Why Does Manual Therapy Work?

manual therapy

Your hips were feeling stiff so your physical therapist performed massage on your glutes and you found you could squat deeper. Your physical therapist gave you a thoracic manipulation when you were experiencing neck pain and you suddenly found you could turn your head further to each side or lift your arms above your head without pain. The effects of manual therapy (massage, trigger point, manipulation, Graston or joint mobilization) are real but until recently have been somewhat misunderstood.

So why does manual therapy work? Before getting into a long winded explanation, the short answer is:

A complex phenomenon that is based on several factors such as patient education, your prior experiences and your nervous system.

As detailed in an editorial in the Journal of Orthopedic and Sports Physical Therapy, “manual therapy effects are multifaceted unlike drugs with identifiable ingredients and systemic interactions.” A stimulus such as touch, pressure or a metal tool has an effect on tissue stiffness and range of motion based on the way your physical therapist explains treatment to you and your beliefs about pain, which causes changes to your pain pathways, which release certain chemicals and decrease your pain. This allows you to move better with less pain among other feel good things that come along with physical therapy. This explains why after treatment your range of motion and mobility continue to improve while your pain continues to decrease. Manual therapy is not necessarily “breaking up scar tissue” or permanently increasing the length of your hamstrings. Because of the factors stated above, your body is able to “realize” you have underutilized available pain free mobility. It then becomes your responsibility as a patient / client (with the guidance of your physical therapist) to strengthen and maintain within your newly acquired range of motion.

physical therapy

If you are having pain, want to prevent pain, or want to improve your mobility to perform sports and your hobbies come in for a mobility assessment and treatment by contacting us at 212-439-1596 to set up an appointment.

– Dave Garaffa PT, DPT, CSCS

What is overtraining syndrome?

By: Jillian Chiappisi PT, DPT, SCS

Although somewhat controversial, “overtraining” is actually considered to be a syndrome in and of itself and is evidence of a body that is being pushed past the point of its ability to heal and repair itself.

According to the authors of this article, which studies gymnasts as a sample population, an increase (over the normal average morning resting heart rate) of just a few beats can indicate overtraining syndrome.

How can I tell if I’m overtraining?

Taking a morning heart rate is an easy way to check if your body is experiencing signs of fatigue and / or overtraining.

    Measuring your heart rate first thing in the morning, just after walking up, can tell you a lot about the processes of healing going in your body. 

“As soon as you wake up in the morning, find your pulse on your neck, just under your chin, or on your wrist. Using the watch, count the number of times your heart beats for 20 seconds. Multiply this number by three and you will have your resting heart rate (RHR) in beats per minute (bpm). Record this number in your notebook next to the day’s date. Now make sure to repeat this process every morning. With each passing day, you’re creating workouts to ensure that you’re recovered.  You can also look at this data when you think you might be facing a case of overtraining.”

For a more detailed example of how to check heart rate, and for age related normal values click here.

How can I avoid overtraining?

  1. See a physical therapist
    • A physical therapist can evaluate your movements and help determine inefficiencies, potential areas for concern, reduce overall risk for injury.
    • A physical therapist can help you structure your training to incorporate the right amount of rest and work to help keep you below injury and overtraining thresholds.
  2. Tracking training 
    • Charting or journaling your training can be a great way to avoid increasing too much too fast.
    • As a general rule, and increase of more than “10%” per week should be applied to training. This is not an exact rule however, & if applied, should be carefully monitored by a health care professional to endure the proper application of the “rule” to avoid injury.
  3. Change up your modality of exercise 
    • One simple way to help reduce your own risk for overuse is by varying your type of training. Evidence shows that those athletes who preform more than one type of exercise considerable reduce risk for injury and overtraining.
  4. Life Style 
    • Achieving a well balanced athletic routine starts with sleep and requires regular maintenance throughout each and every day. Make sure you (or your young athlete) get plenty of good food, water, and sleep. Check out this roadmap by Dr. Joshua Eldridge of GymnastCare for more.
    • Sleep is an essential time for the body to go through its natural healing processes. Getting proper sleep is a key component in reducing risk for overtraining as well a injury.

Keeping​ ​Your​ ​Feet​ ​on​ ​the​ ​Ground

Did You Know…

1 in 4 Americans above the age of 65 fall every year? As individuals get older, the risk of falling increases. The fear of falling is also common as people age, even for those who haven’t fallen. The fear alone can lead people to avoid or minimize performance of their activities of daily living like walking, socializing, etc.

There are several factors (modifiable and non-modifiable) that can increase one’s risk of falling. Being aware of and addressing these risk factors can be instrumental in preventing falls and ultimately injuries.

Some of these risk factors include: lower extremity muscle weakness, poor vision, difficulties with gait and balance, psychoactive medications, postural dizziness, home hazards, previous falls, chronic medical conditions (diabetes, Parkinson’s, dementia, stroke, etc), lack of stair handrails, poor lighting, slippery surfaces, and tripping hazards in the home.


In order to prevent falls and decrease risk of falling, potential risk factors must beaddressed:

Here are some tips to help reduce your chances of falling:

  1. Stay physically active- Exercise improves muscle strength and coordination while decreasing the likelihood of developing osteoporosis. Research shows strength and balance training are effective in preventing fall related injuries.
  2. Eyes and ears testing ( Vision and hearing testing)- Utilize corrective lenses when needed to avoid tripping over objects. Make sure hearing aids fit properly.
  3. Sleep- Adequate sleep decreases fatigue.
  4. Decrease alcohol intake- Rate of fractures in older adults increase with the use of alcohol. Alcohol can impair balance and reaction time.
  5. Be careful when changing positions- Standing up too quickly can cause a decrease in blood pressure, which may in turn cause a feeling of lightheadedness.
  6. If you use assistive devices, such as canes, walkers, etc, make sure they are fitted correctly.

Preventing Fall Related Fractures

Fractures are one of the biggest concerns of those who fall and those who are fearful of falling.

Maintaining healthy bones does not necessarily prevent falls, but it does reduce the risk of fractures if one was to fall.

Calcium and vitamin D intake has been shown to help improve bone health. Vitamin D also plays a role in improving muscle function.

150 minutes per week of moderate intensity exercise has also been shown to improve bone health.

Reducing alcohol intake and cessation of smoking can prevent the loss of bone mass, therefore decreasing risk of fractures.

Maintaining a healthy weight can also decrease the risk of bone mass loss and fracture.

What do I do if I fall?

  1. Try to stay calm. Relax until you have gotten over the shock of falling.
  2. Determine if you are injured before getting up, as getting up incorrectly or too quickly may worsen potential injury.
  3. If you can get up, move slowly and safely, using a firm and stable object, to allow your blood pressure to adjust preventing postural dizziness.
  4. If you are hurt or cannot get up, ask someone for help or call 911:
    1. If you are alone, try to get into a comfortable position and wait for help
    2. Be sure to change your resting position in a safe and pain free way as often as every 20 minutes to prevent pressure sores
  5. Contact your physician. Letting your doctor know about a fall may alert him/her to an underlying medical condition, issues with medication, or an issue with eyesight.

For a falls risk analysis and falls prevention program, contact us at 212-439-1596 to set up an appointment.

NYC Marathon Advice

With two weeks to go until the New York City Marathon, as a first timer or a seasoned veteran, you might be asking yourself what is normal† to feel, and what isn’t normal to feel. Here are some tips to get you through the last 2 weeks before the marathon.

  •  Taper time!
    •  By now, you should be in your taper! One mistake that runners make is training hard right up to marathon day. Your body needs a rest.
    •  Most training programs should peak about 2-3 weeks prior to race day, and then decrease mileage by 50-75% over the next 3 weeks with little to no running in the 2-3 days leading up to the race.
    •  This allows you to go into the marathon with rested legs and restored muscle stores.
  •  Test those sneaks!
    •  Race day is NOT the day to break out those brand new shoes you just bought. You risk blisters and skin breakdown running long distances in brand new shoes.
      •  Make sure to run about 30-40 miles in your shoes before race day. If you haven’t broken out your race day shoes yet- now is the time!
      •  Use a shoe model that you are used to on race day- a shoe that changes your running style can result in injury.
    •  On the contrary, don’t run in shoes you’ve been training in for the last 6 months, either! This increases your risk for injury.
      •  Shoes should be replaced every 300-450 miles.
  •  Should I be stretching?
    •  A recent report from the CDC indicated that static stretching before† exercise does not reduce the risk of injury.
    •  Most evidence exists for dynamic stretching prior to activity.
      •  This involves elongating and shortening the muscles as they move through their full range of motion rather than holding them in one position.
      •  This can include running drills or a light jog prior to activity.
  •  Look out for injury
    •  Notice how your foot sounds and feels as it strikes the ground. Any difference in sound between feet or where your foot lands in relation to your body can predispose you to injury.
    •  Know that as you fatigue, your form is more likely to be compromised.
  •  Why should I see a physical therapist?
    •  A pain that persists more than a few days is a good indicator that you should see a doctor or physical therapist.
    •  A PT can help determine the cause of the problem and identify if a change in form or training will assist and allow the body to repair itself.
    •  Trying to “run through” pain can lead to compensations that can cause further injuries to other parts of the body.
    •  PTs can identify inefficiencies inform through a gait analysis and prevent pain from compromising race day health.
    •  What kind of pain should I see a physical therapist about?
      •  Pain that persists more than several hours after running
      •  Pain that climbs to >3/10 during your run
      •  Sharp pain, or pain that wakes you up at night
  •  Don’t be afraid of strength training!
    •  A huge percentage of runner injuries are ITB syndrome, PFPS, and hamstring strain. Strengthening the glutes can assist in all† of these injuries.
    •  Contact a physical therapist for a safe training plan for your injury!

For more information on running injury prevention or treatment, please contact Evolve Physical Therapy and Sports Rehabilitation at 212-438-1596 or use the “contact us” link on the upper right hand corner of your screen.

Most of all- enjoy the day! The marathon should be a victory lap for your months of hard work and training! Good luck runners!

Three Running Myths: Debunked!

As the first day of summer came and went last week, running season is officially underway. Whether you are out as a casual runner, a competitive runner, or just starting out, we all have one goal in common… to avoid injury.

There is a lot of information available to runners in magazines, throughout the internet, and even word of mouth. With so much information out there, how does one know what is fact and what is fiction? Today’s blog will debunk 3 common running myths in order to keep you in the know and injury free!

Myth: Running and impact sports will increase my risk for knee arthritis.

Many people are concerned about the impact that running has on the long term health of the lower extremity joints, including arthritis. A study published in JOSPT​ ​this June, looked at the effect of running on arthritis of the knees and hips. They found:

  • 3.5% of recreational runners went on to develop hip or knee arthritis
  • 10.2% of non-runners went on to develop hip or knee arthritis
  • 13.3% of competitive runners went on to develop hip or knee arthritis

What does this mean? Recreational running, defined as running less than 57 miles (92 km) per week, has a protective effect on the joints. Individuals who did not run had a higher percentage of arthritis than recreational runners. In addition to the many health benefits of running, this study allows us to be confident that recreational running will not harm your joint health.

Myth: If my knees hurt, it always means my quads are weak and I should strengthen them

Weak quads can wreak havoc on the knees in many sports, but for many runners with knee pain, there are other things at play. In many recent studies, one of the biggest impairments found in runners with knee pain is weak hip abductors​, more commonly known as “glutes”. Your hip abductors are the muscles that stabilize your pelvis when you stand or jump on one leg- however, running does not directly strengthen these muscles that stabilize us in the lateral and rotational planes.

This can cause an imbalance, as the muscles that allow us to keep running forward (quadriceps) get a much larger amount of training than those muscle that stabilize us (hip abductors). Training your hip abductors with simple exercises when you are not running, may decrease your risk of injury from running.

Check out this post by Mike Reinhold describing the different causes and treatments for knee pain. It is important to be evaluated by your physical therapist before beginning any strengthening program, as there are many causes of knee pain that could be impacting your running experience.

Myth: I should do static stretching before I run in order to warm up my muscles and make them more flexible.

Static stretching is also known as holding a stretch for anywhere from 10 seconds – 1
minute with the goal of lengthening a muscle. When one performs a static stretch, the collagen
bonds of the muscle are essentially ripped apart, loosening the structure which is then able to
heal at an increased length. This tearing causes a local inflammatory event in the muscle, and
temporarily decreases the body’s ability to perform at peak capacity. Therefore, to perform static
stretching and damaging your muscles (even if it is at the microscopic level) before a workout
can be detrimental. If your goal is to increase muscle length, these types of stretches should be
done after ​the workout.

A dynamic warm-up, unlike static stretching, increases blood flow to muscles and wakes
up the nervous system, before a run. A dynamic warm up, including a light jog or gentle jumps
or drills, causes short term muscular and neurological adaptations to improve function prior ​to
the workout. Check out some examples of dynamic warm ups from physical therapist, Chris
Johnson here.

The idea that more flexibility is better does not always apply to runners. It is important to
have enough range in your lower extremities to run, and it is important to have symmetrical
flexibility from side to side, but there is no research to show that extra mobility at a joint can
protect you from injury. Having excessive mobility can be just as detrimental as having restricted

For more information on running injury prevention, developing a training program for a race of
any length, or running analysis, please contact Evolve Physical Therapy and Sports
Rehabilitation at 212-438-1596 or use the “contact us” link on the upper right hand corner of
your screen.

Always consult with a medical professional before starting an exercise program.

5 Tips on How to Make Exercise Work for You!

Making time for and sticking to an exercise program can be tough. Whether you’ve been prescribed exercises by a physical therapist, or you’re just trying to be more regimented about your own routine, try these 5 tips to help improve your compliance!

1. Set a date (and time) with yourself

  • It may sound silly, but setting time aside for exercise and putting it in your planner or on your iCal as an immovable meeting can help improve your chances of sticking to a regular routine.
  • Treat the meeting with yourself just like you would an appointment with a physical therapist or trainer, i.e. Take a cancellation very seriously
  • Try leaving yourself reminders in “easy to spot” places like the medicine cabinet or inside the refrigerator!

2. Make your exercise routine a part of your daily life

  • Again, simple but effective.
  • Everybody can spare 2 minutes 2x per day for dental hygiene, why not pair your body care routine with your dental care routine? Try doing half of your exercises in the morning just after brushing your teeth, and the other half just before brushing your teeth at night.

3. Get up every 20-30 minutes throughout the day

  • Have you heard, “sitting is the new smoking?”
  • Human bodies were designed to MOVE! #APTA
  • In 2015 The American College of Physicians concluded, “Prolonged sedentary time was independently associated with deleterious health outcomes regardless of physical activity.”
  • Building exercises into your day can help lower your risk for diseases associated with a sedentary lifestyle such as heart disease, diabetes, and obesity.
  • During your breaks from your desk make good use of your time by doing a few stretches or a set of exercises prescribed by your physical therapist!
    • Try setting a timer for every 20 to 30 minutes to help remind you to get up and move!

BONUS TIP​: Make sure your workstation is set up in the most ergonomic way possible. While this doesn’t substitute for regular breaks from sitting, it can help reduce stress on the body during times of sitting still.

4. Make sure your equipment and handouts from your therapist are easily accessible

  • According to author Gretchen Rubin, The Strategy of Convenience​, “is one of the most powerful, straightforward, and popular strategies of habit change.” Making something “convenient” for yourself is a surefire way to generate a new (positive) habit.
    • “We should pay close attention to the convenience of any activity we want to make into a habit.” – Gretchen Rubin
  • By keeping your equipment and/or handouts nearby, your are significantly more likely to be consistently reminded about your exercises, and experience less barriers to getting them done!
    • Some examples of this could be keeping your therabands tied around your doorknob, leaving the foam roller near your bed, or keeping weights near the couch or TV.

5. Time itself can be a major limiting factor for lots of busy people (especially New Yorkers)!

  • Exercise should always be performed when you can be focused on what you are doing. You may feel like you are saving time by multitasking during exercise but mindfulness during exercise is an important component safe, effective exercise. Sometimes we find ourselves wanting to be distracted from exercise. This may mean it’s time to change up your exercise routine to include movements that require more of your attention.
  • However…
    • If you like to do your exercises during TV time, try muting the television and getting up during the commercial breaks to get in an extra set.
    • If you like to listen to music while you exercise, try the warm up and cool down without music to focus on the quality of your movements and your breathing.
    • If you like to exercise with a friend (a great strategy for sticking to a routine), make sure the conversation doesn’t overthrow the intent of the activity. Try chatting on lower level intervals or during breaks.

Still not sure about sticking to your own exercise routine?

We are here to help!

Give us a call to set up an appointment & let us help get you started on the right track!

Big Announcements


1. Evolve is proud to announce that we are now a participating member of Hospital for Special Surgery Rehabilitation Network!


“The HSS Rehabilitation Network is a hospital-based network of recommended outpatient rehabilitation practices.”

Please see our listing page here for our contact information.

Evolve Physical Therapy & Sports Rehabilitation thanks Hospital for Special Surgery for this opportunity and looks forward to providing quality physical therapy to their patients.

2. We are just about to begin construction on our new office!

It will be just 25 feet down the hall from our current location. We wish we had a time frame, but these things have a way of taking more time than we like.


How Physical Therapy can help with Crossfit

What is Crossfit?

“CrossFit is constantly varied functional movements performed at high intensity. All CrossFit workouts are based on functional movements, and these movements reflect the best aspects of gymnastics, weightlifting, running, rowing and more. These are the core movements of life. They move the largest loads the longest distances, so they are ideal for maximizing the amount of work done in the shortest time.”

What is the Crossfit Open?

“The (CrossFit) Open is the first qualifying stage of the CrossFit Games. Any athlete who wants to compete at the Games must first make it through the Open in their region.”

The CrossFit Open spans 5 weeks with new workouts released every Thursday. The first workout of 2017, 17.1 was released last Thursday and left many of you barely able to get out of bed with sore backs and shoulders!

Don’t let the same thing happen with the rest of the open!

Nervous? You don’t need to be!

Here are some tips to help keep you moving safely throughout this year’s Crossfit Open.

  1. See a physical therapist
  2. Warm up
    • Sure this may seem like a “no-brainer,” but never underestimate the value of a warm up that targets specific muscle groups & energy systems.
    • Remember:
    • Don’t get cold !
      • If your gym is working in heats & you’re helping to judge, don’t forget to go back through a targeted warm up just before it’s your turn to tackle the workout!
    • Not sure what to do for a targeted warm up? See a physical therapist to help you establish a safe, effective warm-up for every exercise routine.
  3. Proper nutrition & hydration
    • Fueling for your open workout starts long before the hour leading up.
    • Proper fueling helps maximize all the training and work you’ve done to get you this far!
      • Consider increasing your carbohydrates the day before
      • Make sure you are drinking plenty of water the day before & the day of
      • Do your best to stay away from alcohol & tobacco, as these are energy sucking & performance limiting substances
  4. Scale!
    • No matter if you’ve done every workout ‘RX’d’ for every Open since the dawn of time, if you can’t do a skill or can’t lift a weight, the open is not the time to try.
    • Check your ego at the door, be honest with yourself and your abilities. Remember that one open workout is not worth ending your entire crossfit career.
  5. Allow proper time for recovery
    • Did you know a really overworked muscle can take 11-14 days to fully repair & recover? Just because you feel 100% doesn’t mean your body is ready to work at a maximum level again.
    • Giving your body 1-3 days of rest between intense workouts is usually sufficient, but sometimes more rest will allow for better healing.
    • Listen to your body, if you’re still reeling from 17.1, take one more day to rest & mobilize.

For more on CrossFit and safe recovery, set up an appointment with one of our physical therapists for a skilled evaluation! Learn how prevent future injuries and how to minimize other factors that could be holding you back.

Good luck in the rest of the open!

2016 TCS New York City Marathon

With marathon season in NYC behind us, I would like to extend a huge congratulations to all runners who completed the 2016 TCS New York City Marathon!

Of our patients who participated, two finishers were Ralph and Meggie, husband and wife, who both completed their first full marathon this November. Each overcame their respective injuries and each finished within their time goals.


Congrats again, Meggie and Ralph!

Running has gained popularity over the last few decades. The first running of the NYC Marathon in 1970 had 127 runners, with only 55 runners crossing the finish line. This year, over 51,000 runners crossed the finish line of the NYC Marathon in Central Park. With the increasing popularity of running, there has also been an increase in prevalence of running-related overuse injuries.


Some examples of common overuse injuries include

– IT Band Syndrome
– Patellofemoral Pain Syndrome
– Achilles Tendinopathy
– Patellar Tendinopathy
– Low Back Pain
– Shin pain

It is important to note that these overuse injuries can be from a number of different causes including strength and joint motion deficits affecting running mechanics, shoewear, and training schedule. In order to properly treat a running injury, it is important to treat not only the impairment itself, but also the root cause of the injury. A comprehensive analysis by a physical therapist of running mechanics as well as strength and motion of all joints involved in running is imperative to remain healthy following rehabilitation of an injury.

Whether you’re returning to running or just beginning, it’s important pay attention to any pain or injuries sustained during training. For more information on running injury prevention, developing a training program for a race of any length, or running analysis, please contact Evolve Physical Therapy and Sports Rehabilitation at 212-438-1596 or use the “contact us” link on the upper right hand corner of your screen.

3 Common Gymnastics Injuries to Be on the Lookout for This Season

As the 2016 Olympics wrapped up, we saw the US Olympic Women’s Team soar high above the rest of the world in skill and execution. This success has undoubtedly motivated kids across the globe to participate in gymnastics programs.

In the last 30 years, the sport itself has become exponentially more demanding. Because of this change in intensity, the injury rates associated with the sport have also increased tenfold.

For more information on injury prevention, healthy nutrition for athletes, and safety practices for young developing athletes, clear your calendar and attend this event at Evolve Physical Therapy and Sports Rehabilitation on September 22, 2016 at 5:00 PM.

To register, please visit: https://www.eventbrite.com/e/2nd-annual-improving-performance-safety-in-gymnastics-info-session-tickets-26807516002

Outlined below are 3 of the most common injuries seen in gymnasts:

  1. Wrist strains
    A gymnasts’ wrists are frequently exposed to forces significantly greater than her own body weight. As a gymnast repeatedly places her hands on the ground for various skills on every apparatus, her wrist often reaches its end range of motion while absorbing the forces of an upper body landing. Wrist strains are often a sign of other underlying instabilities (i.e. within the shoulder) or dysfunctions within the upper body kinetic chain.

    In this article by K. McLaren et al. it was concluded that “Shoulder angles and years of participation correlate with impact wrist angles during the performance of a standing back handspring.”

  2. Back pain
    No amount of back pain is acceptable in a young developing gymnast. In this article, “Stretching the Spines of Gymnasts: A Review,” Dr. William A Sands et al discuss the importance of safely stretching the spines of young athletes. In this review, the authors agree that when done correctly, risk of injury is minimized. However, when put into practice, stretching of gymnast’s backs is often performed carelessly.

    When careless stretching is performed repeatedly, an injury to the spine known as ‘spondylolysis’ can occur. Spondylolysis is a weakening in a bony part of the spine that often occurs in young athletes whose sports involve excessive low back extension such as that seen in gymnastics. If left untreated, this can lead to a stress fracture in the low back. New research shows that those adolescents who rest and get physical therapy earlier on, have significantly safer and quicker return to sport time.


  3. Hip pain / “tightness”
    Gymnastics not only requires its participants to be very flexible, but also extremely strong. The hip itself is an inherently stable joint; however, when maximally stretched over and over, it can incur microinstability and subsequent tightening of the muscles around the joint itself. Basically, once the brain views the hip joint as “unstable” or “unsafe,” it sends a signal back to the muscles around the hip to tighten up to provide some protection. This resultant tightening often gives the gymnast a feeling of discomfort and a “need to stretch” more.

    Check out this post from Dr. Joshua Eldridge on his website www.GymnastCare.com for further explanation:
    “One of the ways that the hip is stressed in gymnastics is through stretching splits. Many times you’ll see in the gym a coach pushing down on a girl, trying to help her attain greater depth in the split position. Most of the times, this coach has stopped stretching muscles and has started stretching the ligaments and capsules of the joint.”

Fall marks the start of a new gymnastics season. Help your gymnast stay safe by asking him or her how he or she is feeling at the end of each practice.

Make sure your gymnast is getting plenty of water and is eating a healthy breakfast, lunch, snack, and dinner.

For more on how to keep your gymnast safe and healthy this season check out our event “2nd Annual: Improving Performance and Safety in Gymnastics Information Session” at Evolve Physical Therapy and Sports Rehabilitation (238 East 75th st.) on September 22, 2016 at 5:00 PM.

To register, please visit: https://www.eventbrite.com/e/2nd-annual-improving-performance-safety-in-gymnastics-info-session-tickets-26807516002