Tag Archives: Phenocane Natural Pain Management

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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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How to Recover Quickly from a Quadriceps Strain

mta_quadstrain

http://marathontrainingacademy.com/quadriceps-strain

Marathon Training Academy

November 15, 2016

After straining your quadriceps, you remain at a higher risk of injury. In this guest post for Marathon Training Academy, you will learn which strategies to implement as you work through your rehabilitation and your return to activity.

Muscle injury. Man with sprain thigh muscles

A quadriceps strain, also known as a quad pull or thigh strain, is a relatively common running injury.

Strains can range from a mild discomfort to a full blown tear of most of the muscle which can result in severe pain and the inability to run or walk. The injury typically happens when one or more of the quadriceps muscles become overloaded.

In this pose you will discover the factors that increase your risk of straining your quadriceps, and learn specific strategies to implement during your rehabilitation and return to activity. Continue Reading

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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.

HamstringSelfMobilizationUsingaMassageTool

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.

HamstringMobilizationUsingtheFoamRoller

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!

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!

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.

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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.

ShinSplints_Treatment_Landscape

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.)

Calves

  • 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!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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

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

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

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

PFPS symptoms include:

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

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

How to Self-Treat PFPS:

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

LacrosseBallForQuad

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

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

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

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If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Self-Treat IT Band Syndrome

Pain in the lateral (outside) leg or knee is commonly associated with a condition known as Iliotibial Band Syndrome (ITBS).  (Iliotibial Band Syndrome is also known as IT Band Syndrome, ITB Syndrome, or IT Band Friction Syndrome.)  Pain can range from the lateral side of the leg up toward the hip area to just below the lateral side of the knee joint (where the head of the fibula bone begins).  The pain can be very debilitating to the point that running or hiking activities have to be stopped.  Even walking becomes difficult.  I will address the many potential causative factors for IT Band Syndrome and offer advice on how to self-treat this condition.

TherabandRoller

The IT Band is a very thick fibrous band of tissue that spans from the hip’s origin point at a muscle known as the Tensor fasciae latae (TFL).  The TFL transitions into the IT band and progresses down the lateral thigh and ends at the head of the fibula.  The IT Band’s primary function is to provide additional lateral support for the knee joint (particularly when standing or landing on one leg).  IT Band Syndrome is often associated with an over use injury.  It can be very painful, but it can be easily self-treated if you handle your pain and symptoms quickly.

How to Self-Treat IT Band Syndrome: 

  • Improve your mobility. Mobility issues and myofascial restrictions are highly correlated with ITBS. Tightness in the IT Band or in the deep hip internal or external rotators is a contributing factor to ITBS. The tighter the IT Band, the more likely it will rub on the femoral condyle and develop into pain. Bowlegged describes a medical condition known as a varus deformity, an inward rotation of the tibia resulting in a leg that looks like it is bowed out. It can develop due to chronic friction of the IT Band along the femoral condyle. ITBS may also occur after a total knee replacement (TKA). I recommend using a foam roller to address tightness in the quadriceps or IT Band. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. I also recommend 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 Tensor fasciae latae (TFL) appropriately. The foam roller and roller massager don’t work as well because the greater trochanter of the hip (the boney part of the hip that sticks out) tends to be in the way. Stretching the IT band or the TFL is very difficult, so I tend to utilize other mobilization techniques. However, I recommend a few pelvic and hip stretches. Please refer to IT Band Syndrome Rehabilitation Exercises for my top stretches, foam rolling, and self-mobilization techniques to address IT Band related issues.
  • Strengthen your hip muscles. Weakness in the hip external rotators and the hip abductors, like the Gluteus medius and the Tensor fasciae latae (TFL), can lead to IT Band Syndrome. Strengthening of these muscle groups can help avoid future ITB issues as well as reduce your risk of developing Patellar Femoral Pain Syndrome (PFPS). Please refer to Hamstring, Hip Flexor, and Piriformis Stretches for LBP for additional hip and lower leg stretching exercises.
  • Over use injury due to downhill running? IT Band Syndrome is often associated with an over use injury. For runners, a common cause of ITBS is running downhill. Few runners actually train appropriately for a race with downhill running. Afterward, they end up with a case of ITBS. I have been guilty of improper training in the past. If you have ever run in the Robie Creek Half Marathon, then you understand the importance of downhill training. To avoid ITBS, adequately train for the downhill portion of the race. Also, vary your running routine and surfaces while training. Although ITBS is often associated with over use, always address other contributing factors as well.
  • Check your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. This could result in IT Band Syndrome or other hip, knee, or ankle related issues. Shoes typically only last 350-500 miles. If you are nearing those miles, then it may be time to change. If you’re unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe. Another option to help control overpronation is an over-the-counter orthotic such as Superfeet Blue Premium Insoles. The blue tends to fit most feet, but a variety of options are available for customization. In my experience, these insoles can last 1,000 to 1,500 miles easily. If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.
  • Did you progress too quickly into a minimalistic shoe? If you are used to a standard built up shoe, progressing into a minimalistic shoe may be more difficult and take more time. Unless you are a child or teenager, expect a safe transition to take at least three months. Don’t transition during a period of intense sports. I highly recommend waiting until the off season as progressing slowly is always a better choice.
  • Have your gait analyzed while running. Gait or running abnormalities can increase your risk of developing IT Band Syndrome. Over striding tends to occur while running downhill. Scissoring occurs when your leg crosses over the midline with each step. Both over striding and scissoring are easily recognized by a professional. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running. Then watch the recording to see if you notice either over striding or scissoring.
  • Don’t forget to ice. IT Band Syndrome is typically is due to a specific event. Afterward, there is usually an active inflammatory process occurring. I typically apply ice to the lateral part of the knee, but place it on your most painful location. The rule for icing is to apply ice no more than twenty minutes per hour. Don’t place the ice directly against the skin, especially if you are using a gel pack style. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be a cheap alternative or you could use one of my favorite gel pack style cold packs.
  • Start a supplement. ITB Syndrome 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. 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 Phenocane Natural Pain Management.

If you’re not experiencing relief after a week or two of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing IT Band Syndrome.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

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

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!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Self-Treat Plantar Fasciitis

Plantar fasciitis is a very painful and potentially very debilitating condition.  It’s one of the most common causes for heel and bottom of the foot pain.  The plantar fascia is essentially a band of connective tissue (a ligament) which runs the length of your foot from your heel to your toes.  It helps to support the arch of your foot by using “windlass mechanism” to make the foot more rigid and aid in the foot’s ability to transfer force and push off when walking or running.   In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk.  It’s typically at its worst in the morning with your first several steps after sleeping.  Plantar fasciitis is also more common the older a person becomes.

Image courtesy of www.runnersgoal.com

Risk factors for developing plantar fasciitis include:

  • Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
  • Either excessively high arches or overly flat feet.
  • Spending long periods of time standing or walking.
  • Spending long periods of time on hard surfaces, such as concrete.
  • Obesity
  • Your shoes don’t fit well or the shoe is worn out.
  • You have transitioned too quickly from a more built up running shoe into a minimalistic style.
  • 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.

Plantar fasciitis typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run.  Plantar fasciitis may occur after a specific event.  The plantar fascia could be over stretched due to a slip.  It could occur after an overzealous training day in unfamiliar circumstances, such as running barefoot in the sand.

Fortunately, plantar fasciitis doesn’t always require formal medical treatment.  The key is to intervene quickly to identify the actual cause or causes that led to the inflammation and irritation.  The recommended treatment is the same whether or not the plantar fasciitis developed over time or due to a specific event.

How to Self-Treat Plantar Fasciitis:

  • Begin your rehabilitation. Start with these Plantar Fasciitis Rehabilitation Exercises. Complete with instructions and photos, this guide outlines how to safely self-treat your plantar fasciitis. Stretch your calves as tight Achilles tendons and calf muscles can cause excessive strain on the plantar fascia, which increases your risk of pain. Stretch your plantar fascia by performing stretches prior to standing or walking upon morning waking and after any prolonged sitting.
  • Mobilize the tissue. Depending on how aggressive you want to be, a tennis ball, lacrosse ball, or golf ball can be used to mobilize the tissue. I recommend mobilizing once or twice per day for 2-3 minutes. Then perform additional stretching of the plantar fascia and calves.
  • Use ice. My favorite technique for icing this area is to use a frozen water bottle. Roll your foot over the bottle for 3-4 minutes until your foot starts to feel numb and the pain subsides. It’s possible to frost bite your foot, so be mindful of the length of time you’re icing.
  • Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the plantar fasciitis. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.
  • Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help reduce the risk of plantar fasciitis and is an important part of the rehabilitation. Please refer to Improving Balance by Using a Water Noodle.
  • Start a supplement. I am a supporter of natural supplements and remedies. Many supplements include herbs which are designed to help reduce inflammation. 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 Phenocane Natural Pain Management.
  • Use a plantar fasciitis night splint. Although a little cumbersome and annoying, night splints can be helpful. While lying, the natural tendency is to flex the foot to point your toes (plantarflex). This position causes the plantar fascia to shorten and tighten, which explains the pain you might experience during the first few steps after sleeping or resting. The night splint helps you to heal by maintaining a neutral position which doesn’t allow the fibers to shorten.

While you’re self-treating your plantar fasciitis, you’ll likely need to modify your exercise or running program.  It’s an excellent time to focus on cross training activities.  I recommend following this protocol for two to three weeks.

If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional.  I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

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

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!

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!