The Role of Physical Therapy in the Treatment of Headaches

woman suffering from a headache

By Rebecca Roberts, PT, DPT

A 2015 study found that over 14% of US adults have had a migraine or severe headache within the past 3 months, with rates as high as 23.5% in women ages 18-44.1 Severe headaches and migraines can cause decreased participation at home and in the community in addition to lost wages due to absenteeism at work. In some severe cases headaches and migraines can even lead to disability. Severe headaches and migraines can be very difficult to treat, with many people seeking provider after provider to get some relief.

There are many different types and causes for headaches including:

Tension type headaches – often Cervicogenic in nature, meaning caused by dysfunction of the muscles, bones, or joints in the neck, shoulders, and base of the skull. Frequently worsened by stress.


Other – there are many other causes for headaches, including trauma, sinus problems, medication overuse, vascular problems, tumors, and more.

Many people who have frequent headaches suffer in silence as they do not know there are treatments that can help decrease the frequency and severity of headaches.

How can Physical Therapy help?

Your Physical Therapist (PT) will perform an evaluation of your head, neck, shoulders, and upper back looking for dysfunction in posture, strength, muscle length, muscle tension, and range of motion that may be contributing to your pain. Your PT will also evaluate your movement to determine if your headaches appear mechanical or non-mechanical in nature, and refer your to another provider if PT is not appropriate. Your PT will then develop a customized treatment plan, targeted to address any dysfunction found during your evaluation. Most treatment plans consist of a mix of exercises, postural adjustments, patient education, stress reduction, and manual therapy to address impairments that contribute to the severity and frequency of your headaches.

Do you suffer from frequent headaches? Whether your headaches are severe or mild, frequent or infrequent, physical therapy treatment for headaches may be right for you. Please contact our office to schedule an appointment to see how physical therapy can help you.

Burch, R. C., Loder, S. , Loder, E. and Smitherman, T. A. (2015), The Prevalence and Burden of Migraine and Severe Headache in the United States: Updated Statistics From Government Health Surveillance Studies. Headache: The Journal of Head and Face Pain, 55: 21-34. doi:10.1111/head.12482

Get To Know Your PT: Becky Roberts


Therapydia Kona physical therapist Becky Roberts takes some time to talk what inspired her career transition, her love of rugby, what she’s learned since becoming a PT.

When did you know that you wanted to be a physical therapist?

I spent my 20’s working long hours in corporate america and playing rugby during most of my off-time. Despite a successful career, I felt something was missing. I was always interested in working in healthcare, so as I became unsatisfied with my career I looked into different patient centered careers. Since I spent most of spare time playing rugby, I also I spent time in therapy getting my injuries treated – as did many of my friends. Through my experiences in PT as a patient I decided I wanted to become a physical therapist.

What’s your favorite song to get you motivated?

I love music, but it all depends on my mood, if I’m working-out, something upbeat and fast paced.

What is the biggest challenge involved in being a PT?

Staying up to date on research. There is always something new to learn – new surgeries, new approaches to rehabilitation, new understandings of how pain works. It’s a constant process to ensure you have the best and most current knowledge possible.

How do you like to stay active?

Hiking, swimming, going to the gym, pick-up sports with friends.

What surprised you the most about the physical therapist profession?

How much impact small changes have in our patient’s life.

Are you currently pursuing any further education/certifications?

Not currently, however, I am debating pursuing a women’s health certification.

What’s your go-to breakfast?

Eggs, a smoothie, or overnight oats.

What do you wish everyone knew about physical therapy?

The breadth of conditions that physical therapists can treat. Prior to becoming a PT I didn’t realize all the roles a PT can play in healthcare.

What is the biggest misconception you hear from new patients?

The old “no pain, no gain” saying, where patients expect therapy must be painful in order to get better. While we do embrace some discomfort in therapy, significant pain is not usually a goal and maintaining good pain management helps improve outcomes for most patients.

What is the most important personality trait that a therapist must have?

Diligence, in addition to the obvious answers of intelligence, compassion, and empathy. I feel diligence is importance to stay on top of research, patient care, and insurance requirements. This profession demands a level of continuous personal and professional growth and diligence to remain self-motivated.

What do you do to de-stress/unwind?

I enjoy connecting with friends and family, reading, relaxing at the pool or beach, and going on solo hikes or adventures.

Finish this sentence: On Saturday mornings, you can usually find me…

Reflecting on my week, connecting with family/friends, going to the beach, or adventuring to some other part of the island.

What is the best piece of wellness advice you’ve ever received?

Actunities (opportunities for activity) are all around us, take advantage of them. For example: park in the far spot at the store, take the stairs at work, walk or bike to the grocery.

What is your favorite piece of wellness advice to offer?

Find an activity you enjoy, or you are unlikely to do it. Not everyone likes running, yoga, weightlifting, etc. Find what you like and do it unapologetically. Find a friend who likes doing the same thing and then you have an accountability partner.

Get to Know Your PT: Kate LaPak, Therapydia Kona Physical Therapist

Kate LaPak physical therapist Kona Hawaii Therapydia

Therapydia Kona physical therapist Kate LaPak takes some time to talk adaptability, Frank Sinatra, and her dog, Dino.

“It’s all about balance and moderation. Balance between muscles, between work and play, between everything.”

When did you first know that you wanted to be a physical therapist?

I was a bit of a late bloomer. I have always had an interest in health and fitness but wasn’t sure where I would fit in. I did an internship through NYU shadowing physical therapists in Bellevue Medical Center for one summer during my junior year of undergrad and fell in love with physical therapy.

What is the biggest challenge involved in being a PT?

Keeping up with the paperwork. It takes more time than I’d like to admit. I’d much rather spend my time reading into the newest and latest physical therapy research for my patients.

How do you like to stay active?

I love doing just about anything with my dog. Walking, running, hiking… I also like to lift weights and practice yoga.

What’s your favorite song to get you motivated?

“1985 (Intro to “The Fall Off”)” by J. Cole. It’s all about not getting ahead of yourself or being overconfident when you are new to the game.

What surprised you the most about the physical therapy profession?

The wide variety of conditions that we are able to treat or specialize in. Before physical therapy school, I always thought of physical therapists as people you go to after a major surgery. PTs are qualified to treat not only musculoskeletal conditions but neurologic, pediatric and women’s health conditions as well.

Are you currently pursuing any further education/certifications?

I am getting my level 1 SFMA certification at the end of the month with my coworker Stephanie. I am also aiming to get my OCS (Orthopedic Clinical Specialist Certification).

What do you wish everyone knew about physical therapy?

You don’t need to be in pain to come see us! We offer wellness screens to help you move better and feel better in your everyday life.

What’s your go-to breakfast?

Grain-free granola and vanilla greek yogurt. Although every now and then I opt for a cinnamon roll 🙂

What is the most important personality trait that a PT must have?

Adaptability. You should be able to adapt to each of your patient’s needs and treat accordingly.

What do you do to de-stress/unwind?

I enjoy cooking, yoga and meditation. There’s nothing better than cooking dinner with a glass of wine and Frank Sinatra playing in the background.

Finish this sentence: On Saturday mornings, you can usually find me…

At the dog part with my dog Dino!

What is your favorite piece of wellness advice to offer?

It’s all about balance and moderation. Balance between muscles, between work and play, between everything.

Click here to learn more about Kate and the other physical therapists at Therapydia Kona.

Basic Steps for Dance Injury Recovery and Enhancement

As a dancer, the summer is the perfect time to plan and prepare for the upcoming dance season. Since dancing is such a highly strenuous physical activity, it is crucial to ensure that your body is in peak condition for performance and injury prevention. While getting injured is never part of the plan, it is an unfortunate reality of such a demanding sport. Overuse injuries like plantar fasciitis, achilles tendinitis, patellofemoral pain syndrome, hip strains/sprains, and many other injuries of the lower extremity/back are common for dancers. Many dancers expect aches and pains to be a part of dancing but this is actually not the case. The discomfort you feel is your body telling you that something needs to change. Luckily, physical therapy can offer the needed edge to ward off these aches and pains, while preventing future injuries and even strengthening and refining your current skills.

Springing Back From Injury

After so much training, preparation, and effort, the last thing a dancer wants to hear is “you’re going to need to stop dancing.” Fortunately, our physical therapists can help you get back to dancing as quickly as possible while increasing body control and restoring strength. This means less pain and more dancing! Your physical therapist will also work to incorporate dancing into your recovery program, making it so time away from the dance floor is optimized to improve your abilities.

While other pain relief solutions may offer a temporary fix, working with a physical therapist can enhance your body’s functions with the long-term in mind. Mixing exercises with an increased knowledge of your body can help you strengthen your skills, ensure that you’re moving properly, and most importantly, get you back to the activity you love doing.

Elevating Your Performance

Whether you’re seeking out ways to recover from an injury or just looking to refine your athletic prowess and become a stronger dancer, utilizing physical therapy to counteract injury will improve your body’s function in a way that is everlasting. Curious what’s involved in a Dancer Wellness Consultation?

When you first meet with a physical therapist, you’ll be taken through a dance-specific physical screening that allows for dynamic and static movement testing. Your physical therapist will evaluate flexibility, strength, body control, and observe technique to design a plan of care that is unique to your body and personal goals. They may evaluate control through:

1. Bridge Exercise Progression: To determine if you can disassociate hip movement from pelvic and low back and to find out which muscles you use to extend your hip. (By the way, you should be using one of the biggest muscles in your body to do this, your gluteus maximus!) This exercise will progress to a squat pattern and can help reduce knee, hip, and back pain, while improving posture and strengthening your core.

2. Plank Variations: To ensure that you organize your core correctly and to assess endurance.

3. Foot Exercises and Challenges: These exercises seem weird at first, but many of us spend so much time in foot coffins (shoes) that we lose the natural abilities our feet possess. Our feet are capable of so much more than we realize. Just think of what people can do with their feet if they have no hands: play instruments, brush their teeth, make meals, and pick up objects! Although many of us do not use our feet to their full potential, a physical therapist can retrain them to be the springs that they were meant to be.

Knowledge in these areas can help when it comes to early detection of bone-stress symptoms, as well as overuse injuries. The supervision and input of a highly-trained dance medicine specialist can provide education and a deeper understanding of your body, giving you the tools necessary to be stronger and move better. To learn more about the Dancer Wellness Consultation, give Therapydia Kona a call at (808) 498 4144.

Faulty Breathing Pattern Can Cause Neck Pain

neck pain treatment

Blog post by Lev Borukhov, PT, DPT

One of the most common causes on neck pain and thoracic spine discomfort is ineffective breathing patterns. To understand the reasoning behind this, we have to take a look at how your body uses muscles and skeletal structures to breath. First lets look at the diaphragm, the primary muscle of respiration.

The Diaphragm shown in the picture below is a parachute shaped muscle that attaches to the inside of your chest bone (sternum) and it goes all the way around your ribcage on both sides. As you inhale the diaphragm expands the chest, and pushes the organs that lie below it down into your belly. Exhalation happens passively as the muscle ascends back into the rib cage.


For one reason or another, a faulty breathing pattern can emerge. A faulty breathing patterns is when you’re not using your diaphragm as efficiently as you can to inhale. Many times your body will recruit the Sternocleidomastoid, Scalenes, Levator Scapulae, Pectoralis minor and major, Trapezius, and Rhoboid Major muscles to assist in expanding the rib cage. When we look at common neck pain patterns, we often see these muscles are tight, overly stretched, or painful. These are the same muscles that turn on when you’re working out or running and need to get more air in.


Learning how to breath better may take some of your neck pain away and even solve them for good. So how do you start?

1) Lay on your back. Make sure that your pelvis, rib cage and head are on the surface you’re laying on with only 1 pillow under your head. Put your feet on the wall or a stool so that your knees and hips are flexed 90 degrees.

2) Take a deep breath in through your nose, keep your mouth closed. As you inhale you want your belly, and ribcage to expand in 360 degrees. Meaning you should feel your rib cage pushing into what you’re laying on.

3) Exhale all the way through your mouth only. Say “Haaaaaaaaa” as you exhale and don’t purse your lips. Make sure your exhale time is at least double the inhale time. You should also feel your obliques contract, if you didn’t that means you have more air in there that you should exhale.

Improve The Timing Of Foot Pronation To Eliminate Plantar Fasciitis

Blog post by: Dr. Lev Borukhov, PT, DPT

Plantar fasciitis can be a painful and limiting injury. It often affects the bottom of your foot between the heel and arch. Plantar fasciitis is usually described as a sharp pain in the morning as soon as you get out of bed. Most people will modify their gait ( the way they walk) by walking on the outside edge of their foot to decrease pain. Over time that compensation my result as a heel spur. Plantar fasciitis is thought of as an overuse injury but the cause is unknown.

Plantar fasciitis symptoms include:
• Pain with walking especially in morning
• Pain with walking after sitting

Physical therapist treatments for people with plantar fasciitis should be custom tailored to their specific functional limitations. At Therapydia we use an individualized approach to every patient. One of my favorite approaches to treat plantar fasciitis is to look at the timing of the foot when it pronates and supinates. I commonly find a discrepancy between what should happen and what is happening.

Your foot begins to enter pronation when your big toe lands on the ground after you heel strike. If your foot doesn’t get to pronate then the shock absorbing properties that are innate to the foot structure don’t get a chance to take place which may lead to plantar fasciitis-like pain.

plantar fasciitis pronation kona

The foot enters supination to give itself rigidity for a stable platform to push off from. If the foot doesn’t supinate properly or in time it may mean that you are pushing off a pronated foot which could cause some pain in the plantar fascia area.

plantar fasciitis supination kona

So speed up or slow down these steps I like to use little foam wedges. In this video we are using wedges to speed up pronation.

In this video we are using wedges to speed up supination of the foot.

Pronation is a normal foot motion and helps to absorb shock on the foot, knee, hip and back. However, over pronation stretches the plantar fascia leading to plantar fasciitis. By improving the timing and positioning on each step, you can eliminate plantar fasciitis pain. There are many other treatment modalities that physical therapists utilize to treat patients with plantar fasciitis. Most treatment plans are tailored to the patient and their specific functional deficits. Give us a call if you’re experiencing heel-related pain and we’ll work with you to create a custom treatment plan for your needs.

Running With A Physical Therapist

running form kona physical terapy

Written by: Stephanie Colasanti, DPT & Tyler Patrick, DPT, OCS, ATC, CSCS

An estimated 10 million in the US run and it is fast becoming the most popular form of exercise. From the cardiovascular improvements to stress relief to losing weight, it’s no surprise that many people pick up running for its health benefits. With the popularity of running increasing, so has the rates of injuries from running. In fact, a whopping 82% of runners will get injured at some point. This could range from relatively minor symptoms to major game changers that  can cause you to halt all of your running goals. Although it may seem like the repetitive nature of running would lead to injury, there is no evidence that running is actually bad for you. Now this comes with a disclaimer….with the right type of training and form, your body should be able to withstand the forces in running and get stronger from them, injury free!

That’s where we come in. As physical therapists, we generally see people after they get hurt, which is extremely frustrating for us. With the right guidance, runners of all ages and skill level could benefit from a screening and assessment to PREVENT injury or even unlock performance potential.

What Happens During a Run Analysis

To decrease run-related injuries and improve your run times, a physical therapist will examine the following:

Muscle strength (muscles provide the force to allow movement)
Muscle length (allows your joints to move through their full range of motion)
Joint mobility (joints create movement between bones)
Ligament integrity (ligaments help keep joints together)
Running form/movement

Problems with one or multiple of these could lead to excessive wear and tear and possible injury. A physical therapist will examine all of these bones, joints, muscles, as well as how they interact with each other during movement. From your spine, all the way down to your big toe, we will make sure that everything is working the way it should in order to keep you out of that 82% or help manage that nagging injury that prevents you from unlocking your full running potential. By assessing your musculoskeletal makeup and movement patterns, you and your PT will have information on your unique biomechanics and develop a custom treatment program based on those findings.

For a little bit of insight and to get you started at home, here is one of the things we would take a look in a running assessment: hip flexor flexibility.

Hip Flexor Assessment For Runners

Hip flexor tone/tightness is a common issue that we find in people because we have made a life that allows us to sit for everything. Sitting causes your hip flexors to be in a shortened position and leaves your hips and legs tight and your glutes inactive. Why does this matter for running? Tight hip flexors limit the ability of your leg to go behind you (hip extension). Running requires a great deal of hip extension to generate the force to propel you forward. Tight hip flexors can also cause your back or knee to take more stress than it should. If you have less than 10-20 degrees of hip extension (or hip flexor flexibility), the range of motion required for normal walking/running, you will increase your chances of injury due to stresses placed on your low back and knees.

To assess your own hip flexor tightness, lay down on the edge of a bed, then bring both of your hips up towards your chest:

assess hip flexor tightness physical therapy

Allow one leg to fall down with your knee bent slowly. You have iliopsoas (hip flexor) tightness if your thigh is not parallel to the table/bed:

hip flexor runners

You have rectus femoris (hip flexor/knee extensor) tightness if your lower leg is not straight up and down:

hip flexor tightness assessment

If you find that you have some tightness, here are a few stretches that will get you started on improving your flexibility.

2 Stretches For Tight Hip Flexors

Lunge Hip Flexor Stretch

couch stretch runners

Couch Stretch
lunge hip flexor stretch runners
Perform each stretch for at least 30 seconds, but preferably 1 minute. Do this about 3 times on each side daily. Contract your butt muscles on the leg where the knee that is down to prevent your pelvis from tilting forward. Also, work on your breathing to sink into the stretch during the exhale.

Get started on your flexibility and come see one of us down at Therapydia for a running assessment, as well as an individualized program that will prepare your body to handle the impact of running.

Stay tuned for the remainder of our running series! We will be discussing shoes, as well as some tests and corrective exercises that should help you unlock your full potential!

How To Properly Warm-up Before Your Workout

side lunge warm up stretch

By Jaime Granchelli, PT, DPT

Yes, it matters. It’s actually kind of a big deal. If you’re not physically warm before you hit your workout, you’re not ready. Muscles don’t like to be asked to move and do work under load and tension when they are cold. Cold muscles also have a higher chance of being strained or even torn.

Why Stretching Isn’t Enough

What muscles prefer is to be warmed up gradually from smaller to bigger range. Kicking your foot up on a bench and hanging in a passive hamstring stretch for a few minutes isn’t going to cut it. Sure, this will help lengthen the muscle but simply gaining more range from sitting in a stretch doesn’t mean that muscle is geared and ready for dynamic movement. In order to achieve more range, your muscle has to relax itself and is technically shutting down. When you hold a stretch for a period of time without involving movement, you’re actually shutting your muscle down even more and goes against exactly what you’re trying to accomplish.

Furthermore, this relaxation of the muscle is shutting down it’s natural responses that are necessary for power and force generation. A 2014 Journal of Strength & Conditioning Research study found that 60 seconds of four different static stretches resulted in substantial decreases in jump height and power compared to not stretching at all. In another 2014 study by the Journal of Sports Medicine found that an upper body static stretching protocol negatively affected peak jump force. With all that said, sitting in a passive stretch after your workout is a great addition to your cool down routine since you will be done putting those muscles under load and going into “shut down mode”, so to speak, and it won’t be detrimental to performance and/or health of the muscle.

Customize a Warm Up Routine For Each Activity

So, how should I warm up for my walking program?… my triathlon training?… surfing? Does it matter?

Warming up doesn’t have to be fancy, but it should be deliberate. Start by easy walking, jogging, biking, or swimming. Then, gradually start to open up your stride or pick up the pace as you feel your body warming up and engaging. Once you’re warm, play around with all those bounty drills we did in P.E. class or high school or college sports: lunges, side lunges, squats, jumping jacks, fire hydrants, regular or knee push ups, soldier kicks, high knee jog, inch worms. These can and should cater to what exercise you’re about to perform, as well as, where you tend to be tight. If you know you are about to do a shoulder intensive workout, the shoulder and arm take priority over hip and leg drills. If you feel you have tight hips, make sure to do some drills that loosen them up. Lastly, depending on what sport you’re warming up for and what skill demands you may require, start honing into more sport/skill specific movements. Tap into muscle memory and get them activated.

Below is a lower body warm-up routine you can do before your next workout!


low body warm up exercise routine


2 rounds of:

  1. 10 Squats
  2. 10 Lunges (5 each leg)
  3. 10 Side lunges (5 each leg)
  4. 10 Fire hydrants (5 each leg)
  5. 20m High knees Jog

Traits of Physical Therapy Patients Who Beat the Odds

physical therapy recovery program

Over the past five and a half years of treating patients for 40+ hours per week, I have seen several patients beat the odds – by a lot! These folks were given very low expectations from neurologists, orthopedic doctors and even other physical therapists.

Sometimes their gains seemed to defy what the science taught us to be possible. What causes such incredible outcomes? Is it great therapy? No, I can’t accept such credit. There seems to be some golden, intangible thread that allows these patients to beat their prognosis. I have tried to read between the lines when working with these patients to better understand what they seem to know and learn how to teach their incredible skills to other patients.

What 4 traits do these patients have in common?

1. The ability to suspend their disbelief: The ability to take one step and a time and be process orientated instead of end goal orientated. The ability to suspend judgement on one’s condition or situation.

Why is this important?: Simple logic – if you don’t swing the bat, you can’t hit the ball. Every great modern accomplishment by humans was initially thought to be impossible. Someone always has to be the first to do what has never been done.

2. Setting intentions is foundation of luck: No you can’t magically speak yourself into getting better after suffering a major physical trauma. However, if you intend on getting better, you are more likely to ask important questions and surround yourself with healthcare providers who are talented enough to help you on your journey.

Why is this important?: Dr. Wayne Dyer says it best with his book “The Power of Intention” that if you intend to succeed then success chases you instead of you chasing it.

3. The ability to put stress in it’s place: A powerful exercise that we teach our patients to do is to set a timer and let yourself worry about your aliment for no longer than 10 minutes per day. During those 10 minutes it is okay to cry, wring hands, complain, etc. After those 10 minutes, turn the stress switch to the off position and focus on how the exercises, information and hard work will help your situation improve.

Why is this important?: Stress in small amounts can be a catalyst and cause incredible motivation. Stress in large amounts bogs the body down and disrupts mental focus needed to accomplish difficult challanges.

4. Assembling the right team: Working with therapists and physicians that mesh well with your personality.

Why is this important?: Rehabilitation needs to be a constructive team effort. Undergoing therapy can be a long process that is incredibly trying mentally and physically. Therapy works best when patient and therapist personalities compliment each other instead of disrupt each other.

Giving credit where credit is due: During one of my student internships, I was fortunate enough to be mentored by Steve Schall of Norfolk Physical Therapy in Virginia. I once asked Steve why he would create incredibly lofty and unlikely goals for patients. Steve answered simply:

“I’m not going to be the one to place limitations on anyone”.

Why a Former Pro Contest Surfer Is Taking a Surfing Lesson

I started surfing frequently when I was 12 and I spent all of my teenage years either surfing or skateboarding. During my 20s I was fortunate enough to obtain surfing sponsors that brought me to wonderful surfing destinations all over the world and supplied me with the best equipment. I surfed many times in professional and invite-only events for both shortboarding and longboarding and even performed well in novelty events such as tandem surfing and stand up bodyboarding. When I wasn’t surfing, I taught surf lessons to newcomers and up and coming surfers with high aspirations.

When I turned 24, I stopped surfing in contests, voluntarily dropped most sponsors and committed myself to the Doctor of Physical Therapy program at Old Dominion University. I imagined that after graduating, I would work full time as a physical therapist but still continue to compete in a few B-list professional contests in Hawaii and do this until I was in my early 40s. But then I had a change of heart…

For the Love Of Surfing

Now at age 32, I am in the best physical shape of my life. Being in the health and wellness field has changed my view of what it means to be at my highest personal athletic performance. Rather than trying to prove myself in professional events, I am surfing for it’s own sake and learning new novel forms of the craft.

Today, I spend my time body surfing large waves and stand up paddling smaller surf in addition to riding a short modern board. I have realized that in order to keep outperforming my 20 year old self, I have to surf smarter and I need to seek out new ways of learning about my technique flaws. There are many learning curves in surfing and getting feedback from friends and other surfers or watching replays captured by Solo Shot / GoPro can help you identify performance gaps that are holding you from the next level.

Physically speaking – surfing in not a difficult sport. Cognitively speaking – surfing may be the single hardest physical activity out there. I believe that most surfers would most greatly improve their performance not through better equipment or finding better waves, but simply spending more time in “deep practice”. The Talent Code by Daniel Coyle speaks volumes about the concept of “deep practice” or in other words increasing your cognitive awareness of what makes someone a better performer. The idea of being process orientated rather than goal orientated. For me, I made the switch of being goal oriented (wanting to win contests) to being process oriented (deeply analysis of technique).

Now instead of worrying about contest results, I focus on timing, exact positioning of my back arm during turns on the wave, breath control when flying down a big wave, etc. As author Daniel Coyle pointed out, learning exact techniques and then spending time repeating and deeply analyzing techniques allows for your body to create more myelin. Myelin insulates nerve fibers, increasing the speed at which impulses are conducted. The more myelin – the faster you can fire nerve impulses / correct mistakes and perfect techniques.

In speaking of technique corrections, many of us saw the video capturing John Florence fracturing his ankle. John Florence is highly regarded as one the best surfers in the world with excellent technique in any conditions. Back in 2013, he was surfing in Australia and performing a routine maneuver when he broke his right ankle. While most of the surf media chalked this injury as a “freak accident”, it is noticeable within the video as to exactly what happened.

Watch his back leg, notice how his hip-knee-foot are not in alignment. If he had pushed his back knee outwards during the aerial rotation it would have most likely avoided the excessive ankle torque that caused the fracture. Basically, instead of his hip pushing outwards to bring the knee and ankle in alignment, his body instead used his knee and shin as a fulcum to destabilize and fracture his back ankle.

Even hearing John’s own explanation of the injury – it doesn’t sound like he had yet figured out that these injuries don’t have to happen. My advice to John would be to practice keeping hip-knee-ankle stability on land as to make proper positioning of his back leg flawless – then slowly translate that positioning into actually riding waves. Because there is so much to think about when riding a wave, proper ergonomic alignment in surfing should be practiced deeply on land and then added into actual surfing.

Movement science can be multi disciplinary. Often I have worked in conjunction with surfing coaches to better a surfer’s performance. A surfing coach can teach the athlete how to add speed, power and flow (contest judging criteria) into their surfing. A physical therapist is better suited though to help an athlete understand how to better command their body and avoid injury while trying seemingly dangerous maneuvers.

From Instructor To Student

Next summer I am finally taking my first surfing lesson. Twenty five years after my first surf session in Cocoa Beach beach I am going to Northern Costa Rica to work with a performance coach. I look forward to finding new ways to accelerate my learning curve. The best athletes are the best because they never stop learning (and figuring out how to avoid injury).

I will be attending the Surf Simply resort in Costa Rica. After listening to many of their podcasts it is apparent that the coaches are truly surf scientists. If there was such a thing as a PhD is surfing, these folks would deserve the title of “Dr.”.

Whether you are a surfer, an athlete or just someone who wants to achieve better balance – never stop learning and know that most injuries are truly avoidable if you have adequate command and understanding over your body.