Hip Flexor Pain and Pain in the Front of the Hip

Pain in the hip flexor or front of the hip/leg can be associated with several possible causes.  When you experience pain in the front of the hip, and it doesn’t have an obvious mechanism of injury (such as tripping in a hole when running), then it’s almost always a repetitive motion injury or related to poor posture and/or biomechanics.

The location of pain in the hip flexor region can range from mid-thigh to the groin area to the lower stomach (from the belly button to the PSIS, which is the posterior superior iliac spine) or the front of the pelvic bone just up and lateral to the groin area where the primary hip flexor (psoas) originates.

Common potential reasons for pain in the front of the hip include:

  1. Femoral Stress Fracture
  2. Hernia
  3. Femoral Acetabular Impingement (FAI)
  4. Groin Muscle Strain
  5. Low Back Pain (LBP)
  6. Hip Flexor Strain

I will cover each one of these in more detail.

There are many common reasons to develop pain in or around the hip flexors.  Often the cause for the pain is nearly identical (overuse).  It’s important to get the proper diagnosis to insure that you’re treating the right structures.  Continue Reading

Can Foam Rolling Really Help Prevent Injury?

From a personal and professional point of view, yes!  I believe foam rolling works and can be a useful tool to reduce the risk of injury.  From a research point of view, there are studies that confirm that foam rolling can reduce muscle soreness after exercise and improve range of motion (ROM).  It may also improve recovery times by affecting how quickly a person recovers and performs one to three days post exercise session.

The actual mechanism of how and why foam rolling works is still under debate.  Foam rolling is touted as being a self-myofascial release technique.  Whether or not the fascia is actually being conclusively changed is still under investigation.  What we do know is that the foam roller has positive effects on pain modulation, nervous system control over ROM, and affects blood flowFoam rolling is generally not advised for anyone on blood thinning medications or with blood clotting disorders.

Foam rolling is one way to potentially improve fascial mobility.  Fascia is a form of connective tissue that is integrated throughout the body like a spider’s web and is in and around all of the tissues.  Injury, chronic poor posture, training and exercise, nutrition, health status, and even age will affect the health and mobility of the fascia.  When fascia becomes restricted, adhesions form which cause soreness, restricted movement, gait change, and potential injury or illness.

Although research has not conclusively proven exactly how foam rolling affects the fascial system, it appears to have a positive effect by decreasing muscle and joint pain while increasing circulation and improving mobility, balance, and gait mechanics.

Range of Motion

Foam rolling likely has a positive effect on arterial stiffness and can improve arterial and vascular function while also positively affecting joint range of motion (ROM).  The change in arterial and vascular function may in part be why foam rolling (after training) seems to have a positive effect in reducing muscle soreness.

Foam rolling also appears to have a beneficial effect on ROM, and more importantly, it can help improve ROM without negatively affecting performance.  In contrast, static stretching has been shown to impede performance.

Aids in Recovery

Foam rolling may promote more blood flow to the area, which allows the body to eliminate waste more efficiently while providing much needed nutrients to aid in recovery.  Improved recovery is important if you plan to participate in multiple events over multiple days such as a relay or weekend tournament.  It may also allow for more intense and frequent training while reducing injury.

It may aid training during certain cycles when the intensity or volume may be higher or during an overreaching phase of training.  Overreaching is typically a very short and deliberate phase in your training when you have a spike in training volume for a week or two followed by a return to baseline or below which can lead to improvements in performance.  Care must be taken though because overreaching can easily turn into overtraining.

How to choose a foam roller:

Choosing the right size and density of foam roller is important.  Research thus far concludes that a firmer high density foam roller has a more positive treatment effect than a softer version.

Depending on how you personally utilize the roller, the preferred length may vary.  This is also true in regards to the texture on the foam roller.  There are many styles of foam rollers to choose from which vary in texture and size.  Each size has a slightly different purpose and use.

The BLACKROLL® FLOW is one of my favorite compact textured foam rollers.  It’s the perfect size for travel or home use, and I can use it for nearly all of my favorite stretches and mobilizations.  In addition, the texture is just the right amount without being too knobby or aggressive.  I like how easily I can attach it to my work out bag for on the go use as well.

How to use the foam roller:

Foam rolling has many practical uses.  It works best when used over larger muscle groups such as the legs.  It’s my go to tool for addressing mobility issues throughout the thoracic spine.  Individuals taking blood thinning medications or with blood clotting disorders should consult his/her physician prior to using a foam roller for mobilization.

  • I typically recommend one to three minutes of body weight rolling (if it is tolerated) per extremity, and the same for the thoracic, low back, and buttock area.
  • A good rule of thumb is to roll out an area that is tender and sore, or recently worked, until it no longer feels tight and sore.
  • Again approximately one to three minutes per area although this may vary based on your size. Do not roll too quickly.  Be careful to not over do.  One to three minutes per area is typically optimal.
  • In cases of painful areas and injured areas, it’s often more effective to roll out the adjacent and associated areas near the injury area while avoiding the most painful spots.
  • Rather than constantly working directly on the area that causes pain, slowly foam roll your way away from the pain center to the connecting muscles.
  • Increased time will be needed the more developed your muscles are.
  • Be sure to roll the tissues in different positions and postures especially in more lengthened positions.

For more information on the use of a foam roller, please refer to Does Foam Rolling Help or Hurt Performance?

What has been your experience with using the foam roller?  Is it worth the effort?  Please share your comments or questions!

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

How to Use the Clamshell Hip Exercise to Treat Knee Pain

Knee pain is the most common running related injury.  There are many different causes of knee pain including: Patellar Femoral Pain Syndrome (PFPS); Iliotibial Band pain (IT Band); Patellar Tendinitis; and meniscus injuries.

The root cause of many of the most common knee related issues is hip weakness.  The hip abductors and hip external (lateral) rotators are very important for knee control and stability.  When weakness is present in these groups of muscles, pain is often felt down the kinetic chain (particularly, in the knee).

One of the best ways to treat many common running aches and pains is to focus on strengthening these muscles which include the gluteus medius, the tensor fascia latae, and the other deep hip rotators.

In this video, I demonstrate how to perform the clamshell exercise.  It’s an excellent non-weight bearing exercise to work on hip rotator strength which will directly affect knee stability.  In the video, I use a red exercise band.  As you progress, you could transition to a thicker band to increase the resistance and difficulty of the exercise.

Looking for more comprehensive information on how to self-treat and prevent the most common running related injuries?  I have teamed up with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast) to give you the tools to become a Resilient Runner.

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

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

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

It’s a virtual library of self-treatment protocols including downloadable podcasts, videos, and .pdf files of rehabilitation guides.  It also includes a 277 page eBook, The Resilient Runner, Prevention and Self-Treatment Guide to Common Running Related Injuries.


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


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

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

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

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

21 Exercises for Better Posture

Cervical (neck), thoracic (upper back), and shoulder pain is often caused from stiffness in the thorax.  We spend so much of our day sitting slouched or standing hunched over (in a forward flexed position for the thoracic spine) that we lose normal mobility.  This stiffness in the thorax can cause compensation patterns in our cervical spine and shoulders.  Over time, this can develop into painful areas.

The key to eliminating pain is to improve posture and improve the mobility of the thoracic spine, so the neck and shoulders no longer have to compensate for the lack of mobility.

In this guest post for Get Correct Posture, you will discover different exercises to help you achieve better posture.

Q.  If you were to recommend just one exercise for someone to help them improve their posture, what would you recommend and why?

A.  The number one exercise to improve posture?  I don’t have just one exercise, but a series of exercises that I recommend.  These stretches are designed to counteract the stresses and postures of daily life and to restore the normal mobility to the upper back.

I prefer to use a foam roller, but you could utilize several rolled up towels as well or possibly a water noodle with or without towels rolled around it.  The key is to have a fairly firm surface which you can lay on that will not impede shoulder mobility.

Repeat the routine twice, at least 1-2 times per day as needed.

A variation of the foam roll stretches could also be to lie over a large Thera-Band Exercise Ball and perform the same arm positions.

When performing these exercises, it’s important to understand that stretching should never be painful.  You should feel a mild to moderate stretching sensation.  If you start to experience numbness or tingling in the hands or arms, you should discontinue the stretch at that time.

When performed regularly, these simple exercises will help you to improve poor posture and can be performed anywhere.

Continue reading for expert recommendations on which exercises to perform in order to improve your posture.

How You can keep Moving with a Busy Schedule

While juggling to have a happy personal life and getting through the burdens of an office job, we forget to do one little thing: move enough during the day.  Technology has made everything simpler, which also means less moving and a more sedentary lifestyle.

We forget that in order to be active, we don’t necessarily have to run to the gym and sign for a membership.  There are other simpler ways that we can adopt in order to make sure we are getting enough movement during the day.  It could be from parking a little further away from your grocery story and walking to it to taking the stairs for one or two floors.  Such little changes have positive impacts in our lives in the long run.

In this guest post for The Diabetes Council, you will discover the different ways in which you can ensure that you are moving enough for the day.

Q.  I have a full day of work, running around on errands. What are the simple ways to make sure I am moving enough for the day?

A.  It’s easy to let the busyness of life keep us from taking the steps necessary to insure a long life span and health span.  The good news is that frequent short bouts of exercise can be effective for maintaining general health.  The key is to incorporate frequent movement into your daily routine.

Get up and move at least every two hours during the day.  One option is to perform ten sit to stand exercises every hour.  (Simply, move from sitting to standing for ten repetitions.)  Another option is to walk at least every two hours for a minute or two.  The faster the walk, the better!  If stairs are available, walk up and down.  Combining the sit to stand exercises with walking is an excellent and fast way to elevate your heart rate no matter where you are!  Try parking further out in the parking lot when you’re out running errands.  It will force you to walk further.

Finally, make time to connect with not only yourself, but loved ones, too.  Walking after meals has been shown to stabilize blood sugar levels.  It’s also an excellent way to boost metabolism and connect with friends and family.  Frequent walking is the most important physical activity you can engage in.

Continue reading for more great responses from fitness experts about the ways in which you can ensure that you are moving enough for the day.

Why You Keep Getting Hurt

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

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

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

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

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

Poorly Designed Training Program 

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

Poor Nutrition

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

Poor Sleep Quality

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

Poor Posture 

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

The Wrong Equipment

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

Common Sense 

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

Muscle Imbalances 

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

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

Poor Mobility and Stability 

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

Overuse Injuries 

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

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

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

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

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

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

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

The Resilient Runner


Treating Low Back Pain during Exercise and Athletics

How to get to the Root Cause of an Injury

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

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

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

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

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!

10 Strategies for Avoiding Injury


Marathon Training Academy

May 16, 2017

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

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

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

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