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? 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

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.

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.

Also... what is a pelvic floor?

Top 3 Reasons Muscles Never Fully Relax

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

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

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! 💪🔥