Category Archives: Fitness

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7 Tips to Self-Treat Morton’s Neuroma

Do you have pain between your toes?  Does it feel like you are always standing on a pebble or have a lump in your socks between your toes?  This may be a Morton’s neuroma.  A neuroma is a painful condition that affects the ball of your foot.  It involves a thickening of the tissue that surrounds the digital nerve bundle.  A Morton’s neuroma is one of the most common types of neuromas, typically occurring between the 3rd and 4th toe, but can form between any of them.

Morton’s neuromas occur due to repeated stresses, irritation, and pressure at the ball of the foot, affecting one of the nerves that lead to the toes.  It’s effectively a repetitive trauma or overuse injury.  There is typically no swelling bumps or bruises with a Morton’s neuroma.

Symptoms:

  • Numbness or tingling affecting the ball of the foot, between the toes, and/or the toes themselves.
  • Sharp, stabbing or burning pains that are intermittent and only affect either the ball of the foot or toes (usually 3rd and 4th toe).
  • The sensation of standing on a pebble or marble or having a lump in your shoe or sock.
  • When running, the pain is often felt during the push off from the toes, prior to the swing through phase.

7 Tips to Self-Treat a Morton’s Neuroma:

1. Avoid wearing tight fitting, ill-fitting, and high heeled shoes.  Be sure that your shoes have an appropriately sized toe box.  In the case of athletic shoes (particularly, for distance running), extra room in the toe box can be beneficial as the foot will often swell during the course of the run.  If you wear high heeled shoes, consider wearing them less frequently and/or switching to a shorter heel.  Even wearing socks that are too small can potentially cause too much compression and lead to increased symptoms.

2. Orthotics.  Many people respond well to a rigid orthotic with an extension underneath the first metatarsal bone.  You may not necessary need custom orthotics.  Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles.  The blue tends to fit most feet, but a variety of options are available for customization.  In my experience, these insoles can last 1,000 to 1,500 miles easily.

If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.  Seek assistance from a professional who is a runner and has experience with treating other runners.  A full length orthotic is indicated.  Try to find one that has a little cushion over the hard rigid plastic portion.  This will significantly help with comfort.  Be sure to see a sample of any custom orthotics before you buy.  I recommend not buying any orthotics without a small layer of foam or cushioning.  The top layer can wear out, but hard rigid plastic without a cushion is too uncomfortable for most people to wear regularly.

3. Improve your foot mobility and strength.  Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) is often found in cases of a Morton’s neuroma as part of the biomechanical issues that lead to its development.  Complete with instructions and photos, this guide, Morton’s Neuroma Rehabilitation Exercises, outlines how to safely perform exercises in order to improve your mobility and strength.

4. Improve your balance.  Poor balance and proprioceptive awareness is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature.  Poor balance and weakness throughout the kinetic chain will cause the foot and ankle complex to have to work harder to compensate (potentially, overworking the tissues).  Also, weakness and balance deficits can lead to poor foot biomechanics.  Please refer to the Balancing on One Foot exercise in the Morton’s Neuroma Rehabilitation Exercises. 

5. Stretch.  It’s critical to maintain proper calf and foot mobility.  Be gentle in stretching any muscles or tissue near the painful site as to not aggravate the neuroma further.  Although the initial focus is on stretching the calf muscles, also consider a full lower body stretching protocol.  Tightness in the calf muscles and loss of dorsiflexion is a risk factor for many foot related disorders.  Work on improving general calf and ankle mobility with an emphasis on dorsiflexion.  Stretching shouldn’t cause more than a mild increase in pain or discomfort.  (If you are lacking mobility in any other part of your body, this is the perfect time to work on it.)

6. Mobilize the Foot.  Be sure to avoid the painful areas (particularly, near the neuroma site).  It’s critical to insure proper foot mobility in the ankle as well as the first metatarsal joint.  Poor mobility in the foot, specifically the first toe, will affect the biomechanics of the foot.  Proceed with great caution if you attempt to mobilize the tissue in or near the neuroma. 

7. Seek Help.  Research concludes that nearly 80% of all cases of Morton’s neuroma can be treated through conservative measures (as outlined above).  However, if you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing the condition.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.  You may need assistance in identifying the biomechanical cause of the condition in order to eliminate the pain and may need additional hands on techniques or modalities to help address the injury.  A custom orthotic may be necessary.  Other modalities, such as iontophoresis (a process of transdermal drug delivery by use of a voltage gradient on the skin either via a hand held machine or self-contained patch) or low-level laser therapy (LLLT), may be indicated.

More specific strategies to help you determine the cause of your Morton’s neuroma along with more thorough treatment and prevention strategies for those suffering from a Morton’s neuroma are covered in the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.

What’s Inside the Resilient Runner Program:

  • Guidance on preventing and self-treating common running related injuries, including Hip Flexor Pain, Runner’s Knee, IT Band Syndrome, Piriformis Syndrome, and more!
  • Specific guidelines on when and how to return to running after experiencing an injury.
  • Rehabilitation guides with step-by-step photos demonstrating recommended exercises.
  • Step-by-step instructions on how to apply Kinesiological tape.
  • Downloadable podcasts, videos, and more!

If you’re tired of ongoing aches, pains, and injuries, learn how to become a resilient runner so that you can continue to train and compete in order to meet your goals!

I WANT TO BE RESILIENT!

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Plantar Fasciitis? Do this First Thing in the Morning

Plantar fasciitis is a very painful and potentially very debilitating condition. It’s one of the most common causes for heel and/or bottom of the foot pain. In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk. It’s typically at its worst in the morning with your first several steps after sleeping.

In this video, I demonstrate a simple, yet effective warm up to perform whenever you get up from sitting or lying down to prevent foot pain from plantar fasciitis.

Since the tissue on the bottom of the foot tightens as you sit or lay down for any length of time, be very intentional about preparing this area BEFORE you walk. This will lessen the pain and speed recovery. This is why I recommend doing this warm up throughout the day and especially, first thing in the morning.

CLICK HERE TO WATCH NOW

Be sure to check out my post, How to Self-Treat Plantar Fasciitis, for more tips! If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by following The Physical Therapy Advisor!

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Want Stronger Hips? Do This

Many lower extremity overuse injuries can stem from poor hip strength. The hip plays a critical role in determining how the foot will actually impact the ground and ultimately how the force of that impact will translate back up the leg. In other words, the hip is a critical component of the lower extremity kinetic chain.

Weakness in the hip musculature (particularly, hip abductors and hip external rotators) will often lead to knee pain as well as many foot and lower leg overuse injuries not to mention pain in the hip itself. Plantar fasciitis as well as knee pain may be caused by hip weakness.

In this video, Hip Strengthening with Band, I demonstrate a unique and advanced exercise designed to specifically strengthen your hip and lower leg in order to address common muscles imbalances found in the hip musculature. It’s a different version of the monster walk using a pull up assistance band. Addressing these muscle imbalances can lead to the permanent resolution of your pain and symptoms.

CLICK HERE TO WATCH NOW

Be sure to check out my other videos, Treating Hip Impingement: Basic Techniques and Treating Hip Impingement: Advanced Techniques.

If you’re interested in more thorough guide along with other videos on how to self-treat lower extremity injuries and pain, check out the Resilient Runner Program. This is the perfect guide to help you take control of your health and fitness as well as self-manage common aches, pains, and injuries. Even if you’re not a runner, this program is appropriate for those who love to stay active and want to enjoy a healthy lifestyle.

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by following The Physical Therapy Advisor!

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How to Self-Treat a Calf Strain/Pull

https://www.marathontrainingacademy.com/calf-strain-pull

Marathon Training Academy

April 20, 2021

In this guest post for Marathon Training Academy, I address the factors that increase your risk of developing a calf strain/pull. You will learn how to recognize the symptoms and how to self-treat this condition so you don’t lose too much time with your training. Continue Reading

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Is Back or Sciatic Pain Preventing You from reaching Your Exercise Goals?

We all know the importance of exercise, fitness, and generally staying active in order to age well. For many, exercise and fitness is a way to have fun and stay in shape. Others use activity to manage stress or chronic illnesses (such as diabetes, osteoporosis or heart disease). The benefit of consistent exercise has a positive effect on our physical, mental, and social well-being. It can be very disappointing when low back or sciatic pain prevents you from reaching your exercise goals.

Low back pain (LBP) or sciatic pain is the most common injury/pain complaint for those in the western world. LBP is estimated to affect nearly 80% of the U.S. population at one time or another. Worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.

How can you address your back or sciatic pain in order to get back to doing the activity that you love (whether that is walking, running, or hitting the gym)? First, you need to assess your risk factors.

Risk Factors for Low Back Pain (LBP) or Sciatic Pain:

  • Sitting too much.
  • Slouched sitting.
  • Prior episodes of LBP.
  • Smoking.
  • Poor core and back extensor muscle strength.
  • Lack of a proper warm up and a cool down.
  • High training volumes with inadequate rest (overtraining syndrome).

Some of the specific risk factors for LBP are also risk factors for other types of injury. Lack of adequate core strength (particularly, strength in the outer core and pelvic/hip musculature) can contribute to other types of injuries, so it’s an important to address the weakness sooner rather than later.

Consider the amount of repetitive force your body must absorb even with walking (not to mention during sports or exercise). The outer core muscles are responsible for movement of the trunk and spine as well as aiding in stability. (Although critical for stability, the inner core muscles don’t actually produce any trunk or spine movement.)

The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Imbalances or a lack of strength within the core musculature often will manifest in altered lower body mechanics and an inability for the body to properly absorb and distribute forces. Over time, the body’s tissues eventually break down and can lead to a repetitive use injury in the lower extremity.

As a physical therapist, I always assess the core and hip musculature and look for imbalances in strength when determining the root cause of low back or sciatic pain. In the majority of cases, I find that a component of hip and core muscle weakness has led to the pain.

The good news is that this is a completely preventable problem. Most of us already know that we need to cross train and that proper core strength is important. However, too many of us either don’t dedicate enough time to the process or we aren’t performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for low back pain (LBP).

Proper core and lumbar extensor strength is the key to preventing an episode of LBP and is also a critical step in avoiding other types of injuries affected by weakness in the core and pelvic/hip muscles. The most important factor in meeting your exercise goals is to be consistent. Don’t let low back or sciatic pain prevent you from staying active and enjoying your favorite activities.

Treatment for back or sciatic pain doesn’t have to include addicting medications, scary injections, surgery or high medical bills. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

The Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package includes:

AVAILABLE NOW ON AMAZON!

Treating Low Back Pain during Exercise and Athletics eBook

In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain. LBP has reoccurrence rates as high as 90%. If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management. Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level. Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies.

 7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics. An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

Save 15% with discount code LBP

“As a long time back pain sufferer I can honestly say I’ve tried it all. True LBP will make you desperate enough to try anything. Long story short – Ben Shatto truly rescued me from this vicious pain cycle. Ben’s methods of physical therapy whether it’s hands on treatment or this amazing video packet, his methods prove to be cutting edge and highly effective. Healing takes work and this video package is a fantastic foundation for the healing process to ignite!” –Sandy

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When Can I Return to Exercise after having Low Back or Sciatic Pain?

“When can I return to my normal activity after experiencing an episode of severe low back or sciatic pain?” is a question I am often asked as a physical therapist. Low back pain (LBP) and sciatic pain can be so severe and debilitating that it can completely derailing your training and lifestyle! It’s hard to run, exercise or even move if your back, buttocks or leg hurts.

Believe it or not, in spite of what your back or sciatic pain is telling you, initial activity and exercise are a critical component to treatment and recovery and is backed by extensive scientific research. 

Everyone’s experience with low back or sciatic pain is different. The severity of pain can widely vary. For some, even walking normally can be difficult. A guide for which exercises and movements to perform is critical in order to successfully return to activity.

One crucial indicator that you’re ready to taper back into more regular activity (as you progress your rehabilitation-based exercise) is whether or not you can walk with a normal gait. In particular, can you walk normally with a longer stride length during your normal gait cycle?

The ability to walk normally (notice that I didn’t say without discomfort) is an important milestone. It means that the spine is being stabilized well enough from the core musculature and that the nerves in the leg are not too tight or inflamed to tolerate and accommodate for the stretch that will occur from other activities.

If you are unable to walk normally, then the emphasis should be on regaining lumbar and lower extremity range of motion in addition to performing core and lumbar stabilization exercises. Limit your sitting, but do not try to taper back into other activities (at least not yet).

It’s critical to remember that everyone’s recovery will be different. Recovery and tapering back into your normal activities should be entirely symptom dependent. Listen to your body on what it can handle. The pain will tell you if you need to stop.

When to Return to Exercise after having Low Back or Sciatic Pain:

Follow the rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. You must stop that activity. If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving.

  • Don’t resume your running, jogging or other training activities until you can walk normally at a quick pace.
  • Be sure to slowly taper back into your training as your back begins to feel better. Don’t quickly resume your prior training volume. Instead, taper back up.
  • Prior to activity and training, perform a very thorough warm up (including press-ups, superman exercises, and bridging). Then transition into an activity specific warm up.
  • Continue with a core and lumbar strengthening program at least until you resume your full volume of training.

Prior to returning to your full and normal training activities, insure the following:

  • Complete lumbar mobility has returned.
  • You no longer have sensations, weakness or instability within the spine.
  • If you experienced leg pain, your involved leg is as flexible as the other. The pain is now either gone or centralized (meaning that you’re not experiencing pain in the leg).
  • Your hip mobility on both sides is equal.
  • Your involved leg is as strong as the other leg, particularly hip abduction (glutes medius) and the hip external rotators. Test this by jumping up and down on one leg. Do you feel strong? Is there pain associated with this? If the strength isn’t there or the pain remains, you are not ready to taper up to full training activities.
  • You can jog, run, sprint, and jump without pain.

With proper treatment, low back or sciatic pain should resolve in as quickly as two weeks. Severe episodes can take 4-6 weeks or longer. Continue with your rehabilitation protocol until you’re performing all exercises normally.

Treatment for back or sciatic pain doesn’t have to include addicting medications, scary injections, surgery or high medical bills. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

The Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package includes:

AVAILABLE NOW ON AMAZON!

Treating Low Back Pain during Exercise and Athletics eBook

In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain. LBP has reoccurrence rates as high as 90%. If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management. Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level. Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies. 

7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics. An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

Save 15% with discount code LBP

“As a long time back pain sufferer I can honestly say I’ve tried it all. True LBP will make you desperate enough to try anything. Long story short – Ben Shatto truly rescued me from this vicious pain cycle. Ben’s methods of physical therapy whether it’s hands on treatment or this amazing video packet, his methods prove to be cutting edge and highly effective. Healing takes work and this video package is a fantastic foundation for the healing process to ignite!” –Sandy

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3 Mistakes Athletes and Weekend Warriors make that cause Low Back Pain

As low back pain sufferers already know, it’s very difficult to exercise and train at a high level when you are experiencing low back pain (LBP). Nothing will derail your best laid training plans and routines faster than a severe episode of low back pain. LBP is the most common injury and pain complaint for athletes and non-exercisers alike. It’s estimated to affect nearly 80% of the U.S. population at one time or another, and it’s one of the top reasons for physician visits.

Fortunately, most LBP is mechanical–meaning it’s from a physical or structural cause not related to conditions such as cancer or infections. The problem with this type of LBP is that it usually comes back. People who have had an episode of mechanical LBP are 90% more likely to experience it again.

If you want to train hard and compete at a high level or even just enjoy the weekend’s events, then avoiding LBP is critical. Avoiding the following three most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services. More importantly, avoiding injury and LBP insures that you can keep training to your heart’s content!

The 3 Most Common Mistakes:

Sitting too much.

Prolonged sitting (and especially, prolonged sitting on a vibrating surface) is one of the biggest risk factors for LBP. Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments. Even if you exercise regularly, many of us still work in an office setting which forces us to sit more than we should. This excessive and prolonged sitting not only impacts our spine, but it also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function.

Even if you are running, exercising, and training during most days of the week, we all spend too much time sitting. To make this worse, many of us are sitting with chronically poor posture.

  • Limit the amount of sitting that you spend at one time. Ideally, move from your sitting position every hour to walk preferably. If you aren’t able to walk, then try to shift your position at least once every twenty minutes. Frequent position changes can help you to avoid LBP. Avoid a long car trip directly before or after a long run, race or event. For destination events, it’s best to arrive at least a day or two early and wait a day prior to returning home.
  • Sit with correct posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.

Poor core training.

Everyone has heard about the benefits of core training. However, most people aren’t doing it correctly. This isn’t about sit ups or crunches. Proper core strength involves training your abdominal muscles and back extensors to produce a rigid cylinder when exercising and moving. The core muscles are not prime movers, but stabilizers. They must be trained this way. The strength needs to be proportional front to back to insure this rigid cylinder for proper spinal stabilization. In general, most of us don’t spend enough time strengthening a key core muscle in back known as the multifidus (shown below) nor do we spend enough time strengthening the back extensors in general.

The core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form a round rigid cylinder that is utilized to support the spine. Ligaments and boney articulations are also important in spinal stabilization. Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).

  • The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown above). The TVA wraps all the way around the stomach and attaches to the spine. This is what helps to form the cylinder. When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
  • The other muscles that help to support the spine are known as the outer core. These muscles are responsible for movement of the trunk and spine as well as aiding in stability. The inner core muscles do not actually produce any trunk or spine movement. The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Those who work on core strength may not be performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP.

To learn how to effectively exercise and work the core muscles in order to prevent or self-treat LBP, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package. USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

Not performing a proper warm up. 

An adequate warm up should always be performed to help minimize the risk of injury and maximize your ability to perform at an optimal level. A proper warm up should include: a cardiovascular warm up; a dynamic warm up; a specific spine warm up; and when indicated, a sport specific warm up.

Cardiovascular Warm Up

To properly prepare the body for activity, the first stage of the warm up is to increase blood flow throughout the body, but in particular, to the core muscles and spine. I recommend approximately 10 minutes as this allows for better mobility in the joints and tissues of the body. It starts to prime the nervous system for activity. It also promotes healing as movement is necessary to bring in the nutrients necessary to heal (if there is already damage or an injury). The cardiovascular warm up will vary and is dependent on your activity or sport.

Dynamic Warm Up

After the initial cardiovascular warm up, progress into a dynamic warm up series. This will typically involve warming up the muscles and joints of the spine, pelvis, and lower legs.

The purpose of the dynamic warm up (specifically in the lower extremity) is to insure adequate mobility in the areas that will be involved in the activity. This will almost always include the hamstrings, hips, and pelvis. Adequate lower leg mobility is important in order to perform your specific exercise or activity. The more motion that can occur through the pelvis and legs, the more force can then be generated and passed through the pelvis.

More mobility in the lower legs and pelvis means less need for mobility in the spine. This means less stress during motion will be placed on the spine—therefore, decreasing your risk of injury. The point is to maximize spinal stability and encourage movement through the hips, pelvis, and upper thoracic.

One example of this is to mobilize your hamstrings by using the foam roller (as demonstrated below).

Spine Specific Warm Up

I am a big proponent to performing a very specific spinal muscle warm up upon completion of the cardiovascular and dynamic warm ups. Since you may have already experienced an episode of LBP, a very specific and thorough warm up is important for prevention. Priming the specific muscles of the core (particularly, the multifidus and lumbar extensors) is a critical step to avoiding re-injury. The multifidus is a critical muscle in preventing LBP and must be active to properly stabilize the spine. It helps to prevent shearing forces from affecting the spine which is critical to avoiding LBP.

Examples of a spine specific warm up may include performing press-ups and the superman exercise (as demonstrated below).

Sport Specific Warm Up

This warm up will vary significantly depending on the type of endeavor you are about to participate in. For example, a sprinter will need a very different warm up compared to an ultramarathon runner or someone performing in a CrossFit competition. For runners, the warm up varies. Are you racing on a flat course or are you heading out for a very hilly trail run?

It’s important to evaluate the requirements for the event and be ready to perform the actual movements required to compete at a high level. A proper warm up allows your body to immediately perform at its peak and reduces the risk of injury. Regardless of the sport or event, this is also the perfect time to make sure all of your equipment is appropriate for the conditions of the event.

Don’t skip the warm up regardless of your training or event time and/or location! You may be the only one performing a thorough warm up, but it’s because you understand the importance of one in order to prevent LBP and to improve your performance.

It’s important to identify the common mistakes that can cause LBP. By implementing these prevention strategies, you can avoid injury and keep training. Fitness is a lifelong pursuit. If you are injured or just not having fun, then you will not stay engaged and motivated in the long term. Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP. In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!

I WANT TO GET RID OF MY BACK PAIN!

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Fitness Exercise Won’t Help Your Low Back Pain

It’s estimated that approximately 82.1 million adults in the United States spend an estimated $28.6 billion on gym memberships each year! Now combine that staggering number with the estimated $50 billion dollars plus spent annually on back pain related issues. Even with the general fitness craze we have seen over the past years, low back pain (LBP) remains one of the most prevalent medical conditions treated in the United States and throughout the western world. It affects nearly 80% of the U.S. population at one time or another. It’s one of the top reasons for physician visits and one of the most common reasons for missed work days.

With so many active individuals and crazy fitness trends you would think that all of this exercise would actually help reduce low back pain, right? Wrong…It turns out that not all exercise (and especially, not all “core” exercise) is created equally.

It’s time to address how to safely self-treat your low back pain through movement and exercise as well as some helpful methods for a speedy recovery. (Not to mention, possibly saving you time and money by avoiding a physician visits for pain you can manage safely and independently with a little instruction.)

To safely self-treat your low back pain, first take a moment to assess your symptoms and pain level. What led to your pain and/or injury? Did the pain come on suddenly or slowly? Evaluate the severity of the injury. If you’re experiencing any of the following, please seek immediate medical attention:

  • Loss of bowel/bladder function.
  • Uncontrollable pain. The pain is so severe you cannot function or move.
  • You are losing muscle function or control. The muscles in the legs will no longer work. (This is different than pain preventing the muscle from working.) This sensation of paralysis occurs when the muscles will not actually function.
  • Significant loss of sensation in the leg or groin area. This is not a tingling sensation, but an actual loss of sensation. For example, you cannot feel the toilet paper when you wipe after using the toilet.
  • Onset of pain without any known mechanism for the injury. (Thoroughly consider your activity. Many times, a slow onset of pain begins several hours after performing an activity.)

Fortunately, most LBP is mechanical–meaning it is from a physical or structural cause and isn’t related to conditions such as cancer or infections. Most LBP will have a directional preference for extension. A majority of injuries occur when performing a forward biased (flexed movement) like chronic slouching or a spinal flexion biased movement. For discussion purposes, I will be addressing an extension biased program.

With mechanically driven low back pain, you should be able to alter and change your LBP within a short period of time. First, establish a directional preference by identifying a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement?

Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try flexion biased movements. In my experience, most episodes of LBP tend to respond better to extension biased movements. If flexion or extension doesn’t help or change the pain in any way, then you may need assistance from a medical provider.

The rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. We must stop that activity. If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving.

Although most LBP isn’t considered serious, the pain tends to re-occur. One major reason for this is that the deep stabilizing muscles known as the multifidus muscles reflexively shrink, weaken, and lose function. Without proper rehabilitation, the muscles will not fully recover. This increases the risk of future episodes because the spine no longer has the ability to stabilize itself normally. Not all “core” work is created equally, so the strength of these muscles needs to be addressed.

How to Safely Self-Treat Low Back Pain:

Perform Press-ups

Once you have injured your back, immediately start press-ups. Perform this exercise with high repetitions and frequently throughout the day as long as the pain does not periperalize down the buttock and into the leg and/or foot. Lie on your stomach and perform 10-20 press-ups. Move slow and easy, but work your way up to full motion multiple times a day.

Perform Standing Back Extensions

After sitting, stand up and perform standing back extensions. Ideally, perform this exercise at least 10 repetitions each time you stand.

Activate the Multifidus

Start exercises to activate the multifidus muscles as soon as possible. Think spine extensor muscle activation. Again, perform this exercise frequently during the day after the initial injury. These Lumbar Extensor Exercises are designed to progressively activate the multifidus muscles (with the final exercise being the most challenging). Once the pain subsides and muscle function improves, more advanced lumbar extension strengthening and stabilizing exercises should be performed to decrease your risk of re-current low back pain.

Don’t Sit

Walking is critical to your recovery! It’s the number one way your spine receives nutrients and disposes of metabolic waste products. Walk frequently, and try to avoid any prolonged sitting.

If you Sit, Use Good Posture

Use a McKenzie Lumbar Roll to help insure a good lumbar curve. If you can’t sit comfortably, listen to your body and don’t sit! Be sure to stand up and walk every 20-30 minutes. Stand with good posture as well.

Stretch the Muscles of the Legs and Pelvis

Hip flexor and hamstring stretches can help to reduce muscle spasms and tightness throughout pelvis area when performed daily. Stretch for at least 30 seconds at a time, 2-3 times each session.

Be as Active as You Can

Don’t stop moving, but avoid exercises that make your back hurt more. Typically, this includes flexion biased movements like sit ups. It’s important that you remain as active as you can. You may need to taper down certain activities that you know will increase your pain. This typically would be activities involving heavy loading of the spine such as squats with weight, deadlifts, and other activities that may cause forward flexion (particularly under a load).

As you are able to, continue to work on cardiovascular conditioning and core muscle activation (particularly, the lumbar extension exercises). Basically stay as active as you can, even lifting weights if you are able.  Just remember the concept of peripheralization and centralization. If your pain progresses from the area of the injury into your leg, then you need to stop that activity. If the pain remains constant or is progressing out of the leg, then continue with the activity as you are helping the body to heal.

Developing adequate strength in the lumbar extensor muscles and core musculature is the primary way to prevent initial episodes and to prevent reoccurring episodes of LBP. Research clearly indicates that the right targeted exercises are the most effective way to manage LBP. 

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package. USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

Want to peek inside the video content? Watch now as I describe what really the “core” is and why it matters.

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If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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Why We Can Be Our Own Worst Enemy

I must warn you that this is not the typical post from me. All of the information is true and sadly, not exaggerated in any way. My hope in documenting this true account of events is that it will help others know how to better avoid injury. If you do develop an injury, then maybe some of my self-treatment strategies could be helpful.

What most people don’t know about me is that I have struggled with low back pain (LBP) for over 20 years. Early on, I had years of constant and chronic LBP. This pain helped drive me to seek out different self-treatment methods. I began to understand LBP along with the best practices on how to self-manage and most importantly, avoid future flare-ups. This has personally helped me manage my own pain while helping thousands of others either directly with physical therapy or by sharing my book, Treating Low Back Pain during Exercise and Athletics.

Even with all my diligent efforts (most of the time), the occasional LBP flare-up occurs. Unfortunately, the last incident was due to poor judgement on my part. In early November of last year, I had been sitting a lot while working on a few projects, and my back started to ache. It was mild at first. However, by mid-month, I could hardly get out of a chair and walk.

As a physical therapist (PT) that specializes in treating LBP, I should have known better, but I chose to do what most people do. I ignored it, and pressed on. I reminded myself that I’ve had this pain before, and it typically goes away. Right then, I didn’t have time to address it.

Monday morning rolled around, and I was scheduled for my 5 mile tempo run. As any runner or exercise enthusiast knows, if it’s scheduled, then it must be done (no matter what, right?). I was sure my back would loosen up as I ran. Often times, a warm up prior to running makes it feel better. (If I was being honest, the pain was pretty bad that particular morning. It was preventing me from sitting, getting out of my car, and even walking straight. Was that a good enough reason to cancel a run?)

I managed a short walking warm up since that was all I could muster and proceeded into a slow jog. About 2 miles into my jog, my right calf started to hurt. Why stop? I was sure it would all shake loose soon…

As mile 3 approached, I was falling apart. My back hurt to the point I couldn’t stand up straight. My right calf was completely locked up. It was giving me a sharp pain with every step. The bottom of my left foot started aching. I finally shut it down and limped home.

Later that day, my calf wasn’t any better (neither was my back), and now I had full on plantar fasciitis. Pretty good start to the week, but I got that run in. By the end of the day Monday (post run), I was miserable, but I didn’t dare tell anyone.

As a PT, I should have known better. I started to analyze exactly what was going on. For some reason, my disc bulges (a pre-existing problem at L4/L5 and L5/S1) had flared up for no apparent reason and were hurting terribly. My back pain had caused a left lateral shift in my spine, which meant I couldn’t stand normally. The nerve tightness down my left leg affected my walk, so I could not fully stride out.

In hindsight, my sad attempt at a run early that morning was actually a terrible idea! I had obviously been running with a poor gait pattern. This altered gait pattern with poor running mechanics resulted in a right calf strain and the development of plantar fasciitis in my left foot. (And this all started in 3 miles!)

My initial treatment was to determine my directional preference for my lumbar spine pain:  

A directional preference is a way to identify a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement? Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try moving in the opposite direction. If you were moving into flexion, try extension. If you had trialed extension biased movements, try flexion. Find the movement pattern that helps the pain improve and that has a positive effect on any other symptoms you may be having.

I determined my directional preference. As I performed my series of movements, my symptoms were peripheralizing (returning back to the middle of my back to the point I could stand straight and walk normal).

After a series of 10 side glides followed by 10 press-ups (as demonstrated below), I could eliminate 75% of my LBP and symptoms as long as I didn’t sit. Sitting would immediately bring the pain back on. For the next several weeks, I avoided sitting at all costs including during dinner.

I also started back extensions over an exercise ball (3 sets of 15 repetitions as demonstrated below) every morning as part of a lumbar strengthening program. I chose back extensions to insure that I was working my lumbar extensor muscles. I kept my movement patterns within my directional preference. This was preceded by and followed by side glides and press-ups as well as continuing to avoiding sitting. I stopped running since I couldn’t fully walk or jog without an altered gait pattern.

For my calf, I started foam rolling and stretching regularly. I used a mobility band (as demonstrated below) as a way to provide compression while I performed heel raises (typically a set of 20-30 repetitions). Thankfully, I had the opportunity to trial a product that not only utilized the compression from the mobility band, but added a way to self-mobilize the calf. The CTM Band worked exceedingly well for this. (“CTM” stands for compression, tension, and movement.) Use code MTA15 for a 15% discount. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)

For my plantar fasciitis, I also performed calf stretches as well as used a small ball (as demonstrated below on the left) to mobilize the bottom of my foot. Pain in the morning seemed to be the biggest issue, so I would sit up and stretch before getting out of bed (as demonstrated below on the right). By the end of the day, my foot would really start to hurt. Since I was unable to sit due to my back, I used a padded stool to kneel on whenever possible.

I continued this treatment plan for over 3 weeks. For the first 2 weeks, I was unable to run, so I concentrated on rehabilitation exercises only. During this time, I utilized a self-prescribed course of over-the-counter Ibuprofen (anti-inflammatory). I didn’t have any medical issues with taking this medication. Please consult your physician before taking any medications or supplements.

I also initiated a supplementation protocol consisting of adding collagen hydrolysate to my daily smoothie as well as taking CapraFlex by Mt. Capra. (It combines an organic glucosamine and chondroitin supplement with other natural herbs and enzymes which are designed to reduce inflammation, promote bone and joint healing, and wellness.)

This continued for approximately 4 weeks. The rationale behind the supplementation was to insure that my body had the necessary building blocks to heal and to provide additional anti-inflammatory support to my body during my recovery.

After 3 weeks, I returned to running for only shorter distances (under 5 miles). I was tapering back into other exercise routines with appropriate modifications which included increasing my warm up and cool down times and avoiding bending forward since I wasn’t 100% better.

The reason I chose to share my most recent LBP episode with you is because I have heard versions of this story over and over again from other runners, weekend warriors, and patients.  We really can be our own worst enemy!

As a PT, I should have known better than to run that day. As a runner and weekend warrior, the feeling that it may be a “mortal” sin to miss a scheduled run or work out can be a powerful temptation to do it even though your body may be telling you to reconsider.

As any frequent exerciser knows, a few aches and pains is par for the course. In fact, it’s pretty normal! Oddly, I will have just as many if not more, aches and pains when I stop running and exercising as when I’m regularly training.

The moral of my story is a reminder to be very self-discerning and self-aware to understand what is a typical ache and pain versus something more serious. In my case, not being able to walk normally due to pain should have been a clue not to run abnormally either. My abnormal running pattern that day is what led to the overuse injuries in both my calf and foot. What was surprising even to me was how fast the pain developed and turned into a true overuse injury in only the course of 3 miles!

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

SAVE 15% NOW!

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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A Year in Review: 2020

The COVID-19 pandemic and the events of 2020 have impacted all of us. Through this hardship, we have learned the importance of working together and being proactive in taking control of our own health and well-being. Working together and supporting one another makes taking the necessary steps to age well easier and more fulfilling. Being proactive is a key component to aging well.

The purpose of The Physical Therapy Advisor is to help people like you to take control of your health and to save money by learning how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions safely and effectively.

A recap of my top 3 posts that resonated with you the most in 2020 include:

The Clamshell: A “go to” Exercise for Treating Foot, Hip, and Knee Pain – The clamshell exercise is a commonly prescribed exercise designed to target the hip abductors and hip external rotators. However, this exercise is often performed incorrectly or ineffectively. In this video post, I demonstrate my preferred method of performing the clamshell exercise in order to insure optimal effectiveness.

3 Easy Exercises to eliminate Wrist and Elbow Pain – In this video post, I describe three easy exercises to help you quickly eliminate pain in your hand, wrist, and elbow. I demonstrate two simple stretches with an easy variation to improve their efficacy and teach you how to easily improve your hand and wrist strength using a simple rubber band.

How to Improve your Recovery from Injury, Illness or Surgery – In this guest post for Smart Strategies For Successful Living, I share two basic reasons why nutrients are not getting to the injured area. There is either a nutrient delivery problem (which includes proper intake) or there is a nutrient absorption problem. This may be affecting your ability to physically recover from injury, illness or surgery.

As 2020 comes to a close, more and more people are realizing the value of taking control of their health care and personal well-being. In today’s health care environment, we all need to learn how to treat common aches and pains proactively instead of reactively. We must truly focus on health and wellness care for ourselves, loved ones, and friends. Together we all can age well.

Thank you for supporting The Physical Therapy Advisor! I look forward to serving you in 2021! If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!