Scars can be both good and bad.  Scar tissue is good in that its formation is a crucial part of your body’s natural way of healing itself when the skin has been compromised.  However, scars can also be bad if excessive tissue restrictions develop.  These restrictions may lead to pain or problems with surrounding tissue.

When an injury to the skin occurs, the body responds by making a blood clot around the opening to close the wound. Once this has happened, fibroblasts, cells that regenerate new healthy tissue, flock to the area of injury.  These cells begin laying down collagen fibers to repair the area.  These same collagen fibers are also found in normal skin.  The difference between collagen in normal skin and collagen in scar tissue with the way the collagen fibers are arranged. Fibers in normal skin overlap in many random directions, allowing the skin to expand and move in many directions.  However, the collagen in scar tissue is arranged in more of a parallel fashion.  As you can imagine, this creates restrictions, changes the texture of the scar, and minimizes the skin’s extensibility.

A scar’s appears can be influenced by many factors – cause of the injury, skin color, presence or absence of infection, and the location of the scar. This new tissue will also lack sweat glands, hair, and have an abnormal blood supply. The following are 5 main types of scars:

Atrophic scars: These scars sink down into the skin (ex. acne scars).

Hypertrophic scars: These can be red or purple and are raised above the skin.  They tend to fade and flatten with time (ex. post-surgical scars).

Contracture scars: These pull the surrounding skin in toward the side of the injury (create a puckered look).

Keloid scars: These are very dark and raised and often grow bigger than the site of the oringinal injury.

Stretch marks: These do not happen as a result of an injury, but are caused by a rapid stretching of the skin (ex. pregnancy, rapid weight gain).

While there is no way to get rid of a scar there are ways to minimize the negative effects during the healing process.  While the wound is healing, you want to keep the wound covered when in the sun.  The UV rays will lead to further discoloration of the scar and may slow the healing process. Once the wound has completely closed you will want to get those new collagen fibers moving.  This will encourage early mobility and minimize the development of soft tissue restrictions.  Massage the scar in all directions.  This may be uncomfortable at first, but will improve with time.  If the healing tissue is kept moving, it will not have a chance to bind down to the layers below.  That new collagen will learn to stretch and move right from the beginning!

Massage — Massaging a scar with lotion or a doctor-recommended gel can help fade many types of scars. This is particularly recommended for keloid scars, since this can keep them from getting sensitive and painful, and can help break down some of the built-up collagen.

Injections — Steroid injections may help with hypertrophic or keloid scars, and atrophic scars can sometimes be filled in with collagen injections. One downside to this type of treatment is that it is almost always temporary, and has to be repeated regularly.

Skin resurfacing — This can be done with lasers or with equipment that works like very fine sandpaper in a procedure called dermabrasion.

Cryotherapy — This is a technique of freezing the scar, and can reduce the appearance of keloid and hypertrophic scars.

In extreme cases, a doctor might recommend surgery. Though surgery can’t get rid of a scar, it can make it less noticeable. Surgery is not recommended for hypertrophic or keloid scars though, since it can make them worse. Another type of treatment for severe scars is radiation therapy, which can sometimes reduce keloid and hypertrophic scars

Dr. Looney is a Physical Therapist at Boston Sports Medicine

When it comes to exercise, sports, or any other physical activity, it is important to vary the intensity.  The variation of intensity can be summed up in one word – periodization.  The variation or creation of cycles of high intensity and low intensity will allow the body to rest, recover, and regenerate.  In turn, this will decrease the risk of “overuse” injuries.

In the world of professional sports (our models of physical activity), the athletes will have a competition of some sort, a day of rest and/or recovery, and then increase the level of activity that will taper off again prior to next day of competition.  This model can be applied to everyone who takes part in some physical activity. Looking at the bigger picture, the amount of activity varies from preseason, in-season, or post-season.  The every-day community based athlete or even physical therapy patient can apply this strategy to their activity or rehabilitation program.

I mentioned a key term – recovery session, you may be wondering what a recovery session would look like.  My recommended recovery session would include: light cardio exercise, dynamic/static stretching, foam rolling, and/or a pool workout (typical session for endurance and/or field based athletes).  You are still remaining active, but at the same time you will be performing activities that are considered to be therapeutic.  Please consult our blog on foam rolling as well.

You may be wondering why would you incorporate this kind of activity into your routine.  Heavy physical activity can create minor areas of trauma throughout the body.  Continuing activity without rest can make small changes in your body worse and/or could create actual injuries that would need to be addressed with more formal treatment.  Considering the fact that the human body is a great self-healer, recovery sessions will allow the body to work in the way it was meant to.

The bottom line…it is not always beneficial to perform your desired physical activity at 100% speed and intensity at all times.   Rest is helpful.  Incorporate highs and lows of intensity into your activity routine.   You will be better off in the long run – no pun intended!

Dr. Merson is a Physical Therapist at Boston Sports Medicine

We are running a special through the month of May: $10 off our regular price of $20 for all classes

Please see our class schedule and come ready to get stronger, more flexible, and clear your mind.  Keep checking as we will be adding more classes each week.  No need to call, just show up with $10 and a Yoga mat.  We have Yoga mat that you can buy for $12.

ALL OF THE FOLLOWING CLASSES ARE $10!!!

Vinyasa Therapeutics

A fusion of vinyasa yoga and bodywork, this unique approach created by Cambridge-based Bo Forbes (founder of Elemental Yoga/Integrative Yoga Therapeutics) features frequent isometric stretches, innovative use of props, core body awakening and creative sequencing. Synergizing long holds with a mindful flow of poses seamlessly linked by the breath and extensive alignment instruction, every class is custom-designed around the specific needs and requests of the student.  This therapeutic approach is designed to promote neurofascial and muscular release/expansion, while enhancing students’ self-knowledge and body awareness in order to promote safe recovery from injury, and shift long-held patterns of thought and movement.

Vinyasa Flow

A series of poses, synchronized with breath.  It is a moving meditation.  The beauty of this class is that nothing is set in stone; each class may present a different series of poses and movements.  All you need to do is show up and do your best with breath.  This is an authentic practice to help you rediscover your true self.  Prepare to be transformed in mind, body and spirit.  From beginners to experienced practitioners — all are welcome!

Vinyasa 1

A flow class that emphasizes strength building postures and a slower pace. Excellent for beginners as well as athletes as there will be an emphasis on alignment and modifications for different fitness levels. AKA Slow Yoga, Yoga for recovery and sometimes, easy does it.

Vinyasa 2

A flow class that emphasizes fluid movement and a swift pace. Best for those who are injury free and have at least 1 year of yoga experience and good physical fitness. AKA Athletic Yoga, Yoga for focus, strength, and endurance. Take your game to a higher level.

Prenatal Yoga

Specially designed to develop awareness of the mind and body, strengthen muscles, improve circulation and address common discomforts. A time to share and reflect upon the experience of being pregnant and preparing for motherhood. AKA Preggers Yoga, Yoga for 9 months of rapid personal growth. We touch on the physical, emotional, practical and inspirational.

 BARRE Essentials

BARRE Essentials is a ballet inspired workout that combines traditional barre exercises, Pilates, and body sculpting techniques designed to lengthen, strengthen, and revitalize your body!

Hatha Yoga

This class will focus on yoga posture alignment, breathing techniques and introduce mindfulness to achieve balance between the mind and body. Improve flexibility, strength, concentration and relaxation. For beginners to advanced students.

 THIS ONE IS FREE!!!

ZOOM Spin Class

Unlike any spin class you’ve ever been to, this class faces you off against the rest of the group as if we were riding in a real bike race. How hard you work is up to you…and the people you’re ‘racing’ against. Stay on your toes as we work our way through a different imaginary course each week because attacks can come at any moment! This fun, interactive take on your gym’s classic spin class.

Classes are designed to build strength and muscular endurance, rather than the pure cardio workout you find at most spin classes. We have riders at every level joining us each week, so come check us out whether you’re a seasoned endurance athlete or someone who’s looking to get back on their bike!

Bring your own trainer*, bike, towel and water. We’ll provide the music and course layout! Come check out the next big idea in race-specific spin classes.

*If you need to borrow a trainer, please email us at jonathan@zoommultisport.com and we’ll do our best to accommodate!

Here in the greater Boston area, we are lucky to have a large and active rowing community. Boston is home to the second largest 2-day regatta in the world, Head of the Charles, with more than 8,900 athletes and about 300,000 spectators throughout the October weekend. The city also hosts the world championship for indoor rowing, CRASH-B, in February. There are many private, university, and high school boat clubs in the area, which means there are a lot of Boston residents doing crew- and potentially injuring themselves if done incorrectly.

 Crew is a balance between strength and technique. Injuries can come about from over training or improper technique. Before starting on the rowing machine (the ERG), be sure to study the instructions of how to do it correctly to avoid injury. For rowing on the river, there are lots of beginner classes in the area to introduce you to the equipment, technique, and rules of the river. But after all that, some people do still end up with injuries. Common injuries involve the back, shoulders, knees, Achilles, and wrists.

 The majority of the rowing stroke is powered by your legs while the back and arms should remain in the same position initially. Then the stroke is completed with leaning back slightly and bringing your hands and the handle to your chest. People get back pain from leaning back too early and bearing the brunt of the force through the low back or from leaning back too far at the end and asking the back to support an unnatural body angle against gravity. Ways to prevent this is to limit how much the back moves throughout the stroke with no excessive or wasteful movement and to strengthen the core to support the back throughout the activity. The back should not strain during rowing but just be a transition from pushing with the legs to pulling with the arms.

 Knee and Achilles tendon pain can come from each end of the stroke. When the knees are bent and the arms outstretched in front of you, you should be in a comfortable and controlled sitting position with the shins vertical. However, as people increase the speed and rate of rowing, they rush up to this position and over-compress the legs, which leads to excessive repetitive stretch on the Achilles and patellar tendons. It also requires the leg muscles to work from this overstretched position to start the next stroke, which leads to muscle strain and compression of the knee cap on the knee joint. Conversely, different knee pain comes from the end of the stroke when the legs are fully extended. As a rower gets tired, the tendency increases to relax the muscles and passively lock the knees at the end of every stroke. With proper rowing, the knees should never lock and unlock, but remain ever so slightly bent so the muscles stay engaged throughout the movement. Muscles like to work the best in mid-ranges and do not perform well when fully compressed or over-stretched.

 Next time you have the opportunity to try rowing on the river or on the rowing machine at the gym, don’t be intimidated! Give it a try and keep these tips in mind. Stay safe to be sure not to develop one of these classic overuse injuries.

 Image sources: http://www.sportsandfitnessideas.com/sports/rowing/technique/how-start-sculling

Dr. Lingerfelt is a Physical Therapist at Boston Sports Medicine

We see many marathon runners after the race with injuries.  The scenario usually goes like this: runner struggles through training with nagging injury, runner completes race, runner takes a week off to heal, runner starts running, nagging injury returns and won’t quit, runner comes to Boston Sports Medicine for help.  The race this year was very different.  Hundreds of seasoned runners did not complete the race and hundreds of runners were hospitalized.  Many have asked me, “Do you expect to see a lot of people from the Boston Marathon?”  The unexpected response is, “no.”  Just because the temperature reached a record breaking 89 degrees, doesn’t mean that there were more musculoskeletal injuries.  We have not seen a correlation between outside temperature and incidence of runner injury.  In fact, one could argue the opposite.  With the record high temperatures, everyone’s pace was slower than their training pace, below the level of intensity they were trained for.  So, with respect to injuries, we will need to see how many calls we get in the coming weeks, but I can predict this year will be no different than last year.  We’ll get the same number of people as in the past.  Those who licked their wounds, started to run again, and realized that they will need a little extra help to get that base going again.

Dr. Velsmid is a Physical Therapist at Boston Sports Medicine

As a PTA myself, this seems to be a common question I encounter often from my patients, other physical therapists and doctors alike.  What is a Physical Therapist Assistant (PTA)?  And how is it different from a Physical Therapist (PT) or a PT Aide?

A PTA is an accredited Associates Degree program.  You have to complete your schooling then pass the Massachusetts licensure exam to become a licensed member of the Allied Board of Health.  We go through extensive training on treatment techniques of patients with orthopedic or neurological disorders.  These techniques include modality use (electric stimulation, ultrasound, laser, etc), hands on approaches, exercise and stretching as well as gait and transfer safety.  The last four months of our education is spent completing 600 hours of patient care.  We are graded by our clinical instructors and they ultimately decide if we are ready to pass our course work and take the licensure exam.

So, what is the difference between a PTA and a PT?  A PT has a Doctorate Degree which includes much more extensive academic and clinical preparation regarding diagnosis and evaluation skills.  PTAs are not trained in the diagnosis, evaluation or discharge of patients.  A patient will always see a PT on their first visit for an evaluation, diagnosis, and a plan of care.  It is the job of the PTA to create and change the physical therapy program and carry out the treatment prescribed by the PT.  We work as a team continually updating each other and presenting new ideas with each patient that comes into our clinic.

A PT Aide is someone who helps out in the clinic to keep things running smoothly.  They do not necessarily have to have any academic preparation or experience in patient care.  They are trained on the job.  Aides can help with clean up, organization of the clinic, applying a hot pack or cold packs on a patient and help to oversee exercises programs for some patients.  Aides are not permitted by law to apply any hands on treatment or modalities or change the exercise program.

So these are the differences between a PT, PTA and PT Aide.  Hopefully it will help you to better understand who you are working with and make sure you are getting the best care possible the next time you walk into a physical therapy clinic!

Stacy Choquette is a Physical Therapy Assistant at Boston Sports Medicine

Massage cupping is a manual technique re-gaining popularity across the country. There are plenty of therapist personal touches and derivations from its traditional roots in Chinese Medicine. So how about an overview of where it came from, current popular techniques and how it can be beneficial to you?

Massage cupping can be traced as far back as 1500 BC in Ebers Papyrus- oldest known medical textbook. Massage cupping is a facet of Traditional Chinese Medicine, known for short as TCM. It became popular in the US and Europe from 1800 to approximately 1940, falling out of favor at the beginning of WWII. In TCM and during it’s European and North American popularity it was used to assist in clearing of chest congestion, diversion of blood flow during/after a surgery, headache resolution, realign Qi, treat TMJ disorders and improve overall connective/soft tissue integrity. With the exception of blood flow diversion regarding surgery cupping is used for the same issues today.

The cups themselves can be made of various materials depending on the type of technique used. Most current cups are made of glass, silicone, plastic or balloon topped plastic/glass. The 2 most common techniques are static or movement. Typically glass or plastic cups are used for static techniques while silicone is best for movement.

Static cupping can be approached in 2 ways, stationary over a problem area or flash cupping for aligning Qi or meridians. Flash cupping involves a series of cups aligned with a particular Qi, meridian, Chakra or blockage line which are cyclically set and removed over a period of 5-15 minutes. Flash cupping is typically used to open up a larger area or address a systemic issue.

Movement cupping uses emollient; is typically addressing a more superficial area and can cover a larger body area such as the back most effectively. Even when using a movement approach a cup can be “parked” over a trouble spot for a minute or two. Movement cupping is also a great medium to incorporate herbs such as arnica, lavender, essential oils or liniments.

Fire cupping is the deepest form of massage cupping, and most aligns with TCM. A piece of cotton is dipped in alcohol, placed inside a glass cup and quickly removed as the cup is placed on the patient. As the heat dissipates suction is created between the patient and cup. This is the type of cupping most likely to bruise or leave a longer lasting reddened area over the treatment site.

There are a few precautionary conditions/situations to massage cupping you should be aware of. If you are taking blood thinners, are prone to bruising/bleeding due to a medical condition or have very thin/fragile skin massage cupping and especially deeper cupping techniques may not be right for you. Also anyone with an active skin infection or open wound should not be cupped in the area.

Considering how safe and diverse of a technique massage cupping is, it can be a great way to explore more of the manual therapy world- and don’t forget to have some fun with it!

Dr. Fox is a Physical Therapist at Boston Sports Medicine

Impingement is one of the most common diagnoses affecting the shoulder joint. We often hear this term, but what exactly is “shoulder impingement?”  The joint is made up of three bones called the humerus, the scapula and the clavicle. These bones serve as attachment sites for muscles of the rotator cuff.

When a person is lifting his arm, the space between the acromion (a bony landmark on the scapula) and the rotator cuff becomes narrower. When the acromion rubs against the tendons, it can cause pain and irritation. This pathology often affects those who are involved in repetitive upper extremity motion including swimmers, baseball and tennis players, construction workers, and painters. Shoulder impingement can also develop over time in individuals who have poor posture. For those of you who have “rounded shoulders,” your scapulae may adaptively tilt forward. This will make you back muscles adaptively longer and weaker, your chest muscles tighter, and ultimately create less space for your rotator cuff muscles to glide beneath the acromion.

In the beginning, your symptoms of this pathology will likely be mild, including pain with lifting heavy objects, pain radiating to your mid arm, and pain with reaching movements. Eventually, you may notice difficulty with activities that require arm placement behind the back, pain at night, and even loss of strength and motion.

Surgery is not often indicated for shoulder impingement. The pathology can be corrected with rest, activity modification, and physical therapy. With the appropriate combination of exercises, your physical therapist can help to correct the mechanics of the shoulder so that impingement will be less likely to occur. Exercises like “Y-T-W-Ls” can challenge the core while strengthening the back and shoulder. They can correct adaptive muscle imbalances to create more space under the acromion in an effort to avoid impingement.

                  “Y” on theraball                                       “W” on theraball

If you have any questions about this pathology, or feel that it may even be affecting your life, make an appointment with a physical therapist for an evaluation. A few exercises can go a long way, and may even brighten your day J

Dr. Barrett is a Physical Therapist at Boston Sports Medicine

“Your legs look so sleek”… “Your heels are so cute”… “You’re calves look amazing.” These are a few of the many things us women love to hear when we wear high heels, BUT to what price should we put beauty above health? Most women do not realize the detrimental effects that high heels can have on the human body. High heels can cause various foot injuries but can also create many problems up the chain of the body including the knees, hips, and back/pelvis. Few women are born with foot pathologies, most women instead acquire them due to neglect for their foot health.

As a physical therapist, I see many foot, knee, hip, and low back injuries as a result of women wearing high heels. I also have quite a few patients who are hell-bent on wearing their cute new pair of pumps even while trying to recover from a lower body injury. I would like to break it down for you, as I do for my female patients: posture, gait, balance, and each body part affected by these poisonous pumps.

A high heel puts your foot in a plantarflexed positioned (toes pointing downward). This position shifts your legs and pelvis forward and places most of your body weight on the balls of your toes. In order to counteract this shift, your upper body leans backward to keep you balanced. This posture puts a lot of unhealthy pressure on your low back and sacroiliac joint, which is explained in greater detail below.

As your posture changes in heel highs, so does your walking pattern. Due to the plantarflexed position of your feet, your calf muscles cannot generate the force needed to push off the ground. Therefore, your hip and knee muscles must worker harder in order to propel you forward. Your knees tend to stay bent during the entire gait cycle due to the increased weight shifted forward at your lower body.

Walking in a high heel requires a significant amount of balance and lower leg strength. The higher the heel, the further your body weight is pushed forward, and the more instability created. There is also minimal support at the ankle joint if you take a wrong step or walk on an uneven surface.

Low back pain is a common injury caused by and exacerbated by wearing high heels. High heels increase the normal forward curve of the back and cause the pelvis to tip forward. This change in pelvic position alters the alignment of the spine and makes it difficult for the body to maintain its normal center of gravity. However, this position is generally desired by women because the exaggerated curve of the back makes the buttocks more prominent.

The hips, knees, and ankles are also affected by wearing high heels. As mentioned above, the hip flexors and knee muscles must work harder to propel the body forward. Over time these muscles can become fatigued and overused, and subsequently weak and prone to injury. When the thigh muscles are overworked, extra strain is put on the knee joint and the patellar tendon, making you more susceptible to knee injury. Adding a heel to a shoe increases the pressure on the inside of the knee by as much as 30 percent. By increasing the height of the heel of a shoe, the hamstring muscles become shortened and cannot work optimally.

There is a large variety of foot injuries that can arise from wearing high heels, including hammer toes, blisters, bunions, neuromas, and skin breakdown leading to infection. The plantarflexed position in the heel causes the foot to become more supinated, or turned to the outside. This causes a change in foot posture and biomechanics of the foot and ankle joints during gait. This then effects the line of pull and function of the achilles tendon, which works to push the foot off of the ground.

I could go on forever about the detrimental effects of wearing high heels. Each and every person is different, and therefore has different postural deficits. A physical therapist can help you to determine your strengths and weaknesses and then adjust your posture and activity accordingly. It is important to remember that postural awareness and supportive comfortable shoes are key to injury prevention and recovery. As cute as those new hot pink pumps are…is it worth chronic low back pain or having to sit out your next marathon?

Dr. Mohns is a Physical Therapist at Boston Sports Medicine