Pain can be a REAL GRINCH! Let TOPS help you STEAL back your Holiday Spirit!

Is the “Grinch” trying to hold you back this year and steal your HOLIDAY SPIRIT?!

Tis the season of giving…. But, pain is not what you want to be given! And, at this time of year, pain can be the REAL Grinch…

How can you overcome the PAIN-Grinch?

Well, we have some GREAT NEWS FOR YOU! Your deductible is most likely met! Arizona is direct access, meaning you don’t even have to see a doctor before coming… You can come straight in and we will check you out, and get you started, on your FIRST appointment. We are a one stop shop at T.O.P.S. (rare thing to find during the Holiday time)!!! In the clinic, we have an Osteopractor, which means you can get all your dry needling, joint manipulations, or physical therapy done in ONE LOCATION!

We want you to enjoy eating TOO much Turkey, Christmas shopping, home decorating… Annnnddddd, great weather in Phoenix! This is the time of year when we start to get back out running, hiking, biking, etc. At T.O.P.S., we believe that getting out and moving is essential to your physical and mental health. We also understand that you may have aches and pains that arise after hibernating all summer! Not only does this affect you physically, but it’ll take a toll on your mental well-being as well. Don’t let that happen! Aches and pains should not be on the forefront of your mind, or limiting your desire to do any of these activities!

Not to mention, once your physical pain is minimized, your mental clarity will improve, providing for shopping stamina, great gift ideas for those hard to shop for, and delicious meals!

As Saint Augustine said, “The greatest evil is physical pain.”

So, we invite you in, to come check out what we can do for you during these hectic holiday times, and get you running, hiking, or biking your way into 2019!!!

Young Female Athletes Sidelined From Injury-Week 2

Why do we see so many young female athletes sidelined from injury?

Did you miss the first blog? Go back and check it out! This is an awesome series!!! Our student Ashley is sharing her personal story and some insight on why so many young female athletes end up injured. If you are wanting to get a better understanding, then this blog series is for you! The purpose of this blog series is to go through some of the most common injuries, early identifications, and prevention of injuries for young female athletes.

Do you know what the most common injuries are that a young female athlete can endure?

Most of you can probably come up the obviously injuries like: rotator cuff tears/ strains, low back pain, and nerve impingement, but what how many of you actually know why these occur? Well, below I have listed common injuries that young female athletes undergo, as well as some explanation as to how these injuries occur.

  • Shoulder-Impingement (most common)

    • Compared to an overhead thrower who has a range of motion (ROM) of 108 degrees, a female windmill pitcher requires 360 degrees of motion. This ROM then places torque on the biceps brachii (talked about in last week’s blog). The biceps tendon can either become impinged underneath the acromion of the shoulder, cause inflammation of the biceps tendon, or at worst, can rupture the tendon. In turn, your young female athlete may start to complain of pain on the front side of their shoulder, state relief of pain when the shoulder is down by their side, or the biceps muscle may look like a “pop-eye.”
    • “Pop-eye” muscle:
  • Ulnar Nerve Impingement 
    • This injury is due to abnormal forces through the elbow. While pitching, you may notice that your young female athlete may have her forearm too far outside her pitching zone while her elbow is tucked near her body. This causes a valgus force and can end up causing impingement on the inside portion of the elbow (Cubital Tunnel) or at the wrist (Guyon’s Tunnel). If your athlete has a nerve impingement they will complain of numbness and tingling down the inside of their forearm and/or in their fourth and fifth (pinky) fingers.
    • Cubital Tunnel Entrapment
    • Guyon’s Tunnel Entrapment
    • Pain Location


Check out the blog next week to learn more about when these young women are over doing it! 

Lower Body Workout Variations

Lower Body Workout Variations

Last week we asked if you were a frequent gym-goer or someone who is newer to the gym to see if you could benefit from upper body variations. This week we would like to share with you all some simple lower body strengthening exercises. We picked a few that we see people perform consistently at the gym. Especially for a beginner, we think it is essential to know some of the big muscle groups that are targeted before performing an exercise and the difference in modifications of each exercise. Use this as a general guideline when tweaking your exercise routine and regardless of your experience working out, always emphasize proper form.

Squat Variations

The squat is everyone’s favorite low extremity strengthening exercise. By adjusting the placement of the bar you can easily target different muscle groups. Keep in mind there will be overlap in muscles you strengthen with each variation and the muscles listed below are not the only muscles being used.

  • Back squat
    • High glute involvement
    • Ideally you want your trunk and tibia in line with each other. Try to not let your knees progress over your toes throughout the movement.

  • Front squat
    • More quad involvement
    • Placing the bar on the front of your shoulders, rather than behind your head, moves the center of gravity of the weight you are lifting forward. This is why your quads now become the chief mover rather than your glutes.

Lunge Variation

The lunge is one of the most versatile lower extremity strengthening exercises that we use consistently in physical therapy.  It is an extremely useful exercise to build frontal plane strength, which may of us lack. In addition, the exercise will strengthen some of the large muscle groups people focus on at the gym, including quads and glutes.

  • Forward lunge
    • More quad involvement
    • It’s ok to progress your front knee over your foot slightly with this exercise, but slowly control the motion and do not let you knee dive inwards

  • Backward lunge
    • More glute maximus involvement
    • Try to keep the front knee behind your toes and actively drive the motion through your hips

  • Lateral lunge
    • More glute medius involvement
    • This is a muscle that stabilizes your hips in the frontal plane and often times a muscle that is weak in the general population
    • When initially performing this exercise, do not use weight and keep your hands in front of you to counterbalance your hips going backwards

Deadlift Variation

The deadlift can be an extremely beneficial lower extremity strengthening exercise. It is easy, however, to perform the exercise with incorrect form and place high levels of stress on the low back. With all variations, think about keeping the shoulders and back engaged and core activated. The bar should always be as close to your body as possible.

  • Traditional deadlift
    • More glute activation here
    • Knees start bent and finished extended

  • Romanian deadlift
    • More hamstring activation here
    • Knees stay relatively extended throughout the movement
    • This is typically a more difficulty variation to perform, thus start with lighter weight and focus on proper form

Upper Body Workout Variations

Are you a frequent gym-goer? Are you new to the gym? If you answered yes to either question, then you could benefit from exercise variations. Why is that? The simple reason is, we all can benefit from variation in our training. (Variation in terms of training can mean intensity, volume, frequency, lifting tempo, exercise selection and so on).

Today we would like to share some simple upper body strengthening exercises. We picked a few that we see people perform consistently at the gym. Especially for a beginner, we think it is essential to know some of the big muscle groups that are targeted before performing an exercise and the difference in modifications of each exercise. Use this as a general guideline when tweaking your exercise routine and regardless of your experience working out, always emphasize proper form.

Push Up Variations
The push-up is an extremely functional and simple exercise that can easily be altered to train different parts of your body. Whether you’re a beginner or advanced gym-goer, knowing the different variations of the exercise can be useful when tailoring your workout and building full body strength. Regardless of alteration keep a neutral spine with chin slightly tucked.

  • Shoulder width
    • Targets deltoids>pecs>triceps
    • Focus on neutral spine throughout the movement
    • Hands slightly outside shoulder level

  • Wide placement
    • Targets pecs>deltoids>triceps
    • Hands should be further outside of shoulder level slightly above mid pec level

  • Close placement
    • Targets triceps>deltoids>pecs
    • Keep hands at or slightly inside of shoulders at level just below the pecs

Pull Up Variations

The pull up is another very functional upper body strengthening exercise.  The pull-up can be adjusted with arm positioning and grip variations to target different muscles in your body. Keep in mind however, the main muscle groups will include your lats, rhomboids, biceps, and forearm musculature regardless.

  • Wide and close grip
    • Back muscles (lats, rhomboids)>biceps>forearm

  • Open grip
    • More biceps activation here with less back and forearm activation

  • Closed grip
    • More forearm/bicep activation here with less back activation

Curl Variations

You’ve likely tried or seen people doing different variations of curls at the gym. All curls should not be considered the same however. With whatever variation you choose to perform, keep the shoulders back and down, keep a neutral spine and work through full elbow ROM.

  • Supinated (open) grip
    • Palm up
    • Targets biceps>medial forearm>lateral forearm
    • Be careful not to lose the palm up grip when lowering the weight.

  • Pronated (closed) grip
    • Palm down
    • Targets lateral forearm>biceps>medial forearm
    • This is typically a more difficult curl, so go down in

  •  Neutral grip
    • In-between an open and closed grip
    • Equal activation of biceps and lateral forearm (roughly), not much medial forearm activation here
    • weight and focus on form

Treating YOU And NOT Just The DIAGNOSIS

There has been a topic we feel that we need to make very clear to our current and future patients regarding their care. TOPS Physical Therapy & Osteopractics is here to treat YOU as an individual, NOT as a diagnosis!

Although that can be considered a cliché statement, it is something we take to heart, believe in, and perform daily.

We have many people who call, text, message, and ask advice on a certain surgery or disease process, which trust me, we would LOVE to be able to give you everything in those avenues. However, there is still a personal touch required in this technology world. We are here to treat you as an individual and unique human being that you are.

Although you may get shoulder surgery for a certain diagnosis, or have knee pain after going down stairs, you are not the same as Labrum Repair surgery, patient #1,304,392.

YOU are a person:
who possibly has laxity versus stiffness;
who has a manual labor job versus a sitting desk job;
who enjoys Scuba diving vs knitting
who is a single bachelor vs a working mother with 5 children

Therefore, we refuse to follow an exact protocol of treatment and provide black and white pictures of exercises, and lump you together with every other “labrum repair” surgical patients.

WE TREAT YOU! We want to engage with you and learn all about who YOU are, so we can better treat your injury, prevent further injury, and ultimately serve you the best way we are able to do so.

What this means…you may have 5 friends who work at your office with the “same” surgery, or watch the NFL and see a quarterback playing again, or have a grandparent who is “back to normal in 5 weeks” and you’re not! Understand, there are 10+ routine surgical interventions being performed on shoulder labrums, and even if it is a “routine” surgery, the person it is being performed on, is different. Thus, even if you had the exact “same” surgical intervention as your buddy or grandparent, your healing time and life experiences are going to drastically effect YOUR pain relief, mobility, and eventual full return to all activities.

If you ever talk to an “expert” or get treated by a provider who is lumping you together with “everyone else who has the same thing”, run my friend. Run far away from them. They are assuming that YOU are exactly the same as the “average American”, but TOPS does not believe so. We believe you are a person, with your own history, and your own active future. We have treated, collectively, 100s of thousands of patients, and we have never seen two exactly the same. Not even with identical twins. Therefore, it is our goal to treat you as the PERSON you are, and not the “injury” or “surgical intervention” that you present to have on your initial evaluation.

At the end of the day… The TOPS Team is here to HELP YOU! We want to get you back doing the things you love. If you have any questions about injuries, workouts, job duties, or anything else, PLEASE FEEL FREE TO CALL US AT ANYTIME! You can reach us by: Phone: (602)826-0037,Text: (602)826-1825, AND Facebook:  TOPSPHYSICALTHERAPY.


How Do YOU Choose The Right Physical Therapy Clinic For YOU?

How do you choose the right Physical Therapy clinic for you?

Currently in this day and time with a saturated market, with Physical Therapy clinics everywhere, what factors into your decision on choosing where to go? You can go where your doctor refers you (ARIZONA IS DIRECT ACESS, NO DOCTOR REFERRAL NEEDED), where a friend/family member recommends, or just solely based off geographic location (check online reviews: Facebook, Google, Yelp, etc.).

Pick the RIGHT FIT for YOU:

We want to spend time on the ladder and talk about why choosing just based off location or referral may be short changing yourself. Here are a few questions to consider if you are currently in Physical Therapy or can think back to the last time you were. Is this clinic you are spending at least 4-6 hours per week performing more than 2 minutes of manual therapy on you? Are you doing the exact same thing every visit? Do you feel like it is a mill? Is there opportunities for you to really speak with the therapist and express how you are feeling or discuss your concerns? Are you unsupervised with your exercises? Did they tell you that you must go to this place because you are dealing with a workers comp injury? If you are answering, yes, to any of these questions, you may consider a change (it is YOUR RIGHT to go where ever YOU WANT).

Treating the Person and not the DIAGNOSIS:

Another thought to consider, is the clinician treating the person and not the diagnosis? Yes, there are standard protocols, but just like with everything else each person has a different background and a different need. A clinician must be able to recognize a person for example, who has a history of shoulder instability with chronic dislocations or subluxations, who undergoes a stabilization surgery that he/she may want to go slower than typical protocols to allow for more scarring and improved overall stability post-surgery. This is just one example, but it is another reason to go to a clinic where you are valued as person and not just a number. You want to build a relationship just like you would your medical doctor.

How T.O.P.S. Physical Therapy can help YOU:

T.O.P.S. Physical Therapy and Osteopractics is interested in building a relationship with you. Our staff is thoroughly trained and has significant experience in various treatment options, including manual work, ASTYM, dry needling, spinal manipulations, and corrective exercises, with the overall goal of DECREASING YOUR PAIN and helping you to RETURN TO YOUR ACTIVE LIFESTYLE AND DAILY ROUTINES.

Our clinicians provide individualized, hands on, full body physical therapy techniques designed to maximize muscle and joint function, core stabilization, and sports rehabilitation. We also offer these specialized physical therapy and training programs:

  • Manual Therapy
  • First Responder Rehabilitation
  • Sports Medicine
    • Sport-Specific Training Programs
    • Balance Training

Potential referring diagnoses may include, but are not limited to:

  • Neck Pain
  • Back Pain
  • Shoulder Pain
  • Strains, Sprains, and Tears
  • Joint Replacements
  • Pre-surgical Strengthening
  • Post-surgical Strengthening
  • Overuse Injuries
  • Exercise Training and Education
  • Carpal Tunnel Syndrome
  • Pregnancy-related Back Pain
  • Generalized Deconditioning

We are in central Phoenix at: 5353 N. 16 th St. Phoenix, Arizona 85016.

If you have any questions or want to know more about our services, please visit us at: or call: 602-826-0037

Advanced Workout

Advanced Workout

The advanced workout routine incorporates the use of plyometric drills and various free weight workouts to give the participant a strength training routine that should also increase heart rate and challenge the cardiovascular system. Plyometric exercises are force-producing movements that incorporate multiple muscle groups and feature an element of coordination. Plyometric drills, in this routine, will involve jumping and throwing a weighted exercise ball. It is extremely important that the participant have good body awareness and a strong core, as these drills are challenging and can cause injury if performed incorrectly. It is also important to complete an active warm up before starting plyometric exercises. Use the following parameters below when performing the routine while also performing the exercises in the order they are provided to avoid fatigue.

• Complete all four workout splits each week, ideally with one day separation between each workout
Perform 3-5 sets of 8-12 reps of each resistance exercise.
• Perform 3 sets of 10-15 reps of each plyometric drill. Number of reps can be increased as you progress.
• Perform the exercise routine for 8 weeks. After this point, the workout will need to be adjusted for accommodation.
• On off days focus on cardiovascular exercises. Cycle, run, hike, elliptical, rowing, stadiums…whatever you enjoy and feel comfortable with.
Perform a quick 10-15 minute cardio warm up prior to each exercise session.


  • Box jumps
  • Landmine deadlift
  • Forward/backward lunges with barbell
  • Wall chest pass with weighted exercise ball
  • Battle rope circles
  • Single arm shoulder press with barbell in corner
  • Lawnmowers with dumbbell


  • Scissor jumps
  • Back squat
  • Side lunges
  • Single leg step downs with dumbbells
  • Half kneeling side toss with weighted exercise ball
  • Upright row + overhead press (superset)
  • Skull crusher + close grip press with easy bar (superset)


  • Skater jumps
  • Front squat
  • Single leg split squats with dumbbells
  • Overhead toss with weighted exercise ball
  • Bicep curls in half kneel
  • Pull up + dips (superset)
  • Low row with barbell


  • Toe taps on box
  • Single leg press
  • Double leg deadlift with barbell
  • Nordic hamstring curls
  • Chops/lifts
  • Dumbbell chest press
  • Farmer walks

Cancer Sucks. Testimonials From Women Who Have Utilized TOPS PT! Week 4

Week 4: Testimonials
Physical Therapy continues to be a questionable treatment option for women who are post-mastectomy, augmentation, or with large breasts. It is highly misunderstood where physical therapists can enhance the recovery process and help to minimize pain. In the past, it was believed that PT was too aggressive for this type of procedure; however, at TOPS, we have shown multiple times that we understand the recovery process and how to be a catalyst for faster, safer recovery.

Here are some of the testimonials of women who have utilized our physical therapy techniques, and their personal road to recovery:

Undergoing any major surgery usually requires some sort of physical therapy to regain normal life. Normal life for some may not include exercise and adventures but for many of us it does! As a competitive swimmer, lover of bikram yoga and pharmacist, I need my brain and body to be in pristine condition for best performance. My personal goals and patient’s lives depend upon it. Being genetically predisposed to having a 90% chance of breast cancer and 50% chance of ovarian cancer, I knew the best choice for me was to prevent my breast cancer by having a double mastectomy. This came with reconstruction and 4-6 weeks of inactivity besides walking. In order to restore normal life, I sought the expertise of Amy and Chad at TOPS. Since the new implants pull on your muscle you want to prevent forward rotation and injury to the shoulder, or extra weight and pressure on the spine. Having a strong core and the manual techniques from TOPS helped me regain my pull-ups and all around ability as a swimmer within 6 months of surgery. I would not be where I am today without them. The staff and experience are TOP notch!

-Lindsey U.

Over a year ago, I was diagnosed with a cancerous nodule in my breast. Rather than worrying, I decided to have a double mastectomy, which I thought was going to be an easier process than I discovered it was. Both physically and emotionally. I sought treatment from Amy after my removal surgery, while I was going through my emotional rollercoaster. Amy helped me regain the ability to reach the top shelves in my cabinet and do my hair. After many tearful PT appointments, she supported my decision for a replacement, which I was not initially going to get. This was a longer process than I had imagined, but Amy helped me through it all. My breast tissue was uneven, so my implants were uneven. As you could imagine, this took again, more emotional toll than I was prepared for. Amy helped me regain my shoulder strength and mobility, not to mention my confidence. I am forever indebted to Amy and will always have a place in my heart for her.

-Dawn B.

Many years ago, I had a boob job that I have now learned is more than I should have done. I started getting really bad headaches, neck pain, shoulder pain, and pain into my arms. I thought it was carpal tunnel and migraines, and many doctors told me the same. I also was told I needed surgery on my neck. My daughter got treatment from Amy and Chad, so I decided to see if they could help me. I never thought it could be from the weight of my boobs, but it seems to be the case. Amy and Chad have worked on my back and neck to help take away that pain. They stretched my chest and sometimes used the awful blue scrapers on me too. In the end, it really helped with my pain. I now know that if I decide to do surgery, I will only get my boobs smaller and not mess with my neck or spine like other doctors told me to do. I appreciate their honesty and willingness to go against what I believed to be my problem.  

-Karen J.

Cancer Sucks. Recovery Doesn’t Have To. Let TOPS Help! Week 1

October is most importantly, Breast Cancer Awareness and Prevention Month. It also happens to be National Physical Therapy Month. Therefore, we felt it was appropriate to integrate the two and make a blog series based on how the two can integrate. It may seem a bit personal and private, yet it has extreme relevance on females dealing with shoulder pain, upper and lower back pain. This series will focus on surgical interventions of breast tissue and how physical therapy can help alleviate some of the associated pain symptoms.


Cancer is a scary topic and it brings with it a lot of uncertainty. Breast cancer occurs as a result of gene mutations and uncontrolled cell growth that can invade surrounding tissue in the chest wall including lymph nodes, areolar ducts, muscles that lay beneath the breast, as well as the ribs. If the cancer metastasizes (travels) too much or growth is out of control, then invasive surgery (Mastectomy) may be required to remove the cancerous cells as well as the surrounding tissue: lymph nodes and ducts and possibly musculature in some extreme cases.

Mastectomy presents challenges for any patient undergoing recovery because the tissue structure of the shoulder and breast region has been surgically altered, not only requiring healing of the surgical site, but also limitations of ROM dependent on the type of mastectomy and phase of healing. The most common and well researched mastectomy procedures are quite invasive.

Least to most invasive:

  • Total (Simple) – removal of all breast tissue, including: nipple, areola, & most skin
  • Modified Radical – all tissue removed in a Total (simple), along with lining of some chest muscles, lymph nodes in the upper arms, neck, and armpit.
  • Radical – all tissue removed in a Modified Radical mastectomy along with all lymph nodes and all chest muscles. (This type was most common for many years but is not rarely used unless the metastasis of cancer has spread through chest muscles).

There are some newer procedures that are less invasive and more sparing than even the Total mastectomy.

  • Skin-sparing & Nipple-sparing: these procedures allow for keeping as much superficial skin while removing the underlying pathologic tissue.

Although these methods may be riskier and not as researched, it allows for the patient to keep more of their body intact and keep their human dignity, which is important for any medical procedure.

Post-Mastectomy surgery, patients can suffer from lymphedema, swelling, phantom pain, range of motion, and strength deficits that physical therapy is very effective at improving.

What about Physical Therapy?? Can it help?? My doctor said I didn’t need to go, so should I??

These are questions we are asked frequently after a mastectomy. It is not well understood what a PT can do, if anything at all. However, from experience, as the testimonials will show in a few weeks, it absolutely can help.

PT can help post-mastectomy surgery by helping to minimize scar tissue build up. The surgical procedure is intimately related to the muscles of the chest and shoulder, which will get very tight, especially when someone is sitting with their shoulders forward. PT will help to lengthen those tissues and minimize the pulling feeling. It will help with shoulder pain, or minimizing the looming shoulder pain that almost always occurs. PT will also help to minimize back pain that starts since the individual is usually rounded forward, in a slouched posture, much worse than normal.

Furthermore, post-mastectomy, many women suffer from lymphedema issues in their hands and arms. There are specialists who are trained to help minimize this swelling and pain associated with swelling. There are many people and services here for your needs, please allow us to help you find who you are in need of!

In the upcoming weeks, we will discuss the anatomy of reconstructive surgery or enhancement surgery, and the general PT effects with that. Then, we will follow up with a much more intensive PT treatment blog. Followed by testimonials and personal experiences.

If you have any input or questions, please let us know. We are always here to help!

Cancer Sucks. Recovery Doesn’t Have To…Let Us Help!


  1. Mastectomy