Shoulder pain can be very debilitating. Tasks that were once small and simple can now seem tedious and painful. And if you enjoy being active, shoulder pain and impingement can prevent you from doing many of the things that you love!! So Where Do I Start?
First, we have to differentiate between two broad types of shoulder pain - there are MANY shoulder conditions out there but we're going to keep it simple and keep it broad.
What was the mechanism of injury? Suffering a Fall or Direct Blow to the Shoulder If you first started noticing your pain after suffering a fall or a direct blow to your shoulder then this post may not be for you. I recommend at least undergoing an x-ray to make sure that you haven't fractured any bones. You don't necessarily need an MRI and it doesn't matter if you tore your RC (minor tear vs major tear - major tears require surgery but most minor tears do not). However, you MUST find out if you did any damage to the bone before exercising - otherwise, you may delay healing to the bone and this can lead to surgery later on down the road.. so please seek care from a healthcare professional if you fit in this category. Gradual Onset Of Pain That Progressively Worsens Over Time On the other hand, if you are unsure when you injured your shoulder but the pain appeared to start gradually and is getting worse and worse every day then this article is for YOU! The longer you wait, the more at risk you are for developing compensatory movement patterns which will lead to more and more pain.
Anatomy & Physiology Of The Shoulder
Okay.. Let's back it up a bit and start with the anatomy. The picture shown below can be a bit intimidating but hopefully after this post you'll have a better understanding of the topic.
There's no better way than taking charge of your own health rather than relying on medical professionals to diagnose and treat you.. unfortunately, the way our health care system works today if you rely on someone else then you may be poorly advised. Especially if you're only with that person for 5-10 minutes at the most! So take the time now to educate yourself and get to know YOUR body :)
Key Concepts Your shoulder is a ball-in-socket joint - picture it like a golfball on a tee. The golfball (humeral head) is bigger than the tee (glenoid fossa of the scapula). Because of this, your shoulder has LOTS of motion and mobility - more than any other joint of the body. But because of this, the shoulder can easily become unstable which can then lead to dislocations, rotator cuff/labral tears and impingement. Back to the ball-in-socket model: The rotator cuff consists of 4 muscles (subscapularis, supraspinatus, infraspintus & teres minor) that, when working properly, assist with centering the ball on the socket. This prevents the bad stuff from happening as discussed in the previous paragraph. When the rotator cuff isn't working properly (this can be due to a number of reasons) then it will have difficulty centering the ball in the socket which can then lead to pain - typically by upward migration of the ball (humeral head) that hits the acromion process which causes pinching (impingement) of the muscles. When these muscles are pinched, they tend to get inflamed and are inhibited. That leads to muscles imbalances and even more pain.
See why this cycle is so nasty??
Now that you know a little more about the anatomy of the shoulder, let's move on to treatment!
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A great exercise for opening up the mid-back is laying vertically on a foam roller. Make sure your tailbone and head are resting on the roller. Then bring your arms by your side to get an added stretch on the pectorals.
Perform this stretch for 5-10 minutes after work and/or before your workouts. If this is too much of a stretch, start with a towel roll. Get a regular sided towel from home and roll it up vertically then perform this same technique. |
# 3 Shoulder Mobility
It's very important that you address thoracic mobility BEFORE shoulder mobility. You can do as many shoulder mobility and flexibility exercises as you like but if you have poor posture and your thoracic spine is restricted it will be impossible to have full shoulder mobility - unless you compensate elsewhere, such as the low back or if you're have significant ligamentous laxity.
Since you've addressed your thoracic spine already (follow @missphysiofit for more thoracic spine mobility exercises), now let's move to shoulder mobility.
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My favorite exercise is repeated shoulder extensions. We typically spend a lot of time in a neutral shoulder position or shoulder flexion (such as reaching forward or overhead) but we rarely spend time in shoulder extension (as pictured).
One way to restore shoulder mobility is by working in the opposite direction that you typically stay or work in. Take a golf club, broom or yard stick and perform the exercise as pictured. Perform 20 reps with 5 sec hold. Make sure you're standing up tall. Don't allow yourself to lean forward to performing this exercise. |
# 4 Shoulder Flexibility
You might hear the term "mobility" and "flexibility" used together. Some people use them to mean the same thing.
However, in the therapy world Mobility refers to motion within the joint. If a joint is hypomobile then it's stiff and restricted. If a joint is hypermobile then it's loosy goosy. Flexibility refers to the length of the muscles surrounding the joint. For example, tight hamstrings is a flexibility issue, restricted hip capsule is a mobility issue.
However, in the therapy world Mobility refers to motion within the joint. If a joint is hypomobile then it's stiff and restricted. If a joint is hypermobile then it's loosy goosy. Flexibility refers to the length of the muscles surrounding the joint. For example, tight hamstrings is a flexibility issue, restricted hip capsule is a mobility issue.
Mobility = intra-articular restriction (inside the joint)
Flexibility = extra-articular restriction (muscle restriction outside the joint)
Flexibility = extra-articular restriction (muscle restriction outside the joint)
Similar to addressing the thoracic spine BEFORE the shoulder... you should also address mobility restrictions BEFORE flexibility restrictions. If the hip joint is restricted, you can stretch your hammies until the cows come home but you won't make a difference at the hip joint.
But since you've already address your thoracic and shoulder mobility.. let's move on to shoulder flexibility exercises. The #1 culprit(s) I see primarily involved in restricted overhead motion is the Latissimus Dorsi (AKA the Lats) and Teres Major.
But since you've already address your thoracic and shoulder mobility.. let's move on to shoulder flexibility exercises. The #1 culprit(s) I see primarily involved in restricted overhead motion is the Latissimus Dorsi (AKA the Lats) and Teres Major.
When there is pain at the shoulder, both muscle groups tighten up as a protective mechanism. However, if the issue at the shoulder isn't addressed quickly, then they can cause further problems.
The Lat is a powerful and broad muscle group that span from the shoulder to the pelvis. It's a powerful extender of the shoulder as well as adducts and internally rotates (IR) the arm (adducts = brings it in toward the body, IR = rotating the arm inward). The teres major is a small muscle that attaches to the blade and the "ball" part of the shoulder, it also adducts and IR the shoulder.
My favorite exercise to restore flexibility of the lats and teres is to foam roll them (see above video). Now this doesn't restore flexibility permanently, nor does it "break up scar tissue". However, it can temporarily restore some muscle length so that you can do the strength and stability exercises in the next section. Once strength/stability is restored to the shoulder joint then the flexibility issues are usually no longer a problem. As stated previously, the muscles get tight and restricted to compensate for the lack of stability.. restore the stability issues and the muscles will naturally elongate over time.
Foam roll for no longer than 5 minutes. I usually foam roll each segment 20-30 second 1-2 times each before performing the strength/stability exercises.
# 5 Rotator Cuff/Scapular Stability
We've discussed avoiding staying in the same position for a prolonged period of time -which usually involves the forward head position. Then we discussed thoracic and shoulder mobility and moved on to flexibility. Now let's get to the fun stuff!
I see trainers do this all too often.. they start with the strength & stability aspect and then end with flexibility/mobility. However, they're missing out on key aspects into recovery which can cause further pain, injury and aberrant movement patterns.
If you attempt to strengthen a muscle crossing a joint that lacks mobility and/or flexibility or even an adjacent joint (such as the thoracic spine) then this WILL lead to further compensations due to the restrictions.
So please don't skip over the previous sections because they're boring or don't seem as effective. They are the bread and butter in restoring full shoulder motion and abolishing pain.
As far as strength & stability goes, you want to focus on the posterior rotator cuff (the muscles on the back of the shoulder) as well as the scapular stabilizers (the muscles that connect to the shoulder blades).
Please watch the video below for some of my favorite rotator cuff and scapular stabilization exercises.
I see trainers do this all too often.. they start with the strength & stability aspect and then end with flexibility/mobility. However, they're missing out on key aspects into recovery which can cause further pain, injury and aberrant movement patterns.
If you attempt to strengthen a muscle crossing a joint that lacks mobility and/or flexibility or even an adjacent joint (such as the thoracic spine) then this WILL lead to further compensations due to the restrictions.
So please don't skip over the previous sections because they're boring or don't seem as effective. They are the bread and butter in restoring full shoulder motion and abolishing pain.
As far as strength & stability goes, you want to focus on the posterior rotator cuff (the muscles on the back of the shoulder) as well as the scapular stabilizers (the muscles that connect to the shoulder blades).
Please watch the video below for some of my favorite rotator cuff and scapular stabilization exercises.
I hope you've found this helpful! Do NOT perform these exercises if they cause you pain. Please seek further help from a local physical therapist or physician of your choosing.
And If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
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If you're new to my blog, please check out my previous blog post to know more about my background and how I was diagnosed with Hypothalamic Amenorrhea (HA) here
A Brief Overview of HA:
Hypothalamic Amenorrhea - when you lose your period completely, have prolonged periods, or irregular periods due to lack of energy for the reproductive system to work properly. There are a lot of factors that play into this but it typically comes down to exercising too much and not eating enough.
Main Factors Involved:
- High-Intensity Exercise (and too much of it)
- High Stress Levels
- Inadequate Nutritional Intake
- Low BMI and/or Body Fat Percentage
As you know from my previous post, I had a difficult experience with a nurse practitioner diagnosing me with Polycystic Ovarian Syndrome (PCOS) without discussing my symptoms or my history.. let alone doing bloodwork or an ultrasound!
Once I found out I had HA, I was very hurt and discouraged. I was embarrassed that as a healthcare professional - Physical Therapist and Strength & Conditioning Specialist- that I didn't know there was something wrong with me. But now the truth was right in front of me the entire time.
All of those years I went to countless physician appointments (primary care and gynecology) and was told that "you are the picture of health" and "you have nothing to worry about" continued to haunt me.
How could I have not known this??
For those of you who know me personally know that I am a researcher.. AKA nerd #nerdalert.
I took several days to research PCOS and Amenorrhea and learned more about HA. I can give you SO many statistics about the average BMI and body fat of women who conceive and the FSH, LH and progresterone levels to ovulate but I'll spare you just this once :)
Through my research, I found a book called No Period, Now What? It has been so very helpful throughout this process. It shows evidence-based research (right up my alley!!) to support HA diagnoses and a step-by-step Recovery Plan. It even has a section for significant others and spouses!
I learned that it was very commonly misdiagnosed and not many people knew much about it (even specialists in obstetrics and gynecology).
To be honest, I'm not sure why that surprised me so much. I see it in my profession all the time.. where many people are mislead to take pain medication and undergo unnecessary injections and surgeries to end up right where they left off..
STILL IN PAIN.
If it's that way in the Orthopedic world then why would it be any different in Women's Health?
Our first thought is, "What medication can help me with that?" rather than figuring out the underlying issue.
Okay.. I'll get off my soap box!
So I decided to follow the Recovery Plan in the book No period, now what?
Okay.. I'll get off my soap box!
So I decided to follow the Recovery Plan in the book No period, now what?
The plan looks a little something like this:
- Significant reduce exercise intensity and frequency
- Eat MORE - I'm talking at least 2500 kcals per day
- Decrease stress levels - mediation, yoga, quiet time, deep breathing, walking
For someone like me - I have NEVER had a regular cycle and usually only have 1-2 per year - then the recovery process needs to be drastic... literally, life altering.
My body fat was also very low so I had to gain some weight and provide my body with a little bit of extra cushion ;)
Now if you're reading this and thinking, "this is bonkers.. how does this help anything?" then you're not alone. I had a VERY difficult time hearing this.
My entire life I've been active and moving. I rarely sit down. I eat when I'm hungry (which is pretty much all the time) and like to keep moving throughout the day. I can also be a bit of a stress ball and that's partly due to me wanting to please and be accepted by everyone.. I also overthink everything I say (not always but sometimes) which causes unnecessary stress.
So to counteract all of that I have to go for long walks, do light yoga, eat as much as want and listen to my hunger cues. I have to incorporate more fat and carbs into my diet- I was unintentionally eating a low carb and low fat diet without realizing it.
I wasn't properly nourishing myself even though it seemed like I was eating ALL. THE. TIME. It wasn't enough and I've learned tricks to incorporate more fats and needed calories without even noticing it.
Moving on.. let's get to the meat and potatoes..
I recently had my bloodwork done and all of my hormone levels were within normal limits!! And I'm talking mid-range levels.. not on the lower range of normal. I wish I had done bloodwork before I started the Recovery Plan to show how much of a difference it made!
When I was in my early 20s I had bloodwork done and at the time I didn't even care to look at the numbers.. I blindly trusted my physician. But I do remember them being very low. I remember the physician telling me they were well below normal limits but that birth control would get them "back on track."
Since that encounter, my exercise, eating and stress habits haven't changed much so I can assume that my bloodwork would have been quite low before starting the Recovery Plan.
I also ended up having to get off birth control. With birth control, my periods were "regular." However, after undergoing an arthroscopic shoulder surgery I developed a blood clot in my arm that eventually went to my lungs (AKA pulmonary embolism (PE)- the silent killer).
After the blood clot and PE, I was not allowed to take estrogen supplements (AKA birth control) and guess what? ... 4 years later and still irregular periods. I thought the birth control was supposed to "fix" it?
Think again.
This recovery process has been one of the most difficult (if not THE most difficult) thing I have faced in my life. I didn't realize how important exercise was to me. I also didn't realize the impact that my body image had on my life.
Since starting my company, I had a healthy view of my body and grew to love my muscles and strength. I was empowered to be a fit female confident in my ability to move and explore the world!
I believe that I will be able to return to working out and moving freely! But my first priority is my health.. BMI and body fat doesn't define me. I have (and probably will) continue to gain more weight during the recovery process but that's okay.
It can be frustrating seeing other women work out as often as they please without having to worry about it affecting their hormones. But I have come to appreciate how every body has a unique genetic makeup.
One person may function great at a BMI of 19 and someone else may function better at a BMI of 23. One person may function well at a body fat of 18% while someone else may function better at a body fat of 23%.
I believe that I'm going through this for a reason.. whether it's to raise awareness for HA to individual women or if it's to discuss this diagnoses (respectfully) with physicians to prevent other women from being misdiagnosed.
I haven't figured out what my role is just yet but I look forward to finding that out.
I want to give a shout out to all of my friends, family and followers who have been so supportive through all of this! There have been many times I wanted to say "forget this, give me the medications!" so I could return to my old way of life but so many people encouraged me to keep on the Recovery Plan.
I also want to throw an extra big shoutout to the hubs!! There have been many nights where I have questioned (and I"m sure there will continue to be more) if I'm doing the right thing. And time and time again, he would continue to tell me how much he loves me and is thankful that I'm doing this for our family. I could not be doing this without him!
For those of you who have been to countless physician's to be told that "you're perfectly normal" but are fearful that something isn't right.. I urge you to read the book No period, now what? It's an informative read backed up by evidence-based research!
The book also teaches you how to read your lab results after having bloodwork done. It also explains how you may have follicular cysts on your ovaries that are from lack of ovulation. They will go away once you have recovered and are regulated but if you're not careful, can easily be misdiagnosed as PCOS.
It's important that we advocate for our health! And in order to properly do so we have to be educated! That may require us to respectfully disagree with our physicians on occasion.. but that's okay! As long as we do so in a kind manner then there should be no issues.
Just know that with the change in healthcare, physicians are seeing more and more patients daily. It's tough for them to remember everything you told them when they're juggling 20-30 other patients that day. So knowing your specific measurements and understanding that BMI is not the only indicator. You can be in a "normal" and "healthy" BMI range but still have HA. You can also be below the "healthy" BMI range without having HA. It all depends on a thorough understanding of your history.
Please feel free to shoot me any questions that you might have! I would love to hear what you think about HA and to see if you might have possibly been misdiagnosed or even overlooked entirely and labeled as "healthy."
If you found this helpful please let me know by commenting below or emailing me at [email protected]
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
Whether you've been suffering with your pain for weeks, months, years or even DECADES! There's no need to fear.. You are not alone!
Let me throw out a few stats:
I'm sure you knew that you weren't the only one in the world suffering with back pain but now you know how it's becoming a bit of an epidemic.
Whether you suffered your injury from saving a child from a burning building or perhaps just sitting at your desk working on your computer.. back pain can literally be a pain in the butt.. *ahem* I'm talking about Sciatica that stems from your back of course ;)
If you read my last blog post regarding The Real Reason You Can't Get Rid Of Your Pain then you know that there can be a number of reasons behind the cause of your pain. And without doing a thorough assessment (and no that doesn't have to involve x-rays and MRIs.. they really aren't needed as often as you think) it can be difficult to diagnose.
In my practice, I have noticed that the majority of patients are lumped into a particular category and that I have found several exercises beneficial. However, I recommend you see a Doctor of Physical Therapy in your area if your back pain persists.
Tip #1
Be mindful of how you're sitting.
Let me throw out a few stats:
- Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease 2010
- Back pain is one of the most common reasons for missed work
- In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections
- One-half of all working Americans admit to having back pain symptoms each year
- Experts estimate that as much as 80% of the population will experience a back problem at some time in their lives
- Most cases of back pain are mechanical —meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer
I'm sure you knew that you weren't the only one in the world suffering with back pain but now you know how it's becoming a bit of an epidemic.
Whether you suffered your injury from saving a child from a burning building or perhaps just sitting at your desk working on your computer.. back pain can literally be a pain in the butt.. *ahem* I'm talking about Sciatica that stems from your back of course ;)
If you read my last blog post regarding The Real Reason You Can't Get Rid Of Your Pain then you know that there can be a number of reasons behind the cause of your pain. And without doing a thorough assessment (and no that doesn't have to involve x-rays and MRIs.. they really aren't needed as often as you think) it can be difficult to diagnose.
In my practice, I have noticed that the majority of patients are lumped into a particular category and that I have found several exercises beneficial. However, I recommend you see a Doctor of Physical Therapy in your area if your back pain persists.
Tip #1
Be mindful of how you're sitting.
That doesn't mean you have to have perfect posture! That just means stop sitting like a slouch!! Sit up tall.. this is can also increase your alertness.. hellloo Monday morning!
Keep your feet flat on the floor and your bottom all the way to the back of the seat. You can roll up a towel from home and put it in the small of your back to promote good posture (you can also purchase a lumbar support roll here).
Make sure your computer is at eye level. So that means, sit tall and then adjust the height.. it might be at "eye level" when you're slumped over but that doesn't help much does it?
And remember.. don't worry about sitting perfectly. Just be more mindful of your positioning throughout the day and you'll be surprised at how much it will help! Although if you suffer with very poor posture then you may be sore from sitting upright.. don't worry, that goes away!
Tip #2
Get up every hour.
One quick an easy way of doing this is drink PLENTY of water. This will force you to get up every hour to go to the restroom so you won't forget.
Another way is setting a timer for every hour. If you're like me, I tend to get consumed in my work and don't realize how much time has passed and realize it's been 4 hours!
By that time it's going to take A LOT of work to undo the pressure that's been placed on your back. Just think.. you were sitting with poor posture for 4+ hours.. what makes you think that you'll fix it with just one exercise?
However, with daily modifications and changes to your life you will gradually start noticing a difference. It might not be right away but it WILL happen!
Tip #3
Do the opposite motion than you're used to.
Wait.. whaatt?
If your job requires you to sit all day or lift objects (or kiddos) off the floor then that shows you're primarily in flexion and need to work on extension.
If you're a gymnast, pole vaulter, crossfitter or any other type of athlete then you will probably benefit from more flexion.
But not always!
I've seen many crossfitters who work out 5+ days a week present with low back pain. After going through their history I find a lot of similarities to my other patients who don't do crossfit on the regular..
They sit majority of the day for work.. They're at home with their kiddos picking up toys, changing diapers and wrangling kiddos all day.. They're a massage therapist or personal trainer working with clients and helping them stretch.
All of these show more of a flexion-based lifestyle.
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Flexion = bending forward at the low back (see pictures above)
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Extension = bending backward at the low back (see pictures above)
You can see how day-to-day activities typically involve more flexion than extension.
If your daily activities involve a lot of flexion then try doing the opposite.. whatever that may be! Listen to your body and see if what you're feeling is painful or more of a stretch.
And for those with bulging and herniated discs.. be very careful! Usually extension based exercises are helpful such as the cobra (see pic below) but sometimes it requires more than that. That's when you need to find a local Physical Therapist to help you find out what the best positioning is for you.. otherwise, you'll be next up on the chopping block.. literally.
If your daily activities involve a lot of flexion then try doing the opposite.. whatever that may be! Listen to your body and see if what you're feeling is painful or more of a stretch.
And for those with bulging and herniated discs.. be very careful! Usually extension based exercises are helpful such as the cobra (see pic below) but sometimes it requires more than that. That's when you need to find a local Physical Therapist to help you find out what the best positioning is for you.. otherwise, you'll be next up on the chopping block.. literally.
Tip #4
Go for a walk!
After work, take some time for yourself and go for a peaceful walk. Take in your surroundings and decompress from the day.
And if you're sitting all day, walking will promote more extension of the low back and should help take pressure off those segments that have been compressed all day while sitting.
It will also help decrease stress levels which will help you relax and sleep better. Sleep is paramount in the recovery process!
And don't forget about those endorphins! They'll make you feel good and give you energy to tackle the rest of the day.
However, be careful not to walk up too many hills.
Walking on an incline can place excess stress on your back and puts your low back into a flexed position. If that's the position you typically stay in all day then no need to add more time in that position!
Tip #5
Lose Weight.
This is a difficult topic to tackle - *cough* elephant in the room *cough*..
Losing weight can be the difference between living an active and enjoyable lifestyle versus undergoing multiple surgeries and taking pain medication for the rest of your life.
Now if you have 5-10 lbs or even 20 lbs to lose.. you would probably benefit more from Tips #1-4.
But if you have 30+ lbs to lose then that's another story.
Now I love people of all shapes and sizes, but if you want to get pain-free and achieve an optimal outcome then you might want to assess what you're eating.
That doesn't mean to calorie count or go on a crazy and restrictive diet.. To me, that's just as bad because once you go off the diet things typically will go right back to the way they were but now you are filled with guilt and shame.
Instead of a restrictive diet, think about building a sustainable eating plan that consists of ALL food groups.. even the "unhealthy" ones. The only difference is eating in moderation, moving more, and listening to your hunger cues.
I recommend going to the grocery store and looking for whole foods.. Foods that come from the earth and are not processed. Stay on the outside of the grocery and don't go to the middle aisles.. usually that's where they store the processed food such as cookies, crackers and other pre-packaged food.
One easy way of navigating the grocery store is by looking at the ingredients and choosing items with 5 ingredients or less!
I can go on and on about this.. but I'll save that for another post.
The main thing I want you to get from this is that...
There is still hope.. LOTS OF IT!!
So don't give up just yet! And it's okay to disagree with your physician.. you don't always have to have pain medications, injections or surgery. There are alternatives!
And I cannot stress this enough to you.. seek out the best Physical Therapist in your town. A true musculoskeletal specialist that can perform a comprehensive assessment to determine the true underlying cause of your pain!
And if you haven't read my previous post.. check it out here. It will tell you more about why you may be having difficulty getting rid of your pain!
If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
Have you been experiencing pain for one week, one month, or over a year? Maybe over 10 years?? Maybe you know someone in your family that has been suffering with the same injury for what seems like decades.
Have you (or they) been to countless physician appointments, taken prescription medications like it's your job, and possibly even undergone surgery?
Maybe you're afraid of that cycle because you've seen your Aunt Bessy go through it and you're afraid that you're going down that same destructive path.
First thing to note:
Our healthcare system is broken.
The days of speaking with your MD or Specialist are over. Now we have become reliant upon assistants and other practitioners. That's not to say that they don't do a fine job. However, physicians are now in charge of seeing their patients and overseeing the patients of PAs (physician assistants) and NPs (nurse practitioners).
You can see how it would be easy to overlook someone's problem or unintentionally let people slip through the cracks. I don't blame the practitioners for this.. I blame the insurance companies and greed - but that's a topic for another day.
Let's get to my point:
Low back and neck pain are key contributors with the rise in opioid use. Many will go to specialist after specialist, undergo countless imaging and testing, along with injections... without any relief in their pain. For many people, their pain actually INCREASES.
And this is where it starts.. for many, it may have started at the very beginning. Their physician gives them a prescriptions for anti-inflammatories and pain killers. When that doesn't work then they start with the injections over the course of several months which then eventually leads to surgery.
Throughout this entire process, physicians continue to prescribe pain killers because what else can be done? Might as well try to help them numb the pain until it can be "fixed" with surgery, right? And don't forget about their caseload.. alot of practitioners don't have time to think about anything other than referring a patient to a specialist or performing surgery.. when was the last time you spent more than 10 min with your physician?
After surgery, the pain still continues... then what happens?
Typically they will refer these patients to other "specialists"..
and so the cycle begins...
AGAIN.
I have a BIG problem with this cycle..
First of all.. IT NEEDS TO END.
Secondly.. How do we do that?
We have to determine the underlying cause of the pain. Pain doesn't happen randomly and for no reason.
This is our body's way of saying.. "I'm not a big fan of what you're doing here.. something's just not right!" If not, then we would continue to do further damage without knowing it.
BUUUTTT..
That's EXACTLY what our painkillers are doing..
They kill the pain. Quite literally.
You might be thinking to yourself, "Well I'd rather not be in pain so what's the harm in taking them for the time being?"
Because it's disrupting your body's normal alarm system. It's quieting it down or shutting it off completely. And just because the pain goes away (or is decreased) that doesn't mean it's getting better. Many times, you'll end up doing more harm because you can't feel what you're doing.
You won't feel the pain when sitting at your desk at work. You won't feel the pain when picking up your kiddo or grandkiddo. You won't feel the pain when picking something up off the floor.
Eventually, you will have to take more medication to have the same effects and that's when it can become scary.
The people getting addicted to opioids aren't the men and women who are living on the streets...
It's the average person trying to get by. Trying to continue working without going on disability... Trying to tackle all of the responsibilities of being a parent... Trying to live an active lifestyle... You get my point.
You won't feel the pain when sitting at your desk at work. You won't feel the pain when picking up your kiddo or grandkiddo. You won't feel the pain when picking something up off the floor.
Eventually, you will have to take more medication to have the same effects and that's when it can become scary.
The people getting addicted to opioids aren't the men and women who are living on the streets...
It's the average person trying to get by. Trying to continue working without going on disability... Trying to tackle all of the responsibilities of being a parent... Trying to live an active lifestyle... You get my point.
What needs to happen is the first line of access should be seeing a Physical Therapist
If you don't know one.. then find one! Do your research. Don't just go to the Physical Therapist that is the closest to your work or home.
Finding a true Musculoskeletal Specialist that isn't bogged down by all of the paperwork as well as being overworked and underpaid may be difficult, but it's not impossible.
But you would do this when researching a Neurosurgeon.
You wouldn't pick the first one that pops up on Google or one because they have a hospital closest to your home.. at least I hope not! :)
I understand that surgery on the spine can be very dangerous so you'll want the best! And I'm not saying Physical Therapy comes with the same precautions as surgery. However, if you see a PT that doesn't perform a thorough comprehensive assessment and establish a treatment progression based on YOUR specific needs then you will slip through the cracks unnoticed and be on the track for surgery.
And get this.. you may have surgery on something that ISN'T the primary cause of your pain. You complain of back pain and symptoms down the leg.. then go in for an MRI to show horrid things.. "oh my! I have degenerative WHHAATT? Well of course I need surgery!"
Let me break it down.. just because you have signs (or actually have) degenerative disc disease or joint disease does NOT mean that you automatically HAVE to have surgery. And just because someone says your joint is "bone on bone" doesn't mean you HAVE to have surgery!
Does it mean that you will never require surgery?? Of course not.
But why not give the conservative route (AKA Physical Therapy) a try? What harm could it do? You can ALWAYS have surgery..
And most importantly, I have helped many people return to active and healthy lifestyles without requiring surgery.. And . yes, these are people who have been told, "You have the worst spine I've ever seen" and "You're bone on bone. There's no way you'll be able to play with your grandchildren".
So there is still hope!
Finding a true Musculoskeletal Specialist that isn't bogged down by all of the paperwork as well as being overworked and underpaid may be difficult, but it's not impossible.
But you would do this when researching a Neurosurgeon.
You wouldn't pick the first one that pops up on Google or one because they have a hospital closest to your home.. at least I hope not! :)
I understand that surgery on the spine can be very dangerous so you'll want the best! And I'm not saying Physical Therapy comes with the same precautions as surgery. However, if you see a PT that doesn't perform a thorough comprehensive assessment and establish a treatment progression based on YOUR specific needs then you will slip through the cracks unnoticed and be on the track for surgery.
And get this.. you may have surgery on something that ISN'T the primary cause of your pain. You complain of back pain and symptoms down the leg.. then go in for an MRI to show horrid things.. "oh my! I have degenerative WHHAATT? Well of course I need surgery!"
Let me break it down.. just because you have signs (or actually have) degenerative disc disease or joint disease does NOT mean that you automatically HAVE to have surgery. And just because someone says your joint is "bone on bone" doesn't mean you HAVE to have surgery!
Does it mean that you will never require surgery?? Of course not.
But why not give the conservative route (AKA Physical Therapy) a try? What harm could it do? You can ALWAYS have surgery..
And most importantly, I have helped many people return to active and healthy lifestyles without requiring surgery.. And . yes, these are people who have been told, "You have the worst spine I've ever seen" and "You're bone on bone. There's no way you'll be able to play with your grandchildren".
So there is still hope!
Musculoskeletal Specialists will provide you with a comprehensive total body assessment
This will involve a detailed history of YOUR PAIN. Each session should be 45-60 minutes long and should be heavily manual based.. meaning they work on your _____ fill in the blank by using manual techniques.
Through their assessment, they should be able to develop a plan of care that tackles the underlying cause of your pain.
Remember that children's song.. "The leg bone's connected to the knee bone, the knee bone's connected to the thigh bone..?"
Well, its true!!
Your body is a kinetic chain.. meaning that everything works TOGETHER.
When one part moves, the other part stabilizes. Therefore, if you have an injury or source of pain in one area of your body.. then you'll certainly develop aches and pains in other areas of your body.
And when you add painkillers into the mix you can see how that can be a toxic concoction.
Through their assessment, they should be able to develop a plan of care that tackles the underlying cause of your pain.
Remember that children's song.. "The leg bone's connected to the knee bone, the knee bone's connected to the thigh bone..?"
Well, its true!!
Your body is a kinetic chain.. meaning that everything works TOGETHER.
When one part moves, the other part stabilizes. Therefore, if you have an injury or source of pain in one area of your body.. then you'll certainly develop aches and pains in other areas of your body.
And when you add painkillers into the mix you can see how that can be a toxic concoction.
One thing that I do want to note is that if you are currently dealing with pain and are discouraged.. DON'T LOSE HOPE!
I have seen, firsthand, how resilient the body is. Just because you've been told, "that's the worse (insert body part) I've ever seen" or "it's bone-on-bone" or even "you have degenerated discs and joints, you shouldn't do xyz.." doesn't mean it's true!
I have had MANY people overcome pain that they thought they would have to deal with the rest of their life.. Is it easy? Heck no!! Is it possible? Heck yes!!
Now depending on how long you've been dealing with the pain and how many body parts are involved, it might take longer than you like. Unfortunately there are no quick fixes in life.
If someone tells you they can fix something in one session then you might want to walk the other way. That's not real life.. However, if you are dedicated to overcoming your pain and will do anything to get back to a healthy and active lifestyle then, by golly, you can!!
Where to go from here?
Over the next few weeks I will be discussing common injuries (starting with back pain) and ways to treat them!
If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
So if you had told me just a few months ago that I would write a topic about being TOO fit then I would have told you that you're bonkers! This is my expertise.. there can never be too much of a good thing, right??
Okay, let's back it up before we get into the real nitty gritty..
Let me start by giving you a brief background about me :)
Sooo.. I've been active pretty much my entire life. I mean really.. I started dribbling a basketball when I was 3! I couldn't let my older brother show me out! Fast-forward 10-15 years later and I'm playing on a Nike traveling team in the summer and playing for my high school the rest of the year. It was a full-time job and I had very little down time. My entire focus was on my basketball career.
I earned a full ride scholarship to UMBC- for you March Madness fans, you might recognize that name. This past year the men's team was the first #16 seed to defeat a #1 Seed, Virginia, in the tournament! I played there for 2 years and decided I wanted to be closer to home so I transferred to Belmont University located in Nashville, TN. That's where I met the hubs and pursued obtaining a Doctor of Physical Therapy.
During Physical Therapy school, I got away from the world of basketball and started to dive head first into training for half marathons and olympic triathlons. I have always (and will always) be a competitor so I needed something to train for and compete in.
I also started researching and learning more about nutrition - even though I was just scratching the surface - because I wanted to learn how to properly fuel myself for training. I believe that proper nutrition is paramount to succeed at any sport. You can train twice as much as everyone else but if you're not adequately fueled then your body will not be able to perform at the optimal level.. That's why the things I'll discuss a bit later have been so tough on me!
Even though I had experience playing at the elite level, earned a Doctor of Physical Therapy and became a certified Strength & Conditioning Specialist, there was still a HUGE aspect of my life that I was putting on the back burner. It had become the norm to me so I didn't think too much into it.
Over the years, I had yearly check-ups and discussed this topic with specialists in that particular field with little to no avail. Each physician told me that I was completely normal and that I need not to worry..
Okay.. so you might know the direction I'm heading in or you might be thinking TELL US ALREADY...
This is a topic that most people do not talk about and to be quite honest, I'm not the most comfortable sharing either. However, I want to raise awareness because (especially in the fitness industry) I know there are other girls who struggle with this and feel as though there is no hope.. or perhaps, they have been misguided and will not realize it until later in life (like me).
What I have struggled with, every since hitting puberty, is amenorrhea- which is absent or missed periods. I started my period when I was 13 but then would only have one a year for the next 3 years. Each time I would go in for my check-up with my gynecologist, she would say not to worry and it's completely normal for someone who is active to not have a period. She would continually encourage me that I was healthy and all was well.
Now before I continue, I want to say that I highly respect the health professionals within Women's Health and that I know they are able to help MANY women all across the boards.
My main point is to raise awareness for this particular topic because it seems that it is quite often overlooked BY EVERYONE. Most healthcare professionals are being taught that the pill (birth control) is the bees knees and that's all we need to make the world go 'round.
The fact that I have seen 5 different gynecological specialists - 1 in Knoxville, 1 in Baltimore, 3 in Nashville - and they all have said the same thing over the past 10 years says a lot. I have read the literature and have seen that there is more research being done to show the negative implications of amenorrhea and that it can not simply be treated by birth control. The underlying cause NEEDS to be addressed and we need to stop putting band-aids on things crossing our fingers in hopes that they will heal on their own.
What I have struggled with, every since hitting puberty, is amenorrhea- which is absent or missed periods. I started my period when I was 13 but then would only have one a year for the next 3 years. Each time I would go in for my check-up with my gynecologist, she would say not to worry and it's completely normal for someone who is active to not have a period. She would continually encourage me that I was healthy and all was well.
Now before I continue, I want to say that I highly respect the health professionals within Women's Health and that I know they are able to help MANY women all across the boards.
My main point is to raise awareness for this particular topic because it seems that it is quite often overlooked BY EVERYONE. Most healthcare professionals are being taught that the pill (birth control) is the bees knees and that's all we need to make the world go 'round.
The fact that I have seen 5 different gynecological specialists - 1 in Knoxville, 1 in Baltimore, 3 in Nashville - and they all have said the same thing over the past 10 years says a lot. I have read the literature and have seen that there is more research being done to show the negative implications of amenorrhea and that it can not simply be treated by birth control. The underlying cause NEEDS to be addressed and we need to stop putting band-aids on things crossing our fingers in hopes that they will heal on their own.
Now that's cleared up.. back to what I was saying before..
I have gone YEARS without having a regular cycle and had no clue what that was doing to my body. 10 years later - 5 years into marriage - my husband and I are in the early stages (emphasis on early) of trying to conceive and I had an appointment to see a nurse practitioner that works under my current gynecologist (I saw her because I would have had to wait 3 months to see my regular doc).
I went into the appointment excited to break the news that we were ready to have the baby talk! I'm no dummy so I knew that I had irregular periods and that could complicate things. But since I had always been told I'm healthy (and all was well in my fertility world) then I figured they would have a few magic tricks up their sleeves to help get things flowing.. pun intended :)
I went into the appointment excited to break the news that we were ready to have the baby talk! I'm no dummy so I knew that I had irregular periods and that could complicate things. But since I had always been told I'm healthy (and all was well in my fertility world) then I figured they would have a few magic tricks up their sleeves to help get things flowing.. pun intended :)
Welp.. needless to say, that is not how it went.
A healthcare professional that I had never even met before who has been doing this for over 20 years stated that I could NOT have a baby because I don't have periods.. therefore I don't ovulate.
The end.
I stared at her blankly... thinking, "I didn't hear her correctly. I'm healthy. I'm a fertile myrtle. This can't be right!"
She then proceeded to say that since I have a protein C deficiency (more on that later) that I can't take birth control (remember, that's the bees knees) so she's going to refer me back to my regular gynecologist and maybe I could take some medicine or something.
Oh yeah, I almost forgot.. She also said that because I don't have regular cycles that I was at risk for cervical cancer and that she thinks I may have PCOS.
For those unfamiliar with PCOS:
PCOS stands for Polycystic Ovarian Syndrome. it is a hormonal disorder causing enlarged ovaries with small cysts on the outer edges.
3 major symptoms include:
The only symptom I had was irregular menstruation. And without doing a blood work-up or ultrasound, there is no way of knowing whether you have PCOS. They typically do it based on general presentation.
This brings me to my next topic:
The end.
I stared at her blankly... thinking, "I didn't hear her correctly. I'm healthy. I'm a fertile myrtle. This can't be right!"
She then proceeded to say that since I have a protein C deficiency (more on that later) that I can't take birth control (remember, that's the bees knees) so she's going to refer me back to my regular gynecologist and maybe I could take some medicine or something.
Oh yeah, I almost forgot.. She also said that because I don't have regular cycles that I was at risk for cervical cancer and that she thinks I may have PCOS.
For those unfamiliar with PCOS:
PCOS stands for Polycystic Ovarian Syndrome. it is a hormonal disorder causing enlarged ovaries with small cysts on the outer edges.
3 major symptoms include:
- Irregular menstruation
- Obesity
- Hirsutism: unwanted hair growth on face, chest and back
The only symptom I had was irregular menstruation. And without doing a blood work-up or ultrasound, there is no way of knowing whether you have PCOS. They typically do it based on general presentation.
This brings me to my next topic:
Hypothalamic Amenorrhea (HA)
According to Shady Grove Fertility:
"Hypothalamic amenorrhea is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain and controls reproduction. It produces gonadotropin-releasing hormone (GnRH). GnRH) signals the production of other hormones needed for the egg to mature and for ovulation, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) after ovulation. In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and - along with progesterone (from LH) - prepares the uterus for a fertilized egg."
"Hypothalamic amenorrhea is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain and controls reproduction. It produces gonadotropin-releasing hormone (GnRH). GnRH) signals the production of other hormones needed for the egg to mature and for ovulation, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) after ovulation. In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and - along with progesterone (from LH) - prepares the uterus for a fertilized egg."
Now in English:
Hypothalamic amenorrhea is when you lose your period completely, have prolonged periods, or irregular periods due to lack of energy for the reproductive system to work properly. There are a lot of factors that play into this but it typically comes down to exercising too much and not eating enough.
Symptoms include:
- Low body weight
- Low percentage of body fat
- Very low intake of calories or fat
- Emotional Stress
- Strenuous exercise that burns more calories than are taken in through food
So I have 4/5 symptoms listed for HA and only 1 symptom for PCOS. I have below average body fat, I tend to stress out a lot due to starting my company, and I exercise frequently. I could fall under the low body weight category but to me, 5'9" and 135-140 lbs is pretty average if not a bit higher than average due to muscle mass.
One other topic is food.. with doing further research, I realized I was not getting enough healthy fats into my diet and that is paramount for optimal reproductive health. I enjoy and eat all food groups but other than avocados, almonds and coconut oil, I was unintentionally eating a low-fat diet. I thought I was properly fueling myself and would average between 2,000-3000 calories per day. However, I was always and hungry and that should have been an indicator that something's not right.
A Few Fast Facts..
- 1/8 couples have trouble getting pregnant
- The average body fat to conceive is between 22-24%
So clearly fertility issues are quite common. And if we are all generalized in the broad PCOS category without looking at other possible diagnoses then we are doing ourselves a disservice.
Also, if you have irregular periods.. THAT IS NOT NORMAL.. I repeat.. That is not normal!! No matter what anyone says! It might be convenient at the time to not have to worry about Aunt Flo but this is your body's way of communicating with you and begging for heeellllpp!
Here is an article from a nutritionist and nurse practitioner, Robyn Nohling, who struggled with HA (and overcame it, she has a precious nugget now) and was misdiagnosed for years. She underwent countless tests that further discouraged her until she decided to dig further into the research herself and go back to school to become a nurse practitioner. Her story is amazing!
She discusses the difference between PCOS and HA here
She also wrote an article specifically about why not getting your period is NOT normal
And lastly, she discusses a topic regarding your body's healthy set point.
Every person has a unique and individual personality and our body's are the same way. There are elite athletes who compete at a very low body fat (some even at 15-18%) who still have regular cycles. Other (like me) don't operate well at 17.5-18.5%. Each person is different and one key way of knowing if we're at our healthy set point is by our monthly flow!
Robyn goes on to say in her blog post:
"One thing about set point theory that is overlooked or not spoken about clearly I think, is that your "set point" isn't one certain number. Or even one number give or take a few pounds. No. Research estimates that the average person has a set point range of ten to twenty pounds. Ten to twenty pounds."
Robyn goes on to say in her blog post:
"One thing about set point theory that is overlooked or not spoken about clearly I think, is that your "set point" isn't one certain number. Or even one number give or take a few pounds. No. Research estimates that the average person has a set point range of ten to twenty pounds. Ten to twenty pounds."
To wrap things up...
This has been one of the most difficult things for me to write about, or even talk about (just ask my bible study peeps from Monday!!). Part of me wanted to wait until I had everything figured out so I could say, "Look at what I struggled with and how I overcame it!" That way no one would know that, as of right now, I feel broken.
I'm broken and beaten down. I'm discouraged and ashamed. I'm even embarrassed.
I can't believe that with all of the knowledge and experience I've acquired over the years that I didn't realize this sooner.
I'm broken and beaten down. I'm discouraged and ashamed. I'm even embarrassed.
I can't believe that with all of the knowledge and experience I've acquired over the years that I didn't realize this sooner.
How did I not realize that my body wasn't operating at a healthy set point?
Why didn't I think about eating a high fat diet?
How did I not know that something was wrong?
Why didn't I think about eating a high fat diet?
How did I not know that something was wrong?
I continue to beat myself up over this.. and blame myself for the fact that I may not be able to bring a new life into this world.
The fact that I'm at the point of even considering have a nugget is a BIG DEAL. God had to do a mighty work within me to come to get to this point..
And this is what keeps bringing me back..
This is why I feel led to share this with you now! I want to take those who are interested through this journey. Because not all hope is lost!
I believe that I have been given a platform to raise awareness for this topic. And if I can help just one person (like Robyn helped encourage me) then feeling super awkward and vulnerable will be more than worth it!
I also highly encourage you to ask you OBGYN these questions. In one of the articles listed above, Robyn shows how to interpret blood work to differentiate between PCOS and HA. You can also get an ultrasound that will rule in or out PCOS by physically seeing if there are cysts on your ovaries (btw.. it's not uncommon to have cysts but those with PCOS have 12 or more.. don't quote me on that though!).
Once all the bloodwork and ultrasound checks out.. I recommend seeking out a Registered Dietician (like Robyn) to help you make sure that you're eating properly to achieve your healthy set point.
Lastly, if you LOVE exercising as much as I do and truly enjoy eating whole foods then you might want to reassess where you're at and what your goals are.
My two main goals are:
1) To continue to pursue what I love in life.. helping adults and athletes of all ages stay active and fit without relying on pain medications, injections or surgery. Through this experience, I understand the body even more now and that each person requires different nutritional requirements.. and that it's waaayy more than just calories in versus calories out when it comes to reproductive health.
You want to know how to lose weight and gain lean muscle mass or rehabilitate from a nagging injury.. then I'm your girl!! But hopefully through this journey I will learn how to help other women maintain a healthy set point while achieving their fitness goals!
For most people, not much will change. However, for the elite athlete or fitness enthusiast, it will look quite differently and I look forward to helping others navigate that process after going through it myself.
2) To make my reproductive health a priority! I want to be able to have a nugget or two (or three!) so that means I'm going to have to make some changes.
For now...
I'm going to incorporate more healthy fats to my diet. I am also going to back off high intensity exercise and switch to yoga and light walking. This will naturally entail that I'm going to gain some extra fluff and lose lean muscle. Once I regain a normal cycle, then I will once again reassess where I'm at.
I truly believe that I will once again be able to perform high intensity exercise but that I need to find balance in my life and establish my body's healthy set point first.
And I want to be honest with ya'll.. I'm not looking forward to it. Part of me fears that people won't listen to me if I gain weight. The other part says, gurrrr.. you gotta do what's best for you! Take care of yourself!
At the end of the day, it doesn't matter what others may think. I have to do what's best for me and my family. We are a unit. Nothing can break us unless we allow it to get in between us.
The fact that I'm at the point of even considering have a nugget is a BIG DEAL. God had to do a mighty work within me to come to get to this point..
And this is what keeps bringing me back..
This is why I feel led to share this with you now! I want to take those who are interested through this journey. Because not all hope is lost!
I believe that I have been given a platform to raise awareness for this topic. And if I can help just one person (like Robyn helped encourage me) then feeling super awkward and vulnerable will be more than worth it!
I also highly encourage you to ask you OBGYN these questions. In one of the articles listed above, Robyn shows how to interpret blood work to differentiate between PCOS and HA. You can also get an ultrasound that will rule in or out PCOS by physically seeing if there are cysts on your ovaries (btw.. it's not uncommon to have cysts but those with PCOS have 12 or more.. don't quote me on that though!).
Once all the bloodwork and ultrasound checks out.. I recommend seeking out a Registered Dietician (like Robyn) to help you make sure that you're eating properly to achieve your healthy set point.
Lastly, if you LOVE exercising as much as I do and truly enjoy eating whole foods then you might want to reassess where you're at and what your goals are.
My two main goals are:
1) To continue to pursue what I love in life.. helping adults and athletes of all ages stay active and fit without relying on pain medications, injections or surgery. Through this experience, I understand the body even more now and that each person requires different nutritional requirements.. and that it's waaayy more than just calories in versus calories out when it comes to reproductive health.
You want to know how to lose weight and gain lean muscle mass or rehabilitate from a nagging injury.. then I'm your girl!! But hopefully through this journey I will learn how to help other women maintain a healthy set point while achieving their fitness goals!
For most people, not much will change. However, for the elite athlete or fitness enthusiast, it will look quite differently and I look forward to helping others navigate that process after going through it myself.
2) To make my reproductive health a priority! I want to be able to have a nugget or two (or three!) so that means I'm going to have to make some changes.
For now...
I'm going to incorporate more healthy fats to my diet. I am also going to back off high intensity exercise and switch to yoga and light walking. This will naturally entail that I'm going to gain some extra fluff and lose lean muscle. Once I regain a normal cycle, then I will once again reassess where I'm at.
I truly believe that I will once again be able to perform high intensity exercise but that I need to find balance in my life and establish my body's healthy set point first.
And I want to be honest with ya'll.. I'm not looking forward to it. Part of me fears that people won't listen to me if I gain weight. The other part says, gurrrr.. you gotta do what's best for you! Take care of yourself!
At the end of the day, it doesn't matter what others may think. I have to do what's best for me and my family. We are a unit. Nothing can break us unless we allow it to get in between us.
Sooo.. I'm both excited and scared to start this journey! I have another appointment to have a full blood work up done as well as an ultrasound. After that, I'll have an even better idea of how to navigate this temporary obstacle :)
For those who took the time to read this post in it's entirety.. THANK YOU!
Until next time...
Dr. Katie Spruel, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
Insurance can be very confusing! There are many terms such as deductible, co-pay, max out-of-pocket, in-network vs out-of-network... and there's not a lot of resources out there that break in down and give it to you straight.
You may be wondering why I'm even writing about this...
The reason is because I have had several potential patients seek Physical Therapy elsewhere because they were thrown off by the fact that my clinic is "Out-Of-Network" with their insurance without fully understanding what that means.
First of all, this does NOT mean that I don't take your insurance!
But before we get into the nitty gritty let me break things down a bit:
Deductible = the amount of money you pay out of your pocket until your insurance will cover part or all of the expenses
This can range from $500 - $10,000!
This can range from $500 - $10,000!
Until your deductible is met, you are paying ALL of the medical expenses regardless if you're going to an "In-Network" or "Out-Of-Network" clinic.
In-Network Provider = the provider (physical therapy, physician, dentist, etc.) has contracted with your insurance company to provide negotiated (discounted) rates
On average, once the deductible is met, the insurance company pays for 80-100% for the cost of service being provided.
On average, once the deductible is met, the insurance company pays for 80-100% for the cost of service being provided.
Out-Of-Network Provider = the provider (physical therapy, physician, dentist, etc.) has NOT contracted with your insurance company to provide negotiated (discounted) rates
On average, once the deductible is met, the insurance company pays for 50-70% for the cost of service being provided.
On average, once the deductible is met, the insurance company pays for 50-70% for the cost of service being provided.
So why would I ever go to an Out-Of-Network Provider?
Most of my patients have such high deductible that they will not come close to reaching it with my services. So regardless if they are going to an "In-Network" or "Out-Of-Network" Physical Therapy clinic, they will be billed the SAME (meaning all out-of-pocket until the deductible is met).
However, for those who HAVE already met their deductible, most "Out-Of-Network" insurance plans cover at least 50-70% of costs.
Anddd..
Due to the In-Network negotiated rates, most outpatient clinics see 2-4 patients per hour! They also see the average patient for 2-3 times a week for 8-12 weeks (I used to work in an In-Network clinic so I know this from firsthand experience).
At my clinic, I typically see patients 1-2 times a week with an average of 5-8 sessions TOTAL.
If you do the math, the total costs average out to be very close if not LESS going to see me Out-Of-Network.
Another Anddd..
You don't need a physician's referral to schedule an appointment with me! You can see me directly and avoid the tedious appointments that can be both time-consuming and expensive!
However, for those who HAVE already met their deductible, most "Out-Of-Network" insurance plans cover at least 50-70% of costs.
Anddd..
Due to the In-Network negotiated rates, most outpatient clinics see 2-4 patients per hour! They also see the average patient for 2-3 times a week for 8-12 weeks (I used to work in an In-Network clinic so I know this from firsthand experience).
At my clinic, I typically see patients 1-2 times a week with an average of 5-8 sessions TOTAL.
If you do the math, the total costs average out to be very close if not LESS going to see me Out-Of-Network.
Another Anddd..
You don't need a physician's referral to schedule an appointment with me! You can see me directly and avoid the tedious appointments that can be both time-consuming and expensive!
My passion is helping adults and athletes (of all ages) get back to what they LOVE doing without relying on pain medications, injections, or surgeries!
SOOOO...
Now is the time to take control of YOUR health and break from this nasty cycle that health care professionals have put you in. Your pain will no longer be overlooked!
Click on the link below for a super quick list of questions to ask your insurance provider!
Insurance Benefits Worksheet
If you've found this article helpful please let me know! I would love to hear feedback from you! And if you have any questions please feel free to shoot 'em my way!
www.amplifyphysio.com.com
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
Now is the time to take control of YOUR health and break from this nasty cycle that health care professionals have put you in. Your pain will no longer be overlooked!
Click on the link below for a super quick list of questions to ask your insurance provider!
Insurance Benefits Worksheet
If you've found this article helpful please let me know! I would love to hear feedback from you! And if you have any questions please feel free to shoot 'em my way!
www.amplifyphysio.com.com
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
Dr. Katie Spruell, PT, DPT, CSCS
I am a licensed Physical Therapist and Certified Strength & Conditioning Specialist practicing in Maryville, TN. I started a small private practice - Amplify Physio, LLC - in April 2018. Recently I moved my practice to Maryville, TN.
My hope is to take Maryville by storm and challenge the current healthcare system! I believe Physical Therapists should be the first line of treatment because who better to treat you than a musculoskeletal & movement specialist?!
I want to help people decrease their pain and live a high quality of life. When you're living in pain, life can seem hopeless and I want to show people there is hope!
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