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UNLEARN YOUR FEAR

I have had a lot more of my patients discussing how they are fearful or "in their head" about completing certain aspects of their sport. It prompted me to want to dig deeper to understand fear and how it works. Fear is one of our oldest emotions and was intended to help protect you from a perceived threat. What has motivated me to complete more research on this topic, is that it appears some of my athletes perceive themselves to be a threat, and I wanted to learn how to help them through the injury process. Let's first address the injury process.

INJURIES

Being injured can create an entire identity problem and a mix of other emotions. The first step is remembering that you are more than your sport and that this is just a bump in the road. I know that is easier said then done, but often times injuries come at the worst time when you want and need to feel your best (I am looking at all those achilles ruptures at the Olympic qualifing meets for the elite gymnasts last year). Being injured can make you feel less valuable, and afraid. Many athletes think they will not be able to play at the same level and can become depressed thinking about everyone progressing while they are sitting. The good news is the brain is a powerful tool that can help you both in your rehab and with fear of returning to sport.

HOW FEAR WORKS

Here's how it works. Fear is manufactured in the amygdala - which is located in the brain and is primarily involved in regulating emotions. Since we Americans enjoy likening anatomy to food related items, we can describe the amygdala as looking like an almond.

What we have recently discovered is that there is a fear pathway and that your brain prioritizes storing fearful memories. This is by design to keep you from making a fatal error. What does this mean when you sprained your ankle doing a jump and you are now afraid of doing that jump or any other because it might hurt? You guessed it. You have a strong memory made to protect you from doing it again. So how do you get past it?

MOVING PAST FEAR

It boils down to control and how you can relabel the fear if it is not indeed a genuine threat. What's my job as a PT? Well I take more of the exposure therapy approach. That means I try and dose just enough of the fearful stimulus by mimicking the skill or other similar skills so that your fear goes the way of the dinosaurs by way of extinction. Extinction is the medical term for exposure therapy whereby exposing you to the stimulus and having no negative outcomes can reinforce safe completion. It is my job to make sure you are strong enough to complete the skill, have improved mechanics that may have been faulty or your brain perceives are faulty, and encourage you to participate once things have healed.

Some "experts" think how we phrase things in the clinic can impact outcomes, most faulty mechanics don't really lead to injury, and all scans are bogus, and more. I agree with these thoughts to an extent. If a dancer continues to sickle while jumping the odds are higher they might sprain an ankle. If a baseball pitcher continues to use just the arm without more lower body support and activation they could increase the risk for an elbow injury. You get the gist. It's like a weather warning. The conditions are right, so we need to be careful and do what we can to prevent a problem. It does not always mean a storm is going to happen; but when the time comes that your care team has decided your strength, alignment, and phases of healing have reached the mark where you can revisit return to your sport - fear can still get in the way.

RELABELING

This is the day you have waited for, so what happens when you are too anxious or afraid to try? This is where I have recently found some of my patients. They know they are ready, they want to be ready, but the brain has strongly wired fear. This creates confusion and perhaps some other emotions. We might decide we have failed it even quit the sport because we can't get out of our own way. There is hope. We can overcome these feelings by relabeling. Relabeling turns the fearful event into something familiar like, "I have done that switch leap so many times, and a ton of jumps just like it, so even though it might seem like I can't, I know I can and that I am safe doing it".

VISUALIZATION

Another step is working to visualize the skill. Your brain pathways are so strong that scientists think your brain is not able to distinguish if you actually did the event or just thought about it. Seeing yourself do the skill well also increases your confidence and helps relabel the scenario in your brain. You also want to ask your brain, "is this true?" It's a great way of making a more emotional program of fear more logical and realistic.

Finally you can help by getting more rest, checking your nutritional status, and making sure you are appropriately active.

I am not saying it's easy, but everytime you have a win, you gain more confidence and the fear starts to go away.

We will do our best to help you along each step.

We also partner with Danscend to help our dance specific population. If you need help connecting with a sports psychologist we are happy to help.

WORKS CITED

How can visualization be used to overcome fears and phobias? (n.d.). Selfpause.https://selfpause.com/visualization/how-can-visualization-be-used-to-overcome-fears-and-phobias/

Team, NeuroLaunch editorial. “Rewire Your Anxious Brain: Effective Strategies for Lasting Change.”NeuroLaunch.com, 30 Sept. 2024, neurolaunch.com/rewire-your-anxious-brain/. Accessed 30 Jan. 2025.

“The Science of Being Scared: How Your Brain Reacts to Fear - CogniFit Blog: Brain Health News.” CogniFit Blog: Brain Health News, 28 Aug. 2024, blog.cognifit.com/how-your-brain-reacts-to-fear/.

Saab, Linda, and Arash Javanbakht. “What Happens in the Brain When We Feel Fear.” Smithsonian, 27 Oct. 2017, www.smithsonianmag.com/science-nature/what-happens-brain-feel-fear-180966992/.

VIBRATION PLATFORMS

The entire concept for vibration platform training originated in Space Science. It was noted that returning astronauts in the Russian space program returned with loss of bone mass. They began to use this training to assist with strengthening bone and muscles.

Vibration training works by making your muscles reflexively contract which increases the activity of the muscle. Several research articles have looked at the benefits of vibration training over the past few years. For instance, Luo et al. discovered that, “Current findings suggest that vibration training my have positive acute and chronic effects on neuromuscular performance and training”.

Jordan et al. also concluded that, “It would appear, based on the limited scientific evidence, that vibration training may serve as a tool to develop explosive ability in athletes”. While these are more art versus science in terms of scholarly article criteria, more and more research is being done on this tool and its efficacy.

Current understood benefits of vibration training are helping strengthen muscles, help with stress incontinence, assistance with flexibility, circulation, balance, proprioception. There seem to be endless applications of how vibration can be helpful and the one we have in the clinic is very low in vibration intensity.

If you have a pacemaker, are pregnant, have a cemented joint implant then this tool may not be the best for you - but we are excited to have these types of state of the art equipment as options for our patients.

NormaTec Compression

We are pleased to announce we have NormaTec compression technology….. GREAT! But what is it?

What does compression technology do?

Compression technology helps improve proprioception (where the joint is in space), improve blood flow, reduce swelling, decrease the perception of soreness after exercising, decrease the amount of creatine kinase in the blood stream (which is from injury to muscle tissues after intense exercise), and increase oxygen to the muscles.

What are the benefits of the NormaTec system we have in the clinic?

It has a pulsing component to the compression so it more closely mimics the way that muscles pump. It also helps the veins and lymphatic system, which are only equipped with one way valves, to hold pressure and not allow pooling into the lower aspects of the extremities. This is more advanced than regular compression therapy due to its distal release and the gradients it provides. It also means the limb gets rest time between compression cycles which provides more benefits.

Does it Work?

YES! Lactic acid build-up is still not well understood but appears linked to the inflammatory process which allows the creatine kinase release; however, creatine kinase can be decreased with compression technology which assists with improved muscle tissue repair. It also lessens pain sensitivity, can regulate gene expression in muscle tissue, decreases fatigue after exercises, and assists with improved range of motion.

Are there other Benefits?

The compression garments we have in the clinic can assist with injury healing by reducing the inflammation and improving the blood flow. Specific injuries that can be addressed are overuse injuries to tendons and ligaments in addition to muscle strains and sprains.

Who can use it?

Weekend warriors and athletes, persons who stand or sit all day and have poor circulation, pregnant females who wish to reduce the edema in the legs especially once in the 3rd trimester, anyone trying to freshen up their muscles especially if training daily.

Who should not use it?

People with: acute pulmonary edema, acute blood clots, acute congestive heart failure, acute infections, wounds/lesions/infections or tumors, where increased venous and lymphatic return are not desired such as with peripheral vascular disease, bone fractures or dislocations near the site.

Should I just rely on the boots?

No. Active recovery is still the best recovery and there are many factors involved in achieving optimal performance. What are some examples of active recovery? Interval training like jumping jacks for a minute and then walking for 2 minutes and repeating this task. On rest days you can also use active recovery like walking or swimming to help decrease overtraining as long as it is only at 30-60% of your max heart rate. Nutrition, sleep, and stretching are also important parts of your recovery process.

Arts and Athletics is committed to keeping you living your life without limits so come in today to get started on your journey to feeling better and training harder!

NUTRITION

March is National Nutrition Month® and part of any great recovery or success in sport at an elite level requires adequate nutrition. Muscles depend on protein to rebuild and become stronger after an injury. An under fueled elite athlete could struggle with injury, fatigue, soreness and trouble advancing in their sport. Caring for the whole patient is our number one goal at Arts and Athletics Physical Therapy which is why we are pleased to announce a partnership with Nutrition Aligned and Sarah Atlas, RD.

Emily has known Sarah for nearly a decade and Sarah has personal insights into both recovery nutrition (post-op and post injury) and nutrition for elite athletes, as well as being an expert in her field and evidence based in her practice.

Although physically located in Nevada, Sarah is able to offer tele-health care.

For more information please visit Nutrition Aligned's website.

Emily has also purchased a series of infographics from Nutrition Aligned designed specifically for Arts and Athletics to help answer basic questions on anti-inflammatory foods, RED-S, sample snacks and meal options to make sure your body is working optimally to help you live life without limits.

WOMEN IN SPORTS

The first week of February marks National Girls and Women in Sports Day that was designed to acknowledge the accomplishments of female athletes. The day was first observed in 1987 to remember Olympic volleyball player Flo Hyman. Women have come a long way in sports since Title IX was passed in 1972 which meant that there were equitable sports opportunities for all students regardless of gender.

According to Women’s Sports Foundation females tend to drop out of sports by age 14, which is 2x higher than their male counterparts, but research has shown that participating in sports has many benefits. As we have discussed in prior blogs, being active helps with mental health, decreases risk for developing chronic diseases due to a sedentary lifestyle, increases confidence and improves self-image further illustrating why participation in a sport can be life changing.

Another hurdle any athlete faces, but also females in a disproportionate amount, is injury. Females face challenges of increased injury risk during their period with researchers finding that the risk is not random and peaks during the first two days after the onset of menses and during ovulation (or days 1-6 when estradiol and progesterone are at their lowest). This makes the chance of major injury more likely. Recent research from Smith et al reviewed a wide body of literature and found that female athletes are at a 4-10x higher risk for developing ACL injuries due to these hormonal fluctuations than their male counterparts.

With all the limitations that could impact girls and women in sports, Arts and Athletics Physical Therapy wants to empower you to live life without limits. Whether you need help with strength, injury prevention, easing back into a sport or fitness routine we are here for you and understand your unique needs as an athlete. Please reach out to schedule a free assessment so we can take whatever is holding you back and use it as a steppingstone to get where you want to be!

Nutrition: Make sure you are getting enough carbs. The brain alone uses 130g of carbs per day. Carbohydrates are not the bad guy or inherently fattening or inflammatory, but instead are your fuel. Make sure you use the power of carbs before, during, and after rehearsals. Try oatmeal and fruit plus eggs for breakfast, a sandwich or baked potato at lunch, fruit and nuts for snacks in your bag, and rice/pasta/bread for dinner with veggies and protein to help with muscle repair and recovery.

Unwind: Remember this is a draining time mentally and physically. Take a few minutes to unwind with a guided meditation, a quick cup of coffee, deep breathing, or anything else you find relaxing. This is a great time to use a heating pad on those sore muscles or even better, enjoy a relaxing hot bath. Take 10 minutes to sit in the sun first thing in the morning for about 10 minutes and just relax. This is a great way for us to get some Vitamin D especially since tech week keeps us indoors.

Time is short when you are performing so working on time management skills are key. Try not to save everything on your list and your holiday shopping for your down days from dance as you will want at least one day that is just for you. Making a schedule for your week ahead can help you best determine how to spend those precious few days off. You might have to say no to extra requests to hang out with friends and family to make sure you are not overbooking yourself.

Confidence: Performance week can be hard emotionally. Remember you got this far because you are talented and this opportunity to perform has been earned. With notes on how to improve your performance it can be hard not to take things personally. Remember those notes are for you as a dancer not you as a person. Keep calm and confident.

Reassess: Do you have enough pointe shoes, are they darned, do you have a first aid kit, toe tape, extra hair accessories? Making of list of emergency items you may need and checking it twice to make sure you have all necessary supplies will help to decrease stress. Grab your heating pad to help with sore muscles, maybe some Biofreeze as well in case you have an ache or pain that is minor and would benefit from some quick TLC.

Active Recovery is a way of letting your body catch up to the physical demands and allow it to get stronger. This means doing Yoga, light stretching, a walk, or the Pilates reformer. For dancers we want to do anything that is not pounding on the joints to allow the bones time to recover since most stages are harder and we do quite a bit of jumping. Active recovery helps to increase blood flow and decrease muscle soreness.

Caffeine: If you are 12-17 it is advised not to have more than 80-100mg of caffeine a day. Caffeine is not as bad as we think and drinking coffee or tea counts as a method of hydration since it contains a lot of water. Turns out it is not truly dehydrating us like we think, and often can help as long as we are not overdoing it - which could increase our anxiety and heart rates in higher doses. Combining coffee/tea with dairy can also increase calcium exposure.

Keep Positive: This is a tough time, but having a positive attitude will help you manage everything that you will need to deal with this week. You have your lists made, you know what nutrition you need, you have recovery techniques so now - enjoy what you have worked so hard for. It goes fast, so enjoy those fun moments on stage and where all your hard work has gotten you.

Energy: Increase your endorphins by working up a sweat. We talked about not doing a lot of pounding, so swimming, bike riding, even doing a body weight work out like a circuit can be helpful for about 20-30 minutes. Try a combination of glute bridges, planks, wall sits, deadlifts, and curtsey squats and just keep rotating through these with 30 seconds on for each and 30 seconds off. This acts almost like a HIIT workout which is designed to get that heart rate up but will not have you pounding your joints.

Recovery: Make sure you are giving yourself ample nutrition to assist with recovery - research shows that chocolate milk is ideal for recovery. Low fat chocolate milk helps restore muscles, and replenish fluids and electrolytes lost in sweat. Foam rolling, and stretching and adequate sleep are also necessary to improve performance. Professional athletes require 8-10 hours of sleep to be prepared for the next day. Athletes that have recovered well between bouts of activity are going to decrease their injury risks and generally have better energy.

DIABETES

November is Diabetes Awareness Month- How Does Diabetes Impact Your Musculoskeletal Health?

DID YOU KNOW? With diabetes certain musculoskeletal conditions are more prevalent like frozen shoulder, carpal tunnel syndrome, and even arthritis. Physical activity is considered one of the three cornerstones for the management of diabetes due to its generally low cost, and ability to promote aerobic and cardiovascular benefits. In addition, it appears that exercise can lower A1C over time which can decrease the risk of diabetic complications.

Diet, medications, and exercise are the hallmark treatments for Type II Diabetes. Research indicates favorable disease reversal in persons with Type II Diabetes who can lose weight since it can eliminate fat in the pancreas. Sometimes people with diabetes cannot tolerate corticosteroids or other pain-relieving medications due to their impact on blood sugars which can make exercise hard since joint pain can be a common finding in this population. In fact, medications used to treat common comorbidities in Type II diabetics and even those patients without Diabetes can often end up hospitalized with combinations of these medications due to their effects on blood sugars. Pharmacist Salum Mkata provides this list below:

So, where do you turn if you have joint pain and Diabetes and are looking for pain control, safe exercise, and ways to decrease your other medications to help with symptom management? Physical therapy is a great resource as we can assist with mobility, provide exercises to help with safe joint loading, weight loss and countless other ways to improve your daily life. Please make your appointment today and let Arts and Athletics Physical Therapy help you live your life without limits.

REFERENCE MATERIAL: Smith LL, Burnet SP, McNeil JD - Musculoskeletal manifestations of diabetes mellitus - British Journal of Sports Medicine 2003;37:30-35.

DEPRESSION

Depression impacts about 280 million people across the world. Many people who have depression often go undiagnosed due to the variety of ways it can present in different individuals, the overlapping of symptoms with other co-morbidities and the way depression can fluctuate (such as seasonal depression). Although activity may seem like the last thing people suffering from depression want to do, the encouraging news is that even just a bit of exercise can help with symptom management. You don’t even have to complete the exercise all at once. Accumulating little bits of exercise throughout your day can benefit both your physical and mental health. So how does exercise help? It increases circulation to the brain in addition to providing a sense of accomplishment by becoming stronger or increasing a sense of well-being.

Looking at 15 studies researchers found that about 12% of depression cases could be prevented with exercise. Brisk walking for 2.5 hours a week had a lower risk for depression than people who did not exercise at all. Research also supports that you can get by with half of the amount of exercise you need for your physical health; however, there is something to be said by too much of a good thing since benefits do not appear to increase for exercise above the recommended physical activity guidelines. Too much exercise can manifest as burnout in athletes and teens and mimic depression.

Regular exercise equates to decreased symptoms of depression. Not sure where to start or how to start? Please contact Arts and Athletics Physical Therapy today. We can help you establish a program that works for you and helps you feel safe, empowered and able to better tackle your day to day activities.

Kim, J. H. (2022). Regular physical exercise and its association with depression: A population-based study short title: Exercise and depression. Psychiatry Research. https://doi.org/March 2022

Murez, C. (2022). Exercise is Powerful Medicine for Depression. U.S. News and World Report. https://www.usnews.com/news/health-news/articles/2022-04/13/exercise-is-powerful-medicine-for-depression

Activity guidelines from the CDC are 150 minutes of moderate intensity aerobic activity a week. Some examples are walking your dog, swimming, biking, mowing the yard. The second component of recommended exercise is strength work 2 or more days a week that work all the major muscle groups- legs, hips, back, chest, shoulders, core, and arms. Some examples are lifting weights, using resistance bands, planks, push-ups, digging and shoveling. Here is an infographic from the CDC for kids and teens and adults

HOW TO RETURN TO SPORT the S.A.F.E. way

RETURN TO SPORT

Whether you have been sidelined due to an injury, illness or just taking a much-needed rest break from your sport, there can still be some questions about how to safely get back in the game. While taking a break can reduce burn out and risk for injury, it can be equally challenging thinking about how to get back into the game. With school having started, here are some tips to help you be ready for return to sport with the easy to remember acronym SAFE.

"S"

Start slowly. UC Davis Health recommends that if you are still moderately fit you start back at 50% of your prior activity level every other day, or 3 times a week. If you are doing well with that after your first week you can increase your duration or how hard you are working by 10% each week. Remember to make slight changes one at a time. So, do not increase your weight, add more distance to your run, or even change your shoes all at the same time.

"A"

Add Goals - Make some SMART goals. Those should be specific and realistic as well attainable. This will help you stay motivated and allow you to continue to progress with your training. Start with some specific to your sport or activity. An example would be, I will complete the same number of heel raises on each foot in 30 seconds to demonstrate I have improved lower leg strength to help with my running, jumping, and overall strength.

"F"

Find a friend. Finding a friend helps motivate you to continue your course, and you can help each other make sure you are not overdoing it. A friend can also help remind you that your goals are attainable and to be patient with yourself as getting back to your sport takes time and persistence. Some days are harder than others and a good friend can help by listening and encouraging you to keep persevering.

"E"

Eliminate comparison – Remember everyone is different and develops at various times. Some people may bounce back quicker than others. You could have had a growth spurt which can change your muscle length tension and endurance. Someone else may have been more active over the break. Remember to take things at your own pace and listen to your body.

SOURCES CITED

Waite, Brandee. “Browse Topic: Rehabilitation: News: UC Davis Health.” Browse Topic: Rehabilitation | News | UC Davis Health, 10 Jan. 2022, https://health.ucdavis.edu/news/topic/rehabilitation.