Healing 101

When we injure ourselves, whether it’s a broken bone, a sprained ankle or a simple skin cut, all of our tissues follow the same stages of healing; inflammation, repair and remodeling. The stages overlap, one stage flowing into another, with elements of different stages happening at the same time. How well the tissue heals depends on many factors including which tissue has been injured, how you manage pain and inflammation and how and when you start to use the tissues again.


Stages of Healing:


1. Inflammation: 

Inflammation seems to be the new buzzword in medicine and has been linked to all kinds of health issues. And it’s true that inflammation in the intestines from food sensitivities and in the joints from arthritis is destructive and should be managed. This is not the kind of inflammation we are talking about here. What we are referring to here is the inflammation that begins with injury and lasts anywhere from four days to three weeks. Immediately after an injury, the damaged tissue is bleeding and without oxygen. This activates your immune system, causing an inflammatory response in the injured tissue. A clot quickly forms and many different kinds of inflammatory cells are attracted to the injured tissue. Over the next several days, debris is removed and cells that are more anti-inflammatory in nature are attracted to the area. These cells will transform into the blood vessels and tissues of the healed injury. It is during this phase that many of the cells that you will need in the next two phases are attracted to the area, called in by the injury and inflammation.


2. Repair:

This phase begins as early as day four and lasts until about day 28. In this phase you begin to make the basic structure of tissue. Basic blood vessels form. You form a matrix, which is sort of like a gel. Into this gel you lay collagen, the fibers that provide structure. The gel gradually firms, trapping the collagen and beginning the healing of the tissue, closing the gap and reconnecting the edges of the injured tissue.


3. Remodeling:

Remodeling is the longest phase and can last as long as two years, depending on the tissue. During remodeling, the basic tissue formation that began in the repair phase is refined. The tissues gradually transform further into the tissue they are meant to be. The ratios of cells and vessels normalize. The collagen fibers become the type that normally occurs in that tissue, the fibers line up along the lines of the forces applied to the tissue and the structural strength of the tissue gradually improves.


Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) After an Injury

Non-steroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, ibuprofen and aspirin (e.g. Tylenol, Advil, etc.), are often used after an injury to manage pain and inflammation. But many studies indicate that the use of NSAIDs in the inflammation phase impairs healing in the repair and remodeling phases. NSAIDs interrupt the inflammation phase by inhibiting certain enzymes. This interruption limits how many and which cells you have for use in the repair and remodeling phases. (Remember that many of the cells you will use during repair and remodeling are attracted to the area during the inflammation phase.) So you might want to minimize the use of or avoid using them altogether during the first one to two weeks after an injury. On the other hand, studies of NSAID use during the repair and remodeling phases indicate that use during these later phases is not detrimental to healing. In fact, NSAID use during repair and remodeling of ligaments and tendons may in fact improve the quality of the tissue and decrease formation of abnormal scars.

Using ice for inflammation and pain does not interrupt the inflammation phase in the way that NSAIDs do. Cold numbs sensation on the skin and constricts the vessels, decreasing the amount of fluid in the area temporarily, thus providing some relief of pain and inflammation.


Tension and Forces through the Healing Tissue

Providing the correct tension to the repairing tissue can assist healing and improve the final quality of the repair. How and when to apply tension through the healing tissue will depend on which tissue is involved and which phase of healing it is in. During the inflammation phase, correct movement will help reduce swelling and prevent abnormal scaring and loss of muscle mass. During the repair and remodeling phase, tissue specific tension will assist with proper bone formation and healing of muscle, ligament and tendon. It does this by providing the stimulus for reorientation of the collagen fibers in the proper direction and encouraging thicker, stronger collagen fibrils that can withstand greater forces. Knowing just how to do this properly is complicated, so get some help. Have your doctor and physical therapist guide you through the phases and tell you how and when to use the tissues, so you can recover from your injury strong and well healed.


Interested in learning more? Join us for our upcoming Healing 101 lecture on Thursday, September 21st at 6PM. Click here for more details. 

How to Have Happy, Healthy Intervertebral Discs

By: Gema Sanchez, PT

As many as 85% of people are affected by low back pain at some point during their lives. Of the  many causes of low back pain, intervertebral disc degeneration and disc herniation are among the most common. So, if you want to have a healthy spine and minimize low back pain, you need to have healthy discs.

What is an intervertebral disc?

The discs are partially movable joints that connect the bones of the spine (the vertebrae).  The function of the disc is mechanical: it transfers loads, dissipates energy and helps joint mobility.  It is composed of two parts: the nucleus pulposis in the center and the annulus fibrosis which encircles the nucleus. The nucleus is gelatinous, it has a high water content in a matrix which resists forces of compression. The annulus is composed of rings of fibrous cartilage surrounding the nucleus which resist the forces of rotation.. Most of the disc has a very poor blood supply so it relies on the squeezing and releasing of the spine through everyday motion to provide it with  nutrition, much like squeezing soap though a sponge. To maintain health, the disc maintains a delicate balance of breaking down and rebuilding. This balance is easily disrupted by factors such as aging, mechanical loading, and environmental and genetic factors.

How is the disc damaged?

Disc degeneration is part of the natural process of aging but can also be caused by excessive and/or repetitive loading.  Disc herniation, also known as a disc bulge, occurs when the annulus tears and the disc begins to change shape, sometimes leaving it’s normal confines and pressing on the spinal cord or nerves. Disc herniation can occur as a result of degeneration or from a sudden injury such as very heavy lifting or a car accident.

What can I do to keep my discs healthy?

  • Don’t smoke. Smoking has been demonstrated to have a profound impact on disc degeneration and herniation. Smoking causes changes to the chemistry of the disc resulting in decreased cell production, disruption in cell architecture and disintegration of cells and matrix.
  • Keep a healthy weight. Increased body mass increases the load on the disc, accelerating disc degeneration. There is also evidence to suggest that there may be a link between disc degeneration and the secretion of the peptide hormone leptin from adipose tissues. This hormone is a biomarker of obesity and is believed to promote the production of abnormal nucleus cells.
  • Stay active, but don’t overdo it. Mechanical loading effects on the disc depend on how much of a load there is and how long it lasts. The normal pattern of unloading at night and loading during the day maintains the balance of breakdown and rebuilding in a healthy disc. If the disc does not get enough of a load, it begins to swell and lose structure. But continuous or excessive loading causes cell death and disc degeneration. So moderate loading is best: laboratory and clinical evidence suggests that moderate mechanical loading promotes effects which protect and repair the spine and may delay the development or progression of disc disease.

Can the disc heal?

Well, that depends on location. The nucleus and inner annulus does not have a blood supply, so it does not heal well. In fact, it is still uncertain if regeneration and repair of the nucleus or the inner annulus is even possible. But there is some research that suggests that releasing compression on   a degenerated disc results in rehydration and chemical changes which indicate tissue recovery. In terms of the outer annulus, the news is better; it appears to demonstrate good healing potential. In animal models, the outer annulus has been shown to be able to resist  pressure within the nucleus in as little as six weeks of healing. The outer annulus is different from the nucleus and inner annulus in several ways; it is anchored directly to bone, has some blood supply and shares similar cells and composition to tendons and ligaments. It has been shown that application of appropriate levels of tension along the lines of fiber orientation assists healing in tendons and may assist in reducing excessive scar formation following an injury. Since the outer annulus shares several important characteristics with tendon, we can apply these healing principles to the outer annulus to promote healing.

So exercise can help heal the disc?

We think so, but the exercise has to target each part of the disc separately and be progressed individually, depending on where you are in your healing process. We use rotation exercises to encourage healing of the annulus and modified compression-decompression exercises for the nucleus, starting with the right amount of force for where you are in your healing process and progressing as you improve.


Getting Back to Gardening

By: Gema Sanchez, PT

If you are a gardener in Portland, February is the longest month of the year. You wait for those rare sunny days and bundle up to finish the fall clean up, admire the hellebores and hunt around for the first signs of Spring. And while all that fresh air and sunshine is good for the soul, your body may be a little stiffer than it was in the Fall, putting you at risk for injury. Here are some recommendations to prevent injury as you transition back to the gardening season:


  1. Alternate light and heavy tasks: Analyze what you have to do and determine if it is a light task such as stacking tomato cages or a heavy task such as clearing awkward branches. Give your body a break from the heavier tasks by alternating them with the lighter tasks. For example, take a break from taking out dead shrubs by spending some time tidying up plastic pots from last year’s garden. After moving heavy pots, rest your back and arms by doing a light task such as starting seeds. When you alternate heavy and light tasks, you use your body in different ways, thus reducing overuse.
  1. Take frequent breaks from repetitive tasks. Early spring cleaning often involves repetitive tasks such as clearing debris and weeding. Staying in these forward bent positions for long periods or repeatedly reaching down and coming back up can be very hard on your back. Remember to take frequent breaks to stretch your back and legs and walk around a bit. A good place to start is to take a 10 minute break for every 30 minutes of work.
  1. Sharpen your pruners and saws: Dull blades are not only dangerous but very hard on your hands and arms. Pruning is much easier, more precise and better for you and your plants with sharp tools in good working order. Pruning can also be a repetitive task, so take frequent breaks to rest your hands and arms, especially if you are pruning thicker branches.
  1. Remember your biomechanics: All the basics of proper lifting and carrying very much apply in the garden. Bend your knees, carry objects close to you, alternate sides when you are carrying buckets or watering cans and get help for awkward or very heavy lifting.
  1. Bring your work to you: Whenever possible, bring your work to your level. Use a waist level surface for potting, transplanting, seed saving, tool maintenance and any other task you can easily lift onto the surface.
  1. Cool down with some stretching: After a day in the garden, take a few minutes to stretch out, especially your back, shoulders and hips. Your therapist can help design a program that is right for you. Hold stretches for at least 20-30 seconds and remember stretching should never be painful.
  1. Start out slow: As tempting as it is to spent the entire day working in the garden, consider limiting your time to a few hours the first day. Or at very least, take a good long lunch break, put your feet up and admire you work.

Pillow Talk: The Importance of Sleep Posture

Choosing the Right Pillow. New Heights Physical Therapy in Vancouver WA and Portland OR.

By: Gema Sanchez, PT

Having the right pillow can make all the difference in getting a good night’s sleep, especially if you have head or neck pain. The purpose of a pillow is to support to your head and neck in good posture as you sleep. Which pillow fits you best depends on two factors: the side/shape of your body and what position you sleep in.

Neutral Position

The first step to choosing the perfect pillow is understanding what position your head and neck should be in. Whether you are sitting, standing or laying down, the optimal head position is neutral. In neutral, your head is positioned centered on your body facing forward, not tipped or rotated in any direction. This position optimizes spinal alignment and minimizes stress on the muscles, ligaments and tendons. When you are laying down, the pillow should be supporting your head so that it can rest in a neutral position.

One good way to see what position your head is in when you are sleeping is to have someone sit at the side of your bed and take pictures of you laying down with your pillow.  Look at the pictures and analyze the position of your head in relationship to your body. Is is positioned in neutral? When you are laying on your side, the pillow needs to fill the space between the bed and your head. If the pillow is too thin, your head will be tipped down toward the bed and if it is too thick your head will be tipped up toward the ceiling. When laying on your back, the pillow needs to fill the space between the bed and the back of your head. If the pillow is too thin, your head will be tipped back toward the bed and if it is too thick your head will be tipped up toward your chest. Also, look at the curve of your neck. Your pillow should be completely filling that space and supporting your neck.

Pillow Types

A good pillow is made of something that is both flexible and resilient. You need to be able to form it to the curve of your neck to support it but it still has to be solid enough to support the weight of your head. Feather pillows or synthetic pillows with similar qualities to feathers do this very well. They are also easy to reshape as you change sleeping position.

Memory foam pillows do a good job of supporting the head when you are laying on your back, but are often too firm to cradle and support the neck well. You can’t fold them to adjust the thickness, so they are usually not thick enough to provide good support when you are laying on your side.

Some pillows are shaped specifically for back or side sleepers. But they are not one size fits all. The curved part of the pillow meant to support your neck is not adjustable, so for many people, they are either too large or too small. Also, very few people stay in one position when they are sleeping. So, for instance, if you are using a pillow designed for a side sleeper and you roll onto your back, the pillow cannot adjust to your new position and will not give you the support you need.

The Pillow Test 

Pillows wear out over time, so if your pillow is older, check to see if it still has enough loft to do it’s job. Try this test: fold the pillow in half and release it. It should bounce back to it’s original shape. If it doesn’t, it is no longer able to loft up and provide you with enough support. Replace it.

Stomach Sleepers

What about sleeping on your stomach? If you have neck pain, you have likely been told that you should not sleep on your stomach. Applying what we now know about head posture, you can see that the reason for this is that in order to breathe while you are sleeping on your stomach you have to position your head rotated to the extreme right or left. This position is very stressful on the neck.  If you can train yourself to avoid sleeping in this position, do. But changing your preferred sleeping position can be very difficult and you may find yourself rolling onto your stomach in your sleep. In order to protect your neck while laying on your stomach you need to position your head as close to neutral as possible while still allowing room to breathe. One way to do this is by resting your forehead on the edge of the pillow. This allows your head to stay in neutral while providing room to breathe. Another is to ditch the pillow altogether and rest your head in the crook of your elbow. This allows you to breathe with your head positioned only slightly in rotation.

Here’s to perfect pillows and a good night’s sleep!

Running Out of Injury

By: Michelle Gilpin, DPT

In last month’s blog post, we talked about the epidemic of running injuries. Running injuries occur in the majority of runners. Why? First of all, the number one predictor of injury is a history of injury. Often it is because the cause of the injury was never treated.

Let’s explore:

We find a weak core and hips in almost every runner we evaluate. Your legs will carry you pretty far, but if you don’t have a strong core and hips serving as a foundation, eventually those legs are going to wear out. Your first sign will be an ache in the knee, hip, and sometimes even in the back. Often, this is when people grab the Rock Tape, knee brace, or buy a new pair of shoes. This might give you some temporary relief, but it doesn’t really fix the problem. One of two things are going to happen, your pain is going to come back – with a vengeance- or you’re going to get pain somewhere else, because now you’re compensating for that pain and weakness. There’s a saying in physical therapy that applies well to runners, “where you think it is, it isn’t.” Treating the symptoms often does nothing for treating the problem.

The solution? Fix the problem of course! If you’ve worn out a tire because the alignment is bad in your car, does it make sense to just change the tire without fixing the alignment? No! You’re going to end up right back where you are. Same goes for your body.

Below are links to several exercises that every runner should be doing to gain and maintain core and hip strength. If you’re strengthening your core and hips, not only will you be helping prevent injuries down the road, but as you get stronger, you’ll be running farther, longer and easier!

These exercises are just a sampler of what is available. The best way for you to figure out where your weaknesses and malalignments lie is to get a running assessment done by a physical therapist. Find one who looks at your strength, balance and running gait – like us! Getting an assessment can help determine weaknesses, predict injuries and improve your form. So, get on it. Prevent those injuries before they happen and show the world what you’re capable of!

See you soon!



For more videos visit our New Heights YouTube channel.

Importance of Hydration

The Importance of Hydration. New Heights Physical Therapy in Vancouver WA and Portland OR.

Importance of Hydration

The human body needs water to survive. Every organ and cell needs to stay hydrated in order for the body to function at its best. Up to 60% of the adult body is made up of water. It is used as the base building material in cells and performs a number of other benefits within our bodies. Age, weight, and gender determine the amount of water you need to drink during the day; athletes may need to drink more water because they lose more fluids during physical activities.

How Do You Know if You Need Water?

A good way to determine if you need to drink more water is to check the color of your urine. The darker your urine is, the more water you need to drink. If your urine is light or has no color, then you are well hydrated. Other signs of dehydration include fatigue, dry mouth, headache, and dizziness.

Reasons for Staying Hydrated

The importance of hydration is essential not only for physical health, but for mental health as well. There is an extensive list of benefits to drinking plenty of water, here are some of the most discussed topics.

  • Increase in Energy and Improved Productivity – Dehydration can cause fatigue and significantly reduce brain function. If you’re feeling like your cognitive skills aren’t at their usual speed, it may be time to grab some water.
  • Improved Physical Performance – Physical activity causes your body to lose a lot of fluids. Staying hydrated before, during, and after exercise can make your workout feel better. Water can keep your performance up while exercising and prevent fatigue after.
  • Weight Loss – Often times when you feel hungry, it may be because your body simply needs water. Drinking water will not satisfy hunger. It is a way to control the calories consumed day to day. The next time you feel hungry, try drinking water first and it may surprise you.
  • Mood Booster – When your body is hydrated, it’s performing its best which helps put you in a good mood. If you notice yourself slipping into a negative mood, drinking water can help.
  • Headache Prevention – Headaches are often due to dehydration and can be relieved by drinking water. It’s important to stay hydrated to avoid headaches and migraines, particularly if you are prone to getting them.

Some people struggle to drink water because they don’t like the taste. Drinking something that tastes like nothing can get boring. There are ways to improve water such as adding fruit, lemon is common, cucumber, or mint. Try spicing things up to stay hydrated!

FAQs About Hydration

Why is hydration important?
Your organs and cells need to stay hydrated to function their best.

Why is it important to drink water?
Up to 60% of the adult human body is made up of water. Your body needs it to survive.

Why is hydration important for athletes?
When you perform high-energy activities, your body loses fluids and electrolytes. If you are dehydrated you start to experience fatigue, putting yourself more at risk of injuries.

What is the importance of hydration?
Hydration is important for physical health like cells and organs, but for your mental health as well including preventing headaches and improving your mood.

What is proper hydration?
One quick and easy way to tell if you’re properly hydrated is to look at the color of your urine. If it is light in color, you are properly hydrated.

How does hydration help the body?
Being hydrated helps your cells and organs work properly. It also helps you stay focused, prevents headaches, and increases your metabolism.

How does hydration affect performance?
Staying hydrated helps prevent fatigue and helps your cognitive skills.

How does hydration help recovery?
Water helps in the recovery process in a variety of ways. After workout water will help replenish any lost fluids in your muscle cells, helping prevent delayed onset muscle soreness. Water also helps in the function of protein synthesis. If you’re dehydrated this process cannot take place, leading to the break down of muscle tissue.


Treating Painful Tendons – Tendinopathy and Its Real Cause

By: Gema Sanchez, PT

tendinopathy, tendinitis, physical therapy
Pain relief and increased strength are a few of the benefits of treating tendinopathy with Physical Therapy.

Pain and tenderness in a tendon, sometimes lasting for many months, is a fairly common occurrence. Many people would still call this tendon pain tendinitis, which means inflammation of the tendon. But when researchers began looking more closely at the structure of chronically painful tendons 20 years ago, they found that many of the painful tendons did not have inflammation. Instead, the tendons showed signs of degeneration without inflammation. These findings indicate that there is much more going on than just inflammation, so the diagnosis of tendonitis was no longer accurate. In an effort to more accurately describe the state of the tendon, a chronic painful tendon is currently diagnosed as tendinopathy, meaning a disorder of the tendon.

Tendinopathy is diagnosed using clinical findings. These include:

  • tenderness/pain with palpation of the involved area
  • pain with activity, stretching and contracting the muscle
  • decreased function
  • gradual onset of stiffness in the tendon
  • sometimes localized swelling and palpable crepitations (a crackling sound or feeling)

An ultrasound or MRI could be used to confirm clinical findings, but these tests are not accurate for diagnosing tendinopathy.

Tendinopathy affects both athletes and non-athletes. The most commonly affected tendons are the Achilles, kneecap, shoulder rotator cuff and elbow extensor tendons. Pain can be debilitating, leading to the inability to perform work and sport activities.

Causes of tendinopathy are not yet fully understood.  It is believed that it occurs due to a combination of intrinsic factors (such as muscle tightness/imbalance/weakness, age, joint hypermobility and systemic disease) and extrinsic factors (such as occupation, physical load and overuse, inadequate equipment and environmental conditions).

Treatment of tendinopathy has influenced and been influenced by the evolving understanding of tendon pathology and healing. Various forms of intervention aimed at decreasing pain and promoting tendon healing have been used. These include: extracorporeal shock wave therapy, low level laser, glyceryl trinitrate patches and injections. Surgical intervention has been shown to be successful in non-responsive cases, but is in general considered a last option.

The most widely used and favored treatment for tendinopathy is eccentric exercise, which has been shown to reduce pain, improve function and normalize tendon structure. Eccentric exercise refers to a specific type of muscle contraction. There are two types of muscle contraction, concentric and eccentric. A concentric muscle contraction is when a muscle contracts while getting shorter. This is what you normally think of as contracting a muscle to move a joint, for example, flexing your biceps to bend your elbow. An eccentric muscle contraction is when a muscles contracts while getting longer. When you are relaxing your elbow back down to straight, the biceps works eccentrically to slow and control the motion.

 In order for an eccentric exercise program to be effective for treating tendinopathy:

  • loading must be customized to the particular tendon involved, taking into account length of tendon, load, and speed
  • exercise program should be as similar as possible to the usual mechanical stressors that the person experiences
  • exercise must be gradually progressed
  • exercise progression must last for at least 12 weeks

Physical therapists have the correct training and knowledge to design, monitor, instruct and progress a customized eccentric exercise program.. They will provide you with a program that stresses the tendon in the right way to promote healing and help you return to your normal work and sport/recreation activities safely and without pain.