Category Archives: Running

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9 Tips to Self-Treat Hip Bursitis (Side of the Hip Pain)

Pain in the lateral (outside) of the hip or leg can be associated with a condition known as hip bursitis or trochanteric bursitis.  This condition is almost always a repetitive motion injury, but it could also be initially caused by direct trauma.  In the case of a runner, the condition is most likely a repetitive overuse injury.

As an overuse injury, hip bursitis is caused by repetitive friction over the greater trochanter of the hip bone (which ultimately leads to pain).  This excessive friction is almost always due to faulty biomechanics.  In this case, it’s faulty running mechanics.

The greater trochanter is a portion of the femur (leg bone) that is easily felt.  It’s the harder portion of the hip bone on the side of the hip.  A bursa is a fluid-filled sac that is around and near boney areas and tendons areas where there is the potential for the tendon to rub or have friction.  The job of the bursa sac is to reduce friction by providing cushion and a viscous synovial fluid for the tendon to slide through.  This sac and/or the associated tendon can become inflamed and painful.  Continue Reading

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Why You Keep Getting Hurt

Have you ever wondered why some people seem to always get injured while others are resilient and seemingly bullet proof?  Injury can be the biggest obstacle you face when trying to be healthy.  Acknowledging that you’re injury prone is the first step.  Instead of letting the fear of getting hurt stop you from achieving your goals, learn how to take precautions and stop being injury prone.

In my series on Why You Won’t Heal, I addressed the six categories of common reasons why a person will not heal or recover from injury.  If you’re frequently injured, it’s time to take a step backward in order to understand why you keep getting hurt in the first place.  Avoiding injury is always best.  When it comes to injury, there are factors, like genetics and luck (whether good or bad), that are out of your control.  There are also many factors that are definitely in your control.

The power of good genetics cannot be understated.  Some people just were lucky and won the genetic lottery.  They picked their parents well!  We all know that one person who seemingly can do whatever he/she wants without ever seeming to have an ill consequence.  That may go for all kinds of questionable behaviors from those who smoke for fifty years, yet still live to be 100 years old.  Good genetics are definitely a gift for some, while the opposite can be true for others.

Like good genetics, you can’t eliminate the effect luck (whether good or bad) may have on your life.  I’m sure that you have known those people who always seem to win contests or drawings or that seem to always be at the right place at the right time.  While others seem to be the ones that if something bad is going to happen, then it happens to them.  Now I’m not a superstitious person, but I think that some people seem to have either more bad or good luck than others.  Louis Pasteur said of his seemingly serendipitous scientific discoveries, “Chance favors the prepared mind.”  Are you prepared?

How can you learn to avoid injury?  Consider the following factors that make you more prone to injury:

Poorly Designed Training Program 

Overtraining syndrome (OTS) occurs when the intensity and/or volume of training/exercise becomes too much for the body to properly recover.  This is usually the result of a poorly designed and/or executed training program.  Pushing your training to the point of overtraining will at best, impede your performance.  At worst, it can lead to serious injury and burn out.  A weekend warrior (those that cram a week’s worth of exercise into just two days) is at high risk of injury because the body can no longer recover from the training stimulus being imparted on it.  To learn how to avoid OTS, please refer to 12 Tips to Prevent Overtraining Syndrome.

Poor Nutrition

The importance of proper nutrition cannot be overstated.  It’s critical in order to insure that your body is functioning at a high level and is capable of recovering from stress.  Your body relies on the stress, recovery, and adaptation cycle to progress forward.  Proper nutrition is a critical component to proper recovery.  Without proper recovery, your body cannot adapt and becomes more prone to injury.  Then you not only suffer from poor performance, but a lack of progress.

Poor Sleep Quality

Like proper nutrition, adequate sleep is a critical component to the recovery process.  Again, a body that cannot recover fully cannot adapt to the training loads being placed on it.  This impedes performance and increases your risk of injury.

Poor Posture 

The effects of chronic poor posture on western society cannot be overstated.  A vast majority of all low back pain (LBP), thoracic pain, and cervical pain is directly related to chronically poor sitting posture.  The effect of a low load long duration stretch on the muscles, ligaments, and discs of your spine can be devastating.  Our bodies were built for frequent movement and activity, not prolonged sitting (especially, with poor posture).  As a physical therapist, I have treated more people who are suffering from back and neck related pain from poor posture than any other injury.  For tips on avoiding poor posture, please refer to How to Improve Posture and Eliminate Pain.

The Wrong Equipment

Can you imagine trying to play basketball in hiking boots or soccer cleats?  Using the proper equipment for a particular sport or activity is critical to avoiding injury.  Wear properly fitting shoes if your sport involves running and jumping.  It’s not necessary to have the most expensive equipment, but it needs to be kept in good working condition and fit properly in order to maximize your safety.  Always wear a helmet when you are skiing or bike riding.

Common Sense 

This may be the most obvious and least used of all of our senses.  Many injuries could be avoided if one just took an extra second or two to think through his/her actions and decisions prior to acting.  Have a purpose and a reason for every action, and be intentional about those actions.  If your common sense tells you to think twice, listen!

Muscle Imbalances 

Although many muscle imbalances are due to poor posture, some can be attributed to other chronically repeated movement patterns.  Often when developing a certain motor skill, one will practice and practice that skill only.  This causes muscles imbalances to occur which will ultimately result in pain.  This can be easily oversimplified though.  Muscle imbalances can form for a variety of reasons including: chronic movement (habits) or sitting postures; neurologic input; overuse; and purposeful development.

Regardless of how the muscle imbalance occurs, once present, you are definitely at a higher risk of injury.  In runners, I often see an imbalance in strength within the rotators of the hip.  The hip’s internal rotators will be stronger than the external rotators.  This can lead to altered movement patterns and excessive strain and stress throughout the lower kinetic chain.  This often results in injuries like patellar femoral pain syndrome, shin splints, and plantar fasciitis.  This is why cross training is such an important component to any training plan.  With the right advice, training plan and cross training, you can avoid muscle imbalances and prevent injury.

Poor Mobility and Stability 

Poor mobility and stability can be components of muscle imbalance, but not necessarily.  One can have symmetrically poor mobility.  Poor mobility (and particularly, asymmetric mobility) can lead to injury.  It’s not necessary or desired to have excessive mobility.  Excessive mobility can also lead to injury as it’s usually accompanied with poor stability for the task at hand.  In the case of mobility, you just need enough in order to safely complete the desired task without over stressing and/or stretching the system.  More than just enough mobility will not provide an additional benefit.  However, there must be enough reserve mobility to accommodate for any unexpected movements that may occur.  There must always be an appropriate amount of stability or strength needed to safely complete the task without overloading the body system being utilized. 

Overuse Injuries 

Overuse injuries (also called repetitive motion injuries) tend to occur when a specific structure is subjective to a repetitive straining over and over again.  This eventually causes the structure to break down and results in injury.  Often, muscle imbalances are to blame for overuse injuries.

Weekend warriors are famous for getting overuse injuries as many people attempt to make up for a week of chronic poor sitting posture at their job in one afternoon of activity.  An example may be developing a case of tennis elbow after attempting to build a deck when you’re not used to swinging a hammer.  It can also happen when a runner tapers up the mileage a little too quickly and suffers a stress fracture.

Overuse injuries are almost always preventable by using common sense, sticking to a proper training plan, and implementing preventative maintenance and cross training.  An overuse injury can be frustrating because it could have been prevented initially with the right advice.

In order to be successful in meeting your movement, exercise, and training goals, injury must be avoided.  Other than lack of time, injury is the number one reason why people report not completing their exercise and training goals.  With the right training advice and preventative maintenance, most injuries can be avoided.

Avoiding injury in the near term is not only a critical component to reaching your training goals, but it’s also an important strategy as you try to optimize your health and truly learn how to age well.  This insures that you not only have a long life span, but also a long health span.

My goal is to help proactive adults like you to understand how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions in a timely manner so you can reach your optimal health.

The following comprehensive programs are designed to help you not only save money on health care costs, but also learn how to be proactive in managing your current aches, pains, and injuries.  And more importantly, how to prevent them in the future!

The Resilient Runner

 

Treating Low Back Pain during Exercise and Athletics

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How to get to the Root Cause of an Injury

Injury can quickly sideline any runner by causing pain, frustration, and disappointment over lost training days and unmet goals.

Injuries can be classified as accidental or as a result of overuse.

Some injuries occur due to accidents (such as tripping or falling).  Accidents are unfortunate, but mostly random.  Using common sense can help you to avoid repeating similar injuries.

Overuse or overload type injuries are preventable if you reduce your risks.  By avoiding injury, you can better train and ultimately, meet your running goals.  Continue Reading

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Do I have Morton’s Neuroma in my Foot?

Do you have pain between your toes?  Does it feel like you are always standing on a pebble or have a lump in your socks between your toes?  This may be Morton’s neuroma.  A neuroma is a thickening of the tissue that surrounds the digital nerve bundle.  Morton’s neuroma is one of the most common types of neuromas and typically occurs between the third and fourth toes.

Morton’s neuromas occur due to repeated stresses, irritation, and/or pressure at the ball of the foot which affects one of the nerves that leads to the toes.  There typically isn’t any swelling, bumps or bruises with Morton’s neuroma.  Learn how to determine if you have Morton’s neuroma in your foot and how to self-treat it.

Morton’s Neuroma Symptoms include:

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

Common Risk Factors for developing Morton’s Neuroma:

  • Sports and activities that involve repeated impact affecting the feet (such as jogging and running sports).
  • Poorly fitting footwear.  This is particularly true for high heel shoes, but it’s also very common in athletic and running shoes.  Most commonly, the toe box is too small.  A sole that is overly flexible in the wrong location can cause excessive give in a location which isn’t in proper alignment with the metatarsals of the foot.
  • People with common foot deformities, such as bunions, hammertoes, flat feet or overly high arches, are at risk for developing Morton’s neuroma.
  • Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
  • Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
  • Women are eight to ten times more likely to develop Morton’s neuroma.  High heels are a likely culprit.

Do I have Morton’s Neuroma in my Foot?

Morton’s neuroma is often diagnosed through a physical examination and imaging.  However, a very thorough history and physical examination can be quite conclusive.  The imaging is typically only to rule out other possible causes of the pain such a stress fracture.

The physical examination includes palpating between the toes.  The painful area will feel “thicker” on the affected foot in comparison to the other.  There is often an associated clicking of the bones when the area is squeezed or moved back and forth.  When the forefoot is squeezed and held for several seconds for a Morton’s Neuroma test, it will often reproduce or worsen the symptoms of burning and or tingling.

How to Self-Treat Morton’s Neuroma:

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

Orthotics.  Many people respond well to a rigid orthotic with an extension underneath the first metatarsal bone.  You may not necessary need custom orthotics.  Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles.  The blue tends to fit most feet, but a variety of options are available for customization.  In my experience, these insoles can last 1,000 to 1,500 miles easily.  If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.  Seek assistance from a professional who is a runner and has experience with treating other runners.

Metatarsal buttons and pads.  Adding a metatarsal button or pad may be enough to spread out the metatarsal heads and alleviate the pain for those who don’t want a full orthotic.  Although often a metatarsal pad may be incorporated into a custom orthotic.  I recommend these Pro-Tec Athletics Metatarsal Pads.

Anti-inflammatories.  Initially an anti-inflammatory may be necessary.  Speak to your physician about the best type of anti-inflammatory for you.  In severe cases, a cortisone injection may also be warranted.  However, you must address the biomechanical causes for the pain in order to prevent it from recurring.

I am a supporter of natural supplements and remedies.  Many supplements include herbs which are designed to help reduce inflammation and support the healing response. 

My most recommended supplement to help recover from injury is Mt. Capra CapraFlex.  Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation and support healing.  CapraFlex can be taken long term or intermittently.

Phenocane Natural Pain Management 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.

Another supplement I frequently recommend to help recover from injury is Tissue Rejuvenator by Hammer Nutrition.  It contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation.  It’s a fantastic supplement.

I recommend taking either CapraFlex OR Tissue Rejuvenator, not both concurrently.

I initially recommend 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 sometimes 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.)

Improve your foot mobility and strength.  Complete with instructions and photos, this guide, Morton’s Neuroma Rehabilitation Exercises, outlines how to safely perform exercises in order to improve your mobility and strength.

Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) is often found in the case of Morton’s neuroma as part of the biomechanical issues that led to its development.  I recommend initiating a complete ankle/foot strengthening protocol.  Please refer to Ankle Resistance Exercises Using the Elastic Exercise Band.

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 biomechanics.  Standing on one foot can be an excellent way to improve your balance.  This technique is demonstrated in the Morton’s Neuroma Rehabilitation Exercises.  For additional ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle.

Research concludes that nearly 80% of all cases of Morton’s neuroma can be treated through conservative measures (as outlined above).  In the rare cases where conservative measures fail, then one may need to consider surgical options.

One surgical option offered is decompression surgery.  During this surgical intervention, the surgeon can relieve the pressure on the nerve by cutting nearby structures (such as the ligament that binds together some of the bones in the front of the foot).  Unfortunately, this alters the shape of the foot and may affect foot dynamics into the future.  Another option is to resect or remove the nerve.  Surgical removal of the nerve is usually successful, but the procedure can result in permanent numbness in the affected toes.

If you’re not experiencing significant relief from Morton’s neuroma upon changing your footwear and addressing other risk factors while progressing into your exercise program, please consult a medical professional.  I recommend a physical therapist that specializes in feet.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for Morton’s neuroma helped you?  Which treatments haven’t worked for you?  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 Resource Guide.  Check it out today!

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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10 Strategies for Avoiding Injury

http://marathontrainingacademy.com/avoid-injury

Marathon Training Academy

May 16, 2017

In this guest post for Marathon Training Academy, you will learn which strategies to implement in order to reduce your risk of injury while taking your training and exercise program to the next level.

An ounce of prevention is worth a pound of cure. –Benjamin Franklin

As a physical therapist, I help people who have suffered from an injury through the process of rehabilitation. Yes, accidents will happen, but being proactive can help you to avoid and limit the chance of an injury.

Nothing derails a perfectly designed training program like an injury. One key to being a Resilient Runner is to optimize your health and lessen your risk of injury by being proactive upfront. Continue Reading

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The Injury Episode!

With Special Guest Dr. Ben Shatto

http://marathontrainingacademy.com/injury-episode

Marathon Training Academy

May 11, 2017

In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss the prevalence of running injuries, the top mistakes we see runners make, and answer injury related questions from runners.

In this episode we talk injury prevention with our friend and physical therapy doctor Ben Shatto. Plus we answer injury related questions from real everyday runners like you. Glutes, calves, hamstrings, IT Band, foot and knee pain . . . we cover it all! 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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How to Become a Resilient Runner

Why do so many people fail to reach their running and training goals?  When questioned about running, why do so many people respond with the following: “Well, I used to be a runner, but I don’t have the time or I have a bad knee.”

The two most common reasons that people fail to meet their running and training goals is lack of time and due to injury.  The painful truth is that 37-56% of runners will experience injury in a given year according to The Journal of Sports Medicine.  The number of runners who will suffer with injury during their lifetime is even higher–I’ve seen estimates as high as 80%!  These statistics even surprised me.  Yet some runners seem to be injury-proof.  How can an injury-prone runner become more resilient?

Most running related injuries are classified as repetitive motion injuries (overuse).  This is fantastic news as it means most running related injuries are preventable!  That’s why I have teamed up with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast) to give you the tools to become a Resilient Runner.

What is a resilient runner you might ask?  A Resilient Runner is able train consistently and effectively at a high level (even at times, taking a pounding) yet keeps on running.  You can learn to be a resilient runner, too!

How to Become a Resilient Runner

Resilient Runners Avoid Injury.

The biggest mistake is thinking I’LL WORRY ABOUT THIS WHEN I GET INJURED.  We can’t emphasize enough how important it is to start thinking about injury prevention now.  If you want to meet your current goals and run well into your older years, THEN you can’t afford to wait until you get injured!

Resilient Runners Train More.

You are bound to experience minor aches and pains associated with any exercise and athletic endeavor.  When these minor irritations are dealt with immediately, you can significantly reduce your risk of an overtraining injury.  Overuse injury is the most common reason for pain and injury associated with running.  Resilient runners know how to properly cross train to avoid common muscle imbalances and biomechanical issues that can lead to injury.  Being pre-emptive in dealing with running injuries before they become full blown will keep you running and progressing toward your goals.

Resilient Runners Recover More Quickly.

Statically speaking, most runners are likely to experience some form of injury.  Resilient runners respond quickly and correctly to their injury.  Knowing what to do and how to do it can significantly reduce the amount of time lost due to injury which equals more time doing what we all love to do…run!

Resilient Runners Save Money.

Health care costs in the United States and around the globe continue to increase often times without actual positive change in health status.  It’s imperative that we all take a leadership role in our own health care by continuing to be proactive.  In the United States, the average cash pay physical therapy visit ranges from $100-$150 per visit, and insurance co-pays can range from 50% of the visit charges to $20-$50 per visit.

With the right information available, most people can safely manage and self-treat the most common running associated musculoskeletal pains.  Even better, with the right training approach, most injuries can be prevented all together!

In the Resilient Runner program, we explain injury prevention strategies to keep you running.  We provide detailed videos and rehabilitation guides on how to effectively SELF-TREAT each problem area of the body including:

  • Lower Back Pain and Piriformis
  • Hip: Hip Bursitis and Hip Flexor Pain
  • Upper Leg: Iliotibial Band and Hamstring Injury
  • Knee Pain: Patellar Femoral Pain Syndrome (Runner’s Knee); Patellar Tendinitis; and Meniscus Injury
  • Lower Leg and Foot: Achilles Tendinitis; Plantar Fasciitis; Posterior Tibial Tendon Dysfunction; Shin Splints; and Stress Fractures

The Resilient Runner program is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.

It’s a virtual library of self-treatment protocols including downloadable podcasts, videos, and .pdf files of rehabilitation guides.  It also includes a 320 page eBook, The Resilient Runner, Prevention and Self-Treatment Guide to Common Running Related Injuries.

In addition, Angie offers in-depth advice on the following topics:

  • Preventing the most common running mistakes and mishaps from side stitches to blisters.
  • How to cope with the mental and physical aspects of injury.
  • Tips on avoiding overtraining.
  • Tips on cross training including a special 27 minutes Yoga for Runners Video.

Not all of us are born bullet proof, but we can all learn how to be more resilient!

I WANT TO BE RESILIENT!

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The Truth About Running Injuries

http://marathontrainingacademy.com/truth-running-injuries

Marathon Training Academy

May 3, 2017

In this guest post for Marathon Training Academy, you will learn how to identify the risk factors and potential causes of overuse running injuries so that you can avoid training errors which can result in lost training days, missed races, and unmet goals.

Running is one of the most popular sports and hobbies in recent times.  In the U.S. alone, there are more than 500,000 annual marathon finishers and up to 40 million people who run regularly.

Of those 40 million people, more than 10 million are running at least 100 days a year!

Running can be enjoyed by almost anyone despite age.  Not only is running fun, but it has many health benefits including (although not limited to) the following:  Continue Reading

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How to Avoid Overtraining Syndrome (OTS)

http://marathontrainingacademy.com/overtraining-syndrome

Marathon Training Academy

April 28, 2017

Don’t let an injury or Overtraining Syndrome (OTS) derail your running plans or affect your performance.  In this guest post for Marathon Training Academy, you will learn which strategies to implement as you self-treat and manage any potential injury safely and quickly.

Nothing can derail your best laid training plans and goals like an injury or suffering from Overtraining Syndrome (OTS).  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.  Many common running injuries are directly associated with OTS.  It’s always best to prevent OTS rather than attempt to recover from it.  Continue Reading

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Preventing Knee Pain

There isn’t a shortage of promising lotions, braces, taping techniques, exercises, and electric modalities when treating knee pain.  Many of these fancy options may or may not work to prevent and/or reduce pain.  There are many potential reasons for experiencing knee pain.  However, an often overlooked cause is the lack of a normal range of motion and tightness in the quadriceps and/or hamstrings.  Getting back to the basics can be an integral component to successfully treating knee pain or preventing further injury.

Potential Risk Factors for Knee Pain:

  • Poor quadriceps strength (particularly, the inner/medial quadriceps).
  • Poor hip abductor and/or hip external rotator strength.
  • Prior knee injury.
  • Over use.
  • Obesity.
  • Poor foot biomechanics including overpronation (when the feet excessively roll inward, which causes the knee to roll inward during each step).
  • A larger “Q-angle” which is the associated angle between the hip and knee.
  • Even anomalies in the shape of one of the bones that make up the knee joint could predispose you to knee pain.

The most obvious (yet rarely talked about) reason for experiencing knee pain directly relates to your range of motion (ROM).  In its simplest form, the knee is a hinge joint.  It bends and straightens (flexes and extends).  If your knee isn’t able to fully bend or straighten because of either excessive quadriceps tightness and/or hamstring tightness, then you’re at an elevated risk for many common knee pain diagnoses including Patellar Femoral Pain Syndrome (PFPS) and Patellar Tendinitis.

Quadriceps Tightness

Poor range of motion in the quadriceps can be associated with a higher risk for developing knee pain.  One potential reason for this is that the quadriceps muscle blends into the quadriceps tendon.  Eventually it attaches to the patella (kneecap) before becoming the patellar tendon where it attaches to the tibial tubercle on the tibial bone (the main lower leg bone).

Excessive tightness will cause alterations in force and tracking of the patella.  This can lead to inflammation and ultimately, pain in or around the structures of the knee (including the patella, quadriceps tendon, patellar tendon, the patellar femoral joint or the infrapatellar fat pad).  The following four muscles make up the quadriceps:  vastus lateralis; vastus medialis; rectus femoris; and the vastus medialis.  The rectus femoris is most likely to be tight as it crosses two joints–both the hip joint and the knee joint.  The other muscles only cross one joint–the knee joint.

Normal range of motion in the quadriceps will vary from person to person (especially, the older you get or if you have a history of injury).  For most healthy and younger to middle aged people, normal range of motion could be defined as the ability to touch your heel to your buttocks with your hip and low back in a neutral (not flexed or extended) position (as demonstrated below).

Regular static stretching and mobilization will help you to improve your range of motion in the quadriceps and ultimately, avoid knee pain. 

Static Stretch

Static stretching is best performed post workouts.  (Static stretching prior to a work out or activity has been shown to decrease performance.)  Hold the following stretch for at least 60 seconds, and perform two to three repetitions.

Quadriceps “Tack and Floss” Mobilization

You can use a foam roller to help mobilize the quadriceps while working on your range of motion.  Position your upper thigh onto the foam roller.  Roll around until you locate a particularly tight and/or restricted area, and then very slowly bend your knee back and forth.  If this is painful, do not exceed more than a mild to moderate amount of pain.  Perform 1-2 minutes on each leg once per day.

Hamstring Tightness

Hamstring tightness can often restrict full knee extension (particularly, during functional activities).  The most common reason for poor hamstring mobility is chronic poor posture while sitting and standing.  Most of us sit for a good portion of the day.  This results in tight hamstrings and increases your risk for experiencing knee pain as well as low back pain.

Poor range of motion can also be a contributing factor to muscle imbalances.  A hamstring that is either too long (over stretched) or a hamstring that is too short and contracted will not generate as much force and strength as a hamstring within its optimal length.  The ability for a muscle to contract optimally is dependent on it being at an optimal length.  This is known as the length tension relationship.

Many people (women in particular) struggle with adequate hamstring strength in relationship to quadriceps strength.  This muscle imbalance can lead to pain and is a major risk factor in suffering an ACL tear.  Therefore, one way to insure proper hamstring strength is to insure proper hamstring length. 

Hamstring Stretch in Doorway 

Static stretching is best performed post workouts.  (Static stretching prior to a work out or activity has been shown to decrease performance.)  Find a doorway and place one leg on the frame and stretch the opposite leg through the doorway.  Try to keep your back with a neutral arch.  As your hamstring relaxes, slowly move closer to the wall or doorframe.  Hold for at least 1 minute per side, and preferably two repetitions per side. 

Hamstring Mobilization Using the Foam Roller 

Place your leg on the foam roller.  Roll your hamstring back and forth on the foam roll.  Move slowly and spend extra time on the more painful areas.  Be sure to mobilize the entire hamstring and feel free to work on other areas of the leg that feel tight or restricted.  If this is painful, do not exceed more than a mild to moderate amount of pain.  Perform for 1-2 minutes per leg.

Don’t forget the basics when it comes to self-treating knee pain.  Lack of range of motion could be the most simple and obvious reason for why you’re experiencing knee pain.  Implement my recommended exercises in order to address any tightness in the quadriceps and/or hamstrings.  Getting back to the basics can be an integral component to successfully treating your knee pain and preventing further injury.

If you’re experiencing knee pain, do you think either poor range of motion and/or tightness in your quadriceps and/or hamstrings are causing it?  Which strategy can you implement to alleviate your pain and prevent injury?  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!