Saturday, December 1, 2018

Why do professional athletes recover faster from injuries?

We see it all the time. A professional athlete gets injured and we see him back on the field just weeks after the injury happened. Then we talk to our neighbor and he is struggling with a bad elbow for 6 or 8 months. Are professional athletes superhuman? What is the difference?
The first huge difference is the age. Top athletes are normally in their twenties, young and healthy. Young bodies recover faster, this is a fact. But this is not the main difference. We see nowadays that athletes are still competing at a very high level well into their forties. Good examples are Tom Brady, Roger Federer or Lebron James.
What is the main difference then? From my experience, after more than 20 years helping professional athletes the main difference is the combination of many different therapies. Let's put an example. A professional athlete with a bad runner's knee can do all these therapies in a day:
- Thermotherapy: yakuzzi (whirlpool baths), heating pads, ultrasound...
Roger Federer receiving treatment.
- Criotherapy: ice, cold baths, ocean swims...
- Manual therapy: osteopathy, chiropractic adjustments, joint mobility, stretching...
- Massage therapy: deep tissue massage, ART, cross friction massage...
- Exercises therapy: prehab exercises, stretching exercises, balancing exercises...
- Strength and conditioning sessions: band work, dumbbell work, core work, functional work...
- Other therapies: laser, acupuncture, shock wave therapy...
In general, any pro athlete can spend 3 to 4 hours taking care of the body and injury. They are proactive, they are not waiting till the injury gets better, they fight for it, they train for it.
I am a big believer in small therapies many times a day. Lets say you have a bad shoulder. My idea is that you should be doing neurodynamic exercises (10 minutes), band work (10 minutes), mobility exercises (10 minutes), small strengthening exercises (10 minutes), stretching (10 minutes), self massage (10 minutes)... you can do all these exercises at home, you don't need to go and see a trainer or therapist. If you can afford to visit a therapist once or twice a week even better. But the responsibility to get better is yours, you have to find the way to get better (with the guidance and knowledge of a professional).

Saturday, November 24, 2018

Official launch of our new website.

We are proud to announce that our new website and program is up and running. Take a look at and start preventing exercises.

Sunday, September 23, 2018

Joint mobility.

Most of the professional athletes use mobility exercises as part of their warm up. They help keep your body and all your joints in tiptop shape. They are key to prevent injuries. 
Limitations in movement are the first cause of knee, elbow and lower back
pain. Also remember, these limitations can lead to secondary injuries like knee and
elbow tendinitis. 
Use mobility exercises as a warm up and you will feel the difference: Choose a joint and move it in every possible direction. Do this slowly, and repeat every movement 10 times. To help you keep track, start by mobilizing the neck, then the shoulder, elbow and wrist, going down through the spine, hip, knee and finishing with the ankle. To get more out of these joint mobilizations, they should be done early morning or before tennis practice.

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Here is an example of shoulder mobility:

Wednesday, September 19, 2018

Shoulder, inflammation and exercises.

It is well known. When you have a shoulder pain and the origin is a rotator cuff tendinosis or a shoulder impingement you have to do exercises. More specifically you have to do band work to strengthen the rotator cuff tendons (supraspinatus, infraspinatus and teres minor). I have followed this protocol with my patients hundreds of times.
But over the last years I have been thinking that maybe strengthening a tendon or joint that is inflamed may not be the best solution. Most of the problems in the shoulder in athletes are due to inflammation and it can be a better idea to let the inflammation go down first. Why not wait till you have no pain and start strengthening then? In the meantime you can do light mobility exercises, ice or heat and do massages treatments. I believe that after 4 or 5 days of doing this the shoulder will feel better and you will be able to do more exercises then.

Sunday, September 16, 2018

How to improve a meniscus tear.

"Exercise therapy is as effective at improving knee function as arthroscopic partial meniscectomy for middle-aged patients with degenerative meniscal tears, according to a trial that compared the 2 interventions (Kise NJ et al. BMJ.doi:10.1136/bmj.i3740 [published online July, 20, 2016]). In Western countries, 300 in 100 000 people undergo arthroscopic surgery for meniscal tears annually, despite lack of compelling evidence that surgery is advantageous. This trial compared exercise therapy alone with arthroscopic surgery alone in patients without knee osteoarthritis and who were younger and more fit than participants in previous studies."

I totally agree with the results of this study. Actually I can talk from experience. I suffered and acute episode of knee pain and the cause of it was a internal meniscus tear. I considered arthroscopic surgery but decided that I wanted to try to heal it myself. 5 years later I can say that the decision was the right one. I don't know what is going to happen in the future, but as for today I am able to run, swim, bike and even play tennis from time to time. For some months after the acute episode I always had the knee in my mind. I avoided weird position or exercises. But now sometimes I don't even remember what knee was the one with the tear. 
I also had dozens of patients with meniscus tears in the last years. Lot's of them got better without doing surgery. In the specific case of the knee meniscus injury I think that doing surgery is a mistake. The meniscus is a "cushion". When a tear occurs than the cushion breaks a bit. What meniscectomy means is that they take the torn piece away. As I see it they take part of the cushion away so you will live the rest of your life with less support. I think that it is better to have the full support, even if it is a bit torn than less support. 
This is my advice: If you are suffer from a degenerative or mild meniscus tear consider not doing surgery. Just put all you effort to regain strength and mobility. There is always time to do the surgery if you cannot manage to improve on your own. 

Wednesday, September 12, 2018

Sciatic pain guidelines

Sciatic pain is one of the bad injuries you can have. Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body. It is debilitating, it makes you uncomfortable and it changes a lot of your daily routines.Over the years I have treated hundreds of patients with sciatic pain and I think I have a good idea on what to do in case of sciatic pain (I also had bad sciatic pain a couple of years ago). 

Here is goes:
- Dr. visit is important but it is more important to get an MRI. 
- Surgery should not even be in your mind so get it out of your head. 
- Cortisone shots or epidural shots not always work. 
- The main problem once you had the pain for a while is muscle tightness and stiffness. Every therapy you do should have the goal of loosing up the muscles and regaining mobility. 

The following therapies can work:
1. Heat. 
2. Massage. 
3. Mobility exercises. 
4. Swimming. 
5. Neurodynamic exercises. 
6. Lumbar traction. 
7. Walking. 
8. Biking. 
Again, this is just my opinion. I see too many people with sciatic pain that just lay or sit around because they are afraid or making it worse or because they have too much pain. 
What they should do is find two or three different things they could do with not much pain, exercises that make them feel better. When I had my acute sciatic pain I would go to the gym and do 15 minutes of light exercises. Then I would go to the swimming pool for 15 minutes and ended up in the yakuzzi for another 15 minutes. This is what helped me and I did it mostly every day. 
It is important that you understand this: nobody is going to help you. You have to do it on your own. There is no magic pill, shot or treatment. It is a hard work to get rid of your pain, but you can do it if you are proactive and look for things that help. The combination of 3 or 4 treatments or exercises is what is going to heal you. 

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Sunday, September 9, 2018

Elastic band shoulder warm up

Elastic bands are one of the easiest tools to use in fitness. They are light, they fit in every bag and you can use them anytime. As a matter of fact I think that 100% of professional tennis players warm up with elastic bands exercises. Looking in detail you can see that they only do 5 to 6 repetitions and it takes them around 3 or 4 minutes. But it is the best tune up exercise to get you ready for practice. It even prevents injuries like rotator cuff or shoulder impingement. 
I personally used the elastic bands with Maria Sharapova around 2000+ times during my 5 years working with her.
Here is a little warm up routine you can find in our preventok program.

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