Why Active Physical Therapy Beats Passive Treatments for Long-Term Recovery

Passive vs. Active Treatments: What’s the Difference?

When most people think of physical therapy, they picture things like ice packs, heating pads, or electrical stimulation. These are called passive modalities—you receive the treatment, but you don’t actively participate.

On the other hand, active treatments involve movement: exercises, mobility drills, balance training, and progressive loading. These treatments put you in the driver’s seat of your recovery.

Why Passive Treatments Alone Aren’t Enough

There’s nothing “wrong” with passive modalities. In fact, they can:

• Help control pain in the early stages of injury

• Reduce muscle tension

• Provide temporary relief so you can tolerate movement

But here’s the problem:
👉 The research is mixed when it comes to their long-term effectiveness.

If your treatment plan consists only of ice, heat, massage, or electrical stimulation, you’re missing a huge part of the rehab puzzle. Passive care may help you feel better in the moment, but it doesn’t prepare your tissues to handle real-world stress.

Why Active Treatments Are Superior

Active rehabilitation focuses on building tissue tolerance and resiliency. Through guided exercises, you safely challenge your muscles, tendons, and joints so they adapt and get stronger.

Benefits of active treatment include:

• Restoring mobility and flexibility

• Improving strength and stability

• Preventing future injuries

• Getting you back to the activities you love faster

Think of it this way: passive treatments calm things down, but active treatments build you back up.

The Role of Load in Recovery

Even in the earliest stages of rehab, some form of light movement should be introduced. It might be as simple as gentle range-of-motion drills or walking.

As healing progresses, it’s crucial to incorporate load—gradually increasing resistance, intensity, and complexity of movement. This progressive loading teaches your tissues to handle stress again, which is essential for returning to sports, hobbies, or daily activities.

Without load, recovery stalls and the risk of reinjury stays high.

Putting It All Together

The best approach to physical therapy blends both passive and active strategies:

• Use passive modalities when needed to reduce pain and inflammation.

• Prioritize active treatments that restore strength, mobility, and resilience.

• Progressively load tissues so your body is ready for the demands of daily life.

At Habits Physical Therapy in Nampa, our sessions are one-on-one, focused, and designed around your unique recovery journey. We don’t just chase short-term relief—we help you build long-term health.

Ready to Move Beyond Passive Care?

If your current recovery plan feels stuck in “ice and heat mode,” it may be time for a more active, evidence-based approach.

📍 Visit us at Habits Physical Therapy, 8 6th St N, Suite 102, Nampa, ID 83687
📞 Call today: 406-560-1048

👉 Let’s get you moving—and keep you moving—for the long term.

Recovering From Surgery? Why Post-Op Physical Therapy in Nampa Is Essential

Why Post-Op Physical Therapy Matters

After surgery, it’s common to feel sore, stiff, and unsure about how to safely move again. While rest is important in the first few days, too much inactivity can actually slow recovery. That’s where post-operative physical therapy comes in.

A skilled physical therapist helps guide you through the healing process, making sure you regain mobility, build strength, and return to the activities you love.

Benefits of Post-Operative Physical Therapy

Here are a few reasons why working with a physical therapist after surgery is so important:

1. Pain Management With less reliance on Medications

   • Gentle exercises, hands-on care, and movement strategies can reduce pain naturally.

2. Restore Strength and Mobility

   • Muscles and joints can weaken after surgery. PT helps you rebuild safely.

3. Prevent Complications

   • Early movement lowers the risk of stiffness, scar tissue buildup, or even re-injury. Trained physical therapists can spot problems early and get in contact with your surgeon for fast treatment.

4. Faster, Safer Return to Activity

   • Whether it’s walking, hiking, golfing, pickleball, running, or just moving without pain, PT helps you get there more quickly.

Common Surgeries That Benefit From Physical Therapy

At Habits Physical Therapy in Nampa, we commonly help patients recover after:

• Knee replacements or arthroscopic surgery

• ACL

• Hip replacements

• Shoulder surgeries (rotator cuff, labrum repair, replacements)

• Back or neck procedures

• Elbow procedures

• Foot and ankle surgeries

No matter the surgery, your program will be customized to your goals and activity level.

Why Choose Habits Physical Therapy in Nampa?

At Habits Physical Therapy, every session is:

• One-on-One: You’ll work directly with a licensed physical therapist for the entire visit.

• Personalized: Your recovery plan is designed around your needs, not a one-size-fits-all protocol.

• Supportive: Our quiet, comfortable clinic in Nampa helps you focus on recovery without distractions.

Ready to Start Your Recovery?

If you’re preparing for surgery—or already recovering—don’t wait to start physical therapy. The sooner you begin, the smoother your recovery will be.

📍 Visit us at Habits Physical Therapy, 8 6th St N, Suite 102, Nampa, ID 83687
📞 Call today: 406-560-1048

👉 Let’s get you moving again, safely and confidently.

Knee Pain: Why Strengthening should be the first option (most of the time)

Knee pain is one of the most common issues people face — from young athletes to older adults. Whether it’s from running, squatting, or just going up the stairs, sore knees can make daily life harder. The good news? Exercise — especially strengthening — is one of the most effective treatments we have.

Quad Strengthening: The Foundation of Knee Rehab

When it comes to knee pain, the quadriceps (the muscles in the front of your thigh) play a central role.

• Research consistently shows that quad weakness is linked to knee pain and conditions like patellofemoral pain and knee osteoarthritis. Why, is a little mixed as people with pain are likely going to test weaker so its kind of a chicken or the egg, but regardless quad strengthening seems to be beneficial in most cases.

• Stronger quads help reduce load on painful areas of the knee, improve shock absorption, and restore function.

• In fact, multiple studies suggest quad strengthening is as effective as many medical treatments — and for many people, it can delay or even prevent the need for surgery.

Hip Strengthening: Helpful, but Maybe for a Different Reason

Over the past decade, hip-focused programs (glute and hip abductor strengthening) have gained popularity for knee pain, especially in runners.

• Evidence does support hip strengthening for reducing pain and improving function.

• But why? One theory is that it changes knee alignment and reduces stress — but newer research suggests the real benefit may be simpler:

  • Exercise itself is beneficial, no matter the muscle group.

  • By working the hips, you stay active and strong while giving the knee a chance to calm down, then gradually reintroduce direct knee loading.

So yes, hip strength helps — but it may be more about keeping you moving while respecting the knee’s tolerance.

When Is Surgery Necessary?

For most people, conservative management should be the first choice:

• Quad and hip strengthening

• Activity modification

• Pain education

• Progressive exercise

But surgery may be considered if:

• There’s a significant injury (like a torn ligament or meniscus) that clearly limits stability or function.

• Pain and disability persist despite months of dedicated rehab.

• Your activity goals (competitive sports, heavy physical work) demand more than rehab alone can restore.

Even in surgical cases, rehab before and after surgery can improve outcomes.

Beyond Strength: Plyometrics for Return to Sport

If your goal is to get back to running, sports, or higher-level activities, it’s not enough to just build strength.

• Adding plyometrics (jumping, hopping, bounding drills) at the end of a rehab program helps retrain the tendon, muscle, and joint to absorb and release energy.

• This prepares your knee for the real-world demands of sport and performance.

Bracing and Taping: Do They Help?

What about knee braces or kinesiology tape?

• Bracing: Evidence is mixed. Some people feel more confident and stable with a brace, especially in activities. But long-term benefits are unclear.

• Taping: Can provide short-term pain relief, especially in patellofemoral pain. But like bracing, it’s usually a short-term tool rather than a fix.

Bottom line: bracing and taping can be useful adjuncts — but they’re not substitutes for strengthening.

The Takeaway

For most types of knee pain, exercise is the first and best treatment.

• Start with quad strengthening, add hip exercises to stay active, and progress gradually.

• Surgery is reserved for specific injuries or when rehab fails.

• Don’t forget plyometrics if your goals include running, jumping, or sports.

• Bracing and taping may help short-term, but strength and consistency are the true game-changers.

Achilles Tendinopathy: Why Stretching Isn’t the Answer and What Actually Works

The Achilles tendon is a very strong tendon in your body, connecting your calf muscles to your heel bone. It’s also a very common site of injury in active people — especially runners. If you’ve been dealing with persistent heel pain, you may have what’s called Achilles tendinopathy.

Many people assume that stretching is the best treatment, but research shows that’s usually not the case. Instead, the key lies in understanding how the tendon changes with injury and how to retrain it properly.

Why Stretching Often Fails

Traditional advice for tendon pain is to “just stretch it out.” But the Achilles tendon isn’t like a tight muscle — it actually behaves more like a spring.

• In chronic tendinopathy, the Achilles loses stiffness — meaning it doesn’t store and release energy efficiently anymore.

• Stretching does not address this loss of stiffness.

Instead of stretching, the goal should be restoring stiffness and strength through the right kind of loading.

Acute Achilles Tendinopathy

When pain is new and sharp, the tendon is in an acute reactive phase. Here’s what works best:

• Unload the tendon temporarily: strategies like heel lifts or activity modification reduce stress.

• Relative rest: avoid high-load activities (like sprinting or hills) while pain is severe.

• Progressive reloading: once symptoms calm, you can start a progressive loading program.

Think of this stage as calming down an irritated tendon before teaching it how to handle stress again.

Chronic Achilles Tendinopathy

When pain lingers for months or even years, the tendon needs a different approach. Here, the goal is to rebuild stiffness and strength.

• Heavy, slow resistance training is the gold standard.

  • Slow calf raises (3–5 seconds up and down) strengthen the tendon and improve stiffness.

  • Tendons adapt best to slow, controlled reps rather than quick movements.

• Runners: uphill running increases Achilles strain. Start with flat surfaces or slight declines until the tendon adapts.

Loading is not only safe but essential for recovery in chronic tendinopathy.

Mid-portion vs. Insertional Achilles Tendinopathy

Not all Achilles pain is the same — and treatment strategies need to reflect that.

• Mid-portion tendinopathy (pain 2–6 cm above the heel):

  • Responds very well to heavy, slow calf loading.

  • Exercises like heel raises on a step are effective.

• Insertional tendinopathy (pain right at the heel bone):

  • Sensitive to compressive forces at the tendon’s attachment point.

  • Avoid exercises or stretches that push into deep dorsiflexion (heel dropping below a step, aggressive calf stretches).

  • Instead, keep the heel slightly elevated during strengthening to avoid compressing the tendon against the heel bone.

The Bottom Line

Stretching might feel good temporarily, but it doesn’t solve Achilles tendinopathy.

• In the acute phase, unload and rest, then carefully reintroduce loading.

• In the chronic phase, tendons thrive on heavy, slow strength training.

• Modify running by avoiding uphills early on, and adjust exercises depending on whether your pain is in the mid-portion or insertional Achilles.

With the right strategy, the Achilles can regain its spring-like stiffness — and you can get back to running, training, and moving without pain.

How to Safely Build Running Mileage: The Envelope of Function Explained

Introduction

One of the most common questions runners ask is: “How much can I safely run without getting injured?” The answer lies in a concept called the Envelope of Function. Understanding this principle can help you build mileage, train smarter, and stay healthy long-term.

What Is the Envelope of Function?

The Envelope of Function is a simple way to think about how much stress your body can handle before it starts to break down.

• Every runner has a capacity—the amount of load your tissues (muscles, tendons, joints) can tolerate.

• Training within your envelope makes you stronger and more resilient.

• Training above your envelope—too much mileage, intensity, or not enough recovery—increases your risk of injury.

Think of it like a credit card limit. If you keep spending within your limit, you build credit (fitness). If you overspend (overtrain), you end up in debt (injury).

How to Expand Your Envelope

The good news? Your “limit” isn’t fixed. With the right training habits, you can expand your envelope and handle more mileage safely.

1. Increase Mileage Gradually

• The most common thing I see is the 10% rule. While I do think this is a decent guideline, I think there is some flexibility in this and times when I would recommend a slower or faster build up depending on circumstances and prior training.

• Add mileage slowly so your tissues adapt to the new load. I also think incorporating an occasional “down week” where you back off your mileage just a bit can help our bodies recover.

• We also need to think about not just mileage, but intensity. If you are planning on adding speedwork, that needs to be added slowly as well and dosed appropriately in comparison to your total mileage.

2. Include Strength/ Power Training

• Strength work builds resilient muscles and tendons.

• Plyo’s, jumps, or explosive movements can be great for our bone health.

• Exercises like squats, lunges, and calf raises reduce injury risk.

3. Prioritize Recovery

• Sleep, hydration, stress management, and nutrition are just as important as workouts.

• Schedule lighter days or cross-training to avoid overload.

• If you feel tired or its scheduled to be an easy day, make sure to keep the pace truly easy.

4. Listen to Your Body

• Don’t be afraid to lessen the intensity or mileage on a day if you are feeling really fatigued.

• While complete rest days don’t always need to be scheduled in, that can be circumstantial as well and based on individual preference. I tend to prefer a day off unless you are an experienced runner.

The Takeaway

Your body thrives when you respect its limits. The Envelope of Function reminds us that progress is about gradual, consistent stress plus recovery. If you build mileage with patience, you’ll run stronger, faster, and healthier for years to come.

Recovering from Acute Injuries: How to Safely Restore Movement and Strength

When you suffer an acute injury—whether it’s a sprained ankle, pulled muscle, or tweak in your back—the first instinct is often to rest completely. While some rest is important in the very early stages, the best path forward isn’t lying on the couch for weeks. Instead, recovery is about striking the right balance between rest and movement so your body can heal while staying strong and mobile.

At Habits Physical Therapy, we often use the concept of the “Envelope of Function” to guide recovery. Let’s break it down and show how you can safely return to activity after an injury.

Step 1: Relative Rest in the Acute Stage

In the first 24–72 hours after injury, your body is going through an inflammatory process. Swelling, bruising, and pain are common. This is where relative rest is key:

• Avoid movements or activities that make the pain worse.

• Use ice or compression if swelling is significant.

• Gentle movement of the area (as tolerated) can help maintain circulation and reduce stiffness.

The goal here isn’t to push through pain, but to protect the tissue without completely shutting it down.

Step 2: Gentle Pain Guided Movement

Once the initial sharp pain and swelling start to settle, it’s time to reintroduce light movement. This may mean:

• Gentle range-of-motion exercises

• Low-load activities (walking, light stretching, or pool exercises)

• Controlled activation of the muscles around the injured area

Even if progress feels small, these early steps tell your body: “It’s safe to move again.” This prevents stiffness and builds confidence.

Step 3: Progressively Restoring Load

As pain decreases and movement improves, you’ll begin to restore load to the injured tissue. This is where the Envelope of Function Theory comes in.

The theory suggests that every tissue in the body has a “zone of optimal loading”:

• Too little load (like complete rest) → tissues weaken and lose capacity.

• Too much load too soon → tissues become irritated, reinjured, or inflamed.

• The sweet spot (the envelope of function) → tissues are stressed just enough to stimulate healing and adaptation without being overloaded.

Think of it like walking a tightrope—you want to challenge the tissue so it grows stronger, but not so much that you have a set back. Sometimes this requires a bit of trial and error.

Step 4: Returning to Full Activity

With gradual increases in activity—adding resistance, speed, or complexity—you’ll expand the envelope of function. Over time, your body rebuilds capacity and resilience, allowing you to return to your sport, exercise, or daily activities confidently.

At this stage, progressions might include:

• Strengthening exercises specific to the injury

• Sport- or activity-specific movements

Key Takeaways

• Start with relative rest—protect the injury, but don’t immobilize unless absolutely necessary.

• Introduce gentle movement early to keep tissues healthy.

• Progressively load the tissue within its envelope of function—just enough stress to stimulate healing, not so much that it causes setbacks.

• Work with a physical therapist to guide the process and ensure you’re staying within the right range for your recovery.

Recovering from an acute injury isn’t just about waiting—it’s about active recovery. By respecting your body’s healing timeline while gradually restoring movement and strength, you set yourself up for a faster, stronger return.

At Habits Physical Therapy in Nampa, ID, we help people find that balance every day. If you’re recovering from an injury and want a clear plan to get back to the activities you love, reach out—we’re here to help.

Chronic Neck Pain: Why One Approach Isn’t Enough

Neck pain is one of the most common issues we as physical therapists see. And more than most other joints, chronic neck pain seems to be a common occurence. For some people, it starts after an injury or accident. For others, it builds slowly over months or years from stress or repetitive habits.

If you’ve had neck pain for more than a few months, you’ve probably tried stretching — and while it may help temporarily, stretching alone often isn’t enough to create lasting relief. Chronic neck pain usually needs a multifaceted approach to address mobility, strength, and how you use your neck in daily life.

Here’s how we can tackle it.

1. Stretching and Mobilization to Restore Motion

When the neck feels tight or restricted, gentle stretching and joint mobilization can help restore movement and temporarily reduce pain. This can include:

• Targeted stretches for the neck, shoulders, and upper back

• Hands-on mobilization by a physical therapist to improve joint glide

• Light active movements to keep gains in range of motion

These techniques help break the “stiffness cycle” and make it easier to move comfortably.

2. Soft Tissue Work to Reduce Pain and Guarding

When neck pain lingers, the muscles often stay tense or “guarded” to protect the area. Soft tissue techniques — such as gentle massage can help:

• Reduce muscle tension

• Decrease sensitivity so you can move more freely

3. Relaxation and Normal Use of Your Neck

Chronic neck pain can change how you move — you might start avoiding turning your head, tensing your shoulders, or holding yourself rigid without realizing it. Over time, this can actually make the stiffness and guarding worse.

A key part of recovery is relaxing and using your neck normally again. This might mean:

• Breathing exercises to reduce overall tension

• Gradually reintroducing normal head movements

• Mindfully using your neck and focusing on relaxing throughout the day

4. Progressive Activity and Loading

We also need to make the neck and surrounding muscles stronger and more resilient. This is where loading comes in.

Strengthening the neck, shoulders, and upper back can:

• Improve support

• Reduce pain

• Restore confidence

• Help you tolerate daily activities without flare-ups

Progressive loading might include isometric exercises, resistance bands, or light weights — always tailored to your needs and comfort level.

Putting It All Together

The best chronic neck pain treatment isn’t about one single “magic” exercise or stretch — it’s about combining strategies:

• Restore motion with stretching and mobilization

• Calm symptoms with soft tissue work and relaxation

• Rebuild resilience through progressive strengthening

With the right plan, most people see improvements in pain, movement, and confidence.

If you’re dealing with chronic neck pain in Nampa, Idaho, I can help create a personalized program that addresses your mobility, strength, and daily movement habits — so you can get back to living without constant stiffness or discomfort.

📞 Call or text Habits Physical Therapy at 406-560-1048 to get started.

Beginner Exercise Tips in Nampa, Idaho: How to Start Working Out Safely

Starting a new exercise routine can be exciting — and maybe a little overwhelming. Many beginners dive in too quickly, which can lead to burnout, injury, or frustration. As a physical therapist in Nampa, Idaho, I’ve helped many people start a safe workout routine that builds strength, improves mobility, and keeps them injury-free.

The secret? Build up slowly, listen to your body, and make your workouts something you actually enjoy.

1. Start Small and Build Gradually

When you’re looking for beginner exercise tips, remember that your muscles, joints, and nervous system need time to adapt.

• Begin with 2–3 sessions per week.

• Choose exercises that feel challenging but still allow you to complete them with good technique.

• Increase only one variable at a time — sets, reps, or resistance.

Example: If you start with 2 sets of 8 squats, try adding a third set after a few weeks, or increase to 10 reps instead of adding both more sets and more reps at once.

2. Prioritize Recovery Early On

When learning how to start working out safely, recovery is just as important as exercise itself.

• Plan at least one rest day between full-body workouts.

• Use active recovery like walking, stretching, or light mobility work.

• Pay attention to soreness — mild is okay, but sharp or worsening pain means you need to back off. Soreness that persists more than a couple of days is a good sign to back off intensity as well.

3. Focus on Form for Efficiency, Not Perfection

The main goal of good form is to:

• Target the right muscles so you get the most out of each movement.

• Reduce unnecessary strain.

• Build efficient movement patterns that last.

You don’t need perfect form on day one — think of it as a skill that improves over time with consistency.

4. Consistency Beats Perfection

When it comes to safe workout routines for beginners, showing up regularly matters more than doing everything “perfectly.”

• Find activities you enjoy — walking, light strength training, swimming, cycling, or yoga.

• Schedule workouts like any other important appointment.

• Remember: momentum builds over time.

5. Enjoy the Process

Exercise shouldn’t feel like punishment. The more you enjoy your routine, the more likely you are to stick with it — and that’s where the real results come from.

Bottom Line:
If you’re looking for beginner exercise tips in Nampa, Idaho, start small, build gradually, respect your rest days, and focus on consistency. You’ll build strength, endurance, and confidence without burning out.

If you’re ready for a personalized exercise program from a Nampa physical therapist, I’d love to help you start your fitness journey safely.

📞 Call or text Habits Physical Therapy at 406-560-1048 to schedule your first session.

How Strength Training After 40 Reduces Injury Risk and Boosts Longevity

— by Clint Choquette, PT, DPT

I think its a common misconception that as we get older, strength training is risky and can lead to injury. In reality that mindset is backwards. The risk of not continuing to move is far greater than the risk of exercise. While we do need to be mindful and smarter about our training as we age (we don’t recover as fast in our 40’s as we did in our 20’s) as long as we are on a good plan there are so many benefits.

If you’re in your 40s, 50s, or beyond, slowing down might feel natural, but it’s strength training that should be front and center in your routine—not less movement.

Here’s why:
After age 30, we start losing muscle mass and power. The process accelerates after 40, and without intervention, it leads to higher fall risk, joint pain, and a noticeable decline in energy levels.

But this isn’t just about “lifting weights.” This is about staying functional, active, and independent well into your later years.

Strength Training = Longevity Insurance

Research consistently shows that people who maintain muscle strength and power as they age live longer, healthier lives.
Not only does strength training build muscle, it improves:

• Bone density (reducing fracture risk)

• Joint health (protecting knees, hips, and shoulders)

• Metabolic health (fighting off age-related weight gain)

It’s not about being a bodybuilder. It’s about being able to climb stairs, carry groceries, or go for a hike without pain.

Injury Risk Goes Up Without Strength

One of the biggest myths is that strength training is risky for older adults. The real risk is NOT doing it.
All of our tissues respond to load. And loading appropriately can help strength and build resiliency in our tissues. Which can help with:

• Tendonitis

• Back pain

• Falls

• Recovery times after minor injuries

I see it often—people come in with an injury that could have been prevented with a simple, consistent strength routine.

"But I Don’t Know Where to Start..."

That’s where a personalized plan comes in.

At Habits Physical Therapy, I work 1-on-1 with clients to:

• Identify strength deficits

• Build safe, progressive routines

• Focus on building a personalized plan that fits you, your environment, and your goals.

Whether you’re active now or haven’t exercised in years, we meet you where you’re at. The goal is long-term sustainability, not quick fixes.

The Bottom Line

If you want to stay active, independent, and injury-free as you age, strength training is non-negotiable.
It’s one of the best investments you can make for your future self.

If you’re not sure how to begin, or you’re dealing with aches and pains that have you hesitant, reach out. I offer free assessments for healthcare professionals this month, but anyone is welcome to schedule a visit.

Let’s build a plan that keeps you moving strong for decades to come.

Clint Choquette, PT, DPT
Habits Physical Therapy — Nampa, ID
📞 (406) 560 1048
🖥️ www.habitspt.com

Understanding Chronic Pain: Why It Persists and What You Can Do About It

By Clint Choquette, PT, DPT | Habits Physical Therapy – Nampa, ID

Pain is something we’ve all felt, and for most of us, it goes away once the injury heals. But for millions of people, pain doesn’t follow that rule. Instead, it lingers for weeks, months, or even years. This is called chronic pain, and it can be incredibly frustrating, confusing, and at times even scary.

So why does pain stick around even after the body has healed?

What Is Chronic Pain?

Chronic pain is typically defined as pain that lasts longer than beyond the expected time of tissue healing. It can follow an injury, surgery, or appear without a clear trigger. While acute pain is your body’s way of saying, “Something’s wrong,” chronic pain becomes less about injury and more about sensitivity.

The Science Behind Persistent Pain

We used to think pain was always a direct signal from damaged tissues. But now, research in pain neuroscience tells us the picture is much more complex.

Here’s what we know:

• Your brain is the ultimate decision-maker for pain.
  Pain isn’t just about what happens in the body—it’s how the brain interprets signals from the body. When tissues heal, the original damage may be gone, but the nervous system may still be on high alert.

• Central sensitization can occur.
  This is a process where the nervous system becomes more sensitive to normal input. Think of it like your pain “volume knob” being turned up. Even gentle movements, touch, or positions can start to feel threatening.

• Emotions, stress, and past experiences all influence pain.
  Chronic pain is closely linked to the parts of the brain responsible for fear, memory, and emotion. Anxiety about movement, previous trauma, and even poor sleep can all turn up the intensity of pain—without more physical damage.

So If It’s In My Nervous System, Is It “All In My Head”?

Not at all. Chronic pain is real pain, but the cause isn’t always physical damage—it’s often an overly protective nervous system.

The good news? Just like the nervous system learned to become sensitive, it can also learn to become less sensitive.

Evidence-Based Strategies to Manage Chronic Pain

There is no magic bullet for chronic pain, but research consistently supports these strategies:

1. Education about pain

Learning how pain works can actually reduce pain. Studies show that when people understand the brain’s role in pain, their fear goes down—and their function improves.

Think: “My pain doesn’t mean I’m broken.”

2. Progressive movement and graded exposure

One of the most powerful tools for chronic pain is gentle, progressive movement—even into painful areas. This doesn’t mean pushing through severe pain, but rather retraining the nervous system to see movement as safe again.

Start small. Choose a movement that causes some discomfort but doesn’t flare things up afterward. Repeat it daily and gradually increase range or resistance. Over time, your brain gets the message: “This is safe.”

Movement isn’t just rehab—it’s a message to your nervous system.

3. Pacing and consistency

People with chronic pain often fall into the “boom and bust” cycle—doing too much on a good day, then crashing afterward. A better approach is to pace your activity and build consistency over time.

4. Stress management and sleep

Pain and stress go hand in hand. Mindfulness, deep breathing, journaling, and cognitive behavioral therapy (CBT) have been shown to reduce the intensity of chronic pain. And don't overlook sleep—improving sleep quality often leads to better pain control.

5. Work with a professional who understands chronic pain

Chronic Pain Can Improve—Even Years Later

This is the biggest takeaway: Chronic pain is changeable. The nervous system is plastic—it can rewire, adapt, and calm down with the right inputs.

At Habits Physical Therapy in Nampa, I help people navigate persistent pain through a combination of education, movement-based strategies, and one-on-one support. Whether your pain started after an injury or came out of nowhere, we’ll work together to build a plan that helps you move more, hurt less, and get back to doing what you love.

Take the First Step

If you’ve been struggling with chronic pain and don’t know where to start, reach out today. There’s hope—and a path forward.

📍 Habits Physical Therapy, 8 6th St N, Suite 102, Nampa, ID
📞 (406) 560-1048
🌐 habitspt.com
✉️ habitspt@proton.me

The Truth About Exercise Form: Why “Perfect” Isn’t Real

When it comes to exercise, everyone seems to be chasing the elusive goal of “perfect form.” But here’s the truth: there is no one-size-fits-all perfect form. What looks right for one person might look very different for someone else—and that’s not just okay, it’s normal.

As a physical therapist, I often get asked: “Am I doing this movement correctly?” And while there are clear cases where form needs to be addressed, small variations in technique are a normal part of human movement. This post will break down what the research says about form, when it matters, and how to approach it in a way that reduces injury risk and improves performance.

What the Research Says About Exercise Form

Despite what you might see on social media, form is not a rigid set of rules—it’s a tool we can use to improve movement efficiency and load management. Studies in both physical therapy and sports performance suggest:

• Biomechanical variations are normal. Research has shown that even elite athletes, such as professional powerlifters and Olympic lifters, exhibit noticeable differences in squat, deadlift, and bench press form. [1]

• Injury risk is multifactorial, and poor form alone doesn’t automatically cause injury. In fact, many injuries occur due to a combination of volume, load, fatigue, and other individual risk factors—not a single “bad” rep.

If you’re interested in learning more about how injuries actually happen, check out our earlier post:
👉 How Injuries Really Occur: It’s Not Just Bad Form

Why Form Still Matters (Just Not How You Think)

So if there’s no perfect form, why do we still coach it?

Because form is a tool, not a rule. Here’s what good form does help us with:

• Targeting or offloading certain structures
  Want to strengthen your glutes? Small tweaks in squat stance or depth can shift the load where you want it. Recovering from knee pain? You might benefit from slight adjustments that reduce joint stress.

• Creating efficient movement
  Efficient form helps you move with less wasted energy. That matters not just for performance, but for recovery and sustainability. Consistently inefficient form can lead to overload injuries over time, especially under heavy loads or high volume.

• Building awareness
  Learning good form is also about developing body awareness and control—both important for injury prevention and athletic performance.

When Does Form Need to Be Corrected?

Not every movement pattern needs to be “fixed.” But here are signs that form might need attention:

✅ You feel pain or discomfort during or after the movement
✅ You’re excessively compensating
✅ You feel out of control or unstable
✅ Your performance plateaus or regresses

The goal isn’t to make your form look like someone else’s—it’s to optimize how your body moves.

A Practical, Personalized Approach to Form

At Habits Physical Therapy, we believe in meeting people where they’re at. Whether you’re a runner, a lifter, or just getting started in the gym, your body and your history matter. Form should be adapted to fit you—not the other way around.

That’s why we focus on:

• Thorough assessments to understand your movement patterns

• Tailored cueing and coaching based on your goals

• Strengthening around your current capabilities—not fear-based avoidance

The bottom line? Form is flexible. Let’s stop chasing perfection and start building efficient, resilient movement that fits you.

Final Thoughts

There’s nothing wrong with wanting to improve your technique. But don’t let the fear of imperfect form stop you from moving. Form is a spectrum. It’s there to help you move better, not hold you back.

Need help figuring out what’s right for you? We offer one-on-one sessions focused on personalized movement coaching, strength training, and pain management. Reach out any time!

📍Clint Choquette, PT, DPT

Habits Physical Therapy LLC
Nampa, ID | habitspt.com | 406-560-1048

References

<a name="refs"></a>

1. Bailey CA, Sato K, Burnett A, Stone MH. Biomechanical differences of the squat among competitive powerlifters. J Strength Cond Res.

2. van Dyk N et al. Sports injuries: consensus on prevention, risk factors, and return-to-play strategies. Br J Sports Med.

3. Sarabon N et al. Influence of individual characteristics on the execution of resistance training exercises. Front Physiol.

Stretching Vs Mobility. How Each Can Improve Flexibility and Range of Motion

Whether you’re an athlete, weekend warrior, or simply want to move better and with less pain, improving range of motion (ROM) is a common goal. But how do you actually do it?

Should you hold long stretches every night? Or is mobility work the better choice?

At Habits Physical Therapy in Nampa, ID, we help clients understand the science behind stretching and mobility so they can make smarter decisions and see better results.

In this post, we’ll break down:

• What is low load long duration (LLLD) stretching?

• What is mobility work?

• How do each of these improve flexibility and movement?

• Which one is better for your goals?

What Is Low Load Long Duration (LLLD) Stretching?

LLLD stretching involves holding a stretch for several minutes at a time using low force — sometimes with straps, body weight, or gentle support. This method is popular in physical therapy and rehab settings because it targets true tissue changes.

How LLLD Stretching Improves Flexibility

LLLD stretching works by targeting the mechanical properties of muscles, tendons, and fascia:

• Creep and tissue deformation: Over time, the tissue lengthens due to its viscoelastic nature.

• Plastic changes: With repetition, the tissues can undergo permanent lengthening.

• Increased stretch tolerance: The nervous system adapts, reducing the protective response to stretch.

This technique is especially effective for tight muscles, post-surgical stiffness, or joint contractures.

What Is Mobility Work?

Mobility work refers to active movements that explore and strengthen range of motion. This includes dynamic stretches, controlled articular rotations (CARs), banded joint mobilizations, and loaded end-range positions (like deep squats or shoulder cars).

Unlike passive stretching, mobility training is active, often shorter in duration, and typically more functional.

How Mobility Work Improves Range of Motion

Mobility work primarily influences the neurological control of movement, including:

• Improved motor control: Teaching your brain how to control end ranges.

• Increased proprioception: Enhancing awareness and feedback of joint position.

• Cortical remapping: Training your brain to "own" new ranges of motion safely.

• Reduced guarding: Reducing unnecessary muscle tension around joints.

These changes don’t always require long time in the stretch — they’re about better coordination and control, not just tissue length.

Which One Is Better for Improving Range of Motion?

The truth is: They both work — in different ways.

At Habits Physical Therapy, we will assess which one will be most beneficial for you. Some times we combine both techniques to get the best of both worlds.

Final Thoughts: Use Both to Move Better, Feel Better, and Perform Better

Improving your range of motion is more than just holding stretches — it's about teaching your brain and body to work together more efficiently.

At Habits Physical Therapy in Nampa, ID, we specialize in creating individualized mobility and flexibility programs based on your needs and goals.

Whether you're recovering from an injury, looking to prevent one, or just want to move and feel better, we can help you develop the right strategy.

📍 Need Help Improving Your Flexibility or Mobility?

We offer one-on-one sessions with a licensed physical therapist in a quiet, private setting. Book a consult at:

Habits Physical Therapy LLC
📍 8 6th St N, Suite 102, Nampa, ID 83687
📞 406-560-1048
🌐 habitspt.com
📧 habitspt@proton.me

Are Injury Screens Worth it? What the Science (and real life) Says

In the world of sports and rehab, athlete injury screens are both popular and controversial. Some question whether they actually predict injuries — and the research is, well… mixed. But that doesn’t mean they aren’t valuable.

At Habits Physical Therapy in Nampa, we use injury screens to support athletes at all levels — not as crystal balls, but as tools for improvement, performance, and smart return to sport.

What Is an Injury Screen?

An injury screen is a series of movement tests designed to assess things like:

• Muscle strength and symmetry

• Joint mobility

• Balance and control

• Functional movements specific to sport

These might include jump tests, single-leg strength measures, range of motion assessments, or agility drills — all done in a controlled, measurable way.

Can Injury Screens Predict Injury?

This is where the research gets murky.

Some studies suggest that no single test or number can reliably predict injury risk across a general athlete population. Factors like fatigue, training load, and previous injury history complicate the picture.

So should we toss screens altogether? Not at all.

What Injury Screens Are Good For

Even if we can’t predict every future injury, injury screens offer real, meaningful value in several key ways:

1. Establishing a Baseline

Screens provide objective data on your strength, mobility, balance, and power when you’re healthy. This helps you and your therapist:

• Track progress over time

• Detect imbalances or changes early

• Compare future test results after an injury

2. Identifying Areas to Improve

An injury screen can highlight:

• Weakness on one side

• Limited range of motion

• Poor movement control
  These don’t always mean injury is coming — but they’re worth training. Addressing these factors can improve performance and resilience.

3. Supporting Safe Return to Sport

This is where the evidence is stronger. Research supports post-injury screening as a way to:

• Detect lingering deficits

• Compare to pre-injury baseline or the uninjured side

• Guide return-to-sport decisions more safely

✅ A study published in the BJSM showed that athletes with persistent asymmetries after ACL rehab were more likely to reinjure if they returned too early.

What We Look At in an Injury Screen

At Habits Physical Therapy, your injury screen may include:

• Quad and hamstring strength testing (with symmetry comparison)

• Jump tests (single-leg jump distance, vertical jump)

• Y-Balance Test

• Mobility screens (e.g., knee to wall, sit and reach)

• Agility and reactive movement drills

We tailor the screen based on your sport and goals — whether you’re a high school football player, recreational runner, or competitive pickleball athlete.

When Should You Get Screened?

• Preseason or before ramping up training

• After an injury to track recovery

• Every year to reassess and adjust your program

Final Word: Injury Screens Aren’t Perfect — But Can Still Be Valuable

While no screen can perfectly predict who will get injured, they give us insight, direction, and measurable targets to work from. In our clinic, they’re a key part of building stronger, smarter, and more durable athletes.

Want to Get Screened?

At Habits Physical Therapy in Nampa, we offer individualized athlete screens to help you:

• Track your progress

• Address weaknesses

• Return to sport safely and confidently

📞 Call/text: 406-560-1048
📍 8 6th St N, Suite 102, Nampa, ID 83687
🌐 habitspt.com
📧 habitspt@proton.me

Build Rotational Power with Ball Throws: A must for Golfers, Pickleball Athletes, and Baseball Players

If you play a rotational sport — think golf, baseball, pickleball, or tennis — developing rotational power isn’t optional. It’s the secret to more speed, more distance, and fewer injuries.

At Habits Physical Therapy in Nampa, we work with athletes of all levels to build explosive power safely and effectively — often using medicine ball throws.

Why Rotational Power Matters

Rotational power is what allows athletes to:

• Hit a baseball farther

• Drive a golf ball with more clubhead speed

• Add punch and spin to a pickleball shot

It's not just about strength — it's about how fast you can generate force through your core, hips, and upper body in a coordinated way.

Why Med Ball Throws Work

Medicine ball throws (also called wall ball throws or slam ball drills) are one of the best tools for training rotational explosiveness because they:

• Mimic real-life sports movements

• Train full-body coordination

• Allow for max effort, high-speed movement without complex technique

You can throw hard — and let go. That’s key for developing power, not just strength.

Key Programming Principles

To train for power, not just fatigue or conditioning, keep these guidelines in mind:

Max Effort Reps Only

Every rep should be explosive — like you're trying to break through the wall.

• Don’t go to fatigue. Once speed drops, stop.

• Think: quality > quantity

Low Reps, High Rest

• 3–5 reps per set is ideal

• 2–3 minutes rest between sets

• Aim for 2–3 sessions per week

This gives your nervous system time to reset so you can stay explosive.

Light Weight = High Speed

Use a light med ball (typically 4–10 lbs) so you can maintain speed. Heavier isn’t better if it slows your movement down.

💡 In our clinic, we use a crash pad to absorb the impact and reduce sound — great for home gyms too.

Do It Before You Lift

Power work should always be done before strength training, while your body is fresh. This ensures you can hit max output.

Variations You Can Use

Try rotating through these ball throw variations throughout the week:

Throw TypePurpose🔄 Rotational PressBuilds core + hip rotation power👊 Chest PassHorizontal power + upper body explosiveness🪑 Seated Chest PassIsolates upper body from legs⛳ Golf-Style ThrowsSpecific for golf swing mechanics💥 Overhead SlamDevelops total-body explosive control

You can also add:

• Step-behind throws for dynamic momentum

• Partner throws for reactivity and timing

Bonus Tip: Use the Ground

Many athletes “leak power” by not using the ground properly. Focus on pushing through your back foot and hips — not just twisting with your arms.

That’s where rotational force really comes from.

The Takeaway

Rotational power is a game-changer for any sport involving torque, swing, or rotation. Medicine ball throws offer a simple, effective way to train it — as long as you focus on:

• Max effort reps

• Full recovery

• Light loads

• Intentional programming

At Habits Physical Therapy in Nampa, we help athletes move better, hit harder, and stay injury-free with smart power training built into their programs.

Local to Nampa? Come see how we build strength and speed with purpose — whether you’re a golfer, baseball player, or weekend pickleball warrior.

Call/text: 406-560-1048
habitspt.com
habitspt@proton.me

Sore or Injured? How to Tell the Difference and When to Seek Help

At Habits Physical Therapy in Nampa, ID, we often hear the same question from runners, weekend warriors, and active individuals:

“Is this normal soreness, or did I injure something?”

Understanding the difference between soreness and injury can help you avoid unnecessary rest — or prevent something small from becoming serious.

What is Normal Muscle Soreness?

Mild soreness that shows up 24–48 hours after activity is likely DOMS (Delayed Onset Muscle Soreness). This is your body adapting to new stress — totally normal.

Signs it’s probably just soreness:

• Dull, achy muscles (not sharp pain)

• Appears a day or two after activity

• Improves with light movement or gentle stretching - This is probably my favorite one.

Signs it Might Be More Serious

If your pain feels sharp, lasts longer than 4-5 days, or worsens with movement, it could be more than soreness.

Red flags for injury:

• Sharp or stabbing pain during movement

• Swelling, bruising, or visible changes in shape

• Pain that worsens over time or doesn’t improve with rest

• Numbness, tingling, or weakness

• Difficulty putting weight on the area (limping, guarding, etc.)

Who’s Most at Risk?

In our Nampa clinic, we see common overuse injuries in:

• Runners increasing mileage too quickly

• Adults returning to workouts after a long break

• Athletes ramping up for sports

Many injuries are preventable with the right training strategies. But if you do find yourself injured, getting early treatment can help get you back to what you love quicker and prevent it from becoming a bigger issue.

When to See a Physical Therapist

You don’t need to wait for a referral to visit a PT in Idaho.
We can evaluate your movement, pain patterns, and strength to guide your recovery — or reassure you if needed.

If you:

• Aren’t sure what’s going on

• Want to stay active without guessing

• Have a nagging ache that’s not going away...

• If pain is sticking around a week or two its likely something to get looked at. Even before that, early treatment can help guide your recovery.

Let’s take a look together.

Local, Expert Care in Nampa, ID

At Habits Physical Therapy, we offer one-on-one care in a quiet, private setting — no big gyms, no rushing. Just thoughtful, experienced care that gets to the root of your pain.

Call/text: 406-560-1048
Visit us at 8 6th St N, Suite 102, Nampa, ID 83687
habitspt.com
habitspt@proton.me

Fall Prevention: How Physical Therapy Can Help You Stay Strong, Independent, and Safe

Falls are the leading cause of injury in older adults. But the good news is that many falls are preventable. At Habits Physical Therapy LLC in Nampa, we specialize in helping people stay active, independent, and safe through personalized fall prevention programs. Whether you're worried about your own balance or a loved one’s, it’s never too early—or too late—to start taking action.

Why Fall Prevention Matters

Every year, 1 in 4 adults over the age of 65 experiences a fall. These accidents can lead to serious injuries such as hip fractures, head trauma, and long-term loss of mobility. Regaining your independence and getting back to your baseline after a serious injury can be very challenging. Preventing a fall is definitely our best strategy. The risk of falling can be significantly reduced with targeted exercises, balance training, and home safety strategies.

Common risk factors for falls include:

• Muscle weakness, especially in the legs

• Poor balance or coordination

• Limited mobility or range of motion

• Vision problems

• Certain medications

• Previous falls or fear of falling

How Physical Therapy Helps Prevent Falls

Physical therapy is one of the most effective and evidence-based ways to prevent falls. At Habits Physical Therapy, we offer one-on-one, hour-long sessions tailored to your individual needs. We begin with a thorough assessment to identify your specific risk factors, then design a customized plan to improve:

• Balance and coordination

• Lower body strength

• Recommending assistive devices if needed

• Confidence with daily activities

We also use objective tests testing such as a hand-held dynamometer to track your strength progression, or the Timed Up and Go (TUG) to track your mobility progress and adjust your plan as needed.

Simple Exercises to Improve Balance and Strength

Here are a few basic exercises we often recommend (always consult a healthcare provider before starting a new program):

• Sit-to-Stand: Improves leg strength and mimics everyday movement.

• Dynamic Balance Challenges: Important to have someone with you for safety

• Single-Leg Stance: Stand on one leg for 10–30 seconds to improve stability.

• Step-Ups: Use a sturdy step to build power and coordination.

Want a more structured approach? Our clinic offers personalized fall prevention programs for all ability levels.

Home Safety Tips to Reduce Fall Risk

In addition to exercise, modifying your environment can dramatically lower your fall risk. Start with these steps:

• Install grab bars in bathrooms

• Improve lighting, especially near stairs

• Remove tripping hazards like rugs or cords

• Use non-slip mats in the shower and kitchen

• Keep frequently used items within easy reach

Take the First Step Toward Fall Prevention

Falls aren’t just a part of aging—you can take control and stay safe, mobile, and independent with the right support. At Habits Physical Therapy LLC, we provide expert care in a quiet, one-on-one environment, ideal for older adults or anyone looking to regain confidence in their balance and mobility.

8 6th St N, Suite 102, Nampa, ID 83687
Call/Text: 406-560-1048
Visit: habitspt.com
Email: habitspt@proton.me

Stay Independent With Power Training

Clint Choquette, Physical Therapist, Nampa Idaho

As we age, it’s common to focus on preserving flexibility, balance, or even cardiovascular fitness. But something that often gets overlooked is muscular power, which is the ability to produce force quickly. While strength is important, power declines much more rapidly with age and may be a better predictor of physical function, fall risk, and independence in older adults.

Power is what helps you catch yourself during a trip or rise quickly from a chair. It also a big determinate of our performance as an athlete. It’s the combination of strength and speed — and it’s critical for maintaining function and performance especially as we age.

Research highlights this point clearly. A 2009 study published in the Journal of Gerontology found that lower limb power is more strongly associated with functional performance than muscle strength alone in older adults. Participants with greater leg power performed better on tasks like stair climbing and walking speed, both of which are essential for everyday independence.

Another study in Medicine & Science in Sports & Exercise (2010) showed that power training — even more than traditional strength training — led to greater improvements in physical performance measures like balance, reaction time, and agility in older individuals. These are exactly the kinds of qualities that can reduce the risk of falls and related injuries, which remain a leading cause of disability in aging populations.

There’s also growing evidence that power-based exercises (e.g., fast sit-to-stands, step-ups, light jump training, or resistance training with speed) can improve neuromuscular function and proprioception, both of which contribute to fall prevention. For example, a 2016 systematic review in Sports Medicine concluded that power training improves mobility and balance and may reduce fall risk in older adults, particularly when tailored to individual ability.

Importantly, power training isn’t just for athletes. It can and should be scaled for anyone — from a 65-year-old golfer to an 85-year-old retiree who wants to stay independent at home. Movements can be simple and safe, with a focus on control and speed of movement, not just heavy lifting.

At Habits Physical Therapy, we integrate age-appropriate power development into our rehab and wellness programs. Our goal is to help individuals not only recover from pain but thrive — to move with purpose, prevent future injury, and maintain the physical capacity to enjoy life fully.

Contact:

8 6th St N ste 102, Nampa, Idaho 83607

406-560-1048

Low Back Pain and Physical Therapy

By Clint Choquette, Physical Therapist, Habits Physical Therapy, Nampa Idaho

For many years, people dealing with low back pain were often told to rest and avoid lifting anything heavy. While this advice is good in the early stages of an injury, we now know that excessive rest and avoiding movement can actually make the problem worse in the long run. In reality low back pain in particular can lead to long lasting pain even after the injury has healed. Our nervous system can become “hypersensitive” and that leads to pain signals without continued tissue damage. Progressive strength training — including exercises like deadlifts and squats (when done right) — are emerging as one of the most effective and empowering strategies to reduce pain, improve function, and build long-term spinal resilience.

When someone experiences back pain, it’s natural to become cautious with movement. But avoiding activity over time leads to deconditioning, increased stiffness, and heightened sensitivity, which only reinforces the cycle of discomfort. It’s almost teaching our body that this movement in dangerous and our bodies sense that as a threat when we go to bend or lift. Strength training helps break that cycle. By gradually reintroducing resistance in a controlled and safe manner, people can rebuild strength, confidence, and trust in their bodies. The deadlift, often misunderstood, is one of the most practical and functional movements we can train. It mirrors real-life tasks like picking up a laundry basket, a child, or groceries. When performed with proper technique, load progressions, and under supervision, it teaches healthy movement patterns, strengthens the core, leg, and hip musculature, and builds capacity in a way that supports daily activities.

Importantly, back pain is not just about structural “wear and tear.” Modern research highlights a metabolic and inflammatory component in many cases of chronic pain, including low back pain. That means it’s not just about what’s happening in the joints or discs, but also what’s happening in the whole system. In this context, strength training does more than improve muscle function — it also supports metabolic health, improves blood flow, reduces systemic inflammation, and can even support better sleep and mood. These systemic benefits are often overlooked in traditional rehab conversations but are critical to long-term recovery. So, if your someone who has back pain that has made any type of bending or lifting difficult, or someone who likes to lift but doesn’t think they can get back to certain lifts, be encouraged there are strategies to get you back to activities you enjoy.

All strength training does not have to be heavy. If your someone who just wants to get back to lifting their grandchildren or the groceries, the load can be modified to match your goals. But challenging your system a bit seems to get the best results.

At Habits Physical Therapy, our goal is to help people move well and live stronger. We take a patient-centered approach that includes thorough assessment, education, and coaching to introduce strength training safely and effectively. Whether you’re new to lifting, recovering from an injury, or simply looking for a better way to manage your back pain, our approach is grounded in current research and customized to meet you where you are. Lifting doesn’t need to be scary — and with the right guidance, it can be one of the most empowering tools in your recovery.

If you’re ready to stop avoiding movement and start rebuilding your strength, we’re here to help. You can reach out anytime to schedule a session or learn more about our process. The path to a healthier, stronger back might just begin with picking up a weight — the right way.

Habits Physical Therapy LLC,

8 6th St N ste 102, Nampa ID 83687

406-560-1048

Knee Replacements and Physical Therapy

Total knee arthroplasty or total knee replacement is becoming more and more common. It can be a life changing procedure that is very effective at reducing pain and the success rates of the procedure are very good. It is something that as a physical therapist, I really encourage those with severe osteoarthritis and knee pain that impairs their daily life to consider sooner rather than later. As with anything there are risks with any surgery and something that needs to be weighed between the patient and their surgeon, but overall, I often hear people wish they would have done it sooner.

The longer you go with knee pain (the kind that can make walking even difficult) the more strength you lose, the more function you lose, and typically the more motion you lose. All of those factors can make your rehab process a bit more difficult and longer. As is the case with most procedures, the better you go into it, the better you are coming out of it. I do think those with mild to moderate arthritis can benefit from physical therapy before electing to undergo surgery, but typically those with severe OA and high pain have difficulty even tolerating physical therapy (see last article on physical therapy and arthritis).

With that said, even though outcomes are generally successful, recovering from a total knee replacement can be very difficult, especially early on. For the first 2-4 weeks it is one of the more painful recoveries from an orthopedic surgery standpoint. At this stage in the recovery, most patients are dealing with a lot of pain and swelling. Managing both of these early on are some of the top priorities. Managing time on our feet early on can really have a positive impact on both of these. We want to move, but short and frequent, and never spend too much time on our feet at once. In this early stage we are focusing a lot of time on regaining the mobility (bending and straightening) of our knee. Your physical therapy will also have some early strengthening likely with a focus on restoring your quadriceps activation. Swelling in our knee tends to cause our quad muscle to be inhibited or “turned off”. The exercises at this stage are often low intensity and done frequently. Isometrics may be a good option here as well as the patient is in control of the load more and are often tolerated better early on.

It seems pretty consistent that about the 8-week mark people really start to turn a corner and note their pain to be better than pre-surgery levels. By this stage strength should be returning and you will likely be on a progressive resisted strengthening program. Swelling is a good guide to activity levels, but again you should be tolerating longer and longer durations on your feet. Getting back into a walking program can be very beneficial. Eary on after total knee replacement you want to avoid high impact activities.

Most physical therapy episodes following a total knee replacement last anywhere from 8-16 weeks depending on how quick the recovery goes and what the patients’ goals are and what type of activities they plan on returning to. By 12-16 weeks you are likely transitioning to more of a home exercise program and returning to most of your activities. For higher impact activities, I always recommend consulting with your surgeon to see what level they are comfortable with you returning to. I have seen patients get back to lifting weights, skiing, higher intensity hiking, and jogging (most surgeons would prefer you not to run but I have seen it multiple times). If you're having knee pain and have known arthritis, I think consulting with an orthopedic doctor and physical therapist is a good place to start and weigh your options from there.

Arthritis and Physical Therapy

By Clint Choquette, Habits Physical Therapy, Nampa ID

When we think about arthritis, I think most of us think about our joints wearing out over time. And along with that line of thinking, there is a misconception that the more we use a certain body part the faster it will wear out and develop arthritis. I do think there is a mechanical stress component to it, and I think in general if we have a repetitive movement that we perform often and that area never gets appropriate rest to recover then over time you do run a risk of that joint wearing down. Thats where I think having a smart training program can allow appropriate stress to a certain body part but then allow it to recover and rest before we train it again. However, recently I think we are starting to uncover there is much more to it than just wear and tear. Recent research has shown there is a metabolic and inflammatory component to it as well. It seems the healthier we are overall, the less likely we are to develop severe arthritis. I say severe, because everyone will develop arthritis (it’s part of aging) it just seems to happen at different rates.

Speaking of everyone developing arthritis. A study looked at prevalence of facet arthritis (a joint in your spine) and found that 53% of 20-29 years olds, 82% of 30-39 years olds, 93% of 40-49, 97% of 50-59 year olds, and 100% of people over 60 had some form of facet joint arthritis. Those are kind of staggering statistics but I think we need to think of it a different way. Developing some arthritis is part of normal aging. The severity and the disability it causes are what should be more focused on. This is one reason I often do not recommend quick imaging of someone’s low back pain (unless there are red flags present that state imaging is necessary). Once someone with low back pain gets imaging (I can almost guarantee it will find something) getting past the impairments that it uncovered can be a difficult thing even though it may just be normal aging. The other thing with arthritis is there are lots of people walking around with moderate to severe arthritis in different areas and they don’t even know it. For some people arthritis can be painful and debilitating and others don’t seem to be as affected. I think there is a lot still to learn, but I think the main take-away from this paragraph should be, arthritis isn’t a guarantee that you will end up in pain and debilitated especially if it is low to moderate in severity. I do think if there is a correlation with pain in a joint and moderate to severe arthritis present, then that’s when interventions are necessary.

Back to the wear and tear part of arthritis. I often see people with OA who are afraid to exercise for fear that it will cause additional wear and tear. The truth is movement and exercise in the appropriate amount can be beneficial for slowing the progression of arthritis and help prevent stiffness and pain. One way I often speak with people about exercise and OA is to talk about runners and knee OA. One myth that it seems almost everyone has heard is running is bad for your knees. People almost always think, if you run, you will develop knee OA. The truth is there is evidence out there that recreational runners have lower incidence of knee OA than sedentary individuals. There is a small study that looked at runners’ knees before and after marathon training and found some improvement after training. Now with everything I think finding a balance is key. If you start running and build up too fast for what your body is adapted to handle or recover from, the opposite could be true. Go back to my first post about how injuries occur from March 5th to read more about that. I use running as an example because it is easy for people to understand and most people have heard the myth, but it applies to all forms of movement and exercise. Establishing a good program in the long run can be beneficial to help prevent or manage existing OA. Some repetitive movements in life are unavoidable, especially when it relates to your occupation. I do think most employers are trying to prevent repetitive use injuries by having people vary their tasks throughout the day, but that is not always the case. In some instances, if you have the ability to adapt your activities throughout the day, that can be beneficial to not overuse a certain area.

One thing I don’t want to make any false promises on regarding exercise, physical therapy, and arthritis are those with severe arthritis, high pain, and limited mobility. If your arthritis has progressed to the point that the bone structure has changed significantly and that has led to range of motion limitations physical therapy is often not successful in those cases. If your bone structure is what is preventing your knee from flexing farther no amount of stretching is going to change that and exercise may just be downright painful. Those are the cases where I think joint replacement ect.. are other options. I think for physical therapy, we are best suited in the low to moderate symptom and severity or before it develops, to help prevent it by establishing good health and exercise habits. Remember preventing and managing arthritis isn’t just about the movements we perform, but our overall health as well. Focus on your stress, nutrition, sleep and recovery also. If you are dealing with arthritis and want to know if physical therapy would be a good option for you, I would be happy to assess and give my best recommendations.

Contact:

Habits Physical Therapy

8 6th St N ste 102, Nampa, ID 83687

406-560-1048

habitspt@proton.me