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    No Pain No Gain? How to stay safe and in the game

    Last updated 22 days ago

    Pain is … well, a “pain” for athletes. It can compromise your training routine and keep you out of the sports that you love. If you ignore it or push through it, you can cause more damage and increase the time you will need to recover. We have all heard the “No Pain, No Gain” or the “Pain is Weakness Leaving the Body” adages, but these motivational quotes can give young athletes, or, for that matter, athletes of all ages, the wrong idea. Eventually this can lead to significant injuries that require extended down time to heal.

    So how do you know what is “normal pain” vs. “abnormal pain”? What is unimportant muscle and joint discomfort or an injury waiting to get worse? Here at the Nirschl Orthopaedic Center for Sports Medicine and Joint Reconstruction we follow the pain phases of our founder, renowned orthopaedic surgeon, Dr. Robert Nirschl.

    These guidelines help athletes, parents, coaches, and trainers to better understand the type and intensity of pain they are dealing with, how to adjust their training routines or when it is time to follow-up with a sports medicine physician.



    Phase 0:  No pain or soreness.

    Phase 1:  Stiffness or mild soreness after activity, usually gone in 24 hours.

    Phase 2:  Stiffness or mild soreness before activity that is relieved by warm-up. Symptoms are not present during activity but return after, lasting up to 48 hours.

    Phase 3: Stiffness or mild soreness before specific sport or occupational activity. Pain is partially relieved by warm-up. It is minimally present during activity but does not cause athlete to alter activity.

    Phase 4: Pain is similar to but more intense than Phase 3 pain. Phase 4 pain causes athlete to alter performance of the activity. Mild pain may also be noticed with activities of daily living.

    Phase 5: significant (moderate or greater) pain before, during, and after activity, causing alteration of activity. Pain occurs with activities of daily living but does not cause a major change in them

    Phase 6: Phase 5 pain that persists even with complete rest. Phase 6 pain disrupts simple activities of daily living and prohibits doing household chores.

    Phase 7: Phase 6 pain that also disrupts sleep consistently. Pain is aching in nature and intensifies with activity.

    If an exercise or activity causes Phase 3 pain or greater, this should be considered indications of injury. You need to modify or adjust the activity if possible or stop the activity completely, check with your therapists or doctor, and work in a “pain free” range.

    Some ideas are as follows:

    a.      Decrease the length of time of the exercise/activity and/or

    b.     Decrease the intensity at which you are performing the activity

    c.      Decrease the speed you are performing the exercise/activity

    d.     Alter the technique of the activity

    If you are unable to find a “pain free” way to complete your exercise, it is a good indication that there is an underlying injury that needs addressing. It is important that you follow up with a sports medicine physician to get an accurate diagnosis. A physical therapist will design a program to get you back to your full work out without further damage.

    Remember “No Pain, No Gain” can sometimes put you on the sidelines for a very long time. Listen to what your body is telling you and take the proper actions to keep you healthy and strong. The pain phases may be a helpful guide. If you are unsure check with your doctor.

    Nirschl Orthopaedic Center is a leader in sports medicine and general orthopedic services. In addition Virginia Sportsmedicine Institute physical therapy has been rated one of the top sports medicine clinics in the area. If you have an orthopaedic injury, schedule an appointment with one of our doctors today by calling our Arlington, VA location at (703) 525-2200. Visit our websites at and to learn more about our services. For more info on orthopaedic issues visit our blog at

    The Importance of Core Strengthening for Pitchers

    Last updated 1 month ago

    The importance of the baseball player’s arm is often the main focus for their preseason and offseason work-out programs.  Often the core of the player is ignored and often neglected.  The strength of the legs and core can often lead to increased power in the correctly conditioned athlete.  If the core of the player is weak, the arm is often placed in increased tension and usually trails behind the body during the throwing motion, leading to increased strain on the shoulder girdle, namely the rotator cuff musculature.  Several studies have shown an increase in strain on the anterior, or front, structures of both the shoulder (capsule and rotator cuff) and elbow (ulnar collateral ligament). Weakened core can often be attributed to an increase in arm injuries in the younger athlete.  Focus on stability, balance, and strength of the lower half of the body should be a main focus for baseball players, in addition to proper conditioning of the throwing arm.

    While strength and conditioning of the arm is also of great importance, large parts of the athlete preseason workouts should be devoted to increasing the strength and balance of the core.  The core consists of many different muscle groups that all must work in concert in order to generate the most power under a well-balanced motion during the throwing process.  Attention should be paid to the gluteus, quadriceps, hamstrings, abdominal, and lower back muscle groups during preseason conditioning.  Several workout protocols can be found and followed in order to strengthen the muscles properly.  Several exercises that can be done in order to maximize your results are as follows: single leg lunges (with and without weights), squats, leg extensions, leg curls, oblique crunches, hyperextensions (for lower back), balance and stability exercises for the push off leg.  These exercises plus many different others will aid you in becoming stronger and generate more power through the throwing motion.  Not only can a stronger core increase your velocity but more importantly it will also greatly decrease the stress and strain on your arm, thus decreasing the chances of an arm injury during the season.

     If you have an orthopaedic injury, contact the experts at Nirschl Orthopaedic Center in Arlington, Virginia. Schedule an appointment with an orthopaedic surgeon today by calling 703-525-2200 or visit our web site.


    Avoid Injuries -Proper Breaking in and Care of your New Orthotics

    Last updated 1 month ago

    If your orthopedic doctor informs you that you have an improper foot alignment or another kind of abnormality, he or she might recommend orthotics. Orthopedic doctors also recommend these devices for those who have low back pain, knee pain, plantar fasciitis, and shin pain. Custom-made orthotics are specially designed to correct your foot problems in order to restore proper function and alleviate discomfort. When you receive your orthotics, follow your orthopedic doctor’s advice carefully. Your orthotics may take a little getting used to.


    We use Foot Management Orthotics in our clinic, they are fabricated using the highest quality material. The body or shell of the orthotics generally lasts 5 or more years depending on the patient's weight and activity. If orthotics need to be cleaned, this is best done by gently wiping the top surface with mild soap and water. Avoid immersing your orthotics. If they get wet, remove them from your shoes and let them air dry. If your orthotics need repair or the top cover replaced, please contact our office.

    Due to the wide variety of footwear used and activities performed, and for convenience, you may want to have more than one pair of orthotics. Your scans will be saved for 5 years. If you are interested in a second pair please inquire with your insurance provider.



    Your new orthotics have been custom fabricated to your unique foot with a digital laser scan and are designed to provide maximum comfort and appropriate biomechanical control to address your specific needs. Initially your body will need time to adjust to this new "foot posture". It is very important that you follow the recommended break-in program to prevent any unnecessary discomfort or injury. Overuse of the orthotics during the break-in period may result in foot/arch discomfort or blisters, as well as ankle, knee, hip or back pain. If these symptoms occur, reduce or suspend use as described in the break-in instructions. Be sure your shoes are in good condition and not broken down. Shoes that are excessively worn will significantly diminish the effectiveness of the device. It is recommended that new orthotics be installed in new shoes.



    Full Length Designs: Remove any existing sock liners or shoe inserts from your shoes. Some shoes have sock liners that are glued in. These may need to be removed to provide enough space for your new orthotics. If they are too large to fit into your shoes this may cause wrinkling of the top cover. If this occurs, take the sock liners from your shoes and, after lining up the heels, carefully trace the toe box shape and trim your orthotics with scissors. Be careful not to cut too much off. The orthotics should lie flat on the bottom of the shoe with minimal "rocking". Place the orthotics in the shoes with the orthotics as far back into the heel cup as possible. When putting on the shoe, be sure the orthotic remains completely at the back of the heel counter. Once in the shoes, the orthotics should feel fairly natural to your feet. They should provide contact over the entire bottom of your feet. It is normal to feel the orthotics slightly more or differently in one foot than in the other for the first few weeks. Orthotics also have unique properties where you will feel different pressure points and may require additional break-in time in these areas, even if you have previously worn orthotics.



    Your new orthotics will take some time to get used to. It is recommended that you wear them in only one pair of shoes during the break-in period. It is best to BREAK-IN ORTHOTICS with a new pair of shoes that have NOT been broken down or stretched out. Properly fitting footwear is essential for the orthotic to work correctly. Start by wearing them for no more than two hours the first day, and increase wear time by one hour each day after that. It may take from three to four weeks before you can wear them comfortably all day. Avoid running or other intense activities with the orthotics until your feet have had an opportunity to adjust to the new foot posture and you can wear them 8 hours a day. For runners, it is possible that some irritation may also develop in the arch, usually just behind the big toe. If you feel a "hotness" developing in this area take the orthotics out before a blister is formed. Lubricating this area may be helpful until the skin becomes toughened up. If you experience discomfort in your feet, ankles, knees or back while wearing your new orthotics, take them out of your shoes and reduce the wear time by one hour each day until the discomfort disappears. Resume the normal break-in procedure, increasing wear time by an hour per day. If after 3-4 weeks, you are still having difficulty adjusting to the orthotics, contact our office for instructions. Your orthotics may need to be adjusted. Do not attempt to adjust the orthotics yourself. Be patient, the results will be long lasting.


    Nirschl Orthopaedic Center is a leader in sports medicine and general orthopedic services. Schedule an appointment with an orthopedic doctor today by calling our Arlington, VA location at (703) 525-2200. You could also visit our website to learn more about orthotics and other orthopedic services


    Preventing Injury & Enhanced Performance for Baseball Players-Dr. Robert Nirschl

    Last updated 2 months ago

    Nirschl Orthopaedic Center renowned surgeon Dr. Robert NIrschl discusses injury prevention and performance enhancement for baseball players. This is the second video in a series on Sports Tips and Injury Prevention. For more information and videos check out our web page at

    Dr. Derek Ochiai discusses hip injuries in baseball players

    Last updated 2 months ago

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