Category Archives: Physical Therapy

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Knee Pain: Causes and Cures

Knee pain affects almost every single person at some point in their lives. From sprains, to cartilage issues, all the way through to posture-related injuries and muscle tears, knee pain seems to play a role in the sometimes debilitating struggle for a pain-free life. We understand how the nagging, irritating, and oftentimes overwhelming pain in your knee affects your day-to-day activities, not to mention your social life, and that’s why this post is all about knee pain: what it is, why it is, and what can be done about it.

When it comes to knee pain, few people really understand its origins. This is not least because of the complex structure of the knee joint and its position in the body. In fact, the knee is one of the most important body parts. Why? Well, it not only grants the lower leg an immense amount of flexibility, but it also support and maintains the mobility of the upper leg and, finally, the torso and entire upper body. In other words, the knee is an invaluable part of the body’s mobility and stability.

It is no wonder, then, that the knee joint is also the site where most of the body’s pressures and strains accumulate. From walking, to running, and even to standing, the knee is subject to an incomprehensible amount of daily pounding and weight. In truth, your knees withstand more strain than you know, and without their resilience you would probably be far less mobile. Which is why, of course, knee pain is so debilitating.

As a knee experiences the constant pressure and strain placed on it by our everyday activities, it gradually starts to experience wear-and-tear, that is, muscles lose their strength and the cartilage is subsequently placed under more and more stress – hence, the pain. Quite often, if this state of affairs isn’t appropriately addressed, the cartilage might give way or tear, leading to serious injuries requiring surgery, or worse still, a complete knee replacement. Amongst these rather alarming injuries are the likes of ACL injuries, knee fractures, dislocations, PCL injuries, tears, popping, swelling, tendon injury, knee cap dislocations, and a myriad more – and, if the names don’t scare you, the pain will.

In lieu of this, it is easy to see why the maintenance of a healthy knee joint is vital. Unfortunately, however, many people already suffering from knee pain turn to temporary solutions for comfort: from painkillers, to surgery, and all the way around to injections and rest, people just aren’t taking action. The issue with pain in the knee joint is that rest and procrastination, not to mention tablets, only make things worse – as you know, the pain often only increases if you try to wait it out, and in the end you’re left with an even longer road to recovery. Yet, in a world where there is so much conflicting information, what can you do? Where do you turn? And how can you get rid of this pain?

Luckily, there are ways to combat knee pain and, in many cases, totally eradicate your daily discomfort, thus getting you back to the activities you love. Take a look:

Exercise – All Things in Moderation

We know you might be active, love golf, running, and sports. Maybe you just like walking and enjoy being outside. The good news is, activity and mobility are sure-fire ways of fast-tracking your journey to a pain-free life. Importantly, however, you need to be very sure that the exercises you do are moderate, low-impact, and do not place unnecessary or damaging strain on your knee. Movement is key… but, in moderation.

That having been said, try doing exercises that strengthen your knee as well as give it extra motion. Straight leg raises, whereby the leg is slowly lifted to extend the knee joint, are really helpful. Try leg presses and balancing exercises to increase the flexibility and strength of the knee joint. In addition, why not try cycling? Riding a bike is a low-impact form of exercise and is incredibly beneficial for strengthening the muscles around the knee joint. It’s all about support: find activities that support your knee so as to get you moving and feeling stronger… all in preparation for those things you long to get back to doing.

Physical Therapy

While increasing the amount of low-impact physical activity you do is helpful, the best and most effective way of eliminating your knee pain – fast and safely – is physical therapy. A professional, hands-on physical therapist is able to diagnose and treat the root-case of your problem, thereby offering you a permanent solution to your knee-pain. And not only that, physical therapy gives you a set of tailor-made exercises and stretches you can do at home; this means that your road to health doesn’t stop when you leave the PT room – you’ll be able to maintain your pain-free life well beyond your physical therapy sessions. Physical therapy is so much more than just a temporary mask for your pain: it’s about your health and your happiness.

Physical therapy gives you the opportunity to restore functionality in your knee, the tools to help rebuild and strengthen muscles, and the comfort of knowing that the range of motion in your knee is being systematically increased.

Don’t let knee-pain ruin even one more day of your life. It’s time to get back to that golf game you’ve been dying to play, that yoga class that’s been in the back of your mind for weeks, and the training for that marathon you’ve waited forever to run. Knee pain is terrible, but there are solutions. To learn more about physical therapists or find one in your area, visit the American Physical Therapy Association (APTA). ​

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!

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3 Causes of Hip-Pain Unrelated To Injuries

We’ve all been there… our hands clutching at our thighs in the hope of relieving hip-stress as we get up or sit down; a grimace on our faces as we try to grapple with what we think are signs of aging while easing into the bath; a frown as we get out of the car, straining to carry the weight in our legs, not our hips. Hip pain: most of us have experienced it, and if you’re reading this, you’re probably still suffering from its tell-tail discomfort. And yet, for most of you reading this, your pain isn’t related to any sort of injury you can think of – it just arrived and has decided to stay. The good news is, though its origins are unknown, hip-pain can be treated and alleviated. In this post, we’re looking at some of the reasons you might be suffering from hip discomfort – and better still – some of the ways in which you can become pain free, right now.

I know what you’re thinking – you haven’t fallen, tumbled, or tripped recently. In fact, you tend to take fairly good care of your hips in so far as you know how. And that’s great! The truth is, though, for the majority of us, joint health is something we don’t really consider in our daily activities. In other words, when it comes to our hips, we often don’t realize that small irregularities in our postures, habits, and routines, can affect the health of our hip joints in the long run. That having been said, take a look at some of the most common reasons you’re experiencing inexplicable pain in your hip area.

Sitting All Day
It’s possible you’ve already considered the fact that a largely sedentary lifestyle might be contributing to your hip pain – if so, you’re on the right track. Sitting for numerous hours a day will eventually lead to stiff, tight muscles, the presence of which will result in pain. Your hip joints are incredibly important when it comes to mobility – not moving or stretching them throughout the day will cause a decreased ability to move with comfort, hence the pulling, stabbing, or dull ache your feel when you leave for home or get out of bed in the mornings.

No Exercise
Your muscles and joints need to be lubricated, stretched, and strengthened in order for them to maintain their flexibility and functionality. And the best way to do this is… yes… you guessed it: exercise. Excluding exercise from your daily routine is a sure-fire way to end up experiencing hip-pain. If you don’t use your muscles often, they weaken and lose their ability to add structural support to your joints; in this way, then, weakening hip muscles can lead to damage in the hip joint, thereby causing and aggravating hip-pain.

Repeated Exercise Routines
Though exercise is a great way to keep your hip-joint healthy, the continual repetition of one single exercise, stretch, or routine can actually cause breakdown within the muscle, thereby aggravating hip-pain instead of alleviating it. Constantly focusing on one single type of activity places continuous pressure on one group of muscles, and so places stress on them whilst weakening those around them: this is the point at which injury, and thus the possibility of serious damage, may occur.

If you’re doing one, two, or even all of the above, don’t fear – your hip-pain can be dealt with. Fortunately, there are ways in which you can tackle and alleviate your pain. Take a look:

Stretch
Doing stretches which target your hip area can be very helpful in loosening and lengthening tight, stiff muscles which may be causing you discomfort. Find the time to hit the mat and stretch out your hip muscles, even if it means getting up 10 minutes earlier.

Varied Exercise
Having realized that a sedentary lifestyle is causing you discomfort, it’s time to begin making some changes. Start by incorporating some exercises in the office: get up every 15 – 20 minutes, and walk for 2 minutes every 30 minutes. In addition, try adding some extra activities to your daily routine. Why not try walking for 30 minutes a day, or cycling along the promenade or in the park? Getting those muscles moving is essential for your recovery and pain-free life. Remember, though, vary your routine as you go along.

Physical Therapy
Physical therapy is by far the fastest and safest way to get rid of your hip pain, right now. If you’ve never considered physical therapy, or have misunderstood the benefits of this therapy, it’s time to reconsider. With the help of a hands-on, qualified, and dedicated physical therapist, you’ll not only be rid of your hip-pain once-and-for-all, but you’ll finally be given the information you’re looking for, thereby gaining peace of mind in the process. Unlike other forms of treatment which offer temporary, often harmful solutions for your pain, physical therapy tackles the root cause of the problem safely and non-invasively, thereby giving you permanent relief from your hip discomfort. In addition, a hands-on physical therapist is able to offer you tailor-made exercises and stretches to suit your needs, thus allowing you to maintain a pain free life and finally gain access to the lifestyle you dream of.

Hip-pain doesn’t need to be a precursor to a life of immobility: it can be overcome and you can gain access to the active, mobile, healthy lifestyle you dream of. By following the above tips, and by contacting a professional, hands-on physical therapist, you’ll be saying goodbye to your surprising discomfort in no time. Don’t waste even a moment more puzzling over the cause; find the answers you’re searching for – and take the actions needed – right now. To learn more about physical therapists or find one in your area, visit the American Physical Therapy Association (APTA).

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!

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5 Tips to Ease Neck and Shoulder Pain

Neck and shoulder pain are one the most common ailments faced by people these days. That having been said, it can be mysterious, too. Pinpointing the exact cause for shoulder or neck problems can be particularly tricky as the underlying cause of the pain may be due to many differing factors. Discover the most common causes of neck and shoulder pain and tips on how to prevent and eliminate the pain.

The 21st century goes hand-in-hand with the parabolic rise of technology. Nowadays, tablets, cellphones, TV’s, computers, and even smart-watches dominate our daily lives. We are accompanied by our cellphone wherever we go, our emails are sure to follow, and we – more often than not – end the day lounging in front of the TV.

Here’s the problem though: all of this tech is actually having a damaging effect on your shoulder and neck health. Why? Well, looking down at our phones, arching our necks at the TV screen, trying desperately to avoid the glare on our tablet screens – these all add up. Our muscles are stretched and moved in peculiar ways, all of which take their toll on our muscles, ligaments, and joints. We ache and experience pain a lot more frequently as we increasingly handle our technological devices incorrectly.

In addition to the rise of technology, we have also lost valuable time connecting with our bodies. Most people don’t really stretch, nor do they do much activity. We have become a sedentary nation, for the most part, and our necks and shoulders tell that story. As a people, we just aren’t moving our muscles and joints enough, and the aches and pains you may be experiencing in your neck and shoulders may well be the result of a lack of activity.

It is also important to mention diet: what are you eating on a daily basis? Diets filled with fatty foods or an overload of simple carbohydrates (or even diets that just aren’t balanced and don’t provide the nutrients your body needs) will directly affect your health. Your neck and shoulders will ache if you aren’t feeding yourself the right anti-inflammatory foods.

It is clear, then, that while we’re living in a time defined by a technological rat-race, we need to take a step back and make some serious changes. Your neck and shoulder health may well be directly related to the everyday habits you’ve forged together with technology, diet, and lifestyle. Luckily, it’s possible to start making changes right now. 

5 Tips to Ease Neck and Shoulder Pain:

Watch your PC and Phone Posture

What is your posture like when you use your computer? Do you have a desktop or laptop? These are very serious considerations when it comes to neck and/or shoulder pain. If you’re using a desktop, make sure your screen is in alignment with your eyes, thereby avoiding forward head movements and incorrect posture which could lead to pain. If, on the other hand, you’re using a laptop, avoid lying down when you’re typing or watching TV. This particular posture forces your head forward, thereby placing immense pressure on your neck muscles as they are pushed into an unnatural position. Rather, use a desk if you can.

Try to limit the time you sit in front of your PC to chunks of around 20 minutes. In addition, make sure that your phone posture is monitored. Never stoop, and always try to keep your phone at eye level with your neck and spine aligned. Always stretch after using technologies like these for long durations of time. Please refer to Got Text Neck?

Sleeping Habits

The way you sleep often directly affects the muscles in your shoulders and neck. Incorrect sleeping habits are one of the biggest culprits in shoulder and neck pain. Sleeping with too many pillows places stress on your neck muscles and actually puts your back and neck out of alignment which can cause pain.

Try sleeping with a pillow that evenly aligns your spine with your neck. It may take some getting used to, but it’s worth it. Also, sleeping on your side with a pillow between your knees is incredibly effective for relieving neck and shoulder pain. Why? Because stress is no longer placed on those two areas, and the weight of the body is evenly distributed along the spine and legs. Please refer to How to Choose the Right Pillow.

Even Distribution of Weight

Without knowing it, many carry their handbags on one side of the body. What about shopping bags? Maybe even our trusty laptop bag. When we carry weight on one side of our bodies the other overcompensates, thereby leading to pain in our shoulders and necks.

It’s very important that weight is distributed evenly. Try carrying shopping bags equally on both sides of the body or switching the side you carry your bags on. This is an absolutely vital step in your journey towards a pain-free life. Please refer to Backpacks = Back Pain?

Diet Matters

Be aware of the types of food you’re eating whether it is fast food, fatty foods, sugary foods, or even salty foods. Cutting down on the types of low-nutrient meals you consume will greatly benefit in relieving pain. Try introducing more seeds, berries, and other anti-inflammatory foods into your diet. Dark, leafy greens, broccoli, eggplant, and sweet potatoes are fantastic additions to your meals. Please refer to How to Leverage your Nutrition to Train Harder and Recover Faster.

Exercise

Moving your body is one of the best ways of getting rid of your neck and shoulder pain. Stretch, move, exercise, and incorporate as much activity as you can – the key to health is to move!

If you want to learn how to stretch and self-mobilize the thoracic spine, be sure to check out My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. By subscribing to my e-mail list, you will automatically gain access to this FREE resource. Download the .pdf file, which is full of photos and exercise instructions, to get started!

Chronic neck and shoulder pain can be debilitating. If you continue to experience pain, seek additional help. Don’t let the pain linger. The longer a condition is left untreated, the more potential for harm and damage which potentially could lead to a longer recovery. The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

What are some of your best tips on how to ease neck and shoulder pain?  Please share 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.  In case you haven’t already, be sure to join our community on Facebook by liking The Physical Therapy Advisor!

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My Top 3 Most Popular Posts of 2018!

As 2018 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 get to the root of the issue instead of placing a Band-Aid over it.  We must realize that our individual health is our responsibility.  We cannot rely on others to make decisions for us.  Our present health care system in America is not designed to help you optimize your health–that is your job!   

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.

My Top 3 Most Popular Posts of 2018:

  1. Does Kinesiological Tape Really Work? – You will learn what can you use Kinesiological tape for and how exactly it works.  You’ll discover why it’s best used in combination with other interventions (such as manual therapy based techniques and exercise).
  2. How to Use an Exercise Ball to Improve Posture and Treat Shoulder, Neck, and Back Pain – Poor posture (due to poor thoracic mobility) and poor scapular muscle strength are often major contributors to neck, shoulder, and upper back pain.  In this video post, I demonstrate how to perform I’s, T’s, and Y’s exercises on an exercise ball in order to address lower and mid trapezius and scapula muscle weakness.
  3. How to Prevent Overtraining Syndrome (OTS) – You will discover why Overtraining Syndrome (OTS) not only impedes your immediate performance, but it also substantially increases your risk of injury.  Implement these recommended prevention strategies in order to avoid OTS while keeping your training at a high level.  Also, be sure to check out my book, Preventing and Treating Overtraining Syndrome.

2018 has been an exciting year!  Thank you for supporting The Physical Therapy Advisor!  I look forward to serving you in 2019!  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 join our community on Facebook by liking The Physical Therapy Advisor!

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How to Properly Perform I’s, T’s, and Y’s Exercises

The purpose of I’s, T’s, and Y’s exercises on an exercise ball is to address lower and mid trapezius and scapula muscle weakness and to generally activate the posterior chain (including the lumbar spine extensors).  Poor posture due to poor thoracic mobility and poor scapular muscle strength are often major contributors to neck, shoulder, and upper back pain.  Poor lumbar extensor strength is linked to low back pain.

I’s, T’s, and Y’s exercises on an exercise ball can be helpful in treating the following: 

  • Poor posture
  • Shoulder pain
  • Cervical pain
  • Headaches
  • Thoracic pain
  • Upper and lower back pain

Begin by performing the I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball.  Please refer to I’s, T’s, and Y’s Exercises for step-by-step instructions.  Start slowly without resistance.  Keep your chin tucked and head aligned with the body.

Version One:  Move your arms slowly up and down in each position of I, T, and Y.

Version Two:  Hold each position for the specified time.

To increase the difficulty for either version, add a 1-3 pound weight in each hand.  These exercises shouldn’t cause any pain in your neck, shoulder or upper/lower back. 

When this exercise is performed correctly, it engages and strengthens many critical muscles that help control many of our most common postures and movement patterns.  A slouched posture with a forward head and rounded shoulders can be associated with many common pain syndromes including:  neck pain and headaches; upper back pain; and shoulder pain.

It’s important to try to keep the proper postural alignment with your shoulders under your ears, and the shoulder blades set in a back and down position.  This is particularly important when performing any activity while using the shoulder.  This series of exercises can help to strengthen the important muscles that can help you maintain proper postural alignment.

Be sure to check out my video post, How to Use an Exercise Ball to Improve Posture and Treat Shoulder, Neck, and Back Pain, in which I demonstrate how to perform I’s, T’s, and Y’s exercises on an exercise ball in order to address lower and mid trapezius and scapula muscle weakness.

When performing these exercises, it is important to understand that they should never be painful.  You may feel a mild to moderate discomfort because the exercises are difficult, but if you are experiencing pain (particularly, the pain you are trying to treat) please discontinue the exercise and speak to your physical therapist.

Have you tried the I’s, T’s, and Y’s exercises on an exercise ball before?  If so, what has your experience been like?  Please leave 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!

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Neck Pain and Headaches? Work Your Core?!

You may have heard that if you suffer from low back pain (LBP) that you need to work your “core” muscles, but what if you suffer from neck pain (cervicogenic pain) and/or headaches?  Well then yes, you would need to work the core muscles of the neck.  Like the lumbar spine, the neck also has a group of core muscles that are specifically designed to insure proper cervical segmental stability and to maintain proper head posture.  When weakness and dysfunction are present within this group of muscles, there is often ongoing neck pain that can lead to headaches.

Muscles of the cervical neck “core” include the deep neck flexors and deep neck extensors.  Most people don’t know the names or how to spell these rarely talked about muscles.  For those who like the nitty gritty details, the deep neck flexor muscles include the longus colli and longus capitis.  The deep neck extensor muscles include the multifidus and the semispinalis cervicis.  The sub occipital muscles (including the rectus capitus posterior major and minor) and the obliquus capitus superior and inferior also play a role in cervical stability.  These muscles as a group make up the core muscles for the cervical spine.

When classifying muscles, and especially the cervical muscles, it can be useful to think of them conceptually as global movers and local stabilizers. 

Global movers are involved in the generation of torque and produce movement.  They function more like a light switch, either moving your head or not.  When dysfunctional, there are spasms, pain, and a restricted range of movement.

Local stabilizers are the deeper muscles that control segmental movement and neutral positioning of a joint and the head.  Their activity is tonic (always on).  It’s like a light switch that is always on, but with a dimmer controlling the intensity.  Local stabilizers operate at much lower levels of contraction for long periods of time.  Dysfunction in the local muscles results in the inhibition of muscle function, delayed timing or recruitment of when the muscle is stabilizing which causes loss of segmental control and poor cervical vertebral joint positioning.  This is often associated with chronic neck pain and headaches as well as muscle spasms in some of the larger muscles (such as the upper trapezius) as it attempts to compensate for the underlying muscle inhibition.

The neck presents a unique challenge of both mobility and muscularly speaking.  It requires intricate muscular control to balance the weight of the head in space.  The neck also moves the head through a large range of motion available; all while positioning it accurately to allow us to use our senses (sight, smell, hearing, and taste) most effectively.

Mobility and stability are both vitally important to how the neck functions.  This is why the deep segmental stabilizing muscles are extremely important.  These deep core muscles (also known as the “inner unit”) have been shown to weaken in the presence of neck pain or injury regardless of the cause.  As part of a compensation pattern, one will often find that the prime mover muscles at the front of the neck, called the SCM (sternocleidomastoid muscle), become overactive trying to protect the neck.

Unfortunately, this creates excessive shear and compression forces on the neck which brings the head forward into the poking chin posture.  This dysfunction pattern tends to persist even when the pain subsides unless properly retrained.  This may explain why so many people experience recurrent episodes of neck pain.  Discover why it’s important to insure proper cervical core strength in order to not only alleviate neck pain and headaches, but also to prevent them from reoccurring.

Most of the time neck pain is mechanical in nature.  This means that there is a structural or mechanical issue affecting proper motion in the neck leading to either neck pain or headaches.  Since the trigger is mechanical (starting or worsening with certain movements), it can just as easily be reduced or eliminated if the correct movements can be initiated.  Mechanical neck pain is often experienced as cervical pain, headache pain or other correlated pain patterns in your upper back and down your arms (even to your fingers).

Neck Pain (Cervicogenic Pain) Symptoms include:

  • Pain in the front of your head, behind your eyes or side of your head.
  • Pain which begins from your neck that extends between your shoulder blades and upper shoulders.
  • Pain which is exacerbated or changed by certain neck movements or neck positions.
  • Pain which is triggered by pressure applied to the upper part of the neck near the base of the skull (known as the sub occipital area) or in the upper trapezius area.
  • Pain down one or both arms.  It can be felt as far as your fingers.
  • Stiff neck.
  • Altered or blurred vision as well as nausea, vomiting, and/or dizziness.

Potential Causes for Cervicogenic Headaches

There are plenty of reasons why one might develop neck/cervical derangements or dysfunction.  Examples include: motor vehicle accidents; sports; falls; sleeping on a poorly fitted pillow; poor posture; and carrying items that are too heavy (such as a backpack).  Chronically sustained non-symmetrical postures, stress, and a sedentary lifestyle are also potential causes.

The actual pain generating structures of the neck (listed below) vary wildly and can be difficult to pinpoint.

  • Nerve related injury or pain
  • Muscle spasms
  • Trigger points
  • Facet joint dysfunction
  • Cervical mal-alignments
  • Cervical disc issues
  • Postural dysfunction

Cervicogenic pain and headaches tend to be more common in women than men.  In general, women experience this due to minor anatomical differences.  Men tend to have muscular necks. Women tend to have longer more slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Treatment for Neck Pain (Cervicogenic Pain) and Headache Pain

Research suggests the most effective management of neck pain conditions include both manual therapy (hands-on mobilization) and manipulation with specific exercises.  If you have to choose one or the other, I find that a correctly designed and implemented exercise program to be the most effective over the long term.

The first step to designing a treatment plan is by identifying a pattern to the pain.

Which head motions change or alter your neck or headache pain?  Does the pain get worse or does it improve when you turn your head?  What happens when you look up, look down, slouch or sit up straight?  What happens when you repeat this movement?

Determine how your pain responds.  This is also known as establishing a directional preference.  You might be moving in the wrong direction if the pain spreads away from the spine and down into the upper back or arm.  Stop that particular movement, and try the opposite direction.

In my experience, most episodes of cervical pain and headaches tend to respond better to cervical extension biased movements and improvements in posture.  Gaining extension in the thoracic spine is also critical to treatment.

In order to determine if extension biased (cervical retraction or extension) movements help you, I recommend starting with this exercise (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 10-20 times.

Carefully monitor symptoms for peripheralization or centralization.  The rule of thumb for movement:  If the pain worsens by spreading peripherally down the arm into the hands, fingers, shoulder blade/upper back or the headache gets worse, then the condition is worsening (peripheralizing).  Stop that activity.  If the pain centralizes and returns back toward the cervical spine, and the headache pain improves (even if the pain in the neck worsens slightly), then keep moving as the condition is actually improving.

If you are unable to help or change the pain in any way, then you may need assistance from a medical provider.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Neck  by Robin A. McKenzie.

Once you have determined a directional preference, then you can focus on the deep core and stabilizer muscles.  For my initial neck core strengthening exercises, please refer to Deep Neck Flexion Exercises.

Once you’re able to engage the deep neck flexors, you can next progress into strengthening your scapulothoracic and postural muscles.  Be sure you are engaging the deep neck flexors during these exercises to insure proper stability of the neck.

For the I’s, T’s, and Y’s exercises (as shown below), work up to holding each position for 30 seconds.  Repeat 3 times.  Keeping the correct posture and deep cervical flexor muscles engaged during this exercise is critical to engaging the full core of the neck.

Other Treatments for Neck Pain (Cervicogenic Pain) and Headache Pain:

  • Focus on your posture.  Poor posture is the bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this leads to muscle weakness and dysfunction in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches using foam roller exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Manual Therapy.  An osteopathic physician, physical therapist or chiropractor can use manual therapy techniques.  This includes joint mobilization and manipulation which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Massage.  Although massage can be a form of manual therapy, it can also be thought of as separate intervention.  There are many types of body workers that can utilize many different forms of massage or manual treatments.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a massage therapist, body worker, physical therapist, athletic trainer or friend who is skillful in body work or massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Other self-mobilization tools.  Many times, a friend or massage therapist isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called the Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms.  They can also mediate the pain response helping to reduce neck pain or headache pain.  You can apply a small amount of topical agent directly over the pain area if it’s accessible and not near your eyes.  (Please use common sense).  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel, Arnica Rub (Arnica Montana, an herbal rub), and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include:  Epsoak Epson Salt and Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD or DO).  If you are suffering with neck pain and headaches, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very effective treatment for those suffering with neck pain and headaches.  The American Physical Therapy Association (APTA) offers wonderful resources 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 hear your physician’s opinion as well).

Don’t give up hope!  Neck pain and headaches can be difficult to manage, but with proper care, most of the pain can be cured or effectively managed.  Begin by implementing one or two of these treatment tips, then assess how well they worked for you.  If the technique helped, continue with it then implement another strategy.

If you suffer from neck pain and headaches, which treatments have worked the best for you?  Please share 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!

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How to Self-Treat Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS), sometimes called jogger’s foot, is a relatively common cause of pain along the inside (medial) portion of your ankle.  TTS can be a repetitive strain injury or an entrapment (compression) type injury.

The tarsal tunnel is a fibrous tunnel that is not structurally flexible.  There is limited room for swelling inside the tunnel.  This can cause nerves and blood vessels to be “entrapped” and lead to pain and other symptoms.

TTS is often caused by repeated pressure that results in damage on the posterior tibial nerve.  Similar to carpel tunnel in the hand, the tarsal tunnel is located just below the medial malleolus (the large bump to the inside of the ankle).  Basically, the tibial nerve branches off of the sciatic nerve and travels down the inside of the leg.  It eventually runs through the tarsal tunnel, which is a narrow passageway inside your ankle that is bound by bone and soft tissue called a retinaculum.  Continue Reading

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Why Physical Therapy is a Key Component to Aging Well

As a leading authority on aging well, I would like to share with you a few of my latest featured articles on how physical therapy can help you to stay active and healthy and improve your quality of life so that you can avoid costly medical expenses and medications which are fraught with side effects.

Why Physical Therapy is a Key Component to Aging Well:

In this featured article in the Seniors BlueBook, you’ll learn why physical therapy can help with healthy aging by improving health span and assisting in a more successful aging process.

https://issuu.com/seniorsbluebook/docs/sbb_idaho1018/86

Discover how to improve your health span and age successfully with these three simple exercises for balance and strength as featured on Smart Strategies for Successful Living.

http://www.agegracefullyamerica.com/how-physical-therapy-can-help-you-age-well/

In this featured article for PT-Helper, you’ll discover how a Physical Therapist (PT) can help you improve, restore or maintain your ability to move and function in your daily life while improving all aspects of your health.

http://pt-helper.blogspot.com/2018/07/how-you-can-benefit-from-physical.html

If you’re interested in learning more about how physical therapy can help you to age successfully and improve your health span, 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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BeastNet Podcast Recap: Ben and Ted

In this podcast interview with Mike James (host of the BeastNet Podcast) and Ted Kielley (friend and Physical Therapy client), we discuss injury rehabilitation and what you need to do practically and mindset-wise to get back to obstacle course racing events (like the Spartan).  We also discuss the importance of teaming up with medical providers who actually understand your specific sport or lifestyle and how to find medical providers that can help you along the way.  Finally, we discuss best practices in preventing injury as a person ages to insure longevity as an Obstacle Course Race (OCR) athlete and how to age well in general.  Listen to the podcast

Disclaimer:  This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

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Does Kinesiological Tape Really Work?

I was first introduced to Kinesiological (Kinesio) style taping during a continuing education class in 2005.  Since then, this style of taping has exploded in the mainstream with athletes and celebrities alike wearing it.  Research on this modality was initially scant.  Today there are over 540 published studies with even more antidotal testimony!  Although the research is ongoing and published regularly, I get asked all the time about what can you use Kinesiological tape for and how exactly it works.  I will review three theories on how Kinesiological tape actually works and the different reasons for using it.

Kinesiological Taping For Achilles Tendinitis

How does Kinesiological Tape Work?

  • Sensory Theory (also known as the Gate Control Theory) – The basic premise of this theory is that the Kinesiological tape, when applied to the skin, activates sensory receptors present on the skin. These receptors relay information to/from the brain.  Since the sensory receptors are faster than other types of receptors (such as pain) the brain reacts to the sensory information first.  This can lead to altered movement patterns and awareness to the area.  It can also allow for decreased sensations of pain.  This theory is similar as to why we think topical analgesics (such as Biofreeze) work as well as why transcutaneous electrical nerve stimulation (TENS units) can reduce pain.
  • Circulatory Theory – The basic premise of this theory is that the when the Kinesiological tape is applied with little tension it forms convolutions in the skin. These convolutions create channels and reduce pressure within the tissues, lymph system, and circulatory system which aids in blood and lymphatic flow.
  • Muscle Activation Theory – The premise of this theory is that when the Kinesiological tape is applied at different levels of tension on the skin over the muscles and tissues, the Kinesiological tape can either mechanically or neurological increase or decrease muscle activation via a nervous system response.

Presently the truth behind Kinesiological taping is that we really don’t know exactly how or why it works.  Based on my clinical experience, I believe that the Kinesiological tape interacts with the body’s tissues in different ways depending on how and where the Kinesiological tape is applied.  Depending on how the Kinesiological tape is utilized, any one or combination of the three theories is likely correct.

Research states that Kinesiological style taping is at least as effective as other minimal interventions for musculoskeletal pain which may include topical analgesics like Arnica montana (Arnica Rub) or Biofreeze.

Research has also shown that taping can reduce pain acutely within first week of injury and possibly even in cases of pain which has been present for as long as three to four weeks (or longer).

Research concludes that there are some improvements in muscle and joint range of motion (ROM) and a reduction of pain.  However, because the improvement isn’t significant or long standing it shouldn’t be used as a standalone intervention.  Kinesiological taping is best used in combination with other interventions (such as manual therapy based techniques and exercise) which have been proven to affect outcomes over the long-term.

When Kinesiological tape is used in conjunction with other treatments, it may help speed up the recovery as the Kinesiological tape can allow for other techniques to be utilized more effectively due to the loss of pain, swelling or easing of movements.

Although there have been hundreds of research studies performed, the effectiveness of Kinesiological tape is still questioned primarily due to issues with research design.  Many of the taping applications are based on theory and not science.  Since there isn’t a consistent application pattern, the research studies aren’t comparing the same techniques over large enough patient populations to show a true effect.  In addition, researchers still need to quantify how much tension is actually being used and the actual Kinesiological taping technique being used versus other types of techniques or interventions.

Unfortunately, without better quality research it’s unclear if the results shown in many of the studies are due to an actual effect or through placebo.  For now, none of the studies show significant benefits regarding long-term pain alleviation or improved strength or range of motion (ROM).  So for now, the main conclusion is that Kinesiological taping should be used only as a short-term treatment in combination with other treatments.  I personally use Kinesiological tape, and I often find that my clients experience success with specific tape applications for different conditions.

What do you use Kinesiological Tape for?

  • Reduce pain
  • Reduce swelling and edema
  • Support muscles and joints
  • Reduce muscle tension
  • Increase strength
  • Improve performance
  • Enhance or correct movement patterns through stimulation of sensory receptors
  • Provide compression
  • Enhance healing by slightly lifting skin away from sore or injured tissues to improve blood flow and lymphatic drainage
  • Support injured joints and muscles without impeding range of motion (ROM)

There are dozens of companies’ now manufacturing Kinesiological style tape.  There are many high quality tapes being manufactured with all kinds of colors, designs, and variations in adhesive quality and elasticity.  Personally, my favorite brands are based on price point and actual use.  This includes ease of application and how long the Kinesiological tape actual stays on.  The brands I use most include:  Kinesio Tape, RockTape, Thera-Band Kinesiology tape, Spider tape, and KT TAPE.  Although there are many more brands available, I have not personally used them.

There are many different applications Kinesiological taping can be used for.  Like any treatment modality, it can work wonders for one person and do nothing for another, but should we really be surprised?  Many of our most popular pharmaceuticals are no different.  Kinesiological taping has the benefit of rarely having significant side effects.  There are rarely side effects to utilizing this style of tape as the products utilized tend to be very hypoallergenic.  Occasional skin irritation has been the only noted side effect I have known of in my clinical experience.  In order to avoid skin related issues (including application and removal tips), please refer to Skin Care with Taping.

I have found success with utilizing Kinesiological taping as an adjunct treatment strategy and as part of a complete treatment approach.  If you are interested in specific applications for different conditions, please see the following in which I demonstrate different taping techniques.

Step-by-step guides:

Kinesiological Taping for Osgood-Schlatter Disease

Kinesiological Taping for Patellar Femoral Pain Syndrome

Kinesiological Taping for Shin Splints

Video:

How to Apply Kinesiological Tape When Treating Achilles Tendinitis

Books with step-by-step guides specific for ankle sprains and low back pain:

The Physical Therapy Advisor’s Guide to Treating Ankle Sprains and Strains

The Physical Therapy Advisor’s Guide to Treating Low Back Pain During Activity and Exercise

Have you tried using Kinesiological taping before?  If so, what was your experience like, and did it help you?  Please leave 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!