Sports Medicine

Sports Medicine

Staying Healthy Through the Spring Sports Season

By PPSM Staff

Spring is finally here and those running into the warmth before warming up might find themselves out for the season.

Dr. Jim Tholany, director of rehabilitation at Performance Spine and Sports Medicine, said the warmer weather leads to a resurgence of activity and recreational activities that lead people into physical therapy clinics across the northeast.

“The most common spring activities I see injuries in involve running. In most cases, most people’s attempt at fitness makes them wind up injured,” said Tholany. “One of my mentor’s has a saying, ‘you don’t run to get fit, you have to be fit to run.’”

Tholany said that’s because patients try to run their way out of a poor diet. But, when you factor in a high BMI and what that means for ground recreation forces with gravity, mass and momentum it can be a disaster. He said running while significantly overweight can lead to degeneration of joints, bones and muscle.

In order to get warmed up for the spring season Tholany recommends first starting with a nutritional consultation, as well as testing with a medical professional prior to starting a fitness routine, especially for those who are struggling with weight loss.

Once diet is addressed they can move on to low impact aerobic activities, such as swimming, cycling and anti-gravity treadmills.

“It is important when trying to run to not conquer the world the first couple times out there, and return with gradual progression,” said Tholany. “This generally means scaling back with what you intend to do especially if you are de-conditioned and have hibernated the majority of the winter.”

Before putting a foot to the pavement Tholany said there are some basic home screenings that potential runners should try. One is to test movement and stability by standing in a doorway with a piece of tape across the width of the doorway just below the kneecap. Then stand tall behind the tape and simply stand on one leg, lifting the other leg over the tape, tapping the heel to the other side then steadily return. He recommends doing this a few times with each leg. He said if the task is too difficult he does not recommend running, as it is the same movement only with more impact.

Instead he recommends seeing a qualified therapist or trainer to prescribe a program to improve movement.

Once given the all clear to run Tholany recommends that complete novices begin with a half mile two to three times per week with additions of a quarter mile week to week. For more active individuals they can start with a mile adding up to a half mile week to week.

“An ounce of prevention is worth a pound of cure. Get medically cleared, get screened, and get moving,” said Tholany.

Small Swimming Tips that Make a Big Difference

By Adam Jellison

It goes without saying.  We’ve all waited long enough for this summer to come along.  And if you’re like me, now that summer is here, it won’t take you too long to find the closest pool and jump right in.  However, before you hop on in, take a minute to think about swimming safely.

We all know the benefits to swimming.  From cardiopulmonary fitness for every age group, to consistent calorie burning for weight-loss enthusiasts, to being a low impact form of exercise for those with aches and pains or orthopedic conditions; there’s a health benefit for just about everyone.  But, many of us do not consider the health risks associated with swimming.

For starters, healthy swimming can be divided into three main categories which require attention.  These are hygiene, sun-safety, and what swimmers do and do not bring into the pool with them.  Remind children to break from the pool every hour for hydration, sunscreen application, and bathroom breaks.  Consider UV protective shirts or shorts for the little ones, as 90% of the lifetime sun exposure occurs before the age of 20.  This wear those of us who happen to be parents can have a large impact on our child’s lifetime risk for skin cancer.

Constantly remind the young ones not swallow pool water.  No swimming when the child has diarrhea.  Shower before swimming and wash hands after using the restroom or changing diapers.  These are simple reminders that go a long way!

So remember, even though we are all excited to get in the water, we all must swim safe and be courteous of everyone around us!

Benefits of Laser Therapy

By PPSM Staff

We have been fortunate enough to add laser therapy to the list of rehabilitation modalities that we offer at Performance Spine and Sports Medicine. This is a tool that very few people have access to in the area. The laser that we have is a class IV high intensity laser from light force. The class IV laser allows you to get deep into injured tissue and achieve a thermal effect that the traditional class III cold laser does not. The thermal effect of the laser promotes increased blood flow to the injured tissue which helps to improve healing time. Deep Tissue Laser Therapy accelerates your body’s own natural healing process through photo-bio-stimulation.

Photo-bio-stimulation is the act of changing the condition of damaged tissue by stimulating cell metabolism which in turn improves the speed of tissue healing. This is achieved by photons from the laser head being emitted into deep tissue cells, which causes soothing warmth in the area. The photon molecules are absorbed by mitochondria in the injured cells. Mitochondria are the driving force behind energy production in a cell. Stimulation of mitochondria produces ATP, nitric oxide, and reactive oxygen species.

  • Increased levels of ATP will help with energy transfer within the cell.
  • Nitric oxide is a powerful vasodilator (which means it opens vessels to allow better blood flow) and an important cellular signaling molecule involved in many physiological processes in the human body.
  • Reactive oxygen species have been shown to affect many important physiological pathways including the inflammatory response.

The production of these signaling molecules in concert has been shown to induce growth factor production and improve cell proliferation (healing).Laser therapy is effective in treating chronic conditions, acute conditions and post-surgical pain. This tool allows us to expedite the healing process which creates quicker recovery times and decreased time in pain and discomfort.

Spring and Summer Season Injuries and Conditions

By Adam Jellison

Are you someone who tends to be more active when the weather gets warmer?  Well, you’re not alone, especially after the winter that we’ve had here in the Mid-Atlantic.  And between the summer time sports mishaps and the sandals snafus, this heavily anticipated change in weather is the time when we tend to see large increases in orthopedic injuries.

The majority of individuals attempt to go from being completely sedentary over the winter months to no holds barred, full throttle spring and summer activities.  This trend has all the makings of accident or injury.

Spring and summer season injuries and conditions can arise from an array of different traumas or repetitive activities.  List below are several examples:

  • Ankle sprain and knee tendonitis or cartilage/meniscus injury due multiple reasons, from twisting the foot or leg, falling, sports injuries and even wearing unstable footwear such as flip-flops or clogs.
  • Plantar fasciitis and stress fractures of the foot from high-impact activities like jumping, track, basketball, etc;  all while wearing improper and/or unsupportive footwear.
  • Golfer’s and tennis elbow, which are repetitive-stressor based activities.
  • Shoulder tendinopathy due to overuse while completing household activities such as gardening, mulching, painting, digging, hammering, etc.
  • Wrist, arm and shoulder fractures from various falls.

If you or your loved ones do end up taking a fall or experiencing pain after a warm weather activity, I suggest you do the following:

  1. Immediately stop the provoking activity, and do not attempt to play or work through the pain.
  2. Follow protocols consistent with the pneumonic PRICE – “protection, rest, ice, compression, elevation.”
  3. If 36-48 hours pass and the pain has not improved, schedule a visit to see a physician.

There are several specific warning signs that are good indicators that you may need immediate care – obvious deformity, joint instability, decreased range of motion and persistent joint swelling.

With all of this in mind, hop off of the couch and start enjoying this nice weather.  It is long overdue!

Soda is a Four Letter Word

By Matthias H. Wiederholz

America has an obesity problem.  And it seems the rest of the developed world is following suit.  A question that many people wonder is whether soda consumption increases the likelihood of weight gain. The short answer is YES.

Soft drink consumption has increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons per person per year in 2010.  Simply a 1% rise in simoft drink consumption contributes to an additional 4.8% overweight adults, 2.3% obese adults, and 0.3% adults with diabetes.1  If this trend of increased consumption of caloric beverages continues, it is clear that these rates will rise drastically.

There is an alarming statistic. Consumption of sugar sweetened beverages (SSB) in the United States is increasing.2,3  About half of mothers with children age 2 reported that their children drank SSB’s at least one day per week.  Moreover, there is a much higher likelihood that children who drink the highest amount of SSB come from low-income families.  These families are the same families that likely have limited access to quality healthcare.

So what does this mean for society in general?  Well, SSB consumption is increasing and the obesity epidemic is worsening.  Insulin resistance is becoming commonplace.  Based on the studies outlined above, we can conclude that soda consumption is certainly contributing to this problem.  In fact, as mentioned earlier, soda consumption predicts weight gain.

Therefore, if you don’t want to gain weight, don’t drink soda!

don’t drink soda


  1. Basu S, et al. Relationship of Soft Drink Consumption to Global Overweight, Obesity, and Diabetes: a Cross-National Analysis of 75 Countries. American Journal of Public Health. Nov 2013; Vol 103, No. 11: pp. 2071-2077.

Get Ready for Winter Running! By: Katie Palmer, DPT

By PPSM Staff

Winter running is a whole other beast compared to running outside in other seasons. In my opinion, winter running is for the strong and truly dedicated. While I choose to take my running indoors during the winter, I can appreciate all that goes into running in cold weather. The air and the surface are different, and it may lead to more injuries if you are not following a set of guidelines. If you choose to brave the cold, here is a set of guidelines I give to my patients who are winter runners to prevent injury:

1)      Layering and proper fabric with running clothes is first and foremost. recommends polypropelene fabrics when layering as opposed to cotton fabrics which do not wick away moisture. Make sure to be properly layered and keep from having too much skin exposed. Wearing a hat always helps me when I am playing tennis in the cold because it helps to trap the heat in.

2)      Warming up is more important than ever. Pre and post running stretches are still imperative! The research is still out on which is better, but in my opinion, you should be stretching before and after a run. Of course, you do not want to stretch cold muscles, so make sure to do a short warm up like jumping jacks or jumping rope indoors before doing your pre running stretching. It is important to maintain flexibility to prevent injury

3)      Diet and hydration are important. Make sure to eat a carb heavy diet the night before the race and avoid fried foods while training. Potassium rich foods such as bananas and leafy greens throughout training will help in preventing muscle cramps. Water intake is highly important during training and of course on race day.  It is usually recommended that you intake 4 to 6 ounces of water for every 20-30 minutes of running. For longer runs, an electrolyte based drink is necessary to replace lost electrolytes.

4)      If the road is slick or icy, I would work on the treadmill that day. While some websites say jogging in light snow is OK, it is hard to tell where there may be icy spots. Be safe and run indoors. If you slip and fall, you may be out of commission for a lot longer than you would like.

5)      Safety first! Wear protective and reflective clothing. Know when the sun is going to set (since it is a lot earlier than we always think) and make sure to be prepared. Bring a cell phone in case of an emergency and limit usage of music when near major highways.


Enjoy the weather safely!

The Functional Movement Screen By: Chris Cush, DPT

By PPSM Staff

What is it? How does it relate to an athlete’s return to sport?

More and more of today’s individuals are working harder to become stronger and healthier. These individuals are constantly working to improve their activities by increasing their flexibility, strength, endurance, and power. A large number of athletes and individuals are performing high-level activities even though they are inefficient in their fundamental movements. Without knowing it, these individuals are putting fitness on dysfunction. This dysfunction is a physical or functional limitation. In order to isolate this dysfunction, the body’s fundamental movement patterns should be considered. The Functional Movement Screen attempts to pinpoint this dysfunction and alleviate it.

The FMS is comprised of seven movement tests that require a balance of mobility and stability. The patterns used in this screen place individuals in positions where weaknesses, imbalances, asymmetries and limitations become noticeable by a trained healthcare professional. The FMS focuses on correcting mobility first because quality stability is driven by quality proprioception (your body’s ability to sense where you are in space). Once these corrections are made the health care professional will then turn their focus on improving stability to maintain the individuals newly improved mobility.

The Functional movement Screen is also a good diagnostic tool for predicting re-injury in athletes and the weekend warrior trying to increase their fitness level. One study performed to assess FMS accuracy in determining re-injury stated that if the FMS score ? 14 then probability of suffering a time loss injury increased from 15% to just over 50%. Another study indicated that a significant amount of injuries were noted in athletes with right to left sided strength and flexibility imbalances (asymmetries). The seven movement patterns performed during the FMS are the Deep Squat, Hurdle Step, Inline Lunge, Shoulder Mobility, Active Straight-Leg Raise, Trunk Stability Pushup, and Rotary Stability. Our physical therapists perform the functional movement screen so if you are an athlete with an injury or a weekend warrior looking to increase your fitness level we would love for you to come in and see us!

PSSM sponsors Shady Brook Farm’s *Holiday Light Show*, a Bucks County tradition

By PPSM Staff

PSSM has partnered up with Shady Brook Farm as a Top Sponsor for their annual Holiday Light Show, Bucks County’s most anticipated community event of the year!

annual Holiday Light Show

Experience the magic of millions of lights illuminating acres of farmland at the Shady Brook Farm 2013 Holiday Light Show!”

This event makes a wonderful holiday tradition for families and friends. There are incredible new displays this year, including the ‘Seven Wonders of the World’….and our very own PSSM customized light display!!

Our PSSM light display is located upfront by the ticket booth entrance. You can’t miss it, at 18′ high by 60′ wide – also seen from highway I-95! We couldn’t be more thrilled of our awesome display and, of course, our partnership with Shady Brook Farm!

Our display design pays homage to a keyword at PSSM; Performance. Its aesthetic correlates to our 3 significant graphic rings shown on the PSSM logo – our performance rings of service & achievement, acknowledging the state-of-the-art non-surgical multidisciplinary platform we offer. Our logo is lit with the animation of a flaming torch, representing PSSM’s promise to serve, treat & help heal our patients. “Our Patients Results are our Goals”.

New Sponsors of the Holiday Light Show

Here is an excerpt from the Bucks County Courier Times special edition Holiday Guide, handed to all who attend the light show:  New Sponsors of the Holiday Light Show, by correspondent Sandi Pachuta:

Percy Naranjo, Chief Executive Officer of Performance Spine & Sports Medicine, said he is excited that his medical practice is a new light display sponsor for Shady Brook Farm this year.  Naranjo’s practice is one block down the road from the farm, and he is pleased they are neighbors.  “We are in step with Shady Brook and how they interact with the community,” said Naranjo.

“We are so glad Shady Brook is having us as a sponsor for the community-oriented event of the light show; Shady Brook Farm provides a great environment for the family all year long,” said Naranjo.

Naranjo has been taking his children, now ages 5 and 7 years, to the light show ever since they were babies. “The light show is awesome, and we have been attending the show ever since we moved to the area six years ago,” said Naranjo. 

Performance Spine & Sports Medicine ( is slated to open its third location in Bordentown, NJ, in December.  The practice began in 2009 in Lawrenceville NJ, followed by the Newtown location in 2011.”

After visiting the light display show, we encourage everyone to enjoy all that the farm has to offer, including the market for their selection of nutritious fruits and nuts for added holiday health!  PSSM brochures are available all year long in the Farm Market and Garden Center, also handed out together with the Holiday Guide on special evenings during the light show event.  Spread the word; PSSM is at your service.

The Holiday Light Show is on display now through January 5, 2014 from dusk to 10PM.  Visit for prices.

Shady Brook Farm is celebrating 100 years in business and we couldn’t be more proud to be associated with this farm’s iconic heritage, commitment and service to Bucks County.  Enjoy some holiday light show magic ~ Doctors orders.  😉

Happy Holidays from PSSM!