Posted on Wednesday, March 2, 2016

How to Self-Treat Metatarsalgia

http://marathontrainingacademy.com/how-to-self-treat-metatarsalgia

Marathon Training Academy

February 22, 2016

In this guest post for Marathon Training Academy, you will learn how to identify the potential causative factors for metatarsalgia and how to self-treat this condition so you don’t lose too much time with your training.

Metatarsalgia is a general term that refers to pain in the foot (typically around the ball of the foot). It’s common in runners, track and field athletes, and for those who participate in high impact related sports (such as basketball and soccer). It’s also commonly associated with overuse syndrome.

Metatarsalgia is pain and irritation at the end of the metatarsal joints near the toes. Potential causes for the pain include: a stress fracture; gout; osteoarthritis; hammertoes; calluses; and pain in the joint from swelling and irritation. It can also be from neuromas, in which nerves tend to bundle and become irritated between the metatarsal heads.

Metatarsalgia typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run. The key to treatment and management of this condition is to intervene quickly and to identify the actual cause or causes that led to the pain and irritation. Learn the potential causative factors for metatarsalgia and how to self-treat this condition so you don’t lose too much time with your training. Continue Reading

Posted on Wednesday, February 17, 2016

Q & A: Running Injuries

http://marathontrainingacademy.com/running-injuries

Marathon Training Academy

February 11, 2016

Do you want to meet your fitness goals? Avoiding injury is critical! In this podcast interview with Marathon Training Academy, I discuss common running injuries and self-treatment strategies.

Running injuries! In this episode we invite Dr. Ben Shatto on the podcast and fire away with injury related questions sent in by Academy members.

You will learn when to self-treat an injury versus visiting a physical therapist, how to pick a PT, and great questions and answers about glutes, hamstrings, and muscle imbalances. Lots to love! 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.

Posted on Wednesday, January 13, 2016

Q & A: What to Expect after Breaking a Collarbone

Q. I fell snowboarding last weekend, and I broke my collarbone. My doctor says that I don’t need surgery and that I will be fine in a couple of months. I want to be more proactive than that. What should I do? -Shawn

A. Thanks for the question, Shawn. I’m sorry to hear about your snowboarding accident. Fractures of the collarbone (clavicle) are actually fairly common and typically result from falling on the shoulder, the collarbone or an outstretched hand. Collarbone injuries are also very common in toddlers, typically due to a fall out of bed or tripping when running.

The collarbone attaches the sternum to the scapula (shoulder blade). Many important structures, such as nerves and blood vessels, lie just below the clavicle. However, these vital structures are rarely injured when the clavicle breaks. Diagnosing a clavicle fracture is typically performed via X-ray. In certain circumstances, a CT Scan may be performed for a more thorough image of the injury.

Symptoms of a Collarbone Fracture include:

Pain in the shoulder or over the collarbone.
Difficulty raising your arm due to pain.
Slumping or sagging of the shoulder, typically downward and forward.
A grinding sensation in the collarbone area when attempting to raise the arm.
A “bump” forms over the collarbone. In severe cases, the bump will be similar to a piano key sticking up and will be mobile.
Bruising and swelling over the collarbone area.

Surgical Intervention

Depending on the severity of the injury, surgery may or may not be indicated. In most cases, a simple fracture (where the bones are still aligned) will not require surgery. Even in cases of minor malalignment, most people will not undergo surgery.

Surgical fixation is most common when there is a significant displacement or malalignment present. The purpose of surgical fixation is to hold the bones in place while they heal. The physician will either utilize a metal plate and screws or small pins to hold the bones in place. Although the surgical hardware can be removed once the bones have sufficiently healed, often it will remain throughout a person’s lifetime.

Rehabilitation post-surgery is fairly straight forward and is similar to the following nonsurgical treatment recommendations. Please follow your physician’s recommendations after surgery as each procedure can be different. Variations in recovery and rehabilitation can occur and are dependent on: the area that was fixed; the severity of the fracture; and the stability of the bone and fixation. These factors will determine how quickly you can progress through the rehabilitation.

Nonsurgical Treatment Recommendations

Most collarbone fractures do not require surgery (particularly, if the fractured area retains its alignment). Your physician will assess the severity of the fracture. This will determine how quickly you can progress through the stages of treatment.

A general time frame for healing (with an initial return to function) is on average 6 weeks for adults and about 4 weeks for children. Complete bone healing, remodeling, and a full return to all activities will take longer. This will depend on your age, health status, and the severity of the injury.

PRICE (Protect, Rest, Ice, Compression, and Elevation)

Protect. In many cases, you will be advised to wear a sling (particularly, during your daily activities). This will help to protect the area from too much motion and activity while allowing the bone to heal in its proper place. It will also indicate to others that you have an injury, so that they may avoid knocking into you.
Rest. Allow the arm and shoulder time to rest and recover. Do not utilize the arm for activities that cause pain. Avoid excessive motions and use. As the pain subsides, you can slowly taper up the use of the arm by starting with simple daily activities.
Ice. Apply ice to the painful area–typically the sooner, the better. 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 gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
Compression. It’s not easy to apply compression in this area. In most cases, it’s not necessary. In some cases, a simple ACE wrap can be used around the shoulder and collarbone area to help reduce the pain. The wrap is typically applied to help hold the shoulder in a backward and slightly downward direction.
Elevation. Elevation is typically not necessary unless you are experiencing excessive swelling in the affected arm and hand. You can position the arm in a slightly elevated position by using pillows while lying on your back or on the non-affected side. This would be an excellent time to apply ice, too.

Sleeping

When sleeping, try not to lie on the affected side. Hug a small pillow for comfort. This also promotes optimal blood flow to the shoulder area.

Pain Management

Initially begin with PRICE (Protect, Rest, Ice, Compression, and Elevation). Pain medication, such as acetaminophen, is always an option if recommended by your physician. You may also want to consider utilizing topical agents, which can help to decrease pain and muscle spasms. The method of action varies greatly according to the product used. 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.

Another option is oral magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Supplements

Mt. Capra, an organic goat farm in eastern Washington State, offers superior quality products primarily utilizing goat based products. CapraFlex by Mt. Capra is the best bone and joint supplement I have found. It is a blend of natural herbs and spices along with glucosamine and chondroitin. The herbal and spice formulation is designed to naturally decrease inflammation and support healing. I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.

Vitamin D3, such as Viva Labs Vitamin D3, is critical to the absorption of calcium through the intestinal wall which is important for bone health. Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation. A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda). Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Be sure to maintain a generally healthy diet. Give your body the needed nutrients to heal and recover quickly.

Range of Motion

Depending on the severity of the fracture, you will likely have to limit the range of motion (ROM) of the shoulder to less than 70-80 degrees of flexion (forward) and abduction (sideways) motion. You will also have to limit reaching behind your back. A person may typically wear a sling for 2-4 weeks while limiting the motion.

The initial treatment to maintain ROM is to perform the pendulum exercise (as demonstrated in the picture on the left down below). Bend forward at the waist, and let your injured arm hang down toward the ground. Make small circles with your hand, and let the momentum move your arm around effortlessly. Try to make both clockwise and counterclockwise circles. For more instruction, please watch How to Properly Perform Pendulum Exercises.

Around the 2-4 weeks mark, you can begin to work on regaining full forward flexion by using an over-the-door shoulder pulley (as demonstrated in the picture on the above right). Work slowly on motion for 5-10 minutes at a time. You may push though minor discomfort, but you should never experience significant pain during this process. For more instruction, please watch How to Use Shoulder Pulleys to Regain Shoulder Motion.

As flexion improves (typically after the 4 weeks mark), then you can begin to work on all other motions of the shoulder. This includes motion out to your side (abduction) and behind your back (internal rotation). The shoulder pulley can be utilized to regain these motions as well. Otherwise, you could walk your fingers up the wall when facing forward to regain flexion and sideways to regain abduction. You could use a towel to regain the motion behind your back.

Strengthening

Initially avoid lifting anything over 5 pounds. Typically around the 4-6 weeks mark (depending on severity of injury), you can begin a gentle rotator cuff strengthening program. These exercises should always be performed pain free and initially, the resistance will be very light. For specific exercises, please refer to Rotator Cuff Exercises.

The rotator cuff is a critical component to shoulder mobility. It is made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates and slides properly in the socket, which is made up of the scapula. The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly move the arm.

When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone. This can lead to impingement or eventually fraying and tearing. Insuring proper strength in the rotator cuff after a collarbone injury is an important component in avoiding shoulder impingement syndrome.

Return to Full Activity

Around the 8-12 weeks mark, you will likely consult with your physician to have another X-ray taken. Once you’re cleared by your physician, you can slowly taper back into more strenuous exercises and a return to full activity.

If your injury was severe or required surgery, it may be closer to the 16 weeks mark before you can return to full activity and be cleared to lift heavier weights. I recommend that you slowly taper back into your prior activities. If you are experiencing pain, then back off that particular activity and try it again at a later date.

Help from a Physical Therapist (PT)

Every injury is different. If you’re experiencing pain or difficulty regaining your strength and shoulder range of motion, please consult with a physical therapist that is an orthopaedic certified specialist (OCS). The American Physical Therapy Association (APTA) 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 hear your physician’s opinion as well).

Good luck, Shawn! I hope you find this information to be helpful and provide some relief from the pain you’re experiencing.

Have you broken your collarbone? What was your experience like? Please share your best tips for recovery.

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com. For additional health and lifestyle information, 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, December 2, 2015

Q & A: Rehabilitation for a Total Knee Replacement

Q. I’m going in for a total knee replacement. I wondered what type of advice you could give me so that I’m better prepared. Thanks! -Judy

A. Great question, Judy! A total knee replacement is often referred to as a total knee arthroplasty (TKA). It’s really more like a resurfacing of the knee joint. TKA is most often used as a treatment for those suffering from moderate to severe osteoarthritis in the knee. Other common causes for the procedure include Rheumatoid arthritis and injury. Knee replacement is more common among women and the likelihood of replacement increases with age.

The following information on total knee arthroplasty (TKA) and rehabilitation is not meant to be all inclusive, but to serve as a starting point as to what you will likely experience during rehabilitation. Each person’s rehabilitation process is likely to vary depending on his/her particular needs.

Four basic steps are performed in a Total Knee Arthroplasty (TKA):

Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. This is not performed with every procedure unless necessary.
Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Proper rehabilitation is a critical component to overall success with this procedure. In most cases, a physical therapist and possibly an occupational therapist will be involved in the rehabilitation process. I tend to classify the rehabilitation into the following four major stages.

Stage I Rehabilitation

This is the initial post-surgical recovery stage in the hospital with physical therapy (typically the same day). The goal is for you (the patient) to be upright and walking with an assistive device, such as a walker, in order to initiate very basic motion in the knee.

Although same day procedures can be performed, you will typically spend two to three days in the hospital following this procedure. With the new surgical techniques utilized, most patients will not have any weight bearing or other mobility precautions.

There are risks of complications with any medical procedure. The biggest risk initially is falling either from the newly operated knee giving way or complications from medication (which can cause dizziness, lightheadedness or other symptoms). Other possible unlikely complications include: loosening of the prosthetic within the bone; blood clots; and infection.

Prior to leaving the hospital, pain management is a priority. In addition, you need to be able to walk at least to a bathroom (typically with some assistance to maintain safety).

Four typical options for discharge:

Discharge home and continue rehabilitation with in-home care.
Discharge home and initiate physical therapy in an outpatient clinic.
Discharge to a skilled nursing facility. This is typically reserved for those who are expected to need an extended recovery.
Discharge to a sub-acute rehabilitation facility. This is typically reserved for those who may need additional medical care, but who can tolerate a more intensive rehabilitation program.

Regardless of the discharge location, the initial treatment is very similar. Focus on pain management. Improve your ability to ambulate. Initiate RICE (Rest, Ice, Compression, and Elevation). Start with basic range of motion (ROM) exercises (as described in Stage II). Also, please refer to Total Knee Replacement Rehabilitation Exercises for many of the most common exercises you may perform depending on your individual need.

Medication Management

A major component of the rehabilitation will be to insure proper pain management. This is typically through pain medication (both narcotic based and/or acetaminophen). It is important to maintain proper pain management because it allows you to perform necessary activities of daily living (ADLs) as you progress through your rehabilitation. Additional medication management may be necessary if you’re taking blood thinning medications in order to decrease the risk of blood clots.

RICE

Rest. Your body has just undergone a major surgery. It will require more rest initially to properly heal and recover. Although exercise and movement will be critical to your recovery, additional rest will be needed. Limit walking on any hard surfaces, such as the flooring in grocery stores, for at least the first three to four weeks in order to minimize pain and swelling.
Ice. Apply ice to the painful areas especially in and around the knee. 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 gel style Cold Pack. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing. Often, your physician will prescribe a machine known as an IceMan (or something comparable) to help with cryotherapy to reduce pain and inflammation.
Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You may utilize a common ACE wrap or your physician may recommend wearing TED hose which helps with swelling and decreases the risk of blood clots.
Elevation. When resting, keep the leg as straight as possible and elevated above the level of your heart to help reduce swelling (edema). Try not to prop anything under the knee because it would cause flexion (bending). You want the knee to move straight into full extension.

Stage II Rehabilitation

Stage II typically starts on about day three to five. It can last up to six to eight weeks depending on your recovery. Continue to progress with pain management, edema management, gait/ambulation training, RICE, and range of motion as initiated in Stage I.

Movement

Regaining range of motion (ROM) is one of the primary goals with TKA rehabilitation. Knee extension (straightening) and knee flexion (bending) must be regained as quickly as possible. There is a limited window of time that ROM must be restored. Aim for full recovery of ROM within the first six to eight weeks (if not sooner).

Regaining both full knee extension and flexion are critical to long term success. Once you regain full ROM, you must maintain it throughout the process. Movement helps tissues receive the needed nutrients and can help with pain management. Movement, including frequent toe tapping and ankle motion along with knee ROM, can also help to reduce swelling and prevents blood clots.

If the patient doesn’t regain adequate motion through the rehabilitation process, I find that knee pain usually remains a long term issue along with poor mobility. The goal for TKA ROM is usually 0-120 degrees of motion. (Zero meaning that the knee is perfectly straight. The 120 degrees is how far backward you can bend the knee.) For a point of reference, touching your heel to your buttock is usually about 150 degrees of motion. Your knee will not have the same available ROM as a healthy knee joint, but it will be functional for most tasks.

Restoring full ROM can be accomplished in many ways. The gentlest way is to perform heel slides by lying on your back and sliding your heel toward your buttock (as demonstrated in Total Knee Replacement Rehabilitation Exercises). A stationary bicycle is also very helpful. These exercises should be performed within a mild to moderate amount of pain and discomfort. Although ROM exercises can be a little painful, they don’t damage the new joint and ultimately, the ROM will help to decrease pain.

Ambulation

In most cases, your initial ambulation will require an assistive device such as a front wheeled walker (FWW), crutches or a cane for safety and pain relief. Initially, the knee motion will be limited. Pain and swelling will affect the strength of the leg. This means that the leg could have a tendency to give way or be unsteady. This should improve quickly over the first several days, but I always recommend an assistive device initially.

Walking with an assistive device also gives you the opportunity to walk with a normal gait pattern which will help improve your knee’s range of motion and aid in your recovery. Your physical therapist will work with you to help restore as normal and safe a gait pattern as possible. It is common to feel or even hear clicking during ambulation and movement due to the plastic and metal components. This is normal (particularly, early in your rehabilitation when the knee is swollen and ROM remains restricted).

Strengthening

Increasing your leg strength is an important part of your recovery, but it will not necessarily be an initial focus of your recovery. The primary goals for rehabilitation initially involve proper ambulation, reducing the swelling, pain relief, and range of motion for your knee. Adequate strength throughout the lower extremity is important. The primary focus will be on quadriceps strengthening and hip abduction (gluteus medius) strengthening. These two muscle groups tend to be the most important in regaining full functional mobility after TKA.

Stage III Rehabilitation

Similar to Stage II, rehabilitation in Stage III continues to focus on range of motion (ROM). At this point, you would typically ride a stationary bike regularly while working to maintain full ROM (0-120 degrees). Movement helps tissues receive the needed nutrients and can help with pain management. Movement also reduces swelling and prevents blood clots. This stage is typically eight to twelve weeks after the operation.

The Stage III exercise program (as demonstrated in Total Knee Replacement Rehabilitation Exercises) is designed to improve strength of the entire lower extremity while still focusing on quadriceps and gluteus medius (hip abduction) strength. Balance and gait drills are typically introduced. The goal is to ambulate without any noticeable abnormalities from the TKA and to reduce the risk of falls (particularly if you’re no longer using an assistive device).

During Stage III rehabilitation, I would generally expect that you have proper pain management without the use of narcotic medications. Mobility for basic daily tasks is usually quite good and the intensity of the rehabilitation has increased. In this stage, you’re working hard on self-rehabilitation and may be continuing formal rehabilitation in an outpatient physical therapy clinic.

Stage IV Rehabilitation

Stage IV usually occurs four to nine months after the operation. Exercises should be designed to help maximize your mobility and desired mobility outcome/goal. Increased exercise intensity and more dynamic balance training are introduced. A return to full functional mobility is the desired outcome. In this stage, a majority of the exercises are performed independently. You may intermittently consult with a physical therapist to progress in rehabilitation to insure that you’re meeting your goals.

Each person’s rehabilitation process is likely to vary depending on his/her particular needs. Always be open and honest with the medical professionals who are assisting you. If you feel as though something is not quite right, don’t hesitate in discussing the issue.

During your recovery, don’t forget the basics! Proper hydration and consuming nutrient dense food is critical to providing your body with the necessary building blocks to optimize your recovery. Proper hydration is critical in reducing your risk of blood clots. It also helps the body to deliver much needed hydration and nutrients to your healing tissues.

Physical therapy will be an important component to your recovery and rehabilitation. If you don’t already have a physical therapist that you are comfortable working with, The American Physical Therapy Association offers a wonderful resource to help find one in your area. Depending on how you progress during your rehabilitation, you will likely work with multiple physical therapists while at the acute care or rehabilitation hospital, during in-home care, and/or at an outpatient clinic.

Thank you, Judy, for your question. Good luck with your procedure! I hope your rehabilitation for your knee goes smoothly and that you recover quickly!

Have you undergone a total knee arthroplasty (TKA)? What was your experience like? Please share your best tips for recovery.

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, November 4, 2015

Q & A: My Top 5 Tips on How to Self-Treat Osgood-Schlatter Disease

Q. For the past several months, my 12 year old son has been experiencing pain below his knee cap just to the top of his shinbone. He typically experiences pain when playing soccer or other sports. The pain goes away when he rests. It’s getting to the point that it’s hard for him to participate in sports. He hasn’t had any injuries. What do you recommend? -Chandra

A. Thanks for your question, Chandra. I’m sorry to hear about your son’s knee pain. Unfortunately, it’s a common problem in children (particularly, boys). The symptoms that you are describing sound like Osgood-Schlatter disease although other potential causes could be Patellar Tendinitis or Patellar Femoral Pain Syndrome. Due to his age, gender, and activity level, it’s most likely Osgood-Schlatter disease.

Osgood-Schlatter disease (OS) is an overuse injury with pain located just below the knee where the patellar tendon ends (inserts) on the Tibial tuberosity. A boney nob may start to develop in this area and usually occurs as the condition progresses. This occurs due to the excessive stress on the skeletal system during a period of rapid growing combined with stress from activity of the quadriceps muscle pulling on the patellar tendon at its insertion site on the bone. If a bump forms, don’t worry as it is benign with OS. It will likely continue to be there as your child ages. There are typically no long term effects for this condition except for pain over the raised area of bone when kneeling on a hard surface.

Risk Factors for Osgood-Schlatter disease include:

Boys who are 11-13 years old.
Period of rapid skeletal growth.
Adolescents who regularly participate in running, jumping, and sports with many cutting or rapid changes in direction.

Symptoms for Osgood-Schlatter disease include:

Pain and possible swelling below the knee located near the top of the shinbone.
A bump or boney growth on the front of the upper shin at the Tibial tuberosity that is typically painful to touch.
Pain with running, jumping, and cutting sports.
Decreased pain or no pain at rest.
Possible loss of knee range of motion, typically flexion.
Possible pain and tightness with quadriceps stretching due to the pull on the patellar tendon.
Loss of quadriceps strength which mostly due to pain inhibiting its use.
Painful kneeling.

OS typically begins with mild soreness. The condition is typically self-limiting because of pain. Continuing to push through the pain can cause significant long-lasting pain resulting in limited function. Early intervention is usually very helpful.

My Top 5 Tips on How to Self-Treat Osgood-Schlatter Disease:

RICE

RICE, which stands for Rest, Ice, Compression, and Elevation.

Rest. In this case, rest would indicate tapering down from your regular exercise activity or any activity that involves running and jumping or that is causing knee pain.

Ice. Apply ice to the painful area–typically the sooner, the better. 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 gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.

Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You can utilize a common ACE wrap. If you have a friend who is medically trained, many different taping techniques can also assist in decreasing swelling. You may also consider a compression sleeve or garment.

Elevation. If there is swelling, then elevating the leg may be helpful.

If it hurts, don’t do it!

Modify the activity or discontinue it completely. If your knee is hurting when performing your sport or activity whether you are running, jumping or even weight lifting, then discontinue the activity temporarily. If you are able to modify and perform the exercise or activity pain free, it would be okay to continue in most cases.

Improve your range of motion (ROM).

The primary goal of a rehabilitation program is to regain full pain free ROM for knee flexion (bending) and extension (straightening). This can be accomplished in many ways. Perform heel slides by lying on your back and sliding your heel toward your buttocks. Consider using a pole to assist in performing deeps squats. Another stretch would be to hang onto a pole or a doorframe, and bring your heel toward your buttocks as you perform a quadriceps stretch.

These exercises should only be performed within a mild to moderate amount of discomfort in order 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.

Work on strengthening.

The primary goal of a strengthening program is to work on the quadriceps and glutes medius (hip abduction). 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 or to increase the resistance (load).

To initiate a physical therapy program, please refer to Osgood-Schlatter Disease 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. Initially, focus on full ROM.

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. Do not perform any seated knee extension exercises.

Kinesiological taping.

Besides pain relief, the purpose of Kinesiological tape is to provide compression over the Tibial tuberosity and to facilitate additional blood flow to the area. It also provides proprioceptive input which can help the knee during activity. I have had luck using Kinesio Tape, Rock Tape, and Mummy Tape brands. There are many other useful taping techniques which utilize different forms of tape. (You could also utilize Spider tape or KT TAPE.) To visually learn how to apply the tape, please refer to Kinesiological Taping for Osgood-Schlatter Disease. For application and removal tips, please refer to Skin Care with Taping.

How to Prevent Osgood-Schlatter Disease:

Be sure to schedule rest between athletic seasons, athletic events, and higher volume training periods. Rest is a critical factor as an adolescent’s body undergoes physical changes. OS is typically associated with overtraining/overuse in combination with a rapidly growing skeletal system. There are times when an adolescent needs to rest. It’s important not to encourage an adolescent to play sports through the pain without adequate recovery, rest, and if necessary, an evaluation by a qualified physical therapist or physician.

As part of a prevention and cross training strategy, implement the exercises demonstrated in the Osgood-Schlatter Disease Rehabilitation Exercises. A proper warm up and cool down is critical when performing in an athletic event or a significant training session.

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 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 ROM. This is the perfect time to work through my recommended rehabilitation exercises.

Thank you, Chandra, for your question! I hope these tips will help you assist your son in his recovery and get him back to playing sports as quickly as he is able to without pain! If the pain continues, please seek additional assistance from a qualified physical therapist or physician. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Do you know an adolescent who may be suffering from Osgood-Schlatter disease? If so, please share my recommendations on how to address this common and treatable condition.

Posted on Wednesday, September 16, 2015

How to Prevent and Self-Treat Shin Splints

http://marathontrainingacademy.com/self-treat-shin-splints

Marathon Training Academy

September 12, 2015

In this guest post for Marathon Training Academy, you will discover the common causes for shin splints and learn simple prevention strategies and treatment options to quickly help aid in your recovery.

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. They are typically caused by inflammation in the anterior muscle of the lower leg 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 and unfortunately, are relatively common in runners. Discover the common causes for shin splints and implement these strategies to prevent and self-treat shin splints. Continue Reading

Posted on Wednesday, July 22, 2015

How to Recover Quickly from a Hamstring Strain/Pull

A hamstring strain, also known as a hamstring pull, is a relatively common injury that can occur in almost any sport: running, CrossFit, ice skating, and weightlifting. The injury typically happens when one of the hamstring muscles (which are located in the posterior or back of the thigh) become overloaded. This causes a strain or small tear of the muscle and a complete tear in severe cases. The pain is typically located in the back of the thigh near the site of injury. This area can range from the back of the knee to the buttock area (specifically near the bones of the pelvis you sit on called the ischium). Discover the factors that increase your risk of straining your hamstring and learn how to self-treat this condition.

The strain most commonly occurs during running or jumping (in particular during sudden movements or when quickly starting and stopping). However, you could just as easily pull your hamstring while weightlifting or working in the yard. The following factors increase your risk of straining your hamstring:

Not warming up prior to exercise
Tightness in the hip flexors or quadriceps muscles
Weakness in the glutes/buttock muscles

Although hamstring strains are relatively common, they can be very debilitating. Depending on the severity of the sprain, you may have to discontinue your sport. A minor strain is classified as Grade I. Grade I injuries tend to be mild. With proper care and rehabilitation, the healing time can be shortened.

Grade II tears are partial ruptures. Grade II tears can often be rehabilitated, but the time frame for healing is longer.

A complete rupture is classified as a Grade III tear. Grade III tears may require surgical intervention. Severe Grade II and Grade III tears cause impaired muscle function and usually have associated bruising that occurs near the site of injury.

The course of treatment is dependent on the severity of the pain and the location of the injury. I recommend that you seek competent advice from a medical doctor, physical therapist or athletic trainer if you’re experiencing severe pain. A professional can assess the severity of the strain and address how to handle the injury.

Initial Treatment

For the purpose of this discussion, I will address a Grade I or minor Grade II injury. The initial course of treatment following the sprain includes RICE, which stands for Rest, Ice, Compression, and Elevation.

Rest. In this case, rest would indicate tapering down from your regular exercise activity or any activity that involves using your hamstrings (bending over, walking uphill, squatting or activities involving hip extension or bending your knee).
Ice. Apply ice to the painful area–typically the sooner, the better. 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 gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You can utilize a common ACE wrap. If you have a friend who is medically trained, many different taping techniques can also assist in decreasing swelling. Many physical therapists or athletic trainers can apply KT Tape, Rock Tape or Mummy Tape for you or you can find application techniques online.
Elevation. Compression and elevation may not be fully possible if the injury is located higher into the buttock region. If there is swelling in the lower leg, then elevating the leg may be helpful.

Gentle Movement

During the acute phase, gently move the leg as you can tolerate. Don’t be aggressive with the movement. Walking is usually the best way to keep the area moving. Be sure to keep your steps shorter if you are experiencing pain. You may also try gently floating or walking in a pool as long as the pain does not worsen.

How to Self-Treat a Hamstring Strain/Pull:

Mobilize the fascia and muscle tissue. As you progress through the initial acute phase (typically 10 to 14 days), work on restoring normal pain free movement of the leg. Mobility issues and myofascial restrictions are very likely to occur following a hamstring injury. Along with tightness in the hamstring, you are likely to have tightness throughout the lower leg including the buttocks, quadriceps, IT Band or in the deep hip internal or external rotators. You may also have more spine tightness or pain due to altered movement patterns in the lower extremity. I recommend using a foam roller to address tightness in the lower leg. Care should be taken, and don’t roll too aggressively on the site of the injury. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. I also recommend using a Thera-Band Standard Roller Massager, which is very firm and allows for a deep amount of pressure. You may also utilize a tennis or lacrosse ball to mobilize the deeper hip and buttock muscles or to more deeply and aggressively mobilize the restricted areas appropriately.
Stretch. As you progress through your rehabilitation, care should be taken when stretching the hamstring. I tend to utilize both mobilization and gentle stretching to help maintain hamstring and lower leg motion. Don’t let the hamstring become tight and restricted. Hamstring Rehabilitation Exercises demonstrate my recommended stretches, foam rolling, and self-mobilization techniques.
Strengthen your glutes, hamstrings, and hip muscles. Weakness in the glutes, hamstrings, and hip muscles is common after injury and was likely a contributing factor to the injury itself. Strengthening of these muscle groups can help avoid future hamstring and even low back pain issues as well as reduce your risk of re-injury. Please refer to Hamstring Rehabilitation Exercises for additional exercises.
Hydrate. The human body is primarily made of water, which is critical for all body functions. I highly encourage you to hydrate more frequently during recovery. Adequate water intake is critical as your body attempts to heal and flush out metabolic wastes. 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. Keep steady supplies of nutrients going to/from the site of the injury. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce. Water is best.
Start a supplement. A hamstring strain is typically associated with a specific event and an active inflammatory process typically occurs. 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 CapraFlex by Mt. Capra. 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. If you are taking blood thinner medication, please consult with your physician prior to taking these supplements.

Return to Activity

As your pain decreases and after your hip and hamstring range of motion has returned to normal, slowly start tapering back into your training routine. During this time, you remain at a higher risk of injury. As you continue working through your rehabilitation and your return to activity, implement the following strategies:

Warm up prior to exercise. I recommend that you increase your normal warm up time. You should warm up 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. You can use a self-massage tool or a foam roller to roll up and down the hamstring as part of your warm up. If you perform hamstring stretches, be mindful that prolonged static stretching before exercise may worsen performance. Warm up exercises may include light jogging, bicycling, rowing or any activity to get the heart rate up and the blood flowing in the lower legs. Be careful when performing any movement that puts the hamstring in a stretched positon with speed or force.
Cool down. After performing your exercise or activity, take the extra time to cool down and stretch. Focus on hamstring stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up.
Initially avoid potential high risk activities. As your recovery progresses and you return to activity, initially avoid high risk activities that put the hamstring muscle under heavy load or a very quick load. Progress slowly. If an activity begins to cause pain in the hamstring, don’t push through it. Instead, stop and give your hamstring more time to heal prior to trying it again. You should be pain free before you progress the intensity of the activity or sport. Hamstring pulls have a high likelihood of re-injury if you rush the process.
Regain full strength and motion before returning to sport. Before a full return to sport or activity is initiated, you should have full lower leg and hamstring mobility and strength without pain. If you continue to experience soreness or restriction, continue to work on your rehabilitation until the leg and hamstring have returned to normal. Then initiate a full return to activity.

If you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your medical doctor, physical therapist or athletic trainer for an assessment and help in managing the injury. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a hamstring strain/pull ever sidelined you? Which treatment was the most effective for you? Additional discussion can help others to manage this condition more effectively. 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!

Disclaimer: The Physical Therapy Advisor Blog and its information 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.

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!