Posted on Monday, March 23, 2015

10 Tips to Self-Treat Overtraining Syndrome

Overtraining Syndrome (OTS) can affect any athlete in any sport or at any level. I have treated high school athletes to weekend warriors for OTS. Recently I have noticed more cases of OTS among CrossFit enthusiasts and runners of all distances. People are training harder and longer than ever before with wonderful results. At times, even the best of intentions can lead to not so desirable consequences. OTS usually starts with muscle soreness and a feeling of fatigue. Then it quickly progresses into a case of overtraining syndrome or injury. Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from. For my tips and strategies to prevent OTS, please refer to 12 Tips to Prevent Overtraining Syndrome. In this follow up post, I will specifically address how to self-treat OTS.

Overtraining Syndrome will significantly impede your performance and frequently leads to a serious injury. In OTS, your body isn’t able to adequately handle or adapt to the high volume and intensity of exercise that you are performing. If you develop OTS, you will need to take specific steps to speed up your recovery in order to prevent injury. Depending on the duration of symptoms and the severity of the case, OTS is a serious condition which can take a long time to recover from. OTS not only affects the muscular system, but also the circulatory system, the nervous system, and the hormone regulation system. Recognizing the warning signs early and being proactive in prevention will help you to avoid OTS. If you’re already suffering, use the following tips and strategies in your recovery.

10 Tips to Self-Treat Overtraining Syndrome:

Rest. One of the first and primary treatments for OTS is to rest. More rest is required the longer the overtraining has occurred. Therefore, early detection is critical. If the overtraining has only occurred for a short period of time (such as three to four weeks), then a brief three to five days of rest may be sufficient while implementing the following treatment strategies. After the rest days, slowly taper back into training at a lower training volume until recovery is complete. Typically, the intensity of training can be maintained as long as the volume is decreased. I also advise that you start an alternate day recovery cycle. Train for one day, and then take a day off. This will typically last for a few more weeks before resuming your normal training cycle. As you resume full training, it is important that the warning signs of overtraining are identified and corrected. In more severe cases, the training program may have to be interrupted for weeks or months for a full recovery.
Cross train. Opt for an alternate form of exercise to help prevent exercise withdrawal syndrome. If you are heavily participating in CrossFit or running, choose leisurely cycling and yoga as part of your cross training routine. The key is to keep both training volume and intensity low while preserving a baseline of fitness. Most of the medical studies on overtraining are geared toward single sport athletes. For triathletes and other multi-sport athletes, the recovery process may be different depending on the circumstances. If you can identify that the overtraining has occurred in only one discipline, then resting from that discipline (as well as significantly decreasing training in the other sports) may result in a full recovery. Don’t try to substitute more workouts in one sport in order to compensate for rest in another. This will only worsen the symptoms of OTS, which affects both the parasympathetic (PSN) and sympathetic nervous system (SNS). Resting from overtraining on the bicycle by swimming more will help to rest fatigued quadriceps. However, stress is stress to the cardiovascular, nervous, and hormone systems. Cross training is an important component in your recovery. Incorporate it in your typical training cycles as a method to limit your risk of injury. Cross training can make training more enjoyable as it keeps your body stimulated and ready for improvement. As you recover from OTS, the volume and intensity must be significantly reduced to allow for adequate rest and recovery.
Spot train your weak areas. In addition to cross training, use this recovery time to spot train your weak areas. Work on your mobility and balance as a prevention technique for areas that are prone to injury. If you have a history of low back pain or a prior knee injury, utilize this time to single out all those weak areas in an effort to prevent injury in the future. As you rest from your primary training routine while incorporating cross training, perform spot training as well. The Resource Guide includes a specific exercise section with rehabilitation exercises ranging from low back pain to knee pain. These .pdf files include photos and detailed descriptions to help you get started on spot training your weak areas. This is also an excellent time to work on the specific technical skills that your sport requires. It may include learning how to mentally manage your sport better.
Actively manage your aches and pains. Consider seeing a masseuse for regular body work. Another option is to use the foam roller after exercise to speed up recovery times and decrease the risk of muscle soreness or restriction. To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.
Acupuncture. Incorporating acupuncture into your recovery process can be very beneficial. Acupuncture can help to address a multitude of conditions which affect the nervous, muscular, and hormonal systems. All three systems should be addressed during the recovery process. Along with many of my clients, I have experienced wonderful results with acupuncture. I highly recommend an acupuncturist who specializes in sports medicine and has experience treating athletes. During acupuncture sessions, you can take time to specifically work on intentional relaxation and meditation which has the added benefit of addressing the nervous and hormonal systems.
Seek help early. If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately. A healthy lifestyle is a lifelong pursuit. If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term. Seeking advice specifically from an experienced coach, physical therapist, or physician can be beneficial.
Decrease the stimulants. It is important to take steps to help both the nervous and hormonal system re-regulate and rejuvenate. Often with OTS, the adrenals become overtaxed and the level of cortisol (a stress hormone) is too high. Intake of stimulants, such as caffeine, tends to worsen the condition. Remember, caffeine can be found in many pre-work out supplements, running gels, soda, coffee, and tea as well as some over the counter (OTC) medications. During your recovery phase, limiting chemicals that promote stimulation to the nervous and hormonal systems (particularly in regard to cortisol and adrenal function) will speed up your recovery. Once you have recovered and are tapering back into full training, I caution you in limiting stimulants as a prevention strategy for future episodes of OTS.
Eat healthy. A healthy diet is critical to avoid injury. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. In the case of OTS, I encourage that you consume a higher fat diet to help your body’s hormonal system re-regulate. Also, adequate protein intake is necessary to support muscle health and development. For more information on protein intake, please refer to How Much Protein Do I Really Need?
Hydrate more frequently. The human body is primarily made of water, which is critical for all body functions. In the case of OTS, I highly encourage you to hydrate more frequently during recovery. Adequate water intake is critical to avoid dehydration which can negatively affect your training. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce. Coconut water is a popular drink that offers vital nutrients. Also, consider a juicing cleanse with a heavy focus on the kidneys and liver to help detoxify the body.
Supplement. My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently. In the case of OTS, I also recommend a colostrum supplement called CapraColostrum by Mt. Capra. Colostrum is the first milk produced by female mammals after giving birth. It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors. It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut. Colostrum can also help a person more effectively exercise in hotter conditions. Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster. Like CapraFlex, Tissue Rejuvenator by Hammer Nutrition contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation. I recommend taking either CapraFlex OR Tissue Rejuvenator. You can take CapraColostrum independently or in conjunction with either CapraFlex or Tissue Rejuvenator. I recommend taking these supplements as a recovery strategy. I recommend initially trying a 30 day protocol. If the supplements are aiding your recovery, you may choose to continue taking them for an additional 30 days. I implement this protocol as part of a prevention strategy during times of heavy volume or high intensity training. (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol. Herbs could interact with some medications particularly if you are taking blood thinners.)

Overtraining Syndrome can be dangerous and severely limit your ability to train. It also significantly increases your risk of injury. A recovery protocol should include a multifaceted approach that incorporates strategies to positively affect the muscular, nervous, and hormonal systems.

Nothing can derail your best laid training plans and goals like an injury or suffering from OTS! If you develop OTS, you will need to take specific steps to speed up your recovery in order to prevent injury and return to a normal training schedule.

AVAILABLE NOW ON AMAZON!

In my book, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of OTS. You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”). This will speed up your results, so that you can train harder and more effectively than ever before! In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

Discover how you can continue to train hard and avoid the associated poor performance, illness, and injury that can result in lost training days and opportunity!

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Posted on Wednesday, March 18, 2015

12 Tips to Prevent Overtraining Syndrome

If you exercise or participate in any sport, then you have likely had some experience with Overtraining Syndrome (OTS). It usually starts with extra muscle soreness and a feeling of fatigue. These symptoms can quickly morph into a serious case of overtraining syndrome. Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from.

Although not well understood yet, research indicates two forms of OTS. One affects the sympathetic nervous system (SNS). The other primarily affects the parasympathetic nervous (PNS). Sympathetic OTS tends to affect sprint or power athletes. The resting heart rate tends to be elevated in the sympathetic form. Parasympathetic OTS tends to affect endurance athletes. In the parasympathetic form, the heart rate is even more decreased than typically found in endurance athletes.

There is no specific test for OTS. The diagnosis is usually determined when a number of factors or symptoms begin to manifest. Warning signs, ranging from mild to severe, include:

Fatigue (mild to severe)
Muscle and body achiness and soreness
A sudden drop in performance
A drop in strength
A drop in cardiovascular endurance
Insomnia or excessive sleepiness
Headache
Illness due to a drop in your immune function
Irritability and moodiness
Decreased appetite or weight loss
An increase in your resting heart rate
A decrease in your heart rate variability
A substantial drop in training capacity and/or intensity
Depression and a loss of enthusiasm for activities (such as training)

Avoid Overtraining Syndrome if you want to effectively train at a high level. It not only impedes your immediate performance, but it also substantially increases your risk of injury. Remember, recovery from a workout is a critical part in avoiding OTS. Your recovery routine should be an intentional and a multifaceted approach.

12 Tips to Prevent Overtraining Syndrome:

Keep a training diary. An exercise or training diary allows you to keep track of how you feel before, during, and after workouts. How did your body respond to training that day? How did you sleep? How was your food intake and nutrition? Also, record your heart rate response during your exercise session. Document as many variables as you can in order to look for patterns. Discover which combinations work well for you and those that have a negative effect on training. Focus on the positive and eliminate variables which cause negative effects. The diary helps you to keep track of it all. There are software programs available to assist in this as well. One such program popular with cyclists and triathletes is Training Peaks.
Monitor heart rate variability. Another potential warning factor for overtraining syndrome is heart rate variability (HRV). It is simply the variation in the time interval between heartbeats. HRV is affected by stress, hormone changes, and changes in the sympathetic or parasympathetic system. A decrease in parasympathetic activity or increased sympathetic activity will result in reduced HRV. A reduced HRV is a sign of OTS. The higher the HRV, the more capable your nervous system is able to adapt to stress. Many different apps can quickly measure HRV. Some apps are more accurate than others. The more accurate and precise the measurement, the more expensive the app. One free app that I use and recommend is Azumio’s Instant Heart Rate.
Monitor for OTS warning signs. Watch for the warning signs (listed above) and decrease your training volume if you are experiencing symptoms. Listen to your body.
Cool down. After performing your exercises, take the extra time to cool down and stretch. Choose exercises and activities that provide range of motion (ROM) to the particular area that you just trained or used. The perfect time to perform static stretching is after exercising. Work on tight and restricted areas. Keep moving throughout the day and avoid sitting for extended periods of time.
Foam rolling. The foam roller is a wonderful tool which allows you to manipulate the body’s soft tissues. This has a potential positive effect on the fascial system, the musculotendinous system, and the circulatory system. It can aid in recovery by improving blood flow and reducing myofascial restrictions. To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.
Active recovery. Every day shouldn’t be an intense training day. As part of your training cycles, be sure to include time to participate in other activities to help the body to recover and rejuvenate. Participate in a yoga class, take a leisurely bike ride, or take a walk in the park.
Proper periodization. You cannot and should not train at a super high intensity all year long. Your work volume needs to be properly periodized. Well-balanced gradual increases in training are recommended. Be sure your training plan varies the training load in cycles with built in mandatory rest phases throughout the year. The plan will likely be based on when you need to peak for certain events or races. During the high workload phase, try to alternate between high intensity interval work and low intensity endurance work.
Taper up the training volume appropriately. The 10 Percent Rule is a guideline that many fitness experts use to help athletes (of all levels) avoid injury while improving performance. Many cases of OTS can be attributed to increasing the intensity, time or type of activity too quickly. The 10 Percent Rule sets a weekly limit on training increases. The guideline indicates not to increase your activity more than 10 percent per week. That includes distance, intensity, amount of weight lifted, and/or time of exercise. For example, if you are running 30 miles per week and want to increase the distance, add 3 miles during the next week for a total of 33 miles a week. If you are squatting 200 pounds and want to increase, don’t add more than 20 pounds during the next week. The 10 Percent Rule is only a guideline. In some cases, 10 percent may be too much. Instead, a 5 percent increase per week may be much more realistic.
Rest more. Your body must rest in order to grow and develop. Training every day is not the best way to improve. It can lead to injury and burn out. Take a rest day and have fun. Sleep more. Proper programming includes mini cycles with an off season as well as active rest cycles in between heavy load and heavy volume training cycles. Don’t fear rest, embrace it!
Eat healthy. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development. For more information on protein intake, please refer to How Much Protein Do I Really Need?
Stay hydrated. The human body is primarily made of water, which is critical for all body functions. Adequate water intake is critical to avoid dehydration which can negatively affect your training. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.
Supplement. I take certain supplements during times of heavy training volume or when I am in a phase of overreaching. I also take them intermittently to help prevent injury or heal from one. My most recommended supplement is CapraFlex by Mt. Capra. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I also recommend a colostrum supplement called CapraColostrum by Mt. Capra. Colostrum is the first milk produced by female mammals after giving birth. It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors. It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut. Colostrum can also help a person more effectively exercise in hotter conditions. Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster. Both of these supplements can be used in heavy volume or intense training phases to help you to recover faster and avoid OTS. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

If you begin to experience any of the warning signs of OTS, be proactive about modifying your training. It is important to objectively measure your training routine and make adjustments before you become sick, overtrained or injured. Incorporate these recommended prevention strategies to help keep your training at a high level. In the follow up post, 10 Tips to Self-Treat Overtraining Syndrome, I specifically address self-treatment strategies.

If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately. Seeking advice specifically from an experienced coach, physical therapist, or physician can be beneficial.

AVAILABLE NOW ON AMAZON!

Discover how you can continue to train hard and avoid the associated poor performance, illness, and injury that can result in lost training days and opportunity!

BUY NOW

I am excited about presenting a Low Back Pain Seminar at CrossFit Station.

Date:	Saturday, April 11, 2015
Time:	10 a.m. – 12 p.m.
Location:	1396 E Iron Eagle Dr. Eagle, ID
Registration:	$25 Registration Fee (due by Friday, April 3)
More Info:	Contact Trina or Tony at 208.631.3410 to reserve your spot! Click CrossFit Low Back Pain Seminar for more information.

Event:	Low Back Pain Seminar

Posted on Wednesday, March 11, 2015

6 Reasons to Self-Treat and Manage Your Health

The United States spends more money by a wide margin than any other country on health care. Our health care system is set up to keep us from dying, not thriving. Our average life span barely makes it in the top 30 when compared to other nations. As it stands now, the American health care system is poorly equipped to help us maximize our health span. Health span is defined as a period of time in which a person is generally healthy and free from serious disease.

Health care costs in America continue to increase without actual positive change in our health status as consumers. It is imperative that we take a leadership role in our own health care by continuing to be proactive. Part of being proactive is learning how to care for and manage common non-life threatening injuries and illnesses. The medical system is not designed to help you to maximize your health and well-being. It is designed to prevent you from dying and to maximize profits for the corporatocracy that controls our health care system. It is imperative that we manage our health by learning how to self-treat non-life threatening and non-emergent injuries and illnesses.

6 Reasons Why You Should Self-Treat and Manage Your Health:

Money – Health care is expensive. Many of the most common treatments and fancy diagnostic methods are not necessary. Costs are only going to rise more in the future. As this occurs, it will be even more important to be able to take care of the simple common place injuries and illnesses. It will save you a lot of time and money!
Empowerment – There is nothing more important than your health. You have control of most of the aspects in your life that affect your health status. Taking care of yourself and your health needs leads to a sense of empowerment.
Improved Care – If you understand how to be healthy and take care of yourself, you will be able to assist your medical practitioner in making the best decision on how to manage your care. Remember, it is your body and your health. Being your own advocate will insure that you receive quality care.
Quicker Recovery Time – Often by taking out the middle man, you can help to increase the speed of recovery. You can address the condition and help your body to initiate the healing response to insure a faster recovery.
Emergency Situations – You never know when an emergency, such as a motor vehicle accident or inclement weather, may occur. You may experience an injury or illness during a camping trip when resources are a far distance away. In the event of an emergency situation, you will be knowledgeable and equipped to take care of yourself and your loved ones. (If necessary, please seek appropriate medical assistance as soon as possible.)
Healthy Living – Take the time to focus on your health. Often, small changes in your diet, activity level, and relationships can make a big difference. You can take control of your health and your life! For more healthy living tips, please refer to My Top 10 Anti- Aging Tips and How to Age Successfully.

Taking a passive role in your health is not a wise choice in America’s current health care environment. Only you are responsible for your health. My goal is to have a positive impact on the lives of others and on the health care system in general. I desire to accomplish this by providing useful and practical types of “how to” information. With the cost of healthcare on the rise, I desire to help proactive adults of all ages to understand how to safely self-treat and manage common physical therapy related conditions in a timely manner so they can reach their optimal health.

To accomplish this goal, I need to hear from YOU! What are your pains? What injuries are you suffering from? Please submit your questions to contact@thePhysicalTherapyAdvisor.com. I look forward to answering your health related questions! You CAN achieve optimal health!

Get started now by checking out the Resource Guide! The specific exercise section is full of rehabilitation exercises ranging from low back pain to knee pain. These .pdf files include photos and detailed descriptions to help you get started. This list of resources also includes books, products, resources, supplements, topical agents, videos, and web sites that I personally use and recommend to my family, friends, clients, and patients (for use in the clinical setting).

Also, be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer: The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.

Posted on Wednesday, March 4, 2015

Q & A: Why Am I Dizzy Upon Standing?

Q. Almost every time I stand up, I feel dizzy. It seems to be worse if I am lying down before standing up. Should I be concerned? –Jill

A. Great question, Jill! We have all likely experienced the sensation of dizziness upon standing at one time or another. You are likely experiencing a sensation known as orthostatic hypotension (also known as postural hypotension). Orthostatic hypotension (OH) is defined by a drop in blood pressure that is greater than 20 mm of mercury during contraction of the heart muscles (systole, the top blood pressure number) and more than 10 mm of mercury during the expansion of the heart muscles (diastole, the bottom blood pressure number).

Suddenly standing up can cause blood to pool in the blood vessels of the body and legs. For a short period of time, a decreased supply of blood is carried back to the heart to be pumped to the brain. This results in a sudden drop in blood pressure which causes a feeling of dizziness.

Unless you’re experiencing severe symptoms or losing consciousness (blacking out), OH is typically not a concern and can happen to anyone. In my clinical experience, I have treated highly active adults and athletes as well as the elderly for OH. The concern is greater for the elderly as it may be a sign of additional cardiac related illness such as congestive heart failure (CHF). OH can increase the risk of falling which is already an issue for many elder adults.

The following conditions may increase the likelihood of developing OH:

A low blood volume from dehydration can cause OH, fatigue, and weakness. Be sure to adequately re-hydrate after activity. Soda and other processed drinks do not optimally hydrate your body. Water is best. Other options include coconut water, caffeine-free tea, and consuming fruits and vegetables.
Postprandial hypotension is a sudden drop in blood pressure after eating. The body shunts blood to the stomach and digestive system to aid in the digestion and transport of nutrients out of the gut. This can lead to low blood volume in other parts of the body and could cause OH. Eating small, low-carbohydrate meals may help to reduce symptoms.
When I am in a high volume cardiovascular training cycle, I tend to experience low blood pressure. Average blood pressure (BP) should be around 110/70 mm mercury. My blood pressure will be close to 100/60 mm mercury when I struggle with OH. To eliminate this problem, I increase my salt intake. Sherpa Pink Gourmet Himalayan Salt is my preferred type of salt to use. The extra sodium retains more fluid in my system which keeps my blood pressure up while providing important trace vitamins and minerals.
Bradycardia (slow heart rate) can increase your risk of OH. A slow heart rate is generally considered a healthy side effect of being cardiovascularly fit. A heart rate less than 60 beats per minute (bpm) is considered low. This is a common finding in well trained athletes as they range between 40-60 bpm. Other more serious heart conditions, such as heart valve related issues and CHF, can be associated with bradycardia. OH is also common post cardiac surgery or heart attack. If your heart rate is low or you’re experiencing cardiac issues, please consult with your physician.
Diabetes, thyroid dysfunction, and adrenal insufficiency as well as other hormone (endocrine) related issues can cause OH.
Many illnesses affecting the nervous system (spinal paralysis, Parkinson’s disease, and some forms of dementia) can cause OH related symptoms.
Many medications have side effects that can result in OH symptoms. If you develop symptoms of OH, address your medications with your medical physician or pharmacist.

Treatment options for OH include:

Compression. Lower extremity compression serves to help prevent blood from pooling in the lower extremities and can aid the venous return system. With compression, the heart doesn’t work as hard to pump blood to and from your toes. You can utilize a common ACE wrap, but I highly recommend that you purchase a mild over the counter compression sock (at least thigh high) such as Jobst Relief Therapeutic Thigh High Stockings. Do not apply any compression too tightly that it causes numbness or tingling in the legs, feet, or toes. In cases of spinal paralysis, an abdominal corset (binder) may be necessary to maintain a normal blood pressure.
Stand up slowly. If you’re suffering from OH, take your time when you first sit up after lying down or after you first stand up. Moving slowly will decrease your risk of injury (should you fall) while feeling dizzy.
Perform a cardiac warm up to get the blood in your legs moving prior to standing and performing an activity or exercise. Begin with tapping your toe 15 times on each foot. Then perform a seated knee extension by moving your leg straight out 15 times on each leg. Next, remain sitting, but march in place 15 times on each leg. Once you have completed this routine, stand up slowly (if you don’t feel dizzy) and proceed with your activity. Be sure to pause briefly to insure that you’re not experiencing dizziness as a delayed response of a few seconds is typical.

In most cases, OH is a common and benign condition. It can affect anyone for many different reasons. In most cases, dizziness can be easily treated with hydration and possibly a small increase in salt intake. Elder adults should take care if they are experiencing dizziness. Seek medical advice to determine if dizziness is a symptom of a more serious condition. If the condition worsens or you lose consciousness, please consult with your medical physician as OH is just one of many forms of dizziness.

Thank you, Jill, for your question. I hope these treatment options for OH will not only help you to determine the cause of your dizziness, but that they also decrease the frequency of your symptoms. For additional information on dizziness, please refer to Q & A: Vertigo – Causes & Treatment and Q & A: How Do I Improve Balance? (Part I).

Have you ever experienced OH symptoms? Which treatments for dizziness are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

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. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on Wednesday, February 18, 2015

Q & A: How to Self-Treat a Baker’s Cyst

Q. My knee started hurting about two weeks ago. I have noticed swelling in the back of my knee. It’s painful when I bend or straighten the knee. I looked up the symptoms on WebMD. I think I might have a Baker’s cyst, but I’m not sure what to do now. Your insight would be appreciated, thanks! –Patti

A. Great question, Patti! The symptoms you are describing sound like they may be caused by a Baker’s cyst. Another common diagnosis with similar symptoms would be a meniscus injury. I recommend that you read my previous post on meniscus pain, Q & A: 7 Tips to Get Rid of Knee Pain. Much of the advice will carry over to either condition.

A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled sack that forms in the back of the knee. Synovial fluid from inside of the knee pushes out into a fluid-filled sack in the back of the knee. Sizes of the cysts can wildly vary as do the symptoms. The cyst can typically best be seen when a person is standing. It may or may not be tender to the touch. In fact, you may or may not have any symptoms at all.

Baker’s cyst symptoms include:

Stiffness or tightness in the back of the knee, thigh, or upper calf.
Swelling noted behind the knee. If the cyst ruptures, then the swelling may be also be in the lower leg and calf area.
Pain is most typically described behind the knee, particularly with full flexion (bending) or extension (straightening). A person may also experience pain in the upper calf or back of the thigh.
Another common complaint is pain when sitting due to the chair touching or rubbing the area behind the knee (known as the popliteal space).

It is not always entirely known why a Baker’s cyst will develop. In my clinical experience, I have seen them form for the following reasons:

Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Recent knee injury or post knee surgery
Poor lower leg biomechanics, which can lead to other forms of knee pain in addition to a Baker’s cyst.

Baker’s cysts should be diagnosed by a medical doctor. Medical treatment of the cysts usually involves a course of anti-inflammatory medication (orally), a cortisone injection, aspiration of the fluid by utilizing a needle, and/or surgical removal. The good news is that often a Baker’s cyst will typically resolve on its own if you just give it time. Rest and treat any symptoms you may be experiencing.

Physical therapy may also be indicated, particularly if the cyst formed due to osteoarthritis pain, recent knee injury/trauma/surgery, or due to poor lower extremity biomechanics. In most cases, I have witnessed Baker’s cysts successfully and conservatively treated by both a physical therapist and a medical physician who are working together to address the issue.

The rehabilitation for a Baker’s cyst is very similar process to treating meniscus pain. The following 10 tips will help you to rehabilitate your knee. You should experience improvement of your symptoms within in a few of weeks or less when initiating this program. Depending on the severity, it could take longer for a full recovery. If your pain continues or worsens, then additional assessment and follow up is likely needed.

10 Tips on How to Self-Treat a Baker’s Cyst:

1. Rest. Initially, take extra time to rest the painful area. The pain and swelling has likely worsened due to a change in activity level. If the pain is more severe, you may choose to use a cane or a crutch initially to take weight off of the knee.

2. Ice. Apply ice to the knee and behind the knee in particular. The rule of thumb is to ice no more than 20 minutes per hour. Do not place the ice directly against the skin especially if you are using a gel pack style Cold Pack. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be ideal in this situation.

3. Compression. Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response. Limit it as much as possible. You could utilize a common ACE bandage wrap or you could purchase a pair of mild over-the-counter compression socks. If you utilize a compression sock, it will need to be at least thigh high like these Jobst Relief Therapeutic Thigh High Stockings. Do not use a knee high version–you may make the swelling and pain worse. Do not apply any compression too tightly as it could cause numbness or tingling in the leg, foot, or toes.

4. Taping Techniques. Kinesiological style taping has been proven to be effective in reducing inflammation. Due to the location of the swelling, you will need help from someone trained in the specific style of kinesiological taping. Many physical therapists (PTs), athletic trainers (ATCs), or chiropractors have training in these techniques. Learn How to apply Kinesiology Tape for a swollen (edema) Knee Joint by watching this YouTube video that demonstrates the proper technique. (However, the taping would be on the back side of the knee, not on the front as shown.) I have had luck using the KT TAPE, RockTape Kinesiology Tape, and Mummy Tape brands. The technique is fairly basic, so your spouse or a friend may be able to apply it for you.

5. If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise. This would also be true for a lunge position or step up. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere or make the knee more painful and irritated.

6. Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.

7. Improve your Range of Motion (ROM). The goal of the rehabilitation program is to regain full pain free ROM. This can be accomplished many ways. Perform heel slides by lying on your back and sliding your heel toward your buttocks. Riding the stationary bicycle can be helpful, too. Remember, the major goal is to regain full pain free ROM. If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. Do not use the foam roller directly behind the knee.

8. Work on strengthening. The primary goal of a strengthening program is to work on quadriceps and glut medius (hip abduction) strengthening. These areas are commonly weak which can lead to poor knee biomechanics and cause pain and instability. Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM). Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing. The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises.

To initiate a physical therapy program, please refer to Baker’s Cyst Rehabilitation Exercises. This exercise guide is designed to address the muscles that I find to be the weakest in most individuals. The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening. Start with exercises like a straight leg raise (possibly with an ankle weight) and bridging (either one or both legs). Wall squats holding for time also works well. A Thera-Band Exercise Band can be tied around the thighs above your knees to make your hips more engaged.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts. If further instruction is needed, search YouTube to watch the proper technique for a specific exercise. If full ROM is causing an increase in your pain, then you need to stay within your pain free limit as you work on the ROM separately from weight training.

Initially, you will likely need to taper down your activities. The speed at which exercise is performed while in group exercise classes is typically too fast for an individual who is properly and safely exercising his/her knee during a rehabilitation and recovery phase. You can still participate in group exercise classes or CrossFit WODs (Work out of the Day), but your specific knee program should be separate from any group structured activity. You will need to modify some of the activities performed in your structured class to avoid further pain.

9. Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing ROM.

10. Add a joint supplement. If you are experiencing osteoarthritis pain, you may want to consider adding a glucosamine and chondroitin supplement. CapraFlex is my preferred supplement for knee related injuries. I have recommended this supplement for years as my clients have had successful outcomes with use. It has also assisted me in recovery from my many injuries. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I recommend that you try it for 30 days to see if it improves your knee pain, but do not use it in combination with other traditional anti-inflammatory medications. If you are under the care of your physician, please inform him/her that you are taking this medication. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

In most cases, you should expect a complete resolution of your symptoms upon completion of the rehabilitation process. To prevent the condition from re-occurring, address any ROM or mobility restrictions as well as any weak areas that are causing altered lower leg biomechanics.

If your symptoms and pain continues or worsens after two to three weeks of rehabilitation, please seek additional assistance from your physician or a qualified physical therapist. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it would be a good idea to seek your physician’s opinion as well).

Thank you, Patti, for your question. I hope these 10 tips will help you to rehabilitate your knee and recover quickly!

Which treatments for knee pain are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

Posted on Wednesday, January 21, 2015

How to Self-Treat Shin Splints

If you have ever experienced shin splints (anterior compartment syndrome), you know how excruciatingly painful it can be. You may struggle to run or walk. The pain can linger for weeks and months–taking the fun out of running and exercise. In the previous post, I discussed How to Prevent Shin Splints. Now I will provide simple treatment options to quickly help aid in your recovery. Shin splints can typically be easily self-treated if you don’t have a more serious medical condition, such as a stress fracture, causing the pain.

How to Self-Treat Shin Splints:

Ice. Although shin splints can occur insidiously, they are often associated with a specific event. An active inflammatory process typically occurs. Apply the ice to the anterior tibialis muscle (the muscle right next to the shinbone). The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a cold pack. A bag of frozen peas can be a cheap alternative. Individuals with poor circulation or impaired sensation should take particular care when icing.
Rest. If you are experiencing an episode of shin splints, then you will need to rest. Avoid running (particularly downhill). At the very least, taper your training intensity and avoid exercises that place undue stress on the shins, particularly the anterior tibialis muscle. Utilize this time to incorporate cross training activities, such as yoga, to improve flexibility as shin splints can be linked to poor mobility.
Consider changing your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. This can lead to shin splints as well as IT band syndrome or other hip, knee, or ankle related issues. Shoes only last 350-500 miles. If you are nearing those miles, then it may be time to change.
Add an orthotic. Additional foot control is often needed to normalize gait mechanics. 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.
Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up. My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager. I also recommend using the massager on your calf muscles. Perform calf stretches, but be mindful that prolonged static stretching before exercise may worsen performance.
Cool down. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up. If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle, as well as the calves. Tightness in the calves and Achilles tendon are a risk factor for developing shin splints. Be sure to emphasize stretching your calves. Hold each of the following stretches for at least 30 seconds, 3 times on each leg, 2-3 times a day. (These stretches shouldn’t cause more than a mild increase in pain or discomfort.)

Self-mobilize the tissue. Be sure to mobilize the tissue of the anterior tibialis. For this particular area, you may want to use one of the self-massage tools referenced above. You could also use a tennis or lacrosse ball to aggressively work out the tissue along the shin. Remember that mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints. Use the foam roller to address any lower leg tightness or restrictions. I tend to use the foam roller for the larger parts of the leg including the thigh, back of the leg, calves, and buttock muscles. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
Work on the stabilizing muscles of your hips and ankles. As part of a comprehensive rehabilitation protocol, I almost always have clients work on keeping the muscles of the pelvis, hips, and ankles strong. This will help to maintain normal gait mechanics during exercise and running. Not only will this help to prevent shin splints, it will likely help to prevent developing other orthopaedic issues such as plantar fasciitis and hip or knee pain. Please refer to Ankle Resistance Exercises and How to Safely Self-Treat Low Back Pain for my recommended hip and lumbar stabilization strengthening exercises.
Work on your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain. I always include balance work as part of my recommended rehabilitation protocol. Please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II).
Kinesiological taping. The purpose of the tape is to assist the anterior tibialis muscle with its contraction and to possibly help with swelling and nutrient exchange by assisting the lymphatic system. I have had luck using the KT TAPE and Mummy Tape brands. When treating shin splints, I recommend following these step by step instructions for Kinesiological Taping for Shin Splints. For application and removal tips, please refer to Skin Care with Taping.
Use a compression sleeve or stocking. This condition is often associated with swelling and inflammation in the anterior compartment of the lower leg near the shinbone (tibia). The compression sleeve/socking can help to limit the amount of swelling and promote blood flow back out of the lower leg. This insures better nutrient exchange, waste removal, and can limit the swelling. I particularly recommend wearing a pair while you are in the rehabilitation phase or tapering back into full activity. There are many different styles of compression socks and sleeves, but I prefer Vitalsox Graduated Compression Socks. If you prefer a sock style, then I recommend choosing a pair that is at least knee high.
Start a supplement. Many herbs help to reduce inflammation and pain. One of my favorites is called Phenocane Natural Pain Management. It combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)
Ask for help. If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. Your medical physician can help to determine if your pain is associated with a stress fracture. He/she could also prescribe stronger anti-inflammatory medication if necessary. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to seek your physician’s opinion as well).

Have you ever experienced shin splints? If so, which treatment techniques have you found to be the most effective? Please leave your comments below.

Looking for that exercise or book I mentioned in a post? Forgot the name of a product or supplement that you’re interested in? It’s all listed in the new Resource Guide. Check it out today!

Posted on Wednesday, January 14, 2015

How to Prevent Shin Splints

The term shin splints, also known as an anterior compartment syndrome, refers to pain along the shinbone (tibia), the large bone in the front of your lower leg. Shin splints can be excruciatingly painful to the point that you may struggle to walk or run. Worse yet, the pain can linger for weeks to months, but it may not be severe enough to prevent you from exercising. However, it will take the fun out of exercising and running. I will address the common causes for shin splints and share my top tips to prevent shin splints. I provide treatment options in How to Self-Treat Shin Splints.

Shin splints are typically caused by inflammation in the lower leg anterior muscles known as the anterior tibialis muscle. This is the primary muscle needed to lift your foot. Shin splints are often considered an over use injury. Unfortunately, shin splints are relatively common in runners and dancers.

As a physical therapist, I commonly treat acute cases of shin splints that occur when an individual suddenly increases his/her training volume by largely increasing the distance he/she is running. This condition may also occur when an individual isn’t appropriately trained for downhill running. Running downhill causes the anterior tibialis muscle to work very hard in an eccentric manner (meaning that the muscle is lengthening). This can very easily overwork a poorly trained muscle and may cause pain and inflammation.

Common Causes of Shin Splints include:

Flat feet, which cause overpronation while running.
Poorly fitting or worn out shoes.
Tightness in the calf muscle or Achilles tendon.
Weak ankle muscles (particularly the anterior tibialis). Shin splints are also associated with weakness in the other muscles of the ankle and foot.
Weakness in the hip, pelvic, and/or core muscles can lead to faulty gait mechanics, which causes shin splints or possibly other knee and lower extremity injuries.
A change in running surfaces. This is most evident when transitioning from a softer running surface, such as dirt, to a concrete running track.
Stress fractures in the shin (tibial bone). Also, stress fractures in the foot can cause alterations in running form which may lead to shin splints.
Training overload. The muscles of the anterior shin (the anterior tibialis) are performing training intensities and volumes that they are incapable of doing. This causes inflammation, swelling, and pain.

How to Prevent Shin Splints:

Check your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. Shoes typically only last 350-500 miles. If you are nearing those miles, then it may be time to change. If you’re unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe. Another option to help control overpronation is 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.
Progress slowly into a minimalistic shoe. If you are used to a standard built up shoe, progressing into a minimalistic shoe may be more difficult and take more time. Unless you are a child or teenager, expect a safe transition to take at least three months. Don’t transition during a period of intense sports. I highly recommend waiting until the off season as progressing slowly is always a better choice.
If you change running surfaces, progress slowly. If you are used to running on softer surfaces, such as dirt or a running track, progress carefully and slowly when you run on a harder surface like concrete. Over all, softer running surfaces are better for your body.
Have your gait analyzed while running. Gait or running abnormalities can increase your risk of developing shin splints. Over striding tends to occur while running downhill. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running. Then watch the recording to see if you notice over striding or any abnormalities.
Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up. My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager.
Cool down. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up. If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle.
Improve your mobility. Mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints. Use the foam roller to address any lower leg tightness or restrictions. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
Strengthen the stabilizing muscles of your hips and ankles. Strengthening the muscles of your hips and ankles will help to maintain normal gait mechanics during exercise and running. Not only will this help to prevent shin splints, it will likely help to prevent developing other orthopaedic issues such as plantar fasciitis and hip or knee pain. Please refer to Ankle Resistance Exercises and How to Safely Self-Treat Low Back Pain for my recommended hip and lumbar stabilization strengthening exercises.
Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help to reduce the risk of shin splints and is an important part of the rehabilitation. Please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II).
Train for running downhill. Running downhill forces the anterior tibialis muscle to work much harder than it would otherwise. Running downhill causes the anterior tibialis to perform more eccentric (when the muscle gets longer) loading and repetition. This can overload the muscle, particularly when running downhill very fast. Although running downhill may not be as aerobically taxing as running uphill, it’s actually physically much harder on your body.
If you experience pain, seek help early. Don’t ignore those little aches and pains that can develop as you exercise and train. They may be early warning signs of a developing problem. If you experience pain in your shins, start implementing my recommended treatment protocol. If the pain persists or continues to progress, please seek assistance from your medical physician or a physical therapist. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Have you ever experienced shin splints? If so, how do you prevent them from re-occurring? Please share the treatments that have been the most effective for you by leaving your comment below.

Looking for that exercise or book I mentioned in a post? Forgot the name of a product or supplement that you’re interested in? It’s all listed in the new Resource Guide. Check it out today!

Posted on Monday, January 5, 2015

My Top 5 Most Popular Posts of 2014!

For many of us, the healthcare system is too expensive or unapproachable as we try to improve our health and live life to its fullest. My desire is to provide you with useful information to achieve both objectives. Thank you for supporting The Physical Therapy Advisor website since its launch in April. I appreciate your questions and feedback, and I look forward to serving you in 2015!

My Top 5 Most Popular Posts of 2014:

My Top 7 Tips to Prevent Low Back Pain While Traveling – Low back pain is one of the most prevalent and pervasive problems in the western world. Whether you’re traveling or working in an office, review these 7 tips to prevent low back pain.
7 Reasons Why the Squat is Fundamental to Life – When was the last time you moved into a full squat? Why does it even matter? Find out 7 reasons why we should continue squatting as a lifelong pursuit.
How to Self-Treat Plantar Fasciitis – Plantar fasciitis is a very painful and potentially very debilitating condition. Don’t let foot pain stop you from reaching your goals in 2015! Learn how to self-treat plantar fasciitis and prevent it from slowing you down.
Q & A: How to Prevent My Mom From Falling Out of Bed – Falling is the number one cause for fracture in the elderly. Many times, a fracture will lead to a cascading decline in mobility and function. Finding methods to limit falling, without restraining or inhibiting important functional mobility, is critical. Discover tips to keep your loved ones safe.
5 Ways to Improve Range-Of-Motion (ROM) – As we age, we naturally lose elastin, an important component to our skin, muscles, and tendons. Elastin is responsible for the elasticity in the body’s tissues. Maintaining Range of Motion (ROM) is critical to maintaining our mobility and for injury prevention and sport performance. Poor ROM can also lead to pain and dysfunction as the body’s ability to move freely is impaired. Discover different methods to maintain your ROM and prevent injury.

2014 was a wonderful start for the blog. I look forward to empowering you to reach your optimal health in 2015! Don’t forget subscribe to my e-mail newsletter! I will send you weekly posts on how to maximize your health, self-treat those annoying orthopaedic injuries, and gracefully age. To thank you for subscribing, you will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.

Posted on Monday, December 15, 2014

How to Self-Treat Patellar Femoral Pain Syndrome (Runner’s Knee)

Patellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, is a common running related issue. The sooner you can manage this condition, the easier it will be to recover and eliminate future problems. Many of my recommended exercises can be adopted as part of a cross training program to prevent PFPS. I will address the many potential causative factors for PFPS and offer advice on how to self-treat this condition.

PFPS can be quite painful and significantly affect a person’s ability to run or move properly. The cause of the pain is often associated with a patellar or knee cap that is tracking in the femoral groove improperly. This can occur for many reasons, but the most common causes are:

Poor quadriceps strength (particularly the inner or medial quadriceps).
Poor hip abductor and/or hip external rotator strength.
Improper foot biomechanics during the single leg stance phase of the gait cycle or the mid foot strike during running. The most common issue within the foot is usually overpronation (when the feet excessively roll inward and cause the knee to roll inward as well during each step). Overpronation is more common among females although males experience it as well. Women may experience overpronation due to the angle of their hips in relation to the knee. A woman’s pelvis is typically a different shape to allow for child bearing. The larger “Q-angle” associated with the hip and knee can cause increased strain on the knee.

PFPS symptoms include:

The pain will typically increase when going downstairs. In more severe cases, going upstairs is also very painful.
Pain with squats, lunges, knee extensions, or other plyometric activity.
Pain typically worsens with prolonged sitting. The longer you sit in one position, the worse the pain becomes.
Grinding, popping, and cracking are often associated symptoms.
Pain can be anywhere along the patella (knee cap), but it’s typically associated with anterior knee pain or medial patellar pain.

In many cases, a very thorough warm up may allow you to participate in activity. However, the pain may worsen again later that day or the next day. Seek help or guidance quickly when your pain worsens with activity. For the best result, the treatment plan should be multifactorial.

How to Self-Treat PFPS:

Improve your quad and your hip strength. Please refer to Patellar Femoral Pain Syndrome Rehabilitation Exercises for my recommended exercise program which is designed to improve quad and hip strength. To improve your quad strength, the emphasis should be on the inner quad known as the vastus medialis oblique (VMO). Weak hip abduction and hip external (lateral) rotation muscles significantly contribute to PFPS. The purpose of the lateral and external rotators of the hip is to prevent internal rotation (rolling inward) of the hip and knee. My recommended exercise program will help to improve your strength.
Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated. Then work on moving into a deep squat position multiple times as part of the warm up. You may need to hang onto a beam or a pole to take some pressure off of your knee as you move in and out of the squat.
Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing range of motion (ROM).
Self-Mobilize the Tissue. Myofascial release of the quadriceps muscle is an important component in order to relieve the pain and reduce the pressure and tension through the patellar femoral tendon and joint. I tend to use the foam roller for the larger part of the quadriceps. I also use a tennis or lacrosse ball to aggressively work the tissue above the patella. You can use your hand to press the ball in and work it around the tissue. To use the weight of your leg for a more aggressive mobilization, place the ball on the ground and mobilize the tissue with your leg on top of the ball.

Kinesiological Taping. The purpose of the tape is to assist the patella in its tracking. I have had luck using Kinesio Tape and Mummy Tape brands. There are many other useful taping techniques which utilize different forms of tape. When treating PFPS, I recommend that you apply the tape in a medial direction across the patella approximately 30 minutes prior to exercise or activity. To utilize Mummy Tape, first measure how much of the tape you intend to use. Start from the outside of the knee cap to half way around the leg minus about an inch. Cut the strip, then round the corners on the edge of the tape. This helps the tape to not catch onto clothing. Apply the tape without extra stretch to the first half of the knee cap, then apply between a 50-75% stretch for half of the tape medially toward the inside of the leg. With the last of the tape, apply without a stretch to the inner side of the leg. (You could also utilize Spider tape or KT TAPE.) To visually learn how to apply the tape, please refer to Kinesiological Taping for Patellar Femoral Pain Syndrome. For application and removal tips, please refer to Skin Care with Taping.
If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise. This would also be true for a lunge position or step up. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere.
Have your gait analyzed while running. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re not a runner, but you’re experiencing pain during other forms of exercise (group aerobics or CrossFit), ask your teacher or coach to analyze your movements during an exercise session. How is your foot striking the ground? Is it rolling in (landing flat footed)? Does your knee rotate inward or stay tracking in line with the foot? Ideally, the knee tracks in line with your second toe. This is important for running as well as squats, step ups, and lunges. If your foot isn’t maintaining a good position during its mid foot strike, a new pair of shoes may be indicated specifically to control pronation. Over-the-counter orthotics can help as well. Superfeet Blue Premium Insoles are available in varying models to help support the arch and heel. They are color coded by model. I wear the blue insoles which are for moderately flat feet. These insoles are very durable. In the past, these insoles have lasted for 1,000 miles through the life cycles of two different pairs of shoes.
Start a supplement. Many herbs help to reduce inflammation and pain. CapraFlex is one of my favorite supplements. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I recommend that you try it for 30 days to see if it improves your pain. Another option is Phenocane Natural Pain Management. It combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

Patellar Femoral Pain Syndrome can be very painful, but it can be easily self-treated if you handle your pain and symptoms quickly. If you’re not experiencing relief after aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing PFPS. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for PFPS helped you? Which treatments haven’t worked for you? Additional discussion can help others to manage this condition more effectively. Please leave your comments below.

Don’t forget to subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step by step exercise instructions and photos!

The Physical Therapy Advisor

Empowering You to Reach Your Optimal Health!

Category Archives: Physical Therapy