Injury Education

Coaches & Athletes

Three Products That Will Help With Recovery Following Total Knee Replacement

Physical Therapy is vital when it comes to successful outcomes following a Total Knee Replacement. Patients usually begin therapy 48 hours after surgery. With any surgery, some degree of pain, stiffness, scar sensitivity, and swelling can be expected. The following products are used to help limit these post op symptoms!


The ActiveWrap Knee wrap is a great choice in combatting stiffness and swelling because it can be used as either an ice or hot pack. The inserted packs can be thrown in the freezer or heated in the microwave for the desired effects! The wrap can also be tightened to allow for low grade compression to help alleviate swelling. When you purchase the ActiveWrap, you are basically getting a two for one professional grade product making it an economical choice as well.


This durable knee sleeve provides a subtle support to the patient while allowing ease of movement. The light compression allows freedom of movement while decreasing swelling which helps foster pain free exercise. It has a unique knitted design which is lightweight and allows for exceptional stretch. The sleeve does not have any seams which is important in avoiding chaffing and painful pressure points.

The KneePro Exerciser

This innovative device provides a portable, INEXPENSIVE, and simple system to exercise the leg following Total Knee Replacement. It's ease of use coupled with its effectiveness is a fantastic product when trying to regain your knee flexion and extension following surgery. The video below demonstrates the incredible ease of use along with instructions on how and when to use the KneePro correctly!



Persistent Low Back Pain: When You Should Seek Attention

Low back pain is one of the world’s leading musculoskeletal ailments. According to the National Institutes of Health, 8 out of 10 people will suffer from significant low back pain which leads them to present to their doctor at some point in their lives. Those other two just happen to be lucky! The fact of the matter is that the vast majority of individuals suffer from some variety of low back pain. If you have ever wondered why physical therapy and chiropractic offices have become vastly more common than Starbucks in most major cities, the statistic above should explain this phenomenon to you now. Back pain is so common that it creates an astounding number of jobs and its very own professions that are dedicated towards identifying sources of low back pain and treating them.

If every individual with back pain for any duration of time presented to a doctor, therapist, or chiropractors office, these offices would be flooded and understaffed. It is essential to identify when your back pain does not fall under the “normal” category and when it is time to seek attention. In the following article I outline some of the more common causes of back pain and when it is essential to seek attention. The low back has many components to it, each with its own purpose. Looking at one “unit” of the spine, we have the vertebrae and in between those vertebrae are discs. You can think of these as a number of hamburgers stacked on top of one another- the buns are made of bone, and the meat is the soft cushion that is the disc. A series of joints (facet joints) connect these burgers (vertebrae) providing stability to the spine. Of course, overlying the spine is a vast array of muscular tissue. Each one of these components of the spine can cause pain. I often tell my patients in jest, “Backs were made to provide stability… but they were also made to hurt.” With so many pain-provoking components present in the spine, it is of no wonder that 8 out of 10 people experience low back pain.

The most common cause of low back pain is a muscle strain. Lumbar strain is, by far, the most common cause of low back pain. This type of strain can occur while performing a wide variety of activities that involve a sudden motion, such as sudden rotation, going from flexion to extension, or a wide variety of other movements. After a strain, even slight movements can cause severe spasms and pain. The severity of the pain with movements often leads people to present to the doctor within one to two days of their initial pain. Generally, in the initial phase, I recommend that patients treat their symptoms with ice, rest, and occasional anti-inflammatory medications as long as they don’t have any contraindications to these. On occasion when the pain is severe I will prescribe a muscle relaxant. I always tell patients, however, that if the pain persists for two weeks they need to come and see me because at this point, a muscle strain becomes less likely and further evaluation and possible imaging may be required. In general, for those of you who have back pain, if this persists past two weeks it is generally a good idea to bring this up to your primary care physician or see a physiatrist trained in pain management.

Next we will discuss the often feared herniated lumbar disc. This is another common cause of low back pain and most often will present with radiating lower extremity pain. The same herniated disc in two different individuals can actually present in different ways. No two individuals behave the same when it comes to low back pain, despite the similarities in cause. I always reassure my patients that almost 80 percent of individuals with herniated lumbar discs can improve with a solid physical therapy program and epidural steroid injections when warranted. Nonetheless, if you have low back pain that begins radiating into either or both legs, it is time to get this checked out by a physician. Your treating physician can direct your care at this point. Generally symptoms will improve with appropriate treatment. Weakness in either one of your legs or any changes to bowel or bladder function may be a sign that you need to consult with a surgeon. Rest assured though, in the vast majority of cases of individuals with herniated discs, improvement is had without major surgery.

Finally, we discuss arthritis as a cause of pain. Almost every individual on the planet, at some point or another, will develop degenerative joint changes. Because we place so much stress on our spines on a daily basis, the small facet joints that hold our spine together are privy to degenerative changes. I often find that patients will present to me from their primary care doctor with significant concerns. I will often hear, “I was told my back is terrible. It is full of arthritis.” When I explain the prevalent nature of arthritis in the back to individuals they tend to feel a sense of ease. One of the most common questions I hear in this group of patients involves how to prevent facet joint arthritis from getting worse and how to avoid surgery. The best way to avoid future complications related to facet joint arthritis (known as spondylosis in the medical world) is to work on your core strength! Many people take this advice for granted, because it seems quite obvious. Nonetheless, I always recommend that these patients consult with a good spine trained physical therapist for a core strengthening program. This can make a world of different in patients who adhere to an exercise regimen. Nonetheless, just as for disc-related concerns, I always impress upon individuals that if back pain is lasting more than two weeks and not improving it is time to consult with a physician. Another major signal that you should contact your physician is any constant back pain that occurs at night and interferes with sleep. This can be a sign of something more sinister that needs to be evaluated.

Three Simple Back Exercises

Here is a statistic from Steven Brill's recently released book on the current state of health care in the United States,"America's Bitter Pill":

"We spend $85.9 billion trying to treat back pain, which is as much as we spend on all of our country's state, city, county and town police forces.  And experts say that as much as half of that is unnecessary."
Wow.  That is just a staggering fact to digest!
Here's the thing.  Most back pain will go away within a reasonable period of time.  What I'm consistently teaching my patients is how to manage their backs, rather than let their backs manage them.  Towards that end, I want to share with you three very basic exercises that will go a long way towards helping you keep a healthy back.  They don't require any special equipment or a gym membership.  Just a little effort, consistency, and attention to form.
Stuart McGill, PhD is a professor at the University of Waterloo outside of Toronto.  He is considered the foremost expert on spine biomechanics and is a go-to resource for anyone in the field of rehabilitation.  If anyone has studied the spine and its properties more thoroughly than Dr. McGill, he or she has yet to identify themselves.  Dr. McGill has shared what he considers his "Big Three" core exercises for good spine health.  They are the McGill curl up, the plank, and the birddog.  Here is a quick clip of each:
McGill Curl Up
The Plank
The Birddog:
In this clip, I use a foam roller as a "coach" to help keep me in a neutral position.  It is not necessary but simply augments the exercise.
Each of these exercises can be progressed or regressed, making them more difficult or easier based on one's capabilities.  As you can see, they're pretty basic movements that don't require more than a little floor space.  Give them a try.  They're free.  Maybe, just maybe, they will help you do your individual part in chipping away at that $85 billion price tag.

Whether To Use Heat or Ice or BOTH!

 One of the most commonly asked questions from patients is how to know whether to use heat or ice after sustaining an injury. Basically, what we recommend in the clinic depends on whether the pain is acute (new onset) or chronic (recurring). Below is a basic description of what each pain relief modality provides and how to appropriately use them.


Heat therapy is used to reduce chronic, recurring pain. Heat decreases stiffness, increases local circulation, and helps reduce muscle spasms/guarding. Heat can be delivered as a dry or moist application, with moist allowing for greater penetration. Warming a body part in the 105 to 113 degree F temperature range is considered to be therapeutic when applied for 15 to 20 minutes. Safety is of most importance as you need to take great care to avoid burning yourself. Wrapping a hot pack in towels allows you to better gauge the heat and avoid burns. If the hotpack is perceived as being too hot, simply add towels until the temperature is comfortable. People who are diabetic, have swelling or poor circulation, and decreased sensation should not use or be very careful when using heat modalities. Also, those of you who have an open wound or stitches should not be using hot packs as well for the simple fact that the heat will cause more swelling and may compromise the wound.  We also use heat to get the muscle and or joint ready for exercise and stretch when treating injuries. As stated above, heat results in increased blood flow through vasodilation. This increased blood flow gets our targeted muscles ready to be worked on and allows for stretching to be done with less overall pain.



Cold therapy or Cryotherapy is used to help decrease pain and inflammation for an acute injury. It does this by slowing down blood circulation which also helps in decreasing muscle spasm. We recommend using ice for the first 48 hours after initial injury. Ice may be applied by using ice bags or cold packs for 15 to 20 minutes. You should allow the area that has been iced to warm up for 45 minutes before icing the area again. Ice should not be used for more than 20 minutes as it actually may cause a burning of the skin or even frostbite! You can ice as frequently as you wish, as long as the tissue continues to return to normal temperature and sensation continues to be normal. If you have an open wound, you should not use ice as this causes decreased blood supply to the wound which will cause the wound to weaken and delay healing. Also, people with Raynaud's phenomenon, those that have undergone a replantation surgery, or who have peripheral vascular diseases should not use cryotherapy.



Contrast baths combine heat and cold therapy when trying to help patients recover from any soft tissue injury that is causing pain, swelling, and inflammation. I have found that using contrast baths helps my patients with pain management who are suffering from carpal tunnel syndrome, fractures, and arthritis of the hands. These baths can also be used for lower extremity diagnoses such as plantar fasciitis, achilles tendinitis, and fractures of the ankle and foot. To perform this treatment, you will need two buckets/containers to accommodate the affected body part. For example, when treating hand pain, I usually have patients fill up their sink with cold water (50 to 60 degrees Fahrenheit) and a stockpot with hot water (98 to 110 degrees Fahrenheit). The patient is instructed to immerse their hand in the hot water for 10 minutes. After ten minutes, they switch over to the cold water for 1 minute. Then switch back to hot for 4 minutes followed by 1 minute in cold and alternate for one more cycle. Finally, the patient is told to end the treatment with a 4 minute soak in the hot water. The patient is also told to gently move the fingers while soaking to help the pumping action. Alternating between hot and cold soaks promotes dilation and constriction of the blood vessels. This helps pump the inflammatory cells and swelling out of the affected body part resulting in a decrease in pain. You obviously should not submerge your hand in any water if you have an open wound or have stitches being used for wound closure. 



If you have just injured yourself, ice for the first 24 to 48 hours to limit inflammation. Switching to heat after this time frame will help increase blood flow to the injured area which will promote healing. If swelling continues to be an issue, then try contrast baths. They take a little bit of time to set up, but people really do find relief from using them. Please check out our complete line of professional grade ice and hot packs. The Active Wrap line is body part specific and can be used as either a hot or cold pack. The Dr. Cool Wrap is a great product that combines compression with ice. The Elasto Gel Hot and Cold packs and Norco ice packs are all professional grade. If you have any questions, please email us at