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Good Pain vs. Bad Pain: When do you need attention?

September 18th, 2018 Posted by Blog 0 thoughts on “Good Pain vs. Bad Pain: When do you need attention?”

What is “good pain”?

I know it sounds hard to believe but there actually is a good pain.

It is called DOMS, or delayed-onset muscle soreness. This is your body’s positive response to exercise that makes you grow stronger. If you exercise your arms and, a day or two later, the area of your arms you worked is tight and tender to touch, you are experienced DOMS.

DOMS can peak at 1–2 days after a challenging exercise. The challenge can come in the form of doing an exercise you have never done before, or increasing resistance for an exercise that you have done before.

What is “bad pain”?

Bad pain is pain that we want to pay attention to. It is your body’s negative response to a weight that was too much load, too quickly or it was a light-weight/load but for too long a period of time.

How can you tell if you need to seek a physical therapist?

  1. Did you have poor-technique with an exercise or even when you did something around the house requiring force? Did that result in a pain that lasted longer than two-three days (beyond the DOMS-window)?
  2. Does your pain interfere with your everyday activity? Things such as bathing, meal-prep, walking, stairs, etc. These are all things that shouldn’t be severely impacted for days.
  3. Does the pain have a very localized point? Generally, “good pain” is in a wide-spread area around muscles that were trained.

If you answered “yes” to the above, it is advisable to seek out a physical therapist near your to help determine the nature of your pain, give you tips on better ways to move as well as help you recover in a safe and efficient way.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at to come in for a visit and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

When should you get an MRI?

September 10th, 2018 Posted by Blog 0 thoughts on “When should you get an MRI?”

“Do you think I need an MRI?”

I hear this quite often. Often times patients in pain wonder when or if they need to get an MRI (magnetic resonance imaging).

From an orthopedic (muscle, bone, tendon) standpoint, it is not needed as often as you may think. Most aches and pain in your joints can be determined with a good exam, assessing how you function/move, and x-rays to rule out any serious conditions.

In fact, research is indicating more and more that MRIs lead us to overdiagnose conditions.

Take back pain for example. An MRI should not be a routinely ordered test, it should only be used if severe dysfunction is noted. In addition, MRIs should be used if a patient is a candidate for surgery and/or spinal injection based on strong research and recommendations.

Often times in major research reviews we see phrases such as this:

“The rate of false-positive imaging is substantial. Anatomic abnormalities have demonstrated a poor correlation with patient symptoms and may lead to increased surgical rates without improved outcomes.” source

The next logical question is, “but how can you know what is wrong without seeing an image?”

The truth is, if your bony structure and other serious issues are taken off the table by a thorough examination, we can usually isolate the pain via stressing the structures not so easily seen by an x-ray.

This is not to say that MRIs are not useful; they just have their indications and appropriate use. With greater bodies of research reporting that a small snapshot can show us (at great detail) anatomical variations that are completely normal and without related symptoms.

If we can pinpoint a movement or an activity that you do that can bring on your pain, it is more likely we can design a program that can rehabilitate it. Think: If there is a way we can provoke and irritate the pain, we can most likely find the solution to the pain.

At RISE Rehabilitation and Fitness, your physical therapy evaluation will work to find any tightness, weakness, or troublesome tissue in order to get you to return to pain-free activity. We use a wide array of therapeutic strategies to eliminate your pain such as manual therapy, instrument-assisted soft tissue massage, cupping, dry needling, therapeutic taping, joint mobilizations, as well as other techniques to get your pain down and your function improving.

Physical therapy prior to an MRI can help many individuals limit medication, avoid expensive procedures (such as an MRI) and avoid surgery. If you have pain and want to seek out treatment prior to more invasive procedures and live in or around Bergen County, NJ, please contact us at RISE Rehabilitation and Fitness.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

Top 3 Reasons Why Your Knee Hurts When You Squat

August 23rd, 2018 Posted by Blog 0 thoughts on “Top 3 Reasons Why Your Knee Hurts When You Squat”

I hear this a lot from people that come to my clinic for help with their knee pain during or after they squat. I first would like to start by saying that squats are one of the best exercises an individual can do. The health benefits are tremendous and far exceed just leg strength. I will save those details for another post. Also, squatting is not bad for your knees and is a common misconception. In fact, not squatting is more likely the cause of generalized knee pain.

With the importance of squats emphasized, what do you do if you have knee pain with squatting? Pain with squats can arise from many different sources however I will discuss three of the most common ones I see with people I treat at my clinic, RISE Rehabilitation and Fitness.

Weak Hips

This is the most common issue I come across. The hip, specifically the gluteal muscles, don’t support the knee sufficiently to allow for a proper squat. The knee is a ‘hinge joint’ and just wants to bend and straighten essentially. When the hips can’t keep the knee steady in place, the knees can cave-in. Doing this repeatedly will cause knee pain and, with enough load, may cause tissue damage.

It looks a bit like the image below:

The photo above shows on the right, an individual that would likely have weaker hips than the individual on the left.

THE FIX! A great way to fix this is to strengthen the gluteal muscles. That includes the series of exercises below.


Limited Ankle Mobility

You might not even realize this but the ankle is critical to a proper squat. Many people pay close attention to the hip as well as strengthening the muscles of the thigh to improve the squat. While these are all important, if the ankle does not have sufficient mobility, no amount of strength will allow proper form and range of motion to have a complete squat.

Here you can see the range of motion needed for a proper squat.

THE FIX! A skilled manual therapist can help do various mobilization techniques to the ankle. At RISE Rehabilitation and Fitness, I work with individuals to target specific tissue or joint restrictions with my hands-on, manual therapy techniques. That essentially works on improving the mobility of the ankle joint.

Poor Form

I would say if you have knee pain with squatting, your form is likely not optimal. Granted there can be exceptions to that but we can review a couple key points.

  1. As we mentioned above, we never want your knees to collapse inward toward each other. You always want a stable base for your legs with your knee/thigh tracking in-line with your toes, or even slightly lateral/outside of your toes — never inward.
  2. We also want you to squat as if sitting back in a chair. Too often people do not bend at their waist to sit back and rather go forward with their knees. This creates tremendous stress on the patellar ligament in the front of the knee (see image below on right). This could be the cause of your pain for those that have excruciating, sharp pain, in the front of the knee. Often, this is diagnosed as patellofemoral pain.









Above you see the knees travel well-beyond the toes and the heels are elevated. Some individuals (say, with long thigh bones) can have their knees safely pass the toes, however, the heels should always stay firmly on the ground. This much pressure through the front of the knee can be dangerous and could contribute to your knee pain (aka, patellofemoral pain).

THE FIX! I find a great way to improve technique with the squat is to do box squats. To execute a box squat you want to be about 8–12 inches away from a box, bench, or chair that is tall enough to allow you to sit on it while keeping your feet firmly planted on the floor (no heel elevation).

Here you see a properly executed box squat

If the above does not work, it is advisable to seek out the help of a physical therapist. Physical therapists at RISE Rehabilitation and Fitness are board-certified orthopedic specialists that focus on manual therapy techniques as well as other approaches to help you improve your function. Book an appointment or just speak with a therapist through

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

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