Why burpees are an essential clinical tool....

Yes, we love/hate them, and we know that you do, too.  Burpees.  Whether they're done with a chest-to-floor push-up at the bottom or a clap in the sky at the top (or both!), burpees are an envogue fitness activity for conditioning purposes, and they just never seem to get that much easier....no matter how fit you are...

Clinically, burpees(aka squat-thrusts, aka "M"urpees) can give us some valuable information about how our patients are faring during the plan of care. Would we use them on every patient we treat? Probably not, but for those patients who live an active lifestyle and want to return to their favorite activities post-rehab, they will find themselves doing burpees at some point during their stay at Maven. As one of Maven's key clinical movement assessment (and treatment) tools, burpees can be used qualitatively and/or quantitatively to:

1. assess a patient's healing progress after they've passed the subacute stage of an injury
2. provide clinicians with a general "clearing test" prior to discharging a patient
3. determine if a patient is ready to be progressed to more dynamic activities or return-to-sport
4. assess gross and regional dynamic joint and segmental stabilization in a closed-chain position (the most functional position for most everyday activities)
5. assess the general status of a patient's or athlete's muscular endurance and conditioning
6. reveal other areas of the body that may need to be screened and evaluated for injury prevention.

Key areas of closed-chain, dynamic stabilization and/or mobility are assessed at the:

• cervical spine
• scapula
• thoraco lumbar region
• lumbo-pelvic region
• hip
• ankle
• wrist
• knee 

The video below shows Dr. Lee explaining how to perform a standard burpee (sans claps or push-ups in this video). Hopefully, you can appreciate how much mobility the wrists, shoulders, hips, knees, ankles must have in order to execute the exercise correctly. Also, notice how the scapulae and trunk("core") muscles have to stabilize the body in motion during the burpee as well.

If a patient comes to us with a wrist injury, for example, and needs to return to competitive gymnastics, multiple repetitions of burpees should be able to be performed with ease before any kind of floor or beam routine can be resumed.  If a patient has pain during a burpee in the lumbar region, most likely, lumbopelvic stabilization is not adequate to keep the spine from overextending, so we need to work on this more to clear the spine.  If a patient bends more at the back and less at the hip when they squat down for the burpees, we know to look more closely at the hip and pelvis as a potential movement limiting factor that needs to be addressed.

These are just a few examples of how burpees can assist rehab professionals during their physical assessment of the active patient and progress them to a successful return to their fitness goals! 

Stay tuned for videos on our Youtube channel providing more insight into our clinical movement assessment tools!

What's triggerpoint dry needling?

Trigger point dry needling is an effectively used modality to treat musculoskeletal pain. Licensed healthcare professionals including doctors of physical therapy have been using dry needling all over the world including the United States.

Maven Sports Medicine has been at the forefront of pushing for rules and regulations in New Jersey to permit the use of this treatment modality, which finally received NJ State Board approval in 2011. Yes, as you all know, we like to move and shake. Obviously, there is contention with the NJ acupuncture state board, who claims that it is indeed "acupuncture" what we are doing, however, allow me to explain some significant differences (btw, I still refer patients out for acupuncture, if that clarifies the picture):

Acupuncture 
Acupuncture requires state licensure, 4 years of education and/or a masters degree.  Training includes extensive knowledge and application of eastern medicine, anatomy, which includes the meridian system, and herbal medicine.  The pulse (there are three in eastern medicine) along with the history and other clinical and subjective measures are used to determine where systematic, energetic dysfunction may lie, and intervention via acupuncture needles, herbal medicine, or acupressure is employed.  For example, back pain may be a result of stagnation or surplus of energy, "chi" in a particular meridian, and needles may be placed in a region away from where the pain appears to be located. 

Dry needling 
 A systematic method of addressing localized trigger point muscle pain using dry needles (that is, needles that do not have medication, developed by Travell and Simons, MD in the mid to late 1900s. Trigger points in muscles result from overuse, disuse/weakness, or (traumatic) injury to muscles.  Posture-related injuries also can lead to trigger points.  Palpation of the muscles or regions involved is performed with the goal of eliciting a patient's symptoms (whether localized or away from the region palpated), a "twitch" response, or "taut/ropy" bands of the muscle. 

Dry needling can also be used to treat long-standing tendinitis or old muscle tears/strains by bringing about a relatively "controlled" inflammation response to initiate the cascade of physiological responses necessary for tissue healing, as an adjunct to other physical therapy modalities.  Applying dry needling or "TDN" requires extensive knowledge of surface/musculoskeletal anatomy, of which DPTs are experts.  Keen palpation and joint assessment (as well as other components of our comprehensive evaluation) are also necessary skill sets, which we practice and use daily to determine where musculoskeletal injuries may be emanating from.

Dry needling, therefore, is absolutely within our physical therapy scope of practice, and I would never call it acupuncture- this would be an insult to the acupuncture profession and all the training that a licensed acupuncturist must go through.

What to expect
Patients often describe transient discomfort, particularly when a twitch response has been elicited.  Following a dry needling "session", we often have patients perform a few gentle active range of motion exercises to further the effects of the needle, ultrasound to relieve dry needling symptoms, and electrical stimulation with ice as well.  Discomfort or pain resulting from dry needling lasts for about 1-2 days on average and icing or over-the-counter NSAIDs can be used. After a few days, many people (especially if we target the right spot) report moderate to significant relief of their pain.  It's pretty amazing, actually.  We've used it on our everyday computer user to our elite athletes and have had good results, thus far.  Obviously, dry needling is not a panacea, or I'd be living in Fiji with my fam right now, but it does offer another way to help you get back to your activities.

Diagnoses
We have treated diagnoses including (cervicogenic) headaches, IT band syndrome, tennis/golfer's elbow, rotator cuff strains, Achilles tendonitis, neck and low back pain, hamstring and quad strains to name a few ailments. 

For more information on how dry needling may help you, contact us via email at mavenoffice@gmail.com or jerrymaven@gmail.com