TENS vs. REST? Should you invest on an Electrical Stim Machine?

TENS vs. REST? Should you invest on an Electrical Stim Machine?

Adequate recovery is essential in order to achieve better performance in any sport. Muscle fatigue is a result of changes at the level of the muscle, such as micro tears, depletion of creatine phosphate, accumulation of metabolites, mismatch of oxygen supply/demand or even central nervous system fatigue. The question is, is TENS an effective method to enhance the rate of recovery after exercise? Based on 10 different articles I reviewed, the results are rather disappointing


Milne 2001 negative review of 5 trials of TENS for chronic low back pain
Johnson 2007 positive review of 38 trials of TENS for chronic musculoskeletal pain, “effective”
Nnoaham 2008 inconclusive review of 25 studies of TENS for chronic pain
Khadilkar 2008 inconclusive review of 4 trials of TENS for chronic low back pain
Walsh 2009 inconclusive review of 12 trials of TENS for acute pain
Hurlow 2012 inconclusive review of 3 trials of TENS for cancer pain
Vance 2014 mixed review: “it’s complicated”?? but promising
Chen 2015 negative review of 18 trials of TENS for knee osteoarthritis
Desmeules 2016 inconclusive (but discouraging) review of 6 trials of TENS for rotator cuff tendinopathy

How does TENS work?


Pain is a result of alarm systems that reach your brain. These alarms go off way too loud and way too often, sometimes even without tissue damage. The brain decides what hurts and what doesn’t. The TENS machine blasts the nervous system with “sensory white noise”, and by stimulating the nerves in this way it distracts the brain (temporarily) from pain. Unless you turn the machine up enough to disable your brain, if it thinks you’re in pain , the alarm will go off again sooner or later, most likely shortly after the TENS is turned off.

 Vance et al. believe that “TENS has been shown to provide analgesia specifically when applied at a strong, non-painful intensity.”

This particular study compared the effects of electrical muscle stimulation, massage and passive rest in athletes after 6 different bouts of exhausting supra maximal training. The chart on the left shows the peak power production following each of these modalities. The chart on the right shoes the blood lactate concentrations following the exercise bouts. As you can see, no significant differences were demonstrated between the effects of EMS, massage and passive rest on recovery markers or peak power output.


Even though there is controversy over the topic, some people can find symptom relief following TENS. If your goal is pain reduction, you can buy a TENS machine for less than $100 at your nearest pharmacy!

Stefanie Cohen


Martin N.A., Zoeller R.F., Robertson R.J. The comparative effects of sports massage, active recovery, and rest in promoting blood lactate clearance after supramaximal leg exercise. J. Athl. Train. 1998;33:30-35.

Foam rolling, mashing… What is it? Does it even work?

Foam rolling, mashing… What is it? Does it even work?


When we think Myofascial Release (MR) we think of foam rolling, “mashing”, laying on a lacrosse ball, getting a massage or deep tissue massage, receiving gratin technique, or maybe even manual therapy from physical therapist. You go in to the clinic or you grab whichever torture device you so choose and for the next (5 minutes for most) 10 minutes to an hour or so we allow ourselves to be put in pain. You jump, cry, wince, moan and groan but afterwards we may be bit soar but we feel better, looser, more mobile. But why?

The original thought process for manual therapy (synonymous with MR in this piece) and why it worked was defined as the biomechanical model. Wellens summarizes this model as the following:

“To summarize this model, it is proposed that biomechanical dysfunctions characterized by a combinations of segmental joint hypo or hyper-mobility  suboptimal postures, muscle weakness and/or poor muscle control play a significant role in the emergence of painful MSK conditions by putting too much strain on different tissues which would ultimately lead local and/or distant tissues to sustain damage or to function sub optimally. The end result of this dysfunctional state would then often be pain. The role of manual therapy in such a model is to find these aforementioned dysfunctions and treat them via manual mobilizations or manipulations, stabilization exercises and postural corrections among others. It is proposed that the manual mobilizations or manipulations will restore the joint play by restoring tissues optimal lengths or by reducing a fixation or sub-luxation and thus, restoring optimal joint function which, in turn, will lead to the resolution of the dysfunction and thus, the pain.

Whoa! What does that mean? In Laymen’s terms: Limited mobility or excessive mobility puts improper strain on muscle tissue which can lead to poor function and usually pain. MT finds these dysfunctions and treats them with manual mobilizations or manipulations and exercise and postural correction. Through the MT we can restore tissue’s proper length by making it more mobile or “less mobile” (through stability work) restoring it to proper function and reduce pain.

Again, WHAT? Basically through the pressure in our hands or a simple tool or lacrosse ball we can’t create enough force to tear our fascia. Lets put that in perspective; if I were to dig my thumb into you and could create enough force for your fascia to release, or even cause micro tears, however you want to describe it, humans would be very frail and fragile and we not be able to function in everyday life. Every fall, stubbed toe, shin on desk would cause torn muscles with no question. So then why after massage or self MR do we instantly feel so much better and have more ROM? Foam rolling works, but not how most people thinks it does. There are a few theories out there but the one we are talking about today is the theory of Neurophysiological Effect (NE)


Numerous Studies have demonstrate immediate positive effects on pain after non specific MR or MT. The NE effects could be a combination of the CNS and PNS. The exact mechanism of this model is far from being explained but the basics are that pain is the brains output in response to various stimuli including but not limited to nociceptive input.

Wellness simplifies the thought: “a simple explanation for a good part of the effectiveness of manual therapy could be that the novel stimulation introduced in the CNS by manual therapy may help the brain down regulate the perceived threat of current stimuli and thus decrease the pain by means of descending inhibition and other peripheral and central mechanisms (which include a placebo response).”

Lastly, I am not saying Manual therapy does not work. I am a recent graduate from PT school and Manual therapy is used in every one of my patients in some form or fashion. Everyone should use self MR by rolling on a roller or lacrosse ball. But what I do believe is that the mechanically lengthening tissue to reduce pain and symptoms is not a sound argument anymore with current research and that another avenue of thought should utilized. The nuerological avenue is my “main street” right now. But MR or MT we can nuerologically calm down the brain which then will calm down the area of pain and thus we may be able to move with improved ability and pain free.

Wellens, F; The Traditional Mechanistic Paradigm in the teaching and practice of manual therapy: Time for a reality check. Clinique Physio Axis.

Written by: Dr. CJ DePalma, DPT, CSCS

Get Your Traps Out of Your Ears

Get Your Traps Out of Your Ears

It seems a lot of the fitness community remains in a state of reverie for the mountainous, python-like upper traps sported by enthusiasts everywhere.Unknown They are the functional cushion for your back squats. They make you look mildly badass in your tank tops. They also have potential to be problematic if you’re not careful.


Rhomboids and mid-and-lower traps

These are two largely discounted members of the group of muscles responsible for (among other things) scapular movement. Both play a large role in the maintenance of a pair of solid, healthy shoulders, yet a massive number of people neglect their upkeep.


A brief example of an action this pair of muscles is responsible for, is retraction of the scapula, also cued as “pinching” your shoulder blades together. It is easy to walk around in public and visually pick out any number of people – fitness junkies or otherwise – with their shoulders rolled forward, upper back hunched over, upper traps so high it just makes your neck hurt to look at, and palms either occupied with a cellphone, or facing totally backwards (see the picture below for proper anatomical position).

This overly frequent problem that is weak or under-active lower traps and serratus anterior can lead to a host of problems both chronic and immediate: injuries to the rotator cuffs, subacromial impingements (ouch, and more common than you might think) and unstable overhead positions, for example. As long as these muscles remain weak or under-active, the upper traps will continue to compensate, and the problems will persist.

Force Couples

A force acting on a body has two effects, one to move it and two to rotate it. A force couple is a system that exerts a resultant movement, but no resultant force.

What does this mean for the shoulder?

In a force couple, the force generated by one muscle requires the activation of an antagonistic muscle so that a dislocating force does not result (Nordin & Frankel, 2001). As you can see on the image below, several muscles aide in the movement of your arm during elevation.

Particularly important for this discussion is the fact that the mid and lower traps are the primary stabilizers during abduction of the arm. What happens if we have an overactive muscle is that we break the force couple relationship. This is when abnormal movement patterns begin to occur and we increase our risk of injury.

Two muscles that are particularly important to target are the Serrates Anterior and the Lower traps 

  • The serratus anterior is the only muscle that rotates the scapula forward, along the shape of the rib cage. Having full strength and motor control of this muscle is extremely important in order to have optimal stability over head.
  • The lower traps act as one of the main stabilizers as the arm reaches 90 degrees.

note: The deltoid is NOT A PART OF THE FORCE COUPLE mechanism, but over recruitment of the deltoid can also lead to impingement.

There are, however, a number of fixes.

  1. Pull

Single arm dumbbell rows, barbell rows, pendlay rows, seated cable rows, resistance bands (think: face pulls, more rows, shoulder “Y”s and “T”s – keep your shoulder blades down and back!).

Note: Whichever exercise you chose, make sure to keep your shoulders down and back. DON’T allow your traps to do all the work, and focus on really recruiting your rhomboids and keeping your scapulae down. 

Face Pulls: https://www.youtube.com/watch?v=HSoHeSjvIdY

Wall angels

  • Keep your entire posterior FLAT against the wall-
    • This includes your butt, lower back, mid back, upper, the back of your head
  • Keep your neck neutral and face forwards
  • Slowly try and work your arms up the wall whilst maintaining contact at all of the points mentioned above – the backs of your hands should be brushing the wall
  • Note: the model in this picture is insanely mobile, and if you don’t get there right away, that is A-OK! Keep working at it, but only go as far as you can while maintaining contact and good position (no arching your back!!)


2. Work on your pecs 

Stretching the pecs will allow you to improve your internal rotation, which is often restricted in most people. Our every day habits such as sitting down, eating, driving, typing are all done with forward shoulders and forward head, which increase the tension and shorten our pecs.  A simple way to stretch out the muscles that may be tight and responsible for some of your internal rotation is illustrated below.


A straight arm will target the serratus and pec minor, while an arm bent at 90 degrees will have your pec major feeling *fantastic*. Think about retracting (pinching) your shoulder blades back and DOWN!

3. Push up Plus

This one is a personal favorite for the serratus anterior! slide_43

Of course, habits take time to break. In due time your shoulders, back, neck, and training will thank you!


Written by: Jamie Brynn Hamilton,

in collaboration with Stefanie Cohen





The common reasons why you lose overhead mobility are deficits in the thoracic spine, shoulder, scapula and lumbo-pelvic area. In this post I will address the importance of proper thoracic spine mobility for over head motions.

Deficits in movement of tforward-head-posture-manhe thoracic spine and ribcage area is a common problem most people face nowadays,
especially in people that have desk jobs, who’s posture is slouched. The relationship between the T-spine and ribcage lays the foundation for the scapula. Their alignment will dictate the function and movement of the scapula. In the image below you can see how positional faults in the T-spine, as it’s seen with increased rounding could yield to limited movement of the shoulder girdle. As we raise our arms overhead, the scapula is supposed to ride along the T-spine. If the position of the thoracic spine is not optimal, the shoulder blade wont be able to move how its supposed to.


Putting your arms over your head requires  160-170 degrees of motion from the shoulder, but this doesn’t get our arms completely over head. We achieve 180 degrees of motion with thoracic spine extension. The biggest issue comes when compensation from other segments occurs, as T-spine extension is lost, it leads to increased lumbar extension to compensate for this deficit, which increases the risk of low back injuries as well. In addition, we need proximal stability before distal mobility. This means that if the scapula is not sitting in a strong stabilizing position, this can also be a limiting factor for how much weight we can put over our head.


The point on mobilizing your spine is to help improve your efficiency with overhead lifts. Remember the shoulder only achieves 160-170 degrees of overhead flexion and in order to get that personal record lift you need the last 15 degrees to come from your T-spine.


Foam rolling

DON’T simply go back and forth over your spine. The main goal is to real the spine over the roller and mobilize each segment. DO relax your spine at every single level along the T-spine, segmentally. 


Quadruped Rotation

 DON’T allow your hips to move along with your arms. DO maintain your core tight and hips aligned. Open to each side while taking a deep breath in. You should have 50 degrees of motion available on each side.


Foam roll vertical stretch

DON’T rush through the movement. DO lie on your back, with the foam roller along your spine, support your hips and head on the roll, stretch out your arms to the side and RELAX! 


Standing overhead stretch

DON’T over extend your lower back DO start by bringing your arms overhead to a position where you feel restricted. Hold this stretch for 20-30 seconds at a time until you can no longer make any more gains.

Hope you find these tips helpful!

Stefanie Cohen, SPT


Posture Matters

Posture Matters

Posture matters. Improving your posture allows you to move bigger weights, improve performance and stay injury free. Do you train with a purpose? Do you know why you squat for example? You most likely squat with the purpose of getting a bigger squat, bigger legs, a bigger booty. You include the squat in the program for a reason. The same should hold true for your ENTIRE training program. Every mobility exercise, soft tissue technique, foam rolling, stretch should be included with a SPECIFIC goal in mind.

Hamstring stretch and Glute stretch

In my latest post I spoke about the importance of understanding the cause of your dysfunction in order to manage the symptoms appropriately. What happens in your pelvis affects what goes on in the rest of the body.

Having a posterior pelvic tilt means your hamstrings are short and stiff, which in-turn decreases your lumbar curvature, leaving you at an increased risk for herniations. The upper back will then compensate with an exaggerated upper back rounding and a forward neck, which puts you at risk for upper extremity and shoulder issues. Keeping your hips and spine aligned means less injuries, better health, optimal muscle recruitment, and better performance.


If you are a student, or work a desk job you most likely sit with slumped shoulders, round upper back and a neck that sticks out. Your upper body is a slave to the lower body. Fix the lower body and the upper body will improve. I hope you get it.

When we sit in a posterior pelvic tilt, we run into a lot of issues. 1) flattening of the lumbar spine, which leads to an increased propensity of moving into lumbar flexion. We’ve covered this point before, the lumbar spine doesn’t like to go into flexion, especially under load. 2) it leads to having a slouched upper back and a “head forward” posture, a position which puts your rotator cuff at higher risk for injury, and contributes to neck pain.

10931345_828448477193199_7080016482411996429_nStop stretching without a purpose. Be mindful about the way you move, sit, stand and incorporate the stretches and exercises that YOU need. By now you should already be wondering
what to do to correct your posterior pelvic tilt, if you have one. Focus on STRENGTHENING your spinal erectors, quads, hip flexors, and TFL, and STRETCHING your hamstrings and glutes.
–>Add these Banded Glute Bridge to strengthen you glutes, hamstrings and TFL


Stefi Cohen, SPT



If your warm up is longer than your workout you have a problem. You stretch, stretch and stretch and most often than not, the stretching doesn’t seem to solve your nagging pain, and sometimes it can even make the problem worst. Understanding the CAUSE of your muscular pain is important so you can treat it effectively.

A muscle imbalance can result either from repeated movements in one direction, sustained posture, or as a result of a neuromuscular imbalance, which predisposes certain muscles to be either tight or weak.

Our sedentary habits and sitting posture every day highly predispose us to developing muscular imbalances.


Muscles prone to tightness are also known as tonic muscles, the most common you will find tightness in are the hamstrings, upper traps, rectus femoris, TFL, iliopsoas, pecs, QL, piriformis and erector-spinae.

Muscles prone to weaknesses are phasic muscles. Some of the common ones are rectus abdominis, serratus anterior, lower and middle traps, neck flexors, rhomboids, glute med and max and vastus medialis


Lets take the hip for example. You commonly complain about tight, stiff  painful hamstrings. You keep stretching in an attempt to release some tension but nothing seems to help. What you don’t know is that lengthened and overstretched muscles can also send “pain” signals. An anterior pelvic tilt is common in those who sit a lot. This pelvic tilt is caused by tight hip flexors, tight quads and tight lower back. This pulls the hamstrings and glutes into a LENGTHENED AND WEAK position, which gives you the feeling of it being taught. Stretching the hip flexors and strengthen your abdominals, glutes and hamstrings in this case will release tension and restore balance.

Who thought stretching your hip flexors could help ease your ‘tight’ hamstrings?