Maintaining Cardiovascular Fitness with an Overuse Injury

Clinicians often recommend limiting time and intensity of workouts to allow for greater recovery time, decreased tissue stress and improved healing. By overloading a injured area either too soon, or too often, the athlete can see regressions in function, pain and dysfunctional mechanics. Yet, for the avid athlete, being told to decrease workout volume can feel disorienting. Aqua jogging can be a safe alternative for many athletes in this predicament, including those recovering from:

• Stress-related bone injuries: stress response, stress reaction or stress fracture

• Tendinopathies of the leg, including gluteal, hamstring and achilles tendinopathy

• Surgical repair of a major injury, including FAI, labral, ACL or a meniscus repair

Aqua jogging can also be a great accessory workout for those with a very high training volume to allow for a effective cardio workout at a decreased level of impact. For many, access to a pool is more convenient than an anti-gravity treadmill! By adding a reduced load workout to your routine, you can decrease your risk of injury.

In all cases, talk to your medical team to ensure you are ready to begin an aquatic rehab program.

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Pro tips for a successful aqua jogging workout:

1) Choose the right equipment

Wear a minimally buoyant belt to allow for moderate challenge throughout your workout. Avoid ones that are bulky, ill-fitting or feel like an inner tube. Click the images below to view our recommendations.

2) It’s aqua jogging, not swimming

Stay upright, keeping your hips under your shoulders. Resist the urge to go horizontal as with swimming; this will be less effective when wearing a floatation belt.

3) You’re in water, not on land

Don't focus on moving forward, as this will happen naturally. Instead, pay attention to the level of effort you’re exerting, regardless of how quickly you traverse the pool. 

4) Adjust your training volume to match

When cross-training specifically for distance running, a general rule of thumb is that you need to do 50% more in the pool to get the same cardio benefit as running on land. In other words, 45 minutes in the pool = 30 minutes of running.

To increase the challenge:

Intervals, intervals, intervals!

Just like with non-water workouts, varying the speed and intensity of your effort in waves can provide increased benefits. Using a timer or landmarks within the pool, challenge yourself to pick up the pace for a measurable interval. Based on your overall health, choose an appropriate recovery window. This can be time-based, for example resting the same, twice as much or half as much time it took you complete the challenging interval, or it can be biometrical, waiting for your heart rate to return to its pre-interval baseline.

Get a resistance band.

Select a band like this one and attach yourself to the wall, you can do "sprints" by creating more resistance than the water naturally provides.

Resistance bands can also be used if the pool is not deep enough throughout to do laps, you can do a stationary workout with this band by anchoring yourself to the wall or pool deck.

Remove the belt!

We recommend waiting until you feel confident with aqua jogging form is before taking this step. Taking it off too soon, even if you are a proficient swimming, will impact the overall quality of your workout.

Choosing A Clinician: A Guide for Athletes and Active Individuals

Whether you’re a seasoned athlete or simply someone who enjoys staying active, finding the right sports physical therapist can make all the difference in your recovery and performance. Sports physical therapists specialize in treating injuries and optimizing movement for individuals with active lifestyles. They work closely with athletes and fitness enthusiasts to help them get back to their peak condition safely and effectively. But with so many options out there, how do you choose the best one for you? Here’s what to look for when selecting a great sports physical therapist, including key qualities of both the clinician and the practice setting.

The Clinician:

1. Expertise in Sports-Related Injuries and Conditions

A good sports physical therapist has extensive knowledge and experience in managing sports-related injuries. Look for a therapist who:

• Has experience treating injuries specific to your sport or activity. For instance, if you’re a runner, a therapist with experience in managing lower extremity injuries, such as shin splints or knee issues, will be invaluable.

• Is certified or has a background in sports physical therapy. Certifications like the SCS (Sports Certified Specialist) indicate a strong foundation in sports injury management and rehabilitation.

• Understands biomechanics and movement patterns specific to athletic activities. This knowledge is crucial for evaluating how you move and pinpointing any issues that may be causing or exacerbating your injury.

2. A Patient-Centered Approach and Strong Communication Skills

One of the most important qualities of a good sports physical therapist is the ability to listen to and understand your goals, needs, and concerns. Look for a therapist who:

• Takes the time to listen to your story and understand how your injury affects your life and sport.

• Communicates clearly about your diagnosis, treatment plan, and expected outcomes. They should be able to explain complex concepts in a way that you understand and feel comfortable with.

• Values your goals and collaborates with you to create a recovery plan that supports both your short-term and long-term aspirations, whether that’s getting back to training or just enjoying a pain-free workout.

3. Customized, Sport-Specific Treatment Plans

No two injuries are alike, and athletes require specialized care tailored to their sport’s unique demands. A good sports physical therapist will:

• Create a customized treatment plan that’s specifically designed to address your injury, taking into account your sport, position, and level of play.

• Incorporate sport-specific exercises and progressions. For instance, if you’re a soccer player, your therapist should include drills that mimic the movement patterns used in soccer, like pivoting and kicking.

• Focus not only on healing the injury but also on injury prevention. A great therapist will identify areas of weakness or instability that may lead to future issues and work with you to build strength and resilience in those areas.

4. Emphasis on Functional and Return-to-Sport Testing

A skilled sports physical therapist knows that recovery isn’t just about feeling better; it’s about getting back to performing at your best. Look for someone who:

• Uses functional testing and return-to-sport assessments to objectively measure your readiness to return to your sport. These assessments help determine if you’re truly ready for the demands of your activity and reduce the risk of re-injury.

• Tracks and evaluates progress over time to ensure you’re moving forward with your recovery.

• Is willing to adapt the plan based on your progress and any challenges you face along the way.

The Practice Setting:

Alongside the characteristics of the therapist, the practice setting itself plays a crucial role in supporting effective treatment. Here’s what to look for in an ideal sports physical therapy setting:

1. Well-Equipped Facility with Sports-Specific Equipment

A good sports physical therapy clinic will have specialized equipment and spaces that allow for sport-specific rehabilitation. Look for a facility that includes:

• Strength and conditioning equipment (like squat racks, resistance bands, free weights) to facilitate sport-specific strengthening and conditioning exercises.

• Open space for dynamic exercises such as running, jumping, or agility drills. This allows for a full range of motion activities and sports-specific drills.

• Advanced equipment for functional assessments and movement analysis, such as motion capture or force plates, which can provide valuable data on your biomechanics and movement patterns.

2. Collaborative, Interdisciplinary Team

In the best sports physical therapy clinics, therapists often work alongside other health and fitness professionals. This type of collaborative environment can be extremely beneficial if you need additional support, such as:

• Sports medicine physicians and orthopedic specialists who can provide input on complex cases or guide the treatment plan based on specific medical needs.

• Athletic trainers and strength coaches who can help transition you from rehabilitation to performance training.

• Massage therapists who help treat soft tissue injuries and optimize recovery.

• Nutritionists and mental health professionals who understand the unique demands placed on athletes and can support holistic recovery and wellness.

3. Emphasis on Education and Injury Prevention

An ideal sports physical therapy practice not only treats injuries but also focuses on educating athletes to prevent future issues. The clinic should provide:

• Resources on injury prevention techniques, warm-up and cool-down strategies, and sport-specific conditioning tips.

• Access to self-management tools (such as foam rollers, resistance bands, and instructional videos) to help you maintain your progress outside of the clinic.

• Follow-up care or programs to support continued improvement after your primary treatment has ended.

Final Thoughts: Finding the Right Fit

Ultimately, finding a good sports physical therapist is about finding someone who understands your sport, values your goals, and has the expertise and resources to support your recovery journey. Take the time to ask questions, explore different clinics, and find a therapist and setting that feels right for you. The right therapist will not only help you recover from injury but also empower you to return stronger, more resilient, and better prepared to reach your full athletic potential.

Planning ahead for holiday success

It’s that time of year again! Whether you’ll be shuttling between relatives’ homes, using the time away from work to check off some bucket list adventures, or hosting the chaos yourself, it’s safe to say your typical routine is going to be impacted.

We firmly believe that consistency and load management are two pillars of a successful plan- don’t let your goals get stuck on the sidelines this holiday season! Below, we’ve outlined how to approach the coming weeks to set yourself up for success:

1-2 Weeks Prior:

Check in with your clinician.

• Plan to discuss your current presentation. Understanding the why behind your exercises helps to increase compliance.

• Share details and goals of your travel- how long of a flight or drive do you have? What are your plans once you arrive? Your clinician can help identify strategies to decrease flare ups.

• Update your circuit to reflect just the priorities. Be realistic about the amount of time you can dedicate while out of your normal routine, and highlight what exercises are critical to your continued progress.

• If you won’t have consistent internet access, ask for a PDF copy of your circuit!

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3-5 Days Prior:

Confirm what you’ll have access to.

• Verify with your hotel if they have an on-site gym and what equipment they have.

• Double check with family members or hosts if they have any home equipment.

• Research local gyms. Consider purchasing a day pass if you need more robust equipment based on your plan.

• Check the weather. If you typically run outdoors, does your temporary location allow for success?

• Purchase travel equipment as needed. We’ve highlighted our go-to’s below:

TRX GO Trainer

Everything you need to a full workout, compact and packable.

Collapsible Foam Roller

Easily fits into a carry-on, while still providing firm massage once expanded.

The Orb

Our go-to massage ball for both upper and lower body.

4-Pack of Mini Bands

Travel friendly resistance, in multiple strengths.

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On Location:

Make a plan.

• Identify optimal times to fit in your exercises. Prioritize your circuit prior to any physical activity, completing a majority of the list at your accommodation, and a light warm up once you arrive at your activity.

• Communicate with family and travel companions that this is important for your recovery. They’ll be more supportive of you taking 15-30 minutes away.

• Split up high demand activities when possible to match your current tolerance. Try to plan lighter activity days between more physically demanding days.

Connect with your clinician sooner rather than later to schedule your pre-holiday appointment!

Email our Team

Holiday Scheduling Request

Therapeutic Applications of Heat vs Cold

If you've ever had an injury—whether it's a sprained ankle from running or joint stiffness after a long day—you've probably wondered: Should I grab an ice pack or reach for a heating pad? The truth is, both cold and heat therapies have their place in both recovery and injury rehabilitation. But knowing when to use each can make all the difference in your healing process.

Cold Therapy

Cold therapy, also known as cryotherapy, is the go-to for acute injuries. Think sudden sprains, strains, or any type of trauma where swelling is your body's immediate response. Ice helps to reduce swelling, numb the pain, and limit damage to the tissues.

How It Works:
When you apply cold, it causes blood vessels to constrict (Knight & Draper, 2013). This reduces blood flow, which means less swelling. It also numbs the area, providing almost instant pain relief—especially useful during the first 48 hours after injury. Research indicates that cryotherapy is particularly effective at reducing swelling and pain during the initial phase after an injury or surgery (Hubbard & Denegar, 2004). Some common methods include:

• Ice packs or gel packs: Quick and easy for small areas like a sprained wrist or ankle.

• Ice baths: Athletes swear by these for post-exercise recovery, especially after intense training.

• Cryotherapy chambers: More intense, these are becoming popular for whole-body cold therapy.

When to Use It:
Cold therapy is most effective within 48 hours of injury and should be applied for no more than 20 minutes at a time. It’s is perfect for:

• Acute injuries (sprains, strains, or fractures)

• Reducing post-workout soreness

• Controlling post-surgical swelling

What to Watch Out For:

• Do not apply ice directly to your skin—it can cause frostbite. Always wrap it in a towel or cloth to protect yourself.

• Cold therapy should also be avoided if you have poor circulation or conditions like Raynaud’s disease. 

Additionally, it's important to note that while ice can reduce pain and swelling in the short term, the long-term benefits of cryotherapy, particularly on tissue repair and recovery, remain unclear (Hubbard & Denegar, 2004).

Heat Therapy

Where cold therapy excels at calming inflammation, heat therapy is ideal for those days when your muscles are tight and your joints feel stiff. Heat is a great way to increase blood flow and relax the muscles. It’s perfect for anyone dealing with chronic pain or conditions like arthritis.

How It Works:
Applying heat causes blood vessels to dilate, allowing more oxygen and nutrients to reach sore areas. This helps relax tight muscles, soothe joint pain, and improve flexibility (Knight & Draper, 2013). There are two main types of heat therapy:

• Dry heat: Heating pads or an infrared sauna.

• Moist heat: Warm baths or steamed towels, which penetrate deeper into the muscles.

When to Use It:
Heat therapy can be beneficial before activities that require significant flexibility or range of motion. It’s recommended to apply heat for 20-30 minutes, and works best for:

• Chronic neck or back pain

• Joint stiffness from arthritis

• Muscle tightness or spasms

What to Watch Out For:

• Be careful not to use heat on new injuries or swollen areas. It can actually make swelling worse. 

• Make sure the heat is comfortable, not too hot, to avoid burns.

Can You Combine Cold and Heat?

If you’re wondering whether you can use both, the answer is yes. This is known as contrast therapy, where you alternate between cold and heat. Cold reduces the swelling, and heat increases blood flow and mobility.

Contrast therapy is especially useful for:

• Soft tissue injuries

• Post-surgical recovery

• Reducing muscle tension after exercise

Listen to Your Body

At the end of the day, both cold and heat therapies are powerful tools, but they aren’t one-size-fits-all. The right treatment depends on your specific condition and how your body responds. Always consult with a healthcare professional if you are unsure, especially if your symptoms persist or worsen.

Cold and heat therapies are simple but effective ways to manage pain, reduce inflammation, and promote recovery. Whether you’re dealing with a new injury or chronic stiffness, using these therapies correctly can help you get back to doing what you love—without unnecessary setbacks. 

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To learn more, check out these resources:

Hubbard, T. J., & Denegar, C. R. (2004). Does cryotherapy improve outcomes with soft tissue injury? Journal of Athletic Training, 39(3), 278-279.

Knight, K. L., & Draper, D. O. (2013). Therapeutic modalities: The art and science. Lippincott Williams & Wilkins.

How intense does massage really need to be?

When it comes to massage therapy, many people wonder how intense the pressure needs to be to achieve the best results. There is a common misconception that the deeper and harder the pressure, the more effective the massage. However, the relationship between pressure and therapeutic outcome is more nuanced. Let’s explore the difference between deep pressure and deep tissue massage, why excessive pressure can be counterproductive, and how to find the optimal level of pressure for your needs.

Too Much Pressure?

One key aspect of effective massage therapy is understanding that getting muscles to release isn't about forcing them into submission. When a massage therapist applies pressure, sensory receptors in the skin and muscles send signals to the brain. These signals can help the brain to recognize tension, slowly convincing it to relax the muscles.

While other physiological effects also contribute to reduced tension in the body, putting the brain into a parasympathetic state is key to maximizing the benefits of massage. This means that excessive pressure is actually counterproductive, causing the body to go into a protective mode and tightening up the muscles even more in response to pain or perceived threat. Even worse, too much pressure can cause bruising, inflammation, or further injury.

Finding the Optimal Pressure

The goal of massage therapy is to promote relaxation and facilitate muscle release, not to cause pain. While a certain level of discomfort might be expected, particularly when working on tight or knotted areas, the sensation should be more of a "hurts so good" feeling rather than outright pain.

The optimal pressure during a massage varies from person to person and even from one area of the body to another. What feels good for one person might be too intense or too light for another. The "hurts so good" sensation is often an indicator that the right amount of pressure is being applied. This feeling suggests that the pressure is sufficient to address the muscle tension without causing excessive pain.

Take Control of Your Experience

To get the most out of your massage therapy session, there are several things you can do to help facilitate muscle release:

1. Stay in Communication

Always communicate with your massage therapist about the pressure being applied. No massage therapist, no matter how experienced, can know exactly what you are feeling. Your feedback is essential to ensure the pressure is just right.

2. Avoid Tensing Up

Try to keep your own muscles from tensing during the massage. Tension in the muscles can counteract the effects of the massage and make it harder for the therapist to work effectively.

3. Breathe Deeply

Make sure not to hold your breath. Deep, steady breathing can help to relax your muscles and enhance the therapeutic effects of the massage. When an especially tender or tight area is being worked on, focus on taking deep breaths to help the muscles release.

4. Relax Your Mind

Mental relaxation is just as important as physical relaxation. Try to let go of any stress or anxiety you may be holding onto. A calm mind can help facilitate muscle relaxation.

Effective muscle release involves communicating with the brain through slow and deliberate touch. The right amount of pressure to accomplish this is different from person to person and won’t even be consistent throughout your entire massage. Let go of any preconceived notions about how light or deep a massage needs to be. By finding a balance that promotes relaxation and healing without causing unnecessary pain, and by communicating with your massage therapist, you’ll be surprised at how much more benefit you can get out of each massage!

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To learn more, check out these articles:

Journal of Bodywork and Movement Therapies

Deep tissue massage: What are we talking about?

National Library of Medicine

Brain Activity Underlying Muscle Relaxation

The mechanisms of massage and effects on performance, muscle recovery and injury prevention