Concussion Treatment: More Than Just Getting “Your Bell Rung”


According to the CDC, 2.87 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States in 2014. Concussions are considered a type of mild Traumatic Brain Injury (TBI); while there is no structural damage, there is a temporary chemical imbalance/flux . The CDC further describes concussions as “any bump, blow, or jolt to the brain or body that causes the head and brain to move rapidly back and forth”. Common causes of concussions include the following: sports and recreation, falls especially with elderly population, car accidents, and military blasts/blunt trauma.

Breaking the Concussion Myth

The common misconception with concussions is that they are not a “big deal” and someone can return-to-game, work, or combat/service without taking the necessary steps to help relieve post-concussion symptoms. During the first 24 hours, it is most important to eliminate the potential risk of a second concussion. The brain is at a highly vulnerable for what we call “Second Impact Syndrome” which can cause further – and more[JD3]  severe – brain injury and potentially even life threatening. Multiple concussions can also cause more and more symptoms and prolong recovery.

Concussions are not just “your bell got rung”! We need to encourage athletes, military, and the community to listen to their bodies, and if they suspect a concussion speak up and take action. Managing your concussion symptoms may be able to return[JD4]  to activity sooner and drastically reduce their time needed to recover as well as reduce the likelihood of having chronic symptoms.

What to Do Immediately After a Concussion

Immediately after a concussion, your brain goes through a flux of chemical imbalances that are at its peak for the first 24 hours and can last up to 7-10 days post-concussion. During this time, someone may experience any of the following symptoms:

Physical/Postural Cognitive
Emotional Sleep
-Light sensitivity
-Eye problems
-General unsteadiness
-Feeling dazed
-Mentally “foggy”
-Feeling slowed down
-Answer questions slowly
-Difficulty concentrating
-Repeats self
-Drop in academic performance
-Personality changes
-More/less emotional
-Sleeping more/less
-Difficulty falling asleep or staying asleep


With current research, complete mental and physical rest is recommended for the first 24-48 hours after a concussion. During this time, it is very important that an athlete not return to play until cleared by a medical provider! After 48 hours, someone can gradually re-engage back into their normal daily activities. It is recommended to schedule half days when returning to work or school as well as allowing breaks as needed throughout the day. In order to manage symptoms and avoid the snowball effect, use the “Rule of 3’s”. This means stopping any activity that is increasing symptoms >3 points from your “baseline” (on healthcare’s 0-10 scale).

When to Seek Further Concussion Treatment

Someone should seek emergency medical care if they suspect skull fractures, potential spinal cord injury, significant loss of consciousness, worsening mental status, seizures, or persistent vomiting. Even have a family member or friend help monitor things! Medical doctors should be the primary team member to manage and follow-up regarding “return to play”, “return to work”, and “return to learn/school” considerations.

Typically, we recommend pursuing Physical Therapy, specifically concussion-based rehabilitation, after  ~1 month of persistent symptoms. Physical Therapy can help with headache management, dizziness/unsteadiness, light/noise sensitivity, eye problems, visual over-stimulation, and coordination/processing speed. It is recommended to find a Physical Therapist in the area that is knowledgeable and has experience with concussion rehabilitation. These types of experienced therapists will be able to make an individualized concussion treatment plan that are specific and directed toward the patient’s goals. Post-concussion rehab can last anywhere from 1 month to > 6 months.

Other team members may include neuro-psychologists who perform neuro-cognitive screening and assessment, ophthalmologist for continued eye problems, speech therapy for continued cognitive deficits, athletic trainers to help assist return to play, and teachers/coaches/employers  to construct appropriately paced return to activity.



Get to Know Your PT – Jessica Dietz, PT, DPT

Jessica Dietz Physical Therapist Denver

Therapydia Denver physical therapist Jessica Dietz, PT, DPT, takes some time to talk about her own experience with a torn ACL, the importance of regular physical activity, and sriracha.

When did you know that you wanted to be a physical therapist?

Since freshman year of high school after I tore my ACL. I had wonderful rehab/therapists, enjoyed the activeness of the job, and overall interacting with patients. It wasn’t until a personal experience in college when I helped my dad rehab after an unexpected stroke that I became more interested in neurorehab.

What surprised you the most about the physical therapy profession?

The reality of holistic care. I strongly believe that in order to be a great therapist you need to understand, treat, and respect all aspects of your patient.

How do you like to stay active?

Anything outdoors! I love trail running, hiking, skiing, playing tennis, gardening, etc.

What is the biggest challenge involved in being a PT?

Changes in healthcare that are primarily dictated by insurance companies. Especially the limitations towards shorter plans of care and fewer numbers of visits.

What’s your favorite song to get you motivated?

“Feel Good” by Neon Trees. It’s a song and band with an 80s vibe. You can’t help but dance when you hear it!

Are you currently pursuing any further education or certifications?

I just recently took my certification exam for becoming a neurologic specialist. Next up, I am hoping to pursue further training in NDT (a specific manual facilitation technique) and LSVT BIG/PWRI for Parkinson’s Disease.

What’s your go-to breakfast?

Open-face egg sandwich with sriracha. Sriracha is a condiment that goes on anything! 🙂

What do you wish everyone knew about PT?

To be successful with physical therapy, it is a collaboration between both the therapist and the patient. There will be skills, techniques, and education that will learn during therapy sessions but doing things like your home exercise program and performing regular physical activity is equally as important. Also, the power of regular bouts of therapy throughout a lifetime is best for prevention and identifying things before they become a problem.

In your opinion, what is the most important personality trait that a PT must have?

Good communication and being compassionate.

What do you do to de-stress/unwind?

Running, doing art projects, and cuddling with my three dogs (lab, rescue mutt, and English bulldog).

Finish this sentence: On Saturday mornings, you can usually find me…

Trail running, hiking with my dogs, or sleeping in.

What is your favorite piece of wellness advice?

Wellness is a life-long commitment where physical activity is an important piece of the puzzle. Staying active is linked to improved mood, mental health, cognition, and overall quality of life as well as reducing risk factors for serious conditions such as heart disease and stroke.

Physical Therapy at the Burton US Open

snowboarding physical therapy denver

By Aaron Page, DPT
Therapydia Denver Physical Therapist

Earlier this year, I was fortunate enough to be selected as one of the medical providers for the Burton US Open Snowboarding Championships in Vail, CO, just up the hill from our Denver clinic. Needless to say, this event brought many of its own unique and exciting challenges for a PT, but overall, it was another incredible way that we at Therapydia are able to relate to our patients and provide high-quality care in a variety of settings.

If you’re not familiar with the US Open, it is one of the largest snowboarding competitions in the country. In its 37th year overall (and 7th year in Vail), the event continues to grow and draw the top snowboarders from all around the world. Burton and the staff involved do an incredible job putting the event together—constructing a world class course in both Slopestyle and Halfpipe, as well as (more directly related to my realm) a remarkable medical support system for the riders.

Situated at the bottom of the Slopestyle course and steps away from the corral where the athletes land on the final jump, is the medical tent. In the tent is what can be described as a “Treatment and Recovery Zone” for the athletes—complete with all of the features you would expect from a small clinic. Treatment tables, compression recovery boots, foam rollers, exercise bikes, etc. all available for athletes throughout the entire event. Behind all of the equipment though, are those practitioners that help facilitate care and are what really shine through when it comes to protecting the pro athlete. The interesting thing to me was that familiarity and environment allowed the treating practitioners, physicians, and physical therapists alike, to jump right in to a quality treatment approach. Interactions with riders still began with an evaluation (though it may look slightly different than from one you see in our clinic) and focused on identifying specific needs and issues the rider may have. Ultimately for a PT in that setting, the foundation was the same: Pinpoint areas of concern (ie. limited mobility, limited flexibility, limited stability) and implement an intervention that addresses those concerns. Though the timeline and plan of care may be different for the snowboarder considering that they have to compete in the next few days, the framework is similar to any patient that we see in the clinic. Our goal was to educate the rider on what we can address together to improve their mobility, stability, and possibly strength, to get them where they needed to be for competition.

physical therapy snowboarding

Headed by Dr. Bryan Huber, Medical Director for Burton Global Snowboard Team/Team Physician for US Snowbaording and Dr. Tom Hackett, Steadman Hawkins Orthopedic Surgeon/Team Physician for the US Snowboard Team, they have developed a system and orchestrated a team that covers all aspects of care for the riders. For orthopedic surgeons, massage therapists, surgical fellows, paramedics, certified athletic trainers and physical therapists, the riders are supervised and cared for in each aspect of the event, something unique to this type of competition.

From a physical therapy perspective, unfortunately this high level of care is sometimes a rare occurrence at an event like this. More often than not, these competitions are not covered with the same detail due to the chaotic nature of trying to manage 40+ riders each day. Though some of the top riders/teams may have a PT on staff and receive quality care, being responsible for the entire team can make personalized treatment difficult following an injury when you also have to ensure the safety and care of the rest of the team. That’s where we came in that week.

physical therapy denver

With the first practice of the day at 9am, the medical tent was open and ready to assist the riders with any pain or concerns that they had. I heard from numerous riders during the first few days that they had been nursing an injury over the last few weeks but didn’t have an opportunity to follow up with a trusted medical practitioner. Some even waited intentionally because they knew they could trust the team at the Burton US Open. Engineered by Mike Giunta, owner and physical therapist at Evolution Physical Therapy in Los Angeles, this system of evaluation and collaboration with the other medical providers allowed for comprehensive, individualized care throughout the whole week. It wasn’t uncommon that a rider would come in shortly after practice, feeling the effects of being 20 feet above the deck of the halfpipe, and leave the medical tent more comfortable and confident that their issue was going to be addressed.

My time at the Burton US Open was extremely valuable. Not only was I fortunate enough to work with some of the best surgeons, ATCs, PTs, and snowboard athletes in the world, it also provided me with a renewed sense of understanding and circumstances of any patient. Now, not all of us are landing the first ever double crippler as a female in competition (shout out Maddie Mastro), but we can all relate to the challenges, on any scale, of dealing with pain and injury. The stakes are high for everyone and it is our responsibility as physical therapists to meet any patient where they are so we can fight for them to overcome their own adversity. Not just on the professional level but on any playing field: in the clinic, in the insurance industry, in the research lab, and with healthcare as a whole. I look forward to taking that back to Therapydia and continuing the high level of care for the field of physical therapy and those who need it.

Hip Labral Tear Recovery Timeline: Treatment Breakdown

hip labral tear hip pain torn labrum hip

A hip labral tear involves damage to the labrum, the ring of cartilage located on the outside rim of the socket of your hip joint. This is precisely where the thigh bone (femur) meets the pelvis (ilium). Tearing can be a result of repetitive twisting, cutting and pivoting movements, common among athletes who participate in sports like hockey, soccer, football, ballet or any other activities that require a lot of sudden movements and directional changes. A hip labral tear could also occur as a result of structural abnormalities that you’re born with, made worse by excessive wear and tear or a trauma that causes an injury or dislocation to the hip. However it occurs, if you’re experiencing a deep ache in the front of your hip or groin, pain that increases with prolonged sitting or walking, stiffness in the hip or symptoms such as clicking and locking, it’s possible that a hip labral tear is to blame.

Although the timeline for hip labral tear recovery varies depending on your specific injury, if you require surgery, you should expect about 4 months of one-on-one treatment with your physical therapist and roughly 6-9 months before you feel 100% again. It’s important to note that not all hip labral tears require surgery. Often times, physical therapy and exercises to stabilize the joint can help patients avoid surgery all together, even with the presence of a tear. If your condition does require surgery, the following timeline will give you some insight into what to expect during your physical therapy treatment process.

*Please note, the recovery times included in this timeline are general estimations and may not correlate with your specific situation.

hip labral tear torn labrum hip hip bursitis

0 Weeks: Prehab Prior to Surgery

So you’ve suffered a hip labral tear and you know that you need surgery. Did you know there are steps you can take prior to surgery to help expedite recovery? The amount of time you spend in prehab depends on a few different factors and is sometimes, unfortunately, dependent on your insurance plan. If you’re limited to 20 visits per year for instance, your physical therapist may have to save some of your PT sessions for post-op but if you have more visits available to you, prehab can take a bit longer. If you have comorbidities, or other limitations or disorders that could complicate the recovery process, this could also delay things.

When you begin prehab, your physical therapist will conduct a full body assessment to check for limitations in range of motion and strength to get an idea of what sort of plan of care your condition requires. If weakness is the main issue, you may be OK with just a few sessions to educate yourself on the post-op rehab process and to get a good idea of what lies ahead. You and your physical therapist will work together to create a prehab program to make sure that you’re entering surgery as strong as possible. Pain management strategies will be discussed as well as methods to strengthen weakened muscles, especially in the glutes, core and legs. This will help you maintain better strength with functional activities.

Torn Labrum Hip Bursitis Hip Stretches Surgery

0-4 Weeks: Post-Surgery Baby Steps

The amount of time after your surgery that you must wait before beginning any sort of physical therapy treatment is dependent on your surgeon’s specific protocol. Once your physical therapist and surgeon have come up with a good time to begin rehabbing your hip labral tear, your PT will ease you into an initial treatment plan that aims to reduce any swelling and pain, improve mobility with precautions/limitations and restore normal gait patterns. The progress you make during this period is dependent on your overall comfort level during mobility exercises and stretches. Because you’re still recovering from surgery, most activities should be avoided during this stage. To protect the repair limitations that are put on the hip, it’s important that certain movements are abstained from. Some physicians may ask you to use crutches with partial weight-bearing to reduce stress and load on the hip / repaired structures.

Your physical therapist will work on your soft tissue and muscles to improve tone and reduce pain. They’ll also prescribe range of motion exercises to help with mobility. It’s common to ease into exercising by riding an upright stationary bike to assist with range of motion. Your PT will guide you through initial exercises to ensure that you’re performing them correctly and with the right precautions. They’ll talk you through the best way to go about staying within range of motion restrictions as you go about daily activities as well. Manual therapy techniques will be utilized to help with passive range of motion through various movements. This helps to promote blood flow to the hip, decreasing swelling and inflammation within and around the joint.

The initial rehabilitation phase may be scary at first but your PT is there to help minimize your pain. It’s their responsibility to make your recovery as efficient as possible while working within your pain tolerance and not pushing you to the point of discomfort.

Physical Therapy Labral Hip Tear Hip Pain Surgery Upright Bike

4-8 Weeks: Keeping it Moving

As you begin moving more comfortably, your physical therapist will work even more to restore full range of motion, improve your strength and stability, normalize your gait and begin focusing more on increasing leg strength. In this phase of rehab, you should see decreased pain and improvements in range of motion, strength and stability. You should also notice the ability to walk further without pain and see progress with the ease of going up and down the stairs. It may be common to experience fatigue when performing weight-bearing activities so any high impact movements should be avoided.

Appropriate activities during this phase of recovery include walking short distances (gradually building up to 1 mile). You can also continue with the upright bike and begin to add resistance about six weeks post-op. Swimming and elliptical training can usually begin around week 8 as long as there is not a lot of pain. Your PT will help you through exercises that focus on hip strength and stability and continue to work on strengthening your glutes, legs and core muscles. There will be more focus on balance and stability as well. If you’re still experiencing a significant amount of pain at the 8 week mark or recovery, your PT will help you modify your activities outside of physical therapy to get a hold on your current threshold to activity. Pain may be the result of weak musculature which would explain why if you’re too active, fatigue sets in and muscles and joints can start to compensate which may cause discomfort.

8-12 Weeks: Beginning Lower Extremity Workouts

2-3 months after your surgery, your goal is to continue building strength and endurance and to train your stability. You’ll know that you’re progressing well if you see an improved tolerance to weight-bearing activities and a decrease in your level of pain. High-impact activities, such as jumping, should still be avoided but walking and stationary biking should continue. Your physical therapy treatment will begin to introduce body weight squats and various other strengthening exercises. Double and single leg closed-chain exercises may be included such as step ups, step downs, lunges, and single leg balance training. Depending on your progress and pain level, your PT may include manual therapy techniques to stretch your muscles and mobilize your joints.

Torn Labrum Hip Physical Therapy Surgery Hip Pain Post op

12-16 Weeks: Back to Jumping

If all is going well around 4 months post-op, you should begin dynamic drills to introduce jumping, agility and running into your plan of care. You’ll continue working on strength, endurance and balance training with the idea that your endurance shows improvement with all activities. It’s important to continue discussing with your physical therapist and surgeon the activities that you should avoid, as it will vary person to person. At this point in your physical therapy treatment, there should be less reliance on manual therapy techniques and more of an emphasis on exercises and self management of your recovery. Exercises included may focus on single limb strength and balance, non-loaded / loaded jumping, agility drills and a return to running program. As a patient, the best thing you can do is to stay compliant with your home exercise program so that you can maintain the gains you’ve achieved during your PT treatment.

4 Months+: Getting Back to Regular Life

Depending on your condition and unique body, it could take anywhere from 6-9 months before you feel 100% again. As mentioned above, staying compliant with the home exercises provided by your physical therapist is the best way to ensure the strength and mobility you’ve achieved continues. Consult your physical therapist if there is any doubt about returning to a certain activity or if you have questions with your home exercises.

Get to Know Your PT: Cami Hatch, DPT

Denver Physical Therapy Cami Hatch

Therapydia Denver physical therapist Cami Hatch takes some time to talk pelvic health PT, the importance of being a good listener and changing up her workout routine.

“It’s important to challenge the body in different ways. Try new things and be adventurous!”

When did you know that you wanted to be a physical therapist?

I took some time off after I graduated from undergraduate and got a job working as a PT aide. I really enjoyed the environment and working with people and I liked that I could stay active throughout the day while still challenging my mind.

What is the biggest challenge involved in being a PT?

I would probably say dealing with the healthcare system. It’s challenging to have to consider how the patient’s insurance will affect their treatment.

How do you like to stay active?

A little bit of everything; running, yoga, hiking, weights. I recently started biking a little more too. I like snow sports in the winter. I snowboard mostly but I am trying to get into cross country skiing.

What’s your favorite song to get you motivated?

I could never pick just one, it varies monthly. Right now I have a lot of 90s hip hop on my running playlists. I’m also a big fan of the 60s and 70s.

What surprised you the most about the physical therapy profession?

The plethora of different theories and beliefs that PTs have. There are so many different treatment options and programs that sometimes it can get a little overwhelming. I try to learn from all the different approaches and take what I can from each one.

Are you currently pursuing any further education/certifications?

I try to take continuing education courses as often as I can. I think eventually I will consider getting a women’s health certification.

What do you wish everyone knew about PT?

From a women’s health/pelvic floor perspective, I wish people knew more about what Pelvic Floor PT is in general. People are often told that medication or surgery is the only option when in fact there are other things we can try. I also wish more women would come in after childbirth. I think people assume that since the female body is designed to give birth, everything will be fine but in reality it is a trauma and it’s important to make sure the muscles and tissues recover fully to regain strength and function.

What is the most important personality trait that a PT must have?

I think it’s really important to be a good listener. Listening to how a patient feels and what their thoughts are about their pain/recovery helps to determine how to approach treatment. I think this is especially important with my women’s health/pelvic floor patients because their pain/issues may have more of an impact on their psychosocial health and personal relationships. It’s important to consider the patient as a whole person rather than just an injury/diagnosis.

What’s your go-to breakfast?

Sprouted wheat bagel with peanut butter and coffee.

What do you do to de-stress/unwind?

It depends on the day. Sometimes I like to go for a run, it helps to organize my thoughts and get out my energy. Other times I enjoy reading, yoga and meditation.

Finish this sentence: On Saturday mornings, you can usually find me…

Well every other Saturday I am working. Otherwise probably sleeping in and trying to convince my boyfriend to go trail running with me.

What is your favorite piece of wellness advice?

Change it up. I think it’s easy to get into a specific routine and to do the same things all the time but it’s important to challenge the body in different ways. Try new things and be adventurous!

Click here to learn more about Cami and the other physical therapists at Therapydia Denver.

4 Exercises for a Stronger Pelvic Floor

pelvic health physical therapy strength exercises women's health

As a part of Therapydia’s Pelvic Floor Dysfunction Treatment, our physical therapists help patients to eliminate symptoms of pain and discomfort by strengthening weakened muscles and relaxing muscles that may be too tight. Along with manual therapy techniques, stretching, and patient education, custom exercises are prescribed to patients in order to increase hip and core strength to provide the necessary tools to eliminate symptoms of pelvic floor dysfunction. Below are a few example exercises utilized in pelvic health physical therapy.

Bridge with Hip Adduction

This exercise increases core activation to help strengthen and stabilize your muscles.

• With your knees bent and your feet on a flat surface, squeeze the Pilates ring using your inner thigh muscles so that your knees, ankles and hips are all in one line.
• Hold this position as you lift your hips up, squeezing through the glute muscles.
• Maintain a tight core throughout to avoid any arching of the back and to ensure proper glute activation.
• Hold for a few seconds at the top and return to the starting position.

Side-lying Hip Abduction

Hip abductor muscles are important muscles that not only contribute to our ability to stand, walk and rotate our leg with ease, but also ensure that the pelvis is stable and functioning properly.

• Lie on your side with your bottom knee bent for stability.
• Roll the top hip forward and contract the lower abs to prevent any arching of the low spine.
• Lift the top leg straight up with the toe pointed forward and squeeze the leg up and slightly back.
• You should feel this exercise in the posterior glute and not in the front or the side of the hip.


Clamshells help to stabilize the pelvis by strengthening the surrounding musculature. Strong hips are important when it comes to the function of your pelvic floor and the prevention of pelvic pain and incontinence.

• Start on your side in a fetal position. Keep the top hip rolled forward and the heels together as you lift the top knee up using your glute muscles. This exercise should be felt in the back of the hip, not in the front, side of inner thigh.
• Make sure that you are not rolling the top hip back as you are lifting your knee.
• Keep the core engaged throughout the entire movement.

90/90 Heel Taps

90/90 heel taps engage the abdominal muscles to promote pelvic stability.

• Start on your back, contract the low abs and lift both legs up to 90 degrees of hip and knee flexion without letting the lower spine come off the table.
• Squeeze the belly button toward the spine and keep the pelvis stable as you tape one heel to the table and bring it back up.
• Alternate legs and make sure that you are not arching through the lower spine.
• Perform this exercise to fatigue.

If you experience any pain with these exercises, stop immediately and contact a Therapydia physical therapist.

What is Visceral Mobilization?

visceral mobilization manipulation physical therapy treatment denver

Part of the manual therapy umbrella, visceral mobilization (aka visceral manipulation) is a hands-on treatment technique used to mobilize the organs.

When everything in your body is working properly, all of your organs should move and slide over each other smoothly. Unfortunately, strain, overuse or poor posture can cause organs like the kidneys, bladder and intestines to get a little “sticky” which may lead to your internal tissues binding together. This can create adhesions which, once formed, may cause areas of tension that make the organs stick together. This can lead to discomfort and decreased function.

Visceral Mobilization is helpful for those who have had any type of abdominal surgery including hysterectomy, C-section, GI surgeries, etc. It can also be beneficial for those who have a lot of scar tissue, common in athletes who play sports with a lot of blunt-force trauma such as football or hockey. The same way that we get scar tissue in the knee joint, scar tissue can form around the organs, limiting motion. This scar tissue is actually formed by your body as a type of protection. Visceral mobilization can be very relevant for lower back and hip pain and may also help with digestion issues like constipation. Though it may seem like a massage as your physical therapist is performing visceral mobilization, they’re not actually changing the tissue. Instead, they’re attempting to elicit a neurological response or more simply, trying to direct the brain’s attention to a specific area in order to get the tissue to relax.

This video created by Albert W. Stern explains the process in a very simple, straightforward way:

Strength Exercises for Baseball Players


Strength training is extremely important for baseball players when it comes to working on things like shoulder stability, injury prevention and maintaining strength throughout the season. Now that baseball season is in full swing, we at Therapydia wanted to provide some great exercises for overhead athletes.

Many of the exercises below are focused on the backside of the shoulder because when an athlete throws forward, all of the deceleration components (everything that slows the arm down) is on that backside. The posterior rotator cuff is one of the main stabilizers of the shoulder and it needs to be really strong in order to protect your arm during a throwing motion. These exercises are designed to increase strength and support during that overhead movement as well as to help increase the compressive forces of the arm bone into its socket to avoid excess strain from the torque when you throw.

Exercise 1: Internal Rotation at 90/90


• Close the resistance band in a door and hold your arm out to the side, as if you’re getting ready to throw.
• Rotate your arm forward until your forearm is parallel with the floor. Hold and return to the upright position. Repeat.

Exercise 2: External Rotation at 90/90


• Face the door and hold your arm out to the side, elbow bent to 90 degrees and your palm facing forward.
• Rotate your hand up and away from the door. Briefly hold the position and then bring your arm back down. Repeat.

Exercise 3: D2 Flexion


• Start from your opposite hip, arm held down across your body.
• Keep your left arm stationary and move your right arm diagonally through the midline while you rotate your shoulder up and away from your body.

Exercise 4: Band-Resisted Overhead Throw


• Perform the throwing motion with a resistance band.

Exercise 5: Sidelying External Rotation


• Lie on the side of your non-throwing arm, place a rolled-up towel under your throwing arm to maintain a neutral shoulder.
• Keep your arm at a 90 degree angle and lift your hand without rotating your trunk or bringing your shoulder blade back too far.

Exercise 6: Sidelying Shoulder Flexion


• Lie on the side of your non-throwing arm. Keep your free arm straight.
• Holding a small dumbbell, follow a horizontal plane and lift your arm up (there shouldn’t be any pain with this movement).

The combination of some of these exercises and making sure that you have appropriate mechanics and mobility through your shoulder can help to prevent injury and avoid wear and tear throughout your season.

Simple Movements for Neck and Upper Back Pain Relief

neck pain relief back pain relief

Therapydia physical therapist Aaron Page, DPT gives us a couple of quick tips to alleviate neck and upper back pain. These simple exercises can be performed almost anywhere and can help you break out of that slouching position that is so easy to fall into. Sure, you may get a couple of odd looks in the office but these stretches will keep your neck and back moving to decrease pain associated with poor posture.

Spine Extension & Pec Stretch

This movement uses the back of your chair and helps to extend through your thoracic spine and stretch out your pec muscles.

• Find the tight spot right at the base of your thoracic spine.
• Interlace your hands back behind your head. Keep your elbows tucked and pointing forward. Keep your head relaxed.
• Tuck your head in and come up over the top of your chair.
• Move up or down an inch or so to find the stiff spot in your upper back.

Make sure that you’re not hyperextending through your low back but emphasizing movement through your upper back to help offload your neck. If the height of your chair isn’t cutting it, use a small towel roll to pin the spot right underneath the area of your stiff upper back.

Lats & Chest Stretch

This doorway/wall exercise works on extending through your upper back, stretching out your lats and the front of your chest. It’s sort of a double dip between a stretch and a thoracic spine mobilization.

• Position yourself a comfortable distance away from the wall, hands in.
• Push your butt back, keeping your spine in a neutral position.
• Look straight down and think about sinking your chest bone down towards the floor.
• Stretch down along the other sides of your arms and move through your upper back.

Dynamic Pec Stretch with Trunk Rotation

• Place your forearm up against the doorway. Bring your opposite foot forward so that you’re in a neutral position.
• Take a small lunge and add in a rotation away from the door jam so that you’re pulling from your pec and not just the front of your shoulder.
• Rotate back one step and repeat. Make sure that you’re pulling through the front of your chest.

Learn more about Neck Pain / Back Pain

Lacrosse Ball Trigger Point Exercises

At Therapydia Denver, every patient receives one-on-one hands-on treatments. Our PTs are certified in manual therapy and these techniques allow us to mobilize the joints and muscles as well as release trigger points. Trigger points are areas of adhesions within soft tissue resulting from trauma or overuse and can lead to ineffective movement and pain. In addition to hands-on manual therapy techniques, all our PTs are also certified in dry needling – a great way to release trigger points.

The goal of each physical therapy visit is to restore proper length tension relationships of soft tissue and enhance normal joint mechanics for proper function. Our patients can replicate some of these myofascial release techniques at home with the use of a lacrosse ball applied to trigger points in tissue. We like lacrosse balls because they can get into those hard to reach places foam rollers may miss. Below are a couple of lacrosse ball exercises we recommend for our patients:



  • Great for posture correction and for patients that sit at a desk or computer all day
  • Picture on left demonstrates a less aggressive pec minor release
  • Picture on right is slightly more aggressive for those stubborn trigger points in the pec muscle
  • Trigger point is typically found an inch or two below the collarbone and just to the inside of the shoulder
  • Be careful not to place ball directly on the front of the shoulder.  This is where the biceps tendon is located and can get irritated from the pressure.  This will typically feel like a sharp pain if you are on the tendon vs an achy sensation on the trigger point.
  • 10-90 second hold, repeat 1-3 times, 1-2 times per day

hip exercise


  • Find boney point in front of hip (ASIS) and move ball 2-3 inches down and to the side
  • Lay on side and apply sustained pressure with ball to the muscle
  • Duration of pressure depends on how long it takes for muscle or trigger point to “release”
  • Release of the trigger point can usually be felt when there is a significant decrease in the intensity of the pain from the pressure of the ball
  • We typically tell patients that the intensity of discomfort should drop several points on the 0-10 pain scale
  • For example, if discomfort is 8/10 on the pain scale, then hold the pressure on the trigger point until the pain drops to at least a 3-4/10
  • This can take anywhere from 10 – 90 seconds

calf tightness exercise


  • Place one calf on ball and cross opposite leg over the top
  • Locate tender trigger point and hold sustained pressure
  • Gently pump bottom ankle up and down for more aggressive trigger point release
  • Again hold pressure until there is significant change in intensity of symptoms
  • 10-90 second hold, repeat 1-3 times, 1-2 times per day


rotator cuff releas


  • Locate tender trigger point(s) in back of shoulder, specifically on back of shoulder blade
  • Start with arm externally rotated (picture on left)
  • Maintain pressure on trigger point as you rotate shoulder into internal rotation (picture on right)
  • There are several trigger points in the back of the shoulder/shoulder blade so more than one point may need to be treated to address symptoms
  • These trigger points tend to cause radiating pain into front of shoulder and/or down the arm so don’t be surprised if ache is felt in areas other than where the ball is placed.
  • 10-90 second hold, repeat 1-3 times, 1-2 times per day



  • Place the lacrosse ball under the arch of your bare foot and begin rolling.
  • Roll the ball in multiple directions
  • You should feel instant relief from tight arches. (Image source: Shape)


  • Place lacrosse ball in between scapula and spin
  • Add movement of the arm into flexion overhead and back down to the hip for several reps, encouraging more upper thoracic extension at end range shoulder flexion.
  • Move lacrosse ball to multiple locations left and right side of spine with short duration holds of pressure