Why You Won’t Heal – Part 3

Psychological, Emotional, and Social Conditions are affecting your Healing

The human experience is a web of how we relate to our surroundings as a physical, social, mental, and spiritual being.  So it comes as no surprise when we recognize that a person’s ability to overcome injury and illness isn’t purely physical.  There are very strong psychological, social, and spiritual elements to it.  It’s nearly impossible to separate the different aspects of our being or experience as a human.  The human body is a complicated.  To fully recover and heal from an injury or illness, all aspects of our being must be addressed at some level.  In Part 3 of the series, Why You Won’t Heal, I address how and why physiological and social conditions can affect your healing.

Your belief in your ability to heal and recover is a critical component to how you actually will heal and recover.  If you fully believe that you will make a recovery and return back to a pre-injury state, then you truly are more likely to do so.

So often I work with individuals who have fear associated with a full recovery.  A common example is someone who has severely injured his/her low back.  It’s common to be overly fearful and afraid that the pain may return if you do the wrong thing.  Consequently, that person will not push his/her rehabilitation and recovery.  And therefore, he/she doesn’t return to his/her prior baseline and will likely never fully recover physically as well as mentally and psychologically.

Because of this large barrier to recovery, most progressive back rehabilitation programs will address fear avoidance beliefs and the fear of disability from pain versus true musculoskeletal disability from injury.  The fear of re-injury is very powerful not only to the general population, but also for elite athletes.  Many elite athletes have failed to return to pre-injury glory because of fear and psychological dysfunction associated with his/her injury.

Other psychosocial issues that I have encountered include identity issues.  Many conditions become chronic because the condition and injury lingers for a long period of time.  As a person maneuvers through the health care system, this sick phenotype becomes ingrained in who the person is at a deeper psychological level.  The person forgets what life was like without the condition and now they become a person with that particular injury or illness.

Once a person takes on this type of deep routed feeling about who he/she is, it can be nearly impossible to actually heal from the condition as the condition is no longer only physical, but now psychological.  The condition and illness becomes part of his/her emotional psychological state and part of a new altered identity.  Subconsciously, this becomes an emotional and psychological paradox to recovery which affects the person physically as well.

Motivations also play a key role in a person’s ultimate recovery.  Are there secondary gain issues?  If a person dislikes his/her job, maybe he/she isn’t really motivated to return to work after a workers’ compensation injury.  Is a person depressed about other issues in his/her life, so he/she isn’t really that motivated to recover or improve?  All of these factors need to be addressed to insure optimal recovery.

However, it’s important to keep in mind that a person’s rehabilitation process can be highly variable even within those who are recovering from the same type of injury.  While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who took significantly longer to heal.

This is completely normal within a course of recovery.  Each person’s physical ability to heal and recover is different.  Unfortunately, there are some who were never able to recover to any significant degree.  The lack of recovery is always routed in physical as well as psychosocial reasons.  The severity of an injury is not necessarily a predictor of who will or will not recover or how the injury may affect a person physiologically.

Although I am not a psychologist, it’s my job as a physical therapist to help clients heal, recover, and/or adapt to injury or illness.  This includes addressing all aspects of the person’s recovery not only from the physical perspective, but also from an emotional, social, psychological, and spiritual perspective.  My treatment primarily focuses on the physiological issue, but I’m always aware of the other aspects and needs within the recovery process.  I help and advise where I can and when needed, I recommended other trained medical professionals.

If you are struggling to heal and recover from an injury or illness (regardless of the severity), consider the possibility that part of your recovery must include the other aspects of who you are as a person.  It’s common to include physiological, emotional, and spiritual support in your recovery.  (And I highly recommend it!)  We need to fully embrace ourselves and who we are (including our feelings and physical and psychological status) to insure that our bodies are operating at the highest level possible.  This type of self-awareness can be painful and difficult at times.  Don’t feel you have to do it alone.  Seek professional help because options are available.  Don’t give up on yourself!

Have you ever struggled to recover from an injury or illness?  How were you able to recover psychologically and emotionally?  Sharing your story can help others in their recovery process.  Please leave your comments below.

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

Why You Won’t Heal – Part 2

The Injury or Condition isn’t Capable of Healing

People choose healthcare as a profession because we have a deep desire to assist others in times of need.  It’s our unique way to make a difference in someone’s life and to make this world a better place.  Our health and our life is the most precious asset we have.  When a person has been ill or injured, the hope is that recovery is possible.  Regardless of the condition, we hear stories of miraculous recovery as well as devastating loss.  Why do some people recover while others do not?

In Part 2 of the series, Why You Won’t Heal, I discuss a topic that no one really wants to hear.  Regardless of intent and hope, sometimes an injury or condition just isn’t capable of healing.  Our current knowledge of the human body through the use of Western or Eastern medicine may not be able to assist the person in healing.

While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who are unable to heal and recover.  Therapy (like speech, occupational, and physical) and assistance from physical medicine physicians and other rehabilitation specialists can help the client to live the best life possible with adaptive equipment and technology when recovery to prior function isn’t possible.

Sadly, some medical conditions are not curable, and a person will not have the ability to heal.  It’s important to keep in mind that there is wide variation of how these types of conditions will present and how a person can adapt and overcome to still lead a productive life.  It’s also important to realize that each individual responds differently to an injury.  One should always try everything he or she can to reasonably try to heal and recover.  However, if those efforts fail, then the focus needs to be on adapting (and not recovering) in order to live a productive and fulfilled life.

Below is a partial list of injuries that may not be able to heal, so other means of adaptation must be taken:

  • Spinal cord injuries
  • Severe spinal nerve root injuries causing paralysis
  • Some peripheral nerve injuries
  • Severe brain injuries
  • Some cerebral vascular accidents (CVA’s), known as brain attacks or strokes
  • Some types of infections
  • Loss of limbs
  • Some chronic progressive neurologic diseases

This list is by no means exhaustive.  No two injuries are alike, so you may have one or more of these conditions and have recovered or nearly recovered.  However, sometimes recovery just isn’t possible.  Openly discuss the injury or condition along with the associated impairments in order to acquire methods of adaptation.  Continuously looking for a cure or waiting for a complete recovery can derail your ability to adapt and move on with a productive life.

Common Traits that may Impair Your Ability to Heal: 

  • There is catastrophic neurologic involvement.  This may be from severe injury to the brain, spinal cord or larger peripheral nerves.
  • There is a chronic progressive neurologic disease which currently doesn’t have treatment methods available.
  • There is an incurable viral or other type of incurable illness.
  • There has been catastrophic injury to the musculoskeletal system to the point that repair isn’t possible (such as in the case of amputation).
  • There has been catastrophic injury to other organs of the body either through trauma or other chronic disease.  In the case of severe kidney disease, the only remaining treatment is dialysis.

If you or your loved one suffers from an illness or injury that is likely unable to heal or improve, then a heartfelt honest discussion with your medical provider is in order.  This is critical if you or your loved one wants to take the next step of learning how to adapt around the condition and continue to live a productive life.

One of the reasons I chose to be a physical therapist was to help others.  Throughout my career, I have met many clients who have been ill or injured without hope of recovery.  Yet these clients (through the use of current adaptive equipment and the will to overcome) are living very inspiring and fruitful lives.  If you can’t fix it, then adapt around it!

What has your experience been like when learning how to adapt to an injury or condition of yours or that of a loved one?  Please leave your comments below.

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

Why You Won’t Heal – Part 1

You’re Getting the Wrong Treatment for Your Condition

As a physical therapist, I have the opportunity to work with individuals who suffer with chronic disease, cardiovascular conditions, neurological disorders, and of course, my specialty:  musculoskeletal and orthopaedic conditions.  A person’s rehabilitation process can be highly variable even within those who are recovering from the same type of injury.  While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who took significantly longer to heal.  Unfortunately, there are some who were never able to recover to any significant degree.

The reasons why a person may not recover are vast and complicated.  However, I have identified six categories of common reasons why a person will not fully heal and recover or take an extended time.

6 Categories of Common Reasons Why You Won’t Heal:

  1. You’re getting the wrong treatment for your condition.
  2. The injury or condition isn’t capable of healing.
  3. Physiological and social conditions are affecting your healing.
  4. Poor nutrition.
  5. Poor sleep quality.
  6. The risk factors and causative factors that led to the disease and injury are still present and affecting the current condition.

In Part 1, treatment for the condition is addressed.  In subsequent posts, I will cover the other categories in addition to providing you with methods and strategies for recovery to insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

You’re Getting the Wrong Treatment for Your Condition:

Sadly in today’s health care environment, it’s not uncommon for individuals to get the wrong treatment for his/her condition and/or inappropriate care which can affect the recovery process.  As a physical therapist, I continue to see countless examples of individuals getting wrong and/or ineffective treatments to manage a particular injury or medical condition.

Sometimes this is deliberate as part of some newest and greatest product scam that is touted as curing this or that condition, but most of the time, it’s done inadvertently.  This problem isn’t just in one medical profession.  It’s throughout the entire healthcare system.

The following three examples illustrate what happened to some of my prior physical therapy clients.  Unfortunately, this list could be very long if I included every example I have witnessed.

Example 1: Total Hip Replacement

The client presents with apparent hip and leg pain.  The client has undergone a total hip replacement in an effort to eliminate the pain only to have it still be present.  Upon further examination, the cause of the hip and leg pain was an undiagnosed lumbar spine injury.  Once the lumbar injury was managed appropriately, the pain in the hip and leg resolved.  Although the client had arthritis and deterioration in the hip to justify the hip replacement, it wasn’t the real cause of the pain.  In this case, the client never needed the hip replacement in the first place.

Example 2: Low Back Pain

The client complains of ongoing low back pain (LBP).  Although there are many reasons why one may experience LBP, the pain is of mechanical origin in the majority of cases.  This means that something in the musculoskeletal system is the pain generator.  The client should be able to establish movement patterns that can help to determine if the pain is improving or worsening.  This directional preference helps me as a physical therapist to guide treatment decisions.

Extending the spine makes the pain improve, but the client’s previous physical therapist has him performing primarily flexion (bending forward) exercises as part of the rehabilitation protocol.  This treatment is not only ineffective, but it significantly slows the healing response as the client continued to aggravate the injury by moving repeatedly in the wrong direction.  Upon stopping the flexion based exercises, the client’s LBP improved and fairly quickly went away.

Example 3: Chronic Headaches

The client sees a neurologist for assistance managing what appears to be a case of chronic migraine headaches.  The client is given prescription medications which are taken on a regular basis in order to help manage the migraines.  Although the medication helps to reduce the length of time of suffering, the client continues to experience migraines on a regular basis.  The treatment may not be wrong, but it certainly isn’t overly effective.  Worse yet, there is the potential for multiple side effects from taking the medication.

In this particular case, the client had a cervical alignment issue which caused mechanical neck pain that would trigger a migraine.  Together, we were able to correct the alignment issue, and more importantly, fix the chronic poor sitting posture that lead to the alignment issue.  This eliminated the headaches completely and the need for the migraine medication.

I tell these stories from past clients to illustrate the point that wrong and/or ineffective treatments can lead to a significantly longer than necessary recovery time.  These clients were fortunate because the true cause for the pain was identified and recovery occurred.

There are a countless number of people who continue to suffer with an incorrect or ineffective treatment therapies.  The key to successfully rehabilitating and recovering from a condition is to direct the right treatment plan for the condition.  This includes how the actual injury or condition is being handled as well as addressing other risk factors or precipitating factors that directly affect the condition.

How to Identify an Incorrect or Ineffective Treatment Therapy:

  • You aren’t experiencing any relief in pain or symptoms from the treatment.
  • Your symptoms continue to worsen.
  • You have been using the same treatment for weeks or months without resolution.  In the case of chronic disease, management of the condition hasn’t been effective.
  • The treatment and why it’s effective cannot be logically explained.
  • You haven’t been given any tools or education on how you to help improve or manage the condition, the rehabilitation or disease process, and its symptoms.
  • You are told that there are no other options.

If you are unsure whether or not the treatment you are receiving for your condition is helping, then it’s up to you to be proactive and seek a second opinion.  Although you should be cautious in researching for medical information online, there are reputable websites that can help to educate you about symptoms and possible causes for your condition.

If you suspect that your treatment course is incorrect, discuss your concerns with your medical provider.  Don’t be afraid to seek a second (or even third opinion) if necessary.  There are many options, and help is available.  Don’t give up!

Have you experienced an incorrect treatment or ineffective medical treatment before?  What did you do in order to resolve it?  Please leave your comments below.

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

Outsmarting Dementia: 5 Techniques for Giving Your Brain a Boost

No matter your age, it’s never too early to begin the fight against dementia. The good news is that it’s easier than you might think. The better news is that there are all kinds of ways to do it, no matter what your interests are! Here are just a few ways you can make the most of your mental workout:

If you’re active (or want to be), combine physical and mental workouts.

Physical exercise is a vital component to total health, and it can even have positive effects on your mental wellness. If you’re already an active person or want to start getting more exercise, combine your efforts! Try going for a walk in the park and issuing yourself mini challenges: how many trees have moss — now what’s the percentage? The ratio of moss to barren trees? If you’re more on the creative side, find objects in nature and find the most accurate color: is that bird in the tree periwinkle, or is it more of a deep sapphire? Maybe it reminds you of the color of the ocean, or of a favorite piece of clothing from long ago. Try thoughtful and engaging challenges.

If you’re bored, play a game.

Some people enjoy having an activity to do every afternoon, evening, or in whatever spare time they find throughout the day. There are lots of card games you can play that can boost memory, require strategic thinking, and many require basic addition and math skills. You can play a game of memory or solitaire on your own or invite some friends over for a group game. Board games are another great option if you have plenty of people to play, but cards tend to be an easier, more portable option.

If you’re a problem-solver, try a puzzle.

Classic jigsaws are a fun, quiet way to work your brain, and like cards they can be done on your own or with loved ones. If dexterity is a problem, there are easier versions you can play online or on a tablet. If sudoku is more of your style, you can find endless options online, and often in local and national newspapers. Try to devote a little time each day, even if it’s just 15 minutes on the puzzle every afternoon.

If you’re on the curious side, learn something new.

For many people, learning is the greatest experience of them all. You probably have a giant list of things you’ve been meaning to research, skills you’ve wanted to acquire, and interests you’ve wanted to pursue. So try one! Maybe you want to learn another language, or take an art class down the street. Even taking a class at a local college could be a great way to get a fresh lesson, and local community centers might offer free or low-cost options.

If you’re adventurous, try a completely foreign experience.

Maybe you’ve always been a thrill-seeker, or after a lifetime of being cautious you’re ready to break out of your comfort zone. Research has shown that you can get maximum mental benefits if you become open to new experiences. Try going to an art show of someone you’re unfamiliar with or sampling a new cuisine. If there’s a cultural fair, grab a friend and go explore as much as you can. If you have the means, traveling is another great way to expand your cognitive horizons and boost your mental health.

Any combination of these techniques can be beneficial, so start with what will be easiest to work into your schedule. From there, you can make adjustments on what activities you enjoy, trips you want to take, or even nightly activity nights you want to hold. Keep challenging yourself, and your brain will thank you for it!

About George Mears

George Mears is a brain fitness expert whose major area of interest is how brain exercises like games, puzzles, and memory activities help people to minimize the brain health deterioration that can lead to Alzheimer’s disease and dementia. Brainwellness.info

Preventing Knee Pain

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

Potential Risk Factors for Knee Pain:

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

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

Quadriceps Tightness

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

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

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

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

Static Stretch

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

Quadriceps “Tack and Floss” Mobilization

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

Hamstring Tightness

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

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

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

Hamstring Stretch in Doorway 

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

Hamstring Mobilization Using the Foam Roller 

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

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

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

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

Why Does My Shoulder Hurt?

Shoulder pain is one of the most common ailments treated by physical therapists.  There are many potential causes of shoulder pain, but the two primary issues to consider include poor mobility and muscle imbalance.  The key to treating most common shoulder related pain is to improve your posture while focusing on thoracic mobility, shoulder position, and proper shoulder strengthening.

Poor Mobility

The most common reason for mobility issues is poor posture.  Poor thoracic mobility and tightness in the posterior capsule of the shoulder are the most common contributors to the lack of mobility which can ultimately lead to shoulder pain.

Mobility issues can occur if you adopt a chronic forward head with rounded shoulders posture.  As this position becomes more chronic, the thoracic vertebrae lose backward mobility (extension).  This happens in conjunction with shortening of the pec minor (which is located underneath the pec major) and causes the shoulders to roll forward.  The forward shoulder posture causes the humeral head (arm bone) to be positioned more forward.

This causes tightness in the posterior (back) portion of the shoulder joint which affects the natural roll and spin motion of the joint.  The alterations of the roll and spin motion combined with alterations in shoulder blade motion negatively affects the mechanics of the shoulder joint.  The alteration in mechanics is what ultimately leads to pain as the rotator cuff or biceps tendons become impinged, irritated, and painful.

This is commonly referred to as Shoulder Impingement Syndrome.  Shoulder impingement pain is often associated with pain reaching overhead, behind your back and/or out to the side.  Those who experience it may feel weaker in the affected shoulder and experience pain when sleeping on the affected side.

Perform the following stretch to address shoulder posterior capsule tightness.  Lie on the side of the affected shoulder.  Be sure to support your head with a pillow.  Your arm should be straight out from your body with your shoulder tucked under your body.  The goal is to pin your shoulder blade down with the floor.  Gently push your arm down (as shown).  You should feel a gentle stretch.  Hold for 30-60 seconds for two to three times.  Perform once or twice per day.

In case you haven’t already subscribed to my e-mail list, please take a moment to do so in order to access my FREE resources, including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address poor thoracic mobility and pec minor tightness.  These simple exercises (with complete instructions and photos) will help you to improve thoracic mobility and can be performed at home.


Muscle Imbalance

Muscle imbalance is often an associated causative factor for shoulder pain.  In addition to mobility issues, altered strength and muscle activation patterns are also related to shoulder pain and shoulder impingement syndrome.  The reasons for muscle imbalance can vary, but are often associated with poor posture and/or cervical/neck related issues.

Two common muscles that must be strengthened in order to insure proper shoulder mechanics are the lower trapezius muscle and the supraspinatus muscle (which is one of four rotator cuff muscles).

The rotator cuff muscles are responsible for the stability of the shoulder and proper roll, glide, and spin of the ball and socket shoulder joint.

The lower trapezius muscle is responsible for proper shoulder blade timing and rotation during arm movements.  It helps in maintaining a proper upright posture.

For three easy and effective exercises to perform to improve your lower trapezius and rotator cuff muscle strength, please refer to Exercises for Lower Trapezius and Rotator Cuff Muscle Strength.

Most shoulder symptoms typically resolve when thoracic mobility and strength in the shoulder is improved.  Shoulder impingement is painful, but worse yet if left untreated.  It can lead to fraying of the rotator cuff tendons (and ultimately, a rotator cuff tear).  It’s always best to be proactive and address the causative factors early.

If you’re not improving or your symptoms worsen, consult with your medical provider to determine if other causes are contributing to the problem.  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).

If you’re experiencing shoulder pain, do you think either poor mobility or a muscle imbalance is causing it?  How can you improve your thoracic mobility and strength in your shoulder?  Please share below.

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

My Top 5 Most Popular Posts of 2016!

As 2016 comes to a close, more and more people are realizing the value of taking control of their health care and personal well-being.  In today’s health care environment, we all need to learn how to treat common aches and pains proactively instead of reactively.  We must get to the root of the issue instead of placing a Band-Aid over it.  Our present health care system in America is not designed to help you optimize your health–that is your job!

2016 marks the first time that the media started to wake up to America’s prescription opioid addiction.  The news and many research articles discussed America’s opioid addiction including their disastrous consequences on one’s health and the nation’s health care system in general.  Not to mention, how poorly opioids actually are in managing long term pain.

The purpose of The Physical Therapy Advisor is to help people like you to take control of your health and to save money by learning how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions safely and effectively without opioid use.

My Top 5 Most Popular Posts of 2016:

  1. How to Use Shoulder Pulleys to Regain Shoulder Motion – Maintaining adequate shoulder mobility is critical after surgery and/or avoiding osteoarthritis of the shoulders.  The shoulder pulley is often one of the first exercises initiated after surgery or injury. However, it’s often performed incorrectly.  In this video, I demonstrate the proper way to utilize a shoulder pulley.
  2. Exercise as Medicine – Too often, people look towards pharmaceuticals in order to help manage medical conditions.  Exercise is a highly effective and often underutilized method to treat many common, yet serious, medical conditions such as diabetes, heart disease, and osteoporosis.  Exercise is medicine when prescribed and performed correctly.
  3. 3 Simple Exercises to Help You Age Well – Maintaining functional mobility as we age is critical.  First, you need to maintain the ability to stand up.  This insures that you can get up from a chair or a commode/toilet.  Second, you need to maintain your ability to ambulate to insure that you can perform the other needed activities of daily living more easily.  Lastly, you need the balance to safely perform these tasks.  Walking, squatting, and improving your balance will help you to age well.
  4. 5 Strategies to Train Smarter for your next Obstacle Course Race – Obstacle course racing (OCR) is one of the hottest new sports around for all fitness levels (including the novice to expert thrill seekers).  This post highlights the five lessons I learned from my training seminar on OCR races with Ben Greenfield from www.Bengreenfieldfitness.com and Michael Caron from www.Getburly.com.
  5. Got Text Neck? – Have you noticed that wherever you go nowadays that you constantly see people walking and looking down at their cell phones?  No wonder that the term “text neck” is now being used to describe chronically poor posture!  This post explores the role of poor posture related to neck and headache pain along with tips for prevention and treatment.

2016 has been a wonderful year!  I successfully launched my first eBook and video package, Treating Low Back Pain (LBP) during Exercise and Athletics.  I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  This eBook addresses the specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  A 7-part series of instructional videos is also available and includes nearly 60 minutes of actionable advice to prevent and treat LBP.


In addition to my new eBook, I have continued to feature reader submitted Q & A’s as well as many exercise and training posts including posts written for the Marathon Training Academy.

This past fall, I featured a six part series on headache pain which includes prevention and treatment tips.  An important focus continues to be on longevity and healthy aging.  This includes ongoing guest posts on healthy senior living for the Seniors Blue Book.  (Check out my top 3 recommended daily fall prevention exercises as featured in the latest Seniors Blue Book!)

Looking toward 2017, I will continue to offer free self-treatment advice to help YOU manage common musculoskeletal, neurological, and mobility related conditions in a timely manner.  Together, we can all learn to age well and reach our optimal health!

Don’t forget subscribe to my e-mail newsletter!  I will send you my blog posts on how to maximize your health, self-treat those annoying orthopaedic injuries, and gracefully age.  To thank you for subscribing, you will automatically gain access to my FREE resources, including a FREE CHAPTER from my eBook, Treating Low Back Pain During Exercise and Athletics.

Thank you for supporting The Physical Therapy Advisor! I look forward to serving you in 2017!  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!

Q & A: How did I get a Stress Fracture in my Foot?

Q.  I have been diagnosed with a stress fracture in my foot.  What causes a stress fracture?  Now what should I do?  The doctor wants me to avoid any weight bearing for the next four weeks.  How do I heal?  Denise

A.  Thanks for your question, Denise.  I’m sorry to hear that this has happened to you.  Stress fractures are a unique type of bone fractures as they rarely occur due to a specific trauma.  Stress fractures typically occur due to a silique of events that leads to the bone not being able to handle the stress of your activity which results in a crack in the bone.  Stress fractures are common in the foot, but they can occur almost anywhere.

Initially, you might barely even notice the pain associated with a stress fracture, but the pain tends to worsen with time.  The tenderness usually originates from a specific spot and decreases during rest.  As the injury worsens, the pain tends to spread out and become more diffused with a focal area of tenderness.  You might have swelling around the painful area.  In some cases, the entire foot may begin to swell.


Stress fractures typically occur as the bone is subjected to a new unaccustomed force without enough time for recovery.  Bone adapts gradually to increased loads through remodeling, a normal process that speeds up when the load on the bone increases.  During remodeling, bone tissue is destroyed, and then rebuilt.  This is a similar process in muscle tissue.  When the load and/or volume of activity are too much for the bone, a fracture will occur.

Risk Factors for a Stress Fracture:

  • Certain sports.  Stress fractures are more common in people who participate in sports such as track and field, basketball, tennis, dance or gymnastics.  High repetitive impact sports tend to have the most stress fractures.
  • Increased activity.  Stress fractures often result from increasing the amount or intensity of an activity too quickly.  For example, people who suddenly shift from a sedentary lifestyle to being more active (increasing training volume significantly) or those who rapidly increase the intensity, duration or frequency of training sessions.
  • Gender.  Women are more likely to develop a stress fracture, especially those who have abnormal or absent menstrual periods (known as amenorrhea).
  • Foot problems.  People who have flat feet or high, rigid arches are more likely to develop stress fractures.  Worn or poorly fitting footwear or high heels can also contribute to this issue.  For runners, transitioning too quickly from a more built up running shoe into a minimalistic style can be a factor.
  • Osteoporosis.  Osteoporosis or osteopenia causes weakening in the bones that makes it easier for stress fractures to occur.
  • Prior stress fractures.  If you have experienced one or more stress fractures, you’re at a higher risk.
  • Poor nutrition.  Lack of Vitamin D, calcium, Vitamin K, and magnesium can make bones more likely to develop stress fractures.  Generally poor eating habits are also a factor.
  • Hard surfaces.  Spending long periods of time or training on hard surfaces, such as concrete, can increase your risk.
  • Smoking.  Smoking leads to poor blood flow and affects the body’s ability to heal and recover.
  • Obesity.  The heavier you are, the more forces that ultimately go through your foot.  Depending on how you are exercising, your particular footwear and the surface which you walk on can contribute to increasing your risk factors.
  • Gait abnormalities.  Alterations to your normal mobility (from either another injury or a change in your body) that affect how you typically move.  The change in mobility, along with your activity level, can be enough to overload the bone.  Particularly, when other risk factors are present.

In most cases, it’s not one specific risk factor that leads to the stress fracture, but a combination of risks and events that lead to the injury.  Diagnosis is usually through X-ray.  However, an acute injury may not initially show, so a second X-ray may be needed after a week or so to confirm the diagnosis.  A bone scan can also be useful to determine if there is an injury to the bone.

In the case of a poorly healing bone, the use of a bone stimulating electrical device may be recommended by your physician.

Initial Treatment

Non-weight bearing or limited weight bearing for four to six weeks is a very common course of treatment.  It provides enough time to initiate the healing response while reducing the stress on the injury site.  If you continue to stress the site of injury, the fracture can worsen and require more invasive treatments (possibly even surgery).  Crutches, a walker or a Roll-A-Bout knee walker can be used while you have weight bearing restrictions.  A walking protective boot is also typically used to protect the injury site.

As with many injuries, the initial treatment for a stress fracture in the foot is PRICE (Protection, Rest, Ice, Compression, and Elevation).

  • Protection.  Wear a walking boot, and limit weight bearing on the foot.
  • Rest.  Limit any activities that cause pain.  Depending on the severity and your personal health status, this can last from two to eight weeks.  Those with diabetes usually take a significantly longer period of time to heal.
  • Ice.  Use ice as needed for pain and edema control.  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.  If swelling is present, utilize a simple ACE wrap around the foot and ankle to help with the swelling and pain.  Start at the toes, and work up the leg.  Take care to not apply the ACE wrap too tightly as over squeezing the foot can be irritating.
  • Elevation.  Use pillows to position the foot above the level of your heart to help reduce swelling.  This would be an excellent time to apply ice, too.

In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness.

Addressing Your Risk Factors

After you have initiated PRICE and the pain and swelling has decreased, address any risk factors (if and when possible).

Stop Smoking

If you smoke, please stop.  It not only affects your bone density, but it has negative effects on every other body system.  It also increases your risk of cancer and heart disease.

Nutritional Management

Address any nutritional deficits.  This includes having adequate levels of Vitamin D3, Vitamin K1 and K2, magnesium, and healthy fats.

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.

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function with in the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected (including heart function).  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.

Vitamin K, found in green leafy vegetables, has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.

I also use magnesium as a sleep and recovery aid.  I consume it at night to help me sleep.  Magnesium can also reduce muscle soreness, cramps, and/or spasms.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.

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 in 100 mg intervals 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 quite as absorbable, Thorne Research Magnesium Citrate is also a fantastic product.

If you’re female (and especially if you suffer from amenorrhea, abnormal or absent menstrual periods), then consuming adequate levels of fats is pertinent.  Adequate levels of Omega-3 fatty acids and other healthy fats (primarily from plant sources such as avocados and coconut or olive oil) are critical in order to insure that your body has what it needs for proper hormonal support.  Amenorrhea can be a sign that your diet is lacking in adequate high quality fats as well as a sign of overtraining.

Avoid Soda and Distilled Water

Excessive soda intake (particularly diet soda) has been linked to poor bone density.  The exact cause isn’t entirely clear.  Many theorize that the acidic nature of the soda along with the chemicals and additives cause increased osteoclast activity in the bones.  This releases more calcium into the blood stream in order to help fight the negative effects of soda consumption.  It’s clear that too much soda is bad for your health and bones.  Similarly, distilled water is water that has been leached of all other nutrients and minerals.  Drinking too much distilled water can leach needed nutrients out of the bones. 

Weight Management

It’s important to manage your weight effectively.  Excessive body weight can cause additional stress on the body.  Whenever possible, work toward optimizing your health.  This includes maintaining a healthy body weight.  The heavier you are the more stress forces present throughout the lower extremity.


Once you’re cleared by your physician to initiate exercise and activity, it’s time to progress your rehabilitation.  For detailed descriptions and photos of potential helpful exercises, please refer to Foot Stress Fracture Rehabilitation Exercises(If you’re already working with a rehabilitation professional, such as a physical therapist, consult with him or her prior to starting my recommended rehabilitation exercises.)

  • 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 tissues on the bottom of the foot including the plantar fascia.  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 weakness in the knee and hip musculature.  Weakness and balance deficits can lead to poor foot mechanics, which ultimately can lead to a stress fracture or even metatarsalgia.  Improving your balance can help to reduce the risk of metatarsalgia and is an important part of the rehabilitation process.  For more ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle.  As your pain level improves, I recommend that you perform these balance exercises without shoes on.
  • Add an orthotic.  Often times, the stress fracture occurred due to alterations in foot mechanics or an old or poorly fitting shoe or orthotic.  If you are recovering from a stress fracture, consult with a podiatrist or a physical therapist that specializes in orthotics to determine the proper orthotic or shoe for you.
  • Did you progress too quickly into a minimalistic shoe?  The standard built up shoe offers more foot support and padding than most minimalistic style shoes.  If you attempted a quick progression, this may have contributed to the injury.  Unless you are a child or teenager, expect a safe transition to take at least three months.  A slow transition will allow your body to adequately adapt to the new stresses.
  • Weight training.  Once you’re cleared by your physician, initiating or returning to a weight training program is critical to the development and maintenance of strong bones.  Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density.  It also positively affects the hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength.  Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation.  The key to maintaining and improving bone density is always progressive axial skeletal loading and the associated pull of muscles against the bone during activity (particularly, strenuous activity).  Examples of such exercises include squats, lunges, and dead lifts.

It’s critical that you to slowly progress back into high impact activities.  It’s equally important that you address any of these risk factors in order to help reduce the risk of re-occurrence.  If you have experienced one or more stress fractures, you’re already at a higher risk.  As you taper up activity, monitor for signs of swelling and pain.  If symptoms occur, taper down the intensity.  Continue to work in a pain free range in order to strengthen around the injury site.

If you don’t experience a significant relief as you progress into your rehabilitation, please consult your medical professional.  I recommend a physical therapist that specializes in feet or who works with athletes for the treatment of stress fractures.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  You may also consider consulting with a podiatrist.

Thanks, Denise, for the question.  I hope you find this information to be helpful as you manage your condition.

Have you experienced a stress fracture in your foot before?  Which treatments worked the best for you?  Which treatments didn’t seem to help as much?  Please leave your comments below.

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

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

How to Recover Quickly from a 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

How to Self-Treat IT Band Pain with a Mini Plunger

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 can be difficult.

Although ITBS can be very painful, it can be easily self-treated if you handle your pain and symptoms quickly.  For many years, I have taught people how to use a mini plunger as a method to provide a suction force for self-treatment.  In this video, I demonstrate how to utilize a mini plunger as a “cupping” technique to self-treat IT Band Syndrome.

Cupping is a method or technique to massage and mobilize tissues such as muscles, skin, fascia, and tendons.  The exact treatment effect is unclear, but presently the research indicates that it helps to reset neural pain receptors and stretch receptors.  Thus, reducing pain and allowing for improved movement.

Cupping has been around as a treatment technique for thousands of years.  The research on cupping is interesting and for the most part, concludes that cupping is helpful in pain management.  There are some indications that the “suction” may lead to improved blood flow to an injured area which could speed up healing times.  Other health claims of the benefits of cupping haven’t been adequately proven in current research.

Traditionally, cupping has been performed with glass cups by using a flammable paper to quickly “burn” the oxygen in the cup which causes a suction force.  There are now many types of plastic or silicon cups that can easily be purchased online.  CupEDGE Massage Tools are what I use and recommend.  Fancy cups are not necessary.  The cups can be more convenient, but even a small sink plunger will do.

Have you tried cupping to treat ITBS?  If so, what was your experience like?  Additional discussion can help others to manage this condition more effectively.  Please leave your comments below.

For more information on how to self-treat ITBS, please refer to the following:

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!