evolve-physical-therapy

Why One Postpartum Visit Isn’t Enough: A Physical Therapy Perspective on ACOG’s New Recommendations

Thu, 16 Apr 2026 03:57:40 GMT

Postpartum Pelvic Floor Specialists - Holly Springs, NC

For decades, postpartum care in the United States has largely centered around a single follow-up appointment at six weeks after delivery. While this timeline has been considered “standard,” it doesn’t reflect the complexity of recovery after pregnancy and childbirth. Recognizing this gap, the American College of Obstetricians and Gynecologists (ACOG) updated its guidelines to recommend a more comprehensive, ongoing approach to postpartum care, one that begins earlier and continues as needed.

From a physical therapy perspective, this shift is not only welcome, it’s essential.

Postpartum Recovery Is Not One-Size-Fits-All

The traditional six-week visit implies that recovery follows a predictable, linear path. In reality, postpartum healing varies widely. Whether someone had a vaginal delivery or cesarean birth, their recovery can involve:

Pelvic floor dysfunction
Core weakness or diastasis recti
Low back, hip, or pelvic pain
Urinary or fecal incontinence
Pain with intercourse
Postural changes and movement compensations

Many of these issues begin well before six weeks or persist long after. Waiting for a single clearance point can delay care and prolong symptoms.

ACOG’s Updated Approach

ACOG now recommends that postpartum care be viewed as an ongoing process rather than a one-time checkup. Key elements include:

Initial contact within the first 3 weeks postpartum
Continued care as needed, with a comprehensive visit no later than 12 weeks
Individualized, patient-centered follow-up

This model better reflects the realities of recovery and opens the door for earlier intervention, especially from rehabilitation professionals.

Where Physical Therapy Fits In

Physical therapists, particularly those specializing in pelvic health, are uniquely positioned to support postpartum individuals throughout this extended care window.

Early intervention can help:

Restore pelvic floor function
Improve core strength and coordination
Address pain and mobility limitations
Support safe return to exercise and daily activities
Prevent long-term dysfunction

Just as importantly, early movement and guided exercise play a meaningful role in mental health. Research shows that gentle, progressive activity in the postpartum period can help reduce the risk and severity of postpartum mood disorders, including postpartum depression and anxiety. Supporting patients in reconnecting with their bodies—safely and confidently—can have benefits that extend well beyond the physical.

Importantly, physical therapy isn’t just for those experiencing obvious symptoms. Proactive care can identify subtle impairments before they become more significant issues.

What We Do at Evolve Physical Therapy

At Evolve Physical Therapy, we align closely with ACOG’s updated recommendations by initiating care earlier in the postpartum period. We typically schedule an initial physical therapy visit around 2 weeks postpartum for both cesarean and vaginal deliveries.

This early visit is gentle, individualized, and focused on:

Education around healing timelines and expectations
Breathing, core, and pelvic floor connection
Safe movement strategies for daily activities (like lifting, feeding, and carrying)
Early identification of any concerns that may benefit from ongoing care

Beginning physical therapy at two weeks allows us to support recovery proactively, rather than waiting until symptoms become more significant or limiting.

Bridging the Gap in Care

Despite ACOG’s updated recommendations, many patients are still unaware that ongoing postpartum support is available—or that physical therapy is an option. This creates an opportunity for healthcare providers to educate and advocate.

Collaborative care between OB-GYNs, midwives, and physical therapists can ensure that postpartum individuals receive the support they need, when they need it.

A New Standard of Care

Shifting away from the single six-week visit is more than a guideline update, it’s a cultural change in how we view postpartum health. Recovery doesn’t end at six weeks, and care shouldn’t either.

As physical therapists, we have a vital role in helping individuals navigate this transition with strength, confidence, and resilience.

Because postpartum recovery deserves more than a checkbox, it deserves ongoing care.

Clinical Practice Guidlines for Hip Pain and Mobility

Thu, 16 Apr 2026 03:52:33 GMT

Hip Pain Physical Therapy Experts - Holly Springs, NC

Hip pain can make everyday activities walking, sitting, exercising feel frustrating and limiting. The good news? The latest 2025 Clinical Practice Guidelines (CPG) published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) give us even clearer direction on what actually works to reduce pain and improve mobility.

At our clinic, we base our care on the most current research so here’s what this update means for you.

This guideline focuses on hip osteoarthritis (OA) a common condition where joint changes lead to pain in the groin, thigh, or buttock, stiffness (especially in the morning or after sitting), reduced mobility and difficulty with daily tasks. The 2025 update builds on previous guidelines (2009, 2017) but focuses specifically on new evidence for physical therapy treatment.

The strongest message from the 2025 CPG. Exercise and hands-on therapy is the BEST outcome.

The guidelines emphasize individualized exercise programs as the foundation of treatment. This includes strength training (especially glutes and hip stabilizers), mobility and flexibility work, aerobic conditioning and functional training (sit-to-stand, walking, stairs).

New in 2025: Aquatic therapy is now specifically included as an effective option.

Manual Therapy or hands-on treatment remains a key component. This may include joint mobilizations, hip distraction techniques and soft tissue work. New research continues to support that manual therapy improves mobility, reduces pain, enhances function. The update emphasizes tailoring techniques based on joint irritability and patient tolerance.

A major update in 2025 is that Dry needling is now supported by strong evidence. It can help with pain reduction, muscle tightness, range of motion, short-term functional improvements. This is a big shift as there was no recommendation for dry needling in 2017 .

The guidelines stress treating the whole person, not just the joint. That means addressing walking mechanics, balance deficits and movement patterns. This is especially important for preventing falls, improving confidence with movement and returning to daily activities.

Patient education is also very important and not optional. Key topics include activity modification (not avoidance!), weight management (if applicable) and long-term exercise habits. The goal: empower you to manage your condition long-term, not just temporarily relieve symptoms.

So if you’re dealing with hip pain or arthritis, resting alone is not the answer! The right guided movement plan is key.

The 2025 CPG reinforces what we see every day in the clinic. Targeted physical therapy works. With the right plan, you don’t have to just “live with” hip pain! You can move better, feel stronger, and get back to doing what you enjoy.

Nicole Perna PT, DPT

Evolve Physical Therapy

Understanding Pelvic Pain and How Pelvic Floor Physical Therapy Can Help

Thu, 16 Apr 2026 03:47:10 GMT

Pelvic Floor Physical Therapy for Pelvic Pain - Holly Springs, NC

Pelvic pain is a common yet often misunderstood condition that affects people of all ages and genders. Whether it’s a dull ache, sharp discomfort, or persistent pressure, pelvic pain can interfere with daily life, relationships, and overall well-being. The good news is that physical therapy offers an effective, non-invasive approach to managing and often resolving this condition.

What Is Pelvic Pain?

Pelvic pain refers to discomfort in the lower abdomen or pelvic region. It can be acute (short-term) or chronic (lasting longer than six months). Causes vary widely and may include:

Muscle dysfunction or tension
Post-surgical complications
Pregnancy and postpartum changes
Endometriosis or other gynecological conditions
Bladder or bowel disorders
Nerve irritation or compression

Because the pelvic region is home to muscles, organs, and connective tissues that all work together, identifying the root cause of pain can sometimes be complex.

The Role of Pelvic Floor Muscles

At the center of many pelvic pain issues are the pelvic floor muscles. These muscles support the bladder, bowel, and reproductive organs, and they play a key role in core stability, posture, and continence.

When these muscles become too tight, weak, or uncoordinated, they can contribute to pain, dysfunction, and a variety of symptoms such as:

Pain during sitting or movement
Discomfort during or after exercise
Pain with intimacy
Urinary or bowel issues

How Physical Therapy Helps

Pelvic floor physical therapy is a specialized branch of care that focuses on restoring proper function to the muscles and structures of the pelvis. A trained physical therapist will perform a thorough evaluation and develop a personalized treatment plan.

Common treatment approaches include:

1. Manual Therapy
Hands-on techniques are used to release muscle tension, improve mobility, and reduce pain in the pelvic region.

2. Targeted Exercises
Patients learn exercises to either relax or strengthen the pelvic floor, depending on their specific condition. Contrary to popular belief, not all pelvic issues require strengthening, many require relaxation and coordination.

3. Biofeedback
This technique uses sensors to help patients become more aware of their muscle activity, making it easier to learn control and improve function.

4. Education and Lifestyle Modifications
Therapists guide patients on posture, movement patterns, bladder and bowel habits, and stress management techniques that can influence pelvic health.

Who Can Benefit?

Pelvic floor physical therapy is beneficial for a wide range of individuals, including:

People with chronic pelvic pain
Postpartum individuals
Athletes experiencing core or hip issues
Individuals recovering from pelvic or abdominal surgery
Those with bladder or bowel dysfunction

Breaking the Stigma

Pelvic pain is often underreported due to embarrassment or the belief that it’s something one must “just live with.” In reality, it’s a treatable condition, and seeking help is an important step toward recovery.

When to Seek Help

If pelvic pain is persistent, worsening, or interfering with your daily activities, it’s worth consulting a healthcare provider or a pelvic floor physical therapist. Early intervention can prevent symptoms from becoming chronic and improve quality of life.

Rethinking ACL Injuries: What 30+ Years of Research Tell Us About Non-Surgical Recovery

Fri, 03 Apr 2026 11:46:37 GMT

Knee PT in Holly Springs

For decades, an ACL tear has often been viewed as a one-way path to surgery, especially for athletes. But, emerging long-term research is challenging that assumption. A landmark 2024 study by Hellberg and colleagues offers a rare and valuable perspective. What actually happens to patients more than 30 years after a nonoperative ACL injury? The results may reshape how we think about treatment and reinforce the critical role of physical therapy. The study followed patients who initially treated their ACL injuries without surgery and checked in over three decades later.

The results showed the following:

65% of patients reported good or excellent knee function decades after injury
Activity levels decreased over time, with an average drop in sports participation
75% showed radiographic signs of osteoarthritis (OA), but only 38% had symptomatic OA
About 71% never required ACL reconstruction later in life

In simple terms: many people functioned well long-term,even without surgery. While there is a time and place for surgery, this shows that it is not the only route to recovery. The main focus to take away from this study is functional recovery vs imaging.

One of the most important insights from this study is the disconnect between what shows up on imaging and how patients actually feel. While a large portion of participants had signs of osteoarthritis on X-rays, far fewer experienced symptoms that affected daily life. This highlights a key concept in physical therapy: structural changes don’t always equal pain or disability. For clinicians and patients alike, this reinforces the importance of focusing on function, strength, and quality of movement, not just what an image shows.

So how did these patients maintain function for decades? The study points to two major factors, which include early physical therapy and activity modification. Patients were guided to strengthen the knee and avoid high-risk movements like pivoting and cutting. Over time, many adapted their activity levels—but maintained independence and quality of life.

This aligns closely with modern rehab principles:

Build strong quadriceps and hamstrings
Improve neuromuscular control and stability
Gradually return to activity based on function—not timelines

Surgery Isn’t Always the First Answer. This research doesn’t suggest that surgery is unnecessary, but it does challenge the idea that it’s always required.Instead, it supports a “rehab-first” approach, especially for individuals who have lower to moderate activity levels, and can achieve stability through strength and control. The other important factor is willingness to modify high-risk activities. Only about 29% of patients eventually needed reconstuction due to instability if they could address those 3 main factors.

What Does This Means for Patients Today?

If you’ve recently torn your ACL, this study offers an important perspective about more conservative treatments. This could mean that you many not need surgery immediately and long-term function is possible with the right rehab plan. Physical therapy is not just a supplement. It can be the foundation of recovery however, it’s also important to recognize that outcomes vary. Athletes in high-demand sports or those with persistent instability may still benefit from surgical reconstruction.The 30+ year findings from Hellberg et al. remind us that recovery from an ACL injury is not just about fixing a ligament, it’s about building a resilient, functional knee for life (2024).Whether you choose surgery or not, physical therapy remains the cornerstone of long-term success.

References

Hellberg, C., Kostogiannis, I., Stylianides, A., & Neuman, P. (2024). Outcomes >30 Years After Initial Nonoperative Treatment of Anterior Cruciate Ligament Injuries. The American journal of sports medicine , 52 (2), 320–329. https://doi.org/10.1177/03635465231214423

The Powerful Effects of Sleep on Exercise Performance and Recovery

Sun, 08 Mar 2026 10:53:59 GMT

Orthopedic Physical Therapy, Holly Springs, NC

In the world of fitness, we often focus on training programs, protein intake, and supplements. But there’s one powerful performance enhancer many people overlook: sleep. Whether you're training for a marathon, lifting weights, or just trying to stay active, sleep plays a critical role in how well your body performs, recovers, and adapts. Let’s explore how sleep directly impacts exercise and why prioritizing it may be the smartest move you make for your fitness goals.

1. Sleep Boosts Physical Performance

Getting adequate sleep improves:

Strength and power output
Reaction time
Endurance
Coordination and accuracy

Studies involving athletes from organizations like Stanford University have shown that extending sleep improves sprint speed, free-throw accuracy, and overall athletic performance. When you're well-rested, your nervous system functions more efficiently, allowing faster muscle activation and better movement control.On the other hand, even one night of poor sleep can reduce time-to-exhaustion and decrease peak performance.

2. Muscle Growth Happens During Sleep

You don’t build muscle while lifting weights, you build it while recovering.During deep sleep, your body releases growth hormone , which supports the following functions:

Muscle repair
Tissue growth
Fat metabolism
Protein synthesis

Without sufficient sleep, your body produces less growth hormone and struggles to repair muscle fibers effectively. Over time, this can stall strength gains and increase injury risk.

3. Sleep Reduces Injury Risk

Chronic sleep deprivation impairs:

Balance
Reaction time
Decision-making
Joint stability

Athletes who consistently sleep fewer than 7 hours per night have significantly higher injury rates compared to those who sleep 8–9 hours. Fatigue affects movement patterns, which increases strain on muscles and ligaments.

In simple terms: tired bodies move poor and poor movement leads to injury.

4. Mental Performance and Motivation

Exercise isn’t purely physical, it’s also mental. Lack of sleep reduces motivation to train, reduces pain tolerance, focus during workouts, and mood stability. Sleep deprivation increases perceived effort, meaning workouts feel harder than they actually are. This can lead to skipped sessions and inconsistent training.

5. Recovery, Inflammation, and Immune Function

Sleep is when your body repairs damaged tissues and reduces inflammation. Poor sleep increases inflammatory markers, slows muscle recovery, and weakens immune function. If you’re training intensely but not sleeping enough, you may experience persistent soreness, fatigue, or even frequent illness.This all can lead to increased risk of injury.

Tips to Improve Sleep for Better Workouts

Keep a consistent sleep schedule.
Limit caffeine 6–8 hours before bed.
Reduce screen time 30- 60 minutes at night before going to sleep.
Keep your bedroom cool and dark.
Avoid intense late-night workouts (if they disrupt sleep).

You can train hard, eat clean, buy the best shoes, and follow the perfect program, however, without sleep, your results will always be limited.Think of sleep as your body’s natural recovery supplement that is free, powerful, and essential. If you want better strength, endurance, muscle growth, and overall performance, start by protecting your sleep.

References

Dolezal, B. A., Neufeld, E. V., Boland, D. M., Martin, J. L., & Cooper, C. B. (2017). Interrelationship between Sleep and Exercise: A Systematic Review. Advances in preventive medicine , 2017 , 1364387. https://doi.org/10.1155/2017/1364387

Dry Needling vs Acupuncture- What's the Difference?

Sat, 07 Mar 2026 02:56:19 GMT

Dry Needling in Holly Springs, NC

A common statement I hear from a lot of patients is: “Oh yeah! I’ve had dry needling before, it's just like acupuncture right?”

My answer…not exactly! The only similarity is the needles that we use!

Dry needling and acupuncture are based on very different philosophies and are used for different purposes.

Dry needling is a modern treatment technique that can be used by physical therapists to treat muscle pain and movement problems. It is based on Western medicine principles using anatomy, physiology, and neuroscience. During dry needling, a thin needle is inserted directly into a tight muscle band or “trigger point”. These tight areas can cause pain at the area itself, restrict movement and even refer pain to other parts of the body.

The goal of dry needling is to release muscle tension, decrease pain, improve blood flow, restore movement and calm an overactive nervous system. Dry needling is typically one part of a comprehensive physical therapy plan that also includes exercise, mobility work, and strength training.

Acupuncture is part of Traditional Chinese Medicine and has been practiced for over 2,000 years. It is based on the concept of balancing the body’s energy or “qi” which flows through pathways called meridians. Rather than targeting specific tight muscles, acupuncture involves placing needles at specific points along these energy pathways and only minimally breaks the skin’s barrier.

Acupuncture is often used for pain relief, stress, anxiety, sleep issues and digestive problems and is usually performed as a stand-alone treatment rather than as part of a rehab program.

If you’re curious whether dry needling is right for you, talk with your physical therapist. We can help determine if it fits your specific condition and goals.

Nicole Perna PT, DPT

Evolve Physical Therapy

Abdominophrenic Dyssynergia: What is it and How Physical Therapy Can Help

Wed, 18 Feb 2026 19:23:49 GMT

Physical Therapy for Abdominophrenic Dyssnergia in Holly Springs, NC

A patient presented to our clinic with a chronic history (greater than 15 years) of GI discomfort, bloating and pain. He was seen by multiple different physicians and prescribed GI medications to help with heartburn and acid reflux. Nothing seemed to change his symptoms. He received numerous tests and scans with no specific outcomes or diagnosis. Unfortunately, he continued to suffer, having to eat smaller portions at a significantly slowed speed and his relationship with food was surrounded by pain and discomfort.

Frustrated with the medical system and desperate for help, he completed his own research which led him to explore more about abdominophrenic dyssynergia.

Abdominophrenic dyssynergia (APD) is a faulty breathing and abdominal muscle pattern where the diaphragm and abdominal wall don’t coordinate the way they should.

Normally: as we inhale the diaphragm contracts to descend downward, abdominals and pelvic floor relax. As we exhale: diaphragm relaxes upward and abdominal wall gently engages.

With APD: we see a paradoxical pattern. As we exhale the diaphragm contracts downward and the abdominal wall stays relaxed. Causing bloating to often be more muscular and pressure related, not digestive.

APD can happen for many different reasons:IBS, pelvic floor dysfunction, postpartum core changes, history of abdominal surgery, chronic stress or shallow breathing, and/or persistent “belly gripping” or abdominal bracing habits.

What have we worked on in Physical Therapy :

Breathing Retraining: 360 breathing, rib cage expansion and controlled exhale with gentle abdominal engagement
Abdominal Wall Coordination: deep core activation (transverse abdominis), timing with breathing and relaxation when appropriate
Posture and Rib Mobility: improving thoracic and rib mobility through manual therapy and postural retraining
Nervous System Regulation: slow breathing drills, parasympathetic activation and education to improve the gut-brain connection

This patient has been attending physical therapy once a week 6 weeks and is now being treated bi-weekly. He reports decreased bloating, improved speed of eating and decreased pain during and after eating. He states that his relationship with food and overall meal experiences have improved. He now has confidence that his symptoms can improve and be controlled.

If you have been dealing with constant unexplained bloating and nothing has helped it’s not just how your body is and you do not just have to deal with it. APD is common and treatable just often overlooked. Physical therapy may be the answer.

Nicole Perna PT, DPT

Evolve Physical Therapy

The Importance of Posture With Breastfeeding

Tue, 17 Feb 2026 12:04:03 GMT

Physical therapy tips for neck pain with breastfeeding, Holly Springs, NC

Breastfeeding is often described as a natural and bonding experience—but it can also be physically demanding. Hours spent feeding your baby, especially in the early weeks, can take a toll on your body if posture is overlooked. Good posture while breastfeeding isn’t just about comfort; it plays a crucial role in preventing pain, supporting milk flow, and helping you enjoy the experience more fully.

Why Posture Matters

When you’re breastfeeding, your body is doing repetitive work for extended periods. Slouching, hunching your shoulders, or craning your neck to look at your baby may feel harmless at first, but over time these habits can lead to neck, shoulder, and upper back pain, lower back strain, wrist and arm discomfort, and fatigue and tension headaches.

How Posture Affects Your Baby

Posture doesn’t just affect you; it impacts your baby too. When you’re well-supported and aligned:

Your baby can latch more effectively
Feeding tends to be more efficient and comfortable
Baby is better positioned for swallowing and digestion

Instead of bringing your breast to the baby by leaning forward, bringing the baby to your breast helps maintain proper alignment for both of you.

Common Posture Mistakes During Breastfeeding

Many parents fall into these habits, especially during night feeds or long sessions:

Leaning forward or hunching over the baby
Raising shoulders toward the ears
Twisting the torso to one side
Holding the baby’s weight with arms alone

These positions may feel manageable short-term but can cause cumulative strain over weeks and months.

Tips for Maintaining Good Breastfeeding Posture

Small adjustments can make a big difference:

Sit with support
Choose a chair with good back support or use pillows behind your lower back. Your spine should feel upright but relaxed.
Bring the baby to you
Use breastfeeding pillows or cushions so your baby is lifted to breast level. Avoid bending your body forward.
Relax your shoulders and neck
Keep shoulders down and back. If you find yourself looking down often, try bringing the baby slightly higher instead.
Support your arms
Rest your elbows on armrests or pillows to prevent arm and wrist fatigue.
Keep your feet grounded
Feet flat on the floor (or a small footstool) help stabilize your posture and reduce lower back strain.

Posture Changes for Different Feeding Positions

Whether you prefer cradle hold, football hold,or laid-back breastfeeding, posture still matters. The key principles remain the same: support your body, keep your spine neutral, and avoid holding tension. Experiment with positions to find what feels best for both you and your baby.Breastfeeding already asks a lot of your body—good posture is one way to give back to yourself. With the right support and awareness, feeding time can be more comfortable, calmer, and more enjoyable for both you and your baby. Listen to your body, make adjustments when something doesn’t feel right, and remember: comfort matters.

The Most Common CrossFit Injuries - And How to Avoid Them

Mon, 02 Feb 2026 01:41:47 GMT

Physical Therapy For CrossFit Injuries, Holly Springs, NC

CrossFit has taken the fitness world by storm, offering high-intensity, functional workouts that challenge strength, endurance, and mental toughness. But with its popularity has come growing attention to injury risks. While CrossFit isn't inherently dangerous, the combination of complex movements, high reps, and competitive drive can increase the likelihood of getting hurt, espcially if form and recovery are overlooked.

In this blog, we’ll dive into the most common CrossFit injuries , why they happen, and how to prevent them so you can train hard and smart.

Shoulder Injuries

Movements like kipping pull-ups, overhead presses, snatches, and muscle-ups put a lot of stress on the shoulder joint. Without proper mobility or stability, this can lead to rotator cuff strains, impingement, or labrum tears.

Prevention Tips:

Focus on shoulder mobility and stability exercises.
Prioritize strict strength movements before progressing to kipping or dynamic skills.
Warm up thoroughly, especially before overhead lifts.

Lower Back Pain

Deadlifts, squats, and Olympic lifts all load the spine. When fatigue sets in or form breaks down, the lower back often takes the hit. The result? Muscle strains, disc issues, or SI joint dysfunction.

Prevention Tips:

Maintain a neutral spine during lifts.
Scale weight appropriately, especially under fatigue.
Strengthen your core and posterior chain to support spinal alignment.

Knee Pain or Injury

High-volume squats, box jumps, and running can aggravate the knees, especially if there's poor hip or ankle mobility. Patellar tendinitis, meniscus irritation, and ligament strain are all common.

Prevention Tips:

Work on hip and ankle mobility to improve squat mechanics.
Don’t neglect glute activation in your warm-up.
Learn proper landing mechanics for jumps

Tendinitis (Especially in the Elbows and Knees)

Repetitive stress without adequate rest can lead to overuse injuries like tendinitis, commonly in the elbow (e.g., "tennis elbow"), knee (e.g., "jumper’s knee"), and ankle (e.g. achilles tendonitis).

Prevention Tips:

Rotate programming to avoid overusing the same joints.
Incorporate deload weeks and active recovery.
Listen to early warning signs, don’t push through sharp pain.

Injury Prevention: Your Best Strategy

While CrossFit can lead to injuries, the rate of injury is really no higher than any other sport. The cause of injury is normally due to working out with an ego, over- or under-training and not scaling when needed, and, lastly, not warming up thoroughly for the workout. Just like any sport, proper coaching, smart programming, and listening to your body go a long way. Here's how to stay injury-free:

Warm up thoroughly before every workout.

Cool down and stretch post-WOD to aid recovery.
Scale workouts to match your current fitness and mobility level.
Prioritize technique over ego or leaderboard rankings.
Rest and recover: gains happen when you recover, not just when you train.

References

Alekseyev, K., John, A., Malek, A., Lakdawala, M., Verma, N., Southall, C., Nikolaidis, A., Akella, S., Erosa, S., Islam, R., Perez-Bravo, E., & Ross, M. (2020). Identifying the Most Common CrossFit Injuries in a Variety of Athletes. Rehabilitation process and outcome , 9 , 1179572719897069. https://doi.org/10.1177/1179572719897069

Why Resistance Training is Important During Pregnancy

Wed, 28 Jan 2026 04:46:44 GMT

Pregnancy Physical Therapy, Holly Springs, NC

If able, exercise during pregnancy should be considered necessary as part of your pregnancy

journey. While walking and aerobic exercise are commonly recommended, strength work with

weights or resistance bands may offer unique benefits. Previous research was limited and

inconsistent on this however a recent article titled “Resistance training in pregnancy:

systematic review and meta-analysis of pregnancy, delivery, fetal and pelvic floor

outcomes and call to action” breaks down new information.

Researchers pulled together all the best available studies on the topic to answer a big question:

Does resistance training during pregnancy influence outcomes for the pregnant person,

the baby, labor and delivery, or pelvic floor health?

They included: 47,619 pregnant participants from 14 countries and 50 studies.

They found that resistance training can:

- Lower Risk of High-Risk Pregnancy Conditions compared to usual care or no resistance

training

- Gestational Hypertension

- Gestational Diabetes

- Perinatal Mood Disorders

- Provide Fetal Benefits

- Fewer causes of macrosomina (when a baby grows very large before birth)

They reported resistance training provided no clear benefits or harms in regard to:

- C-section rates

- Perineal tearing

- Instrumental delivery (forceps/vacuum)

- Length of labor

Resistance training during pregnancy appears safe and beneficial for preventing gestational

hypertension, gestational diabetes, mood disorders, and large birth weight when compared to

standard care. It does not seem to increase risks of negative outcomes like cesarean section or

pelvic floor problems.

Real benefits likely depend on how resistance training is done including exercise selection,

intensity, and progression. It is important to have thoughtfully prescribed and supervised

activities that are tailored to your medical history. You should always discuss exercise with your

healthcare provider or Pelvic Floor Physical Therapist prior to starting.

Dr. Nicole Perna, PT, DPT

Evolve Physical Therapy

Can a Walking Program Reduce the Recurrence of Low Back Pain?

Fri, 09 Jan 2026 13:51:59 GMT

Physical Therapy for Low Back Pain in Holly Springs, NC

Low back pain is the leading cause of disability and frequently reoccurring. Rates of hospitalization associated with low back pain have been estimated between 13.4%-18.7% and around $1,226.25 per patient/annually .1 Although exercise is often recommended for the prevention of low back pain, there was not a consensus on what is the most simple method with few barriers to entry. The WalkBack Randomized Control Trial by Lancet in 2024 looked to establish a low cost, effective, and accessible walking program that could reduce the rate of recurrence of low back pain.

In the WalkBack Study, they found that walking and education by physical therapists decreased the recurrence risk of low back pain by nearly 30% and extended pain-free time by 96 days on average.2 The follow up study in 2025 identified that when patients did have flare-ups, they were shorter in duration (3 vs 4 days) and milder in intensity.3

These positive benefits were achieved with only a structured walking program and accountability— no expensive monthly gym membership or equipment needed. Because walking is accessible, safe, scalable, and effective in reducing the recurrence of low back pain, it should be considered our baseline for physical activity. From there, outcomes could improve even more from the additional benefits of progressive strength training by improving tissue resiliency for functional strength and capacity.

References:

Fatoye F, Gebrye T, Mbada CE, Useh U. Clinical and economic burden of low back pain in low- and middle-income countries: a systematic review. BMJ Open . 2023;13(4):e064119. Published 2023 Apr 25. doi:10.1136/bmjopen-2022-064119

Pocovi NC, Lin CC, French SD, et al. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Lancet . 2024;404(10448):134-144. doi:10.1016/S0140-6736(24)00755-4

Pocovi NC, Graham PL, Adelaide A, et al. Effect of a Walking Plus Education Program on the Duration and Severity of Recurrences of Low Back Pain: A Secondary Exploratory Analysis of the WalkBack Trial. J Orthop Sports Phys Ther . 2025;55(9):1-6. doi:10.2519/jospt.2025.13361

Best position to push in for labor (from a pelvic-floor PT)

Mon, 05 Jan 2026 19:04:39 GMT

Birth Prep & Pelvic Floor Physical Therapy in Holly Springs, NC

As a pelvic-floor physical therapist I get asked a lot: “What position should I push in so I don’t tear?” Short answer: there isn’t a single “magic” position that guarantees no tear , but current evidence and guidelines support giving people freedom to choose positions that keep the sacrum mobile. Below I summarize the evidence and point out what really seems to reduce tears, and give practical, evidence-based tips you can use when making a birth plan.

Why position might matter

Perineal tears happen when tissues are stretched faster or beyond their capacity during crowning. The shape of the pelvis and how the sacrum and pelvic outlet can move changes the space through which the baby passes.
Upright or “flexible-sacrum” positions (standing, kneeling, hands-and-knees, squatting, sitting on a birth stool/ball) tend to increase the pelvic outlet diameter and use gravity. This can speed descent and how the head rotates/descends. That can be helpful, but faster descent can theoretically increase risk in some contexts if not well managed.

What the evidence actually shows

1. Flexible-sacrum or non-supine positions often lead to more intact perinea and shorter second stage.
The most up to date literature shows that allowing and encouraging upright or flexible-sacrum positions is associated with a higher chance of an intact perineum, fewer episiotomies, and a shorter fetal-descent/second stage versus strict supine . However studies are mixed. This pattern appears whether or not an epidural is used, but research quality and settings do vary.

2. There is no single position proven to eliminate tears and some positions show mixed signals.
Different upright positions (e.g., squatting vs. side-lying vs. hands-and-knees) have been studied, and results are not similar. Overall, the evidence supports choice and flexibility rather than a single mandated posture.

3. How you push (directed vs spontaneous/delayed) matters too!! BUT evidence is mixed.
Systematic reviews show no clear, consistent advantage of forceful coached Valsalva pushing vs spontaneous/physiologic pushing on rates of severe perineal trauma. Pushing technique can influence outcomes, but it’s not the only thing.

4. Other factors often outweigh position alone.
Instrumental births (forceps/vacuum), fetal size and position (occipito-posterior, big baby), episiotomy policies, perineal protection techniques (warm compresses, manual “hands-on” support), and the attendant’s approach are all strong factors of perineal outcome.

What I tell my patients:

Plan for choice rather than a single “best” position.
Evidence and international guidance favor supporting the birthing person to choose their position and remain mobile when safe to do so.
Try positions that keep the sacrum free to move (flexible-sacrum positions):

hands-and-knees (all-fours): good for posterior-position babies and for perineal relaxation
side-lying (lying on the side): allows controlled descent and is useful if you want to slow crowning a bit
semi-upright / sitting on a birth ball or stool: uses gravity but can be modified for perineal control
Squatting: can open the pelvis and shorten the second stage, but discuss with your team because some studies have mixed findings about severe tears in some contexts.

Use perineal-protection techniques during the actual birth of the head.
Evidence supports techniques like warm compresses, gentle manual support (“hands-on” guarding), and controlled birth of the head rather than rapid uncontrolled expulsion. So discuss with your midwife or OB beforehand.
Aim for physiologic/spontaneous pushing when appropriate.
If possible and safe, spontaneous (mother-directed) pushing often leads to similar or better outcomes for mother and baby than coached Valsalva pushing. If you have an epidural, timing and technique may need to be adjusted so just talk with your team. They are there to help guide you.
Instrument births and fetal position matter a lot.
If an operative vaginal delivery (vacuum/forceps) becomes necessary, or the baby is in an OP position or is large, the risk of severe perineal trauma increases regardless of maternal position. Some factors we just can’t control.

What to put in your birth plan

“I want to be offered mobility and a choice of positions during the second stage if no contraindication.”
“Please use warm compresses and manual perineal support at crowning unless not possible.”
“If I have an epidural, please discuss options to safely allow non-supine positioning if feasible.”

Final practical note from a pelvic-floor PT

Position is an important factor but it’s not the only one. The best strategy to reduce tearing is multi-factorial: encourage movement and flexible-sacrum positions when safe, use perineal-protection techniques at crowning, favor mother-directed pushing when possible, and make sure your care team knows your preferences ahead of time. After birth, whether or not you had a tear, pelvic-floor PT can help with recovery, pain, scar mobilization, functional return, and pelvic-floor muscle training. Feel free to reach out if you want help with a pre or postpartum plan.

Low Back Pain: More than just a physical injury - Holly Springs Physical Therapy

Mon, 08 Dec 2025 16:11:45 GMT

Holly Springs Physical Therapy For Low Back Pain

Low back pain is one of the leading causes of disability worldwide (IHME, 2023). It can hinder people from performing daily activities, working, and enjoying a good quality of life. While many instances of low back pain do resolve, a significant number of individuals experience chronic low back pain that lasts for weeks, months, and even years. This pain can persist and result in disability, which will limit individuals from performing daily tasks at work or home. This can impair mobility, such as standing, walking, bending, and reduce the ability to perform tasks related to their job.

Many believe low back pain is predominantly a musculoskeletal issue, but it can also have a huge impact on your social life, mental health, and even have economic consequences from the limitations and restrictions it can create in your daily life. Living with chronic pain can cause depression, anxiety, and decrease the quality of life due to the inability to participate in activities that bring that individual meaning and joy. This can often occur from fear of pain or catastrophizing about movements or activities that may cause or increase pain (Singhal et al., 2021). This can create an endless cycle of preventing patients from becoming active or doing activities that they love to do out of fear, which we call pain purgatory.

Physical therapy can be an excellent option to help determine the factors contributing to an individual’s pain experience. During physical therapy an initial evaluation is performed that allows the clinician to learn the patient’s history, gather information through a variety of tests and measures, and then develop a plan of care with the patient. This plan is used to address the impairments, limitations and restrictions, and work towards the patient’s goals. Within treatment, this can include introducing exercise, using manual therapy to help reduce the symptoms experienced, discussing ways to improve health and wellness, as well as working on fear avoidance behaviors with movements. Combining these tools as well as working with other healthcare providers can really help to improve the symptoms experienced, and, therefore, improve their quality of life as well.

This can look like:

Utilizing coping strategies while performing a task that is fearful

Gradual exposure to movements that have caused pain or fear

Guided imagery

Improving strength and endurance to improve resilience and reduce risk fo injury

References

Current guidelines . Current Guidelines | odphp.health.gov. (n.d.). https://health.gov/paguidelines/second-edition/

Delitto, A., George, S.Z., Van Dillen, L., Whitman, J.M., Sowa, G., Shekelle P, et al. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1-A57.

George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021). Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. The Journal of orthopaedic and sports physical therapy , 51 (11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304

Singhal, K., Muliyala, K. P., Pakhare, A. P., Behera, P., & Santoshi, J. A. (2021). Do Patients of Chronic Low Back Pain have Psychological Comorbidities?. Avicenna journal of medicine , 11 (3), 145–151. https://doi.org/10.1055/s-0041-1734385

How to Handle Plantar Fascia Pain?

Fri, 26 Sep 2025 11:44:39 GMT

Physical Therapy for Plantar Fasciitis in Holly Springs, NC

You woke up and went to take your first step out of bed, only to be jolted fully awake with an intense pain at your heel. Plantar fasciitis is the term used to describe acute inflammation of the plantar fascia, which is a connective tissue that runs from the heel to the toes. However, research has shown that more often what we are seeing is a chronic issue of degenerative changes to the tissue instead of an acute inflammatory response. This condition can become functionally debilitating by negatively impacting walking and standing tolerance.

Although rest may seem like a good treatment option for pain with weight bearing, plantar fasciitis normally is worse during the transition between resting and walking. Instead of avoiding rest or movement altogether, a quick warmup prior to getting up from bed or standing up to walk will help increase blood flow to the area and increase muscular activation to help stabilize the ankle/foot. An example of 3 exercises that may help prep the foot prior to walking include seated calf raises, toe yoga, and seated arch raises.

Evidence based treatment for heel pain includes stretching of the plantar fascia, gastrocnemius and soleus as well as hands on manual therapy techniques to address joint restrictions and muscle tightness for temporary pain management. Dry needling of trigger points in the gastrocnemius, soleus and/or plantar fascia is recommended for reducing pain. Long term pain management strategies include a progressive strengthening program that improves the loading tolerance of the foot. Orthotics should not be used alone in the treatment of plantar fasciitis, but may be beneficial when combined with other supported treatment recommendations. For those that deal with consistent pain with the first step in the morning, a 1-3 month night splint program is recommended. Ultrasound is not recommended in the treatment of plantar fasciitis.

Are you dealing with chronic nagging plantar fascia pain and ready to get long term pain relief? Book a consultation with us to discuss if physical therapy would be a good fit for you!

Dr. Rebecca Acevedo, PT, DPT

Reference:

J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303

Find Your “Sweet Spot”: Exercising While Injured

Mon, 22 Sep 2025 20:31:45 GMT

Holly Springs Physical Therapy For Orthopedic Injuries

When exercising or participating in sports, injuries are bound to happen. More often than not, when we get injured, we find ourselves wondering if we should continue to be active out of concern of either increasing our pain or potentially causing more harm. While resting or taking a break may be recommended with some injuries, this doesn’t mean that it is “one-size-fits all” for all injuries or that one should skip the gym entirely until your injury heals. While resting is essential to allow our body to recover from the stress placed on it while exercising, even when injured, continuing to be active often aids in our recovery process more so than resting until we feel better.

Continuing to exercise while injured has many physiological benefits, and results in changes in the body by responding to the stress placed on it during that activity (Khan & Scott, 2009). For example when we lift weights, this results in our bones becoming stronger from the stress of the weight applied to the body. As we continue to do this, our body adapts, we become stronger, and we can gradually increase the amount of weight we lift. Now applying this to an injury, while we may not be increasing our weights or hitting a PR, continuing to train helps the body to continue to respond to the loads and stresses of training. Ultimately, this helps to reduce the risk of injury and progressively load our body back to our “normal” training volume as we are still somewhat adjusted to exercising.

When we choose to rest or skip the gym as a whole, this can actually increase our risk of re-injury, because we have lost strength and our bodies are not used to exercising or training anymore (Gabbett, T.J., 2016). After resting for long periods of time, we are no longer conditioned to the stimulus to exercising, and we end up shocking the system by taking a long break and trying to return to our activities at pre-injury level. So the question is, how do we go about continuing to train while injured?

The goal is to find our “sweet spot” where we can continue to stay active to optimize recovery and limit outlying factors, such as increased fatigue, increased symptoms, and rapid changes in our recovery process (Gabbett, 2016). When we discuss rapid changes in our recovery process, this includes the lengthy rest breaks before trying to resume our normal activity level and the overactive training to try to compensate for our injury or symptoms sustained. Gabbett demonstrates this “sweet spot” in the image below, as well as the “the danger zone” in the image below (2016).

When we are consistent with our recovery process and train in that “sweet spot”, we are more resilient to re-injury and can continually progress back to our normal state or volume of training. In comparison, if we are over-training or avoid training while injured, we are increasing our risk of flare-ups or re-injury by increasing those outlying factors discussed earlier.

By incorporating modifications to our training sessions, prioritizing safety while exercising when injured, and allowing ourselves to be consistent with our recovery, we can continue to participate in the sports we enjoy, even when not at 100%. Below are a few suggested modifications we can use while exercising and injured:

Reduce intensity
Decrease speed, weight, or reps
Increase rest the interval
Modify the range of motion
Instead of a full depth squat, squat to a box
Reduce the distance from the floor or height of target
Modify movements
Try strict movements or lifts
Substitute different cardio equipment
Try different loading strategies
Utilize different equipment like barbells, kettlebells, or rings
Change body position

References

Gabbatt, T.J.(November, 2016). The training-injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine , (50), 273-280. doi:10.1136/bjsports-2015-095788

Khan, K. M., & Scott, A. (2009). Mechanotherapy: How physical therapists' prescription of exercise promotes tissue repair. British Journal of Sports Medicine , 43 (4), 247–252. https://doi.org/10.1136/bjsm.2008.054239

Birth Preferences

Wed, 10 Sep 2025 11:44:25 GMT

Birth Preparation Holly Springs, NC

If you are expecting, then you have probably heard about making a birth plan. Although I don’t love the word “plan” when thinking about labor and delivery, I do think there is great value in taking time to understand the possible interventions during childbirth and early newborn care so that you can develop a list of “birth preferences.”

I encourage patients to make a Vaginal Birth Preferences list as well as an Unplanned C-Section Preferences list. As we prepare at the end of pregnancy for what we hope will happen during the birth of our baby, we have to realize that childbirth is an unpredictable experience that can very quickly move outside of our control. Whether it is your first birth or sixth, each pregnancy, labor, delivery, and postpartum experience is unique. Creating a hierarchy of interventions that you prefer is often a helpful way to adapt to the unexpected situations that may arise. For example, imagine that you are a first-time mom and your goal is to have an unmedicated vaginal delivery. You end up having a very long first phase of labor, are getting very fatigued, and are starting to feel overwhelmed by the pain and lack of dilation progress despite staying moving, changing positions, and using the labor tub. In this situation, you may need to discuss with your medical team what interventions may assist with pain management to allow you to rest so that you have energy to push and achieve your overall goal of a vaginal delivery.

To clarify, I don’t believe that there are births that are superior to others. Whether it is vaginal or abdominal, medicated or unmedicated, no one birth is better or more legitimate than another. The hierarchy that I am referring to is reserved exclusively for your preferences and priorities. There are so many options available to you that can be started low and slow, reduced, or completely stopped if they are not working well for you or your baby. If you are unsure about certain interventions and early newborn care decisions, Evidence-Based Birth is a phenomenal free resource for you and your partner to educate yourselves in advance: https://evidencebasedbirth.com/signature-article-directory/ (they also have a podcast if you prefer listening vs reading).

In pelvic floor physical therapy birth prep sessions, we provide education on the first and second stages of labor by helping you understand the physiologic process of birth, your pelvic floor anatomy, stretches and positions to help with labor progress, and how to effectively push to reduce your risk of severe perineal tearing. Our goal is that you go into birth with the tools you need to make empowered decisions to improve your outcome. Let us know if you would like a free consultation on what our birth prep package includes!

Birth Prep in 3rd Trimester - What does it include?

Wed, 03 Sep 2025 15:19:30 GMT

Typically, once people get into their 3rd trimester of pregnancy, they focus on winding down, resting, and focusing more on stretching. While stretching is helpful, there is more you can do in your 3rd trimester to better prepare for labor, delivery, and recovery after childbirth. Birth prep physical therapy during the third trimester (weeks 28–40) focuses on helping the body prepare for labor and delivery, relieve discomfort, and support postpartum recovery. Here's what it typically includes:

Optimize Pelvic Alignment & Mobility

Encourages smoother fetal positioning and reduces chances restrictions from your pelvis and surrounding structures.
This can include incorporating different positions to help open up different areas of the pelvis, which allow for a smooth transition as the baby moves through the pelvis.

Reduce Pain & Discomfort

Targets low back pain, pelvic girdle pain, sciatica, and round ligament pain as the baby continues to grow.
Diaphragmatic breathing to help manage labor pain and regulate intra-abdominal pressure

Prepare Muscles & Tissues for Labor

Pelvic floor coordination and perineal mobility can ease labor and reduce tearing risk.
Learning to engage abdominal muscles to assist with pushing.

Gentle core exercises for transverse abdominis support.

Empowerment Through Education

Helps you understand pushing mechanics, breathing techniques, and labor positions.
This can include:

Pelvic Floor Work

Focus is on coordination between diaphragm, pelvic floor muscles, and abdominal
Learning how to relax the pelvic floor (just as important as contracting it).
Gentle perineal massage techniques (usually after 34 weeks).

Postural Adjustments & Alignment

Body mechanics for daily life (getting out of bed, lifting other children, etc.).
Pelvic tilts, cat-cow, and modified squats to maintain mobility.

Laboring positions and strategies for fetal positioning

Practice labor positions using birth balls, stools, or partner-assisted techniques.
Learn strategies for optimal fetal positioning (like Spinning Babies techniques).

Manual Therapy

Myofascial release, sacral mobilization, and soft tissue work to relieve tension.
Addressing hip or SI joint pain.

Ultimately, birth prep is tailored to the needs of the mother and her goals when it comes to her birthing experience. The items listed above are just a snapshot of techniques that can be incorporated into sessions to help one become more educated and aware of what the birth experience may encompass, as well as address aches and pains along the way.

Knee Pain Success Story - Physical Therapy Holly Springs, NC

Thu, 14 Aug 2025 18:21:56 GMT

Patient Knee Pain Success Story - Physical Therapy Holly Springs, NC

This week I want to highlight one of my patients that has recently graduated from a successful PT plan of care. She is an awesome teenager that had broken the growth plate at her knee during gymnastics several years ago. She was dealing with constant knee pain even after going through traditional PT after the initial injury. When she came for her initial appointment, she was having pain with the stairs and prolonged walking at school. She was dealing with pain while running and jumping, which limited her ability to participate in PE class and volleyball. She missed gymnastics and felt like she would never be able to get back to the sport she loved.

During her initial evaluation, I performed a comprehensive orthopedic exam that included checking for muscle imbalances, movement compensations, joint mobility restrictions, and tenderness for palpation. We utilized tools such as dry needling with electrical stimulation, IASTM, cupping, and myofascial release techniques to reduce her pain. We began restoring her quadriceps loading tolerance, as well as the strength of her gluteus medius and hamstrings. Limited ankle dorsiflexion range of motion was also addressed to improve her squat and stair negotiation mechanics. We worked on increasing her ankle and lower extremity proprioception to improve her stability. Progressively we worked up to low level hopping drills to build confidence and knee tolerance. Soon after we were able to complete a running assessment and single leg hop testing to begin improving her biomechanics for more complex plyometric exercises.

This patient went from having knee pain with a body weight squat on day 1 to completing 10 reps of 65# barbell front squats with her heels elevated without symptoms at the end of her 10 visits. She was able to control single leg hopping and jump a distance equal to the opposite side. She was able to run without pain and with good form. Her ability to jump progressed in vertical height and eccentric control, even with landings onto uneven surfaces. She reached her goals for strength, dynamic balance and hopping, and sport specific activities.

I am so grateful to her family for trusting me to guide her care. She was disciplined to complete her home exercises and come to therapy willing to try new things. If you have been dealing with a chronic injury and feel like there is no hope, then I hope this story encourages you to give one-on-one physical therapy a chance. We would be happy to provide a free injury screening to learn more about your story and see if we would be a good fit to help!

Dr. Rebecca Acevedo, PT, DPT

What Does A Running Analysis Look Like With A Physical Therapist - Holly Springs, NC

Thu, 14 Aug 2025 18:17:02 GMT

Evolve Physical Therapy in Holly Springs, NC

Whether you're a seasoned marathoner, a weekend jogger, or just lacing up for your first mile, running efficiently and safely is key to performance and injury prevention. A running analysis with a physical therapist (PT) offers valuable insights into your movement patterns, strengths, and potential areas for improvement.

But what exactly happens during a running analysis? Let’s break it down.

During the first phase of the running analysis, your PT will provide an initial consult and discuss your past medical history. This can include, current/past injuries, training history and goals, pain/discomfort while running, assess footwear, and any past medical conditions that you may have. Understanding your background helps the PT tailor the assessment to your needs and identify possible causes of pain or inefficiency.

Next, your PT will perform a movement assessment of you prior to hitting the treadmill. This can include:

Single-leg balance tests
Squats, lunges, and step-downs
Range of motion and flexibility checks (hip, knee, ankle, spine)
Core and lower extremity strength tests

This part reveals underlying mobility or strength deficits that might impact your running form. After this part of the assessment, your PT will move onto the gait analysis.Now it’s time to run. You’ll typically jog on a treadmill while being recorded from multiple angles (rear, side, and front). This footage allows your PT to analyze:

Foot strike pattern (heel, midfoot, forefoot)
Cadence (steps per minute)
Stride length and symmetry
Hip, knee, and ankle alignment
Pelvic stability
Arm swing and posture

Slow-motion playback and frame-by-frame analysis can highlight subtle imbalances or inefficient mechanics. After analyzing your running, your PT will walk you through the footage and discuss any deficits or impairments found.This will allow the PT to make improvements and help you become a more efficient runner. Your PT will walk you through the video footage and explain:

What your gait looks like
Where inefficiencies or risks for injury lie
How your form may contribute to pain or recurring injuries

Based on your analysis, your PT will design a custom program, which may include, strength training, mobility work, running drills, cadence adjustments, or a protocol for returning to running if the patient is coming back from an injury. Overall, a running analysis can be a very beneficial tool to address recurring injuries, pain during or after running, or if you are just looking for ways to improve your performance.

Benefits of Dry Needling During Physical Therapy

Wed, 06 Aug 2025 16:44:42 GMT

Dry Needling in Holly Springs, NC

The Benefits of Dry Needling During Physical Therapy

If you've ever experienced stubborn muscle pain that just won't go away, even with stretching, massage, or rest, you’re not alone. Chronic muscle tightness and trigger points are common culprits behind lingering discomfort and restricted mobility. That’s where dry needling, a modern technique used by many physical therapists, can make a real difference.

What Is Dry Needling?

Dry needling is a technique used by licensed physical therapists that involves inserting thin, sterile needles directly into myofascial trigger points, which are tight bands of muscle or knots that contribute to pain and dysfunction. The goal is to release tension, improve blood flow, and reset the muscle’s function.

Despite the similarity in tools, dry needling is not acupuncture . While acupuncture is rooted in traditional Chinese medicine and focuses on energy meridians, dry needling is based on Western anatomy and neuroscience, targeting specific muscular and connective tissue dysfunction.

So What Are The Benefits of Dry Needling?

1. Pain Reduction

Dry needling can provide immediate and significant pain relief by disrupting the pain cycle. The needle stimulation helps deactivate trigger points and release tight muscle fibers, leading to reduced soreness and improved comfort.

2. Improved Mobility and Range of Motion

When muscles are knotted and tight, they restrict movement. By releasing these restrictions, dry needling can help restore normal muscle length and joint motion, especially beneficial for athletes or individuals recovering from orthopedic injuries.

3. Accelerated Healing

Needling creates a micro-lesion that stimulates the body’s natural healing response. This increases blood flow and brings oxygen and nutrients to the area, helping injured tissues repair more efficiently.

4. Enhanced Physical Therapy Outcomes

When combined with exercises and manual therapy, dry needling often accelerates progress in physical therapy. Releasing muscle tension allows for better engagement during rehab exercises and helps patients move more efficiently with less pain.

5. Drug-Free Pain Management

In a world where opioids and medications are commonly prescribed for pain, dry needling offers a non-pharmacological alternative. Many patients find it to be an effective tool for managing chronic pain conditions without side effects.

Common Conditions Treated with Dry Needling

Neck and back pain
Tension headaches and migraines
Shoulder pain
IT band syndrome
Low back pain
Plantar fasciitis
Postural dysfunction and repetitive strain injuries

What to Expect During a Dry Needling Session

The procedure is generally well-tolerated, though you may feel a twitch or cramping sensation when the needle hits a trigger point, that’s a good sign it’s working. Some muscle soreness is normal after treatment and usually resolves within 24–48 hours.

Sessions are typically short and can be integrated seamlessly into your physical therapy treatment plan.

References

Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. The Journal of orthopaedic and sports physical therapy , 47 (3), 133–149. https://doi.org/10.2519/jospt.2017.7096

Hypermobility = More Responsibility

Fri, 01 Aug 2025 23:04:19 GMT

There are three primary categories to classify joint mobility: normal mobility, hypermobile, or hypomobile. Hypermobile joints are classified as those that exceed the normative range of motion values. While being extra flexible sounds advantageous, it also requires increased strength and coordination through a larger than usual range of motion.

When considering the stability of a joint, there are passive structures such as the shape of the bones, ligaments, joint capsules, labrum and bursa which help the joint maintain its alignment without muscular activation. Dynamic stability of a joint comes from the nervous system working together with our muscles to create smooth and efficient movements. With hypermobile joints, we can work to protect them by improving their dynamic stability through their large range of motion to help reduce risk of injury.

Joint hypermobility is also a common presentation in patients with genetic connective tissue disorders such as Ehlers-Danlos Syndromes. Some patients with EDS may experience frequent subluxations, sprains and dislocations due to the instability of their joints. Because of the compromise to their passive stabilizers, sometimes patients with EDS will present with complaints of muscular tightness that truly are stemming from decreased muscular flexibility, as the muscles have been essentially working double time to create stability.

A common complaint I often hear from patients is “feeling tight.” But when we check their active and passive range of motion and muscular flexibility, their mobility is above average. Instead, their symptoms of tightness are often caused by muscular weakness, poor endurance, or suboptimal coordination. One treatment strategy I like to try is dry needling with electrical stimulation for pain modulation and improved activation of the targeted muscle’s motor unit, followed by neuromuscular stabilization and strengthening activities to provide long term benefits. Although joint manipulations and stretching feel good at the moment, these treatments are essentially reinforcing excessive mobility in already hyper flexible joints.

As Uncle Ben warned Peter Parker (aka Spider Man), “With great power comes great responsibility.” If you have the superpower of being extra bendy, then take into consideration the increased demand on your neuromuscular system to keep your joints stable, and train accordingly!

Dr. Rebecca Acevedo, PT, DPT - Holly Springs, NC Physical Therapy

Understanding Temporomandibular Dysfunction (TMD): How Physical Therapy Can Help

Wed, 30 Jul 2025 16:42:18 GMT

If you’ve ever felt pain in your jaw, heard a clicking sound when you chew, or experienced headaches that seem to start near your ears, you may be dealing with temporomandibular dysfunction, or TMD. This often-overlooked condition affects the temporomandibular joint (TMJ)—the hinge that connects your jaw to your skull and plays a critical role in everyday activities like eating, speaking, and yawning.

What Is Temporomandibular Dysfunction? Temporomandibular dysfunction (TMD) is a broad term that refers to disorders affecting the jaw joint and surrounding muscles. The TMJ is one of the most complex joints in the body, allowing both hinge and sliding movements, which allows the jaw to open and close, slide forward/backward, and side-to-side. When something goes wrong with the muscles, ligaments, or joint surfaces, TMD symptoms can develop.

Common Symptoms of TMD:

Jaw pain or tenderness with opening or closing the jaw
Clicking, popping, or grinding sounds when opening or closing the mouth
Difficulty chewing or locking of the jaw
Headaches and neck pain
Facial pain or fatigue

What Causes TMD?

TMD can be caused by a variety of factors, including:

Teeth grinding or clenching (bruxism)
Stress and tension leading to muscle tightness
Poor posture, particularly in the neck and upper back
Injury to the jaw, neck, or head
Arthritis or degenerative joint changes
Dental issues, such as bite misalignment

How Physical Therapy Helps with TMD

Physical therapy is a conservative treatment option that can significantly improve TMJ function and reduce pain. A physical therapist trained in TMJ disorders will assess not only your jaw, but also your neck, posture, and muscle patterns to create a personalized treatment plan. Some of the benefits of physical therapy for TMD include:

1. Pain Relief

Manual therapy techniques, including soft tissue massage and joint mobilization, can reduce muscle tension and inflammation in the jaw and surrounding areas.

2. Improved Jaw Mobility

Therapists use specific exercises to restore normal movement to the jaw, helping to reduce clicking, locking, or restricted motion.

3. Postural Correction

Forward head posture and strength deficits of muscles surrounding the spine can put extra stress on the TMJ. PT can help you improve you strength key postural muscles and reduce the strain on your jaw.

4. Muscle Strength and Balance

Therapeutic exercises can improve the strength and coordination of the muscles that control jaw movement, reducing dysfunction and recurrence.

5. Stress Reduction Techniques

Since stress is a major contributor to jaw clenching and muscle tension, PT often includes relaxation techniques and education on how to manage these habits.

Final thoughts

If you’re experiencing jaw pain, popping, or limited mobility that lasts more than a couple of weeks, or if you’ve been diagnosed with TMD by your dentist or physician, physical therapy could be a valuable part of your recovery.Temporomandibular dysfunction can have a major impact on your quality of life, but it’s highly treatable—especially when addressed early. Physical therapy offers a safe and effective approach to managing TMD, restoring normal function to your jaw, and helping you return to a pain-free life.

References

U.S. Department of Health and Human Services. (February 2025.). TMD (temporomandibular disorders) . National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/health-info/tmd

Diastasis Recti and Misinformation

Sun, 20 Jul 2025 12:27:57 GMT

Maybe you’ve noticed coning or loafing in the middle of your abdomen with certain exercises or daily activities, like getting out of bed. You hop onto Instagram in search of answers to your questions on what to do and not do so that it doesn’t get worse. After all, you’re scared that your organs are going to push through the widening in your abdomen and cause herniations. You find an account by an influencer (possibly credentialed, or not…) who is selling their program to correct your diastasis recti and lose your mom pooch- sounds simple enough. They tell you to never do any exercises or activities that cause coning along your midline. You start the program you bought from them but notice your midline tenting/coning even with the most basic exercises, so you never progress to the next level of exercises because you don’t want to make things worse. You get down on yourself that you’ll never get back to your previous level of fitness because of your core problem. Due to frustration, you start working out less because you’re scared of doing it wrong and ruining your abdominal wall health. Exercise is no longer enjoyable because you are hyperfixated on if your abdominals are coning or not. Instead of bouncing back after kids, your self-image, mental health, and physical conditioning all take a dive.

This story could sound a lot different, but unfortunately we frequently hear some version of it more than we would like. We recognize that misinformation is rampant in multiple spaces, including but not limited to personal trainers, social media influencers, coaches, physical therapists, and medical doctors. We acknowledge that it is incredibly difficult in this day of immediate access to a vast amount of information to find out what is actually true. After all, you are just trying to make the most informed decisions possible about your health. We are trying as rehab providers to increase our voices as educators on evidence based practice because it shouldn’t be this hard.

The core is a canister that manages intraabdominal pressure. It is made up of your diaphragm, pelvic floor, transverse abdominus, obliques, latissimus dorsi, and multifidi muscles. As Orthopedic and Pelvic Health Doctors of Physical Therapy, our job is to teach you hands on how to recruit and coordinate these muscles to improve your abdominal wall resilience and load tolerance in a variety of movement planes. You deserve personalized, one-on-one care to retrain your core without the guess work of if you’re doing it right or not. The goal is to rebuild trust in your body so that you reach your specific goals, instead of forming a list of exercises that you should never do.

The fear of movement leads to further deconditioning and musculoskeletal dysfunction. We want to help break that cycle with you. If you have questions, please don’t hesitate to reach out to our team- we would love to be a resource to you!

Diastasis Recti Abdominis and Returning to Exercise

Wed, 16 Jul 2025 17:17:02 GMT

Throughout pregnancy, the female body encounters a number of changes to allow room for the baby to grow. Some changes we may notice are that our hips start to tilt forward a little bit more, we have a more extension in our lumbar spine, the rib cage widens to allow room for organs to move up, and, with that, the abdominal wall stretches too.

With the widening of the abdominal wall, we will also see the connective tissue, the linea alba, in the center of the abdominal muscles widen as well, which is termed diastasis recti abdominis.

One fun fact about these changes is that all women during pregnancy have a diastasis recti abdominis, as it allows for adaptations and fetal growth with pregnancy (Gingerich & Prevett, 2023).

With this particular change, you will hear a lot of talk and concern about pelvic floor weakness, abdominal weakness, and worsening of that widening with abdominal exercises that causes coning or doming of that tissue. However, all of these concerns are not necessarily true.

During this blog, we are going to focus on how to return to exercise while addressing your diastasis rectus abdominus or DRA.

Before we address some of the concerns with DRA, I think it’s important to recognize who this might occur in and factors contributing to it. While the pregnancy and postpartum population is the most common to experience this, it can also be seen in the very lean and muscular athletes, babies, and individuals with increased abdominal circumference (Gingerich & Prevett, 2023).

There are many factors that can impact the extent of DRA, including genetics, type of delivery, time between and number of pregnancies prior and current activity level, as well as rehabilitation and strength return between pregnancies or before first pregnancy.

Outside of pregnancy and postpartum and genetics, ability to manage intra-abdominal pressure and willingness to focus on form and quality of movement will also have an impact on an individual's DRA.

So how does this impact our ability to exercising or return to our daily activities? With DRA, many people are aware that coning in the center of the abdomen can cause weakness of the abdominals muscles, particularly rectus abdominis, and pelvic floor weakness as well.

This is thought to be because coning can worsen our DRA, result in poor management or activation of the core, and difficulty managing intra-abdominal pressure. These theories have led a lot of individuals astray from accessory core work that results in abdominal crunching or rotation of the abdomen to prevent weakness or abdominal/pelvic floor dysfunction.

However, in a recent study by Gluppe et al., it has been found that there was no increase in prevalence of pelvic floor dysfunction or low back pain among postpartum individuals with DRA compared to those without (2021). It was noted, however, that abdominal weakness and pain were associated with diastasis recti abdominis (DRA) (Gluppe, et al. 2021).

Along with this, Hills et al., found that individuals who worked on improving abdominal strength with sit ups and abdominal rotation consistently demonstrated improved strength through abdominal musculature and reduced pain (2018).

While the inter-rectal abdominal distance may not have improved, working on rotation torque and lower sit ups actually was beneficial with improving the strength of our abdominal muscles regardless of coning (Hills et al., 2018).

So, collectively the answer to the question above is with progressive loading and creating tension across the abdomen!

Lastly, how do we go about this? If you are returning to exercise and are experiencing DRA, we need to focus on managing our intra-abdominal pressure by creating tension across the linea alba…this means we need to load it with exercise and really focus on muscle activation (Gingerich & Prevett, 2023).

Ultimately, this means being intentional about our core activation whether we are squatting, picking up our baby, or lifting in the gym.

And, before you go directly back to kipping and increasing your intensity, take the time to really work on the quality of form and consistency of practice so we can improve our efficiency with movements and reduce risk of injury.

References

Gingerich, J. & Prevett, C. (2023, April). CMFA: Pregnancy & postpartum [Powerpoint slide]. Institute of Clinical Excellence.

Gluppe, S., Ellström Engh, M., & Kari, B. (2021). Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis. Physiotherapy , 111 , 57–65. https://doi.org/10.1016/j.physio.2021.01.008

Hills, N. F., Graham, R. B., & McLean, L. (2018). Comparison of trunk muscle function between women with and without diastasis recti abdominis at 1 year postpartum. Physical therapy and Rehabilitation Journal , 98 (10), 891–901. https://doi.org/10.1093/ptj/pzy083

Strength Training and Osteoporosis: Building Stronger Bones for a Healthier Future

Sat, 28 Jun 2025 12:10:20 GMT

Osteoporosis is a disease that weakens bones, makes the bones thin, and is often called a "silent disease" because it progresses without symptoms until a fracture occurs (NIH, 2022).Affecting millions worldwide—especially postmenopausal women and older adults—it weakens bones and increases the risk of breaks from minor falls or even simple activities like bending or coughing. While medication and dietary strategies are important in managing osteoporosis, one of the most effective and empowering approaches is strength training.

Why Strength Training?

Strength training, also known as resistance training or weightlifting, involves exercises that cause muscles to contract against external resistance. This can be done using free weights, resistance bands, weight machines, or even body weight.

But here’s the critical part: strength training doesn’t just build muscle—it stimulates bone growth . When muscles pull on bones during resistance exercises, they trigger bone-forming cells called osteoblasts, helping to maintain or even increase bone density (Hong, 2018).

Key Benefits of Strength Training for Osteoporosis

Increases Bone Density
Regular strength training can slow bone loss and may even build new bone in some people. This is particularly important in areas prone to osteoporotic fractures, like the spine, hips, and wrists.
Improves Balance and Coordination
By strengthening core and lower-body muscles, strength training reduces the risk of falls—the leading cause of fractures in older adults.
Enhances Posture and Mobility
Targeted exercises can combat the stooped posture and spinal compression often seen with advanced osteoporosis.
Boosts Overall Health
Strength training improves metabolism, insulin sensitivity, and mood, making it an all-around excellent tool for healthy aging.

Getting Started Safely

Before starting a strength training program, especially if you have osteoporosis or are at high risk, consult your healthcare provider or a physical therapist. They can help tailor a program to your needs and avoid movements that could be unsafe.

Safe Practices Include:

Start slow with light resistance and progress gradually.
Focus on form, not weight—proper technique is key to preventing injury. As form gets better, slowly increase the weight
Slowly work into high-impact movements, such as jumping
Include balance exercises like standing on one foot to enhance fall prevention.

Osteoporosis doesn’t have to mean frailty or fear. With a consistent, safe strength training routine, you can build resilience—not just in your bones and muscles, but in your confidence and quality of life as well!

Resources:

Hong, A. R., & Kim, S. W. (2018). Effects of resistance exercise on bone health. Endocrinology and metabolism (Seoul, Korea), 33(4), 435–444. https://doi.org/10.3803/EnM.2018.33.4.435

National Institute of Health: Arthritis and Musculoskeletal and Skin Disease. (2022). Osteoporosis. Retrieved from https://www.niams.nih.gov/health-topics/osteoporosis#:~:text=Osteoporosis%20in%20Men-,Osteoporosis%20is%20a%20bone%20disease%20that%20develops%20when%20bone%20mineral,Pregnancy%2C%20Breastfeeding%2C%20and%20Bone%20Health

A Positive VBAC Experience!

Thu, 12 Jun 2025 16:39:38 GMT

A Client Success Story!

This week, I want to highlight one of my birth prep clients who came to me at 36 weeks pregnant with the goal of a VBAC (vaginal birth after Cesarean). During the labor and delivery of her first two children, the position of the baby was suboptimal and ultimately led to a failure to progress with pushing, leading to two C-sections. For her third child, she was determined to learn and prepare her body as much as possible in hopes of a vaginal delivery.

Over the course of our 1x/week sessions for 4 weeks, we worked to improve the mobility of her hips, pelvis, and lumbosacral spine with gentle joint mobilizations, PNF stretching, cupping, scraping and myofascial release techniques. We addressed tightness of the adductors, hamstrings, quadratus lumborum, lumbar paraspinals, diaphragm, piriformis and gluteals that were contributing to lumbopelvic pain and mobility restrictions. The sidelying release technique from Spinning Babies was one of her favorites each session, as it was hard to find time with her partner to recreate the effective stretch at home. Her stretching program focused on improving pelvic inlet, mid pelvis, and pelvic outlet mobility combined with diaphragmatic breathing to optimize baby’s position in the weeks leading up to and throughout labor.

When we started push practice, her initial strategy was to hold her breath, engage the core and tighten the pelvic floor. During the internal pelvic floor assessment, there was notable tightness and pain limiting the ability to effectively coordinate pelvic floor muscle lengthening and expansion, which are crucial for a vaginal delivery. After manual release techniques and teaching her how to use a pelvic wand for self-release at home, the tenderness and pain of her pelvic floor resolved, allowing her to improve her ability to lengthen and relax the pelvic outlet.

After working together, we were able to improve her coordination to where she could exhale, engage the abdominals and expand the pelvic floor in a variety of delivery positions suitable for with or without an epidural.

She had a calm confidence at her last visit and told me how prepared she felt this time compared to her first two deliveries. Whatever happened, she knew that she had done everything possible to optimize her outcome because she invested in her knowledge and physical preparation. Ultimately, she went into spontaneous labor and was able to achieve the vaginal delivery after two Cesareans that she had hoped for! Mom & baby are both healthy and we are looking forward to seeing them back in the clinic to start postpartum rehab.

Bringing babies from the womb to the world is a wild experience that is largely out of our control, but we know that knowledge and preparation empower outcomes. Even if things don’t go exactly as we hope, increasing our awareness in advance improves advocacy and can change the trajectory of our responses, leading to less birth trauma carried into the future.

Dr. Rebecca Acevedo, PT, DPT

Evolve Physical Therapy

Can Alcohol Inhibit My Healing From An Injury?

Fri, 06 Jun 2025 15:04:34 GMT

Is Alcohol an Irritant for Pain?

Often in sessions, I will discuss factors that can be an irritant to pain and what “low hanging fruit” we can work to improve upon to help reduce symptom irritation. This typically includes sleep habits, stress, volume/load management of exercise, overall daily movement, and diet. But is alcohol an irritant for pain and should you avoid it while coping with pain?

The short answer is yes! Alcohol absolutely is an irritant and often worsens pain, especially for those coping with chronic pain. Alcohol can often increase inflammation due to how it is processed in the liver and GI tract, creating oxidative stress and cell damage inhibiting the repair of muscular tissue. It can also trigger the immune response and cause the release of pro-inflammatory cytokines, which can increase inflammation in the muscles and other tissues of the body. While rehabbing from an injury, some inflammation is expected and necessary for recovery, but the goal is to reduce exacerbation to inflammation of the tissues to allow them to heal

Lastly, alcohol can also impact overall recovery by interfering with nutrient absorption, can create hormonal imbalances with growth factor hormones, and interfere with sleep. By interfering with these last three processes this prevents muscle and other tissues within the body from recovering and rebuilding from trauma/damage or general use, and can often increase lactic acid. Collectively, with the increased inflammation, this can enhance muscle soreness, slow recovery rates, and can mimic the pain that people are experiencing.

In conclusion, while alcohol can be enjoyable when out with friends or at dinner (in moderation), it is best to at least reduce or abstain from alcohol consumption while recovering from an injury (or wanting to improve athletic performance). Overall, it can increase inflammation in the body, reduce your body’s ability to recover from the injury but also daily stressors by interfering with a wide variety of bodily processes, and enhance the overall pain that one may experience.

Simon, L., Jolley, S. E., & Molina, P. E. (2017). Alcoholic Myopathy: Pathophysiologic Mechanisms and Clinical Implications. Alcohol research : current reviews , 38 (2), 207–217.

Steiner, J. L., Gordon, B. S., & Lang, C. H. (2015). Moderate alcohol consumption does not impair overload-induced muscle hypertrophy and protein synthesis. Physiological reports , 3 (3), e12333. https://doi.org/10.14814/phy2.12333

What Happened to RICE and What Do We Recommend Now?

Wed, 28 May 2025 17:11:18 GMT

What happened to RICE and what do we recommend now?

The acronym RICE has been used for decades to guide management of acute musculoskeletal injuries. Although Dr. Gabe Mirkin coined the concept of Rest, Ice, Compression and Elevation in 1978, he changed his position in 2015 as new research demonstrated that “rest and ice can actually delay recovery.”

When a muscle, tendon, or a ligament are injured, the body responds with a 3 step process of inflammation, followed by repair and lastly, remodeling. Inflammation has a bad reputation, but without an inflammatory response, there is no healing. Part of the inflammatory response is vasodilation, which allows increased blood flow to the site of injury to usher in immune supporting cells such as neutrophils and macrophages. Macrophages release a hormone called insulin-like growth factor (IGF-1) that helps with muscle regeneration. Ice causes vasoconstriction and therefore limits the body’s inflammatory response, leading to delay of steps 2-3 for full recovery.

The lymphatic system is responsible for removing waste carried in lymphatic fluid from the site of injury up towards the heart to join the circulatory system to then be removed from the body via the urinary or gastrointestinal systems. Since the lymphatic vessels are passive structures with a one one direction of flow, contraction of muscles around the capillaries is vital for creating a pump effect to move the lymph through the system. Prolonged rest and inactivity reduces this muscle pump action, contributing to delayed clearing of waste at the site of injury, which can lead to increased swelling and incomplete healing of the tissues. Inactivity also leads to muscle atrophy, increases risk of reinjury, and reduces revascularization of the injured tissues.

Clinical research does not have high level evidence supporting the usage of compression and elevation in a recovery process, but also has not found significant harm. Therefore, these two treatments are included in the updated, very long acronym PEACE & LOVE .

P rotect: modify aggravating activities for 1-3 days after injury

E levate: support limb in position above the heart

A void antiinflammatory modalities: avoid antiinflammatory medications and ice

C ompress: taping, wraps/bandages for swelling control

E ducate: education from a therapist on load management and early activity to optimize recovery timeline and full healing with reduced risk reinjury, fear of movement and unnecessary medical interventions.

After the first few days after injury:

L oad: muscles, tendons, and ligaments rebuild in response to graded exposure to load. Early movement encourages this remodeling needed for daily, recreational and sport activities

O ptimism: better outcomes and prognoses are correlated with positive outlook on recovery

V ascularization: pain free aerobic exercise improves blood flow to injured tissues and helps manage pain without medications

E xercise: improve proprioception, increase mobility, restore strength, and reduce risk of reinjury

As with any injury, there is always nuance and exceptions that would be best answered for your specific situation by your rehabilitative medicine team. As Doctors of Physical Therapy practicing in an out of network model, our team at Evolve Physical Therapy is perfectly positioned to screen or evaluate your injury with reduced barriers to entry (no doctor’s referral needed, quick availability, and no limitations from insurance). Feel free to call or text our team at (919) 948-0880 for evidence based guidance to optimize your recovery!

Dr. Rebecca Acevedo, PT, DPT

Evolve Physical Therapy

References:

Scialoia, D., & Swartzendruber, A. J. (n.d.). The R.I.C.E. Protocol is a myth: A review and recommendations . Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733153/

Dubois, B., & Esculier, J.-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine , 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253

Is Exercising During Pregnancy Safe?

Sat, 17 May 2025 20:42:26 GMT

Exercising While Pregnant: What You Need to Know

Pregnancy is a transformative time in a woman's life, and staying active during this period can bring significant physical and emotional benefits. While every pregnancy is unique, the consensus among healthcare professionals is that moderate exercise is both safe and beneficial for expectant mothers! These guidelines have changed drastically over the years from recommending bed rest, to light exercise, and now encouraging women to continue to stay active throughout their pregnancy. Currently don’t exercise? That’s okay! Pregnancy can be an ideal time to start adopting a routine to help improve your health during pregnancy and postpartum.

Why Exercise During Pregnancy?

Staying active can help you:

Reduce backaches, constipation, bloating, and swelling
Boost your mood and energy levels (reduce risk of postpartum depression)
Improve sleep quality
Promote muscular strength and endurance
Lower your risk of gestational diabetes and pre-eclampsia
Enhance your ability to cope with labor and potentially shorten its duration
Speed up postpartum recovery

General Guidelines During Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) recommends that people engage in strength training and cardiovascular exercise before, during, and after pregnancy (2020). For a non-complicated pregnancy, some of the guidelines include:

At least 150 minutes of moderate-intensity aerobic activity per week that is spread out over the week, such as 30 minutes a day for five days
Women who engaged in vigorous-intensity aerobic activity before pregnancy can continue these activities during pregnancy and the postpartum period
Strength training 2-3 times a week with following appropriate modifications as you progress through pregnancy

Exercises to Avoid

To protect yourself and your baby, avoid:

Activities with a high risk of falling
Contact sports
Hot yoga or exercising in hot, humid conditions

Warning Signs to Stop Exercising

As you progress through your pregnancy, exercise modifications will start to occur. This is typically more common in the second and third trimester. But how do you know when to modify or stop exercising? While these are more significant signs and tend to signal for further medical care, some symptoms to look out for include:

Vaginal bleeding
Dizziness or feeling faint
Chest pain
Headache
Shortness of breath before exercise
Muscle weakness
Calf pain or swelling
Preterm labor signs or decreased fetal movement

In conclusion, exercise during pregnancy offers many benefits for both mother and baby. This includes improving maternal health during pregnancy, improved sleep quality, and reduced risk of diabetes and preeclampsia. The key is to stay active in ways that are safe and appropriate for your trimester and personal health. Always work with your healthcare provider to create a plan that suits your individual needs.

References

Physical activity and exercise during pregnancy and the postpartum period . ACOG. (2020). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period

Current guidelines . Current Guidelines | odphp.health.gov. (2018). https://health.gov/paguidelines/second-edition/

Global Recommendations on physical activity for health.WHO. (2010). http://www.who.int/dietphysicalactivity/publications/9789241599979/en

What's the point of Dry Needling (Literally)

Thu, 24 Apr 2025 14:36:41 GMT

Let’s Talk About Dry Needling

Have you been talking to someone about your chronic pain and they mention dry needling? We are here to answer all your dry needling questions!

Don’t worry, it’s not as scary as it sounds. In fact, for many, it’s a game-changer in pain relief and mobility.

What Is Dry Needling, Anyway?

Dry needling is a modern therapeutic technique used by licensed physical therapists and other trained healthcare professionals.

One of the biggest questions we get is, how is it different than acupuncture? Acupuncture is rooted in Traditional Chinese Medicine, dry needling is based on Western anatomy and science.

It involves inserting ultra-thin, sterile needles into myofascial trigger points —aka “knots” in your muscles, to help reduce pain, improve movement, and restore function.

How It Works

The theory is simple: When a needle hits a tight or irritable muscle band, it causes a twitch response, which helps the muscle release, improves blood flow, and promotes healing. The needle itself is “dry,” meaning no medication is injected.

Patients have Post session:

- Decreased Pain

- Improved mobility

- Improved function

- Increased healing

Does It Hurt?

Most people describe it as a quick cramp or twitch, while others just experience a dull ache or mild soreness afterward (like post-workout stiffness).

Who’s It For?

Dry needling may help if you suffer from:

Chronic muscle tightness
Sports injuries
Sciatica or low back pain
Neck tension or whiplash
Shoulder or knee pain
Plantar fasciitis
Headaches

Final Thoughts: Should You Try It?

If traditional methods like massage, stretching, or medications haven’t quite done the trick, dry needling might be the missing piece in your recovery puzzle.

Birth Prep Isn’t Just About the Hospital Bag—Let’s Talk Physical Therapy

Tue, 22 Apr 2025 14:15:11 GMT

When most people think about preparing for birth, their minds jump to packing a hospital bag, picking out onesies, or maybe writing a birth plan. And while those are important, there's one powerful piece of prep that often flies under the radar: physical therapy—specifically, pelvic floor physical therapy.

Yes, birth is natural. But natural doesn’t mean easy. It’s one of the most physically demanding events a body can go through, and just like you’d train for a marathon, preparing your body for labor and recovery can make a huge difference in how you feel during and after birth.

What Is Birth Prep Physical Therapy?

Birth prep physical therapy is about optimizing the body for labor, delivery, and postpartum recovery. It typically involves working with a pelvic floor physical therapist who focuses on:

Pelvic floor awareness and relaxation
Core strength and trunk stability
Hip and spine mobility
Breath work and pushing techniques
Postural alignment
Labor positions

It’s not about doing Kegels on repeat (actually, in some cases, Kegels might not be what you need at all). It’s about balance—learning to relax and engage the right muscles when you need them most.

Why It Matters

Labor is like a full-body workout meets endurance event. Physical therapy can help you:

Prepare for different labor positions that optimize pelvic space
Minimize pain or discomfort during pregnancy, especially in the hips, back, and pelvis
Improve pelvic floor mobility, which can aid in pushing and reduce tearing risk
Recover more smoothly postpartum, especially if you’ve had a C-section or perineal trauma

Bonus: Postpartum Care

Here’s the truth no one talks about enough: birth recovery doesn’t have to start or stop at your 6-week checkup. Physical therapy can support your healing journey sooner (up to 2 weeks postpartum), and can start months (or years!) postpartum, and can help with:

Scar tissue mobilization (from tears or C-sections)
Core and pelvic floor rehab
Returning to exercise safely
Managing pain with sex or daily movement
Bowel and bladder dysfunction

Final Thoughts

Birth prep is more than buying the right swaddle. It’s about feeling connected to your body, understanding how it works, and feeling confident heading into labor. Physical therapy is a powerful, evidence-based tool that every birthing person deserves access to.

If you’re pregnant, consider adding a pelvic floor PT to your birth team. It might just be the best-kept secret in birth prep and in your postpartum recovery.

What is Pelvic Floor Physical Therapy?

Mon, 07 Apr 2025 20:40:25 GMT

Also... what is a pelvic floor?

When people think about core muscles, they often think of the muscles that create the abdominal wall as well as the muscles that are surrounding the spine. However, they often forget about one other crucial group of muscles that helps form the core: the pelvic floor . The pelvic floor is a group of muscles that stretch like hammock along the pelvis. These muscles are not easily visible to the eye and are just now gaining popularity, but the pelvic floor muscles play a critical role ranging from supporting internal organs, helping with bowel/bladder functions, and even sexual function.

So what are the functions of the pelvic floor?

Control your bladder and bowel: these muscles allow you to hold it in until you’re ready to go

Support your internal organs : they support the bladder, intestines, and reproductive organs

Enhance sexual function: a strong pelvic floor can improve sensation and support sexual health

Assist with core stability: The pelvic floor is part of the core muscle system and helps with balance, support, and stability of the axial skeleton (the spine)

Sump-pump function: the pelvic floor helps to move fluid through the lymphatic system from the legs all the way back to the trunk and heart

Now that we know what the pelvic floor is, what is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized form of PT that targets the muscles, ligaments, and connective tissues surrounding the pelvis. When individuals start to experience dysfunction with any of the functions listed above, pelvic floor physical therapy can be used to assess the pelvic floor and body as whole to see what is causing the dysfunction.

During the assessment, a pelvic PT can perform an internal exam to assess functions of the pelvic floor, how the pelvic floor moves with breathing, strength of the pelvic floor, and even what the pelvic floor does while you are bracing, coughing, or sneezing. The PT will also gather medical information about you, when your symptoms started and how long they have been going on, as well as assess your overall movements, like bending over to touch your toes, what your squat looks like, and what your hip strength looks like.

Some symptoms that may indicate dysfunction are bowel or bladder incontinence, constipation, difficulty voiding the bladder, pain with intercourse, and hip, back, or tailbone pain. If you are experiencing any of these symptoms you may benefit from pelvic floor PT. Your pelvic floor is a key part of your overall health, and it’s never too early- or too late- to start paying attention to it.

Whether you’re preparing for childbirth, recovering from surgery, or managing incontinence, taking care of your pelvic floor will benefit you as whole!

Why Massage Isn't Fixing My Chronic Pain

Sat, 29 Mar 2025 01:56:59 GMT

Top 3 Reasons Muscles Never Fully Relax

We get this question A LOT . When you are in pain, you try everything to help give you relief! Most people will start with getting a massage to help decrease tension and pain.

You initially feel amazing but, the pain always comes back within 1-3 days after the massage. Why is that?

Massage therapists are wonderful! We refer a lot of our patients to sports massage therapists to help with maintenance soft tissue work. But sometimes, there is a deeper issue that is causing the muscles to tighten again and needs to be addressed by a physical therapist.

There are 3 reasons our muscles like to tighten or spasm:

1) The muscles are very weak and the body "tightens" these muscles to help give the body support to compensate for the weakness.

2) The muscles are extremely overused and tighten because they are "overactive".

3) The muscles are in a shortened position for long periods of time and the muscles stay tight.

Most people are either #1 or #2 . When you have a muscle that is weak and then you get a massage to loosen it, you actually are decreasing the stability of that joint. The joint has been relying on that 'tight' muscle because it does not have the strength to hold the joint in its proper position. So the muscle will just tighten right back up again!

If you’re tired of temporary relief and want to actually fix the problem, the next step is a personalized evaluation

When we massage an overactive muscle, it will allow it to relax initially, but it will tighten back up again because there is a muscle imbalance. For example, if you are someone with tight upper traps or neck muscles that are caused by being overused, then the tightness will come right back because there usually is weakness in the lower/middle traps and hyperactivity in the upper traps (this causes the shoulders to shrug). Until we figure out the root cause of the muscle imbalance, you'll never be symptom free for more than a few days.

Soft-tissue work and tailored exercises are extremely important to do in conjunction with each other. This is how we relax the muscles and keep it from tightening up again! If you are doing constant massages for pain relief, make an appointment with a physical therapist as well! Massage therapy and PT together will help you finally get out of pain for good!

We recommend coming in to get an evaluation to see if you are #1, #2 or #3! Your treatment will be very different based on which category your muscles fall in!

Pain Management For Low Back Injuries

Fri, 21 Mar 2025 22:59:52 GMT

Why you should keep moving when you have low back pain!

Managing low back pain can be challenging, but there are several strategies to help alleviate discomfort and improve mobility. Previous beliefs suggest resting, and while that may be helpful initially, long term rest can often worsen the pain. Here are some effective tips for managing acute low back pain:

Stay active throughout the day
This can include gentle stretching, walking, or even riding a bike. The goal is to work on balancing this with rest. Resting for long periods of time can increase stiffness and symptoms, so working on moving frequently can be helpful to improve blood flow throughout the body and promote healing.
Continue to exercise
Injuries do not necessarily mean that you cannot exercise or move your body. It just may require you to modify for a little bit. Instead of following your normal programming to a T, maybe start with cardiovascular exercise.
You can also continue to workout by modifying the range of motion, intensity, and volume of your workout.
Find positions that feel good
When resting or getting ready to sleep, find positions that feel comfortable or alleviate your pain. This can help to improve the quality of your sleep or your recovery.
This can include sleeping on your side with a pillow between your legs or under your knees
If you are resting on the coach and feel discomfort with your legs straight out, try bending your knees, rocking your knees side-to-side, or sitting in a figure 4.
Work with a physical therapist!
PT’s are movement experts, as well as excellent sources for helping to manage pain, recent or long term injuries, and can help guide you back to living your life fully.
A physical therapist can help by performing an initial evaluation, determine the impairments at hand, and help to address those so you can reach your goals. They can also provide many natural ways of managing pain with pharmaceutical or significant medical interventions.

Low Back Pain and Low Hanging Fruit

Tue, 11 Mar 2025 16:28:06 GMT

Low back pain: What is it and what steps can I take to improve it?

Low back pain is one of the leading causes of disability worldwide, and millions of individuals of all ages suffered from back pain in 2020 (IHME, 2023). It can hinder people from performing daily activities, working, and enjoying a good quality of life. While many instances of low back pain do resolve with proper care, including PT, a significant number of individuals experience chronic low back pain that lasts for weeks, months, and even years. While many believe low back pain is predominantly a musculoskeletal issue, it can also have a huge impact on your social life, mental health, and even have economic consequences from the limitations and restrictions it can create in your daily life.

Low back pain is defined as pain in the lower part of the spine. It can range from being mild to severe in intensity and range from being acute, lasting a few days to a few weeks, to severe, lasting more than three months. There are many factors that can contribute to the severity of the pain, including factors that are modifiable and nonmodifiable. Nonmodifiable factors include our age, past medical history of back pain or other injuries endured that cause pain, and our genetics. Modifiable factors include occupation, increased body weight/obesity, lack of quality and quantity of sleep, increased stress levels, poor activity level or sedentary behavior, and poor eating habits.

While it is not as easy to change our occupation or age, we can make other adjustments to help improve our pain and therefore, quality of life. Many of the modifiable factors listed above pertain to our behaviors and over wellness, which often have a big impact on our pain and symptoms, severity of discomfort, and even our perception when it comes to addressing our aches and pains. Taking the time to improve these modifiable factors can often help to alleviate the severity of the pain, and help people get back to living a more meaningful life.

You can do this by:

Aim to get 150 minutes of moderate intensity exercise throughout the week.
This will improve activity levels throughout the day and increase blood flow throughout the body.
Walk frequently throughout the day
Increasing activity levels will help to reduce sedentary time as well as static positions. Posture is often questioned as being a contributor to pain, however, the duration of a position is a bigger cause of discomfort.
Reduce screen time up to 30 minutes to 1 hour before bed and aim for 7-8 hours of sleep
This can help to improve the quality of sleep, all and allow the body to recover from stress the day before.
Work on managing stress levels with meditation, therapy, journaling, and more exercise!
Mental health and stress are often big contributors to pain and can often worsen symptoms. Taking time to improve this area can often help alleviate symptoms as well as perception of pain.
Lastly, aim to focus on consuming 1 gram of protein per lb of body weight and consuming whole foods
Sugar and alcohol can often be irritants for pain, and can exacerbate symptoms.

References

https://www.healthdata.org/news-events/newsroom/news-releases/lancet-new-study-shows-low-back-pain-leading-cause-disability

Crush the 2025 CrossFit Open

Wed, 19 Feb 2025 14:47:12 GMT

CrossFit Open 2025

Your Guide to Preparation and Recovery

The CrossFit Open is here, and whether you're a seasoned athlete or a first-time participant, it's an event like no other! I've been participating in the Open for the past few years—not as a professional CrossFitter, but just for the sheer fun and challenge of it. The energy at Shoofly Athletics, where I compete, is unmatched. The cheers, the adrenaline, and the personal breakthroughs make it an incredible experience. Somehow, I always find strength I didn’t know I had!

As a physical therapist, I know firsthand how important it is to prepare properly and recover effectively. Here are my top tips to help you get the most out of the Open, stay injury-free, and recover like a pro.

Preparing for the Open

1. Have a Performance-Based PT on Call

Having a knowledgeable performance PT can be a game-changer. If you don’t have one, let me be that person for you! Even if you're not a patient at our clinic, I’m happy to answer your questions. Feel free to text me at 919-948-0881 or email amanda.brewer@evolveptnc.com.

2. Prioritize Mobility and Accessory Work

Make sure you're dedicating 3-4 sessions per week to mobility and accessory exercises. If you need a plan, follow us on Instagram @EvolvePT.NC , where we’re posting Open Prep videos to help you stay on track.

Game Day: How to Perform Your Best

The Night Before

Fuel your body with a well-balanced dinner rich in carbohydrates and protein. The Open is a marathon, not a sprint, and proper fueling will make a difference. We’ll be sharing some great pre-Open meal ideas on our Instagram and blog!

The Day Of

Fuel Up

2 hours before: Eat a balanced meal, such as eggs, potatoes, toast, and fruit or a Greek yogurt bowl with fruit and granola.
30 minutes before: Have quick carbs like gummies, applesauce, or a banana to give you a final energy boost.

Warm Up Properly

A 15-20 minute warm-up that mimics your workout is essential. Don't just hop on a bike or rower for five minutes—this won’t prepare your body properly and increases your risk of injury. We’ll be sharing optimal warm-ups for each Open workout on our Instagram @EvolvePT.NC —so be sure to check them out!

Recovery Between Workouts

1. Schedule a Recovery Visit

Nagging issues won’t disappear on their own, and pushing through pain can lead to injury. Even if you feel fine, maintenance techniques like dry needling, cupping, and scraping can help muscles recover efficiently and prepare for the next workout.

We offer 15-minute complimentary Recovery Room visits after each session, including Normatec Boots, heating pads, and red light therapy. Want to schedule a session? Text 919-948-0880, and Sarah will set you up!

2. Keep Up with Mobility and Accessory Work

Recovery isn’t just about rest—it’s about active recovery. Keep your body moving with targeted mobility work to ensure optimal performance throughout the Open.

Post-Open Recovery Plan

1. Refuel Your Body

Your muscles need protein to repair and grow. A good rule of thumb is 1 gram of protein per pound of body weight . For example, if you weigh 200 lbs, aim for 200g of protein per day to support recovery.

2. Meet with Your Performance PT

After the Open, it's crucial to assess any aches, pains, or weaknesses that surfaced during the workouts. A professional evaluation can help prevent future injuries, accelerate recovery, and improve performance for next year!

Ready to Crush the Open?

By following these steps, you’ll not only perform at your best but also recover efficiently so you can continue training without setbacks.

Want to set up a personalized plan for the CrossFit Open? Fill out our contact form here: Evolve PT Contact Form

Let’s make this year’s Open your best one yet! ��

Pelvic Floor Dysfunction and Pain with Sex

Mon, 17 Feb 2025 21:09:00 GMT

Pelvic floor dysfunction can encompass a wide range of issues related to the muscles and organs housed in the pelvis. These muscles help with childbirth, bowel and bladder movements, supporting our internal organs, sexual activity, and supporting our skeletal system. There are a wide variety of signs and symptoms for dysfunction, including hip and low back pain, tail bone pain, bowel and bladder incontinence, constipation or difficulty voiding, and increased urgency to void. However, did you know that pelvic floor dysfunction can also present as pain with intercourse and difficulty achieving an orgasm?

Sexual health can be one of the most commonly over looked issues with pelvic floor dysfunction. Orgasm and sexual experiences are a complex process, and pelvic floor dysfunction can interfere with this process at a mental level, musculoskeletal level, and interfere with nerve stimulation (Handa et al., 2008). Overactivity, heaviness, or weakness of the pelvic floor muscles can make it difficult to achieve muscular contraction or may even cause pain with insertion. If nerve damage or increased sensitivity of the nerves are noted, this can negatively impact sexual health by increasing or decreasing sensitivity of the genitalia (Handa et al., 2008). Lastly, these changes or lack of sensation and muscular imbalances can create psychological challenges with sexual health and reduce libido (Martinex-Galiano, et al. 2024). If someone has pain with intercourse, this can create fear or anxiety with sexual activity which can negatively impact the physical symptoms experienced. Collectively, this can create a cyclical pattern between the physical symptoms and mental concerns, and can often worsen symptoms and experiences associated with one’s sexual health.

Luckily, pelvic floor physical therapy can be a tool to help address these issues and address the deficits with muscles, nerves, and mental barriers when it comes to sexual health. Performing a thorough assessment can allow a pelvic floor PT to help develop a plan of care to help address these symptoms utilizing manual therapy techniques, exercises, education, and different tools to reduce discomfort or pain with intercourse, as well as improve the experience and discuss ways to enjoy intimacy with your partner!

References:

Handa, V. L., Cundiff, G., Chang, H. H., & Helzlsouer, K. J. (2008). Female sexual function and pelvic floor disorders. Obstetrics and gynecology , 111 (5), 1045–1052. https://doi.org/10.1097/AOG.0b013e31816bbe85

Martínez-Galiano J.M., Peinado-Molina, R.A., Martínez-Vazquez, S., Hita-Contreras F., Delgado-Rodríguez, M., & Hernández-Martínez, A. (2024).Influence of pelvic floor disorders on sexuality in women. Int J Gynecol Obstet , (164), 1141-1150. doi: 10.1002/ijgo.15189

Zhuo, Z., Wang, C., Yu, H., & Li, J. (2021). The Relationship Between Pelvic Floor Function and Sexual Function in Perimenopausal Women. Sexual medicine , 9 (6), 100441. https://doi.org/10.1016/j.esxm.2021.100441

Tips To Improve Sleep

Fri, 07 Feb 2025 22:16:57 GMT

Read below things that you can do to help improve the quality of your sleep!

Sleep is a vital role of recovery and overall wellness . Improving one’s sleep can help to positively impact the quality of our life by improving mental clarity, emotional health, and physical recovery. Working on improving the quality and quantity of sleep can help to improve growth factor release and reduce cortisol, improve our cells ability to communicate with each other, and allow our body systems to rejuvenate and recover. This can help improve muscle growth, cardiovascular and respiratory function, repair damage that occurred during workouts (or throughout the day), and allow the nervous system to recuperate from the stress and demands placed on it. With that said, while training hard in the gym is important, so is our recovery. And, the best way to improve our recovery is to improve sleep quality and duration.

Here are some tips to incorporate to do just that:

Reduce blue light exposure/screen time to at least 30 minutes to 1 hour prior to sleep
Focus on reading a book
Work on diaphragmatic breathing or gentle mobility
Keep the room cool at night
This can help with body temperature regulation and lead to deeper sleep
Limit light and noise as this can wake you up
Light and sound can disrupt your circadian rhythm and make it difficult to fall back to sleep
Limit caffeine intake at least 8- 10 hours before bedtime
Caffeine can block receptors in your brain that make you feel sleep and can make it difficult to fall asleep
Reduce food and liquid consumption intake prior to bed
Large meals, spicy or acidic foods or foods that are high in fat can disrupt sleep due to digestion disturbance and discomfort
Alcoholic beverages and large qualities of liquid can increase pelvic floor irritation and may disrupt sleep

References

Iao, S. I., Jansen, E., Shedden, K., O'Brien, L. M., Chervin, R. D., Knutson, K. L., & Dunietz, G. L. (2021). Associations between bedtime eating or drinking, sleep duration and wake after sleep onset: findings from the American time use survey. The British journal of nutrition , 127 (12), 1–10. Advance online publication. https://doi.org/10.1017/S0007114521003597

Lazarus, M., Shen, H. Y., Cherasse, Y., Qu, W. M., Huang, Z. L., Bass, C. E., Winsky-Sommerer, R., Semba, K., Fredholm, B. B., Boison, D., Hayaishi, O., Urade, Y., & Chen, J. F. (2011). Arousal effect of caffeine depends on adenosine A2A receptors in the shell of the nucleus accumbens. The Journal of neuroscience : the official journal of the Society for Neuroscience , 31 (27), 10067–10075. https://doi.org/10.1523/JNEUROSCI.6730-10.2011

National Heart, Lung, and Blood Institute. (2011). In brief: Your guide to healthy sleep. Retrieved January 16, 2018, from https://www.nhlbi.nih.gov/resources/your-guide-healthy-sleep

National Institute of Neurological Disorders and Strokes. (2024, September 05). Brain basics: understanding sleep https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

Let's take a Walk: Why does daily step count matter?

Fri, 24 Jan 2025 18:44:36 GMT

Tracking daily step counts can significantly enhance physical fitness and overall well-being.

It’s a new year and that means new goals!

Often during this time we see a lot of individuals rev-up their exercise, and see more gym goers, runners, and people wanting to get in shape. This one hour of increased activity is much needed, and has a lot of benefits like increasing bone density, improving muscle mass, and improving overall life-longevity, however, we often forget about what we are doing the rest of the day and how that matters for our health as well.

While structured exercise and training has immense benefits, unstructured physical activity, such as daily walks, playing with your kids and dogs, or even going for a bike ride, is equally as important for long-term health. Because structured exercise/physical activity is so highly praised, this can result in gaps of knowledge of the benefits of unstructured physical activity and can actually be a contributing factor to health problems such as heart disease, various cancers, and obesity (Bonilla et al., 2023).

In a recent article by Bonilla et al., they described physical inactivity as a problem of insufficient activity to meet the recommendation of health benefits (i.e. 150-300 minutes of moderate intensity activity or 75-150 minutes of vigorous intensity activity per week). If we look at our day and factor in how long we are exercising, that is only 1-2 hours/24 hours. While this is beneficial, it is important to consider what we are doing for the rest of the day, especially when assessing our aches, pains, and overall wellness. If we find ourselves working at our desk or sitting more often than not, this can result in a decline in overall physical fitness, but also increases the risk for cardiovascular comorbidities, diabetes, obesity, and mortality (Bonilla, et al. 2023).

The increased time at our desk, sitting on the couch, or time driving factors into our sedentary behavior, which is essentially any waking behavior that expends very little energy or less than 1.5 MET. For reference, MET stands for metabolic equivalent task and is a way to rank the intensity of an exercise. So for example, sitting requires very little energy expenditure and is ranked at 1.5 MET, walking is ranked anywhere between 1.5-3.0 MET, and running is 6.0 MET or more (Harvard, 2023). Bonilla et al. goes on to compare activity levels and found that individuals with lower sedentary behavior (< 4 hours/day) and high levels of physical activity (35.5 hours/week) showed lower mortality rates and risk for comorbid conditions than those who were sedentary for > 8 hours/day and had lower physical activity levels. So ultimately individuals who spent more time expending more energy over that 1.5 MET were able to reduce their risk of comorbid conditions and mortality vs those who spent more time sitting. So, does this mean you need to start walking or biking to work and walking all day while you are working?

Not necessarily, however, what it does show is that adding some additional exercises throughout the day can help reduce your risk of all cause mortality, cardiovascular disorders, metabolic dysfunction, obesity, and can be beneficial when coping with injuries or aches and pains. Trying to rapidly increase activity levels and add in longer bouts of movement has been found to be less sustainable. Silva et al. found that adding in small bursts of activity (< 40 minutes) compared to longer durations (180 minutes) was more sustainable in helping individuals adapt these behaviors (2018). While 40 minutes a can seem like a large chunk of your day, adding in shorter durations of activity (walking, biking, or playing with your dog for 10 minutes) multiple times a day, can be a great way to increase your overall activity and reap the benefits as well.

Lastly, a great way to gauge or rank your activity level is by step count. In an article by Kraus et al., they went on to categorize step count into different activity levels which can be a great scale to use as a target to increase overall daily movement (2019). For reference, they found that accumulating 7.5K steps/day was categorized as moderate activity, 10K was categorized as active, and 12.5K was highly active. Increasing this aspect of physical activity can really help to improve your health and wellness for the long run and reduce your feelings of tightness/stiffness from being in one position for too long.

References

Bonilla, D. A., Peralta-Alzate, J. O., Bonilla-Henao, J. A., Cannataro, R., Cardozo, L. A., Vargas-Molina, S., Stout, J. R., Kreider, R. B., & Petro, J. L. (2023). Insights into Non-Exercise Physical Activity on Control of Body Mass: A Review with Practical Recommendations. Journal of functional morphology and kinesiology , 8 (2), 44. https://doi.org/10.3390/jfmk8020044

Harvard, School of Public Health. (2023, October 27). The nutrition source: Staying active. https://www.hsph.harvard.edu/nutritionsource/staying-active/#:~:text=METs,may%20use%208%2D9%20METs.

Kraus, W. E., Janz, K. F., Powell, K. E., Campbell, W. W., Jakicic, J. M., Troiano, R. P., Sprow, K., Torres, A., Piercy, K. L., & 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE* (2019). Daily Step Counts for Measuring Physical Activity Exposure and Its Relation to Health. Medicine and science in sports and exercise , 51 (6), 1206–1212. https://doi.org/10.1249/MSS.0000000000001932

Silva, A., Júdice, P., Carraça, E., King, N., Teixeira, P., & Sardinha, L. (2018). What is the effect of diet and/or exercise interventions on behavioural compensation in non-exercise physical activity and related energy expenditure of free-living adults? A systematic review. British Journal of Nutrition, 119 (12), 1327-1345. doi:10.1017/S000711451800096X

evolve-physical-therapy

Why One Postpartum Visit Isn’t Enough: A Physical Therapy Perspective on ACOG’s New Recommendations

Postpartum Pelvic Floor Specialists - Holly Springs, NC

Postpartum Recovery Is Not One-Size-Fits-All

ACOG’s Updated Approach

Where Physical Therapy Fits In

What We Do at Evolve Physical Therapy

Bridging the Gap in Care

A New Standard of Care

Clinical Practice Guidlines for Hip Pain and Mobility

Hip Pain Physical Therapy Experts - Holly Springs, NC

Understanding Pelvic Pain and How Pelvic Floor Physical Therapy Can Help

Pelvic Floor Physical Therapy for Pelvic Pain - Holly Springs, NC

What Is Pelvic Pain?

The Role of Pelvic Floor Muscles

How Physical Therapy Helps

Who Can Benefit?

Breaking the Stigma

When to Seek Help

Rethinking ACL Injuries: What 30+ Years of Research Tell Us About Non-Surgical Recovery

Knee PT in Holly Springs

What Does This Means for Patients Today?

The Powerful Effects of Sleep on Exercise Performance and Recovery

Orthopedic Physical Therapy, Holly Springs, NC

1. Sleep Boosts Physical Performance

2. Muscle Growth Happens During Sleep

3. Sleep Reduces Injury Risk

4. Mental Performance and Motivation

5. Recovery, Inflammation, and Immune Function

Tips to Improve Sleep for Better Workouts

Dry Needling vs Acupuncture- What's the Difference?

Dry Needling in Holly Springs, NC

Abdominophrenic Dyssynergia: What is it and How Physical Therapy Can Help

Physical Therapy for Abdominophrenic Dyssnergia in Holly Springs, NC

The Importance of Posture With Breastfeeding

Physical therapy tips for neck pain with breastfeeding, Holly Springs, NC

Why Posture Matters

How Posture Affects Your Baby

Common Posture Mistakes During Breastfeeding

Tips for Maintaining Good Breastfeeding Posture

Posture Changes for Different Feeding Positions

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The Most Common CrossFit Injuries - And How to Avoid Them

Physical Therapy For CrossFit Injuries, Holly Springs, NC

Shoulder Injuries

Lower Back Pain

Knee Pain or Injury

Tendinitis (Especially in the Elbows and Knees)

Injury Prevention: Your Best Strategy

Why Resistance Training is Important During Pregnancy

Pregnancy Physical Therapy, Holly Springs, NC

Can a Walking Program Reduce the Recurrence of Low Back Pain?

Physical Therapy for Low Back Pain in Holly Springs, NC

Best position to push in for labor (from a pelvic-floor PT)

Birth Prep & Pelvic Floor Physical Therapy in Holly Springs, NC

Why position might matter

What the evidence actually shows

What I tell my patients:

What to put in your birth plan

Final practical note from a pelvic-floor PT

Low Back Pain: More than just a physical injury - Holly Springs Physical Therapy

Holly Springs Physical Therapy For Low Back Pain

How to Handle Plantar Fascia Pain?

Physical Therapy for Plantar Fasciitis in Holly Springs, NC

Find Your “Sweet Spot”: Exercising While Injured

Holly Springs Physical Therapy For Orthopedic Injuries

Birth Preferences

Birth Preparation Holly Springs, NC

Birth Prep in 3rd Trimester - What does it include?

Laboring positions and strategies for fetal positioning

Manual Therapy

Knee Pain Success Story - Physical Therapy Holly Springs, NC

Patient Knee Pain Success Story - Physical Therapy Holly Springs, NC

What Does A Running Analysis Look Like With A Physical Therapist - Holly Springs, NC

Evolve Physical Therapy in Holly Springs, NC

Benefits of Dry Needling During Physical Therapy

Dry Needling in Holly Springs, NC

What Is Dry Needling?

So What Are The Benefits of Dry Needling?

1. Pain Reduction