Physical TheraPT
Clinical Wisdom
Shannon Vigil
Superbill Best Practices
The Recovery Mindset
Nina Szemis, ATC
Can You Outrun Illness?

General common sense, as well as scientific research, tells us that lifelong physical activity acts as a protecting agent against chronic illness and disease. If you’re able to consistently rack up 300 minutes of moderate intensity activity per week, you’re at much lower risk for things like cancer, cardiovascular disease and other inflammatory disorders. Regular physical activity also increases your resilience against communicable diseases, like bacteria and viral infections. However, here’s where the research starts to diverge.

The Science of Stretching

Stretching has been a go-to practice for athletes, fitness enthusiasts, and physical therapy patients alike. But what’s really happening inside your body when you stretch? More importantly, is stretching as beneficial as we’ve been told?

For years, the idea was simple: stretch to improve flexibility, prevent injuries, and enhance performance. However, modern research paints a more nuanced picture. While stretching does have benefits, how, when, and why you stretch matters. In this post, we’ll explore the science behind stretching, the differences between dynamic and static stretching, and how to make your stretching routine more effective.

What Happens at the Cellular Level?

When you stretch, your muscles don’t just "loosen up"—a series of complex physiological reactions occur at the cellular level.

1. Muscle Fibers and Fascia Adapt

Muscle fibers (sarcomeres) temporarily elongate during stretching, but lasting flexibility gains occur when connective tissues, like fascia, gradually adapt over time. This aligns with Davis’s law, which states that soft tissues remodel in response to consistent mechanical stress. Research also shows that fascia is dynamic and can adapt to mechanical forces, influencing long-term flexibility (Schleip et al., 2019).

2. Neuromuscular Inhibition (Stretch Reflex)

The stretch reflex protects muscles from overstretching by triggering a contraction when a muscle is rapidly lengthened. However, consistent stretching can reduce this reflex's excitability, allowing for greater flexibility. A study found that repeated stretching, especially when muscles remain relaxed, can attenuate stretch reflex activity, supporting the idea that long-term stretching helps muscles tolerate greater lengthening without resistance (Ogawa et al., 2022).

3. Increased Blood Flow and Tissue Elasticity

Stretching improves blood circulation, which brings oxygen and nutrients to the muscles. This can enhance recovery, reduce muscle stiffness, and even contribute to long-term joint health.

Has Science Proven That Stretching is Beneficial?

Yes and no. While stretching can improve flexibility, studies show that static stretching before exercise doesn’t significantly reduce injury risk or enhance performance (Behm et al., 2016). However, dynamic stretching and long-term flexibility training have been shown to improve range of motion, recovery, and even reduce chronic pain when done correctly (Oppert & Babault, 2018).

Dynamic vs. Static Stretching: How to Use Each Effectively

Not all stretching is created equal. The type of stretching you do should match your goal:

Dynamic Stretching:
Best Before Activity

Dynamic stretching involves active movements that take your joints through their full range of motion. Instead of holding a stretch, you move fluidly through it—mimicking the movements you’re about to perform.

Benefits:

  • Increases blood flow and muscle temperature

  • Activates the nervous system for movement

  • Improves range of motion without reducing muscle power

EXAMPLES:

  • Leg Swings – Swing your leg forward and backward to activate hip flexors and hamstrings.

  • Lunges with a Twist – Engage core, hips, and spine before running or sports.

  • Arm Circles – Increase mobility in the shoulders before upper-body activities.

Bottom Line: Use dynamic stretching before workouts to prepare your muscles for activity without reducing power output.

Static Stretching:
Best After Activity

Static stretching involves holding a position for an extended period (15–60 seconds), allowing muscles to relax and lengthen.

Benefits:

  • Improves long-term flexibility

  • Helps muscles recover and reduces post-exercise stiffness

  • Promotes relaxation and stress relief

EXAMPLES:

  • Hamstring Stretch – While lying on your back, use a strap to anchor around your foot and pull your leg up towards the ceiling, feeling a stretch in the back of your leg

  • Chest Opener – While sitting, clasp hands behind your head and open your chest to counteract hunching, opening your elbows out and away from you

  • Quad Stretch – While standing, grab one ankle behind you to stretch the front of your thigh.

Bottom Line: Use static stretching after workouts or as part of a flexibility routine to improve long-term mobility.

When to Stretch
(And When Not To)

When You Should Stretch:

✔ Before a workout? – Yes, but only dynamic stretching.
✔ After a workout? – Yes, static stretching can aid in recovery.
✔ To improve flexibility? – Yes, but hold stretches for 15-60 seconds & perform them regularly.
✔ To address muscle imbalances? – Yes, targeted stretching can help correct asymmetries.

When You Should Avoid Stretching:

❌ When muscles are cold – Jumping into static stretching without warming up can lead to injury.
❌ If you're experiencing sharp pain – Stretching shouldn’t cause pain; if it does, you may have an underlying issue.
❌ If you suspect a sprain or strain – these types of injuries involve the tearing of ligaments or muscles/tendons, respectively (sometimes these tears are minimal). If there’s any torn tissue, stretching is not advised
❌ When you have a history of dislocation or subluxation – joints that are likely to pop out of place are not suited for stretching

TOOLS FOR OPTIMIZING YOUR STRETCHING ROUTINE

A stretching strap promotes better alignment and controlled muscle lengthening, while a yoga mat provides joint support and stability—both enhancing safety and effectiveness through improved biomechanics.

 

Addressing Muscle Imbalances: Focusing on the Tighter Side

If you notice one side of your body is significantly tighter than the other, this could indicate:

  • An imbalance in muscle strength

  • A previous injury that caused compensatory patterns

  • Postural habits affecting mobility

How to Fix It:

  • During warmups, spend extra time dynamically stretching the tighter side.

  • During cooldowns, hold static stretches longer on the less flexible side.

  • If asymmetry persists, consider working with a physical therapist to address underlying issues.

Conclusion: Smarter Stretching for Better Movement

Stretching isn’t just about flexibility—it’s about training your nervous system and connective tissues to function optimally. Keep in mind that your body needs time to adapt to a new stretching routine, so start slow and don’t stretch more than once a day.

Here’s what to remember:

✔ Dynamic stretching before workouts prepares muscles for movement.
✔ Static stretching after workouts improves flexibility and recovery.
✔ Stretching should be intentional—focusing on imbalances and avoiding overdoing it.
✔ Flexibility is a long-term process—consistency is key.

Rather than mindlessly holding stretches, use stretching as a tool to enhance movement, prevent injury, and improve overall mobility. If you’re struggling with flexibility issues, a structured stretching routine (or a visit to a physical therapist) could make all the difference.

References

  • Schleip, R., Gabbiani, G., Wilke, J., Naylor, I. L., Hinz, B., Zorn, A., Jäger, H., & Klingler, W. (2019). Fascia is able to actively contract and may thereby influence musculoskeletal dynamics: A histochemical and mechanographic investigation. Frontiers in Physiology, 10, 336.

  • Ogawa, Y., Hasegawa, N., Nakazawa, K., Akai, M., & Murayama, M. (2022). Effect of repeated fast stretches on stretch reflex excitability in individuals post-stroke. Frontiers in Neurology, 13, 764650.

  • Behm, D. G., Blazevich, A. J., Kay, A. D., & McHugh, M. (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: A systematic review. Applied Physiology, Nutrition, and Metabolism, 41(1), 1–11.

  • Opplert, J., & Babault, N. (2018). Acute effects of dynamic stretching on muscle flexibility and performance: An analysis of the current literature. Sports Medicine, 48(2), 299–325.

Maintaining Cardiovascular Fitness with an Overuse Injury

Clinicians often recommend limiting time and intensity of workouts to allow for greater recovery time, decreased tissue stress and improved healing. By overloading a injured area either too soon, or too often, the athlete can see regressions in function, pain and dysfunctional mechanics. Yet, for the avid athlete, being told to decrease workout volume can feel disorienting. Aqua jogging can be a safe alternative for many athletes in this predicament, including those recovering from:

  • Stress-related bone injuries: stress response, stress reaction or stress fracture

  • Tendinopathies of the leg, including gluteal, hamstring and achilles tendinopathy

  • Surgical repair of a major injury, including FAI, labral, ACL or a meniscus repair

Aqua jogging can also be a great accessory workout for those with a very high training volume to allow for a effective cardio workout at a decreased level of impact. For many, access to a pool is more convenient than an anti-gravity treadmill! By adding a reduced load workout to your routine, you can decrease your risk of injury.

In all cases, talk to your medical team to ensure you are ready to begin an aquatic rehab program.

Pro tips for a successful aqua jogging workout:

1) Choose the right equipment

Wear a minimally buoyant belt to allow for moderate challenge throughout your workout. Avoid ones that are bulky, ill-fitting or feel like an inner tube. Click the images below to view our recommendations.

2) It’s aqua jogging, not swimming

Stay upright, keeping your hips under your shoulders. Resist the urge to go horizontal as with swimming; this will be less effective when wearing a floatation belt.

3) You’re in water, not on land

Don't focus on moving forward, as this will happen naturally. Instead, pay attention to the level of effort you’re exerting, regardless of how quickly you traverse the pool. 

4) Adjust your training volume to match

When cross-training specifically for distance running, a general rule of thumb is that you need to do 50% more in the pool to get the same cardio benefit as running on land. In other words, 45 minutes in the pool = 30 minutes of running.

To increase the challenge:

Intervals, intervals, intervals!

Just like with non-water workouts, varying the speed and intensity of your effort in waves can provide increased benefits. Using a timer or landmarks within the pool, challenge yourself to pick up the pace for a measurable interval. Based on your overall health, choose an appropriate recovery window. This can be time-based, for example resting the same, twice as much or half as much time it took you complete the challenging interval, or it can be biometrical, waiting for your heart rate to return to its pre-interval baseline.

Get a resistance band.

Select a band like this one and attach yourself to the wall, you can do "sprints" by creating more resistance than the water naturally provides.

Resistance bands can also be used if the pool is not deep enough throughout to do laps, you can do a stationary workout with this band by anchoring yourself to the wall or pool deck.

Remove the belt!

We recommend waiting until you feel confident with aqua jogging form is before taking this step. Taking it off too soon, even if you are a proficient swimming, will impact the overall quality of your workout.

Understanding the Role of Myofascial Decompression in Sports Rehab

Cupping massage, an ancient practice rooted in traditional Chinese medicine, has grown in popularity for its potential health benefits. In this therapy, suction cups are applied to the skin to create a vacuum, which pulls skin and underlying tissue upward. In western medicine, this technique is more commonly referred to as myofascial decompression. In both systems, similar tools are used- cups can be made of glass, plastic, or silicone and can be applied to the skin in a variety of strategies. The technique is often used to promote blood flow, relieve pain, and support recovery from muscle tension or injury.

If you haven’t experienced this technique first-hand, you may be wondering: what are the distinctive marks left by cupping, what does science reveal about one of its most frequently touted benefits, and is this right for me? Let’s dive into the details!

Myth #1: Cupping Marks aren’t Bruises

The short answer: Yes, actually they are.

Many sources try to claim that cupping marks are not bruises. Most notably, they will cite that bruises are defined as both painful and a result of blunt force—two characteristics that are notably lacking in cupping application. But these flat-out denials seem to conflate the definitions of bruise and contusion.

For starters, bruise is mostly synonymous with a medical term: ecchymosis. Ecchymosis can be defined simply as bleeding under the skin due to broken capillaries. Whether these tiny blood vessels leak due to blunt force or suction is irrelevant, as the end result is the same. On the other hand, contusion is most commonly defined as ecchymosis due to blunt force, usually accompanied by pain and damage to underlying tissue.

As the purplish mark left behind by cupping therapy is a result of broken capillaries, this mark is technically a bruise. However, since the mode of achieving this bruise is suction instead of blunt force trauma, a cupping mark is not a contusion.

Myth #2: Creating damage actually helps healing

While the idea of intentionally breaking capillaries might sound counterintuitive, it can have a therapeutic effect. Cupping increases blood flow to the area, triggering the body’s inflammatory response—a natural healing mechanism.

Studies suggest that cupping may stimulate the release of cytokines and other inflammatory mediators, which help repair tissues and reduce pain (Kim et al., 2018). Moreover, the pooling of blood and interstitial fluid under the skin can encourage lymphatic drainage and reduce swelling, further promoting recovery (Al-Bedah et al., 2019).

Myth #3: Cupping releases Toxins

One of the most debated claims about cupping is whether it helps the body detoxify. To better understand the evidence, it’s important to first distinguish between wet and dry cupping. Wet cupping, an ancient form of bloodletting, involves making small incisions on the skin to draw out blood. This practice is NOT common in the United States and is not part of treatment offered at Physical TheraPT. In contrast, the more widely practiced dry cupping involves applying suction cups to unbroken skin.

Some studies suggest that wet cupping may help lower levels of uric acid and cholesterol in the body (Sutriyono et al., 2014). Current research has not shown a significant connection between dry cupping and toxin removal. The enduring association between cupping and detoxification may be attributed to the specific effects of wet cupping rather than the dry cupping methods commonly used today.

The Takeaway

Despite the lack of evidence for the detoxifying effects of dry cupping, other benefits of this modality tend to be a larger focus in physical therapy. The lifting of the skin due to suction draws blood into the area, bringing oxygen and nutrients to tissues. The mechanical stretching and lifting of the skin can help to release fascia, also known as myofascial decompression, helping to release tension surrounding muscles. And, while cupping does cause microscopic injury, targeted application of it can help us bring your body’s attention to the areas that need extra care by jump-starting the inflammatory process.

If you’re considering cupping, talk to your practitioner to see how it can fit into your recovery or wellness plan.


To learn more, check out these resources:

Al-Bedah, A. M., Elsubai, I. S., Qureshi, N. A., et al. (2019). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complementary Medicine, 9(2), 90–97.

Kim, J., Lee, H., & Lee, M. (2018). Effects of cupping therapy on chronic back pain: A systematic review and meta-analysis. Complementary Therapies in Medicine, 41, 129–137.

Sutriyono, S., Robbina, M. R., & Ndii, M. Z. (2019). The effects of wet cupping therapy on blood pressure, glucose, uric acid, and total cholesterol levels. Biology, Medicine, & Natural Product Chemistry, 8(2), 33–36.

Choosing A Clinician: A Guide for Athletes and Active Individuals

Whether you’re a seasoned athlete or simply someone who enjoys staying active, finding the right sports physical therapist can make all the difference in your recovery and performance. Sports physical therapists specialize in treating injuries and optimizing movement for individuals with active lifestyles. They work closely with athletes and fitness enthusiasts to help them get back to their peak condition safely and effectively. But with so many options out there, how do you choose the best one for you? Here’s what to look for when selecting a great sports physical therapist, including key qualities of both the clinician and the practice setting.

The Clinician:

1. Expertise in Sports-Related Injuries and Conditions

A good sports physical therapist has extensive knowledge and experience in managing sports-related injuries. Look for a therapist who:

  • Has experience treating injuries specific to your sport or activity. For instance, if you’re a runner, a therapist with experience in managing lower extremity injuries, such as shin splints or knee issues, will be invaluable.

  • Is certified or has a background in sports physical therapy. Certifications like the SCS (Sports Certified Specialist) indicate a strong foundation in sports injury management and rehabilitation.

  • Understands biomechanics and movement patterns specific to athletic activities. This knowledge is crucial for evaluating how you move and pinpointing any issues that may be causing or exacerbating your injury.

2. A Patient-Centered Approach and Strong Communication Skills

One of the most important qualities of a good sports physical therapist is the ability to listen to and understand your goals, needs, and concerns. Look for a therapist who:

  • Takes the time to listen to your story and understand how your injury affects your life and sport.

  • Communicates clearly about your diagnosis, treatment plan, and expected outcomes. They should be able to explain complex concepts in a way that you understand and feel comfortable with.

  • Values your goals and collaborates with you to create a recovery plan that supports both your short-term and long-term aspirations, whether that’s getting back to training or just enjoying a pain-free workout.

3. Customized, Sport-Specific Treatment Plans

No two injuries are alike, and athletes require specialized care tailored to their sport’s unique demands. A good sports physical therapist will:

  • Create a customized treatment plan that’s specifically designed to address your injury, taking into account your sport, position, and level of play.

  • Incorporate sport-specific exercises and progressions. For instance, if you’re a soccer player, your therapist should include drills that mimic the movement patterns used in soccer, like pivoting and kicking.

  • Focus not only on healing the injury but also on injury prevention. A great therapist will identify areas of weakness or instability that may lead to future issues and work with you to build strength and resilience in those areas.

4. Emphasis on Functional and Return-to-Sport Testing

A skilled sports physical therapist knows that recovery isn’t just about feeling better; it’s about getting back to performing at your best. Look for someone who:

  • Uses functional testing and return-to-sport assessments to objectively measure your readiness to return to your sport. These assessments help determine if you’re truly ready for the demands of your activity and reduce the risk of re-injury.

  • Tracks and evaluates progress over time to ensure you’re moving forward with your recovery.

  • Is willing to adapt the plan based on your progress and any challenges you face along the way.

The Practice Setting:

Alongside the characteristics of the therapist, the practice setting itself plays a crucial role in supporting effective treatment. Here’s what to look for in an ideal sports physical therapy setting:

1. Well-Equipped Facility with Sports-Specific Equipment

A good sports physical therapy clinic will have specialized equipment and spaces that allow for sport-specific rehabilitation. Look for a facility that includes:

  • Strength and conditioning equipment (like squat racks, resistance bands, free weights) to facilitate sport-specific strengthening and conditioning exercises.

  • Open space for dynamic exercises such as running, jumping, or agility drills. This allows for a full range of motion activities and sports-specific drills.

  • Advanced equipment for functional assessments and movement analysis, such as motion capture or force plates, which can provide valuable data on your biomechanics and movement patterns.

2. Collaborative, Interdisciplinary Team

In the best sports physical therapy clinics, therapists often work alongside other health and fitness professionals. This type of collaborative environment can be extremely beneficial if you need additional support, such as:

  • Sports medicine physicians and orthopedic specialists who can provide input on complex cases or guide the treatment plan based on specific medical needs.

  • Athletic trainers and strength coaches who can help transition you from rehabilitation to performance training.

  • Massage therapists who help treat soft tissue injuries and optimize recovery.

  • Nutritionists and mental health professionals who understand the unique demands placed on athletes and can support holistic recovery and wellness.

3. Emphasis on Education and Injury Prevention

An ideal sports physical therapy practice not only treats injuries but also focuses on educating athletes to prevent future issues. The clinic should provide:

  • Resources on injury prevention techniques, warm-up and cool-down strategies, and sport-specific conditioning tips.

  • Access to self-management tools (such as foam rollers, resistance bands, and instructional videos) to help you maintain your progress outside of the clinic.

  • Follow-up care or programs to support continued improvement after your primary treatment has ended.

Final Thoughts: Finding the Right Fit

Ultimately, finding a good sports physical therapist is about finding someone who understands your sport, values your goals, and has the expertise and resources to support your recovery journey. Take the time to ask questions, explore different clinics, and find a therapist and setting that feels right for you. The right therapist will not only help you recover from injury but also empower you to return stronger, more resilient, and better prepared to reach your full athletic potential.

Planning ahead for holiday success

It’s that time of year again! Whether you’ll be shuttling between relatives’ homes, using the time away from work to check off some bucket list adventures, or hosting the chaos yourself, it’s safe to say your typical routine is going to be impacted.

We firmly believe that consistency and load management are two pillars of a successful plan- don’t let your goals get stuck on the sidelines this holiday season! Below, we’ve outlined how to approach the coming weeks to set yourself up for success:

 
 

1-2 Weeks Prior:

Check in with your clinician.

  • Plan to discuss your current presentation. Understanding the why behind your exercises helps to increase compliance.

  • Share details and goals of your travel- how long of a flight or drive do you have? What are your plans once you arrive? Your clinician can help identify strategies to decrease flare ups.

  • Update your circuit to reflect just the priorities. Be realistic about the amount of time you can dedicate while out of your normal routine, and highlight what exercises are critical to your continued progress.

  • If you won’t have consistent internet access, ask for a PDF copy of your circuit!

 
 

3-5 Days Prior:

Confirm what you’ll have access to.

  • Verify with your hotel if they have an on-site gym and what equipment they have.

  • Double check with family members or hosts if they have any home equipment.

  • Research local gyms. Consider purchasing a day pass if you need more robust equipment based on your plan.

  • Check the weather. If you typically run outdoors, does your temporary location allow for success?

  • Purchase travel equipment as needed. We’ve highlighted our go-to’s below:

 
 

On Location:

Make a plan.

  • Identify optimal times to fit in your exercises. Prioritize your circuit prior to any physical activity, completing a majority of the list at your accommodation, and a light warm up once you arrive at your activity.

  • Communicate with family and travel companions that this is important for your recovery. They’ll be more supportive of you taking 15-30 minutes away.

  • Split up high demand activities when possible to match your current tolerance. Try to plan lighter activity days between more physically demanding days.

Connect with your clinician sooner rather than later to schedule your pre-holiday appointment!