Category: Uncategorized

5 Questions to Ask

This article was published by the ACA (American Chiropractic Association) in regard to information that you, the patient, needs to understand during the course of your musculoskeletal care.

It is very enlightening that we do these things already in the office at InBox, by educating as much as we possible can about your injury.

Without further ado, here we go:

  1. Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags.
  2. Do not perform repeat imaging to monitor patients’ progress.
  3. Avoid protracted use of passive or palliative physical therapeutic modalities for low-back pain disorders unless they support the goal(s) of an active treatment plan.
  4. Do not provide long-term pain management without a psychosocial screening or assessment.
  5. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain.

The article goes into much more details for each point made.  I will deconstruct them in separate parts in future posts.  Stay tune for some knowledge bombs in the near future!

Parting words of wisdom-  Please don’t stay into the eclipse on Monday.  Be kind to your retinas.


Dr. B

Recovery 101

What does recovery meant to you?

Recovery seems so simple. “I’ll just take the day off.” How do you know if today is the best day to rest? What if it should have been tomorrow? Or worse, yesterday?

The answer to the question, “What day(s) should I take as a recovery day?” can be answered in 2 ways.
1. Every day
2. Consistently
That answer would have given you a C+ on a test as they are very vague. But C’s make degrees, right? Let me elaborate.

1. Every day: We need to recover every day to maintain proper progress within the current training program you are under. Whether you are training for a 5k, marathon, power lifting meet, CrossFit competition, or a potato sack race at your child’s schools field day. In order to maintain progress and keep moving closer to your goals, recovery needs to happen on a daily basis between workouts.

2. Consistently: Keeping your rest days consistent is also a huge part of maintaining progress with your program. Don’t be the guy/gal who goes 2 days on and 4 days off, then goes 6 days on, 1 day off, 5 days on, etc. etc. The best designed training programs build in rest days to allow the body to heal and restore after specific stimuli are placed on the system. The caveat here, is that the program must be developed by someone knowledgeable and experienced in periodization, and well as physiological systems. This will help you maintain a consistent approach to you rest days. For example: (3 days on) – (1 day off) – (2 days on) – (1 day off) – (3 days on) repeat for infinity (or until your Mexican vacation..ahem 7 days off). This is very individualistic as well. Talk to you coach, trainer, chief in charge, and discuss the best plan for you and your schedule.

To get the most bang for your buck there are 4 main recovery variables that need to be addressed:

1. Sleep: Sleep allows the body to reset. Hormones fluctuate and balance out during sleep. It is also crucial for homeostasis and metabolic regeneration of muscle tissue. A study showed that chronic restriction of sleep to 6 hours or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation. This type of restriction can seriously impair waking neurobehavioral functions in healthy adults. The moral of the story is get AT LEAST 6 hours of sleep to maintain healthy bodily functions as well as training progress and gains.

2. Nutrition: I will include supplementation and hydration in this category as well. A lean body was built in the kitchen, not in the gym. Think of food as fuel. You need to make sure that you are getting the right amount fuel at the right times in order for your body run as efficiently as possible. This will also speed the recovery from DOMS (delayed onset muscle soreness), and it will help you sleep more soundly. Your cells will functional at a higher level to do more ‘out with the bad and in with the good’ scenario. Your body is 70% water, so drinking water is a no-brainer. Supplementation is exactly that, supplemental. Whatever you are not getting from your food, you should supplement. Consult you coach, training, of nutritionist for a specific approach. But you won’t go wrong with a fish oil, magnesium, Vitamin D, and B-complex vitamins.

3. De-Loading: This is directed by your coach/trainer. He/she is in charge of your programming which should always include a de-loading to allow muscle, tendon, ligament, and joints to rest, relax, and recover. This allows for tissue regrowth and body composition change. Contrary to popular belief, the money is made during the de-load weeks. If by money, you mean physique changes, numbers on the scale, and weight on the bar.

4. Self-Myofascial Release (SMFR): Taking care of your tissues is like brushing your teeth. It’s a daily practice that will allow you to move more efficiently, thus reducing the threat of an injury. Every joint in your body needs movement for nutrition. Except for your skull sutures. We don’t want those to move. If muscular soreness is limiting a joint from is full range of motion, then the joint will eventually become painful if placed into the full range. Foam rolling, lacrosse balls, massage sticks, etc. will do the trick. The key is to find the areas that need it the most (hurts so good sensation) and attach those to a level of 4-6/10 pain scale. We want this to be therapeutic. The beautiful thing about SMFR is that it only takes about 2-3 minutes to make the biggest effect. If there’s still pain or limitation with movement, give us a call here at InBox Rehab.  We’ll fix you up before you need a lot of rest.. like after surgery.

Remember to trust your intuition.  If you’re back and legs are torched from moving boxes and unpacking all weekend, a 1 RM deadlift workout is not safe for a Monday morning session.  Take a rest day.

Dr. B

Low Back Tightness? How to recover..


There’s been a lot of talk about the CrossFit open workout 17.1 in past 18 hours on how to PREPARE..

What’s the best game plan?  How to strategize the movements standards?  How to pace to make it all the way through the reps?  When to rest?  How to breathe?

But what about the after?  There’s not been much talk on the RECOVERY afterward.  After you collect yourself, and retrieve your soul that you left in a pool of sweat by the dumbbell, what should you do to make sure the rest of your day and the next day(s) aren’t wasted and completely miserable?

3 main things:  Perform this sequence throughout the day following your 17.1 attempt

  1. Cat – Camels.  2 sets of 30
    These will help you regain some safe spinal motion into your low back; and allow the muscles to relax back to normal.  ***Tuck your hips/pelvis under and then push your hips back toward to wall behind you***
  2. Kneeling Hip Flexor stretch.  2 sets of 15/leg
    This position will loosen up your hip flexor muscles; and your quads, which will be on fire following the workout.  ***Key in this mobilization is to keep your back straight,  avoid over extending, or leaning backwards.***
  3. Supported Breathing Position. Accumulate 2 minutes in this position.
    This position may be the most important of the 3.  It will help take gravity out of the picture to allow you body to reset and allow your low back to relax.

Some other helpful tips:

  • Try not to sit or stand following the workout for longer than 20-30 minutes at a time.  Long duration’s of one position will cause the muscles and tissues to tighten back up.
  • Drink fluids.  Something with electrolytes immediately after the workout and then water the rest of the day (Ice in your whiskey doesn’t count).  Think of Adam Sandler’s movie, The Waterboy
  • Run through this routine outlines above a couple times throughout the day.  It should be the first thing you do the next morning.  Obviously after coffee..

If tightness doesn’t start to dissipate and you don’t feel back to ‘normal’ after 2-3 days,  give us a call at the office and we can get you back to 100% ASAP.



Tight Hamstrings Part 2: Neural Tension

After the original post of Tight Hamstrings, I got some great feedback and some questions regarding the topic.

The question we have to ask ourselves, “Is the tightness that we feel coming from a truly SHORT muscle?”

The answer to this question is:
1. multi-faceted
2. a hard one to nailed down in a black/white sense.

However, most often, the answer is ‘No’.  The muscle is not anatomically short.  This video does a good job at explaining some other variables that can contribute to the sensation of tightness.

High amounts of neural tension will facilitate the muscle to sub-maximally contract.  In other worse, if there is some excess input from the brain to the muscle, the muscle will inherently be ‘tighter’ because it is contracting at level higher compared to when it is at ‘rest’.  If we can removed or decrease some of the signals from the nervous system, the muscle will return to its normal resting state and voila, we have looser feeling Hammies!

If you’re feeling like you can never get you hamstrings to loosen up, or you’ve been experiencing some low back tightness, give this technique a try and see if you have any tangible results.  I bet you will..

As always, if you’re in the St. Louis area and you want some help dealing with an injury or getting back to an activity you’ve been avoiding, give us a call.

Dr. B



Tight Hamstrings? Part 1

“Why are my hamstrings so tight?” is a frequent topic of conversation among people everywhere, clinic, running groups, local gyms, etc.

Tightness in the hamstrings is very common in today’s society.  Because of the increased amount of sitting, we are essentially smashing the groups of muscles together causing tension to build up into the fascia and common muscular connections.  This tension hinders the muscle’s ability to contract and relax properly. Thus we have the feeling of “tight hamstrings”  Like the peanut butter and jelly sandwich in the bottom of a 3rd grade lunch box; everything was smashed together.

If the above scenario is the sole reason, then manual therapy, self myofascial release (foam rolling/lacrosse ball) will provide huge benefits.  However this is usually only one piece to the puzzle.

Another reason for tight hamstrings is the position of the pelvis. If your pelvis is anteriorly rotated, it is pulling the hamstring points of attachment away from one another.  Hence they seem tight.  So it would make sense why stretching, and foam rolling don’t make much difference.  Anterior-Pelvic-Tilt

In order to alleviate some of the tension in the hamstring group, effort needs to focused on reducing the pelvic tilt.

Great ways to reduce the anterior pelvic tilt is to squeeze your butt (glutes) and tighten your abs like you’re about to get punched in the gut.  This will approximate the hamstring attachment sites and reduce the tension being placed on the muscle.

Another way is to mobilize and stretch your hip flexor.  This is a great demo and explanation of a ‘true hip flexor stretch’.

Combining some self-myofascial release techniques along with the proper stretches and posture cues, you will enjoy some looser feeling hamstrings.  You’ll also get the benefit of reducing the compression forces in your low back.  Win-Win!

If you’re in the St. Louis area and you want some help dealing with an injury or getting back to an activity you’ve been avoiding, give us a call.

Dr. B



Hip Mobility

Can you move your pelvis like Elvis?


If you can’t, you may not win any dance-offs, but you could set yourself up for lower back pain. Your hips are designed to be mobile. Your low back is designed to be stable. The skinny is that if your hips and pelvis don’t move like they are designed to, your low back will move more to pick up the slack.

#1 problem for tight hips? Sitting. And we as a society sit…A LOT. So with the increased NY resolutions upon us, let’s set ourselves up for success for the New Year.

The low back (lumbar spine) needs to be stable at all times. This will limit the possibility for disc herniations and other nasty problems. But if your hips are tight and immobile, you’re opening to door for potential low back problems. More on low back stability in a future post.

Thanks to the guys at Movement at Medicine for these easy drills. The key with all these positions is to maintain good posture in your low back. If your position resembles an elephant performing yoga… take a step back and reset.


Always quality over quantity. These movements will help keep those pesky low back pains at bay. If you need something more specific or have questions about a particular problem, call InBox Functional Rehab to set up an evaluation.


Dr. B

Front Squat Mojo

Do you have cringe when front squats are programmed? Do you suddenly start grabbing your wrists and rolling them in clockwise and counter-clockwise circles in and OCD pattern? The good news is that you’re not alone. Even more good news is the problem is more than likely not in your wrist. (Air fist pump). Let’s look at 3 big culprits.

  1. Lats
  2. Tricep
  3. Wrist flexors

First, The biggest problem that I see in clinic with a #frontsquatproblem is an overactive latissimus dorsi (lat. for short). If the lats are overactive the ‘elbows up’ cue is nearly impossible the achieve. The muscle is not technically ‘short’. It’s more likely that the lats have become neurologically irritated causing the tiny muscle units to hold contractions. (More on the neuro part of muscle tightness in a future post). To release some of the tension in the lats and regain normal ROM, hop on a foam roller for about 90 seconds and retest your front rack position.

The same over activity that you have in your lats, you could be experiencing in your triceps. This will also contribute to a lack of front rack perfection. In order to get into optimal elbow flexion, the tricep needs to be supple and pliable. In order to reduce the tension and adhesion in the tricep, hop a rolling and give this a whirl. Just like the lat, always retest after about 90 seconds of focused work.

Finally let’s look at the wrist flexors. These can become chronically tightened from all the computer work we do as a society. Over activity in the flexors limit the amount of range on motion available for wrist extension. Take a baseball, lacrosse ball, something similar to release the tension in the tissue. **Note: go much slower and be mythodical with the release. This dude took way too much pre-workout.

There’s always more to the story, and if these 3 tenchiques don’t help, it might be more of a joint problem within the wrist itself. We have 8 small bones (called carpals) arranged in 2 rows of 4. These rows need to glide and slide on each other as the wrist is flexed and extended. If there is aberrant motion or the motion is simply lacking in these rows, Houston, we have a problem! A specific assessment by your chiro, PT, sports med. doc is needed to determine if the wrist is the problem. As always, contact InBox Functional Rehab to get assessed so you can Feel Better Faster


Dr. B