Monday, December 10, 2018

Trigger Point Dry Needling Explained

Functional Dry Needling (FDN) is simply a treatment used by health professionals to help with the management of pain, orthopedic issues and sports-related injuries to improve your function. Yes, it does involve a thin filament needle being advanced into tissue of your body, but the good news is, typically you feel better immediately. FDN stimulates the healing process of soft tissue which results in pain relief and restoration of healthy physiology. Let me address some of the most frequent questions I get asked:

Is Dry Needling the same as Acupuncture?
Acupuncture and FDN use similar needles, but they are very different in the application and goals of treatment. Acupuncture is based on ancient theories of traditional Chinese medicine and uses insertion points all over the body based on meridians and focuses on balancing energy or Qi in the body. Dry needling in physical therapy practice is based on Western neuroanatomy and the musculoskeletal systems to provide treatment of acute and chronic pain, as well as treatment of orthopedic and sports-related injuries. Both FDN and Acupuncture do, however, use the same tool: a solid needle filament.

Does it hurt?
Needles used with FDN are not the same ones that your doctors/nurses use for injections. They are typically much smaller and “wispy” in nature which renders them more comfortable. Also, FDN uses a needle with a rounded tip that is distinctly different than the beveled, cutting-edge tip of hypodermic needles. Muscles that are sensitive, have active “trigger points” (*see below) or that are tight may feel a slight cramping sensation or muscle twitch when the needle is inserted.

*Trigger Point is a hyperirritable point in a muscle that is associated with a hypersensitive palpable nodule, or “knot”. This area becomes painful at the site and can also “radiate” in other patterns.

What are some conditions that Dry Needling can be used to treat?

Almost anyone experiencing pain that is of musculoskeletal origin can benefit, including:
Neck/back pain, tendinitis, muscle spasms, “sciatica”, hip/knee pain, muscle strains, “tennis/golfer’s elbow”, overuse injuries, tightness in your neck and shoulders, tight muscles.

What are the risks with Dry Needling?
Some individuals experience a little bruising or minimal bleeding at the insertion site of the needle. Some report a feeling of achiness or soreness for a few hours after the treatment session. All of these are completely normal. While risks associated with dry needling are minimal, a conscientious dry needling practitioner will be well-versed in precautions, contraindications, and potential complications associated with dry needling. There are certain areas of the body that require more caution than others, but will always be discussed during your initial consultation to determine if FDN will even be beneficial to you.

Is FDN covered by insurance?
In most cases, it is a fee or cash-based service.

Thursday, December 6, 2018

Can You Rehab a Total Knee in 3 Weeks?

If you have been practicing as a therapist or an orthopedic surgeon for any number of years, I would ask you what are you doing differently now than you did 5 or 10 years ago when it comes to your post-op total knee?  If your unable to think of anything then I would encourage you to open your mind and follow along with me for what I believe is a revolutionary approach to total knee rehab.  If your someone who is considering a total knee replacement you can’t afford to be uneducated when it comes to your care.  Keep reading!

What is the single most untapped resource as it relates to total knee rehab?  It’s the patient themselves.  I would suggest to you that there are some novel approaches to total knee rehab that invest heavily in the biopsychosocial model and put the patient in control.  Give the patient a physical tool and protocol to mimic bringing the therapist home with them.  Essentially, turn the patient into their own therapist.  By utilizing a tool which allows the patient to perform a joint mobilization with movement into knee flexion and knee extension the patient becomes much more effective in gaining range of motion.  By utilizing a protocol which focuses on making the nervous system feel safe, creating neural drive at end ranges of flexion and extension and imparting motor control at those end ranges the patient regains active control of the extremity post-operatively much faster.

The combination of this protocol and a physical tool produces a return to full ROM and (I) ambulation with a cane or no AD within 2-3 weeks.  Combine the use of a kinesiotape in a basketweave pattern for edema management and IASTM techniques using a Pacinian stroke and the patient moves quickly and smoothly through their ROM and their rehab. 
Typical case scenarios I have are as follows:  TKA pt utilizes joint mobilization tool and protocol daily beginning day 3 post op and receives 1 therapy visit per week to guide progress.  Pt undergoes basketweave taping to effected knee day 3 post op.  Pt follows specific protocol on their own and has weekly therapy visit for 3 weeks.  At the end of 3 week time frame, the average results are pt ROM 0-120 deg effected knee with active end range control of all ROM resulting in motor control to be (I) ambulators with cane or no AD.

What are the implications of this?  As a profession utilizing this new protocol and tool we can cut post-op rehab by half for the majority of patients receiving total knees.  Currently there are 700,000 total knees every year in the US.  The average rehab costs for each total knee is $2-3,000.  That’s a total of roughly 2.4 billion dollars per year.  By using this new tool and process and speeding up the post op recovery we could save the patient and insurers 1.2 billion dollars every year.
We can deliver a better product, a better service and better outcomes to the patient and do it for a fraction of the cost.  Think outside the box.  Use tools and techniques that are getting results.  We are using the GoKnee device and protocol with our total knees and can turn your rehab around in 4-6 visits.

Monday, December 3, 2018

Product Review: Rumble Rollers - Gator

GATOR PROVIDES HIGH COMPRESSIONThe first thing to note about the Gator is that its firm surface and small diameter (about 4.5" or 115mm) produce high compressive forces in the muscle. You'll get as much localized compression as with PVC pipe, but with much less pain or soft tissue damage.

You'll also find that the smaller diameter allows you to better work smaller body depressions, such as the arch of your foot or the curve in your neck.

Pressing harder and deeper isn't the only way to massage a muscle. Another way to free stuck tissues is to pull them apart. Of course you can't grab the deeper tissue directly, but you can move higher layers of soft tissue to create a separating (shear) force that displaces underlying layers. This approach is often referred to as cross frictional massage.

Cross frictional massage is normally done by a massage therapist who uses his thumbs or fingertips to apply short, firm strokes across the muscle fibers. RumbleRoller's Gator is the only foam roller that can grip your skin well enough to mimic this type of massage.
INGENIOUS PATENT PENDING TECHNOLOGY. The surface of the Gator contains specially-designed bumps that enable both muscle compression and cross friction.

MULTI-DIRECTIONAL MUSCLE THERAPY. With its unique design, the RumbleRoller Gator helps erode trigger points, restore flexibility, and bring quick relief to common types of muscular pain.

Gator is more beginner-friendly than RumbleRoller's deep-tissue rollers, but don't mistake it for a beginner's roller. The advanced features of this roller benefit even the most experienced athlete.

CUTTING-EDGE CONSTRUCTION. RumbleRoller uses a solid multi-piece core made from very resilient grades of high-density EVA foam. The core and outer shell are both carefully engineered to provide maximum durability and optimal feel. Other manufacturers use hollow cores to reduce costs, but this has a negative effect on a roller's performance and long-term durability. RumbleRoller builds the most effective products that it can, and refuses to cut corners.

My Review:
This roller is great! It’s a little smaller in diameter, but I’ve found that I’m able to get into places of my body (Quads, posterior delts/lats, IT Band) comfortably without the discomfort of sitting too high off the ground. With the bumps on the roller, I’m able to grip my skin and pull my skin perpendicular to the direction of the muscle fibers, and enables me to focus on the fascia system - which is intricately woven into your muscular system and often gets neglected for various reasons. My mobility is better as well as my recovery. Anyone that lives an active lifestyle must do some research on this type of recovery to extend the life of that activity and perform above their current fitness level. Sure, it’s a little expensive, but I’d rather spend money on things like this as a preventative measure to keep me out of the doctor’s office

The center core is made of firm foam rubber. The roller is not soft... but it's not hard either. It's very firm but flexible enough to roll over bony areas without any discomfort. Works great for fascial release and getting out those stubborn knotty areas in the larger muscle groups.

Testimonial from Rick R.:
          "My Physical Therapist highly recommend me to buy this roller. It definitely does not disappoint. Out of all the foam rollers I've tried, only this one really helped me loosen up my fascia. The well shaped bumps along the roller are firm and perfectly spaced and do a great job deeply pressing into skin and muscle. The material screams quality and I can feel results immediately with fewer rolls than other brands.

I'll admit, I was on the fence on this item because it was quite pricy, but you definitely get what you pay for. Its the best roller I ever bought and is really helping me with my tight legs and lower back."

Testimonial from Lauren J.:          "Surprising effective!! Product provides the perfect amount of pressure and hits the right spots without being too aggressive. I was afraid it might not be aggressive enough, but it works wonders! This item has been very successful in helping me rehab my hip and back after three back to back pregnancies. I had several sciatica and my hips kept rotating back and going out of place. Some of the most pains things I’ve ever experienced. I struggled with even walking. My hips would go out at any time with no warning. I am feeling amazing after a few weeks of use and feel like I can start becoming active again. I have missed being active and fit and this has given me the relief I needed to begin!"

Wednesday, November 28, 2018

WOD Wednesday #93

Complete as many rounds as possible in 20 minutes of:
10 strict knees-to-elbows
3 wall walks

ScalingThis workout will quickly become tedious and uncomfortable. Each set of movements should be challenging but doable, forcing you to manage muscular failure in order to maintain a decent pace.

Intermediate OptionComplete as many rounds as possible in 20 minutes of:
7 strict knees-to-elbows
2 wall walks

Beginner OptionComplete as many rounds as possible in 15minutes of:
10 hanging knee-raises
50-ft. bear crawl

Monday, November 26, 2018

Top 5 Kettlebell Movements - Part 2

The Snatch is one of the quintessential kettlebell movements; the combination of strength, power, stability, and cardiovascular fitness embodies kettlebell lifting perfectly. Whether you want to build power or strength endurance, the Snatch is a great exercise to add to your training. Another reason to love the kettlebell Snatch is that the movement is accessible to a larger population than the barbell Snatch; the mobility requirement is less stringent, with many of the same benefits.

Since the Snatch is a highly technical movement, take plenty of time to practice with a light kettlebell. The neuromuscular system needs time to coordinate the movement and build muscle memory. The shoulder also needs time to build stability in the overhead position. A great way to start is to practice the Half Snatch. This allows you to focus on the upswing of the movement before tackling the more challenging drop into the backswing. Once the upswing is mastered, you can work on the drop, making sure that you allow the bell handle to skip the center of your hand on the way down so there is no pulling on your palm, which can cause blisters and tears.

There are two variations in technique you can use on the Snatch. The first is a Snatch that uses a hinge motion, which is great for building strength and power. The second is a Snatch that uses a pendulum leg action, which is ideal for endurance work. Choose the variation that suits your goals, or simply the one you enjoy more!

1.      Start in a standing position with feet about hip width apart and a kettlebell in front of your feet. Grab onto the kettlebell with hook grip (bell handle in the fingertips, and thumb locked over the fingers).
2.      Pull the bell into the backswing, then drive with the legs to bring the kettlebell up. For the hinge-based power swing, use a hinge motion and extend the hips forcefully. For the pendulum-based endurance swing, use a slower pendulum leg action that follows the motion of the kettlebell.
3.      When the kettlebell reaches the float point (somewhere between hip and shoulder level), redirect the kettlebell into the overhead position as you punch the hand up and through the bell handle to meet the kettlebell in the overhead position. For the power swing, the arm and the kettlebell should stay tight to the body on the way up. For the endurance swing, the bell should be allowed to follow its natural path (which will be farther from the body) before redirecting into the overhead position.
4.      After stabilizing the kettlebell in the overhead position for a couple seconds, turn the bell and allow it to drop; give the kettlebell a head start before following it into the backswing with the torso. The arm should hit the hip before the torso folds forward.
5.      Once the kettlebell completes the backswing, go into the next repetition. 
The Renegade Row is a challenging core exercise that involves both pushing and pulling upper body components. The movement is comprised of one kettlebell push up followed by a row on each side from the plank position. One of the main functions of your core is to prevent trunk rotation, which requires your core, glutes, and hips to work together. Keeping the hips in place while performing rows in the plank position is a great way to train anti-rotation, as well as upper body pulling. The push up provides the upper body pushing component, and requires the core to stay active.

The Renegade Row should be trained with focus on form, not speed. Moving quickly typically leads to hip rotation and less core engagement. Instead, move slowly and deliberately to ensure proper body position in each part of the sequence. Start with 3-5 repetitions and work up to 10 repetitions. When you can easily complete 10 repetitions at a particular kettlebell weight, you can move up to a heavier weight.

1.      Start in the plank position with a kettlebell underneath each shoulder. Begin with the feet spread apart wide, and move them closer if you want to make the movement harder.
2.      Perform a push up, keeping the elbows in close and the belly button pulled up toward the spine to engage the core.
3.      From the plank position, perform one row on each side. Try not to move the hips -- this is the anti-rotation component -- and think of pulling the elbow and hip toward each other while you row.
4.      Once you complete the rows, go into the next repetition.

About Kettlebell Kings
Kettlebell Kings is a premium-quality kettlebell and kettlebell content provider, based in Austin, Texas. You can view our equipment, kettlebell how-tos, and get expert advice at and For more information, call us at 855-7KETTLE to learn more.

Thursday, November 22, 2018

Product Review: Black Mountain Products 20lb Slam/Wall Ball

Product Details:
Black Mountain Products Slam/Wall Ball is a great addition to any workout program. Its soft outer shell makes for comfortable and easy throwing and catching. The design of the exercise ball allows it to maintain shape and balance of the weight for a uniform strength training or cardio workout at any intensity. Soft slam balls range in weight from 4lbs to 25lbs to accommodate anyone from the beginner to an expert in fitness. This is the perfect workout tool for abdominal training and building endurance.
-Synthetic leather shell maintains durability even with regular use
-All medicine balls measure 14” in diameter
-Maintains a uniform shape and weight balance at all intensity workouts
-Slam Balls range in weight from 4lbs, 8lbs, 12lbs, 20lbs, and 25lbs
-Lifetime warranty on all Fitness Slam Balls   >>> MOST IMPORTANT FEATURE! SLAM AWAY!
My Review:
Medicine ball training is one of the easier ways to improve your endurance, explosiveness, and core strength. Use them for anything from wall ball throws to traditional trunk twists, squats, sit-ups, presses, ball slams and more. BMP Medballs have been battle tested and they've really earned their keep in the day-to-day grind from home gyms to commercial gyms with their life time warranty.

Whether you are using our medicine balls for traditional movements such as wallballs and abdominal resistant work, or feel like blowing off some steam with some slams, I trust the BMP Medballs to withstand any workout you put them through.  The interior filling is substantial enough to help the ball keep its shape over repeated use, but forgiving enough for athletes to safely stop or catch the ball at high velocity.

This medicine ball quality is exceptional, I have used and purchased competitors as well and this one is far superior. Medicine ball is balanced well, has great gripping surface and even warrantied for slamming.  Excellent grip, even when the sweat is pouring. Definitely worth the money, especially compared to competitive brands. The difference, compared to other brands, seems to be in the "catch" for wall balls. The BMP Ball seems more balanced.

Exercises You Can Do With a Medicine Ball
There is a lot you can do with a Medicine Ball. Not only can it be used to build strength but it is also great for perfecting squatting technique, also known as squat therapy:

  • Wall Balls
  • Lunge with Twist or Overhead Press
  • Squat Press
  • Rolling Push-Up
  • Shoulder Press
  • Figure 8
  • V-Up
  • Overhead Slam
  • Use to learn how to clean
  • Use to teach squat and get more comfortable with your squat depth.
  • So much more...
My Rating: 9.5
Does not get better than BMP, their superior quality and attention to their customers. I look forward to purchasing more equipment from them in the future.  The rating is based on the quality I have experienced these past 30 days but also I know if I ever have a problem in the future I will be taken care of!

Order your own Black Mountain Products Fitness Slam Ball for Strength and Endurance Training, 20 lb (click the link) on AMAZON for $33.20!

Monday, November 19, 2018

Top 5 Kettlebell Movements - Part 1

While getting depth in the squat is important to to involve the glutes and hamstrings (as opposed to using the quads only), the spine should stay neutral throughout the movement. Try not to let your butt tuck under in the bottom position; if it does, you are likely going lower than your range of motion allows and your lower back will take some of the load. Mobilizing the hips and hamstrings prior to squatting can improve depth and activation of the posterior chain.

The Goblet Squat can be utilized to build strength by completing sets of 3-5 reps; Kettlebell Kings bells go up to 203 lbs, so there is a bell weight to challenge almost anyone’s strength! The Goblet Squat can also increase strength endurance and metabolic conditioning; simply use a repetition range of 8-20 with a lighter weight. A fun variation to try is the Goblet Squat Curl, which requires holding the bottom position while doing a bicep curl - guaranteed to cause extra muscle pump!

1.      Stand with feet about hip width apart. Bring the kettlebell into the goblet position, grabbing hold of the handle on other side.
2.      Squat down while keeping the chest up and weight in the heels. An easy way to determine proper depth is to bring the elbows to the inside of the knees. The spine should stay neutral.
3.      Drive into the ground as to come back up to standing position, contracting the glutes and fully extending the hips.

The Turkish Get Up (TGU) is a total body movement that builds shoulder stability and core strength. Since there are many parts to the movement, be sure to practice the sequence with bodyweight initially. Ensure proper and smooth execution of the entire movement before adding a kettlebell. You should have control over each part of the movement; if someone yelled “freeze!” at any point, you would be able to stop and maintain stability of the kettlebell.

The TGU is best practiced in sets of 1-5 repetitions. There is a lot of focus required, so doing a lower rep count will ensure better quality movement. Build up your volume slowly by increasing the number of sets. I recommend being able to do at least 3-5 perfect repetitions with the weight you are using before moving up in weight. A perfect repetition means there is no wobbling of the kettlebell and you have complete control of each portion of the movement (including the return to the floor).  

The TGU can be practiced in parts as well. Typically the most challenging part of the movement is the Turkish Sit Up (also known as the Half Get Up), which is the initial portion of the movement where you come to an upright torso position with hips still on the floor, then slowly return to the floor. When training toward a heavy TGU, it’s helpful to work on the TSU with heavier weights than what you would use for the full TGU. Besides the TSU, other parts of the TGU to isolate would be the pass through of the leg from the TSU into the Kneeling Windmill, the Kneeling Windmill, and the Overhead Lunge.

1.      Start lying on your side in the fetal position. Insert your hand fully through the kettlebell handle.
2.      Roll onto your back, keeping both hands over the kettlebell handle and elbow tight to the body. Set the legs about 45 degrees apart, with the leg bent and foot flat on the side you are holding the kettlebell. The other leg should be straight.
3.      Press the kettlebell up until the arm is straight and the weight of the kettlebell is balanced over the shoulder. Remove the free arm and place it on the floor, palm down and about 45 degrees from the body.
4.      Use the elbow of the free arm and the foot of the bent leg to drive into the ground and bring yourself up onto your elbow, then up onto your hand.
5.      Lift the hips, then pass the straight leg underneath until the knee is under the hip. Keep your eyes on the kettlebell.
6.      Bring the torso up straight, then pivot the back leg so you are in a lunge position.
7.      Drive into the heel of the front leg to come up to a standing position.
8.      To reverse the movement, step back with the leg opposite to the side youre holding the kettlebell and come back into the bottom of the lunge position (knee resting on the floor).
9.      Pivot the back foot in, then slide the free arm down the thigh and onto the floor directly beneath the shoulder. Pass the back leg through the free arm and the front leg and set your hips down onto the floor.
10.  Lower down to the elbow. As you lower all the way down to the floor, feather the kettlebell across the body slightly to slow its descent.

The Bottoms Up Press (BU Press) is an upper body pushing exercise that encourages proper mechanics for the shoulder and activates the neuromuscular system. Due to how hard the handle must be gripped during this movement, muscles that wouldn’t contract on a regular press are suddenly brought to life, i.e. rotator cuff, core, glutes, lats.

Since the BU Press is much harder than a regular press, start with a light weight and let the body adapt before trying anything heavy. The BU Press can be utilized in a training program like any other upper body pushing exercise -- and may actually be better than other pushing exercises for anyone with shoulder pain. To build muscular endurance, train higher repetitions with lighter weight. To increase strength, train lower repetitions with heavier weight.

Before even attempting the BU Press, you should know how to fail out of the movement safely. If you fail before the kettlebell reaches shoulder level, you can simply use the free hand to prevent the bell from hitting you. If you lose control of the bell in the top position, simply let the bell fall and step in the opposite direction so the bell drops onto the floor. Another precursor to doing the BU Press is to have a solid and stable BU Clean. If you perform a poor BU Clean, the BU Press that follows will not go well! You should be able to stabilize the kettlebell in the BU rack position before attempting a press overhead.

1.      Start in a standing position with feet about hip width apart and a kettlebell in front of your feet.
2.      Hinge at the hips and grab onto the kettlebell handle, then hike the kettlebell back between the legs. Fully extend the hips and bring the kettlebell into the rack position, with bottom side up. Stabilize the bell here first; if you have a bad clean, re-clean the kettlebell before attempting the press.
3.      From the bottoms up rack position, inhale and engage the lats by pulling the shoulder down and away from the ear. Press the bell overhead as you exhale.
4.      Hold the bell in the top position for 1-2 seconds before slowly lowering the bell down with control, again engaging the lats by pulling the shoulder down.
5.      Once back in the rack position, prepare for the next repetition.