5 Ways To Correct Poor Sitting Posture


Poor sitting posture and workplace ergonomics are related to the development of low back pain, neck pain, and other musculoskeletal Injuries.

Implementing the following suggestions can help minimize stresses on the body while sitting and decrease the chances of developing a musculoskeletal injury.

  1. ADJUST YOUR CHAIR HEIGHT: Your chair height should be adjusted so that your hip joints are above your knee joint. This will place your spine in a more neutral position and prevent excessive rounding of the back.

  2. ADJUST YOUR MONITOR HEIGHT AND DISTANCE: The monitor should be positioned in line with your eyes and the distance should be a length that is comfortable on your eyes to prevent strain.

  3. PLACE YOUR FEET ON THE FLOOR: Sitting with your feet unsupported increases the pressure inside of your spinal discs leading to the potential for a disc injury.

  4. USE BACK SUPPORT: Using the back of the chair for support will help you sit straight and give your back muscles a break. Consider using an added lumbar support for increased comfort.

  5. POSITION HEAD AND NECK IN NEUTRAL: Align your ears over your shoulders and slightly tuck your chin. Aligning your spine in neutral will allow for the equal transmission of forces from your head down into your feet.



Managing Overuse Injuries

activity-adult-athlete-703009 (1).jpg

What is an overuse injury? An overuse injury is any type of soft tissue or joint injury that is caused by repetitive trauma. Overuse injuries are typically due to biomechanical imbalances as well as a sudden increase in exercise activity. (posterior chain weakness, limited range of motion in a joint)

Common overuse injuries include: plantar fasciitis, achilles tendinopathy, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), patella tendinopathy, rotator cuff tendinopathy, medial tibial stress syndrome (shin splints) etc.

The following steps will aid in preventing overuse injuries:

  • Ramp up your exercise slowly. Increasing at a rate no faster than 10% per week for all activities (running, weights, speed, etc.)

  • Getting enough sleep is also important in preventing overuse injuries. 7-8 hours of sleep per night has been recommended.

  • Always perform a warm up and cool down

  • Not performing the same exercise too often and allowing 48 hours of rest in between intense exercise.

  • Listen to your body: Pain is a signal that something is wrong in your body. Identifying this early can help speed up your recovery.

In order to safely progress your training, modifying the following training factors are important to avoiding overuse injuries:

Frequency: How often you train

Intensity: How hard you train

Time: How long you train

Type: The kind of training that you do

Treatments for an overuse injury include:

  • Eliminate the cause

  • Manage the inflammation

  • Slowly return to activity as tolerated

  • Seek guidance from a qualified healthcare professional to assess the underlying cause of the injury



Recover from an Injury Faster with Proper Nutrition


“Let food be thy medicine and medicine be thy food”

       - Hippocrates

I am often asked what foods to be eating or supplements to be taking in order to recover from an injury faster. Nutrition plays a powerful role in optimizing and facilitating the healing cascade and should be considered when recovering from an acute or chronic injury.

The body goes through three stages of healing after an injury: Inflammation, Proliferation, and Remodeling. Using food to optimize each phase of the healing process can allow for a quicker recovery.

Managing Inflammation during the Inflammatory Phase

Inflammation is critical during injury healing as it triggers the repair process, but too much inflammation can be detrimental to the healing cascade. The focus during this stage should be on controlling excess inflammation, allowing your body to transition into the next phase of proliferation. Incorporating anti-inflammatory foods into your diet and eliminating pro-inflammatory foods is one way to control excessive inflammation.

The following Anti-Inflammatory foods should be incorporated into your diet;

  • Avocado
  • Fatty Fish
  • Fish oil; Supplementing with fish oil has been shown to decrease inflammatory markers in the body.
  • Nuts/Seeds
  • Leafy Greens (Kale, Spinach, etc.)
  • Olive/Flax oil
  • Curcumin, a potent antioxidant and the active ingredient in the spice turmeric, has been used as a medicinal food for thousands of years. Research has shown that supplementation of curcumin can promote reduced swelling and tenderness.
  • Bromelain from Pineapples; Supplementing with bromelain, an enzyme found in pineapples has been shown to promote reduced swelling and bruising after surgery and can help manage inflammation.

The following Pro-Inflammatory foods should be avoided;

  • Highly processed foods
  • Trans-fats
  • Fried Foods
  • Vegetable oils like corn oil, sunflower oil, safflower oil
  • Soda or other sugar-sweetened drinks

Repairing Damaged Tissue during the Proliferation and Remodeling Phases

Protein, vitamins, and minerals are essential for repairing damaged tissue and optimizing the healing cascade in the body after an injury. Receiving adequate amounts of Vitamin A, Vitamin C, and Zinc can help to support injury repair and recovery.

Vitamin A is linked with a decrease in immune suppression that is normally seen after an injury. Sources of Vitamin A include;

  • Red/yellow/orange vegetables such as carrots, pumpkin, sweet potatoes, beets, orange melon, Dark leafy greens such as spinach, kale, collards, mustard greens, and Egg yolks.

Vitamin C helps to support a normal inflammatory response and assists in the formation of collagen, which helps provide the structure of tendons, ligaments, and skin.  Vitamin C deficiency can lead to decreased stability of tissues and abnormal scar formation. Sources of Vitamin C include;

  • Most fruits and vegetables

Zinc plays a role in new DNA creation and the ability of cells to multiply and protein formation. Zinc deficiency can limit wound healing. Sources of zinc include;

  • Beans and legumes, Nuts and seeds, Whole grains, Seafood, Meats including beef, lamb, pork, poultry, Eggs, and Mushrooms

Protein plays a crucial role in the process of repairing damaged tissue and building new tissue. The American College of Sports Medicine recommends 1.2-1.7 g of protein per kg of body mass, but our protein needs can go up if we are injured or recovering from a surgery.  In order to meet our body’s protein needs when recovering from an injury or surgery supplementing with a whey protein or vegan protein can be beneficial.

Arginine is a semi-essential amino acid that is involved in multiple areas of human physiology and metabolism. It increases nitric oxide production, which can improve blood flow to damaged areas and provide important nutrients to promote the removal of dead and damaged cells. 

Glutamine is an amino acid that assists in healing after injury or surgery and in muscle cell repair. Supplementing with L-glutamine during the later stages of healing can optimize healing rates.

Tissue healing is a complex process of reactions that take place in the body with the end goal of restoring structure and function to the damaged tissues. Proper nutrition can and should be used to optimize this complex process of healing allowing for a quicker return to sport or activity.

If you are in or around the Chattanooga area and are dealing with an injury, Athletic Edge Physical Therapy provides one-on-one physical therapy services with Dr. Brandon Whitworth.


Cortisone Injections and Your Body


What is a cortisone injection and what does it do to your body?

Cortisone is a powerful anti-inflammatory medication and is naturally produced in the body. Cortisone injections are commonly used to treat a wide range of musculoskeletal conditions including muscular tears, tendinopathies, bursitis and arthritis etc. As with nearly any procedure where medication is introduced into the body, there are a number of adverse reactions that may occur.  

Some of the common side effects can include;

Soft Tissue Death: Cortisone injections are harmful to certain types of tissues including tendons. A 2014 systematic review concluded that there is emerging clinical evidence showing significant long-term harm to tendon tissue and cells associated with glucocorticoid injections. (Dean BJ, 2014) These effects include increased collagen disorganization and necrosis.

Infection: Injection associated infections can occur in any intradermal, subcutaneous, intraarticular and intramuscular injections.  The use of best infection control practices can help to minimize these risks with any needle injection.  

Osteonecrosis: Repeated cortisone injections have the potential for osteonecrosis (bone death) and bone thinning (osteoporosis). In this 2010 case report, a single hip joint corticosteroid injection caused rapid onset avascular necrosis in a 79-year-old man with no comorbidities (Kassam, 2010).

Cushing's Syndrome: Exogenous Cushing’s Syndrome is a form of Cushing's Syndrome that can occur in people taking corticosteroids with symptoms including bruising, bone weakness, increased hair growth, and infertility. It usually develops in long-term exposure to corticosteroids, but a 2016 study in the Medical Journal of Case Reports found that there have been a few reported cases of the development of Exogenous Cushing’s Syndrome after a single dose of glucocorticoid in the literature. (Mohamad Motawea, 2016)

Increased Blood Sugar: Cortisone can have an effect on increasing blood sugar levels in people with diabetes as discussed in a 2014 study in the Journal of Hand Surgery. (Jeffrey G. Stepan, 2014)

Cortisone Reaction: The injected cortisone can crystallize in the body and cause an increase in inflammation and pain. Although uncommon this cortisone flare can last for one to two days.

Cortisone injections may treat the present symptoms but don't often treat the cause of the condition.  It is important to be assessed by your Physical Therapist and Physician to determine if a cortisone injection is recommended for your specific condition.  For all medical interventions, it is important to weigh the risks vs. benefits when determining the best approach for treatment.



Dean BJ, L. E. (2014). The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Seminars in Arthritis Rheumatology, 570-576.

Jeffrey G. Stepan, B. D. (2014). Blood glucose levels in diabetic patients following corticosteroid injections into the hand and wrist. Journal of Hand Surgery , 706-712.

Kassam, A. M. (2010). Accelerated avascular necrosis after single intra-articular injection of corticosteroid into the hip joint. BMJ.

Mohamad Motawea, (2016). Cushing Syndrome Following Single Steroid Injection: A Case Report and Review of the Literature. American Journal of Medical Case Reports, 4, 130-133.

4 Stretches For Neck Pain And Stiffness


An effective stretching program can enhance the overall function of your body and help reduce your risk of injury. But when it comes to targeting neck pain and stiffness, how do you know which muscles to stretch? By knowing which stretching exercises to perform and what muscles to target for your neck, you can start on a path to becoming pain free and improve your posture at the same time.

All exercises can be potentially harmful if not performed correctly. Here are some tips for stretching exercises;

  • Stretching sensations should be localized to the muscles being stretched.

  • There should be no pain or radiating pain (pain moving down your arms) during or after stretching. If pain is present during or after stretching, stop immediately.

  • All stretches should be held for 20-30 seconds

Improving flexibility to the muscles targeted below will have a tremendous impact on improving your neck pain and stiffness by restoring both balance to the muscles and range of motion to the joints.

1. Upper Trapezius Stretch:

Benefits include: Decreased compression forces on the joints of your neck allowing for increased range of motion at your neck.


2. Pectoralis Major Stretch:

Benefits include: Improved upright posture, balancing out the tightness incurred from a forward slouched, rounded shoulder position. An improved upright posture with your shoulders back takes the tension off of your neck muscles.

3. Scalene Stretch:

Benefits include: Decreased pressure on the nerves that run from your neck down into your arms and decreased compression forces on the joints of your neck allowing for increased range of motion at your neck.

4. Suboccipital Stretch:

Benefits include: Decreased pressure around the nerves at the base of your head and neck, allowing for improved postural alignment of your head and neck.


5 Tips For A Healthy Spine

Your spine is a machine that is made to move and remains strong and flexible by staying active. 80-90% people will suffer from back pain at some point in their lives which is why it is important to take a proactive approach to maintaining a healthy spine.

Here are five tips to keeping your back healthy this year

1. Exercise More! A new 2016 research study (systematic review and meta-analysis) links exercise to a 35% reduction in the risk for low back pain. This is just another reason to start an exercise program this year. Reach your fitness goals and minimize your risk for low back pain at the same time.

2. Get more sleep! Sleep quality and quantity play a vital role in maintaining and improving your overall health and well-being. Your spinal discs receive their nutrient supply through diffusion which occurs in an unloaded position while we sleep. Positioning your body in a supported neutral position during the night will allow for all parts of your spinal discs to receive adequate nutrition and stay healthy. Some strategies to get a good night sleep include; Limiting technology use prior to bed, avoid caffeine 4-6 hours before bed, and using relaxation techniques like meditation before bed. It is also recommended that you get 7-9 hours of sleep per night.

3. Strengthen your core! Your core muscles give you stability and help to power every move you make throughout the day. There are outer muscles that move your spine and inner muscles that hold your spine together when you move. Having a strong balanced inner/outer core can help to prevent back injuries. Some of my favorite core exercises include bird dogs, dead bugs, and planks. Check out the videos below.

4. Improve Your Posture!  Poor posture can place abnormal stresses on your spine and over time lead to dysfunction and pain. Sitting places three times more load on your spinal discs than standing. If your day involves a lot of sitting try to ensure good posture by positioning your feet flat on the ground and your back up against your chair. Positioning your body in a supported aligned seated position will help to lessen the load on your spine. Also, avoid sitting for too long, getting up every 20 minutes to stretch and walk around.

5. Get help if you need it! If you do hurt your back, don't wait for the pain to go away. Starting physical therapy within the first 14 days of injuring your low back can save you (on average) $2700.



Low Back Injuries: Physical Therapy vs. Surgery

Lowback pain.jpeg

Because 80-90% of us will experience back pain at some point in our lives, today's post looks to demystify current management strategies surrounding low back injuries.

Just a normal part of the aging process

Low back pain has multiple potential causes and the source of low back pain can be somewhat of a mystery.  Even the trained clinician may not be able to identify whether the source of pain is stemming directly from a disc, a facet joint or the surrounding soft tissue. Imaging findings of disc degeneration are present in a high number of healthy pain-free individuals, which increases with age. 37% of 20-year-old individuals without pain present with disc degeneration on imaging. Findings of disc degeneration on imaging may just be normal changes taking place in the body and may not be problematic now or in the future.

These eye-opening statistics make me wonder how many unnecessary surgeries have been performed on patients with low back pain presenting with findings of disc degeneration on imaging. The New York Times posted a recent article titled “Why ‘Useless Surgery’ Is Still Popular” discussing this very topic. As healthcare consumers, it is important to be educated regarding the most up to date research and medical advice in order to make informed decisions regarding your healthcare.   

A 2013 study conducted at Thomas Jefferson University Hospital found that patients who pursued surgical intervention to treat degenerative disc disease did not experience greater relief in pain, disability or improved health status, as compared to individuals that received physical therapy.

Not all physical therapy clinics are created equal

In regards to quality of care, not every physical therapy clinic provides high-quality patient-centered care. If you attend physical therapy and spend fifteen minutes receiving heat and electric stimulation and then do a few sets of hamstring stretches, there is a good chance you are not receiving the best evidence-guided treatments available, most likely only delaying your recovery. 

A well-trained, experienced physical therapist will perform a thorough clinical examination and review any available imaging findings in order to determine the best treatment options.  Hands-on manual therapy combined with therapeutic exercise should be incorporated into a treatment plan to manage low back injuries. Not every patient that walks into a physical therapy clinic with complaints of low back pain should be treated the same way. The treatment based classification is an evidence-guided approach to categorize patients with low back pain and has been shown to significantly reduce disability and pain compared with current clinical practice guideline standards.

Low back pain can be severe and discouraging, but in most cases, it is not due to serious injury or disease. It is highly recommended to seek medical advice for injuries, including injuries affecting your lower back.  

If you are in or around the Chattanooga area and dealing with low back pain, Athletic Edge Physical Therapy provides one-on-one evidence-guided treatment sessions from a board certified sport/orthopedic physical therapist, Dr. Brandon Whitworth.


IT Band Syndrome: Is Foam Rolling Enough?

Chattanooga is a great city for active individuals. There are lots of hiking/running trails, Crossfit gyms, rock climbing spots, as well as the annual ironman and half ironman triathlon events. With all of these avenues for exercise in Chattanooga, there is also the potential for injuries to occur.  

IT Band Syndrome is a common injury in runners and endurance athletes. There are many factors that may contribute to IT Band syndrome including muscle imbalances, pelvic innominate rotations, motor control impairments, and structural issues (genu valgum). The underlying source of pain may be due to compression of the fat pad of the lateral femoral epicondyle secondary to shortening of the distal IT band.

Should you foam roll your IT Bands?

If there is already compression of the lateral femoral condyle fat pad, foam rolling the outside of the knee may lead to further compression of that area and delay or rather prolong healing. With that said, self-myofascial release with a foam roller can be an effective tool for targeting the dysfunctional tissue surrounding the pelvis and hip, commonly including the tensor fascia lata, piriformis, gluteus medius and gluteus maximus.

What other treatments are effective for treating IT Band Syndrome?

Dry needling is a highly effective form of physical therapy treatment for a multitude of musculoskeletal conditions. Dry needling involves inserting a thin, solid filament into the body creating a micro-lesion within the pathologic tissue enhancing the body's ability to heal.  Dry needling can have a profound impact on IT band pain by targeting the dysfunctional soft tissue surrounding the pelvis, hips and knees speeding up healing and allowing for a quicker return to running and other activities. Addressing any underlying movement and motor control issues is also very important when addressing IT Band Syndrome in order to treat the cause of the problem and not just treat the symptoms.


If you do have IT Band syndrome and your symptoms are not improving, you should be seen by a qualified physical therapist to address the cause of the problem.  If you are unsure of how to choose a qualified physical therapist in your area, check out my blog post titled "How To Choose Your Physical Therapist" for more information.

If you are in or around the Chattanooga area and dealing with an injury, Athletic Edge Physical Therapy offers a free 15-minute consultation to discuss your case and determine the best options for treatment.

Are We Serving The Insurance Company Or The Patient?

Have you ever been to a healthcare provider (physician, physical therapist, nurse, etc.) and felt as though you didn’t get the time and attention you deserved?

Most people have!

Why is that so common throughout our healthcare system today? And why are many healthcare providers choosing to go out of network with insurance companies?

An out of network provider does not contract with insurance companies to accept certain negotiated rates. 

For the providers themselves, reimbursement rates from insurance companies are decreasing, leading to the demand for providers to see more patients in a shorter amount of time. This does not promote improved health care.

How could a provider give better, more effective care when they have to see more patients in a shorter period of time? This can only lead to patient misdiagnosis, prolonged recovery, and increased costs, as well as increased burnout rates for the healthcare providers themselves.

Patients are dealing with increased financial responsibility out of their own pockets as well. Co-payments are skyrocketing. There are increasing deductibles and decreasing percent of coverage. Patients are not only receiving lower quality of care but also having more financial burden!

Let’s take a look at the following example:

Patient A goes to a traditional physical therapist who is in network with their insurance company and covered at 80%. During each session, Patient A receives 10 minutes of one-on-one treatment from their physical therapist and is then handed off to an aide. This patient attends physical therapy 3 times per week for 6 weeks, for a total of 18 visits. The total one-on-one care equals three hours. With each visit costing $125 dollars with 80% coverage, the total cost out of the patient’s own pocket is $450.

Patient B goes to a nontraditional physical therapist, who is out of network with their insurance company and is covered at 50%. Patient B receives 60 minutes of one-on-one care from their physical therapist. This patient attends physical therapy 1 time per week for 4 weeks, for a total of 4 visits. The total one-on-one care equals 4 hours. With each visit costing $125 dollars with 50% coverage, the total cost out of the patient's own pocket is $250.

It is clear that Patient B spends less time at physical therapy, receives higher quality of care and spends less money out of their own pocket.

I had the opportunity to complete my clinical hours for my orthopedic residency at an out-of-network physical therapy clinic in Manhattan, NY, called KIMA: The Center for Physical Therapy and Wellness. KIMA promotes individual, personalized care, treating one patient every 45 minutes. It was there that I realized that patients can receive high-quality physical therapy services with them as the priority, not the insurance company

As an out-of-network physical therapy provider, I have the luxury to design treatment plans to address my patient’s needs, not the needs of the insurance company. I now have the time to to give patients my undivided attention that they deserve and give more effective care. Because of this, my patients get better and often faster results. I became a physical therapist to help people live better, healthier lives, and my physical therapy practice was established for the same reasons.


How to Choose Your Physical Therapist

In this day and age, your health care seems to be limited by what health insurance you carry. On average, people spend 7 hours researching and shopping online for a new car to buy and less than 60 minutes choosing their healthcare provider! With our healthcare system continually changing, consumers must be proactive and take the responsibility of their health into their own hands.

So what factors should be considered when choosing a health care provider?

More specifically, how do you choose a qualified physical therapist?

You want a physical therapist who is going to perform a thorough examination, listen to you discuss your injury, and spend quality one-on-one time with you.

You want a physical therapist who understands that the human body works as an integrated organism and that often times the injury is not local to the site but has an effect on the rest of the body.

All 50 states have some form of direct access to physical therapy services without a physician referral, yet often times, patients are referred to physical therapy from their physician. Physicians may refer you to a physical therapy clinic in their office or to a clinic in which they have a financial interest. With this in mind, patients need to understand that they can choose any physical therapy provider that they want, in any facility! 

Here is some important information you need to consider:


Your physical therapist should be specialized

Physical therapists can specialize in treating different areas of the body and can become board-certified in specialties such as orthopedics, sports, neurology, pediatrics, etc. Ask to see if your physical therapist is board-certified and in what specialty.

Did you have surgery and you want the best possible outcome? Look for a physical therapist who is board certified in orthopedics with the credentials “OCS” after their name.  Are you an athlete looking to overcome a specific sports injury, prevent further injuries, and optimize performance? Look for a physical therapist who is board certified in sports, with the credentials “SCS” after their name.  


Your physical therapist should see no more than one patient per hour

Quality is more important than quantity. You want to find a physical therapist who sees no more than one patient per hour. I have worked in busy outpatient clinics seeing over 100 patients a week and found that I cannot give patients the treatment that they deserve.

Often when you are seen by a therapist with multiple patients at the same time, you are handed off to an aide or technician. Sometimes, these aides have no healthcare education at all. This only delays your recovery and increases your healthcare costs! Aides or technicians are there to help assist physical therapists by preparing the treatment areas and modalities and should never be providing direct care to patients.

A model based on one-on-one care from a physical therapist will promote a faster return to the activities that you love and will not waste your time handing you off to an aide or technician.


Your physical therapist should use modern and relevant research

Healthcare is continually evolving with new medications, procedures, and techniques constantly becoming available to healthcare consumers. As experts of the musculoskeletal system, physical therapists must uphold the value of well-established and rigorously tested interventions. A good physical therapist uses research to help guide patient treatment decisions to allow for the promotion of optimal health.  


Your physical therapist should Provide hands-on care

Choose a physical therapist who provides hands-on care and not just counts your repetitions during exercises. Hands-on manual therapy can be extremely beneficial in speeding up your recovery and getting you better faster! Types of hands-on manual therapy can include dry needling, myofascial release, joint mobilizations, soft tissue massage, proprioceptive neuromuscular facilitation, nerve gliding, etc.


If you do have an injury and need physical therapy, here are

5 questions to ask your physical therapist:

1.   How many patients do they see at one time?

2.   Are they board certified?

3.   Who fills in for them when he/she is not available?

4.   Will my care be provided by a physical therapist or will I be handed off to a technician or aide?

5.   Do they stay current with the latest research and let evidence guide their treatment decisions?


If you are in the Chattanooga area and dealing with an injury, Athletic Edge Physical Therapy offers a free 15-minute consultation to discuss your case and determine your best options for your treatment.