Mike Stella ATC

“Coach, should I be doing cold plunges after every practice?”

I get this question more than almost any other in the clinic.
So let’s rank the top 5 recovery tools athletes actually ask me about and where cold plunge really lands.

Cold plunge and sauna have a time and place. But they’re small potatoes compared to what’s actually driving recovery for the athletes I work with.

Compression boots help with soreness and circulation a little.
Not magic.

Nutrition matters more than most athletes realize. Fuel the training you’re doing, not just eating “healthy.”

Daily steps and smart load management matter more than that.

And sleep beats all of it. Undefeated.
If sleep is broken, that’s the first thing to fix before any recovery gadget gets added.

What’s the most overrated recovery tool you’ve seen parents or athletes swear by?
Tag a coach who needs to see this.

The Movement Underground | Long Island, NY

A stress reaction is what happens before a stress fracture.

Load is outpacing the bone's ability to repair itself.
The window between "this aches" and "this is a fracture" is the one most athletes ignore and pay for it later.

Who's most at risk:
Distance runners. Track and cross-country athletes.
Female athletes with high load and low energy availability.
Anyone who spikes their training volume without building to it.
Athletes who train year-round with no strength work in their program.
Youth athletes playing year round single sport participation.

The mistakes that get people here?

Volume spikes — too much too soon, this is it almost every time.
No resistance training — bone needs to be loaded to stay resilient. If youth athlete are playing sports, they should learn resistance training too.
Underfueling — Nutrition is so key, especially in young female athletes. Bone can't repair in a depleted environment, hormonal dysregulation, and altered menstrual cycle are common co-pilots here.
Ignoring early signals — point tenderness over bone, pain that worsens with activity and eases with rest. That's not something to push through.

The fix — 4 variables:

Metabolic health — bone density, nutrition, hormonal status
Load management — progressive, periodized, no spikes
Resistance training — non-negotiable for bone resilience
Lifestyle — sleep, nutrition, stress. The environment bone heals in.

Caught early = a plan.
Caught late = a boot and a 6 week rest timeline.

Save this. Send it to your coach.

This tool isn't magic.

It's not fixing this hamstring.
The body fixes the hamstring.

So what is it doing?

Pain relief. That's real and that matters.
Improved tissue glide and local blood flow. Also real.

And potentially something more interesting...
though I want to be honest about the evidence before I say it.

Fibroblasts are the cells that produce the collagen your tissue needs to remodel after injury.
And fibroblasts are 'mechanosensitive' aka they respond to mechanical stimulation.

Meltzer & Standley (2007) demonstrated in vitro that modeled manual therapy techniques can modify fibroblast proliferation and cytokine secretion...

shifting the tissue environment from pro-inflammatory toward pro-healing.

J Am Osteopath Assoc. 107(12):527-36. PMID: 18178762.

Is that definitively what's happening when I run this tool across a hamstring?
Not proven at that level. This is mechanistic data.

But it's the best mechanistic explanation we have.
And if the mechanism holds...
then this tool may be doing more than just managing pain.
It may be helping stimulate the very building blocks the tissue needs to heal well.

Beyond metal on skin, there are other conceptual things happening here that change the healing environment...

I'm talking to this athlete.
I'm understanding what they need.
I'm explaining what's going on and what we're going to do about it.
I'm building the plan while I help them feel better right now.

The table isn't passive care.
It's where the whole session gets set up to be more effective.

Pain relief + patient education + tissue work + a plan.
That's what this tool is actually for.

Save this for the skeptics who've been sold the lie that manual therapy has no mechanism.

It does.
We just have to be honest about where the evidence actually sits, and it doesn't sit in magic or mysticism.

📍 The Movement Underground | Seaford, Long Island, NY

An ounce of prevention is worth a pound of cure.

It's one of the oldest sayings in the world.
And almost nobody actually lives it.

They know it's true.
It's obvious in its simplicity and pragmatism.
But they wait anyway.

Waiting until the pain gets bad enough.
Waiting until the season is over.
Waiting until they have more time.
Until things slow down.
Until something finally breaks and forces the conversation they should have started months ago.

Only thing is...they're only waiting to lose...

The morning where you get out of bed and nothing protests.
The run where your legs just respond....no bracing, no compensation, no convincing yourself it'll loosen up.
The game where your shoulder never even crossed your mind.
The training session where the ceiling felt higher than it did last week.

That version of you exists.

Not after the injury.
Not after the surgery.
Not after the long road back.

Right now.
In the work you haven't started yet because you're still waiting...
In the small investment made consistently before anything breaks.

The preparation is where the outcome is decided.
Not the performance.

You don't win on the field.
You win in the work nobody sees...
the mobility session before practice, the recovery work after, the proactive conversation with someone who helps you understand your body before it forces you to.

The body you want to have in 10 years
is being built or destroyed right now.

Not by the big moments.
By the small ones you're choosing in between.

The opportunity to move better, feel better, perform better, and stay in the game longer than you thought possible...

It's not waiting for you on the other side of an injury.

It's here.
Now.
Go get it.

📍 The Movement Underground | Seaford, Long Island, NY

Most therapists and coaches think as far as tissue.

Muscle. Tendon. Ligament.
And for most...that's where the thinking stops.

The treatment is tissue-based.
The training is tissue-based.
The answers are tissue-based.

But there's a HUGE problem with thinking only in terms of tissue...

Tissue doesn't work in isolation.
It never has.
It never will.

A muscle doesn't contract because IT decided to.
A tendon doesn't load in a vacuum.
A joint doesn't move without a nervous system deciding it's safe to do so.

Pain isn't coming from a body part.
It's coming from the brain — processing information, making decisions, producing outputs — that happens to involve that body part.

This is the fundamental mistake in mechanical clinical thinking.

The division of the body into parts is a concept.
It's useful for communication.
It's useful for anatomy class.
It's not the truth.

The only truth is the WHOLE person.

Because the moment you look at a hamstring and call it a hamstring problem...
you've already missed everything that made the hamstring the most convenient place for the problem to show up.

The best clinicians and coaches understand this.
They hold the whole picture.
They treat the parts they can access while keeping the system in mind.

The rest argue about which muscle isn't firing in comment sections.

📍 The Movement Underground | Seaford, Long Island, NY

I'm done arguing about ice.

Do what you want.
I don't care anymore.

But let's at least be honest about what it actually does
and what it doesn't.

What ice does NOT do:

Reduce inflammation.
Reduce swelling.
Improve healing.
Speed recovery.

What ice DOES do:

Help with pain.

That's the whole list.

And pain relief has value... I'm not asking post-op athletes to suffer.
But pain relief has a cost too.
And that cost is the healing process you just interrupted.

So here's what I actually recommend...

Manage pain early.
Yes. Do that.
But don't let pain management become your ENTIRE recovery plan.

Because swelling doesn't respond to ice.
It responds to lymphatics, movement, muscle contractions, and active work...
even on non-operated areas.

That's how you actually move fluid.

The real problem with ice was never whether "it worked" or not...

The real problem is what happens when you give someone a choice
between lying on the couch with an ice pack...
and doing something actually hard.

They'll choose the ice pack.
Every time.

And then they'll convince themselves they made the difficult choice.
They made the responsible choice.
They're doing the 'work.'

They didn't.
They aren't.

And now they believe they are...
which is the most dangerous place to be in a recovery.

Save this before your next surgery.
Send it to a friend who is post-op...
Tell me I'm wrong in the comments.

📍 The Movement Underground | Seaford, Long Island, NY

Your massage gun isn't just for sore muscles.

If you're post-op and swollen...
it might be one of the most useful tools in your house right now.

But most people use it completely wrong for swelling.

To use it for swelling, you need to understand the mechanism for how and why it works...

The lymphatic system... the system responsible for clearing fluid and waste from your tissues...

relies on muscle contractions and movement as its primary way to "pump" fluid through the system...

And after surgery, especially lower extremity surgery,
movement and muscle contractions are limited.

You're not weight-bearing fully.
Your quad is inhibited.
The natural pump is offline.

So the fluid pools.

Most people try to solve this with a flow solution.
Rest. Elevate. Ice. Compress.

Those things have value. But they're treating a flow problem when you actually have a drain problem.

Think about it this way....

If your shower drain is slow... you don't fix it by turning down the water pressure.
You clear the drain.
You can't use a flow solution to a drainage problem...

That's exactly what we're doing here.

The lymph node clusters are your drain.
For the lower extremity... all lymph roads lead to the left collarbone (A).

That's 'pumping station' number one.
Then the front side of the hip (B),
Then the groin (C)...
then behind the knee (D)...

Work the gun at each pumping station for 60-90 seconds in order...
then reverse it.
A-B-C-D, D-C-B-A
Open the drain before you push anything toward it.

Then work from the swollen area proximally... toward the drain...
using the gun to move fluid in the direction the lymphatic system is supposed to take it.

You're replacing the muscle pump that surgery temporarily took offline.

Save this.
Send it to someone who just had surgery and doesn't know why they're still so swollen.

📍 The Movement Underground | Seaford, Long Island, NY

Your low back pain might not be a back problem.
It might be your back doing your hip's job...
That's what we in the biz call "Athletic Low Back Pain."

Here's what that actually looks like in practice...

This athlete came in with low back pain that gets worse with walking, worse with running, and worst with sprinting.

History of pars stress fractures.
Intermittent flares that nobody has fully explained.

So we assessed how he moves, and not just his MRI report.

Limited hip internal rotation.
Limited hip extension.
Limited great toe extension.

That combination is a story.
And it tells a tale as old as time...

Every running stride requires the hip to extend behind the body.
When the hip can't get there...because of its own movement constraint...
Your body finds extension somewhere else.

The lumbar spine...

Walking is uncomfortable.
Running is worse... the hip extension demand increases.
Sprinting is the worst... you're now at max demand on a system that's already borrowing from the wrong account.

And the pars stress fracture history?
That's what happens to the posterior elements of a spine asked to do too much extension, too often, for too long.

This is what we mean when we say biomechanics matter...
not for everyone, not as a universal explanation either...

but for athletes with a specific movement trigger, a clear movement constraint, and a history that connects the dots?

The assessment changes everything.

The fix here isn't "strengthen your core."
It's build real hip extension and mobility into his strength work.

And dose the running more conservatively while we close that gap.
Save this if you run and have "Athletic Low Back Pain"
(Yes, this can be you even if you're not an "athlete")

📍 The Movement Underground | Seaford, Long Island, NY

Most athletes think the first two weeks post-op are just waiting.

They're not.
They're one of the most important windows you have.

Here's why we get post-op athletes in as early as possible...
even when there's still a lot they can't do.

Because there's still plenty they CAN.

Swelling is the first enemy after surgery.
Not just because it's uncomfortable...
but more so that swelling in a joint actively inhibits the muscles around it.

Its harder to build a connection to the muscle, if swelling around the joint is shutting things down.

And the longer that fluid sits, the harder everything downstream becomes.
So we go after it early.

Lymphatic drainage — hands-on, percussion, or NMES pumping —
to actively move fluid out of the joint instead of waiting for the body to handle it alone.

Early mobilization...
not overly aggressive or stupid loading...
just reintroducing controlled movement to a joint that was just operated on.

Keeping the tissue supple.
Keeping the nervous system engaged.
Preventing the stiffness that turns a 2-week setback into a 6-week fight for 3 painful degrees of motion.

And the piece nobody talks about enough?

Early wins.
The mental side.
Making progress versus sitting and degrading more.

An athlete who just lost their sport to surgery needs to feel like they're doing something.
Every session where they leave feeling better than they arrived
changes the trajectory of the entire rehab...
not just physically, but mentally.

The standard approach says wait for the swelling to go down before starting PT.

We say...
start the process of making the swelling go down.
That's a huge difference in approach.

📍 The Movement Underground | Seaford, Long Island, NY

This is what pain science education looks like in real life.

Not a podcast soundbite that sounds smart.
Not a dissertation about central sensitization that is over their head.
Not a provider explaining that pain doesn't equal damage from a zoom call...
This.

An engaged clinician, treating, having a real, genuine, conversation while delivering care.
Explaining what the treatment is and isn't doing...
Explaining what adaptations would be favorable to train for...
Explaining what we're going to do about it, and what their role and responsibility in the process looks like.

Trust, Accountability, Encouragement.

Pain science didn't 'kill' manual therapy.
It's probably the best argument FOR manual therapy that exists.

Pain science didn't prove hands on care 'doesn't work.'
It just proved theres more to it than hands and tissue...

It shows us that...
👉 The therapeutic relationship matters more than we think.
👉 Being cared for changes the pain experience.
👉 Feeling heard, understood, and treated, not just processed, shifts the nervous system's threat response.

That's not anecdote. That's the literature.

So when I see clinicians online use pain science as the reason they stopped touching patients, stopped treating people, stopped delivering hands-on care...
because pain science is "better"... I laugh...

That's not evidence-based practice.
That's your preferred business model masquerading as a clinical philosophy.

Selling online programs SCALES better than in-person, hands-on therapy.
That does not mean it SERVES the client better.

There's a version of pain science education that empowers people...
that teaches them their pain is real, understandable, and addressable, while doing the work to help them move forward.

And there's a version that tells people their pain is about sensitivity and sends them home.

One of those is care.
The other just calls itself evidence-based because nobody's checking.

We aren't the same.

Save this if you've been told hands-on treatment isn't "evidence-based."
Tell me I'm wrong in the comments.

📍 The Movement Underground | Seaford, Long Island, NY