant degree.  The lack of recovery is always routed in physical as well as psychosocial reasons.  The severity of an injury is not necessarily a predictor of who will or will not recover or how the injury may affect a person physiologically.

Although I am not a psychologist, it’s my job as a physical therapist to help clients heal, recover, and/or adapt to injury or illness.  This includes addressing all aspects of the person’s recovery not only from the physical perspective, but also from an emotional, social, psychological, and spiritual perspective.  My treatment primarily focuses on the physiological issue, but I’m always aware of the other aspects and needs within the recovery process.  I help and advise where I can and when needed, I recommended other trained medical professionals.

If you are struggling to heal and recover from an injury or illness (regardless of the severity), consider the possibility that part of your recovery must include the other aspects of who you are as a person.  It’s common to include physiological, emotional, and spiritual support in your recovery.  (And I highly recommend it!)  We need to fully embrace ourselves and who we are (including our feelings and physical and psychological status) to insure that our bodies are operating at the highest level possible.  This type of self-awareness can be painful and difficult at times.  Don’t feel you have to do it alone.  Seek professional help because options are available.  Don’t give up on yourself!

Have you ever struggled to recover from an injury or illness?  How were you able to recover psychologically and emotionally?  Sharing your story can help others in their recovery process.  Please leave your comments below.

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